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Purpose: The COVID-19 pandemic has generated significant psychological distress among health care workers worldwide. New York State, particularly New York City and surrounding counties, were especially affected, and experienced over 430,000 COVID-19 cases and 25,000 deaths by mid-August 2020. We hypothesized that physicians and trainees (residents/fellows) who were redeployed outside of their specialty to treat COVID-19 inpatients would have higher burnout. Methods: We conducted a cross-sectional survey to assess burnout among attending and trainee physicians who provided patient care during the COVID-19 pandemic between March-May 2020 across a diverse health care system in New York. Separate multivariable logistic regressions were performed to determine the association between redeployment and measures of burnout: Emotional Exhaustion (EE) and Depersonalization. Burnout measures were also compared by physician vs trainee status. The differential association between redeployment and outcomes with respect to trainee status was also evaluated. Results: Redeployment was significantly associated with increased odds of EE {OR =1.53, 95% CI: 1.01–2.31} after adjusting for gender and Epidemic-Pandemic Impacts Inventory (EPII) score. Similarly, being a trainee, especially a junior level trainee, was associated with increased odds of EE {OR = 1.59, 95% CI: 1.01–2.51} after adjusting for gender and EPII scores. However, neither redeployment nor trainee status were significantly associated with Depersonalization. Interactions between redeployment and trainee status were not significant for any of the outcomes (p>.05). Conclusion: Physicians who were redeployed to treat COVID–19 patients had higher reported measures of EE. Trainees, irrespective of redeployment status, had higher EE as compared with attendings. Additional research is needed to understand the long-term impact of redeployment on burnout among redeployed physicians. Programs to identify and address potential burnout among physicians, particularly trainees, during pandemics may be beneficial. [ABSTRACT FROM AUTHOR]

Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population. [ABSTRACT FROM AUTHOR]

Rationale: During the first wave of the coronavirus disease (COVID-19) pandemic in New York City, the number of mechanically ventilated COVID-19 patients rapidly surpassed the capacity of traditional intensive care units (ICUs), resulting in health systems utilizing other areas as expanded ICUs to provide critical care. Objectives: To evaluate the mortality of patients admitted to expanded ICUs compared with those admitted to traditional ICUs. Methods: Multicenter, retrospective, cohort study of mechanically ventilated patients with COVID-19 admitted to the ICUs at 11 Northwell Health hospitals in the greater New York City area between March 1, 2020 and April 30, 2020. Primary outcome was in-hospital mortality up to 28 days after intubation of COVID-19 patients. Results: Among 1,966 mechanically ventilated patients with COVID-19, 1,198 (61%) died within 28 days after intubation, 46 (2%) were transferred to other hospitals outside of the Northwell Health system, 722 (37%) survived in the hospital until 28 days or were discharged after recovery. The risk of mortality of mechanically ventilated patients admitted to expanded ICUs was not different from those admitted to traditional ICUs (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.95-1.20; P = 0.28), while hospital occupancy for critically ill patients itself was associated with increased risk of mortality (HR, 1.28; 95% CI, 1.12-1.45; P < 0.001). Conclusions: Although increased hospital occupancy for critically ill patients itself was associated with increased mortality, the risk of 28-day in-hospital mortality of mechanically ventilated patients with COVID-19 who were admitted to expanded ICUs was not different from those admitted to traditional ICUs. [ABSTRACT FROM AUTHOR]

Background: Although over 5000 platelet transfusions occur daily in the United States, the presence of SARS‐CoV‐2 antibodies in platelet units is not commonly evaluated for. The effects of platelet transfusions with SARS‐CoV‐2 antibodies remain largely unknown. We evaluated single‐donor (apheresis) platelet units for SARS‐CoV‐2 antibodies and determined if platelet transfusions passively transferred antibodies to seronegative recipients. Study Design and Methods: We conducted a retrospective analysis as part of a quality assurance initiative during February to March 2021 at a tertiary referral academic center in suburban New York. Platelet units and platelet recipients were evaluated for the presence of SARS‐CoV‐2 antibodies using the DiaSorin LIASON SARS‐CoV‐2 S1/S2 IgG assay. There were 47 platelet recipients eligible for study inclusion. The primary outcome was the presence of SARS‐CoV‐2 spike protein IgG antibodies in the recipient's blood after platelet transfusion. Results: Twenty‐three patients received platelets with SARS‐CoV‐2 spike protein IgG antibodies; 13 recipients had detection of SARS‐COV‐2 antibodies (56.5%), and 10 recipients did not. The median antibody titer in the platelet units given to the group with passive antibodies detected was significantly higher compared to the median antibody titer in the platelet units given to the group without antibodies detected (median [interquartile range]: 306 AU/ml [132, 400] vs. 96.1 AU/ml [30.6, 186], p =.027). Conclusions: Our study demonstrated a significant rate of passive transfer of SARS‐CoV‐2 spike protein IgG antibodies through platelet transfusions. Considering the volume of daily platelet transfusions, this is something all clinicians should be aware of. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether hurricane exposure, lack of access to medical care (LAMC), and displacement during Hurricane Sandy were associated with PTSD and other mental health (MH) symptoms among older adult New York residents. Methods: Participants (N = 411) were ≥60 years old at the time of survey data collection (1–4 years post-Sandy). Outcomes included PTSD, depression, and anxiety symptoms and stress. Hurricane exposure, displacement, and LAMC were primary predictors. Results: Older adults with greater hurricane exposure had increased PTSD, anxiety, and stress symptoms. LAMC had a strong association (ORadj = 4.11) with PTSD symptoms but was not associated with other MH symptoms. Displacement was not associated with MH outcomes. Discussion: This is the first study to examine exposure, displacement, and LAMC together and to examine their varying impacts on different MH outcomes among older adults post-hurricane. Findings support the importance of disaster preparedness interventions tailored to the MH needs of community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Objectives: Given the importance of continued COVID-19 surveillance, our objective was to present findings from a short follow-up survey of workforce SARS-CoV-2 antibody testing in previously seropositive participants and describe associations between work locations and negative seroconversion.Methods: We conducted a follow-up cross-sectional survey on previously seropositive healthcare workers, using questionnaires and serology testing. Eligible employees previously consented to be contacted were invited by email to participate in a survey and laboratory blood draws. SAS V.9.4 was used to describe employee characteristics and seroconversion status. Binomial regression models were used to calculate unadjusted and adjusted prevalence ratios (PRs) of seronegativity. The multivariable analyses included age, gender, race/ethnicity, region of residence, work location, prior diagnosis/PCR results and days between antibody tests. Unadjusted and adjusted PRs 95% CIs and p values were reported.Results: Of the 3990 employees emailed in the follow-up, 1631 completed an exposure survey and generated a blood-draw requisition form. Average time between serology testing was 4 months. Of the 955 employees with complete serology results, 79.1% were female, 53.4% were white and 46.4% resided in Long Island; 176 participants seroconverted to negative. In multivariable regression analyses adjusted for gender, race/ethnicity and region of residence, younger employees (<20-30 years), intensive care unit workers and those with no/negative prior PCR results were more likely to have negative seroconversion.Conclusions and Relevance: Patterns of negative seroconversion showed significant differences by sociodemographic and workplace characteristics. These results contribute information to workplace serosurveillance. [ABSTRACT FROM AUTHOR]

Patients with coronavirus disease 2019 (COVID-19) can have increased risk of mortality shortly after intubation. The aim of this study is to develop a model using predictors of early mortality after intubation from COVID-19. A retrospective study of 1945 intubated patients with COVID-19 admitted to 12 Northwell hospitals in the greater New York City area was performed. Logistic regression model using backward selection was applied. This study evaluated predictors of 14-day mortality after intubation for COVID-19 patients. The predictors of mortality within 14 days after intubation included older age, history of chronic kidney disease, lower mean arterial pressure or increased dose of required vasopressors, higher urea nitrogen level, higher ferritin, higher oxygen index, and abnormal pH levels. We developed and externally validated an intubated COVID-19 predictive score (ICOP). The area under the receiver operating characteristic curve was 0.75 (95% CI 0.73–0.78) in the derivation cohort and 0.71 (95% CI 0.67–0.75) in the validation cohort; both were significantly greater than corresponding values for sequential organ failure assessment (SOFA) or CURB-65 scores. The externally validated predictive score may help clinicians estimate early mortality risk after intubation and provide guidance for deciding the most effective patient therapies. [ABSTRACT FROM AUTHOR]

COVID-19 in-hospital morbidity and mortality in people living with HIV (PLWH) were compared to HIV-negative COVID-19 patients within a New York City metropolitan health system, the hardest hit region in the United States early in the pandemic. A total of 10,202 inpatients were diagnosed with COVID-19, of which 99 were PLWH. PLWH were younger (58.3 years (SD = 12.42) versus 64.32 years (SD = 16.77), p < 0.001) and had a higher prevalence of men (73.7% versus 57.9%, p = 0.002) and Blacks (43.4% versus 21.7%, p < 0.001) than the HIV-negative population. PLWH had a higher prevalence of malignancies (18% versus 7%, p = < 0.001), chronic liver disease (12% versus 3%, p < 0.001), and end-stage renal disease (11% versus 4%, p = 0.007). Use of a ventilator, admission to the ICU, and in-hospital mortality were not different. Of the 99 PLWH, 12 were virally unsuppressed and 9 had CD4% < 14. Two of the 12 virally unsuppressed patients and 4/9 patients with CD4% < 14 died. Ninety-one of the 99 PLWH were on treatment for HIV, and 5 of the 8 not on treatment died. Among PLWH with prior values, absolute CD4 count decreased an average of 192 cells/mm3 at the time of COVID-19 diagnosis (p < 0.001). Hospitalized patients with HIV and COVID-19 coinfection did not have worse outcomes than the general population. Among PLWH, those with CD4%<14 or not on treatment for HIV had higher mortality rates. Those PLWH who received IL-6 inhibitors had lower mortality rates. PLWH given antifungal medications, hydroxychloroquine, antibiotics (including azithromycin), steroids, and vasopressors had higher mortality rates. [ABSTRACT FROM AUTHOR]

Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p <.001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies. [ABSTRACT FROM AUTHOR]

Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p < .001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether the association between Hurricane Sandy exposures and post-traumatic stress disorder (PTSD) symptom severity was greater for exposed community members compared with responders.Methods: Data were analysed from three existing studies with similar methodologies (N=1648): two community studies, Leaders in Gathering Hope Together (n=531) and Project Restoration (n=763); and the Sandy/World Trade Center Responders Study (n=354). Sandy-related PTSD symptoms were measured using the PTSD checklist-specific traumatic event and dichotomised as elevated (>30) versus low/no (<30) PTSD symptoms. Sandy exposures were measured with a summed checklist. Multivariable logistic regression was performed to evaluate the differential effect of exposures on PTSD by responder status, adjusting for demographics and time elapsed since Sandy.Results: Responders were somewhat older (50.5 years (SD=8.3) vs 45.8 years (SD=20.0)), more likely to identify as white (92.4% vs 48.1%) and were male (90.7% vs 38.4%). Responders were less likely to have elevated PTSD symptoms than community members (8.6% vs 31.1%; adjusted OR=0.28, 95% CI 0.17 to 0.46). While exposure was significantly related to elevated PTSD status, the effects were similar for responders and community members.Conclusions: Responders appear to be more resilient to PTSD symptoms post-Sandy than community members. Understanding the mechanisms that foster such resilience can inform interventions aimed at populations that are more vulnerable to experiencing PTSD after natural disasters. [ABSTRACT FROM AUTHOR]

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The Rockaways area of New York City was especially devastated by Hurricane Sandy. This study examined participant characteristics associated with acceptance of a linkage to and attendance at appointments for mental health difficulties (MHD). Participants (N = 1,011) completed questionnaires to assess mental health symptoms. Participants who met screening criteria (n = 442) were offered linkage to care. Individuals who had a higher mental health symptom burden (MHSB; i.e., those who screened in on more than one criteria vs. only one criterion) had 2.68 greater odds of accepting services (95% confidence interval [1.68, 4.26]). MHSB was not associated with attending a first appointment (p = 0.80). Female gender and Hispanic ethnicity were also associated with acceptance of linkage to care, though not attendance. Reducing stigma around MHD associated with natural disasters and increasing knowledge about the mental health care system could promote help‐seeking behavior among survivors. [ABSTRACT FROM AUTHOR]

Background: Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. Questions/purposes: Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups? Methods: We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve block. Groups were compared with regard to demographics, comorbidities, major perioperative complications, and length of stay. Multivariable logistic regressions were performed to measure complications and resource use. A negative binomial regression was fitted to measure length of stay. Results: We identified 17,157 patients who underwent total shoulder arthroplasty between 2007 and 2011. Of those, approximately 21% received an upper-extremity peripheral nerve block in addition to general anesthesia. Patients receiving combined regional-general anesthesia had similar mean age (68.6 years [95% CI: 68.2-68.9 years] versus 69.1 years [95% CI: 68.9-69.3 years], p < 0.0043), a slightly lower mean Deyo (comorbidity) index (0.87 versus 0.93, p = 0.0052), and similar prevalence of individual comorbidities, compared to those patients receiving general anesthesia only. Addition of regional anesthesia was not associated with different odds ratios for complications, transfusion, and intensive care unit admission. Incident rates for length of stay were also similar between groups (incident rate ratio = 0.99; 95% CI: 0.97-1.02; p = 0.467) Conclusions: Addition of regional to general anesthesia was not associated with an increased complication profile or increased use of resources. In combination with improved pain control as known from previous research, regional anesthesia may represent a viable management option for shoulder arthroplasty. However, further research is necessary to better clarify the risk of neurologic complications. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12-9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions. [ABSTRACT FROM AUTHOR]

Background Preventing the transmission of multidrug-resistant organisms requires strict adherence to isolation precautions. Candida auris (CA), an emerging multidrug-resistant fungal pathogen, can cause widespread and persistent contamination of environmental surfaces within healthcare facilities and lead to outbreaks. While direct observation (DO) with "secret shoppers" is traditionally used to monitor adherence to isolation precautions and personal protective equipment (PPE) use by healthcare personnel (HCP), this method is limited by logistic and cost issues. We studied the use of remote video auditing (RVA) to monitor adherence to isolation precautions in a patient with CA fungemia. Methods This is a cross-sectional study of HCP who were in contact with a single patient with CA fungemia. This patient was placed on standard and contact precautions and held in isolation in a single room in an acute care setting. Adherence to isolation precautions by HCP was observed by DO and RVA. RVA consisted of recording videos of HCP entering and exiting the room and auditing adherence using a standardized protocol by remotely-placed observers. Hand hygiene (HH) on entry and exit, the use of gloves and gowns upon entry, correct gown donning and the proper doffing sequence upon exit were observed by both methods. In the DO method, data were recorded per visit and not by entry/exit. Results RVA captured data for 120 visits by HCP (entry data [ n = 62]; exit data [ n = 58]) and DO captured data for 173 visits by HCP during 23 days. Table 1 shows the compliance rates determined by both methods. RVA yielded lower compliance rates on most measures than the DO method. Also, there were a higher number of missing observations in the DO group Conclusion RVA, when used to monitor adherence to isolation precautions in a high-concern CA patient, demonstrated lower compliance rates compared with DO and had fewer missing data elements. These results suggest that RVA is a novel monitoring method that may be a more precise alternative to DO for ensuring adherence to isolation precautions and the prevention of nosocomial transmission of high-concern pathogens such as CA. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Fever is a beneficial physiologic response to infection and is protective in gram-negative bacteremia and invasive candidiasis. Cooling blankets (CBs) are used in fevers due to a perception of providing symptomatic relief. However, external cooling of septic patients has been shown to be an independent risk factor for adverse effects. Here, we present a retrospective analysis of CB use in our institution and the associations of infections with CB duration. Methods We reviewed electronic medical records of patients aged ≥18 years admitted to a tertiary care hospital between 2015–2017 and in whom a CB was used. Study variables included demographics and clinical characteristics such as infection and fever duration (time of CB start to first defervescence). Correlations between continuous variables were assessed using the Spearman's rank correlation test and differences in the distribution of continuous variables by groups were assessed using Mann–Whitney U and Kruskal–Wallis tests. Results This analysis included 548 patients who used a total of 575 CBs during their stay (27 patients used ≥1 CB). The median age was 61.9 years and 56.9% were male. The most frequent comorbidities were immunocompromised state (40.3%), diabetes mellitus (33.6%) and coronary artery disease (32.3%). Pneumonia was the most common infection within 5 days of CB start (31.9%). Only 174 CBs had a documented discontinuation during hospitalization; for the remaining CBs, such documentation was absent. The median CB duration for these patients was 33.8 hrs (IQR: 18.0–80.9) while median fever duration was only 21.8 hours (IQR: 6.6–52.2). CB duration was highly correlated with fever duration (rho=.773, p Conclusion Clinician documentation of CB use was poor, only 30.2% recorded a stop time. Documented CB duration exceeded fever duration by more than 1.5 times and led to shivering responses in over 2/3 of patients. These findings suggest that CB use is arbitrary, not in keeping with established protocol or rationale, and its adverse effects may outweigh potential benefits. Their role should be re-evaluated and appropriate institutional protocols formulated. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the association between perioperative fluid resuscitation with hydroxyethyl starch or albumin and adverse outcomes in patients undergoing elective joint arthroplasty procedures. Topics covered include the link between the fluid resuscitation and an increased risk for acute renal failure, the use of standardized billing items in determining the perioperative use of hydroxyethyl starch or albumin and the decline in the use of hydroxyethyl starch.

The article discusses a study conducted by Jashvant Poeran and colleagues which aims to assess the perioperative use of the medication tranexamic acid in total hip and total knee arthroplasties without the need for blood transfusions and risks for thromboembolic and renal problems. Topics discussed include the summary answer and the main result of the study, what the research adds on previous studies on tranexamic acid use, and the methodology of the study.