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Anesth Analg ; 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33136661


BACKGROUND: Covid-19 emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit area, the ORICU. METHODS: 23 ORs were converted into an 82-bed ORICU. Adaptations to the OR environment permitted the delivery of standard critical care therapies. Non-intensive-care-trained staff were educated on the basics of critical care and deployed in a hybrid staffing model. Anesthesia machines were repurposed as critical care ventilators, with accommodations to ensure reliable function and patient safety. To compare ORICU survivorship to outcomes in more traditional environments, we performed Kaplan-Meier survival analysis of all patients cared for in the ORICU, censoring data at the time of ORICU closure. We hypothesized that age, gender, and obesity may have influenced the risk of death. Thus, we estimated hazard ratios for death using Cox proportional hazard regression models with age, gender, and body mass index (BMI) as covariables and, separately, using older age (65 years and older) adjusted for gender and BMI. RESULTS: The ORICU cared for 133 patients from March 24 - May 14, 2020. Patients were transferred to the ORICU from other ICUs, inpatient wards, the Emergency Department, and other institutions. Patients remained in the ORICU until either transfer to another unit or death. As the hospital patient load decreased, patients were transferred out of the ORICU. This process was completed on May 14, 2020. At time of data censoring, 55 (41.4%) of patients had died. The estimated probability of survival 30 days after admission was 0.61 (95% CI 0.52 - 0.69). Age was significantly associated with increased risk of mortality (HR = 1.05, 95% CI 1.03 - 1.08, p < 0.001 for a 1 year increase in age). Patients who were 65 years or older were an estimated 3.17 times more likely to die than younger patients (95% CI 1.78 - 5.63, p < 0.001) when adjusting for gender and BMI. CONCLUSIONS: A large number of critically ill Covid-19 patients were cared for in the ORICU, which substantially increased ICU capacity at NYP-Columbia. The estimated ORICU survival rate at 30 days was comparable to other reported rates, suggesting this was an effective approach to manage the influx of critically ill Covid-19 patients during a time of crisis.

J Urol ; : 101097JU0000000000001468, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33131401
J Urol ; : 101097JU0000000000001502, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200646
World J Urol ; 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32926225


PURPOSE: Online health information-seeking behavior has increased over the past 15 years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide. METHODS: Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019. RESULTS: From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide. CONCLUSIONS: A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.

J Endourol ; 34(6): 682-686, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32216458


Introduction: Flexible ureteroscopy is a mainstay of upper urinary tract stone treatment. Holmium laser lithotripsy is a particularly common and notable technique for the dusting and fragmenting of renal stones. During ureteroscopy, optical fibers are subject to sharp bends in pursuit of stones, particularly those at the lower pole. Following from principles of fiber optics, subjecting these fibers to sharp bending angle has the potential to reduce the efficiency of power transmission at the fiber tip. Due to the potential implications this hypothesis could have on endourological practice and research, we aimed to explore the potential impact of fiber bending on end-fiber power output. Materials and Methods: Using a highly sensitive oscilloscope and a urological holmium laser, we assessed the end-fiber power output under a variety of bending conditions. To ensure maximal confidence in our results, the maximal bending conditions explored substantially exceeded any condition, which could occur during ureteroscopic surgery. Results: We found evidence that bending radius alone has a clinically insignificant impact on the light power transmission in the fiber. At certain bending conditions, we observed a clinically unimportant but statistically significant reduction in power transmission. This was verified using two commonly used delivery fiber types exposed to 8-second bursts for each bending condition.