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1.
J Am Assoc Nurse Pract ; 33(1): 2-4, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395028

RESUMO

ABSTRACT: JAANP Fellow Dr. Leslie-Faith Morritt Taub, NYU Adult-Gerontology Primary Care Program Director, describes the emotional, political, and social impact of COVID-19 on one graduating cohort of nurse practitioner (NP) students at New York University and one incoming cohort of students. Through the lens of a seasoned professor she describes the changes to her teaching methods because she leads these students through the course work and clinical work required to take on the role of the NP in the midst of a global pandemic in the heart of New York City.


Assuntos
/psicologia , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/psicologia , Estudantes de Enfermagem/psicologia , /enfermagem , Humanos , New York , Estados Unidos
2.
Pest Manag Sci ; 77(1): 389-396, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32738015

RESUMO

BACKGROUND: Automated aerosol puffers releasing behaviorally active volatile organic compounds can deter insect pests in crops. During 2016, we tested the efficacy of aerosol puffer arrays emitting 1-octen-3-ol at reducing Drosophila suzukii oviposition in fall-bearing raspberries in Western New York State. During 2017, we compared the performance of aerosol puffers with a passive diffusion release method (vial dispensers), as well as puffer timing and placement within the field. RESULTS: During 2016, we found that octenol application in the field via aerosol puffer systems resulted in a 20% decrease in D. suzukii oviposition compared to control plots. During 2017, we found that aerosol puffers releasing octenol were 42-55% more effective than vial dispensers at deterring oviposition. We also found that a discontinuous application of octenol during dawn and dusk was sufficient to deter D. suzukii oviposition equivalent to continuous applications throughout the day. Although we observed no differences in infestation depending on puffer placement, low fly populations at the time of the trial may have affected the data. CONCLUSIONS: Our data indicate that automated aerosol puffer systems may reduce D. suzukii infestation to a greater extent than vial dispensers. If adopted, a discontinuous puffer release schedule may protect both economic and ecological interests by reducing the amount of material required to achieve efficacy. Further research on puffer placement is needed to determine whether perimeter applications are effective in larger scale field research and in combination with attractants as part of a push-pull management system.


Assuntos
Oviposição , Tetraodontiformes , Aerossóis , Animais , Drosophila , Feminino , Controle de Insetos , New York , Octanóis
3.
J Environ Manage ; 280: 111831, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33352378

RESUMO

Owing to high rates of land and forest degradation, there is consensus that forest landscape restoration is a global priority with the Bonn Challenge and the New York Declaration on Forests committing to restore about 350 Million hectares by 2030, globally. However, there is a need for incentives that motivate these restoration efforts and disincentives aimed at restricting activities that result in further land degradation. We provide insights and understanding of the incentives and disincentives measures applied within the forest restoration systems through a case study in the Shinyanga region of Tanzania. Incentives that have promoted forest landscape restoration in Shinyanga include; conservation benefits, education and information, Reducing Emissions from Deforestation and forest Degradation (REDD+), well-defined property rights & increasing land prices and awards while disincentives include; penalties, quotas and permits. Intrinsic incentives that are derived from self-desire within an individual such as conservation benefits and education & information were more preferred within Shinyanga region compared to extrinsic incentives which relied more on external factors such as REDD+ and awards. Nonetheless, a combination of both incentives and disincentives has led to the success of restoration in Shinyanga; positive incentives worked better for privately owned lands while regulatory disincentives worked better for communally owned restoration lands. High levels of social equity and trust have enabled the functioning of these incentives while a robust governance structure at the local level has been instrumental in enforcing the disincentives. There is need for government and all stakeholders to maintain and enhance the gains from restoration, especially empowering communities further, for these incentives to work.


Assuntos
Conservação dos Recursos Naturais , Motivação , Ecossistema , Florestas , New York , Tanzânia
4.
J Urol ; 205(1): 183-190, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32749936

RESUMO

PURPOSE: We examined long-term risks and predictors of mesh erosion and reoperation following mid urethral sling procedure for stress urinary incontinence. MATERIALS AND METHODS: Women aged 18 years or older who received a mid urethral sling for stress urinary incontinence between 2008 and 2016 in outpatient surgical settings in New York State were included in our study. Those who underwent concomitant mesh pelvic organ prolapse repair were excluded. Primary outcomes were post-implantation time to erosion and reoperations. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the risks of erosion diagnosis and reoperation. RESULTS: Our cohort included 36,195 women with a mean±SD age of 53.7±12.4 years. Estimated risks of erosions and reoperations at 7 years after sling procedures were 3.7% and 6.7%, respectively. Older age (≥65 vs <65: HR 0.83, 95% CI 0.70-0.99) and high volume facilities (high vs low: HR 0.79, 95% CI 0.68-0.92) were associated with a lower risk of erosion. History of hysterectomy was associated with a higher risk of erosion (HR 1.62, 95% CI 1.36-1.92). Predictors of reoperation included concurrent abdominal or native tissue transvaginal prolapse repair, previous hysterectomy and depression. CONCLUSIONS: One in 27 women had sling erosions and 1 in 15 had invasive reoperations at 7 years after sling procedures. The highest erosion cases were observed among younger White women treated at low volume facilities. Continued and vigilant surveillance of mesh in stress urinary incontinence repairs, the nature and burden of stress urinary incontinence recurrence, different types of re-treatment, patient reported outcomes and information about treating surgeons are crucial.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Estudos de Coortes , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , New York/epidemiologia , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia
5.
Med Care ; 59(1): 77-81, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33201083

RESUMO

BACKGROUND: Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival. OBJECTIVE: We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality. RESEARCH DESIGN: A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation. SUBJECTS: A total of 14,183 Medicare beneficiaries with breast cancer in 2006-2008 or 2014-2015. MEASURES: All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data. RESULTS: Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness. CONCLUSION: Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.


Assuntos
Neoplasias da Mama , Disparidades em Assistência à Saúde , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Feminino , Humanos , New York , Estados Unidos
6.
Subst Use Misuse ; 56(2): 238-244, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33317365

RESUMO

Background: Little is known about how COVID-19-related social distancing has affected illegal drug use. We surveyed electronic dance music (EDM) partygoers-a population known for high levels of drug use-to determine whether their drug use patterns had changed during state-mandated social distancing in New York. Methods: Individuals were recruited online and screened for eligibility throughout April and May 2020. We surveyed 128 eligible adults and queried, retrospectively, whether their drug use behavior had changed during COVID-19-related social distancing. Results: Most participants reporting past-three-month use reported decreased frequency of use during COVID-19-related social distancing. Specifically, 78.6% reduced frequency of use of cocaine, 71.1% reduced frequency of use of ecstasy/MDMA/Molly, and 68.0% reduced frequency of use of LSD. Although some participants reported increased frequency of use of cocaine (7.1%), ecstasy (7.9%), or LSD (12.0%), 35.0% reported increased frequency of cannabis use. Most (66.7%) of those reporting cocaine use reduced the amount used. The majority of those reporting use of cannabis, ecstasy, cocaine, and/or LSD reported that drug cost (80.0-84.0%) and drug quality (84.2-92.0%) did not change during social distancing. Having a college degree was associated with higher odds for decreasing frequency of cannabis use. Older participants (ages ≥23) were at lower odds for decreasing frequency of cocaine use, as were those earning >$500 per week, and participants who attended EDM events biweekly or more often were at higher odds for decreasing frequency of LSD use. Conclusions: Participants in this sample tended to reduce party drug use during COVID-19-related social distancing.


Assuntos
/psicologia , Dança , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Feminino , Humanos , Masculino , New York , Fatores de Proteção , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
7.
JAMA Netw Open ; 3(12): e2029250, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315112

RESUMO

Importance: In the current setting of the coronavirus disease 2019 pandemic, there is concern for the possible need for triage criteria for ventilator allocation; to our knowledge, the implications of using specific criteria have never been assessed. Objective: To determine which and how many admissions to intensive care units are identified as having the lowest priority for ventilator allocation using 2 distinct sets of proposed triage criteria. Design, Setting, and Participants: This retrospective cohort study conducted in spring 2020 used data collected from US hospitals and reported in the Philips eICU Collaborative Research Database. Adult admissions (N = 40 439) to 291 intensive care units from 2014 to 2015 who received mechanical ventilation and were not elective surgery patients were included. Exposures: New York State triage criteria and original triage criteria proposed by White and Lo. Main Outcomes and Measures: Sequential Organ Failure Assessment (SOFA) scores were calculated for admissions. The proportion of patients who met initial criteria for the lowest level of priority for mechanical ventilation using each set of criteria and their characteristics and outcomes were assessed. Agreement was compared between the 2 sets of triage criteria, recognizing differences in stated criteria aims. Results: Among 40 439 intensive care unit admissions of patients who received mechanical ventilation, the mean (SD) age was 62.6 (16.6) years, 54.9% were male, and the mean (SD) SOFA score was 4.5 (3.7). Using the New York State triage criteria, 8.9% (95% CI, 8.7%-9.2%) were in the lowest priority category; these lowest priority admissions had a mean (SD) age of 62.9 (16.6) years, used a median (interquartile range) of 57.3 (20.1-133.5) ventilator hours each, and had a hospital survival rate of 38.6% (95% CI, 37.0%-40.2%). Using the White and Lo triage criteria, 4.3% (95% CI, 4.1%-4.5%) were in the lowest priority category; these admissions had a mean (SD) age of 68.6 (13.2) years, used a median (interquartile range) of 61.7 (24.3-142.8) ventilator hours each, and had a hospital survival rate of 56.2% (95% CI, 53.8%-58.7%). Only 655 admissions (1.6%) were in the lowest priority category for both guidelines, with the κ statistic for agreement equal to 0.20 (95% CI, 0.18-0.21). Conclusions and Relevance: Use of 2 initially proposed ventilator triage guidelines identified approximately 1 in every 10 to 25 admissions as having the lowest priority for ventilator allocation, with little agreement. Clinical assessment of different potential criteria for triage decisions in critically ill populations is important to ensure valid and equitable allocation of resources.


Assuntos
Alocação de Recursos para a Atenção à Saúde/métodos , Triagem/métodos , Ventiladores Mecânicos , Idoso , /epidemiologia , Estado Terminal , Feminino , Alocação de Recursos para a Atenção à Saúde/normas , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , New York , Escores de Disfunção Orgânica , Estudos Retrospectivos , Triagem/normas
8.
BMC Emerg Med ; 20(1): 97, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308165

RESUMO

BACKGROUND: Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. METHODS: We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. RESULTS: A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). CONCLUSIONS: We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Algoritmos , Finlândia/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , New York , Pandemias , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Fatores de Tempo , Universidades , Ferimentos e Lesões/epidemiologia
9.
Trials ; 21(1): 942, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225989

RESUMO

OBJECTIVES: To evaluate a therapeutic role for omega-3 fatty acid supplementation in the treatment of olfactory dysfunction associated with COVID-19 infection TRIAL DESIGN: Randomized, double-blinded, placebo-controlled trial PARTICIPANTS: Eligible patients are adults with self-reported new-onset olfactory dysfunction of any duration associated with laboratory-confirmed or clinically suspected COVID-19 patients. Exclusion criteria include patients with pre-existing olfactory dysfunction, history of chronic rhinosinusitis or history of sinus surgery, current use of nasal steroid sprays or omega-3 supplementation, fish allergy, or inability to provide informed consent for any reason. The trial is conducted at Mount Sinai Hospital INTERVENTION AND COMPARATOR: The intervention group will receive 2000 mg daily of omega-3 supplementation in the form of two "Fish Oil, Ultra Omega-3" capsules (product of Pharmavite®) daily. The comparator group will take 2 placebo capsules of identical size, shape, and odor daily for 6 weeks. MAIN OUTCOMES: Each subject will take a Brief Smell Identification Test at study enrolment and completion after 6 weeks. The primary outcome will be change in Brief Smell Identification Test over the 6-week period. RANDOMISATION: Patients will be randomized by the Investigational Drug Pharmacy at the Icahn School of Medicine at Sinai via a computer-generated sequence in a 1:1 allocation to treatment or control arms. BLINDING (MASKING): Both participants and researchers will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): There will be 88 participants randomized to each group. A total of 176 participants will be randomized. TRIAL STATUS: Protocol Version 1, 8/3/2020 Recruitment is ongoing, started 8/5/2020 with estimated completion 11/30/2020. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov with Protocol Identifier: NCT04495816 . TRIAL REGISTRATION: ClinicalTrials.gov, NCT04495816 . Registered 3 August 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1).


Assuntos
Infecções por Coronavirus/complicações , Suplementos Nutricionais/efeitos adversos , Ácidos Graxos Ômega-3/uso terapêutico , Transtornos do Olfato/tratamento farmacológico , Pneumonia Viral/complicações , Betacoronavirus/genética , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Suplementos Nutricionais/estatística & dados numéricos , Método Duplo-Cego , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , New York/epidemiologia , Transtornos do Olfato/etiologia , Pandemias , Placebos/administração & dosagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Olfato/efeitos dos fármacos , Olfato/fisiologia
12.
J Clin Pediatr Dent ; 44(4): 249-255, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33167019

RESUMO

OBJECTIVE: To determine changes in knowledge, attitudes, and practices of primary care physicians (PCPs) regarding fluoride varnish (FV). STUDY DESIGN: Fifty-four PCPs at an urban medical center in New York completed a pre-intervention survey. A pediatric dental resident provided an hour-long educational lecture and a hands-on demonstration regarding FV application. Six months later, PCPs were sent a post-intervention survey via electronic mail. RESULTS: Fifty-four PCPs participated in the pre-survey and FV training and 48% completed the post-survey. Prior to the FV training, 57% of PCPs knew that FV application by medical practitioners was reimbursable for children under 6-years-old and 2% of PCPs were applying FV. Post FV training, 62% of PCPs reported applying FV. Pre and post survey, barriers to FV application was not enough hands-on training (43% to 15% respectively) and not enough time (50% to 85% respectively). CONCLUSIONS: Post FV training, PCPs' knowledge, attitudes and practices in regard to FV changed. Interprofessional education may be one approach to increasing FV application participation.


Assuntos
Fluoretos Tópicos , Médicos de Atenção Primária , Atitude do Pessoal de Saúde , Criança , Fluoretos , Humanos , New York , Inquéritos e Questionários
13.
Ecotoxicology ; 29(10): 1565-1589, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33170395

RESUMO

Mercury (Hg) pollution is an environmental problem that adversely affects human and ecosystem health at local, regional, and global scales-including within New York State. More than two-thirds of the Hg currently released to the environment originates, either directly or indirectly, from human activities. Since the early 1800s, global atmospheric Hg concentrations have increased by three- to eight-fold over natural levels. In the U.S., atmospheric emissions and point-source releases to waterways increased following industrialization into the mid-1980s. Since then, water discharges have largely been curtailed. As a result, Hg emissions, atmospheric concentrations, and deposition over the past few decades have declined across the eastern U.S. Despite these decreases, Hg pollution persists. To inform policy efforts and to advance public understanding, the New York State Energy Research and Development Authority (NYSERDA) sponsored a scientific synthesis of information on Hg in New York State. This effort includes 23 papers focused on Hg in atmospheric deposition, water, fish, and wildlife published in Ecotoxicology. New York State experiences Hg contamination largely due to atmospheric deposition. Some landscapes are inherently sensitive to Hg inputs driven by the transport of inorganic Hg to zones of methylation, the conversion of inorganic Hg to methylmercury, and the bioaccumulation and biomagnification along food webs. Mercury concentrations exceed human and ecological risk thresholds in many areas of New York State, particularly the Adirondacks, Catskills, and parts of Long Island. Mercury concentrations in some biota have declined in the Eastern Great Lakes Lowlands and the Northeastern Highlands over the last four decades, concurrent with decreases in water releases and air emissions from regional and U.S. sources. However, widespread changes have not occurred in other ecoregions of New York State. While the timing and magnitude of the response of Hg levels in biota varies, policies expected to further diminish Hg emissions should continue to decrease Hg concentrations in food webs, yielding benefits to the fish, wildlife, and people of New York State. Anticipated improvements in the Hg status of aquatic ecosystems are likely to be greatest for inland surface waters and should be roughly proportional to declines in atmospheric Hg deposition. Efforts that advance recovery from Hg pollution in recent years have yielded significant progress, but Hg remains a pollutant of concern. Indeed, due to this extensive compilation of Hg observations in biota, it appears that the extent and intensity of the contamination on the New York landscape and waterscape is greater than previously recognized. Understanding the extent of Hg contamination and recovery following decreases in atmospheric Hg deposition will require further study, underscoring the need to continue existing monitoring efforts.


Assuntos
Monitoramento Ambiental , Poluição Ambiental/estatística & dados numéricos , Mercúrio/análise , Poluentes Ambientais/análise , Humanos , Lagos , Compostos de Metilmercúrio , New York
14.
New Bioeth ; 26(4): 328-350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33196403

RESUMO

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.


Assuntos
Comércio/legislação & jurisprudência , Direitos Humanos , Legislação Médica/ética , Técnicas Reprodutivas/legislação & jurisprudência , Controle Social Formal , Mães Substitutas/legislação & jurisprudência , Acesso à Informação , Adulto , Criança , Bem-Estar da Criança , Comércio/ética , Infecções por Coronavirus/epidemiologia , Dissidências e Disputas , Família , Feminino , Humanos , Indústrias/ética , Indústrias/legislação & jurisprudência , Mães , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Direitos da Mulher
15.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33055227

RESUMO

BACKGROUND: Given the risks associated with antibiotics, efforts to reduce unnecessary antibiotic use in the NICU have become increasingly urgent. In 2016, a comprehensive 3-year quality improvement (QI) initiative was conducted in a level 4 NICU that sought to decrease the antibiotic use rate (AUR) by 20%. METHODS: This local QI initiative was conducted in the context of a multicenter learning collaborative focused on decreasing unnecessary antibiotic use. Improvement strategies focused on addressing gaps in the core elements of antibiotic stewardship programs. Outcome measures included the AUR and the percent of infants discharged without antibiotic exposure. Process measures included the percent of infants evaluated for early-onset sepsis (EOS) and duration of antibiotics used for various infections. Statistical process control charts were used to display and analyze data over time. RESULTS: The AUR decreased from 27.6% at baseline to 15.5%, a 43% reduction, and has been sustained for >18 months. Changes most attributable to this decrease include implementation of the sepsis risk calculator, adopting a 36-hour rule-out period for sepsis evaluations, a 36-hour antibiotic hard stop, and novel guideline for EOS evaluation among infants <35 weeks. The percent of infants discharged without antibiotic exposure increased from 15.8% to 35.1%. The percent of infants ≥36 weeks undergoing evaluation for EOS decreased by 42.3% and for those <35 weeks by 26%. CONCLUSIONS: Our efforts significantly reduced antibiotic use and exposure in our NICU. Our comprehensive, rigorous approach to QI is applicable to teams focused on improvement.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Unidades de Terapia Intensiva Neonatal , Sepse Neonatal/tratamento farmacológico , Melhoria de Qualidade , Humanos , Recém-Nascido , Sobremedicalização/prevenção & controle , Sepse Neonatal/diagnóstico , New York , Medição de Risco , Fatores de Tempo
16.
Environ Sci Process Impacts ; 22(11): 2147-2161, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33104143

RESUMO

Wastewater entering sewer networks represents a unique source of pooled epidemiological information. In this study, we coupled online solid-phase extraction with liquid chromatography-high resolution mass spectrometry to achieve high-throughput analysis of health and lifestyle-related substances in untreated municipal wastewater during the coronavirus disease 2019 (COVID-19) pandemic. Twenty-six substances were identified and quantified in influent samples collected from six wastewater treatment plants during the COVID-19 pandemic in central New York. Over a 12 week sampling period, the mean summed consumption rate of six major substance groups (i.e., antidepressants, antiepileptics, antihistamines, antihypertensives, synthetic opioids, and central nervous system stimulants) correlated with disparities in household income, marital status, and age of the contributing populations as well as the detection frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater and the COVID-19 test positivity in the studied sewersheds. Nontarget screening revealed the covariation of piperine, a nontarget substance, with SARS-CoV-2 RNA in wastewater collected from one of the sewersheds. Overall, this proof-of-the-concept study demonstrated the utility of high-throughput wastewater analysis for assessing the population-level substance use patterns during a public health crisis such as COVID-19.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos , New York , Águas Residuárias
20.
Anesth Analg ; 131(5): 1337-1341, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079852

RESUMO

BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/terapia , Cuidados Críticos , Prestação Integrada de Cuidados de Saúde , Procedimentos Cirúrgicos Eletivos , Unidades de Terapia Intensiva/provisão & distribução , Admissão do Paciente , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Necessidades e Demandas de Serviços de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , New York/epidemiologia , Sistemas de Informação em Salas Cirúrgicas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Respiração Artificial , Fatores de Tempo , Ventiladores Mecânicos/provisão & distribução
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