Perspectives From the Foot and Ankle Department at an Academic Orthopedic Hospital During the Surge Phase of the COVID-19 Pandemic in New York City.
Ontology highlight
ABSTRACT:
SUBMITTER: Day J
PROVIDER: S-EPMC7251625 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
Perspectives From the Foot and Ankle Department at an Academic Orthopedic Hospital During the Surge Phase of the COVID-19 Pandemic in New York City.
Day Jonathan J MacMahon Aoife A Roberts Matthew M MM Drakos Mark C MC Johnson Anne H AH Levine David S DS O'Malley Martin J MJ Cody Elizabeth A EA Behrens Steve B SB Deland Jonathan T JT Demetracopoulos Constantine A CA Elliot Andrew J AJ Ellis Scott J SJ
Foot & ankle international 20200525 7
Similar Datasets
Project description:IntroductionCoronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients' critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23-April 16, 2020.MethodsA clinical greeter evaluated patients 18 years and older who presented to the walk-in entrance of the ED where they were screened for COVID-19-like complaints. If they did not appear critically ill and could ambulate they were directed into the FTA. Clinical and non-clinical staff worked in concert to register, evaluate, and process patients with either a disposition of directly home or into the ED for further care.ResultsA total of 634 patients were seen in the FTA from March 23-April 16, 2020. Of the 634 patients evaluated, 135 (21%) were referred into the ED for further evaluation, of whom 81 (12.7% of the total) were admitted. These patients were disproportionately male (91 into the ED and 63 admitted) and tended to have a higher heart rate (105.4 vs 93.7), a higher respiratory rate (21.5 vs 18.1), and lower oxygen saturation (93.9% vs 97.8%).ConclusionA forward treatment area is an effective method to rapidly screen and process an increased volume of COVID-19 patients when resources are limited. This treatment area helped decompress the ED by being rapidly deployable and effectively screening patients for safe discharge home.
| S-EPMC8328161 | biostudies-literature
Project description:BackgroundDigital media is an effective tool to enhance brand recognition and is currently referenced by more than 40% of orthopedic patients when selecting a physician. The purpose of this study was to evaluate the use of social media among foot and ankle (F&A) orthopedic surgeons, and the impact of that social media presence on scores of a physician-rated website (PRW).MethodsRandomly selected F&A orthopedic surgeons from all major geographical locations across the United States were identified using the AAOS.org website. Internet searches were then performed using the physician's name and the respective social media platform. A comprehensive social media use index (SMI) was created for each surgeon using a scoring system based on social media platform use. The use of individual platforms and SMI was compared to the F&A surgeon's Healthgrades scores. Descriptive statistics, unpaired Student t tests, and linear regression were used to assess the effect of social media on the PRW scores.ResultsA total of 123 board-certified F&A orthopedic surgeons were included in our study demonstrating varying social media use: Facebook (48.8%), Twitter (15.4%), YouTube (23.6%), LinkedIn (47.9%), personal website (24.4%), group website (52.9%), and Instagram (0%). The mean SMI was 2.4 ± 1.6 (range 0-7). Surgeons who used a Facebook page were older, whereas those using a group website were younger (P < .05). F&A orthopedic surgeons with a YouTube page had statistically higher Healthgrades scores compared to those without (P < .05).ConclusionF&A orthopedic surgeons underused social media platforms in their clinical practice. Among all the platforms studied, a YouTube page was the most impactful social media platform on Healthgrades scores for F&A orthopedic surgeons. Given these findings, we recommend that physicians closely monitor their digital identity and maintain a diverse social media presence including a YouTube page to promote their clinical practice.Level of evidenceLevel IV.
| S-EPMC8702771 | biostudies-literature
Project description:Academic medical centers (AMCs) are widely perceived as providing the highest-quality medical care. To investigate disparities in access to such care, we studied the racial/ethnic and payer mixes at private AMCs of New York City (NYC) and Boston, two cities where these prestigious institutions play a dominant role in the health care system. We used individual-level inpatient discharge data for acute care hospitals to examine the degree of hospital racial/ethnic and insurance segregation in both cities using the Index of Dissimilarity, together with recent changes in patterns of care in NYC. In multivariable logistic regression analyses, black patients in NYC were two to three times less likely than whites, and uninsured patients approximately five times less likely than privately insured patients, to be discharged from AMCs. In Boston, minorities were overrepresented at AMCs relative to other hospitals. NYC hospitals were more segregated overall according to race/ethnicity and insurance than Boston hospitals, and insurance segregation became more pronounced in NYC after the Affordable Care Act. Although health reform improved access to insurance, access to AMCs remains limited for disadvantaged populations, which may undermine the quality of care available to these groups.
| S-EPMC6090544 | biostudies-literature
Project description:BackgroundAt present, the geographic distribution of orthopedic foot and ankle (OFA) surgeons in the United States is poorly defined. The purpose of this investigation is to determine the geographic distribution of OFA surgeons in the United States. We hypothesize that there will be differences in OFA surgeon density throughout the United States and that economic factors may play a role in access to subspecialty OFA care.MethodsA current membership list was obtained from the American Orthopaedic Foot & Ankle Society (AOFAS). Active members were categorized relative to states and US congressional districts, using publicly available census data. The relationship between income and surgeon density was determined using a Pearson correlation.ResultsWe identified a list of 1103 active AOFAS members. There was an average of 0.38 and 0.40 OFA surgeons per 100 000 people in each state and congressional district, respectively. We found a weak negative relationship demonstrating that regions with higher levels of poverty had fewer OFA surgeons, with a Pearson correlation coefficient of -0.14 (95% CI: -0.24, -0.04), P = .008.ConclusionThere is wide geographic variation of OFA surgeon density throughout the United States. Regions with higher levels of poverty were weakly associated with decreased population density of OFA surgeons compared to regions with lower poverty levels. Understanding these trends may aid in developing both recruitment and referral strategies for complex foot and ankle care in underserved regions.Level of evidenceLevel V.
| S-EPMC8702914 | biostudies-literature
Project description:BackgroundKnee scooters ("scooters") are a commonly used device to facilitate postoperative adherence to weightbearing restrictions. Although high rates of falls have been reported, little is known about injuries related to scooter use.MethodsWe analyzed survey responses from 316 of 2046 members (15%) of the American Orthopaedic Foot & Ankle Society in May-June 2019 describing (1) frequency of scooter recommendation; (2) indications for which they recommended scooters; (3) characteristics of patients for whom they recommended scooters; (4) prevalence, anatomic locations, mechanisms, and sequelae of scooter-related injuries; and (5) characteristics of patients with scooter-related injuries. Descriptive statistics and χ2 goodness-of-fit tests were performed (alpha = .05).ResultsMean frequency with which respondents recommended scooters in particular was 69%. Respondents most often recommended scooters after hindfoot arthrodesis (97% [305/316]), ankle arthrodesis (96% [302/316]), and for total nonweightbearing (64% [202/316]) and to patients who were overweight (vs obese) or aged 45-75 years. Mean prevalence of scooter-related injuries was 2.5%. The most common injury mechanism was making a sharp turn (reported by 62% [103/166]). Thirty-four percent (56/166) of respondents with injured patients said patients underwent surgery to treat scooter-related injuries. Patients with scooter-related injuries were more often women, >44 years old, obese, and sedentary.ConclusionScooters were commonly recommended postoperatively, most often for total nonweightbearing after hindfoot or ankle arthrodesis, and most often in overweight adults or those aged 45-75 years. Mean reported prevalence of scooter-related injuries was 2.5%. Female sex, older age, obesity, and sedentary lifestyle were associated with scooter-related injury.Level of evidenceLevel IV, retrospective case series.
| S-EPMC8697236 | biostudies-literature
Project description:Level V, clinical tips.
| S-EPMC8673941 | biostudies-literature
Project description:ObjectivesThe goal of this study was to describe outcomes and associated characteristics of patients who were intubated during the initial (3/2020-4/2020) New York City surge of the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, during which time we were confronted by an unknown and unprecedented respiratory distress syndrome with extremely high degrees of morbidity and mortality. Our secondary aim was to analyze our physician's rapidly evolving approaches to COVID-19 airway management.MethodsA retrospective cohort analysis of all patients intubated at two emergency departments (EDs) for COVID-19 suspected respiratory failure. In addition, a survey was done to analyze clinician airway management trends and attitudes as they evolved during that period.ResultsNinety-five patients met inclusion criteria for the study. Primary outcomes looked at the spectrum of mortality outcomes ranging from died on arrival (DOA) to the ED, died in the ED (DED), died an inpatient (DIH), and survival to discharge. Overall mortalitywas 71.6% with an average age of 62.7 years. Female sex, as a demographic, was associated with higher rates of survival to discharge at 42.3% when compared to males at 23.2% (P < 0.001). Mean age was 70.8 years DOA, 65.6 years DED, 62.9 years DIH, and 60.0 years for survivors (P = 0.0037). Initial lactate levels were 8.15 mmol/L DED, 3.56 mmol/L DIH, and 2.61 mmol/L survivors (P < 0.0001). Initial creatinine levels were 3.38 mg/dL DED, 1.94 mg/dL DIH, and 1.77 mg/dL survivors (P = 0.0073). D-dimer levels were 7520.5 ng/mL DED, 5932.4 ng/mL DIH, and 1133.9 ng/mL survivors (P = 0.0045). Physician survey respondents reported high levels (69%) of laryngeal edema and prolonged post intubation hypoxia (>50% of time) and >80% remained concerned for their safety. There was a dramatic shift from early (73% of time) to late intubation strategies (67% of time) or non-invasive approaches (28% of time) as the first surge of the pandemic evolved.ConclusionOur findings demonstrate that several demographic, clinical and laboratory parameters correlated with mortality in our cohort of patients intubated during the initial phase of the COVID-19 pandemic. These included male sex, advanced age, high levels of initial lactic acidosis, elevated D-dimer, and chronic kidney disease/acute kidney injury. In contrast, presenting respiratory characteristics were not correlated with mortality. In addition, our findings demonstrate that physician attitudes and strategies related to COVID-19 airway management evolved significantly and rapidly over the initial phase of the pandemic.
| S-EPMC8612629 | biostudies-literature
Project description:A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) (P < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.
| S-EPMC7383550 | biostudies-literature
Project description:IntroductionFoot deformities are frequent complications in Charcot-Marie-Tooth disease (CMT) patients, often requiring orthopedic surgery. However, there are no prospective, randomized studies on surgical management, and there is variation in the approaches among centers both within and between countries.MethodsIn this study we assessed the frequency of foot deformities and surgery among patients recruited into the Inherited Neuropathies Consortium (INC). We also designed a survey addressed to orthopedic surgeons at INC centers to determine whether surgical approaches to orthopedic complications in CMT are variable.ResultsFoot deformities were reported in 71% of CMT patients; 30% of the patients had surgery. Survey questions were answered by 16 surgeons working in different specialized centers. Most of the respondents were foot and ankle surgeons. There was marked variation in surgical management.DiscussionOur findings confirm that the approaches to orthopedic management of CMT are varied. We identify areas that require further research. Muscle Nerve 57: 255-259, 2018.
| S-EPMC5811923 | biostudies-literature
Project description:Introduction: With the COVID-19 epidemic ever-expanding, nonemergent access to health care resources has been reduced to decrease the exposure for patients and health care providers. Alternatives to in-office outpatient medical evaluations are necessary. We aimed to analyze how quickly orthopedic surgery providers at a large academic institution adopted telemedicine, and identify any factors that were associated with earlier or "faster" telemedicine adoption. Methods: We analyzed the telemedicine activity of 39 providers within the Department of Orthopedic Surgery between March 16, 2020, and May 30, 2020, and constructed logistic regression models to identify characteristics with significant association to earlier or faster telemedicine adoption. Results: No significant predictors of percentage of visits conducted via telemedicine were found. However, increased experience and practice at multiple locations was associated with slower telemedicine adoption time, while Professor level academic rank was associated with a faster time to achieving 10% of pre-COVID visit volumes via telemedicine. Higher pre-COVID visit volumes were also significantly associated with faster telemedicine adoption. Demographic factors, including, age, gender, practice locations, academic degrees, pediatric specialty, and use of physician assistants/nurse practitioners, were not found to have significant associations with telemedicine use. Conclusions: These results indicate that telemedicine has an important role to play within academic orthopedic surgery practices, with a wide and diverse range of orthopedic surgery providers choosing to utilize it during the COVID-19 pandemic. Given the rapid expansion and urgency driving the adoption of telemedicine, these results illustrate the importance of considering provider-side characteristics in ensuring that providers are well equipped to utilize telemedicine.
| S-EPMC9022183 | biostudies-literature