Brooklyn Hospital Center

Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography. Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021-2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography-associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration. Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million. For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.

Investigate the association between placental vascular abnormalities and regional brain volumes in congenital heart disease (CHD) fetuses with and without genetic abnormalities. Secondary analysis of brain magnetic resonance imaging (MRI) and placental pathology data from 121 CHD fetuses enrolled in prospective neuroimaging studies at two centers. Placental vascular abnormality was present in 46% of fetuses, and genetic abnormality was present in 19%, including 12% with both abnormalities. Fetuses with the combination of placental and genetic abnormalities had smaller brain volumes compared to fetuses without either abnormality for total brain, subcortical gray matter, brainstem, and cerebellum, with a significant interaction (P < 0.05) between placental and genetic abnormalities for intracranial and subcortical gray matter volumes. Smaller brain volumes for CHD fetuses with placental and genetic abnormalities may suggest common genetic pathways affect placental, heart, and brain development, or that genetic abnormalities heighten vulnerability when placental changes occur.

Historically, Speech Language Pathology (SLP) dysphagia aspiration precautions and feeding guidelines were placed in an SLP note and posted on a paper bedside sign. In the past decade, these signs have decreased in popularity and/or been eliminated at the facility level due to limited effectiveness, infection control, HIPAA compliance, and the general shift towards digital communication. The purpose of this quality improvement initiative was to evaluate if electronic Dysphagia Aspiration Precautions (DAP) can be effective in helping nurses identify appropriate dysphagia precautions and improve implementation of those precautions. Pre and post surveys were conducted on 60 nurses in the neuroscience units across three campuses—Manhattan (M), Long Island (LI), and Langone Orthopedic Hospital (LOH)—to identify staff awareness regarding dysphagia precautions. Pre-intervention, nursing identified dysphagia 100% (M) and 90% (LI) of the time (LOH had no data); located the dysphagia aspiration precautions 57% (M), 94% (LI) and 90% (LOH) of the time; and identified the location of documentation of precautions 65% (M), 94% (LI) and 95% (LOH) of the time. An interdisciplinary team designed a DAP panel in the EMR. Additional steps included face testing the order panel, pre and post phase education with interdisciplinary teams, including providers and post-implementation chart abstractions. Following implementation of the panel, all sites demonstrated improvement in knowledge and implementation of DAP. DAP orders were “pended” by the SLP 100% of the time, and signed by the provider 100% of the time, at the six-week mark post go-live. Post-intervention nursing identified dysphagia 100%, 100% and 92% of the time; were able to locate DAP 82%, 100% and 100 % of the time; and completed initial documentation of DAP 94%, 90% and 87% of the time. An average of five precautions were ordered by SLP. Using informatics to transition recommendations from discipline-specific notes to an electronic, orders-based-workflow improved interdisciplinary communication, knowledge and adherence to patient-specific precautions. Future steps include exploring electronic-based-workflows with other precautions, identifying a key number of precautions that are consistently adhered to and documented on, and analyzing the impact to therapy documentation. Ideally, digital expansion would include caregivers via our electronic enterprise patient portal.

Background: The Society of Critical Care Medicine's 2025 update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption suggest the use of dexmedetomidine over propofol for sedation in critically-ill, mechanically ventilated patients. With widespread use of dexmedetomidine, reports have been published describing development of fever with its use. Drug-induced fevers are usually a diagnosis of exclusion, making them hard to recognize, and misdiagnosis can lead to utilization of additional medications and resources. The objective of this study was to identify risk factors associated with dexmedetomidine-related fever in critically-ill patients. Methods: This was a single-center retrospective study conducted at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients, admitted to the intensive care unit, who received at least 12hours of continuous dexmedetomidine infusion were included. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for dexmedetomidine-related fever. Results: Eighty one patients were included, of whom 31 (38.3%) were febrile and 50 (61.7%) were afebrile while receiving dexmedetomidine infusion. Multivariate analysis showed higher likelihood of developing fever if patients received dexmedetomidine continuously for ≥72hours (OR 5.97, 95% CI 1.90-18.75) and if dexmedetomidine rate was ≥1mcg/kg/hr at Tmax (OR 6.16, 95% CI 1.80-21.09). Conclusion: Dexmedetomidine infusion for 72hours or longer and dexmedetomidine infusion rate at 1mcg/kg/hr or greater were risk factors for developing a fever in critically ill patients in a community teaching hospital.

Fever is a prevalent clinical manifestation in pediatrics, representing a significant proportion of emergency department (ED) visits worldwide. While fever is often benign and self-limiting, it can also indicate life-threatening infections requiring immediate intervention, particularly in neonates and immunocompromised children. This comprehensive review delves into the intricate pathophysiology of fever, exploring its dual role as a protective immune mechanism and a potential physiological risk. It critically examines diagnostic challenges, evidence-based management strategies, and global disparities in fever treatment. Special emphasis is placed on parental perceptions, the overuse of antipyretics, and the emerging role of artificial intelligence in fever diagnosis. Future directions include refining diagnostic biomarkers, implementing digital health tools, and advancing antimicrobial stewardship to curb antibiotic resistance. By improving clinical decision-making and public awareness, this review aims to optimize the management of febrile children worldwide and enhance patient outcomes.

Disclosure: M. Kakakhel: None. S. Cheema: None. S. Fatima: None. R. Noor: None. H. Javaid: None. P.K. Singh: None. H. Jawad: None. R. Haider: None. A. Qadeer: None. M. Khawar: None. T. Ashraf: None. F. Naveed: None. H. Ahmad: None. F. Ahmed: None. R. Kirchoff: None.Introduction: The health of a nation is often a reflection of the equity within its systems. Yet, when we examine the United States, one of the most developed nations globally, a concerning picture emerges in the realm of public health significant racial and ethnic disparities in disease outcomes. Among these, endocrine- related mortality, which includes conditions like diabetes, thyroid disorders, and hormonal imbalances, stands as a silent yet significant contributor to health inequities. Using data from the CDC WONDER database, this study seeks to explore these trends in depth, not just to identify the gaps but to shed light on the lived experiences of marginalized communities who bear the brunt of these inequities to pave the way for more equitable healthcare interventions. Methods: This descriptive study analyzes Racial and Ethnic Disparities in Endocrine-Related Mortality in the United States from 1999-2022, utilizing data from CDC Wonder database. We searched the Center for Disease Control database from 1999 to 2022 for mortality statistics with an underlying cause of death. The age-adjusted mortality rate (AAMR) was calculated per 1,000,000 deaths. We evaluated the AAMR using demographic variables such as race/ethnicity, geographic density, gender, age (25 or above), place of death, and the US Census Region. Temporal trends were assessed using Joinpoint regression software. Mortality rates by age, demographics, and place of death were examined. Statistical analysis calculated endocrine-related mortality rates and trends, with findings deemed significant at P < 0. 05. Results: Between the years 1999 to 2022, 837203 deaths were recorded to be caused by endocrine-related disorders. An overall rising mortality trend from 1999-2022 among all races and ethnicities is noted, except in Asian or Pacific Islander, Black or African American, and Hispanic patients, which shows a rise till 2020 followed by fall in age-adjusted mortality rates (AAMR) in 2022. A significant dip in mortality rate was seen in 2017 in all racial and ethnic groups. American Indian or Alaska Natives showed highest AAMR (181.87, 95% CI 178.06-185.69) followed by Black or African Americans (149.78, 95% CI 148.9-150.64), Hispanic or Latinos (112.33, 95% CI 111.59-113.07), Whites (94.31, 95% CI 66.6-68.25), Asian or Pacific Islanders (67.45, 95% CI 66.6-68.25). American Indians or Alaska Natives exhibit the steepest rise over time (APC -0.32 TO 8.85) from 1999-2022. Conclusions: Mortality due to endocrine-related disorders has dramatically increased over time. Significant disparities have been noted among different races and ethnic groups, with the highest rate among Americans and the lowest among Asians. This underscores the need for targeted interventions for specific racial groups to reduce the mortality burden of endocrine-related diseases.Presentation: Sunday, July 13, 2025