New York Hospital Queens

Over 90% of people with hereditary cancer syndromes in the United States remain unidentified. The Genetic Cancer Risk Detector (GARDE) is an open-source, electronic health record (EHR)-integrated, digital health platform that can facilitate genetic cancer risk assessment and genetic testing. This study evaluates its budget impact on health care institutions. A budget impact analysis was performed from the perspective of a US health care provider system over a 3-year horizon. Data from the BRIDGE randomized controlled trial data from the University of Utah Health (UHealth) were used, where eligible primary care patients were screened for genetic cancer risk via GARDE. Costs of GARDE were categorized across planning, implementation, and operational phases. Revenue projections were based on Centers for Medicare & Medicaid Services reimbursement rates. Scenario analyses varied uptake of interventions, surveillance intervals, reimbursement rates, and implementation scale. Of 1,444 patients identified by GARDE at UHealth and enrolled in the BRIDGE trial, 205 completed genetic testing, with 15 found to carry pathogenic variants. The total 3-year implementation cost was $29,217 US dollars (USD). Revenue from guideline-recommended procedures totaled $86,563 USD, yielding a net positive budget impact of $57,347 USD. Most revenue (76.4%) was generated by surgical risk-reduction procedures. Scenario analyses revealed high sensitivity to cancer risk-reducing surgery uptake and implementation scale. Modeling 100% uptake of risk-reducing surgeries increased revenue to $128,102 USD, while 20-fold scaling of the implementation population increased revenue to $1.7 million USD. Commercial insurance reimbursement assumptions further amplified revenue. GARDE enables scalable hereditary cancer risk assessment within a health care provider system. Even with modest uptake, it yields a positive financial return, and significantly greater revenue is achievable with broader implementation. These findings support adoption of EHR-integrated tools to enhance clinical outcomes in precision cancer prevention and risk management, in an economically viable manner.

To evaluate outcomes of proximal humerus fractures (PHFs) treated with locked plating constructs and assess association between fracture reduction and outcome. Retrospective cohort study. Academic tertiary care hospital and affiliated level 1 Trauma Center. All patients treated with proximal humerus locked plating for PHFs (OTA/AO 11A/B/C) by 3 fellowship-trained orthopaedic traumatologists from 2008 to 2020 were screened. Patients were excluded for <12-month follow-up, lack of preoperative radiographic imaging, segmental fracture, isolated tuberosity fracture, humeral nailing, and revision surgery as initial procedure at the study institution. Fracture pattern, reduction, fixation characteristics, and failure were radiographically evaluated. Functional outcomes were assessed using range of motion, American Shoulder and Elbow Surgeons score, QuickDASH, Constant score, and SF-12. Survivorship was calculated using the Kaplan-Meier method. Association of variables with failure was assessed. Among 153 patients treated for PHFs with proximal humerus locked plating, there were 23 OTA/AO A-type, 40 B-type, and 90 C-type fractures. Mean follow-up was 66 months, and mean age 59 ± 15 years (68% female). Mean postoperative coronal alignment was 135 degrees, 91% were fixed within 120-150 degrees, and 53% within 130-140 degrees. Sagittal reduction was neutral in 94%. Medial column restoration was achieved in 80%. Survivorship free from revision surgery was 89% at 5 years. Reduction with coronal alignment outside all neutral reduction ranges (120-150 degrees, 125-145 degrees, 130-140 degrees) and sagittal alignment outside neutral were associated with both radiographic failure and revision surgery ( P < 0.05). Preoperative factors associated with failure included female sex, number of fragments, head-split, fracture-dislocation, valgus coronal alignment, and medial calcar displacement ( P < 0.05). Functional outcomes included overall mean American Shoulder and Elbow Surgeons score of 81 ± 21, QuickDASH 16 ± 19, Constant 80 ± 18, SF-12 Physical 50 ± 9, SF-12 Mental 53 ± 8, active forward flexion 145 ± 33 degrees, active abduction 140 ± 35 degrees, active external rotation 73 ± 24 degrees. Proximal humerus locked plating demonstrated a survivorship free from revision surgery of 89% free at 5 years and favorable functional outcomes including mean Constant scores of 80. Fracture reduction was associated with outcome. Reduction with coronal and sagittal alignment outside of neutral were associated with radiographic failure and revision surgery. These findings highlight that favorable functional outcomes can be achieved with restoration of the proximal humerus anatomy. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Introduction: The purpose of this study was to investigate the trauma community’s use of the CAM scoring for delirium, and what shortfalls they believe it has in practice. Additionally, we wanted to discover what can be done to improve delirium care. Methods: A ten-question mixed-methods survey was sent to the members of the Society of Trauma Nurses via Email listserv. The survey included two open-response questions, allowing three responses for each question, and eight multiple-choice questions about delirium and delirium scoring. Results: There were 130 respondents who completed the survey. The majority (42.5%%) are using CAM-B for scoring delirium, however, it was shocking that we discovered 35% indicated currently not using any scoring for delirium. Sleep/wake cycle bundle was reported as the most utilized intervention with CAM-positive patients. Mandatory screening was the most suggested change for improvement of delirium management. Conclusions: A significant amount (35%) of our participants were not using any screening tool for delirium. Education of providers and nurses of the importance of CAM scoring as well as improving the utilization of the CAM score across all areas of inpatient care was indicated as much needed by participants. Those surveyed did not think that facilities had protocolized interventions when a patient was CAM positive, and also they expressed frustration with using the tool screening patients with traumatic brain injury and dementia. This is a potential practice improvement area to improve patient outcomes. The new unifying definition of delirium is a one of the many ways we are improving care for these patients, however this study indicated that additional research is needed to discover the best ways to educate nurses and providers on the importance of delirium and utilizing EMR communication now that the platform has become more advanced.

Introduction: Measles is a highly contagious, potentially fatal, but vaccine preventable disease. In 2025, due to increased rates of unvaccinated individuals, there has been a surge of measles infections in Israel, especially among unvaccinated children who come from densely populated communities. Several of these children have required intensive care and one developed myocarditis requiring extracorporeal life support. Description: A one-year-old unvaccinated female presented to the emergency room with 2 days of fever, weakness and coryzal symptoms with conjunctivitis. On exam, she demonstrated severe respiratory distress with tachypnea, retractions and desaturations, and tachycardia to 200. Her initial laboratory workup demonstrated hyperlactatemia (40 mg/dl), leukopenia (WBC 3.34K) and mildly elevated inflammatory markers. She was intubated shortly after admission to the PICU with subsequent hemodynamic compromise necessitating 3 high-dose vasoactive medications. Her chest X-ray demonstrated diffuse bilateral patchy infiltrates with an oxygenation index of 27. Echocardiography on admission demonstrated severely reduced biventricular function with moderate mitral and tricuspid regurgitation. In view of her high vasoactive need, she was cannulated to peripheral veno-arterial ECMO. On ECMO day 3, she underwent placement of a left atrial cannula for left heart decompression in view of pulmonary edema with bloody endotracheal tube secretions and loss of pulsatility in the arterial line. She was treated with intravenous immunoglobulin as immunomodulator. Within 3 days following decompression of the left heart, her pulmonary edema improved gradually with recovery of the cardiac function. Her ECMO run was complicated with right sided infarct in the internal capsule. The LA vent was removed on ECMO day 11. Discussion: As rates of vaccination fall and cases increase, the pediatric intensivist must be prepared for the critical manifestations of measles infection. Myocarditis is a rare but life-threatening complication of acute measles infection. Timely recognition and appropriate management are necessary to improve the outcomes of these patients.

BACKGROUNDPercutaneous cholecystostomy (PCT) is widely used for high-risk acute cholecystitis as an alternative to emergent cholecystectomy. Despite its effectiveness, the optimal timing, catheter management, and long-term outcomes remain to be elucidated.AIMTo characterize timing, catheter management, survival, and follow-up outcomes after PCT in a high-risk cohort.METHODSThis single center retrospective cohort study included consecutive adult patients undergoing PCT placement for acute cholecystitis at a community hospital setting in New York between January 2012 and December 2024. The study population was grouped according to type of acute cholecystitis (calculous vs acalculous), according to the timing of PCT placement since diagnosis [early (≤ 4 days) vs late (> 4 days)], and according to level of care [intensive care unit (ICU) vs non-ICU patients]. Cox proportional hazards models were used to examine effects of PCT placement interval on mortality rates, after accounting for potential confounding factors (age, Charlson Comorbidity Index, cholecystitis type, ICU status, bile culture and blood culture data).RESULTSThe population consisted of 174 patients who underwent PCT placement for acute cholecystitis between 2012 and 2024 at a community hospital in New York. Median time to PCT was 2 days (interquartile range 1-4). Overall, mortality was 21% (36/174) and was higher with delayed PCT (> 4 days) vs early PCT [35% (17/49) vs 15% (19/125), P = 0.001]. Catheter removal occurred in 13% (23/174), 55% (96/174) remained catheter-dependent, and 32% (56/174) had interval cholecystectomy. ICU admission was associated with prolonged catheter duration but was not associated with mortality. Kaplan-Meier analysis demonstrated a significantly higher survival rate in the early group compared with the late group (log-rank P = 0.006). In both unadjusted models and models adjusted for selected covariates, patients who had catheters placed late (> 4 days) had 2.5-fold higher risk of death than patients with early placement.CONCLUSIONEarly PCT was associated with higher survival in high-risk acute cholecystitis. High rates of catheter dependency highlight the need for standardized protocols and reassessment for definitive surgery.

Effective glucose management of hospitalized individuals is essential for improving outcomes such as wound healing and reducing complications including hypoglycemia. There are many models of effective management, including a Virtual Glucose Management Service (VGMS), where a team of diabetes specialists reviews patient data remotely and recommends interventions to optimize glucose management in hospitalized individuals. The objective of our study was to assess the effectiveness of VGMS for glycemic management in hospitalized individuals in a large academic medical center in New York City. We conducted a prospective, quality improvement intervention-control study on individuals ≥ 18 years old with at least one inpatient point-of-care blood glucose (POC BG) value <70 mg/dL and/or > 200 mg/dL admitted to the hospital from January 1, 2022, to December 31, 2023. VGMS was implemented across four intervention units and differences in glycemic outcomes were measured against two control units. A total of 1338 individuals were included in the intervention and 1019 individuals were included in the control group. Average glucose values in the control and intervention groups were similar [Mean mg/dL: 174.1 (CI: 172.0, 176.7) vs Mean mg/dL: 175.9 (CI: 173.8, 178.0), P = .1798], however the proportion of individuals with hyperglycemia (POC BG >180 mg/dL) was significantly higher in the control group [72.2% (69.5%, 74.9%) vs 65.5% (63.5%, 67.7%), P ≤ .0001]. The implementation of a VGMS team significantly reduced hyperglycemia in hospitalized individuals. This study shows that VGMS is an effective and efficient process to implement in hospital settings to improve inpatient glycemic management.

Dysphagia is one of the most common complications following anti-reflux surgery (ARS). The factors affecting the development of new onset or worsening dysphagia are not well understood. This study aimed to investigate how lower esophageal sphincter distensibility impacts the development of new onset or worsening dysphagia after ARS. A review of patients who underwent robotic ARS was conducted. All patients had intra-operative EndoFLIP monitoring at two-time points, pre-repair, and post-wrap. Dysphagia was assessed pre-operatively and at 3-6months after surgery. Out of 168 patients (63.8%) with 3- to 6-month follow-up, 24 patients (14.2%) developed new onset or worsening post-operative dysphagia. Among these, 13 patients reported mild symptoms, and 11 patients experienced moderate-to-severe dysphagia. Patients with new onset or worsening post-operative dysphagia had lower DI values compared to those without [0.9 IQR (0.7-1.5) mm2/mmHg vs 1.3 IQR (0.9-1.8) mm2/mmHg, p = 0.04]. No significant differences were observed in post-wrap high pressure zone length (HPZ) between groups [3.5 IQR (3-4) cm vs 3.5 IQR (3-3.8) cm, p = 0.71]. A post-wrap DI value of ( 0.9 mm2/mmHg) was associated with increased risk of new onset/worsening dysphagia [4.1 95% CI (1.3-13), p = 0.02]. Patients who developed new onset or worsening dysphagia after ARS had lower post-wrap LES DI values compared to those who did not. A post-wrap DI value of ( 0.9 mm2/mmHg) was associated with increased risk of new onset/worsening dysphagia. While clinicians should consider optimizing post-wrap DI values during ARS to reduce the risk of post-operative new onset/worsening dysphagia, larger scale prospective studies are needed to validate the application of this cutoff and determine its role in tailoring fundoplication, given the single-center design and the limited sample size of our cohort.