Trends in the Use of Cameras and Computer Technology Among Dermatologists in New York City 2001–2002

Background. Photography and computers can enhance dermatologic visit documentation and care.
Objective. To determine dermatologists' use of cameras and computers.
Methods. We surveyed computer and camera use during the Dermatologic Society of Greater New York's meetings in January 2001 and 2002.
Results. Approximately 75% of dermatologists can use computers. Between 2001 and 2002, 35-mm film camera use by attending and resident dermatologists fell from 60% to 47% and 43% to 32%, respectively, and digital camera increased from 25% to 38% and 35% to 59%, respectively. Approximately 50% of dermatologists use instant cameras. Approximately 15% of dermatologists use no camera. Most find images useful; however, medical dermatologists usually image only interesting patients, and dermatologic surgeons image almost all patients. Approximately 15% of dermatologist used electronic medical records (EMRs).
Conclusion. Computers and cameras are widely used but have not changed dermatologic practice. Images are not used to track skin disease or integrated with EMRs nor are EMRs widely used, probably because of difficulty of use and limited computer literacy. Where images appear to add value, for example, for preoperative and postoperative documentation among dermatologic surgeons, camera use is common, suggesting that utility drives technology adoption.     

Two New York City hospitals' surgical response to the September 11, 2001, terrorist attack in New York City

BACKGROUND: We describe the surgical response of two affiliated hospitals during the day of, and week following, the September 11th, 2001 terrorist attack at the World Trade Center in New York City. The city of New York has 18 state designated regional trauma centers that receive major trauma victims. The southern half of Manhattan is served by a burn center, two regional trauma centers, and a community hospital that is an affiliate of one of the regional trauma centers. This report accounts for the surgical response by a regional trauma center (Hospital A, located 2.5 miles from the World Trade Center) and its affiliate hospital (Hospital B, located 5 city blocks from the World Trade Center) on September 11th when two commercial jets crashed into the Twin Towers at the World Trade Center mall. METHODS: Hospital A maintained a concurrent log of patients received during the first 5 hours, the first day, and the first week after the disaster which was kept by the Surgical Triage Officer. The trauma registry completed and verified this data by September 18th. Hospital B collected its data by hand counting and verification by chart review. Both hospitals, A and B, had established disaster plans that were implemented. RESULTS: Nine hundred eleven patients were received by two affiliated hospitals from the World Trade Center attack. Seven hundred seventy six patients (85%) were walking wounded, sustaining mild inhalation and eye irritant injuries. One hundred thirty five (15%) were admitted with 18 (13%) of these undergoing surgery. Twenty two of the 23 transfers were from the community hospital to specialized orthopedic or burn centers. Of the 109 patients admitted to Hospital A, 30 were to the surgical service. The mean ISS score of these patients was 12. There were 4 deaths (within minutes of arrival at the hospital) and 6 delayed deaths (day 1-14). Excluding walking wounded and DOAs, the critical mortality rate was 37.5% overall. CONCLUSION: The September 11th, 2001, terrorist attack in New York City, involving two commercial airliners crashing into the World Trade Center, led to 911 patients received at two affiliated hospitals in lower Manhattan. One hospital is a regional trauma center and one was an affiliate community hospital. Eighty five percent of the patients received were walking wounded. Of the rest, 13% underwent surgical procedures with an overall critical mortality rate of 37.5%.     

Surgical procedures for melanoma in public and private New South Wales hospitals, 2001-2002

BACKGROUND: Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost-ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high-quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined. METHODS: Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001-2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined. RESULTS: During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty-seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0-53%). Eight hundred and fifty-eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0-47%). CONCLUSION: Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.     

Cannabis and other drug use among trauma patients in three South African cities, 1999-2001.

OBJECTIVE: To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001. DESIGN: Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples. OUTCOME MEASURES: Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine. RESULTS: Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries. CONCLUSIONS: Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.     

Racial and Neighborhood-Level Disparities in COVID-19 Incidence among Patients on Hemodialysis in New York City

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown.MethodsOur study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract–level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020 and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors.ResultsOf the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract–level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses.ConclusionsAmong patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19–related exposures, requiring targeted risk-mitigation strategies.     

Media use by children and adolescents from New York City 6 months after the WTC attack

Six months after the World Trade Center (WTC) attacks of September 11, 2001 (9/11), a representative sample of New York City students (N = 8,236) in Grades 4 through 12 reported their use of TV, Web, and combined radio and print media regarding the WTC attack. Demographic factors, WTC exposure, other exposure to trauma, and probable posttraumatic stress disorder (PTSD) were used to predict intensive use of the 3 types of media. Intensive use was associated with direct exposure to the WTC attack (with the exception of Web use) and to having reported symptoms of PTSD. Stratified analyses indicated that the association between probable PTSD and intensive media use was more consistently present among those who had no direct or familial exposure to the WTC attack. As well, media, particularly TV, was intensively used by children after the WTC attack. Variations existed in the factors associated with intensive media use, which should be considered when planning postdisaster media coverage and advising families.     

Penicillin-nonsusceptible pneumococcus in acute otitis media in New York City.

OBJECTIVE: To determine the proportion of children with acute otitis media (AOM) presenting in our catchment area in New York City who were infected with nonsusceptible Streptococcus pneumoniae and to determine the susceptibility of these organisms to penicillins and other antibiotics commonly used to treat AOM. SETTING: Ambulatory clinics and the emergency department of a tertiary care, inner-city medical center. PATIENTS: During a 2-year period from 1993 to 1995, 115 children (aged 6 months to 12 years) with AOM underwent tympanocentesis. Patients did not receive antibiotics for at least 1 week before tympanocentesis. RESULTS: Thirty-one children were infected with S pneumoniae, and 83.9% of isolates were susceptible to penicillin. Of the 16.1% strains that were nonsusceptible, most (4 of 5 strains) were intermediately resistant, and only 1 exhibited high-level resistance to penicillin. Of all the cephalosporins tested, only cefotaxime had consistent activity against the intermediately resistant strains. Notably, all nonsusceptible pneumococci were inhibited by macrolides. CONCLUSIONS: This study provides unique reference data for nonsusceptible Streptococcus pneumoniae in children with AOM and documents that newer cephalosporin agents are not active against all of these strains.     

A history of hand surgery in New York City

The origins of Hand Surgery in New York City are temporally centered around World War II. Arthur J. Barsky, MD, Condict W. Cutler, Jr, MD and Emanuel B. Kaplan, MD laid the groundwork for our regional specialty prior to the War. J. William Littler, MD, Robert E. Carroll, MD, served in the Armed Forces and were instrumental in the development of the specialty in the second half of the 20th century. Hand services evolved in each of the major academic centers in New York including those led by Lee Ramsey Straub, MD, at the Hospital for Special Surgery, Richard J. Smith, MD at the Hospital for Joint Disease, Robert W. Beasley, MD at New York University and Berish Strauch, MD, and Morton Spinner, MD, at Albert Einstein and Montefiore. Several surgeons who worked with or were trained by these masters formed the nucleus of the next generation of leaders including Richard G. Eaton, MD, Martin A. Posner, MD, Harold M. Dick, MD, and Charles Melone, MD. Their proteges and a relatively small number of surgeons trained elsewhere, like Andrew J. Weiland, MD, and Robert Hotchkiss, MD, make up the current leadership of Hand Surgery in New York City.     

Impact of the increasing burden of diabetes on acute myocardial infarction in New York City: 1990-2000

Worldwide increases in obesity and diabetes have aroused concern that increased morbidity and mortality will follow. The objective here is to determine the trend of diabetes-related morbidity and mortality in New York, New York. Using New York death certificate data for 1989-1991 and 1999-2001 and hospital discharge data for 1988-2002, we measured all-cause and cause-specific mortality in 1990 and 2000, as well as annual hospitalization rates for diabetes and its complications among patients hospitalized with acute myocardial infarction and/or diabetes. During this decade, all-cause and cause-specific mortality rates declined, with the striking exception of diabetes, which increased 61 and 52% for men and women, respectively, as did hospitalization rates for diabetes and its complications. The percentage of all acute myocardial infarctions occurring in patients with diabetes increased from 21 to 36%, and the absolute number doubled from 2,951 to 6,048. Although hospital days due to acute myocardial infarction fell overall, for those with diabetes, they increased 51% (from 34,188 to 51,566). These data document a marked upsurge in diabetes-related mortality and morbidity in New York City, including a sharp increase in diabetic patients hospitalized for myocardial infarction. If continued, this threatens the long-established nationwide trend to reduced coronary artery disease events.     

Legal termination of pregnancy among teenagers and older women in Soweto, 1999-2001.

BACKGROUND: Legal termination of pregnancy (TOP) was introduced in South Africa in 1996. No data are available to relate the numbers of TOPs to the total number of pregnancies in specific health regions. The level of use of TOPs by women of different age groups is not known. OBJECTIVE: To determine the proportion of pregnancies that end in TOP, with special reference to maternal age, and to measure trends in use from 1999 to 2001. SETTING: Greater Soweto, Orange Farm and Lenasia, a densely populated urban health region served by Chris Hani Baragwanath Hospital and comprehensive primary care reproductive health services. METHODS: Two cross-sectional studies performed in 1999 and 2001, counting all pregnancies managed in state-run health services, including legal terminations, spontaneous miscarriages, ectopic pregnancies and deliveries. RESULTS: There were 5,412 pregnancies in the study period (9 weeks) in 1999, and 5,316 in the study period (8 weeks) in 2001. The TOP rates decreased from 16.1% to 13.6% (P = 0.20). The TOP rates for teenagers decreased from 22.3% to 16.3% (P = 0.006), but were higher than those for older women (15.2% in 1999 and 13.2% in 2001, P = 0.006 and 0.028 respectively). TOP rates for teenagers 13-16 years decreased from 28.0% to 23.0% (P = 0.44), and rates for older teenagers declined from 21.0% to 14.9% (P = 0.008). In 2001, 16.2% of women aged 35 and above underwent TOP, compared with 12.7% of women aged 20-34 years (P = 0.014). CONCLUSION: Use of TOP services was highest in women at the extremes of reproductive age. There was a significant decline in TOP rates among older teenagers between 1999 and 2001. These data, from a comprehensive urban reproductive health service, provide a benchmark for comparison elsewhere and in the future.