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Item Adaptation and restructuring of an academic anesthesiology department during the COVID-19 pandemic in New York City: Challenges and lessons learned(Elsevier, 2021) Shaparin, Naum; Mann, Glenn E.; Streiff, Agathe; Kiyatkin, Michael E.; Choice, Curtis; Ramachandran, Sujatha; Delphin, Ellise; Adams, David C.; Anesthesia, School of MedicineThe novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.Item Heme Causes Pain in Sickle Mice via Toll-Like Receptor 4-Mediated Reactive Oxygen Species- and Endoplasmic Reticulum Stress-Induced Glial Activation(Mary Ann Liebert, 2021) Lei, Jianxun; Paul, Jinny; Wang, Ying; Gupta, Mihir; Vang, Derek; Thompson, Susan; Jha, Ritu; Nguyen, Julia; Valverde, Yessenia; Lamarre, Yann; Jones, Michael K.; Gupta, Kalpna; Anesthesia, School of MedicineAims: Lifelong pain is a hallmark feature of sickle cell disease (SCD). How sickle pathobiology evokes pain remains unknown. We hypothesize that increased cell-free heme due to ongoing hemolysis activates toll-like receptor 4 (TLR4), leading to the formation of reactive oxygen species (ROS) and endoplasmic reticulum (ER) stress. Together, these processes lead to spinal microglial activation and neuroinflammation, culminating in acute and chronic pain. Results: Spinal heme levels, TLR4 transcripts, oxidative stress, and ER stress were significantly higher in sickle mice than controls. In vitro, TLR4 inhibition in spinal cord microglial cells attenuated heme-induced ROS and ER stress. Heme treatment led to a time-dependent increase in the characteristic features of sickle pain (mechanical and thermal hyperalgesia) in both sickle and control mice; this effect was absent in TLR4-knockout sickle and control mice. TLR4 deletion in sickle mice attenuated chronic and hypoxia/reoxygenation (H/R)-evoked acute hyperalgesia. Sickle mice treated with the TLR4 inhibitor resatorvid; selective small-molecule inhibitor of TLR4 (TAK242) had significantly reduced chronic hyperalgesia and had less severe H/R-evoked acute pain with quicker recovery. Notably, reducing ER stress with salubrinal ameliorated chronic hyperalgesia in sickle mice. Innovation: Our findings demonstrate the causal role of free heme in the genesis of acute and chronic sickle pain and suggest that TLR4 and/or ER stress are novel therapeutic targets for treating pain in SCD. Conclusion: Heme-induced microglial activation via TLR4 in the central nervous system contributes to the initiation and maintenance of sickle pain via ER stress in SCD.Item A comparative study of English and Japanese ChatGPT responses to anaesthesia-related medical questions(Elsevier, 2024-06-14) Ando, Kazuo; Sato, Masaki; Wakatsuki, Shin; Nagai, Ryotaro; Chino, Kumiko; Kai, Hinata; Sasaki, Tomomi; Kato, Rie; Phuongtram Nguyen, Teresa; Guo, Nan; Sultan, Pervez; Anesthesia, School of MedicineBackground: The expansion of artificial intelligence (AI) within large language models (LLMs) has the potential to streamline healthcare delivery. Despite the increased use of LLMs, disparities in their performance particularly in different languages, remain underexplored. This study examines the quality of ChatGPT responses in English and Japanese, specifically to questions related to anaesthesiology. Methods: Anaesthesiologists proficient in both languages were recruited as experts in this study. Ten frequently asked questions in anaesthesia were selected and translated for evaluation. Three non-sequential responses from ChatGPT were assessed for content quality (accuracy, comprehensiveness, and safety) and communication quality (understanding, empathy/tone, and ethics) by expert evaluators. Results: Eight anaesthesiologists evaluated English and Japanese LLM responses. The overall quality for all questions combined was higher in English compared with Japanese responses. Content and communication quality were significantly higher in English compared with Japanese LLMs responses (both P<0.001) in all three responses. Comprehensiveness, safety, and understanding were higher scores in English LLM responses. In all three responses, more than half of the evaluators marked overall English responses as better than Japanese responses. Conclusions: English LLM responses to anaesthesia-related frequently asked questions were superior in quality to Japanese responses when assessed by bilingual anaesthesia experts in this report. This study highlights the potential for language-related disparities in healthcare information and the need to improve the quality of AI responses in underrepresented languages. Future studies are needed to explore these disparities in other commonly spoken languages and to compare the performance of different LLMs.Item Processed Electroencephalography: Functional or Fictional?(2024-09-19) Dijak, FrankItem Bringing Virtual Reality to Mainstream Pediatric Care(Advocate Aurora Research Institute, 2024-07-16) Kuang, Wayne; Yang, Eric J.; Truong, Roland; Woo, Benjamin K. P.; Anesthesia, School of MedicineVirtual reality (VR) stands as an innovative technology transforming our interactions with the digital world. Its integration into health care has proven advantageous for both patients and health care providers across multiple levels and modalities. Given that VR is becoming increasingly accessible and prevalent, health care providers should explore incorporating the technology into their practices, particularly within the pediatric population, which is becoming progressively more accustomed to the technology. This topic synopsis provides a broad discussion of the current literature, exploring current and probable future applications of VR in pediatric patient care, particularly in improving the hospital experience, facilitating education during hospitalizations, providing an alternative to pharmacological therapy for pain management, and enhancing mental health care practices.Item A prospective observational study evaluating the use of remote patient monitoring in ED discharged COVID-19 patients in NYC(Elsevier, 2022) Oh, Seung Mi; Nair, Singh; Casler, Alexander; Nguyen, Diana; Forero, Juan Pablo; Joco, Celina; Kubert, Jason; Esses, David; Adams, David; Jariwala, Sunit; Leff, Jonathan; Anesthesia, School of MedicineObjectives: We investigated whether continuous remote patient monitoring (RPM) could significantly reduce return Emergency Department (ED) revisits among coronavirus disease 2019 (COVID-19) patients discharged from the emergency Department. Materials and methods: A prospective observational study was conducted from a total of 2833 COVID-19 diagnosed patients who presented to the Montefiore Medical Center ED between September 2020-March 2021. Study patients were remotely monitored through a digital platform that was supervised 24/7 by licensed healthcare professionals. Age and time-period matched controls were randomly sampled through retrospective review. The primary outcome was ED revisit rates among the two groups. Results: In our study, 150 patients enrolled in the RPM program and 150 controls were sampled for a total of 300 patients. Overall, 59.1% of the patients identified as Hispanic/Latino. The RPM group had higher body mass index (BMI) (29 (25-35) vs. 27 (25-31) p-value 0.020) and rates of hypertension (50.7% (76) vs. 35.8% (54) p-value 0.009). There were no statistically significant differences in rates of ED revisit between the RPM group (8% (12)) and control group (9.3% (14)) (OR: 0.863; 95% CI:0.413-1. 803; p- 0.695). Discussion and conclusion: Our study explored the impact of continuous monitoring versus intermittent monitoring for reducing ED revisits in a largely underrepresented population of the Bronx. Our study demonstrated that continuous remote patient monitoring showed no significant difference in preventing ED revisits compared to non-standardized intermittent monitoring. However, potential other acute care settings where RPM may be useful for identifying high-risk patients for early interventions warrant further study.Item Artificial Intelligence–Generated Research in the Literature: Is It Real or Is It Fraud?(Mary Ann Liebert, 2023) Stone, Jennifer A. M.; Anesthesia, School of MedicineItem A Case of Hyponatremia in a Patient with Necrotizing Fasciitis(2024-04-06) Dijak, Frank; Yu, CorinnaItem Rapid Review: ASA Difficult Airway Algorithm(2024-08-20) Dijak, FrankItem How do Characteristic Descriptors Relate to Medical Student Performance Ratings on an Anesthesiology Elective: Implications for Letters of Recommendation(2024-04-26) Yu, Corinna; Dijak, Frank; Dammann, Erin; Guillaud, Daniel; Packiasabapathy, Senthil