Patient Experience with Telehealth Medicine During the Ongoing COVID-19 Pandemic in New York City.

Background: The COVID-19 pandemic accelerated integration of telehealth services into OBGYN practices in New York City. Since then, studies have shown high patient satisfaction with OBGYN telehealth services. However, few studies have compared satisfaction between obstetric and gynecologic patients. The primary objective of this study was to compare satisfaction with telehealth services between obstetric and gynecologic patients. Methods: This was an institutional review board-approved cross-sectional survey study among patients who had a telehealth visit at NYU OBGYN Faculty Group Practice from March 2020 to March 2021. Results: Gynecologic patients had higher rates of being "completely satisfied" compared with obstetric patients (40% vs. 24%, p < 0.001). Gynecologic patients were more likely to opt for telehealth services than obstetric patients both during a pandemic (70% vs. 59%, p < 0.001) and in the absence of a pandemic (53% vs. 37%, p < 0.001). Discussion: Prior studies have demonstrated high satisfaction with OBGYN telehealth. However, obstetric patients were less likely than gynecologic patients to feel satisfied with and opt for telehealth services.

Overhydration in acute kidney injury: Is it always a menace to critically ill patients? A survival study using bioimpedance spectroscopy.

INTRODUCTION: The hydration status is a predictor of survival in critically ill patients. However, it is unclear whether this association depends on the patient clinical condition. This study was designed to analyze the impact of hydration status on survival of critically ill patients with acute kidney injury (AKI) with or without sepsis. METHODS: A prospective cohort study following critically ill patients with AKI consecutively admitted over a one-year period to a teaching hospital intensive care unit (ICU). All patients with AKI stage three or higher of the KDIGO score were included. The hydration status was evaluated through the overhydration (OH) parameter of spectroscopy bioimpedance and sepsis was defined according Sepse-3 criteria. The survival analysis used adjusted competing-risks regression. RESULTS: Forty-eight patients were included, 27 (56%) with a sepsis diagnosis. The main negative predictors of survival among sepsis patients, adjusted by SAPS3 score, were higher OH (SHR 1.1, 95% CI 1.0-1.2, p = 0.02), mechanical ventilation (SHR 6.9, 95% CI 1.0-47.8, p = 0.04) and older age (SHR 1.1, 95% CI 1.0-1.1, p = 0.005). The predictors in non-sepsis patients were lower OH (SHR 0.82, 95% CI 0.71-0.95, p = 0.008) and mechanical ventilation (SHR 12, 95% CI 2.4-6.6, p < 0.001). CONCLUSIONS: This finding suggests that extracellular overhydration is an independent predictor of survival in critically ill patients with sepsis, but it seems to have opposite effect in non-sepsis patients.

Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation.

BACKGROUND: The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. PATIENTS AND METHODS: Using a retrospective design, 407 patients completed a 6-minute walk distance (6 MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6 MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6 MWD category (<400 m vs. ≥ 400 m) and the change in 6 MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. RESULTS: Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6 MWD ≥ 400 m. A 6 MWD of ≥ 400 m provided incremental information on the prediction of NRM with adjustment for age (p = .032) but not KPS alone (p = .062) or adjustment for other prognostic markers (p = .099). A significant association was found between the 6 MWD and OS (p = .027). A 6 MWD of ≥ 400 m provided incremental information on the prediction of OS with adjustment for age (p = .032) but not for other prognostic markers (p > .05 for all). Patients presenting with a pre-HCT 6 MWD of <400 m and experiencing a decline in 6 MWD had the highest risk of NRM. CONCLUSION: The 6 MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT. IMPLICATIONS FOR PRACTICE: The pretransplant 6-minute walk test is a significant univariate predictor of clinical outcomes in hematological patients beyond age but not beyond that of performance status. On this basis, 6-minute walk distance testing should not be considered part of the standard battery of assessments for risk stratification before hematopoietic cell transplantation.

Ectopic production of human chorionic gonadotropin by synovial sarcoma of the hip.

BACKGROUND: Human chorionic gonadotropin (hCG) is a marker of pregnancy and a tumor marker for some gynecologic malignancies, including germ cell tumors and gestational trophoblastic neoplasia. Rarely, hCG is secreted by nongynecologic tumors, confounding the diagnosis. CASE: A 45-year-old woman was evaluated for a persistently elevated ß-hCG. Diagnosis of her primary malignancy, synovial sarcoma of the hip, was delayed as more common etiologies were considered, including ectopic pregnancy and gestational trophoblastic neoplasm. The workup eventually led to the diagnosis using imaging studies but ultimately resulted in a 3-month delay and unnecessary medical and surgical treatments. CONCLUSION: This case highlights the importance of nongynecologic malignancies when evaluating patients with a persistent ß-hCG.

Attention and the processing of emotional words: dissociating effects of arousal.

There is debate as to whether emotionally charged words receive preferential attentional processing in normal individuals. Using a digit-parity task, Harris and Pashler (2004) found that threat-related words captured attention on only the first trial, suggesting no attention capture for emotional words aside from an initial surprise reaction. We examined whether sexually explicit words would be more effective at capturing attention in a similar task. Our results with threat words replicated those of Harris and Pashler in that threat words did not lead to an increase in reaction time (RT) on the parity task, relative to emotionally neutral words. However, sexual words led to a marked increase in RTs for over 100 trials. Words' arousal ratings, but not their valence ratings, predicted the amount of interference. Parity RTs for individual words were also related to memory for the word on a surprise memory test. Sexually explicit words may have more potential to capture attention than do threat-related words. The words presented here as distractors in the digit-parity task, along with their corresponding valence ratings, arousal ratings, and digit-parity RTs, can be downloaded from www.psychonomic.org/archive.