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Affiliation(s)
- Robert S Crupi
- Division of Geriatrics and Palliative Care Medicine, NewYork-Presbyterian Queens, Flushing, New York
| | - Melissa Patterson
- Division of Geriatric Medicine and Aging, Columbia University Irving Medical Center, New York, New York
| | - Cynthia X Pan
- Division of Geriatric Medicine and Aging, Columbia University Irving Medical Center, New York, New York
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Pan CX, Luo EJ, Wang E, Szeto DA, Lum H, Ma J, Chen Stokes S, Chan S, Wong C, Guo J, Wang L, Chang V, Crupi RS. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Chinese American Patients. J Palliat Med 2023; 26:423-430. [PMID: 36260416 DOI: 10.1089/jpm.2022.0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Chinese American population is one of the fastest-growing communities in the United States, composed of ∼5.4 million people, and represents ∼5.5% of overseas Chinese populations. With an expected exponential population rise, Chinese American patients who experience serious illness or approach end-of-life (EOL) may find their cultural values influencing the medical care they receive. Palliative care clinicians must recognize diverse cultural beliefs and preferences of Chinese American patients and their families. In this study, we provide 10 cultural pearls to guide the provision of palliative and EOL care for Chinese American patients, including discussions of Chinese traditions, communication strategies for Chinese patients and families, advance care planning, and EOL care beliefs.
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Affiliation(s)
- Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Esther J Luo
- Outpatient Palliative Care, Supportive Care Services, Kaiser Permanente, Santa Clara, California, USA
| | - Eric Wang
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Deborah A Szeto
- Inpatient Palliative Care, Supportive Care Services, Kaiser Permanente, Santa Clara, California, USA
| | - Hillary Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica Ma
- Geriatric Research, Education, and Clinical Center, Durham VA Health System, Durham, North Carolina, USA.,Division of Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care (CACCC), Shingle Springs, California, USA
| | - Sandy Chan
- Department of Palliative Medicine and Geriatrics, Stanford Health Care. Palo Alto, California, USA
| | - Christian Wong
- Department of Medicine, Albany Medical Center, Albany, New York, USA
| | - Jing Guo
- Division of Hospital Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Lifeng Wang
- Department of Pastoral Care and Education, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Victor Chang
- Section Hematology/Oncology, Medical Service, VA New Jersey Health Care System, East Orange, New Jersey, USA.,Division of Hematology Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark New Jersey, USA
| | - Robert S Crupi
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
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Lerario MP, Kummer BR, Wu X, Diáz I, Pishanidar S, Willey JZ, Mir S, Cheng N, Rostanski SK, Efraim ES, Crupi RS, Schenker J, Asaeda G, Bokser J, Kamel H, Marshall RS, Navi BB, Fink ME. Abstract WP104: Clinical Characteristics of Stroke Mimics Treated on an Urban Mobile Stroke Unit. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
It is unknown how the clinical characteristics of stroke mimics treated on Mobile Stroke Units (MSUs) compare to confirmed acute strokes treated on these units.
Methods:
We retrospectively analyzed all patients transported by the NewYork-Presbyterian MSU in New York City from October 2016-May 2018. A vascular neurologist assigned a final diagnosis after comprehensive medical record review. Clinical data were abstracted, including comorbidities, presenting symptoms, stroke severity, acute treatments, and short-term outcomes. We compared characteristics of patients with a stroke mimic diagnosis versus those with acute ischemic or hemorrhagic stroke using targeted minimum loss-based estimation to adjust for demographics, comorbidities, NIH Stroke Scale (NIHSS) score, and intravenous tPA administration.
Results:
Among 92 suspected stroke patients transported by MSU, 56 (61%) had confirmed acute stroke (77% ischemic, 23% hemorrhagic) and 36 (39%) had a stroke mimic. Mimics consisted of seizure (n=8), metabolic encephalopathy (n=6), somatoform disorders (n=4), and others (n=18). The mean NIHSS score was 8 (SD 7) among mimics versus 11 (SD 8) among confirmed strokes (p=0.14). The top presenting symptoms among mimics were unilateral weakness (n=8), aphasia (n=6), confusion (n=6), and decreased consciousness (n=6). Nine mimics (25%) received tPA and none had hemorrhagic conversion; while 30 (53%) confirmed strokes received tPA and 2 (7%) had hemorrhagic conversion. There was no difference in MSU arrival-to-tPA time between groups (46 vs. 44 minutes, p=0.70). In multivariable analyses, compared to patients with confirmed stroke, mimics had significantly lower NIHSS scores, higher initial blood pressures, and shorter lengths-of-stay. Rates of death and discharge disposition were similar between groups.
Conclusions:
Among patients transported by a MSU for suspected stroke, two-fifths were stroke mimics. Seizure, metabolic encephalopathy, and somatoform disorders were the most common mimic diagnoses. Patients with stroke mimics had lower NIHSS scores and less often were treated with tPA.
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Affiliation(s)
- Michael P Lerario
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Queens, New York, NY
| | - Benjamin R Kummer
- Dept of Neurology, Columbia Univ Med Cntr; Dept of Neurology, Icahn Sch of Medicine at Mount Sinai, New York, NY
| | - Xian Wu
- Dept of Healthcare Policy and Rsch, Div of Biostatistics and Epidemiology, Weill Cornell Med College, New York, NY
| | - Iván Diáz
- Dept of Healthcare Policy and Rsch, Div of Biostatistics and Epidemiology, Weill Cornell Med College, New York, NY
| | - Sammy Pishanidar
- Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Queens, New York, NY
| | | | - Saad Mir
- Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Natalie Cheng
- Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Brooklyn Methodist Hosp, New York, NY
| | | | | | - Robert S Crupi
- Dept of Medicine, NewYork-Presbyterian Queens, Flushing, NY
| | - Josef Schenker
- Dept of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hosp, Brooklyn, NY
| | - Glenn Asaeda
- Office of Med Affairs, Fire Dept of New York, New York, NY
| | - Jeffrey Bokser
- Dept of Emergency Med Services, NewYork-Presbyterian Hosp, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | | | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Matthew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
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Crupi RS, Di John D, Mangubat PM, Asnis D, Devera J, Maguire P, Palevsky SL. Linking emergency preparedness and health care worker vaccination against influenza: a novel approach. Jt Comm J Qual Patient Saf 2010; 36:499-503. [PMID: 21090019 PMCID: PMC7106101 DOI: 10.1016/s1553-7250(10)36073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Health care workers (HCWs) can acquire and transmit influenza to their patients and coworkers, even while asymptomatic. The U.S. Healthy People 2010 initiative set a national goal of 60% coverage for HCW influenza vaccination by 2010. Yet vaccination rates remain low. In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a “push/pull” point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. Launch of the HCW Vaccination Program In mid-September 2008, a two-week HCW vaccination program was launched using a sequential POD approach. In Push POD, teams assigned to specific patient units educated all HCWs about influenza vaccination and offered on-site vaccination; vaccinated HCWs received a 2009 identification (ID) validation sticker. In Pull POD, HCWs could enter the hospital only through one entrance; all other employee entrances were “locked down.” A 2009 ID validation sticker was required for entry and to punch in for duty. Employees without the new validation sticker were directed to a nearby vaccination team. After the Push/Pull POD was completed, the employee vaccination drive at FHMC was continued for the remainder of the influenza season by the Employee Health Service. Results Using this model, in two days 72% of the employees were reached, with 54% of those reached accepting vaccination. Conclusions This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.
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Affiliation(s)
- Robert S Crupi
- Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, New York, USA.
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Lee CC, Vainchenker U, Crupi RS. Ten-year-old boy with a swollen knee: unusual cause of knee pain. J Emerg Med 2003; 25:449-50. [PMID: 14654188 DOI: 10.1016/j.jemermed.2003.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Christopher C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, New York 11355, USA
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Abstract
Missed diagnosis of avascular necrosis (AVN) may result in substantial morbidity. Early diagnosis is crucial for appropriate intervention and, ultimately, improved outcome. Emerging physicians need to recognize AVN to avoid unsatisfactory clinical results for their patients. Avascular necrosis (AVN) of the bone can occur when the blood supply to the bone is disrupted and is usually found in areas with terminal circulation. Commonly involved bones include the femoral head, talus, and scaphoid.
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Affiliation(s)
- Christopher C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, 45th Avenue at Parsons Boulevard, Flushing, NY 11355, USA.
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Abstract
Eclampsia is defined by the occurrence of seizures resulting from hypertensive encephalopathy on the background of preeclampsia. The development of hypertension during pregnancy, a serious and potentially fatal condition, is a leading cause of maternal and fetal morbidity and death in the United States.(1-3) It is a disease with preventable complications. The pathophysiology of hypertension during pregnancy is unclear, but there is consensus that aggressive treatment is warranted to prevent complications to both fetus and mother. A current concept of pathophysiological character, diagnosis, prevention, and management of eclampsia is discussed.
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Affiliation(s)
- Hadassah Lipstein
- Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, NY 11355, USA
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Crupi RS, Asnis DS, Lee CC, Santucci T, Marino MJ, Flanz BJ. Meeting the challenge of bioterrorism: lessons learned from West Nile virus and anthrax. Am J Emerg Med 2003; 21:77-9. [PMID: 12563588 DOI: 10.1053/ajem.2003.50015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hospital emergency departments (EDs) and ambulatory clinics may be the first to recognize illness related to a bioterrorist event. Every health-care institution must develop a weapons-of-mass- destruction (WMD) preparedness plan as part of its all-hazards disaster planning. As part of an all-hazards disaster plan, WMD preparedness should use the incident-command model to insure the required chain of command for effectively coordinating activities between hospital departments and external agencies. Preparedness for bioterrorism poses unique challenges. In the event of a biological attack, the hospital infection control staff and administration must already have in place the means to communicate with local and state public health agencies, the Centers for Disease Control and Prevention (CDC), local law-enforcement agencies, and the Federal Bureau of Investigation (FBI). Local and regional planners must consider how to coordinate the responses of emergency medical services (EMS), police, and fire departments with healthcare providers and the news media. Most hospitals are ill equipped to deal with a catastrophic event caused by WMD. The burden of responding to such events will fall initially on ED physicians and staff members. The severity of such an incident might be mitigated with careful planning, training and education. The responses of one hospital network to the outbreak of West Nile virus and, more recently, to the threat of anthrax, are presented as guides for bioterrorism preparedness.
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Affiliation(s)
- Robert S Crupi
- Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, NY 11355, USA.
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Lee CC, Kim SH, Crupi RS. Emergency department presentation of spontaneous rupture of hepatocellular carcinoma. J Emerg Med 2002; 23:83-5. [PMID: 12217477 DOI: 10.1016/s0736-4679(02)00466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christopher C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, New York 11355, USA
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Abstract
Trauma deaths continue to show a trimodal distribution: immediately at the scene, within the first 24 hours during initial resuscitation, and in the next 3 to 4 weeks as a result of multiple organ failure.(1) Failure to resuscitate adequately in the emergency department can lead to acidosis, hypothermia, and coagulopathy, which can result in multiple organ failure and cause death in these patients. Our current understanding of the initial response to shock and trauma and the development of the systemic inflammatory response syndrome and progressive organ failure is one of a continuum initiated and perpetuated by inflammation and inflammatory mediators. The pathophysiologic character, diagnosis, prevention, and treatment of traumatic injury-induced multiple organ failure are discussed.
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Affiliation(s)
- C C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, 45th Avenue at Parsons Boulevard, Flushing, NY 11355, USA.
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Affiliation(s)
- C C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, New York 11355, USA
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Affiliation(s)
- C C Lee
- Flushing Hospital Medical Center, Department of Emergency Medicine, New York, New York, USA.
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