Publications by authors named "Caroline Wu"

8 Publications

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Laboratory Interventions to Eliminate Unnecessary Rapid COVID-19 Testing During a Reagent Shortage.

Am J Clin Pathol 2022 Jun 1. Epub 2022 Jun 1.

Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.

Objectives: In the fall of 2020, US medical centers were running out of rapid coronavirus disease 2019 (COVID-19) tests. The aim of this study is to evaluate the impact of an intervention to eliminate rapid test misutilization and to quantify the effect of the countermeasures to control rapid test ordering using a test utilization dashboard.

Methods: Interventions were made to preserve a severely limited supply of rapid diagnostic tests based on real-time analysis of a COVID-19 test utilization dashboard. This study is a retrospective observational study evaluating pre- and postintervention rates of appropriate rapid test use, reporting times, and cost/savings of resources used.

Results: This study included 14,462 severe acute respiratory syndrome coronavirus 2 reverse transcriptase polymerase chain reaction tests ordered during the study period. After the intervention, there was a 27.3% decrease in nonconforming rapid tests. Rapid test reporting time from laboratory receipt decreased by 1.47 hours. The number of days of rapid test inventory on hand increased by 39 days.

Conclusions: Performing diagnostic test stewardship, informed by real-time review of a test utilization dashboard, was associated with significantly improved appropriate utilization of rapid diagnostic COVID-19 tests, improved reporting times, implied cost savings, and improved reagent inventory on hand, which facilitated the management of scarce resources during a pandemic.
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http://dx.doi.org/10.1093/ajcp/aqac063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213858PMC
June 2022

Total Joint Arthroplasty of a Proximal Interphalangeal Joint with Proximal Metal Surface Replacement and Distal Hemi-Hamate Autograft: A Long-Term Follow-Up.

J Hand Surg Glob Online 2022 May 3;4(3):189-193. Epub 2022 Mar 3.

The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.

A 28-year-old female recreational athlete presented with middle finger proximal interphalangeal joint pain, stiffness, and ulnar deviation deformity 2 years after internal fixation of a middle phalanx base fracture-dislocation. Radiographs revealed posttraumatic changes on both sides of the proximal interphalangeal joint. Having failed nonsurgical measures, she elected to proceed with surgical reconstruction. Intraoperatively, we confirmed substantial articular damage on both sides of the joint. We proceeded with hemi-hamate autograft for 80% of the middle phalanx base. We used a cobalt chrome proximal phalanx component. After healing, the patient returned to all daily-living and athletic activities with resolution of preoperative pain, stiffness, and deformity. Twelve years after surgey, she had no pain or substantial limitations because of the finger. We measured 80° of proximal interphalangeal joint motion. The grip and fingertip-pinch strength were 91% and 73%, respectively, of the contralateral dominant hand. Radiographs showed no progressive changes compared to 3 years after surgery.
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http://dx.doi.org/10.1016/j.jhsg.2022.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120795PMC
May 2022

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions.

Crit Care Explor 2022 Feb 8;4(2):e0605. Epub 2022 Feb 8.

Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.

Objectives: The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts.

Design: Retrospective cohort study.

Setting: New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY.

Patients: Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest.

Interventions: None.

Measurement And Main Results: Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; = 0.03), but otherwise there were no significant differences between groups.

Conclusions: Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.
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http://dx.doi.org/10.1097/CCE.0000000000000605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826953PMC
February 2022

Health insurance coverage and access to care in China.

BMC Health Serv Res 2022 Feb 3;22(1):140. Epub 2022 Feb 3.

Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong, 510515, P.R. China.

Objective: The study examined the relationship between health insurance coverage and access to needed healthcare including preventive, primary, and tertiary care among Chinese adult population.

Data And Methods: Data for this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a population-based probability sample survey. Key measures included insurance coverage (high-, moderate-, low- and no-insurance), access to care (physical examination, physician visit, office visit, inpatient care, and satisfaction with care), and personal sociodemographics. Multiple-factor generalized linear mixed model was applied to estimate the odds ratio (OR) and the 95% confidence interval (CI) of HI coverage for the four indicators of access to care, after controlling for individual characteristics and aggregation among different villages.

Results: The majority of Chinese adults had some health insurance with only 3.15% uninsured. However, most had low-coverage insurance (64.82%), followed by moderate-coverage insurance (16.70%), and high-coverage insurance (15.33%). Health insurance was significantly and positively associated with access to needed healthcare (preventive, primary, and tertiary). There was also a significant gradient association between extent of insurance coverage and access to care.

Conclusion: Not only health insurance mattered in enhancing access to care but that there was a significant gradient association between extent of insurance coverage and access to care with higher coverage relating to better access.
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http://dx.doi.org/10.1186/s12913-022-07498-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812221PMC
February 2022

Orthobiologics in Hand Surgery.

J Hand Surg Am 2021 05;46(5):409-415

Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address:

Orthobiologic agents are used as innovative adjuvant therapy to treat common upper-extremity pathology, including carpal tunnel syndrome, de Quervain tenosynovitis, and distal radius fractures. In this article, we perform a narrative review and evaluate current literature on orthobiologics in the upper extremity. Orthobiologics evaluated include bone morphogenetic proteins, platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stem cells, and amniotic membrane. Studies selected include randomized control trials, case studies, and animal studies. Although there is some clinical evidence regarding the use of orthobiologic agents in the treatment of shoulder, elbow, and sports injuries, there is a paucity of literature regarding their use to treat pathology of the hand and wrist. Further investigation is necessary to determine their effectiveness and therapeutic value in treatment of upper extremity injuries.
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http://dx.doi.org/10.1016/j.jhsa.2021.01.006DOI Listing
May 2021

Effect of a stepwise opioid-sparing analgesic protocol on in-hospital oxycodone use and discharge prescription after cesarean delivery.

Reg Anesth Pain Med 2021 02 10;46(2):151-156. Epub 2020 Nov 10.

Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA

Introduction: Opioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge.

Methods: This retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay ('non-oxycodone user'). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed.

Results: The intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (-12 pills difference; 95% CI -11 to -13).

Conclusions: Multimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.
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http://dx.doi.org/10.1136/rapm-2020-102007DOI Listing
February 2021

Stimulus Context and Reward Contingency Induce Behavioral Adaptation in a Rodent Tactile Detection Task.

J Neurosci 2019 02 10;39(6):1088-1099. Epub 2018 Dec 10.

Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332

Behavioral adaptation is a prerequisite for survival in a constantly changing sensory environment, but the underlying strategies and relevant variables driving adaptive behavior are not well understood. Many learning models and neural theories consider probabilistic computations as an efficient way to solve a variety of tasks, especially if uncertainty is involved. Although this suggests a possible role for probabilistic inference and expectation in adaptive behaviors, there is little if any evidence of this relationship experimentally. Here, we investigated adaptive behavior in the rat model by using a well controlled behavioral paradigm within a psychophysical framework to predict and quantify changes in performance of animals trained on a simple whisker-based detection task. The sensory environment of the task was changed by transforming the probabilistic distribution of whisker deflection amplitudes systematically while measuring the animal's detection performance and corresponding rate of accumulated reward. We show that the psychometric function deviates significantly and reversibly depending on the probabilistic distribution of stimuli. This change in performance relates to accumulating a constant reward count across trials, yet it is exempt from changes in reward volume. Our simple model of reward accumulation captures the observed change in psychometric sensitivity and predicts a strategy seeking to maintain reward expectation across trials in the face of the changing stimulus distribution. We conclude that rats are able maintain a constant payoff under changing sensory conditions by flexibly adjusting their behavioral strategy. Our findings suggest the existence of an internal probabilistic model that facilitates behavioral adaptation when sensory demands change. The strategy animals use to deal with a complex and ever-changing world is a key to understanding natural behavior. This study provides evidence that rodent behavioral performance is highly flexible in the face of a changing stimulus distribution, consistent with a strategy to maintain a desired accumulation of reward.
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http://dx.doi.org/10.1523/JNEUROSCI.2032-18.2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363924PMC
February 2019

Probing blood cell mechanics of hematologic processes at the single micron level.

Lab Chip 2017 11;17(22):3804-3816

Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.

Blood cells circulate in a dynamic fluidic environment, and during hematologic processes such as hemostasis, thrombosis, and inflammation, blood cells interact biophysically with a myriad of vascular matrices-blood clots and the subendothelial matrix. While it is known that adherent cells physiologically respond to the mechanical properties of their underlying matrices, how blood cells interact with their mechanical microenvironment of vascular matrices remains poorly understood. To that end, we developed microfluidic systems that achieve high fidelity, high resolution, single-micron PDMS features that mimic the physical geometries of vascular matrices. With these electron beam lithography (EBL)-based microsystems, the physical interactions of individual blood cells with the mechanical properties of the matrices can be directly visualized. We observe that the physical presence of the matrix, in and of itself, mediates hematologic processes of the three major blood cell types: platelets, erythrocytes, and leukocytes. First, we find that the physical presence of single micron micropillars creates a shear microgradient that is sufficient to cause rapid, localized platelet adhesion and aggregation that leads to complete microchannel occlusion; this response is enhanced with the presence of fibrinogen or collagen on the micropillar surface. Second, we begin to describe the heretofore unknown biophysical parameters for the formation of schistocytes, pathologic erythrocyte fragments associated with various thrombotic microangiopathies (poorly understood, yet life-threatening blood disorders associated with microvascular thrombosis). Finally, we observe that the physical interactions with a vascular matrix is sufficient to cause neutrophils to form procoagulant neutrophil extracellular trap (NET)-like structures. By combining electron beam lithography (EBL), photolithography, and soft lithography, we thus create microfluidic devices that provide novel insight into the response of blood cells to the mechanical microenvironment of vascular matrices and have promise as research-enabling and diagnostic platforms.
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http://dx.doi.org/10.1039/c7lc00720eDOI Listing
November 2017
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