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Pilot study of expedited HIV-1 testing of women in labor at an inner-city hospital in New York City.

To evaluate the feasibility of offering voluntary counseling and expedited human immunodeficiency virus (HIV) testing to women in labor, and to assess the characteristics of two rapid HIV assays compared with results from an expedited standard enzyme immunoassay (EIA), with Western blot confirmation, as indicated, we undertook a pilot study immediately prior to enactment of New York State regulations (August 1999) requiring expedited testing of laboring women (or newborns) with undocumented HIV status. From June 9, 1999 through July 2, 1999, we offered HIV counseling and testing (C&T) to all medically stable women in active labor, 106 of 125 (85%) of whom accepted. One woman was confirmed HIV-1 seropositive. Rapid assay sensitivity and specificity were: SUDS 100 and 98%, and Multispot 100 and 100%, respectively in comparison with 100 and 99% for the standard EIA. The positive predictive values (PPV) were SUDS 33%; Multispot 100%; and EIA 50%. While our sample size was small, it appears that the accuracy of rapid and expedited HIV assays may be improved by requiring two different reactive assays before informing women of HIV-seropositive results or initiating antiretroviral treatment.

Adolescent↗

Diabetes care needs of Hispanic patients treated at inner-city neighborhood clinics in New York City.

The charts of 254 Hispanic patients were selected from a sample of 321 patients with diabetes in four urban clinics that received federal funding to provide medical care in underserved communities. A standardized chart-audit protocol was used to assess the process of healthcare delivery and the presence of diabetes-associated comorbidities and complications in patients. Inconsistent recognition of obesity (11% identified vs 59% present), hyperlipidemia (17% identified vs 69% present), and renal dysfunction (3.5% identified vs 16% present) was evident on chart review. We also found inadequate compliance with current recommendations for diabetes care with respect to routine health screenings for diabetes-related complications, recognition of comorbid diagnoses, and referral of patients for recommended specialty consultations. Issues specific to the varied Hispanic populations may need to be considered to improve the delivery of diabetes care for the growing Hispanic population with diabetes.

Community Health Centers↗

A registry for carbon monoxide poisoning in New York City. Hyperbaric Center Advisory Committee Emergency Medical Service, City of New York.

In 1983 the North American Hyperbaric Center (affiliated with Bronx Municipal Hospital Center) was designated to provide Hyperbaric oxygen (HBO) for carbon monoxide (CO) patients meeting Emergency Medical System (EMS) criteria: 1. Unconscious or CNS derangement, any carboxyhemoglobin level [( COHb]); 2. [COHb] 25% or more; 3. Pregnant, any [COHb]. Through 1984, 39 CO patients received HBO; in 1985 81 were treated including 8 pregnant and 16 pediatric. CO sources were: fire, 43; heater, 21; engine, 17. 42 of 59 acute patients were initially in coma; 16 required CPR. Time to HBO averaged 4.5 hrs. Mean hospital [COHb] was 31% for acute, 28% for subacute/chronic, 15% for pregnant; mean maximum [COHb] was estimated: 51% for acute, 40% for subacute/chronic patients. Mean half life for [COHb] was 2.1 hrs. HBO typically was 46 min at 3ATA (2 [COHb] half lives), presented few problems, and gave rapid clinical improvement. 13 of 19 patients comatose before HBO were responsive after HBO (mean [COHb] was 1.8%). Four pediatric deaths occurred; brain damage was noted in two other patients. EMS efforts to make HBO available for CO is a success.

Adolescent↗

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