Donald Brand, PhD
I am a decision scientist and clinical epidemiologist at NYU Langone Hospital—Long Island, where I focus on the development and evaluation of patient management protocols and decision aids. I’ve applied these skills to solve problems in medicine, pediatrics, and surgery that have involved organ transplantation, infant health, cardiovascular disease, and trauma.
One area of my work has involved developing a decision-making model for the optimal timing of kidney transplantation. When a patient is awaiting a kidney transplant, surgery is rarely considered until the person has reached end-stage renal failure. The worldwide organ shortage dictates that people with any viable kidney function have lower priority than those who need dialysis. When a living donor is available, the timing of transplantation can be more flexible, but the most appropriate timing is unclear.
To address this uncertainty, I discovered a mathematical theorem to predict how long a person’s native kidneys will remain viable. The theorem demonstrates that the optimal timing of transplantation does not depend on the future rate of disease progression, but only on the current burden of disease. The general nature of the theorem makes it applicable to any degenerative disease that can be treated by engraftment.
Another area of my work concerns infant health, and my main contributions have addressed two problems: abuse prevention and brief resolved unexplained events, or BRUEs, a term that refers to sudden alterations in an infant’s breathing, color, tone, or responsiveness that prompt a parent or caregiver to seek emergency medical care.
Abusive head trauma resulting from shaking, also called shaken baby syndrome, is the most common cause of traumatic death for children younger than one year.
I was the senior scientist for study to evaluate a prevention program to teach parents about the dangers of shaking an infant and how to cope safely with infant crying. The program, which involved 20 hospitals in the Hudson Valley Region of New York State, decreased the incidence of shaking injuries by 75 percent (P<.03). New York State subsequently expanded the program to all 154 maternity services throughout the state, which together oversee 250,000 births per year.
In the area of BRUEs, infants typically undergo an extensive diagnostic evaluation and hospitalization to rule out unknown pathologies when an apparent life-threatening event (ALTE) occurs. Such evaluations rarely prove productive in patients who appear well on presentation and have an unremarkable clinical assessment.
I led an investigation to determine the yield of different diagnostic tests in understanding the cause of an ALTE. The study found that a small number tests are potentially useful, but that broad evaluations for systemic infections, metabolic diseases, and blood chemistry abnormalities are not helpful. The detailed findings from this study have been incorporated into a 2016 American Academy of Pediatrics clinical practice guideline for the management of BRUEs.
Education and Training
- Fellowship, U.S. Public Health Service and Yale University Institution for Social and Policy Studies, Health Services Research Traineeship, 1972–76
- MA, University of Wisconsin–Madison, History of Science, 1970
- BS, Antioch College, Physics, 1968
1300 Franklin Ave
Garden City, New York, 11530