Christy Spalink

Faculty

Spalink Headshot

Christy Spalink

ACHPN ACNP-BC DNP MSN OCN RN

1 212 998 5811

433 First Ave
New York, NY 10010
United States

Christy Spalink is a clinical assistant professor. She is double board certified as an acute care and hospice and palliative care nurse practitioner and is an Oncology Certified Nurse. Prof. Spalink earned her DNP from NYU Meyers in 2020 and her MSN in 2011. She obtained her BSN in 2004 from Calvin University. Dr. Spalink conducted her DNP project at NYU Langone Health Perlmutter Cancer Center where she created an evidence-based toolkit for electronic health record palliative care referrals in the outpatient oncology setting to improve equitable access to palliative care services and comply with the NCCN Palliative Care Guidelines.

Prof. Spalink’s diverse clinical, education, and leadership experience enable her to approach healthcare challenges from numerous perspectives, creating coalitions of support to build sustainable solutions for populations and medical centers. In her previous role as Administrative Director of Clinical Operations at NYU Langone Health Perlmutter Cancer Center Clinical Trials Office Prof. Spalink reduced the annual staff turnover rate from 34.4% to 24.6%, increased clinical employee retention from 59.3% to 77.1%, and increased the internal employee promotion rate from 2.9% to 39.9% while maintaining a vacancy rate of 14.7% and building the clinical department from 40 positions in 2019 to 65 in 2022. She received an abstract award through AACI-CRI for this work (2023). She did this by creating and implementing an evidence-based orientation and training curriculum and by cultivating a psychologically safe and collaborative culture through the implementation of High Reliability practices and communication. During her tenure in nursing clinical leadership all internal and external audits were passed, and clinical audit findings were reduced by 80%. Prof. Spalink created several evidence-based, financially sustainable patient programs that increased diverse patient access to complex early-phase clinical trials, including an inpatient early phase oncology clinical trial program and an outpatient solid tumor cellular therapy program. During her time in the Neurology Department at NYU Langone Prof. Spalink contributed to the research and clinical practice advancements for several rare autonomic diseases. Prof. Spalink designed, obtained funding for, and implemented a clinical program to provide cognitive behavioral therapy via telemedicine for patients with a rare neurodegenerative disease resulting in blindness and social isolation to improve anxiety, depression, and self-esteem. She collaborated with an expert team of clinicians and researchers to publish the first respiratory guidelines for Familial Dysautonomia supporting evidence-based practice respiratory care for children and adults and spoke internationally to support training and awareness.

In her current clinical practice Prof. Spalink provides advanced practice nursing care for adults with urgent complications of cancer and its treatment. Her clinical areas of interest include acute care, neurology, oncology, and clinical trials nursing practice and operations.

DNP, NYU Meyers
MSN, NYU Meyers
BSN, Calvin University

Acute care
Oncology
Neurology
Palliative care
Leadership

Association of Clinical Research Professionals
National Organization of Nurse Practitioner Faculties
Oncology Nursing Society

AACI-CRI (2023)

Prescreening to Increase Therapeutic Oncology Trial Enrollment at the Largest Public Hospital in the United States

Wu, J., Yakubov, A., Abdul-Hay, M., Love, E., Kroening, G., Cohen, D., Spalink, C., Joshi, A., Balar, A., Joseph, K. A., Ravenell, J., & Mehnert, J. (2022). JCO Oncology Practice, 18(4), E620-E625. 10.1200/OP.21.00629
Abstract
Abstract
PURPOSE:The recruitment of underserved patients into therapeutic oncology trials is imperative. The National Institutes of Health mandates the inclusion of minorities in clinical research, although their participation remains under-represented. Institutions have used data mining to match patients to clinical trials. In a public health care system, such expensive tools are unavailable.METHODS:The NYU Clinical Trials Office implemented a quality improvement program at Bellevue Hospital Cancer Center to increase therapeutic trial enrollment. Patients are screened through the electronic medical record, tumor board conferences, and the cancer registry. Our analysis evaluated two variables: number of patients identified and those enrolled into clinical trials.RESULTS:Two years before the program, there were 31 patients enrolled. For a period of 24 months (July 2017 to July 2019), we identified 255 patients, of whom 143 (56.1%) were enrolled. Of those enrolled, 121 (84.6%) received treatment, and 22 (15%) were screen failures. Fifty-five (38.5%) were referred to NYU Perlmutter Cancer Center for therapy. Of the total enrollees, 64% were female, 56% were non-White, and overall median age was 55 years (range: 33-88 years). Our participants spoke 16 different languages, and 57% were non-English-speaking. We enrolled patients into eight different disease categories, with 38% recruited to breast cancer trials. Eighty-three percent of our patients reside in low-income areas, with 62% in both low-income and Health Professional Shortage Areas.CONCLUSION:Prescreening at Bellevue has led to a 4.6-fold increase in patient enrollment to clinical trials. Future research into using prescreening programs at public institutions may improve access to clinical trials for underserved populations.

Frequency and burden of gastrointestinal symptoms in familial dysautonomia

Ramprasad, C., Norcliffe-Kaufmann, L., Palma, J. A., Levy, J., Zhang, Y., Spalink, C. L., Khan, A., Smukalla, S., Kaufmann, H., & Chen, L. A. (2021). Clinical Autonomic Research, 31(1), 109-116. 10.1007/s10286-020-00735-9
Abstract
Abstract
Purpose: Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy (HSAN-3) that is clinically characterized by impaired pain and temperature perception and abnormal autonomic function. Patients with FD have gastrointestinal dysmotility and report a range of gastrointestinal symptoms that have yet to be systematically evaluated. The aim of this study was to establish the frequency and severity of gastrointestinal symptoms in patients with FD. Methods: The validated National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) survey questionnaire, together with additional FD-specific questions, were distributed to 202 living patients with genetically confirmed FD who had been identified from the New York University FD Patient Registry or, when relevant, to their respective caretaker. As a comparison group, we used a general US adult population for whom PROMIS scores were available (N = 71,812). Results: Of the 202 questionnaires distributed, 77 (38%) were returned, of which 53% were completed by the patient. Median age of the respondents was 25 years, and 44% were male. Gastrostomy tube was the sole nutrition route for 25% of the patients, while 53% were reliant on the gastrostomy tube only for liquid intake. The prevalence of gastrointestinal symptoms was significantly higher in each of the eight domains of PROMIS in patients with FD than in the controls. Gastrointestinal symptoms as measured by raw scores on the PROMIS scale were significantly less severe in the FD patient group than in the control population in all domains with the exception of the abdominal pain domain. The surveys completed by caregivers reported the same burden of symptoms as those completed only by patients. Conclusion: Gastrointestinal symptoms affect nearly all patients with FD. Gastrointestinal symptoms are more prevalent in adult patients with FD than in the average US adult population but are less severe in the former.

Neurogenic dysphagia with undigested macaroni and megaesophagus in familial dysautonomia

Palma, J. A., Spalink, C., Barnes, E. P., Norcliffe-Kaufmann, L., & Kaufmann, H. (2018, February 1). In Clinical Autonomic Research (Vols. 28, Issue 1, pp. 125-126). 10.1007/s10286-017-0487-6

Prevalence and characteristics of sleep-disordered breathing in familial dysautonomia

Singh, K., Palma, J. A., Kaufmann, H., Tkachenko, N., Norcliffe-Kaufmann, L., Spalink, C., Kazachkov, M., & Kothare, S. V. (2018). Sleep Medicine, 45, 33-38. 10.1016/j.sleep.2017.12.013
Abstract
Abstract
Objective: Familial dysautonomia (FD) is an autosomal recessive disorder characterized by impaired development of sensory and afferent autonomic nerves. Untreated sleep-disordered breathing (SDB) has been reported to increase the risk of sudden unexpected death in FD. We aimed to describe the prevalence and characteristics of SDB in FD. Patients/Methods: Seventy-five patients with FD (20 adults and 55 children) underwent in-lab polysomnography, including peripheral capillary oxygen saturation (SpO 2 ) and end-tidal capnography (EtCO 2 ) measurements. A t-test and Spearman's correlation analysis were performed to evaluate the impact of age on sleep, occurrence of apneas, SpO 2 and EtCO 2 levels; and to determine the relationship between apneas and SpO 2 /EtCO 2 measurements during different sleep stages. Results: Overall, 85% of adults and 91% of pediatric patients had some degree of SDB. Obstructive sleep apneas were more severe in adults (8.5 events/h in adults vs. 3.5 events/h in children, p = 0.04), whereas central apneas were more severe (10.8 vs. 2.8 events/h, p = 0.04) and frequent (61.8% vs. 45%, p = 0.017) in children. Overall, a higher apnea–hypopnea index was associated with increased severity of hypoxia and hypoventilation, although in a significant fraction of patients (67% and 46%), hypoxemia and hypoventilation occurred independent of apneas. Conclusion: Most adult and pediatric patients with FD suffer from some degree of SDB. There was a differential effect of age in the pattern of SDB observed. In some FD patients, hypoventilation and hypoxia occurred independently of apneas. Therefore, we recommend including EtCO 2 monitoring during polysomnography in all patients with FD to detect SDB.

Respiratory care in familial dysautonomia: Systematic review and expert consensus recommendations

Kazachkov, M., Palma, J. A., Norcliffe-Kaufmann, L., Bar-Aluma, B. E., Spalink, C. L., Barnes, E. P., Amoroso, N. E., Balou, S. M., Bess, S., Chopra, A., Condos, R., Efrati, O., Fitzgerald, K., Fridman, D., Goldenberg, R. M., Goldhaber, A., Kaufman, D. A., Kothare, S. V., Levine, J., … Kaufmann, H. (2018). Respiratory Medicine, 141, 37-46. 10.1016/j.rmed.2018.06.017
Abstract
Abstract
Background: Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and afferent autonomic nerves. As a consequence, patients develop neurogenic dysphagia with frequent aspiration, chronic lung disease, and chemoreflex failure leading to severe sleep disordered breathing. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of respiratory disorders in familial dysautonomia. Methods: We performed a systematic review to summarize the evidence related to our questions. When evidence was not sufficient, we used data from the New York University Familial Dysautonomia Patient Registry, a database containing ongoing prospective comprehensive clinical data from 670 cases. The evidence was summarized and discussed by a multidisciplinary panel of experts. Evidence-based and expert recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: Recommendations were formulated for or against specific diagnostic tests and clinical interventions. Diagnostic tests reviewed included radiological evaluation, dysphagia evaluation, gastroesophageal evaluation, bronchoscopy and bronchoalveolar lavage, pulmonary function tests, laryngoscopy and polysomnography. Clinical interventions and therapies reviewed included prevention and management of aspiration, airway mucus clearance and chest physical therapy, viral respiratory infections, precautions during high altitude or air-flight travel, non-invasive ventilation during sleep, antibiotic therapy, steroid therapy, oxygen therapy, gastrostomy tube placement, Nissen fundoplication surgery, scoliosis surgery, tracheostomy and lung lobectomy. Conclusions: Expert recommendations for the diagnosis and management of respiratory disease in patients with familial dysautonomia are provided. Frequent reassessment and updating will be needed.

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

Dillon, R. C., Palma, J. A., Spalink, C. L., Altshuler, D., Norcliffe-Kaufmann, L., Fridman, D., Papadopoulos, J., & Kaufmann, H. (2017). Clinical Autonomic Research, 27(1), 7-15. 10.1007/s10286-016-0383-5
Abstract
Abstract
Objective: Adrenergic crises are a cardinal feature of familial dysautonomia (FD). Traditionally, adrenergic crises have been treated with the sympatholytic agent clonidine or with benzodiazepines, which can cause excessive sedation and respiratory depression. Dexmedetomidine is a centrally-acting α2-adrenergic agonist with greater selectivity and shorter half-life than clonidine. We evaluated the preliminary effectiveness and safety of intravenous dexmedetomidine in the treatment of refractory adrenergic crisis in patients with FD. Methods: Retrospective chart review of patients with genetically confirmed FD who received intravenous dexmedetomidine for refractory adrenergic crises. The primary outcome was preliminary effectiveness of dexmedetomidine defined as change in blood pressure (BP) and heart rate (HR) 1 h after the initiation of dexmedetomidine. Secondary outcomes included incidence of adverse events related to dexmedetomidine, hospital and intensive care unit (ICU) length of stay, and hemodynamic parameters 12 h after dexmedetomidine cessation. Results: Nine patients over 14 admissions were included in the final analysis. At 1 h after the initiation of dexmedetomidine, systolic BP decreased from 160 ± 7 to 122 ± 7 mmHg (p = 0.0005), diastolic BP decreased from 103 ± 6 to 65 ± 8 (p = 0.0003), and HR decreased from 112 ± 4 to 100 ± 5 bpm (p = 0.0047). The median total adverse events during dexmedetomidine infusion was 1 per admission. Median hospital length of stay was 9 days [interquartile range (IQR) 3–11 days] and median ICU length of stay was 7 days (IQR 3–11 days). Conclusions: Intravenous dexmedetomidine is safe in patients with FD and appears to be effective to treat refractory adrenergic crisis. Dexmedetomidine may be considered in FD patients who do not respond to conventional clonidine and benzodiazepine pharmacotherapy.

Disorders of the Autonomic Nervous System

Palma, J. A., Norcliffe-Kaufmann, L., Fuente-Mora, C., Percival, L., Spalink, C. L., & Kaufmann, H. (2017). In Swaiman’s Pediatric Neurology: Autonomic Dysfunction in Pediatric Practice (1–, pp. 1173-1183). Elsevier Inc. 10.1016/B978-0-323-37101-8.00154-5

Intranasal dexmedetomidine for adrenergic crisis in familial dysautonomia

Spalink, C. L., Barnes, E., Palma, J. A., Norcliffe-Kaufmann, L., & Kaufmann, H. (2017). Clinical Autonomic Research, 27(4), 279-282. 10.1007/s10286-017-0442-6
Abstract
Abstract
Purpose: To report the use of intranasal dexmedetomidine, an α2-adrenergic agonist for the acute treatment of refractory adrenergic crisis in patients with familial dysautonomia. Methods: Case series. Results: Three patients with genetically confirmed familial dysautonomia (case 1: 20-year-old male; case 2: 43-year-old male; case 3: 26-year-old female) received intranasal dexmedetomidine 2 mcg/kg, half of the dose in each nostril, for the acute treatment of adrenergic crisis. Within 8–17 min of administering the intranasal dose, the adrenergic crisis symptoms abated, and blood pressure and heart rate returned to pre-crises values. Adrenergic crises eventually resumed, and all three patients required hospitalization for investigation of the cause of the crises. Conclusions: Intranasal dexmedetomidine is a feasible and safe acute treatment for adrenergic crisis in patients with familial dysautonomia. Further controlled studies are required to confirm the safety and efficacy in this population.

Sudden unexpected death during sleep in familial dysautonomia: A case-control study

Palma, J. A., Norcliffe-Kaufmann, L., Perez, M. A., Spalink, C. L., & Kaufmann, H. (2017). Sleep, 40(8). 10.1093/sleep/zsx083
Abstract
Abstract
Study Objectives: Sudden unexpected death during sleep (SUDS) is the most common cause of death in patients with familial dysautonomia (FD), an autosomal recessive disease characterized by sensory and autonomic dysfunction. It remains unknown what causes SUDS in these patients and who is at highest risk. We tested the hypothesis that SUDS in FD is linked to sleep-disordered breathing. Methods: We retrospectively identified patients with FD who died suddenly and unexpectedly during sleep and had undergone polysomnography within the 18-month period before death. For each case, we sampled one age-matched surviving subject with FD that had also undergone polysomnography within the 18-month period before study. Data on polysomnography, EKG, ambulatory blood pressure monitoring, arterial blood gases, blood count, and metabolic panel were analyzed. Results: Thirty-two deceased cases and 31 surviving controls were included. Autopsy was available in six cases. Compared with controls, participants with SUDS were more likely to be receiving treatment with fludrocortisone (odds ratio [OR]; 95% confidence interval) (OR 29.7; 4.1-213.4), have untreated obstructive sleep apnea (OR 17.4; 1.5-193), and plasma potassium levels <4 mEq/L (OR 19.5; 2.36-161) but less likely to use noninvasive ventilation at night (OR 0.19; 0.06-0.61). Conclusions: Initiation of noninvasive ventilation when required and discontinuation of fludrocortisone treatment may reduce the high incidence rate of SUDS in patients with FD. Our findings contribute to the understanding of the link between autonomic, cardiovascular, and respiratory risk factors in SUDS.