Internal Medicine Commons^™

Adaptive Design Of A Clinical Decision Support Tool: What The Impact On Utilization Rates Means For Future Cds Research, D. Mann, R. Hess, T. Mcginn, R. Mishuris, S. Chokshi, L. Mccullagh, P. D. Smith, J. Palmisano, S. Richardson, D. A. Feldstein

Journal Articles

© The Author(s) 2019. OBJECTIVE: We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: …

Improving Provider Adoption With Adaptive Clinical Decision Support Surveillance: An Observational Study, S. Khan, S. Richardson, A. Liu, V. Mechery, L. Mccullagh, A. Schachter, S. Pardo, T. Mcginn

Journal Articles

© Sundas Khan, Safiya Richardson, Andrew Liu, Vinodh Mechery, Lauren McCullagh, Andy Schachter, Salvatore Pardo, Thomas McGinn. Background: Successful clinical decision support (CDS) tools can help use evidence-based medicine to effectively improve patient outcomes. However, the impact of these tools has been limited by low provider adoption due to overtriggering, leading to alert fatigue. We developed a tracking mechanism for monitoring trigger (percent of total visits for which the tool triggers) and adoption (percent of completed tools) rates of a complex CDS tool based on the Wells criteria for pulmonary embolism (PE). Objective: We aimed to monitor and evaluate the …

Small Septal Branch Artery Thrombus Inducing Ventricular Fibrillation: To Intervene Or Not To Intervene, V. Agarwal, P. C. Olson, J. Mroue, Y. Olkovsky, S. Bekheit, J. Lafferty

Journal Articles

© The Author(s) 2019. A 64-year-old woman presented for chest pain and was diagnosed with anteroseptal ST segment elevation myocardial infarction (STEMI). Emergent angiography showed 95% stenosis at the ostium of the second septal branch, consistent with thrombus, and no other significant lesions. The lesion was not amenable to intervention due to small caliber. Post angiography, the patient’s electrical rhythm deteriorated into ventricular fibrillation. Following resuscitation, repeat angiography confirmed same findings. Electrophysiology study at 3 months was positive for inducing fibrillation. Due to patient risk factors, she had placement of a dual chamber defibrillator. A 5-month follow-up echocardiogram showed a …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Triggered By Emotional Stress, C. A. Obi, E. Thompson, L. Mordukhaev, I. Khan, N. J. Zhang

Journal Articles

© 2019, Copyright © 2019 Baylor University Medical Center. A 22-year-old woman presented with disorganized behaviors, restlessness, and subacute decline in mental status in the setting of stress. Extensive workup for autoimmune diseases disclosed positive anti-N-methyl-d-aspartate (NMDA) receptor antibodies. We recommend that fertility preservation should be discussed and stress management should be considered in patients with a history of anti-NMDA autoimmune encephalitis because this can help in preventing relapse.

Quantifying Patient Satisfaction With Process Metrics Using A Weighted Bundle Approach., N. B. Riebling, S. Norouzzadeh, G. Reeder, C. Mouradian, A. Hillier, R. Cowan, M. Doerfler

Journal Articles

Background:Current patient satisfaction assessment results are delayed and obtained from select patient surveys. As a result, these assessments may not represent the experience of the entire patient population. This study developed a method to measure and evaluate all patients' experiences while they are within the care episode and link it to processes within the organisation. Methods:Using the Six Sigma methodology, sites assembled diverse teams to categorise and analyse negative experience comments from patients to understand the drivers of dissatisfaction. These customer expectations lead to the development of the four components in the Patient Experience Bundle (PEB): communication, environment, basic needs/comfort …

Medical Education Using Minimal Technology: Achieving Professional Development, K. A. Friedman, S. W. Herman, A. Fornari

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No abstract provided.

A Novel Curriculum To Prepare Internal Medicine Residents For Fellowship Interviews., M. Sinclair, J. Raimo, K. Wong, M. Kline, K. Friedman

Journal Articles

Background:Applications to the Fellowship Match through the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high. Data regarding the preparedness of medical residents who go through the interview process is limited. Objective:To assess whether the implementation of an interview curriculum could improve medical resident preparedness for and performance during fellowship interviews. Methods:All third-year internal medicine residents (N = 18) at the Zucker School of Medicine at Hofstra/Northwell (Northwell) applying to subspecialty fellowship participated in an interview curriculum that comprised a didactic session and an Objective Structured Teaching Exercise (OSTE). Participants were surveyed on preparedness before …

Live Usability Testing Of Two Complex Clinical Decision Support Tools: Observational Study, S. Richardson, D. Feldstein, T. Mcginn, L. S. Park, S. Khan, R. Hess, P. D. Smith, R. G. Mishuris, L. Mccullagh, D. Mann

Journal Articles

© 2019 Journal of Medical Internet Research. All rights reserved. Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction …

Adult Onset Morgagni Hernia: Medical Vs. Surgical Management., A. Elfiky, D. Daneshvar, M. Krzyzak, I. Mukherjee

Journal Articles

Morgagni hernia is a type of diaphragmatic hernia where bowel content herniates through an irregular opening into the thoracic cavity. Herein, we present the case of an 84-year-old female patient with multiple hospital admissions for abdominal symptoms. Radiological studies confirmed Morgagni hernia. She underwent a laparoscopic intervention with mesh placement. She was discharged in stable condition and was doing well on follow-up.

Developmental Subtypes Assessed By Dna Methylation-Iplex Forecast The Natural History Of Chronic Lymphocytic Leukemia, B. Giacopelli, Q. Zhao, A. S. Ruppert, A. Agyeman, C. Weigel, Y. Z. Wu, M. M. Gerber, K. G. Rabe, K. R. Rai, C. C. Oakes, +16 Additional Authors

Journal Articles

© 2019 by The American Society of Hematology Alterations in global DNA methylation patterns are a major hallmark of cancer and represent attractive biomarkers for personalized risk stratification. Chronic lymphocytic leukemia (CLL) risk stratification studies typically focus on time to first treatment (TTFT), time to progression (TTP) after treatment, and overall survival (OS). Whereas TTFT risk stratification remains similar over time, TTP and OS have changed dramatically with the introduction of targeted therapies, such as the Bruton tyrosine kinase inhibitor ibrutinib. We have shown that genome-wide DNA methylation patterns in CLL are strongly associated with phenotypic differentiation and patient outcomes. …

Predictors Of Overtesting In Pulmonary Embolism Diagnosis, S. Richardson, E. Lucas, S. Cohen, M. Zhang, G. Qiu, S. Khan, T. Mcginn

Journal Articles

© 2019 Background: The benefits of computed tomography pulmonary angiography (CTPA) for pulmonary embolism (PE) diagnosis must be weighed against its risks, radiation-induced malignancy, and contrast-induced nephropathy. Appropriate use of CTPA can be assessed by monitoring yield, the percentage of tests positive for PE. We identify factors that are associated low CTPA yield, which may predict overtesting. Methods: This was a retrospective cohort study of six emergency departments between June 2014 and February 2017. The electronic health record was queried for CTPAs ordered for adult patients in the emergency department. We assessed the following patient factors: age, gender, body mass …

Long-Term Safety Of Single-Agent Ibrutinib In Patients With Chronic Lymphocytic Leukemia In 3 Pivotal Studies, S. E. Coutre, J. C. Byrd, P. Hillmen, J. C. Barrientos, P. M. Barr, S. Devereux, T. Robak, T. J. Kipps, A. Schuh, S. M. O’Brien, +9 Additional Authors

Journal Articles

© 2019 by The American Society of Hematology Ibrutinib, a first-in-class once-daily oral Bruton tyrosine kinase inhibitor indicated for chronic lymphocytic leukemia (CLL), is continued until progressive disease or unacceptable toxicity. We conducted an integrated safety analysis of single-agent ibrutinib from randomized phase 3 studies PCYC-1112 (RESONATE, n 5 195) and PCYC-1115/1116 (RESONATE-2, n 5 135), and examined longer-term safety separately in the phase 1b/2 PCYC-1102/1103 study (n 5 94, 420 mg/d). In the integrated analysis (ibrutinib treatment up to 43 months), the most common adverse events (AEs) were primarily grade 1/2; diarrhea (n 5 173, 52% any-grade; n 5 …

Which Clinical And Biochemical Predictors Should Be Used To Screen For Diabetes In Patients With Serious Mental Illness Receiving Antipsychotic Medication? A Large Observational Study, A. J. Mitchell, D. Vancampfort, P. Manu, C. U. Correll, M. Wampers, R. Van Winkel, W. Yu, M. De Hert

Journal Articles

© 2019 Mitchell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective We aimed to investigate which clinical and metabolic tests offer optimal accuracy and acceptability to help diagnose diabetes among a large sample of people with serious mental illness in receipt of antipsychotic medication. Methods A prospective observational study design of biochemical and clinical factors was used. Biochemical measures were fasting glucose, insulin and lipids, oral glucose tolerance testing (OGTT), hemoglobin …

The High Cost Of Low Value Care, T. Mcginn, S. Cohen, S. Khan, S. Richardson, M. Oppenheim, J. Wang

Journal Articles

The main focus of this study is bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From our work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, we integrated the highly validated Wells' criteria into the electronic health record at two of our major academic tertiary hospitals. The Wells' clinical decision support tool triggered for patients being evaluated for PE and therefore determined a patients' pretest probability for having a PE. There were 12,759 patient visits representing 11,836 patients, 51% had …

Correction: Posttraumatic Stress Disorder Prevalence And Risk Of Recurrence In Acute Coronary Syndrome Patients: A Meta-Analytic Review., D. Edmondson, S. Richardson, L. Falzon, K. W. Davidson, M. A. Mills, Y. Neria

Journal Articles

© 2019 Edmondson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. There are a number of errors in the citations in Table 1. Please see the correct Table 1 here. (Table presented).

Recruitment Via Social Media: Advantages And Potential Biases, C. Benedict, A. L. Hahn, M. A. Diefenbach, J. S. Ford

Journal Articles

© The Author(s) 2019. Background: Adolescent and young adult (AYA) cancer survivors are under-represented in research. Social media is increasingly used for recruitment given its ability to reach large audiences. Differences in participant characteristics and potential biases due to recruitment source are not well understood. Purpose: This study aimed to: (a) compare recruitment strategies (hospital-based v. social media) in enrollment metrics, and (b) among enrolled participants, evaluate group differences in patient characteristics and patient reported outcomes (PROs). Methods: Preliminary data from a cancer and fertility study with female AYAs were evaluated. Hospital-based recruitment used electronic medical records (EMR) to identify …

Behavioral Economics Implementation: Regret Lottery Improves Mhealth Patient Study Adherence., S. A. Husain, K. Diaz, J. E. Schwartz, F. E. Parsons, M. M. Burg, K. W. Davidson, I. M. Kronish

Journal Articles

Background: Nonadherence to study protocols reduces the generalizability, validity, and statistical power of longitudinal studies.

Purpose: To determine whether an automated electronically-delivered regret lottery would improve adherence to an intensive mHealth self-monitoring protocol as part of a longitudinal observational study.

Methods: We enrolled 77 adults into a 52-week study requiring five daily ecologic momentary assessments (EMA) of stress and daily accelerometer use. We performed a pre/post single-arm study to evaluate the efficacy of a lottery intervention in improving adherence to this protocol. Midway through the study, participants were invited to enter a weekly regret lottery ($50 prize, expected value

Results: …

Racial/Ethnic Disparities Among Asian Americans In Inpatient Acute Myocardial Infarction Mortality In The United States, E. J. Kim, N. R. Kressin, M. K. Paasche-Orlow, L. Lopez, J. E. Rosens, M. Lin, A. D. Hanchate

Journal Articles

No abstract provided.

Understanding The Digital Gap Among Us Adults With Disability: Cross-Sectional Analysis Of The Health Information National Trends Survey 2013, E. J. Kim, Y. Yuan, J. Liebschutz, H. Cabral, L. Kazis

Journal Articles

©Eun Ji Kim, Yiyang Yuan, Jane Liebschutz, Howard Cabral, Lewis Kazis. Background: Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. Objective: This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer …

Fertility Information Needs And Concerns Post-Treatment Contribute To Lowered Quality Of Life Among Young Adult Female Cancer Survivors, C. Benedict, B. Thom, D. N. Friedman, E. Pottenger, N. Raghunathan, J. F. Kelvin

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No abstract provided.

The Intersection Of Financial Toxicity And Family Building In Young Adult Cancer Survivors, B. Thom, C. Benedict, D. N. Friedman, J. F. Kelvin

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No abstract provided.

Disparities In Potentially Preventable Hospitalizations: Near-National Estimates For Hispanics, C. Feng, M. K. Paasche-Orlow, N. R. Kressin, J. E. Rosen, L. López, E. J. Kim, M. Y. Lin, A. D. Hanchate

Journal Articles

© Health Research and Educational Trust Objective: To obtain near-national rates of potentially preventable hospitalization (PPH)—a marker of barriers to outpatient care access—for Hispanics; to examine their differences from other race-ethnic groups and by Hispanic national origin; and to identify key mediating factors. Data Sources/Study Setting: Data from all-payer inpatient discharge databases for 15 states accounting for 85 percent of Hispanics nationally. Study Design: Combining counts of inpatient discharges with census population for adults aged 18 and older, we estimated age-sex-adjusted PPH rates. We examined county-level variation in race-ethnic disparities in these rates to identify the mediating role of area-level …

A Computerized Method For Measuring Computed Tomography Pulmonary Angiography Yield In The Emergency Department: Validation Study., S. Richardson, P. Solomon, A. O'Connell, S. Khan, J. Gong, A. Makhnevich, G. Qiu, M. Zhang, T. Mcginn

Journal Articles

BACKGROUND:Use of computed tomography pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) has markedly increased over the past two decades. While this technology has improved the accuracy of radiological testing for PE, CTPA also carries the risk of substantial iatrogenic harm. Each CTPA carries a 14% risk of contrast-induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. The appropriate use of CTPA can be estimated by monitoring the CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring the CTPA …

Improvement In Parameters Of Hematologic And Immunologic Function And Patient Well-Being In The Phase Iii Resonate Study Of Ibrutinib Versus Ofatumumab In Patients With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma., J. C. Barrientos, S. O'Brien, J. R. Brown, N. E. Kay, N. M. Reddy, S. Coutre, C. Tam, S. Mulligan, U. Jaeger, P. Hillmen, +18 Additional Authors

Journal Articles

BACKGROUND: Ibrutinib compared with ofatumumab significantly improves progression-free and overall survival in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).

PATIENTS AND METHODS: Measures of well-being were assessed in RESONATE, where previously treated patients with CLL/SLL were randomized to receive ibrutinib 420 mg/day (n = 195) or ofatumumab (n = 196) for up to 24 weeks. Endpoints included hematologic function, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), disease-related symptoms, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30), and medical resource utilization.

RESULTS: With up to 24 months' follow-up (median, 16.4 …

Postthrombotic Syndrome In Patients Treated With Rivaroxaban Or Warfarin For Venous Thromboembolism., C. I. Coleman, J. Beyer-Westendorf, T. J. Bunz, C. E. Mahan, A. C. Spyropoulos

Journal Articles

Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with

Young Adult Female Cancer Survivors' Concerns About Future Children's Health And Genetic Risk, N. J. Raghunathan, C. Benedict, B. Thom, D. N. Friedman, J. F. Kelvin

Journal Articles

No abstract provided.

The Relationship Of Physical Performance And Osteoporosis Prevention With Vitamin D In Older African Americans (Poda), R. Dhaliwal, M. Mikhail, G. Usera, A. Stolberg, S. Islam, L. Ragolia, J. F. Aloia

Journal Articles

© 2017 Elsevier Inc. Rationale Vitamin D deficiency is associated with bone loss, poor muscle strength, falls and fracture. This information in older African Americans (AAs) is sparse. Objective The study of the relationship of Physical performance, Osteoporosis prevention with vitamin D in older African Americans (PODA) is a randomized, double-blind, placebo-controlled 3-year trial examining the effect of vitamin D on bone loss and physical performance in older AA women. Methods 260 healthy AA women aged > 60 years were assigned to receive placebo or vitamin D3. Initial vitamin D3dose was determined by the baseline serum 25OHD level, and adjusted further …

Successful Pulmonary Thromboendarterectomy In A Patient With Sickle Cell Disease And Associated Resolution Of A Leg Ulcer, A. Agrawal, R. Shah, M. D. Bacchetta, A. Talwar

Journal Articles

© 2017 Indian Chest Society | Published by Wolters Kluwer -Medknow. Pulmonary hypertension (PH) is a relatively frequent and severe complication of sickle cell disease (SCD). PH associated with SCD is classified as Group 5 PH. The exact pathogenesis of PH in SCD in not known. There are also very limited treatment options available at this time for such patients with Group 5 PH. Patients with SCD are predisposed to a hypercoagulable state and thus can also suffer from chronic thromboembolism. These patients can have associated chronic thromboembolic pulmonary hypertension (CTEPH), thus being classified as Group 4 PH. We present …

Prostate Cancer Patients’ Understanding Of The Gleason Scoring System: Implications For Shared Decision-Making, E. K. Tagai, S. M. Miller, A. Kutikov, M. A. Diefenbach, R. A. Gor, T. Al-Saleem, D. Y. Chen, S. Fleszar, G. Roy

Journal Articles

© 2018 American Association for Cancer Education The Gleason scoring system is a key component of a prostate cancer diagnosis, since it indicates disease aggressiveness. It also serves as a risk communication tool that facilitates shared treatment decision-making. However, the system is highly complex and therefore difficult to communicate: factors which have been shown to undermine well-informed and high-quality shared treatment decision-making. To systematically explore prostate cancer patients’ understanding of the Gleason scoring system (GSS), we assessed knowledge and perceived importance among men who had completed treatment (N = 50). Patients were administered a survey that assessed patient knowledge and …

Reduction In Social Activities Mediates The Relationship Between Diarrhea And Distress In Rectal/Anal Cancer Survivors, C. Benedict, K. Duhamel, C. J. Nelson

Journal Articles

No abstract provided.