Internal Medicine Commons^™

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

Journal Articles

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: …

Case Report: Steroid Responsive Mesothelioma-Related Pleural Effusion, Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy Munn

Internal Medicine

Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in …

Is This Rash Measles?, Sandy Hoar Dmsc(C), Pa-C

Medicine Faculty Posters and Presentations

Is This Rash Measles?

Sandy Hoar, DSMc(c), LSHTM, PA-C

[email protected]

A patient presents to a Maryland clinic complaining of a dry red, bleeding, crusting, painful, non-itchy rash which started on her right forearm, 3-1/2 days ago. It spread to the trunk, face and thighs. The patient is complaining of fatigue, bilateral eye and mastoid pain, frontal headache, sore scalp, and bone pain. She reported no exposure, or travel but does have contact with children. She had childhood measles and chickenpox. The patient had tried oral tetracycline. The patient had discrete, mostly papular lesions on the upper arms, trunk, face/neck, and …

Patients’ Experiences On Accessing Health Care Services For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: A Qualitative Study, Helena Legido Quigley, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Z Samad

Department of Medicine

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertensiondisproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. …

Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy In Adults In A Tertiary Hospital In Nairobi, Joseph Odunga Abuodha

Master of Medicine in Internal Medicine

Introduction: Anthracyclines are known to improve survival in some malignancies, but may also be associated with irreversible cardiotoxicity, which is partly dose dependent. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters predict development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters which predict development of cardiac dysfunction in a sub-Saharan African population. Methods: Patients with a diagnosis of cancer and receiving anthracyclines at AKUH,N were evaluated if they met eligibility criteria (≥18years at first anthracycline administration, archived baseline echocardiogram, no prior history of heart disease or use of anthracyclines). Patients …

Impact Of Serratus Plane Block On Pain Scores And Incentive Spirometry Volumes After Chest Trauma, Nadia Hernandez, Johanna De Haan, Dallis Clendeninn, David E Meyer, Semhar Ghebremichael, Carlos Artime, George Williams, Holger Eltzschig, Sudipta Sen

Faculty, Staff and Student Publications

Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis.

Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center.

Methods: Our hospital’s Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients …

Eligibility And Patient Barriers To Peritoneal Dialysis In Patients With Advanced Chronic Kidney Disease, Saleem Mohamed Abdulkarim

Master of Medicine in Internal Medicine

Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis. Purpose: The main objective of this study is to …

Disease Activity And Functional Status And Their Relation To Depression In Patients With Rheumatoid Arthritis, Joe Rosana Rakiro

Master of Medicine in Internal Medicine

Introduction: Rheumatoid Arthritis, one of the commonest forms of inflammatory arthritis, has significant societal impact with regards to cost, induction of disability and loss of productivity. This impact is magnified in the presence of comorbid mood disorders, as these constitute independent factors for unexplained flares and relapses. Purpose: The primary purpose of this study was to determine the correlation between disease activity and depression in Rheumatoid Arthritis patients. Methods: Patients with Rheumatoid Arthritis attending rheumatology clinic at Aga Khan University Hospital, Nairobi were recruited into the study. The patients’ disease activity and functional status were assessed using the Clinical Disease …