All

BRONX-LEBANON HOSPITAL CENTER

HOSPITAL DAY NOVEMBER 10, 2013

HOSPITAL DAY PROGRAM 8:15 Welcome and Opening Remar ! Daniel T" #ar a!$ MD$ Depar%men% o& S'rger( Ho!pi%al Da( Program Modera%or 8:)5 a"m" * 1+:15 a"m" PAP,R S,SSIO1" .omm'ni%( Garden! Presented by: Nina M Hicks, M.D., MBA Family Medicine Department )" /i e S0are in So'%0 /ron1$ -Y * Heal%0 and .omm'ni%( /ene&i%!" Presented by: Mohammad Jabr, M.D. ( esident!" Neha Jain, M..#" A $e%ine, Ph.D Department o& Family Medicine 2" Tro'3le!0oo%ing d'ring In%ra4Opera%i5e -er5e Moni%oring 6 IO-M 7 &or T0(roid !'rger( Presented by: 'em(r( #(nil ) eddy M.D." A*ay ) #hah FA+#" amasamy ,o%indara*an M.D. Harish N Nir(*o-i M.D." +hristopher $ +han- M.D." John M +os-ro%e, M.D. FA+#" Mathe. M John M.D." 'ellore # Parithi%el, M.D. FA+#, Department o& #(r-ery, Department o& Anesthesiolo-y. 8" /e%adine Irriga%ion #or Trea%men% O& Ac'%e ,pidemic 9era%ocon:'nc%i5i%i! Presented by: /imei /ho( M.D. Ph.D., Martin Mayers M.D., Department o& 0phthalmolo-y 5" Impro5ing Tran!i%ion o& care in a Re!idenc( Program Presented by: Naeem Abbas M.D., +arlos A Na%arro M.D., Associate, Molham Abd(lsamad M.D., +haitanya ) +handrala M.D., Ha&i1 Hashmi M.D., Abayomi #alako M.D., #ridhar +hilim(ri M.D., Physician23n2 +hie&, +hairman, Department o& Medicine Pro-ram Director, 3nternal Medicine esidency Pro-ram ;" In%erne% <!e &or Oral Heal%0 Rela%ed In&orma%ion 3( Paren%! o& Pedia%ric Den%al Pa%ien%! Presented by: a*ni #in-h, D.D.#." #elene 4(n, D.D.#." N-o1i 5b(, D.D.#.,MPH" Pa(l ,ates, D.D.#.,M.B.A., Department o& Dentistry, Bron6 $ebanon Hospital, Bron6 N7

=" T0e ,&&ec%i5ene!! O& T0e Primar( .are /a!ed Dia3e%e! ,d'ca%or program a% a #ederall( >'ali&ied Heal%0 .en%er in %0e So'%0 /ron1 Presented by: +rystal 'idal, (Medical #t(dent!, +haitanya +handrala, M.D., +hie& esident, Dept. o& Medicine, Dr. 3saac Dapkins, M.D., Department o& Medicine 8" #armer!? Mar e%: A Hidden @eAel Presented by: Fallon Andrea Mattis, M.D. (P,78!, Do(- eich, M.D. , +hairman, Department o& Family Medicine, Jose Dr. 9ib(rcio, M.D. Pro-ram Director, Department o& Family Medicine B" Spiri%'ali%( and Heal%0 Presented by: :l2#heri&, Dana M.D., Department o& Family Medicine 1+" Opera%i5e managemen% o& 0'ge pel5ic ma!! o& 'n noAn origin 6preopera%i5el(7" Presented by: Priya Prasad, M.D. 'ard(i Asiryan, M.D. 0ksana Pylypi%,M.D. $arry Ham, M.D. Patrick Anderson, M.D. Ma-dy Mikhail, M.D., +hairman and esidency Pro-ram Director, Dept. o& 0B;,7N 11" Pre5alence o& Deliri'm in Medical Pa%ien%! re&erred %o P!(c0o!oma%ic Medicine .on!'l%a%ion Ser5ice" Presented by: )etank(mar Bodarya, M.D., Maria M. Pere12+oste, M.D., 'ictoria Pa1 , M.D., 'icente Jose $i1 De&illo, M.D., +onnie +han, M.D., < Ali )hadi%i, Ph.D. Department o& Psychiatry, Di%ision o& Psychosomatic Medicine"
12.

Depar%men% o& -'r!ing ,d'ca%ion C Re!earc0$ Pa%ien% .are Ser5ice! Presented by: #ally Francisco, M#N, N, ABD (:dD! :d(cation Mana-er

12" A Pa%ien% ,5en% Diar( Impro5e! Sel&4Managemen% in Pedia%ric Sic le .ell Di!ea!e Pa%ien%! Presented by: )ranthi N. #eelaboyina, MBB#, Jenni&er B(sse, +.N.P., M.P.H., ,race Malon-a, M.P.H. and 9homas Mo(lton, M.D. Department o& Pediatrics

1+:15 a"m" * 1+:2+ a"m"

1+:2+ a"m" * 1):++ p"m" PAP,R S,SSIO18" #ac%or! predic%ing In%erna%ional Medical Grad'a%e! Pedia%ric /oard .er%i&ica%ion Pa!! Ra%e! Presented by: 7(sra )han, M.D., #(dershan #(bedi, .M.D., Jessica +al%o, M.D., Jessica Berrios, M3#, Fernando Matos, #te&an Ha-mann, M.D .M#c, ichard Ne(-eba(er, Ph.D, Ayoade Adeniyi, M.D. 15" Wedge Re!ec%ion 5er!'! Lo3ec%om( &or S%age 1A -on4Small .ell L'ng .ancer 6-S.L.7 in %0e elderl(: A S'r5eillance$ ,pidemiolog( and ,nd Re!'l%! 6S,,R7 Da%a3a!e anal(!i!" Presented by: #yed a1i, M.D., Mohan Mathe. John, M.D., #andeep #ainathan, M.D., +hristos #ta%ropo(los, M.D. 1;" Ind'c%ion o& la3or a% 81 Aee ! o& pregnanc( among primipara! Ai%0 an 'n&a5ora3le /i!0op !core
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Presented by: ,(illermo A Marro=(in M.D,. Nicolae 9(dorica M.D., +arolyn M #ala&ia M.D. M.#., obert Hecht M.D., Ma-dy Mikhail M.D., +hairman and Pro-ram Director, Department o& 0bstetrics and ,ynecolo-y

1=" H(per%en!ion ,&&ec% on Le&% Den%ric'lar Remodeling and S(!%olic #'nc%ion i! Grea%er in A&rican4American %0an in .ari33ean4Hi!panic Ad'l%! Presented by: ichard Peralta, M.D., )aromibal Me*ia, M.D., , H(ssein #ha=ra, M.D., FA++, Jonathan N. Bella, M.D., FA++ 18" .oronar( Ar%er% Di!ea!e4Depar%men% O& In%ernal Medicine Presented by: Aisha #ira*, M.D, Maryam A&shar, M.D, Mano* Bhandari, M.D, Harish Patel, M.D, +hase +eleb, MPH, Narendra Balodkar, M.D, Dr. #ridhar #. +hilim(ri, M.D. Physician23n2 +hie&, +hairman, Department o& Medicine Pro-ram Director, 3nternal Medicine esidency Pro-ram 1B" .ompari!on o& ,arl( 5er!'! La%e Trac0eo%om( in an Inner .i%( Medical In%en!i5e .are <ni% Presented by: N(p(r #inha M.D., 3*a1 Mohsin M.D., #indha-hatta 'enkatram M.D., F++P, ,ilda Dia12F(entes M.D., F++P, Department o& 3nternal Medicine, P(lmonary Di%ision )+" <nderrepre!en%ed Minori%( Den%i!% in %0e <ni%ed S%a%e! )+12 Presented by: Pa(l ,ates, D.D.#., M.B.A. >,, :li1abeth Mert1, Ph.D., MA?, +ynthia 4ides, M.A.8, Ale6is +ooke, M.P.H.8 ?. Assistant Pro&essor in esidence, Pre%enti%e and estorati%e Dental #ciences, +enter &or the Health Pro&essions, 5+#F #chool o& Dentistry. 8. esearch Analyst, Pre%enti%e and estorati%e Dental #ciences, +enter &or the Health Pro&essions, 5+#F #chool o& Dentistry. >. +hairman, Bron6 $ebanon Hospital +enter Dental Department

1):++ P"M" 4 L'nc0 1):85 P"M" 4 AAard Pre!en%a%ion!4

A--<AL M,,TI-G O# TH, M,DI.AL STA## ORGA-IEATIO1:++ p"m" * ):++ p"m"

ABSTRACTS

Ti%le: Food N(trition: Are 0-den patients a.are o& comm(nity -ardens in the #o(th Bron6@ A'%0or: Nina M Hicks, M.D., MBA Family Medicine Department In%rod'c%ion: +omm(nity -ardens are a potential so(rce to increase cons(mption o& &r(its and %e-etables in nei-hborhoods. 3n addition to bein- a &ood so(rce, comm(nity -ardens also re%itali1e nei-hborhoods and stren-then comm(nity ties. 9here are o%er ?A,BBB comm(nity -ardens in the 5nited #tates and +anada. 9here are o%er ?,BBB -ardens in Ne. 7ork #tate, abo(t CBB -ardens in Ne. 7ork +ity. 4ith this n(mber o& comm(nity -ardens, are they bein- (tili1ed@ 4hat are the obstacles to (sin- this &ood so(rce@ Me%0od!: First, a s(r%ey .as -i%en in :n-lish and #panish at 0-den +linic askinthree =(estions. ?! Do yo( kno. .hat a comm(nity -arden is@ 8! Did yo( kno. there are comm(nity -ardens aro(nd 0-den +linic@ >! 4o(ld yo( be interested in *oinin- a comm(nity -arden, i& no, .hy not@ 9hen a presentation .as -i%en e6plainin- abo(t comm(nity and container -ardenin-. Flyers .ere handed o(t .ith the location o& the nearest comm(nity -arden alon- .ith listin-s o& .ebsites abo(t comm(nity -ardens. Re!'l%!: Fi&teen s(r%eys .ere ret(rned. 9hree did not kno. the de&inition o& a comm(nity -arden. :i-ht did not kno. the location o& comm(nity -ardens in the nei-hborhood. #i6 .ere not interested in *oinin- a -arden and the most common listed reason .as bein- too b(sy. .oncl'!ion!: Most o& the people s(r%eyed did not kno. they had comm(nity -ardens a%ailable to them. Ho.e%er, many .ere interested in *oininthe -ardens. 3& .e ad%ertise in o(r clinics the a%ailability o& &resh &r(its and %e-etables that are a%ailable at these -ardens, .e may be able to increase healthy eatin- and e6ercise" both o& .hich ha%e been sho.n to be associated .ith comm(nity -ardenin-. For those that are b(sy .e can o&&er alternati%es s(ch as container -ardenin-. F(t(re st(dies may look into brin-in- these comm(nity reso(rces directly into the clinic in alliance .ith n(tritionists.

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Ti%le: Bike #hare in #o(th Bron6, N7 D Health and +omm(nity Bene&its A'%0or6!7 Mohammad Jabr, M.D. ( esident!" Neha Jain, M.#" A $e%ine, Ph.D Department o& Family Medicine In%rod'c%ion: Physical inacti%ity is a ma*or health problem in 5#A, incl(din- #o(th Bron6, Ne. 7ork. Health bene&its o& physical acti%ity ha%e been .ell doc(mented in medical literat(re. Ho.e%er, co(nselin- patients on e6ercisin- has poor e%idence o& compliance. A proposed sol(tion is de%elopment o& a pro-ram that is lo. cost, increases physical acti%ity, tracks per&ormance and compliance, and is mana-ed by PMD ro(tinely. A bike share pro-ram in #o(th Bron6 paid &or by ad%ertisers and health ins(rance bene&its co(ld be a possible sol(tion. Me%0od!: 4e are proposin- to st(dy the cost e&&ecti%eness, limitations, health bene&its, and positi%e e&&ects on the comm(nity o& startin- a bike share pro-ram in #o(th Bron6. 4e propose to establish eli-ibility < e6cl(sion criteriaEs, pro%ide sa&ety in&ormation, s(--est possible locations &or bike kiosks, and de%elop &ollo. (p -(idelines .ith PMD. Financial limitations o& the #o(th Bron6 residents are ma*or concerns &or accessibility to s(ch a pro-ram, and .e .ish to address that .ith se%eral alternate s(--estions. .oncl'!ion: Addition o& bike share bene&its in ins(rance plans o& #o(th Bron6 residents co(ld red(ce incidence o& obesity, pre%ent complications o& coronary artery disease, cardio%asc(lar disease, hypertension and diabetes. Additionally it makes #o(th Bron6 comm(nity a sa&er, &(n place &or all residents to en*oy and increase their physical acti%ity.

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Ti%le: 9ro(bleshootin- d(rin- 3ntra20perati%e Ner%e Monitorin- ( 30NM ! &or 9hyroid s(r-ery A'%0or6!7: 'em(r( #(nil ) eddy M.D. " A*ay ) #hah FA+#" amasamy ,o%indara*an M.D." Harish N Nir(*o-i M.D." +hristopher $ +han- M.D." John M +os-ro%e FA+#" Mathe. M John M.D." 'ellore # Parithi%el FA+#, Department o& #(r-ery, Department o& Anesthesiolo-y ( A di%ision o& NAPA2 North American Partners in Anesthesia !, Bron6 $ebanon Hospital center, ?FCB ,rand +onco(rse, Bron6, N7, ?BGCH In%rod'c%ion: 30NM is rapidly becomin- a standard o& care in many instit(tions across the co(ntry. Ability to interpret the e%ents d(rin- 30NM .ill -reatly enhance the %al(e o& this (se&(l monitorin- tool. Me%0od!: FB years old &emale .ith nonto6ic m(lti nod(lar -oiter .as sched(led &or near total thyroidectomy .ith planned 3ntra operati%e ner%e monitorin- (30NM! employin- endotracheal t(be (:99! mo(nted s(r&ace electrodes. 4ithin a &e. min(tes o& the commencement, the s(r-ery .as &re=(ently held (p by episodes o& s.allo.in- and b(ckinon the :99. 3ncreasin- the depth o& anesthesia to co(nteract these tro(blesome re&le6es res(lted in pro&o(nd hemodynamic instability, necessitatin- the (se o& lar-e doses o& sympathomimetic amines. $idocaine in&(sion .as started I ?.Cm-;k-;hr a&ter a bol(s dose o& ?m-;k-. 9he laryn-o tracheal re&le6es .ere s(ccess&(lly bl(nted and .e .ere able to moderate the depth o& anesthesia res(ltin- in stable hemodynamics. A Bi spectral inde6 (B3#! monitor .as connected to ens(re absence o& recall d(rin- li-hter plane o& anesthesia and a train o& &o(r (90F! monitor .as employed to -(ard a-ainst inad%ertent ne(rom(sc(lar blockade. D(rin- s(r-ery there .as loss o& si-nal ($0#! on le&t rec(rrent laryn-eal ner%e ( $N! a&ter initial identi&ication and later %is(al con&irmation. :99 electrode position .as checked .ith ,lidescope %is(ally and the :99 .as rotated on its lon- a6is to brinthe electrode in better contact, .hich restored the si-nal stren-th. F(rther s(r-ery proceeded smoothly .ith (ne%ent&(l post operati%e co(rse. Re!'l%!: 9he s(r-ery .as completed (ne%ent&(lly .ith ner%e monitorin- and stable hemodynamics .oncl'!ion:

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$idocaine in&(sion pro%ides optimal conditions &or intra operati%e ner%e monitorin- and also decreases the re=(irement o& inhalational anesthesia and opioids d(rin- s(r-ery .ith better hemodynamic stability.

Ti%le: Betadine 3rri-ation )eratocon*(ncti%itis A'%0or6!7 /imei /ho( M.D. 0phthalmolo-y

For

9reatment

0&

Ac(te

:pidemic

Ph.D,

Martin

Mayers

M.D.,

Department

o&

P'rpo!e: 9o test the e&&icacy o& CJ Betadine irri-ation &or the treatment o& ac(te epidemic keratocon*(ncti%itis (:)+!. Me%0od!: 9his is a retrospecti%e chart re%ie. st(dy. Patients .ith :)+ .ere enrolled into Betadine treatment or control -ro(ps. 9he treatment -ro(p recei%ed CJ Betadine irri-ation at the &irst clinical enco(nter in addition to conser%ati%e treatment (sin- cool compressesion and arti&icial tears. 9he patients in the control -ro(p .ere only treated conser%ati%ely. D(rin- the initial and ?2.eek &ollo.2(p %isits, each patient .as -raded &or symptom scores (ran-ed &rom B2K! based on the se%erity o& sel&2 reported symptoms, as .ell as si-n scores (ran-ed &rom B2?C! based on clinically obser%ed se%erity o& si-ns. 9he hi-her scores indicated .orse clinical o(tcomes. 9he n(mber o& patients in each -ro(p .ho reported impro%ed clinical symptoms at the ?2.eek &ollo.2(p %isit .as compared (sin- +hi2s=(are analysis. 9he chan-es o& si-n scores in the t.o consec(ti%e %isits bet.een the t.o -ro(ps .ere analy1ed (sin- Mann 4hitney 5 test. Re!'l%!: ?C patients .ere enrolled into the st(dy (nLH in the Betadine -ro(p and nLA in the control -ro(p!. F o(t o& the H Betadine treated patients reported impro%ed clinical symptoms d(rin- the ?2.eek &ollo.2(p %isit, as compared to F o(t o& A patients in the control -ro(p (pLB.FB!. 9he medi(m si-n score chan-e .as an C point decrease (initial %s ?2.eek &ollo.2(p %isit! in the Betadine treatment -ro(p %s 8.C point decrease in the control -ro(p (pLB.>>!. Altho(-h there .as a trend to.ards more rapid impro%ement in clinical si-ns in the Betadine %s control -ro(ps, o(r res(lts .ere not statistically si-ni&icant. .oncl'!ion!: CJ Betadine irri-ation &ailed to sho. statistically si-ni&icant short2term clinical e&&icacy &or the treatment o& :)+. A st(dy
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o& lar-er sample si1e may be necessary to &(rther el(cidate the role o& Betadine irri-ation in the settin- o& :)+.

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Ti%le: 3mpro%in- 9ransition o& care in a esidency Pro-ram A'%0or6!7 +arlos A Na%arro M.D., Associate, Naeem Abbas M.D., Molham Abd(lsamad M.D., +haitanya ) +handrala M.D., Ha&i1 Hashmi M.D, Abayomi #alako M.D., #ridhar +hilim(ri M.D., Physician23n2 +hie&, +hairman, Department o& Medicine Pro-ram Director, 3nternal Medicine esidency Pro-ram Bron62$ebanon Hospital +enter, Bron6, Ne. 7ork, ?BGCH In%rod'c%ion: D(e to residency trainin- sched(les, transition o& care &rom inpatients to amb(latory clinics is o&ten (nsatis&actory. 4e implemented a ne. system .ide transition o& care model to impro%e &ollo.2(p care in o(r lar-e residency trainin- pro-ram. Me%0od!: 3n Jan(ary 8B?8, .e implemented a ne. dischar-e process takinad%anta-e o& o(r completely implemented (ni&ied :M (3npatient and Amb(latory care!. 9his system mandates all patients dischar-ed &rom the medicine teachin- ser%ice .ith an appointment .ithin one .eek a&ter dischar-e. 9he appointment re=(est is imbedded into the allscripts dischar-e order set and completed .ithin one ho(r by a central appointment desk and posted into the system. 9his is &ollo.ed .ith an interacti%e a(tomated phone call (+ipher Health! .ithin GA ho(rs o& dischar-e. 9his phone call &oc(ses on transition o& care D appointments, dischar-e medications and %isitin- n(rse ser%ices. Patients .ho ha%e concerns and =(estions d(rin- the a(tomated call are &ollo.ed .ith an additional phone call to resol%e and rein&orce &ollo.2(p care. All in2patients dischar-es &rom Jan(ary 8B?B to J(ne 8B?> .ere analy1ed abo(t their &ollo. (p %isits. Re!'l%!: 9otal o& GC,C?G patients .ere dischar-ed o%er G8 months period o& .hich >B>B patients .ere seen by residents &or &ollo.2(p care. 3n 8B?B, there .ere total o& ?F> clinic patient %isits per =(arter by residents. 3n 8B?? there .ere ?FK patient %isits per =(arter by residents. 9his n(mber increased to 8C8 patient %isits per =(arter by 8B?8. D(rin- the &irst F months o& 8B?>, patient %isits increased to >CB %isits per =(arter nearly do(blin- &rom baseline. D(rin- this period there .as no si-ni&icant chan-e in the n(mber o& dischar-es per =(arter &rom the hospital. 9he total resident complement in the trainin- pro-ram .as constant d(rin- this st(dy period. 9he ne. dischar-e process clearly contrib(ted to -ains in residency clinic &ollo.2 (p care.

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.oncl'!ion: A comprehensi%e dischar-e process (sin- .ell desi-ned order sets, patient interacti%e a(tomated telephone technolo-y and an e&&icient appointment sched(lin- system can si-ni&icantly impro%e transition o& care in residency trainin- pro-rams.

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Ti%le: 3nternet 5se &or 0ral Health Dental Patients

elated 3n&ormation by Parents o& Pediatric

a*ni #in-h, D.D.#." #elene 4(n, D.D.#." N-o1i 5b(, D.D.#.,MPH" Pa(l ,ates, D.D.#.,MBA, Department o& Dentistry, Bron6 $ebanon Hospital, Bron6 N7 ?BGCH In%rod'c%ion: Parents are increasin-ly (sin- the 3nternet to obtain health related in&ormation. 5nderstandin- the impact o& parental 3nternet (se in relationship to dental treatment is (se&(l &or dentists and parents alike. 3t .ill help to establish practice models that (se internet reso(rces &or patient;parent ed(cation. 9he p(rpose o& this st(dy is to (?! meas(re the pre%alence o& internet (se to access oral health in&ormation by parents o& pediatric dental patients (8! 9o e6amine the e&&ects on (ser attit(des, and acti%ities .ith re-ard to 3nternet (se &or oral health2 related in&ormation" Me%0od!: #(r%ey o& parents o& pediatric dental patients .ho recei%e dental ser%ices at B$H+ pediatric dental clinic .as cond(cted. Data .as collected (sin- a =(estionnaire administered to a con%enience sample o& ?88 parents. Parents ret(rned completed &orm in a drop bo6. 9he st(dy .as cond(cted &rom J(ly 8B?> to #eptember 8B?>. Descripti%e analysis .as done (sin- co(nts and proportions. Re!'l%!: 9otal o& ?88 parents .ere incl(ded in the st(dy: ??F (K? J! had access to internet. A8 (HB J! (sed internet to access medical in&ormation. FC (CG J! (sed internet to access dental (oral health! in&ormation. #i6ty2 &o(r percent o& parent disc(sses in&ormation .ith their pediatric dentist to %eri&y acc(racy. AF J &elt that the in&ormation on the internet helped them disc(ss alternati%e treatments .ith their childEs pediatric dentist. AF J o& parents &elt that oral health in&ormation they &ind on the internet makes them more kno.led-eable. .oncl'!ion: Based on hi-h percenta-e o& parents that access internet &or oral health in&ormation, it is essential &or pediatric dentists to be prepared to o&&er s(--estions &or 4eb2based health reso(rces. Dentists sho(ld assist patients in e%al(atin- the =(ality o& dental in&ormation a%ailable on the 3nternet. Health pro&essionals sho(ld ed(cate the patients abo(t ac=(irin- health in&ormation online and pro%ide tools to na%i-ate to the hi-hest2=(ality in&ormation.

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Ti%le: 9he e&&ecti%eness o& the primary care based diabetes pro-ram at a &ederally =(ali&ied health center in the so(th Bron6. A'%0or6!7 Presented by: +rystal 'idal, (Medical st(dent!, Dr. +haitanya +handrala, M.D., +hie& esident, Dept. o& Medicine, Dr. 3saac Dapkins, M.D., Department o& Medicine, Bron6 $ebanon Hospital +enter. In%rod'c%ion: #o(th Bron6 has one o& the hi-hest pre%alence o& Diabetes mellit(s (DM! in Ne. 7ork +ity. Many patients in o(r clinics ha%e poorly controlled DM. 4e e%al(ated the impact o& a primary care based Diabetes #el& Mana-ement :d(cation (D#M:! pro-ram by dedicated +erti&ied Diabetic :d(cators in a (rban inner city FMH+ . Me%0od!: 3n Jan(ary 8B?8 .e implemented a system .ide primary care based diabetes ed(cation pro-ram. 9his pro-ram in%ol%ed primary care physicians and +erti&ied Diabetic ed(cators (+D:!. All patients .ith Diabetes .ere re&erred by primary care physicians to +D:. D#M: in%ol%es t.o dedicated sessions cond(cted by +D: per patient. 3n the &irst session patient is ed(cated abo(t diabetes, medications, diet and li&estyle chan-es and settin- (p sel& directed -oals. 3n the second session +D: assesses achie%ement o& sel& directed -oals and rein&orces diabetic ed(cation. Data is collected on all patients .ho completed the t.o sessions o& the pro-ram. Data incl(des HbA?c, BM3, BP and $D$ cholesterol. Re!'l%!: A total o& ?FG patients completed the pro-ram. HbA?c le%els obtained be&ore and a&ter D#M: sho.ed an a%era-e impro%ement &rom A.HJ to H.HJ. A paired t2 test e%al(ation sho.ed a p %al(e o& NB.BBB?. $D$ cholesterol le%els sho.ed a decrease by an a%era-e o& ?B m-;dl .ith a similar statistical si-ni&icance. BM3 and Blood press(re le%els did not sho. si-ni&icant chan-e. .oncl'!ion: 0(r st(dy s(--ests that primary care based diabetes ed(cation pro-ram .ith a dedicated +D: impro%es diabetes mana-ement in this (rban socioeconomic disad%anta-ed pop(lation. :&&orts m(st be made to enroll more patients into D#M: pro-ram. 9able ?: Lab Parameter #b$1C Number of patients Change after omp!eting program 164 %0.99 P "a!ue. 0.0001
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L&L 124 '() 266 *+sto!i 'P 257 &iasto!i 'P 257 Title: ,armers- (ar.et/ $ #i00en 1e2e!3

%10.58 0.20 0.98 %0.36

0.0037 0.22 0.43 0.62

A'%0or6!7 Fallon Andrea Mattis, M.D. (P,78!, Do(- eich, M.D. +hairman to the Departmet o& Family Medicine, Jose Dr. 9ib(rcio, M.D. (Pro-ram Director, Department o& Family Medicine! Bron6 $ebanon Hospital2 Family Medicine Introduction: ,armers4 mar.ets are opportunities for onsumers to bu+ pro0u ts5 parti u!ar!+ fruits an0 "egetab!es5 0ire t!+ from farmers. 6he !ini a! 7uestion pose0 for this pro8e t is the fo!!o2ing/ )f gi"en appropriate e0u ation5 2hat per entage of outpatient fami!+ me0i ine patients are !i.e!+ to "isit a farmers mar.et in this ommunit+3 Method: Literature resear h on the histor+9benefits of farmers mar.ets 2as 0one. $ pre% sur"e+ 2as 0e"e!ope0 in or0er to 0etermine 2hat proportion of fami!+ me0i ine !ini patients ha0 an un0erstan0ing of farmers4 mar.ets. $n e0u ationa! han0 out 2as a!so 0e"e!ope0 as an inter"entiona! too!. 6en patients 2ere ran0om!+ se!e te0 an0 gi"en the pre%sur"e+5 fo!!o2e0 b+ the han0out 2hi h the+ rea0. $ post sur"e+ 2as gi"en to ea h patient in or0er to assess 2hether the patient4s .no2!e0ge of farmers4 mar.ets in rease0 an0 ho2 !i.e!+ the patient 2ou!0 be to a tua!!+ atten0 this .in0 of mar.et. Results:

20

Conclusion: 1. 6he "ast ma8orit+ of the samp!e fami!+ me0i ine ,u!ton patients ha0 a reasonab!e un0erstan0ing of farmers mar.ets. 2. 6he "ast ma8orit+ of the samp!e fami!+ me0i ine ,u!ton patients be!ie"e0 that farmers mar.ets 2ere possib!+ usefu! to the ommunities an0 for themse!"es. 3. ,ift+ per ent of the patients 0i0 not .no2 that a !o a! farmers mar.et e:iste0 near 'ron: Lebanon #ospita!5 suggesting that a !a . of a2areness of these opportunities ma+ ontribute to its un0eruti!i;ation. 4. *e"ent+ per ent of the patients ha"e ne"er been to a farmers4 mar.et5 suggesting that its un0eruti!i;ation ma+ a tua!!+ be mu!tifa toria!. $!though man+ farmers mar.ets a ept <'6 ar0s5 hea!th bu .s5 an0 other means of pa+ment5 patients 2ho ha"e e:treme finan ia! 0iffi u!ties ma+ fin0 it 0iffi u!t to be a regu!ar farmers4 mar.et onsumer. $nother fa tor is reasonab!e a ess ="ia transportation> to a !o a! mar.et. 6hese fa tors an0 of ourse man+ more re7uire further in"estigation an0 resear h. 5. $fter appropriate e0u ation about these mar.ets5 there 2as a t2ent+ per ent in rease in the number of patients 2ho be!ie"e0 the+ 2ou!0 "isit a mar.et 2ithin the ne:t 12 months. 6his suggests that onsistent e0u ation might pro0u e a re!iab!e in rease in Pre-survey Questions &o +ou thin. farmers4 mar.ets are usefu! to the ommunit+3 &o +ou thin. farmer4s mar.ets are usefu! for +ou as the onsumer3 &o +ou .no2 that there is a 2ee.!+ farmer4s mar.et near 'ron: Lebanon hospita!3 #a"e +ou e"er been to a farmers4 mar.et3 Are you li(ely to visit ) *)rmer+s m)r(et within the ne,t ye)r- now th)t you h)ve more in.orm)tion )bout it/ 0duc)tion)l Intervention Post 1urvey Response &o +ou thin. farmers4 mar.ets are usefu! to the ommunit+3 &o +ou thin. farmer4s mar.ets are usefu! for +ou as the onsumer3 &o +ou .no2 that there is a 2ee.!+ farmer4s mar.et near 'ron: Lebanon hospita!3 #a"e +ou e"er been to a farmers4 mar.et3 Are you li(ely to visit ) *)rmer+s m)r(et within the ne,t ye)r- now th)t you h)ve more in.orm)tion )bout it/ Question Answer: Answer: No Number yes no Response 1 !" #!" !" # $ & % 1!!" %!" '!" '!" !" &!" $!" $!" !" 1!" !" !"

1 # $ & %

1!!" 1!!" '!" '!" 2!"

!" !" $!" $!" 1!"

!" !" !" !" !"

21

the per entage of fami!+ me0i ine patients 2ho be ome onsumers at farmers4 mar.ets.

Ti%le: #pirit(ality and Health A'%0or: :l2#heri&, Dana M.D., Department o& Family Medicine In%rod'c%ion: #pirit(ality can be de&ined as the .ay a person &inds meanin-, hope, com&ort, and inner peace in his or her li&e. #ome o& the spirit(al practices and belie&s ha%e a positi%e impact on a patientEs health. 0thers can ca(se harm, and illness. #t(dies ha%e &o(nd that incorporatin- spirit(ality .ith medical health pro%ide impro%ed =(ality o& care, and health mana-ement, and better patient satis&action. Me%0od: FB patients &rom the comm(nity o& Bron6 .ere asked to complete the F3+A tool and identi&y the aspects in their li%es that pro%ide spirit(al s(pport. 9hey .ere also asked to e6press their opinion on the a&&ect o& incorporatin- spirit(al assessment .ith health mana-ement.
22

F(rthermore &o(r Botonica mana-ers in the area o& Bron6 .ere pro%ided .ith ed(cation related to the dan-er o& (sin- merc(ry in spirit(al practices. Re!'l%!: ?BBJ o& the patients ans.ered yes .hen asked i& the spirit(al assessment can impro%e doctor patient relationship. A&ter disc(ssinthe F3+A tool .ith the patients .ho completed it, the patients a-reed that the tool can be (sed to help them reco-ni1e spirit(al and emotional challen-es that may be a&&ectin- their physical and mental health. 3n addition, participants a-reed that the F3+A tool can be (sed to aid doctors -ain a better (nderstandin- o& their patients, and to stren-then the tr(st bet.een them. All &o(r Botanica mana-ers .ho .ere pro%ided .ith ed(cation related to the dan-er o& (sin- merc(ry in spirit(al practices e6pressed %erbal (nderstandin-, and a-reed to stop enco(ra-in- merc(ry (se. .oncl'!ion: 3n the pop(lation o& Bron6, #pirit(ality plays an important element in the .ay patients &ace chronic illness, loss, and death. 3ncorporation o& the patientEs c(lt(ral identity, spirit(al belie&s, and practices to their health mana-ement lead to impro%ed =(ality o& care, and impro%ed patient satis&action. Ti%le: 0perati%e mana-ement o& h(-e pel%ic mass o& (nkno.n ori-in (preoperati%ely!. A'%0or6!7: Priya Prasad, M.D. 'ard(i Asiryan, M.D. 0ksana Pylypi%,M.D. $arry Ham, M.D. Patrick Anderson, M.D. Ma-dy Mikhail, M.D., +hairman and esidency Pro-ram Director, Dept. o& 0B;,7N2Bron6 $ebanon Hospital +enter In%rod'c%ion:

23

9o describe the mana-ement o& h(-e pel%ic mass o& (ndetermined ori-in. M,THOD: +ase report Re!'l%!: A GG year old -ra%ida F, para G2B282G presentin- .ith history o& rapidly enlar-in- abdominal -irth &or past three months, bilateral les.ellin- &or past one month, &ati-(e, di&&ic(lty breathin- and sleepin-, .as admitted to ++5. #he had normal menstr(al cycles .ith history o& sterili1ation. #he had history o& &ibroid (ter(s and one year back, .as told she had a small clementine si1ed &ibroid. 0n physical e6amination, an abdominal mass abo(t >H2>A .eeks o& -estation in si1e and non2tender, .as noted. 0n pel%ic e6amination, cer%i6 .as normal and ori-in o& mass co(ld not be delineated. 9(mor markers .ere all normal e6cept +A ?8C, .hich .as ?>F.>. +9 scan sho.ed lar-e abdominopel%ic mass >G 6 8? 6 8Kcms .ith o%aries not .ell %is(ali1ed, moderate to lar-e pericardial e&&(sion .ith no ple(ral e&&(sion. :*ection &raction on echocardio-ram .as FA.?? J. +9 chest .ith contrast indicated pericardial e&&(sion s(--esti%e o& an in&lammatory process. 0n the day o& e6ploratory laparotomy, (.ith s(r-ical team and cardiothoracic s(r-eon on stand2by!, appro6imately >C cms pel%ic mass .as &o(nd attached to posterior .all o& an enlar-ed (ter(s by a thick stalk. 9otal abdominal hysterectomy .as per&ormed a&ter &ro1en section sho.ed spindle cell neoplasm, likely beni-n. Final patholo-y report sho.ed ne-ati%e peritoneal cytolo-y &or mali-nant cells, (ter(s .ei-hin- KG8B -rams .ith the lar-est s(bserosal &ibroid >C 6 886 ?8cms .ith e6tensi%e edema cystic de-eneration and m(ltiple other &ibroids. Postoperati%e period .as (ne%ent&(l .ith pericardial e&&(sion decreasin- by post2 operati%e day three. .oncl'!ion: A beni-n &ibroid (ter(s can mimic mali-nancy, .hich can lead to cardiorespiratory symptoms .ith rapid enlar-ement. Fro1en section is instr(mental in decidin- the co(rse o& mana-ement in s(ch cases.

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Ti%le: Pre%alence o& Deliri(m in Medical Patients re&erred to Psychosomatic Medicine +ons(ltation #er%ice. A'%0or!: Maria M. Pere12+oste, M.D., 'ictori Pa1 , M.D., 'icente Jose $i1 De&illo, M.D., )etank(mar Bodarya, M.D. +onnie +han, M.D., < Ali )hadi%i, Ph.D., Department o& Psychiatry, Di%ision o& Psychosomatic 2Presenter: Marie M. Pere12+oste, M.D. (Attendin- ! In%rod'c%ion: Deliri(m is a &re=(ent complication seen in medical settin-s, and can o&ten be missed or misinterpreted by the medical team as a psychiatric disorder. A mistaken dia-nosis potentially can prolon- and e6acerbate the symptoms o& deliri(m. Fe. st(dies ha%e e6amined the pre%alence o& deliri(m in patients .ho ha%e been re&erred &or psychiatric cons(ltation. 9he -oal o& the st(dy .as to e6amine the rate o& misidenti&ication o& deliri(m by comparin- the initial reason &or cons(ltation to the &inal o(tcome o& cons(ltation. Me%0od: 9he st(dy is 3 B appro%ed and is desi-ned as a retrospecti%e +hart e%ie. st(dy that incl(des all ad(lt patients admitted to Bron62 $ebanon Hospital +enter, ,rand +onco(rse Medical Di%ision, in the period o& #eptember 8B??2May 8B?8. 9he st(dy incl(ded patients .ho are assessed by the Psychosomatic Medicine #er%ice d(rin- the st(dy period. 9he reason &or cons(ltation is compared to the o(tcome o& psychosomatic cons(lt. 9he patients are selected &rom a lo- o& all psychosomatic cons(lts ordered. A sample o& ??A s(b*ects .ere selected based on po.er analysis. 3n additon to the demo-raphic %ariables, the st(dy e6amined the reason &or cons(lt, psychiatric dia-noses, medical problems, s(bstance ab(se, and the &inal dia-nosis by psychosomatic medicine. Re!'l%!: 9he res(lts indicate that GKJ o& the sample .ere male, and C?J .ere &emale. Most o& the re&errals to Psychosomatic Medicine +ons(ltation #er%ice came &rom Medicine (CKJ!. More than hal& the sample (CFJ! had a posti%e (rine to6icolo-y. 9he patients .ere re&erred to psychosomatic ser%ice &or a %ariety o& psychiatric reasons" ho.e%er, only H.FJ o& the intial reasons &or cons(lt .ere &or altered mental stat(s. None o& the initial re&errals to psychosomatic medicine ser%ice
25

.ere beca(se o& deliri(m 9he psychosomatic cons(ltation ser%ice dia-nosed 8FJ o& the sample as ha%in- deliri(m. .oncl'!ion: Misidenti&ication o& deliri(m in medically ill patients re&erred &or psychiatric cons(ltation is common. eser%ed &or n(rsinTi%le: 9he :&&ects o& N(rsesE +(lt(ral +ompetency (pon Patient #atis&action A'%0or: #ally Francisco, M#N, N, ABD (:dD! :d(cation Mana-er, Department o& N(rsin- :d(cation < esearch, Patient +are #er%ices In%rod'c%ion: Describe a research st(dy that looked at correlation bet.een the sta&& n(rsesE c(lt(ral competency and patient satis&action in the (F! medical2 s(r-ical (nits o& B$H+. Me%0od: 9he researcher meas(red the c(lt(ral competency o& sta&& n(rses and analy1e the res(lts side2by2side the H+AHP# scores ??A o(t o& ?AB n(rses participated. 9he 9ransc(lt(ral #el&2:&&icacy 9ool or 9#:9 (Je&&reys, 8BBFa" Je&&reys, 8BBFb" < Je&&reys, 8B?B! .as (sed to meas(re the n(rsesE c(lt(ral competency. 9#:9 .as (ploaded in the intranet. ecr(itment &lyers .ere posted on (nits and recr(itment letters .ere distrib(ted d(rin- chan-e o& shi&ts. B$H+ 8B?8 H+AHP# scores (Hospital +are M(ality 3n&ormation &rom the +ons(mer Perspecti%e, 8B?B! .ere (sed to identi&y correlations. Re!'l%!: es(lts sho.ed di&&erences in c(lt(ral competency related to a-e, n(mber o& years .orked in B$H+, and -ender. 9here .ere se%eral c(lt(ral competency statements that .ere predictors o& increased in patient satis&action scores. 9he res(lts .ere s(bmitted to Dr. Fr(menti, 'P;+N0 and Dr. )(rt1, Director o& :d(cation. 9he res(lts .ill be (sed to desi-n a c(lt(ral competency pro-ram &or the sta&& n(rses. 9his can also assist the hospital in lookin- at one &actor that may or may not a&&ect the patient satis&action scores. Re&erence! Hospital +are M(ality 3n&ormation &rom the +ons(mer Perspecti%e. (8B?B!. Ne.s and notes &rom the H+AHP# pro*ect team. Hospital care =(ality in&ormation &rom the cons(mer perspecti%e. etrie%ed &rom http:;;....hcahpsonline.or-;e6ec(ti%eOinsi-ht;. Je&&reys, M. . (8BBFa!. 9eachin- c(lt(ral competence in n(rsin- and health care. Ne. 7ork, N7: #prin-er. Je&&reys, M. (8BBFb, Febr(ary;March!. +(lt(ral competence in clinical practice. N#NA 3mprint, 3, >H2G?.
26

Je&&reys, M. . (8B?B!. 9he c(lt(ral competence ed(cation reso(rce toolkit. Ne. 7ork, N7: #prin-er.

Ti%le: A Patient :%ent Diary 3mpro%es #el&2Mana-ement in Pediatric #ickle +ell Disease Patients A'%0or6!7 Jenni&er B(sse, +.N.P., M.P.H., )ranthi N #eelaboyina, M.B.B.#., ,race Malon-a, M.P.H. and 9homas Mo(lton, M.D. Department o& Pediatrics Promotion o& chronic illness sel&2mana-ement is cr(cial to impro%e o(tcomes o& children .ith sickle cell disease (#+D!. 9hro(-h the (se o& an e%ent diary, o(r pediatric #+D patients are able to track si-ni&icant health e%ents and health care appointments. 9his st(dy seeks to %alidate the e&&ecti%eness o& the patient e%ent diary as a tool &or impro%ement in sel& mana-ement, allo.in- &or impro%ement in medication and clinic compliance, as .ell as in a red(ction in n(mber o& emer-ency room %isits. Me%0od: 0(r sample incl(ded a pop(lation o& GF sickle cell disease patients a-ed B to 8?. 4e assessed patientsE medication compliance on %itamin D and hydro6y(rea thro(-h 8C2hydro6y%itamin D (8C20HD! and M+' (mean corp(sc(lar %ol(me! le%els, respecti%ely. Re!'l%!: 8C20HD data sho.ed si-ni&icantly impro%ed compliance .ith %itamin D treatment (M L GH, #D L 8B! as compared to be&ore recei%in- the e%ent diary (M L 8F, #D L ?C, p N B.BC!. 9here .as a statistically si-ni&icant impro%ement in M+' le%els a&ter recei%in- the e%ent diary (ML?B?.F, #DLK.F!, as opposed to be&ore (MLKH.H, #DLC.F, pNB.BC!. 9here .as an impro%ement in appointment compliance, ho.e%er not statistically si-ni&icant, bet.een one year be&ore (ML>>.>J, #DLG?.HJ! and one year a&ter patients recei%ed the diary (ML 8H.8J, #DL>B.>J, pLB.8!. :mer-ency department %isits did decrease be&ore recei%in- the e%ent diary (ML?.A, #DL8.C! to one year a&ter (ML ?.>, #DL?.K, pLB.?H!. .oncl'!ion: 9hese data s(--est the patient e%ent diary has si-ni&icantly impro%ed patient sel&2mana-ement. 4e belie%e this e&&ect is thro(-h enhanced (nderstandin- o& disease processes and increased
27

con&idence and skills in sel&2mana-ement. 3n the &(t(re, .e hope to see that .ith impro%ed patient kno.led-e o& sickle cell disease and sel&2mana-ement &acilitated by (se o& the e%ent diary, there .ill be si-ni&icantly &e.er emer-ency room %isits, &e.er hospital admissions, and most important, impro%ed =(ality o& li&e.

Ti%le: Factors predictin- 3nternational Medical ,rad(ates Pediatric Board +erti&ication Pass ates A'%0or6!7 #(dershan #(bedi, .MD., 7(sra )han, M.D., Jessica +al%o, M.D., Jessica Berrios, M3#, Fernando Matos, #te&an Ha-mann, M.D .M#c, ichard Ne(-eba(er, Ph.D, Ayoade Adeniyi, M.D. In%rod'c%ion: 0& >,BBB pediatric residents takin- the the American Board o& Pediatrics (ABP! certi&ication e6am each year ?AJ are international medical -rad(ates (3M,s!. Pro-ram directors &ace the challen-e o& selectin- candidates that are most likely to pass the ABP e6am &rom a .ide array o& applicants .ith di%erse academic back-ro(nds. 9he aim o& st(dy is to identi&y the demo-raphic and ed(cational &actors that in&l(ence board pass rates on &irst attempt. Me%0od!: Bron62$ebanon Hospital +enter (B$H+! is a lar-e comm(nity teachinhospital ser%in- the #o(th2+entral Bron6. 9he pediatric residency pro-ram -rad(ates ?C residents ann(ally, e6cl(si%ely 3M,s. Demo-raphic and academic records o& ?CH trainees .ho -rad(ated bet.een 8BBB28B?? .ere re%ie.ed. Re!'l%!: A total o& ?>C trainees -rad(ated .ith a%ailable board e6am res(lts (HF.>J passed on &irst attempt!. Abo(t hal& .ere &emales (C>J! .ith a mean a-e (#D! o& >8y (H!, CKJ .ere &rom Asia, CKJ had H?B %isa, and FFJ had prior post2-rad(ate trainin-. Amon- demo-raphic %ariables, only re-ion o& ori-in (:(rope, ?BBJ" A&rica, ACJ" Asia, H8J" $atin America, >>J" pLB.BB>! and %isa stat(s (H?B, ABJ " ,reen card, HCJ" J?,H>J" American citi1ens, BJ" 0ther, K8J" pNB.BB?! .ere si-ni&icant predictors. Marital stat(s had borderline si-ni&icance (married, A8J" sin-les, FAJ" pLB.BFF!.
28

F(rther, there .as si-ni&icant linear association .ith risin- 5#M$: #tep ? and 8 scores and ABP2e6am pass rates (pLB.B8A! b(t not .ith 5#M$: > (pLB.8G8!. $ike.ise, there .as si-ni&icant linear correlation .ith risin- 39: e6am scores and ABP2e6am pass rates (pNB.BBC!. .oncl'!ion!: Per&ormance on 5#M$: #tep ? and 8, and 39: e6am res(lts ha%e stron- predicti%e %al(es &or ABP2e6am s(ccess. Additional m(lti%ariate analysis .ill be done to e%al(ate to &(rther in%esti-ate the role o& demo-raphic &actors.

Ti%le: 4ed-e esection %ers(s $obectomy &or #ta-e ?A Non2#mall +ell $(n+ancer (N#+$+! in the elderly: A #(r%eillance, :pidemiolo-y and :nd es(lts (#:: ! Database analysis. A'%0or!: Presented by: #yed a1i, Mohan Mathe. John, #andeep #ainathan, +hristos #ta%ropo(los In%rod'c%ion: 9here is limited data a%ailable re-ardin- the lon-2term o(tcomes o& l(n- resection &or non2small cell l(n- cancer (N#+$+! in the elderly pop(lation (PHC years!. 4e in%esti-ated the pro-nostic si-ni&icance o& .ed-e resection %ers(s lobectomy in this -ro(p o& patients .ith sta-e 3A N#+$+ (sin- the #:: database. Me%0od!: 9he #:: database .as =(eried &or patients PHC years o& a-e .ho .ere dia-nosed .ith sta-e 3A s=(amo(s cell carcinoma and adenocarcinoma o& the l(n- &rom ?KKA to 8BBC. 0%erall and cancer2 speci&ic s(r%i%al rates .ere calc(lated and compared. Re!'l%!: A total o& ?GB? patients PHC years o& a-e .ith sta-e 3A N#+$+ .ere analy1ed. $obectomy .as per&ormed in ?BBB patients, and GB? patients (nder.ent .ed-e resection. A-e, &emale -ender, black race and poorly di&&erentiated t(mors .ere &o(nd to be independent ne-ati%e predictors o& o%erall s(r%i%al. 9he o%erall s(r%i%al .as lo.er in the .ed-e resection -ro(p (H ?.>H, +3 ?.B82?.CH, pNB.BC!. Ho.e%er,

29

there .as no si-ni&icant di&&erence in cancer2speci&ic s(r%i%al bet.een the t.o -ro(ps (H ?.?>, +3 B.K>2?.>H, pLB.8?!. .oncl'!ion!: 4ed-e resection is not in&erior to lobectomy &or sta-e 3A N#+$+ in the elderly, and sho(ld be considered a %iable alternati%e in this hi-h2risk pop(lation.

Ti%le: 3nd(ction o& labor at G? .eeks o& pre-nancy amon- primiparas .ith an (n&a%orable Bishop score A'%0or6!7 ,(illermo A Marro=(in M.D, Nicolae 9(dorica M.D., MD +arolyn M #ala&ia M.#., obert Hecht M.D., Ma-dy Mikhail M.D. , +hairman and Pro-ram Director, Department o& 0bstetrics and ,ynecolo-y2Bron6 $ebanon Hospital +enter, Bron6, Ne. 7ork. In%rod'c%ion: 3nd(ction o& labor (30$! is one o& the most commonly per&ormed obstetrical proced(res in the 5nited #tates and re&ers to the iatro-enic stim(lation o& (terine contractions be&ore the onset o& spontaneo(s labor to accomplish %a-inal deli%ery. QAn (n&a%orable cer%i6 is de&ined by A+0, as a Bishop score o& F or less Q8R. 3n o(r instit(tion is o&&ered to the patients at G? .eeks o& -estational a-e to a%oid (ndesirable o(tcomes &rom a prolon-ed pre-nancy. 9he modi&ied Bishop score is based on the station o& the presentin30

part and &o(r characteristics o& the cer%i6: dilation, e&&acement, consistency, and position. 3& the Bishop score is hi-h, the likelihood o& %a-inal deli%ery is similar .hether labor is spontaneo(s or ind(ced. 3n contrast, a lo. Bishop score is predicti%e that ind(ction .ill &ail and res(lt in cesarean deli%ery. 9hese relationships are partic(larly stronin n(lliparo(s .omen .ho (nder-o ind(ction. Me%0od!: 9his .as a retrospecti%e analysis that incl(ded n(lliparo(s patients .ho presented to the $abor and Deli%ery (nit at the Bron6 $ebanon Hospital +enter bet.een 8B?? and 8B?8 &or electi%e 30$ at G? .eeks o& ,A. 9he Bishop score .as assessed (pon admission and 30$ a-ents .ere (sed in compliance .ith A+0, -(idelines in di&&erent combinations, based on the obstetrical team pre&erence. Re!'l%!: 9he o%erall s(ccess&(l rate .as C?.>8J. Factors associated .ith s(ccess&(l 30$ .ere yo(n-er a-e Q88.> years %s. 8C.?(pLB.B?C!R, lo.er BM3 Q8C %s. 8A.?(pLB.GF!R and lo.er maternal .ei-ht QFG.HCk- %s. HG.B8 (pLB.8A!R. Maternal hei-ht .as not a contrib(tin- &actor" the arti&icial r(pt(re o& membranes, epid(ral anesthesia and the prosta-landins (sed did not contrib(te. 5se o& cer%ical balloon and o6ytocin .as associated .ith &ailed 30$. .oncl'!ion!: Patients (nder-oin- 30$ at G? .eeks .ith an (n&a%orable cer%i6 had a s(ccess&(l rate o& C?.>8J. Maternal a-e, .ei-ht, and BM3 .ere associated .ith s(ccess&(l 30$. Re&erence!: ?. ,abbe # , Niebyl J , ,alan H , Ja(nia(6 : , $andon M, #impson J, et al. 0bstetrics: Normal and Problem Pre-nancies. Fth ed. Philadelphia, PA: #a(nders :lse%ier" c8B?8. +hapter ?G, Abnormal $abor and 3nd(ction o& labor" p. 8AH2>?B. 8. American +olle-e o& 0bstetricians and ,ynecolo-ists: 3nd(ction o& $abor. Practice B(lletin n(mber ?BH, A(-(st 8BBK. >. Martin JA, Hamilton B:, #(tton PD, 'ent(ra #J, Menacker F, )irmeyer # and 9J. Mathe.s, M.#., et al. Di%ision o& 'ital #tatistics Births: &inal data &or 8BBF. Natl 'ital #tat ep 8BBK"CH:?D?B8.
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G. +alder AA, Brennand J:: $abor and normal deli%ery: ind(ction o& labor. +(rr 0pin 0bstet ,ynecol ?KK?" >:HFG. C. Senakis :M, Piper JM, +on.ay D$, $an-er 0: 3nd(ction o& labor in the nineties: con=(erin- the (n&a%orable cer%i6. 0bstet ,ynecol ?KKH" KB:8>C. F. Johnson DP, Da%is N , Bro.n AJ: isk o& cesarean deli%ery a&ter ind(ction at term in n(lliparo(s .omen .ith an (n&a%orable cer%i6. Am J 0bstet ,ynecol 8BB>" ?AA:?CFC. H. 'ro(enraets FP, o(men FJ, Dehin- +J, et al: Bishop score and risk o& cesarean deli%ery a&ter ind(ction o& labor in n(lliparo(s .omen. 0bstet ,ynecol 8BBC" ?BC:FKB TA/L, 1" Pa%ien% Demograp0ic! 5aginal deli5er( and no 5aginal deli5er( 'a-inal deli%ery Mean No #D N Mean 7es #D N #i-ni&icanc e B.CB B.>C

Bishop score 8.AK ?.K> 8.CF 8.8F Hei-ht in ?.F8 B.BA ?.F? B.BF meters /MI )8"+8 ="5= )5"+1 5"5) +"+5 Ma%ernal age )5"18 5"1B ))"22 8";2 +"+) in (ear! >H.B >K.B B B Ma%ernal =8"+) )+"=1 ;8"=5 15"+8 +"+2 Weig0% in 9g Neonatal >CBA.> G?>.K >>BC.8 FCC.F B.?? 4ei-ht in B A B C 30$ d(ration ?.BH B.C8 B.KA B.CG B.GH (days! Ti%le: Hypertension :&&ect on $e&t 'entric(lar emodelin- and #ystolic F(nction is ,reater in A&rican2American than in +aribbean2Hispanic Ad(lts A'%0or6!7 ichard Peralta, M.D., )aromibal Me*ia, M.D., , H(ssein #ha=ra, M.D., FA++, Jonathan N. Bella, M.D., FA++, Bron6 $ebanon Hospital +enter, Bron6, N7 In%rod'c%ion:

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9here are no st(dies comparin- the e&&ect o& hypertension on $' remodelin- and systolic &(nction bet.een +aribbean2Hispanics (+H! and A&rican2Americans (AA!. 0(r ob*ecti%e identi&y hypertension e&&ect on le&t %entric(lar ($'! remodelin- and systolic &(nction in hypertensi%e (H9! +H and AA ad(lts. Me%0od!: Accordin-ly, echocardio-rams .ere per&ormed in ?GG +H (GF J men, mean a-eLCF years QKCJ +3, C82 FBR!, mean BM3 (8A.> k-;m 8, QKCJ +3, 8C.?2 >?.GR! and ?>H AA (GA J men, mean a-eLCK years QKCJ +3, CC2 F8R!, mean BM3 (8F k-;m8 QKCJ +3, 8G.C28H.FR! patients consec(ti%ely. Re!'l%!: A&ter ad*(stin- &or a-e and se6, and BM3 relati%e .all thickness (B.G8 QKCJ +3: B.G?2B.GGR!, (B.>K QKCJ +3: B.>A2B.GAR, (pLB.B8! .ere sli-htly b(t statistically si-ni&icantly hi-her in +H normotensi%e (N9! compared to AA N9 respecti%ely. $' &ractional shortenin- (>C QKCJ +3: >?2>AR!, (>> QKCJ +3: >B2>FR!" :*ection &raction (CH QKCJ +3: CB2FGR!, (CG QKCJ +3: GC2FGR" and mitral :;A atio (?.8 QKCJ +3: ?.?2?.GR!, (?.? QKCJ +3: ?2 ?.>R .ere similar in +H and AA N9 respecti%ely. :;eE atio, a meas(re o& $' &illin- press(re, .as sli-htly b(t statistically si-ni&icantly hi-her +H N9 (K.> QKCJ +3: A2??R! than in AA N9 (A.F QKCJ +3: A2?BR (pNB.BB?!. Ho.e%er, the ma-nit(de o& increase in $' mass (8GK QKCJ +3: 8>>2 8F>R!, 8>C QKCJ +3: 88828GHR!" :;eE (?8.C QKCJ +3: ??2?GR!, (??.C QKCJ +3 ?B2?>R!" and relati%e .all thickness (B.GF QKCJ +3: B.GG2B.GHR!, (B.G> QKCJ +3: B.G82B.GCR! associated .ith H9 .as -reater in AA than +H respecti%ely (pLB.BB>!. .oncl'!ion!: H9N e&&ect on $' remodelin- and diastolic &(nction is -reater in AA H9 than +H H9. 9hese echocardio-raphic di&&erences may be (sed to &(rther risk2strati&y AA and +H H9 nonin%asi%ely.

Ti%le: +orrelation bet.een hemo-lobin A+?+ 'al(es and se%erity o& +oronary artery disease. A'%0or6!7 Maryam A&shar, M.D,. Aisha #ira*, M.D., Mano* Bhandari, M.D., Harish Patel, M.D., +hase +eleb, MPH, Narendra Balodkar, M.D., Dr. #ridhar #.
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+hilim(ri, M.D., Physician23n2 +hie&, +hairman, Department o& Medicine , Pro-ram Director, 3nternal Medicine esidency Pro-ram Bron62$ebanon Hospital +enter, Bron6, Ne. 7ork, ?BGCH O3:ec%i5e: 0(r ob*ecti%e is to st(dy the correlation bet.een hemo-lobin A?+ (HbA?+! %al(es and se%erity o& +oronary artery disease (+AD! on coronary an-io-raphy amon- patient .ho ha%e 9ransient ischemic dilatation (93D! on their myocardial per&(sion ima-es in an inner city pop(lation. /ac gro'nd: DM increases the risk o& de%elopin- cardio%asc(lar disease and is considered as +AD e=(i%alent. Atherosclerotic +AD claims many li%es in this pop(lation. 0ne .ay to assess the control o& DM is by meas(rinHbA?+ le%el. 3t is kno.n that DM can impair s(bendocardial per&(sion, .hich can in t(rn ca(se 93D on #P:+9 ima-in-. 93D has been %alidated to be a marker &or e6tensi%e and se%ere +AD.93D ratio is -enerated (sin- an a(tomated comp(ter so&t.are and a ratio o& T ?.8 is considered abnormal. Me%0od!: A retrospecti%e analysis o& patients re&erred &or e6ercise or %asodilation n(clear stress testin- &rom 8BBH to 8B?B .as cond(cted. 93D .as &o(nd in ?FA patients. 0& these ?FA patients, ?B8 (nder.ent coronary an-io-raphy and .ere incl(ded in o(r st(dy" FA patients .ere diabetic and >G .ere non diabetics. 4e then compared three -ro(ps (non2 diabetics, diabetics .ith HbA?c NH, and PH! based on their HbA?+ done .ithin F months o& their myocardial per&(sion scan. #i-ni&icant +AD .as de&ined as presence o& T CBJ $e&t main coronary artery or THBJ stenosis in any other ma*or %essel on coronary an-io-raphy. 4e did not e%al(ate other risk &actors &or de%elopment o& +AD. Re!'l%!: 9he mean a-e .as FC.B?U ??.B> years, GAJ male, CGJ Hispanics and 8AJ non2Hispanics and ?8J .ere others. 9he mean $':F .as C>.FHU??.8>, HFJ (nder.ent pharmacolo-ical stress test and 8GJ e6ercise stress testin-. Patients in the ele%ated HbA?c (PH! -ro(p had the hi-hest incidence o& obstr(cti%e +AD (nLC8;CK!. 3n patients .ith controlled HbA?c (NH! only ? o& K patients and in non2diabetics A o& >G patients had si-ni&icant +AD. 9his .as statistically si-ni&icant (p L B.BBF! (sin- )r(skal24allis test. .oncl'!ion: 3n o(r inner city pop(lation, patients .ith DM and 9ransient ischemic dilation on myocardial per&(sion ima-es, HbA?+ is not only a -a(-e o& diabetic control b(t also predictor o& se%erity Ti%le:
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+omparison o& :arly %ers(s $ate 9racheotomy in an 3nner +ity Medical 3ntensi%e +are 5nit A'%0or6!7 N(p(r #inha M.D., 3*a1 Mohsin M.D., #indha-hatta 'enkatram M.D. F++P, ,ilda Dia12F(entes M.D. F++P. Department o& 3nternal Medicine, P(lmonary Di%ision In%rod'c%ion: 9racheotomy is per&ormed to replace the endotracheal t(be in patients needin- prolon-ed mechanical %entilation (M'!. #t(dies ha%e compared early %ers(s late tracheotomy in a %ariety o& clinical settin-s. 9here is no clear consens(s re-ardin- the de&inition o& Vearly tracheotomyW. Most o& the o(tcomes reported ha%e (sed F2?B days as a c(t2o&& o& early tracheotomy in medical 3+5. 9racheotomy practices in an inner2city 3+5Es are still lar-ely (nkno.n. 9he aim o& o(r st(dy .as to characteri1e the patients and compare the o(tcomes o& early %ers(s late tracheotomy in o(r 3+5 settin-. Me%0od!: etrospecti%e re%ie. o& patients admitted to M3+5 that (nder.ent tracheotomy &rom Jan(ary 8BBK to Jan(ary 8B?>. Demo-raphics, select laboratory parameters, and reasons &or initiatin- M' .ere analy1ed. :arly tracheotomy .as de&ined as tracheotomy per&ormed XH days a&ter initiatin- M'. Patients .ere classi&ied in t.o -ro(ps: :arly tracheotomy (XH days! and late tracheotomy -ro(p (P H days!. Primary end points o& the st(dy .ere 3+5 len-th o& stay ($0#! and hospital mortality. #econdary end points incl(ded hospital $0#, percenta-e .eaned and immediate tracheotomy related complications. Re!'l%!: A total o& FFB tracheotomies .ere per&ormed d(rin- the st(dy period. CG electi%e tracheotomies per&ormed on the day o& admission .ere e6cl(ded. 0& the remainin- FBF, ?>H (88.FJ! .ere early and GFK (HH.GJ! .ere delayed tracheotomies. 9here .as no di&&erence in demo-raphic characteristics o& patients and reasons &or initiatin- M'
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bet.een 8 -ro(ps (9able ?!. 3+5 $0# .as lo.er in the early tracheotomy -ro(p (K.HUH.B %s ?H.GU?8.G" pLN B.BBB?!, and so .as hospital $0# (>F.G U >>.C %s. GG.FU 8A.A!. 9here .as no di&&erence in other o(tcomes (9able ?!. .oncl'!ion!: 3n o(r M3+5 pop(lation, early tracheotomy si-ni&icantly decreases 3+5 $0# as .ell as hospital $0#. Ho.e%er timin- o& tracheotomy has no impact on mortality, complications, and .eanin- rate. 3n e&&ect, early tracheotomy allo.s better (tili1ation o& 3+5 and healthcare reso(rces .itho(t a&&ectin- patient o(tcome. 3le 1
,arl( Trac0eo%om( 6 F = da(!7 nG12= La%e Trac0eo%om( 6 H = da(!7 nG8;B P Dal'e

B5I .I

Demograp0ic! and Selec%ed /a!eline .0arac%eri!%ic! Age Gender Male I ,%0nici%( A&rican American! Hi!panic! O%0er! Smo erJ,1 !mo er S'3!%ance a3'!e Weig0% Ser'm .rea%inine Al3'min Hemoglo3in F8.CU ?G.G HG (CGJ! FC CA ?G FA (CBJ! >H (8HJ! ?BH.? U A>.F 8.B U ?.K >.B U B.A ?B.C U ?.K F>.> U ?G.> 8G8 (C8J! 8BA 8B> CA 8CC (CGJ! ?HC (>HJ! ?BG.H U C?.F 8.8 U 8.C 8.K U B.K ??.G U ?.F B.CFCG B.F8AG B.CCAC B.K8?K B.CC?? B.>>8G B.B>88 B.FA8? B.>AFK B.8G?F B.BBB? 2K.?BH to ?>.KBH 2B.FCG to B.8CG 2B.BFA to B.8FA 2?.8?K to 2B.CA? 2>.C>> to ?.K>>

Rea!on! &or In%'3a%ion AirAa( pro%ec%ion .ardiac arre!% T(pe I C II Re!pira%or( #ail're T(pe ID Re!pira%or( #ail're O%0er! ?C C KK K K 8F ?A >8A CH GB B.B>>> ?.BBBB B.FHBC B.BAC? B.CK>?

Primar( and Secondar( o'%come! Da(! on mec0anical 5en%ila%ion 3e&ore %rac0eo%om( 6mean7 N B.BBB? 2?B.>B? to 2H.FKK 36

C.? U ?.F

?G.B U H.H

I.< LOS Ho!pi%al LOS Mor%ali%( Immedia%e %rac0eo%om( complica%ion! Weaned o& 5en%ila%or Decan'la%ion

K.H U H.B >F.G U >>.C C?(>HJ! ? (>.>J! ?> (K.C J! ?> (K.CJ!

?H.GU ?8.G GG.FU 8A.A ?FG(>CJ! > (>J! GH (?B.?J! G> (KJ!

N B.BBB? B.BBGK B.FAGK ?.B ?.BBBB B.AFA8

2K.AHH to 2C.C8> 2?>.KBK to 28.GK?

Ti%le: 5nderrepresented Minority Dentist in the 5nited #tates 8B?> A'%0or6!7 :li1abeth Mert1, Ph.D., MA?, +ynthia 4ides, M.A.8, Ale6is +ooke, M.P.H.8, Pa(l ,ates, D.D.#., M.B.A.> ?. Assistant Pro&essor in esidence, Pre%enti%e and estorati%e Dental #ciences, +enter &or the Health Pro&essions, 5+#F #chool o& Dentistry. 8. esearch Analyst, Pre%enti%e and estorati%e Dental #ciences, +enter &or the Health Pro&essions, 5+#F #chool o& Dentistry. >. +hairman, Bron6 $ebanon Hospital +enter Dental Department /ac gro'nd: 3n dentistry, A&rican Americans (AA!, Hispanic;$atinos (H;$!, and American 3ndian;Alaska Nati%es (A3;AN! are historically (nderrepresented. Despite n(mero(s initiati%es o%er the last decade addressin- the c(lt(ral competence o& dentists and di%ersi&yin- the pro&ession, o(tcome data remains scarce. 9he n(mber o& minority pro%iders remains si-ni&icantly belo. parity. 0(r -oal .as to assess the o(tcomes o& e&&orts to impro%e the dental .ork&orce di%ersity and their relationship to impro%ements in access to care and red(ctions in oral health disparities. Me%0od!: A strati&ied sample s(r%ey o& licensed 5 M dentists in the 5nited #tates .as cond(cted bet.een K;8B?8 and >;8B?>. An e6pert ad%isory committee in&ormed s(r%ey de%elopment. esearchers partnered .ith the National Dental Association, Hispanic Dental Association, #ociety o& American 3ndian Dentists and the American Dental :d(cation Association &or o(treach. Foc(s -ro(ps .ith minority dentists .ere completed prior to s(r%ey de%elopment. 9he s(r%ey .as piloted .ith F pro%iders, 8 &rom each racial;ethnic -ro(p, (sin- the online and hard copy %ersions. Final s(r%ey .as ?8 pa-es, A sections, and appro6imately ?CB =(estions. 9he sample .as CBHA pro%iders. Re!'l%!:

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9he American Dental Association Master&ile incl(ded ?8,KA> 5 M pro%iders listed as ha%in- a 5# address and an acti%e license" GH? A3;AN, FCAF AA, and CK8F H;$ dentists, appro6imately HJ o& the total dentist .ork&orce. 0(r o(treach identi&ied FK8 indi%id(als ineli-ible .ith ?G not located in the 5#, ?K deceased, >K retired;(nlicensed, 8FF non25 M, or >8? not located. 9his rendered o(r sample at G>AK .ith a >GJ response rate. 5 M dentists are more likely to see racially concordant patients: G8J o& AA dentistsY patients are AA" ?HJ o& A3;AN dentistsY patients are A3;AN" and >FJ H;$ dentistsY patients are H;$. .oncl'!ion!: 5 M dentists represent a small proportion o& the dental .ork&orce" these pro%iders see a disproportionate n(mber o& 5 M patients compared to the o%erall pop(lation and to their peers.

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