Faculty Bibliography

Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.

Program/Project Purpose: Although, the internist plays a central role in the hospital, as the coordinator of interdisciplinary diagnostic and therapeutic care, they may function differently in different parts of the world. This project aims to compare the general structure of internal medicine clinical services at hospitals in USA and Turkey. Structure/Method/Design: The study was conducted in Koc University Hospital in Istanbul, Turkey, and Bellevue Hospital in New York, USA, in 2015, by trainees participating in an academic exchange. At Bellevue Hospital, approximately 80% of internal medicine beds are managed by internal medicine attendings and hospitalists. In United States (US), general internists provide comprehensive and organized care for both acute and chronic diseases. In comparison, in Koc University Hospital, Istanbul, all internal medicine beds are managed by nine different subspecialties, with general internal medicine as its own subspecialty, and not a primary hospitalist team. Outcome and Evaluation: In New York, once the patient is admitted and stabilized, the primary hospitalist teams provide medical care. Thereafter, the primary internist team may request a subspecialty consult considering medical condition of the patient. On the other hand, in Istanbul, transfer of patients are triaged from the first point of contact to subspecialty service that is related to their medical condition. This subspecialty team manages the patient's condition and provides appropriate medical care until discharge. When there is a need to consult, the primary subspecialty team would consult other subspecialties. Going Forward: These two different ecoles have their own advantages and disadvantages. While a central role for internists in US offers important advantages such as high patient-population satisfaction and cost effectiveness, it also has been associated with discontinuity of care, patient dissatisfaction, loss of acute care skills by primary care physicians, and burnout among hospitalists. In Turkey, although subspecialized services may provide better-focused medical care, they may sometimesmiss the big picture and are over-used. In future exchanges, the division of care between generalist/hospitalist and consultant/ subspecialist care will be studied, which can include type of ward patient is assigned, stratification by chief complaint, percentage of consults requested, length of stay, and patient satisfaction

Global health (GH) spans every scientific, clinical and social science discipline. Cultural competency/ cross-cultural sensitivity has been identified as a GH priority for U.S. medical schools (Peluso 2013). As part of Curriculum for the 21st Century (C21), the Global Health Selective is prerequisite to the new Global Health Concentration at NYU School of Medicine (SoM). With special emphasis on cultural competency/ crosscultural sensitivity, its primary aim is to teach future physicians fund of knowledge and clinical skills that strengthen GH care. As a 4-week clinical clerkship, the GH Selective was first completed by 9 medical students in 2012, and again by 12 medical students in 2013. Activities included 18 ninety-minute patient case discussions in tropical medicine; related clinical assignments at NYU; literature review and journal clubs; and 9 half-day clinical skills simulation workshops covering 1) diarrhea in Haiti and Egypt, 2) tuberculosis in Peru 3) malaria in sub-Saharan Africa 4) hypertension screening by community health workers in Ghana 5) survivors of torture from central Africa 6) humanitarian response to tsunami in Indonesia 7) obstetrical emergencies in rural Liberia 8) interpreter exercise in Tibetan, and 9) smoking cessation via interpreters. Leadership is from NYU SoM Departments of Medicine and Population Health, and Center for Healthful Behavior Change. Over two years of the GH Selective, student feedback was overwhelmingly positive. Each year, at least 37 faculty volunteered from 11 departments at SoM to log at least 225 hours of direct contact teaching hours each offering. In its first two years, the GH Selective exceeded expectations. Its interdisciplinary curriculum is a particular strength, and its special emphasis on working with standardized patients in cross-cultural settings, focused on communication skills, health literacy, and health navigation, provided students with knowledge and clinical skills applicable for any clinical care provided locally, nationally,!