Faculty Bibliography

BACKGROUND:Effective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination. METHODS:From March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child's pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment. RESULTS:144 parent-child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09-4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22-5.86), p = 0.009). CONCLUSIONS:Peer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).

BACKGROUND:Working with influenza-like illness (ILI) is pervasive throughout health care. We assessed knowledge, attitudes, and practices regarding ILI presenteeism of both postgraduate trainees and program leaders. METHODS:This survey study was conducted at the Montefiore Medical Center, Albert Einstein College of Medicine, a large academic center in the Bronx, New York. Internal medicine and subspecialty house staff and program directors completed an anonymous electronic survey between April 23 and June 15, 2018. RESULTS:A total of 197 of 400 (49%) house staff and 23 of 39 (59%) program leaders participated; 107 (54%) trainees and 6 (26%) program leaders self-reported ILI presenteeism in the past 12 months. More than 90% of trainees and program leaders reported that ILI presenteeism places others at risk. Only 9% of program leaders accurately estimated trainee ILI presenteeism prevalence. Both cited "not wanting to burden colleagues" as the top reason for ILI presenteeism. Twenty-six (24%) trainees practiced ILI presenteeism on critical care units. The majority reported that they would provide patient care with upper respiratory symptoms without fever. Most trainees incorrectly answered influenza knowledge questions. CONCLUSIONS:ILI presenteeism prevalence is high within training programs at our medical center. Program leaders can model best practices, enforce nonpunitive sick-leave policies, and ensure infection prevention competencies are met annually.

Breast conservation therapy (BCT) has a reported incidence of positive margins ranging widely in the literature from 20% to 70%. Efforts have been made to refine standards for partial mastectomy and to predict which patients are at highest risk for incomplete excision. Most have focused on histology and demographics. We sought to further define modifiable risk factors for positive margins and residual disease. A retrospective study was conducted of 567 consecutive partial mastectomies by 21 breast and general surgeons from 2009 to 2012. Four hundred fourteen cases of neoplasm were reviewed for localization, intraoperative assessment, excision technique, rates, and results of re-excision/mastectomy. Histologic margins were positive in 23% of patients, 25% had margins 0.1-0.9 mm, and 7% had tumor within 1-1.9 mm. Residual tumor was identified at-in 61 cases: 38% (disease at margin), 21% (0.1-0.9 mm), and 14% (1-1.9 mm). Ductal carcinoma in situ (DCIS) was present in 85% of residual disease on re-excision and correlated to higher rates of re-excision (p = <0.001), residual disease, and subsequent mastectomy. The use of multiple needles to localize neoplasms was associated with 2-3 times the likelihood for positive margins than when a single needle was required. The removal of additional margins at initial surgery correlated with improved rates of complete excision when DCIS was present. Patients must have careful analysis of specimen margins at the time of surgery and may benefit from additional tissue excision or routine shaving of the cavity of resection. Surgeons should conduct careful patient selection for BCT, in the context of multifocal, and multicentric disease. Patients for whom tumor localization requires bracketing may be at higher risk for positive margins and residual disease and should be counseled accordingly.