Faculty Bibliography

BACKGROUND: Inconsistencies in adherence to evidence-based medicine practice guidelines and quality indicators for inflammatory bowel disease (IBD) have been a recognized limitation in the quality of care afforded to IBD patients. We designed an Objective Structured Clinical Examination (OSCE) to assess many of the core competencies and to provide GI fellows with a simulated, case-based learning experience in the management of IBD patients. To supplement this experience, we provided GI fellows with an easily accessible educational resource in the form of a pocket-sized guide to highlight key evidence-based concepts in IBD education stressed in the OSCE. We assessed the utility of the NYU Gastroenterology Fellowship Training Program Pocket Guide's usefulness, functionality, utilization, and the GI fellows' satisfaction with this educational resource. METHODS: The NYU Gastroenterology Fellowship Training Program's OSCE course included 4 real life IBD clinical scenarios. Five New York City GI training programs and 12 second-year GI fellows participated. Following the OSCE, each fellow was given a pocket guide entitled "NYU Gastroenterology Fellowship Training Program Pocket Guide: Key Concepts in Managing Patients with Inflammatory Bowel Disease." In addition, the pocket guide was given to the remaining 8 NYU GI fellows who did not participate in the OSCE. The white coat pocket-sized guide is comprised of 5 front and back laminated pages, with approximately 2 pages devoted to each OSCE case. Three months following the distribution of the pocket guide, 20 fellows were invited to participate in an online survey about the pocket guide in general as an education tool, and about its specific elements, and the fellows' answers were collected. RESULTS: Sixteen of 20 (80%) fellows responded to the survey. Nearly 94% (15/16) of responders found the pocket guide to be a useful supplement to their fellowship IBD training, and 100% agreed that the guide would have been a useful reference tool to have at the s!

Th17 cells are enriched in the gut mucosa and play a critical role in maintenance of the mucosal barrier and host defense against extracellular bacteria and fungal infections. During chronic human immunodeficiency virus (HIV) infection, Th17 cells were more depleted compared to Th1 cells, even when the patients had low or undetectable viremia. To investigate the differential effects of HIV infection on Th17 and Th1 cells, a culture system was used in which CCR6(+) CD4(+) T cells were sorted from healthy human peripheral blood and activated in the presence of interleukin 1beta (IL-1beta) and IL-23 to drive expansion of Th17 cells while maintaining Th1 cells. HIV infection of these cultures had minimal effects on Th1 cells but caused depletion of Th17 cells. Th17 loss correlated with greater levels of virus-infected cells and cell death. In identifying cellular factors contributing to higher susceptibility of Th17 cells to HIV, we compared Th17-enriched CCR6(+) and Th17-depleted CCR6(-) CD4 T cell cultures and noted that Th17-enriched CCR6(+) cells expressed higher levels of alpha4beta7 and bound HIV envelope in an alpha4beta7-dependent manner. The cells also had greater expression of CD4 and CXCR4, but not CCR5, than CCR6(-) cells. Moreover, unlike Th1 cells, Th17 cells produced little CCR5 ligand, and transfection with one of the CCR5 ligands, MIP-1beta (CCL4), increased their resistance against HIV. These results indicate that features unique to Th17 cells, including higher expression of HIV receptors and lack of autocrine CCR5 ligands, are associated with enhanced permissiveness of these cells to HIV.

Aim: To identify factors that affect outpatient colonoscopy attendance in a tertiary care center. Methods: A retrospective review of the electronic medical record system was performed for patients scheduled for outpatient colonoscopies from July to October 2008 at the Manhattan VA Hospital. Patient age, gender, ethnicity, marital status, gender of referring healthcare provider (HCP), distance from hospital (in miles), living situation (e.g. apartment vs. shelter, alone vs. with others), employment status, smoking history, appointment time, day of the week, month, proximity to holiday (in days), family history of gastrointestinal malignancy, prior colon procedures, indication for current procedure, comorbidities (diabetes, hypertension, hyperlipidemia, obesity, pathologies of the major organ systems, psychiatric disorders, and history of cancer) were compared. Statistical analysis using t- and +/-2-tests was performed, with p values 0.05 denoting statistical significance. Results: A total of 517 patients were identified, comprised of 358 patients who presented for their scheduled colonoscopies ("shows") and 159 patients who did not ("no shows"). Patients were more likely to attend their procedure if the referring HCP was female rather than male (p<0.001, Figure 1a). A higher percentage of employed patients presented at their scheduled time compared with patients who were not employed (p<0.005, Figure 1b). Fewer active smokers attended compared with non-smokers. A higher percentage of "shows" who quit smoking attended compared with that of "no shows" (p<0.05, Figure 1c). Patients were less likely to attend the morning time slots from 8-11:30am compared with the afternoon/ early evening time slots from 12-5:30pm (p<0.05, Figure 1d). Patients with neurological conditions (Figure 2, footnote) were less likely to show up at their scheduled appointments (p<0.05, Figure 1e). A greater percentage of "no shows" showed up for future outpatient colonoscopies at the VA Hospital compared with "shows" (p<0.00!