Faculty Bibliography

BACKGROUND:Inflammatory bowel disease (IBD) is a chronic, immune-mediated inflammatory disorder of the gastrointestinal tract. In IBD, systemic inflammation and immune dysregulation may also impact extraintestinal organs, such as the thyroid gland. Despite this, little is known about the influence of concomitant hypothyroidism on the clinical course of IBD. METHODS:A retrospective analysis was conducted among adult patients with IBD and at least one thyroid stimulating hormone (TSH) measurement within a large healthcare network. Patient charts were reviewed, and baseline demographics, disease characteristics, biomarkers, healthcare utilization, medication use, and other comorbidities were extracted. Patients were stratified by those with IBD only and those with concomitant IBD and hypothyroidism. Multivariable logistic regression was used to identify factors associated with concomitant hypothyroidism. Concomitant disease as an independent predictor for lab abnormalities and increased healthcare utilization was also assessed using multivariable logistic and negative binomial regression. RESULTS:IRR: 1.89, 95% CI 1.08, 3.32). CONCLUSION/CONCLUSIONS:Patients with both IBD and hypothyroidism have an increased likelihood of other extraintestinal manifestations compared to individuals who have IBD without hypothyroidism. Furthermore, patients with concomitant disease exhibited greater healthcare utilization, specifically, increased rates of RBAI studies. The presence of concomitant hypothyroidism may be associated with a more severe course of IBD.

CONTEXT/BACKGROUND:Over 200 000 people seeking asylum have arrived in New York City from 2022 to 2024. PROGRAM/METHODS:As the safety net hospital system for our city, New York City (NYC) Health + Hospitals (H + H) has taken the lead in caring for newly arrived asylum seekers. We used electronic medical record data to gain early insights into utilization and needs among these patients. IMPLEMENTATION/METHODS:We developed a hybrid definition to identify patients who are asylum seekers and examined their demographics, insurance, utilization, primary billing diagnoses, and immunizations from the Epic EMR. We included data on other patients as a point of comparison and analyzed data separately for adult and pediatric patients. EVALUATION/RESULTS:In 2023, 15 233 or 1.4% of H + H patients were asylum seekers. Asylum seekers had fewer visits than other patients in 2023, and utilization was particularly driven by pregnancy and childbirth. Children seeking asylum were engaged in primary care at high rates. Documented childhood vaccinations were higher among asylum-seeking children engaged in primary care compared to those who were not. The majority of adults and children were insured. Adult primary care engagement was low, as were visits for those seeking care for behavioral health issues. DISCUSSION/CONCLUSIONS:For adult asylum seekers, pregnancy and childbirth are key needs for adults. Increasing vaccination rates among children is critical and promoting engagement in primary care is a promising way to do so. Coordinated efforts are required to meet the varied needs of migrant arrivals, and safety net hospitals can play a key role in addressing their health care needs.

OBJECTIVES/OBJECTIVE:This study aims to explore the impact of telehealth on buprenorphine prescribing and retention in care for patients with opioid use disorder (OUD) seen at a large federally qualified health center (FQHC) the year prior to and following the start of the COVID-19 pandemic. METHODS:We conducted a retrospective study of patients with OUD and at least one medical visit to the FQHC between March 1, 2019, and February 28, 2021. This study utilized March 1, 2020, to delineate the beginning of COVID as the FQHC widely instituted telehealth during the month in response to the pandemic. We examined buprenorphine prescribing before and during year 1 of the pandemic; we applied logistic regression to estimate the association between telehealth and buprenorphine prescribing and we assessed buprenorphine retention through survival analysis. RESULTS:In the year before COVID, 24% of patients (502/2090) received buprenorphine compared with 31% (656/2110) during the first year of COVID ( P < 0.01). Patients with at least one telehealth visit were three times more likely to receive buprenorphine compared to those without telehealth (odds ratio: 3.2, confidence interval: 2.1-5.0). Among those who received buprenorphine, those with at least one telehealth visit were retained in buprenorphine care longer (hazard ratio: 2.7, confidence interval: 1.8-3.9). CONCLUSIONS:During the first year of COVID, telehealth was associated with increased likelihood that patients received buprenorphine; those who had telehealth remained in buprenorphine care longer compared to those who only had office-based visits. Increasing buprenorphine access through telehealth can play a significant role in retention in care for OUD.

The Journal of General Internal Medicine (JGIM) has a long-standing history of publishing manuscripts focused on health equity and is committed to diversity, equity, and inclusion (DEI) in scientific writing and publishing. This is extremely important in the current climate where false narratives and attacks on DEI and health equity are rampant. To demonstrate their commitment to DEI and health equity, the JGIM Editors-in-Chief created an inaugural DEI Advocacy Team. Composed of four academic scholars with vast knowledge and expertise in health equity and DEI, the JGIM DEI Advocacy Team is posed to create the infrastructure for improving DEI in scientific writing and publishing within JGIM. The team strives to advocate for diversity among the editorial board and staff; foster an inclusive environment where all contributions are valued; and facilitate increased and equitable opportunities for publishing of scholarly work by underrepresented groups in medicine. To operationalize their goals, the JGIM DEI Advocacy Team created the 5TDEI Conceptual Framework (team, tools, tracking, transparency, training). This perspective provides a statement from the inaugural JGIM DEI Advocacy Team on how we envision promoting health equity, diversity, and inclusion in medical and scientific writing and publishing of research in JGIM.

BACKGROUND:Objective measures and large datasets are needed to determine aspects of the Clinical Learning Environment (CLE) impacting the essential skill of clinical reasoning documentation. Artificial Intelligence (AI) offers a solution. Here, the authors sought to determine what aspects of the CLE might be impacting resident clinical reasoning documentation quality assessed by AI. METHODS:In this observational, retrospective cross-sectional analysis of hospital admission notes from the Electronic Health Record (EHR), all categorical internal medicine (IM) residents who wrote at least one admission note during the study period July 1, 2018- June 30, 2023 at two sites of NYU Grossman School of Medicine's IM residency program were included. Clinical reasoning documentation quality of admission notes was determined to be low or high-quality using a supervised machine learning model. From note-level data, the shift (day or night) and note index within shift (if a note was first, second, etc. within shift) were calculated. These aspects of the CLE were included as potential markers of workload, which have been shown to have a strong relationship with resident performance. Patient data was also captured, including age, sex, Charlson Comorbidity Index, and primary diagnosis. The relationship between these variables and clinical reasoning documentation quality was analyzed using generalized estimating equations accounting for resident-level clustering. RESULTS:Across 37,750 notes authored by 474 residents, patients who were older, had more pre-existing comorbidities, and presented with certain primary diagnoses (e.g., infectious and pulmonary conditions) were associated with higher clinical reasoning documentation quality. When controlling for these and other patient factors, variables associated with clinical reasoning documentation quality included academic year (adjusted odds ratio, aOR, for high-quality: 1.10; 95% CI 1.06-1.15; P <.001), night shift (aOR 1.21; 95% CI 1.13-1.30; P <.001), and note index (aOR 0.93; 95% CI 0.90-0.95; P <.001). CONCLUSIONS:AI can be used to assess complex skills such as clinical reasoning in authentic clinical notes that can help elucidate the potential impact of the CLE on resident clinical reasoning documentation quality. Future work should explore residency program and systems interventions to optimize the CLE.

Non-mutational epigenetic reprogramming is considered an important enabling characteristic of neoplasia. Corticotroph tumors and other subtypes of pituitary tumors are characterized by distinct epigenetic profiles. The DNA methylation profile is consistent with disease-specific gene expression, which highlights the importance of epigenetic changes in tumor formation and progression. Elucidating the epigenetic changes underlying tumorigenesis plays an important role in understanding the molecular pathogenesis of corticotroph tumors and may ultimately contribute to improving tumor-specific treatment. Here, we provide an overview of the epigenetic landscape of corticotroph tumors. We also review the role of epigenetics in silencing the expression of tumor suppressor genes and promoting oncogenes expression, which could potentially be involved in the pathogenesis of corticotroph tumors. We briefly discuss microRNAs and epigenetic aspects of POMC regulation. Lastly, since the epigenetic changes are reversible, we discuss drugs that target epigenetic modifiers that could potentially be used in the arsenal of Cushing's disease treatment modalities.

OBJECTIVE/UNASSIGNED:We expect medical students to be able to apply evidence-based medicine (EBM) skills in the context of the clinical care of patients. Previous assessments of this domain have primarily utilized decontextualized knowledge tests, which provide limited insights into students' understanding of EBM skills in the context of patient care. New performance-based EBM competence assessments using Objective Structured Clinical Examinations (OSCEs) are being developed and tested. Understanding how students experience and interact with a simulation-based assessment of EBM competence would enable us to improve the modality. METHODS/UNASSIGNED:We recruited 13 graduating medical students from one medical school who had recently completed an immersive multi station readiness-for-residency OSCE (Night onCall) which included a case-based EBM assessment. We conducted individual interviews to explore their perceptions of participating in this OSCE as a method of EBM assessment. The interviews were transcribed, coded, and analyzed using Dedoose by three health science librarians. RESULTS/UNASSIGNED:Students discussed their experience and perceptions in six main areas: connection to clinical practice, curricular timing and content coverage, feedback, station instructions, awareness of their own limitations, and an OSCE as a format for assessing EBM. CONCLUSION/UNASSIGNED:Medical students appreciated the EBM OSCE because it enhanced their learning about how to integrate EBM into clinical practice. They proposed implementing multiple such opportunities throughout medical school because it would improve their competence and provide highly impactful opportunities to build toward EBM mastery. They endorsed that this would be well-accepted by medical students.

BACKGROUND:Public health threats (PHTs) influence how and in what ways managers communicate with employees. Employee resources and information during uncertain times has been noted as a reoccurring gap, especially as it relates to personal protective equipment (PPE). This study explored general and PPE-specific communication practices with 22 healthcare and emergency medical service (EMS) managers to support workers, particularly in the context of preparedness and response. METHODS:Data collection occurred in two phases that involved interviews and small group discussions to identify, examine, and better frame and execute communication practices. Qualitative analysis was informed by the 4i FACT framework and the social ecological model (SEM) to identify relevant communication practices and intervention points within health delivery settings. RESULTS:Results elucidated perceived, effective leadership practices and interpersonal influences in the workplace. Tangible leadership communication practices were identified as important intervention points within the SEM, with a focus on proactive behaviors to procure necessary PPE and disseminate information. Participants emphasized one-on-one interactions with employees, and the use of trusted messengers to share health-related messages. They also highlighted the challenges of PPE shortages and the importance of access to resources across different job roles, organizations, and work settings. CONCLUSIONS/APPLICATION TO PRACTICE/CONCLUSIONS:This study contributes insights into communication practices during a public health emergency, offering a nuanced understanding of managerial approaches, PPE-related communication, and the broader contextual factors influencing information dissemination. Further, the integration of frameworks like 4i FACT and SEM provides a structured perspective for future communication strategies, supporting tailored approaches across organizations.