Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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Randomized Phase II Trial of Nivolumab With Stereotactic Body Radiotherapy Versus Nivolumab Alone in Metastatic Head and Neck Squamous Cell Carcinoma
PURPOSE:The objective response rate (ORR) for single-agent anti-programmed death receptor 1 (anti-PD-1) therapy is modest in patients with metastatic or recurrent head and neck squamous cell carcinoma (HNSCC). We aimed to test whether radiotherapy may act synergistically with anti-PD-1 therapy to improve response through the abscopal effect. PATIENTS AND METHODS:We conducted a single-center, randomized, phase II trial of nivolumab (anti-PD-1 therapy) versus nivolumab plus stereotactic body radiotherapy (SBRT) in patients with metastatic HNSCC. Patients had at least two metastatic lesions: one that could be safely irradiated and one measurable by RECIST version 1.1. Patients were randomly assigned (1:1), stratified by human papillomavirus status, to nivolumab (3 mg/kg intravenously every 2 weeks) or nivolumab (same dose) plus SBRT (9 Gy × 3) to 1 lesion. The primary end point was ORR in nonirradiated lesions, which was assessed by RECIST in patients with at least one available set of on-treatment images; safety was assessed in a per-protocol population. RESULTS:= .70). CONCLUSION:We found no improvement in response and no evidence of an abscopal effect with the addition of SBRT to nivolumab in unselected patients with metastatic HNSCC.
PMID: 32822275
ISSN: 1527-7755
CID: 5052902
Nutritional approaches and plant-dominant diets for conservative and preservative management of chronic kidney disease
[S.l.] : Elsevier, 2021
pp. 515-543
ISBN: 9780128185414
CID: 5369572
American journal of physiology. Heart & circulatory physiology. 2021:320(1):H469-H470.DOI: 10.1152/ajpheart.00862.2020
Letter to the editor: The venous circulation actively alters flow: a brief evolutionary perspective [Letter]
PMID: 33448258
ISSN: 1522-1539
CID: 4747302
A Model for Exploring Compatibility Between Applicants and Residency Programs: Right Resident, Right Program
Holistic review of residency applications is touted as the gold standard for selection, yet vast application numbers leave programs reliant on screening using filters such as United States Medical Licensing Examination scores that do not reliably predict resident performance and may threaten diversity. Applicants struggle to identify which programs to apply to, and devote attention to these processes throughout most of the fourth year, distracting from their clinical education. In this perspective, educators across the undergraduate and graduate medical education continuum propose new models for student-program compatibility based on design thinking sessions with stakeholders in obstetrics and gynecology education from a broad range of training environments. First, we describe a framework for applicant-program compatibility based on applicant priorities and program offerings, including clinical training, academic training, practice setting, residency culture, personal life, and professional goals. Second, a conceptual model for applicant screening based on metrics, experiences, attributes, and alignment with program priorities is presented that might facilitate holistic review. We call for design and validation of novel metrics, such as situational judgment tests for professionalism. Together, these steps could improve the transparency, efficiency and fidelity of the residency application process. The models presented can be adapted to the priorities and values of other specialties.
PMID: 33278296
ISSN: 1873-233x
CID: 4708352
A Novel Ticket System for Capping Residency Interview Numbers: Reimagining Interviews in the COVID-19 Era
The 2019 novel coronavirus (COVID-19) pandemic has led to dramatic changes in the 2020 residency application cycle, including halting away rotations and delaying the application timeline. These stressors are laid on top of a resident selection process already under duress with exploding application and interview numbers-the latter likely to be exacerbated with the widespread shift to virtual interviewing. Leveraging their trainee perspective, the authors propose enforcing a cap on the number of interviews that applicants may attend through a novel interview ticket system (ITS). Specialties electing to participate in the ITS would select an evidence-based, specialty-specific interview cap. Applicants would then receive unique electronic tickets-equal in number to the cap-that would be given to participating programs at the time of an interview, when the tickets would be marked as used. The system would be self-enforcing and would ensure each interview represents genuine interest between applicant and program, while potentially increasing the number of interviews-and thus match rate-for less competitive applicants. Limitations of the ITS and alternative approaches for interview capping, including an honor code system, are also discussed. Finally, in the context of capped interview numbers, the authors emphasize the need for transparent preinterview data from programs to inform applicants and their advisors on which interviews to attend, learning from prior experiences and studies on virtual interviewing, adherence to best practices for interviewing, and careful consideration of how virtual interviews may shift inequities in the resident selection process.
PMID: 32910007
ISSN: 1938-808x
CID: 4764712
Metabolic syndrome and kidney disease
[S.l.] : Elsevier, 2021
pp. 763-777
ISBN: 9780128185414
CID: 5369602
Telemedicine Training in the COVID Era: Revamping a Routine OSCE to Prepare Medicine Residents for Virtual Care
Background/UNASSIGNED:During the rapid onset of the pandemic, clinicians transitioned from traditional outpatient practice to virtual modalities for providing routine care to patient panels. Like training programs nationwide, telemedicine training and assessment had not been systematically incorporated into our residency. In response, a scheduled Internal Medicine (IM) Objective Structured Clinical Examination (OSCE) was adapted to a remote modality to become virtual care-focused learning experience for trainees and to provide valuable feedback to educators. Methods/UNASSIGNED:Standardized Patients (SPs) rated residents on their communication (including information gathering, relationship development and patient education), patient activation and satisfaction, and telemedicine skills. Analyses included a comparison of domain scores for residents who participated in both the 2020 remote and 2019 in-person OSCEs, and a review of written resident comments about the virtual OSCE. Results/UNASSIGNED: = .008). Conclusion/UNASSIGNED:Our reformulated OSCE accomplished 3 goals including; (1) physically distancing residents from SPs per COVID regulations, (2) providing residents with the opportunity to practice critical virtual visit skills, and (3) alerting our educators to curricular improvement areas. Our methods are useful for other institutions and have applications to the larger medical education community.
PMCID:8212360
PMID: 34189270
ISSN: 2382-1205
CID: 4950972
Multi-Level Predictors of Discharges Against Medical Advice: Identifying Contributors to Variation Using an All-Payer Database
ABSTRACT/UNASSIGNED:There is increasing evidence of the role of non-patient-level factors on discharge against medical advice (DAMA), but limited quantitative information regarding the extent of their impact. This study quantifies the contribution of discharge-level and hospital-level factors to the variation in DAMA. We grouped variables from the 2014 National Inpatient Sample data and ran incremental mixed-effects logit models with grouping at the level of the discharge, the hospital, and the census region. We obtained the intraclass correlation coefficients (ICCs), and evaluated the incremental change in ICC. The final sample included 2,687,430 discharges. 12.8% of the identified variation in the probability of DAMA was associated with the hospital, and 1.2% of the variation was associated with the census division in which the hospital was located. The final, fully-adjusted model had 7.3% of variation in DAMA associated with the hospital-level, with the greatest percentage reductions because of the addition of patient demographics. Even after adjusting for measured patient-level characteristics, there was a contribution of non-patient-level factors to DAMA outcomes. The findings identify a role for a multi-level approach to addressing DAMA.
PMID: 32134810
ISSN: 1945-1474
CID: 4774092
The case for simplifying and using absolute targets for viral hepatitis elimination goals
The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.
PMID: 32979881
ISSN: 1365-2893
CID: 4679282
Using an osce to teach neurology residents to discuss prognosis after hypoxic ischemic brain injury [Meeting Abstract]
INTRODUCTION: Clinicians caring for critically-ill patients must be able to discuss prognosis and deliver bad news. To teach Neurology residents how to do this, we designed an objective structured clinical examination (OSCE) case in which trainees discussed prognosis with a standardized patient (SP).
METHOD(S): In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident was tasked with informing a SP her father had severe global hypoxic ischemic injury. The SP was instructed to assess the resident's ability to 1) explain the neurologic findings and 2) to respond to an emotional outburst. A neurology attending observed the encounter via one-way glass. After a 10-minute encounter, the resident was provided 5 minutes of feedback. The residents were surveyed on how prepared they felt for the OSCE, how useful it was, how they rated their performance, and how much they learned from the activity via a Likert scale from 1 (worst) to 5 (best) and free text response. The SP completed a behavioral anchored checklist to assess the residents' ability to gather information, develop a relationship, provide education and counseling, present bad news, and maintain professionalism.
RESULT(S): 57 third and fourth year neurology residents completed the case from 2018-2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared (mean Likert score 3.7/5) and rated their performance as average (3.4/5). Overall they found the case to be very helpful (4.6/5). Several reported difficultly with 1) addressing a complex medical case in a limited amount of time 2) reacting appropriately to an emotional family member and 3) avoiding medical jargon. The SP reported that residents performed well in the realms of non-verbal behavior enriched communication, being non-judgmental, not interrupting, acknowledging emotion, and avoiding medical jargon. Areas in which there was room for improvement included collaborating with the SP to decide upon next steps, identifying a support system, and asking "what is going through your mind right now?".
CONCLUSION(S): OSCE cases can be used to teach clinicians how to discuss prognosis and break bad news. Feedback about this simulation was positive, however its efficacy has yet to be evaluated
METHOD(S): In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident was tasked with informing a SP her father had severe global hypoxic ischemic injury. The SP was instructed to assess the resident's ability to 1) explain the neurologic findings and 2) to respond to an emotional outburst. A neurology attending observed the encounter via one-way glass. After a 10-minute encounter, the resident was provided 5 minutes of feedback. The residents were surveyed on how prepared they felt for the OSCE, how useful it was, how they rated their performance, and how much they learned from the activity via a Likert scale from 1 (worst) to 5 (best) and free text response. The SP completed a behavioral anchored checklist to assess the residents' ability to gather information, develop a relationship, provide education and counseling, present bad news, and maintain professionalism.
RESULT(S): 57 third and fourth year neurology residents completed the case from 2018-2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared (mean Likert score 3.7/5) and rated their performance as average (3.4/5). Overall they found the case to be very helpful (4.6/5). Several reported difficultly with 1) addressing a complex medical case in a limited amount of time 2) reacting appropriately to an emotional family member and 3) avoiding medical jargon. The SP reported that residents performed well in the realms of non-verbal behavior enriched communication, being non-judgmental, not interrupting, acknowledging emotion, and avoiding medical jargon. Areas in which there was room for improvement included collaborating with the SP to decide upon next steps, identifying a support system, and asking "what is going through your mind right now?".
CONCLUSION(S): OSCE cases can be used to teach clinicians how to discuss prognosis and break bad news. Feedback about this simulation was positive, however its efficacy has yet to be evaluated
EMBASE:634766367
ISSN: 1530-0293
CID: 4869422
