Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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14544
Timing and Measurement Variability Are Critical When Using Carotid Doppler to Infer Hemodynamics [Letter]
PMID: 32988668
ISSN: 1879-291x
CID: 4626262
Engagement in Eliminating Overuse: The Argument for Safety and Beyond
PMCID:6195488
PMID: 29672355
ISSN: 1549-8425
CID: 3545822
Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy
OBJECTIVE:To test the hypothesis that people with focal epilepsy experience diagnostic delays that may be associated with preventable morbidity, particularly when seizures have only nonmotor symptoms, we compared time to diagnosis, injuries, and motor vehicle accidents (MVAs) in people with focal nonmotor versus focal seizures with motor involvement at epilepsy onset. METHODS:This retrospective study analyzed the enrollment data from the Human Epilepsy Project, which enrolled participants between 2012 and 2017 across 34 sites in the USA, Canada, Europe, and Australia, within 4 months of treatment for focal epilepsy. A total of 447 participants were grouped by initial seizure semiology (focal nonmotor or focal with motor involvement) to compare time to diagnosis and prediagnostic injuries including MVAs. RESULTS:Demographic characteristics were similar between groups. There were 246 participants (55%) with nonmotor seizures and 201 participants (45%) with motor seizures at epilepsy onset. Median time to diagnosis from first seizure was 10 times longer in patients with nonmotor seizures compared to motor seizures at onset (PÂ <Â .001). The number and severity of injuries were similar between groups. However, 82.6% of MVAs occurred in patients with undiagnosed nonmotor seizures. SIGNIFICANCE/CONCLUSIONS:This study identifies reasons for delayed diagnosis and consequences of delay in patients with new onset focal epilepsy, highlighting a treatment gap that is particularly significant in patients who experience nonmotor seizures at epilepsy onset.
PMID: 33078409
ISSN: 1528-1167
CID: 4647112
Journal of women's health (Larchmont, N.Y. : 2002). 2020:29(12):1547-1558.DOI: 10.1089/jwh.2019.7999
From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities
PMID: 32286931
ISSN: 1931-843x
CID: 4383322
A wearable carotid Doppler tracks changes in the descending aorta and stroke volume induced by end-inspiratory and end-expiratory occlusion: A pilot study
Background and Aims/UNASSIGNED:To test the feasibility of a novel, wearable carotid Doppler ultrasound to track changes in cardiac output induced by end-inspiratory and end-expiratory occlusion tests. Methods/UNASSIGNED:We observed the pattern of Doppler change of the common carotid artery during a simulated end-inspiratory and expiratory occlusion test (sEIOT/sEEOT) in 10, nonventilated, healthy subjects. Simultaneously, we measured the Doppler signal of the descending aorta using duplex ultrasound (Xario, Toshiba Medical Systems) and stroke volume (SV) using noninvasive pulse contour analysis (Clearsight, Edwards Lifesciences, Irvine, California). Results/UNASSIGNED:= 0.95).The coefficient of variation of the VTI measured by the Doppler patch was roughly 60% less than that of the duplex system. Conclusions/UNASSIGNED:The pattern of SV change induced by a sEIOT/sEEOT in nonmechanically ventilated volunteers is reflected in the common carotid artery and descending aorta. The VTI variability of the Doppler patch was less than that of the traditional, duplex Doppler.
PMCID:7534617
PMID: 33033751
ISSN: 2398-8835
CID: 4627232
Modernizing Medical Attribution [Editorial]
PMID: 32323134
ISSN: 1525-1497
CID: 4464352
Correlates of sleep quality and excessive daytime sleepiness in people with opioid use disorder receiving methadone treatment
PURPOSE/OBJECTIVE:The aim of this study was to evaluate the prevalence and clinical correlates of impaired sleep quality and excessive daytime sleepiness among patients receiving methadone for opioid use disorder (OUD). METHODS:Patients receiving methadone (n = 164) completed surveys assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), and related comorbidities. We used bivariate and multivariable linear regression models to evaluate correlates of sleep quality and daytime sleepiness. RESULTS:Ninety percent of patients had poor sleep quality (PSQI >5), and the mean PSQI was high (11.0 ±4). Forty-six percent reported excessive daytime sleepiness (ESS > 10). In multivariable analyses, higher PSQI (worse sleep quality) was significantly associated with pain interference (coefficient = 0.40; 95% CI = 0.18-0.62; β = 0.31), somatization (coefficient = 2.2; 95% CI = 0.75-3.6; β = 0.26), and negatively associated with employment (coefficient = - 2.6; 95% CI = - 4.9 to - 0.19; β = - 0.17). Greater sleepiness was significantly associated with body mass index (coefficient = 0.32; 95% CI = 0.18-0.46; β = 0.33), and there was a non-significant association between sleepiness and current chronic pain (coefficient = 1.6; 95% CI = 0.26-3.5; β = 0.13; p value = 0.09). CONCLUSIONS:Poor sleep quality and excessive daytime sleepiness are common in patients receiving methadone for OUD. Chronic pain, somatization, employment status, and obesity are potentially modifiable risk factors for sleep problems for individuals maintained on methadone. People with OUD receiving methadone should be routinely and promptly evaluated and treated for sleep disorders.
PMID: 32556918
ISSN: 1522-1709
CID: 4653442
The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic
PURPOSE/OBJECTIVE:The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection. METHODS:IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected. RESULTS:Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001). CONCLUSIONS:Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.
PMCID:7306559
PMID: 32572707
ISSN: 1438-1435
CID: 4492972
Diabetes Phenotyping Using the Electronic Health Record [Letter]
PMID: 32948954
ISSN: 1525-1497
CID: 4605252
Internal Medicine Resident Work Absence During the COVID-19 Pandemic at a Large Academic Medical Center in New York City
Background/UNASSIGNED:Montefiore Medical Center (MMC) is a large tertiary care center in the Bronx, New York City, with 245 internal medicine residents. Beginning on February 29, 2020, residents became ill with COVID-19-like illness (CLI), which required absence from work. There was initially a shortage of personal protective equipment and delays in SARS-CoV-2 testing, which gradually improved during March and April 2020. Objective/UNASSIGNED:We evaluated the relationship between CLI-related work absence rates of internal medicine residents and MMC's COVID-19 hospital census over time. Methods/UNASSIGNED:Data on resident work absence between February 29 and May 22 were reviewed along with MMC's COVID-19 hospital census data. To determine the effect of patient exposure on resident CLI incidence, we compared the mean incidence of CLI per patient exposure days (PED = daily hospital census × days pre- or post-peak) before and after peak COVID-19 hospital census. Results/UNASSIGNED:= .003). Conclusions/UNASSIGNED:At the beginning of the COVID-19 pandemic in New York City, a large portion of internal medicine residents at this single center became ill. However, the incidence of CLI decreased over time, despite ongoing exposure to patients with COVID-19.
PMCID:7771614
PMID: 33391591
ISSN: 1949-8357
CID: 4738472
