Faculty Bibliography

[This corrects the article DOI: 10.1371/journal.pone.0194541.].

Needs and Objectives: Given the rise in mobile devices, it is critical that academic medical centers create new ways to support the educational, research, and patient care missions through mobile technology. Companion isa mobile app with a primary objective of promoting the use of evidence-based medicine at the point-of-care and enhancing the educational experience for medical students and residents through the rapid dissemination of knowledge. Setting and Participants:Companion launched in July 2017 across NYU Langone Health (NYULH), a tertiary-care academic medical center, and NYU School of Medicine. The Companion app was made available to all faculty, housestaff, and medical students for download on any Apple iPhone or iPad through NYULH's internal app catalog. Though available throughout the institution, special attention was given to the internal medicine residency program and medical students including dedicated training sessions on how to maximize the app's features for rounds and conferences. Description: Companion's core feature is a search function, similar to Google, where a user types in a keyword they are interested in looking up. For example, if a resident were admitting a patient with Congestive Heart Failure (CHF), and types "CHF" into the search box, the app will return NYULH institutional clinical guidelines related to CHF. From the results page, users can also use their finger to "swipe" into additional medical databases such as UpToDate and PubMed if they do not find what they are looking for in the institutional guidelines all from within the app. Once users find the document they are looking for they can "Favorite" the document for future reference, "Mark Up" the document with a virtual pen or highlighter, or "share" the document via QR code technology. Companion also utilizes location-aware technology for virtual "check-in" at conferences and pushing relevant clinical guidelines based on a user's physical location. Evaluation: Since launching in July 2017 our evaluation data is limited, but thus far, we have 747 active "60-day users" and over 5, 000 downloads of institutional clinical guidelines through the app. Further, there have been 5, 200 total "searches" performed within the app and over 10, 000 unique location check-ins at conference by medical students and residents. Discussion/Reflection/Lessons Learned: While still in the early stages of rolling out Companion, initial signs indicate that the app has potential to accomplish its goal of bringing evidence-based medicine to the bedside and enhancing the academic environment at our AMC. User feedback from front-line users has been instrumental in helping to refine the app and idenitfy new features that would improve the app. Since launching, we've pushed out 6 new version updates and recognize the importance of constantly iterating and adding new features to make the app as useful as possible. Next steps include integrating Companion with our electronic medical record and focusing on publicizing the app to other departments outside of internal medicine

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing globally, with different molecular mechanisms described. Here we studied the molecular mechanisms of carbapenem resistance, including clonal and plasmid dissemination, of 67 CRE isolates collected between 2012 and 2016 from a tertiary hospital in Eastern China, an CRE endemic region. Species identification and susceptibility testing were performed using the BD Phoenix Automated Microbiology System. Isolates were characterized by PCR (for carbapenemases, ESBLs, AmpC and porin genes), multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and conjugation transfer experiments. Selected bla_KPC-2 -harboring plasmids were subjected to next-generation sequencing using the Illumina Miseq platform. Among the 67 CRE isolates, 42 Klebsiella pneumoniae, 10 Serratia marcescens, 6 Enterobacter cloacae, 2 Raoultella ornithinolytica, 2 K. oxytoca, 1 K. aerogenes, and 4 Escherichia coli isolates were identified. Six different carbapenemases were detected, including bla_KPC-2 (n = 45), bla_KPC-3 (n = 1), bla_NDM-1 (n = 6), bla_NDM-5 (n = 1), bla_IMP-4 (n = 2), and bla_VIM-1 (n = 2); bla_OXA-48-like genes were not detected. One E. cloacae strain possessed both bla_NDM-1 and bla_KPC-3, while two E. cloacae isolates harbored bla_NDM-1 and bla_VIM-1. ESBLs (CTX-M, SHV, and TEM) and/or AmpC (CMY, DHA, and ACT/MIR) genes were also identified in 59 isolates, including 13 strains that lacked carbapenemases. Several insertions or stop codon mutations were found within porin genes of K. pneumoniae, E. coli and S. marcescens isolates, both with and without carbapenemases. The 42 K. pneumoniae isolates belonged to 12 different sequence types (ST), with ST11 being the most common, while the 6 E. cloacae isolates comprised 4 different STs. The 10 S. marcescens all shared the same PFGE pulsotype, suggestive of clonal spread. Complete plasmid sequencing and PCR screening revealed both intra-strain and inter-species spread of a common bla_KPC-2-harboring plasmid in our hospital. Taken together, our study revealed extensive genetic diversity among CRE isolates form a single Chinese hospital. CRE isolates circulating in the hospital differ significantly in their species, STs, porin genes, carbapenemase genes, and their plasmid content, highlighting the complex dissemination of CRE in this endemic region.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition; emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

Recreational drugs are commonly abused in all age groups. Intoxication with these substances can induce silent but significant electrocardiographic signs which may lead to sudden death. In this case study, we present a 49-year-old male with no medical comorbidities who came to the emergency department requesting opioid detoxification. Toxicology screen was positive for cocaine, heroin, and cannabis. Initial electrocardiogram (EKG) showed features of a Brugada pattern in the right precordial leads, which resolved within one day into admission. This presentation is consistent with the recently recognized clinical entity known as Brugada phenocopy.