Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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14445
Becoming a Doctor in Different Cultures: Toward a Cross-Cultural Approach to Supporting Professional Identity Formation in Medicine
Becoming a doctor is fundamentally about developing a new, professional identity as a physician, which in and of itself may evoke many emotions. Additionally, medical trainees are increasingly moving from one cultural context to another and are challenged with navigating the resulting shifts in their professional identify. In this Article, the authors aim to address medical professional identity formation from a polyvocal, multidisciplinary, cross-cultural perspective. They delineate the cultural approaches to medical professionalism, reflect on professional identity formation in different cultures and on different theories of identity development, and advocate for a context-specific approach to professional identity formation. In doing so, the authors aim to broaden the developing professional identity formation discourse to include non-Western approaches and notions.
PMID: 27782917
ISSN: 1938-808x
CID: 2288732
Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study
BACKGROUND: While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety. DESIGN: A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. PARTICIPANTS: Primary care clinicians and their diabetic and hypertensive patients. INTERVENTIONS: Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. MAIN MEASURES: We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. KEY RESULTS: There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p
PMCID:5215160
PMID: 27612486
ISSN: 1525-1497
CID: 2238812
Associations Between Neurocognitive Impairment and Biomarkers of Poor Physiologic Reserve in a Clinic-Based Sample of Older Adults Living with HIV
Data from a cross-sectional study of a clinic-based sample of older people living with HIV (PLWH; n = 100) were used to examine associations between biomarkers of physical health and neurocognitive impairment (NCI). In this sample, anemia, chronic kidney disease (CKD) stages 4-5, and hypocalcemia were associated with impairment in executive functioning or processing speed. Furthermore, participants with anemia were more likely to have CD4+ T cell counts <200 cells/mm3 (chi2 [1] = 19.57, p < .001); hypocalcemia (chi2 [1] = 17.55, p < .001); and CKD 4-5 (chi2 [2] = 10.12, p = .006). Black and Hispanic participants were more likely to be anemic compared to other races and ethnicities (chi2 [3] = 12.76, p = .005). Common medical conditions (e.g., anemia, hypocalcemia, CKD) should be investigated as potential contributors to NCI in older PLWH. Additionally, laboratory testing in racial/ethnic minority PLWH may help inform NCI screening.
PMID: 27639980
ISSN: 1552-6917
CID: 2518032
Severe Cushing's syndrome and bilateral pulmonary nodules: beyond ectopic ACTH
Cushing's syndrome is a rare disease that results from prolonged exposure to supraphysiological levels of glucocorticoids. Severe and rapidly progressive cases are often, but not exclusively, attributable to ectopic ACTH secretion. Extreme hypercortisolism usually has florid metabolic consequences and is associated with an increased infectious and thrombotic risk. The authors report on a case of a 51-year-old male that presented with severe Cushing's syndrome secondary to an ACTH-secreting pituitary macroadenoma, whose diagnostic workup was affected by concurrent subclinical multifocal pulmonary infectious nodules. The case is noteworthy for the atypically severe presentation of Cushing's disease, and it should remind the clinician of the possible infectious and thrombotic complications associated with Cushing's syndrome.
PMCID:5683386
PMID: 29158903
ISSN: 2052-0573
CID: 4003332
Mentoring to build midwifery and nursing capacity in the Africa region: An integrative review
EMBASE:618801577
ISSN: 2214-1391
CID: 2788702
Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium
BACKGROUND:Patients in intensive care units (ICU) are often diagnosed with postoperative delirium; the duration of which has a relevant negative impact on various clinical outcomes. Recent research found a potentially important role of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in delirium of critically ill patients on non-surgical ICU or in non-cardiac-surgery patients. We tested the hypothesis that AChE and BChE have an impact on patients after cardiac surgery with postoperative delirium. METHODS:from Securetec. RESULTS: > 0.10). CONCLUSIONS:Postoperative measurement of AChE and BChE did not discern between patients with and without POD. The effect of the cardiac surgical procedure on AChE and BChE remains unclear. Further studies with patients in cardiac surgery are needed to evaluate a possible combination of delirium and the cholinergic transmitter system. There might be possible interactions with AChE/BChE and blood products and the use of cardiopulmonary bypass, which should be investigated more intensively. TRIAL REGISTRATION/BACKGROUND:German Clinical Trials Register, DRKS00006217.
PMCID:5446746
PMID: 28560042
ISSN: 2052-0492
CID: 4590062
MEASURING PROFESSIONAL IDENTITY FORMATION EARLY IN MEDICAL SCHOOL: VALIDITY EVIDENCE. [Meeting Abstract]
ISI:000440259000365
ISSN: 0884-8734
CID: 5327732
Hemoptysis in a previously healthy elderly patient with an unrecognized tracheal bronchus: A case report [Case Report]
A 83-year-old healthy female with no past medical history presented with persistent hemoptysis and respiratory failure. She was found to have a tracheal bronchus on bronchoscopy. Patient underwent pulmonary lavage and sterile irrigation. Patient was stable, but developed excessive hemoptysis which prompted a repeat, emergent, bronchoscopy was performed to advance the ET tube to isolate the left lung from the bleeding right lung. Despite the effort taken, the patient became pulseless from the hypoxia caused by blood spillover into the entire tracheobronchial field. ACLS protocol initiated without successful ROSC. Tracheal bronchus is uncommon but when present patients usually develop recurrent pulmonary symptoms at a younger age which require extensive workup which can lead to discovery of pulmonary anomalies. In our patient, she has no recurrent pulmonary symptoms as a child nor as an adult. We suspect the reason to this is the normal size diameter of the bronchus that connects the accessary lobe to the trachea. There are a few Medical conditions that may present with hemoptysis. When there is persistent, new onset hemoptysis in an otherwise healthy individual there should be no hesitation in performing the necessary procedural studies to reach a diagnosis.
PMCID:5472183
PMID: 28649488
ISSN: 2213-0071
CID: 4652542
Identification of differentially expressed genes associated with clinical response after treatment of breast cancer skin metastases with imiquimod. [Meeting Abstract]
ISI:000411895702111
ISSN: 0732-183x
CID: 5525542
Engaging the community to develop solutions for languages of lesser diffusion
pp. 149-169
ISBN: 9781783097777
CID: 3273782
