Faculty Bibliography

OBJECTIVE:Large-scale disasters may disrupt health surveillance systems, depriving health officials and researchers of timely and accurate information needed to assess disaster-related health effects and leading to use of less reliable self-reports of health outcomes. In particular, ascertainment of cancer in a population is ordinarily obtained through linkage of self-reported data with regional cancer registries, but exclusive reliance on these sources following a disaster may result in lengthy delays or loss of critical data. To assess the impact of such reliance, we validated self-reported cancer in a cohort of 59,340 responders and survivors of the World Trade Center disaster against data from 11 state cancer registries (SCRs). METHODS:We focused on residents of the 11 states with SCRs and on cancers diagnosed from September 11, 2001, to the date of their last survey participation. Medical records were also sought in a subset of 595 self-reported cancer patients who were not recorded in an SCR. RESULTS:Overall sensitivity and specificity of self-reported cancer were 83.9% (95% confidence interval [CI] 81.9, 85.9) and 98.5% (95% CI 98.4, 98.6), respectively. Site-specific sensitivities were highest for pancreatic (90.9%) and testicular (82.4%) cancers and multiple myeloma (84.6%). Compared with enrollees with true-positive reports, enrollees with false-negative reports were more likely to be non-Hispanic black (adjusted odds ratio [aOR] = 1.8, 95% CI 1.2, 2.9) or Asian (aOR=2.2, 95% CI 1.2, 4.1). Among the 595 cases not recorded in an SCR, 13 of 62 (21%) cases confirmed through medical records were reportable to SCRs. CONCLUSION:Self-report of cancer had relatively high sensitivity among adults exposed to the World Trade Center disaster, suggesting that self-reports of other disaster-related conditions less amenable to external validation may also be reasonably valid.

The relationship between obesity and hypogonadism is complicated. The relationship is bidirectional and there are numerous causative and correlative factors on both sides of the equation. Obesity is increasing in prevalence in epidemic proportions. Likewise, we are beginning to see the rapid increase in the incidence of male hypogonadism. It is only recently that we are learning the ways in which these 2 conditions exacerbate each other, and we are only beginning to understand how by treating one of these conditions, we can help to treat the other as well.

PROBLEM: Efforts to evaluate and optimize the effectiveness of medical education have been limited by the difficulty of designing medical education research. Longitudinal, epidemiological views of educational outcomes can help overcome limitations, but these approaches require "bigger data"-more learners, sources, and time points. The rich data institutions collect on students and residents can be mined, however, ethical and practical barriers to using these data must first be overcome. APPROACH: In 2008, the authors established the Research on Medical Education Outcomes (ROMEO) Registry, an educational data registry modeled after patient registries. New York University School of Medicine students, residents, and fellows provide consent for routinely collected educational, performance, quality improvement, and clinical practice data to be compiled into a deidentified, longitudinal database. As of January 2015, this registry included 1,225 residents and fellows across 12 programs (71% consent rate) and 841 medical students (86% consent rate). Procedures ensuring voluntary informed consent are essential to ethical enrollment and data use. Substantial resources are required to provide access to and manage the data. OUTCOMES: The registry supports educational scholarship. Seventy-two studies using registry data have been presented or published. These focus on evaluating the curriculum, quality of care, and measurement quality and on assessing needs, competencies, skills development, transfer of skills to practice, remediation patterns, and links between education and patient outcomes. NEXT STEPS: The authors are working to integrate assessment of relevant outcomes into the curriculum, maximize both the quantity and quality of the data, and expand the registry across institutions.

We compared ceftazidime-avibactam, ceftolozane-tazobactam, ceftazidime, cefepime and piperacillin-tazobactam minimum inhibitory concentrations (MICs) against 38 meropenem-resistant P. aeruginosa. No isolates harbored carbapenemases; 74% were OprD mutants. Ceftazidime-avibactam and ceftolozane-tazobactam were active against 92%, including 80% that were resistant to all three beta-lactams. Forty-three percent of ceftazidime-avibactam and 6% of ceftolozane-tazobactam-susceptible isolates exhibited MICs at respective breakpoints. Ceftolozane-tazobactam and ceftazidime-avibactam are therapeutic options against meropenem-resistant P. aeruginosa infections, which should be used judiciously to preserve activity.

Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described.

Acquired QT prolongation can be caused by cardiac and noncardiac medications. Macrolides are known to prolong QT interval. Rarely, it can be fatal. We report a case of torsades de pointes in a patient taking clarithromycin as a part of Helicobacter pylori eradication regimen.

GOALS: To describe a multicenter experience using an endoscopic suturing device for management of gastrointestinal (GI) defects and stent anchorage. BACKGROUND: Endoscopic closure of GI defects including perforations, fistulas, and anastomotic leaks as well as stent anchorage has improved with technological advances. An endoscopic suturing device (OverStitch; Apollo Endosurgery Inc.) has been used. STUDY: Retrospective study of consecutive patients who underwent endoscopic suturing for management of GI defects and/or stent anchorage were enrolled between March 2012 and January 2014 at multiple academic medical centers. Data regarding demographic information and outcomes including long-term success were collected. RESULTS: One hundred and twenty-two patients (mean age, 52.6 y; 64.2% females) underwent endoscopic suturing at 8 centers for stent anchorage (n=47; 38.5%), fistulas (n=40; 32.7%), leaks (n=15; 12.3%), and perforations (n=20; 16.4%). A total of 44.2% underwent prior therapy and 97.5% achieved technical success. Immediate clinical success was achieved in 79.5%. Long-term clinical success was noted in 78.8% with mean follow-up of 68 days. Clinical success was 91.4% in stent anchorage, 93% in perforations, 80% in fistulas, but only 27% in anastomotic leak closure. CONCLUSIONS: Endoscopic suturing for management of GI defects and stent anchoring is safe and efficacious. Stent migration after stent anchoring was reduced compared with published data. Long-term success without further intervention was achieved in the majority of patients. The role of endoscopic suturing for repair of anastomotic leaks remains unclear given limited success in this retrospective study.

BACKGROUND: In Madagascar, prevalence of sexually transmitted infections (STIs) and unplanned pregnancies are high among adolescents. Limited reproductive health education is available. METHODS: In northern Madagascar, in 2014, we assessed the baseline knowledge, attitudes and self-efficacy regarding STIs/HIV and family planning among 155 adolescents, and designed and implemented a 6-week reproductive health curriculum for adolescents using complementary teaching methods. We evaluated the curriculum through pre- and post-curriculum surveys of adolescents using paired t-tests. RESULTS: Pre-test survey revealed a general lack of knowledge regarding different types of STIs. Post-curriculum, there was a significant improvement in the following educational domains: general knowledge of HIV/AIDS, other STIs and family planning (49%+/-17% to 65%+/-15%) (p<0.001), self-efficacy and use of contraceptives (57%+/-26% to 70%+/-26%) (p<0.01), and the overall combined scores of knowledge, attitude and self-efficacy (53%+/-14% to 68%+/-14%) (p<0.001). Open-ended questions revealed significant misconceptions and stigma regarding oral and anal sex and usage of condoms. CONCLUSIONS: Important misconceptions and knowledge gaps regarding reproductive health exist amongst adolescents. The comprehensive reproductive health curriculum with complementary teaching methods was feasible, well-received and effective, and could be considered for integration into the schools' curricula.