Faculty Bibliography

Introduction: Participation in a medically-supervised weight management (MSWM) program before bariatric surgery is mandated by several insurance payers. However, this requirement is not evidencebased and serves as a barrier to medically necessary treatment. We conducted a pilot randomized trial funded by SAGES to determine the effect of an insurance-mandated MSWM prior to surgery. Our hypotheses are: (1) There is no difference in BMI between patients who have participated in a medically-supervised weight management program and those who don't. (2) MSWM does not change self-reported adherence, physical activity, eating behavior, and health beliefs. Methods & Procedures: 55 patients were scheduled for laparoscopic adjustable gastric banding (LAGB) and consented to enroll in an ongoing prospective pilot study in a large public hospital. of these, 12 patients cancelled surgery and 10 patients have been enrolled for less than 6 months. Thus, 33 patients were included in the analysis, with 17 randomized to MSWM (defined as monthly visits over 6 months directed by a physician or nutritionist) and 16 randomized to usual care. Measures of weight, height, adherence, activity level, health beliefs, and eating behavior were obtained at enrollment (ie, baseline) and 6 months after enrollment (ie, MSWM program completion and 2 weeks prior to surgery). For categorical and continuous data, Fisher's Exact Test and t-test were used to compare groups at the 2 time points before surgery. Results: Mean age was 45.5 (SD = 12.5) years. Majority were female (97%) and non-Caucasian (85%) with an income of less than $20,000 (64%). No significant differences were found between MSWM and usual care for age, gender, ethnicity, education, and income, indicating that the 2 groups were evenly matched for demographic variables. Mean BMI for the MSWM group was 46.3 kg/m2 at baseline and 46.0 kg/m2 at 6 months. Mean BMI for usual care was 44.7 kg/m2 and 44.6 kg/m2 (see Table 1). After 6 months of eitherMSWMor wait and at pre-surgery, no significant differences in BMIor patient behaviors were found between the 2 groups. Preliminary analysis of available 3-month post-operative data (n = 13) showed similar mean BMI when comparing MSWM (41.3 kg/m2) and usual care (41.2 kg/m 2). Conclusion: Our preliminary results indicate that MSWM does not affect BMI changes or patient behaviors prior to or after LAGB surgery

Background: The failure of recent generations of physicians to be proficient in physical diagnosis is well known in the medical community, and recently even the mainstream(Image presented) media have taken to reporting on the problem. However, the medical literature does not offer guidance to programs interested in improving the education of physical diagnosis. Purpose: To describe the peer-led curriculum implemented at our institution to teach cardiac physical diagnosis to hospitalists and house staff. Description: Our institution has created a peer-led curriculum to enhance the teaching of the cardiac physical examination that focuses on faculty development. The curriculum consists of a series of lectures and regular bedside rounds led by experienced hospitalists and cardiologists. Lecture topics include heart sounds, murmurs, and examination of the precordium and neck veins. Lectures on physical diagnosis are evidence based and supplemented with heart sounds played through a loudspeaker so learners can hear and see cardiac findings. Bedside teaching is enhanced with an electronic stethoscope wired for simultaneous auscultation with a group of learners and an iPod application that displays real-time phonocardiography (Fig. 1). These same tools allow for bedside teaching to be transferred easily to a variety of conference-based settings such as morning report or physical diagnosis-themed lectures. Conclusions: Implementation of a cardiac physical diagnosis curriculum aimed at hospitalists is an effective way to improve the education of faculty, house staff, and medical students, offers an opportunity for scholarship, and may improve patient care

Torture has been defined most precisely in legal contexts. Practitioners who work with torture survivors and researchers who study torture have frequently cited legal definitions, particularly those in the United States' Torture Victims Relief Act, the United Nations Convention against Torture, or the World Medical Association's Declaration of Tokyo. Few practitioners have operationalized these definitions and applied them in their practice. We describe how a New York City torture treatment clinic used a coding checklist that operationalizes the definitions, and present results. We found that in practice these definitions were nested; that using guidelines for applying the definitions in practice altered the number of cases meeting criteria for these definitions; and that the severity of psychological symptoms did not differ between those who were tortured and those who were not under any definition. We propose theoretical and practical implications of these findings.