Faculty Bibliography

Introduction: The objective structured clinical examination (OSCE) is a common educational strategy to assess interpersonal skills and knowledge gaps, and we have previously shown its benefits in inflammatory bowel disease (IBD) education. As a result of the COVID-19 pandemic, there has been explosive growth in telehealth. Currently, we lack methods to teach and evaluate trainees' related skillset and no telehealth-specific milestones exist. We assessed the telehealth proficiency of gastroenterology (GI) fellows as part of an annual IBD OSCE over Zoom (Z-OSCE).
Method(s): Seven GI fellows from four programs participated in Z-OSCE featuring four clinical scenarios. We used previously validated OSCE checklists to assess the fellows' performance in IBDspecific cases. Telehealth communication skills were also assessed. One of the scenarios required the trainees to conduct a televisit focusing on preventative care for a Crohn's disease patient based on the ACG guideline. Checklists were scored on a 3-point Likert scale by the Standardized Patient (SP).
Result(s): The telehealth behavioral anchored checklist items included: maintaining proper computer etiquette, use of non-verbal communication and positioning to optimize the encounter, optimized technical aspects, and exhibiting comfort and confidence with the virtual platform. In these domains 5 or 6 (out of 7) fellows received 3 points. In contrast less than half of the fellows asked questions of the SP to make sure they understood or acknowledged emotion, and 3 out 7 fellows did not make appropriate eye contact. Despite high performance in the telehealth aspects of the encounter, the SP did not fully recommend fellows for their communication skills without reservations to friends/ family, with all fellows receiving 2 points.
Conclusion(s): Telehealth has quickly become a fixture of our profession, and merits educational opportunities and assessment to improve clinicians' competency, as it will likely outlast the COVID- 19 pandemic. To our knowledge, this is the first OSCE designed to assess telehealth performance in the delivery of IBD care. Z-OSCEs can play a unique role in simulating realistic telehealth visits and this pilot program helps us identify future educational needs. Assessment of fellows' performance during this virtual program can provide an opportunity for learning, growth and reflection as well as prepare trainees for future patient encounters

OBJECTIVES:The number of hospitalized coronavirus disease 2019 patients in March 2020 to April 2020 in our New York City hospital required increased physician staffing, including deployment of pediatricians to adult care. To improve the deployment process, we sought to understand the mindset, preparations for, and experience during deployment of pediatric faculty in our institution. METHODS:test were used to compare groups. Free-text responses were categorized by topic. Survey responses were shared with leadership in real time and adjustments to the deployment process made. RESULTS:= 16). Dissemination of details about schedules and role clarification before deployment were areas for improvement. CONCLUSIONS:Pediatric faculty facing deployment to adult care have concerns about the process of deployment as well as the work itself. Specific information distributed in advance, along with consistent and frequent communication, may help mitigate these fears.

Introduction: The objective structured clinical examination (OSCE) has been shown to not only assess but also improve the performance of trainees. Our group has previously demonstrated the benefits of OSCEs to assess gastroenterology (GI) fellows. We have successfully assessed performance across numerous milestones. Typically, OSCEs are held in person, however the COVID-19 pandemic has precipitated the need for virtual learning. We accordingly transitioned to a virtual zoom OSCE (Z-OSCE) and evaluated trainees' perception of this program.
Method(s): Fourteen first- and second-year GI fellows from five programs across multiple states participated in a four-station virtual OSCE on Zoom. Afterwards, participants answered a survey to share their perspectives and provide feedback. Learners were asked to rate the usefulness of the virtual OSCE and compare it to other in-person and virtual educational modalities. These questions were rated on a 10-point Likert scale (Figure 1). Additionally, free-text responses regarding any aspect of the OSCE were evaluated for comments on the virtual format.
Result(s): In comparing the usefulness of the virtual OSCE to other in-person modalities, trainees rated it a mean of 7.15 (range 5-10), and 31% of respondents rated it a 9 or 10. Trainees rated the virtual OSCE compared to other virtual learning modalities a mean of 8.15 (range 5-10), and 43% rated it 9 or 10. When asked whether they would recommend this OSCE as a training tool, the trainees gave a mean recommendation of 7.77 (range 5-10), and 38% gave a 9 or 10. General feedback regarding the nature of the OSCE noted the virtual format worked well, orientation to the format was important and could be improved by providing it in an email beforehand.
Conclusion(s): Virtual learning has been necessary during the COVID-19 pandemic, and it is crucial to evaluate the value of the novel Z-OSCE. Participants found the virtual OSCE may be more useful than in-person learning modalities and it compared favorably to other virtual learning modalities. One benefit of this modality was the easier inclusion of fellows from geographically disparate areas negating the need to travel for this program, a benefit given lack of universal access to simulation using standardized patients. To improve future exams, orientation prior to the day of the OSCE may improve trainees' experiences.

Background: Forensic odontology, a branch of dentistry includes identification of individuals in various crime scenes, natural calamities, and mass disasters. The identification is possible because every individual body is unique and so is our tongue due to its morphological variations. The primary objective of the study was to assess the morphological features of the tongue and its use in sex determination.
Method(s): The study included a sample size of 100 individuals (50 males and 50 females) in the age range of 20-50 years old. Photographs were taken of front and side view of the tongue; visual inspection was done and lastly impressions of the tongue were made with help of alginate and then poured with the help of dental stone. IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data. Microsoft word and Excel were used to generate graphs, tables etc. Females presented with triangular shape, presence of shallow fissures more commonly and a sharp lingual apex of tongue. Males presented with rectangular shape, presence of deep fissure/absence of fissures more commonly and septate/ sharp lingual apex of the tongue.
Conclusion(s): Tongue exhibits various unique characteristics and can be used in sex determination.
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PURPOSE/OBJECTIVE:Racial/ethnic minorities experience greater job loss than whites during periods of economic downturn and after a cancer diagnosis. Therefore, race/ethnicity-matched controls are needed to distinguish the impact of illness on job loss from secular trends METHODS: Surveys were administered during and 4-month post-completion of breast cancer treatment. Patients were pre-diagnosis employed women aged 18-64, undergoing treatment for stage I-III breast cancers, who spoke English, Chinese, Korean, or Spanish. Each patient was asked to: (1) nominate peers who were surveyed in a corresponding timeframe (active controls), (2) report a friend's work status at baseline and follow-up (passive controls). Both types of controls were healthy, employed at baseline, and shared the nominating patient's race/ethnicity, language, and age. The primary outcome was number of evaluable patient-control pairs by type of control. A patient-control pair was evaluable if work status at follow-up was reported for both individuals. RESULTS:Of the 180 patients, 25% had evaluable active controls (45 patient-control pairs); 84% had evaluable passive controls (151 patient-control pairs). Although patients with controls differed from those without controls under each strategy, there was no difference in the percentage of controls who were working at follow-up (96% of active controls; 91% of passive controls). However, only 65% of patients were working at follow-up. CONCLUSIONS:The majority of patients had evaluable passive controls. There was no significant difference in outcome between controls ascertained through either method IMPLICATIONS FOR CANCER SURVIVORS: Passive controls are a low-cost, higher-yield option to control for secular trends in racially/ethnically diverse samples.

INTRODUCTION:Self-rated health has been extensively studied, but the utility of a similarly structured question to rate diet quality is not well characterized. This study aims to assess the relative validity of self-rated diet quality, compared with that of a validated diet quality measure (Healthy Eating Index-2015) and to examine the associations with cardiometabolic risk factors. METHODS:Analyses were conducted in 2020-2021 using cross-sectional data from the National Health and Nutrition Examination Survey, 2011-2018. Nonpregnant adults who responded to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic risk factors were assessed by linear regression, accounting for the complex survey design and adjusting for demographic and lifestyle characteristics. RESULTS:. CONCLUSIONS:Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic disease risk factors. This single-item assessment may be useful in time-limited settings to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic health.

Introduction: Children and adolescents with pre-existing type 1 diabetes (T1D) diagnosed with COVID-19 are at risk of adverse outcomes such as hospitalizations and diabetic ketoacidosis (DKA). There is limited data on the association between the presence of one or more comorbidities and the risk of adverse outcomes for patients with preexisting T1D and COVID19.
Objective(s): This study's aim is to determine if pediatric and adolescent patients with T1D and other pre-existing comorbidities were more likely to experience adverse outcomes than T1D patients with COVID-19 who did not have any other comorbidities.
Method(s): Data from 592 patients with previously established T1D aged <24 years with COVID-19 were analyzed from the T1Dx COVID-19 Surveillance Registry. Data were collected from 52 endocrinology clinics across the US using an online survey tool. Each clinic completed the survey using electronic medical record (EMR) data between April 2020 and May 2021. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, insurance type, use of diabetes technology, presence of comorbidities, adverse outcomes, and hospitalization.
Result(s): The most frequent comorbidities were obesity (14%), asthma (11%), celiac disease (9%), and hypothyroidism (7%). T1D patients with at least one other comorbidity had a higher DKA presentation (16% vs 12%, p = 0.03) and a higher all-cause hospitalization rate (24% vs 15%, p = 0.02) compared to T1D patients without additional comorbidities. T1D Patients with comorbidities and COVID-19 were almost twice as likely to be hospitalized than those with no comorbidities (Odds Ratio 1.94, 95% CI: 1.23-3.03). The most frequent comorbidities were obesity (14%), asthma (11%), celiac disease (9%), and hypothyroidism (7%). T1D patients with at least one other comorbidity had a higher DKA presentation (16% vs 12%, p = 0.03) and a higher all-cause hospitalization rate (24% vs 15%, p = 0.02) compared to T1D patients without additional comorbidities. T1D Patients with comorbidities and COVID-19 were almost twice as likely to be hospitalized than those with no comorbidities (Odds Ratio 1.94, 95% CI: 1.23-3.03).
Conclusion(s): Our data reveal higher rates of hospitalizations and adverse outcomes among children and adolescents with T1D with at least one more comorbidities and COVID-19 in comparison with T1D patients without additional comorbidities. (Table Presented)

Introduction: Patients with inflammatory bowel disease (IBD) have a 2-to 3-fold greater risk of venous thromboembolism (VTE) than the general population, with increased risk during hospitalization. However, recent evidence suggests that this increased risk persists post-discharge. As such, we aimed to determine the cost-effectiveness of post-discharge VTE prophylaxis among hospitalized patients with IBD.
Method(s): A decision tree was used to compare inpatient prophylaxis alone versus 4 weeks of postdischarge VTE prophylaxis with rivaroxaban 10 mg/day. Our primary outcome was quality-adjusted life years (QALYs) over one year, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (in 2020 $US), incremental cost-effectiveness ratios (ICERs), and number needed to treat (NNT) to prevent one VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses were performed to assess uncertainty within the model.
Result(s): Four-week post-discharge prophylaxis with rivaroxaban resulted in 1.68 higher QALYs per 1000 persons and an incremental cost of $185,778 per QALY as compared to no postdischarge prophylaxis (see Table). The NNT to prevent a single VTE was 78 individuals, while the NNT to prevent a single VTE-related death was 3190 individuals. One-way sensitivity analyses showed that higher baseline VTE risk>4.5% or decreased cost of rivaroxaban <=$280 can reduce the ICER to<$100,000/QALY (see Figure, Tornado Diagram showing main drivers of the ICER). Probabilistic sensitivity analyses favored post-discharge prophylaxis in 30.5% of iterations
Conclusion(s): Four weeks of post-discharge VTE prophylaxis results in higher QALYs as compared to inpatient prophylaxis alone, and can prevent one post-discharge VTE among 78 patients with IBD. As such, post-discharge VTE prophylaxis in patients with IBD should be considered in a case-by-case scenario considering VTE risk profile, costs, and patient preference

Introduction: A transcatheter aortic valve replacement (TAVR) carries a 2% risk of postoperative upper gastrointestinal bleeding. It presents as extensive bleeding resulting in hemorrhagic shock or respiratory failure. In this case, an early clot with sentinel bleeding prevented the widening of a full thickness aortoesophageal fistula formed from the TAVR placement, was symptomatic enough to prompt an earlier esophagogastroduodenoscopy (EGD) and prevented a probable fatality. Case Description/Methods: An 85-year-old male with a past medical history of AAA repair, GERD, HLD, TIA, aortic dissection s/p coronary bypass graft, AS with TAVR 5 months prior presented with hematemesis after initiating colonoscopy bowel prep. He also had unintentional 30-lb weight loss over 3 months, fecal incontinence, and melena. Medications include a daily aspirin. Abdominal CT demonstrated an 8cm aortic arch aneurysm, a 5cm descending thoracic aortic aneurysm, and a 5.8 x 4 cm collection posterolateral to the aorta with proximal dilation of the esophagus. EGD demonstrated a partially obstructing protruding mass in the esophagus 20 cm from the incisors with sentinel bleeding from an adherent clot. The mass was determined to be extrinsic compression from the aortic arch aneurysm with the TAVR seen through the aortoesophageal fistula (Image 1A-1B). The stomach and duodenum were unremarkable. Patient was transferred to vascular surgery where a 1cm compressed Amplatzer Vascular Plug II embolization and reinforcement of the endoleak was done. Patient remained hemodynamically stable and discharged home with a vascular follow up.
Discussion(s): Aorto-esophageal fistula following TAVR is a rare complication with a wide etiology ranging from infections, antithrombotic use, pressure necrosis, angiodysplasia, underlying PUD, or uncontrolled comorbidities such as HTN. Our patient's risk factors were his elderly age, comorbidities, use of daily aspirin, and contribution from the pressure or ischemic necrosis of the aortic aneurysm compressing on the esophagus. Presentation involves hemoptysis, chest pain, hemorrhagic shock, respiratory failure and frank bleeding. CTA is considered the initial test of diagnosis as endoscopy, though sensitive, could rupture the clot and unleash massive bleeding. In this case, sentinel bleeding and visualization of the TAVR through the fistula was enough to diagnose and retreat to be treated appropriately with embolization and reinforcement