Publications by authors named "William B Burton"

23 Publications

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J Am Acad Dermatol 2021 Feb 4. Epub 2021 Feb 4.

private practice, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2021.02.002DOI Listing
February 2021

The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial.

J Am Acad Dermatol 2020 Nov 7;83(5):1294-1297. Epub 2020 Jul 7.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Platelet-rich plasma (PRP) may be a useful treatment for androgenetic alopecia (AGA), although objective studies are needed.

Objective: To determine whether PRP injections improve female AGA.

Method: Prospective randomized controlled trial of 30 women diagnosed with AGA. Patients received subdermal scalp injections of Eclipse system PRP or placebo saline at weeks 0, 4, and 8. Outcome measures were changes in hair density (hair/cm), hair caliber (mm), and blinded global photographic assessment (improved or not improved) at week 24.

Results: Blinded global photographic assessment indicated that 57% of patients receiving PRP versus 7% of patients receiving saline improved at week 24 from baseline (P < .01). Compared to baseline, there was improvement in mean density in the PRP group versus the placebo group at week 8 (+71.1 vs -26.7 hairs/cm; P < .01) and week 24 (+105.9 vs -52.4 hairs/cm; P < .01). Compared to baseline, there was improvement in mean caliber in the PRP group versus the placebo group at week 8 (+0.0043 vs -0.0034 mm; P < .01) and week 24 (+0.0053 vs -0.0060 mm; P < .01). Adverse effects included headache, scalp tightness, swelling, redness, and postinjection bleeding.

Limitations: Two patients lost to follow-up.

Conclusions: PRP with the Eclipse system is a safe and effective intervention for female AGA.
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http://dx.doi.org/10.1016/j.jaad.2020.06.1021DOI Listing
November 2020

A physicians survey assessing management of pulmonary airway involvement in sickle cell disease.

Pediatr Pulmonol 2019 07 22;54(7):993-1001. Epub 2019 Apr 22.

Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.

Background: Airway involvement in patients with sickle cell disease (SCD) involves recurrent episodes of acute chest syndrome (ACS), co-existent asthma, lower airway obstruction (LAO), or airway hyper-responsiveness/ bronchodilator response (AHR/BDR). With increased recognition that sickle cell (SC) airway inflammation may be distinct from asthma, our aim was to study regional and individual practices among pediatric pulmonologists and elucidate the patient characteristics that determine the diagnosis of asthma or SC airway inflammation.

Methods: A cross-sectional web-based survey including 6 case scenarios on diagnosis and management of pulmonary manifestations of pediatric SC airway disease was conducted. The case scenarios, combined different risk factors for airway inflammation: history of recurrent ACS, atopy, family history of asthma, LAO, or AHR/BDR, with possible responses including - diagnosis of asthma, SC airway inflammation, both or neither.

Results: Of the 130 responses, 83 were complete. "Asthma" was diagnosed when LAO (OR, 7.96 [4.28, 14.79]; p < 0.001), family history of asthma (OR 18.88 [5.87, 60.7]; p < 0.001), and atopy (OR 3.19 [1.74, 5.8]; p < 0.001) were present. "SC airway inflammation" was diagnosed when ACS (OR 3.95 [2.08, 7.51]; p < 0.001), and restrictive pattern on PFT (OR 3.75 [2.3, 6.09]; p < 0.001) were present in the scenarios. Regardless of the diagnosis, there was a high likelihood of initiating or stepping up inhaled corticosteroid as compared to prescribing montelukast.

Conclusion: There is variability in the diagnosis and management of SC airway inflammation among pediatric pulmonologists. This study highlights the need for consensus guidelines to improve management of SC airway inflammation.
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http://dx.doi.org/10.1002/ppul.24289DOI Listing
July 2019

Retrospective comparison of Velcro and twill tie outcomes following pediatric tracheotomy.

Int J Pediatr Otorhinolaryngol 2019 Jan 16;116:192-195. Epub 2018 Oct 16.

Albert Einstein College of Medicine, United States; Montefiore Medical Center and Children's Hospital at Montefiore, Department of Otorhinolaryngology-Head & Neck Surgery, United States. Electronic address:

Objectives: To compare the rates of skin-related complications and accidental decannulation in pediatric patients who received Velcro ties versus twill ties during the early postoperative period following tracheotomy. The rates of skin-related complications and accidental decannulation in patients with Velcro ties was hypothesized to differ from those in patients with twill ties.

Methods: Medical records of 109 patients ≤18 years old who underwent elective tracheotomy were reviewed: 70 received twill ties and 39 received Velcro ties. Patients were followed for the first seven postoperative days. The primary outcome was skin-related complications, which were further categorized into mild (irritation) and severe (breakdown). The secondary outcome was accidental decannulation. Rates of skin-related complication and accidental decannulation were compared across the two groups using chi-square analysis.

Results: Skin irritation occurred in 32 patients (45.7%) with twill ties and 10 patients (25.6%) with Velcro. Skin breakdown occurred in 20 patients (28.6%) with twill ties and 6 patients (15.4%) with Velcro. There were no accidental decannulation events. The use of Velcro ties was associated with a decreased rate of skin irritation (OR: 0.41; 95% CI: 0.17-0.97; P = 0.039).

Conclusions: The use of Velcro ties was associated with a decrease in the rate of skin irritation. There were no accidental decannulation events. These findings support the use of Velcro ties at the time of pediatric tracheotomy placement.
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http://dx.doi.org/10.1016/j.ijporl.2018.10.022DOI Listing
January 2019

Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection.

Anat Sci Educ 2018 Nov 30;11(6):605-612. Epub 2018 Mar 30.

Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York.

Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.
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http://dx.doi.org/10.1002/ase.1785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165707PMC
November 2018

The Relationship Between Method of Viewing Lectures, Course Ratings, and Course Timing.

J Med Educ Curric Dev 2017 Jan-Dec;4:2382120517720215. Epub 2017 Jul 11.

Office of Medical Education, Albert Einstein College of Medicine, Bronx, NY, USA.

Background: In recent years, medical schools have provided students access to video recordings of course lectures, but few studies have investigated the impact of this on ratings of courses and teachers. This study investigated whether the method of viewing lectures was related to student ratings of the course and its components and whether the method used changed over time.

Methods: Preclinical medical students indicated whether ratings of course lectures were based primarily on lecture attendance, video capture, or both. Students were categorized into Lecture, Video, or Both groups based on their responses to this question. The data consisted of 7584 student evaluations collected over 2 years.

Results: Students who attended live lectures rated the course and its components higher than students who only viewed the video or used both methods, although these differences were very small. Students increasingly watched lectures exclusively by video over time: in comparison with first-year students, second-year students were more likely to watch lectures exclusively by video; in comparison with students in the first half of the academic year, students in the second half of the academic year were more likely to watch lectures exclusively by video.

Conclusions: With the increase in use of lecture video recordings across medical schools, attention must be paid to student attitudes regarding these methods.
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http://dx.doi.org/10.1177/2382120517720215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736287PMC
July 2017

Etiology and long-term functional swallow outcomes in pediatric unilateral vocal fold immobility.

Int J Pediatr Otorhinolaryngol 2016 Sep 11;88:179-83. Epub 2016 Jul 11.

Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 10467, USA.

Objective: Unilateral vocal fold immobility (UVFI) results in deficits in phonatory, respiratory, and swallow function of the pediatric patient. Little is known about long-term functional swallow outcomes.

Methods: Medical records of children diagnosed with UVFI between 2005 and 2014 at a tertiary children's hospital were retrospectively reviewed. Etiology, laryngoscopy findings, and swallow status at diagnosis and follow-up were recorded. Swallow outcomes were compared by etiology using Fisher's exact test. McNemar's test was used to identify correlations between return of mobility and swallow recovery. Rates of pneumonia were compared with initial swallow evaluation results using a two-tailed t-test.

Results: Eighty-eight patients with UVFI were identified and 73 patients (47% female, mean age 14.4 months, standard deviation (SD) 26.7 months) had complete medical records. Mean follow up time was 52.7 months (SD 36.8 months). Etiologies included cardiothoracic surgery (68.5%), idiopathic (12.3%), prolonged intubation (11.0%), central nervous system (CNS) abnormality (5.5%), and non-cardiac iatrogenic injury to the recurrent laryngeal nerve (2.7%). Forty-seven patients underwent a follow up laryngoscopy, and recovery of vocal fold (VF) mobility was documented in 42.6% (20/47). At diagnosis, 31.5% fed orally, compared with 79.5% at follow-up. Direct correlation between recovery of VF mobility and swallow recovery was not demonstrated. Cardiac etiologies demonstrated higher rates of swallow recovery than CNS abnormalities (p = 0.0393). Twenty-five children aspirated on initial modified barium swallow (MBS) and 10 children developed pneumonias at some point during the follow up period. There was no significant difference in rates of pneumonia in patients with and without aspiration on MBS.

Conclusion: Recovery of swallow in children with UVFI does not directly parallel return of VF mobility. Long-term swallow outcome is favorable in this population. Initial MBS does not indicate ultimate swallow outcome.
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http://dx.doi.org/10.1016/j.ijporl.2016.07.008DOI Listing
September 2016

Evaluation of care access and hypertension control in a community health worker driven non-communicable disease programme in rural Uganda: the chronic disease in the community project.

Health Policy Plan 2016 09 8;31(7):878-883. Epub 2016 Mar 8.

Doctors for Global Health, Kisoro, Uganda, Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA, and.

The burden of non-communicable diseases continues to grow throughout the developing world. Health systems in low- and middle-income regions face significant human resource shortages, which limit the ability to meet the growing need for non-communicable disease care. Specially trained community health workers may be useful in filling that provider gap. This study aimed to evaluate consistency of access to care and quality of hypertension control in a community health worker led, decentralized non-communicable disease programme operating in rural Uganda. Days between clinical evaluations and average systolic blood pressure were described for programme patients; these markers were also compared with patients seen in a central, hospital-based clinic. In 2013, community health worker programme patients were seen every 35.6 days and significantly more often than clinic patients (50.8 days, P < 0.001). From October to December 2013, hypertensive patients in the community health worker programme had a mean systolic blood pressure of 147.8 mmHg. This was lower than the average systolic pressure of clinic patients (156.7 mmHg, P < 0.001). Programme patients' blood pressures were also more frequently measured at below goal than clinic patients (71.2 vs 59.8%, P = 0.048). Decentralizing care and shifting significant clinical management responsibilities to community health workers improved consistency of access to care and did not come with a demonstrable cost in quality of hypertension control. Community health workers may have the potential to bridge the provider gap in low-income nations, providing expanded non-communicable disease care.
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http://dx.doi.org/10.1093/heapol/czw006DOI Listing
September 2016

Community practice patterns for bacterial corneal ulcer evaluation and treatment.

Eye Contact Lens 2015 Jan;41(1):12-8

Albert Einstein College of Medicine (J.P., K.M.L., M.R., K.J., W.B.B.), Bronx, NY; State University of New York Downstate College of Medicine (H.Z.), Brooklyn, NY; Departments of Ophthalmology and Visual Sciences (K.J., D.C.G.); and Epidemiology and Population Health (D.C.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Objective: To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists.

Methods: A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics.

Results: One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001).

Conclusions: Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.
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http://dx.doi.org/10.1097/ICL.0000000000000059DOI Listing
January 2015

Evaluation of the cardiac chambers on axial CT: comparison with echocardiography.

J Comput Assist Tomogr 2014 Jan-Feb;38(1):53-60

From the *Departments of Radiology, †Medicine, Division of Cardiology, ‡Medicine, and §Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.

Objective: To evaluate qualitative and simple quantitative measures of all 4 cardiac chamber sizes on computed tomography (CT) in comparison with transthoracic echocardiography (TTE).

Methods: We retrospectively identified 104 adults with electrocardiographically gated cardiac CT and TTE within 3 months. Axial early diastolic (75% R-R) CT images were reviewed for qualitative chamber enlargement, and each chamber was measured linearly. Transthoracic echocardiography was reviewed for linear, area, and volume measurements. Interrater agreement was calculated using Cohen κ and Pearson correlation.

Results: There were significant correlations between linear left atrium and left ventricle sizes by CT and TTE (r = 0.686 and r = 0.709, respectively). Correlations for right atrium and right ventricle measurements were lower (r = 0.447 and r = 0.492, respectively). Agreement between CT and TTE for qualitative chamber enlargement was poor (highest κ = 0.35). Computed tomography sensitivity was ≤ 62% for enlargement of all chambers.

Conclusions: Linear CT measurements of left-sided chamber sizes correlate well with TTE. Right heart measurements and qualitative assessments agreed poorly with TTE.
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http://dx.doi.org/10.1097/RCT.0b013e3182a75fbeDOI Listing
March 2014

Retained fibrin sheaths: chest computed tomography findings and clinical associations.

J Thorac Imaging 2014 Mar;29(2):118-24

Departments of *Radiology §Medicine ∥Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx †Department of Radiology, Staten Island University Hospital, Staten Island, NY ‡Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Purpose: Fibrin sheaths may develop around long-term indwelling central venous catheters (CVCs) and remain in place after the catheters are removed. We evaluated the prevalence, computed tomographic (CT) appearance, and clinical associations of retained fibrin sheaths after CVC removal.

Materials And Methods: We retrospectively identified 147 adults (77 men and 70 women; mean age 58 y) who underwent CT after CVC removal. The prevalence of fibrin sheath remnants was calculated. Bivariate and multivariate analyses were performed to assess for associations between sheath remnants and underlying diagnoses leading to CVC placement; patients' age and sex; venous stenosis, occlusion, and collaterals; CVC infection; and pulmonary embolism.

Results: Retained fibrin sheaths were present in 13.6% (20/147) of cases, of which 45% (9/20) were calcified. Bivariate analysis revealed sheath remnants to be more common in women than in men [23% (16/70) vs. 5% (4/77), P=0.0018] and to be more commonly associated with venous occlusion and collaterals [30% (6/20) vs. 5% (6/127), P=0.0001 and 30% (6/20) vs. 6% (7/127), P=0.0003, respectively]. Other variables were not associated. Multivariate analysis confirmed the relationship between fibrin sheaths and both female sex (P=0.005) and venous occlusion (P=0.01).

Conclusions: Retained fibrin sheaths were seen on CT in a substantial minority of patients after CVC removal; nearly half of them were calcified. They were more common in women and associated with venous occlusion.
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http://dx.doi.org/10.1097/RTI.0b013e318299ff22DOI Listing
March 2014

Crude tonsillectomy and local concepts of illness in Kisoro, Uganda: community perception of gapfura and its treatment.

Glob Public Health 2013 26;8(3):298-311. Epub 2013 Feb 26.

Albert Einstein College of Medicine, Bronx, NY, USA.

The practice of crude tonsillectomy (CT), performed by traditional healers for a locally defined illness known as gapfura, has become increasingly common in south-western Uganda. This study describes perceptions of gapfura and examines the intersection of locally defined and biomedical illness. Kisoro District Hospital (KDH) staff (n=55) were surveyed, with 95% reporting that CT caused death, and 60% estimating that recipients died as a result of the procedure. Surveys of community members (n=737) revealed that 95% were familiar with gapfura as a common illness with variable symptoms; syndrome classification categorised 58% of descriptive responses as 'upper respiratory infection', while 42% suggested more severe diseases. Although only 26% of community respondents told the interviewer that CT was the best treatment, 47% believed the majority of community members use CT and 43% of those treated for gapfura within the past year received CT. The divergent perceptions of community members and allopathic health providers may be rooted in the use of gapfura as an idiom reflecting larger social stressors and CT as a response to this distress. Interventions to curb the practice of CT need to be multifaceted and will involve further anthropologic investigation, public health involvement, and education that encompasses the social context of disease.
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http://dx.doi.org/10.1080/17441692.2013.770901DOI Listing
September 2013

Coronary artery dilation in sickle cell disease.

J Pediatr 2011 Nov 30;159(5):789-794.e1-2. Epub 2011 Jun 30.

Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA.

Objective: To evaluate the prevalence of coronary artery dilation in children with sickle cell disease (SCD).

Study Design: This is a retrospective analysis performed in patients, between 10 and 19 years old, with SCD who underwent a routine transthoracic echocardiographic evaluation over a 20-month period. The left main, left anterior descending, and proximal right coronary artery diameters, as well as clinical and laboratory variables and other echocardiographic results were collected. Echocardiographic measurements were converted to z scores by using information from a large control population of normal children. Coronary artery ectasia (CAE) was defined as a coronary artery diameter z score ≥ 2. The patients with CAE were compared with those without CAE by using univariate and multivariate analyses.

Results: Seventeen of 96 patients with SCD (17.7%) had CAE. There were no differences in sex, age, height, weight, body surface area, or genotype between those with and those without CAE. Patients with CAE had larger left ventricular end-diastolic dimension, shortening fraction, septal thickness, posterior wall thickness, mass, mass-to-volume ratio, and white blood cell count. Multivariate analysis revealed that the mass-to-volume ratio and elevated white blood cell count were associated with CAE.

Conclusion: CAE is common in SCD and is associated with left ventricular hypertrophy and inflammation.
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http://dx.doi.org/10.1016/j.jpeds.2011.05.013DOI Listing
November 2011

Should CT play a greater role in preventing the resection of granulomas in the era of PET?

AJR Am J Roentgenol 2011 Apr;196(4):795-800

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 St, Bronx, NY 10467, USA.

Objective: PET cannot distinguish between bronchogenic carcinoma and granuloma, but positive scans may prompt surgery. We systematically evaluated the CT appearance of resected carcinomas and granulomas to identify features that could be used to reduce granuloma resections.

Materials And Methods: We retrospectively identified 93 consecutive patients between January 2005 and November 2008 who had resection of a pulmonary nodule pathologically diagnosed as bronchogenic carcinoma or granuloma and preoperative imaging with CT and PET. Each nodule was evaluated on CT for size, doubling time, location, borders, shape, internal characteristics, calcification, clustering, air bronchograms, and cavitation. A diagnostic impression was rendered. Bivariate and logistic regression analyses were performed. Pre-PET data regarding the proportion of resected granulomas and carcinomas between January 1995 and December 1996 were reviewed.

Results: Sixty-eight percent (65/96) of nodules were carcinomas and 32% (31/96) were granulomas. The CT impression was benign in 65% (20/31) of granulomas and 5% (3/65) of carcinomas (p < 0.0001; negative predictive value [NPV], 87% [20/23]). Specific CT features significantly associated with granuloma were clustering, cavitation, irregular shape, lack of pleural tags, and solid attenuation. The combination of nonspiculated borders, irregular shape, and solid attenuation had an NPV of 86% (12/14). Granulomas represented 18% (9/50) of resected nodules in 1995 and 1996 (p = 0.066).

Conclusion: CT findings reduce but cannot eliminate the possibility that a nodule is malignant. Outcomes-based clinical trials are needed to determine whether CT features of benignity can guide less-invasive initial management and reverse a concerning trend in granuloma resection.
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http://dx.doi.org/10.2214/AJR.10.5190DOI Listing
April 2011

Normal myocardial perfusion on 64-detector resting cardiac CT.

J Cardiovasc Comput Tomogr 2011 Jan-Feb;5(1):52-60. Epub 2010 Nov 26.

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467-2490, USA.

Background: Computed tomography (CT) of the heart is increasingly used to characterize not only the coronary arteries but also cardiac structure and function. The performance of CT in depicting myocardial perfusion is under active investigation.

Objective: We describe the pattern of normal myocardial perfusion on resting 64-detector cardiac CT.

Methods: Patients (n = 33; 20 women, 13 men; mean age, 52 years) with normal radionuclide myocardial perfusion imaging and normal coronary arteries on CT angiography (120 kVp) comprised the study population. Segmental myocardial perfusion on CT was measured in Hounsfield units (HU) with manual and semiautomated methods for the 17-segment American Heart Association model in both systole and diastole. Segments were aggregated into coronary artery territories, from apex to base and by myocardial wall. The relationships between myocardial perfusion and various patient factors were evaluated.

Results: Overall mean myocardial perfusion was 98 HU in systole and 94 HU in diastole with the manual method (P = .011) and 92 HU in systole and 95 HU in diastole with the automated method (P = .001). The septum showed significantly higher mean attenuation values than the other walls in systole and diastole with both methods. Generally, attenuation values were lower in the left circumflex artery territory and in the apex. Bivariate analysis showed higher mean myocardial attenuation values for women than men, although this difference did not persist on multivariate analysis adjusted for patient size.

Conclusion: Normal mean resting myocardial perfusion correlates with CT attenuation values of approximately 92-98 HU on CT angiography in the coronary arterial phase. The septum consistently shows greater attenuation values than the other walls.
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http://dx.doi.org/10.1016/j.jcct.2010.11.003DOI Listing
June 2011

Educational video tool to increase syphilis knowledge among black and Hispanic male patients.

J Health Care Poor Underserved 2010 Feb;21(1):371-85

Department of Emergency Medicine, Albert Einstein College of Medicine, USA.

Study Objective: To determine the effectiveness of an educational video entitled Syphilis and Men to increase syphilis knowledge among at-risk Black and Hispanic male patients.

Methods: In this randomized controlled trial, participants were randomly assigned to one of four groups and completed a pre-test survey, viewed the video (intervention group) and/or completed a post-test knowledge survey. Our analysis assessed whether the intervention group in comparison to the control group had an increase in syphilis knowledge, regardless of self-reported socio-demographic and sexual behavior characteristics associated with increased risk for syphilis infection.

Results: Two hundred and six (206) males were studied. The intervention group participants scored on average 24.8 percentage points higher than the control group participants (p<.001) on the post-test survey after viewing the video. This difference was present regardless of certain self-reported socio-demographic and sexual behavior characteristics associated with increased risk for syphilis infection.

Conclusion: The Syphilis and Men video is a five-minute, low-cost tool that increased syphilis knowledge among Black and Hispanic male patients and could have similar effects in other settings.
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http://dx.doi.org/10.1353/hpu.0.0248DOI Listing
February 2010

Video tool to promote knowledge of syphilis among black and Hispanic men recruited from clinical and non-clinical settings.

J Community Health 2010 Jun;35(3):220-8

Department of Emergency Medicine, Jacobi Medical Center, 1400 Pelham Pkwy South, Bronx, NY 10461, USA.

Unlabelled: Recent syphilis outbreaks in metropolitan cities are attributed to men who have sex with men (MSM) with a significant proportion of Black or Hispanic identity. However, there are few syphilis interventions that are tailored to minority MSM.

Methods: We conducted a randomized controlled trial to assess whether Black and Hispanic MSM recruited from various venues who viewed the "Syphilis and Men" video showed an increase in syphilis knowledge, regardless of self-reported characteristics associated with increased risk for syphilis infection.

Results: Of the 168 participants, 91.1% were Black or Hispanic and 64.9% had a male partner in the past 6 months. The video intervention group had a significant increase of 19.5-20.9 percentage points on the post-test survey, depending on the venue. This difference was present irrespective of participant socio-demographic and health-related characteristics.

Discussion: The "Syphilis and Men" video is a brief, cost-limited intervention to promote syphilis knowledge among Black and Hispanic MSM that can potentially be implemented in various venues.
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http://dx.doi.org/10.1007/s10900-010-9239-4DOI Listing
June 2010

Ejection fractions determined by cardiac computed tomographic angiography and single photon emission computed tomographic myocardial perfusion imaging are not interchangeable: evidence of significant and sex-associated disparities.

J Comput Assist Tomogr 2009 Jul-Aug;33(4):489-97

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467-2490, USA.

Purpose: Left ventricular ejection fraction (LVEF) determines patient management and is a standard part of cardiac imaging evaluation. Intermodality comparisons are useful in determining whether modalities are interchangeable. Multidetector Computed tomography (CT) and single photon emission CT (SPECT) myocardial perfusion imaging (MPI) have been compared in only a few cohorts. We compared these modalities in a sex-balanced group.

Materials And Methods: Sixty outpatients (30 women 30 men) referred for MPI underwent CT on the same day. We calculated LVEF, end-diastolic volume (EDV), and end-systolic volume (ESV) from CT and MPI datasets using a commercially available, semi-automated routine and quantitative gated SPECT (QGS) respectively. Correlations, t-tests and Bland-Altman plots were performed for ESV, EDV, and LVEF. Bivariate and multiple regression analyses for LVEF were performed for both modalities. The subgroups for men and women were analyzed.

Results: Computed tomography showed moderate to high correlations with SPECT for LVEF (0.62), EDV (0.70), and ESV (0.63). End-diastolic volume and LVEF were significantly higher on CT as compared to SPECT (P < 0.001 each). Multiple regression analysis showed a significant relationship between sex and LVEF (P < 0.0001) on SPECT but not on CT. In men, there were significantly higher EDV (P = 0.014) and LVEF (P < 0.001) on CT compared with SPECT, but there was no difference in ESV. For women, there were significantly higher EDV and ESV on CT (P < 0.001 each), but no difference in LVEF.

Conclusions: Left ventricular volumes and LVEF differed significantly on CT compared with SPECT and varied according to sex. Therefore, left ventricular volumes and LVEF values on CT and SPECT are not interchangeable.
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http://dx.doi.org/10.1097/RCT.0b013e3181a1c820DOI Listing
August 2009

Development, impact, and measurement of enhanced physical diagnosis skills.

Adv Health Sci Educ Theory Pract 2009 Oct 22;14(4):547-56. Epub 2008 Oct 22.

Division of Infectious Disease-Staff house rm. 226, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, Lakeville Rd., New Hyde Park, NY 11042, USA.

Evidence suggests that the quality and frequency of bedside clinical examination have declined. We undertook the study to (1) determine whether intensive instruction in physical examination enhances medical student skills and (2) develop a tool to evaluate those skills using a modified observed structured clinical examination (OSCE). This was a randomized, blinded, prospective, year-long study involving 3rd year students at the Albert Einstein College of Medicine. Students were randomized to receive intensive instruction in physical examination [study group (n = 46)] or usual instruction [control group (n = 75)] and evaluated by a modified OSCE. The OSCE consisted of 6 real patient stations: Head, ears, eyes, neck, throat; pulmonary; cardiovascular; gastrointestinal; neurology; musculoskeletal; and 2 computer imaging stations: genitourinary and dermatology. A faculty member present at each patient station evaluated student performance. Data were analyzed using t-tests for comparison of the mean scores between the two groups for each station and for average scores across stations. A total of 121 students were tested. The study group performed significantly better than the control group in the gastrointestinal station (p = 0.0004), the combined average score across the six real patient stations (p = 0.0001), and the combined average score across all eight stations (p = 0.0014). Intensive physical diagnosis instruction enhances physical examination skills of 3rd year medical students. The modified OSCE is a useful tool to evaluate these skills.
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http://dx.doi.org/10.1007/s10459-008-9137-zDOI Listing
October 2009

Teaching clinical skills through videotape review: a randomized trial of group versus individual reviews.

Teach Learn Med 2006 ;18(2):92-8

Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.

Background: Video review is a valuable educational tool for teaching communication skills. Many studies have demonstrated its efficacy with individual learners, but few studies have addressed its use in a group format.

Purpose: To assess the educational benefits of group versus individual video review of standardized patient encounters through the evaluations of 4th-year students at the Albert Einstein College of Medicine.

Methods: Students (128) who participated in a 7-station, standardized patient, clinical competency exam were randomly assigned to an individual or small group video review of selected segments of these encounters in 2000-2001. Students filled out an anonymous 13-item questionnaire assessing the experience and provided open-ended responses.

Results: With both review formats, most students had a positive learning experience (80%), found it less stressful than they expected (67%), and would not have preferred to do the review the other way (84%). Students randomized to individual reviews had a significantly higher level of satisfaction with the amount of time for the session (91% vs. 78%, p < .05) and the amount of feedback they received (95% vs. 79%, p = .01) and were more likely to view the session as a positive learning experience (88% vs. 73%, p < .05). Students in the individual review format were more likely to choose self-assessed weak segments (63% vs. 49%, p = .01). Students' comments indicated that they appreciated the value of peer review in a group setting.

Conclusions: Although both group reviews and individual reviews of videotaped standardized patient encounters were received well by the students, there were several statistical differences in favor of the individual format.
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http://dx.doi.org/10.1207/s15328015tlm1802_1DOI Listing
May 2006

The effect of the season on otitis media with effusion resolution rates in the New York Metropolitan area.

Int J Pediatr Otorhinolaryngol 2004 Feb;68(2):191-5

Department of Otolaryngology and Communicative Disorders, Section of Otology and Neurotology, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.

Objective: To study the relationship between season and resolution rates of otitis media with effusion (OME) in the New York Metropolitan area, in order to provide objective data useful to the practicing otolaryngologist in determining if seasonal factors should be considered in OME management decisions.

Methods: This was a prospective study of children referred to a tertiary medical center. Children with OME (confirmed by pneumatoscopy and tympanometry) were followed by an otologist at an academic medical center over a 3 years period. They returned approximately every 6 weeks until the end points of resolution of the effusions or ventilating tube placement. Each period between visits is termed an "interval."

Results: 127 patients with 231 effusions were followed for a total of 354 intervals. Effusions at intervals beginning in autumn were least likely to resolve by the next visit (24.29%) while intervals ending in the summer had the greatest rate of resolution (44.32%). Analyzed by month, the lowest rates of resolution were seen in intervals beginning in September, November, February, and March (16.67, 21.05, 20.51, and 19.15%, respectively). Intervals beginning in May had the greatest chance of resolution (51.72%). There was a positive correlation between resolution rates and average daily temperatures as reported by month.

Conclusions: The season and month of the year are relevant factors in the clinical course of OME in the New York Metropolitan area. Based on the observed rates of resolution, one could reasonably consider taking a more conservative approach to OME management in May through August, and a more aggressive approach in the fall and winter months.
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http://dx.doi.org/10.1016/j.ijporl.2003.10.011DOI Listing
February 2004

Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference?

Arch Pediatr Adolesc Med 2003 Feb;157(2):125-9

Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA.

Background: About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome.

Objective: To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs.

Setting: Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs).

Participants: Nine hundred forty-nine inner-city schoolchildren with asthma.

Design: To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information.

Results: Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high-during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively; P =.02).

Conclusion: Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.
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http://dx.doi.org/10.1001/archpedi.157.2.125DOI Listing
February 2003