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A Review: Embedding a Simulation Training Program in Labor and Delivery to Improve healthcare Quality, Clinical Outcomes, and Patient Satisfaction

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Open Journal of Obstetrics and Gynecology 2019年第9期9卷 1226-1249页

作者： Dana K. Bryant new york city health and hospitals/kings county hospital New York USA

In response to maternal deaths being three-fold higher for black women than other races in new york city, Governor Andrew M. Cuomo created a taskforce which met for a year. In March 2019, the taskforce published ten recommendations to address the current healthcare disparities. The taskforce recommended utilizing medical simulation training to improve skills and communication. Peer-reviewed literature was explored for evidentiary support for embedding a simulation program in a NYC public hospital. In addition, obstacles to and advantages of in-situ simulation programs were discussed. Steps for garnering executive leadership support, improving teamwork, defining outcome measures, and identifying beneficiaries of in-situ simulation programs were explored.

关键词： Embedded Simulation Postpartum Hemorrhage Drills Interdisciplinary Teaching Teamwork in Obstetrics Qualitative and Quantitative Improvements in Obstetrical Outcomes

Uterine Didelphys in a Pregnant Mother

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Open Journal of Obstetrics and Gynecology 2018年第13期8卷 1423-1430页

作者： Omeed Paknejad Dana Bryant Carla Peterkin Wendy Wilcox Saint George’s University School of Medicine St. George Grenada new york city health and hospitals Corporation: kings county hospital Obstetrics Gynecology and Women’s Health Brooklyn NY USA

Background: Uterine Didelphys is a rare congenital condition and it can affect both mother and fetus. A 24 year-old patient presented to the emergency room with pelvic pain and a pelvic ultrasound confirmed the presence of Uterine Didelphys. She subsequently became pregnant and was first seen at 21 weeks gestation. She was designated as a high-risk patient during the second trimester when she experienced irregular contractions. She was monitored weekly with Non-Stress Tests and eventually was delivered by Cesarean Section. Uterine Didelphys can be detected in-utero in affected individuals, and clinical findings vary among individuals. Some may be asymptomatic, whereas others will experience dyspareunia, and still others may present with concurrent renal agenesis. Serial sonograms are performed throughout their pregnancy to evaluate fetal growth and well-being, as well as cervical length. Unlike many uterine anomalies, Uterine Didelphys does not affect fertility but can affect labor, fetal growth, placentation, fetal viability and fetal outcome. Uterine Didelphys frequently results in recurrent miscarriages and may cause preterm labor and necessitate cesarean section. The presentation, associated symptoms, methods of detection and management options for Uterine Didelphys will be discussed.

关键词： Uterine Didelphys and Pregnancy Uterine Anomaly and Pregnancy

Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

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Journal of Cancer Therapy 2019年第4期10卷 269-289页

作者： Yakira David Lorenzo Ottaviano Jihye Park Sadat Iqbal Michelle Likhtshteyn Samir Kumar Helen Lyo Ayanna E. Lewis Brandon E. Lung Jesse T. Frye Li Huang Ellen Li Jie Yang Laura Martello Shivakumar Vignesh Joshua D. Miller Michele Follen Evan B. Grossman Department of Medicine SUNY Downstate Medical Center Brooklyn NY USA Department of Gastroenterology Icahn School of Medicine at Mount Sinai New York City NY USA Department of Medicine Stony Brook University Stony Brook NY USA Department of Applied Mathematics and Statistics Stony Brook University Stony Brook NY USA Department of Family Population and Preventive Medicine Stony Brook University Stony Brook NY USA Department of Obstetrics and Gynecology NYC HNC/Kings County Brooklyn NY USA Department of Medicine Division of Gastroenterology NYC Health and Hospitals/Kings County Brooklyn NY USA

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

关键词： Colorectal Cancer Screening Adenoma Quality

Survey of the current state of emergency care in Chennai, India

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World Journal of Emergency Medicine 2011年第3期2卷 169-174页

作者： Jay Khadpe Tausif Thangalvadi Parivalavan Rajavclu Richard Sinert kings county hospital Center / SUNY Downstate Medical Center Brooklyn NY USA Sundaram Medical Foundation Chennai India

BACKGROUND：On July 21, 2009, the Medical Council of India officially recognized the specialty of emergency medicine in India. The city of Chennai with over six and a half million people is the fourth largest on the subcontinent and has already been a prominent city of interest in the specialty＇s development. However, there is no standardization of the resources found in the city＇s emergency departments. This study was to survey the equipment, training, and certification of Chennai area emergency departments and their staff. METHODS：We conducted a cross-sectional survey of emergency department staff from 38 Chennai area hospitals. The survey instrument contained 44 questions pertaining to hospital demographics, staff training and certification, and ED equipment and supplies. The items on the survey were specifically chosen to represent only the most basic and common resources necessary to practise emergency medicine. RESULTS： The survey found a majority of hospitals are privately operated but there is a wide range in terms of size and volume of patients. A minority of both doctors and nurses are certified in BLS, ACLS, PALS, and ATLS. While almost all departments surveyed had the basic code medications, a number of basic equipment items were lacking from a large percentage of the EDs surveyed. CONCLUSION：The newly established EP community in Chennai will have the responsibility to establish standards for both training and resources so that the specialty may grow and provide a higher standard of emergency care moving into the future.

关键词： Survey of the current state of emergency care in Chennai India