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Winters AC, Aby ES, Pourmand K, Barman P, Kriss M, Pillai A. Many transplant hepatology graduates feel unprepared for first job search: Results from a national employment survey of early career hepatologists. Liver Transpl 2023; 29:1332-1336. [PMID: 37309214 DOI: 10.1097/lvt.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Adam C Winters
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth S Aby
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kamron Pourmand
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pranab Barman
- Division of Gastroenterology, University of California, San Diego, California, USA
| | - Michael Kriss
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
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2
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Goodman MC, Chesner JH, Pourmand K, Farouk SS, Shah BJ, Rao BB. Developing a Novel Case-Based Gastroenterology/Hepatology Online Resource for Enhanced Education During and After the COVID-19 Pandemic. Dig Dis Sci 2023; 68:2370-2378. [PMID: 36920667 PMCID: PMC10015521 DOI: 10.1007/s10620-023-07910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic reshaped the delivery of medical education, necessitating novel modes of instruction to facilitate distance learning. Online medical education resources provide opportunities for self-directed and asynchronous learning. GISIM is a free, open access educational website dedicated to gastroenterology (GI)/hepatology, which teaches pathophysiology and disease management, and supports clinical reasoning skill development through interactive, dynamic, case presentation-based journeys. AIMS (1) To describe the creation of a mobile-optimized, GI/hepatology educational resource for medical trainees, and (2) to report on trainee feedback on completing and authoring GISIM cases. METHODS GISIM was created on WordPress and modeled after NephSIM, an e-learning platform dedicated to Nephrology. Content was developed by internal medicine residents and GI/hepatology fellows and attendings. Cases are interactive, prompting users to select differential diagnoses and management plans, with immediate feedback provided on response. Self-reported user demographics and website feedback were collected with an embedded survey. A separate survey evaluated case authors' experiences. RESULTS GISIM launched in February 2021 and received 12,184 website views and 2003 unique visitors between February 1 2021 and February 28 2022. New cases are disseminated bimonthly. Sixty-one user surveys were collected, with a majority completed by fellows (38%) and residents (26%). All users found the website easy to use and most reported enhanced understanding of case topic areas. Nine author surveys were collected. Authors reported significant learning on chosen topics and improved clinical knowledge through their participation. CONCLUSIONS We developed a novel GI/hepatology case-based resource that enables distance learning and was perceived as a valuable educational tool by users and authors.
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Affiliation(s)
- Morgan C Goodman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn H Chesner
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kamron Pourmand
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samira S Farouk
- Barbara T. Murphy Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brijen J Shah
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bhavana Bhagya Rao
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Horwich BH, Leven E, Winters AC, Pourmand K. The evolving paradigm of alcohol‐associated hepatitis and liver transplantation. Clin Liver Dis (Hoboken) 2022; 21:80-83. [PMID: 37095774 PMCID: PMC10121440 DOI: 10.1002/cld.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
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Affiliation(s)
- Brian H. Horwich
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Leven
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam C. Winters
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kamron Pourmand
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Leven EA, Luo Y, Nguyen VT, Pourmand K. Enhanced Communication for Interhospital Transfers Increases Preparedness in an Academic Tertiary Care Center. Appl Clin Inform 2022; 13:811-819. [PMID: 36044918 PMCID: PMC9433165 DOI: 10.1055/s-0042-1756371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/21/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES This quality improvement project sought to enhance clinical information sharing for interhospital transfers to an inpatient hepatology service comprised of internal medicine resident frontline providers (housestaff) with the specific aims of making housestaff aware of 100% of incoming transfers and providing timely access to clinical summaries. INTERVENTIONS In February 2020, an email notification system to senior medicine residents responsible for patient triage shared planned arrival time for patients pending transfer. In July 2020, a clinical data repository ("Transfer Log") updated daily by accepting providers (attending physicians and subspecialty fellows) became available to senior medicine residents responsible for triage. METHODS Likert scale surveys were administered to housestaff before email intervention (pre) and after transfer log intervention (post). The time from patient arrival to team assignment (TTA) in the electronic medical record was used as a proxy for time to patient assessment and was measured pre- and postinterventions; >2 hours to TTA was considered an extreme delay. RESULTS Housestaff reported frequency of access to clinical information as follows: preinterventions 4/31 (13%) sometimes/very often and 27/31 (87%) never/rarely; postinterventions 11/26 (42%) sometimes/very often and 15/26 (58%) never/rarely (p = 0.02). Preinterventions 12/39 (31%) felt "not at all prepared" versus 27/39 (69%) "somewhat" or "adequately"; postinterventions 2/24 (8%) felt "not at all prepared" versus 22/24 (92%) somewhat/adequately prepared (p = 0.06). There was a significant difference in mean TTA between pre- and posttransfer log groups (62 vs. 40 minutes, p = 0.01) and a significant reduction in patients with extreme delays in TTA post-email (18/180 pre-email vs. 7/174 post-email, p = 0.04). CONCLUSION Early notification and increased access to clinical information were associated with better sense of preparedness for admitting housestaff, reduction in TTA, and reduced frequency of extreme delays in team assignment.
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Affiliation(s)
- Emily A. Leven
- Department of Medicine, Mount Sinai Hospital, New York, New York, United States
| | - Yuying Luo
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, New York, New York, United States
| | - Vinh-Tung Nguyen
- Division of Hospital Medicine, Department of Medicine, Mount Sinai Hospital, New York, New York, United States
| | - Kamron Pourmand
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, United States
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Pourmand K, Schiano TD, Motwani Y, Kriss M, Keefer L, Patel A. Burnout Among Transplant Hepatologists in the United States. Liver Transpl 2022; 28:867-875. [PMID: 34826182 DOI: 10.1002/lt.26375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022]
Abstract
Burnout among transplant hepatologists has not been well characterized. The goal of this study was to describe the prevalence and predictors of burnout among practicing transplant hepatologists in the United States. We designed a 69-item survey, including the Maslach Burnout Inventory (MBI)-Human Services Survey and questions on provider demographics, practice characteristics, and psychological factors. The survey was administered to practicing US transplant hepatologists between October and December 2019. We described burnout using MBI subscales (emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA]) and determined significant predictors of burnout, which we defined as high EE, using univariate and multivariate analyses. A total of 185 transplant hepatologists completed the survey (response rate = 25% of 738 practicing transplant hepatologists in the United States). A total of 40% reported high EE, whereas 17% and 16% reported high DP and low PA, respectively. On multivariate analysis, respondents with more than 5 colleagues (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.23-0.84) reporting adequate time for outpatient visits (OR, 0.42; 95% CI, 0.22-0.80), reporting greater comfort with their clinical caseload (OR, 0.61; 95% CI, 0.39-0.96), and reporting higher confidence in their prior training (OR, 0.49; 95% CI, 0.28-0.87) had a lower likelihood of high EE. Working 6 or more hours from home outside of work per week (OR, 2.04; 95% CI, 1.07-3.89) predicted a higher likelihood of burnout. Compensation, age, gender, career phase, caregiver status, and transplant center volume did not predict burnout. Of the surveyed transplant hepatologists, 40% experienced burnout, predicted mostly by factors related to work-time distribution, peer support, and affect. These findings should prompt development of system-level initiatives.
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Affiliation(s)
- Kamron Pourmand
- Division of Liver Diseases Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai New York NY Department of Medicine Statistics Core David Geffen School of Medicine at University of California Los Angeles CA Division of Gastroenterology and Hepatology University of Colorado School of Medicine Aurora CO Division of Gastroenterology Icahn School of Medicine at Mount Sinai New York NY Division of Digestive Diseases David Geffen School of Medicine at University of California Los Angeles CA Division of Gastroenterology and Hepatology Veterans Affairs Greater Los Angeles Healthcare System Los Angeles CA
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Tabrizian P, Pourmand K, Florman S. Liver Transplantation in a Patient With Human Immunodeficiency Virus and Coronavirus Disease 2019. Liver Transpl 2021; 27:1355-1356. [PMID: 33207069 PMCID: PMC7753545 DOI: 10.1002/lt.25947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Parissa Tabrizian
- Liver Transplant and Hepatobiliary SurgeryRecanati/Miller Transplantation InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Kamron Pourmand
- Liver Transplant and Hepatobiliary SurgeryRecanati/Miller Transplantation InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Sander Florman
- Liver Transplant and Hepatobiliary SurgeryRecanati/Miller Transplantation InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
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Fiel MI, El Jamal SM, Paniz-Mondolfi A, Gordon RE, Reidy J, Bandovic J, Advani R, Kilaru S, Pourmand K, Ward S, Thung SN, Schiano T. Findings of Hepatic Severe Acute Respiratory Syndrome Coronavirus-2 Infection. Cell Mol Gastroenterol Hepatol 2020; 11:763-770. [PMID: 32992052 PMCID: PMC7521427 DOI: 10.1016/j.jcmgh.2020.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Liver injury due to coronavirus disease 2019 (COVID-19) is being increasingly recognized. Abnormal liver chemistry tests of varying severities occur in a majority of patients. However, there is a dearth of accompanying liver histologic studies in these patients. METHODS The current report details the clinical courses of 2 patients having severe COVID-19 hepatitis. Liver biopsies were analyzed under light microscopy, portions of liver tissue were hybridized with a target probe to the severe acute respiratory syndrome coronavirus-2 S gene, and small sections from formalin-fixed paraffin-embedded liver tissue were processed for electron microscopy. RESULTS The liver histology of both cases showed a mixed inflammatory infiltrate with prominent bile duct damage, endotheliitis, and many apoptotic bodies. In situ hybridization and electron microscopy suggest the intrahepatic presence of severe acute respiratory syndrome coronavirus-2, the findings of which may indicate the possibility of direct cell injury. CONCLUSIONS On the basis of the abundant apoptosis and severe cholangiocyte injury, these histopathologic changes suggest a direct cytopathic injury. Furthermore, some of the histopathologic changes may resemble acute cellular rejection occurring after liver transplantation. These 2 cases demonstrate that severe COVID-19 hepatitis can occur even in the absence of significant involvement of other organs.
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Affiliation(s)
- M Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Siraj M El Jamal
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald E Gordon
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Reidy
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jela Bandovic
- Department of Pathology and Division of Gastroenterology, State University of New York, Stony Brook Medical Center, Stony Brook, New York
| | - Rashmi Advani
- Department of Pathology and Division of Gastroenterology, State University of New York, Stony Brook Medical Center, Stony Brook, New York
| | - Saikiran Kilaru
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kamron Pourmand
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Swan N Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Schiano
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Pourmand K, Nagula S, Keefer L, Shah B. Faculty Development Workshop for Endoscopic Teaching Techniques. MedEdPORTAL 2020; 16:10960. [PMID: 32995496 PMCID: PMC7511062 DOI: 10.15766/mep_2374-8265.10960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Given the substantial variability in endoscopy teaching that gastroenterology fellows can be expected to encounter over the course of their fellowship, it is important to identify a standard set of behaviors that faculty can adopt to help trainees gain competence in endoscopy at an efficient rate. There remains a scarcity of easily distributed, effective tools for faculty development in regard to teaching endoscopy. METHODS Based on a prior qualitative study, we developed a three-part trigger video to be used for discussion during a faculty development session. We utilized three role-play scenarios between a fellow and supervisor managing a gastrointestinal bleed in the endoscopy suite. We summarized the implementation and instructions in a faculty guide. We used a postsession survey to measure effectiveness of the faculty development session. RESULTS This workshop has been successfully administered twice in 2018 with over 30 gastroenterologists and hepatologists involved in endoscopic teaching. Overall, all faculty have found the workshop useful in learning about endoscopic teaching behaviors and helpful in adjusting their own behaviors in endoscopic teaching. DISCUSSION We developed a faculty development workshop specifically for teaching endoscopy to gastroenterology trainees that is widely generalizable to other programs. Overall, we found a high level of satisfaction amongst the participants who have completed it. The tools we created can be easily tailored to complement any existing faculty development session and extrapolated to similar procedural disciplines.
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Affiliation(s)
- Kamron Pourmand
- Assistant Professor, Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai
| | - Satish Nagula
- Associate Professor, Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - Laurie Keefer
- Professor, Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - Brijen Shah
- Associate Professor, Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
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Patel A, Kogekar N, Agarwal R, Cohen C, Esteban JP, Pourmand K, Tsai E, Harty A, Pelham-Braithwaite A, Perumalswami P, Dieterich D, Schiano T. Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study. J Pain Symptom Manage 2020; 59:864-870. [PMID: 31881290 DOI: 10.1016/j.jpainsymman.2019.12.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. MEASURES Rates of AD and GCD completion, as well as self-reported barriers to ACP. INTERVENTION Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD. OUTCOMES Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers. CONCLUSIONS/LESSONS LEARNED Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.
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Affiliation(s)
- Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, USA.
| | - Nina Kogekar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ritu Agarwal
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cynthia Cohen
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James Phillip Esteban
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kamron Pourmand
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Eugenia Tsai
- Texas Liver Institute, San Antonio, Texas, USA; Division of Gastroenterology, University of Texas Health Science Center, Houston, Texas, USA
| | - Alyson Harty
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andre Pelham-Braithwaite
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ponni Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
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Pourmand K, Sewell JL, Shah BJ. What Makes a Good Endoscopic Teacher: A Qualitative Analysis. J Surg Educ 2018; 75:1195-1199. [PMID: 29574017 DOI: 10.1016/j.jsurg.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Teaching learners to perform endoscopic procedures is challenging, yet effective endoscopy teaching practices are not well-described in the literature, and prior studies have focused on perspectives of supervising physicians rather than learners. We sought to characterize, from the perspective of endoscopy learners, endoscopic teaching behaviors perceived as beneficial and detrimental to learning using qualitative methods. DESIGN This is a prospective qualitative content analysis. Gastroenterology fellows from 2 tertiary care centers anonymously provided feedback regarding supervising physicians' teaching behaviors during endoscopic training between March 2016 and December 2016. Preprinted cards were completed at the conclusion of procedures to document behaviors that fellows perceived as enhancing or hampering their learning. Two investigators performed content analysis of written comments; each identified behavior was assigned positive or negative valence. SETTING Mount Sinai Hospital in New York, New York and University of California San Francisco in San Francisco, California. Both institutions are academic tertiary care centers. PARTICIPANTS A total of 19 gastroenterology fellows at 2 training institutions participated. RESULTS A total of 239 teaching behaviors were identified by 19 fellows who worked with 31 supervising physicians; 29 unique behaviors were identified and organized into 7 themes: teaching, learning environment, autonomy, communication, coaching, feedback, and professionalism. Of all, 185 (77.4%) behaviors were reported as beneficial, and 54 (22.6%) as detrimental to the learning experience. Behaviors related to teaching were most often perceived as beneficial, while behaviors related to professionalism and communication were most often perceived as detrimental to learning. CONCLUSIONS Specific teaching behaviors may help or hinder learning of endoscopic skills. These behaviors may be useful for efforts related to teaching evaluation, faculty development, and direct teaching.
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Affiliation(s)
- Kamron Pourmand
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin L Sewell
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Brijen J Shah
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Nagula S, Pourmand K, Aslanian H, Bucobo JC, Gonda TA, Gonzalez S, Goodman A, Gross SA, Ho S, DiMaio CJ, Kim MK, Pais S, Poneros JM, Robbins DH, Schnoll-Sussman F, Sethi A, Buscaglia JM. Comparison of Endoscopic Ultrasound-Fine-Needle Aspiration and Endoscopic Ultrasound-Fine-Needle Biopsy for Solid Lesions in a Multicenter, Randomized Trial. Clin Gastroenterol Hepatol 2018. [PMID: 28624647 DOI: 10.1016/j.cgh.2017.06.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound with fine-needle aspiration (FNA) is the standard of care for tissue sampling of solid lesions adjacent to the gastrointestinal tract. Fine-needle biopsy (FNB) may provide higher diagnostic yield with fewer needle passes. The aim of this study was to assess the difference in diagnostic yield between FNA and FNB. METHODS This is a multicenter, prospective randomized clinical trial from 6 large tertiary care centers. Patients referred for tissue sampling of solid lesions were randomized to either FNA or FNB of the target lesion. Demographics, size, location, number of needle passes, and final diagnosis were recorded. RESULTS After enrollment, 135 patients were randomized to FNA (49.3%), and 139 patients were randomized to FNB (50.7%).The following lesions were sampled: mass (n = 210, 76.6%), lymph nodes (n = 46, 16.8%), and submucosal tumors (n = 18, 6.6%). Final diagnosis was malignancy (n = 192, 70.1%), reactive lymphadenopathy (n = 30, 11.0%), and spindle cell tumors (n = 24, 8.8%). FNA had a diagnostic yield of 91.1% compared with 88.5% for FNB (P = .48). There was no difference between FNA and FNB when stratified by the presence of on-site cytopathology or by type of lesion sampled. A median of 1 needle pass was needed to obtain a diagnostic sample for both needles. CONCLUSIONS FNA and FNB obtained a similar diagnostic yield with a comparable number of needle passes. On the basis of these results, there is no significant difference in the performance of FNA compared with FNB in the cytologic diagnosis of solid lesions adjacent to the gastrointestinal tract. ClinicalTrials.gov identifier: NCT01698190.
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Affiliation(s)
- Satish Nagula
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Harry Aslanian
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Tamas A Gonda
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | | | - Adam Goodman
- New York University School of Medicine, New York, New York
| | - Seth A Gross
- New York University School of Medicine, New York, New York
| | - Sammy Ho
- Montefiore Medical Center, Bronx, New York
| | | | - Michelle K Kim
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - John M Poneros
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | | | | | - Amrita Sethi
- Stony Brook University School of Medicine, Stony Brook, New York
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Uzzan M, Ko HM, Rosenstein AK, Pourmand K, Colombel JF, Mehandru S. Efficient long-term depletion of CD20 + B cells by rituximab does not affect gut-resident plasma cells. Ann N Y Acad Sci 2017; 1415:5-10. [PMID: 29291255 DOI: 10.1111/nyas.13577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
The vast majority of antibody-producing B cells are located within the gastrointestinal tract and are key players in maintaining homeostasis. The failure of rituximab, a potent B cell-depleting agent, to ameliorate ulcerative colitis in a single clinical trial has dampened enthusiasm to study B cells in patients with inflammatory bowel disease (IBD). However, several lines of evidence suggest that intestinal B cells may be affected in IBD. Additionally, the pathophysiological mechanisms underlying rituximab's lack of efficacy in IBD remain unclear. Here, on the basis of detailed immunophenotyping of a patient who underwent a colonoscopy 6 months after the end of rituximab-based therapy, we observed that rituximab did not deplete colon-resident plasma cells (PCs) while ablating all CD20+ B cells in tissues and in the circulation. On the basis of these observations, we propose that one factor underlying the lack of efficacy of rituximab relates to the fact that it does not affect the entire B cell compartment in tissues, sparing the intestinal-resident PCs while effectively depleting CD20+ B cell populations. Thus, we contend that, despite the results of the Rituximab study, there is a need for more intensive B cell-oriented research in inflammatory disorders, including IBD.
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Affiliation(s)
- Mathieu Uzzan
- The Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huaibin M Ko
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam K Rosenstein
- The Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kamron Pourmand
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saurabh Mehandru
- The Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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13
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Abstract
The small intestine is a relatively privileged organ that only rarely develops malignant or even benign tumors. Given this rarity, the relative inaccessibility of the organ during routine endoscopic procedures, and the typical absence or nonspecific nature of clinical manifestations, these tumors often go undiagnosed. Treatment and prognosis are tailored to each histological subtype of tumor. This chapter will discuss the epidemiology, presentation, diagnostics, and management for the most common small bowel tumors, and will highlight the importance of recognizing patients at higher risk of small bowel neoplasia.
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Affiliation(s)
- Kamron Pourmand
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, GI Division, Box 1069, New York City, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, GI Division, Box 1069, New York City, NY, 10029, USA.
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14
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Kaimakliotis P, Riff B, Pourmand K, Chandrasekhara V, Furth EE, Siegelman ES, Drebin J, Vollmer CM, Kochman ML, Ginsberg GG, Ahmad NA. Sendai and Fukuoka Consensus Guidelines Identify Advanced Neoplasia in Patients With Suspected Mucinous Cystic Neoplasms of the Pancreas. Clin Gastroenterol Hepatol 2015; 13:1808-15. [PMID: 25818077 DOI: 10.1016/j.cgh.2015.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Little is known about whether the 2006 Sendai guidelines or 2012 Fukuoka guidelines are being used to determine the level of risk posed by suspected pancreatic mucinous cystic neoplasms (PCNs). We evaluated whether the guidelines accurately predicted which patients with suspected PCNs, which was based on cross-sectional imaging findings, would be found to have advanced neoplasia in surgery. METHODS We performed a retrospective study of data collected from 194 patients with cystic lesions of the pancreas, which were assessed by cross-sectional imaging analyses, who underwent surgery for suspected PCNs at the Hospital at the University of Pennsylvania from 2000 through 2008. Imaging data were used to classify patients according to the Sendai guidelines as high risk or low risk and according to the Fukuoka guidelines as high risk, worrisome, or low risk. Pathology analyses of samples collected during surgery were used as the reference. A logistic regression model was created to identify factors associated with advanced neoplasia. The Sendai and Fukuoka guideline criteria were analyzed by univariate and multivariable logistic regression analyses. RESULTS Advanced neoplasias were found in 36 patients (18.5%; 22 invasive cancers and 14 high-grade dysplasias). The median size of cysts was 33 mm. All patients found to have invasive cancers were accurately assigned to the Sendai guidelines high risk or Fukuoka guidelines high risk groups. However, 3 patients in the Sendai guidelines low risk and 2 patients in the Fukuoka guidelines low risk groups were found to have high-grade dysplasia. The Sendai guidelines identified patients with advanced neoplasia with 91.7% sensitivity, 21.5% specificity, 21% positive predictive value, and 91.9% negative predictive value. A designation of Fukuoka guidelines high risk identified patients with advanced neoplasia with 55.6% sensitivity, 73% specificity, 32% positive predictive value, and 87.9% negative predictive value. Overall, there was no statistically significant difference between the guidelines in predicting which patients had advanced neoplasia. On multivariate analysis, the presence of a mural nodule (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.33-6.27; P = .008), dilated main pancreatic duct >10 mm (OR, 7.44; 95% CI, 2.36-23.52; P = .001), or enhancing solid component (OR, 2.92; 95% CI, 1.16-7.64; P = .02) were associated with detection of advanced neoplasia in pancreatic cysts. CONCLUSION On the basis of a retrospective analysis, the Sendai and Fukuoka guidelines accurately determine which patients with pancreatic cysts have advanced neoplasia. The guidelines accurately recommended surgical resection for all patients found to have invasive cancer, although some patients with high-grade dysplasia were missed. The updated Fukuoka guidelines are not superior to the Sendai guidelines in identifying neoplasias. Cyst size was not associated with advanced neoplasia.
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Affiliation(s)
- Pavlos Kaimakliotis
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Riff
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kamron Pourmand
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinay Chandrasekhara
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma E Furth
- Department of Surgical Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan S Siegelman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffery Drebin
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles M Vollmer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L Kochman
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory G Ginsberg
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nuzhat A Ahmad
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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15
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Bussmann RW, Ashley G, Sharon D, Chait G, Diaz D, Pourmand K, Jonat B, Somogy S, Guardado G, Aguirre C, Chan R, Meyer K, Rothrock A, Townesmith A. Proving that Traditional Knowledge Works: The antibacterial activity of Northern Peruvian medicinal plants. ACTA ACUST UNITED AC 2011. [DOI: 10.17348/era.9.0.67-96] [Citation(s) in RCA: 306] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Bussmann RW, Malca-García G, Glenn A, Sharon D, Chait G, Díaz D, Pourmand K, Jonat B, Somogy S, Guardado G, Aguirre C, Chan R, Meyer K, Kuhlman A, Townesmith A, Effio-Carbajal J, Frías-Fernandez F, Benito M. Minimum inhibitory concentrations of medicinal plants used in Northern Peru as antibacterial remedies. J Ethnopharmacol 2010; 132:101-8. [PMID: 20678568 PMCID: PMC2956840 DOI: 10.1016/j.jep.2010.07.048] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/22/2010] [Accepted: 07/26/2010] [Indexed: 05/18/2023]
Abstract
AIM The plant species reported here are traditionally used in Northern Peru to treat bacterial infections, often addressed by the local healers as "inflammation". The aim of this study was to evaluate the minimum inhibitory concentration (MIC) of their antibacterial properties against gram-positive and gram-negative bacteria. MATERIALS AND METHODS The antimicrobial activity of ethanolic and water extracts of 141 plant species was determined using a deep-well broth microdilution method on commercially available bacterial strains. RESULTS The ethanolic extracts of 51 species inhibited Escherichia coli, and 114 ethanolic extracts inhibited Staphylococcus aureus. In contrast, only 30 aqueous extracts showed activity against Escherichia coli and 38 extracts against Staphylococcus aureus. The MIC concentrations were mostly very high and ranged from 0.008 to 256 mg/ml, with only 36 species showing inhibitory concentrations of <4 mg/ml. The ethanolic extracts exhibited stronger activity and a much broader spectrum of action than the aqueous extracts. Hypericum laricifolium, Hura crepitans, Caesalpinia paipai, Cassia fistula, Hyptis sidifolia, Salvia sp., Banisteriopsis caapi, Miconia salicifolia and Polygonum hydropiperoides showed the lowest MIC values and would be interesting candidates for future research. CONCLUSIONS The presence of antibacterial activity could be confirmed in most species used in traditional medicine in Peru which were assayed in this study. However, the MIC for the species employed showed a very large range, and were mostly very high. Nevertheless, traditional knowledge might provide some leads to elucidate potential candidates for future development of new antibiotic agents.
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Affiliation(s)
- R W Bussmann
- William L. Brown Center, Missouri Botanical Garden, P.O. Box 299, St. Louis, MO 63166-0299, USA.
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17
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Saleh JS, Pourmand K, Mojaradi N. A study of the trophoblastic disease among the Iranian population. Br J Clin Pract 1966; 20:119-27. [PMID: 5908244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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