Beth Israel Medical Center Research Articles

Edwards, I. (ed.). (2007). Music: Promoting health and creating community in healthcare contexts. Newcastle, UK: Cambridge Scholars Publishing. 202 pages. ISBN 1-84718-351-4. $52.99

Edwards, J. (ed.). (2007). Music: Promoting health and creating community in healthcare contexts. Newcastle, UK: Cambridge Scholars Publishing. 202 pages. ISBN 1-84718-351-4. $52.99 The book, Music: Promoting Health and Creating Community in Healthcare, was the result of a 2005 symposium on and health held at the World Academy of and Dance, University of Limerick, Ireland. The first therapy degree program in Ireland was established at the University of Limerick in 1998 and is now headed by Jane Edwards. The 2005 Symposium brought together 16 colleagues from 8 countries to address the broad use of and the arts in healthcare settings. Twelve of the participants contributed chapters to this book. The philosophical orientation and expertise of the contributors varies greatly and is not confined to a traditional therapy orientation. Edwards intended this book to be an overview of contemporary practices in the use of to promote health and well-being in the United Kingdom and to be an exploration of the possible tensions between therapy and art in health care initiatives. It succeeds on both counts. Chapter 1 by Clare O'Callaghan, RMT is entitled Music Therapy Inspired Transient Ward Communities in Oncology. It is an overview of her therapy work in a hospital setting focusing on the use of to form ward communities, which she defines as a group of people united by a cooperative spirit providing a helpful social connection. O'Callaghan believes that therapy experiences on the hospital wards creates these transient ward communities (contrasted to a community therapy model) with psychosocial group expression through the and other creative art experiences, song writing, and provision of in open spaces as musical environmental A large portion of the chapter is devoted to an overview of research that the author conducted as part of her doctoral dissertation. This research focused on evidence as to the mechanism for creating these helpful communities and on how useful they are. For the research, O'Callaghan collected anonymous written feedback on people's perception of the relevance of therapy. She also kept a detailed journal of her thoughts and reactions to the sessions she conducted. She then analyzed both the feedback and journal entries using thematic analysis informed by grounded theory. Conclusions included that transient ward communities were created where therapy enabled a music space to be formed, psychosocial, or spiritual benefits were noted, and the experiences had a profound effect on the staff. This chapter was hard to follow and lacked a clear organization of the material. It did introduce an important psychosocial research approach and the use of grounded theory in investigating the effects of a therapy program in a hospital setting. Chapter 2, entitled Developing Therapy Programs in Medical Practice and Healthcare Communities, is by American therapist, Joanne Loewy, MT-BC. The chapter reports on the Louis Armstrong Center for and Medicine program she established at Beth Israel Medical Center in New York. The chapter describes research conducted on pain management and on the research that established three areas of profound effect of therapy in pediatric care: 1) helping children breathe, 2) assisting in sleep and sedation, and 3) relieving anxiety when a child has fear of sleeping or resting toward the end of life. The remaining portion of this well-organized chapter delineates the Model of Integrative Medical Psychotherapy, which is the basis of the program at Beth Israel and is based on a psycho-spiritual commitment to health. This model first involves enhancement of the medical aspects of treatment through the and, secondly, the use of the process to build from a patient's inner resources or treating the patient from within. …

A Retrospective Study to Determine the Ability of Video Capsule Endoscopy to Detect Upper Gastrointestinal Pathology Compared to Standard Endoscopy in Patients with Obscure Bleed

Purpose: Currently no dedicated studies comparing upper gastrointestinal findings on video capsule endoscopy (VCE) to standard upper endoscopy (EGD) exist. The purpose of this retrospective study is to examine whether VCE and EGD can detect similar upper gastrointestinal findings in patients with obscure bleeding. Methods: All patients 18 years or older who presented with obscure bleeding and underwent both EGD and VCE within 1 month of each other at Beth Israel Medical Center were retrospectively reviewed from January 2000 to December 2007. All VCEs were performed with the M2A (Given) Pillcam. Each VCE and EGD report was blindly reviewed and findings were noted for both modalities. Patient demographics, dates, indications, findings, gastric transit time, and post endoscopy Rockall scores were collected. Data was analyzed by Spearman correlation coefficients and descriptive statistics. Results: Sixty-five (31 M:34 F) subjects were enrolled. Mean age was 66.5 years (18–96). The indication was 38% for iron deficiency anemia and 62% for occult bleeding. The duodenum was reached in 100% of subjects. The mean gastric transit time was 35.2 seconds. See Table 1 for findings. One duodenal ulcer was detected on VCE and fresh blood was seen on the corresponding EGD. Unremarkable VCE exams had corresponding non-significant findings on EGD 82% of the time. Post endoscopy Rockall scores for the VCE and EGD were 0.55 and 0.47 respectively, with a Spearman correlation coefficient of 0.29 (P= 0.0191). Rockall scores agreed perfectly 55% of the time and by one unit 97% of the time.Table 1: Comparison of FindingsConclusion: Video capsule endoscopy and standard upper endoscopy appear to have similar detection rates for upper gastrointestinal pathology in patients presenting with obscure bleeding. The correlation appears to be strongest for erosive and non-erosive gastroduodenitis. VCE appears to detect more vascular lesions compared to EGD. The majority of unremarkable exams on VCE corresponded to non-significant findings on EGD.

Mammary Ductoscopy for Evaluation of Nipple Discharge

Most breast cancers originate in the ductal epithelium with normal cells progressing to atypia and finally to carcinoma. Ductoscopy enables one to visualize and sample the ductal epithelium and therefore identify early changes cytologically. This report describes our experience with mammary ductoscopy as a tool for evaluation of nipple discharge at Beth Israel Medical Center. A prospective review of all patients who have undergone ductoscopy for evaluation of persistent nipple discharge was performed. The Acueity ductoscopy system with .9-mm scope and a video monitor with x60 magnification were used. Brush biopsy samples and lavage fluid were obtained from some patients and were sent for cytologic analysis. A subset of patients underwent ductoscopically guided duct excision. Ninety-three patients underwent ductoscopic evaluation of 110 ducts. Of these, 67 patients had abnormal findings and therefore underwent ductoscopically guided duct excision. The remaining 26 patients (28%) had normal ductoscopic examinations. The depth at which intraductal abnormalities were visualized was from 3 to 8 cm with an average of 4.4 cm for cancer cases and from 1 to 10 cm with an average of 4.5 cm for papillomas. Forty-two patients were diagnosed with papilloma/papillomatosis, six patients were diagnosed with atypical papilloma/atypical ductal hyperplasia/atypical lobular hyperplasia, and six patients were diagnosed with cancer. Of the six patients diagnosed with cancer, 67% had normal breast imaging, and other than nipple discharge, 67% had normal breast examinations. Mammary ductoscopy is a useful tool in the evaluation of patients with nipple discharge. Although the most common cause of nipple discharge is an intraductal papilloma, nipple discharge can be the presenting symptom for cancer. Our experience revealed a papilloma rate of 45% (42 of 93), cancer rate of 6.5% (6 of 93), and an atypia rate of 6.5% (6 of 93) among the patients with nipple discharge. Mammary ductoscopy allows for accurate visualization, analysis, and excision of intraductal abnormalities. Many deeper intraductal abnormalities could be missed by blind surgical excision.

PRESENCE OF BK VIRURIA IN HEART TRANSPLANT PATIENTS

1 Division of Nephrology and Transplantation Newark Beth Israel Medical Center., 2 Division of Cardiac Transplantation Newark Beth Israel Medical Center.

REDUCTION OF IMMUNOSUPPRESSION IN OHT PATIENTS WITH BK VIRURIA

1 Division of Nephrology and Transplantation Newark Beth Israel Medical Center, Newark, New Jersey, United States, 2Division of Cardiac Transplantation Newark Beth Israel Medical Center, Newark, New Jersey, United States

The Dorsal Nasal Flap for Reconstruction of Large Nasal Tip Defects

Division of Facial and Plastic Reconstructive Surgery Department of Otolaryngology–Head & Neck Surgery, Beth Israel Medical Center, New York, NY

A Morbidity and Mortality Conference-Based Classification System for Adverse Events: Surgical Outcome Analysis: Part I

We hypothesized that an archive database in conjunction with Morbidity and Mortality (M&M) review could be used to define a systematic list of post-surgical adverse events and identify areas for performance improvement. Adverse event data following surgery were prospectively collected at the Beth Israel Medical Center in NYC from academic, specialty, community hospital, and ambulatory care settings over a 5-year period from September 2000 through April 2005. A classification system and analysis methodology was developed to guide and maximize the effectiveness of M&M review. A total of 1618 adverse events, including 219 deaths, were analyzed following 29,237 operative procedures according to the analysis method described. A list of 245 adverse events was classified among 15 groups, and a subgroup of 25 adverse events accounted for over 80% of total adverse events. Five categories of adverse events were associated with death in surgical patients and 4 of 5 categories were post-operative events. Used in conjunction with M&M review, data derived from this analysis highlighted those adverse events with the greatest clinical frequency to the department's quality profile. We present a classification system for surgical adverse events and propose a specific analysis method which may be used in conjunction with Morbidity and Mortality Conference to standardize the profiling of surgical performance.

Robotic‐assisted gynaecological surgery—establishing training criteria; minimizing operative time and blood loss

The objective was an evaluation of operative time and estimated blood loss (EBL) as a function of experience in gynaecological robotic surgery. A retrospective analysis of 40 consecutive cases (approximately one case/week) over a 1 year period using the da Vinci) robotic system was performed, using data from two institutions, Newark Beth Israel Medical Center and Hackensack University Medical Center. Information was obtained from a single surgeon. Among the 40 cases there were 17 hysterectomies and 23 myomectomies. Each patient met the criteria of benign disease. In each institution, a da Vinci) system using three instrument arms and a camera arm was employed for every operation. Tests of differences in means were performed to compare the two groups. In group I (cases 1-20) the mean uterine volume was 863.0 cc and was similar to Group II (cases 21-40) at 632.6 cc. There was no significant difference between the groups when comparing blood loss; means were 86 cc for group I and 62.5 cc for group II. Operative time between groups, however, showed a significant difference (mean of 211.8 min for group 1 compared to 151 min for group 2; p < 0.05) and console time demonstrated a similar trend (mean for group 1 was 159.8 min compared to 90.8 min for group 2; p < 0.05). There were no conversions to laparotomy. Body mass index (BMI) and prior abdominal surgery were not significantly different. Multivariate regressions on operative time and EBL were performed, controlling for uterine weight and volume. The effect of experience on operative time was significant and negative; the coefficient on EBL was not significant. This study demonstrates statistical improvement in operative time after the first 20 cases for a single surgeon. This information could be used to establish criteria for training surgeons.

Feasibility of Flap Reconstruction in Conjunction With Intraoperative Radiation Therapy for Advanced and Recurrent Head and Neck Cancer

Radiation is a known risk factor for poor wound healing. Patients undergoing intraoperative radiation therapy (IORT) typically receive higher cumulative doses to their wound beds than patients treated with conventional radiation therapy. We review our experience with IORT in patients undergoing resection of head and neck cancer and flap reconstruction. Logistics of delivery and outcomes are discussed. A retrospective chart review was performed on all patients at Beth Israel Medical Center who underwent IORT for head and neck cancer between 2000 and 2007. Twenty-one patients receiving 22 treatments involving flap reconstruction were identified. The results of these reconstructions were evaluated for complications and functional outcome. All patients had complex surgical wounds of the face, upper aerodigestive tract, or neck who received IORT in conjunction with pedicled or free flap closure. Twenty-five flaps in 21 patients were performed in the setting of IORT. All patients received between 10 and 15 Gy of IORT administered directly to the wound bed. There were no perioperative mortalities. Wound breakdown occurred in three cases, all of which were treated successfully by operative revision. Functionally, most patients did well and performed similarly to historic controls for their type of reconstruction. Reconstruction using flaps in the context of IORT can be achieved with expectation of good wound healing in the majority of cases despite heavy cumulative doses of radiation to recipient wound beds.

Susan Bressman: deciphering dystonia in the Big Apple

Susan Bressman: deciphering dystonia in the Big Apple

Attention-deficit/Hyperactivity Disorder and Integrative Approaches

&lt;p&gt;Increasing numbers of Americans are turning to complementary and alternative medical therapies (CAM) for themselves and their children. A host of explanations for this increase has been surveyed and researched. A recent study reported 54% of parents using CAM therapies for their children, but only 11% ever discussing them with their physicians. The most important attraction of CAM therapies for patients and parents is the belief that they are &amp;#147;a more natural therapy&amp;#148; and that they have greater control over treatments. Dissatisfaction with the process or the results of conventional care was noted in a small but increasing number within the population studied. Concerns regarding side effects and long-term use of medications are also factors fueling this quest, particularly in the case of children diagnosed with attention-deficit/hyperactivity disorder (ADHD).&lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHOR&lt;/h4&gt; &lt;p&gt;Asma J. Sadiq, MD, is Director, Division of Developmental and Behavioral Pediatrics, Beth Israel Medical Center, and Assistant Professor of Pediatrics, Albert Einstein College of Medicine, New York, NY.&lt;/p&gt; &lt;p&gt;Address correspondence to: Asma J. Sadiq, MD, Albert Einstein College of Medicine, 10 Union Square East, New York, NY 10003; fax 212-844-8338; &lt;a href="mailto:asadiq@bethisraelny.org"&gt;asadiq@bethisraelny.org&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;Dr. Sadiq disclosed no relevant financial relationships.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt; &lt;li&gt;Discuss complementary and alternative medical therapies for children with attention-deficit/hyperactivity disorder.&lt;/li&gt; &lt;li&gt;Describe the neurobiology of attention-deficit/hyperactivity disorder.&lt;/li&gt; &lt;li&gt;Review a multi-modal treatment plan for the treatment of attention-deficit/hyperactivity disorder.&lt;/li&gt; &lt;/ol&gt;

2007 World Robotic Gyn Symposium: the dawn of a new age in minimally invasive gynecologic surgery.

2007 World Robotic Gyn Symposium: the dawn of a new age in minimally invasive gynecologic surgery.

Charles Bonnet Syndrome: Long-term Outcome of Treatment

&lt;p&gt;Charles Bonnet syndrome (CBS) was first described by Swiss philosopher Charles Bonnet in 1760. The defining characteristics of the syndrome include visual impairment, complex visual hallucinations, preservation of mental competence, and insight. The syndrome is an infrequently diagnosed but rather common cause of complex visual hallucinations. Its prevalence in patients with visual impairment varies from 10% to 15%, and it occurs most commonly in elderly people. The common conditions leading to the syndrome are age-related macular degeneration, glaucoma, and cataract.&lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHORS&lt;/h4&gt; &lt;p&gt;Nahla Mahgoub, MD, is Staff Psychiatrist, Weill Cornell University-Westchester Division, New York. Michael Serby, MD, is Professor of Clinical Psychiatry, Beth Israel Medical Center, Albert Einstein College of Medicine, New York.&lt;/p&gt; &lt;p&gt;Address correspondence to Dr. Mahgoub via e-mail at: &lt;a href="mailto:NAMD06@aol.com"&gt;NAMD06@aol.com&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;Dr. Mahgoub and Dr. Serby have disclosed no relevant financial relationships.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt; &lt;li&gt;Identify the common clinical features of Charles Bonnet syndrome.&lt;/li&gt; &lt;li&gt;Discuss potential treatments for Charles Bonnet syndrome.&lt;/li&gt; &lt;li&gt;Name the type of disorder of which Charles Bonnet syndrome is comprised.&lt;/li&gt; &lt;/ol&gt;

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

Consultation with the Specialist: Red Blood Cell Transfusions

1. Moshe D. Bell, MD* 1. *The Valerie Fund Children's Center for Cancer and Blood Disorders, Children's Hospital of New Jersey, at Newark Beth Israel Medical Center, Newark, NJ After completing this article, readers should be able to: 1. Discuss the complications of a red blood cell transfusion for a child who has autoimmune hemolytic anemia. 2. Delineate the risk of transmitting infectious diseases during blood transfusions. 3. Describe the hemolytic, febrile, and urticarial reactions that may be associated with red blood cell transfusions. 4. Explain the role of red blood cell transfusions in the management of anemia. Red blood cells (RBCs) carry hemoglobin-bound oxygen from the lungs to capillaries, where they release some of their oxygen for diffusion into surrounding tissues that have lower oxygen tension. The ability to increase cardiac output and to shift the oxygen dissociation curve of hemoglobin allows the body, in most instances, to compensate for loss of oxygen-carrying capacity, increased tissue need, or hypoxia. In some circumstances, however, the compensatory mechanisms are insufficient, and RBC transfusion may be beneficial. The first reported blood transfusion took place between two dogs in 1666 at Oxford University in an experiment by Richard Lower. By the following year, French physician Jean Denys was transfusing blood from lambs and calves into patients afflicted with mental illness, hoping to balance their “humors” with those of the docile, domesticated animals. Many transfusion recipients had acute hemolytic reactions, and some died (Denys was tried for murder in one instance), essentially putting a halt to the use of blood transfusions for more than a century. In 1818, British obstetrician James Blundell performed the first known human-to-human transfusions, reporting success in some women who had severe postpartum hemorrhage. By mid-century, the first transfusions in the United States were performed, but they remained rare until the 20th century. The early 1900s brought major advances in transfusion medicine, starting with Karl Landesteiner's discovery and description of the ABO blood grouping system (he called it ABC) and, subsequently, the Rh …

Intraoperative Touch Preparation Cytology for Margin Assessment in Breast-Conservation Surgery: Does It Work for Lobular Carcinoma?

Breast carcinoma is the most frequently diagnosed malignancy in women of the North America. The combination of breast-conservation surgery and radiotherapy has become a standard of treatment for most breast cancers. It is critical to obtain clear margins to minimize local recurrence. The literature suggests that intraoperative touch preparation cytology (IOTPC) can be useful in evaluation of margins. Invasive lobular carcinoma (ILC) accounts for 10% to 15% of all breast cancers. Obtaining clear margins in ILC can be more challenging. Literature shows the positive margin rate for ILC to be as high as 60%. This report describes our experience with IOTPC for margin assessment in ILC by a single surgeon at Beth Israel Medical Center. The purpose of this study is to determine whether IOTPC is reliable for ILC. A prospective review of 73 patients who underwent breast-conservation surgery with the use of IOTPC for margin assessment at Beth Israel Medical Center was performed. Pathology revealed ILC in 12 of these patients (16.4%), who are the subjects of this study. The lumpectomy specimens were oriented by the surgeon intraoperatively and were submitted fresh to pathology for cytologic assessment. IOTPC consisted of touching the corresponding margin onto the glass slide. The principle of this technique is that if cancer cells are present, they will stick to the slide, whereas fat cells will not. Six slides were prepared for each lumpectomy specimen. Air-dried samples were stained immediately by the Diff-Quik method and examined under the microscope by a cytopathologist. Twelve patients with ILC underwent breast-conservation surgery with IOTPC for assessment of 72 margins. Ten patients had lobular carcinoma only, and the remaining two patients had a combination of lobular and ductal carcinoma. There was a correlation between IOTPC and final pathology in 60 of 72 margins, which accounted for 83.3% of the cases. IOTPC for assessment of margins in patients undergoing breast-conservation surgery for ILC has a sensitivity of 8.3%, specificity of 98.3%, positive predictive value of 50%, and negative predictive value of 84.3%. On the basis of our experience, IOTPC is of limited value for intraoperative assessment of margins for ILC.

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Model for Troponin I as a Quantitative Predictor of In-Hospital Mortality: Waxman DL, Hecht S, Schappert J, et al. J AM COLL CARDIOL 2006;48:1755–62

This retrospective study from Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital sought to evaluate the in-hospital mortality of patients as predicted by the initial troponin I drawn from the Emergency Department. The authors expounded on the idea that the troponin I test currently has a single diagnostic cutoff, resulting with scores of either zero, negative, indeterminate, or positive in nature. Yet, it has been reported that “non-diagnostic” results may be associated with an adverse prognosis.

Strategies in Antistigma Battle Appear to Be Working

Back to table of contents Previous article Next article Professional NewsFull AccessStrategies in Antistigma Battle Appear to Be WorkingEve BenderEve BenderSearch for more papers by this authorPublished Online:15 Jun 2007https://doi.org/10.1176/pn.42.12.0008aSeeking treatment for mental health problems has become more acceptable since the early 1990s, according to a new study. The more positive attitudes toward treatment over time may have contributed to a growing demand for mental health services over recent years.Data comparing attitudes toward mental health treatment in two nationally representative surveys showed that 27.1 percent of those surveyed between 1990 and 1992 reported being “very comfortable” with talking to a professional about personal problems, compared with 32.4 percent of those surveyed between 2001 and 2003.The findings appeared in the May Psychiatric Services.Lead author Ramin Mojtabai, M.D., Ph.D., told Psychiatric News that although he couldn't draw any definitive conclusions about these findings, he believed that a number of changes in the mental health field may have shifted attitudes for the better. Mojtabai is a PGY-3 resident in psychiatry at Beth Israel Medical Center in New York.Throughout the 1990s there was an increase in direct-to-consumer marketing of antidepressants, he explained, and a surge in depression-prevention and suicide-screening programs. This may have had a positive effect on public attitudes toward treatment.To detect these trends in attitudes about mental illness, Mojtabai compared data from respondents to the 1990-1992 National Comorbidity Study (NCS) with those from the 2001-2003 NCS–Replication (NCS-R), both of which studied mental health problems and treatment in the United States.For the NCS, researchers interviewed 8,098 randomly selected people aged 15 to 54 in their homes. For the NCS-R 10 years later, they interviewed a separate, randomly selected sample of 9,282 adults over age 18 in their homes.Three questions generated responses on attitudes toward mental health treatment: Participants reported whether they would seek help for a serious emotional problem on a scale ranging from “probably” to“ definitely not,” the degree to which they were comfortable talking about personal problems to a professional, and the degree to which they would be embarrassed if their friends knew they were getting professional help for an emotional problem (see chart). Responses to these questions were categorized on a scale from 0 to 3, with higher scores indicating more positive attitudes toward treatment.Mojtabai found that 35.6 percent of respondents to the NCS reported that they would “definitely” go for professional help for a serious emotional problem, compared with 41.4 percent of NCS-R respondents. He also found that 33.7 percent of NCS respondents reported that they would not be embarrassed if friends knew about their getting professional help. This number jumped to 40.3 percent for respondents to the later survey.When Mojtabai analyzed the findings by age, he found that adults aged 18 to 34 in the NCS-R had more positive attitudes toward mental health treatment seeking than adults of the same age did in the original NCS. However, adults in the 35 to 54 age range showed little change in attitudes at the two time points.“Although attitudes toward mental health treatment seeking improved in all generations,” he said, “the improvement was greatest in the generation that was 15 to 24 years old in 1990 to 1992.” This may be because they had more exposure to public-information campaigns and other positive media messages about mental illness, Mojtabai speculated.Data based on logistical regression analyses of treatment-seeking attitudes showed that black participants were 56 percent more likely to have a positive attitude toward treatment than were whites.In addition, respondents with a history of mental health treatment were 68 times as likely to have a favorable attitude toward mental health treatment as those who didn't.Mojtabai said future research should explore what specific factors impact attitude toward mental health treatment. “We also need to examine the impact of attitudes on service use,” he noted.An abstract of “Americans' Attitudes Toward Mental Health Treatment Seeking: 1990-2003” is posted at<http://ps.psychiatryonline.org/cgi/content/full/58/5/642>.▪ ISSUES NewArchived

Chronic Pain in the Emergency Department

1Department of Emergency Services, San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, 2Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 3Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, and 4Pain and Emergency Medicine Institute, Beth Israel Medical Center, New York On behalf of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study