Lenox Hill Hospital Research Articles

Understanding Internal Medicine Residents' Rheumatology Knowledge Base.

Rheumatology is one of the internal medicine subspecialties that residents train to become proficient in during their internal medicine training. Our study sought to understand how residents across all postgraduate year levels felt in terms of comfortability and exposure to rheumatology. We focused on the subjective measurement of resident knowledge and exposure rather than objective data. A five-question survey was distributed to all 75 residents of Lenox Hill Hospital's Internal Medicine categorical residency program, from PGY1 to PGY3. When asked if they get enough exposure or feel confident treating patients with rheumatology diseases, 96% of residents responded no. When asked about their confidence in boards, the average response was a 3/10. The residents at our program voiced a strong concern for lack of exposure and education. Other studies and institutions have shown this to be a problem that has also been seen with poor testperformance on the subject. We explore educational modalities to help improve this gap in education.

First in-human intrathecal delivery of bevacizumab for leptomeningeal spread from recurrent glioblastoma: rationale for a dose escalation trial.

To outline the dose rationale for the first in-human intrathecal delivery of bevacizumab for LMS of GBM. A 19-year-old female patient presented to Lenox Hill Hospital following thalamic GBM recurrence. She subsequently underwent two infusions of intra-arterial BEV (NCT01269853) and experienced a period of relative disease stability until progression in 2022. One month later, MRI disclosed diffuse enhancement representative of LMS of GBM. The patient subsequently underwent five cycles of IT BEV in mid-2022 (IND 162119). Doses of 25mg, 37.5mg, 50mg, 50mg, and 37.8mg were delivered at two-week intervals between doses 1-4. The final 37.8mg dose was given one day following her fourth dose, given that the patient was to be discharged, traveled several hours to our center, and was tolerating therapy well. Dosage was decreased due to the short interval between the final two treatments. Shortly after IT BEV completion, she received a third dose of IA BEV. Our patient did not show any signs of serious adverse effects or dose limiting toxicities following any of the treatments. It is difficult to determine PFS due to the rapid progression associated with LMS of GBM and rapid timeframe of treatment. LMS continues to be a devastating progression in many types of cancer, including GBM, and novel ways to deliver therapeutics may offer patients symptomatic and therapeutic benefits.

MP06-14 QUALITY METRICS FOR PATIENTS REQUIRING URGENT SURGICAL INTERVENTION - COMPARING A FREESTANDING EMERGENCY DEPARTMENT TO A HOSPITAL-BASED EMERGENCY DEPARTMENT

You have accessJournal of UrologyCME1 Apr 2023MP06-14 QUALITY METRICS FOR PATIENTS REQUIRING URGENT SURGICAL INTERVENTION - COMPARING A FREESTANDING EMERGENCY DEPARTMENT TO A HOSPITAL-BASED EMERGENCY DEPARTMENT Ginnie Jeng, Alexa Meyer, Adam Hass, Eric Cruzen, Yves Duroseau, and Lee Richstone Ginnie JengGinnie Jeng More articles by this author , Alexa MeyerAlexa Meyer More articles by this author , Adam HassAdam Hass More articles by this author , Eric CruzenEric Cruzen More articles by this author , Yves DuroseauYves Duroseau More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past decade, there has been a dramatic increase in the number of freestanding emergency departments (EDs) affiliated and located near existing hospital-based EDs. Given freestanding EDs do not have in-house surgical specialty providers, the purpose of this study was to determine whether differences exist in the quality of care and clinical outcomes of patients presenting to freestanding versus hospital-based EDs for urgent surgical conditions. METHODS: Retrospective analysis of patients that presented to Lenox Health Greenwich Village (freestanding) and Lenox Hill Hospital (hospital-based) EDs in New York City between 01/2019 and 02/2021 with urgent surgical conditions was performed. Data collected include patient demographics, ED and procedure time data, principal diagnosis and procedure, and post-operative data. Statistical analyses include Mann-Whitney test, Chi square test, COX regression, and logistic regression, with p<0.05 considered statistically significant. RESULTS: 1220 patient were included in this study, with 356 presenting to freestanding and 864 to hospital-based ED for surgically urgent conditions, including testicular torsion (Table 1). Median times from ED arrival to surgical intervention were 14.7 hours in freestanding and 12.7 hours in hospital-based ED (p=0.073). Factors associated with significantly longer time intervals include African American race (HR=0.75, 95% CI: 0.57-0.90), Medicaid (HR=0.80, 95% CI: 0.68-0.95), and Medicare (HR=0.63, 95% CI: 0.49-0.81). Patients who presented to freestanding ED had significantly shorter ED length of stay (p<0.0001) and more accurate ED diagnoses (p=0.022). There were no statistical differences in ICU admission (p=0.188), post-operative complication (p=0.957), 30-day readmission (p=0.256), and mortality rates (p=0.524) between the two groups. CONCLUSIONS: Within our system, the quality of care and clinical outcomes of patients requiring urgent surgical intervention are comparable for those presenting to a freestanding ED versus a hospital-based ED. Thus, freestanding EDs in an urban environment may be beneficial for both patients and health care facilities. However, differences in care across race and insurance group must be further explored. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e58 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ginnie Jeng More articles by this author Alexa Meyer More articles by this author Adam Hass More articles by this author Eric Cruzen More articles by this author Yves Duroseau More articles by this author Lee Richstone More articles by this author Expand All Advertisement PDF downloadLoading ...

Papillary Renal Cell Carcinomas Demonstrating Micropapillary Features: An Investigation Into the Diagnostic and Prognostic Implications.

Aims: Papillary renal cell carcinoma (PRCC) with micropapillary carcinoma (MC) has been rarely described. We conducted a retrospective descriptive evaluation of the association of MC with PRCC and the possible prognostic implications.Methods: A database search was made at the University of Southern California (USC) and Lenox Hill Hospital (LHH; New York City) in June 2016-June 2019 of PRCC cases with MC. Diagnosis of MC was made using routine histology, based on the presence of small clusters of cells without a vascular core. Features evaluated included: percent of MC, gross appearance, PRCC typing, nuclear grade, lymphovascular invasion, and lymph node metastasis.Results: 848 RCC cases (690 from USC and 157 from LHH); 70 cases PRCC (54 from USC, 16 from LHH) of these cases, 13 had an MC, 12 were from radical nephrectomy, and 12 cases were male. Mean age was 68.3 years; seven were located in the right kidney. Average tumor size was 8.6 cm. MC ranged from 10% to 80% (average 37.5%), nine cases were PRCC type 2 and four type 1. Nuclear grade: three cases (grade 2), nine cases (grade 3), and one case (grade 4); 11 out of 13 tumors presented with extrarenal extension; nine cases that had lymph nodes submitted had metastatic carcinoma.Conclusions: The presence of a micropapillary component in PRCC was found to be 18.5%, and it was predominantly associated with high pathologic stage and lymph node metastases. The clinical course of these tumors seems similar to MC in other tissues/organ systems. We advocate reporting this pattern when identified.

Interview With Launette Woolforde, EdD, DNP, RN, NEA-BC, NPD-BC, FAAN

Interview With Launette Woolforde, EdD, DNP, RN, NEA-BC, NPD-BC, FAAN

1116: BLUE DESPITE O2: A RARE CASE OF METHEMOGLOBINEMIA

1Northwell Health - Lenox Hill Hospital 2Lenox Hill Hospital, NY 3Montefiore Medical Center- Wakefield

Letter to the Editor Regarding “Web-Based Education and Social Media Increase Access to Careers in Neurosurgery: The Lenox Hill Hospital BRAINterns Experience”

Letter to the Editor Regarding “Web-Based Education and Social Media Increase Access to Careers in Neurosurgery: The Lenox Hill Hospital BRAINterns Experience”

Web-Based Education and Social Media Increase Access to Careers in Neurosurgery: The Lenox Hill Hospital BRAINterns Experience

To replace educational opportunities lost during the coronavirus disease 2019 (COVID-19) pandemic, the Department of Neurosurgery at Lenox Hill Hospital produced an open-access webinar series ("BRAINterns") that covered a broad range of health care topics with a focus on neurosurgery. This 8-week webinar series ran from July 1 to August 28, 2020. An optional exit survey was distributed to participants. Data were analyzed to characterize and better understand trends among a global cohort of participants. A total of 16,484 people registered for BRAINterns, and 6675 took the survey (40.5% response rate). Responders represented 87 countries, of which the majority were from the United States and Canada (90.48%, n= 6039). Responders were primarily female (82.9%, n= 5521). Racial and ethnic representation was majority Asian (42%, n=2798), followed by White (22.7%, n= 1514), Hispanic/Latino (16.2%, n= 1080), and Black and African American (7.7%, n= 516). Participants reported hearing about BRAINterns through various social media platforms (72.18%, n= 4818)-the most popular was TikTok (33.4%, n= 2232). Overall, 93.4% of participants reported that the course was a good use of their time during the pandemic, and 86.7% reported that the course helped replace lost opportunities. These data demonstrate that webinar-based education is an effective method of expanding access to careers in medicine and in particular, neurosurgery, to traditionally underrepresented populations. Social media can be a powerful tool to combat barriers to early exposure and vastly improve diversity within the field.

Increased Utilization of Social Media in Neurosurgery During the COVID-19 Pandemic

To replace educational opportunities lost during the coronavirus disease 2019 (COVID-19) pandemic, the Department of Neurosurgery at Lenox Hill Hospital produced an open-access webinar series (“BRAINterns”) that covered a broad range of health care topics with a focus on neurosurgery.This 8-week webinar series ran from July 1 to August 28, 2020. An optional exit survey was distributed to participants. Data were analyzed to characterize and better understand trends among a global cohort of participants.A total of 16,484 people registered for BRAINterns, and 6675 took the survey (40.5% response rate). Responders represented 87 countries, of which the majority were from the United States and Canada (90.48%, n = 6039). Responders were primarily female (82.9%, n = 5521). Racial and ethnic representation was majority Asian (42%, n = 2798), followed by White (22.7%, n = 1514), Hispanic/Latino (16.2%, n = 1080), and Black and African American (7.7%, n = 516). Participants reported hearing about BRAINterns through various social media platforms (72.18%, n = 4818)—the most popular was TikTok (33.4%, n = 2232). Overall, 93.4% of participants reported that the course was a good use of their time during the pandemic, and 86.7% reported that the course helped replace lost opportunities.These data demonstrate that webinar-based education is an effective method of expanding access to careers in medicine and in particular, neurosurgery, to traditionally underrepresented populations. Social media can be a powerful tool to combat barriers to early exposure and vastly improve diversity within the field.

Aquapheresis: An Institutional Experience.

Aquapheresis (AQ) consists of the extracorporeal extraction of plasma water from the vascular space across a semipermeable membrane in response to a transmembrane pressure gradient. The primary utilization of AQ has been in the management of patients with diuretic resistant heart failure with a treatment goal directed to quickly eliminate the excess fluid and optimize volume status. This modality is similar to isolated ultrafiltration performed on those patients requiring dialysis, but utilizes a machine that is smaller and easier to initiate and operate compared with traditional dialysis equipment. A retrospective study that describes the indications in which AQ was utilized at Lenox Hill Hospital. The patient list was generated by searching for the keyword "Aquaph" in our electronic health record (EHR) orders. Patients were categorized based on hospital location and indication of AQ therapy. Additional information includes duration of treatment (days), changes in creatinine (start of AQ to stop of AQ), and total volume removed. The search generated 28 patients; five were excluded as AQ was not initiated. In the remaining 23 patients, the mean aquapheretic volume per day was 1954 mls, with no significant change in creatinine. Indications for AQ broke out into five main categories: cardiogenic shock including post cardiothoracic procedure (10 pts); anasarca (5 pts); ATN with volume overload (4 pts); ESKD with bridge ultrafiltration between hemodialysis treatments (2 pts); and post-op volume overload (2 pts). We found that aquapheresis can be utilized in situations other than diuretic resistant heart failure. Also to consider, is the ease in which this less complicated aquapheresis equipment can be operated compared to the more complex hemodialysis equipment.

Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19.

Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19.

Early Data From Case Series of Tracheostomy in Patients With SARS-CoV-2.

Thirty-eight tracheostomies were performed on patients with respiratory failure secondary to SARS-CoV-2 infection over the month of April at North Shore University Hospital and Lenox Hill Hospital (members of Northwell Health System in Long Island and New York City). Follow-up by May 14 revealed that 21 (55.2%) had been weaned from ventilators and 7 (18.4%) underwent decannulation. Two patients (5.3%) expired in the weeks following tracheostomy. Between the 2 institutions, 10 attending surgeons performed all of the tracheostomies using appropriate personal protective equipment, and none demonstrated seroconversion within 1 to 2 weeks of this article.

Landscape of targetable alterations discovered by next generation sequencing demonstrates the role a community hospital can play in precision-guided oncology: Experience from Lenox Hill Hospital.

e19279 Background: Next generation sequencing (NGS) has become standard of care in aiding diagnosis and treatment of advanced solid cancers, and in conducting clinical trials at large centers. It is imperative that this is expanded to other hospitals that care for the majority of cancer patients. We analyzed NGS reports from our hospital to assess the number of patients who can benefit from approved or investigational targeted therapies. Methods: We analyzed NGS data for 511 solid tumor samples sequenced between January 1, 2018 and December 31, 2019. NGS was performed by GenPath Dx (77%), Caris Life Sciences (16%) or Foundation Medicine (7%). Results: The majority of samples represented advanced stage malignancies and 21% were stage I or II. They originated from the following primaries: 195 lung (37%), 150 gastrointestinal (29%), 64 primary brain (12%), 20 gynecological (4%), 14 skin (3%), 13 head and neck (3%) and 11 sarcomas (1%). 72 samples had mutations in EGFR (14%), 170 in TP53 (33%), 124 in KRAS (24%), 28 in BRAF (6%), and 3 in RET (0.6%). 34/107 (32%) early stage samples harbored an actionable mutation (20 EGFR mutations, 1 MET exon 14 skipping, 4 KRAS G12C, 7 BRAF V600E, 1 FGFR3 amplification and 1 CD74/NRG1 fusion). In contrast, only 58/317 (18%) advanced stage samples had a targetable mutation (p-value = 0.02, χ² test). 76% of EGFR-mutated samples were lung adenocarcinomas, and 19% were primary brain tumors; 54% of these are targetable by FDA-approved EGFR inhibitors. KRAS mutations were found in gastrointestinal (54%), lung (37%) and pancreatic (5%) malignancies. 17 patients had a KRAS G12C mutation and, therefore, could benefit from one of the KRAS G12C inhibitors in early clinical trials. Four samples harbored crizotinib-sensitive mutations (2 MET amplifications and 2 MET exon 14 skipping mutations). Regarding gene fusions, one glioblastoma sample had a PTPRZ-MET fusion and one lung adenocarcinoma sample harbored a CD74-NRG1 fusion. Conclusions: We identified 92/511 samples (18%) with clinically actionable mutations; distributed in 32% early stage and 18% advanced stage disease, indicating that actionable mutations are present at an increased frequency in early stage solid malignancies in our data set and trials to investigate targeted therapy in such settings should be considered. Furthermore, we show that a community-based hospital can be a site for future clinical trials of small molecule inhibitors and bring precision-guided medicine to additional patients.

Impact of New Evidence-Based Sepsis Guidelines on Breastfeeding Rates

Purpose: Traditional management of asymptomatic full term neonates with risk factors for early-onset sepsis has potentially negatively affected maternal-infant bonding and breastfeeding success. Beginning in January 2016, the Lenox Hill Hospital NICU adopted new evidence-based early-onset sepsis guidelines for the evaluation of asymptomatic full term neonates. While the length of stay in the NICU was decreased to just hours in some cases, overall antibiotic utilization did not decrease. In June 2017, the guidelines were modified using the Kaiser Permanente Neonatal Early-Onset Sepsis Calculator to further stratify risk of sepsis. Infants …

FIGO Committee Statement: Ethical responsibilities in post-abortion care.

International Journal of Gynecology & ObstetricsVolume 146, Issue 3 p. 269-270 FIGO STATEMENT FIGO Committee Statement: Ethical responsibilities in post-abortion care FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee, Corresponding Author FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee fchervenak@northwell.edu Participating members of the FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee 2015–2018 are listed at the end of the paper. Correspondence Frank Chervenak, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, 100 East 77th St., New York, NY 10075, USA. Email: fchervenak@northwell.eduSearch for more papers by this author FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee, Corresponding Author FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee fchervenak@northwell.edu Participating members of the FIGO Ethical and Professional Aspects of Human Reproduction and Women's Health Committee 2015–2018 are listed at the end of the paper. Correspondence Frank Chervenak, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, 100 East 77th St., New York, NY 10075, USA. Email: fchervenak@northwell.eduSearch for more papers by this author First published: 17 July 2019 https://doi.org/10.1002/ijgo.12899Citations: 4 The following statement on the professional ethics of post-abortion care have been prepared by the FIGO Committee on Ethical and Professional Aspects of Human Reproduction and Women's Health. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume146, Issue3September 2019Pages 269-270 This article also appears in:FIGO World Congress – FIGO Committee & Working Group publicationsFree-to-view Collection RelatedInformation

2215-PUB: Serum Levels of the Advanced Glycation End Product (AGE) Pentosidine Do Not Correlate with the Extent of Coronary Artery Disease Assessed by SYNTAX Score

Advanced glycation end-products (AGEs) are endogenously produced or exogenously derived glycated proteins and lipoproteins. The accumulation of AGEs may have a variety of adverse effects since they cause oxidative stress and thus may act as contributing factors to the development of disease states such as, for example, complications of diabetes mellitus. The aim of this study was to investigate whether the levels of three AGEs (pentosidine, N(6)-carboxymethyllysine [CML], and methylglyoxal [MGO]) and the soluble form of the AGE receptor (sRAGE) may be used as markers for the presence and extent of coronary artery disease (CAD). We recruited 363 consecutive patients with suspected CAD who presented for cardiac catheterization at Lenox Hill Hospital in New York City (54% of patients were male, 48% of the patients had diabetes). At the time of this abstract submission 169 patients had circulating pentosidine levels measured (74 of these patients had diabetes). We examined relations between pentosidine levels, HbA1c, LDL, and the extend of CAD (measured by SYNTAX score). Serum pentosidine levels did not significantly correlate with any of other parameters. There was, however, a positive correlation between HbA1c levels and the SYNTAX score (Spearman correlation coefficients of 0.26, ρ = 0.0001 for the entire group; 0.18, ρ = 0.01 for patients without diabetes; and 0.29, ρ= 0.0001 for patients with diabetes). In conclusion, our preliminary results demonstrate that in patients with suspected CAD undergoing cardiac catheterization, SYNTAX score does not correlate with pentosidine levels but correlates positively with HbA1c. The data on all three AGEs and sRAGE in the entire cohort of 363 patients will be presented at the meeting. Disclosure C. Basman: None. D. Avtanski: None. K. Ziskovich: None. R. Jonas: None. S. Fishman: None. H. Sonmez: None. U. Rashid: None. A. Kodra: None. G. Stoffels: None. M. Lesser: None. V. Singh: None. L. Poretsky: None. Funding The Gerald J. and Dorothy R. Friedman New York Foundation for Medical Research

MON-192 Improving Transgender Care through Comprehensive Wellness Program in the Endocrine Division: First Year Experience

Transgender individuals are medically underserved in the United States. Based on the National Transgender Discrimination Survey, 19% transgender population were refused healthcare, 50% had providers with no knowledge of transgender care and 28% had to delay medical care because of discrimination based on the sexual orientation [1]. The Friedman Transgender Health and Wellness Program (FTHWP) was established in 2017 at Lenox Hill Hospital to provide clinical, legal and social services to transgender individuals. These services include pediatric and adult endocrinology services, primary care, mental health, gynecological services, HIV/AIDS testing and care, referrals for hair removal, vocal cord training and gender confirming surgery, legal services, specialty referrals and social work assistance. There were 10 participants at FTHWP in June 2017. The number of participants increased to 60 by September 2018. The patients’ ages range from 11 years to 80 years old. 32 are Caucasians (53%), 13 are African American (21%), 10 are Asian (16%) and 6 are Hispanic (10%). 29 patients are trans-male, 28 patients are trans-female, 4 patients are gender-fluid. 39 patients have received previous hormone therapy, while 22 patients initiated hormonal therapy in our program. From this limited initial experience we concluded that the demand for comprehensive transgender medical services exists and that the patients display diverse demographic and clinical characteristics. Endocrinologists are well positioned to establish transgender health centers because of their background in both internal medicine and hormone therapy. Reference: [1] Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

High Incidence of Recurrent Crohn's Disease Following Colectomy for Ulcerative Colitis Revealed with Long Follow-Up.

Ulcerative colitis (UC) patients with progression of their disease despite optimized medical therapy may warrant "curative" proctocolectomy with end ileostomy or ileo-anal pouch (IPAA) anastomosis. The aim of our study was to assess the incidence of later recurrent ileitis that lead to altering the initial diagnosis to Crohn's disease (CD). A retrospective analysis was conducted on the inflammatory bowel disease database at Lenox Hill Hospital. The database consisted of patients that were diagnosed with UC or CD based on clinical assessment, endoscopic appearance, gross and histological examination, and imaging between 1960 and 2015. The post-colectomy follow-up period was at least 10years. Recurrent disease was classified by evidence of transmural inflammation in the distal ileum, fistulizing disease, or stricturing disease. From our IBD database, we identified 128 patients who underwent elective or urgent colectomy with the preoperative diagnosis of UC. Thirty-two (25%) had either an IPAA or end ileostomy with documented recurrence of inflammation in the small bowel mucosa consistent with CD. There was no significant difference between the type of surgical approach and the chance of recurrent disease (p=.20). The average time to clinically significant recurrence was 5years. The incidence of recurrent CD following colectomy for ulcerative colitis, when followed postoperatively for an average of 20years, was 25%, considerably more than previously reported. Patients who come to colectomy for ulcerative colitis and are followed for at least 10years show a high incidence of recurrent Crohn's disease in the ileostomy or ileo-anal pouch. Extended follow-up should be included in patients coming to colectomy for ulcerative colitis before they should be considered cured of their disease.

Changing the Culture of Inpatient Constipation Management

Introduction: Hospitalized patients are at increased risk for constipation, with a prevalence of 79% in patients on a geriatric ward. Constipation results in greater indirect downstream costs in form of diagnostic tests, treatments, and prolonged hospital stays. However, there is a lack of specific performance improvement measures related to prevention and management of inpatient constipation. We hypothesize that Housestaff overwhelmingly order Senna and Docusate sodium for management of inpatient constipation while research data has not found those medications to be effective and is likely contributing to inefficient health care expenditures. Methods: We performed a retrospective chart review of patients admitted at Lenox Hill Hospital in NY under the general medicine service in January 2016 that were ordered for the following laxatives: Senna, Docusate sodium, and Polyethylene Glycol 3350 (PEG 3350). Patients with a diagnosis of bowel obstruction and perforation were excluded. Risk factors for inpatient constipation as well as comorbidities associated with constipation were collected. A voluntary survey was distributed to Internal Medicine Housestaff to look at their level of confidence and basic knowledge surrounding prevention and management of inpatient constipation. Results: 185 inpatient charts were reviewed. Docusate sodium was the most common laxative ordered, at 82%, followed by Senna at 73% and Polyethylene Glycol 3350 at 37%. Most patients were placed on a laxative combination therapy, commonly Senna and Docusate sodium 42% and also the trio of Senna, Docusate sodium, and PEG 3350 at 20%. 98% of the patients were high risk for inpatient constipation (High risk = 1 or more risk factors), with age and use of a constipation-causing medication being the 2 most common risk factors. 76% of Internal Medicine residents (evenly distributed among all three years of training) completed the survey. Survey report revealed knowledge deficiency in management of inpatient constipation. Conclusion: As shown in our study, the hospitalized population is at high risk for constipation. Furthermore, evidence-based treatment or published algorithm is not being followed. We plan to change the culture in our institution by educating Housestaff and working with nursing staff to not only identify high risk patients but to also help implement nonpharmacologic intervention to prevent and treat inpatient constipation.

Discussion: Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years.

New York, N.Y. From the Manhattan Eye, Ear, Throat Hospital, Lenox Hill Hospital, Hofstra-Northwell Health System. Received for publication March 20, 2017; accepted April 26, 2017. Disclosure:The author has no financial interest to declare in relation to the content of this Discussion or of the associated article. Alan Matarasso, M.D., 1009 Park Avenue, New York, N.Y. 10028, [email protected]