Stony Brook University Medical Center Research Articles

Monitoring Hospitalized Dialysis Patients With COVID-19: Repurposing Baby Monitors for Patient and Staff Safety

Monitoring Hospitalized Dialysis Patients With COVID-19: Repurposing Baby Monitors for Patient and Staff Safety

Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection.

Data regarding the benefits or harm associated with the continuation of Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs), especially the impact on inflammation, in hypertensive, hospitalized patients with COVID-19 in the United States is unclear. This is a single-center cohort study of sequentially hospitalized patients with COVID-19 at Stony Brook University Medical Center from March 7, 2020 to April 1, 2020, inclusive of these dates. Data collection included history of known comorbidities, medications, vital signs and laboratory values (admission and during the hospitalization). Outcomes include inflammatory burden (composite scores for multiple markers of inflammation), acute kidney injury (AKI), admission to the intensive care unit (ICU), need for invasive mechanical ventilation, and mortality. Of the 300 patients in the study cohort, 80 patients (26.7%) had history of ACEI or ARB use prior to admission, with 61.3% (49/80) of these patients continuing the medications during hospitalization. Multivariable analysis revealed that the history of ACEI or ARB use prior to hospitalization was not associated with worse outcomes. In addition, the continuation of these agents during hospitalization was not associated with an increase in adverse outcomes and predicted fewer ICU admissions (OR=0.25, 0.08-0.81) with a decrease in the severity of inflammatory burden (peak CRP (6.9±3.1mg/dl, p=0.03) and peak inflammation score (2.3±1.1unit reduction, p=0.04)). Use of ACEI or ARBs prior to hospitalization was not associated with adverse outcomes in COVID-19 and the therapeutic benefits of continuing ACEI or ARB in hospitalized patients with COVID-19 was not offset by adverse outcomes.

Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ² test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

A multicenter, randomized, placebo-controlled trial of endovenous thermal ablation with or without polidocanol endovenous microfoam treatment in patients with great saphenous vein incompetence and visible varicosities.

Objectives *Varithena 017 Investigator Group: Michael Vasquez, MD, Venous Institute of Buffalo, Amherst, NY; Antonios Gasparis, MD, Stony Brook University Medical Center, Stony Brook, NY; Kathleen Gibson, MD, Lake Washington Vascular, Bellevue, WA; James Theodore King, MD, Vein Clinics of America, Oakbrook Terrace, IL; Nick Morrison, MD, Morrison Vein Institute, Scottsdale, AZ; Girish Munavalli, MD, Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, NC; Eulogio J. Sanchez, MD, Batey Cardiovascular Center, Bradenton, FL. Varithena® is a trademark of Provensis Ltd, a BTG International group company.To determine the efficacy and safety of polidocanol endovenous microfoam (PEM 0.5%, 1.0%) and placebo each administered with endovenous thermal ablation.MethodsA multicenter, randomized, placebo-controlled, blinded study was conducted in patients with great saphenous vein incompetence and symptomatic and visible superficial venous disease. Co-primary endpoints were physician-assessed and patient-assessed appearance change from Baseline to Week 8.ResultsA total of 117 patients received treatment (38 placebo, 39 PEM 0.5%, 40 PEM 1%). Physician-rated vein appearance at Week 8 was significantly better with PEM (p = 0.001 vs. placebo); patient-assessed appearance trended similarly. Polidocanol endovenous microfoam provided improvements in clinically meaningful change in patient-assessed and physician-assessed appearance (p < 0.05), need for additional treatment (p < 0.05), saphenofemoral junction reflux elimination, symptoms, and QOL. In PEM recipients, the most frequent adverse event was superficial thrombophlebitis (35.4%)ConclusionsEndovenous thermal ablation + PEM significantly improved physician-assessed appearance at Week 8, increased the proportion of patients with a clinically meaningful change in appearance, and reduced need for additional treatment. www.clinicaltrials.gov (NCT01197833)

Microsurgical Simulation Exercise for Surgical Training

Initial training for orthopedic surgical residents (postgraduate years 1-5) in microsurgery using the turkey wing model and evaluation of their proficiency. Residents were given a questionnaire on their comfort level with microsurgery and microsurgical knowledge, followed by a lecture on the subject. They watched a surgical dissection and repair of the turkey wing's neurovasculature. Residents performed the dissection and repairs of the artery, vein, and nerve. A postquestionnaire was administered following the simulation exercise. Their performances on repairs were graded and results compared by academic year. A total of 21 orthopedic surgery residents were recruited from Stony Brook University Medical Center, Stony Brook, NK. This training activity resulted in significant improvements in both microsurgical knowledge (41%) and comfort (37%). Senior residents scored significantly higher than juniors on 6 microsurgical parameters. The largest effect was in nerve repair showing 4 parameters that differed significantly between groups. Microsurgical techniques require extensive training to master. The turkey wing model for repair of the artery, vein, and nerve represents a realistic simulation of a human hand artery, vein, and nerve. It provides an inexpensive method for residents to practice on real tissue for improving microsurgical technique.

Ultrasonic Technology Decreases Wound Complications in Groin Dissection for Vascular Procedures

Methods: A retrospective analysis of prospectively collected data from a single institution (Stony Brook University Medical Center) using the Vascular Quality Initiative database was performed. The research protocol was defined prior to initiating data collection. Included were consecutive pa- tients who underwent groin dissection with either electrocautery (group A) or ultrasonic devices (group B) during the following procedures: endovascu- lar aortic aneurysm repair, thoracic endovascular aortic aneurysm repair, lower extremity bypass, or hybrid peripheral vascular intervention. In-hospi- tal and outpatient records were reviewed to capture postoperative surgical site complications, and clinical outcomes were compared between the groups. Results: Over a 24-month period, 233 patients underwent peripheral vascular interventions that required 346 groin dissections. There were no significant differences in the risk profile of the patients between group A (n ¼ 135) and group B (n ¼ 98). Wound complications (hematoma, infec- tion, dehiscence, lymphocutaneous fistula, and seroma/lymphocele) occurred significantly less often in the ultrasonic group (group B: 7.2%) compared with the electrocautery group (group A: 28.5%; P < .0001). When looking at specific wound complications, use of the ultrasonic energy device significantly decreased the rate of lymphatic complications (2.1% vs 14.6%; P < .01) and wound dehiscence (0% vs 7%; P ¼ .01). Conclusions: The use of the ultrasonic energy device (Harmonic), when compared with electrocautery (Bovie) in surgical dissection of the groin, is associated with a lower rate of wound complications, specifically lymphatic leaks and wound dehiscence. Routine use of this alternative tool may help decrease surgical site complications in this particularly vulner- able area.

Review of Brain On Fire: My Month of Madness by Susannah Cahalan

[Author Affiliation]Deborah M. Weisbrot. 1 Child & Adolescent Psychiatry Outpatient Clinic, Stony Brook University Medical Center, Stony Brook, New York.Alan B. Ettinger. 2 Albert Einstein College of Medicine, Bronx, New York, and Epilepsy Center, Neurological Surgery P. C. , Lake Success, New York.IBSN: 987-1-4516-2137-2. 2012. New York: Simon and Schuster. 263 pagesAddress correspondence to: Deborah M. Weisbrot, MD, Associate Professor of Psychiatry, Director, Child & Adolescent Psychiatry Outpatient Clinic, Stony Brook University Medical Center, Stony Brook, New York 11894-8790, E-mail: deborah.weisbrot@stonybrook.eduWhat is the value for doctors to read about the experience of illness? Certainly there is an abundance of books written by individuals who have suffered from assorted medical problems. If physicians conclude that the value is simply to remind them to be more sensitive or compassionate, they will miss the point of the extraordinary learning opportunities afforded by reading Brain on Fire.Brain on Fire will undoubtedly create healthy anxiety in medical readers who will have to ask themselves the crucial question, What would I have done if I had been in charge of this case? Brain on Fire will be both humbling and frightening for the neurologist or psychiatrist reader. Clinicians will ask themselves how many of their own patients could have had an unrecognized neurological syndrome of the type incurred by Cahalan. Even we, the authors of a soon-to-be-released text on neurologic differential diagnosis, scrambled to ensure that this particular diagnosis was adequately represented. Yet, hoping to figure out the enigmatic diagnosis misses the more important lesson. We would argue that the best physicians are not necessarily the most savvy or knowledgeable; rather, they are the ones with humility who asks themselves the vital questions, What else could this be? and, Should I get help?The initial symptoms experienced by author, Susannah Cahalan, were both neurological and Cahalan's experience early on with a psychiatrist who did not apparently inquire further about neurological symptoms might lead neurologists to feel justified in failing to bring in psychiatrists early in the evaluation of patients with altered mental status, out of concern that symptoms would be dismissed as merely psychiatric. This conclusion would be unfortunate since the broader concern is the frequent failure of neurologists and psychiatrists to communicate with each other. A better model of collaboration is demonstrated subsequently when the new psychiatrist appropriately states that bipolar disorder was a possibility, but only after neurological causes are excluded.It was disturbing to read the description of the original outpatient neurologist who dismissed Cahalan's symptoms as a result of drinking and partying. While this attribution was particularly egregious because it was completely unfounded, the reader's demonizing of the neurologist will also block consideration of a broader issue that affects all of us. How often do clinicians latch on to diagnoses that seem easy to package and most probable, rather than taking each and every case and wonder, What else could it be? How often do we discipline ourselves to ask Have we reasonably excluded other possibilities? How many of us take the time to examine the broad differential diagnosis for each case we encounter before moving on to the next patient in a busy work day?Furthermore, Brain on Fire poses a dilemma for all physicians who want to do well for their patients but find themselves practicing in a health care system that limits the amount of time which can be reasonably spent with each patient. Indeed, the emergency room physician evaluating Cahalan for a new-onset seizure followed typical clinical practice in discharging Cahalan after performing routine testing. Yet, taking more time to elicit a detailed history would have revealed her extraordinary change in mental status and that would likely have led to her admission and further investigations. …

Pregnancy complicated by valvular heart disease: an update.

Cardiovascular disease complicates ≈1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. Although its prevalence is considered relatively low in pregnant women, heart disease is the most common cause of maternal mortality. Because more women with congenital or

Impact of Project SCOPE on Racial/Ethnic Disparities in Screening Colonoscopies

BackgroundA federally funded demonstration project (Project SCOPE) was conducted to develop a model for delivering screening colonoscopy to underinsured patients in Suffolk County, NY. The recruitment model featured collaboration between Stony Brook University Medical Center and the Suffolk County Department of Health Services’ network of community health centers; bilingual patient navigators, and reimbursement of physicians and the hospital at Medicare rates.MethodsWe conducted a retrospective analysis of all (11,752) colonoscopies performed at Stony Brook Medicine, during the pre-SCOPE time period (2003–2004), during SCOPE period (2007–2008), and post-SCOPE (2010–2011), to measure the impact of SCOPE on reducing racial and ethnic disparities. Multiple logistic regression models were used to compare the likelihood of a patient being Hispanic or African American after adjusting for potential covariates.ResultsThe numbers of Hispanics undergoing colonoscopies were 146 (4.3 %), 506 (12.3 %), and 262 (6 %) during the pre-SCOPE, SCOPE, and post-SCOPE time periods. The numbers of African Americans were 166 (5.1 %), 298 (7.2 %), and 255 (5.8 %). The odds ratio (OR = 1.4, 95 % CI = 1.06–1.83, p = 0.014) of a screening colonoscopy patient being Hispanic during the Project SCOPE period compared to the post-SCOPE period remained significant after taking into consideration the other covariates, such as diabetes, smoking, and insurance status.ConclusionsProject SCOPE had a significant impact on increasing the proportion of Hispanics undergoing screening colonoscopies. Factors such as bilingual patient navigators, in addition to removing financial barriers, may have contributed to the increase.

Impact of Project SCOPE on Racial/Ethnic Disparities in Colorectal Cancer Screening

Purpose: During 2005-2009, Stony Brook University Medical Center (SBUMC) led a CDC funded project, Suffolk County Preventive Endoscopy Project (Project SCOPE), to expand colorectal cancer (CRC) screening for Suffolk County (New York) residents (age ≥50 years) who had inadequate or no insurance coverage for CRC screening. We hypothesized that this project significantly expanded CRC screening in racial/ethnic minorities at SBUMC. Methods: We conducted a retrospective analysis of colonoscopies performed at SBUMC, prior to Project SCOPE (2003-2004), during Project SCOPE (2007-2008), and after Project SCOPE (2010-2011). Colonoscopies were excluded for patients aged <50 and >80 or with a history of inflammatory bowel diseases. Clinical metadata (e.g., race/ethnicity, medical insurance) was obtained from the electronic medical record. Multiple logistic regression model was used to compare the likelihood of a patient being Hispanic or African American after adjusting for potential confounders. All marginally significant factors and their first order interactions were considered in the model based on backward selection. Results: During the three time periods, the total number of colonoscopies included in the study was 11,752. The total number of Hispanic patients undergoing colonoscopy was 146 (4.5%) in 2003-2004, 506 (12.3%) in 2007-2008, and 262 (6%) in 2010-2011. The proportion of Hispanic patients undergoing colonoscopy was significantly different between the three time periods after adjusting for potentially confounding variables (patient's age, gender, and medical insurance status [p< 0.0001]). The statistical difference between the three time periods remained significant when we only considered colonoscopies designated as screening procedures. The total number of African-American patients undergoing colonoscopy was 166 (5%) in 2003-2004, 298 (7.2%) in 2007-2008, and 255 (5.9%) in 2010-2011. However, these differences were not statistically significant after controlling for patient's age and medical insurance status. The overall detection rates of adenomas, sessile serrated polyps and adenocarcinoma on colonoscopy were respectively 25%, 0.8%, and 1.2%. Hispanic ethnicity or African-American race was not significantly associated with detection of adenoma, sessile serrated polyp, or adenocarcinoma in this study. Conclusion: Reducing financial and language barriers through Project SCOPE significantly improved CRC screening by colonoscopy among Hispanics and African Americans. Future increases in national health insurance coverage for previously uninsured populations may result in increased minority participation in CRC screening as well as an increased need for language assistance.

Mental Illness Linked to Premature Death in Epilepsy Patients

Mental Illness Linked to Premature Death in Epilepsy Patients

Delivering colonoscopy screening for low‐income populations in Suffolk County

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands. Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified. During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows. Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations.

Testimony

Ad Libitum4 September 2012TestimonyRichard Bronson, MDRichard Bronson, MDFrom Stony Brook University Medical Center, Stony Brook, NY 11794-8091.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-5-201209040-00013 Audio Reading - “Testimony” Audio. Listen to a reading of "Testimony" by Richard Bronson, MD. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Now what is the purpose of Connecticut in telling married people that they cannot use contraceptives?—The Court, Griswold v. Conn. (1965)The Garage had three bays,usually filled.We pumped your gas,washed your windshield,always with a smile.Bazooka gum for the kids,or a couple kitchen glassescame with a fill-up.A hand reaches under the counter—my hand,under the counter.We lived in a three-story housebehind the garage,me and my brother—three generations,two families, the children,grandparents from the old country.Eggs was their business, chicken coopsfilled the backyard.We had another business.A man comes in for a rubber.Usual customer, say,doubt it's a setup.Fuzz never bothered anyone anyway.... Author, Article, and Disclosure InformationAffiliations: From Stony Brook University Medical Center, Stony Brook, NY 11794-8091.Current Author Address: Richard Bronson, MD, Department of Obstetrics and Gynecology, Stony Brook University Medical Center, HSC T9-080, Stony Brook, NY 11794-8091. PreviousarticleNextarticle Advertisement Audio Reading - “Testimony” Audio. Listen to a reading of "Testimony" by Richard Bronson, MD. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 4 September 2012Volume 157, Issue 5Page: 383KeywordsChildrenContraceptivesFemale contraceptionObstetrics and gynecology ePublished: 4 September 2012 Issue Published: 4 September 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

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Stony Brook University Medical Center, US, [email protected] Stony Brook University Medical Center, US Stony Brook University Medical Center, US Stony Brook University Medical Center, US

Medically-derived 131I in municipal sewage effluent

This work presents 131I (t½ = 8.04 d) concentrations in sewage effluent from the Stony Brook Water Pollution Control Plant (WPCP), a small plant serving a regional thyroid cancer treatment facility in Stony Brook, NY, USA. The concentrations detected in sewage effluent ranged from 1.8 ± 0.3 to 227 ± 2 Bq L−1. The primary source of 131I is excreta from thyroid cancer inpatients treated at the Stony Brook University Medical Center. Based on several time series measurements following known inpatient treatments, the mean sewage half-life (Ts) of iodine is 3 d in this plant. The Ts, analogous to a radioactive half-life, describes the time it takes for half of a wastewater component to be removed from a WPCP. Flow recycling, or activated sludge, used to maintain bacterial populations necessary for sewage treatment causes iodine to remain in this plant far longer than its hydraulic retention time. The experimental results suggest that most 131I entering the Stony Brook WPCP leaves in sewage effluent, not in sewage sludge. Patient treatments can result in continuous discharges of 131I to surface waters where it can be used as a tracer of sewage-derived material and to understand the behavior of 131I in aquatic environments.

ASSOCIATION OF FINANCIAL BARRIERS TO HEALTH CARE WITH ACCESS TO CARE, QUALITY OF CARE AND OUTCOMES IN DIABETICS WITH CORONARY ARTERY DISEASE

Abstract Category: 31. Quality of Care and Outcomes AssessmentPresentation Number: 1256-292Authors: Puja Parikh, Steven Leigh, Roopali Parikh, Hongdao Meng, Nicholas Sakellarios, David Brown, Stony Brook University Medical Center, Stony Brook, NY, USA Background: As the cost of health care in the United States increases, more patients experience difficulty paying their medical bills. We sought to describe the impact of financial barriers to health care on access to care, quality of care and vascular outcomes of diabetic patients with coronary artery disease (CAD).Methods: The 2007 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 11,274 diabetics with CAD. Demographic data, clinical history, quality of care indices, and clinical outcomes were recorded in these patients. The primary outcome was a composite of major adverse vascular events (MAVE), defined by a history of stroke, retinopathy or diabetes-related ocular changes, bilateral foot amputations, and nonhealing foot sores.Results: Of 11,274 patients, 1,541 (14%) patients reported financial barriers to health care and 9,733 (86%) reported no such barriers. Patients with financial barriers were younger, more often female, less often with health insurance, and had higher rates of obesity, smoking, and hypercholesterolemia. They were also noted to have impaired access to care resulting in less frequent medical checkups, lower rates of annual cholesterol screening, HgbA1c screening, eye exams, foot exams, and diabetic education classes, and less aspirin and antihypertensive use. Patients with financial barriers experienced significantly higher MAVE rates (68% vs 55%, p<0.001). In multivariate analysis, financial barriers to care were an independent predictor of MAVE (OR 1.82, 95% CI 1.31-2.53). Financial barriers were also independently associated with indices of access to and quality of care including, medical checkup within the past two years (OR 0.33, 95% CI 0.26-0.42), annual cholesterol (OR 0.58, 95% CI 0.34-0.98) and HbA1c (OR 0.66, 95% CI 0.48-0.92) screening, annual eye (OR 0.75, 95% CI 0.61-0.92) and foot (OR 0.72, 95% CI 0.59-0.89) examinations, aspirin use (OR 0.65, 95% CI 0.48-0.89), and diabetic education (OR 0.77, 95% CI 0.63-0.93).Conclusions: Financial barriers to health care are independently associated with impaired access to care, poorer quality of care and worse clinical outcomes in diabetics with CAD.

Counting Sexual Violence in the Congo

An interview with Tia Palermo, a professor of preventive medicine at Stony Brook University Medical Center. Palermo used population-based data to better understand the occurrence of sexual violence in Congo. Palermo talks about how the magnitude of sexual violence is higher than previous studies suggest and also offers insight on the geographic spread of such violence.

The Value of Data Collection to Palliative Care Program Sustainability and Growth (521)

3. Develop a hospital based medical/legal partnership to address the medical legal needs of patients and families. Medical-Legal Partnership (MLP) is increasingly recognized as a tool to address the unmet medical legal needs of vulnerable patients and their families. Medical-legal partnerships create an alliance between frontline clinicians and community legal advocates as a method for proactively addressing legal issues of patients. For patients with advanced cancer and their families unresolved financial/legal-social issues can be a source of intense suffering and adversely impact their ability to cope with the extreme challenges of advanced illness. Hospitalized cancer patients in the mist of health crisis are particularly at risk for medical legal suffering. The need for a rapid multi-dimensional intervention can be acute for patients with limited life-expectancy and unresolved financial-legal issues. Hospital-based MLP’s can assist clinicians and patient-clients in identifying and addressing major sources of financial, legal, and social anxieties surrounding legacy planning, guardianships/planning for minor children, future planning documents, access to care to next step in care, and shoring up resources. Currently, even the best provider may not be trained to recognize these social legal problems and therefore may be ill equipped to remedy the distress. Through partnerships, clinicians can become skilled in recognition and facilitate subsequent medical legal consultation to benefit patients and their families. In this session, discussion will include: (a) methods for identifying patients at high risk for complex medical-legal issues and how to facilitate patient recognition of financial and legal distress; (b) a review of national models for MLPs and how to initiate a local MLP alliance; and (c) approaches to MLPs consultation for inpatients and description of the currently used model for consultation and medical student teaching at Stony Brook University Medical Center.

595: Placental dysfunction and decreased trophoblast invasion induced by infection with Chlamydia pneumoniae is prevented by low-dose acetyl-salicylic acid

We demonstrated previously that acute Chlamydia pneumoniae (Cp) infection of the placenta impairs extravillous trophoblast (EVT) invasion and we detected Cp DNA in placentas from preeclampsia cases more frequently than controls. We also showed that chronic Cp infection induces a proinflammatory response in EVTs and that elevated IgG against Cp is associated with preeclampsia. We sought to determine if potential therapeutic interventions are protective of the effects of Cp in EVTs.

Foreward to IMANA/Hofstra University Ethics Conference, 2010: End-of-Life Issues: Ethical and Religious Perspectives

Dear IMANA Members and JIMA Readers: Since I assumed the chairmanship of the Ethics Committee of the Islamic Medical Association of North America (IMANA), we have been deliberating on the need to have a conference solely devoted to ethics. To be successful, we wanted it to be multidisciplinary and not to be limited to IMANA members as has been with other IMANA conferences. To achieve these two goals we agreed that it would be best to hold the conference jointly with an established medical institution and for it to be held in a metropolitan area. Dr. Faroque Khan, the vice chairman of the Ethics Committee and a resident of Long Island, New York, suggested the local Hofstra University to be the venue for the conference. The next major decision was to decide the theme of the conference. At the time there was a lot of heated debate between politicians and in the media about health-care reform. Part of these discussions involved end-of-life care. This is a very significant issue, more so for the immigrant community with their different cultural backgrounds and specifically with Muslims because of their religious beliefs. We felt a great need to explore these issues in depth and decided to have the theme End-of-Life Issues: Ethical and Religious Perspectives. Dr. Khan has good connections with leaders of other faith communities in the area and specifically with several faculty members of the newly established medical school that is a part of the well-recognized Hofstra University. We agreed with the suggestion. We contacted the university’s Muslim chaplain, Professor Mamdouh Farid, professor emeritus of management, entrepreneurship, and general business,. He was very enthusiastic about the project and assumed the responsibility of providing the space and the local arrangements. I contacted Professor Daniel Varisco, of Hofstra’s Anthropology Department, who has been working in Yemen. He showed great interest in the project and offered to recruit Hofstra faculty members for the conference. I asked him to co-chair the program, and he graciously agreed. The next step was to select the faculty. Several members of IMANA Ethics Committee – Drs. Malika Haque, Shahid Athar, Faroque Khan, and myself –agreed to participate. Other IMANA members with great interest in medical ethics – Drs. Hasan Shanawani and Aasim Padela – were asked to and agreed to participate. Other IMANA members who work in disciplines that involve end-of-life issues were asked to participate: Dr. Tanveer Mir in palliative care, and Dr. Ali Nadroo in neonatology. We then looked for religious leaders. I selected Dr. Gamal Badawi to represent the Islamic faith. Dr. Khan recruited Rabbi Jerome Davidson and Dr. Fredrick Smith to represent the Jewish and Christian faiths, respectively. Professor Varisco asked the head of the Anthropology Department, Professor Cheryl Mwaria, and Professors Warren Frisina and Julie Byrne of the Religion Department to participate. Professor Frisina invited Professor Stephen Post, director, Center for Medical Humanities, Compassionate Care, and Bioethics Department of Preventive Medicine, Stony Brook University Medical Center, to be part of the program. Dr. Samuel Packer, the chair of the Ophthalmology Department and the past chair of the Ethics Committee, American Academy of Ophthalmology, agreed to participate. To complete the mix of speakers, I wanted to include a chaplain, preferably, a Muslim. After some search, I chose Ms. Mary Lahaj. She not only was a Muslim chaplain but the first woman Muslim chaplain. She has done extensive clinical training at Brigham and Women Hospital, Boston, after completing the chaplaincy program, making her a perfect candidate for the program. The conference was held September 17–18, 2010. Considering that this was the first such conference to be held by IMANA and the first IMANA conference to be cosponsored by an established university, it was a great success alhamdulillah. We hope to follow with other similar conferences in the future. In this issue of JIMA, we publish the edited proceedings of this conference. The presentations are arranged in two categories; panel discussions and articles. The styles of the presentations are different. Some authors submitted edited versions of their presentations, while others submitted regular articles. There were many informative questions and comments, which are included either at the end of the specific article or at the end of the presentations of the panelists in each of the panels. I edited the arrangement and wording of texts in this issue to improve flow and readability. The conference was videotaped, and web-friendly videos are available online. Links to the video presentations are included with each article in this issue. The conference covered a wide variety of subjects from different perspectives. It provides useful information that I hope will be useful for all the readers. As you know, it will be available online at jima.imana.org and indexed in PubMed Central.