Add a comment May 31st, 2008 by bronxdoc
Residents in the Montefiore Residency Program in Social Medicine are required to produce a social medicine project in the course of their 3 year residency. These projects can involve community service, advocacy or research (and often a combination of all three). These projects are presented to the Department in the last Social Medicine Rounds before graduation in June. Here are the abstracts from the presentations by the 2008 graduating class:
Rashiah Elam, MD & Robert Roose, MD, MPH
Increasing Uptake of Buprenorphine Among HIV Physicians and Non-Physicians
Office-based buprenorphine places health care providers in a unique position to combine HIV and drug treatment in the primary care setting. Despite this, few physicians prescribe buprenorphine. Our first study examined barriers to obtaining waivers to prescribe buprenorphine and found that physicians with waivers were less likely to be male (51.1 vs 63.7%, p<.05), more likely to be in New York (51.1 vs 29.5%, p<.01), less likely to be infectious disease specialists (25.5 vs 41.6%, p<.05), and more likely to be general internists (43.6 vs 33.5%, p<.05). Adjusting for physician characteristics, confidence addressing drug problems (adjusted odds ratio [AOR]=2.05, 95% confidence interval [95% CI]=1.08 - 3.88) and concern about lack of access to addiction experts (AOR=0.56, 95% CI=0.32 - 0.97) were significantly associated with having a buprenorphine waiver. Understanding and remediating barriers HIV physicians face may lead to new opportunities to improve outcomes for opioid-dependent HIV-infected patients.
Furthermore, federal legislation restricting nurse practitioners (NPs) and physician assistants (PAs) from prescribing buprenorphine may limit its potential for uptake and inhibit the role of these nonphysician providers in delivering drug addiction treatment to patients with HIV. Our second study aimed to examine the level of interest in prescribing buprenorphine among nonphysician providers and found that, overall, 48.6% (n = 92) of nonphysician providers were interested in prescribing buprenorphine. Compared to infectious disease specialists, nonphysician providers (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.22 - 6.83) and generalist physicians (AOR = 2.04, 95% CI = 1.09 - 3.84) were significantly more likely to be interested in prescribing buprenorphine. To improve uptake of buprenorphine in HIV settings, the implications of permitting nonphysician providers to prescribe buprenorphine should be further explored.
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Kim Nguyen, MD
Screening for depression in elderly Vietnameses at Family Health Clinic Bronx, NY.
A recent depression screen for elderly Asians in New York City in 2003 concluded that more than 40 % are considered to be depressed. Our hypothesis is that the percentage is much higher for elderly Vietnameses at the Family Health Clinic as this unique group seems to be more socially and cultural isolated than others. A validated GDS screen tool for Vietnameses was used. Approximately 40 % of elderly Vietnameses over 65 who came to clinic between January 2008 and April 2008 were found to have GDS score > 5, which is suggestive of depression. In conclusion, using the same GDS screen, this study has the same result as in the previous study.
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Teryn Edwards, MD
Creating and Evaluating a Peer-Developed Exercise Program for Overweight Inner-City Girls
Obesity is an ever-increasing national epidemic that we see mirrored in urban settings and in urban adolescents. While exercise is a proven method of weight reduction, overweight teen girls from ethnic minorities are less likely to exercise. While numerous programs have been devised for this population, they have been designed by the investigators, based upon their perceptions of the target population’s needs. The goal of this project is to design an exercise program for overweight inner city girls using their input. Using a focus group model, we aimed to determine what overweight inner-city teen girls perceive as the most important and desirable components of an exercise program for their peers. Additional goals were to determine the effects of a peer-developed exercise program on the girls’ utilization and satisfaction with the class.
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Adam Richards MD, MPH
Public Health & Human Rights Praxis in Burma: Training Internally Displaced People to Control Malaria & Document Associations between Human Rights Violations & Health
Civil war has ravaged Eastern Burma for over 40 years and displaced hundreds of thousands of villagers. Adam discusses over eight years of experience training internally displaced people (IDPs) to document and take action to ameliorate the deplorable health status of their own communities. The discussion will focus on data presented in four primary- or co-authored research papers published in or submitted to peer-reviewed journals, including exclusive estimates of 1) mortality rates and 2) malaria prevalence from eastern Burma; 3) the successful reduction of malaria transmission among over 40,000 IDPs; and 4) novel methods to document associations between exposure to human rights violations and health outcomes. We will conclude with a discussion of the uses of data to inform policy and advocacy at the US and international levels.
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Minesh Shah, MD
Interfaces With The Law: Criminal Justice Involvement Among Patients Presenting For Primary Care
Background: In 2005, almost 72,000 arrests were made in Bronx County, NY, a 45% increase from 1990. From the time of arrest, individuals are navigated through a complex process, which includes arrest, detention, arraignment, plea bargain or trial, and if convicted, sentencing and incarceration in jail or prison. Each of these stages poses various potential health risks, particularly the disruption of continuity care. There are also several health risks related to incarceration, including exposure to high rates of HIV, Hepatitis C, and TB infection, and inadequate mental health care. Upon release, individuals return to their families and communities, often ill-equipped to manage the re-entry process. Although it is suspected that many patients from underserved populations have a high burden of criminal justice involvement, this has not been well quantified. In a pilot study, our goal was to describe the extent and nature of criminal justice involvement of patients and their family members presenting to a community-based, primary care clinic in the South Bronx.
Methods: The sample consisted of consenting patients who presented to a single resident-physician for primary care at a community clinic in the South Bronx during a 4 week period. Patients were asked to participate in a standardized survey to explore current and past legal involvement of themselves and their family members. Legal involvement was divided into trials, arrests, and incarceration in jail or prison. In addition to criminal involvement, patients were also asked about civic legal proceedings involving housing, child support, employment and immigration. The data were analyzed using Microsoft Excel spreadsheet software. Results: Of 44 patients completing the survey, 30 (68%) were women and 22 (50%) were foreign-born. At the time of the interview, 17 (39%) were currently participating in active legal proceedings, of which 10 were criminal charges. In addition, 8 respondents (18%) had been incarcerated in jail or prison in the past 2 years, and 11 (25%) had a spouse or significant other who had been incarcerated during that time. More than half of all respondents (24, 55%) had themselves or had a family member (including 12 children) who had been arrested in the past 2 years. Furthermore, 7 respondents (16%) currently had a family member in jail or prison. Finally, 30 respondents (68%) felt that they would utilize legal services if they were available at the clinic. Conclusions: Questions about criminal justice involvement are not typically asked at intake or as part of routine medical visits. Our study found that, when asked, patients will agree to share this information. In our South Bronx population, we found a high burden of criminal justice involvement among primary health care patients. Although not specifically elicited, some respondents also described how this involvement affected their health care. Better integration of health and legal services could be of significant benefit to providing health care to similar patient populations. Further research is needed to better delineate the type of involvement and its impact on the health of individuals, families, and communities.
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Anagha Loharikar, MD
Mental Health Care Needs of Latino Families in the South Bronx: Perspectives of Parents and Pediatricians
Background: Latino communities in the United States suffer disparities in access to adequate mental health (MH) care, which has been attributed to systemic barriers and coordination between health care providers and community based organizations. While some studies have reported on perspectives of the Latino community on MH, no studies have reported perspectives of pediatricians working in such communities. We present data collected as part of an AAP CATCH grant to develop a MH home for Latino families in the South Bronx, where 63% of the population is Latino.
Objective: To understand and compare the perceptions of Latino parents and practicing pediatricians regarding 1) the causes of MH problems, 2) barriers to MH services, and 3) MH needs. Design/Methods: We conducted a qualitative study. Parents of children with a history of MH services referral, use or need were recruited at a federally-qualified community health center to participate in a focus group. We conducted two 90-minute groups with parents. Next, we conducted one 90-minute focus group with pediatricians at the same health center. Focus groups were audio-taped and transcribed. Two investigators independently coded each transcript for thematic content. Differences in coding were resolved via consensus.
Results: Causes: Parents and pediatricians both identified familial disruption as well as poverty/violence as etiologies of MH problems in Latino children. Parents also emphasized a causal relationship between the actions of God and the devil on MH. Barriers: Both parents and pediatricians acknowledged stigma associated with MH disorders. Parents described distrust of authority and public institutions and incompetence among MH providers, including lack of caring. Pediatricians attributed lack of access to systemic barriers, such as lack of insurance. Needs: Both groups described a need for preventive services in the community. Parents described consequences of MH problems on self, family, and community. Parents emphasized a need to be heard and for community awareness about MH. Themes distinctive to the pediatricians included the high prevalence and range of MH problems of their patients and discomfort with personal experiences in managing MH. Conclusions: Parents and pediatricians gave differing perceptions of the MH needs of the Latino population in this inner-city setting. Further exploration can inform the intervention-design of the CATCH initiative to improve access to MH care.
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Giliane Joseph, MD
Prevalence of isolate Hepatitis B core antibody positivity in the MMG population
A descriptive study looking at the various serology results in our patient population; and looking for a pattern in the patients who lose or never develop protective immunity.
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Sara Doorley, MD
The underutilization of Comprehensive Health Care Center (CHCC) services by the foreign-born population in the South Bronx
Objectives: Increase utilization of health care services by the uninsured immigrant population in the South Bronx. Create a collaborative team of Community Health Workers (CHW), resident physicians, and Community Based Organizations (CBO) to facilitate access to care among new immigrants.
The Montefiore CHCC is federally qualified health center in the Highbridge-Morrisania (HM) section of the South Bronx where 30% of the population is foreign born and 45% do not have a personal doctor. The CHCC established the OPEN-IT Clinic (Opportunities Pro-Immigrant Elderly Newcomers-International Travel) to provide culturally appropriate clinical services to immigrants, and educate resident physicians in immigration/travel medicine. The multiple barriers for HM residents to access available health care services include language, cultural differences, fear of retribution (for undocumented residents), and lack of knowledge regarding available services. To address these barriers, the CHW-OPEN-IT clinic collaboration recruited and trained Community Health Workers (CHWs). The training began with bilingual health classes led by Montefiore medical residents and progressed to a biweekly “health promoter certification” for interested participants. In collaboration with CBOs, the CHWs conducted outreach to places of worship, businesses, immigrant organizations, and schools. The CHWs accompanied interested new immigrant patients to the OPEN-IT clinic to facilitate the registration, visit, and follow-up processes. The CHWs also arranged for home visits to clients by physicians when necessary and conducted follow-up phone calls to the patients. The CHWs were available to assist residents in providing cross-cultural care and facilitate communication between patient and physician.
Findings to Date: 1) Increased utilization of health care services by the foreign-born population. Via our collaboration, 57 new immigrant patients have received health care at the Montefiore CHCC OPEN-IT clinic. 2) Discovery of barriers to receiving health care services at the CHCC. We learned that uninsured patients erroneously received bills from the clinic and were hesitant to return for follow up. Although prescriptions are available to uninsured patients on a sliding-fee basis, we learned that some OPEN-IT clinic patients were charges full prices for medications. 3) Novel feelings of provider trust and service satisfaction by the new patients
Key Lessons Learned: Community Health Workers can link the health care sector with the community, improve utilization of existing services, provide valuable feedback regarding patient care, and dissolve existing barriers to access.
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Sara Lorenz, MD
A Descriptive Epidemiology Of Locus Of Control (Loc) Among Participants In The South Bronx Obesity Reduction Initiative (Sobori)
Despite the serious consequences associated with obesity, prevention and treatment continue to be difficult to achieve in part because there is little known about the factors affecting engagement in weight loss programs. The objective of this study was to assess beliefs and weight-related attitudes among a group who agreed to participate in a weight reduction program. We used internal-external locus of control as a personality construct to describe engagement in a weight reduction program among obese urban population. In our population we found that administering a full Multidimensional Health Locus of Control survey was not practical. However, particular items related to weight loss locus of control were feasible to administer and provided valuable data. These items revealed that patients have an external locus of control with regard to family understanding and availability of exercise infrastructure but an internal locus of control with regard to understanding of personal behavior as causes of obesity and perceived ability to change their health status. These scores predicted responses to weight-related measures and may be used in planning a new weight reduction program to specifically address the population’s needs.
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Bernice M. Vicil, MD
CAM use among children hospitalized with asthma
Children in New York State have substantially higher rates of asthma hospitalizations as compared to children in the U.S. This becomes even more notable in the borough of the Bronx, where pediatric asthma hospitalization rates have consistently towered above the rest. Since hospitalizations are a major marker of morbidity for asthmatic patients, it seems important to quantify, and analyze, CAM use among patients in this specific setting. A better understanding of the prevalence, and types, of CAM usage among children hospitalized with asthma can further enhance patient care by allowing the medical team to communicate more effectively with families regarding their child’s asthma, and its management. This study investigates the prevalence of CAM use among hospitalized children with asthma.
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Sharon Welch, MD
Spirituality, Religion and Medicine: A needs assessment survey
Research has shown that most patients would like for their physicians to inquire about spiritual issues especially in times of serious illness. However, many physicians have not done so for a variety of reasons including their comfort level, time and inadequate training. I wanted to assess residents reasons for not inquiring about spiritual issues and whether they think that this can be improved by formal training.
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Yadiera Brown, MD & Eric Churchill, MD, MPH
Spirituality, trust in the medical system and preferences for end of life care in two Bronx clinic populations
There are significant differences among ethnic groups in the utilization of hospice and palliative care services. This discrepancy persists even when sex, access to health care, income, marital status and existence of a living will are controlled for (Greiner 2003). There are many possible reasons for this discrepancy including a lack of trust in the medical system and a greater prevalence of strong religious beliefs or a general preference for more aggressive care. While many studies have shown that these traits exist in ethnic minority populations there has been little research attempting to correlate these beliefs specifically with preferences for end of life care (Brandon 2005). We have conducted a study of two MMG2 clinic populations, assessing religiosity, trust in the medical system and preferences for care at the end of life.
Refrences: Greiner KA. Perera S. Ahluwalia JS. Hospice usage by minorities in the last year of life: results from the National Mortality Followback Survey. Journal of the American Geriatrics Society. 51(7):970-8, 2003 Jul.
Brandon DT, Isaac LA, MS, LaVeist TA. The Legacy of Tuskegee and Trust in Medical Care: Is Tuskegee Responsible for Race Differences in Mistrust of Medical Care? J Natl Med Assoc. 2005; Vol 97 No 6 p951-56.
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Gabriella Gellrich, MD
Falling through the Cracks- stories of struggles and small victories within the current U.S. healthcare system
Inspired by her work at a community health center in the Bronx, Dr. Gellrich has created a short film that takes us on a journey in a culture where healthcare seems to be a privilege and not a right. Dr. Gellrich brings a special perspective to the film- she grew up in Canada- a country that affords its citizens universal health care at the expense of their tax dollars. She hopes this will serve as another inspiration for us to continue to rally for change, while also serving as a resource for both patients and providers. It reminds us of some of the strings that help make up the safety net for a health care system in need of major repair.
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Lisa Rubin Hartman, MD
Assessing the Needs of Adolescents in the South Bronx
A focus group study exploring the community needs of and access of services by teenagers living in the South Bronx.
Add a comment May 10th, 2008 by bronxdoc
January 16: 4:30-6pm
Binswanger Auditorium
Ernie Drucker, PhD
“A Plague of Prisons -
The Epidemiology of Mass Incarceration”
America is now in the 30th year of a great epidemic - one of the most devastating in our nations history. It has already stolen more years of life from Americans than Yellow Fever or Cholera did in the 19th century or AIDS in the 20th. But unlike these afflictions, this epidemic is not caused by a deadly new virus or bacteria. It is self inflicted - the result of deliberate social policies. Hundreds of federal and state laws mandate it and the expenditure of a great fortune have financed it - more than $1 trillion in public funds over its 30-year course. This great American epidemic is mass incarceration - a plague of prisons.
Today there are millions of Americans behind bars – over 10 times the number we had 30 years ago - fueled by millions of arrests of the war on drugs, long mandatory prison sentences, and high rates of recidivism. The famous revolving door of the system puts 67% of re-entering prisoners back inside within 3 years of their release. Even a decade after drug use and crime declined sharply (reaching historic lows in 2005) the progression of epidemic incarceration is relentless - in 2006 there were over 1000 additional inmates put in prison each week, reaching 2,700,000 by Jan 1, 2007. Yet, despite its vast scale and profound effects on the lives of tens of millions of American families, this epidemic goes largely unrecognized. Indeed, for most Americans, massive imprisonment is not seen as a problem at all.
Mass incarceration in America disproportionately affects minorities. Only 1% of the country’s white adult male population is in the criminal justice system; but for blacks and Hispanics the figure is 13 %. In most big cities, 50% of all the African American males have been incarcerated in their lifetimes - in Washington DC the figure is over 85%. For the hundred years from the end of slavery to the 1970s, blacks were incarcerated at 3 - 4 times the rate of whites. Today that ratio is 12 to 1; for drug offenses it is 40 to 1 - despite evidence that blacks use illegal drugs at the same rate as whites
And this epidemic has another “hidden” face - an even larger population, none of whom are in prison, but who are powerfully affected - the “collateral damage” of mass incarceration. Tens of millions of children, wives, parents, siblings and other family members of those incarcerated over the course of the 30 year epidemic of incarceration. They are concentrated in the mostly urban minority communities targeted for mass arrests, and while innocent of any crime, they are also punished by the effects of incarceration, just as surely as if they were convicted. In this 30 year epidemic over 25 million American children have been directly exposed to parental incarceration. They are the “innocent” victims of the war on drugs - the children of the “feeder communities” where the epidemic of incarceration affects everyone – more damaging even then the drugs and other crimes that are the rationale for the arrests. In these communities incarceration has become the norm - spawning successive generations of prison orphans and gang members. Over 90% of all the extended black and Hispanic families in the US must by now have had a member incarcerated in the last 30 years.
This presentation will paint an epidemiological portrait of this great plague. The goal is to focus on the scale, structure, and effects of large-scale imprisonment - seen as a public health problem - with measures of disease, disability, and the loss of life that all epidemics bring with them - the closest thing we have to universal measure of human worth. I will also talk about some of the people and programs that are the “plague fighters” – individuals and organizations who are fighting mass imprisonment and beginning to turn the tide of this terrible epidemic.
Note: Mass Imprisonment was also discussed by Robin Steinberg of Bronx Defenders during Social Medicine Rounds of May 2, 2006
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February 6:
Residency Program in Social Medicine
3rd Floor Conference Room
4:30-6:00 PM
Megan Charlop, MPH and David Appel, MD,
Montefiore’s School Health Program:
A Unique Model of Primary Care
The Montefiore School Health Program is the largest school-based health program of its kind in the country, with more than 13,000 children registered in 13 schools in the Bronx - five elementary, one K-8, two middle and five high schools.
All Montefiore school-based health centers provide comprehensive primary care services. The program has a particular interest in improved asthma care. Mental health services focusing on depression, anxiety, bereavement, crisis intervention and family issues are available at each site.
The high school centers offer comprehensive adolescent health care including reproductive health care services that provide pregnancy testing and prenatal care; options counseling; family planning; screening, diagnosis and treatment of sexually transmitted diseases including HIV counseling and testing; and routine pap tests for sexually active girls. A mobile oral health program visits each elementary and middle school program, providing preventive care as well as minor reparative work.
Dr. David Appel was designated one of New York Magazine’s most “Influentials”of 2006. Dr. Appel has been one of the most visible faces and audible voices advocating for children’s access to quality, comprehensive primary care and mental health services in school-based settings. For more information on Dr. Appel, click here. For a brochure about the program, click here.Some articles describing the program are available at the following links:Burden of Asthma in Inner-city Elementary Schoolchildren: Do School-Based Health Centers Make a Difference? Arch Pediatr Adolesc Med. 2003;157:125-129. Impact of Asthma Intervention in Two Elementary School-Based Health Centers in the Bronx, New York City. Pediatric Pulmonology 40:487–493 (2005)
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February 27
4:30-6PM
Rounds in the Community:
Visit to the Ahmadiyya Community Center
Muslim Law and Culture
in the Doctor-Patient Relationship
Imam I.H. Kauser and Dr. Shaded Ahmad will discuss issues related to the medical treatment of Islamic patients. A Halal meal will be served by Imam Kauser’s congregation following the presentation. The Ahmadiyya Community Center is located at 3421 White Plains Road (between a gas station and law offices). This event is a chance to explore many questions related to our practices in the treatment of Muslim patients such as:
1. What is relevant culture/law/expectations regarding female/male dress/undress and touch during physical examinations?
2. What is relevant law during Ramadan and any other designated time in Islam regarding fasting, the taking of medications, water for people who may be frail and dehydrated, etc.
3. What is the advisable way for a physician to greet/say goodbye/wish good health, etc. to an Islamic patient?
4. Are there cultural and/or family issues we should be aware of related to recent immigrants from Bangladesh/West Africa of Muslim faith?
This Social Medicine Rounds was featured in an article in the New York Times
by Clyde Haberman published on March 6, 2007 entitled: “At Mosque, Doctors’ Ways Get an Update”:
“As the city’s population continues to change, pretty much everyone must come to grips sooner or later with new realities. Exceptions are
few. They most definitely do not include doctors.
“And that is why about 20 attending physicians and residents at Montefiore Medical Center found themselves in a small mosque in the
Bronx the other evening. With not a Muslim in the bunch, they were there for a quickie course on how Islamic law and customs can affect
patient-doctor relationships — from womb to tomb, with much of life’s messiness in between. [...]“
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March 6: Global Health Month
Residency Program in Social Medicine
3rd Floor Conference Room
4:30-6:00 PM
Viewing of the Film “Salud!”
Produced and directed by Academy Award nominee Connie Field, the film tells the story of Cuba’s unique and highly effective health system and how it brings its community-oriented and preventive model to medically under-served nations in other parts of the world. The film also takes viewers inside the Latin American School of Medicine (ELAM) in Havana where 12,000 low income students from 27 countries-including about 100 from the USA-receive a free education in exchange for pledging to return to poor communities when they graduate. In this school, as in all other medical schools in Cuba, the goal of the curriculum is to produce doctors committed to public service. The film probes the motivations of the students attending ELAM and traces the opinions and competing agendas that mark the battle for better global health. For more information visit the Film’s website.
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March 20: Global Health Month
Residency Program
in Social Medicine,4:30-6PM
3rd Floor Conference Room
Darin Portnoy, MD, MPH
Medical Humanitarian Aid Organizations:
Present Crises and Future Challenges
Doctors without Borders (www.msf.org) is the world’s largest medical humanitarian aid organization, working in over 70 countries bringing direct medical assistance to populations in need. In more than 30 years of work this group has worked to alleviate suffering and to speak out often and strongly for those that have no voice.
Much has changed since the organization was founded, and humanitarian aid workers now routinely arrive to work in extremely complicated and politically charged environments. Hundreds of international organizations now undertake medical humanitarian work. And while this ought to translate into less need and diminished crisis around the world, this has not been the case.
Using the example of Doctors without Borders and the contexts where the organization is now active, Dr. Portnoy will explain the work of humanitarian aid organizations. In the presentation he will explain how an organization chooses where to work, how it works and how it decides when to leave a particular country. And he will discuss some of the world’s most neglected and underreported crisis and share his impressions of what organizations can expect to confront in coming years.
Dr. Portnoy is an Attending Physician, Montefiore Medical Group Family Health Center and President, Doctors Without Borders/Médecins Sans Frontières (MSF) USA. He has worked with Doctors without Borders/Medecins Sans Frontieres (MSF) for nearly 10 years and since 2004 he has been the President of the US section of MSF. He joined the organization in 1997 as a field doctor and later field coordinator for tuberculosis treatment and control programs in Uzbekistan. After an exploratory mission to Turkmenistan, in 1999, he ran cholera programs in El Salvador. He left for Georgia the following year, coordinating emergency health care for Chechen refugees. In 2003, he worked as a medical coordinator for sleeping sickness and primary health care programs in southern Sudan. And in 2004 he opened medical programs in the isolated northern part of Liberia. He was last in the field just over a year ago, in Nigeria, where he worked with a team to set up MSF’s emergency program to treat a measles outbreak.
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April 17
4:30-6PM
Moses II Conference Room
Walter Lear, MD
Pediatrician Activists
For information about Dr. Lear, please consult our posting: A Visit with Dr. Walter Lear.
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May 1: 4:30-6PM
RPSM 3rd Floor Conf. Room
“How We Get Better:
Family Medicine Residents and Practice Based Learning
and Improvement”
Convener: Victoria Gorski, MD
Presenters: Family medicine PGY-3s
This forum will feature presentations by the four resident/faculty/staff CQI teams of the Family Health Center and Williamsbridge Family Practice. Dr. Gorski will present a brief overview of CQI and its relationship to the ACGME competency “Practice Based Learning and Improvement”. Each team will present its work on behalf of improving tobacco cessation rates or improving parameters of diabetes care at the clinical sites. A discussion will follow on the implications of the teams’ work in fostering clinical quality improvement and resident learning/competency development.
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May 22, May 29th, June 5 4:30-6PM
RPSM 3rd Floor Conference Room
Social Medicine Project Presentations
Dr. Jamal Harris
Quality Improvement: HIV Testing of the Children
of Adult Patients in a HIV Treatment Program
During the summer of 2006, we conducted a quality improvement project to enhance family based care at Sinikithemba, the HIV/AIDS care program at McCord Hospital in Durban, South Africa. The project included revising the family care page with the introduction of an electronic version and a focus on the testing of children. To complete the project we conducted a retrospective chart review, staff interviews, focus groups, and staff trainings.
Dr. Manel Silva
Adolescence: At-Promise Group
Comprehensive health education as a primary prevention for HIV
Dr. Kathryn Scharbach
Development of a Pain Management Curriculum for Pediatric Residents
Inadequate treatment of pain has been a problem in children. Racial and ethnic minorities are at risk for problematic access to pain care and poor pain assessment, and often receive inferior treatment for their pain complaints. The goal of this project was to expand the “Pain Curriculum” for pediatric residents at CHAM. A survey was conducted among Pediatric Housestaff to assess: knowledge about and comfort with managing pain, perceived barriers to pain management, and preference for learning methods. Based on the results of this survey a morning lecture, two case conferences and an EBM session were created – these educational sessions were conducted in collaboration with the Pediatric Palliative Care Service and the Pediatric Pain Service. Finally, a post survey will be distributed to test the effectiveness of a pain management curriculum on improving knowledge & confidence.
Dr. Homer Venters
Bringing Primary Care to Legal Aid:
A Collaboration Between CHCC and the Bronx Defenders
Montefiore Comprehensive Health Care Clinic (CHCC) is located within one block of the Bronx Defenders, a legal aid agency that represents 12,000 criminal defense clients per year. For 2 1/2 years, we have collaborated in assessing the need for primary care services among Bronx Defenders clients. One medical resident has spent over 200 hours at Bronx Defenders helping clients with medical questions and reestablish prior medical care. For those who wish (approximately 1/3 of clients met), appointments were made at CHCC for medical care. This collaboration has joined the resources of two advocacy groups in the South Bronx with the goal of helping legal aid clients when their medical care is interrupted by arrest or other criminal justice system contact.
Dr. Sean Misciagna
My Diabetes Visit Summary: A quality improvement effort
arising from an innovative approach to diabetes as
described by the Chronic Care Model
Historically, medicine has been designed to care for acute needs, and has been poorly equipped to deal with the chronic illness that many of our patients face. Diabetes is an example of this. In order to achieve quality care and improved outcomes, the Chronic Care Model was developed. My Diabetes Visit Summary is an example of a quality improvement effort that supports this model.
Drs. Melissa Tesher and Sarah Siegel
Use of a pocket guide to improve resident knowledge about,
and comfort with, breastfeeding support
Breastfeeding rates are generally lower in poor, urban communities. We evaluated knowledge about, and confidence with, breastfeeding guidance amongst residence physicians serving such a community. We then sought to improve residents’ confidence and knowledge by creating a pocket-sized breastfeeding guide, and evaluated the usefulness of this educational tool.
Dr. Misha Kogan
Spirituality in Family Decision Making in End of Life Care
Purpose: To understand the role of spirituality and spiritual values in family decision making at the end of life. Methods: Researchers observed 24 family meetings between house staff and families of patients who are unable or unwilling to make decisions. Semi-structured interviews were conducted immediately after initial meetings and at set time points including post-death follow-up. Using standard qualitative methods, we examined spiritual themes and functions emerging in family meetings and follow up interviews.
Drs. Carlos Victorica and Angela Vidal
Parenting behaviors of Bronx adolescents,
and the influence of a high school based parenting class intervention on parenting stress
Parenting behaviors and stress in the adolescent parent population can account for significant risk of morbidity to neonates, and has resulted in lower amounts of infant bonding and cognitive scoring. Our original project had hoped to assess the intervention of a physician assisted parenting program at Martha Nielson High School. Unfortunately, after several setbacks, the project was re-directed as a program in “responsible sexuality” at Marble Hill High School for International Studies. The new goals were to qualitatively assess some of the attitudes and beliefs of these adolescents with regards to STD’s, HIV, pregnancy and their management by physicians.
Drs. Ana Matos and Denise Reyes
Voluntary Counseling and Testing
and the HIV Partner Notification Project in Guatemala
The Guatemalan Health Law mandates a system for notification of partners of HIV-positive patients. This project followed in the footsteps of former resident Dr. Amy Miglani and was under the guidance of Dr. Matt Anderson. It included the feasibility of beginning a partner notification system in Guatemala and the pilot of a pre- and post-voluntary counseling and testing questionnaire to assess risk factors, effectiveness, and risk behavior change in patients presenting for HIV testing.
Dr. William B Jordan
HIV Prevention in a Community Mental Health Setting
HIV prevalence is high in the south Bronx and higher among those with chronic mental illness. Past HIV prevention classes for
community-dwelling populations with chronic mental illness demonstrated persistent effects on knowledge and behavior. No programs of this kind exist in the Bronx. This project attempted to demonstrate the feasibility of an HIV prevention workshop for people with chronic mental illness in the south Bronx. Retention rates were improved with incentives. Recruiting new students was challenging. Survey results trended towards improvement in knowledge and self-efficacy, but the sample size was too small for formal analysis.
Elizabeth Natal, MD
Patient-Physician Perceptions regarding Breastfeeding Counseling at Montefiore’s Family Medicine Community Health Centers
A study looking at what both physicians and patients believe is being done with regards to breastfeeding counseling at the clinics. An important focus of the study was to identify the key periods when patients were making decisions regarding infant feeding practices and the associated influencing factors. Another focus was to identify areas where we can mainstream efforts to continue current successful practices, as well as make overall improvements in less approached areas. The study is a quantitative retrospective study and data was collected through one time patient and physician surveys.
Aaron Fox, MD
Perceptions of health and housing
in an unstably housed HIV infected population
HIV-infected individuals, particularly those with unstable housing situations, have difficulty maintaining adequate access to health care. 14 semi-structured interviews were conducted with HIV-infected residents of single room occupancy (SRO) hotels in New York City. The interviews established detailed timelines related to housing status and health care following HIV diagnosis. For most individuals, diagnosis of HIV was followed by a period of chaos, which often included loss of housing, escalating drug use, and worsening self-care behaviors. Competing priorities negatively affected health care. The need for housing resulted in frequent moves, which disrupted continuity of medical care, and food insecurity impeded adherence with medications. Ultimately, when considering health care for HIV-infected marginalized populations, housing must be addressed as a vital component.
Rupali Kotwal-Doshi , MD
An Intimate Partner Violence Educational Program For Medical Residents
Primary care physicians frequently report feeling unprepared and uncomfortable with intimate partner violence (IPV), leading to low rates of screening and detection. To improve screening rates and comfort levels with IPV, a longitudinal, three-level educational intervention for internal medicine residents about IPV screening and management was developed and implemented. Data from the baseline questionnaire about knowledge, attitudes, and behavior about IPV will be presented, as well as follow-up data from the PGY-3 residents who participated in the first session. Overall, we detected low rates of screening and low levels of comfort with management of IPV among the study participants.
Catherine DeGood, DO
Abortion in Primary Care
A Needs Assessment Survey of Female Patients. A descriptive survey to assess the acceptability and desirability of early abortion provision at a residency-based family medicine office.
Carolyn Chu, MD
Social Medicine In Practice
Development of complementary audiovisual materials for “Social Medicine”, a new online journal devoted to the promotion of social medicine. (www.socialmedicine.info).
Dr. David Herszenson
Health care proxies in the outpatient setting:
Needs assessment and intervention
As our population ages and our ability to prolong life increases, it has become more and more important that those who treat adults in a primary care setting have discussions about advance directives. The health care proxy, the agent who makes decisions on behalf of the patient who is otherwise unable, is considered by many to be the most important component of one’s advance directives. This project includes an assessment and intervention at one of Montefiore’s outpatient clinics in regards to discussion and completion of the health care proxy.
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June 19, 4:30-6PM
Binswanger Auditorium
BCHN: Bronx Community Health Network
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July 3
RPSM goes to the Movies:
SiCKO
Clearview
Bronxville Cinema
Web sites related to the film:
Michael Moore’s official website for the movie is located at MichaelMoore.com
Physicians for a National Health Program created a website devoted to SiCKO which is available at www.sickocure.org.
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Amy Goodman hosted “An Hour with Michael Moore on ‘SiCKO,’ his Trip to Cuba with 9/11 Rescue Workers, the Removal of Private Healthcare Companies & the Healthcare Policies of the 2008 Democratic Candidates” on Democracy Now: www.democracynow.org.
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July 17:
Judy Sheridan-Gonzalez, RN (NYSNA)
Peter Barland, MD (PNHP)
SiCKO:
A discussion forum
3rd floor, RPSM
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August 7:
Dr. Penny Grant,
Methamphetamine labs: effects on children
Binswanger Auditorium
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September 4:
Lois Uttley, MPP,
Medicine and Morality:
The Impact of Faith-based Health Restrictions
on Patients’ Rights and Access Care
Binswanger Auditorium
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September 18, 4:30-6PM:
Linda Landesman, MSW, DrPH
Steven Safyer, MD
The Berger Commission Report:
What has been its Real Impact?
Binswanger Auditorium
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October 2, 2007
4:30-6PM
Camara Jones, MD
The Impact of Racism on the Health of Our Nation
Binswanger Auditorium
Camara Phyllis Jones, MD, MPH, PhD is Research Director on Social Determinants of Health in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.
Dr. Jones is a family physician and epidemiologist whose work focuses on the impacts of racism on the health and well-being of the nation. As a methodologist, she has developed new methods for comparing full distributions of data (rather than means or proportions) in order to investigate population-level risk factors and propose population-level interventions. As a social epidemiologist, her work on “race”-associated differences in health outcomes goes beyond documenting those differences to vigorously investigating the structural causes of the differences. As a teacher, her allegories on “race” and racism illuminate topics that are otherwise difficult for many Americans to understand or discuss. She hopes through her work to initiate a national conversation on racism that will eventually lead to a National Campaign Against Racism.
Several of Dr. Jone’s papers can be downloaded here:
Levels of Racism: A Theoretic Framework and a Gardener’s Tale
“Race,” Racism, and the Practice of Epidemiology
Confronting Institutionalized Racism
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October 9, 5-6PM:
Nassim Assefi, MD
“Why I left Medical Academia and
Global Health to Write Novels”
Binswanger Auditorium
Nassim Assefi (www.nassimassefi.com) is a writer and doctor specializing in women’s health and global medicine. She is the author of Aria (Harcourt, May 2007, and 5 foreign presses), an epistolary novel that explores the trajectory of maternal grief for an oncologist after the death of her only child. She has published a piece in This Side of Doctoring, an anthology of true stories by women in medicine (Sage Press, 2003). She is currently at work on her second novel, Say I Am You, set in post-conflict Afghanistan, where she was a humanitarian aid worker rebuilding health infrastructure for two years and an underground salsa teacher. She currently volunteers in the Women’s Clinic at Harborview, the county hospital affiliated with the University of Washington School of Medicine, where she was once full-time faculty and director of the abortion clinic. Nassim has now left a beloved post in academic medicine and the frontlines of international women’s health (where family planning really does save lives) to write fiction full-time. Come hear why she believes her social justice work is more effectively delivered as a writer and speaker, and why her only aspirations for medicine are now as a volunteer doc.
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October 16, 4:30-6PM:
Robert Ruben, MD
History of deaf culture
and treatment of hearing-impaired populations
Binswanger Auditorium
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November 13, 4:30-6PM:
Dr. Phuong
Health Impacts of Agent Orange
in South Vietnam
Binswanger Auditorium
To learn more about the campaign to clean up Agent Orange in Vietnam, visit the website of the Vietnam Agent Orange Relief & Responsibility Campaign. For learn about Dr. Phuong, click here.
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November 20
4:30-6PM:
Intern Orientation Project Presentation
Binswanger Auditorium
The 2007 Orientation explored the impact of violence on our clinical practices. This was done through indepth discussions of three actual cases. One involved issues of mass incarceration, the second domestic violence and the third concerned a political refugee, Victor Toro (shown above with Dr. Lanny Smith).
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December 11:
New York City Research and Improvement Networking Group (NYC RING) Convocation
Nurses’ Residence, Jacobi Medical Center
1 Comment May 7th, 2008 by bronxdoc
January 17:
Emily Jackson
Rounds in the Community:
“A Visit to the Bronx
Lesbian and Gay Health Resource”
Founded in 1996 by health care practitioners and activists as a source of health information and social services, the Bronx Lesbian and Gay Health Resource Consortium has become the only center for the gay and lesbian community in the Bronx. We will be visiting the consortium and speaking with program developers and community members in an effort to learn more about this unique cultural group in the Bronx.
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February 7:
Emmanuel d’Harcourt
IRC : Recent Projects of the
International Rescue Committee
3rd Floor Conference Room, RPSM
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February 21: 4:30-6PM
Jeffrey D. Sachs
“The Millennium Development Goals”
Cherkasky Auditorium
Professor Jeffrey D. Sachs is the Director of The Earth Institute at Columbia University and the UN Millennium Project. He also serves as a Special Advisor to United Nations Secretary-General Kofi Annan on the Millennium Development Goals. The Millennium Development Goals are the internationally agreed goals to reduce extreme poverty, disease, and hunger by the year 2015. Sachs is internationally renowned for advising governments in Latin America, Eastern Europe, the former Soviet Union, Asia and Africa on economic reforms and for his work with international agencies to promote poverty reduction, disease control, and debt reduction of poor countries.
A critique of the Millennium Development Goals was published in the March 2006 Monthly Review by Samir Amin, Director of the Third World Forum in Dakar, Senegal. Amin states: “A critical examination of the formulation of the goals as well as the definition of the means that would be required to implement them can only lead to the conclusion that the MDGs cannot be taken seriously. A litany of pious hopes commits no one.” (See: The Millennium Development Goals: A Critique from the South)
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March 7: 4:30-6PM
Dr. Ron Waldman,
“Pathways to Survival”
3rd Floor Conference Room, RPSM
Pathway to Survival is about strategies to combat child mortality in the world and addressing child mortality issues. It is one on the UN’s millennium program goals. Professor Waldman is a world known expert in refugee health and child mortality issues. He has been serving as a consultant to WHO, government and non-governmental organizations for the last 30 years. He is a prominent member of the Refugee Health Department at the CDC, Chairman of the Emergency Response Committee of WHO and Professor of Clinical Public Health at Columbia University. Since the early 1970’s, he has been involved in many refugee situations all over the world. Professor Waldman has helped to design and perform many studies which have shaped the framework for current guidelines to address current refugees needs globally.
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March 21: 4:30-6PM
Dr. Jennifer Kasper,
“International Child Health”
3rd Floor Conference Room, RPSM
Jennifer Kasper, MD, MPH is on the faculty of the Department of Family and Community Medicine at the University of Arizona Health Sciences and a pediatrician in the Tucson Medical Center Emergency Department. She is the President and CEO of Doctors for Global Health, a private, not-for-profit organization promoting health, education, art and other human rights throughout the world. She is a former Soros Medicine as a Profession Advocacy Fellow who worked with Physicians for Human Rights on immigrant issues.
Dr. Kasper’s domestic interests include child poverty and health; food insecurity and hunger; immigrant populations; and, child rights. She spent nearly two years in El Salvador serving as the field coordinator and community health worker trainer, as well as providing pediatric care. She has also worked in Honduras, India, and Chiapas, Mexico.
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March 30, 2006: 4:30-6 PM
Dr. Judith Cook
“Medical Consequences of the War in Iraq”
Cherkasky Auditorium
Judith Cook, MD is a general practitioner working with marginalized and excluded groups in London, UK. She volunteered with Médecins du Monde, www.medecinsdumonde.org.uk, for projects in Afghanistan in 2002 and Liberia in 2003. She currently volunteers for Médecins du Monde-UK in Project: London, a new initiative to help vulnerable groups access main stream health care services.
Dr. Cook is a member of the board of Medact, www.medact.org, and was involved in Medact’s work on violence, conflict and health, including their three reports on the impact on health of war on Iraq. She has presented on the War in Iraq, both in the UK and internationally.
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April 4:30-6PM
Emily Jackson
Rounds in the Community:
The Bótanicas Tour
Botanicas play an important role in the physical and emotional well being of many of our patients. Explore these centers of healing, spirituality and culture with our guides, trained in traditional herbal healing at the Bronx Botanical Garden. The Garden maintains a research program devoted to Understanding Plants in Human Health.
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April 4: 4:30-6PM
Zach Rosen
“The Genocide in Darfur”
Cherkasky Auditorium
Presenting, after recently returning from Darfur will be Michael Neuman, Program Officer, Medecins Sans Frontieres and Olivier Bercault, Counsel, Human Rights Watch. For more information on Darfur: www.savedarfur.org, www.hrw.org and www.msf.org.
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April 18: 4:30-6PM
Dr. Abraham George,
“Improving primary health care delivery in rural areas of developing countries”
3rd Floor Conference Room, RPSM
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May 2, 2006: 4:30-6 PM
Robin G. Steinberg
“The Bronx Defenders: Building Bridges between Clinicians and Public Defenders”
3rd Floor Conference Room
Residency Program in Social Medicine
Robin G. Steinberg is the Executive Director of The Bronx Defenders, an organization created in 1997 to provide outstanding legal representation to Bronx residents charged with crimes. The Bronx Defenders has developed a relationship with the Department’s CHCC (Comprehensive Health Care Center) Clinic through which patients facing legal problems can be referred to clinic for health care.
Readings & Links: Please visit the library at the Bronx Defenders web-site and read about their model of holistic advocacy.
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May 30, 2006: 4:30-6 PM
Social Medicine Project Presentations (1 of 3)
3rd Floor, Residency Program in Social Medicine
Gerald A. Paccione, M.D.
Noga Shalev, MD
From public to private care:
the historical trajectory of medical services in a New York City jail
This research investigates the historical shifts in health care provision within the correctional setting. It looks at a case study correctional facility Rikers Island in order to examine trends in the bureaucratic and financial arrangement of medical services over the past half a century.
Juliet Widoff, MD
Health Care Experiences of Street-Based Sex Workers in New York City
A qualitative study of the health experiences, perceived health needs and barriers to care of street-based sex workers in New York City.
Manuel R. Esteban, MD and Gunther Groning, MD
Psychosocial Impact Of Erectile Dysfunction In Hispanic Patients
Qualitative study done with male patients from the Family health center
Sharmila Ramprasad, MD
Sugarbusters
Evaluation of the existing diabetes education program to determine if a structured telephone follow up after the 4 week program improved the effectiveness as compared to regular 4 week program without follow up.
Melanie Ukanwa, MD
St John’s Wort and Omega 3 Fatty Acids in the Management of the Depressed Patient: Creating Provider Pamphlets
Depression is Depression is recognized as an important cause of significant morbidity and mortality. Current standard pharmacotherapies, although effective, are notorious for side effect profiles which discourage patient adherence. Via a systematic review of current evidence-based literature and data obtained from need assessment surveys of WBFP and FHC providers, two provider pamphlets were created to educate on the use of the better tolerated alternative medicines, St John’s Wort and Omega 3 Fatty Acids, in the management of the mildly depressed patient.
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June 6, 2006: 4:30-6 PM
Social Medicine Project Presentations (2 of 3)
3rd Floor, Residency Program in Social Medicine
Daniel O’Connell, MD
