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March 7, 2014 ACP AMERICAN COLLEGE OF PHYSICIANS INTERNAL MEDICINE Doctors for Adults NEW JERSEY CHAPTER AMERICAN COLLEGE OF PHYSICIANS REGIONAL SCIENTIFIC MEETING ASSOCIATES ABSTRACT COMPETITION MARCH 7, 2014 PARTICIPATING INSTITUTIONS: Atlantic Health System - Morristown Memorial Hospital - Overlook Hospital Atlanticare Regional Medical Center Barnabas Health System - Monmouth Medical Center - Newark Beth Israel Medical Center - Saint Barnabas Medical Center Capital Health System Drexel University College of Medicine, Saint Peter’s University Hospital HUMC Mountainside Hospital Meridian Health System - Jersey Shore University Medical Center Mount Sinai School of Medicine - Englewood - Jersey City Medical Center Palisades Medical Center Raritan Bay Medical Center Rowan University - Cooper Medical School - School of Osteopathic Medicine Rutgers - Robert Wood Johnson Medical School - New Jersey Medical School Seton Hall University School of Health and Sciences Medical Science - Trinitas Regional Medical Center - St. Francis Medical Center COMMITTEE MEMBERS: William E. Farrer, MD, FACP – Chairperson Neil Kothari, MD, FACP Ed Liu, MD- Co- Chairperson Michael B. Steinberg, MD, MPH, FACP Vallur Thirumavalavan, MD Shuvendu Sen, MD DISCLAIMER: It is assumed that all participants adhered to the rules as stated in the original abstract submission form. It is also assumed that the abstracts submitted were original works, represented by the true authors. The abstracts appear in no particular order. Judging was performed in an attempt to minimize bias. Judges were unaware of the authors or institutions the competitor unless they were directly involved with the associate. Although there were many excellent abstracts those selected to be presented as poster or oral presentation were chosen on the basis of content. This content was felt to be intriguing from a clinical education standpoint, thought provoking, or could stimulate debate regarding our current practice of medicine. ORAL PRESENTATIONS Barnabas Health - Monmouth Accuracy of breast Specific gamma imaging in diagnosis of breast cancer; Preliminary report Hadie Razjouyan, David Sharon, Aedon Olaso, Shahrooz Tahvilian, Jorge Pardes Introduction: Breast cancer is one of the most frequently diagnosed cancers and the leading cause of cancer death in females worldwide. With advances in the sensitivity of mammographic screening, the diagnosis of breast tumors has changed considerably. Most screening programs are based on mammogram which has some drawbacks including radiation, false positivity, not being much reliable in breast dense patients like those young age patients. Recently, breast-specific gamma imaging (BSGI) or Molecular Breast Imaging has been introduced in literature with high sensitivity comparable to breast MRI and even better Specificity to MRI. Our center established using this modality recently. Therefore, we would like to check for its accuracy in diagnosing of breast cancer and also would like to look for important contributing factors which may refine present indications of using this modality. Material and methods: Present study is a retrospective cross-sectional study including all patients who referred to breast center at Monmouth Medical Center between September, 2010 to January, 2013. Data on the patient’s age, date of birth, race, history of smoking or drinking, date of performing BSGI, reason for BSGI, findings of BSGI (presence or absence of uptake), personal history of breast cancer with any subsequent therapy, first degree family history of breast cancer, any prior to exam procedure on breasts, pathological results of prior to and after BSGI, type of procedure after BSGI, pathologic staging including T, N and M. estrogen, progesterone receptor status, her2neu status, other modality findings like corresponding ultrasound, mammography and MRI reports, if performed. BSGI examinations are interpreted in the clinical setting by one radiologist experienced in BSGI interpretation. The pathology report was considered as gold standard. Results: Hundred and 4 patients had BSGI at Monmouth Medical Center [Mean age (SD): 60.7 (11.9), age range: 33-89]. 61 did not have any uptake (58.7%) and 42 had suspicious uptake and one of the imaging was incomplete. 80 of these patients were Caucasian female (76.9%). Twenty seven of these patients underwent either biopsy or surgical removal of the breast. Out of 24 positive BSGI, 22 had pathology proven carcinoma and two were normal. Two of the negative BSGI, had positive findings on Pathology. The sensitivity of the test is 91.6% and because of low number of patients, currently calculation of specificity will not be accurate. Conclusions: According to our preliminary result, BSGI sensitivity in our center is acceptable and comparable to previous reports. We need more patients to have estimate of specificity of the test. We will also look for the sensitivity of the test in different subtype of breast carcinoma as we get more patients and also compare the agreement of this method with conventional screening and pre-operation imaging evaluation. Drexel - St. Peter’s Management of gallstone related complications: The impact of admitting team, insurance and diagnosis on guideline compliance Gregoris Komodikis, Vishal Jariwala, MBBS Introduction: Gallstone disease with its related complications is a common emergency presentation. Current guidelines support that laparoscopic cholecystectomy should be performed at index admission. Methods: A retrospective cohort study was performed at Saint Peter’s University Hospital to determine compliance to current recommendations and test for differences in waiting time from admission to cholecystectomy based on (a) admitting service (medicine, surgery), (b) insurance (Private-Medicare, Charity-care, Self-pay, Medicaid)and (c) diagnosis (biliary colic, cholecystitis, choledocholithiasis, pancreatitis). In addition, we evaluated the readmission rate in those cases where cholecystectomy was not done at index admission and identified reasons for not performing the procedure. All patients admitted with gallstone related diagnosis from January 1, 2012, through December 31,2012 were included. An independent sample t-test was used to test the differences in cholecystectomy waiting time between patients admitted under surgery or medicine service. A one-way ANOVA was used to test for waiting time differences based on admission diagnosis and insurance status. Results: Two hundred and twelve consecutive patients were included for analysis. A total of 166 patients (75.5%) had cholecystectomy at index admission. Nine percent (8/90) of patients admitted under surgery service did not have cholecystectomy at index admission compared to 36%(44/122) under medicine service. There was a statistically significant difference (t (120) =4.7, p=0.0001 p<0.05) in average admission to cholecystectomy waiting time for patients admitted under medicine service (M= 3, SD= 2.2) compared to surgery service (M= 1.6, SD= 1.2).Twenty-eight percent (34/123) privately insured patients did not have a procedure at index admission compared to 16%(8/45) with charity care, 23% (8/35) self-pay and 22%(2/9) with Medicaid. Admission to cholecystectomy waiting time based on insurance status was not statistically significant at p<0.05. Admission to cholecystectomy waiting time differed significantly based on admitting diagnosis, F (3.156) =23.8, p=0.00001. Post-hoc comparisons indicate that patients with biliary colic (M=1.61, SD=1.33) and cholecystitis (M=1.69, SD=1.38) waited less time than patients with choledocholithiasis (M=4, SD=1.8) and pancreatitis (M=4.24, SD=2.3). Fifty-two patients (24.5%) did not have a cholecystectomy from which nine (17.3%) were readmitted within a year. Sixteen patients (36%) that were admitted under medicine service and did not have cholecystectomy at index admission a surgeon was not consulted. Conclusions: Adherence to current recommendations for the management of gallstone related complications is of paramount importance to reduce costs. Patients admitted under medicine service experience unnecessary delays for cholecystectomy and increased risk of not having the procedure at index admission. Suspected biliary disease patients should be admitted directly to surgical service in order to reduce costs of care. Rutgers- New Jersey Medical School Low diagnostic yield of urinary pneumococcal antigen testing at a large tertiary hospital Aesha Jobanputra, Shashi Kapadia, M.D., Lata Cherath, M.D., Hayder Hashim, M.D. Background Streptococcus pneumoniae is a leading cause of community acquired pneumonia. Rapid testing for S. Pneumoniae using the Binax Now® urinary antigen test (UAT) has been used to aid diagnosis. The sensitivity of UAT varies by study but has generally been reported to be between 55 to 100%[1]. The routine use of this testing in affecting therapy or cost-effectiveness remains in question [2]. In this study, we seek characterize UAT diagnostic yield in a sample of patients from a large tertiary hospital. Methods: This was a retrospective chart review. The study population consisted of all adult patients from December 2010 to August 2011 who were admitted to Hackensack University Medical Center (HUMC) and had UAT performed. HUMC laboratory data were used to identify patients. Data collected included age, sex, sputum culture, blood culture, result of UAT, patient origin, and presence of immunocompromise. Descriptive statistics were used on all data. Results: Evaluation of 356 patients revealed that UAT
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