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Hawai'i Chapter Scientific Meeting 2017 February 25, 2017 Pomaika'i

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Hawai'i Chapter Scientific Meeting 2017 February 25, 2017 Pomaika'i Hawai‘i Chapter Scientific Meeting 2017 February 25, 2017 Pomaika‘i Ballrooms at Dole Cannery Honolulu, HI Hot Topics This live activity has been designated for 5 CME credits. 1 Learning Objectives At the conclusion of this activity, the participant will be able to: • Improve clinical internal medicine practice by incorporating major developments in physician wellness. • Describe elements and limits of knowledge of marijuana pharmacology. • Discuss physician-assisted suicide in modern political and regulatory climates. • List characteristics and complications of Zika virus infection for adults and infants. CME Accreditation The American College of Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American College of Physicians designates this live activity for a maximum of 5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Resident/Fellows' and Medical Students’ Activities Clinical vignettes, posters, and research papers prepared by Resident/Fellow Members and Medical Students will be presented at the meeting. Winners will receive a cash prize and be eligible for entrance into the national competition held during Internal Medicine 2018. Pathways to Fellowship Attendance at chapter meetings can help all ACP members meet the qualifications for advancement to Fellowship. It is especially important for those applying under the pathway that calls for five years of activity as a member. Governor Mary Ann Antonelli, MD, FACP Phone: (808)433-0645 E-mail: [email protected] Program Committee Chair: Lisa Camara, MD, FACP Committee: Mary Ann Antonelli, MD, FACP S. Kalani Brady, MD, MPH, MACP Kent DeZee, MD, FACP Alvin Furuike, MD, FACP Jone Geimer-Flanders, DO, FACP Donald Helman, MD, FACP Lori Karan, MD, FACP Kuo-Chiang Lian, MD, FACP Glenn Rediger, MD, FACP Elizabeth Tam, MD, FACP 2 Faculty Robert Centor, MD, MACP, Past-Chair ACP Board of Regents, Regional Dean, UAB, Huntsville Regional Medical Campus, Professor, Department of Medicine, UAB, Huntsville, AL David John, MD, Associate Clinical Professor of Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu Chad Kawakami, PharmD, Assistant Professor of Pharmacy Practice, Department of Veteran’s Affairs Pacific Islands Health Care System, Honolulu Marian Melish, MD, Professor of Pediatrics, University of Hawai‘i, John A Burns School of Medicine, Honolulu Craig Nakatsuka, MD, FACP, Kaiser Permanente, Honolulu Between scientific sessions, please visit the College table where you can find information on new ACP programs, and many other products. There’s always something new at the College table. Stop by and see for yourself. 3 Program Schedule Saturday, February 25, 2017 7:30 AM Check-In/Poster Judging 7:55 AM Governor’s Welcome Dr. Mary Ann Antonelli, MD, FACP 8:00 AM Podium Presentation (2) Moderator: Dr. Kent DeZee, MD, FACP Wanted And Unwanted Care: The Double Edged Sword Of Partial Do-Not-Resuscitate Orders Dr. Nobuiro Ariyoshi, MD The Incidence Of Immune-Related Adverse Events In Cancer Treatment: A Meta-Analysis Dr. Takeo Fujii, MD 8:30 AM Session #1–Update on Zika Virus Dr. Marian Melish, MD 9:30 AM Break/Poster Judging 10:00 AM Session #2–Physician Assisted Suicide Dr. Craig Nakatsuka, MD, FACP 11:00 AM Podium Presentation (2) Moderator: Dr. Kuo-Chiang Lian, MD, FACP Predictors For Antimicrobial De-Escalation Among Hospitalized Patients With Culture-Positive Pneumonia Dr. Zao Zhang, MD Evaluating The Effect Of A Wellness Curriculum On Overall Resident Well-Being And Burnout Dr. Nishal Brahmbhatt, MD 11:30 AM Dr. Irwin J. Schatz, MD, MACP Lectureship: Learning to think like a Clinician 2017 Meeting/Lunch/Posters Dr. Robert Centor, MD, MACP 4 1:00 PM Podium Presentation (2) Moderator: Dr. Linda Anegawa, MD, FACP Late-Life Handgrip Strength Predicts Incident Stroke: The Kuakini Honolulu Heart Program Dr. Eleanor R. Hastings, MD Low Ankle-Brachial Index And Risk Of Cognitive Decline In Elderly Japanese-American Men: The Kuakini Honolulu-Asia Aging Study Dr. James Templeman, MD 1:30 PM Session #3– Medical Marijuana : Clearing the Smoke Dr. Chad Kawakami, PharmD 2:30 PM Break/Last Poster Judging 3:00 PM Podium Presentation (2) Moderator: Dr. Jone Flanders DO, FACP Augmented Reality Presentation Of Anatomical Variations: Example With Aberrant Right Subclavian Arteries Trudy Hong Oral And Intratympanic Steroid Therapy For Idiopathic Sudden Sensorineural Hearing Loss Julia Zhang 3:30 PM Session #4–Physician Well-Being Dr. David John, MD 4:30 Doctor’s Dilemma/ Pupus Exhibits are open for the entire day. 5 6 7 JEFFREY L. BERENBERG, MD, MACP : ACP Hawai‘i’s Newest Master Jeffrey L. Berenberg, MD, MACP is a native of Massachusetts but has called Hawaii home since 1983. Jeff attended Boston University School of Medicine after graduating Cum Laude from Harvard College. He completed Internal Medicine internship and residency training at Peter Bent Brigham Hospital in Boston and was a Clinical Fellow in Medicine at Harvard University in 1970. Afterward, he completed fellowship training in Hematology & Oncology at Walter Reed Army Medical Center. Colonel Berenberg was then assigned to Tripler Army Medical Center where he served as Chief of Hematology & Oncology from 1983-2010. After retiring from the Army, Dr. Berenberg has continued as a full-time physician while pursuing his clinical and academic endeavors. He is widely recognized by both peers and patients for his evidence-based and compassionate care. Dr. Berenberg remains one of Hawaii’s most distinguished scholar-clinicians. He joined the faculty of the John A. Burns School of Medicine in 1988 where currently holds the rank of Clinical Professor and serves as the Chief, Division of Medical Oncology. Dr. Berenberg also holds academic positions with the Uniformed Services University of the Health Sciences as well as the University of Hawaii Cancer Center. Jeff is a member of the key clinical faculty of Tripler’s Internal Medicine residency program and regularly hosts visiting students & residents from Hawaii and the mainland. He has mentored trainees on innumerable presentations at Hawaii ACP meetings and elsewhere. Jeff is kindly regarded as one of the best teachers in the Department of Medicine. Dr. Berenberg is the Principal Investigator for the Hawaii Minority Based Community Clinical Oncology Program and has been an investigator on multiple Southwest Oncology Group and other national trials. He is a member of the National Adjuvant Project for Breast and Bowel Cancers. Jeff takes an active role locally and nationally with the American Cancer Society and he sits on the Governor’s Blue Ribbon Panel on Cancer Care. Colonel Berenberg is the recipient of many military awards, including the Legion of Merit Award and was selected to the Order of Military Medical Merit. Since publishing his first paper in 1972, Dr. Berenberg has gone on to author over 50 peer-reviewed publications. Dr. Berenberg is uniquely deserving of selection for Mastership in the American College of Physicians. Jeff is the doctor’s doctor. He has devoted himself to a life of service to his patients and his colleagues. He promotes excellence in Internal Medicine in Hawaii. And, even after 49 years of practice, Dr. Berenberg continues to be a role model for the next generation. Mastership in the ACP is a capstone -- recognizing his decades of service and advocacy to the College and to his patients. 8 PODIUM PRESENTATIONS 9 Podium 8:00AM WANTED AND UNWANTED CARE: THE DOUBLE EDGED SWORD OF PARTIAL DO-NOT- RESUSCITATE ORDERS Nobuiro Ariyoshi, MD1, Masayuki Nogi, MD1, Damon Sakai, MD1, Eiji Hiraoka, MD, PhD2, Daniel Fischberg, MD, PhD1,3,4 1 Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 2 Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan 3Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 4 Pain & Palliative Care Department, The Queen’s Medical Center, Honolulu, HI BACKGROUND: The interpretation of do-not-resuscitate (DNR) orders may vary in non-arrest situations. In order to reduce ambiguity, many hospitals allow patients to elect a partial DNR code status. The aim of this study was to investigate the effect of partial DNR orders on hospitalists, internal medical residents, and medical students’ willingness to perform cardiopulmonary resuscitation (CPR) and non-CPR related procedures. METHODS: Scenario-based questionnaire surveys were administered between October 2015 and March 2016 to hospitalists at a tertiary-care academic medical center, and internal medicine residents and medical students at a single medical school. A partial DNR order was identified as a DNR with Adult Emergency Protocols (AEP) order. Each survey presented three patient scenarios followed by ten interventions: case 1 with advanced multiple myeloma and dementia that had a DNR order with AEP; case 2 with advanced breast cancer that had a DNR order without AEP (full DNR); and case 3 with advanced AIDS-related illness that had a DNR order with AEP. We categorized the following groups: pre-clerkship students as group 1; clerkship students as group 2; residents as group 3; and hospitalists as group 4. RESULTS: Responses from 275 of 366 eligible subjects were collected from 134 pre-clerkship students (49%), 85 clerkship students (31%), 34 residents (12%), and 22 hospitalists (8%). Among the respondents, 46.5% (n=128) were men and 5.5% (n=15) were international medical graduates. Compared to the case with a full DNR order, the presence of a DNR with AEP order was positively associated with subjects’ willingness to provide AEP procedures in all groups (p < 0.001) and CPR in groups 1 to 3 (p < 0.05). The number of training or practice years was positively associated with a decision not to perform CPR in all cases as follows: case 1 (p < .001); case 2 (p < .05); and case 3 (p < .001).
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