Beth Israel Clinical Departments 2011 Year End Report

Beth Israel Clinical Departments Year End Report Table of Contents

Department of Anesthesiology 1 Department of Dermatology 5 Department of Emergency Medicine 9 Department of Integrative Medicine 15 Department of Medicine 21 I. Division of Cardiology 23 II. Division of Chemical Dependency 28 III. Division of Clinical Immunology and Allergy 31 IV. Division of Digestive Diseases 32 V. Division of Endocrinology 35 VI. General Medical Associates 39 VII. Division of Geriatric Medicine 42 VIII. Hospital Medicine 45 IX. Division of Infectious Diseases 51 X. Division of Infectious Diseases—AIDS Center 59 XI. Internal Medicine Residency Training Program 62 XII. Methadone Maintenance Treatment Program (MMTP) 65 XIII. Division of Nephrology and Hypertension 71 XIV. Occupational Medicine/Employee Health And Business Health Services 74 XV. Division of Pulmonary and Critical Care 77 XVI. Division of Rheumatology 84 Department of Neurology 87 Department of Neurosurgery 103 Department of Obstetrics and Gynecology 107 Department of Orthopedic Surgery 113 Department of Otolaryngology 119 Department of Pain Medicine and Palliative Care 127 Department of Pathology and Laboratory Medicine 139 Department of Pediatrics 147 Department of Physical Medicine and Rehabilitation 159 Department of Psychiatry and Behavioral Sciences 167 Department of Radiology 181 Department of Surgery 189 Department of Urology 199 Continuum Cancer Centers of New York 205 Patient Care Services 217 Year End Activity Report/Faculty Listing 231

2011 Year End Report A3

Department of Anesthesiology

2011

Department of Anesthesiology

DEPARTMENT OF ANESTHESIOLOGY Sundar Koppolu, MD, Chairman

1. New Faculty —— Jesse Searles, MD, Assistant Physician, Full-time, August 2011.

2. Program Enhancements

A. New Programs i. Anesthesia Services at Carnegie Endoscopy Center: Planning construction and implementation of Anesthesia Services at Carnegie Endoscopy Center.

3. Capital Enhancements

A. Equipment Enhancements i. Updating the old anesthesia machines and monitors at the Petrie Division and Beth Israel Brooklyn.

4. Quality Initiatives/Achievements

A. Perioperative Services with FOJP. B. Blood management at Petrie. C. Number of anesthetics administered: ——Petrie - 32,372 ——PACC - 7,817 ——Kings Highway - 9,304 ——Beth Israel Cancer Center – 1,450 ——East Side Endoscopy Center – 9,553.

2011 Year End Report 3

Department of Dermatology

2011

Department of Dermatology

DEPARTMENT OF DERMATOLOGY Vincent DeLeo, MD, Chairman

1. Program Enhancements

A. New Programs i. Cutaneous Cancer Service at CCCNY: Relocated the Mohs service to the BI West Campus in January 2011. Residents also receive surgical training at this location.

2. Quality Initiatives/Achievements

A. The department developed a dashboard to track our quality initiatives.

3. Fellow/Resident Board Passage Rates —— Fellows: N/A. —— Residents: 75%.

4. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Rossi, Alexis. “Cosmetic Procedures in Skin of Color.” G Ital Dermatol Venereol. 2011 August 146 (4): 265-72. ——Shah, Arthur, Yang, Stevens, Alexis. “A Retrospective Study to Investigate Racial and Ethnic Variations in the Treatment of Psoriasis with Etanercept.” J Drugs Dermatol. 2011 August 1 10 (8): 866-72. ——Summers, Bena, Arrigain, Alexis, Cooper, Bordeaux. “Sunscreen Use: Non- Hispanic Blacks Compared with Other Racial and/or Ethnic Groups.” Arch Dermatol. 2011 July 147 (7): 863-4. ——Alexis. “Acne in Patients with Skin of Color.” J Drugs Dermatol. 2011 June 1 10 (6): s 13-6. ——Shah, Bhanusali, Sachdev, Geria, Alexis. “A Survey of Skin Conditions and Concerns in South Asian Americans: A Community-Based Study.” J Drugs Dermatol. 2011 May 10 (5): 524-8. ——Coley, Bhanusali, Silverberg, Alexis, Silverberg. “Scalp Hyperkeratosis and Alopecia in Children of Color.” J Drugs Dermatol. 2011 May 10 (5): 511-6. ——Alexis. “Skin of Color: Progress Made, Challenges Remain.” J Drugs Dermatol. 2011 May 10 (5): 459-60. ——Weinberg, Koestenblatt. “Treatment of Interdigital Tinea Pedis: Once-Daily Therapy with Sertaconazole Nitrate.” J Drugs Dermatol. 2011 October 10 (10): 1135-40. ——Weinberg. “Rights and Wrongs.” Cutis. 2011 September 88: 112-113. ——Fung, Xi, Yang, Seiffert-Sinha, Wai Chie Lai, Sinha. “Quantitative Analysis of Human Keratinocyte Cell Elasticity Using Atomic Force Microscopy (AFM).” IEEE Transactions on NanoBioScience. 2011 March 10 (1): 9. ——Sachdev, Bhanusali, Zamora, Gerlach, Sinha. “PTPN22 1858T Is Not a Risk Factor for North American Pemphigus Vulgaris.” Exp Dermatol. 2011 June 20 (6): 514.

2011 Year End Report 7 Department of Dermatology

——Coda, Sinha. “Integration of Genome-Wide Transcriptional and Genetic Profiles Provides Insight into Disease Development and Clinical Heterogeneity in Alopecia Areata.” Genomics. 2011 September 98 (6): 431. ——Chacon, Sinha. “Bullous Pemphigoid after Herpes Zoster Vaccine Administration: Association or Coincidence?” J Drugs Dermatol. 2011 November 10 (11): 1328. ——Murrell, Daniel, Joly, Borradori, Amagai, Hashimoto, Caux, Marinovic, Sinha, Hertl, Bernard, Sirois, Cianchini, Fairley, Jonkman, Pandya, Rubenstein, Zillikens, Payne, Woodley, Zambruno, Aoki, Pincelli, Diaz, Hall, Meurer, Mascaro, Schmidt, Shimizu, Zone, Swerlick, Mimouni, Culton, Lipozencic, Bince, Bystryn, Werth. “Definitions and Outcome Measures for Bullous Pemphigoid: Recommendations by an International Panel of Experts.” J Am Acad Dermatol. 2011 December 66 (3): 479.

5. Honors/Awards Vincent DeLeo, MD —— New York Magazine’s Best Doctors. Rajiv Nijhawan, MD, Resident: ——First Place, American Society of Dermatologic Surgery Resident Jeopardy Competition. ——American Society of Dermatologic Surgery Scholarship Award. Anthony Rossi, MD, Resident: ——First Place, American Society of Dermatologic Surgery Resident Jeopardy Competition. ——American Society of Dermatologic Surgery Scholarship Award. Jonathan Silverberg, MD, Resident: ——Travel Award for Federation of Clinical Immunology Societies 2011 Annual Meeting, Washington, DC. ——Selected Participant for the Resident Retreat for Future Physician Scientists, Society of Investigative Dermatology, Phoenix, AZ. ——Young Alumnus Award, City University of New York, Brooklyn College.

2011 Year End Report 8 Department of Emergency Medicine

2011

DepartmentEmergency Medicine of Emergency Medicine

THE DAVID B. KRISER DEPARTMENT OF EMERGENCY MEDICINE Gregg Husk, MD, Chairman

1. Program Enhancements

A. New Programs i. Patient Satisfaction: We implemented a patient satisfaction survey for the ED, and are using it as the centerpiece of staff and management meetings. We have implemented “internal benchmarking” in our patient satisfaction program. ii. Operational Efficiency in Our Non-Teaching Zone: We have implemented a scribe program to improve the time-efficiency of care, and clinical documentation. iii. Improvement of ED Professional Revenue by a Clinical Documentation Improvement Program: Dr. Joseph Habboushe, an MD/MBA member of our faculty, is coaching residents, physician assistants and attending physicians on improving documentation, resulting in improved professional collections. iv. Care of Sepsis Patients: We have worked with colleagues from Critical Care to sim- plify the sepsis program, and modified our electronic health record to better capture clinical process quality indicators.

2. Capital Enhancements

A. Equipment Enhancements i. We upgraded the monitoring equipment at Beth Israel Brooklyn, resulting in improved capability to monitor patients and to document the patients’ physiology.

3. Quality Initiatives/Achievements

A. In 2011, the ED was strongly focused on managing the increase in patient volume associated with the 4/2010 closure of St. Vincent’s. We focused on improving the total treatment time for patients in our non-teaching zone, reducing walkout rates, and beginning to measure and manage patient satisfaction. Walkout rates rose in 2011, but we were able to improve operational efficiency, and patient experience is beginning to improve. i. We hoped to improve overall treatment time for patients in the “Orange” (non-teaching) pod of the ED by 15% (compared to the 2010 TAT in the main ED). We exceeded our goals. The 2010 treatment time in the ED for 2010 (excluding pediatrics) was 4.1 hours. For the Orange pod in 2011, the overall treatment time was 3.2 hours, 22% less than the historical average for the main ED. This environment is a non-teaching environment, staffed by ED attendings and PAs. There are no ED residents, or residents from other services who rotate through the area. We anticipated that reducing the “overhead” of educational activities would improve cycle times, and our results are consistent with this. We centered on “Orange pod” efficiency in our departmental management meetings for 2011, and made a number of changes to evaluate means by which the Orange pod can contribute to overall departmental efficiency (not only focusing on TAT for patients within Orange, but also case-mix of the patients within Orange, utilization of Orange pod spaces during the early morning hours, and focusing the Scribe program

2011 Year End Report 11 DepartmentEmergency Medicine of Emergency Medicine

within Orange). Overall, the percentage of ED volume cared for in Orange during its hours of operation rose by about 4% during 2011. ii. Managing patient walkout rates when ED volumes increase. The ED volume at Petrie has increased by 23% since the closure of St. Vincent’s Catholic Medical Center, and the ED completed its renovation and move into a new clinical space. In association with this, the ED created a non-teaching pod (the Orange pod) that we keep open 16 hours per day. We had hoped to maintain our historical walkout rates in association with the increase in volume. Here are the results: Trends in Petrie ED Walkout Rate The walkout rates are 0.8% higher than their historical norm (but significantly lower than

6.0% 2010 2011 5.0

4.0

3.0

2.0 ED Walkout Rate ED Walkout

1.0

0.0

Jan Feb Mar April May Jun July Aug Sep Oct Nov Dec

the walkout rates from the 2006–2008 time period. This is directly related to intra-ED processes and challenges in bed access for admitted patients. We have approached this by focusing on the intra-ED operational issues and participating in hospital committees that are attempting to improve access to inpatient beds. Our major focus in operational improvements is in ensuring consistent performance of our pneumatic tube system (which transports specimens to the lab). This has been very effective. In partnership with Engineering and Paul Boehringer, under the leadership of Debbie Gulecki, we have driven sustained improvements in this area. In addition, we have worked on improving the time-efficiency of our Orange pod, the non-teaching zone of the ED. This has been impactful as well, but insufficient to mitigate the challenges of our increased patient volume.

iii. Improving patient satisfaction in the ED. We implemented a patient satisfaction survey process in the ED. In partnership with Medical Center leadership, we selected NRC Picker as our vendor, so that the reports and benchmark hospitals could be similar to those used on the inpatient side. The initial overall satisfaction scores for BI Brooklyn were in the 1st percentile nationally, and for Petrie were in the 27th percentile. We have initiated a number of programs to improve satisfaction, including implementing the Medical Center’s

2011 Year End Report 12 DepartmentEmergency Medicine of Emergency Medicine

ambassador program, framing satisfaction in all management and staff meetings, and engaging our labor management committee in this area. Resident QI projects surrounding patient satisfaction have been implemented.

4. Academic Appointments —— Robert Hoffman, MD, was promoted to Associate Professor of Emergency Medicine, July 1, 2011.

5. Fellow/Resident Board Passage Rates —— Fellows: N/A. —— Residents: 89% (average of oral and written pass rates for first-time takers).

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Heller MB, Finefrock DC, Bowers WL, Cohen TR, Allen JR. “Human Immunodeficiency Virus Screening in a Cosmopolitan, Urban Emergency Department: Is the Yield Worth the Effort?” Abstract, Academic Emergency Medicine. 2011: in press. ——Husk G, Ansari A, Stoller M, Hasandzekaj A, Carey P. “Triage Determination of Respiratory Rate Does Not Reliably Suggest Severe Diabetic Ketoacidosis (DKA).” Abstract, Academic Emergency Medicine. 2011: in press. ——Husk G, Nguyen T, Woo K, Mcleod S, Ansari A, Stoller M. “Do Emergency Department Providers Accurately Document Patient Identification Errors Made During Computerized Provider Order Entry?” Abstract, Academic Emergency Medicine. 2011: in press. ——Gupta A, Nguyen T, Ansari A, Husk G. “Hyperkalemia in Emergency Department Hemolyzed Samples: Must They Be Repeated?” Abstract, Academic Emergency Medicine. 2011: in press. ——Nguyen T, Husk G, Avram A, Gupta A, Woo K, Heller M. “Patient Identification Errors in an Emergency Department Using Computerized Provider Order Entry.” Abstract, Academic Emergency Medicine. 2011: in press. ——Heller M, Husk G, Bowers W, Finefrock D, Nguyen T, Woo K, Cohen T, Allen J, Friedman P, Akhtar S. “Contrast CT Scans in the Emergency Department: Is There Really an Increased Risk of Adverse Clinical Outcomes?” Abstract, Academic Emergency Medicine. 2011: in press. ——Akhtar S, Hakim J, Dehdashtian S, Tjoe A, Jennings A, Finefrock D, Heller M. “Ultrasound Education in Allopathic Versus Osteopathic Emergency Medicine Residency Programs.” Abstract, Academic Emergency Medicine. 2011: in press.

B. Presentations Nguyen T, Husk G, Avram A, Gupta A, Woo K, Heller M ——“Patient Identification Errors in an Emergency Department Using Computerized Provider Order Entry.” Society for Academic Emergency Medicine, 2011 Western Regional Conference, Hartford, CT, April 2011.

2011 Year End Report 13 DepartmentEmergency Medicine of Emergency Medicine

Gupta A, Nguyen T, Husk G ——“Hyperkalemia in Emergency Department Hemolyzed Samples: Must They Be Repeated?” Society for Academic Emergency Medicine, 2011 Western Regional Conference, Hartford, CT, April 2011.

Nguyen T, Husk G, Avram A, Gupta A, Woo K, Heller M ——“Patient Identification Errors in an Emergency Department Using Computerized Provider Order Entry.” Council of Residency Directors—EM Annual Meeting, San Diego, CA, March 2011.

Heller M, Husk G, Bowers W, Finefrock D, Nguyen T, Woo K, Cohen T, Allen J, Friedman P, Akhtar S ——“Contrast CT Scans in the Emergency Department: Is There Really an Increased Risk of Adverse Clinical Outcomes?” Society for Academic Emergency Medicine, 2011 Western Regional Conference, Keystone, CO, February 2011.

Yahalom S, Gupta A, Gupta N, Pugeda J, Greenstein C, Heller M ——“The Effect of Bedside Ultrasound in the Emergency Department by Physician Assistants on ED Throughput.” Society for Academic Emergency Medicine, 2011 Western Regional Conference, Keystone, CO, February 2011.

7. Grants —— National Institutes of Health—National Institute on Aging: To Dr. Saadia Akhtar for “Improving Pain and Function in Hip Fracture.” —— National Institutes of Health: To Dr. Gregg Husk for “Targeted Antibiotic for Community Acquired Pneumonia.”

2011 Year End Report 14 Department of Integrative Medicine

2011

Department of Integrative Medicine

DEPARTMENT OF INTEGRATIVE MEDICINE Woodson Merrell, MD, Chairman

1. New Faculty —— Parveen Sondhi, MD, Gynecology, Full-time, November 2011. —— Jeffrey Young, BS (Kinesiology), Director of Personal Training, Full-time, November 2011.

2. Program Enhancements

A. New Programs i. Charles Evans Integrative Stress Management Program: Three-year grant-funded program brings stress reduction and self-care modalities to RNs and other clinical support staff throughout BIMC. B. Program Expansions i. Urban Zen Integrative Therapy (UZIT) Training Program: Continues to be the Manhattan base for training of yoga therapists (30 biannually) in collaboration with Donna Karan’s Urban Zen Foundation, with three yoga therapists permanently sta- tioned at Petrie and PACC to provide care and training to patients, staff and students. The program is widely received by inpatients who are exposed to the program and are currently represented on Oncology (9 Dazian), General Surgery (10 Silver), Orthopedic Surgery (7 Silver) and Family Medicine (8 Linsky). ii. Acupuncture Fellowship: Hospital-based one-year mentorship program to train post- graduate (licensed) acupuncturists in medical-based acupuncture in the hospital. The program continues to expand throughout the hospital, treating inpatients and exposing staff. iii. Reiki Volunteer Program: Continues to promote relaxation and healing to inpatients and is continuing to expand to various units throughout the hospital. iv. Holistic Preparing for Surgery Program: Continues to introduce self-care modalities to surgery patients to help reduce their anxiety and pain. v. Physical Therapy and Personal Training: Increasing volumes and services at the Continuum Center for Health and Healing (CCHH). vi. Outpatient Volume: CCHH significantly increased outpatient volume by 12% during 2011. vii. Appointment Access: CCHH significantly expanded access with evening and weekend hours: In 2011, 2,125 patients were seen after 5:00 pm and on Saturdays.

3. Capital Enhancements

A. Equipment Enhancements i. Addition of ultrasound modality to assist accuracy of injection techniques at the CCHH. ii. CCHH’s website, www.healthandhealingny.org, received nearly a million hits/month in 2011, providing patients, professionals and consumers with the most reliable information in the U.S. on integrative medicine.

2011 Year End Report 17 Department of Integrative Medicine

B. Facility Enhancements i. CCHH is expanding to another floor to offer more outpatient services. The lease was signed in 2011, with the landlord at 245 5th Avenue, to take possession on April 1, 2012 of the 12,000-sq.-ft. third floor, thereby doubling the size of CCHH. This will incorporate a medical fitness/wellness program and fitness center, as well as enhanced medical specialty care. Architectural plans, all construction/zoning permits and the first $500,000 contribution from the donor have been completed.

4. Quality Initiatives/Achievements

A. The Charles Evans Integrative Stress Management Program is scheduled to complete its first year in February 2012. To date, 64% of all unit employees (1,116, including RNs, PCAs and USAs) were taught tools for self-care in managing stress. Pre- and post-surveys showed a dramatic reduction in employees’ Perceived Stress Scale—from 6.2 to 1.4. B. The department sponsored a free Relaxation Immersion Event for housestaff with the Resident Health and Wellbeing Committee in the Department of Graduate Medical Education. C. Services to inpatients at the hospital continue to be a commitment. During 2011, more than 1,100 inpatients received Acupuncture, Reiki or Yoga Services from our staff/therapists at no charge. (Urban Zen continues to use BIMC as its main clinical training site, sending dozens of UZITs to Petrie and PACC from Fall 2011 to Spring 2012) D. Press Ganey scoring for CCHH was excellent, with an overall score of 4.1. E. QI Primary Care Indicators Data—Overall we have: —— 100% compliance for Influenza, Pap, Mammogram and Lead Screenings. —— some improvement in Diabetes Management, although it’s not a large population we serve here at CCHH. Our numbers will always be slightly off, mostly because patients are being followed by their endocrinologist. We have modified our risk factor form to capture the data from the screening tool, and need providers to maintain 100% compliance and document the information during an annual or follow-up visit. —— some improvement with Pediatric Indicators. We do well in this area, but are not at 100% due to parent’s religious beliefs or spacing out vaccinations. We do have documentation when parents refuse any vaccines. —— scored between 90-96% for Colon Cancer Screenings. Providers need to document that they are at least offering the screening to capture and improve percentages.

5. Fellow/Resident Board Passage Rates —— Fellows: Ortho-Sports-Spine passed certification boards.

2011 Year End Report 18 Department of Integrative Medicine

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Handel MJ. “mHealth (mobile health): Using Apps for Health and Wellness.” Explore. 2011 July-Aug 7 (4): 256-61. ——Kligler B, Homel P, Harrison LB, Levenson HD, Kenney JB, Merrell W. “Cost Savings in Inpatient Oncology through an Integrative Medicine Approach.” American Journal of Managed Care. 2011 December 17 (12): 779-784. www. ncbi.nlm.nih.gov/pubmed/22216749. ——Kligler B, Homel P, Harrison LB, Sackett E, Levenson H, Kenney J, Fleishman SB, Serra D, Merrell W. “Impact of the Urban Zen Initiative on Patients’ Experience of Admission to an Inpatient Oncology Floor: A Mixed-Methods Analysis.” J Altern Complement Med. 2011 August 17 (8): 729-34. http://www.ncbi.nlm.nih.gov/ pubmed/21745096. ——Braun M, Schwickert M, Nielsen A, et al. “Effectiveness of Traditional Chinese ‘Gua sha’ Therapy for Neck Pain: A Randomized Controlled Trial.” Pain Med. 2011 March 12 (3): 362-9. ——Kligler B, Homel P, Blank AE, et al. “Randomized Trial of the Effect of an Integrative Medicine Approach to the Management of Asthma in Adults on Disease-Related Quality of Life and Pulmonary Function.” Alternative Therapies in Health and Medicine. 2011 January-February 17 (1): 10-15. ——Kligler B. “Commentary on ‘Probiotics for Treating Persistent Diarrhea in Children.’” Evidence-Based Child Health: A Cochrane Review Journal. 2011 6 (6): 1892–1893.

B. Presentations Robert Gotlin, DO ——“Earning Respect in the Health Care Industry.” 2011 Annual Meeting of the American Osteopathic Association, Phoenix, AZ, April 2011.

Lisa Bartoli, DO ——“Update on Integrative Medicine in Physical Medicine and Rehabilitation Practice.” 2011 Mid-Year Meeting, American Osteopathic College of Physical Medicine and Rehabilitation, Phoenix, AZ, April 2011. ——“Medical Concerns in the Female Rugby Player.” 2011 USA Rugby Sports Medicine Symposium, Las Vegas, NV, February 2011.

Robert Gotlin, DO, Lisa Bartoli, DO ——“Injection Indication and Procedure.” 2011 Mid-Year Meeting, American Osteopathic College of Physical Medicine and Rehabilitation, Phoenix, AZ, April 2011.

Benjamin Kligler, MD ——“Pain Didactic: CAM Treatment in Pain.” View Presentation (VIDEO on HealingChronicPain.org).

2011 Year End Report 19 Department of Integrative Medicine

7. Honors/Awards Robert Gotlin, DO ——Castle Connolly Best Doctors in New York (PM&R). ——Elected to Board of Director’s-Medical Fitness Association. Martin Ehrlich, MD ——Castle Connolly Best Doctors in New York (Internal Medicine). Mary Beth Augustine, RD, CDN ——Cochair of the Dietitians in Integrative and Functional Medicine Credentialing Task Force, working with the Academy of Nutrition and Dietetics, the Commission on Dietetic Registration, and the Council on Future Practice to create board certification as a specialist in Integrative and Functional Medicine. Joanna Cadiz, PT ——OCS (Orthopedic Clinical Specialist) certification. Philippe Corbanese, RPT ——Teaching Assistant at Touro College of Physical Therapy. Yvonne Johnson, RPT ——Teaching Assistant at Columbia College of Physical Therapy.

8. Grants Acupuncture to Decrease Disparities in Outcomes of Pain Treatment ——NIH #1R21AT004543-01A1 [McKee, PI] [9/08-6/11], $450,000 (Sub-contract) ——Specific Aim #1: To assess the adoption and implementation of acupuncture as a treatment for chronic pain due to osteoarthritis and neck and back pain among minority low-income patients in primary care practice. ——Specific Aim #2: To determine whether adding acupuncture services to routine management of chronic pain in the community health center setting results in improvements in pain measures and health-related quality of life. ——Role: Co-investigator. Academic Career Development Award in Complementary/Alternative Medicine ——NIH #1 K07AT004570-01A2 [Kligler, PI] [8/09-7/14], $630,000 ($126,000 for 2011) ——Specific Aim #1: To use qualitative methods to identify specific personal values and traits associated with a positive response to integrative medicine interventions in the treatment of asthma and diabetes. ——Specific Aim #2: To develop and implement a competency-based evaluation strategy for an Internet-based curriculum in Integrative Medicine for primary care residents. ——Role: Principal investigator.

2011 Year End Report 20 Department of Medicine

2011

Department of Medicine – Division of Cardiology Henry C. Bodenheimer, MD, Chairman

I. THOMAS KILLIP, MD, DIVISION OF CARDIOLOGY Steven Bergmann, MD, Chief

1. New Faculty —— David Lau, MD, Electrophysiology, Part-time, July 1, 2011. —— Yili Hwang, MD, Interventional Cardiology, Part-time, July 1, 2011 —— Jacqueline Chan, MD, Consultative Cardiology, Part-time, July 1, 2011 —— Tatyazna Danilov, MD, Consultative Cardiology, Echocardiography, Full-time, July 1, 2011.

2. Program Enhancements

A. New Programs i. Vascular Medicine: General cardiology fellows are now trained in vascular medicine, including symptoms, signs, diagnostic techniques such as ultrasound, ankle brachial index, CT and MR angiography, contrast angiography, as well as medications and interventional approaches for treatment. ii. Three-Dimensional Ultrasound: This new cardiac ultrasound technique is being taught to fellows for the assessment of valvular disease. B. Program Expansions i. We expanded nuclear cardiology services at our Greenpoint office in Brooklyn. ii. We began to offer vascular screening services (ankle/brachial pressure index, vascular ultrasound) at our Greenpoint office. iii. Several of our attending physicians have trained in vascular medicine and become board certified. iv. We are now sending a physician to ODA to serve the Hasidic community. v. We partnered with Senior Health to provide cardiology services at that location. vi. The Women’s Cardiology Group has expanded its outreach activity with lectures, community screenings, etc. vii. The Cardiology Division began offering exercise rehabilitation for patients with peripheral artery disease.

3. Capital Enhancements

A. Equipment Enhancements i. Two new echocardiography machines with three-D echo capabilities were purchased, one for PACC and one for Petrie. This permits advanced imaging of valvular disorders of the heart and will improve our ability to diagnose and treat such disorders. ii. We opened Room C, a new Siemens’ single plane angiography unit in the Cardiac Catheterization Laboratory (11 Dazian), which expands our capability to do cardiac catheterization as well as peripheral artery catheterization and intervention. iii. ProSolv, our image acquisition, archiving and reporting system, was implemented in the echocardiography laboratories at all hospital and outpatient sites.

2011 Year End Report 23 Department of Medicine – Division of Cardiology

4. Quality Initiatives/Achievements

A. Core Measures: We have achieved greater than 95% compliance with core measures for the treatment of acute myocardial infarction and for the treatment of heart failure. B. Door to Balloon Time: A major goal was to decrease the time to definitive treatment of patients with acute myocardial infarction. In 2011, we noted a marked decrease in the time so that more than 85% of patients had opening of their occluded coronary artery within 90 minutes of entry into the Emergency Department. C. Ventilated Associated Pneumonia (VAP): Patients in the intensive care unit are prone to infections when they are on ventilators to assist breathing. The CCU uses best practices to reduce the incidence of VAP. A standardized order set is employed and in 2011, the VAP rates were 0. D. Time Outs: This procedure is used to make sure that the right patient undergoes the right procedure. Time outs are tracked throughout the division for all procedures. In 2011, the time out compliance was 100%.

5. Academic Appointments —— Maurice Rachko, MD, promoted from Assistant Professor of Medicine to Associate Professor of Medicine, July 1, 2011. —— Kenneth Giedd, MD, promoted from Assistant Professor of Medicine to Associate Professor of Medicine, July 1, 2011. —— Tak Kwan, MD, promoted from Associate Professor of Medicine to Clinical Professor of Medicine, July 1, 2011. —— Tatyana Danilov, MD, appointed Instructor in Medicine. —— Pablo Navarro, MD, appointed Instructor in Medicine.

6. Fellow/Resident Board Passage Rates —— Fellows: 100%. —— Residents: N/A.

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Barbhaiya CR, Seewald R, Hanon S. “QT Prolongation and Arrhythmia Risk in Methadone Maintenance Treatment.” Innov Cardiac Rhythm Management. 2011 2: 566-568. ——Bourji N, Chen O, Kumar L, Hernandez L, Brener S. “Is There an Association between Hemoglobin A1C Level and Severity of Coronary Artery Disease in Patients without Diabetes Mellitus? Treatment Strategies.” Interventional Cardiology. 2011 1: 44. ——Chen SL, Santoso T, Zhang JJ, Ye F, Xu YW, Fu Q, Kan J, Paiboon C, Zhou Y, Ding SQ, Kwan TW. “A Randomized Clinical Study Comparing Double Kissing (DK) Crush with Provisional Stenting for Treatment of Coronary Bifurcation Lesions: The Results from the DKCRUSH-II Trial.” J Am Coll Cardiol. 2011 57: 914-920. ——Danilov T, Saric M, Srichai MB, Kronzon, I. “Bilateral Left-Sidedness Heterotaxy Syndrome.” J Am Coll Cardiol. 2011 58: 87.

2011 Year End Report 24 Department of Medicine – Division of Cardiology

——Kanei Y, Nakra NC, Liou M, Vales LL, Gowda R, Rosero H, Kwan T, Fox JT. “Randomized Comparison of Transradial Coronary Angiography via Right or Left Radial Artery Approaches.” Am J Card. 2011 107: 195-197. ——Kanei Y, Kwan T, Nakra NC, Liou M, Huang Y, Vales LL, Fox JT, Chen JP, Saito S. “Transradial Cardiac Catheterization: A Review of Access Site Complications.” Catheter Cardiovas Interv. 2011 78: 840-846. ——Kanei Y, Ayabe K, Ratcliffe J, Vales LL, Nakra NC, Friedmann P, Fox JT. “The Impact of Iso-osmolar Contrast Use in Emergent Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.” J Invasive Cardiology. 2011 23: 448-50. ——Kahn, MR, Fallahi, A, Kim, MC, Esquitin, R, Robbins, MJ. “Coronary Artery Disease in a Large Renal Transplant Population: Implications for Management.” Am J Transpl. 2011 1: 2665–2674. ——Kato S, Takahashi K, Ayabe K, Samad R, Fukaya E, Friedmann P, Varma M, Bergmann SR. “Heparin-Induced Thrombocytopenia: Analysis of Risk Factors in Medical Inpatients.” Br J Haematol. 2011 154: 373-377. ——Kwan J, Htun WW, Huang Y, Ko W, Kwan T. “Effect of Proton Pump Inhibitors on Platelet Inhibition Activity of Clopidogrel in Chinese Patients with Percutaneous Coronary Intervention.” Vasc Health Risk Mgmt. 2011 7: 399-404. ——Shimada Y, Nakra NC, Fox JT, Kanei Y. “Meta-Analysis of Prospective Randomized Trials Comparing Intracoronary versus Intravenous Abciximab in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.” Am J Card. 2011 Dec 5. Epub. ——Valdiviezo C, Motivala AA, Hachamovitch R, Chamarthy M, Navarro PC, Ostfeld RJ, Kim M, Travin MI. “The Significance of Transient Ischemic Dilation in the Setting of Otherwise Normal SPECT Radionuclide Myocardial Perfusion Images.” J Nucl Cardiol. 2011 18: 215-9. ——Vales L, Kanei Y, Ephrem G, Misra D. “Intra-Aortic Balloon Pump Use and Outcomes with Current Therapies.” J Inv Cardiology. 2011 23: 116-119. ——Vales L, Kanei Y, Schweitzer P. “Electrocardiographic Predictors of Culprit Artery in Acute Inferior ST Elevation Myocardial Infarction.” J of Electrocardiol. 2011 44: 31-35. ——Wong SS, Dixon BL, Gilbride JA, Chin WW, Kwan TW. “Cardiovascular Disease Risk Factors among Older Chinese Americans Living in New York City.” J Comm Health. 2011 36: 446-452.

B. Presentations (abstracts presented at national meetings) Barbhaiya CR, Po JR, Hanon S, Schweitzer P ——“Tpeak–tend and Tpeak–tend/QT Ratio as Markers of Ventricular Arrhythmia Risk in Cardiac Resynchronization Therapy Patients.” JICE. 2011 30: 118-119.

Brodsky J, Katz J, James D, Samuel O ——“Recurrent Takotsubo Cardiomyopathy: The Role of Adrenergic Blockade.” E-journal of Cardiology. 2011 1: 29-39.

2011 Year End Report 25 Department of Medicine – Division of Cardiology

Chen SL, Santoso T, Xu YW, Fu Q, Paiboon C, Zhou YY, Ding SQ, Kwan TW ——“Effect and Mechanism of Coronary Bifurcation Angle from 3-D on Clinical Outcomes after Percutaneous Treatment with Stents Results from DKCRUSH II Trial.” J Am Coll Cardiol. 2011 58: TCT-312.

Cherukuri S, Kwan J, Huang Y, Vales L, Liou M, Kanei Y, Nakra N, Diwan R, Kwan T ——“Feasibility of Percutaneous Coronary Interventions Using Anchor-Wire (Szabo) Technique via Transradial Approach.” Catheter Cardiovas Interv. 2011 77: S40.

Diwan R, Huang Y, Navin N, Kanei Y, Liou M, Kwan TW ——“Safety of Jailing a Hydrophilicwire: Case Series Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions.” 2011 Conference, Baltimore, MD, May 2011.

Ephrem G, Kanei Y ——“Elevated Red Blood Cell Distribution Width Is Associated with Severe Coronary Artery Disease in Patients with Unstable Angina or Non-ST-Elevation Myocardial Infarction.” Clin Trans Sci. 2011 4: 114.

Gujja K, Misra D, Roncari C, Sulica R ——“Exercise Induced Pulmonary Hypertension: Comparison of Stress Echocardiography to Right Heart Catheterization.” J of Cardiac Failure. 2011 17: S99-100.

Hanon S, Barbhaiya C, Po JR, Schweitzer P ——“T Peak– T End and T Peak– T End /QT Ratio as Markers of Ventricular Arrhythmia Risk in Cardiac Resynchronization Therapy. J Interv Card Electrophysiol. 30:118.

Tranbaugh R, Dimitrova K, Friedmann P, Geller C, Ko W, Hoffman D ——“Coronary Artery Bypass Grafting Using Radial Artery: Clinical Outcomes and Patency.” Circulation. 2011 124: A14082.

Kanei Y, Gujja K, Ayabe K, Nakra N, Huang Y, Liou M, Kwan T, Fox J ——“The Incidence of Procedural Difficulty in Transradial Coronary Angiography. J Am Coll Cardiol. 2011 57: 1876.

Katz JS, Ruisi M, Gerhie E, Celestin L, Giedd K, Rachko M ——“Assessment of Transient Ischemic Dilation (TID) Ratio in Gated SPECT Myocardial Perfusion Imaging (MPI) Using Regadenoson, a New Agent for Pharmacologic Stress Sesting.” J Nucl Cardiol. 2011 18: 756.

Kwan J, Huang Y, Vales L, Liou M, Diwan R, Cherukuri S, Nakra N, Kanei Y, Kwan T ——“7- Fr Sheathless Transradial Percutaneous Coronary Intervention.” Oral and Poster Presentations. Catheterization and Cardiovascular Interventions. 2011 77: S1-S156. doi: 10.1002/ccd.23089. The Society of Coronary Angiography and Intervention 34th Annual Scientific Sessions, Baltimore, MD, May 2011.

Nakra N, Kanei Y, Vales L, Huang Y, Diwan R, Talati S, Fox J ——“The Long-Term Outcome of Bifurcation Lesions Treated with Second- Generation Drug Eluting Stents.” Catheter Cardiovas Interv. 2011 77: S129.

2011 Year End Report 26 Department of Medicine – Division of Cardiology

Shimada Y, Po JR, Kanei Y, Schweitzer P ——“Prognostic Impact of Terminal T Wave Inversion on Presentation in Patients with ST-Elevation Myocardial Infarction Treated with Urgent Percutaneous Coronary Intervention.” J Am Coll Cardiol. 2011 57: 1810.

Singh SP, Dhillon SK, Rachko M, Giedd KN ——“The Heart Rate Recovery Three Minutes after Treadmill Stress is Higher in Patients with Normal Myocardial Perfusion Imaging than in Those with Abnormal Imaging, but Does Not Predict the Results of Perfusion Imaging Studies.” J Nucl Cardiol. 2011 18: 759.

Tranbaugh R, Dimitrova K, Friedmann P, Geller C, Ko W, Hoffman D ——“Coronary Artery Bypass Grafting Using Radial Artery: Clinical Outcomes and Patency.” Circulation. 2011 124: A14082.

8. Honors/Awards Castle Connolly Best Doctors – 2011: ——Alexander Askanas, MD ——Russell Berdoff, MD ——Marvin Berger, MD ——Steven R Bergmann, MD, PhD ——John Fox, MD ——Philip Varriale, MD Super Doctors – 2011: ——Russell Berdoff, MD ——Steven R. Bergmann, MD, PhD ——John Fox, MD ——Lawrence Heller, MD ——Eric Kirschner, MD

9. Grants Educational Fellowship Awards ——Boston Scientific (one year, $30,000) and St. Jude’s (one year, $15,000) to fund educational program for the electrophysiology fellow. Board of Trustees Award—Heart Failure Quality Improvement ——$50,000, one year. SCIOS (industry sponsored) ——Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) - per patient reimbursement.

2011 Year End Report 27 Department of Medicine – Division of Chemical Dependency Henry C. Bodenheimer, MD, Chairman

II. NATHANIEL MELTZER, MD, DIVISION OF CHEMICAL DEPENDENCY Stanley Yancovitz, MD, Division Chief

1. New Faculty —— Sarah Lorenz, MD, Faculty Practice, Part-time, December 2011. —— Rashiah Elam, MD, Weekends, Part-time, May 2011.

2. Program Enhancements

A. New Programs i. “Special Team” Project: “Special Team” monitors and tracks patients with high re-admission rates to detoxification services. These patients are paired up with an interdisciplinary treatment team and upon each re-admission are assigned to their designated team. During the patient’s course of treatment for each admission, the treatment team holds interdisciplinary interventions with the patient, led by the counseling staff. When the patient is known to other departments of BIMC, the staff from that department are invited to the team meetings to collaborate. The goal of the project is to provide continuity of care and interdisciplinary intervention, while reducing re-admissions and increasing the potential for short- and/or long-term recovery. ii. Aftercare Service for Inpatient Detoxification and Rehabilitation Service: Established regular telephone contact with patient post-discharge to assure continued progress in recovery, follow up on aftercare services, and provide intervention if patient is risking relapse. iii. Family Services Initiative: Created to engage family members and significant others for direct care and in support of the person in recovery. Outreach to families is conducted at admissions, and educational sessions in detoxification, rehabilitation and outpatient services are offered. Family members are engaged in direct, individual counseling, groups for family members and multi-family groups. B. Program Expansions i. Afternoon Service Delivery Options in Outpatient Program: Day rehabilitation services and ambulatory detoxification admissions previously were provided during morning hours only. During 2011, staff schedules were reorganized to accommodate groups in the afternoon hours, and admissions to ambulatory detoxification were extended to 4 p.m. ii. Family Services Initiative: Family counseling services had been limited to the rehabilitation service only. During 2011, their provision was expanded from admissions through the continuum of care to outpatients, as explained in the “Enhancements” section above. iii. Enhanced Patient Engagement through Improved Orientation and Expanded Group Services: The detoxification service revised its patient orientation to better familiarize patients with the detoxification service and other service availability within Chemical Dependency. More group services were added to support the improved orientation and to encourage the patient during the recovery process. iv. Expanded Network of Community-Based Agencies in Collaborative Network: Training has been provided for an array of community-based agencies, including child

2011 Year End Report 28 Department of Medicine – Division of Chemical Dependency

welfare services, housing services and other social services. There has been a focus on increasing coordination of care with these agencies, which has built our relationships with them from referral resources to true collaborative efforts. v. Internship Placements: Provided internship placements for more than 80 counselors, social workers and PhD/psychology and PA students. BIMC has become a preferred provider for chemical dependency training among a number of educational services.

3. Capital Enhancements

A. Facility Enhancements i. Moldy broken millwork in dining room was replaced.

4. Quality Initiatives/Achievements

A. Suicide Risk Assessment Project: The goal was to develop a mechanism to assist the team in early identification of patients at risk for suicide. Screening and risk assessments, which help the team to recognize patient characteristics and environmental features that may increase or decrease the risk of suicide, are now completed on admission and at regular intervals (shift assessments, counselor interviews, etc.) throughout a patient’s stay. The rate of assessment completion is 100%. B. Reduction in AMAs: Because addiction treatment is difficult, many patients sign out against medical advice before completion of treatment. This QI project assessed our current approach to this problem and resulted in several modifications of our policies and procedures in this area, which we anticipate will significantly reduce our AMA rate. C. Methadone and QT-intervals: There is controversy in the field as to whether routine ECG monitoring of patients on methadone maintenance is necessary. We conducted a QI project and found that ECG monitoring is advisable only for patients treated with 120 mg of methadone or more daily.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Kraus, Alford, Kotz, Levounis, Mandell, Meyer, Salsitz, Wetterau, Wyatt. “Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction.” Journal of Addiction Medicine. 2011 December 5 (4): 254-263. ——Juliana, P. “Evaluation of an Integrated Treatment Model for Persons with Co-Occurring Substance Abuse and Mental Health Disorders.” 2011 May. (Dissertation, not yet published.)

2011 Year End Report 29 Department of Medicine – Division of Chemical Dependency

B. Presentations Edwin A. Salsitz, MD, FASAM ——“Prescription Opioid Misuse”—CME Chair and Moderator. Annual New York Society of Addiction Medicine Conference, New York, NY, February 2011. ——“Pain and Addiction: Common Threads Course”—Cochair, Speaker and Moderator. Part of Annual American Society of Addiction Medicine Conference, Washington, DC, April 2011. ——“Opioid Agonist Therapy”—Presenter. North Carolina Society of Addiction Medicine, Asheville, NC, April 2011. ——American Society of Addiction Medicine, State of the Art Conference— Moderator. Washington DC, October 2011.

Juliana P, Coppola J, Carise D, Taylor P ——“Health Care Reform: Threats and Opportunities.” NYU Conference on Substance Use: Responding to Changes in Policy, Research and Services, New York, NY, December 2011.

McQuirk, S ——“Co-Occurring Mental Health and Substance Abuse Disorders.” NYU MSW Program, May and July 2011.

6. Honors/Awards Patti Juliana, PhD ——ASAP NYS “Women in Leadership” Award, April 2011.

2011 Year End Report 30 Department of Medicine – Clinical Immunology and Allergy Henry C. Bodenheimer, MD, Chairman

III. CLINICAL IMMUNOLOGY AND ALLERGY James M. Rubin, MD, Division Chief

1. Quality Initiatives/Achievements

A. Spirometry before instituting asthma treatment.

2. Honors/Awards James M Rubin, MD ——Castle Connolly America’s Top Doctors.

Paul M Ehrlich, MD ——New York Magazine “Best Doctors.”

Michael Teitel, MD ——New York Times Superdocs.

2011 Year End Report 31 Department of Medicine – Division of Digestive Diseases Henry C. Bodenheimer, MD, Chairman

IV. DIVISION OF DIGESTIVE DISEASES David Carr-Locke, MD, Division Chief

1. New Faculty —— David Hudesman, MD, Full-time faculty, July 1, 2011. —— Gil Ascunce, MD, Full-time faculty, July 1, 2011.

2. Program Enhancements

A. New Programs i. Endosonography: Provided by full-time faculty for the evaluation of esophageal, gastric, pancreatic and rectal masses/cysts. ii. Center for Inflammatory Bowel Disease (ulcerative colitis and Crohn’s disease): Provides expert advice on management of these conditions. iii. Evening Outpatient Clinic Hours: Provides expanded access to our division. iv. Advanced Endoscopic Procedure Room within Endoscopy Unit at Petrie: Provides enhanced therapy for patients and training of specialists worldwide through electronic media. v. Regular Multidisciplinary Conference for Pancreatic and Biliary Diseases: To determine management decisions. B. Program Expansions i. Increased direct access to colon cancer screening by adding a second patient navigator from the Department of Health. ii. Expanded use of Endoscopic Confocal Endomicroscopy, providing real-time pathology evaluation of esophageal, gastric and biliary diseases. iii. Increased acceptance of patients referred for difficult GI problems requiring advanced endoscopic expertise. iv. Growth of Ambulatory Endoscopy at Petrie and Ease Side Endoscopy (Second Avenue). v. Implementation of quality data gathering across all affiliated endoscopy centers, which will have a direct impact on the standard of patient care.

3. Capital Enhancements

A. Equipment Enhancements i. Replacement of outdated endoscope reprocessors in the Petrie Endoscopy Unit, which will improve efficiency and reduce costs considerably.

4. Quality Initiatives/Achievements

A. Outpatient Satisfaction Surveys—Improvements: —— Wait times at PACC. —— Ease of scheduling appointments. —— Courtesy of schedulers. —— Promptness of returning calls.

2011 Year End Report 32 Department of Medicine – Division of Digestive Diseases

—— Courtesy of registration staff. —— Concern by Nurse/Medical Assistant. —— Being involved in decisions. —— Privacy. —— Cleanliness. —— Overall care. —— Recommendation to others. B. Outpatient Process Improvements: —— Wait times for new appointments. —— Access for colon cancer screening. C. Inpatient Service Improvements: —— Time to consultation. —— Completeness of documentation. —— Time to endoscopy. D. Endoscopy Service Improvements: —— Completeness of documentation. —— Adherence to universal protocol. —— Reporting of adverse events. —— Colonoscopy quality indicators, e.g., cecal intubation rate, withdrawal times, inad- equate preparation.

5. Fellow/Resident Board Passage Rates —— Fellows: 100%. —— Residents: N/A.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Lipp MJ, Broder A, Hudesman D, Suwandhi P, Okon SA, Horowitz M, Clain DJ, Friedmann P, Min AD. “Detection of Esophageal Varices Using CT and MRI.” Dig Dis Sci. 2011 September 56 (9): 2696-700. ——Gouw AS, Clouston AD, Theise ND. “Ductular Reactions in Human Liver: Diversity at the Interface.” Hepatology. 2011 November 54 (5): 1853-63. ——Hudacko R, Theise N. “Liver Biopsies in Chronic Viral Hepatitis: Beyond Grading and Staging.” Arch Pathol Lab Med. 2011 October 135 (10): 1320-8. ——Paniz Mondolfi AE, Slova D, Fan W, Attiyeh FF, Afthinos J, Reidy J, Pang Y, Theise ND. “Mixed Adenoneuroendocrine Carcinoma (MANEC) of the Gallbladder: A Possible Stem Cell Tumor?” Pathol Int. 2011 October 61 (10): 608-14. ——Yoon SM, Gerasimidou D, Kuwahara R, Hytiroglou P, Yoo JE, Park YN, Theise ND. “Epithelial Cell Adhesion Molecule (EpCAM) Marks Hepatocytes Newly Derived from Stem/Progenitor Cells in Humans.” Hepatology. 2011 March 53 (3): 964-73. ——Hudacko R, Theise ND. “Chronic Viral Hepatitis: Beyond Grading and Staging.” Arch Pathol Lab Med. 2011 October 135: 1320-8. ——Gouw ASW, Clouston AD, Theise ND. “Ductular Reactions in Human Livers: Diversity at the Interface.” Hepatology. 2011 November 54: 1853-63.

2011 Year End Report 33 Department of Medicine – Division of Digestive Diseases

——Wang LS, Feldman DM, Carr-Locke DL. “Gastric Antral Vascular Ectasia: An Ongoing Case...” Medscape Gastroenterology. 2011 January. ——Carr-Locke DL, Bilal M, Ambreen S, Shehzad Q, Umar M. “A Girl with a Gastric Trichobezoar.” Clinical Case, Medscape Gastroenterology. 2011 March. ——Patton B, Loree R, Reyes AT, Carr-Locke DL. “Bronchoesophageal Fistula from Self-Induced Vomiting.” Clinical Case, Medscape Gastroenterology. 2011 May. ——Benias, PC, Min AD. “Goals of Antiviral Therapy for Hepatitis B: HBeAg Seroconversion, HBsAg Seroconversion, Histologic Improvement, and Possible Impact on Risk of Hepatocellular Carcinoma.” Current Hepatitis Reports. Volume 10, Number 4 (2011), 292-296. ——Costamagna G, Tringali A, Reddy DN, Devière J, Bruno M, Ponchon T, Neuhaus H, Mutignani M, Rao GV, Lakhtakia S, Le Moine O, Fockens P, Rauws EA, Lepilliez V, Schumacher B, Seelhoff A, Carr-Locke DL. “A New Partially Covered Nitinol Stent for Palliative Treatment of Malignant Bile Duct Obstruction: A Multicenter Single-Arm Prospective Study.” Endoscopy. 2011 April 43 (4): 317-24.

B. Presentations Petros Benias, Kavitha Gopal, Joseph Kim, David M. Feldman, Henry C. Bodenheimer, Albert D. Min AD ——“Low Prevalence of Hepatitis B and Delta Virus Infection in an Urban Medical Center in the United States.” DDW, New Orleans, LA, May 2011.

Chaya Abelow MD, Arkady Broder MD, Angelo Reyes MD, Seth Cohen ——“Esophageal Rupture Presenting with Massive Hematemesis.” Beth Israel Medical Center Annual Research Fair, New York, NY, June 2011.

Kuntsevich V, Bushell WC, Theise ND ——“Systems Biology Studies of Yogic Cognitive-Behavioral Practices.” Poster Presentation, International Conference on Pathways, Networks, and Systems Medicine, Crete, Greece, June 2011.

Abramov F, Benias P, Mendoza PG, Theise ND, Bodenheimer Jr, HC ——“Lipoamide Dehydrogenase Deficiency: An Under Recognized Cause of Episodic Acute Hepatitis in Adult Ashkenazi Jews.” American Association for the Study of Liver Diseases, Boston, MA, November 2011.

7. Honors/Awards David L. Carr-Locke, MD ——New York Magazine, Best Doctors 2011. ——Schwartz Center Award as Compassionate Caregiver.

2011 Year End Report 34 Department of Medicine – Division of Endocrinology Henry C. Bodenheimer, MD, Chairman

V. DIVISION OF ENDOCRINOLOGY Leonid Poretsky, MD, Division Chief

1. New Faculty —— Anindita Nandi, MD, Part-time Physician, November 7, 2011.

2. Program Enhancements

A. New Programs i. Activating People for Disease Prevention and Lifestyle Change through Empowerment (APPLE): In collaboration with the Albert Einstein College of Medicine and using the funds received from the National Institutes of Health (NIH) for Minority Health and Health Disparities, this pilot project is focusing on Bangladeshi immigrant women living in the Bronx. It is a community lifestyle and weight loss intervention, which incorporates behavior change strategies such as goal setting, self-monitoring, peer and individual support, motivation enhancement and group interventions. ii. The Diabetes Health Coach Program: In collaboration with Beth Israel Medical Center’s Volunteer Department, this study, supported by the United Hospital Fund, is engaging volunteer health coaches to support individuals with diabetes and facilitate improved knowledge and awareness of their disease, teach them diabetes self-management skills, and assist them in navigating the health care system. iii. Vitamin D for Type 2 Diabetes (D2D trial): In collaboration with Tufts University and using funds from the National Institutes of Health (NIH), this study is testing whether optimizing vitamin D status with vitamin D3 supplementation leads to a reduction in the rate of progression from pre-diabetes to diabetes. iv. Multi-Center Study of the Effect of Sevelamer Carbonate on Metabolic/ Inflammatory/Reactive Oxygen Species (ROS) in Diabetic Patients with Nephropathy: In collaboration with The Mount Sinai School of Medicine and Beth Israel’s Division of Nephrology and funded by the Genzyme Corporation, this study is comparing the effect of Renvela® (Sevelamer Carbonate) versus calcium carbonate (also known as Tums) on glucose metabolism (HbA1c) and serum advanced glycation end product (AGE) levels in patients with stage II-IV chronic kidney disease resulting from diabetic nephropathy. v. Outreaching, Building, and Writing for Social Media Platforms (Facebook, Twitter, Dig and YouTube): Certified Diabetes Educators (CDEs) answer questions pertaining to diabetes-related issues, in addition to providing nutritional counseling/ education. B. Program Expansions i. Overall Growth of 19.5% in the Division: 31,171 clinical encounters in 2010 – 37,260 in 2011. FDI growth from 3,082 clinical encounters in 2010 to 6,004 in 2011. ii. Clinical Program/Adult Primary Care: We are now focusing on providing diabetes education to adults with diabetes in collaboration with the patients’ primary care physician. Our approach incorporates family and friends into our diabetes education programs. We also provide diabetes education and prevention strategies for groups at risk of diabetes.

2011 Year End Report 35 Department of Medicine – Division of Endocrinology

iii. Deaf Community Program: We are now providing individual and group diabetes education for the deaf (ongoing). iv. Insulin Pump Program: We are now providing weekly sessions on advanced pump features with the pump trainers (MiniMed). Resources are available to people with diabetes interested in insulin pump therapy. v. Pediatric Program: We are now providing multidisciplinary diabetes care for pediatric cases. This includes sessions with a pediatric endocrinologist, NP, nutritionist and exercise consultant.

3. Quality Initiatives/Achievements

A. Hba1C within last 6 months <7.0 = 92%. B. LDL within past year = 100%.

4. Fellow/Resident Board Passage Rates —— Fellows: 100%.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Seto-Young D, Avtanski D, Parikh G, Suwandhi P, Strizhevsky M, Araki T, Rosenwaks Z, Poretsky L. “Rosiglitazone and Pioglitazone Inhibit Estrogen Synthesis in Human Granulosa Cells by Interfering with Androgen Binding to Aromatase.” Horm Metab Res. 2011 February 43: 250-256. ——Seto-Young D, Avtanski D, Varadinova M, Park A, Suwandhi P, Parikh G, Poretsky L. “Differential Roles of MAPK-Erk1/2 and MAPK-p38 in Insulin or Insulin- Like Growth Factor-I (IGF-I) Signaling Pathways for Progesterone Production in Human Ovarian Cells.” Horm Metab Res. 2011 December 43: 386-390. ——Abelev Z, Seth A, Patel R, Goldstein S, Bogun M, Paliou M, Schlosser J, Homel P, Busta A, Seto-Young D, Tranbaugh R, Poretsky L. “Continuous Insulin Infusion (CII) Is Associated with a Reduced Post-Surgical Length of Stay (LOS), but Not the Complication Rate, in Patients with Diabetes Mellitus (DM) Undergoing Coronary Artery Bypass Graft (CABG).” J Endocr Invest. 2011 July 34: 770-774. ——Araki T, Varadinova M, Goldman M, Rosenwaks Z, Poretsky L, Seto- Young D. “Rosiglitazone and Pioglitazone Alter Aromatase Kinetic Properties in Human Granulose Cells.” PPAR Research. 2011 September doi:10.1155/2011/926438. ——Araki T, Elias R, Rosenwaks Z, Poretsky L. “Achieving a Successful Pregnancy in Women with PCOS.” Endocrinology and Metabolism Clinics of North America. 2011 December 40: 865-894. ——Araki T, Holick MF, Alfonso BD, Charlap E, Romero CM, Rizk D, Newman LG. “Vitamin D Intoxication with Severe Hypercalcemia due to Manufacturing and Labeling Errors of Two Dietary Supplements Made in the United States.” J Clin Endocrinol Metab. 2011 December 96: 3603-3608. ——Araki T. “A Case of Hypophosphatemia Due to Tumor Induced Osteomalasia.” EndoTrends. 2011 December Vol 18, Issue 1, page 9-10.

2011 Year End Report 36 Department of Medicine – Division of Endocrinology

B. Presentations (Abstracts) Araki T, Dekio F, Ushiba T, Sy V, Zumoff B ——“A Case of MEN Type 1, the Diagnostic Challenges of Insulinoma, and a Literature Review.” American Association of Clinical Endocrinologists’ 2011 Annual Meeting and Clinical Congress, Abstract #733, San Diego, CA, April 2011.

Kim S, Seth A, Almakaev I, Fleckman A ——“Impact of a Project Renewal Shelter on Diabetic Management.” American Association of Clinical Endocrinologists’ 2011 Annual Meeting and Clinical Congress, Abstract #276, San Diego, CA, April 2011.

Ramnaraine M, Seth A, Romero C, Bouzouki M, Fleckman A ——“Graves’ or Thyroiditis Thyrotoxicosis: Etiologic Mystery Solved by Ultrasound?” American Association of Clinical Endocrinologists’ 2011 Annual Meeting and Clinical Congress, Abstract #1071, San Diego, CA, April 2011.

Charlap E, Seth A, Manessis A ——“Acute Hypothyroidism Presenting with Myopathy following Radioiodine Therapy for Graves’ Disease.” American Association of Clinical Endocrinologists’ 2011 Annual Meeting and Clinical Congress, Abstract #1075, San Diego, CA, April 2011.

Alfonso B, Medvedovsky B, Rapoport D, Araki T, Dubrow A, Poretsky L ——“Use of Hemodialysis in a Patient with Hyperosmolar Hyperglycemic State and Rhabdomyolysis – Case Report, and a Literature Review.” 93rd Annual Meeting of the Endocrine Society, Abstract #PI-560, Boston, MA, June 2011.

Suwandhi P, Pareek A, Sy V, Seth A, Kim SY, Branis N, Seto-Young D, Poretsky L ——“Effect of Thiazolidinediones on Osteoblast Biomarkers.” 93rd Annual Meeting of the Endocrine Society, Abstract #PI-189, Boston, MA, June 2011.

Araki T, Alfonso BD, Liao EP ——“Case Series - Hemichorea-Hemiballismus (HC-HB) in Diabetes Mellitus, and a Literature Review.” 93rd Annual Meeting of the Endocrine Society, Abstract #P1-569, Boston, MA, June 2011.

Myint F, Araki T, Alfonso BD, Dekio F, Saliby AH ——“Ectopic ACTH Syndrome, Discrepancy of ACTH Levels, and a Literature Review.” 93rd Annual Meeting of the Endocrine Society, Abstract #P3-62, Boston, MA, June 2011.

Alfonso BD, Bier R, Araki T, Busta A ——“A Patient with Kallman Syndrome and a Rare Craniofacial Defect, and a Literature Review.” 93rd Annual Meeting of the Endocrine Society, Abstract #P3-225, Boston, MA, June 2011.

Alfonso BD, Racedo-Rolon K, Nigo M, Patel R, Gouller A ——“Atypical Presentation of Cushing Syndrome (CS) Secondary to Ectopic Adrenocorticotropin (ACTH) Secretion in an Elderly Patient.” 93rd Annual Meeting of the Endocrine Society, Abstract #P2-651, Boston, MA, June 2011.

2011 Year End Report 37 Department of Medicine – Division of Endocrinology

Alfonso B, Araki, T, Busta A ——“Hypermagnesemia-Induced Hypocalcemia and the Effects on Parathyroid Hormone: Case Report and a Literature Review.” 93rd Annual Meeting of the Endocrine Society, Abstract #P3-100, Boston, MA, June 2011.

Kim S, Friedmann P, Seth A, Fleckman A ——“Abstract Poster Presentation: Finger-Stick Glucose Values Are an Essential Complement to Hemoglobin A1c and Fructosamine in HIV-Infected Patients with Diabetes.” 93rd Annual Meeting of the Endocrine Society, Abstract #P2- 526, Boston, MA, June 2011.

Seth A, Needleman N, Busta A ——“A Rare Case of Rapid Growth of a Rathke’s Cleft Cyst in an Adult Patient.” 93rd Annual Meeting of the Endocrine Society, Abstract #P1-441, Boston, MA, June 2011.

DeJesus J, Krymskaya M, Poretsky L ——“Diabetes Prevention and Management in Hispanic/Latino Population: The Friedman Diabetes Institute (FDI) Model.” Annual Meeting of the American Diabetes Association, Abstract #2153-PO, San Diego, CA, June 2011.

6. Honors/Awards Leonid Poretsky, MD ——New York Times Best Doctors – 2011. ——Editorial Boards (Journal of Diabetes, Journal of Clinical Endocrinology and Metabolism, International Scholarly Research Network Endocrinology, World Journal of Diabetes, Journal of Diabetes Research and Clinical Metabolism).

Takako Araki, MD, Fellow ——Third Prize, “Achieving a Successful Pregnancy in Women with PCOS,” Beth Israel Medical Center Alumni Essay Contest, May 2011.

7. Grants The Gerald J. and Dorothy Friedman Foundation: ——$1,172,598 to the Gerald J. Friedman Diabetes Institute. ——$100,000 to the Basic Science and Research Laboratory. Bernard Kabakow Research Program: ——$10,000. Stonewall Community Foundation: ——$10,000. Holbrook Family Foundation: ——$7,500. Mount Sinai Medical Center: ——$117,344. Tufts University: ——$2,500.

2011 Year End Report 38 Department of Medicine – General Medical Associates Henry C. Bodenheimer, MD, Chairman

VI. GENERAL MEDICAL ASSOCIATES Jayson Park, MD, Medical Director

1. New Faculty —— Tehila Zuckerman, MD, Faculty Physician, July 2011-June 2012 (1-year contract). —— Alan Tso, MD, Lead Preceptor at Ryan Nena, August 2011.

2. Program Enhancements

A. New Programs i. Medical Home Initiative: GMA met with Medical Home Leadership throughout the year to plan for GMA’s participation in Rollout 2 of the Medical Home Initiative starting in February 2012. This major initiative will position GMA to transition to a team-based care model that allows enhanced use of eCW (BI’s electronic medical record), provides interdisciplinary coordinated care by all levels of administrative and clinical staff, decentralizes care from physicians, and enhances the patient’s experience. GMA will begin to incorporate case managers, clinical pharmacists, mid-level providers, patient navigators and data analysts to improve transitions-of-care, reduce hospital readmissions, reduce ER visits, and improve target quality measures. This initiative will position GMA to be awarded Level 1 NCQA Medical Home status by mid- 2012 and receive enhanced financial incentives; furthermore, GMA will be positioned to meet Meaningful Use reporting standards and other insurance plan financial incentives. ii. Healthfirst Grant to Support New Patient Care Roles: The Healthfirst grant will support the salaries of a case manager, navigator and data analyst. The case manager will target high-risk Healthfirst patients to reduce hospital readmissions and ER visits, support patients with multiple co-morbidities, and facilitate transitions of care. The navigator will assist in providing support for transitions of care and facilitate timely appointment access. The data analyst will manage data to improve quality targets and standards set forth by Healthfirst. iii. eCW Resident Go Live: 73 residents were trained to use eCW in Fall 2011. The rollout period was two months and included extensive patient care schedule adjustments and coordination with the eCW Roll-out Team. With this new integration, all GMA patient visit documentation is paperless.

2011 Year End Report 39 Department of Medicine – General Medical Associates

B. Program Expansions i. Ryan Nena: Beth Israel expanded its health care delivery presence on the Lower East Side by collaborating with Ryan Nena. Beginning in July 2011, sixteen residents transitioned to Ryan Nena for their ambulatory training experience. The residents are supervised by experienced GMA faculty. ii. New Resident Rotation Schedule: Beginning July 2011, residents will rotate in GMA for two-week blocks, morning and afternoon (compared to the previous one afternoon a week continuity session and intermittent four-week morning and afternoon block), for improved in-hospital training and ambulatory training. The new schedule has increased the residents’ exposure to primary care medicine and further prepares residents to deliver health care in the ambulatory setting.

3. Capital Enhancements

A. Equipment Enhancements i. New patient waiting room chairs in Suites 3G, 3H and 3J.

4. Quality Initiatives/Achievements

A. Breast Cancer Screening: GMA continues to appropriately offer and/or document screening mammograms greater than 91% of the time based on quarterly chart reviews.

Mammography Screening 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Mammography Offered 93% 97% 91% 91%

Documentation of Refusal 3% 4% 3% 3%

Results Documented 93% 86% 91% 100%

B. Pap Smears: GMA continues to appropriately offer and/or document pap smears greater than 93% of the time based on quarterly chart reviews.

Pap Smear 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Pap Smear Offered 93% 93% 97% 93%

Documentation of Refusal 6% 0% 3% 0%

Results Documented 86% 69% 100% 69%

C. Quality and Patient Safety: The use of eCW allows physicians to use an automatic drug- to-drug interaction check and receive notification to reduce adverse events, especially for patients with polypharmacy.

Diabetes Management 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Hba1C within 6 months 100 96% 100% 100

Hba1C within 6 months if <7.0 40 54% 56% 56

LDL within past year 100 94% 96% 70

LDL within past year < 100mg/dl 50 67% 70% 71

Annual Microalbuminuria 83 70% 73% 71

Annual Foot Assessment 67 61% 39% 51

Annual Ophthalmology Assessment 63 56% 46% 64

2011 Year End Report 40 Department of Medicine – General Medical Associates

——The last table reflects GMA performance data on diabetes management based on quarterly chart reviews. Through eCW and the Medical Home Initiative, we hope to improve on performance measures. Documentation will be standardized using structured fields for diabetes management to enhance future performance in meeting ADA guidelines. GMA plans to provide “report cards” to all primary care providers, including residents to benchmark quality measures.

5. Fellow/Resident Board Passage Rates —— Refer to Residency Program, Internal Medicine.

6. Peer-Reviewed Publications and Presentations

A. Presentations Martin Arron, MD ——Arron MJ, Kurtz N, Elkin P, Bluni S. “End User Perspective in Innovation.” Panel Discussion, Life Sciences Summit, Landmark Ventures, New York, NY, February 2011.

Lisa Auerbach, MD ——“Teaching Strategies for Pre-clinical Students in the Clinical Setting.” CME for Attending. Observation and Feedback, Beth Israel Medical Center, New York, NY, September 2011. ——“Observing the Teachers: Is Faculty Development Effective for Preceptors Teaching Medical Students in a Physical Diagnosis Course?” Poster Presentation, Northeast Group on Educational Affairs, March 2011. ——The Department of Family and Social Medicine Faculty Development Workshop. Direct observation and feedback, Montefiore Hospital, Bronx, NY, April 2011. ——“Observing the Teachers: Is Faculty Development Effective for Preceptors Teaching Medical Students in a Physical Diagnosis Course?” Poster Presentation, Davidoff Day, Albert Einstein College of Medicine, May 2011.

2011 Year End Report 41 Department of Medicine – Division of Geriatric Medicine Henry C. Bodenheimer, MD, Chairman

VII. BETTY AND MORTON YARMON DIVISION OF GERIATRIC MEDICINE Joyce Fogel, MD, Division ChieF

1. Program Enhancements

A. New Programs i. The Geriatrics Fellowship received ACGME accreditation on November 21, 2011. The fellowship provides experiences across the continuum of care, including ambulatory care, house calls, inpatient consultation, sub-acute and long-term care. The fellow has the opportunity to gain expertise in other fields that impact geriatric care, such as neurology, psychiatry, rheumatology, urology and wound care. In addition, he/ she is exposed to community resources and the interdisciplinary team approach. ii. Our Caregiver Support Program started on September 1, 2011 with the support of the DeBare Fund. It includes individual counseling and support groups run by Susan Group, MSW. iii. Community Collaboration with SAGE (Services and Advocacy for Gay, Lesbian, Bisexuals and Transgender Elders) was developed. Working with LGBT Coordinator Dr. Barbara Warren, we will develop an education program for SAGE’s new senior center, which services more than 2,000. Collaboration with Greenwich House, which incorporates four senior centers and a senior mental health and consultation program, has begun as well. We are working with them to enhance clinical and educational programs. B. Program Expansions i. Growth of Outpatient Services: In 2011, a total of 3,573 patients visits were seen, 218 of which were new to the practice. In Senior Health, a total of 2,699 patients were seen, 164 of which were new. In House Calls, a total of 874 patients were seen, 54 of which were new. There were 266 hospital admissions, in addition to 113 emergency room visits of Senior Health and House Calls patients.

2. Capital Enhancements

A. Equipment Enhancements i. During 2011, we transitioned from an older freestanding version of eCW (utilized by the practice while affiliated with St. Vincent’s), to be fully integrated with Continuum eCW. B. Facility Enhancements i. Replacement of carpet to tile wood flooring. ii. Power washing and cleaning of exterior windows and metal area/frames of windows of facility. iii. Replacement of chairs in waiting room.

2011 Year End Report 42 Department of Medicine – Division of Geriatric Medicine

3. Quality Initiatives/Achievements

A. QI Project 2011 i. Assess: Patients’ concerns regarding inability to access the office to get appointments and responses to medical inquires and test results. ii. Data: Survey on all aspects of daily office functions. The following reflected the greatest areas of concern to our patients: ——An appointment when you want it. ——Feedback regarding medical question during regular office hours. ——Feedback regarding medical question after office hours. ——Feedback regarding x-ray and other tests. iii. Data collected by conducting a month long survey of patients:

iv. Implement Solutions: ——Increase urgent visit sessions. ——Utilization of BIMC sites with extended and weekend hours. ——LPN will triage question, then relay the information to the provider. ——Educate the patient and caregivers about the best time to call to get responses to their questions. ——Improve accessibility of results to providers at time of office visits. ——Assure communication between the on-call and primary provider.

4. Academic Appointments —— Joyce Fogel, MD, appointed Associate Professor of Clinical Medicine, February 2011.

5. Fellow/Resident Board Passage Rates —— N/A.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Levine JM, Ayello EA. “MDS 3.0 Section M: Skin Condition: What the Medical Director Needs to Know.” Journal of the American Medical Directors Association. 2011 12 (3): 179-183.

2011 Year End Report 43 Department of Medicine – Division of Geriatric Medicine

B. Presentations JM Levine, EA Ayello, K Zulkowski, et al ——“Pressure Ulcer Knowledge in Medical Residents.” National Pressure Ulcer Advisory Panel Biennial Meeting, Las Vegas, NV, February 2011.

JM Levine ——“The History of Wound Care: Ancient Egypt to the Present.” New York Academy of Medicine, New York, NY, May 2011. ——“MDS 3.0 Section M: Skin Condition. What the Medical Director Needs to Know.” American Medical Directors Association (AMDA) Annual Meeting, Tampa, FL, March 2011. J Fogel ——“Advanced Dementia as a Terminal Illness.” Palliative Medicine Faculty Development, Lenox Hill Hospital, New York, NY, October 2011.

7. Honors/Awards Joyce Fogel, MD ——Best Doctor, Castle Connelly Guide. ——Associate Professor Promotion Committee, Albert Einstein College of Medicine. ——Board of Directors, Metropolitan Area Geriatrics Society.

2011 Year End Report 44 Department of Medicine – Hospital Medicine Henry C. Bodenheimer, MD, Chairman

VIII. HOSPITAL MEDICINE Dahlia Rizk, DO, Section Chief

1. New Faculty —— Charles Peng, MD, Hospitalist, Full-time, July 1, 2011. —— Joanna Mecca, MD, Hospitalist, Full-time, July 15, 2011. —— Joseph Arcuri, MD, Hospitalist, Full-time, August 1, 2011. —— Svetlana Chernyavsky, DO, Hospitalist, Full-time, October 1, 2011. —— Marcel Collazo, MD, Hospitalist, Full-time, October 31, 2011.

2. Program Enhancements

A. New Programs i. Standardized Education Curriculum: We created a standardized education curriculum to ensure that all PAs on the Hospitalist Service, who came to us with varying de- grees of experience, would be appropriately trained to manage the complex patients that are admitted to the service. The curriculum included feedback from hospitalists on observed clinical exams and case presentations, formalized weekly lectures by hospitalists for PAs, participation in the weekly Hospitalist Faculty Development Series, and simulation training to focus on acute medical presentations. B. Program Expansions i. Colon Cancer Patient Navigator Program: Our colon cancer navigator grant ended in 2011. The navigator transitioned from a grant-supported position to a permanent program and position housed in the Division of Digestive Diseases. The navigator was responsible for coordinating 742 colonoscopies in 2011; the program is responsible for more than 2,000 colonoscopies since its inception. ii. Expansion of Academic CME-Accredited Hospitalist Lecture Series for PAs and Hospitalist Faculty: This robust lecture series was given by Beth Israel faculty across all specialties. Goals include enhancing interdisciplinary communication and care, as well as educating hospitalists on best practices and the latest guidelines in evidence- based medicine. iii. Continued Expansion of the Attending Directed Service: With nocturnist attending and PA coverage, the service was able to expand capacity and offload patient volume from the housestaff service. The unit is able to achieve a level of high-quality care by providing attending coverage 24 hours a day, 7 days a week.

3. Quality Initiatives/Achievements

A. Discharge summary quality improvement project: i. Goals: a. Evaluate quality of discharge summaries written by the housestaff. b. Evaluate the perception of an educational intervention designed to improve quality and content of the summaries. c. Study the impact of the intervention on discharge summary quality. ii. Studied quality of discharge summaries by 29 house officers.

2011 Year End Report 45 Department of Medicine – Hospital Medicine

iii. House officers attended a noon conference lecture reviewing the results of discharge summary evaluations as well as a review of current literature on the effects of quality discharge summaries on morbidity and mortality. a. Education provided on how to write effective, high-quality discharge summaries. iv. Randomly selected discharge summaries were reviewed following the intervention and quality was assessed. v. Results showed: a. Quality improved from pre-intervention score of 87% to post-intervention score of 93%. b. Pre-intervention study showed 9 quality indicators scoring below 80%. c. Post-intervention study showed only 1 quality indicator scoring below 80%. vi. Results showed educational series had positive impact on quality of summaries. vii. Over 86% of housestaff and attendings thought ongoing education would be helpful. a. Discharge summary education to become ongoing component of housestaff education. b. PAs educated on quality discharge summaries as well. B. Comprehensive quality improvement on Attending-Directed Service i. Goal: To improve operations on the rapidly growing Attending-Directed Service and off-load housestaff. ii. Conducted focus groups with all involved parties (attendings, PAs, learn-and-earn residents) to identify challenges and come up with solutions. iii. Identified challenges and targeted improvements, which included: a. Creation of a standardized workflow and set of expectations for PAs and attendings. b. Creation of a PA-focused educational curriculum to ensure standardization of knowledge. • PA curriculum included Observed Clinical Exams by hospitalists, formal presentations by PAs to hospitalists with feedback, formalized PA-specific lecture series, participation in Hospitalists’ weekly faculty development lecture series, simulation center training for PAs. iv. PAs reported feeling more engaged with the Hospitalist Program following implementation of the curriculum. v. Majority of PAs reported feeling that most elements of the QI project and educational curriculum were beneficial to their development as an inpatient PA. a. Simulation training and PA-specific lecture series seen as the most beneficial. C. Pre-Op evaluation template i. Goal: To standardize and improve process for pre-op evaluation by medical consultants with the ultimate goal of reducing morbidity and mortality. ii. Hospitalists participated in a series of meetings with representatives from other area hospitals to create a standard process and template to reduce variability in pre-op testing with the ultimate goal of improving patient outcomes.

2011 Year End Report 46 Department of Medicine – Hospital Medicine

a. Initiated universal hospitalist use of process and pre-op template. b. Ongoing evaluation of perioperative outcomes to determine if use of standardized guidelines reduces the number of adverse events. D. Identifying precursors leading to rapid response or medical code i. Goal: To implement process improvements and create systems-based interventions that address recognition, intervention and communication. ii. Studied the 8 hours prior to a code or rapid response on 69 medical charts to identify opportunities to prevent codes. iii. Data showed three main factors leading to preventable codes: a. Failure of recognition. b. Failure of communication. c. Failure of action. iv. Identified opportunity for improved communication between PCAs, RNs, housestaff, and attendings. v. Educational lectures provided to housestaff on findings and opportunities for improvement. vi. Project continuing into 2012. E. Joint Commission compliance i. Goal: To achieve and maintain compliance with Joint Commission’s patient safety objectives. ii. Monitored hospitalist compliance to Joint Commission standards through ongoing chart reviews. iii. Provided intensive education for the division. a. Educated providers (hospitalists and PAs) about prohibited abbreviations and elements required for complete H&Ps and progress notes. iv. Showed a 110% improvement in occurrence of violations in hospitalist and PA charts. v. Continue to monitor and provide feedback to ensure standards are met. F. Implementation of a new hospitalist feedback model. i. Goals: a. To educate physicians on institutional metrics and align performance goals. b. To provide physicians with a forum to discuss professional goals and offer program feedback in order to increase engagement. ii. Implemented a new hospitalist attending feedback model using a variety of performance metrics that are important to the institution and the program including: a. Volume and productivity. b. Average length of stay. c. Charges and collections. d. Coding practices. e. PCP communication.

2011 Year End Report 47 Department of Medicine – Hospital Medicine

f. Teaching evaluations. g. Timely medical record completion. h. Joint Commission compliance. iii. Individual sessions provided hospitalists with education on metrics and gave them a better understanding of how their performance was being evaluated by Hospitalist Chief. iv. Sessions also gave hospitalists an opportunity to discuss their personal goals with the Section Chief and give feedback on the program. v. Survey conducted after all feedback sessions were completed. vi. Results showed: a. Overall impression of the feedback model was positive. b. Hospitalists had a better understanding of performance metrics used to evaluate them. c. 100% of hospitalists reported feeling engaged or fully engaged with the Hospitalist Program compared to a Gallup poll that showed only 26% of physicians nationally reported feeling either engaged or fully engaged in their job. d. Majority of hospitalists felt it would be valuable to receive feedback in this format on a regular and ongoing basis. G. Transition of routine morning blood draws to midnight blood draws. i. Goals: a. To receive more timely morning lab results. b. Avoid delays in the laboratory. ii. Program piloted on 5 med/surg units to change the blood draw time from 6 am to midnight. a. Helped to prevent batching. b. Helped ensure more results are ready for morning rounding. c. Results were available faster. iii. Patients were surveyed and a majority preferred the midnight draw. iv. Majority of providers thought the midnight draws were better for patient care. v. Next steps: a. Identifying a more patient-centered time to do blood draws. b. Incorporating new time into the workflow for providers, RNs and laboratory.

4. Academic Appointments —— Priyanka Mittar, DO, appointed Instructor of Medicine, May 1, 2011. —— Patricia Dharapak, MD, appointed Assistant Professor of Medicine, May 25, 2011. —— Elizabeth Gilbert, MD, appointed Instructor of Medicine, July 1, 2011. —— Jennifer Hui, MD, appointed Instructor of Medicine July 1, 2011. —— Sooraj Shah, MD, appointed Instructor of Medicine, August 1, 2011. —— Joseph Arcuri, MD, appointed Assistant Professor of Medicine, August 1, 2011.

2011 Year End Report 48 Department of Medicine – Hospital Medicine

5. Peer-Reviewed Publications and Presentations

A. Presentations Dahlia Rizk, DO, Annie Nussbaum, MPA ——“The Impact and Perception of a New Hospitalist Feedback Model.” Poster and Oral Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Daniel Steinberg, MD ——“Updates in Hospital Medicine.” Conference Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Latha Sivaprasad, MD, Rebecca Calabrese, MD ——“The Successful Development and Implementation of a Comprehensive Blood Management Program at a Large, Urban Medical Center.” Poster Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Dahlia Rizk, DO, Charlene Monaco, Scott Barnett, Nadim Salomon, MD ——“Hospitalists’ Critical Role in Public Health: Tackling HIV Awareness with Inpatient Health Educators.” Poster Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Dahlia Rizk, DO, Carla M. Romero, MD ——“Vitamin D Toxicity: Rare or Under Detected?” Poster Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Gweneth M. Francis, MD, David Perlman, MD, Dahlia Rizk, DO ——“Tap Wager Enemas and Cryptosporidium Infection in Acute HIV Infection.” Poster Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Esther Huang, Latha Sivaprasad, MD, Elizabeth Palillo ——“An Assessment of Intravenous Immunoglobulin (IVIG) Utilization at an Urban Teaching Hospital as Part of a Larger Multi-Hospital System Analysis.” American Society of Health-System Pharmacists Annual Meeting, New Orleans, LA, December 2011.

Latha Sivaprasad, MD, Rachel Sussman ——“The Impact of Interdisciplinary Anticoagulation Safety Rounds at a Large Urban Teaching Hospital.” Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

Atsushi Sorita, MD, Daniel Steinberg, MD, Michael Leitman, MD, Pat Luhan, Alfred Burger, MD, Latha Sivaprasad, MD ——“The Impact of Targeted Individual Feedback on Provider Patterns of STAT Laboratory Tests Ordering Frequency.” Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

2011 Year End Report 49 Department of Medicine – Hospital Medicine

Robert Goldstein, MD, Jagdeep Singh, MD, Yuriy Israel, MD, Latha Sivaprasad, MD, Miwako Kobayashi, MD, Jose Cortes, MD ——“Villaret’s Syndrome due to Skull Base Aspergillosis in a Diabetic Male: A Case Report.” Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

P. Plumb, Michael Leitman, MD, Claudia Jimenez, MD, Latha Sivaprasad, MD, Ruth Levin, David Bernard, MD ——“Can Gainsharing Significantly Impact Cost Savings in Critical Care Units?” Society of Critical Care Medicine, 40th Critical Care Congress, San Diego, CA, January 2011.

6. Honors/Awards Dahlia Rizk, DO, and Carla Romero, MD ——“Vitamin D Toxicity: Rare or Under Detected?” Winner: Society of Hospital Medicine 2011 National Conference, Dallas, TX, “Best Clinical Vignette.”

Dahlia Rizk, DO, and Annie Nussbaum, MPA ——“The Impact and Perception of a New Hospitalist Feedback Model.” Semi- finalist: Society of Hospital Medicine 2011 National Conference, Dallas, TX, “Innovations.”

Dahlia Rizk, DO ——“Legislative Resolution Award” given in recognition of her work expanding colon cancer screenings; awarded by New York State Assemblyman Steve Cymbrowitz.

Lionel D’Souza, MD ——“Teacher of the Year,” as voted by the medicine housestaff. (Awarded to attendings in the Section of Hospital Medicine for the second year in a row and the fourth time in the past 10 years.)

7. Grants Mayday Fund ——$132,417 for “The Mayday Pain NP: An Innovative Model for Improving Pain and Other Outcomes in Adult Inpatients Managed by Hospitalist Physicians.” Awarded to the Section of Hospital Medicine and the Department of Pain Medicine and Palliative Care to study the barriers to successful pain management in the inpatient setting and use data to implement strategies for reducing the number of inpatients reporting sustained high pain. (Dahlia Rizk, DO; Rebecca Calabrese, MD; Cameron Page, MD; Russell Portenoy, MD; Marilyn Bookbinder, RN, PhD) Trustee Joel I. Picket ——$15,500 to purchase portable, electronic tablets and create an electronic note that the hospitalists can complete at the bedside allowing more face-time with patients and improved clinical documentation.

2011 Year End Report 50 Department of Medicine – Division of Infectious Diseases Henry C. Bodenheimer, MD, Chairman

IX. DIVISION OF INFECTIOUS DISEASES Donna Mildvan, MD, Division Chief

1. Program Enhancements

A. Program Expansions i. Antibiotic Stewardship Program (ASP): The Beth Israel Antibiotic Stewardship Program was established to improve the usage of antiretroviral and antimicrobial agents in hospitalized patients (see Quality Initiatives below). The purpose of its expansion, in conjunction with the Pharmacy and Microbiology Departments, is additionally to monitor antibiotic resistance trends and antimicrobial use and expenditures. ii. Zosyn® Restriction: An initiative to replace piperacillin/tazobactam (Zosyn®) with cefepime—an equally effective fourth generation cephalosporin—was started in the second half of 2010 and was fully realized in 2011. Measures to facilitate this “culture change” included educational sessions for the housestaff, “one-on-one” conver- sations with housestaff and faculty members, and our antibiotic restriction program. In 2010, purchase costs for Zosyn® at Beth Israel were $557,796; the annualized purchase costs for 2011 (based on data from January through November) were $79,442, which translates into a net savings of $478,354. In contrast, purchase costs for cefepime did not increase ($162,664 spent in 2010 versus $134,680 spent in 2011 based on annualized data from January to November with a net savings of $27,984). The unexpected decrease in cefepime purchase costs may be in part due to contract changes and associated lower unit prices. During this same timeframe, resistance patterns among gram negative isolates remained stable. iii. Additional Optimization and Savings were generated by (1) IV to PO switches, carried out by Pharmacy residents and (2) Antibiotic Restriction Program, carried out by ID fellows, where permission for use of fully restricted agents must be obtained prior to dispensing of the first dose, and for use of partially restricted agents, permission must be obtained for continued use after 24 hours (see Quality Initiatives for additional details).

2. Capital Enhancements

A. Facility Enhancements i. The ID/AIDS Clinical Trials Unit was renovated, including the installation of new floors and new cubicles. The renovation resulted in a significant enhancement of the environment of the IACTU for both patients and staff.

3. Quality Initiatives/Achievements

A. Division of Infectious Diseases General Quality Initiatives i. In 2011, the Infectious Diseases Quality Improvement Committee (Chair: Jorg Ruhe; faculty members: Mary Waldron, Sanjana Koshy, Tessa Gomez; all fellows-in-training members: Robert Goldstein, Leo De Guzman, Gweneth Francis, Vicente Maco Flores, Catalina Salinas Cevallos, Krystina Woods) collaborated on the following topics:

2011 Year End Report 51 Department of Medicine – Division of Infectious Diseases

a. Monitoring of patients with positive blood cultures ——Bloodstream infections are associated with significant morbidity, mortality and increased health care costs. Early appropriate antimicrobial therapy (i.e., receipt of at least one antibiotic to which the organism is susceptible) has been demonstrated to be associated with improved patient outcomes in multiple studies on different patient populations. ——An earlier review (2009) of the medical records of 174 patients with blood cultures positive for either Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, or Pseudomonas aeruginosa found that only 139 (79%) received active therapy within 48 hours after blood cultures were obtained. To improve these results, PowerPoint presentations and other educational efforts were made by ID faculty and fellows, and a new real-time strategy was implemented: ID fellows have begun to review the antimicrobial therapy of patients with positive blood cultures on a daily basis utilizing a customized computer-generated list from the Microbiology Laboratory. If the patient’s current antimicrobial therapy is not considered adequate for the organism isolated, suggestions are made by the ID fellow to the primary care team. These suggestions typically relate to either starting new therapy, narrowing or widening the spectrum of current therapy, or other interventions such as obtaining additional blood cultures, diagnostic tests or an infectious diseases consult. An Infectious Diseases faculty member is available to discuss potential questions. Through September 2011, at least 135 such interventions were made, including: • Recommendation to correct inactive or no therapy (n=40). • De-escalation of therapy, i.e., switch to a narrower spectrum agent (n=33). • Early antibiotic discontinuation (i.e., contaminant) (n=15). • Recommendations on antibiotic dose adjustments (n=8). • Other interventions (n=39). ——In order to evaluate the potential impact of the intervention, the rates of early appropriate antimicrobial therapy were reviewed among a subset of patients with Klebsiella pneumonia bacteremia between 2009 and 2011. Rates of appropriate early antimicrobial therapy increased from 55% in 2009 to 86% in 2011 (P=0.003). Further investigations to evaluate the impact of the intervention are underway. b. Impact of moxifloxacin- and ceftriaxone-based therapy of community-acquired pneumonia in hospitalized patients and their risk of subsequent colonization and infection with multidrug-resistant organisms. ——Infections with multidrug-resistant organisms are associated with increased mortality and a prolonged hospital stay. Significantly higher rates of colonization and infection with multidrug-resistant organisms among patients who received moxifloxacin-based therapy (compared to those who received ceftriaxone-based therapy) were identified. These important data provide further support for ID’s ongoing antibiotic restriction policies that seek to diminish the use of moxifloxacin for patients admitted with community-acquired pneumonia. A fellow’s project was incorporated into this quality initiative, results of which were published (see next page).

2011 Year End Report 52 Department of Medicine – Division of Infectious Diseases

B. Quality Activities of the Antibiotic Stewardship Program (ASP) 2011 i. ASP activities to improve the usage of HIV medications within the hospital ——A total of 162 interventions (i.e., concrete suggestions to change the medication management of patients with HIV/AIDS) were made, of which 104 (64%) were accepted by the patient’s care provider within 48 hours. The main reason for rejection of the proposed intervention was early discharge from the hospital. The following graph shows the types of interventions made: Categories of interventions

ii. ASP activities to improve the usage of antimicrobial agents within the hospital ——A total of 392 interventions were made. Recommendations to discontinue antibiotics or to deescalate the antibiotic regimen (i.e., to switch therapy to an agent with a narrower spectrum of activity) were the most common types of intervention: Categories of interventions

——Vancomycin, cefepime and ceftriaxone were the agents most frequently targeted for intervention. The median length of stay after the intervention was 4 to 5 days; 72% of suggested interventions were accepted by the patient’s care provider within 48 hours. C. Inpatient ID Activities i. 9 Linsky: Patient satisfaction reports identified patient-staff communication as an area for improvement. To address issues regarding communication, 9L staff are being increasingly included and trained in Ambassador skills.

4. Academic Appointments —— Brian Koll, MD, promoted to Professor of Clinical Medicine at the Albert Einstein College of Medicine, Spring 2011.

2011 Year End Report 53 Department of Medicine – Division of Infectious Diseases

5. Fellow/Resident Board Passage Rates —— 100%.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications (Print and Electronic) ——Gwadz MV, Leonard NR, Cleland CM, Riedel M, Banfield A, Mildvan D, ACT2 Project Collaborative Research Team. “The Effect of Peer-Driven Intervention on Rates of Screening for AIDS Clinical Trials among African Americans and Hispanics.” Am J Public Health. 2011 June 101 (6): 1096-102. PMID: 21330587. ——Brehm JH, Lalama CM, Hughes MD, Haurich R, Riddler SA, Sluis-Cremer N, Mellor JW, AIDS Clinical Trials Group A5142 Protocol Team (Mildvan D col- laborator). “Failure of Initial Therapy with Two Nucleosides and Efavirenz Is Not Associated with Early Emergence of Mutations in the C-Terminus of HIV-1 Reverse Transcriptase.” J Acquir Immune Defic Syndr. 2011 April 56 (4): 344-8. PMID: 21350368. ——Daar ES, Tierney C, Fischl MA, Sax PE, Mollan K, Budhathoki C, Godfrey C, Jahed NC, Myers L, Katzenstein D, Fatjallah A, Rooney JF, Pappa KA, Woodward WC, Patterson K, Bolivar H, Benson CA, Collier AC, AIDS Clinical Trials Group A5202 Team (Mildvan D, Revuelta M, collaborators). “Atazanavir Plus Ritonavir or Efavirenz as Part of a 3-Drug Regimen for Initial Treatment of HIV-1.” Ann Intern Med. 2011 September 154: 445-56. PMID: 21320923. ——Ruhe JJ, de Guzman K, Moss M, Riley W, Mildvan D, Perlman DC, Koll B. “Methicillin-Susceptible Staphylococcus Aureus Nasal Colonization and the Risk of Subsequent Methicillin-Resistant Staphylococcus Aureus Infections among Hospitalized Patients.” Diagn Microbiol Infect Dis. 2011 October 71 (2): 163-6. PMID: 21840671. ——Jodlowski, TZ, Ruhe, J. “Antiretroviral Medication Errors.” Hosp Pharm. 2011 April 46: 1. ——Sax PE, Tierney C, Collier AC, Daar ES, Mollan K, Budhathoki C, Godfrey C, Jahed NC, Myers L, Katzenstein D, Farajallah A, Rooney JF, Ha B, Woodward WC, Feinberg J, Tashima K, Murphy RL, Fischl MA, AIDS Clinical Trials Group Study A5202 Team (Mildvan D, Revuelta M, collaborators). “Abacavir/Lamivudine versus Tenofovir DF/Emtricitabine as Part of Combination Regimens for Initial Treatment of HIV: Final Results.” J Infect Dis. 2011 October 204 (8): 1191-201. PMID: 21917892. ——Deren S, Hagan H, Friedman S, Des Jarlais DC, Perlman D, Gwadz M, Cleland C, Osborne A, Lunievicz J. “Current and Emerging Research Needs in Studying the NYC HIV-Drug Use Epidemic.” Substance Use & Misuse. 2011 46: 316-319. ——Hagan H, Perlman DC, Des Jarlais DC. “Sexual Risk and HIV Infection among Drug Users in New York City: A Pilot Study.” Substance Use & Misuse. 2011 46 (2-3) 201-207. ——Des Jarlais DC, Arasteh K, McKnight C, Hagan H, Perlman DC, Semaan S. “Associations between Herpes Simplex Type 2 and HCV with HIV among Injecting Drug Users in New York City: The Current Importance of Sexual Transmission of HIV.” Am J Pub Health. 2011 July 101: 1277-1283.

2011 Year End Report 54 Department of Medicine – Division of Infectious Diseases

B. Presentations Mills A, Mildvan D, Podzamczer D, Falkenheuer G, Leal M, Than S, Valluri SR, Craig C, Heera J, Portsmouth S ——“Week 48 Results of Once-Caily Maraviroc (MVC) in Combination with Ritonavir- Boosted Atazanavir (ATV/r) Compared to Emtricitabine/Tenofovir (FTC/TDF) + ATv/r in Treatment-Naïve Patients Infected with CCR5-Tropic HIV-1 (Study A4001078).” 18th CROI, Boston, MA, February/March 2011.

Ruhe JJ, Francis F, de Guzman L, Goldstein R, Maco Flores V, Mildvan D, Perlman D, Waldron M, Koshy S, Gomez T ——“The Urine Nitrite Dipstick Test: Potential Usefulness for Guiding Empiric Antibiotic Therapy for Patients (pts) Admitted with Urinary Tract Infections.” Abstract 4874, SHEA, Dallas, TX, April 2011.

Jodlowski, TZ, Patel PN, Maisch NM, Mildvan D ——“Comparison of Online Drug Interaction Databases to Evaluate Antiretroviral Medication Interactions.” Abstract 24090, Annual ACCP Meeting, Pittsburgh, PA, October 2011.

Dhingra L, Masson C, Perlman D, Seewald R, McKnight C, Portenoy R ——“Epidemiology of Pain in a Methadone Maintenance Treatment Population: Demographic and Medical Correlates of Pain Experience.” Symposium, Meeting of the College on Problems of Drug Dependence, Hollywood, FL, June 2011.

Francis G, Rizk D, Perlman DC ——”Tap Water Enema and Cryptosporidium Infection in Acute HIV Infection. Abstract, Society of Hospitalist Medicine, Spring 2011. ID: 1046091.

Masson CL, Delucchi KL, McKnight C, Hall J, Young C, Ferrara J, Jordan A, Khalili M, Min A, Dominy S, Seewald R, Bodenheimer H, Des Jarlais DC, Sorensen JL, Perlman D ——“A Randomized Trial Evaluating the Effectiveness of a Hepatitis Care Coordination Model in Methadone Maintenance Treatment.” Abstract #1039113, CPPD meeting, Hollywood, FL, June 2011.

Larios SE, Masson CL, Delucchi KL, Dominy S, Khalili M, Hall J, McKnight C, Jordan A, Seewald R, Sorensen JL, Des Jarlais DC, Perlman DC ——“Education and Counseling Intervention Effective in Increasing HIV and Hepatitis Knowledge among Drug Users” Abstract #243143, Oral, 139TH APHA Meeting, Washington, DC, November 2011.

Arasteh K, Des Jarlais DC, Vorobjov S, Uuskula A, Perlman DC ——“Can Non-Injecting Drug Use Protect against Blood Borne Viruses among People Who Inject Drugs? Evidence from Tallinn, Estonia and New York City, USA.” Abstract #244981, 139TH APHA Meeting, Washington, DC, November 2011.

Seewald RM, Kamara E, Tio R, Elam R, Lorenz S, Bonilla V, Perlman DC ——“Need for Vaccination for Vaccine Preventable Hepatitis in Methadone Treatment. Abstract #237717, Oral, 139TH APHA Meeting, Washington, DC, October 2011.

2011 Year End Report 55 Department of Medicine – Division of Infectious Diseases

Des Jarlais DC, Arasteh K, McKnight C, Hagan H, Perlman DC, Semaan S ——“Associations between Herpes Simplex Type 2 Virus and Hepatitis C Virus with HIV among Injecting Drug Users in New York City: The Current Importance of Sexual Transmission of HIV.” Abstract #244581, 139TH APHA Meeting, Washington, DC, November 2011.

Hall JE, Larios SE, Hengl NS, Masson CL, Sorensen JL, Khalili M, Dominy S, Des Jarlais DC, McKnight CA, Jordan AE, Young CM, Perlman DC ——“Impact of Knowledge on Susceptibility Perceptions to HAV and HBV Infection among Methadone Maintenance Patients.” Abstract # 246303, Oral, 139TH APHA Meeting, Washington, DC, October 2011.

Masson CL, Delucchi K, McKnight C, Hall, Young C, Ferrara J, Jordan AE, Khalili M, Min A, Domini S, Seewald R, Bodenheimer H, Des Jarlais DC, Sorensen J, Perlman DC ——“Integrated Viral Hepatitis Care for Methadone Maintenance Treatment (MMT) Patients—Results from an RCT.” Abstract #244763, 139TH APHA Meeting, Washington, DC, November 2011.

Dhingra L, Masson CL, Perlman DC, Seewald RM, McKnight R, Jordan AE, Hall J, Young C, Katz J, Wald E, Delucchi K, Portenoy R ——“Epidemiology of Pain among Drug Users in Methadone Maintenance.” Abstract #246820, Oral, 139TH APHA Meeting, Washington, DC, November 2011. Goldstein R, Lalite S, Mildvan D, Perlman DC, Jodlowski T, Ruhe J ——Fluoroquinolone- and Ceftriaxone-Based Therapies of Community-Acquired Pneumonia (CAP) and the Risk of Subsequent Infection and Colonization with Multidrug-Resistant (MDR) Organisms in Hospitalized Patients.” Abstract, 49th Annual Meeting of the Infectious Diseases Society of America, Boston, MA, Fall 2011. Perlman D ——“Access to HIV and Hepatitis Screening and Care among Ethnic Minority Drug Users In and Out of Drug Treatment.” Invited Presentation, NIDA National Drug Abuse Treatment Clinical Trials Network, Steering Committee Meeting, Bethesda, MD, March 2011. ——“Transdisciplinary Implications of Human Genomics and Pharmacogenomics for the Study, Management, and Prevention of HIV, Hepatitis and Addiction.” Invited Presentation, Center for Drug Use and HIV Research, New York, NY, March 2011. ——“Hepatitis Care Coordination in Methadone Maintenance.” Invited Presentation, Center for Drug Use and HIV Research, NYU School of Nursing, New York, NY, May 2011. Koll B ——“Lessons Learned from the Campaign—Using the Improvement Map to Make Care Safer.” Invited Presentation, Institute for Healthcare Improvement Webinar, April 2011. ——“Standardization of Clinical Processes to Reduce C.difficile.” Invited Presentation, Association for Professionals in Infection Control and Epidemiology, Baltimore, MD, June 2011.

2011 Year End Report 56 Department of Medicine – Division of Infectious Diseases

——“Getting to Zero: Strategies to Reduce Central Line Associated Bloodstream Infections.” Invited Presentation, Turquoise Trail New Mexico Infusion Nurse Society Annual Conference, Albuquerque, NM, September 2011. —— Invited Presentation, Medicare Quality Improvement Organization (QIO) for NYS, Hartford, CT, November 2011. ——“Preventing Healthcare Associated Infections: Catheter Associated Urinary Tract Infections.” Invited Presentation, Island Peer Review (IPRO) 10th Scope of Work, New York, NY, November 2011. ——“Strategies to Reduce Central Line Associated Bloodstream Infections (CLABSls). Invited Presentation, Healthcare Association of New York State, On the CUSP: Stop BSI Webinar, December 2011.

7. Honors/Awards Donna Mildvan, MD ——Top Doctor (Global Directory of Who’s Who) 2011. ——Super Doctor (New York Times) 2011. ——America’s Top Doctors (Castle Connolly) 2011. Brian Koll, MD ——Continuum Health Partners, Inc., 2011, Board of Trustees Honorable Mention. Award for Quality & Patient Safety. David Perlman, MD ——Super Doctor (New York Times) 2011. ——America’s Top Doctors (Castle Connolly) 2011. ——New York Magazine “Best Doctors” 2011. ——Patients’ Choice Award 2011. Nadim Salomon, MD ——New York Super Doctor (New York Times) 2011.

8. Grants Non-Industry Funded ——NIAID 1R01AI070005, Peer-Driven Intervention to Enroll Minorities in HIV Clinical Trials. 2007-2011. PI: M Gwadz (NYU); Co-I: D Mildvan. ——NIMH 5R34MH093352-02, Intervention to Increase Timely Initiation of HAART among Those Who Delay/Decline. 2011-2014. PI: M Gwadz (NYU); Site-PI: N Salomon; Co-Investigator: D Mildvan. ——BAA NIAID-DMID NIH AI 2009 058, Microbiology Testing with the Aim of Directed Antimicrobial Therapy for CAP. 2011-2016. PI: V Yu (University of Pittsburgh); Site-PI: D Mildvan. ——NIDA, 5 R01DA003574-29, Risk Factors for AIDS Among IV Drug Users. 1994- 2014. PI: D Des Jarlais; Consultant: D Mildvan. ——NIDA/NIH R01 DA020841-01A1, Hepatitis Care Coordination in Methadone Treatment. 2006-2012. PI: D Perlman. ——NIDA/NIH P30 DA011041-09, High Risk Drug Use & Learning from the NYC Epidemic. 2006-2013. PI: S Deren (NYU); Subcontract PI: D Perlman, Director Infectious Disease Core, Center for Drug Use and HIV research (NYU).

2011 Year End Report 57 Department of Medicine – Division of Infectious Diseases

——NIH R01 DA03766-01, Start Together: HIV Testing and Treatment In and After Jail. 2010-2012. PI: S Sacks (NDRI); Co-Investigator: D Perlman. ——NIH 1R01 DA032083-01, Seek, Test, and Treat: Identifying and Treating HIV Infected High Risk Heterosexuals in Hyper-Endemic Urban Areas. 2011-2016. PI: M Gwadz (NYU); Co-Investigator: D Perlman. ——CDC TBESC Task Order 28 Protocol: Treatment Practices, Outcomes, and Cost of Multidrug Resistant and Extensively Drug-Resistant Tuberculosis in the United States. 2009-2012. Co-Investigator: M Revuelta.

Industry-Funded Grants: 13 active

2011 Year End Report 58 Department of Medicine – Division of Infectious Diseases—AIDS Center Henry C. Bodenheimer, MD, Chairman

X. DIVISION OF INFECTIOUS DISEASES—AIDS CENTER Donna Mildvan, MD, Division Chief

1. Program Enhancements

A. New Programs i. HIV Testing Support Service Grant: We successfully competed for new HIV prevention funding to enhance and support the implementation of routine HIV testing among inpatient units. The new program focuses on providing technical assistance and training to inpatient staff (attending, housestaff and nursing) to ensure compliance with 2010 NYS HIV testing law. ii. HAART-To-Heart Project: We initiated the NIH-funded HAART-to-Heart Program at PKC (Marya Gwadz, NYU, PI). This program encourages engagement into care and supports initiation and adherence to treatment by providing education, resources and mentorship. iii. Diabetes Navigator Program: In conjunction with the Friedman Diabetes Institute, we initiated referral of PKC patients for the Diabetes Navigator Program. This program provides patient assistance and support for diabetes management via education and other resources. B. Program Expansions i. Routine HIV Testing: The AIDS Program was an integral participant in the finaliza- tion of the Continuum-wide HIV testing policy. Its subsequent implementation was achieved through the support of the HIV Testing Support Service Grant (see above). Staff of the AIDS Center continue to provide support and expertise on issues related to HIV testing across the medical center. ii. Dental Services: Due to staffing changes that resulted in a service reduction as well as increased patient demand, dental services at PKC were increased from 2 to 4 sessions per week. iii. Care Coordination: The HRSA/Ryan White Part A-Funded Care Coordination Program saw a significant expansion in enrollments during the year, increasing from 95 enrolled patients to over 176 enrolled patients by year-end. Patients enrolled in the program showed a significant increase in HIV medication adherence rates, with 92% of enrolled clients achieving 95% adherence or higher compared with 81% of enrolled clients achieving 95% adherence or higher across all NYC Care Coordination Programs.

2. Capital Enhancements

A. Facility Enhancements —— The AIDS Center used Krueger Funds to purchase and install new furniture for the PKC patient waiting room, greatly enhancing the overall environment and improving the overall patient experience at PKC.

2011 Year End Report 59 Department of Medicine – Division of Infectious Diseases—AIDS Center

3. Quality Initiatives/Achievements

A. PKC is committed to ensuring that patients are satisfied with the care and services they receive. Annual patient satisfaction surveys are one of the methods used to track quality improvement. Results are presented to staff, and data are used to improve processes. Although clinic ratings have generally been high over the years on most parameters measured, patient feedback has indicated that social work services specifically have improved markedly. B. PKC regularly monitors the clinical standards of care set by the NYS AIDS Institute. Data on quality indicators are entered into the web-based HIVQUAL database for program evaluation and statewide comparisons. PKC has been at or above benchmark on many clinical indicators (i.e., HIV monitoring, HCV evaluation, annual comprehensive visits), both at the internal programmatic level and statewide comparisons among DACs. C. PKC medical staff submitted an abstract to IDSA on factors associated with viral load suppression. The research study focused on subpopulations underrepresented in clinical trials, i.e., substance abuse, psychiatric illness, Hepatitis C (HCV) and ethnic minorities. The statistical analyses indicated that race was a significant predictor of VL suppression, with the black race more likely to have a detectable viral load. Increasing age was also found to be a contributing factor promoting VL suppression. D. PKC recognizes the importance of improving patients’ access to health information. All staff is committed to assisting patients in understanding this information and how to use it in making good decisions about their health. In 2011, PKC implemented Health Literacy Screening for all patients at initial and annual medical visits. Patients identified with health literacy concerns are referred to the Care Coordination Program.

4. Academic Appointments Refer to Division of Infectious Diseases.

5. Fellow/Resident Board Passage Rates Refer to Division of Infectious Diseases.

6. Peer-Reviewed Publications and Presentations

A. Presentations Dahlia Rizk, DO, Charlene Monaco, Scott Barnett, Nadim Salomon, MD ——“Hospitalists’ Critical Role in Public Health: Tackling HIV Awareness with Inpatient Health Educators.” Poster Presentation, Society of Hospital Medicine Annual Conference, Dallas, TX, May 2011.

7. Honors/Awards Refer to Division of Infectious Diseases.

2011 Year End Report 60 Department of Medicine – Division of Infectious Diseases—AIDS Center

8. Grants Non-Industry Funded ——HRSA Ryan White Part A - Care Coordination. 12/1/2009 – 2/28/2014. ——HRSA Ryan White Part A - Project SHARE: Harm Reduction Services. 3/1/2007 – 2/28/14. ——CDC Prevention - HIV Testing Support Service Grant. 1/1/2012-12/31/2014.

2011 Year End Report 61 Department of Medicine – Internal Medicine Residency Training Program Henry C. Bodenheimer, MD, Chairman

XI. INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM Daniel Steinberg, MD, Division Chief

1. Program Enhancements

A. New Programs i. Fellowship in Medical Education and Administration: On July 1, 2011, the department launched a one-year fellowship in medical education and administration, to run concurrent with the chief medical resident position. The inaugural class of five fellows designed, led and helped implement education, quality improvement and patient safety initiatives at the departmental and institutional levels. ii. “6+2” System: On July 1, 2011, the residency adopted an entirely new structure for inpatient and ambulatory rotations. The new “6+2” system enables greater inpatient team cohesiveness, reduces handoff and allows for a more patient-centered ambulatory schedule. This type of “inpatient/ambulatory” block scheduling is a goal of many residency programs around the country and we are proud to have implemented it. B. Program Expansions i. Simulation Training: Simulation training for medical residents was expanded, with new scenarios for COPD and acute cardiac emergency added to the curriculum. ii. Additional Residency Rotation: On July 1, 2011, 16 categorical internal medicine residents began rotating at the Ryan Nena Community Health Care Center for their ambulatory continuity care experience. Located in the heart of the Lower East Side of Manhattan, Ryan Nena serves a diverse patient population, making it an ideal site for residents to learn and practice primary care.

2. Capital Enhancements

A. Equipment Enhancements i. Two-way video teleconferencing equipment was installed at General Medical Associates and the Ryan Nena Community Health Care Center, and in the Resident library. This has allowed residents to view and participate in departmental teaching conferences remotely. B. Facility Enhancements i. Remodeling of the Resident library and lounge room on 18 Baird was completed, including the installation of brand new computers, leather and wood furnishings, and two-way video teleconferencing equipment, providing our residents with the most up- to-date facilities in which to learn, work and relax.

3. Quality Initiatives/Achievements

A. The program directors and the fellows in Medical Education and Administration completed a quality improvement project titled “The Hawthorne Effect Improved Admission Medication Reconciliation by Internal Medicine Residents.” As compared with educational efforts alone, regular audits of resident performance demonstrated a statistically significant increase in compliance with admission medication reconciliation (preliminary unpublished data).

2011 Year End Report 62 Department of Medicine – Internal Medicine Residency Training Program

B. In July 2011, the residency program began collecting anonymous multi-lingual patient satisfaction evaluations of residents at all three teaching ambulatory sites. The results of these evaluations are reviewed semi-annually with residents, providing an important additional source of feedback. C. The “Patient Acuity Score,” a new tool to improve the quality of resident handoff, was developed. The tool generates a severity score for patients based on acuity of illness or the presence of factors that place patients at higher risk of adverse outcomes. Launch is planned for 2012, concurrent with institutional revision of the eSignout online handoff program.

4. Fellow/Resident Board Passage Rates —— Residents: 75%.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications Daniel Steinberg, MD ——Boonyasai RT, Steinberg DI, Scheleyer AM, Mourad MM, Harte BJ, Sharpe BA. “Update in Hospital Medicine for the General Internist 2010—2011.” Journal of General Internal Medicine. 2011 December 26 (12): 1492-7. ——Steinberg DI. ACP Journal Club Review: “Risk Prediction Scales Have Different Strengths and Weaknesses for Predicting Mortality in Community—Acquired Pneumonia.” Annals of Internal Medicine. 2011 Apr 19; 154 (8): JC4-12. PMID: 21502638. ——Sorita A, Steinberg D, Leitman M, Luhan P, Burger A, Sivaprasad L. “Impact of Targeted Individual Feedback on Provider Patterns of STAT Laboratory Test Ordering Frequency.” Journal of Hospital Medicine. 2011 6 (s2) 135-136.

Alfred Burger, MD ——Farnan J, Lycium L, Burger A, Harrison R, Maclusky J, Parekh V, Sharpe B, Schleyer A, Boonyasai R, Aroroa V. “Hospitalists and Housestaff Supervision: A Marriage of Convenience?” Journal of General Internal Medicine. 2011 26 (s1) 284-285, and Journal of Hospital Medicine 2011 6 (s2) 28-29. ——Lee M, Khan F, Glockenberg K, Burger A. “Digital Ischemia Secondary to Essential Thrombocythemia.” Journal of Hospital Medicine. 2011 6 (s2) 208. ——Sorita A, Steinberg D, Leitman M, Luhan P, Burger A, Sivaprasad L. Impact of Targeted Individual Feedback on Provider Patterns of STAT Laboratory Test Ordering Frequency. Journal of Hospital Medicine 2011 6 (s2) 135-136.

Jose A Cortes, MD ——Robert Goldstein, Jagdeep Singh, Yuriy Israel, Latha Sivaprasad, Miwako Kobayashi, Jose Cortes, MD. “Villaret’s Syndrome Due to Skull Base Aspergilloma in a Diabetic Male: A Case Report.” Journal of Hospital Medicine. 2011 Vol 6 (S4) 185-186.

2011 Year End Report 63 Department of Medicine – Internal Medicine Residency Training Program

B. Presentations Daniel Steinberg, MD ——“Update in Hospital Medicine.” Plenary Session, Society of Hospital Medicine Annual Meeting 2011, Dallas, TX, May 2011.

Alfred Burger, MD ——“Digging a Deeper Well for the Pipeline QI and Patient Safety.” Alliance for Academic Internal Medicine Fall Meeting, Anaheim, CA, October 2011.

Alfred Burger, MD, and Jose Cortes, MD ——“How Did You Do That? Development of Resident Teaching and Leadership Skills ‘Boot Camp’.” Albert Einstein College of Medicine Clerkship Retreat, Bronx, NY, June 2011.

Jose A Cortes, MD ——“Immune Reconstitution Inflammatory Syndrome in an HIV-NEGATIVE Patient as a Result of Pregnancy.” Oral Presentation (with Akshay Manohar), ACP Annual Meeting, San Diego, CA, April 2011.

Adrienne M. Fleckman, MD ——“Impact of a Project Renewal™ Shelter on Diabetic Management.” Poster Presentation, Abstract #276 (with Kim SY, Seth A, Almakaev IM), 20th Annual Meeting American Association of Clinical Endocrinologists (AACE 2011), San Diego, CA, April 2011. ——“Graves’ or Thyroiditis Thyrotoxicosis: Etiologic Mystery Solved by Ultrasound.” Poster Presentation, Abstract 1071 (with Ramnaraine M, Romero C), 20th Annual Meeting American Association of Clinical Endocrinologists (AACE 2011), San Diego, CA, April 2011. ——“Finger−Stick Glucose Values Are an Essential Complement to Hemoglobin A1c and Fructosamine in HIV−Infected Patients with Diabetes.” Poster Presentation, Abstract P2−526 (with Kim SY, Friedmann P, Seth A), Endocrine Society 93rd Annual Meeting, Boston, MA, June 2011. ——“Using ‘Prolonged’ Cosyntropin Stimulation Test to Diagnose Secondary Adrenal Insufficiency following a Single Epidural Injection of Triamcinolone Acetonide (Kenalog) a Rare Case.” Poster Presentation, Abstract P3-550 (with Feng Y, Needleman N, Araki T), Endocrine Society 93rd Annual Meeting, Boston, MA, June 2011.

6. Honors/Awards Alfred P. Burger, MD ——Associate Program Director was elected to the Leo M. Davidoff Society at Einstein, for “outstanding achievement in the teaching of medical students” for at least five years. The Internal Medicine Residency Program and all accredited fellowships in the Department of Medicine ——Received full continued accreditation status from the ACGME.

2011 Year End Report 64 Department of Medicine – Methadone Maintenance Treatment Program (MMTP) Henry C. Bodenheimer, MD, Chairman

XII. METHADONE MAINTENANCE TREATMENT PROGRAM (MMTP) Randy Seewald, MD, Medical Director

1. New Faculty —— Elizabeth Wilson, MD, MMTP Physician-in-Charge, Full-time, July 2011. —— Irene Hwang, MD, MMTP Physician-in-Charge, Full-time, August 2011.

2. Program Enhancements

A. New Programs i. HIV and Hep C Care: Implemented HIV and Hep C specialty level primary care on site, and HIV medical case management with patients who are HIV positive at the Community Primary Care Clinic on 125th street, focusing on HIV and Hep C prevention. ii. Hep C Testing/Referrals Protocols Developed: All patients in MMTP are screened for Hep A, B and C, and vaccinations are provided on site when indicated. Enhanced linkages with referral resources for Hep C evaluation and treatment. Referrals for follow-up arranged, consistent with best practice standards as established by OASAS. iii. Twinrix 4 Dose Accelerated Vaccination Series: Implemented with SAMHSA- provided vaccine. Over 2,300 patients completed full vaccination series. iv. Buprenorphine Certification and American Board of Addiction Medicine: Now required of all new physicians within two years of employment. v. Short-Term Maintenance and Ambulatory Detoxification Programs: Developed, approved by OASAS and implemented, setting the standard for the field. vi. Switched to Fee-for-Service Billing (APGs): This new reimbursement structure allows for enhanced services to be provided. Retrained all medical and counseling staff on documentation of service provision, and revised billing format. vii. Prepared for Joint Commission Accreditation in all 18 locations. Conducted audits of all service provision and in accordance with TJC standards. viii. Began Implementation of Electronic Case Record: Dispensing and billing services were conducted through the AVATAR system. Case documentation for medical services was folded into this documentation, and lab work is integrated into Avatar. During 2012, this case record system will include counseling services, including treatment planning. ix. Prepared for Health Home Implementation in terms of coordination of care and enhancement of collaborative relationships with key referral resources. Participated in the development of Continuum’s application for DOH Health Home and in forma- tion of the model of care to be provided. B. Program Expansions i. Enhanced MMTP Capacity to Respond to Patients with Co-Occurring Mental Health Disorders: Currently, screening and assessment is conducted. Program seeks to add group treatment and other services for people suffering from mental health disorders (these are billable under APG‘s). ii. Revised and Implemented Suicide Risk Assessment: Previous screening was not specific to suicide risk. Patients are now screened for risk and protective factors within 72 hours, with re-assessment at regular intervals.

2011 Year End Report 65 Department of Medicine – Methadone Maintenance Treatment Program (MMTP)

iii. Enhanced Collaboration with Child Welfare System: MMTP and Stuyvesant Square host trainings for child welfare staff and onsite visits. MMTP has received approval of parent training curriculum that satisfies requirements of child welfare for patients who are involved with child welfare. Joint efforts of child welfare and MMTP foster the integrity of the families of people in treatment. iv. Re-established Patient Advocacy and Peer Services: Patient committees are being established in each clinic to provide feedback to program leadership. Training is being planned for September 2012 to develop peer recovery services. Twenty to 25 patients will be trained as peer recovery coaches and will help support the progress of other patients; these patients will be certified as peer recovery specialists. v. Expanded Availability of Group Counseling in All Clinics: Extensive training on group facilitation was provided for counselors in all clinics. Wurzweiler School of Social Work provided the training on site. Group supervision of facilitators is being provided.

3. Capital Enhancements

A. Equipment Enhancements i. Obtained ECG machine at 125th Street Community Primary Care, enabling program to screen for and monitor for cardiac arrhythmias caused by methadone. ii. Upgraded office equipment in all clinics (new printers, fax machines and scanners). B. Facility Enhancements i. Desks and chairs replaced to upgrade office furniture for staff and patients, improving environment of care. ii. Upgraded fire alarm systems in many clinics to improve safety.

4. Quality Initiatives/Achievements i. Medication Reconciliation: Improved coordination of care with primary care physicians and psychiatric services. MMTP Clinic staff had a QI project on care coordination with outside providers accepted for oral presentation as a workshop at the National American Association for the Treatment of Opioid Dependence (AATOD) in Las Vegas. ii. Routine Monitoring of Program Quality Measures: Including illicit substance and treatment retention. iii. Clinic Specific Projects: Developed by each clinic, and quality indicators such as illicit drug use and toxicology monitored.

2011 Year End Report 66 Department of Medicine – Methadone Maintenance Treatment Program (MMTP)

MONTH CLINICS MANAGER CQI PROJECT REQUESTED Cumberland Marie Medication Reconciliation April 3 Orlando Medication Reconciliation July 8 Charles COD city project Coordination of services between 1E Toni mental health provider and MMTP. August 1 Gail Efficacy of attending groups (1) AVE A Steve Medication Reconciliation. 6/7 Maria Medication Reconciliation Billie’s Place Maria Medication Reconciliation September Gouverneur Amanda COD city project Nyswander Calvin Medication Reconciliation % maintained or improved employ- 8D Larry October ment status 3G Joan COD city project 2F Rose NIATX addressing retention issues. November 2C Keith Medication Reconciliation 2 Roselyn 1 month retention rate. Dole Meredith Assessment of completion of MMS. December 3C Rubenette Medication Reconciliation

Toxicology Analysis

2010 19.98% 17.63% 16.59% 42.16%

2011 19.35% 17.29% 16.52% 41.56%

2012 19.66% 16.39% 15.52% 39.99%

These results include patients with prescribed medications.

2011 Year End Report 67 Department of Medicine – Methadone Maintenance Treatment Program (MMTP)

Randomized Toxicology Results (Jan 2012 – May 2012)

3.5% 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Oxycodone Amphetamine PCP Barbiturate Buprenorphine Tricyclic

Randomized Toxicology Analysis from January 2012 to May 2012

Oxycodone Amphetamine PCP Barbiturate Buprenorphine Tricyclic

Clinic Name Total Positive Total Positive Total Positive Total Positive Total Positive Total Positive

3G 1618 2.47% 921 1.95% 437 0.23% 986 0.10% 294 1.02% 327 2.45%

2C 2290 3.62% 1120 1.43% 601 0.83% 1207 0.50% 450 1.78% 413 3.15%

2F 2100 1.48% 1197 0.67% 534 0.56% 1304 0.38% 427 0.47% 389 2.57%

1E 1956 5.32% 1096 1.09% 514 0.97% 1164 0.17% 398 2.76% 361 2.49%

3C 1961 1.94% 1028 0.78% 480 0.42% 1091 0.27% 400 1.50% 398 3.27%

AVENUE A 2149 3.44% 1179 0.42% 579 1.21% 1222 0.82% 416 1.92% 416 1.20%

HARLEM 1 2034 3.49% 1067 0.09% 466 1.07% 1142 0.53% 433 1.85% 394 2.28%

HARLEM 2 3583 3.07% 1776 0.39% 915 0.98% 1914 0.16% 718 1.67% 711 2.67%

HARLEM 3 2769 2.60% 1453 0.21% 705 0.57% 1579 0.44% 544 1.65% 551 4.36%

HARLEM 6/7 2800 2.75% 1575 0.25% 696 2.16% 1720 0.52% 588 0.85% 535 2.06%

BILLIE’S PLACE 449 4.01% 201 0.00% 112 0.00% 223 0.00% 119 12.61% 60 6.67%

HARLEM 8 1866 3.22% 1101 0.54% 482 1.66% 1143 0.44% 498 7.63% 227 5.73%

HARLEM 8D 2346 3.54% 1312 0.15% 584 0.86% 1406 1.07% 481 0.21% 456 5.48%

NYSWANDER 739 3.25% 410 0.24% 189 2.65% 436 0.23% 164 0.61% 134 1.49%

ST. VINCENTS 810 5.56% 458 1.97% 217 0.46% 461 0.22% 177 2.26% 159 2.52%

GOUVERNEUR 2157 2.36% 1183 0.59% 501 0.40% 1266 1.34% 436 0.69% 421 2.85%

DOLE 2735 5.52% 1532 0.00% 716 0.56% 1639 1.10% 522 1.92% 522 3.26%

CUMBERLAND 3275 2.53% 1755 0.06% 827 0.24% 1934 0.88% 669 1.20% 579 4.15%

MMTP 37637 3.23% 20364 0.53% 9555 0.87% 21837 0.58% 7734 1.97% 7053 3.15%

5. Academic Appointments —— All new physicians hired by MMTP are in the process of obtaining academic appointments at AECOM and are increasingly involved in the resident training programs at BIMC.

6. Fellow/Resident Board Passage Rates —— All new physicians are sitting for their American Board of Addiction Medicine exams within two years of their date of hire. To date, 100% addiction medicine and primary board passage rate.

2011 Year End Report 68 Department of Medicine – Methadone Maintenance Treatment Program (MMTP)

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Deren S, Kang S-Y, Mino M, Seewald RM. “Attitudes of Methadone Program Staff toward Provision of Harm Reduction and Other Services.” Journal of Addiction Medicine. 2011 December Vol 5- Issue 4- p 289-292 doi:10.1097/ ADM.0b013e31821dc61a. ——Juliana, P. “Evaluation of an Integrated Treatment Model for Persons with Co- Occurring Substance Abuse and Mental Health Disorders.” Dissertation, 2011 May.

B. Presentations Randy Seewald, MD ——“Effective Use of Urine Drug Screening”—Faculty and Session Chair. Emerging Practices in Pain and Chemical Dependency: Update on the Clinical Use of Drugs of Abuse, New York, NY, March 2011. ——“Pain Management in Active Substance Users with HIV”—Faculty. Cooper Health Systems, Camden, NJ, February 2011. ——“Overview of Treatment for Opioid Dependence.” New School for Social Research, Advanced Issues in Substance Abuse Counseling Course, New York, NY, February 2011.

Patti Juliana, PhD ——Juliana P, Coppola J, Carise D, Taylor P. “Health Care Reform: Threats and Opportunities.” NYU Conference on Substance Use: Responding to Changes in Policy, Research and Services, NYU, New York, NY, December 2011.

Loran E, Todman M, Sivesind D, Cruciani R, Haller D, Seewald RM ——“Boredom, Pain and Illicit Drug Use in MMTP Patients.” Abstract, CPDD 73rd Annual Meeting, FL, June 2011.

Seewald RM, Todman M, Loran E, Sivesind D, Roane D, Haller D, Cruciani R ——“Pain in Methadone Maintenance Patients.” Abstract, CPDD 73rd Annual Meeting, FL, June 2011.

CL Masson, KL Delucchi, C McKnight, J Hall, C Young, J Ferrara, A Jordan, M Khalili, A Min, S Dominy, R Seewald, H Bodenheimer, DC Des Jarlais, JL Sorensen, DC Perlman ——“A Randomized Trial Evaluating the Effectiveness of a Hepatitis Care Coordination Model in Methadone Maintenance Treatment (MMT).” Abstract, CPPD 73rd Annual Meeting, FL, June 2011.

Dhingra L, Masson CL, Perlman, D, Seewald R, McKnight C, Portenoy RK ——“Epidemiology of Pain in a Methadone Maintenance Treatment Population: Demographic and Medical Correlates of Pain Experience: Associations among Pain, Psychological Distress, Quality of Life, and Substance Use in a Methadone Maintenance Treatment Population.” Symposium, CPPD 73rd Annual Meeting, FL, June 2011.

2011 Year End Report 69 Department of Medicine – Methadone Maintenance Treatment Program (MMTP)

Larios S, Masson CL, Delucchi KL, Dominy S, Khalili M, Hall J, McKnight C, Jordon A, Young C, Seewald RM, Sorenson J, Des Jarlais DC, Perlman DC ——“Education and Counseling Intervention Effective in Increasing HIV and Hepatitis Knowledge among Drug Users.” Oral Presentation, APHA Annual Meeting, Washington, DC, October 2011.

Seewald RM, Kamara E, Tio R, Elam R, Lorenz S, Bonilla V, Perlman DC ——“Need for Vaccination for Vaccine Preventable Hepatitis in Methadone Maintenance Treatment.” Oral Presentation, APHA 139th Annual Meeting, Washington, DC, October 2011.

Masson CL, Delucchi KL, McKnight C, Hall J, Young C, Ferrara J, Jordon A, Khalili M, Min A, Dominy S, Seewald RM, Bodenheimer H, Des Jarlais DC, Sorenson J, Perlman DC ——“Integrated Viral Hepatitis Care for Methadone Maintenance Treatment Patient—Results from an RCT.” APHA 139th Annual Meeting, Washington, DC, October 2011.

Dhingra L, Masson CL, Perlman D, Seewald RM, McKnight C, Jordon AE, Hall J, Young C, Katz J, Wald E, Delucchi KL, Portenoy RK ——“Epidemiology of Pain among Drug Users in Methadone Maintenance.” Oral presentation, APHA 139th Annual Meeting, Washington, DC, November 2011.

8. Honors/Awards Patti Juliana, PhD ——ASAP NYS “Women in Leadership” Award, April 2011.

9. Grants Substance Use-Onsite Primary Care, Prevention, Retention in Drug Treatment ——Sponsor: NYS Department of Health - AIDS Institute. ——Contract # C025693. ——Budget Period: 05/01/11 to 04/30/12. ——Budget Amount: $540,000. ——Total Expenditure: $507,447.86. ——Payment Structure: Cost Reimbursement. ——SF # PT56004039AIDS Institute Grant - HIV Services /Medical Case Management and prevention with positives. ——P Juliana, Co-Principal Investigator, “Modifiable Risk Factors for Chronic Disease of HIV+ New Yorkers: Baseline Assessment.”

2011 Year End Report 70 Department of Medicine – Division of Nephrology and Hypertension Henry C. Bodenheimer, MD, Chairman

XIII. DIVISION OF NEPHROLOGY AND HYPERTENSION James F. Winchester, MD, Division Chief

1. Program Enhancements

A. New Programs i. Five-year accreditation of training program November 2010.

2. Capital Enhancements

A. Equipment Enhancements i. Ten new hemodialysis machines and water purifiers have been placed at Petrie and BI Brooklyn. B. Facility Enhancements i. Upgrade of outpatient dialysis facility at Irving Place will be completed in 2012 (Medical Director: Dr. R. Amerling).

3. Quality Initiatives/Achievements

A. Hyponatremia as a risk for in-patient falls. i. Demonstrated many fold risk of in-patient falls when serum sodium is between 130 and 135 mEq/L (abstract presentation). ii. Goal is grant application by renal division. B. Proteinuria as a risk factor for venous thromboembolism. i. Demonstrated many fold risk of venous thrombosis when urine protein is between 1+ and 3+ (abstract presentation and publication). ii. Goal is grant application by renal division. C. Petrie dialysis quality improvement (ongoing monthly, combined with environments of care assessment (EOC)). D. Outpatient dialysis quality improvements (ongoing monthly, combined with environment of care assessment (EOC)), performed at Irving Place, Yorkville and Upper Manhattan facilities. E. Quarterly review of outpatient dialysis quality improvement and other issues by governing bodies of each dialysis facility. F. Quality review of outpatient dialysis quality improvement and other issues by Executive Oversight Committee of all dialysis facilities. G. Divisional report to Petrie CQI committee. i. Satisfaction (patient/employee). a. J. Winchester is ambassador for “We are always here to help” program. b. J. Winchester is floor leader on 9 Silver. H. Pilot project on pain management underway to identify pain-free hours and establish criteria for pain consultation. Plan is to roll out the project to other units. I. Patient satisfaction scores have improved.

2011 Year End Report 71 Department of Medicine – Division of Nephrology and Hypertension

4. Fellow/Resident Board Passage Rates —— Fellows: 100% (100% pass rate in past eight years).

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Brener ZZ, Winchester JF, Salman H, Bergman M. “Nephrolithiasis: Evaluation and Management.” Southern Medical Journal. 2011 February 104: 133-9. ——Brener ZZ, Winchester JF, Bergman M. “Response to Nephrolithiasis: Evaluation and Management.” Southern Medical Journal. 2011 June 104: 463. ——Amerling R, Ronco C, Kuhlman M, Winchester JF. “Arteriovenous Fistula Toxicity.” Blood Purification. 2011 January 31 (1-3): 113-20, E-pub January 10, 2011. ——Latif W, Karaboyas A, Tong L, Winchester JF, Arrington CJ, Pisoni RL, Marshall MR, Kleophas W, Levin NW, Sen A, Robinson BM, Saran R. “Uric Acid Levels and All-Cause and Cardiovascular Mortality in the Dialysis Population: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).” Clinical Journal of the American Society of Nephrology. 2011 October 6: 2470-7, E-pub ahead of print August 25, 2011. ——(Jointly) Ghannoum M, Nolin TD, Lavergne V, Hoffman RS; EXTRIP workgroup. “Blood Purification in Toxicology: Nephrology’s Ugly Duckling.” Advances in Chronic Kidney Disease. 2011 May 18: 160-6. ——(Jointly) Kaysen GA, Larive B, Painter P, Craig A, Lindsay RM, Rocco MV, Daugirdas JT, Schulman G, Chertow GM; FHN Trial Group. “Baseline Physical Performance, Health, and Functioning of Participants in the Frequent Hemodialysis Network (FHN) Trial.” American Journal of Kidney Disease. 2011 July 57 (1): 101-12. ——(Jointly) Suri RS, Larive B, Garg AX, Hall YN, Pierratos A, Chertow GM, Gorodetskeya I, Kliger AS; FHN Study Group. “Burden on Caregivers as Perceived by Hemodialysis Patients in the Frequent Hemodialysis Network (FHN) Trials.” Nephrology Dialysis and Transplantation. 2011 July 26: 2316-22, E-pub Mar 18, 2011. ——(Jointly) Jhamb M, Tamura MK, Gassman J, Garg AX, Lindsay RM, Suri RS, Ting G, Finkelstein FO, Beach S, Kimmel PL, Unruh M; Frequent Hemodialysis Network Trial Group. “Design and Rationale of Health-Related Quality of Life and Patient-Reported Outcomes Assessment in the Frequent Hemodialysis Network Trials.” Blood Purification. 2011 January 31: 151-8, E-pub Jan 10, 2011. ——Winchester JF, Harbord NB. “Intoxications Amenable to Extracorporeal Treatment.” Advances in Chronic Kidney Disease. 2011 May 18: 167-171. ——Goldfarb DS, Harbord NB, Winchester JF. (Editorial) “The Hemodialysis Machine: Where the Nephrologists and Toxicologists Meet.” Advances in Chronic Kidney Disease. 2011 May 18: 157-159.

2011 Year End Report 72 Department of Medicine – Division of Nephrology and Hypertension

6. Honors/Awards J Winchester, MD —— New York Best Doctors, Castle Connolly Top Doctors 2007-2011. —— Appointed Committee Member, EXTRIP International Toxicology Committee on Dialysis of Poisons. S Gruber, MD —— Super Doctors NY, 2009-2012. —— Elected to FACP 2011. R Amerling, MD —— Super Doctors NY, 2009-2012. N Harbord, MD —— Named Most Compassionate Doctor, American Registry. —— Awarded certification as specialist in hypertension.

7. Grants Internally funded: Conducted by Renal Research Institute, with several joint projects. ——IRB #005-11 : A Phase 2, Randomized, Open-Label Active-Comparator (Epoetin alfa) and Single-Blind Placebo-Controlled, Dose Ranging Safety and Exploratory Efficacy Study of FG 4592 in Subjects with End-Stage Renal Disease Receiving Maintenance Hemodialysis. ——IRB #062-11: A Pilot Study: Examining the Link between Tryptophan Levels and Fatigue, Sleep and Depression in Chronic Hemodialysis Patients ——IRB #063-11: Monitoring Body Hydration State in Hemodialysis Patients with POD Compared to Hydra, ZOE and DF50 Bioimpedance Devices. ——IRB #081-11: Determining the Impact of Hemodialysis on the Variability of Clinical Measures of Body Composition. ——IRB #102-11: A Randomized, Multi-Center, Phase IV, 2-Arm, Open-Label, Cross- Over Study to Demonstrate Equivalence of Calcium Acetate Oral Solution vs. Sevelamer Carbonate Tablets in Hemodialysis Patients (11-183 NE IRB). ——IRB #150-11: Hemodialysis with the 2008 Sorbent System: A Pilot Evaluation of Different Treatment Prescriptions. ——IRB #267-11: Characteristics of Residual Renal Function at Dialysis Initiation and Trajectory of Its Decline. ——IRB #271-11: The Effect of Erythopoetin Dosing in Accumulation of Oxidative Stress Products in Erythrocytes in ESA Resistant Dialysis Patients (not approved).

Industry funded: Several studies in area of pulmonary hypertension (P.I. R. Sulica) being coordinated.

2011 Year End Report 73 Department of Medicine – Occupational Medicine/Employee Health and Business Health Services Henry C. Bodenheimer, MD, Chairman

XIV. OCCUPATIONAL MEDICINE/EMPLOYEE HEALTH AND BUSINESS HEALTH SERVICES David D’Souza, MD, MPH, Division Chief

1. New Faculty —— Joseph Bottner, MD, Disability Evaluations, Part-time, April 27, 2011.

2. Program Enhancements

A. New Programs i. Medical Disability Evaluations: Metro-North Railroad contracted with Business Health Services (BH) to conduct medical disability evaluations on its employees. The evaluations occur in the Occupational Medicine Department two to four half-days a month. ii. Specialty Evaluations: BH contracted with New York City Employee Retirement Services (NYCERS) to perform specialty evaluations in psychiatry, ophthalmology, cardiology and other specialties for its retirees. B. Program Expansions i. Student Health Center at Baruch: Due to increasing use of the student health center at Baruch, an additional nurse was added to assist the mid-level provider with preventive health counseling and wellness programs as well as perform ancillary testing. ii. Business Health Services: BH increased its gross revenue by 30% for 2010 and 2011, compared to 2009. It also continued outreach to business clients and saw the addition of new clients, among them Alcoa for executive physicals, Columbia University’s health center for occupational medicine services for its staff, and newly- opened endoscopy centers in the city for pre-placement examinations for staff. BH also participated in health fairs at employers, colleges and universities to increase Beth Israel’s brand exposure among their staff and students. iii. Employee Health (EH): EH nurses and PAs were trained to perform breath-alcohol testing and urine drug collection, following Department of Transportation regulations including chain-of-custody protocol.

3. Capital Enhancements

A. Equipment Enhancements i. The Occupational Medicine (OM) department is expected to upgrade its employee compliance tracking program later in 2012 to a web-based server. The current system is no longer supported by the manufacturer. IT has been working with the departments here and at St. Luke’s-Roosevelt on this contract.

4. Quality Initiatives/Achievements

A. BH implemented student satisfaction surveys at student health sites in addition to the Petrie campus. The reviews by employees/patients/students have been very good, with almost all categories showing improvement over 2010 scores.

2011 Year End Report 74 Department of Medicine – Occupational Medicine/Employee Health and Business Health Services

Division of Occupational Medicine Patient Satisfaction Survey Results

2010 2011

5 4.5 4 3.5 3 2.5 2 Scale of 1–5 Scale 1.5 1 0.5 0 Appearance Appearance Overall Courtesy of Time it took Clinical of waiting of physician appearance front desk to be seen evaluation by room room staff clinician

Division of Occupational Medicine Patient Satisfaction Survey Results

2010 2011

3 2.5 2 1.5

Scale of 1–3 Scale 1 0.5 0 How likely to return How likely to refer someone

B. Health care worker (HCW) vaccinations for influenza increased by 8% for the 2010-2011 season from the 2008-2009 season, but were less than the 2009-2010 season in which vaccination was mandatory for a time. HCW influenza vaccination is being considered a direct patient safety issue by regulatory bodies including the Joint Commission, and health care facilities will be required to publish health care worker vaccination rates. EH is working with administration and Infection Control to achieve >90% compliance. C. EH achieved 100% “hand washing” compliance. D. EH increased the number of visits/rounds to departments and BI satellite locations by EHS nurses with the aim of getting over 90% employee compliance in each department.

2011 Year End Report 75 Department of Medicine – Occupational Medicine/Employee Health and Business Health Services

5. Peer-Reviewed Publications and Presentations

A. Presentations David D’Souza, MD, MPH (with Dr. David Roane, Psychiatry) ——“Physician Depression and Suicide” to several departments in the institution, with the aim of increasing understanding of the culture (of silence) among physicians/institutions; teaching the ability to recognize depression in providers; and promoting the attitude to be willing to seek help for mental health issues and avail of opportunities within the health system.

6. Honors/Awards David D’Souza, MD, MPH ——Elected Vice-President of the New York Occupational and Environmental Association (NYOEMA), and will become President of the organization in 2012.

2011 Year End Report 76 Department of Medicine – Division of Pulmonary and Critical Care Henry C. Bodenheimer, MD, Chairman

XV. DIVISION OF PULMONARY AND CRITICAL CARE Patricia Walker, MD, Acting Division Chief

1. Program Enhancements

A. New Programs i. Full Overnight Coverage: We have committed to full overnight coverage in the hospital with a board-certified intensivist whose responsibilities include overseeing MICU patient care and critical illness issues (RRTs, codes) on the hospital floors. B. Program Expansions i. Cystic Fibrosis Center at BI: The center is working with LICH/Downstate to improve access to sweat testing and cystic fibrosis newborn screening follow-up. The creation of a satellite center will enhance the delivery of CF services and improve the follow-up for positive CF screens.

2. Capital Enhancements

A. Equipment Enhancements i. We obtained a new Point-of-Care Ultrasound System for use in the Intensive Care Unit. This machine produces significantly higher quality images, which aide in on- the-spot clinical management, and the state-of-the-art imaging database software (QPATH) allows for immediate storage and review of all studies done by fellows and attendings in the division. Report templates within the software program were implemented and have mandated the interpretation and filling out of a report by all members in the division. Drs. Kory and Acquah will over-read all studies and perform QI assessments on accuracy of interpretation and adequacy of images obtained, with the purpose of ensuring and improving the quality and accuracy of all diagnostic ultrasound activity in the division. ii. New continuous hemodynamic monitors were installed in the Respiratory Step-Down Unit. This upgrade will allow us to slowly introduce more acutely ill patients into this environment, which will “unload” our ICU. B. Facility Enhancements i. The hospital partnered with United Sleep Diagnostics and launched a state-of-the-art sleep laboratory. The sleep laboratory medical director with be the new Director of Sleep Medicine at Beth Israel (under recruitment).

3. Quality Initiatives/Achievements

A. ICU Severity Assessment (Champion: Dr. Samuel Acquah) We have initiated (along with other critical care divisions/departments in the Continuum network) collection of APACHE data (a scoring system to assess severity of illness on ICU admission). Our compliance with this data collection has improved significantly since implementation. This data collection has begun to allow us to assess our clinical performance in an appropriate manner using severity-adjusted outcomes (such as mortality). B. STOP Sepsis Collaborative (Champion: Dr. Samuel Acquah) We have recently joined in the “STOP Sepsis Collaborative” sponsored by the Greater NY Hospital Association. This program is being used by many hospitals throughout the city to promote compliance with proven therapies in sepsis care and to track and benchmark outcomes against one another.

2011 Year End Report 77 Department of Medicine – Division of Pulmonary and Critical Care

C. IPRO (Champion: Dr. Samuel Acquah) The division is involved in a hospital-wide project to reduce central line and urinary catheter-related sepsis. Dr. Acquah and his group were awarded Outstanding Achievement and Leadership in the Elimination of Central Line-Associated Bloodstream Infections from the U.S. Department of Health and Human Services and Critical Care Societies Collaborative (CCSC) D. Protocols in the ICU (Champions: Drs. Samuel Acquah, Hayley Gershengorn, Earle Hayes) We have developed/are developing many new protocols to improve and standardize the care of critically ill patients. We have joined with the Emergency Department to recreate and implement a sepsis early identification program (using EmSTAT) and sepsis management protocol. This new protocol and an accompanying flowsheet will hopefully reduce variation in care provided and make us more compliant with standards of care. Additionally, we are working on a diabetic ketoacidosis protocol with the Endocrine Division to achieve similar goals. Finally, all of our protocols (i.e., glucose control, sedation practices and ventilator weaning strategies) currently are being reassessed. E. Quality and Patient Safety: In working with Laura O’Brien, we are excited to start implementing the “early mobilization” of critically ill patients that she has piloted in the surgical ICUs. F. Palliative Care in the ICU (Champion: Dr. Earle Hayes) We have detailed a list of triggers and initiated a twice per month notification of utilization rates and appropriateness of palliative care consultations from the ICU. We hope to use this data to optimize our use of this valuable and now mandatory (by law) consultation service. G. Night Environment in the ICU (Champion: Dr. Earle Hayes) We have endeavored (through physician and nursing education) to provide an environment more conducive to sleep in the ICU overnight. The lights are dimmed, the noise level is reduced, and bloodwork and imaging are performed before or after 11 pm-6 am daily. H. Delirium in the ICU (Champion: Dr. Earle Hayes) Quality and Patient Safety: We have initiated a program to improve recognition and treatment of delirium in our intensive care unit patients (both MICU and SICU). All providers are being educated (via lecture) on delirium with a pre- and post-test to assess improved knowledge (physicians have completed both portions, nurses just the pre-test as of yet). We are in the process of educating providers in a screening tool for delirium (the CAM-ICU) and will begin training soon. Our first goal is to assess baseline incidence in our environment. I. Bronchoscopy Quality Assessment (Champion: Dr. Arthur Sung) We have put together a quality improvement committee and initiated quarterly meetings to assess timeliness and quality issues (procedure volume, suite utilization, diagnostic yield and correctness, and complication rates) for both inpatient and outpatient bronchosco- pies. The quarterly analysis of all pulmonary procedures done in the bronchoscopy suite includes: J. Complication Rates: Tracks complications and compares to national standards. K. Equipment Damage and Scope Repair: Tracks incidence of scope damage and implements education strategies for damage prevention. L. Flow/Scheduling: Tracks start and end times for all pulmonary procedures and identifies factors that lead to delayed start times. M. Volume: Tracks bronchoscopy volume quarterly with the goal of maintaining quality as volume increases.

2011 Year End Report 78 Department of Medicine – Division of Pulmonary and Critical Care

N. ICU Quality Assessment (Champion: Dr. Samuel Acquah) We meet monthly as a division with the inclusion of senior nursing staff in the MICU and respiratory therapy to review LOS, mortality, infection rates (CLABSI, VAP), duration of me- chanical ventilation, hospice transfers, ICU readmissions and other quality markers. O. Cystic Fibrosis Clinic Efficiency (Champions: Drs. Patricia Walker, Maria Berdella) We have initiated a program to assess CF Center patient flow, waiting times, staff efficiency and unplanned interruptions. We will also be conducting a staff satisfaction survey. P. Infection Control in the Cystic Fibrosis Center (Champions: Drs. Patricia Walker, Maria Berdella) We have implemented the CF Foundation’s Learning and Leadership Collaborative Systems to reduce the rate of spread of multi-resistant bacteria. Q. Vitamin D Deficiency (Champion: Dr. Maria Berdella) We are working with the New York State CF Newborn Screening Consortium to assess and address vitamin D deficiency in children with CF, in keeping with practice guidelines. R. PFT Appropriateness (Champions: Drs. Patricia Villamena, Albert Miller) We are tracking compliance with national guidelines for annual spirometry to assess our performance. S. Training and Simulation for Central Line Placement (Champion: Dr. Pierre Kory) We have created a training video to explain and model optimal practice for placement of central venous catheters in the internal jugular vein under ultrasound guidance. We have adopted a program in which all medical housestaff first watch the video and then practice the placement of these lines in the simulation center for 90 minutes just before they are to start their MICU rotation. We are beginning to create a tool (a “test”) to assess proficiency to place these lines independently.

4. Fellow/Resident Board Passage Rates —— Fellows: 100% (three of three fellows in third year) for pulmonary boards 2011; 100% (three of three fellows in first year out of fellowship) for critical care 2011 —— Residents: N/A.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Gershengorn HB, Johnson MP, Factor P. “The Use of Non-Physician Providers in Adult Intensive Care Units.” Am J Respir Crit Care Med. Epub 2011 December 1. ——Gershengorn HB, Wunsch H, Wahab R, Leaf D, Brodie D, Li G, Factor P. “Impact of Non-Physician Staffing on Outcomes in a Medical Intensive Care Unit.” Chest. 2011 June 139 (6): 1347-53. ——Wunsch H, Gershengorn H, Meyer SA, Claassen J. “The Effect of Window Rooms on Critically Ill Patients Admitted to Intensive Care with Subarachnoid Hemorrhages.” Crit Care. 2011 March 3 15 (2): R81. ——Greenstein Y, Lakticova V, Kory P, Mayo P. “Adequacy of Chest Compressions Performed by Medical Housestaff.” Hosp Pract (Minneap). 2011 August 39 (3): 44-9. ——Mayo PH, Hegde A, Eisen LA, Kory P, Doelken P. “A Program to Improve the Quality of Emergency Endotracheal Intubation.” J Intensive Care Med. 2011 January-February 26 (1): 50-6.

2011 Year End Report 79 Department of Medicine – Division of Pulmonary and Critical Care

——Kory P, Weiner J, Mathew JP, Fukunaga M, Palmero V, Singh B, Haimowitz S, Clark ET, Fischer A, Mayo PH. “A Rapid, Safe, and Low-Cost Technique for the Induction of Mild Therapeutic Hypothermia in Post-Cardiac Arrest Patients.” Resuscitation. 2011 January 82 (1): 15-20. ——Kory PD, Pellecchia CM, Shiloh AL, Mayo PH, DiBello C, Koenig S. “Accuracy of Ultrasonography Performed by Critical Care Physicians for the Diagnosis of DVT.” Chest. 2011 March 139 (3): 538-42. ——Accurso FJ, Moss RB, Wilmott RW, Anbar RD, Schaberg AE, Durham TA, Ramsey BW, TIGER-1 Investigator Study Group (including Walker P). “Denufosol Tetrasodium in Patients with Cystic Fibrosis and Normal to Mildly Impaired Lung Function.” Am J Respir Crit Care Med. 2011 March 1 183 (5): 627-34. ——Schechter MS, McColley SA, Regelmann W, Millar SJ, Pasta DJ, Wagener JS, Konstan MW, Morgan WJ; Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis (including Berdella M.). “Socioeconomic Status and the Likelihood of Antibiotic Treatment for Signs and Symptoms of Pulmonary Exacerbation in Children with Cystic Fibrosis.” J Pediatr. 2011 November 159 (5): 819-824.e1. Epub 2011 June 25. ——Huang Y, Xu D, Jirapatnakul A, Reeves AP, Farooqi A, Zhang L, Giunta S, Zulueta J, Aye R, Miller A, Mendelson DS, Aylesworth C, Sheppard B, Klingler K, Yankelevitz DF, Henschke CI. “CT- and Computer-Based Features of Small Hamartomas.” Clin Imaging. 2011 March-April 35 (2): 116-22.

B. Presentations Sulica R ——“End-Points in Clinical Trials of Sarcoidosis-Associated Pulmonary Hypertension.” WASOG Meeting, Maastricht, Holland, June 2011. ——“Management of Sarcoidosis-Associated Pulmonary Hypertension.” The Alvin Teirstein Memorial Symposium, American Thoracic Society International Conference, Denver, CO, May 2011. ——“Treatment of Pulmonary Arterial Hypertension.” Pulmonary Hypertension Association, New York, NY, November 2011. ——“Pulmonary Arterial Hypertension in Connective Tissue Disorders.” Pulmonary Hypertension Association, New York, NY, March 2011.

Palmero V, Sulica R ——“Bosentan for the Treatment of Sarcoidosis-Associated Pulmonary Hypertension.” American Thoracic Society Meeting, Denver, CO, May 2011.

Tulliano G, Sulica R ——“Distinctive Hemodynamic Profile of Patients with HIV-Related Pulmonary Arterial Hypertension with Concomitant Portal Hypertension.” American Thoracic Society Meeting, Denver, CO, May 2011.

Channick RN, Frantz RP, Kawut SM, Palevsky H, Tumuliri R, Sulica R, Benton W, deBoisblanc B ——“A Multicenter, Retrospective Study of Patients with Pulmonary Arterial Hypertension Transitioned from Parenteral Prostacyclin Therapy to Inhaled Iloprost.” American Thoracic Society Meeting, Denver, CO, May 2011.

2011 Year End Report 80 Department of Medicine – Division of Pulmonary and Critical Care

Palmero V, Klatchko T, Aslam H, Kory P, Acquah S ——“Diagnostic Accuracy of Cytopathologic Patterns found on EBUS FNA in Patients with Suspected Pulmonary Sarcoidosis.” Annual Meeting of the American College of Chest Physicians, Honolulu, HI, October 2011.

Kory P, Hwang C, Pellechia C, Acquah S ——“Team Performance Assessment during Rapid Response Events.” Annual Meeting of the American College of Chest Physicians, Honolulu, HI, October 2011.

Koenig S, Lacticova V, Hegde A, Kory P, Narasimhan M, Doelken P, Mayo PH ——“Safety of Urgent Endotracheal Intubation Performed without a Paralytic Agent.” Annual Meeting of the American College of Chest Physicians, Honolulu, HI, October 2011.

Ahuja J, Mathew J, Sharif M, Annan E, Kory P, Walker P ——“Pleural Fluid Analysis in a Patient with Pleuro-Myopericarditis Secondary to Crohns Disease.” Oral Presentation, Annual Meeting of the American College of Chest Physicians, Honolulu, HI, October 2011.

Annan E, Guevarra KP, Mathew J, Ahuja J, Sharif M, Acquah S, Kory P ——“Primary Videolaryngoscopy Improves First Pass Success during Emergency Endotracheal Intubation by First Year Fellows.” Annual Meeting of the American College of Chest Physicians, Honolulu, HI, October 2011.

NYC Project Hypothermia Working Group (including Kory P) ——“Intra-Arrest Induction of Therapeutic Hypothermia via Large-Volume Ice-Cold Saline Infusion Improves Immediate Outcomes for Out-of-Hospital Cardiac Arrest.” AHA Resuscitation Science Symposium, Orlando, FL, November 2011. ——“Intra-Arrest Induction of Therapeutic Hypothermia via Large-Volume, Ice-Cold Saline Infusion Results in Improved Outcomes among Out-of-Hospital Cardiac Arrests of Cardiac Etiology.” AHA Resuscitation Science Symposium, Orlando, FL, November 2011. ——“Incidence and Relevance of Pulmonary Edema as a Result of Large-Volume, Ice-Cold Saline Infusion for the Induction of Hypothermia during Out-of-Hospital Cardiopulmonary Resuscitation.” AHA Resuscitation Science Symposium, Orlando, FL, November 2011. ——“Initiation of Large-Volume, Ice-Cold Saline Infusion during Initial Resuscitation Attempts for Out-of-Hospital Cardiac Arrest Results in Near-Target Temperatures for Therapeutic Hypothermia upon Emergency Department Arrival.” AHA Resuscitation Science Symposium, Orlando, FL, November 2011.

Langfelder-Schwind, E ——“The Spectrum of CFTR-Related Disorders: Case Examples from the Trenches.” North American Cystic Fibrosis Conference, Anaheim, CA, November 2011. ——“Gene Modulation Research – Opportunities for Genetic Counselors.” National Society of Genetic Counselors’ Annual Education Conference, San Diego, CA, October 2011.

2011 Year End Report 81 Department of Medicine – Division of Pulmonary and Critical Care

6. Honors/Awards Arthur Sung, MD ——Super Doctor (SuperDoctors.com), 2011.

Albert Miller, MD ——Super Doctor (SuperDoctors.com), 2011.

Patricia Villamena, MD ——Super Doctor (SuperDoctors.com), 2011.

7. Grants Industry Funded ——Glaxo-Smith-Kline support for Novel Therapeutic Intervention for Acute Lung Injury; fall, 2011 until enrollment complete; $6,000-$10,000 per patient enrolled; projected total: ~$70,000. (PI: Dr. Hayley Gershengorn) ——IKARIA Protocol IK-7001-PAH-201 – A Phase 2, Placebo Controlled, Double- Blind, Randomized, Clinical Study to Determine Safety, Tolerability and Efficacy of Pulsed, Inhaled Nitric Oxide (iNO) Versus Placebo as Add-On Therapy in Symptomatic Subjects with Pulmonary Arterial Hypertension (PAH). (PI: Dr. Roxana Sulica) ——AMBITION Study: A Randomized, Double-Blind, Multicenter Study of First- Line Combination Therapy with AMBrIsentan and Tadalafil in Subjects with Pulmonary Arterial Hypertension. (PI: Dr. Roxana Sulica) ——Actelion Transition Study: A Multicenter, Retrospective Study of Patients with Pulmonary Arterial Hypertension Transitioned from Parenteral Prostacyclin Therapy to Inhaled Iloprost. (PI: Dr. Roxana Sulica) ——A 12-Week, Double-Blind, International, Multicenter, Dose-Response Study of the Safety and Efficacy of Beraprost Sodium Modified Release (BPS-MR) in Patients with Pulmonary Arterial Hypertension (PAH) (Protocol# BPS-MR- PAH-203). (PI: Dr. Roxana Sulica) ——Protocol GS-US-235-0101, “A Phase 2, Randomized, Double-blind, Placebo- Controlled, Multicenter, Dose-Ranging Study of Cicletanine in Subjects with Pulmonary Arterial Hypertension.” (PI: Dr. Roxana Sulica) ——Protocol AC-063A402 (INHALE-15), “Phase IIIb, Multicenter, Open-label Study of Patients with Pulmonary Arterial Hypertension Treated with Iloprost (Inhalation) Evaluating Safety and Inhalation Times when Converting from Power Disc-6 to Disc-15 with the I-Neb®.” (PI: Dr. Roxana Sulica) ——A Phase 3 Efficacy and Safety Study of PTC 124 as an Oral Treatment for Nonsense-Mutation Medicated Cystic Fibrosis (Protocol PTC 124-GD-009-CF). (PI: Dr. Patricia Walker) ——A Phase 3 Extension Study of Ataluren (PTC124) in Subjects with Nonsense– Mutation Mediated Cystic Fibrosis (Protocol PTC 124-GD-009e-CF). (PI: Dr. Patricia Walker)

2011 Year End Report 82 Department of Medicine – Division of Pulmonary and Critical Care

——A Phase 2, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Safety and Efficacy of VX 770 in Subjects Aged 12 Years and Older with Cystic Fibrosis Who Are Homozygous for the F508del-CFTR Mutation. (PI: Dr. Maria Berdella) ——VX-770 Expanded Access Program. (PI: Dr. Maria Berdella) ——Effect of Proton Pump Inhibitors on CF Pulmonary Exacerbations. (PI: Dr. Patricia Walker) ——Participation in the Cystic Fibrosis Foundation Registry. (PI: Dr. Maria Berdella) ——Genetic Modifiers of Cystic Fibrosis. (PI: Dr. Maria Berdella) ——Genetic Modifiers of Cystic Fibrosis Lung and Liver Disease. (PI: Dr. Patricia Walker) ——MPEX-207: A Phase 3, Multicenter, Multinational, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Mp-376 (Levofloxacin Inhalation Solution; Aeroquin™) in Stable Cystic Fibrosis Patients. (PI: Dr. Patricia Walker) ——A Phase 3, Open-Label, Randomized Trial to Evaluate the Safety and Efficacy of MP-376 Inhalation Solution (AEROQUIN™) versus Tobramycin Inhalation Solution in Stable Cystic Fibrosis Patients (Mpex209). (PI: Dr. Patricia Walker) ——Evaluating the Quality of the Cystic Fibrosis Foundation Newborn Screening Webpages. (PI: Elinor Langfelder Schwind, MS) ——A Phase 3, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy and Safety of Ivacaftor in Subjects with Cystic Fibrosis Who Have the R117H CFTR Mutation. (PI: Dr. Maria Berdella) ——A Long-Term Prospective Observational Safety Study of the Incidence of and Risk Factors for Fibrosing Colonopathy in US Patients with Cystic Fibrosis Treated with Pancreatic Enzyme Replacement Therapy: A Harmonized Protocol Across Sponsors (the “Study”). (PI: Dr. Patricia Walker)

A. Non-Industry Funded ——CF Foundation Therapeutics Award #C081-TDC09Y “Therapeutics Development Center” Annual Award: $74,088. (PI: Dr. Patricia Walker) ——Cystic Fibrosis Foundation #C081-10 “Care Center Grant Award” Annual Funding: $87,740. (PI: Dr. Maria Berdella) ——New York State Department of Health Contract #C-023851 “Ensuring Comprehensive Genetic Services“ Annual Funding: $50,000. (PI: Elinor Langfelder Schwind, MS)

2011 Year End Report 83 Department of Medicine – Division of Rheumatology Henry C. Bodenheimer, MD, Chairman

XVI. DIVISION OF RHEUMATOLOGY Harry Fischer, MD, Division Chief

1. Program Enhancements

A. New Programs i. Utilization of Knee Simulation Model for training of medical residents in arthrocentesis. ii. Enhancement of Medical Grand Rounds through resident participation in clinico- pathologic conferences and clinical problem working with Sonal Jani, MD, and medical chief residents. iii. Institution of E-prescribing by all members of the division. B. Program Expansions i. Expansion of Collaboration with Orthopedics in evaluation of all fracture patients for osteoporosis, and new emphasis on patient education regarding risk factors for fractures and prevention of future fractures. ii. Greater Use of Muscular Skeletal Ultrasound for the evaluation and treatment of rheumatic diseases. iii. Expansion of Involvement in Housestaff Education through noon conference series, board review course and summer research series. Housestaff continue to play a major role in all research projects. iv. Continued Involvement and Support for the Division of Rheumatology at St Luke’s and Roosevelt Hospitals and helping to recruit a new full-time faculty member for the division.

2. Quality Initiatives/Achievements

A. Completion of an ABIM QI initiative using nationally recognized ways of improving communication with referring physicians. This initiative used nationally recognized quality measures and resulted in acknowledgement of quality achievement by managed care organizations. B. Review of hydroxychloroquine use by patients with systemic Lupus erythematosis. C. Continued reporting of quality measures to CMS for rheumatoid arthritis, osteoarthritis and osteoporosis.

3. Fellow/Resident Board Passage Rates —— N/A.

4. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications —— Patton E, Fischer HD, Greenfield M. “Osteoporosis Screening.” Menopause 2011 February 19 (2): 154.

2011 Year End Report 84 Department of Medicine – Division of Rheumatology

B. Presentations Harry D. Fischer, MD ——Rivera TL, Irish R, Steiner GS, Hoda SA, Fischer HD. “A 76-Year-Old Woman with Rheumatoid Arthritis.” Abstract, ACR Winter Clinical Symposium, Honolulu, HI, January 2011. ——Chernyavsky S, Fischer HD. “A Medical Mystery: The Proof Is in the Genes.” Clinical Vignette, ACP Annual Meeting, San Diego, CA, April 2011. ——Brodsky JE, Patton EP, Fischer HD. “Arthrocentesis Training Using a Knee Simulation Model.” Abstract, ACR Annual Meeting, Chicago, IL, November 2011.

Paula Rackoff, MD ——“Teripeptide in Fracture Healing.” New York Bone Club, New York, NY, May 2011.

5. Honors/Awards Harry D. Fischer, MD ——New York Magazine Best Doctor. ——Super Doctors—New York Times Magazine. ——Castle Connolly Top Doctor. ——Best Doctors. ——Patient Choice Award. Paula Rackoff, MD ——Super Doctors—New York Times Magazine. ——Castle Connolly—Top Doctors.

2011 Year End Report 85

Department of Neurology

2011

Department of Neurology

THE ALAN AND BARBARA MIRKEN DEPARTMENT OF NEUROLOGY Susan Bressman, MD, Chairman

1. New Faculty —— Weiyi Gao, MD, Full-time Physician, Division of Adult Epilepsy, July 2011. —— Kevin Khodabakhsh, MD, Full-time Physician, Division of Pediatric Epilepsy, July 2011.

2. Program Enhancements A. New Programs i. Privileges and Credentialing Partnership: Together with St. Luke’s-Roosevelt Hospital, a common process for delineating privileges and credentialing was established. This involved vetting current procedures and methods for assessing competency at both institutions as well as outside institutions and national organizations. ii. Epilepsy Support Group: The department created a new Epilepsy Support Program for families of children with epilepsy. The support group meets monthly at the Hartsdale location. B. Program Expansions i. Access to Care: Access to the Department of Neurology was improved as the new recruits from 2010 continue to grow their practice in 2011 through increasing capacity for appointments within the 14-day goal. Additionally, emergent appointments are able to be readily accommodated, often with patients being seen on the same day as they request. ii. Continuum Comprehensive Pediatric Epilepsy Program: Dr. Kevin Khodabakhsh, a new attending physician, joined our Pediatric Epilepsy team, which increased access for pediatric patients. In addition, Dr. Khodabakhsh’s practice expanded the Pediatric Epilepsy Program to patients in Westchester and increased access for autism patients. iii. Continuum Comprehensive Adult Epilepsy Program: Dr. Weiyi Gao, a new attending physician, joined our Adult Epilepsy team, which allowed the center to successfully expand the Adult Epilepsy Program and decreased access wait times for the adult population. Dr. Gao extended the center’s outreach in the Asian community. iv. Clinical Trials and Translational Research: The department expanded its staff, with a new Clinical Trials Manager and a new Research Coordinator joining the team. The new Clinical Trials Manager allowed us to expand our movement disorder clinical trials and enroll more subjects into the studies. The Research Coordinator helps facilitate the process through coordinating and organizing the activities of participants in the research trials. v. Parkinson’s Disease Program: The department increased its outreach into the Latino community by offering lectures about Parkinson’s disease in both English and Spanish. This program increases awareness and allows the department to offer needed services to this diverse population.

2011 Year End Report 89 Department of Neurology

3. Capital Enhancements

A. Equipment Enhancements i. The department purchased a Sorvall ST 16 Refrigerated Centrifuge, which is a 4º refrigerated centrifuge used to process both blood (for plasma and serum extraction) and urine samples collected for research. The centrifuge aids the department, as samples are required to be spun in a refrigerated centrifuge to optimize the integrity of the samples that are stored at Beth Israel before the samples are shipped for storage at a biologics repository. ii. The purchase of a Sanyo/Panasonic 86c Ultra Low Upright Freezer simplifies the process for maximum efficiency for onsite storing and organizing samples for all research studies. Since 2009, the department has utilized the freezers at clinical trial sites at the Petrie location when the department’s 10+ year old -80º freezer stopped working. iii. Five new neurophysiological OR monitoring and review machines were purchased to replace aging equipment. The new machines have new capabilities, including better amplifiers, better fillers and improved stimulators. This allows for more timely feedback to the surgeons in the OR, and it allows simultaneity of multimodality monitoring. iv. A new TECA Synergy EMG/NCS machine was purchased for several reasons: 1) the old EMG machine stopped working in the Neurophysiology Department located at First Avenue at 16th Street, 2) the old EMG machine was no longer supported by the manufacturer, and 3) replacement parts were no longer available. The new EMG machine is more efficient as doctors are able to share patient data among the other three EMG machines within the Neurology Department at PACC, as all of the machines are now linked with the same software.

4. Quality Initiatives/Achievements

A. Goal: Finance—Increase Revenue —— Objective: To increase department revenue by $500,000. —— Outcome: Met and exceeded goal. Revenue increased by $1,076,657.00 from 2010. Grants and philanthropy brought in nearly $500,000 in new funding, and faculty practice increased by nearly $600,000. B. Goal: Improve Access —— Objective 1: To ensure outpatient access (new and current) is at 14 days or less. —— Outcome: Met and exceeded goal. In 2011, the average wait times for new patients were 4.6 days and 7.1 days for current patients. —— Objective 2: Increase evening hour volume/visits by 20%. —— Outcome: Met and exceeded goal. Evening patient volume increased 38% from 193 visits in 2010 to 268 visits in 2011. C. Goal: Growth —— Objective: To increase both inpatient and outpatient volume by 5% each. —— Outcome: Met and exceeded goal. The outpatient volume increased 7.3% from 21,925 outpatient visits in 2010 to 23,534 in 2011. The inpatient volume increased 6.4% from 1,676 in 2010 to 1,784 in 2011.

2011 Year End Report 90 Department of Neurology

D. Goal: Improve Quality of Services —— Objective: Track outpatient satisfaction, including developing methodologies that identify outliers and approaches that improve scores, with the aim of showing improvement on the question, “Would you recommend this practice to others?” —— Outcome: Met and exceeded goal. The procedure/screening instrument was changed to track waiting room/practice. The number of surveys received significantly increased from 28 to 109. Our scores have improved, including those endorsing “I would recommend this practice” from 86% in 2010 to 92% in 2011.

PACC Outpatient Satisfaction

2010 n=55 2011 n=109

100%

0 Ease of Courtesy in Promptness Courtesy in Courtesy/ Provider Concern for Cleanliness Overall rating Likelihood of scheduling scheduling in returning registering concern of concern/ privacy of care recommending calls nurse inclusion in decision

E. Goal: Decrease Response Time in Adult Epilepsy Monitoring Unit to Clinical Event —— Objective: To decrease the response time to less than two minutes. —— Outcome: Met and exceeded goal. By the last quarter of 2011, the response time was approximately one and a half minutes compared to over two minutes in 2010.

Continuum Comprehensive Pediatric and Adult Epilepsy Program

Response Time in Adult Epilepsy Monitoring Unit to Clinical Event

Response Time in Seconds Response 20

0 Average 2nd Quarter 3rd Quarter 4th Quarter Average 2010 2011 2011 2011 2010

2011 Year End Report 91 Department of Neurology

F. Beth Israel Medical Center Manhattan and Beth Israel Brooklyn received the American Heart Association/American Stroke Association’s Get With the Guidelines-Stroke Silver Plus Quality Achievement Award. —— This prestigious award is one of the highest stroke achievement awards given and is attained by maintaining at least 12 consecutive months of 85% or higher adherence to all “Get With the Guidelines” stroke quality achievement indicators. This award recognizes Beth Israel’s commitment to providing higher standards of care to patients through adherence to nationally accepted stroke patient treatment standards.

Stroke Quality Achievement

Arrive by 2 hrs, TPA by 3 hrs Dysphagia Screening Performed Rx Statin for LDL < 100

100 100 100 100 100 99 100 100 99 100 97 97 94 92 93 92 88 86 87 80 80 83 80 79

60 60 60

40 40 40

20 20 20

0 0 0 Arr 2Hr, Arr 2Hr, Dysphag Scr Dysphag Scr Rx Statin 2010 Rx Statin 2011 Rx 3Hr 2010 Rx 3Hr 2011 2010 2011

BI Petrie BI Brooklyn NYC

G. Beth Israel Medical Center recertified as a National Parkinson Foundation’s Center of Excellence. —— To be certified as a Center of Excellence, the center must be renowned for accom- plishing exceptional achievements in Parkinson’s research, care and outreach in the community. Beth Israel Medical Center received this prestigious award, as we were recognized as a leader in providing Parkinson’s disease care by peers (other medical professionals). H. Beth Israel Medical Center newly designated as a Tuberous Sclerosis Complex (TSC) Clinic by the Tuberous Sclerosis Alliance. —— Designation as a TSC Clinic is achieved through providing exceptional expertise in specific aspects of tuberous sclerosis disease, including multidisciplinary care and being an educational resource. Beth Israel Medical Center is one of only two centers in New York State to hold this distinction.

2011 Year End Report 92 Department of Neurology

I. Beth Israel Medical Center achieved the highest level designation by the National Association of Epilepsy Centers. —— The Adult and Pediatric Epilepsy Divisions achieved the highest level (Level 5) designation by the National Association of Epilepsy Centers. To achieve this level of designation, our center was recognized for providing complete evaluations and treatments of the most complex forms of epilepsy, including intracranial electrodes and an extensive range of surgical procedures.

5. Academic Appointments —— Maryna Skliut, MD, appointed Assistant Professor, January 1, 2011. —— Rivka Sachdev, MD, appointed Assistant Professor, July 1, 2011.

6. Fellow/Resident Board Passage Rates —— Fellows: 100%. —— Residents: 100%.

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications —— Haridas A, Tagliati M, Osborn I, Isaias I, Gologorsky Y, Bressman SB, Weisz D, Alterman RL. “Pallidal Deep Brain Stimulation for Children with Primary Dystonia.” Neurosurgery. 2011 68 (3): 738-43. PMID: 21164379. —— Alcalay RN, Siderowf A, Ottman R, Caccappolo E, Mejia-Santana H, Tang MX, Rosado L, Louis E, Ruiz D, Waters C, Fahn S, Cote L, Frucht S, Ford B, Orbe- Reilly M, Ross B, Verbitsky M, Kisselev S, Comella C, Colcher A, Jennings D, Nance M, Bressman S, Scott WK, Tanner C, Mickel S, Rezak M, Novak KE, Friedman JH, Pfeiffer R, Marsh L, Hiner B, Clark LN, Marder K. “Olfaction in Parkin Heterzygotes and Compound Heterzygotes. The Core PD Study.” Neurology. 2011 76 (4): 319-26. PMID: 21205674. —— Bruggemann N, Hafenah J, Stanley K, Klein C, Wang C, Raymond D, Ozelius LJ, Bressman S, Saunders-Pullman R. “Substantia Ingra Hyperechogenicity with LRRK2 G22019S Mutations.” Mov Disord. 2011 26 (5): 885-8. PMID: 21312285. —— Schmidt A, Jabusch H-C, Altenmüller E, Enders L, Saunders-Pullman R, Bressman SB, Münchau A, Klein C, Hagenah J. “Phenotypic Spectrum of Musician’s Dystonia: A Task-Specific Disorder?” Mov Disord. 2011 26: 546-9. PMID: 21462264. —— Carbon M, Argyelan M, Ghilardi MF, Mattis P, Dhawan V, Bressman S, Eidelberg D. “Impaired Sequence Learning in Dystonia Mutation Carriers: A Genotypic Effect.” Brain. 2011 134: 1416-27. PMID: 21515903. —— Saunders-Pullman R, Stanley K, San Luciano M, Barrett MJ, Shanker V, Raymond D, Ozelius LJ, Bressman SB. “Gender Differences in the Risk of Familial Parkinsonism: Beyond LRRK2?” Neurosci Lett. 2011 496: 125-8. PMID: 21511009. —— Shanker V, Groves M, Heiman G, Palmese C, Saunders-Pullman R, Ozelius L, Raymond D, Bressman S. “Mood and Cognition in LRRK2 G2019S Parkinson’s Disease.” Mov Disord. 2011 26 (10): 1875-80. PMID: 21611978.

2011 Year End Report 93 Department of Neurology

—— Landazuri P, Abramowitz M, Obe V, Palmese C. “Anxiety and Depression: To Screen or Not to Screen in Parkinson’s Disease.” Abstract #322, Movement Disorder Society International Congress on Parkinson’s Disease and Movement Disorders, Toronto, ON, June 2011. —— Saunders-Pullman R, Wang C, Stanley K, Bressman SB. “Diagnosis and Referral Delay in Women with Parkinson’s Disease.” Gend Med. 2011 8: 209-17. PMID: 21664587. —— Saunders-Pullman R, Stanley K, Wang C, San Luciano M, Shanker V, Hunt A, Severt L, Raymond D, Ozelius LJ, Lipton RB, Bressman SB. “Olfactory Dysfunction in LRKK2 G2019S Mutation Carriers. Neurology. 2011 77: 319-24. PMID: 21753159. —— Barrett MJ, Bressman SB, Levy OA, Fahn S, O’Dell MW. “Functional Electrical Stimulation for the Treatment of Lower Extremity Dystonia.” Parkinsonism Relat Disord. 2011 18: 660-1. PMID: 21975264. —— Srivastava A, Tang MX, Mejia-Santana H, Rosado L, Louis ED, Caccappolo E, Comella C, Colcher A, Siderowf A, Jennings D, Nance M, Bressman S, Scott WK, Tanner C, Mickel S, Andrews H, Waters C, Fahn S, Cote L, Frucht S, Ford B, Alcalay RN, Ross B, Orbe Reilly M, Rezak M, Novak K, Friedman JH, Pfeiffer RD, Marsh L, Hiner B, Merle D, Ottman R, Clark LN, Marder K. “The Relation between Depression and Parkin Genotype: The Core-PD Study.” Parkinsonism Relat Disord. 2011 17: 740-4. PMID: 21856206. —— Huang X, Auinger P, Eberly S, Oakes D, Schwarzschild M, Ascherio A, Mailman R, Chen H; Parkinson Study Group DATATOP Investigators. “Serum Cholesterol and the Progression of Parkinson’s Disease: Results from DATATOP.” PLoS One. 2011 6 (8): e22854. PMID: 21853051. —— Marras C, McDermott MP, Marek K, Rochon P, Naglie G, Tanner CM, Rudolph A, Shoulson I, Lang AE; Parkinson Study Group DATATOP and PRECEPT Investigators. “Predictors of Time to Requiring Dopaminergic Treatment in 2 Parkinson’s Disease Cohorts.” Mov Disord. 2011 26: 608-13. PMID: 21287602. —— Lubarr N, Bressman SB. “Treatment of Generalized Dystonia.” Curr Treat Options Neurol. 2011 13: 274-89. PMID: 21455718. —— Bronte-Stewart H, Taira T, Valldeoriola F, Merello M, Marks Jr WJ, Albanese A, Bressman S, Moro E. “Inclusion and Exclusion Criteria for DBS in Dystonia.” Mov Disord. 2011 June 26 Suppl 1: S5-16. PMID: 21692112. —— Saunders-Pullman R, Cabassa J, San Luciano M, Stanley K, Raymond D, Ozelius LJ, Bressman SB. “LRRK2 G2019S Mutations May Be Increased in Puerto Ricans.” Mov Disord. 2011 26 (9): 17772-3. PMID: 21449009. —— Ozelius LJ, Lubarr N, Bressman SB. “Milestones in Dystonia.” Mov Disord. 2011 26 (6): 1106-26. PMID: 21626555. —— Barrett MJ, Bressman S. “Genetics and Pharmacological Treatment of Dystonia.” Int Rev Neurobiol. 2011 98: 525-49. —— Thobois S, Taira T, Comella C, Moro E, Bressman S, Albanese A. “Preoperative Evaluations for DBS in Dystonia.” Mov Disord. 2011 June 26 Suppl 1: S17-22. PMID: 21692107.

2011 Year End Report 94 Department of Neurology

—— Barrett MJ, Hagenah J, Bruggeman N, Stanley K, Raymond D, Ozelius LJ, Bressman SB, Saunders-Pullman R. “Substantia Nigra Hyperschogenicity in Parkinson’s Disease Patients with Heterozygous Glucocerebrosidase Mutations.” Mov Disord. 2011 26 (suppl 2): S699. —— Brugemann N, Hagenah J, Stanley K, Klein C, Wang C, Raymond D, Ozelius LJ, Bressman SB, Saunders-Pullman R. “Substantia Nigra Hyperechogenicity with LRRK2 G2019S Mutations.” Mov Disord. 2011 26 (suppl 2): S911. —— Marder K, Tang MX, Giladi N, Saunders-Pullman R, Mirelman A, Alcalay R, Gurevitch T, Clark L, Ozelius LJ, Orrurtreger A, Mejia-Santana H, Raymond D, Bressman SB. “Development of a Consortium to Study LRRK2 PD in Ashkenazi Jews.” Mov Disord. 2011 26 (suppl 2): S933. —— Deik A, Shanker V, Saunders-Pullman R, Severt W, Bressman S. “Cervical Dystonia and Hand Tremor (CD+) – A Distinct Phenotype from Cervical Dystonia (CD) and Essential Tremor (ET).” Neurology. 2011 76 (suppl 4) P02.135. —— Deik A, Shanker V, Saunders-Pullman R, Severt W, Bressman S. “Differing Neck Symptoms Idiopathic Cervical Dystonia (CD) from Essential Tremor with Neck Involvement (ETN).” Neurology. 2011 76 (suppl 4) P04.244. —— Alcalay R, Rosado L, Siderowf A, Ottman R, Caccappolo E, Mejia-Santana H, Tang M, Louis E, Ruiz D, Andrews H, Waters C, Fahn S, Cote L, Frucht S, Ford B, Orbe-Reily M, Ross B, Verbitsky M, Kisselev S, Comella C, Colcher A, Station M, Jennings D, Nance M, Bressman S, Scott W, Tanner C, Mickel S, Rezak M, Novak K, Friedman J, Pfeiffer R, Marsh L, Hiner B, Clark L, Marder K. “Olfaction in Glucocerebrosidase Mutation Carriers with and without PD.” Neurology. 2011 76 (suppl 4) P06.103. —— Shanker V, Groves M, Heiman G, Saunders-Pullman R, Ozelius LJ, Palmese C, Raymond D, Bressman SB. “Mood and Cognition in Leucine-Rich Repeat Kinase 2 G2019S Parkinson’s Disease.” Movement Disorders. 2011 26: 1772-3. —— Paudyal B, Gao W, MacGowan D. “Multiple Sclerosis in Patients with Distal Sensory Complaints and Normal Peripheral Electrophysiological Testing.” Neurology. 2011 76 (suppl 4): A605. —— Karam C, Dyck PJ, Engelstadt JK, MacGowan DJL. “Clinical Reasoning: A 34-Year-Old Man with Recurrent Limb Weakness.” Neurology. 2011 77 (12): e68-72, 2011. —— Karam C, Dyck J, Englestad J, MacGowan DJL. “Multifocal Motor Neuropathy with Conduction Block.” Neurology. 2011 —— Karam C, Barrett M, Imperato T, MacGowan D, Scelsa S. “Effect of Vitamin D Supplementation on ALSFRS in Patients with ALS.” Abstract, Neurology. 2011. —— Zimmerman ME, Lipton RB, Santoro N, McConnell DS, Derby CA, Katz MJ, Baigi K, Saunders-Pullman R. “Endogenous Estradiol Is Associated with Verbal Memory in Nondemented Older Men.” Brain and Cognition. 2011 76: 158-65. —— Pankratz N, Dumitriu A, Hetrick KN, Sun M, Latourelle JC, Wilk JB, Halter C, Doheny KF, Gusella JF, Nichols WC, Myers RH, Foroud T, DeStefano AL; PSG- PROGENI and GenePD Investigators, Coordinators and Molecular Genetic Laboratories. “Copy Number Variation in Familial Parkinson Disease.” PLoS One. 2011 6 (8): e20988. Epub 2011 August 2.

2011 Year End Report 95 Department of Neurology

—— Deik A, O’Riordan S, San Luciano M, Shanker V, Raymond D, Bressman S, Saunders-Pullman R. “Spatial Discrimination Threshold Abnormalities Are Not Detected in a Pilot Study of DYT6 Dystonia Mutation Carriers.” Tremor and Other Hyperkinetic Movements. In press. —— Kasarskis EJ, Mendiondo MS, Wells S, Malguizo MS, Thompson M, Healey M, Kryscio RJ; ALS Nutrition/NIPPV Study Group. “The ALS Nutrition/NIPPV Study: Design, Feasibility, and Initial Results.” Amyotroph Lateral Scler. 2011 January 12 (1): 17-25. —— Karam C, Scelsa SN. “Can Vitamin D Delay the Progression of ALS?” Med Hypotheses. 2011 February 8. —— Karam C, Scelsa SN. “Clinical Reasoning: A 79-Year-Old Man with Polyneuropathy and Dysautonomia.” Neurology. 2011 May 10 76 (19): e93-7.

B. Presentations Susan Bressman, MD ——“LRRK Cohort AD/PD Symposium”—Invited Speaker. Barcelona, Spain, September 2011. ——“Parallel Session: Phenotype, Genotype and Pathophysiology in Hereditary Dystonia”–Chair. Movement Disorders Society Annual Meeting, Toronto, ON, June 2011. ——“Genetic Counseling: Viewpoint from a Practicing Movement Disorder Neurologist”–Course Faculty. 15th International Congress of Parkinson’s Disease and Movement Disorders, Toronto, ON, June 2011. ——“Unusual Movement Disorders”—Course Director. American Academy of Neurology Annual Meeting, Honolulu, HI, April 2011. ——“Approach to the Shaky Patient”—Course Faculty. American Academy of Neurology Annual Meeting, Honolulu, HI, April 2011. ——“Young Professionals”—Invited Speaker. The Bachmann-Strauss Dystonia and Parkinson’s Foundation, New York, NY, February 2011.

Susan Bressman, MD, Vicki Shanker, MD, Rachel Saunders-Pullman, MD, MPH, and Lawrence Severt, MD, PhD —— With Deik A. “Cervical Dystonia and Hand Tremor (CD+)–A Distinct Phenotype from Cervical Dystonia (CD) and Essential Tremor (ET)?” Poster Presentation, American Academy of Neurology’s Annual Meeting, Honolulu, HI, April 2011. —— With Deik A. “Differentiating Neck Symptoms in Idiopathic Cervical Dystonia (CD) from Essential Tremor with Neck Involvement (ETN).” Poster Presentation, American Academy of Neurology’s Annual Meeting, Honolulu, HI, April 2011.

Jeffrey Cohen, MD, PhD ——“Lacosamide as Adjunctive Therapy for Refractory Trigeminal Neuralgia.” Poster Presentation, American Headache Society, Washington DC, June 2011. —— With Joshi S, Cohen J. “Lacosamide as Adjunctive Therapy for Refractory Trigeminal Neuralgia.” Poster Presentation, Beth Israel Regional Meeting Research Fair, New York, NY, May 2011.

2011 Year End Report 96 Department of Neurology

—— With Ali S, Joshi S. “Identification and Management of Psychogenic Non- Epileptic Seizures in the Emergency Department: How Are These Patients Treated?” American Epilepsy Society, Baltimore, MD, December 2011. —— With Ali S. “Survey of Public Awareness and Attitude toward Epilepsy in New York City.” – American Epilepsy Society, Baltimore, MD, December 2011. Poster selected for recognition by the American Epilepsy Society Public Health walking tour.

Weiyi Gao, MD, and Daniel MacGowan, MD —— With Paudyal B. “Multiple Sclerosis (MS) in Patients with Distal Sensory Complaints and Normal Peripheral Electrophysiological Testing.” American Academy of Neurology Annual Meeting, Honolulu, HI, April 2011. ——“Multiple Sclerosis in Patients with Distal Sensory Symptoms and Normal Electrophysiological Testing.” Poster Presentation, American Academy of Neurology Annual Meeting, Honolulu, HI, April 2011.

Christina Palmese, PhD —— With Landazuri P. “Anxiety and Depression: To Screen or Not to Screen.” Poster Presentation, International Movement Disorder Society Meeting, Toronto, ON, June 2011.

Rachel Saunders-Pullman, MD, MPH ——“Potential Markers of Pre-Clinical Disease in LRRK2-Related PD: Olfaction, Transcranial Sonography, and Graphonomics.” The Fifth Annual Parkinson’s Disease Therapeutics Conference, The New York Academy of Sciences, New York, NY, October, 2011. ——“Parkinson’s Disease Research: Focus on Genetics and Gene Therapy, and New Biomarkers.” Current Research in Parkinson Disease, Bachmann-Strauss Dystonia and Parkinson Foundation, New York, NY, May 2011. ——“Psychiatric Features of Primary Dystonia and Dystonia-Plus Syndromes.” 3rd Annual Symposium of Movement Disorders in Childhood, Barcelona, Spain, February 2011 .

Vicki Shanker, MD ——“Approach to the Shaky Patient.” Notre Dame Hospital, Montreal, Canada, May 2011. ——“Approach to the Shaky Patient.” American Academy of Neurology 63rd Annual Meeting, Honolulu, HI, April 2011. ——“Update on Blepharospasm.” NY Blepharospasm Support Group, New York, NY, April 2011. ——“Atypical Parkinsonian Disorders.” NY Chapter of Geriatric Care Managers, New York, NY, February 2011.

Maryna Skliut, MD —— With Azar L, Paudyal B, Rackoff P. “Case Control Study–Role of Low Vitamin D in Acute Stroke.” Poster Presentation, 63rd American Academy of Neurology Annual Meeting, Honolulu, HI, April 2011.

2011 Year End Report 97 Department of Neurology

—— With Azar L, Paudyal B, Skliut M, Rackoff P. “Vitamin D Deficiency and the Risk of Acute Ischemic Stroke.” American Academy of Neurology Annual Meeting, Honolulu, HI. April 2011.

Steven Wolf, MD, and Patricia McGoldrick, NP ——“MELAS Children’s Hour Special Interest Group.” American Epilepsy Society, Baltimore, MD, December 2011. ——“Difficult Surgical Case. Surgical Special Interest Group.” American Epilepsy Society, San Antonio, TX, December 2011. —— With Ghatan S. “Neurovascular Medically Intractable Epilepsy: Surgical Outcome.” Cleveland Clinic-Marburg German Epilepsy Conference, Marburg, Germany, June 2011.

8. Honors/Awards Susan Bressman, MD —— New York Super Doctors. —— America’s Top Doctor–US News & World Report. —— Top Doctor–New York Magazine. —— Top Doctor–Castle Connolly Guide (among the top 1% in the nation). —— Board Member–Dystonia Medical Research Foundation. Jeffrey Cohen, MD —— Best Doctors–BestDoctors.com. —— America’s Top Physicians–Consumers Research Council of America. —— Medical Board Member–TNA–The Facial Pain Association. Harriet Kang, MD —— New York Super Doctors. —— America’s Top Doctor–US News & World Report. Louise M. Klebanoff, MD —— New York Super Doctors. Kyusang S. Lee, MD —— New York Super Doctors. —— Best Doctor–BestDoctors.com. —— America’s Top Physicians. —— Top Neurologist in New York, NY– International Association of Health Care Professionals (IAHCP). Daniel J.L. MacGowan, MD —— New York Super Doctors. Walter Molofsky, MD —— New York Super Doctors. —— Top Doctors–Family Magazine. —— Top Doctors–Castle Connolly Guide. Christina Palmese, PhD, ABPP-CN —— Nominated as President-Elect of the New York Neuropsychology Group.

2011 Year End Report 98 Department of Neurology

Rachel Saunders-Pullman, MD, MPH —— Executive Committee–The Dystonia Study Group. —— Medical and Scientific Advisory Board–The Dystonia Medical Research Foundation. —— Neurogenetics Topic Workgroup–American Academy of Neurology Education Committee. —— Grant Reviewer: German Federal Ministry of Education and Research; Integrated Networks of Medical Genome Research; Michael J. Fox Foundation for Parkinson’s Research; Dystonia Medical Research Foundation; Irish Institute of Clinical Neuroscience. —— America’s Top Doctor–US News & World Report. —— New York Super Doctors. —— Board Member–Dystonia Medical Research Foundation. —— Top Doctor–Castle Connolly Guide (among the top 10% in the New York region). Stephen Scelsa, MD —— Annual Teaching Award–Dept. of Neurology, Beth Israel Medical Center, NY. —— Best Doctors, Best Doctors in America. Vicki Shanker, MD —— Reviewed reports on Preladent and Cogane for treatment of Parkinson’s disease for the ECRI Institute. Steven Wolf, MD —— Zella Bronfman Butler Award–UJA Federation. —— America’s Top Doctor–US News & World Report. —— New York Super Doctors. —— Top Doctors–Family Magazine. —— Top Doctors–Castle Connolly Guide.

9. Grants The Department of Neurology currently has 26 grants of which 14 were new grants awarded in 2011. —— Structure Function Relationships in Dystonia: A Network Approach, National Institutes of Health via North Shore LIJ Health System, May 2011, 4/1/11- 3/31/12, $60,902. —— The Parkinson’s Disease, Ashkenazi Jews and LRRK2 Consortium: Longitudinal Extension, The Michael J. Fox Foundation, March 2011, 4/11-3/15, $4,717,696. —— Autonomic Dysfunction in LRRK2 Mutation Carriers, The Michael J. Fox Foundation, December 2011, 1/1/12-12/31/14, $22,500. —— Einstein Center of Excellence for Clinical Trials in Neuroscience, National Institutes of Health via Albert Einstein College of Medicine of Yeshiva University, March 2012, 9/1/2011-8/31/2018, $58,080. —— ALS Genome Wide Association & Exomic Sequencing in Ashkenazi Jews with ALS, ALS Association, September 2011, 10/1/11-9/30/14, $160,000. —— K02–LRRK2 Parkinson’s Disease, National Institutes of Health, National Institute of Neurological Disorders and Stroke, March 2011, 4/1/11-3/31/16, $187,761.

2011 Year End Report 99 Department of Neurology

—— Empire Clinical Research Investigator Program (ECRIP), NYS Department of Health, Graduate Medical Education Unit, June 2011, 7/1/11-6/30/13, $220,000. —— Analytic Models in Biomarker Development, The Michael J. Fox Foundation for Parkinson’s Research, December 2011, 1/31/12-1/30/14, $104,473. —— Progeni Family Study, The Michael J. Fox Foundation via The Trustees of Indiana University, April 2012, 1/1/2011-6/30/13, $20,000. —— Dystonia Coalition Project II–Validity & Reliability of Diagnostic Methods & Measures of Spasmodic Dysphonia, Dystonia Medical Research Foundation via Dystonia Coalition, September 2011, 9/1/11-12/31/12, $1,200 per subject. —— Neurogenic Orthostatic Hypotension-NOH304, Chelsea Therapeutics Via Biomedical Research Alliance of New York, November 2011, 1/8/09-12/31/12, $63,281. —— Prospective, Observational Trial Evaluating Xeomin for Cervical Dystonia or Blepharospasm in the United States via Merz Pharmaceuticals, LLC, September 2011, 11/11-12/12, $1,750 per subject. —— CD Flex–An Open-Label, Non-Inferiority Study Evaluating the Efficacy and Safety of Two Injection Schedules of Xeomin in Subjects with Cervical Dystonia with < 10 Weeks of Benefit from OnabotulinumtoxinA Treatment, via Merz Pharmaceuticals, LLC, April 2011, 1/11-12/12, $9,270 per subject. —— Clinical Trial of Ceftriaxone in ALS, National Institutes of Health via Massachusetts General Hospital, December 2011, 12/11-11/12, $10,400, Renewed. —— Efficacy and Safety of Eslicarbazepine Acetate (Bia 2-093), Sunovlon Pharmaceutic, March 2011, $17,902 per subject, Renewed. —— Neurogenic Orthostatic Hypotension-NOH306, Chelsea Therapeutics via Biomedical Research Alliance of New York, August 2010, 8/10-until complete, $85,140, Renewed. —— Molecular Etiology of Early Onset Torsion Dystonia, National Institutes of Health via Massachusetts General Hospital, August 2010, 8/10–7/14, $11,500 per year, Renewed. —— Characterizing the Role of Glucocerebrosidase Mutations in Parkinson’s Disease, Marcled Foundation, May 2011, 4/11-4/12, $35,000, Renewed. —— Supplement for Biomaker Battery Assessment in LRRK2, The Michael J. Fox Foundation, August 2009, 9/09-8/12, $340,283. —— Determining Pharmacodynamic Biomarkers of LRRK2 Activity in Lymphocytes, The Michael J. Fox Foundation via Mount Sinai School of Medicine, February 2011, 10/10–9/11, $6,750. —— DAT Imaging in Ashkenazi Jews LRRK2 Gene Carriers, The Michael J. Fox Foundation via Institute for Neurodegenerative Disorders, October 2010, 10/10 until complete, $1,087.50 per subject, Renewed. —— Ceregene-120-09, Ceregene, Inc., 2010, 9/10-until complete, $131,750.

2011 Year End Report 100 Department of Neurology

—— A Multicenter Open-label Extension Trial to Assess the Long-Term Use of Lacosamide Monotherapy and Safety of Lacosamide Monotherapy and Adjunctive Therapy in Subjects with Partial-Onset Seizures, Chiltern International, Inc., 2007-2011, $9,148.75 per subject. —— A Historical-Controlled, Multicenter, Double-blind, Randomized Trial to Assess the Efficacy and Safety of Conversion to Lacosamide 400mg/day Monotherapy in Subjects with Partial-Onset Seizures, Chiltern International, Inc., 2007-2011. $10,935.75 per subject. —— A Randomized, Double-Blind, Parallel Group, Multicenter Study to Evaluate the Retention Rate, Efficacy, Safety and Tolerability of Carisbamate, Topiramate and Levetiracetam as Adjunctive Therapy in Subjects with Partial-Onset Seizures, Ortho-McNeile Janssen Scientific Affairs, LLS, August 2009, 7/09-12/12, $25,500 per subject.

2011 Year End Report 101

Department of Neurosurgery

2011

Department of Neurosurgery

DEPARTMENT OF NEUROSURGERY Robert R. Goodman, MD, PhD, Chairman Allen H. Maniker, MD, BI Division Chief

1. Program Enhancements

A. New Programs i. Brain Lab Curve™ system: We purchased this new neuronavigational tool, only the second such system in the United States and the first in New York City, putting BI at the forefront of neuronavigational systems. B. Program Expansions i. Departmental Operative Growth: Since the department’s conception four years ago, the number of neurosurgical procedures performed annually at Beth Israel has increased from 41 in 2008 to 315 in 2011. Additionally, there are now six neurosur- geons operating at BI, served by a complement of five physician assistants for 24/7 neurosurgical coverage. ii. Neurosurgical Care Delivery: We have successfully implemented a program to deliver superior neurosurgical care to patients throughout the BI system. This initiative includes inpatients, patients seen in the BI Emergency Department, and outpatients from the private practice and neurology clinic referrals seen at PACC. Consulative services also are provided at Beth Israel Brooklyn, so that patients with neurosurgical disorders are assessed and, if necessary, transferred to the Petrie Division or to Roosevelt Hospital (certain patients) for more timely and efficient care.

2. Quality Initiatives/Achievements

A. We showed 100% compliance with time out in the OR. Other tracked indicators in 2011, without incidence, include post-operative hemorrhage, unplanned return to OR, post-op DVT, unexpected death, pre- and post-op diagnosis change and retained foreign body; there was one case of wound dehiscence. We discontinued time from ordering of stat CT/ MRI to completion (in conjunction with Radiology) as an indicator, as it was not seen to be a problem.

3. Publications and Presentations

A. Peer-Reviewed Publications ——Lange G, Janal D, Maniker AH, et al. “Safety and Efficacy of Vagus Nerve Stimulation in Fibromyalgia: A Phase I/II Proof of Concept Trial.” Pain Medicine. 2011 June. ——Maniker AH. “Regarding Efficacy of Neurosurgery Resident Education.” (Letter) Neurosurgery. 2011 March 68 (3): on line. ——Maniker AH. “Comment; The Double Fascicular Nerve Transfer: Operative.” Neurosurgery. 2011 March 68 (3): 67.

2011 Year End Report 105 Department of Neurosurgery

B. Presentations Allen H. Maniker, MD ——“Peripheral Nerve Injuries, Entrapments and Tumors”—Course Faculty. AANS, Denver, April 2011. ——“Glass Wound to the Leg.” Peripheral Nerve Plenary Session, AANS, Denver, April 2011. —— “Abstract: Acute and Subacute Neural Stem Cell Delivery for TBI.” Oral Poster Presentation with Gandhi CD, Siriwardane M, Skop N, Levison S. CNS, Washington, DC, October 2011. ——“Nerve Trauma.” CNS, Washington DC, October 2011. ——“Entrapment Neuropathies for Board Review.” CNS, Washington DC, October 2011

4. Honors/Awards Allen H. Maniker, MD ——Appointed Reviewer, Manuscript Submissions, for Neurosurgery (Journal of the Congress of Neurological Surgeons). ——Appointed Reviewer, AANS Annual Meeting Abstracts for 2011. ——Visiting Professor, Hofstra North Shore-LIJ School of Medicine, Department of Neurosurgery, North Shore University Hospital, July 2011.

2011 Year End Report 106 Department of Obstetrics and Gynecology

2011

Department of PainObstetrics Medicine and andGynecology Palliative Care

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY Arnold J. Friedman, MD, Chairman

1. New Faculty —— Iris Orbuch, MD, Codirector of Robotic Laparoscopic Surgery for Gynecology, Faculty, Part-time, March 2011.

2. Program Enhancements

A. New Programs i. Robotic Surgery for Non-Malignant Gynecology: Iris Orbuch, MD, and Laurence Orbuch, MD, are Codirectors. ii. Division of Genetics: The division moved from the Department of Pediatrics to the Department of OB/GYN. We are collaborating with NYU’s Division of Genetics, under John Pappas, MD, and are recruiting for a full-time geneticist to be shared between the two institutions.

3. Capital Enhancements

A. Facility Enhancements i. Renovation of Labor and Delivery waiting and triage areas has increased space and comfort for laboring patients and their families, as well as improved throughput, quality and safety, and compliance with HIPAA and EMTALA requirements.

4. Quality Initiatives/Achievements

A. Reduced score for Adverse Outcomes Index Project (to reduce obstetrical morbidity) from 12 to 6.5, a statistically significant improvement that is associated with reduction in NICU admissions and reduction in third- and fourth-degree obstetric lacerations. B. Improved compliance with best practice guidelines and documentation for Obstetrics, from 65% to 80%. C. Provided fetal heart monitoring training for all providers and nursing staff. All providers (100%) and residents completed and passed the test, thereby improving uniformity of interpretation and communication about fetal heart rate patterns. D. Completed obstetrical shoulder dystocia simulation for all obstetric personnel, i.e., physicians, midwives and residents. This is the first simulation module designed to enhance communication and teamwork when encountering high-risk, low-frequency occurrences in the clinical setting. E. Implemented new triage policy to enhance patient throughput and safety through an acuity-based approach that ensures HIPAA and EMTALA compliance and improved patient satisfaction. F. Developed a portable care map and educational material for obstetrical care of the morbidly obese paturient.

2011 Year End Report 109 Department of PainObstetrics Medicine and andGynecology Palliative Care

G. Launched a breastfeeding initiative to educate caregivers in the value and methods of promoting breastfeeding toward a goal of increased number of mothers doing exclusive breastfeeding. Certification as a “Baby Friendly Hospital” is our pathway toward this goal. H. Developed protocol for the use of Duramorph for long-lasting post-Cesarean section analgesia. I. Began abnormal pap smear project to confirm recognition and appropriate referral for evaluation and treatment of precancerous cervical findings (not completed in 2011). J. Provider performance in key areas such as compliance with best practice guidelines, online education in fetal heart monitoring, simulation, continuing education, provider behavior, communication and teamwork all tied to recredentialing.

5. Fellow/Resident Board Passage Rates —— Fellows: N/A. —— Residents: 80% (unofficial, self-reported).

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Ju R, Perretta T, Chang PL. “Large Intact Tubal Ectopic Pregnancy Removed via Laparoscopy.” The Female Patient. 2011 36 (6): 40-42. ——Masch R, Ditzian LR, April AK, Maza M, Peralta E, Cremer ML. “Cervical Cancer Screening and Treatment Training Course in El Salvador: Experience and Lessons Learned.” J Womens Health (Larchmt). 2011 September 20 (9): 1357- 61. Epub 2011 July 28. ——MacIsaac L (Long-Acting Reversible Contraception Working Group). “Committee Opinion: Understanding and Using the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010.” Obstet Gynecol. September 2011 505: 54–60. ——Diana Huang, Tony Carugno, Davendra Patel: “Tuberculous Peritonitis Presenting as an Acute Abdomen: A Case Report.” AM J Obstet Gynecol. July 2011 E11-E14.

B. Presentations Ju R ——“Is Nintendo Wii a More Suitable Video Game Platform than PlayStation 2 for Enhancing Laparoscopic Skills?” American Association of Laparoscopic Gynecologists 40th Global Congress on Minimally Invasive Gynecology, Hollywood, FL, November 2011. ——“Quantifying Successful Models of Collaborative Practice in Maternity Care between Physicians and Certified Nurse Midwives.” The American Congress of Obstetricians and Gynecologists Annual Meeting, New York, NY, October 2011.

Goffman D ——(With Bernstein P, Nero D, Buckley AP, Burgess T, Chazotte C, Dupree E, Fuks A, Callahan M). “Collaborative Obstetric Patient Safety Initiative on Outcome Measures.” Society for Maternal Fetal Medicine Annual Meeting, February 2011.

2011 Year End Report 110 Department of PainObstetrics Medicine and andGynecology Palliative Care

Buckley AP ——(With Rothenberg S, Perretta T, Mullan J, Bernasko J, Nero D, Callahan M). “A Multidisciplinary, Collaborative Approach to Decreasing Obstetrical Morbidity.” National Patient Safety Foundation Annual Congress, May 2011. ——(With Callahan M, Chazotte C, Landesberger E, Dupree E, Fuks A, Nero D, Nemerofsky S, Steinberg E, Burgess T, Haberman S, McCalla S). “A Multi– Center, Multidisciplinary Collaborative Project to Design and Validate a Portable Care Map and Culturally Sensitive Patient Education Material for the Morbidly Obese Parturient.” National Patient Safety Foundation Annual Congress, May 2011.

Tsimis, M ——(With Buckley, A, Nero, D, Laurio, A). “Association between Oxytocin Usage and Neonatal and Obstetrical Outcomes.” National Patient Safety Foundation Annual Congress, May 2011. ——(With Lipshutz R, Chang PL). “Quantifying Successful Models of Collaborative Practice in Maternity Care between Physicians and Certified Nurse Midwives.” The American Congress of Obstetricians and Gynecologists Annual Meeting, New York, NY, October 2011.

7. Honors/Awards Arnold J. Friedman, MD ——Received National Faculty Award as Best Teacher of OB/GYN Residents, from the Council for Resident Education in OB/GYN.

John P. Koulos, MD ——Cited as Best Doctor for Gynecologic Oncology, Castle Connolly.

8. Grants —— Communities Putting Prevention to Work (CPPW): $50,000 for 1 year (awarded 2010, received 2011). —— United Hospital Fund Quality Improvement Grant: To Adam Buckley, MD, to develop a portable care map for the morbidly obese pregnant patient. —— NY State Infertility Demonstration Grant: To Peter Chang, MD, 04/01/2010-03/31/2012.

2011 Year End Report 111

Department of Orthopedic Surgery

2011

Department of Orthopedic Surgery

DEPARTMENT OF ORTHOPEDIC SURGERY Peter D. McCann, MD, Chairman

1. Program Enhancements

A. New Programs i. Electronic Medical Record (EMR): Implemented EMR in the outpatient department in November 2011. B. Program Expansions i. Joint Replacement Surgical Volume: Increased by 15% to 937 cases. ii. Union Square, SC, LLC: Established in an effort to develop an off-site independent ambulatory surgical center in the Union Square area, partnering with attending surgeons and Beth Israel Medical Center, to increase ambulatory capacity at Beth Israel. iii. Enhanced Departmental Profit and Loss: Improved profit and loss by 23% over previous year.

2. Quality Initiatives/Achievements

A. Standardized delineation of privileges form across Continuum. B. Standardized proctoring program across Continuum. C. Achieved 99% compliance with SCIP measures. D. Achieved better than expected infection rates in total hip and total knee replacements, SIR 0.6 and 0.2, respectively. E. Established standardized criteria and automated recording system for quality improvement data across Continuum. F. Developed Surgeon Outcome Report delineating and summarizing all QI data for each surgeon in the department. G. Department of Orthopedic Surgery contributed $267,000 to special funds as a result of the pay for performance program. (The Department also contributed $208,500 to the Beth Israel Annual Ball.)

3. Academic Appointments —— Peter D. McCann, MD, appointed Professor of Clinical Orthopedic Surgery, November 2011.

4. Fellow/Resident Board Passage Rates —— Fellows: 100%.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Harwin S, Green KS. “Maximizing Patient Satisfaction and Functional Results following Total Knee Arthroplasty.” Journal of Knee Surgery. 2011 Volume 24.

2011 Year End Report 115 Department of Orthopedic Surgery

——McCann, PD. “ACGME Accreditation and National Health Care Reform.” Am J Orthop. 2011 40 (1): 12-13. ——McCann, PD. “The American Journal of Orthopedics Turns 40.” Am J Orthop. 2011 40 (2): 65-66. ——McCann, PD. “A Conversation with AAOS President Daniel J. Berry, MD.” Am J Orthop. 2011 40 (7): 332. ——McCann, PD. “Lessons We Can All Learn.” Am J Orthop. 2011 40 (11): 557.

B. Presentations Steven Harwin, MD ——“Current Concepts in Complex Revision Knee Surgery”—Course Chairman. Mahwah, NJ, August 2011. ——“Orthopaedic Surgery: A Bloodless Approach”—Faculty Member. New York, NY, November 2011.

Daniel Polatsch, MD ——“Silicone Arthroplasty for Osteoarthritis of the PIP Joint Employing the Dorsal Approach: Mid to Long-Term Analysis.” American Society for Surgery of the Hand Annual Meeting, Las Vegas, NV, September 2011. ——“Silicone Arthroplasty for Osteoarthritis of the PIP Joint Employing the Dorsal Approach: Mid to Long-Term Analysis.” New York Society for Surgery of the Hand, Residents and Fellows Night, New York, NY, May 2011.

Charles Melone, MD ——“The Hand in Scleroderma: Surgical Options.” National Scleroderma Foundation – Annual Patient Education Conference, San Francisco, CA, July 2011.

Kevin Plancher, MD ——“American Journal of Orthopaedics Inaugural Course “Emerging Techniques in Orthopaedics”—Conference Chair. Las Vegas, NV, 2011. ——“Wrist/Elbow Lecture”—Faculty. Arthroscopy Association of North America, Palm Desert, CA, November 2011. ——“2011 Shoulder Course”—Master Instructor. Arthroscopy Association of North America, Rosemont, IL, October 2011. ——Invited Faculty. American Osteopathic Academy of Orthopedics 2011 Annual Meeting, Chicago, IL, October 2011. ——Faculty. Eastern Orthopaedic Association Annual Meeting, Williamsburg, VA, October 2011. ——Faculty and Part II Examiner. Maine Orthopaedic Review Course, Colby College, Waterville, ME, June 2011. ——Faculty. Miller Orthopaedic Review Course, Denver, CO, May 2011. ——Co-Chairman. ISAKOS 8th Biennial Congress, Rio de Janeiro, Brazil, May 2011. ——“Don’t Let Arthritis Slow You Down”—Speaker. Greenwich Library Community Education, Greenwich, CT, May 2011.

2011 Year End Report 116 Department of Orthopedic Surgery

——CA ICL Coordinator/Moderator. Arthroscopy Association of North America Annual Meeting, San Francisco, CA, April 2011. ——“Sports Medicine/Arthroscopy III: ACL Reconstruction Pediatric, Revision, PCL, and Meniscus”—Co-Moderator. American Academy of Orthopaedic Surgeons Annual Meeting, San Diego, CA, February 2011. ——“Breaking Topics in Orthopaedics”—Faculty. Delray Beach Medical Center, Hollywood, FL January 2011.

Peter D. McCann, MD ——“Transition to Arthroscopic Rotator Cuff Repair - The Basics.” AAOS 2011 Annual Meeting, San Diego, CA, February 2011. ——“Effect of Pitch Count, Shoulder Range of Motion and Strength on the Risk of Shoulder Injury in Collegiate Female Fast-Pitch Softball Pitchers.” Annual Closed Meeting, American Shoulder and Elbow Surgeons, White Sulfur Springs, WV, October 2011. ——“How to Avoid Complications in Non-Constrained Shoulder Arthroplasty.” State- of-the-Art Shoulder Arthroplasty Course, NYU Hospital for Joint Diseases, New York, NY, November 2011.

6. Honors/Awards Frances Cuomo, MD ——President, American Shoulder and Elbow Surgeons, 2011. Peter D. McCann, MD ——Co-Chairman, Course Director, AAOS/ASES Sports Shoulder Injuries, Rosemont, IL, May 2011. ——Lifetime Achievement Award, Arthritis Foundation, New York Chapter, November 2011. Department of Orthopedic Surgery ——Aetna Institute of Quality Award for hip and knee joint replacement surgery and spine fusion surgery. Castle Connolly Top Doctors – NY Metro Area ——Steven Beldner, MD ——Fabien Bitan, MD ——Andrew Casden, MD ——Catherine Compito, MD ——Frances Cuomo, MD ——Steven Harwin, MD ——Christopher Hubbard, MD ——Paul Kuflik, MD ——Salvatore Lenzo, MD ——Howard Levy, MD ——Jerry Lubliner, MD ——Peter D. McCann, MD ——Charles Melone, MD ——Daniel Morgan, MD ——Michael Neuwirth, MD

2011 Year End Report 117 Department of Orthopedic Surgery

——Kevin Plancher, MD ——Jacob Rozbruch, MD ——Sheldon Simon, MD ——Todd Soifer, MD ——Andrew Turtel, MD New York Magazine Best Doctors – NY Metro Area ——Fabien Bitan, MD ——Andrew Casden, MD ——Peter D. McCann, MD ——Charles Melone, MD ——Daniel Morgan, MD ——Kevin Plancher, MD ——Todd Soifer, MD Super Doctors – Key Professional Media ——Steven Arsht, MD ——Steven Beldner, MD ——Andrew Casden, MD ——Frances Cuomo, MD ——David Drucker, MD ——Robert Gotlin, DO ——Steven Harwin, MD ——Christopher Hubbard, MD ——Donald Kastenbaum, MD ——Samuel Kenan, MD ——Salvatore Lenzo, MD ——Howard Levy, MD ——Jerry Lubliner, MD ——Peter D. McCann, MD ——Charles Melone, MD ——Michael Neuwirth, MD ——Debra Parisi, MD ——Daniel Polatsch, MD ——Thomas Scilaris, MD ——Sheldon Simon, MD ——Andrew Turtel, MD US News – Top 1% Nationally ——Fabien Bitan, MD ——Samuel Kenan, MD ——Peter D. McCann, MD ——Charles Melone, MD ——Michael Neuwirth, MD ——Kevin Plancher, MD Becker’s Orthopedic Review – Top 125 Surgeons in America in respective field ——Frances Cuomo, MD: 67 Outstanding Shoulder Surgeons and Specialists. ——Frances Cuomo, MD: 70 Female Orthopedic and Spine Surgeon Leaders to Know. ——Steven Harwin, MD: 125 Outstanding Knee Surgeons. ——Michael Neuwirth, MD: 100 of the Best Spine Surgeons & Specialists in America. ——Kevin Plancher, MD: 100 Orthopedic and Spine Physician Leaders to Know.

2011 Year End Report 118 Department of Otolaryngology

2011

Department of Otolaryngology

THE MAX L. SOM, MD, DEPARTMENT OF OTOLARYNGOLOGY Mark Persky, MD, Chairman

1. New Faculty —— Michael Turner, DDS, MD, Oral and Maxillofacial Surgery, Full-time, September 1, 2011.

2. Program Enhancements

A. New Programs i. Functional Outcomes Research Center: The Center has increased the number of IRB-approved studies, several of which are interdisciplinary (Otolaryngology, Radiation Oncology, Medical Oncology, Social Work). In addition, studies include collaboration across Continuum hospitals (NYEEI). Patients have been accrued in all current studies and many patients have been followed at several time points following completion of treatment. Several talks, posters and manuscript submissions have been generated from the data obtained. ii. Facial Nerve Rehabilitation Program – Multidisciplinary iii. Division of Sleep and Airway Surgery iv. Salivary Gland Disorders Clinic B. Program Expansions i. Skull Base Surgery Program: Expanded to Roosevelt Hospital; jointly with Neurosurgery.

3. Capital Enhancements

A. Equipment Enhancements i. Advanced Operating Microscope for facilitating microvascular and skull base surgery. ii. BrainLab software upgrade to assist with facial reconstruction.

4. Quality Initiatives/Achievements

A. Josh Verona, DDS, protocol for treatment of post-radiation and post-chemotherapy mucositis. B. Outpatient clinical pertinence chart review. C. Speech and swallowing pre-op teaching of tracheostomy care. D. Academic/clinical/research productivity. E. Patient satisfaction survey.

2011 Year End Report 121 Department of Otolaryngology

Patient Satisfactory Survey: BIMC

Rating System: Very Good Very Poor

5 4 3 2 1

100 90 80 70 70 70 60 50

Percent 40 30 20 22 26 10 0 2011: Q2 2011: Q3 N=522 N=1517

1 2 3 4 5 4 or 5 rating

2011 Q2 8 (2%) 4 (0.8%) 29 (6%) 113 (22%) 368 (70%) 92%

2011 Q3 4 (0.3%) 8 (0.5%) 61 (4%) 388 (26%) 1056 (70%) 96%

F. Measures to improve: i. T&A post-op bleeding requiring return to OR. ii. Post-op bleeding requiring return to OR. iii. Post-op CSF lead following FESS. iv. Post-op wound infection. v. Deaths related to tracheostomies. vi. Unplanned readmission within 30 days related to complications of initial procedure. vii. Free flap complications.

Beth Israel Free Flap Complications

10 Failure Other Complications Benchmark for Failure1: 3.2% 9 8 7 8 6 5 6 4

Percent 3 2 3 1 2 2 0.8 0 2009 2010 2011

2009 2010 2011

Failure 3/124 3/131 2/124

Other Complications* 4/124 11/131 8/124

* Hematoma, Wound Dehiscence, Congestion

1 Benchmark Kroll, SS et al. Timing of Pedicle Thrombosis and Flap Loss after Free Tissue Transfer, Plastic and Reconst. Surg 1996, 98: 1230-3 (review of 990 Flaps)

2011 Year End Report 122 Department of Otolaryngology

5. Academic Appointments —— Spiros Manolidis, MD, appointed Associate Professor, Department of Otolaryngology–Head & Neck Surgery, Albert Einstein College of Medicine, April 16, 2011. —— Boris Chernobilsky MD, appointed Assistant Professor, Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, July 1, 2011.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications —— Urken ML, Jacobson AS, Lazarus C. “A Comprehensive Approach to Restoration of Function in Patients with Radiation Induced Pharyngoesophageal Stenosis: Report of 31 Patients and Proposal of a New Classification Scheme.” Head Neck. 2011 November 15. doi: 10.1002/hed.21927. [Epub ahead of print] PMID: 22083567. —— Jacobson AS, Smith M, Urken ML. “Internal Mammary Artery and Vein as Recipient Vessels in Head and Neck Reconstruction.” Under Review, Head Neck. 2011. —— Slova D, Paniz Mondolfi A, Moisini I, Levi G, Urken M, Zevallos J, Mansoor S, Khorsandi A, Bloch D, Vidhun R, Wenig B. “Colonic-Type Adenocarcinoma of the Base of the Tongue: A Case Report of a Rare Neoplasm.” Head Neck Pathol. 2011 September 25. [Epub ahead of print]. —— Leder SB, Lazarus CL, Suiter DM. “Effect of Orogastric Tubes on Aspiration Status and Recommendations for Oral Feeding.” Otolaryngol Head Neck Surg. 2011 March 144: 372-5. —— Amin MR, Lazarus CL, Mulholland T, Shephard T, Branski RC, Wang EY. “3T Turbo- FLASH Magnetic Resonance Imaging of Deglutition.” Laryngoscope. In press. —— Tabaee A, Hsu A, Kacker A. “Indications, Technique, Safety and Accuracy of Office- Based Nasal Endoscopy with Biopsy for Sinonasal Neoplasm.” International Forum of Allergy & Rhinology. 2011 May-June 1 (3): 225-8. B. Presentations Jacobson AS, Zevallos J, Lazarus C, Buchbinder D, Urken ML ——“Functional Outcomes after Free Tissue Transfer for Osteoradionecrosis of the Mandible.” Poster Presentation, 2011 American Head and Neck Society Meeting, Combined Otolaryngology Society Meeting, Chicago, IL, April/May 2011.

Zevallos J, Hu K, Jacobson AS, Urken ML, Harrison L ——“High Dose Rate Intra-operative Radiation Therapy for the Salvage Treatment of Recurrent Nodal Disease in Head and Neck Squamous Cell Carcinoma.” Poster Presentation, 2011 American Head and Neck Society Meeting, Combined Otolaryngology Society Meeting, Chicago, IL, April/May 2011.

Lazarus CL, Jacobson A, Zevallos J, Buchbinder D, Urken M ——“Functional Outcomes in Patients with Osteoradionecrosis of the Mandible Undergoing Definitive Microvascular Reconstruction.” Poster Presentation, 2011 Dysphagia Research Society Annual Meeting, San Antonio, TX, March 2011.

2011 Year End Report 123 Department of Otolaryngology

Kothary S, Khorsandi A, Lazarus C ——“Swallowing Complications of Head and Neck Cancer Treatment Seen on Videofluoroscopy.” Poster Presentation, Annual Association of University Radiologists (AUR), Boston, MA, April 2011.

Lazarus C, Burkhead L, Troche M, Clarke H ——“Tongue Strength and Swallowing in Head and Neck Cancer Patients.” Part of Short Course, “Exercise Principles: How Much, How Often and How Intense?”, American Speech-Hearing-Language Association Annual Meeting, San Diego, CA, November 2011.

Abtin Tabaee, MD ——“Inter-Rater Agreement of Nasal Endoscopy for Chronic Rhinosinusitis.” Scientific Research Presentation, American Rhinologic Society, San Francisco, CA, September 2011. ——“Stereotactic Navigation and Intraoperative MRI”—Lecturer and Dissection Proctor. Advanced Endoscopic Skull Base and Pituitary Surgery Course, Weill Medical College of Cornell University, Palm Beach Gardens, FL, October 2011. ——“Preoperative Medical Management: Standardization, Medications and Timing”—Panel Moderator. “Primary Medical and Surgical Management”— Panelist. 10th Annual New York Rhinology Update, New York University, New York, NY, May 2011. ——“Indications & Techniques for Office-Based Rhinology”—Lecturer. “Surgical Rhinology/Skull Base”—Panelist. Cherry Blossom Otolaryngology Update, George Washington University Medical Center, Washington, DC, April 2011. ——“Surgical Anatomy and Skull Base Approaches”—Lecturer and Dissection Proctor. Instructional Course in Endoscopic Skull Base Surgery, North American Skull Base Surgery, Scottsdale, AZ, February 2011.

Mark Persky, MD ——Visiting Professor, Rabin Medical Center, Petach Tikvah, Israel.

Spiros Manolidis, MD ——“Pediatric Skull Base Surgery”—Invited Lecturer. Mastery of Advanced Head & Neck Reconstruction and Skull Base Surgery, Houston, TX, February 2011. ——“Management of Frontal Sinus Fractures”—Invited Lecturer. Mastery of Advanced Head & Neck Reconstruction and Skull Base Surgery,” Houston, TX, February 2011.

7. Honors/Awards Mark Persky MD —— Top Doctor, Castle Connolly Medical Ltd, American Registry, LLC. —— Best Cancer Doctors in America, Castle Connolly. —— New York Magazine’s Best Doctors in New York. —— Visiting Professor, Rabin Medical Center, Petach Tikvah, Israel. —— Top New York Doctors, Best Physicians as chosen by their peers, Otolaryngology, New York Times.

2011 Year End Report 124 Department of Otolaryngology

Mark L. Urken, MD —— Top Doctor, Castle Connolly Medical Ltd, American Registry, LLC. —— Best Doctors on New York edition of Better Living. —— Best Cancer Doctors in America, Castle Connolly. —— The Helmuth Goepfert Visiting Lecturer, Division of Head and Neck Surgery, MD Anderson Center, February 2011. —— New York Magazine’s Best Doctors in New York. —— Top New York Doctors, Best Physicians as chosen by their peers, Otolaryngology, New York Times. Spiros Manolidis, MD —— Leading Health Professionals of the World, International Biographical Center, Cambridge, England. —— Top New York Doctors, Best Physicians as chosen by their peers, Otolaryngology, New York Times.

8. Grants —— NIH/NCI R01CA120950-01A1: $2,670,000 (sub-contract $27,142), 7/1/07- 6/30/12, for “Efficacy of Electrical Stimulation for Dysphagia in Head & Neck Cancer Patients.” (PI: Langmore, Boston University; C Lazarus: Co-Investigator) (sub-contract, 9% effort).

2011 Year End Report 125

Department of Pain Medicine and Palliative Care

2011

Department of Pain Medicine and Palliative Care

DEPARTMENT OF PAIN MEDICINE AND PALLIATIVE CARE Russell Portenoy, MD, Chairman

1. Program Enhancements

A. New Programs i. Voluntary-Led Pain and Palliative Care Program at Beth Israel Brooklyn: We helped create a model for improved access to pain and palliative care consultations, with the palliative care consultants collaborating with MJHS Hospice and Palliative Care to improve access to inpatient hospice services. ii. Addiction Psychiatry Session in the Pain Practice: We established a weekly session that enables fellows in Addiction Psychiatry to improve access to onsite evaluation of pain patients and assist in the collaboration between the Pain Practice and the Division. iii. Volunteer Support for the Pain Practice: We created a model to oversee volunteers in the Pain Practice. B. Program Expansions i. Nurse Practitioner (NP) Provider Program: We expanded an NP-led program to improve access to pain care. When fully staffed, this program will substantially enhance the Department’s teaching practice in pain medicine. ii. Supportive Therapies and Treatment Program: We re-initiated the grant-funded STAR program to provide both bridge home-aide hours to patients going home and better access to distressed inpatients with advanced illness. iii. Supportive and Palliative Care Practice: We expanded the ambulatory practice for patients with serious illness through a collaboration with Continuum Cancer Centers of New York. The program offers access to a specialist in palliative medicine and other caregivers as needed.

2. Quality Initiatives/Achievements

A. We continue working with the Continuum Pain QI Committee to oversee interventions to reduce pain among inpatients, and obtained funding to conduct a new Hospitalist Pain Program. B. A satisfaction survey of outpatients (N=98) identified strengths and weaknesses in the practice.

3. Academic Appointments —— Earle Hayes, DO, appointed Assistant Professor of Medicine at AECOM, March 2011.

4. Fellow/Resident Board Passage Rates —— 80% for Fellows in Pain Medicine; too early for statistics for the Fellowship in Hospice and Palliative Medicine. —— No residents.

2011 Year End Report 129 Department of Pain Medicine and Palliative Care

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Abelev Z, Seth A, Patel R, Goldstein S, Bogun M, Paliou M, Schlosser J, Homel P, Busta A, Seto-Young D, Tranbaugh R, Poretsky L. “Continuous Insulin Infusion Is Associated with a Reduced Post-Surgical Length of Stay, but Not with the Complication Rate, in Patients with Diabetes Mellitus Undergoing Coronary Artery Bypass Graft. J Endocrinol Invest. 2011 November 34 (10): 770-4. ——Bezov D, Ashina S, Jensen R, Bendtsen L. “Pain Perception Studies in Tension- Type Headache.” Headache. 2011 51 (2): 262-271. ——Biswal B, Kunwar P, Natelson BH. “Cerebral Blood Flow Is Reduced in Patients with Chronic Fatigue Syndrome as Assessed by Arterial Spin Labeling.” J Neurol Sci. 2011 301 (1-2): 9-11. ——Bookbinder M, Glajchen M, McHugh M, Higgins P, Budis J, Solomon N, Homel P, Cassin C, Portenoy RK. “Nurse Practitioner-Based Models of Specialist Palliative Care in the Home: Evaluation of Feasibility.” J Pain Symptom Manage. 2011 41: 25-34 ——Breuer B, Fleishman SB, Cruciani R, Portenoy RK. “Medical Oncologist Attitudes and Practice in Cancer Pain Management: A National Survey.” J Clin Onco. 2011 29 (36): 4769-4775. ——Cook DB, Stegner AJ, Nagelkirk PR, Meyer JD, Togo F, Natelson BH. “Responses to Exercise Differ for Chronic Fatigue Syndrome Patients with Fibromyalgia.” Med Sci Sports Exerc. In press. ——Cruciani RA, Soto E. “Impacto de Los Nuevos Fentanilos en El Tratamiento del Dolor Irruptivo.” Revista de la Sociedad Española del Dolor. 2011 18 (4): 203-206. ——Cruciani RA, Katz N, Portenoy RK. “Dose Equivalence of Immediate-Release Hydromorphone and Once-Daily OROS® Hydromorphone (Exalgo®): A Randomized, Double-Blind Trial Incorporating a Measure of Assay Sensitivity.” J Pain. In press. ——Dhingra L, Lam K, Homel P, Chen J, Chang V, Zhou J, Chan S, Lam WL, Portenoy R. “Pain in Community-Dwelling Chinese American Cancer Patients: Demographics and Medical Correlates.” Oncologist. 2011 16 (4): 523-533. ——Dhingra L, Masson C, Perlman D, Seewald R, Katz J, McKnight C, Wald E, Homel P, Portenoy R. “Epidemiology of Pain in Outpatients Undergoing Opioid Agonist Therapy for Addiction.” Submitted for publication. ——Dhingra L, Shuk E, Grossman B, Strada A, Wald E, Portenoy A, Knotkova H, Portenoy R. “A Qualitative Study to Explore Psychological Distress Associated with Opioid-Induced Constipation in Cancer Patients with Advanced Disease.” Palliat Med. In press. ——Factor A, Stock V, Robbins N, Sabia M, Thapa C, Cruciani RA, Knotkova H. “An Update on the Pharmacological Treatment of Neuropathic Pain.” J Alt Med and Research. 2011 3 (1): 379-385. ——Glajchen M, Lawson R, Homel P, DeSandre P, Todd KH. “A Rapid Two-Stage Screening Protocol for Palliative Care in the Emergency Department: A Quality Improvement Initiative.” Journal of Pain and Symptom Management. 2011 42: 657-662.

2011 Year End Report 130 Department of Pain Medicine and Palliative Care

——Kishi A, Natelson BH, Togo F, Ztruzik ZR, Rapaport DM, Yamamoto Y. “Sleep Stage Dynamics in Chronic Fatigue Syndrome Patients with or without Fibromyalgia.” Sleep. 2011 34 (11): 1551-1560. ——Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, Singh J, Nallamothu R, Mahbub H, Eden E, Delfiner J. “Changes in Health-Related Quality of Life and Factors Predicting Long-Term Outcomes in Older Adults Admitted to Intensive Care Units.” Crit Care Med. 2011 April 39 (4): 731-7. ——Kligler B, Homel P, Harrison LB, Levenson HD, Kenney JB, Merrell W. “Cost Savings in Inpatient Oncology through an Integrative Medicine Approach.” Am J Manag Care. 2011 December 17 (12): 779-84. ——Kligler B, Homel P, Harrison LB, Sackett E, Levenson H, Kenney J, Fleishman SB, Serra D, Merrell W. “Impact of the Urban Zen Initiative on Patients’ Experience of Admission to an Inpatient Oncology Floor: A Mixed-Methods Analysis.” J Altern Complement Med. 2011 August 17 (8): 729-34. ——Kligler B, Homel P, Blank AE, Kenney J, Levenson H, Merrell W. “Randomized Trial of the Effect of an Integrative Medicine Approach to the Management of Asthma in Adults on Disease-Related Quality of Life and Pulmonary Function.” Altern Ther Health Med. 2011 January-February 17 (1): 10-5. ——Knotkova H, Cruciani RA, Tronnier V, Rasche D. “Current and Future Options for the Management of Phantom-Limb Pain.” J Pain Res. Submitted. ——Knotkova H, Nafissi A, Leuschner Z, Das D, Dhokal I, Cruciani RA. “Safety of the Transcranial Direct Current Stimulation (tDCS): Evaluation of 815 tDCS Sessions in 100 Chronic-Pain Patients.” J of Pain. 2011 12 (4) (Supp1): P54. ——Lange G, Janal MN, Maniker A, FitzGibbons J, Fobler M, Cook D, Natelson BH. “Safety and Efficacy of Vagus Nerve Stimulation in Fibromyalgia: A Phase I/II Proof of Concept Trial.” Pain Med. 2011 12 (9): 1406-1413. ——Mui A, Glajchen M, Chen H, Sun J. “Developing an Older Adult Volunteer Program in a New York Chinese Community: An Evidence-Based Approach.” Ageing International. 2011. In press. ——Portenoy RK. “Cancer Pain.” Lancet. 2011 377: 2236-2247. ——Portenoy RK. “Clinical Perspectives on Preclinical Models of Bone Pain. Questions and Promises.” Pain. 2011 152: 2455-2456. ——Rosedale M, Malaspina D, Malamud D, Strauss SM, Horne JD, Abouzied S, Cruciani RA, Knotkova H. “Developing Patient-Centered Treatment Protocols in Brain Stimulation: A Rationale for Combining Quantitative and Qualitative Approaches in Persons with HIV.” J Psych Dis. In press. ——Schutzer SE, Rounds MA, Natelson BH, Ecker DJ, Eshoo MW. “Analysis of Cerebrospinal Fluid from Chronic Fatigue Syndrome Patients for Multiple Human Ubiquitous Viruses and Xenotropic Murine Leukemia-Related Virus.” Ann Neurol. 2011 69 (4): 735-738. ——Schutzer SE, Angel TE, Liu T, Schepmoes AA, Clauss TR, Adkins TN, Camp II DG, Holland BK, Bergquist J, Coyle PK, Smith RD, Fallon BA, Natelson BH. “Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome.” PLoS One. 2011 6 (2): e17287.

2011 Year End Report 131 Department of Pain Medicine and Palliative Care

——Shungu D, Weiduschat N, Murrough JW, Mao X, Pillemer S, Dyke JP, Medow M, Natelson BH, Stewart J, Mathew SJ. “Increased Ventricular Lactate in Chronic Fatigue Syndrome. III: Relationships to Cortical Glutathione and Clinical Symptoms Implicate Oxidative Stress in Disorder Pathophysiology.” NMR Biomed. In press. ——Smith EM, Bakitas MA, Homel P, Piehl M, Kingman L, Fadul CE, Bookbinder M. “Preliminary Assessment of a Neuropathic Pain Treatment and Referral Algorithm for Patients with Cancer.” J Pain Symptom Manage. 2011 December 42 (6): 822-38. ——Strada EA, Scott E, Billings JA, Portenoy RK, Tennstedt S, Homel P. “Spiritual Well-Being in Patients with Advanced Heart and Lung Disease.” Palliat Support Care. In press. ——Sundaram A, Nafissi A, Schweitzer A, Dvorkin E, Homel P, Feldman D, Portenoy R, Cruciani RA. “Effect of Oral Methadone on the QTc Interval in Patients with Increased Risk for QTc Prolongation.” J of Pain. 2011 12 (4) (Supp1): P69.

B. Presentations Terry Altilio LCSW ——“ExCel Faculty–Excellence in Cancer Education & Leadership.” NCI-funded project, City of Hope Hospital, St. Louis, MO, May 2011. ——Speaker. Social Work Conference, Mississippi Hospice and Palliative Care Organization, Baton Rouge, LA, January 2011. ——Speaker. California Veterans Administration Conference, Palo Alto, CA, August 2011. ——Speaker. Social Work Conference, National Hospice and Palliative Care, San Diego, CA, September 2011. ——Speaker. End of Life Certification Program for Social Workers, Baystate Health Continuing Education & Smith College School of Social Work, Northhampton, MA, October 2011. ——Speaker. Symposium on Hospice & Palliative Care, Lubbock, TX, September 2011. ——Speaker. Palliative Care Conference, Portland, ME, June 2011. ——Speaker. BCBS of South Carolina, Columbia, SC, March 2011.

Sait Ashina, MD ——“Association of Neck Pain with Reduced Physical Quality of Life and Increased Neuroticism and Mental Vulnerability Scores Adjusted for Headache: A Cross- Sectional Population Study”—Co-Presenter. 15th Congress of International Headache Society, Berlin, Germany, June 2011. ——“Neck Pain Is Highly Prevalent in Migraine and Tension-Type Headache: A Cross- Sectional Population Study”—Co-Presenter. 53rd Annual Scientific Meeting of the American Headache Society, Washington, DC, June 2011.

2011 Year End Report 132 Department of Pain Medicine and Palliative Care

Brenda Breuer, PhD ——“Access of Cancer Patients to Appropriate Pain Management”—Speaker. 12th Conference of the European Association for Palliative Care, Lisbon, Portugal, May 2011.

Ricardo Cruciani, MD, PhD ——“Methadone for Pain”—Speaker. 10th International Conference on Pain and Chemical Dependency, New York, NY, March 2011. ——“The Nuances and Complexities of Opioid Rotation: A Point-Counterpoint Debate”—Speaker. Satellite Symposium, 27th Annual Meeting, American Academy of Pain Medicine, Washington, DC, March 2011. ——“Drugs in Development: What’s New?”—Keynote Speaker. VI Mediterranean Forum for Pain Management, Menorca, Spain, May 2011. ——“Strategies to Manipulate Maladaptive Brain Plasticity and Excitability in Chronic Pain”–Plenary Lecture Speaker. VI Mediterranean Forum for Pain Management, Menorca, Spain, May 2011. ——“Management of the Patient with Chronic Pain” Symposium—Speaker, VI Mediterranean Forum on Pain Management, Menorca, Spain, May 2011. ——“Neural Plasticity in Chronic Pain and its Clinical Implications”—Speaker. Symposium, 30th Annual Meeting of the American Pain Society, Austin, TX, May 2011. ——“Pain in Methadone Maintenance Patients” Abstract—Presenter with Seewald RM, Todman M, Loran E, Sivesind D, Roane D, Haller D. College on Problems of Drug Dependence (CPPD) 73rd Annual Meeting, FL, June 2011. ——“Boredom, Pain and Illicit Drug Use in MMTP Patients” Abstract—Presenter with Loran E, Todman M, Sivesind D, Haller D, Seewald RM. CPDD 73rd Annual Meeting, FL, June 2011. ——“Clinical Trials in Pain Management”—Speaker. NINR Pain Methodologies Boot Camp Workshop, NINR, NIH, Bethesda, MD, July 2011. ——“Long Term Opioid Therapy: State of the Evidence”—Keynote Speaker. Israeli Pain Society Annual Meeting, Dead Sea, Israel, November 2011. ——“Manipulation of Cortical Excitability as a Tool for the Management of Pain”— Speaker. Israeli Pain Society Annual Meeting, Dead Sea, Israel, November 2011.

Lara Dhingra, PhD ——“Assessment of Smoking Behavior in Persistent Pain Patients”—Speaker. Annual Meeting of the Society of Behavioral Medicine, New Orleans, LA, April 2011. ——“Research Strategies for Improving Quality in Pain and Palliative Care”—Invited Speaker. Annual Meeting of the Philippine Nurses Association, “Leading and Engaging Nurses through Evidenced-Based Practice,” New York, NY, May 2011. ——“Epidemiology of Pain in a Methadone Maintenance Treatment Population: Demographic and Medical Correlates of Pain Experience”—Chair and Speaker. Annual Meeting of the College on Problems of Drug Dependence, Hollywood, FL, June 2011.

2011 Year End Report 133 Department of Pain Medicine and Palliative Care

——“Managing and Creating Access Databases for Research Purposes”—Speaker, 2011 Research Forum “Essentials in Clinical Research,” Beth Israel Medical Center, New York, NY, June 2011. ——“Clinical Management of Pain in Patients with Substance Use Disorders” —Chair and Speaker. Annual Meeting of the American Academy of Pain Management, Las Vegas, NV, September 2011. —— American Cancer Society Cancer Action Network (ACS CAN) Event—Speaker. Flushing, Queens, September 2011. (Press conference and media coverage in two print and three online newspapers.) ——“Psychobehavioral Research in Chronic Pain: Emerging Issues in Special Populations”—Invited Speaker. 5th Annual Pain Awareness Program Conference, Hospital for Special Surgery, New York, NY, September 2011. ——“Using Quantitative Urine Drug Levels to Monitor Adherence to Chronic Opioid Therapy: A Comparison across Two Pain Populations”—Presenter. PAIN Week Conference, Las Vegas, NV, September 2011. ——“Pain Assessment and Diversity” —Invited Speaker. Hospice and Palliative Care: “2011 Update for the Specialist Team” Conference, New York, NY, November 2011. ——“Epidemiology of Pain among Drug Users in Methadone Maintenance”— Speaker. Annual Meeting of the American Public Health Association, Washington, DC, October/November 2011.

Serife Eti, MD ——Hospice and Palliative Care Symposium: 2011 Update for the Specialist Team— Speaker. Marriott Marquis, New York, NY, November 2011. ——Center to Advance Palliative Care-CAPC National Meeting—Presenter. San Diego, CA, November 2011.

Myra Glajchen, DSW ——“Use of the Family Meeting in Palliative Care”—Speaker. Fellows’ Didactic Lecture, Beth Israel Medical Center, New York, NY, February 2011. ——“State of the Science Lecture: Physical Well-Being and Family Caregivers: Family Members Providing Care and Caring for Themselves”—Keynote Speaker. Improving Quality of Life and Quality of Care for Oncology Family Caregivers Conference, Anaheim, CA, March 2011. ——“Support Groups and Family Meetings”—Speaker. Breakout Session, Improving Quality of Life and Quality of Care for Oncology Family Caregivers Conference, Anaheim, CA, March 2011. ——“State of the Science Lecture: Physical Well-Being and Family Caregivers: Family Members Providing Care and Caring for Themselves”—Keynote Speaker. Improving Quality of Life and Quality of Care for Oncology Family Caregivers Conference, Anaheim, CA, July 2011. ——“Support Groups and Family Meetings”—Speaker. Breakout Session, Improving Quality of Life and Quality of Care for Oncology Family Caregivers Conference, Anaheim, CA, July 2011.

2011 Year End Report 134 Department of Pain Medicine and Palliative Care

——“Negotiating Treatment Goals in the Family Meeting”—Speaker. Fellows’ Didactic Lecture, Beth Israel Medical Center, New York, NY, August 2011. ——“Caregivers in End-of-Life Care: Companions on the Road Less Traveled”— Keynote Speaker. Fall Conference, The Hospice Institute, Cleveland, OH, September 2011. ——“Family and Professional Caregivers across the Continuum of Care”—Speaker. UJA Healing and Hospice Alliance, United Jewish Appeal, New York, NY, November 2011. ——“The Many Faces of Caregiver Burden and Distress”—Speaker. Breakout Session, Hospice and Palliative Care: 2011 Update for the Specialist Team, Beth Israel Medical Center and MJHS, New York, NY, November 2011.

Helena Knotkova PhD ——“Neural Plasticity: Mechanisms and Networks”—Speaker. Symposium: “Neural Plasticity in Chronic Pain and Its Clinical Implications for Pain Management, with a Special Focus on Interventional Approach,” Annual Meeting of the American Pain Society, Austin, TX, May 2011. ——“Neural Plasticity in Chronic Pain and Its Clinical Implications for Pain Management, with a Special Focus on an Interventional Approach”—Chair, Co- Organizer and Speaker. Annual Meeting of the American Pain Society, Austin, TX, May 2011. ——“Neural Plasticity: A Rationale for Central Neuromodulation”— Invited Lecturer. Langone Medical Center, Department of Psychiatry, NYU, New York, NY, June 2011. ——“Neural Plasticity and Clinical Potential of Neuromodulation”—Speaker. Lecture for a Nursing Practicum Course, College of Nursing, NYU, New York, NY, October 2011.

Deborah Miller-Saultz DNS, NP ——“Complementary/Alternative Therapies in Pain Management”—Speaker. Pain Symposium NYP-Cornell Weil Division, New York, NY, April 2011. ——“Palliative Care”—Speaker. 27th Annual Conference of the Nurse Practitioner Association of New York, Saratoga Springs, NY, October 2011.

Russell Portenoy, MD ——New York Society of Addiction Medicine—Speaker. New York, NY, February 2011. ——“Hot Topics” Conference—Speaker. Lisbon, Portugal, April 2011. ——Annual Palliative Care Conference—Speaker. Dublin, Ireland, April 2011. ——Conference Sponsored by the Office of Professional Medical Conduct of NYS— Speaker. New York, NY, June 2011. ——Annual Meeting of the Multinational Association of Supportive Care in Cancer (MASCC)—Speaker. Athens, Greece, June 2011. ——Meeting of the Westchester Coalition for Palliative Care—Speaker. White Plains, NY, September 2011. ——Annual Meeting of the Hospice and Palliative Care Association of New York— Speaker. Saratoga Springs, NY, October 2011.

2011 Year End Report 135 Department of Pain Medicine and Palliative Care

——Annual Meeting of the Eastern Pain Association—Speaker. New York, NY, November 2011. ——Annual DPMPC-MJHS Meeting on Palliative Care—Speaker. New York, NY, November 2011. ——NYU Symposium on Safe Opioid Prescribing—Speaker. New York, NY, December 2011.

Ricardo Cruciani, MD, PhD, and Russell Portenoy, MD —— “Comparison of ECG and Holter Monitoring QTc Interval Measurements in Patients with Increased Risk for QTc Prolongation”—Presenters (with Sundaram A, Nafissi A, Schweitzer P, Dvorkin E, Homel P, Feldman D). Pain Week, Las Vegas, NV, Sept 2011.

Helena Knotkova, PhD, and Ricardo Cruciani, MD, PhD ——“A Randomized, Sham-Controlled, Two-Parallel-Arm Study of Transcranial Direct Current Stimulation (tDCS) for the Treatment of Neuropathic Pain in Complex Regional Pain Syndrome - Type I (CRPS/RSD)”—Presenters (with Nafissi A, Sibirceva U, Feldman D, Dvorkin E, Sundaram A, Stock VM, Das D, Robbins N, Kovacs DD, Homel P). Annual Meeting of the AAPM.241, Washington, DC, August 2011. ——“Using tDCS to Treat Depression in HIV-infected Persons”—Poster Presenter (with Horne J, Rosedale M, Malaspina D, Malamud D, Strauss M, Soto E). NYU Summer Research Day, New York, NY, July 2011.

Russell Portenoy, MD, Lara Dhingra PhD, Helena Knotkova, PhD, and Ricardo Cruciani, MD, PhD ——“Using Quantitative Urine Drug Levels to Monitor Adherence to Chronic Opioid Therapy: A Comparison across Two Pain Populations—Presenters (with Harry L, Linden A, Bronstein K). Pain Week, Las Vegas, NV, September 2011.

6. Honors/Awards Terry Altilio, LCSW ——Invited member of the Advisory Committee of the Social Work Leadership Fellowship in Palliative and End of Life Care, New York University School of Social Work, New York, NY. Ricardo Cruciani, MD, PhD ——New York Magazine’s Best Doctors. ——Recipient of the Empire Clinical Research Investigator Program Award, New York State Department of Health. Lara Dhingra, PhD ——2011 Meritorious Abstract Submission, “Assessment of Smoking Behavior in Persistent Pain Patients,” Annual Meeting of the Society of Behavioral Medicine. Myra Glajchen, DSW ——Appointed as Capstone Mentor, Social Work Leadership Fellowship in Palliative and End of Life Care, New York University School of Social Work, New York, NY. Ronald Kaplan, MD ——American Top Doctors, Castle Connolly Guide. ——New York Magazine’s Best Doctors.

2011 Year End Report 136 Department of Pain Medicine and Palliative Care

Helena Knotkova, PhD ——Founder and First Chair of Special Interest Group on Neuromodulation, International Association for the Study of Pain. Russell Portenoy, MD ——American Top Doctors, Castle Connolly Guide. ——American Top Doctors in Cancer, Castle Connolly Guide. ——New York Magazine’s Best Doctors. ——Appointed to the Board of Directors, National Hospice and Palliative Care Organization. ——Appointed to the Greater New York Healthcare Association Palliative Care Leadership Network. ——Appointed to the New York State Working Group on Reducing Prescription Drug Abuse. ——2011 Contemplative Care Award from the Zen Center for Contemplative Care.

7. Grants YC Ho/Helen and Michael Chang Foundation ——$200,000 for Palliative Care MD and NP Fellowships. UJA-Federation of New York ——$150,000 for Regional Palliative Care Network: A Hospital-Community Partnership. Sigmund Freedman Charitable Trust ——$156,070 for Supportive Treatment and Resources (STAR) Program. The Mayday Fund ——$132,417 to establish “The Mayday Pain NP: An Innovative Model for Improving Pain and Other Outcomes in Adult Inpatients Managed by Hospitalist Physicians.” The Leir Charitable Foundations ——$100,000 for Palliative Care Fellowships. Cynthia Zirinksy ——$75,000 for Social Work Palliative Care Fellowship. Gerald J. and Dorothy R. Friedman New York Foundation ——$75,000 for Research Division. Pharmaceutical Educational Grants (6) ——$140,000 for March 2011 Conference. Pharmaceutical Educational Grants (4) ——$57,500 for November Palliative Care Conference. MJHS Foundation ——$25,000 for November Palliative Care Conference. Medtronic Pain Fellowship ——$25,000. Boston Scientific Pain Fellowship ——$25,000. American Cancer Society Research Grant ——$352,416 for Study of Pain in Community-Dwelling Chinese Cancer Patients.

2011 Year End Report 137 Department of Pain Medicine and Palliative Care

Grant from Ms. Stephanie Feld ——$100,000 for Fellowship Support. Medtronic Pain Fellowship ——$18,750. Gerald J. Friedman Chair Endowment ——$150,000. Waechter Family Foundation ——$10,000. UJA-Federation of NY ——$75,343 for Collaborative Project with Regional Care Centers. United Hospital Fund ——$40,000. Empire Clinical Research Investigator Program (ECRIP) ——$110,000/Year for Two Years to Fund a Research Fellowship on tDCS to Treat Pain Resistance to Medications. National Institute of Nursing Research (Duke University Subcontract) ——$319,881 for National Palliative Care Research Consortium. National Institute on Drug Abuse (NDRI Subcontract, Year 2) ——$82,099 for “Web-Based CBT for Opioid-Treated Chronic Pain Patients with Aberrant Behavior.” National Institutes of Health ——$511,829 for “Neuropathologic Abnormalities Define a Subgroup of Patients with CFS.” Veterans Bio-Medical Research Institute, Inc. ——$26,116 for “Integrative Physiology of Gulf War Illness: Role of Autonomic Function, Central Neural, and Sleep.” Centers for Disease Control ——$253,675 for Research on Chronic Fatigue Syndrome. Endo Pharmaceuticals ——$60,000 for “Improving Access to Cancer Pain Management, Part 2: A National Survey to Benchmark the Skills of Oncologists and Pain Specialists.” Covidien ——$117,029 for “Improving Access to Cancer Pain Management, Part 2: A National Survey to Benchmark the Skills of Oncologists and Pain Specialists.”

2011 Year End Report 138 Department of Pathology and Laboratory Medicine

2011

Department of PainPathology Medicine and andLaboratory Palliative Medicine Care

DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE Bruce Wenig, MD, Chairman

1. New Faculty —— Beverly Wang, MD, Vice Chairman and Site Director, Anatomic Pathology, July 1, 2011. —— Cary Johnson, MD, Staff Pathologist, July 1, 2011.

2. Program Enhancements

A. New Programs i. New Outreach Accounts including (but not limited to) additional Institute for Family Health accounts in the Bronx. ii. Enhancement of Residency Training Program by hiring new Site Director with direct oversight of residents; adding new Pathology Assistants allowing residency to focus on diagnostic/educational components of residency training; and adding daily/weekly resident-focused lectures/seminars. B. Program Expansions i. Expanded existing in-house molecular lab testing. ii. Outsourced testing to specialty/commercial lab for testing not performed in house. iii. Partnered with specialty laboratory offering genomic and proteomics for experi- mental molecular testing. iv. Growth 2011: Outreach Revenue Actual = $35,973,827 Budget = $31,111,213 % increase = 15.6%

Outreach Testing volume 2011 Actual = 1,746,526 2010 Actual = 1,471,649 Increase = 18.7%

The Margin contribution on the Outreach Revenue was 30% for BI.

3. Capital Enhancements

A. Equipment Enhancements i. Anatomic Pathology Laboratory Information System (PowerPath) upgrade.

4. Quality Initiatives/Achievements

A. Turnaround Time – Microbiology: —— Outreach genital CX. —— Goal: TAT will be met 95% of the time.

2011 Year End Report 141 Department of PainPathology Medicine and andLaboratory Palliative Medicine Care

B. Corrected Reports – Microbiology: A goal of less than 0.5% has been set for both sites. C. Result Reporting: Unacceptable specimens. D. Generation of Results in a Clinically Relevant Time Frame: TAT of early morning draw. E. Production of Accurate Laboratory Test Results: —— Biannual reports on external QC and external audits, including the number of examinations conducted, the number of failures, and the reasons and corrective action(s) for each failure. —— NYS CAP. F. Assurance of Timely and Accurate Entry of Orders: Monitor order entry errors for all manual requisitions. G. Anatomic Pathology: —— Turn-around-time: Frozen sections. —— Correlation of frozen section specimen diagnosis to permanent section diagnosis. —— Correlation of internal diagnosis with outside consultation diagnosis. H. Assurance of Patient & Employee Safety: Monitor accident reports, test quality and employee safety. I. Alternate Site Testing (Point of Care Testing): —— Continue 2011 indicators plus add creatinine testing monitors. —— Monitor connectivity for GEM 3500, ABL80, Signature Elite at SLR. —— Activate connectivity for GEM3500, Coaguchek XS, and Clinitek Status at BIP. —— Expand use of E-quiz. J. Laboratory Service Delivery for Inpatients and Outpatients: Patient wait time. K. Ensuring Valid Identification of Specimens and Requests: Patients with no orders. L. Result Reporting – Corrected Results: Monitor the number of corrected results in hematology and chemistry. M. Ensuring valid identification of specimens and requests: Blood Bank labeling errors. N. Cytology: —— Correlation between Histology and Cytology results. —— Correlation between Cytology results and Surgical Pathology results.

5. Academic Appointments —— Beverly Wang, MD, appointed to Professor of Pathology, AECOM, July 2011.

6. Fellow/Resident Board Passage Rates —— Residents: 6/8 (75%).

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Ephrem G, Jour G, Smith BL. “Successful Treatment of Von Zumbusch Generalized Pustular Psoriasis with Cyclosporine after Eruption Post Etanercept Injection in a Pso-Patient. J Med Liban. 2011 July-September 59 (3): 168-9. ——Jour G, Batra R. “Chromophobe Renal Cell Carcinoma with Osseous Metaplasia. ASCP Check Sample Surgical Pathology. 2011 March 39 (2): 13-22.

2011 Year End Report 142 Department of PainPathology Medicine and andLaboratory Palliative Medicine Care

——Razi SS, Latif MJ, Li X, Afthinos JN, Ippagunta N, Schwartz G, Belsley SJ, Connery CP, Jour G, Christofidou-Solomidou M, Bhora FY. “Dietary Flaxseed Protects against Lung Ischemia Reperfusion Injury via Inhibition of Apoptosis and Inflammation in a Murine Model.” J Surg Res. 2011 November 171 (1): e113-21. Epub 2011 July 7. ——Bedrosian AS, Nguyen AH, Hackman M, Connolly MK, Malhotra A, Ibrahim J, Cieza-Rubio NE, Henning JR, Barilla R, Rehman A, Pachter HL, Medina-Zea MV, Cohen SM, Frey AB, Acehan D, Miller G. “Dendritic Cells Promote Pancreatic Viability in Mice with Acute Pancreatitis.” Gastroenterology. 2011 November 141 (5): 1915-26.e1-14. ——Connolly MK, Ayo D, Malhotra A, Hackman M, Bedrosian AS, Ibrahim J, Cieza-Rubio NE, Nguyen AH, Henning JR, Dorvil-Castro M, Pachter HL, Miller G. “Dendritic Cell Depletion Exacerbates Acetaminophen Hepatotoxicity.” Hepatology. 2011 September 54 (3): 959-68. ——Ibrahim J, Nguyen AH, Mitchell A, Bedrosian AS, Henning JR, Khan A, Rehman AU, Graffeo C, Tan P, Miller G. “Divergent Lipid-Laden Dendritic Cell Subpopulations Regulate Hepatic Tolerance and Immunity.” J Am College of Surgeons. 2011 September 213: S68. ——Huang W, Moisini I, Bethunaickan R, Sahu R, Akerman M, Eilat D, Lesser M, Davidson A. “BAFF/APRIL Inhibition Decreases Selection of Naive but Not Antigen-Induced Autoreactive B Cells in Murine Systemic Lupus Erythematosus.” The Journal of Immunology. 2011 December 187 (12): 6571-6580. ——Yoon SM, Gerasimidou D, Kuwahara R, Hytiroglou P, Yoo JE, Park YN, Theise ND. “Epithelial Cell Adhesion Molecule (EpCAM) Marks Hepatocytes Newly Derived from Stem/Progenitor Cells in Humans. Hepatology. 2011 March 53: 964-73. ——Paniz-Mondolfi AE, Slova D, Fan W, Attiyeh FF, Afthinos J, Reidy J, Pang Y, Theise ND. “Mixed Adenoneuroendocrine Carcinoma (MANEC) of the Gallbladder: A Possible Stem Cell Tumor? Pathology International. 2011 October 61: 608-14. ——Hudacko R, Theise ND. “Chronic Viral Hepatitis: Beyond Grading and Staging.” Arch Pathol Lab Med. 2011 October 135: 1320-8. ——Gouw ASW, Clouston AD, Theise ND. “Ductular Reactions in Human Livers: Diversity at the Interface.” Hepatology. 2011 November 54: 1853-63.

B. Presentations Neil Theise, MD ——“Complexity Theory and the ‘Science of Being’: The Relationship of Insights from Scientific and Contemplative Practices of Investigation.” Synesthesia Workshop, Toward a Science of Consciousness Annual Meeting, Stockholm, Sweden, May 2011. ——“Sentience Everywhere: Complexity and Evolutionary Emergence of Sentient Activity across All Scales of Existence.” Toward a Science of Consciousness Annual Meeting, Stockholm, Sweden, May 2011. ——“Who Are We? Stem Cells, Complexity and the Science of Being.” Science and Technology Club Seminar Series, Baruch College, New York NY, October 2011. ——“Liver Stem Cells.” Early Morning Breakfast Workshop, American Association for the Study of Liver Diseases, Annual Meeting, Boston, MA, November 2011.

2011 Year End Report 143 Department of PainPathology Medicine and andLaboratory Palliative Medicine Care

——“Chronic Hepatitis: Beyond Grading and Staging” and “Diagnosis of Liver Tumors and Cysts: Updates from the New WHO ‘Blue Book’.” Hong Kong International Academy of Pathology, Annual Meeting, Hong Kong, October 2011. ——“Chronic Hepatitis: Beyond Grading and Staging”, “Fatty Liver Disease” and “Clinico-Pathologic Correlations.” Gastrointestinal and Liver Pathology Updates, Boca Raton, FL, November 2011.

Bruce M. Wenig, MD ——“Noninvasive Poorly-Differentiated Thyroid Carcinoma.” Head and Neck– Endocrine Pathology Evening Session, United States and Canadian Academy of Pathology 100th Annual Meeting, San Antonio, TX, March 2011. ——“Pitfalls in the Diagnosis of Head and Neck Lesions.” The Big Apple Review and Update Course: The Art and Science of Surgical Pathology, New York, NY, April 2011. ——“Selected Lesions of the Head and Neck.” Ohio Society of Pathology, Columbus, OH. May 2011. ——“IgG4-Associated Sialadentitis.” 23rd Annual European Congress of Pathology, Helsinki, Finland, August 2011. ——“HPV-Associated Squamous Cell Carcinoma of the Head and Neck.” Post- Congress Meeting of the 23rd Annual European Congress of Pathology, St. Petersburg, Russia, August 2011. ——“Undifferentiated Malignant Neoplasms of the Sinonasal Tract.” Post-Congress Meeting of the 23rd Annual European Congress of Pathology, St. Petersburg, Russia, August 2011. ——“Thyroid Papillary Carcinoma. Fallacies and Realities in the Diagnosis.” Midwestern Conference Update Course in Surgical Pathology, Milwaukee, WI, September 2011. ——“Selected Salivary Gland Neoplasms.” Midwestern Conference Update Course in Surgical Pathology, Milwaukee, WI, September 2011. ——“Pitfalls in the Biopsy Diagnosis of Head and Neck Lesions.” Short Course Presentation, College of American Pathologists 2011 Annual Meeting, Grapevine, TX, September 2011. ——“Thyroid Papillary Carcinoma. Fallacies and Realities in the Diagnosis.” 2011 Ohio State University Pathology Update Course, Columbus, OH, September 2011. ——“Pitfalls in the Biopsy Diagnosis of Head and Neck Lesions.” 2011 Ohio State University Pathology Update Course, Columbus, OH, September 2011. ——“Intraepithelial Dysplasia and Variant of Squamous Cell Carcinoma of the Head and Neck.” Thyroid and Head and Neck Pathology Course, Florence, Italy, October 2011. ——“Sinonasal Undifferentiated Malignant Neoplasms.” Thyroid and Head and Neck Pathology Course, Florence, Italy, October 2011. ——“Salivary Gland Pathology.” Thyroid and Head and Neck Pathology Course, Florence, Italy, October 2011.

2011 Year End Report 144 Department of PainPathology Medicine and andLaboratory Palliative Medicine Care

——“Pitfalls in the Biopsy Diagnosis of Head and Neck Lesions.” Thyroid and Head and Neck Pathology Course, Florence, Italy, October 2011. ——“Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma.” XLIInd Professor Janez Plečnik Memorial Meeting sponsored by the Faculty of Medicine at University of Ljubljana, Ljubljana, Solvenia, December 2011.

George Jour, MD (Resident) and Beverly Wang, MD ——“Pattern of Invasion Strongly Predicts Disease Progression for Low Stage Oral Cancers.” Platform Presentation, United States and Canadian Academy of Pathology 100th Annual Meeting, San Antonio, TX, March 2011.

George Jour, MD (Resident) ——“Differential Expression of CK19, CD56 and CD57 in Neuroendocrine and Conventional Basal Cell Carcinoma: Is Neuroendocrine Basal Cell Carcinoma a Stand-Alone Entity?” Poster Presentation, United States and Canadian Academy of Pathology 100th Annual Meeting, San Antonio, TX, March 2011. ——“Prolonged versus Standard Balloon Angioplasty Inflation Time in an Atherosclerotic Rat Aorta Model.” Poster Presentation, Annual Meeting of the Society of Vascular Surgery, Chicago, IL, June 2011. ——“Paclitaxel Cytotoxicity Is Significantly Enhanced by a Novel Pro-Apoptotic Agent in the Treatment of Non-Small Cell Lung Cancer.” Platform Presentation in the Surgical Forum, 97th Annual Meeting of the American College of Surgeons, San Francisco, CA, October 2011.

Ioana Moisini, MD (Resident) ——“BAFF/APRIL Inhibition Induces Negative Selection of Naïve Autoreactive B Cells but Does Not Prevent Positive Selection of Autoreactive B Cells in the Germinal Center.” Poster Presentation, ACR/ARHP Scientific Meeting, Chicago, IL, November 2011.

Mariko Yabe, MD (Resident) ——“Distinct Clinical Characteristics of Myelodysplastic Syndrome in Human Immunodeficiency Virus-Infected Patients.” Poster Presentation, American Society of Hematology Annual Meeting, Atlanta, GA, December 2011.

8. Honors/Awards Bruce M. Wenig, MD ——Castle Connolly Top Doctors New York. ——New York Times Super Doctors. ——President, North American Society of Head and Neck Pathologists. Beverly Wang, MD ——Castle Connolly Top Doctors New York. ——New York Times Super Doctors. Jean Marc Cohen, MD ——New York Times Super Doctors.

2011 Year End Report 145

Department of Pediatrics

2011

Department of Pediatrics

THE MILTON AND BERNICE STERN DEPARTMENT OF PEDIATRICS Edward E. Conway, Jr., MD, Chairman

1. New Faculty —— Maria Vomvolakis, MD, 14th Street Ambulatory Practice, Full-time, June 2, 2011.

2. Program Enhancements

A. New Programs i. Kids Yoga Classes: Sponsored by the Division of Developmental and Behavioral Pediatrics and the Department of Integrative Medicine, Kids Yoga Classes are being offered free of charge to developmental pediatric patients. ii. Pediatric Fundamentals of Critical Care Medicine Course: This course includes pediatric hospitalists and PICU nurses, and involves a combination of lectures and hands-on simulation. B. Program Expansions i. Breastfeeding Initiative: Beth Israel continues our efforts to increase breastfeeding rates among our patient population and become designated as a “Baby Friendly Hospital” by the New York City Department of Health (www.babyfriendlyusa.org). Hospital policies that relate to newborn admission and breastfeeding were reviewed and revised. Using funds in part from a two-year $50,000 NYCDOHMH Breastfeeding Initiative grant, Beth Israel mandated breastfeeding-specific training for all patient care staff caring for expectant mothers and newborns. Within the Pediatrics Department, approximately fifty salaried and voluntary pediatric physicians as well as pediatric physician extenders completed three hours of mandatory breastfeeding training in 2011; a pediatric nurse practitioner also completed 100 hours of structured training to receive international certification as a lactation consultant (IBCLC). ii. Developmental and Behavioral Pediatrics Division Evening Guest Lecture Series: Originally developed in 2010, the program significantly expanded in 2011 and is conducted in collaboration with the parent group called NAA (New York Metro Chapter of the National Autism Association). iii. Opening of BIMC Affiliated Sleep Lab on 17th Street: This has helped the Pediatric Pulmonology Division to provide sleep medicine services to patients ages 5 and older with obstructive sleep apnea, a growing problem in pediatrics.

3. Capital Enhancements

A. Equipment Enhancements i. Successful Implementation of Ambulatory Electronic Medical Record: Our main pediatric ambulatory care practice was the first PACC-based practice to fully implement e-Clinical Works. With 39,619 visits seen in 2011 (30,553 general pediatric visits and 9,066 specialty visits), it was a major project to train and transition over 25 physicians and approximately 30 supporting staff, as well as convert the majority of approximately 17,000+ active paper charts. ii. NICU Equipment: Two Radiant Warmers were purchased for the NICU. One Giraffe Incubator was donated by the Small Family and the Seventh District Association to be used in the NICU.

2011 Year End Report 149 Department of Pediatrics

iii. Purchase of Spirometer for Pediatric Pulmonologist Dr. Rasik Shah: An essential instrument for the Pulmonary Division, this has helped a lot in providing standard of care for patient with asthma and other lung-related conditions. iv. Kids Yoga Equipment: Yoga mats, a promotional poster and an I-pod (Sony) speaker were acquired for yoga classes for children with developmental disabilities and for other children in the pediatric practice. B. Facility Enhancement i. The 6 Dazian Pediatric Treatment Room was renovated.

4. Quality Initiatives/Achievements ——Successful Joint Commission site surveys of all inpatient pediatric units as well as ambulatory practices.

2011 Year End Report 150 Year End Activity Report BIMC DEPARTMENT OF PEDIATRICS 2000–2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Petrie Acute Unit 969 973 870 774 822 1246 1326 1282 1,205 1,156 1,253 1,225

Singer Acute Unit 911 1048 1113 1087 **735 0 0 0 0 0 0 0

Singer PICU 639 653 624 537 **368 0 0 0 0 0 0 0

Petrie PICU 0 0 0 0 ##132 325 289 269 215 196 247 236

NICU 602 492 532 516 538 651 651 653 525 436 441 474

Well Baby Nursery 4,115 3,534 3,507 3,658 4,037 3,806 3,148 3,133 3,470 3,403 3513 3,534

Peds Ed 12,395 12,268 12,356 12,287 11,649 11,968 13,043 14,471 14,700 16,694 14,271 15,000

PACC Practice 33,236 32,207 31,973 32,687 32,759 33,774 35,438 36,365 36,668 41,170 39,708 39,619

PACC General 25,588 26,406 26,113 27,768 27,598 28,272 29,138 29,611 28,564 32,432 29,996 30,553

PACC Subspecialties 7,648 5,801 5,860 4,919 5,161 5,502 6,300 6,754 8,104 8,738 9,712 9,066

Chinatown Practice 0 0 ^2,026 3,696 3,770 ^^3,881 0 0 0 0 0 0

Genetics Practice !973 913 903 683 609 663 &471

Newborn Hearing Screening :)5110 5,215 5492 5,274

Inpatient 4,915 5,000 5277 5025

Outpatient 195 215 215 249

** Closed 8/2004 ## Opened 8/2004 ^ Opened BIMC Practice 1/02 ^^ Ended BIMC support of practice 12/05 ! Division began reporting visit volume 1/05 & Medical Geneticist Dr. Iglesias left in 9/2012 and division became part of OB/GYN Division :) Equals more than the number of babies born since newborns often need multiple screenings performed

2011 Year End Report 151 Department of Pediatrics

——Our annual neonatal mortality rate continues to decrease. In 2011, Beth Israel had a neonatal mortality rate of .7 deaths per 1,000 births, significantly lower than the national benchmark of 4.19 per 1,000 births as well as nearly all worldwide rates. Neonatal Mortality Rate

National Vital Statistics RH BI RH BI Deaths per 1000 7 6.3 100 100 100 6 90 94 96 6 93 4.7 4.7 4.7 80 5 4.6 4.5 4.52 4.55 4.6 4.5 4.2 4.19 70 80 4 60 3.3 3 2.6 50 2.1 2.2 2.1 1.7 40 2 1.6 1.7 1.7 1.6 1.3 1.2 30 1 0.9 0.9 1 0.6 0.7 1.1 1.1 1.1 1.3 20 0.8 0.8 0.8 0.7 0 10 ‘90 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10 ‘11 0 2009 2010 2011 ——By promoting use of human milk as well as ensuring proper collection and storage, Maternal and Child Health staff were able to work with new mothers to achieve a 2011 rate of 100% expressed breast milk (EBM) as first feedings for newborns. This is an increase from 90% in 2010, and a significant increase over the past seven years with a rate of 63% in 2005. ——For the second year in a row, Beth Israel’s Pediatrics Department achieved

Promoting use of human milk as well as ensuring proper collection and storage. Rates of expressed breast milk (EBM) as 1st feedings for newborns

RH BI

100 100 100 90 95 95 95 80 90 90 90 90

60 70 63 50

0 2005 2006 2007 2009 2010 2011

2011 Year End Report 152 Department of Pediatrics

100% hand washing compliance. Meticulous attention to hand washing with regular monitoring and surveillance of practice is proven to be important for preventing nosocomial infections. ——With regard to quality and patient safety and the creation of a BIMC Plan for

Practices for Preventing Nosocomial Infection at RH and BI

(% handwashing compliance)

RH BI

100 90 100 100 94 96 80 93

70 80 60

0 2009 2010 2011

Pediatric Critical Care Surge Capacity, Beth Israel pediatric leadership collaborated with the NYC Department of Health to participate in hospital-specific as well as citywide pediatric surge planning in the event of a pediatric mass casualty event.

5. Fellow/Resident Board Passage Rates —— N/A.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Xu J, Treem WR, Roman C, Anderson V, Rubinstein R, Schwarz SM. “Ileal Immune Dysregulation in Necrotizing Enterocolitis: The Role of CD40/CD40L in the Pathogenesis of Disease.” Journal of Pediatric Gastroenterology and Nutrition. 2011 February 52: 140-146. ——Gill RK, Al-Subu A, Elitsur Y, Gupta R, Treem R, Rabinowitz S, Schwarz SM. “Eosinophilic Esophagitis Presents at an Earlier Age with a More Aggressive Histologic Phenotype in Non-Caucasian Children.” Manuscript submitted for publication. ——Sugumaran HK, Pappas JG, Kodsi SR. “Congenital Absence of the Superior Oblique Tendon in Noonan-Neurofibromatosis Syndrome.” Journal of American Association for Pediatric Ophthalmology and Strabismus. 2011 December 15 (6): 593-4. PubMed PMID: 22153407. ——Papenhausen P, Schwartz S, Risheg H, Keitges E, Gadi I, Burnside RD, Jaswaney V, Pappas J, Pasion R, Friedman K, Tepperberg J. “UPD Detection Using Homozygosity Profiling with a SNP Genotyping Microarray.” American Journal of Medical Genetics. 2011 April 155A (4): 757-68. doi:10.1002/ajmg.a.33939. Epub 2011 March 15. PubMed PMID: 21594998.

2011 Year End Report 153 Department of Pediatrics

——Nakagawa T, Ashwal S, Matthew M, Mysore M, Bruce D, Conway, Jr. EE, et al. “Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations.” Critical Care Medicine. 2011 Vol. 39 (9): 2139-2155. ——Tegtmeyer K, Conway, Jr. EE, Upperman JS, Kisson T. “Education in a Pediatric Emergency Mass Critical Care Setting.” Pediatric Critical Care Medicine. 2011 Vol. 12 (6) Suppl: 5135-5140. ——Conway, Jr. EE, Foltin G, Cooper A, et al. “Had the Times Square Bomb Exploded: What about the Injured Children?” Pre-Hospital and Disaster Medicine. 2011 May 26: S/110. ——Flamm A, Foltin G, Uraneck K, Cooper A, Greenwald B, Conway, Jr. EE, et al. “Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital PCC Surge Plans. Pre-Hospital and Disaster Medicine. 2011 May 26: S132. ——Foltin G, Flamm, A, Cooper A, Sagy M, Greenwald B, Conway, Jr. EE, et al. “Utilization of a Pediatric Disaster Coalition as a Model for Regional Pediatric Disaster Planning.” Pre-Hospital and Disaster Medicine. 2011 May 26: S140-141. ——Flamm A, Foltin G, Uraneck K, Cooper A, Greenwald B, Conway, Jr. EE, et al. “Pediatric Disaster Coalition: Successful On-Site Assistance to Hospitals in Creating PCC Surge Plans.” Pediatric Critical Care Medicine. 2011 December 12 (6): 703. ——Conway, Jr. EE, Flamm A, Frogel M, Cooper A. Greenwald B, Biagas K, et al. “Citywide Disaster Planning Utilizing a Car Bomb Scenario in a Busy Urban Area.” Pediatric Critical Care Medicine. 2011 December 12 (6): 708-709. ——Schwarz SM. “Pediatric Biliary Atresia.” 2011 October http://emedicine.medscape.com/article/927029. ——Schwarz SM. “Pediatric Cholecystitis.” 2011 March http://emedicine.medscape.com/article/927340. ——Schwarz SM. “Pediatric Rickets.” 2011 August http://emedicine.medscape.com/article/ 985510

B. Presentations Edward E. Conway, Jr., MD ——“Pediatric Fundamentals of Critical Care”—Course Director. Society of Critical Care Medicine, San Diego, CA, January 2011. ——“Cerebral Water Wasting.” Annual Academic Meeting, Society of Critical Care Medicine, San Diego, CA, January 2011. ——“Pediatric Fundamentals of Critical Care”—Course Director. Nairobi Hospital, Nairobi, Kenya, March 2011. ——“The History of PCCM in the United States.” Nairobi Hospital, Nairobi, Kenya, March 2011. ——“Child Abuse in the United States.” Annual Meeting, Kenyan Pediatric Society, Nairobi, Kenya, March 2011.

2011 Year End Report 154 Department of Pediatrics

——“The Acutely Decompensating Child.” New York City Inaugural Pediatric Hospitalist Meeting, New York Academy of Medicine, New York, NY, March 2011. ——“Blast Injuries in Pediatric Patients: Are We Ready?” NYC Department of Health Disaster Symposium, Memorial Sloan-Kettering Cancer Center, New York, NY, June, 2011. ——“Are You Smarter than a Pediatric Intensivist?” 2011 National Conference and Exhibition, American Academy of Pediatrics, Boston, MA, October 2011. ——“Things You Didn’t Learn in Fellowship.” PICU Case Presentation, 2011 National Conference and Exhibition, American Academy of Pediatrics, Boston, MA, October 2011. ——“Non-Accidental Head Injury in Pediatric Patients.” 2011 New Jersey Statewide Conference on EMS, Atlantic City, NJ, November 2011. ——“Neurologic Emergencies in Pediatric Patients.” 2011 New Jersey Statewide Conference on EMS, Atlantic City, NJ, November 2011.

Lawrence Fordjour, MD, et al ——“PGE2, eNOS and Genes Regulating Onset, Development, and Progression of Diabetes in the Large Bowels of the Fetus and Adolescent Offspring of Diabetic Rats.” Abstract/Platform Presentation, Pediatric Academy Society Meeting, Denver, CO, May 2011. ——“Regulators of Angiogenesis in the Large Bowels of the Fetus and Adolescent Offspring of Diabetic Rats.” Abstract/Platform Presentation, Pediatric Academy Society Meeting, Denver, CO, May 2011.

John Pappas, MD, et al ——“Germline Deletion in the INI1/SMARCB1 Gene in a Child with Ependymoma and in His Father with Multiple Schwannomatosis.” Poster Presentation, 12th International Congress of Human Genetics/61st Annual Meeting of The American Society of Human Genetics, Montreal, Canada, October 2011.

Steven Schwarz, MD ——“Ethics in Clinical Research: Designing an Ethical Study.” Presentation, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, 2nd Year Fellows’ Conference, Scottsdale, AZ, October 2011. ——“Gut Health–Importance of Dietary Fiber, Prebiotics and the Intestinal Microbiome.” Presentation, Nutricia Learning Center Symposium, Brooklyn, NY, 2011. ——“GD3 Ganglioside Ameliorates the Necroinflammatory Lesion in a Murine Model of Necrotizing Enterocolitis (NEC)”—Copresenter. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting, Orlando, FL, October 2011. ——“Inverse Correlation between Helicobacter Pylori Colonization and Obesity in a Cohort of Inner City Children”—Copresenter. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting, Orlando, FL, October 2011.

2011 Year End Report 155 Department of Pediatrics

——“Lack of Correlation between BMI and Gastroesophageal Reflux in an Inner City Pediatric Cohort”—Co-Presenter. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting, Orlando, FL, October 2011. ——“Hepatocellular Carcinoma in Chronic Hepatitis B: A Cause for Modifying Current Screening Criteria?”—Copresenter. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting, Orlando, FL, October 2011.

Asma Sadiq, MD ——“Nature, Nurture & Nutrition: Awakening Health in Children and Families.” Presentation, Food as Medicine Annual Conferences, Bethesda, MD, June 2011.

7. Honors/Awards Morton Borg, MD, Pediatric Cardiologist ——2011 Top Doctor, New York Super Docs.

Edward E. Conway, Jr., MD ——2011 Top Doctor, New York Super Docs. ——Member, New York State Emergency Medical Services for Children (EMSC) Advisory Board. ——Board of Regents of the American College of Critical Care Medicine. ——Presidential Citation from the Society of Critical Care Medicine.

Marcia Graham, Manager, Child Life ——2011 Beth Israel Medical Center Heart Award for outstanding performance and extraordinary dedication and interaction with colleagues, patients and families.

Lucille Perrotta, MD, Neonatologist ——2011 Wholeness of Life Award from the Beth Israel Department of Pastoral Care and Education and the HealthCare Chaplaincy.

Laura Rodriguez, RN, 6 Dazian Inpatient Pediatrics/PICU ——2011 Beth Israel Medical Center Beatrice Renfield Circle of Excellence Award for Excellence in Patient-Centered Care.

Steven Schwarz, MD, Pediatric Gastroenterologist ——Ethics Committee Chair (2009-2012) of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. ——Vice-Chair of the Institutional Review Board (2009- ), Biomedical Research Alliance of New York (BRANY). ——Editorial Board 2008-2014 of the Pediatrics Review and Education Program (PREP), American Academy of Pediatrics.

2011 Year End Report 156 Department of Pediatrics

Julie Topsis, MD, Neonatologist ——2011 Top Pediatrician, Consumer’s Research Council of America.

8. Grants New York State grant for provision of genetic counseling services, to the Medical Genetics Division: ——$60,000 per year to be renewed in 2013. Scholastic Books in coordination with Reach Out and Read National Chapter: ——$10,000 in books (more than 3,600 books). Reach Out and Read prepares children ages 6 months to 5 years of age to succeed in school by partnering with doctors to prescribe books and encourage families to read together. Beth Israel Pediatric Associates, our ambulatory general pediatrics practice, provides new and age- and language-appropriate books and literacy guidance to young patients and their parents. By giving all young patients a book of their own at each well visit, by the time they enter kindergarten they have a small library to call their very own. Since Reach Out and Read’s 2002 inception at Beth Israel Pediatric Associates, the practice has received over $60,000 in books and in- kind funding from outside sources. We distributed nearly 7,500 new books in 2011 as part of this program. Child Life Grants received from: ——The Starlight Children’s Foundation to produce an epilepsy patient education video ($16,000); The Cowles Charitable Trust for the Child Life Program ($12,500); The Eugene Zitwer Foundation for weekend playroom staffing ($1,200); and The Tilden Midtown Democratic Club to purchase teddy bears for our patients ($1,000). The Starlight Children’s Foundation: ——Donated 2011 funds to renovate the 6 Dazian pediatric treatment room.

2011 Year End Report 157

Department of Physical Medicine and Rehabilitation

2011

PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION Christine Hinke, MD, Chairman

1. Program Enhancements

A. New Programs i. Bedside NICU Physical Therapy Services: In 2011, the PM&R Department rein- stituted physical therapy services for infants in the NICU, and received a total of 33 consultations, or an average of 2.75 referrals per month. Currently, there are two therapists trained to deliver therapy to these patients, and the department plans to train additional therapists as necessary. ii. Staffing Weekends with Per Diem Staff: We have added 13 per diem physical and occupational therapists, who primarily provide therapy services on weekends and hol- idays. This single change has allowed the department to enhance the seven-day-per- week rehabilitation services given to the Inpatient Rehabilitation Unit, the Orthopedic Joint Replacement and Spine Services, and the Cardiothoracic Surgery Service. iii. 3K Observation Room(s): With the completion of the 3K renovation in early 2011, two rooms on the Inpatient Rehabilitation unit were designated as observation rooms to implement a quality improvement project to simultaneously reduce the fall rate and the usage of 1:1 companions for patients at increased risk of falls. The program was extremely successful and led to winning the Board of Trustees Award for Quality and Patient Safety in 2011. B. Program Expansions i. Community Education: The PM&R Department has participated in several community education projects that include the following topics: Energy Conservation and ADL Education for Persons with Cardiopulmonary Conditions, Osteoporosis and Exercise, Osteoporosis and Physical Therapy Interventions, and Asthma and Exercise. ii. Neurology Clinics: In collaboration with the Department of Neurology, the Outpatient Therapy Department continues to provide physical therapy services during clinic hours to the patients in the ALS, Dystonia, and Parkinson’s disease Clinics. Additionally, therapists provided lectures to ALS and PD support groups, and participated in the education of neurology residents. iii. Clinical Therapy Internships and Instruction: Physical and Occupational therapists, working as clinical instructors, continue to provide clinical experience and education to students in physical and occupational therapy graduate programs throughout the country. These internships are required as part of professional study, and the department provided educational experiences of 8-12 weeks duration to 22 interns in 2011.

2. Capital Enhancements

A. Equipment Enhancements i. PACC Occupational Therapy Treatment Area: New treatment tables and chairs have been added to our outpatient occupational therapy treatment area. These additions ensure compliance with infection control guidelines and have significantly improved patient and staff satisfaction.

2011 Year End Report 161 PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

B. Facility Enhancements i. 3 Karpas Renovation: In early 2011, the renovation to the Inpatient Rehabilitation Unit on 3 Karpas was completed and all 27 beds became available for patient use. These upgrades have been instrumental in improving the appearance and cleanliness of the unit, have enhanced compliance with JCAHO standards, and have significantly improved both patient and staff satisfaction. ii. Inpatient Rehabilitation Unit Storage Areas: As part of the renovation, storage areas on 3 Karpas were expanded and modified to allow easy accessibility to assistive devices required by rehabilitation patients. This has also ensured compliance with JCAHO standards for storage and infection control hospital policies, and has improved facilities management. iii. PACC Therapy Suite 5N: PACC’s outpatient physical therapy gym has received upgrades to its infrastructure, which have ensured compliance with JCAHO standards and infection control policies, and have enhanced staff and patient safety and patient satisfaction. iv. 3K Nursing Station and Patient Lounge: Seating, desk areas and computer sta- tions were upgraded on the 3K Inpatient Rehabilitation unit to provide increased workspace and increased number of workstations, and to comply with infection control guidelines.

3. Quality Initiatives/Achievements

A. Fall Reduction Project on 3K: The fall reduction program on the Inpatient Rehabilitation Unit was very successful, and resulted in a marked reduction in falls, injuries from falls, and expenditures for patient companions. Fall rates per 1,000 patient days declined significantly from 2009 through 2011 as follows: 2009 – 9.5, 2010 – 7.9, and 2011 – 5.7, which is now below the national average. Injury falls per 1,000 patient days also declined significantly from 2009 through 2011 as follows: 2009 – 0.59, 2010 – 0.43, and 2011 - 0.34, which is well below the national mean of 0.83. Additionally, the project allowed significant savings in companion usage from $81,720 in 2009, to $51,090 in 2010, to $16,399 in 2011 (see next page).

2011 Year End Report 162 PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

3K Fall Reduction Project

Fall Rate Injury Fall Rate

11 0.70

10 0.60

0.50 9

0.40 8 0.30 7 0.20

6 0.10

5 0.00

2009 2010 2011 2009 2010 2011

Reduction in Expenditures for 1:1 Companions

$100,000 2009 2010 $80,000 2011

$60,000

$40,000

$20,000

2011 Year End Report 163 PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

B. Timeliness of Bedside Therapy Consultations: As hospitals and physicians try to improve efficiencyandshortenlengthofstayintheacutecarehospital,ourdepartmenthasbeen asked to develop strategies to expedite bedside therapy consultations for early mobilization, prevention of deconditioning and other complications of immobility, equipment evaluations, and recommendations regarding discharge setting. A team approach was developed and has been successful in improving the response within one business day from 83.2% in 2010 to 92.3% in 2011, despite a 4.6% increase in the number of consultation requests.

Bedside Therapy Consultation Response Times

100

2009 2010 2011 Total Consults: Total Consults: Total Consults: Percent of Patients Seen of Patients Percent 9374 10709 11194 70

85.6 95 83.2 96 92.3 99.6 60 2009 2010 2011

Percentage seen within 1 business day Percentage seen within 1 business day

2011 Year End Report 164 PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

C. Outpatient Therapy Patient Satisfaction: Patient satisfaction in the outpatient therapy department is continuously monitored using several indicators, including waiting time, ease of scheduling appointments, courtesy, returning calls, inclusion in setting treatment goals, concern for privacy needs, and cleanliness. Overall, patient satisfaction has either been good or very good as indicated in the uploaded graphic.

2011 Average Outpatient Satisfaction

100% 5 – Very Good

90% 4 – Good 3 – Fair 80% 2 – Poor

1 – Very Poor 70%

60%

50%

40%

30%

20%

10%

Overall rating of care received Likelihood of recommending during your visit our practice to others

D. Clinical Documentation Projects: The department has several clinical documentation projects targeting physician and therapist documentation, both at the inpatient and outpatient sites. All of the projects include monitoring of compliance with dating, timing and signing all notes with appropriate titles. Initial compliance rates varied between 50-80%, but with education and monitoring, they have been consistently above 90% across all disciplines. Avoidance of prohibited abbreviations is nearly 100% across disciplines. E. Advanced Clinical Certifications: In 2011, eight physical and occupational therapists earned advanced clinical certifications in a variety of clinical techniques. This has enhanced the department’s ability to provide specialty services to specific subgroups of patients who benefit from these interventions. F. CPR Certifications:Michele Chery, Senior PTA, recertified 50 staff members in Basic Life Support for Health Care Providers in accordance with AHA guidelines.

2011 Year End Report 165 PhysicalDepartment Medicine of Physical and RehabilitationMedicine and Rehabilitation

4. Fellow/Resident Board Passage Rates —— N/A.

5. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Presentations Oster, S ——“Focused Review for the Hand Therapy Certification Exam.” Philadelphia Hand Therapy Symposium, Philadelphia, PA, March 2011.

6. Honors/Awards 3K Inpatient Rehabilitation Unit/Wayde Binder, BSN, RN, Nurse Manager (Project Manager) ——Board of Trustees Award for Quality and Patient Safety, Continuum Health Partners, November 2011.

Carrie Gatlin, Senior PTA ——Recognition of Advanced Proficiency in Neuromuscular Physical Therapy, American Physical Therapy Association, August 2011.

2011 Year End Report 166 Department of Psychiatry and Behavioral Sciences

2011

Department of Psychiatry and Behavioral Sciences

DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES Arnold Winston, MD, Chairman

1. New Faculty —— David Edgcomb, MD, Staff Psychiatrist, July 1, 2011. —— Herbert Fox, MD, ECT Psychiatrist, January 1, 2011. —— Britt Jagodnik, LCSW, Clinical Social Worker, July 1, 2011. —— Emily Upshur, Psychology Fellow, January 3, 2011. —— Shiming Wu, MD, Staff Psychiatrist, July 1, 2011.

2. Program Enhancements

A. New Programs i. Child & Adolescent Psychiatry Program: We began collaborating with NYC’s branch of the Office of Mental Health to provide clinical training in the management of traumatized children and invaluable trauma-informed treatment for complex trauma to the adolescent community residences at St. Vincent’s Services. As part of this program, Dr. Ham served as coleader of a two-day training on attachment, self-regulation, and competence for all psychology externs, interns, and social work interns. The Child Division also started providing a model treatment for child-parent psychotherapy. ii. Addiction Psychiatry: We have developed a new collaboration with the Pain and Palliative Care Clinic at PACC, where Addiction Psychiatry fellows rotate through that service, leading to enhanced integration of services and to better care. Additionally, the division has expanded its commitment to the use of motivational interviewing, establishing a seminar to introduce PGY2 psychiatry residents and addiction psychiatry fellows to the philosophy and practice of motivational interviewing; meetings take place twice monthly on 8 Bernstein, and residents/fellows are given the opportunity to interview a patient under observation with group feedback. iii. Assertive Community Treatment Program (ACT): ACT initiated new therapy groups, facilitated by the participation of psychology externs, and added a yoga group to promote wellness among its clients. iv. Dialectical Behavioral Psychotherapy Program (DBT): Our Psychiatry Outpatient Service has initiated a DBT group for patients with borderline personality disorder. DBT groups, along with a women’s group, also have been incorporated in the Inpatient Service. B. Program Expansions i. Consultation-Liaison Psychiatry: There has been a dramatic increase in the number of in-hospital consults, and increased urgency for having them done in a timely fashion (within 12 hours). Despite the increased number of consults in 2011—there were 1,692 consults, up 12 % for 2012—the quality of consults was maintained. ii. Psychiatric Outpatient Service (POSA): POSA expanded its PSYCKES program, a database that allows monthly identification of patients who have developed metabolic side effects from antipsychotic medications, so that changes may be made in their regimen. Ninety-six patients were reported, and after review by physicians-in-charge and prescribing psychiatrists, 12 of them received a change in their antipsychotic

2011 Year End Report 169 Department of Psychiatry and Behavioral Sciences

medication. (Polypharmacy is being monitored via PSYCKES as well). Also, in collaboration with our colleagues at St. Lukes and Roosevelt Hospitals, our outpatient services converted to the eClinicalWorks electronic medical records system, which will allow sharing of clinical information (medication lists, physical findings, and lab and imaging results) with Primary Care, Medicine, Surgery and Addiction Medicine, thereby contributing to patient safety. iii. Comprehensive Psychiatry Emergency Program (CPEP): CPEP has seen an increase in patient flow from an annualized average of 2,500 visits in prior years to 4,700 visits in 2011. The number of patients admitted to extended-observation beds has increased steadily, as have referrals to the Mobil Crisis Unit (MCU); in 2011, a growing number of referrals to the MCU came from inpatient psychiatric units and the outpatient clinic at BI as well as outside sources, with the MCU reaching an average of 75 visits per month in the community and 10 more interim visits per month at the office. We currently are negotiating with Community Access to deliver Crisis Residence, an important component of the CPEP.

3. Capital Enhancements

A. Facility Enhancements i. With funding from HEAL NY, a $1.8-million-dollar renovation of the 6 Karpas Inpatient Psychiatric Unit began in 2011 and should be completed by mid-2012. The renovation includes beautification of the clinical environment with state-of-the-art features and safety upgrades.

4. Quality Initiatives/Achievements

A. The Department of Psychiatry maintained a solid record in environmental safety for patients and staff, and achieved a high level of patient satisfaction. B. Inpatient-restraint rates for the year were 2.38 per 1,000 patient days, continuing our track record of being well below the benchmark of the Maryland QI Project (MQIP). Furthermore, the time patients spend in restraints is consistently shorter than benchmarks. C. Inpatient-seclusion rates have followed suit, coming closer to the MQIP benchmark level, down considerably from the prior year. Of note, the rate of time spent in seclusion was very low for the year, indicating that use of seclusion (number of episodes and time spent in seclusion considered together) has been quite limited. D. The rate of inpatient falls also continues to be quite low, less than the MQIP benchmark. This is predominantly an effect seen in patients 65 years and older, who are at greatest risk. E. The rate of antipsychotic polypharmacy, which contributes to a variety of adverse outcomes, was 7%, much lower than the national rate of 17% and the Joint Commission benchmark of 30-40%. F. In our Outpatient Service, the use of the PSYCKES database (made available by the NYS Office of Mental Health) has enabled identification of patients who have developed metabolic side effects on certain antipsychotic medications. Fourteen percent of these cases had their antipsychotic regimen successfully changed.

2011 Year End Report 170 Department of Psychiatry and Behavioral Sciences

G. To reduce violence on inpatient units, the department formed a task force on violence in psychiatry. The task force met weekly for three months and implemented a number of policies and guidelines aimed at producing a safer inpatient environment. H. The McLean Hospital revised Perceptions of Care Survey was used on the Inpatient Service, and ratings for global evaluation of care exceeded the benchmark. The Outpatient Service utilizes the MHSIP surveys developed by the Department of Health; the POS-A Survey (for adults) was well above the benchmark of 3.5 for each of the five domains measured and for the total score (the overall score was 4.5, out of 5.0), and the POS-C survey (for children) also yielded an excellent overall score, of 4.3.

5. Academic Appointments —— Boris Mekinulov, MD, appointed to Assistant Professor of Psychiatry at AECOM, October 1, 2011. —— Melanie Mulligan, PhD, appointed to Assistant Professor of Psychiatry, March 1, 2011. —— Omayra Ortiz, MD, appointed to Assistant Professor of Psychiatry, March 1, 2011. —— David Venarde, PsyD, appointed to Assistant Professor of Psychiatry, September 1, 2011.

6. Fellow/Resident Board Passage Rates —— Fellows: 100%. —— Residents: Part I: 91%; Part II: 71%.

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Aniskin DB, Fink E, Prosser J, Cohen LJ, Boda N*, Steinfield M, Galynker II. “The Effects of Pain on Stroop Performance in Patients with Opiate Dependence in Sustained Remission.” Journal of Addiction Medicine. 2011 5 (1): 50-56. ——Ascher M*. “A Focus on Learning Disabilities and Psychiatry.” Am J Psychiatry Res J. 2011 5: 8-10. ——Ascher M*. Guest Section Editor, Child and Adolescent Psychiatry Issue. Resident’s Journal of the American Journal of Psychiatry. May 2011. ——Ascher M*, Mutalik S*. Book Review: “Talking to Families about Mental Illness.” Am J. Psychiatry Res. 2011 9: 14. ——Barbhaiya CR, Seewald RM, Hanon S. “OT Prolongation and Arrhythmia Risk in Methadone Maintenance Treatment.” Journal of Innovations in Cardiac Rhythm Management. 2011 2: 1-3. ——Bun S, Serby M, Friedmann P. “Psychotropic Medication Use, Hyponatremia and Falls.” J. Clin Psychopharm. 2011 31 (3): 395-397. ——Deren S, Kang SY, Mino MN, Seewald RS. “Attitudes of Methadone Staff toward Provision of Harm Reduction and Other Services.” Journal of Addiction Medicine. 2011 DOI:10.1097/ADM.0b013e31821dc61a. ——Dhingra L, Grossman B, Chen J, Homel P, Portenoy R. “Assessment of Smoking Behavior in Persistent Pain Patients.” Ann Behav Med. 2011 41 (Suppl 1), S259.

2011 Year End Report 171 Department of Psychiatry and Behavioral Sciences

——Dhingra L, Lam K, Homel P, Chen J, Chang V, Zhou J, Chan S, Lam WL, Portenoy RK. “Pain in Underserved Community-Dwelling Chinese American Cancer Patients: Demographics and Medical Correlates.” The Oncologist. 2011 16 (4): 523-33. ——Dhingra L, Thakker D, Lo G, Lam K, Chen J, Chang V Chan S, Homel P, Bookbinder M, Cheng S, Portenoy R. “Symptom Control in Underserved Chinese American Cancer Patients.” J Pain. 2011 12 (4) Suppl P29. ——Feinberg, TE. “The Nested Neural Hierarchy and the Self.” Consciousness and Cognitive. 2011 20: 4-15. ——Feinberg, TE. “Neuropathologies of the Self: Clinical and Anatomical Features.” Consciousness and Cognitive. 2011 20: 75-81. ——Galynker II, Yaseen Z*, Katz C, Zhang X, Jennings-Donovan G, Dashnaw S, Hirsh J, Mayberg H, Cohen LJ, Winston A. “Distant but Overlapping Neural Networks Subserve Depression and Insecure Attachment.” Social Cognitive and Affective Neuroscience. 2011 doi: 10.1093/scan/nsr074. ——Gluckman ML, Kramer M. “The Clinical and Predictive Value of the Initial Dream of Treatment.” J. American Academy of Psychoanalysis and Dynamic Psychiatry. 2011 39: 263-283. ——Haeri S, Williams J, Kopeykina I, Newmark A, Cohen LF, Galynker II. “Disparities in Diagnosis of Bipolar Disorder in Individuals of African and European Descent: A Review.” Journal of Psychiatric Practice. 2011 17 (6) 394-403. ——Kaplowitz M, Safran JD, Muran JC. “Impact of Therapist Emotional Intelligence on Psychotherapy.” Journal of Nervous & Mental Disorders. 2011 19: 74-84. ——Katz C, Yaseen Z*, Mojtabai R, Cohen L, Galynker II. “Panic Attack: An Independent Risk Factor for Suicide Attempt in Depressive Illness: A NESARC Database Analysis.” J Clin Psychiatry. 2011 (e-published ahead of printing). ——Knotek P, Dhingra L, Knotkova H. “A Dynamic Model of Psychological Changes in Chronic Pain: Evaluating Interactions among the Factors.” J Pain. 2011 12 (4), Suppl P17. ——Landozuri P, Abramowitz M, Obe V, Palmese C. “Anxiety and Depression: To Screen or Not to Screen in Parkinson’s Disease.” Movement Disorder Society International Congress on Parkinson’s Disease and Movement Disorders, Abstract 322, 2011. ——Lee AM, Simeon D, Samuel J, Steele A, Cohen L, Galynker, II. “Predictors of Patient and Caregiver Distress in a Bipolar Adult Sample Seeking Family Treatment.” J. Nervous & Mental Disease. 2011 Jan 199 (1): 18-24. ——Lee AM, Galynker II. “How to Study Mentally Balanced in a Bipolar World. A Guide for People with Bipolar Disorder and Their Families.” The FCBD Press. 2011. ——Maguire GA, Franklin DL, Kirsten J*. “Asenapine for the Treatment of Stuttering: An Analysis of Three Cases.” Am J Psychiatry. 2011 168: 651-652. 10.1176/ appi.ajp. ——Northoff G, Feinberg TE, Panksepp J. “The `Resting State Hypothesis’ If Major Depressive Disorder-Translational Subcortical-Cortical Integration.” Neuroscience and BioBehavioral Reviews. 2011 35: 1929-1945.

2011 Year End Report 172 Department of Psychiatry and Behavioral Sciences

——Northoff G, Qin P, Feinberg TE. “Brain Imaging of the Self-Conceptual, Anatomical and Methodological Issues.” Consciousness and Cognition. 2011 20: 4-15. ——Portenoy RK, Portenoy A, Dhingra LK. “Cancer Pain: Assessment.” Available at: http://www.uptodate.com/contents/assessment-of-cancer-pain?source=see_ link. 2011. ——Portenoy RK, Portenoy A, Dhingra LK. “Cancer Pain: Syndromes I & II.” Available at: http://www.uptodate.com/contents/overview-of-cancer-pain- syndromes?source=see_link. 2011. ——Safran JD. “Theodor Reik’s Listening with the Third Ear and the Role of Self- Analysis in Contemporary Psychoanalytic Thinking.” The Psychoanalytic Review. 2011 98: 205-216. ——Safran JD, Muran JC, Eubanks-Carter C. “Repairing Alliance Ruptures.” Psychotherapy. 2011 48: 80-87. ——Serby MJ, Bun S, Bernay LJ. “Antipsychotic Polypharmacy and Adverse Outcomes.” Biol Psychiatry. 2011 69: 52S. ——Serby MJ, Edgcomb D. “Psychotic Illness and Managed Care Denials.” Biol Psychiatry. 2011 69: 246S. ——Shanker V, Groves M, Heiman G, Palmese C, Saunders-Pullman R, Ozelius K, Raymond D, Bressman S. “Mood and Cognition in Leucine-Rioh Repeat Kinase 2 G2019S Parkinson’s Disease.” Movement Disorder. 2011 24. ——Shoyinka S, Aggraval R, Kagan S, Kramer M, Rand B. “Emerging Roles of International Medical Graduates [IMGS] as Educators for the Future Transcultural Psychiatry.” SAGE Journals. 2011 511-513. ——Torgovnick J, Izzo P, Arsura E, Sethi NK, Amrami B, Martone L*. “An Unusual Case of Anti-NMDA-Receptor Encephalitis in the Psychiatry Inpatient Unit.” J Neuropsychiatry Clin Neurosci. 2011 Summer 23 (3): E8-9. ——Yaseen ZS*, Katz C, Johnson M, Eisenberg D, Cohen LJ, Galynker, II. “Construct Development: The Suicide Trigger Scale (STS-2), a Measure of a Hypothesized Suicide Trigger State.” BMC Psychiatry. 2011 10:110doi:10.1186/1471-244X-10-110. ——Yaseen ZS*, Katz C, Mojtabai R, Cohen LJ, Galynker II. “Panic as an Independent Risk Factor for Suicide Attempt in Depressive Illness: Findings from the National Epidemiological Survey on Alcohol and Related Conditions.” The Journal of Clinical Psychiatry. 2011 10.4088/JCP.10m6186blu. ——Zhang X, Yaseen ZS*, Galynker II, Hirsch J, Winston A. “Can Depression Be Diagnosed by Response to Mother’s Face? A Personalized Attachment-Based Paradigm for Diagnosis.” fMRI. PLos ONE 2011 6 (12): e27253. doi: 10.137/ journal.pone.0027253. *Psychiatry Housestaff

2011 Year End Report 173 Department of Psychiatry and Behavioral Sciences

B. Presentations Kenneth Ashley, MD ——“Bullying and Bias Across the Lesbian, Gay, Bisexual and Transgender Life Cycle.” APA New York County District Branch Annual Meeting, New York, NY, May 2011. ——“Applications and Lessons Learned from the HIV Psychiatry Liaison Experience for the General Psychiatrist.” Workshop Presentation in Neurocognitive Disorder in HIV, American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011. ——“All in the Gay Family-Lesbian and Gay Families: Past, Present and Future”— Workshop Chair. American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011. ——“The Sixth Vital Sign: Assessing Cognitive Impairment in HIV.” Case Presentation, American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011. ——“Advances in HIV Mental Health and Prevention Inventions.” Presentation, New Prevention Issues in HIV, World Psychiatric Association, 15th World Congress of Psychiatry, Buenos Aires, Argentina, September 2011.

Jena Bobish, Allison M. Lee, MD, Lisa J. Cohen, PhD, Stan Kats, Daphne Simeon, MD, and Igor Galynker, MD, PhD ——“Coping Styles and Suicidal Ideation in Bipolar Patients Participating in Family- Inclusive Treatment.” The Ninth International Conference on Bipolar Disorder, Pittsburgh, PA, June 2011.

Lisa Cohen, PhD ——“The Psychological Correlates of Pedophilia, Clinical and Research Seminar.” New School University, New York, NY, April 2011. ——“Pedophilia: Clinical Features and Treatment, Clinical and Research Seminar.” New School University, New York, NY, October 2011.

Lisa Cohen, PhD, and Igor Galynker, MD, PhD ——“Identifying the Psychological Correlates of Pedophilic Desire and Behavior: How Can We Generalize Beyond Forensic Samples?” Paper Presentation, “Pedophilia, Minor-Attracted Persons, and the DSM: Issues and Controversies,” Baltimore, MD, August 2011.

Lara Dhingra, PhD ——“Research Strategies for Improving Quality in Pain and Palliative Care.” Invited Presentation, Annual Meeting of the Philippine Nurses Association, “Leading and Engaging Nurses through Evidenced-Based Practice,” New York, NY, May 2011. ——“Epidemiology of Chronic Pain and Clinical Management among Individuals with a Substance Use Disorder.” In L.K. Dhingra (Chair), “Epidemiology of Pain in a Methadone Maintenance Treatment Population: Demographic and Medical Correlates of Pain Experience” Symposium, Annual Meeting of the College of Problems of Drug Dependence, Hollywood, FL, June 2011.

2011 Year End Report 174 Department of Psychiatry and Behavioral Sciences

——“Special Issue in Chronic Pain: Clinical Management of Pain in Patients with Substance Use Disorders.” In L. K. Dhingra (Chair), “The Interface of Pain and Chemical Dependency: From the Clinical Encounter to Emerging Clinical Research” Symposium, Annual Meeting of the American Academy of Pain Management, Las Vegas, NV, September 2011. ——“Psychobehavioral Research in Chronic Pain: Emerging Issues in Special Populations.” Invited Presentation, 5th Annual Pain Assessment Program, Hospital for Special Surgery, New York, NY September 2011. ——“Using Quantitative Urine Drug Levels to Monitor Adherence to Chronic Opioid Therapy: A Comparison across Two Pain Populations.” Poster Presentation, PAIN Week, Las Vegas, NV, September 2011. ——“Epidemiology of Pain among Drug Users in Methadone Maintenance.” Paper Presentation, American Public Health Association, Washington, DC, November 2011. ——“Symptom Control in Underserved Chinese American Cancer Patients.” Poster Presentation, Annual Meeting of the Chinese American Medical Society, New York, NY, November 2011. ——“Association between Social Well-Being and Pain among Underserved Chinese American Cancer Patients.” Poster Presentation, Annual Meeting of the Chinese American Medical Society, New York, NY, November 2011.

David Edgcomb, MD, Nancy Maruyama, MD, and Joel Wallack, MD ——“A Case of Fulminant Neuroleptic Malignant Syndrome.” Poster Session, Academy of Psychosomatic Medicine 58th Annual Meeting, Phoenix, AZ, November 2011.

Todd Feinberg, MD ——“Neuropathologies of the Self.” New York Psychoanalytic Institute, Arnold Pfeffer Center for Neuro-Psychoanalytic Lecture Series, New York, NY, February 2011. ——“Right Hemisphere Syndromes including Anosognosai, Asomatognosia and Somatoparaphrenia.” Sackler University School of Medicine, Tel Aviv, Israel, March 2011.

Igor Galynker, MD, PhD ——“Suicide and Anxiety: What Are the Risks?”—Symposium Chair. The 164th Annual Meeting of the American Psychiatric Association, Honolulu, HI, May 2011.

Vicki Gluhoski, PhD, Hulya Erhan, PhD, David Roane, MD, Anne Buchannan,MD*, and D. Sudak, MD ——“Multiple Perspectives on Overcoming Challenges to CBT Training for Psychiatry Residents.” Workshop Presentation, 2011 American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011.

Winter Halmi, MA, Igor Galynker, MD, PhD, and Lisa Cohen, PhD ——“Dimensions of Severity: Core Domains of Personality Pathology and the Maladaptive Functioning Associated with Emotional Abuse in Childhood.” The APA 164th Annual Meeting, Honolulu, HI, May 2011.

2011 Year End Report 175 Department of Psychiatry and Behavioral Sciences

Winter Halmi, MA, Thachelle Tannis, Igor Galynker, MD, PhD and Lisa Cohen, PhD ——“Dimensions of Severity: Core Domains of Personality Pathology and the Maladaptive Functioning Associated with Emotional Abuse in Childhood.” The APA 164th Annual Meeting, Honolulu, HI, May 2011.

Jacob Ham, PhD ——“Say It Quickly: Using an Elevator Speech to Get Noticed.” NCTSN Webinar, January 2011. http://www.nctsn.org/sites/default/files/assets/video/gallup/ Webinar/index.htm ——“Models for Complex Trauma Assessment in the Network: The Complexity of Assessing Complex Trauma in Children.” NCTSN All Network Conference, Baltimore, MD, February 2011. ——“Trauma Experience Integration (TEI) with Complex Clients: Applications of TEI with Preverbal and Complex Developmental Trauma.” NCTSN All Network Conference, Baltimore, MD, February 2011. ——“First Impressions: Creating an Engaging and Family-Friendly Process.” NCTSN All Network Conference, Baltimore, MD, March 2011. ——“Relational Psychophysiology: Lessons from Mother-Infant Interaction Research.” Converging Disciplines in NICU Care: Psychophysiology, Neurology, NIDCAP, and Music Therapy, New York, NY, June 2011. ——“Post-Natal Lunch and Learn.” Hearst Corporation B-Well Series, New York, NY, August 2011. ——“Delivering Trauma Care to Families: Policy Issues and Implications.” NCTSN Webinar, November 2011.

Melinda Lantz, MD, Alena Antohina, MD*, and Nidhi Goel, MD* ——“Performance in Practice: Dementia Guidelines.” Symposium, Annual Meeting of the American Association for Geriatric Psychiatry, San Antonio, TX, March 2011.

Allison M. Lee, MD, Jena Bobish, Lisa J. Cohen, PhD, Stan Kats, Janine Samuel, Daphne Simeon, MD, and Igor Galynker, MD, PhD ——“Burden and History of Childhood Abuse in Caregivers of Patients with Bipolar Disorder.” The Ninth International Conference on Bipolar Disorder, Pittsburgh, PA, June 2011.

Dennis Lin, MD ——“Integrating Sexology Education into Psychiatry Residency Training: Perspectives from the USA.” 20th World Congress for Sexual Health, Glasgow, United Kingdom, June 2011. ——“Sexual Function in Schizophrenia.” 20th World Congress for Sexual Health, Glasgow, United Kingdom, June 2011. ——“Integrating Sexology Education into Psychiatry Residency Training: Perspectives from the USA.” 14th Congress of the European Society for Sexual Medicine, Milan, Italy, December 2011.

2011 Year End Report 176 Department of Psychiatry and Behavioral Sciences

Louis Martone, MD* ——“Police Homicide: Characteristic of Perpetrators and Victims. Poster Presentation, Annual AAPL Meeting, Boston, MA, October 2011.

Nancy Maruyama, MD ——“A Case of Fulminant Neuroleptic Maligant Syndrome.” Academy of Psychosomatic Annual Meeting, Phoenix, AZ, November 2011. ——“Consultations for Capacity and Behavioral Disturbance: Recognition of Delirium by Non-Psychiatric Housestaff.” Academy of Psychosomatics Annual Meeting, Phoenix, AZ, November 2011.

Daniel Medeiros, MD ——“All in the Gay Family–Lesbian and Gay Families: Past, Present and Future.” Workshop Presentation, APA Annual Meeting, Honolulu, HI, May 2011. ——“Bullying and Bias across the LGBT Life Cycle.” APA New York District Branch, New York, NY, May 2011. ——“Helping Teens and Young Adults Recover from Addiction.” Wellness Wednesdays, Roosevelt Hospital, New York, NY, November 2011. ——“Baby Blues and Postpartum Depression.” Wellness Wednesdays, Roosevelt Hospital, New York, NY, September 2011.

Shruti Mutalik, MD *, Daniel Safin, MD, Nancy Maruyama, MD, and S. Cheung ——“Documentation of Risk Factors for Cardiac Arrthymias in the Treatment of Delirium with Neuroleptics.” 58th Academy of Psychosomatic Medicine Annual Meeting, Phoenix, AZ, November 2011.

Elizabeth Ochoa, PhD ——“On and Off the Couch: Enactment.” New York University, New York, NY, March 2011.

Seth Resnick, MD ——“Death and Dying.” A Crossroads of Palliative Care and Psychiatry.” Department of Psychiatry Residency, Psychosomatic Medicine Fellowship, and Clerkship Lecture Series, Beth Israel Medical Center, New York, NY, November 2011. ——“Depression and Anxiety in Palliative Care.” Department of Pain Medicine and Palliative Care, Palliative Care Fellowship Lecture Series, November 2011. ——“The Difficult Patient” and “Hospice and End-of-Life Care.” Continuum Cancer Centers of New York, Summer Internship Program, July 2011.

David Roane, MD ——“Multiple Perspectives on Overcoming Challenges to CBT Training for Residents.” American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011. ——“The Prevalence of Hoarding in an Outpatient Geropsychiatry Clinic.” American Psychiatric Association Annual Meeting, Honolulu, HI, May 2011. ——“Integrating Sexology into Psychiatry Residency Training: Perspective from the USA.” World Congress for Sexual Health, Glasgow, UK, June 2011.

2011 Year End Report 177 Department of Psychiatry and Behavioral Sciences

——“Pain in Methadone Maintenance Patients.” Poster Presentation, The College on Problems of Drug Dependence (annual meeting), New York, NY, June 2011.

Daniel Rosen, MD ——“The Undocumented Patient: Challenges When Working in a Cross-Cultural Setting.” Schwartz Rounds, New York Presbyterian Hospital, White Plains, NY, November 2011.

Richard Rosenthal, MD ——“The Interface of Electronic Health Records and Addiction Medicine: What You Should Know and How It Will Affect Your Practice.” American Society of Addiction Medicine, 42nd Annual Medical Scientific Conference, Washington, DC, April 2011. ——“Comparing the Efficacy and Safety of Probuphine to Placebo Implants and Suboxone for Opioid Addiction: A Six Month Randomized, Controlled, Phase 3 Trial.” 13th Annual Meeting of the International Society of Addiction Medicine, Oslo, Norway, September 2011. ——“Compulsive Internet Use: Is It Really an Addiction?” In Section Symposium, “Informatics and Telecommunications in Psychiatry.” 15th World Congress of Psychiatry, Buenos Aires, Argentina, September 2011.

Randy Seewald, MD ——“Pain Management in Active Substance Users with HIV.” Faculty, Cooper Health Systems, Camden, NJ, February 2011. ——“Overview of Treatment for Opioid Dependence.” New School for Social Research, Advanced Issues in Substance Abuse Counseling Course, New York, NY, February 2011. ——“Effective Use of Urine Drug Screening”—Session Chair. Faculty, “Emerging Practices in Pain and Chemical Dependency: Update on the Clinical Use of Drugs of Abuse,” New York, NY, March 2011. ——“Boredom, Pain and Illicit Drug Use in MMTP Patients.” Abstract Presentation, CPDD 73rd Annual Meeting, FL, June 2011. ——“Pain in Methadone Maintenance Patients.” Abstract Presentation, CPDD 73rd Annual Meeting, FL, June 2011. ——“A Randomized Trial Evaluating the Effectiveness of a Hepatitis Care Coordination Model in Methadone Maintenance Treatment (MMT).” Abstract Presentation, CPDD 73rd Annual Meeting, FL, June 2011. ——“Epidemiology of Pain in a Methadone Maintenance Treatment Population: Demographic and Medical Correlates of Pain Experience: Associations among Pain, Psychological Distress, Quality of Life, and Substance Use in a Methadone Maintenance Treatment Population.” Symposium, CPDD 73rd Annual Meeting, FL, June 2011. ——“Pain Management in Addiction and Pregnancy.” Faculty, “Growing Healthy Children Before, During and after Pregnancy Conference,” Central Jersey Family Health Consortium, North Brunswick, NJ, October 2011. ——“Education and Counseling Intervention Effective in Increasing HIV and Hepatitis Knowledge among Drug Users.” Oral Presentation, APHA 139th Annual Meeting, Washington, DC, October 2011.

2011 Year End Report 178 Department of Psychiatry and Behavioral Sciences

——“Need for Vaccination for Vaccine Preventable Hepatitis in Methadone Maintenance Treatment.” Oral Presentation, APHA 139th Annual Meeting, Washington, DC, October 2011. ——“Integrated Viral Hepatitis Care for Methadone Maintenance Treatment Patient- Results from an RCT.” Presentation, APHA 139th Annual Meeting, Washington, DC, October 2011. ——“Epidemiology of Pain among Drug Users in Methadone Maintenance.” Oral Presentation, APHA 139th Annual Meeting, Washington, DC, October 2011.

Michael Serby, MD, and David Edgcomb, MD* ——“Psychotic Illness and Managed Care Denials.” Society of Biological Psychiatry Annual Meeting, San Francisco, CA, May 2011.

Michael Serby, MD, Shogyoku Bun, MD, and Laura Bernay, MD ——“Antipsychotic Polypharmacy and Adverse Outcomes.” Society of Biological Psychiatry Annual Meeting, San Francisco, CA, May 2011.

Jason Staal, PhD ——“The Effects of Snoezelen and Psychiatric Care on Agitation, Apathy and Activities of Daily Living in Dementia Patients on a Short-Term Geriatric Psychiatric Unit.” Come To Your Senses 4th International Sensory Conference, Toronto, Canada, October 2011.

Zimri Yaseen, MD*, Curren Katz, MA, Arnold Winston, MD, and Igor Galynker, MD, PhD ——“Differential Activation of Cortico-striato-thalamic Circuitry by Depression and Insecure Attachment.” The APA 164th Annual Meeting, Honolulu, HI, May 2011.

Xian Zhang, PhD, Zimri Yaseen, MD*, and Igor Galynker, MD, PhD ——“Predicting Depression and Insecure Attachment Using Functional Magnetic Resonance Imaging.” The APA 164th Annual Meeting, Honolulu, HI, May 2011. *Psychiatry Housestaff

8. Honors/Awards Kenneth Ashley, MD ——Site Coordinator, American Psychiatric Association Minority Student Elective in HIV Psychiatry. ——President, Association of Gay and Lesbian Psychiatrists. Todd Feinberg, MD ——2011 New York Magazine’s “The Best Doctors” in Neurology. ——2011 New York Super Doctors in Neurology and Psychiatry. ——2011 “Top Doctor” in Neurology, Castle Connolly, New York Metro Area Guide. ——Guest Editor, Consciousness and Cognition Special Issue: “Brain and Self: Bridging the Gap,” 2011. Jacob Ham, PhD ——Advisory Board Member to the National Child Traumatic Stress Network’s Advisory Board, 2011.

2011 Year End Report 179 Department of Psychiatry and Behavioral Sciences

Seth Resnick, MD ——Recognition, Fashion Fights Cancer, November 2011. Jesse Rosenthal, MD ——2011 New York Magazine’s Best Doctors. Michael Serby, MD ——2011 New York Magazine’s Best Doctors. ——2011 New York Super Doctors. ——2011 Castle Connolly Top Doctor, New York Metro Area. Joel Wallack, MD ——2011 Top Doctors, New York Metro Area-15th Edition. Arnold Winston, MD ——2011 Castle Connolly Top Doctor, New York Metro Area. Zimri Yaseen, MD ——New York State Psychiatric Association Member in Training Scientific Paper Competition: 3rd Place, October 2011. ——Cynthia Horner Research Award, Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, May 2011. ——American Psychiatric Association, New York County District Branch Resident Research Award: Honorable Mention, May 2011. ——AADPRT Pre-Meeting Scholar, January 2011.

9. Grants Fisher Wallace Corporation ——$50,000 for the Family Center for Bipolar Study, “A Single Blind, Randomized, Sham Controlled Study of Cranial Electrical Stimulation in Bipolar II Disorder.”

The Sexual Medicine Society of North American (SMSNA) Scholars in Sexuality Research Grant Program ——$2,000 to Carlyn Snyder, MD, for “Study on Sexual Side Affects of Anti-Psychotics.”

2011 Year End Report 180 Department of Radiology

2011

Department of Radiology

DEPARTMENT OF RADIOLOGY Michael Abiri, MD, Chairman

1. New Faculty —— Eli Halpert, Vascular Interventional Radiology, Full-time, September 1, 2011. —— Leonid Lempert, Musculoskeletal Radiology, Full-time, July 1, 2011. —— Yuliya Jhanwar, Breast Imaging, Full-time, July 1, 2011.

2. Program Enhancements

A. New Programs i. SIRT (Selective Interarterial Radiation Therapy) in Vascular Interventional Radiology led by Dr. Patel. Infusion of Y-90 beta emitter into tumoral vascular supply. ii. Conversion of Resident Conference Schedule from twice daily conference to one full day of conference. This allows for enhanced and uninterrupted resident teaching on the remaining four weekdays, with more exposure to case volume, improved resident productivity with increasing volume of dictated reports, and improved quality of attending lectures. B. Program Expansions i. Prostate, Abdominal, and Cardiac MRI: Enhanced expertise for prostate/abdominal MRI (Dr. Kagen) and Cardiac MRI (Dr. Legasto) has resulted in increasing acceptance by clinical services, enhanced radiology participation in interdepartmental clinical conferences, and growth in imaging volume for these exams. Total MRI of the heart, abdomen and prostate numbered 258 in 2010 and grew to 362 in 2011, with an annualized projection of 511 for 2012. ii. Kyphoplasty: Growth due to focused marketing efforts by Drs. Markowitz and Halpert.

3. Capital Enhancements

A. Equipment Enhancements i. McKesson PACS. ii. Upgrade of Legacy RIS, IDX9, to ImageCast IDX10. B. Facility Enhancements i. Renovation of hallways and bathroom for improved patient and physician experience.

4. Quality Initiatives/Achievements

A. Commitment to Radiation Safety in Diagnostic Imaging: i. 100% of the radiology group pledged to image wisely and gently. This emphasizes our awareness of radiation safety, and our continued focus on patient safety.

2011 Year End Report 183 Department of Radiology

2011 Year End Report 184 Department of Radiology

ii. New strategies for CT dose reduction, re: writing CT protocols to reduce dose while still producing diagnostic images. iii. Identifying certain exams that can be performed with greater dose reduction, such as follow up for renal and ureteral calculi. iv. Eliminating exams performed both with and without contrast wherever possible. v. Fluoroscopy time now automatically maps to the exam report. B. Focus on Head CT TAT in ED: 2011 saw a 50% increase in ED volume with stable ED Radiology technical staffing, the new ED with new variability issues, and implementation of a new PACS system which slowed down many components of the TAT time during implementation phase. The TAT numbers demonstrated a 25% increase despite these obstacles. C. Patient Satisfaction at BIMG 34th St.: Patient satisfaction survey scores of 8, 9 and 10 dropped from 88% in 2009 to 82% 2010. This was reversed in 2011 back to 88% by significant renovation of the facility, new equipment and employee coaching.

5. Fellow/Resident Board Passage Rates —— Fellows: N/A. —— Residents: 100%.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Wayne, Narang, Verzosa, Cooperman. “Superior Mesenteric Artery Originating from the Celiac Axis: A Rare Vascular Anomaly.” World J Surg Oncol. 2011 July 9: 71. ——Slova, Mondolfi, Moisini, Levi, Urken, Zevallos, Mansoor, Khorsandi, Bloch, Vidhun, Wenig. “Colonic-Type Adenocarcinoma of the Base of the Tongue: A Case Report of a Rare Neoplasm.” Head Neck Pathol. Epub 2011 September 25. ——Acholonu, Silberzweig, Stein, Keltz. “Hysterosalpingography versus Sonohysterography for Intrauterine Abnormalities.” Journal of the Society of Laparoendoscopic Surgeons JSLS. 2011 October-December 15 (4): 471-474. ——Statler, Miller, Dixon, Kuo, Cohen, Duncan, Gordon, Gross, Saad, Silberzwieg, Stecher, Suri, Thornton, Bartal. “Society of Interventional Radiology Position Statement: Prevention of Unintentionally Retained Foreign Bodies during Interventional Radiology Procedures.” J Vasc Interv Radiology. 2011 November 22 (11): 1561-2. ——Murphy, Kuo, Benenati, Dixon, Goodwin, Hicks, Miller, Sidhu, Silberzweig, Vedantham, Cardella. “Position Statement by the Society of Interventional Radiology: Maintenance of Privileges for Image-Guided Interventions.” J Vasc Interv Radiol. 2011 October 22 (10): 1353-4. ——Burke, Funaki, Ray, Kinney, Kostelic, Loesberg, Lorenz, Millward, Nemcek, Owens, Saw, Silberzweig, Vatakencherry. “ACR Appropriateness Criteria on Treatment of Uterine Leiomyomas.” J Am Coll Radiol. 2011 April 8 (4): 228-34. ——Mijangos, Meltzer. “Diagnosis Please: Facial Nerve Hemangioma.” Radiology. 2011 July 260: 296-301.

2011 Year End Report 185 Department of Radiology

——Ghesani, Noor, Pang, Buyuk, Meltzer. “Chondrosarcoma of the Petroclival Synchondrosis.” HemOncToday.com. January 10, 2011. ——Ghesani, Meltzer, Moomjian L. “MRI, CT findings in ALL with Leptomeningeal Disease.” HemOncToday.com. April 10, 2011. ——Sura A, Ho A. “Enforcing Quality Metrics over Equipment Utilization Rates as Means to Reduce Centers for Medicare and Medicaid Services Imaging Costs and Improve Quality of Care.” J Clin Imaging Sci. 2011 January 1: 28. ——Moomjian, Meltzer. “Ramsay Hunt Syndrome.” ACR Case in Point. (electronic) June 3, 2011. ——Gebara, Heller, Phillips, Hatzoglou. “MR findings of Fibrodysplasia Ossificans Progressiva Complicated by Acute Cord Compression: Case Report and Literature Review.” Radiology Case Reports. (Online) 2011 6: 467. ——Ghesani, Moomjian, Meltzer. “Intracranial Hemorrhage as the Initial Presentation of Gliosarcoma in a Young Woman.” HemOncToday.com. September 10, 2011.

B. Presentations i. American Roentgen Ray Society, Chicago, IL, May 2011 Raj Surapaneni, MD, Stacey Verzosa, MD ——“The Lost Art of Plain Films.”

Stacey Verzosa, MD ——“Short Focused Reports by the On-Call Resident: Are There Consequences?”

Angela Yim, MD, Sara Ortiz-Romero, MD ——“Comparison of Bowel Transit Time and ER Turnaround Time of Oral Iohexol versus Diatrizoate Solution.”

Alan Legasto, MD, Sara Ortiz-Romero, MD ——“Cardiothoracic Sarcoidosis.”

Richard Goldfarb MD, Fukiat Ongseng, Dan Powell ——“Pericholecystic Hepatic Uptake on Hepatoscintigraphy and Its Implications for Complicated and Non-Complicated Acute Cholecystitis.”

Alex Kagen, MD, Neil Theise, MD, Venkata Meduri, MD, Marie Winestone, MD, Robert Loree, MD ——“Clinical-Radiopathologic Correlation and MR Appearance of Hepatic Sarcoidosis Using Gadoxetate Disodium.”

Alan Legasto, MD, Venkata Meduri, MD, Sandor Szylagyi, MD ——“Pulmonary Fungal Infections in the Immunocompromised Patient: From Halo and Back.”

Alan Legasto, MD, Hannah Rapaport, MD ——“Non Compaction of Ventricular Myocardium: CT and MRI Manifestations.”

2011 Year End Report 186 Department of Radiology

Kevin Math, MD, Hannah Rapaport, MD ——“Traumatic Lateral Patellar Dislocation Revisited: Retrospective Analysis of 150 Knee MRIs for Characteristic Imaging Findings.”

Bechy Hwang, Judyta Loomis, Gordon Heller ——“MRI of Pediatric Seizure.” (Electronic Exhibit).

ii. American Society of Head and Neck Radiology, San Diego, CA, September 2011 Christopher Moran, Francisco DeLara, Deborah Shatzkes ——“The Aberrant Sulcus Sign: “Cross-Sectional Imaging Indicator of Temporal Bone Meningocele.” (Oral Presentation)

iii. Radiological Society of North America, Chicago, IL, November 2011 Alan Legasto, MD, Robert Loree, MD, Franklin Nwoke, MD ——“Kustis Pulmonarius: A Resident’s Guide to Cystic Lung Disease.”

Alex Kagen, MD, Stacey Verzosa, MD, Yuriy Babayev, MD ——“Imaging Treated Prostate Cancer: Appearance on Endorectal MR Imaging after Hormones, Radiation, and Surgery.”

Edward Libfeld, MD, Sujoy Menon, MD, Shefali Kothary, MD, Hristina Hatcheva ——“Revisiting Orbital Fracture: Multiplanar Projections and 3D Reconstructions.”

James Silberzweig, MD, Emmett Lynskey ——“Brain Drain: A Quiz-Based Teaching Module of the Various Types of Herniation and the Associated Neuroanatomy.”

James Silberzweig, MD, Emmett Lynskey ——“Hot or Not? Radiographic Shielding and Collimation in the Era of New York Times Oversight.”

Marlene Rackson, MD, Sara Ortiz-Romero, MD ——“History of Contrast Agents: What, When, How, and Why No More?”

Amit Sura, John Flug ——“Healthcare Law for the Radiologist.” (Electronic Exhibit)

William Nghiem, Nasima Jafferjee, Krishna Surapaneni, Ken Cook ——“Anti-NMDA Receptor Paraneoplastic Limbic Encephalitis (PLE): What Radiologists Need to Know about This Potentially Lethal but Curable Disease.” (Electronic Exhibit),

7. Honors/Awards Roy Holliday, MD ——Best Doctors in America, New York Magazine Best Doctors in NYC.

Drs. Kevin Math, Dan Lefton, Francisco Delara ——Super Doctors, New York Times Magazine.

2011 Year End Report 187

Department of Surgery

2011

Department of Surgery

DEPARTMENT OF SURGERY Martin Karpeh, MD, Chairman

1. New Faculty —— Steven T. Brower, MD, Vice Chairman, Department of Surgery; Chief of Surgical Oncology, BIMC; Director of Strategic Planning and Extramural Affairs, Continuum Cancer Centers of NY (CCCNY), October 1, 2011. —— David Gitlin, DPM, Director, Podiatry Residency Program; Part-time Physician, Division of Podiatry, Department of Surgery, September 12, 2011. —— Jennifer Marti, MD, Full-time Physician, Department of Surgery, September 26, 2011. —— Kurt Melstrom, MD, Full-time Physician, Department of Surgery, July 1, 2011. —— Agnes Radzio, MD, Site Director, Breast Surgery at Beth Israel Brooklyn; Full-time Physician, Department of Surgery, March 1, 2011.

2. Program Enhancements

A. New Programs i. Advanced Wound Healing Center: In January 2011, the Department of Surgery opened the Advanced Wound Healing Center, co-directed by Drs. Michael Cioroiu and Nitin Sheth. The center’s primary goal is to prevent amputations and further wound complications by healing the patients’ wounds 100%. The healing rate for 2011 was 92% for all types of wounds. ii. Chinatown Multispecialty Group Practice: In March 2011, the Chinatown Multispecialty Group Practice opened at 110 Lafayette Street. This practice now has ten physicians covering numerous specialties, including breast, general, thoracic and vascular surgery, as well as pulmonary medicine and medical oncology/hematology oncology. This center continues to grow and will soon have a hepatologist, gastroenterologist and surgical oncologist joining the team. iii. Department of Surgery Research Conference: This conference was started in 2011 under the leadership of Dr. Steven Brower. It identifies current ongoing research projects, helps investigators identify needs and allows leadership to help address them, and keeps projects on track. This conference has been the forum for several guest speakers covering topics such as the IRB process and statistics. iv. Robotic Surgery: This was introduced in 2011 with a focus in the Colorectal, General, Surgical Oncology and Thoracic Surgery Divisions. Almost 40% of all robotic cases at BIMC in 2011 were performed by the Department of Surgery. v. TeamSTEPPS: In August 2011, a team from the Department of Surgery underwent Master Training in the teaching and implementation of TeamSTEPPS, an evidenced- based communication and teamwork strategy. Health care institutions that have effectively implemented a medical teamwork system have observed the following: ICU stays and adverse outcomes are reduced by as much as 50%; OR sepsis rates are reduced by more than half as compared to ORs that do not implement a teamwork strategy; an overall decrease from 30.9% to 4.4% in clinical errors; and a 27% reduction in nurse turnover.

2011 Year End Report 191 Department of Surgery

B. Program Expansions i. Third Vascular Lab: In July 2011, the Department of Surgery’s third Vascular Lab opened on the 12th floor of Fierman Hall. ii. Breast Services in Brooklyn: In March 2011, the Breast Services Program expanded to the BI Brooklyn community when Dr. Agnes Radzio joined the Department of Surgery. iii. Colorectal Surgery Division: The Colorectal Surgery Division expanded its services by recruiting Dr. Kurt Melstrom, who is an expert in inflammatory bowel disease. iv. Division of Surgical Oncology: The Division of Surgical Oncology expanded its services by recruiting by Dr. Jennifer Marti, who is dually board certified in both breast and endocrine surgery. v. Division of Plastic and Reconstructive Surgery: The Division of Plastic and Reconstructive Surgery expanded its services, as Drs. Joseph Dayan and Mark Smith became the first in the region to successfully perform microsurgical lymph node transfer surgery for patients with chronic lymphodema.

3. Capital Enhancements

A. Equipment Enhancements i. New ultrasonography equipment was purchased for both our Chinatown Multispecialty Group and our Vascular Lab in Fierman Hall. This enables us to provide our patients with higher quality vascular imaging. B. Facility Enhancements i. Our Vascular Surgery Division opened an office on the 12th Floor of Fierman Hall in a newly renovated space. This space features a dedicated waiting area, reception area, two exam rooms, a vascular lab as well as two physician consultation offices. ii. The 7th Floor of the Bernstein Building is now home to the Centers for Advanced Wound Healing and Podiatry. iii. The reception area of suites 2 N & P at PACC were renovated. This space offers a more efficient flow and a modern and comfortable environment for our patients and staff.

4. Quality Initiatives/Achievements

A. In 2011, the Department of Surgery Quality Improvement Committee focused on volume, morbidity and mortality, core measures, HCAHPS, NSQIP, surgical infection surveillance, National Patient Safety Goals, ambulatory breast surgery quality, hand hygiene, medical record completion, cardiac surgery monitors, surgical tissue review, blood management and conservation, resident supervision and work hours, and high-risk procedures (carotid artery surgery and robotic surgery). B. The Department of Surgery was recognized by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) for exemplary outcomes in three of five areas: DVT, SSI and UTI.

2011 Year End Report 192 Department of Surgery

General / Vascular 01/01/11 - 12/31/11 Report / Site: 4166 / 0216

Hospital Odds Ratio 0.68 0.76 1.06 0.45 1.08 0.73 1.17 0.90 0.70 0.87 0.61 5.0

4.5

4.0

3.5

3.0

2.5

Odds Ratio Odds 2.0

1.5

1.0

0.5

0.0 L1 L2 7 L1 7 2 8 3 2 4 L1

Outlier and Decile Status

GV GV GV Cadiac GV GV GV GV DVT/PE GV Renal GV UTI GV SSI GV ROR Mortality Morbidity Pnemonia Unplanned Ventilator Failure intubation > 48 hours

Measure 01/01/11 - 12/31/11 Report / Site: 4166 / 0216

Hospital Odds Ratio 0.63 0.63 0.65 1.24 0.69 0.85 5.0

4.5

4.0

3.5

3.0

2.5

Odds Ratio Odds 2.0

1.5

1.0

0.5

0.0 L1 L1 L1 8 2 1

Outlier and Decile Status

Measure Measure Measure Measure Measure Measure DSM Elderly Colon Deep/OS UTI LEB DSM DSM DSM SSI

2011 Year End Report 193 Department of Surgery

C. There are ten specific SCIP measures tracked on a monthly basis. Areas where we continue to focus our efforts for improvement are the 6 am blood glucose check for cardiac surgery patients, removal of the urinary catheter on post-operative day one or two, and giving beta blockers in the peri-operative period to patients on a beta blocker pre-operatively. Core Measures—SCIP Composite Score 2011

99% 98% 98% 98% 98 97% 97 96% 96% 96 96% 96% 95% 95% 95 95% 94 94% 93 93% 92

90 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Total

5. Academic Appointments —— Susan Boolbol, MD, reappointed Assistant Professor, July 1, 2011. Recommendation for promotion. —— Simon Eiref, MD, reappointed Instructor, July 1, 2011. Recommendation for promotion. —— Warren Enker, MD, reappointed Professor, July 1, 2011. —— Ira Friedman, MD, reappointed Associate Clinical Professor, July 1, 2011. —— Richard Friedman, MD, reappointed Associate Clinical Professor, July 1, 2011. —— Elliot Goodman, MD, reappointed Assistant Professor, July 1, 2011. —— Steven Haveson, MD, reappointed Assistant Professor, July 1, 2011. —— I. Michael Leitman, MD, reappointed Professor of Clinical Surgery, July 1, 2011. Promotion pending. —— Andrew Lo, MD, reappointed Assistant Professor, July 1, 2011. —— Burton Surick, MD, reappointed Associate Professor of Clinical Surgery, July 1, 2011. —— Paul Yang, MD, reappointed Assistant Professor, July 1, 2011.

6. Fellow/Resident Board Passage Rates —— Fellows (breast): 100%. —— Residents: 100% (three out of three took written boards).

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Cerfolio RJ, Milanez De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krsna MJ. “The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis.” Annals of Thoracic Surgery. 2011 May 91: 1642-1648.

2011 Year End Report 194 Department of Surgery

——Razi SS, Latif MJ, Li X, Afthinos JN, Ippagunta N, Schwartz G, Sagalovich D, Belsley SJ, Connery CP, Jour G, Christofidou-Solomidou M, Bhora FY. “Dietary Flaxseed Protects against Lung Ischemia Reperfusion Injury via Inhibition of Apoptosis and Inflammation in a Murine Model.” Journal of Surgical Research. 2011 November 171 (1): e113-21. Epub 2011 July 7. ——Yanni DS, Connery CP, Perin NI. “Video-Assisted Thoracoscopic Surgery Combined with a Tubular Retractor System for Minimally Invasive Thoracic Discectomy.” Neurosurgery. 2011 March 68 (1 Suppl operative): 138-43. ——Llaguna OH, Avgerinos DV, Nagda P, Elfant D, Leitman IM, Goodman E. “Does Prophylatic Biologic Mesh Placement Protect against the Development of Incisional Hernia in High-Risk Patients?” World J Surg. 2011 July 35 (7): 1651-5. ——Kwan J, Htun W, Huang Y, Ko W, Kwan T. “Effect of Proton Pump Inhibitors on Platelet Inhibition Activity of Clopidogrel in Chinese Patients with Percutaneous Coronary Intervention.” Vascular Health and Risk Management. 2011 7: 399- 404. Epub 2011 Jun 24. ——Zhang M, Hou Y, Lee D, Steffensen R, Yang L, Jensenius JC, Marmur J, Schwaeble W, Ko W, Shevde K. “MASP-2 Activation Is Involved in Ischemia- Related Necrotic Myocardial Injury in Humans.” Int J Cardiol. 2011 December 15. [Epub ahead of print]. ——Leitman, IM, Lugo, JZ, Deitch JS, Yu A, Jang JH, Patel R, Slova D, Lantin J. “Demographic and Laboratory Data May Predict Positive Temporal Artery Biopsy.” J. Surg Res. 2011 March 31. ——Plumb PG, Leitman IM, Factor PH, Sivaprasad L, Bernard DS. “Gainsharing in the ICU; is now the right time?” ICU Director. 2011 May Volume 2 Issue 3 pp. 74-77. ——McMillen MA. “Evolving an Acute Care Surgery/Surgical Critical Care Service at a Non-Trauma Hospital. SICU Director. 2011 May 2: 68-73. ——Smith ML, Clarke-Pearson E, Dayan JH. “Fibula Osteo-Adipofascial Flap for Mandibular and Maxillary Reconstruction: Complex Mandibular and Maxillary Defects.” Head Neck. 2011 October 24. doi: 10.1002/hed.21947. [Epub ahead of print] ——Brower S, Katz M, Pisters P, Merchant N, Weber S, Posner M. “Electronic Synoptic Operative Reporting for Pancreatic Resection.” (Editorial) Journal of the American College of Surgeons. 2011 March 212 (3): 425-26. ——Katz MH, Merchant NB, Brower S, Campbell M, Posner M, Traverso LW, Abrams RA, Picozzi VJ, Pisters PW. “Standardization and Documentation of Surgical and Pathologic Variables in a Multi-Institutional Trial of Adjuvant Therapy for Pancreatic Cancer: Results From ACOSOG Z5031.” Ann Surg Oncol. 2011 February 18 (2): 337-44.

B. Presentations IM Leitman, MD ——“Gainsharing - Aligning the Goals of Hospitals and Physicians; A Four-Year Experience.” 3rd Healthcare Payment Solutions Summit, Orlando, FL, January 2011.

2011 Year End Report 195 Department of Surgery

CP Connery, MD ——“Successful Short-Term Follow-Up after First Robotic Sympathetic Nerve Reconstruction with Autologous Nerve Grafts.” Invited Lecture, 9th International Symposium on Sympathetic Surgery Conference (ISSS), Odense, Denmark, June 2011. ——“Update on CT Screening for Lung Cancer – Discussant.” Invited Lecture, New York General Thoracic Surgery Club Spring Meeting, New York, NY, April 2011. ——“Histologic Demonstration of Successful Nerve Growth after Robotic Sympathetic Surgery Chain Reconstruction in Animal Survival Model.” Poster Presentation/Invited Lecture, 9th International Symposium on Sympathetic Surgery Conference (ISSS), Odense, Denmark, June 2011.

Kamellia Dimitrova, MD ——“Mitral Regurgitation - What Is Best for My Patient? Minimally Invasive Mitral Valve Repair or Percutaneous MutraClip?” Invited Lecture, for Brooklyn cardi- ologists at the River Café, Brooklyn, NY, May 2011. ——“Coronary Artery Bypass Surgery in Women: The Role of Radial Artery Grafting.” Oral Presentation, Annual Meeting of the International Academy of Cardiology 16th World Congress on Heart Disease, Vancouver, BC, July 2011.

Martin Karpeh, MD ——“Palliative Surgery/Treatment for Metastatic Gastric Cancer.” 9th International Gastric Cancer Conference, Seoul, Korea, April 2011. ——“Locoregional Gastroesophageal Junction Tumor.” Case Presentation/Panel Discussion, 8th Annual ISGIO Meeting/Gastrointestinal Oncology Conference, Arlington, VA, September 2011.

McMillen MA, Boucher N, Keith D, Gould S, Gerbier B, Gave A, Hoffman D ——“Comparison of 24/7 Surgical ICU In-Unit Coverage by Physician Assistants and PGY-3’s following Evidence-Based Guidelines with 24/7 SICU Coverage by In-Unit Surgical Intensivists and Cardiac Surgeons.” Abstract, Society of Critical Care Medicine, San Diego, CA, January 2011.

Boucher N, McMillen MA, Keith D, Gould S, Gerbier B, Gave A, Hoffman D ——“Maintaining Quality 24/7: A Comparison of Guideline-Guided PAs and Residents to 24/7 In-Unit Intensivists.” Abstract, American College of Healthcare Executives, Chicago, IL, March 2011.

Wilson Ko, Robert Tranbaugh, Jonathan Marmur, Phyllis Supino, Jeffrey Borer ——“The Evolution of Myocardial Revascularization in New York: Variation in PCI/ CABG Ratio and Its Implication.” Invited Lecture, American Heart Association Scientific Session, Orlando, FL, November 2011.

Wilson Ko, Daniel Lee, Jeffrey Borer ——“Off-Pump versus On-Pump CABG in Octogenarian Patients: Comparison of Hospital Outcome, Long-Term Survival, and Its Implication for Resource Utilization.” Invited Lecture, American College of Surgeons Clinical Congress, San Francisco, CA, October 2011.

2011 Year End Report 196 Department of Surgery

Wilson KO ——“Off Pump CABG in 2011.” Invited Lecture, 13th South China International Congress of Cardiology, Guangzhou (Canton), China, April 2011.

IM Leitman, G Plumb, L Sivaprasad, R Levin, C Jimenez ——“Can Gainsharing Significantly Impact Cost Savings in Critical Care Units?” Abstract, Society of Critical Care Medicine, San Diego, CA, January 2011.

JZ Lugo, JH Jang, R Patel, A Yu, J Lantis, J Deitch, IM Leitman ——“Demographic and Laboratory Data May Predict Positive Temporal Artery Biopsy.” 6th Annual Academic Surgical Congress, Huntington Beach, CA, February 2011.

AD Yu, IM Leitman, MS Karpeh, Jr., C Roker, MW Mandy ——“Are Patients that Undergo Bariatric Surgery at a Greater Risk for Gastro-Jejunal Anastomotic Complication Compared to Those Undergoing Non-Bariatric Foregut Surgery?” Abstract, Scientific Session of the SAGES 2011 Annual Meeting, San Antonio, TX, March 2011.

L Sivaprasad, P Luhan D, Steinberg, A Burger, M Leitman ——“The Impact of Targeted Individual Feedback on Provider Patterns of Stat Laboratory Tests Ordering Frequency.” Abstract, Society of Hospital Medicine Annual Meeting, Dallas, TX, May 2011.

8. Honors/Awards Martin Karpeh, MD —— President Elect, NY Surgical Society. —— President (3 years), NY Cancer Society. Steven Brower, MD —— Best Doctors in America —— Distinguished Clinical Cancer Scholar, State of Georgia. —— Cambridge Who’s Who: Surgical Oncologist of the Year. Joseph Martz, MD —— Murray G. Fischer Distinguished Educator Award. Simon Eiref, MD —— New Member Award, Surgical Infection Society. Rahul Narang, MD —— NY Surgical Society, “Best Resident Presentation.” New York’s Best Doctors/Castle Connolly Guide: —— Susan Boolbol, MD, breast surgery. —— Martin Karpeh, MD, surgical oncology. —— Michael Osborne, MD, breast surgery. —— Mark Sultan, MD, plastic surgery. —— Thomas Bernik, MD, vascular surgery. Department of Surgery —— Health Grades General Surgery Excellence Award 2011— Recognized for superior outcomes in three areas of general surgery: bowel obstruction, cholecystectomy and gastrointestinal surgical procedures.

2011 Year End Report 197 Department of Surgery

9. Grants FOJP —— $250,000/year for 5 years (2010-2015) for Simulation Center.

2011 Year End Report 198 Department of Urology

2011

Department of Urology

THE SOL AND MARGARET BERGER DEPARTMENT OF UROLOGY Harris M. Nagler, MD, FACS, Chairman

1. New Faculty —— Erik T. Goluboff, MD, Urologic Oncology, Full-time, July 2011. —— Doron Stember, MD, Reproductive and Sexual Medicine, Full-time, August 2011. —— Jay Motola, MD, General Urology, Part-time, April 2011.

2. Program Enhancements

A. New Programs i. Sexual Dysfunction Procedures: Dr. Doron Stember has expanded the range and complexity of diagnostic studies available for patients with sexual dysfunction. These studies allow for more specific diagnosis and treatment of men with sexual dysfunction. B. Program Expansions i. Additional Faculty: Urology office procedure volume has increased by 15%. Pediatric visit volume increased by 18%. ii. Extended Hours: The Urology Department was an early adopter at PACC to implement the extended hours. These have been increased. The department now offers extended hours on Tuesday and Wednesday evenings and early mornings on Mondays. This has resulted in: ——234 evening hours visits during 2011. ——55% were new patients. ——45% were new to BIMC. ——54% had commercial insurance. ——64 patients had radiology testing scheduled. ——83 patients had urology office procedures. ——18 had surgeries scheduled.

3. Capital Enhancements

A. Equipment Enhancements i. Color Doppler ultrasound. ii. New ultrasound probe for guidance of prostate biopsies. iii. Steris machine for sterilization of endoscopic equipment. B. Facility Enhancements i. The department completed renovation of the department suite, 3A at PACC, during summer 2011. This resulted in additional seating for patients in the waiting area, two new exam rooms, a faculty room, a faculty workroom and a patient specimen-pro- cessing lab. There is a new donor wall for recognition of our many generous donors.

4. Quality Initiatives/Achievements (In addition to the quality improvement initiatives of the department in conjunction with the institutional quality improvement process.)

2011 Year End Report 201 Department of Urology

A. Operational: i. The department was concerned about the safety and well-being of the employees, which prompted the installation of a new filing system. This also has resulted in greater efficiency of the office and improved employee and patient satisfaction. ii. We have led and embraced the centralized telephone answering and scheduling modules, which have resulted in marked improvements. B. Clinical: i. We completed a review of recent prosthesis infection rates and sources of penile implant infection. We standardized and implemented best practice techniques. ii. We are charting reviews for medication reconciliation and prohibited abbreviations. iii. We implemented nursing visit schedules to bring operational efficiency. This has provided more access for patients to appropriate level providers. iv. Monthly patient satisfaction survey results afforded us the opportunity to further conduct a focused study for the 4th quarter of 2011 on telephone call response time. The clinical call response time was reduced from 61 to 18 minutes, and the prescription request call response time from 61 to 31 minutes.

5. Academic Appointments —— Erik T. Goluboff, MD, promoted to Clinical Professor of Urology, AECOM, July 2011.

6. Fellow/Resident Board Passage Rates —— Residents: 100%.

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Nagler, HM. A “Solitary Semen Analysis Can Never Predict Fertility.” Nature Clinical Reviews. 2011 January Vol 8:1, 16-17. ——Katz BF, Stember D, Nagler HM. “Sexual Disparities between Asia and North America: Commentary on Male Sexual Dysfunction in Asia.” Asian Journal of Andrology. 2011 June 6, doi:10.1038/aja.2010.13. ——Akoluk A, Barazani Y, Slova D, Shah SM, Tareen B. “Carcinosarcoma of the Bladder: Case Report and Review of the Literature.” Can Urol Assoc J. 2011 August 5 (4): eXX-XX; DOI:10.5489/cuaj.10161, 2011. ——Cubillos J, Palmer JS, Friedman SC, Freyle J, Lowe FC, Palmer LS. “Familial Testicular Torsion.” Journal of Urology 2011 June 185 (6 Suppl): 2469-72. ——Wiygul J, Palmer LS. “The Inguinal Approach to Extravesical Ureteral Reimplantation Is Safe, Effective and Efficient.” Journal of Pediatric Urology. 2011 June 7 (3): 257-60. ——Srinivasan A, Cinman N, Feber KM, Gitlin J, Palmer LS. “History and Physical Examination Findings Predictive of Testicular Torsion: An Attempt to Promote Clinical Diagnosis by Housestaff.” Journal of Pediatric Urology 2011 August 7 (4): 470-4. ——Cubillos J, George A, Gitlin J, Palmer LS. “Tailored Sutureless Meatoplasty - A New Technique for Correcting Meatal Stenosis.” Journal of Pediatric Urology (In press).

2011 Year End Report 202 Department of Urology

——Montag S, Palmer LS. “Abnormalities of Penile Curvature: Chordee and Penile Torsion.” Scientific World Journal. 2011 July 11: 1470-8. ——Wiygul J, Palmer LS. “Micropenis.” Scientific World Journal. 2011 July 11: 1462-1469. ——Krill AJ, Palmer LS, Palmer JS. “Complications of Circumcision.” Scientific World Journal. 2011 11: 2458-2468. ——Srinivasan AK, Palmer LS, Palmer JS. “Inconspicuous Penis.” Scientific World Journal. 2011 11: 2559-2564. ——Palmer LS. “Commentary on Hagstroem, S. et al. Timer Watch Assisted Urotherapy in Children: A Randomized Controlled Trial.” Nature Reviews Urology. 2011 January 8 (1): 13-4. ——Karle W, Barazani Y, Tareen B. “Rare Case of Metastatic Lung Cancer to the Bladder.” Can Urol Assoc J. 2011, In Press, CUAJ-11-129. ——Stahl PJ, Stember DS, Schlegel PN. “Interpretation of the Semen Analysis and Initial Male Factor Management.” Clinical Obstetrics & Gynecology. 2011 December 54 (4): 656-665. ——Stember DS, Nelson CJ, Mulhall JP. “Preoperative Erectile Function Is an Independent Predictor of Nerve-Sparing Status during Radical Prostatectomy.” Journal of Sexual Medicine (submitted). ——Katz DF, Stember DS (co-first authors), Nelson CJ, Mulhall JP. “Peri-Operative Prevention of Penile Prosthesis Infection: Practice Patterns among Surgeons of SMSNA and ISSM.” Journal of Sexual Medicine (submitted). ——Nosnik IP, Kutikov A. “Today’s Urological Presence in the American College of Surgeons.” AUANews. 2011 January 16 (1): 12-13. ——Barazani Y, Nagler HM. “Limitations of Using Histopathology to Predict Success after Varicocelectomy.” Fertil Steril. 2011 February 95:487. ——Yilmaz E, Barazani Y, Tareen B. “Penile Ossification: A Traumatic Event or Evolutionary Throwback? Case Report and Review of the Literature.” Can Urol Assoc J. Pending Review. 2011 CUAJ-11-270.

B. Presentations Israel Paul Nosnik, MD, Jeremy Wiygul, MD, Martin L. Lesser, MD, Lane S. Palmer, MD ——“Under-Reporting of Confidence Intervals and Over-Reporting of p-Values in the Pediatric Urology Literature.” AAP Section on Urology, Boston, MA, October 2011.

Benjamin Farrel Katz, MD ——“Comprehension of Surgical Informed Consent in English and Non-English Speaking Patients.” Abstract and Podium Presentation, Ferdinand C. Valentine Resident Research Meeting, AUA New York Section, New York, NY, January 2011.

2011 Year End Report 203 Department of Urology

8. Honors/Awards Harris M. Nagler, MD ——President of NY Section of Urology (completed term). ——Distinguished Service Award of the American Urological Association. ——Appointed Chair of AUA By-laws Committee. ——Super Doctors, New York Times. ——Professional Achievement Award, Association of Chinese American Physicians. ——Heart Award, Beth Israel Medical Center. ——Best Doctors in New York. ——Community Excellence Award, Visiting Nurse Service of New York. Caner Z. Dinlenc, MD ——AUA Leadership Program Participant 2010-2011. ——AUA Bylaws Committee.

2011 Year End Report 204 Continuum Cancer Centers of New York

2011

ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

THE CHARLES AND BERNICE BLITMAN DEPARTMENT OF RADIATION ONCOLOGY Louis Harrison, MD, Chairman LEO AND RACHEL SUSSMAN DIVISION OF HEMATOLOGY/ONCOLOGY Michael Grossbard, MD, Division Chief DIVISION OF SURGICAL ONCOLOGY Steven Brower, MD, Division Chief

1. New Faculty —— Steven Brower, MD, Vice Chairman, Department of Surgery; Chief, Surgical Oncology, BIMC; Director, Strategic Planning and Extramural Affairs, CCCNY, November 2011. —— Alyssa Gillego, MD, Full-time Breast Surgeon, August 2011. —— James Talcott, MD, Director, Center for Health Care Quality and Outcomes Research, CCCNY; Full-time Medical Oncologist, April 2011. —— Jennifer L. Marti, MD, Full-time General Surgeon, Department of Surgery, Specializing in Endocrine & Breast Surgery, November 2011.

2. Program Enhancements

A. New Programs i. Center for Health Care Quality and Outcomes Research, CCCNY: This program was established under the leadership of Dr. James Talcott to assess outcomes of various cancer treatments at CCCNY. It also will develop expertise in reporting patient-derived outcomes, and will create a website that can be accessed by patients and physicians to report specific cancer disease related outcomes at CCCNY. ii. Melanoma/Sarcoma Program: This program is a consolidation of experts from Surgical Oncology, Medical Oncology, Radiation Oncology, Dermatology and Pathology. The program incorporates multidisciplinary treatment from early diagnosis through complex multidisciplinary care. Patients are offered state-of-the-art clinical trials for melanoma and sarcoma. iii. Multidisciplinary Pancreatic Cancer Center: This center incorporates a disease management team approach and combines clinical expertise with investigator-initiated and cooperative group trials for pancreatic cancer. iv. Liver Tumor Program for Metastatic Colorectal Cancer: This surgical program utilizes techniques of surgery, ablation, ultrasound, robotics and combined modality therapy for patients with metastatic colorectal liver cancer. v. Parathyroid and Adrenal Glands, and Pancreatic and Gastrointestinal Neuroendocrine Tumors Team: This multidisciplinary team includes colleagues from endocrinology, radiology, nuclear medicine and pathology. B. Program Expansions i. Robotics Program in Multivisceral Cancer: Members of the Department of Surgery, Otolaryngology, Gynecology and Urology participate in advanced surgery for GI, GYN, thoracic, ENT and urological cancers. ii. Asian American GI Cancer Center for GI Risk and Surveillance: This program is to be centered in Chinatown with experts in liver and GI diseases for screening, diagnosis and treatment of Asian Americans at risk for GI cancer.

2011 Year End Report 207 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

3. Capital Enhancements

A. Equipment Enhancements i. CCCNY/Medical Oncology–Intellidose Chemotherapy Order Entry System: An electronic chemotherapy order entry and documentation system commissioned and installed in 2011 across all CCCNY sites. Promotes standardization of chemotherapy orders, increases patient safety through electronic documentation, and allows physicians, nursing and pharmacy access to a single treatment record. ii. BICCC-E/Radiation Oncology–True Beam Linear Accelerator: Commissioned and installed, this state-of-the-art LINAC enables us to identify and treat tumors faster and with increased accuracy. This ability to improve tumor localization and deliver faster treatment will lead to a reduction of irradiated healthy tissue. This reduction will result in reduced side effects and increased tumor dose, which improves tumor control and provides patients with quality-of-life improvements. iii. BICCC-W–Mohs Dermatologic Oncology Program: Renovation and creation of a new laboratory and patient waiting area to support Mohs Surgical Services at BICCC-West. This program works in partnership with Plastic and Reconstructive Surgery to remove cancerous skin lesions with minimal cosmetic effect. iv. Radiation Oncology–GYN Oncology High-Dose-Rate Brachytherapy: Purchased special- ized applicators to support implementation of high-dose-rate brachytherapy for GYN cancers. v. Radiology–Computer-Aided Detection for Digital Mammography: Purchased to provide our radiologists with the most state-of-the-art computer aided detection tools for diagnosing women with breast abnormalities.

4. Quality Initiatives/Achievements

A. Participation in ASCO QOPI voluntary program to assess quality of cancer care in accordance with national standards. B. Audits from the Bureau of Radiologic Health passed without citation. Radiation safety review on treatment errors for 2011 was 0.05%. None of the events were state reportable. C. In 2011, we successfully implemented the application of IGRT in routine clinical practice at PACC. This was verified by serially studying patient therapy timelines. D. Patient satisfaction surveys continued to show a high level of satisfaction with the care provided. In 2011, patients in Radiation Oncology also benefited from a pilot program in music therapy and yoga.

5. Academic Appointments —— Theresa Shao, MD, appointed Assistant Professor of Medicine, AECOM, July 1, 2011.

6. Fellow/Resident Board Passage Rates —— Fellows: Hematology/Oncology 3/3 100%; Radiation Oncology 1/1 100%.

2011 Year End Report 208 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

7. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications ——Wiernik PH, Elkadi D, Luongo-Cespedes A, Battistoni J, Rossi S, Caceres S, Platero R, Piriz N, Lamas A. “Detection of a New Embryonic Antigen (ESA-10) in the Blood of Patients with Cancer: Preliminary Results in the United States.” Medical Oncol. 2011 28: 67-70. ——Kumar S, Zhang M-J, Li P, Dispenzieri A, Milone GA, Lonial S, Krishnan AY, Malolino A, Wirk B, Weiss BM, Freytes CO, Vogl DT, Vesole DH, Lazarus HM, Meehan KR, Hamadani M, Lill M, Callander NS, Majhail NS, Wiernik PH, Nath R, Kamble R, Vij R, Kyle RA, Gale RP, Hari P. “Trends in Allogeneic Stem Cell Transplantation for Multiple Myeloma: A Center for International Blood and Marrow Transplant Research Analysis.” Blood. 2011 118: 1979-1988. ——Wiernik PH, Baig MA, Lee SH, Dutcher JP, Paietta E, Racevskis J. “Survival More than 19 Years after the Diagnosis of Accelerated Phase of Chronic Myelocytic Leukemia.” Clin Adv Hematol Oncol. 2011 9: 242-247. ——Wiernik PH, Adiga GU. “Single-Agent Rituximab in Treatment-Refractory or Poor Prognosis Patients with Chronic Lymphocytic Leukemia.” Curr Med Res Opin. 2011 27: 1987-1993. ——Wiernik PH. “Current Status of the Development of Lenalidomide as Treatment for Mantle Cell Lymphoma.” Haematologica. 2011, in press. ——Wiernik PH. “Acute Lymphoblastic Leukemia of Adulthood: Progress or Not?” Curr Treat Options Oncol. 2011 12: 303-311. ——Wiernik PH. “Update: APOR.” Clin Transl Sci. 2011 6: 399. ——Van Vlierberghe P, Ambesi-Impiombato A, Perez-Garcia A, Haydu E, Rigo I, Hadler M, Tosello V, Gatta GD, Paietta E, Racevskis J, Wiernik PH, Rowe JM, Rue M, Ferrando AA. “ETV6 Mutations in Early Immature T-Cell Leukemias.” J Expl Med. 2011 208: 2571-2579. ——Farag SS, Maharry K, Zhang MJ, Perez WS, George SL, Mrόzek K, DiPersio J, Bunjes DW, Marcucci G, Baer MR, Copelan E, Cutler CS, Isola L, Lazarus HM, Litzow MR, Marks DI, Ringdén O, Rizzieri DA, Soiffer R, Larson RA, Tallman MS, Bloomfield CD, Weisdorf DJ, Artz A, Bredeson C, Gale RP, Gupta V, Jakubowski A, Klumpp T, Schiller G, Wiernik P. “Comparison of Reduced-Intensity Hematopoietic Cell Transplantation with Chemotherapy in Patients Age 60-70 Years with Acute Myelogenous Leukemia in First Remission.” Biol Blood Marrow Transplant. 2011 17: 1796-1803. ——Moroto JP, Hudes G, Dutcher JP, Logan TF, White C, Krygowski M, Cincotta M, Shapiro M, Duran I, Berkenblit A. “Drug-Related Pneumonitis in Patients with Advanced Renal Cell Carcinoma Treated with Temsirolimus.” J Clin Oncol. 2011 29: 1750-1756. ——Manola J, Bacik J, Elson P, Royston P, Mazumdar M, Motzer R, Negrier S, Escudier B, Eisen T, Dutcher J, Atkins M, Heng D, Choueiri TK, Bukowski R. “Prognostic Factors for Survival in Patients with Metastatic Renal Cell Carcinoma: Results from the International Kidney Cancer Working Group.” Clin Cancer Res. 2011 17 (16): 5443-5450; epub 2011 Aug 9.

2011 Year End Report 209 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

——Haas NB, Lin C, Manola J, Pins M, Liu G, McDermott D, Nanus D, Heath E, Wilding G, Dutcher J. “A Phase II Trial of Doxorubicin and Gemcitabine in Renal Cell Carcinoma with Sarcomatoid Features: ECOG 8802.” Epub 2011 Feb 6. ——Rini BI, Garrett M, Dutcher J, Rixe O, Wilding G, Stadler WM, Pithalvala Y, Kim S, Tarazi J, Motzer R. “Axitinib in Metastatic Renal Cell Carcinoma: Results of a Pharmacokinetic and Pharmacodynamic Analysis.” Clin Cancer Res. 2011, Submitted. ——Dutcher JP. “High Dose Interleukin-2 Therapy for Metastatic Renal Cell Carcinoma and Metastatic Melanoma: Still the Standard.” Oncology. 2011 April 30 25: 427-428. ——Escudier B, Dutcher JP, Hutson TE, Wilhelm S, Lewis J, Eisen T, Riedl B, Bukowski RM: Sorafenib. “The First Targeted Therapy Demonstrating Clinical Benefit in RCC - Insight on Its Clinical Development.” Clin Cancer Res. 2011, Submitted. ——Dutcher JP. “Commentary: Perceptions of Patient-Oriented Research Amongst House Staff and Faculty in a Clinically Oriented Internal Medicine Program.” Clinical and Translational Science. 2011 October 4 (5): 310-311. ——Furman RR, Grossbard ML, Johnson JL, Pecora AL, Cassileth PA, Jung SH, Peterson BA, Nadler LM, Freedman A, Bayer RL, Bartlett NL, Hurd DD, Cheson BD; Cancer Leukemia Group B; Eastern Cooperative Oncology Group. “A Phase III Study of Anti-B4-Blocked Ricin as Adjuvant Therapy Post-Autologous Bone Marrow Transplant.” Leuk Lymphoma. 2011 52: 587-596. ——Shao T, Grossbard ML, Klein P. “Breast Cancer in Female-to-Male Transsexuals: Two Cases with a Review of Physiology and Management.” Clin Breast Cancer. 2011 11: 417-419. ——Kato S, Takahashi K, Ayabe K, Samad R, Fukaya E, Friedmann P, Varma M, Bergmann SR. “Heparin-Induced Thrombocytopenia: Analysis of Risk Factors in Medical Inpatients.” Br J Haematol. 2011 154 (3): 373-7. ——Coen JJ, Paly JJ, Niemierko A, Weyman E, Rodrigues A, Shipley WU, Zietman AL, Talcott JA. “Long-Term Quality of Life Outcome after Proton Beam Monotherapy for Localized Prostate Cancer.” Int J Radiat Oncol Biol Phys. 26 May 2011. ——Chockalingam P, Astrow AB, Klein P, Huang Y, Reichman BS, Citron ML. “Isolated Sternal Recurrence In Breast Cancer, Is It Truly Stage 4 Disease.” Clinical Breast Cancer. 2011 Vol. 11 (3): 191-194. ——Chuang E, Christos P, Flam A, McCarville K, Forst M, Shin S, Vahdat L, Swistel A, Simmons R, Osborne M, Mazumder M, Klein P. “Breast Cancer Subtypes in Asian-Americans Differ According to Asian Ethnic Group.” Journal of Immigrant and Minority Health. DOI: 10.1007/s10903-012-9577. ——Gotfried J, Kozuch PS. “Long-Term Survival in Patients with Initial Lung-Only Metastasis from Pancreatic Adenocarcinoma.” J Gastrointest Canc. 2011 July 14. ——Sullivan K, Kozuch PS. “Impact of KRAS Mutations on Management of Colorectal Cancer.” Pathology Research International. 2011 January 10, Volume 2011.

2011 Year End Report 210 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

——Darshan D, Loftus M, Thadani-Mulero M, Levy B, Esculin D, Zhou X, Gjyrez A, Chanel-Vos C, Shen R, Tagawa S, Bander N, Nanus D, Giannakakou P. “Taxane- Induced Blockade to Nuclear Accumulation of the Androgen Receptor Predicts Clinical Response in Metastatic Prostate Cancer.” Cancer Research. 2011 Vol. 18, No. 1, 51-63. ——Hershman DL, Shao T, Kushi L, Buono D, Tsai WY, Fehrenbacher L, Neugut, AI. “Early Discontinuation and Non-Adherence to Adjuvant Hormonal Therapy Is Associated with Increased Mortality in Women with Breast Cancer.” Breast Cancer Res Treat. 2011 126 (2): 529-37. ——Kligler B, Homel P, Harrison LB, Sackett E, Levenson H, Kenney J, Fleishman SB, Serra D, Merrell W. “Impact of the Urban Zen Initiative on Patients’ Experience of Admission to an Inpatient Oncology Floor: A Mixed-Methods Analysis.” J Altern Complement Med. 2011 August 17 (8): 729-34. ——Richter SM, Friedmann P, Mourad WF, Hu KS, Persky MS, Harrison LB. “Postoperative Radiation Therapy for Small, Low-/Intermediate-Grade Parotid Tumors with Close and/or Positive Surgical Margins.” Head Neck. 2011 August 17. ——Chadha M, Vongtama D, Friedmann P, Parris C, Boolbol SK, Woode R, Harrison LB. “Comparative Acute Toxicity from Whole Breast Irradiation Using 3-Week Accelerated Schedule with Concomitant Boost and the 6.5-Week Conventional Schedule with Sequential Boost for Early-Stage Breast Cancer.” Clin Breast Cancer. 2011 November 4. ——Klinger B, Homel P, Harrison LB, Hanniel D, Levenson MS, Kenney JB, Merrell W. “Cost Savings in Inpatient Oncology through an Integrative Medicine Approach.” Am J Managed Care. 2011 17: 779-784. ——Ennis R, Jotkowitz A. “Good Ethics Begins with Sound Medicine: Prostate Cancer Screening and Chemoprevention.” Am J Bioethics. 2011 11: 26-27.

B. Presentations Dutcher JP, Wiernik PH ——“Renal Cell Carcinoma and Hematologic Malignancy in the Same Patients.” J Invest Med. 2011 59: 634. Oral Presentation, Meeting of the American Federation of Medical Researchers, Washington DC, April 2011.

Douer D, Zickl L, Schiffer C, Appelbaum FR, Feusner JH, Shepherd L, Willman C, Bloomfield CD, Rowe JM, Wiernik PH, Tallman MS ——“Very Late Relapses following All-Trans Retinoic Acid for Acute Promyelocytic Leukemia Are Uncommon, Respond Well to Salvage Therapy and Occur Independently of Prognostic Factors at Diagnosis: Long-term Follow-Up of North American Intergroup Study 0129.” Blood. 2011 118: 40. Plenary Session Oral Presentation, American Society of Hematology, Annual Meeting, San Diego, CA, December 2011.

Van Vlierberghe P, Ambesi A, Rigo I, Paietta E, Racevskis J, Wiernik PH, Rowe JM, Rue M, Ferrando AA ——“ETV6 Is an Early T-Cell Progenitor (ETP) Specific Tumor Suppressor Gene in Adult T-ALL.” Blood. 2011 118: 186. Oral Presentation, American Society of Hematology, Annual Meeting, San Diego, CA, December 2011.

2011 Year End Report 211 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

Etkind PR, Stewart AAF, Wiernik PH, Melana SM, Holland JF, Pogo BGT ——“Mouse Mammary Tumor Virus (MMTV) in Human Breast Cancer and Lymphoma.” Oral Presentation, Proc 3rd International Conference on Viral Oncology Research, Naples, Italy, October 2011.

Becker DJ, Hershman DL, Insel BJ, Neugut AI ——“Relationship between Physician Characteristics and the Use of Newer Chemotherapy for the Treatment of Colon Cancer.” Journal of Clinical Oncology. 29: 2011 (suppl; abstr 6106) Poster presentation, American Society of Clinical Oncology, Annual Meeting, Chicago, IL, June 2011.

Takahashi K, Yabe M, Shapira I, Varma M ——“Distinct Clinical Characteristics of Myelodysplastic Syndrome in Human Immunodeficiency Virus-Infected Patients.” Blood. 2011 November 118: 3821. ASH Annual Meeting, San Diego, CA, December 2011.

S.B. Fleishman, M. Bookbinder, E. Silen, B. Buddhdev, S. Shah, P. Homel, J. Nabatian, V. Rosenwald, R.H. Blum ——“Feasibility of Implementing a Personalized Electronic Health Record for Patients with Head and Neck Cancer.” J Clin Oncol. 29: 2011 (suppl; abstr e19514). American Society of Clinical Oncology, Annual Meeting, Chicago, IL, June 2011

Talcott JA, Zietman AL, Kaplan I, Clark JA, D’Amico AV ——“Evaluation of a Prostate Brachytherapy Technique Designed to Reduce Short- and Long-Term Urinary Dysfunction: 5-Year Results of a Multi-Institutional Comparative Cohort Study.” J Clin Oncol. Vol 29, No 7_suppl (March 1 Supplement), 2011: 70. 2011 Genitourinary Cancers Symposium, Orlando, FL, February 2011.

Coen J, Paly JJ, Rodrigues A, Shipley WU, Zietman AL, Efstathiou JA, Talcott JA ——“Long-Term QOL Outcome after Proton Beam Monotherapy for Localized Prostate Cancer.” J Clin Oncol. Vol 29, No 7_suppl (March 1 Supplement), 2011: 68. 2011 Genitourinary Cancers Symposium, Orlando, FL, February 2011.

Talcott JA, Zietman AL, Kaplan I, Clark JA, D’Amico AV ——“Does Prostate Brachytherapy that Avoids the Central Zone Prevent Long-Term Urinary Incontinence?: 5-Year Results of a Multi-Institutional Comparative Cohort Study.” Proc Annu Meet Am Soc Clin Oncol 2011; 29:A4665, Chicago, IL, June 2011.

Hu K, Mourad W, Persky M, Urken M, Jacobson A, Culliney B, Tran T, Schantz A, Costantino P, Harrison L ——“Pretreatment PET and Post-Treatment Pathologic Nodal Status as a Predictor for Distant Metastasis in Locally Advanced Head and Neck Squamous Cell Carcinoma Treated with Definitive Concurrent Chemoradiotherapy.” ASCO Proceedings 2011:5541, Chicago, IL, June 2011.

2011 Year End Report 212 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

Harrison L, Mourad W, Persky M, Urken M, Jacobson A, Culliney B, Tran T, Schantz S, Costantino P, Hu K ——“High Dose Rate Intraoperative Radiation Therapy for Recurrent Head and Neck Cancer: The Importance of In-Field Control on Survival.” ASCO Proceedings 2011:5593, Chicago, IL, June 2011.

Mourad W, Hu K, Persky M, Urken M, Jacobson A, Tran T, Culliney B, Costantino P, Schantz S, Harrison L ——“Concurrent Chemoradiotherapy and Brachytherapy Boost for Base of Tongue Cancer Treatment Outcomes.” ASCO Proceedings 2011:16026, Chicago, IL, June 2011.

Hu K, Kumar M, Sura S, Culliney B, Tran T, Jacobson A, Persky M, Urken M, Costantino P, Harrison L ——“Can Stage III-IV Head and Neck Cancer Patients Be Treated with Unilateral Radiotherapy?” International Journal of Radiation Oncology Biology Physics. 2011,Vol. 81, Issue 2, Supplement, Pages S486-S487. Miami, FL, October 2011.

Khair T, Boolbol S, Boachie-Adjei K, Klein P ——“Factors Affecting the Development of Axillary Lymph Node Metastases in T1a- T1b Breast Cancers.” Abstract 851497 accepted with Poster Presentation, San Antonio Breast Cancer Symposium, San Antonio, TX, December 2011.

Shao T, Boolbol SK, Boachie-Adjei K, Klein P ——“Clinical Significance of HER2+ and Triple-Negative Status in Patients with Tumor Size ≤ 1 cm and Node Negative Breast Cancer.” Abstract #P4-09-03, San Antonio Breast Cancer Symposium, San Antonio, TX, December 2011.

Boolbol SK, Kirstein L, Harshan M, Klein P, Cohen JM, Chadha M, Baehner FL, Malamud SC ——“Genomic Comparison of Paired Primary Breast Carcinomas and Macrometastatic Lymph Node Metastases Using Quantitative RT-PCR by Oncotype DX: Assessment of the Recurrence Score and Qualitative Single Genes.” Abstract #P5-14-03, San Antonio Breast Cancer Symposium, San Antonio, TX, December 2011.

Ennis KY, Chen MH, Zhang V, Smith GC, D’Amico AD, Ennis RD ——“The Impact of Economic Recession on the Incidence and Treatment of Cancer.” J Clin Oncol. 29: 2011 (suppl; abstr 6005), Chicago, IL, June 2011.

Ennis, RD ——“Differential Dose (a.k.a. Dose Painted) Prostate Brachytherapy Guided by Cancer-Specific Ultrasound Spectrum Analysis (USA) Prostate Imaging: A Prospective Phase I Trial.” Int J Radiat Oncol Biol Phys. 2011 81: S412-3, Miami, FL, October 2011.

D. Lazos, W. Mourad, D. Hauerstock, L. Harrison, E. Furhang, F. Trichter, R.D. Ennis ——“Comparison of Fiducial-Based 2D kV Orthogonal Imaging, Fiducial-Based CBCT and Soft Tissue-Based CBCT Registration for Patient Positioning Correction in Image-Guided Radiation Therapy for Prostate Cancer.” Int J Radiat Oncol Biol Phys. 2011 81: S763, Miami, FL, October 2011.

2011 Year End Report 213 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

Santoro J, Furhang EE, Kim CS, Whittum D, Van Heteren J, Potter R, Kalantarov E ——“A Study of TrueBeam LINAC Operation in a Varying Magnetic Field Environment.” AAPM Conference, SU-E-T-344, Vancouver, BC, Canada, August 2011.

Lazos D, Sillanpaa J, Furhang EE, Harrison LB ——“A Quality Control Computer Program for MLC Leafs Position Verification in IMRT. AAPM Conference, SU-E-T-62, Vancouver BC, Canada, August 2011.

Chadha M, Portenoy J, Boolbol SK, Kierstin L, Baoch- Abaje K, Harrison LB ——“Treatment of Ductal Carcinoma in Situ (DCIS) with Lumpectomy and Accelerated Whole Breast Radiation Therapy with Concomitant Boost (ARTB).” ASCO/ASTRO Breast Symposium, San Francisco, CA, September 2011.

Hopkins LA, Chang SH, Kirstein LJ, Fulop T, Malamud SC, Chadha M, Boolbol SK ——“Does Mammography Affect the Nodal Status at Presentation in 40-49 Year Old Breast Cancer Patients?” ASCO/ASTRO Breast Symposium, San Francisco, CA, August 2011.

Hopkins LA, Chang S, Kirstein LJ, Fulop T, Chadha M, Malamud S, Boolbol SK ——“Does Mammography Affect the Nodal Status at Presentation in 40-49 Year Old Breast Cancer Patients?” Am. Soc. Breast Dis., San Antonio, TX, December 2011.

Boolbol SK, Kirstein LJ, Harshan M, Klein P, Cohen JM, Chadha M, Baehner FL, Malamud S ——“Genomic Comparison of Paired Primary Breast Carcinomas and Macrometastatic Lymph Node Metastases Using Quantitative RT-PCR by OncotypeDX: Assessment of the Recurrence Score and Quantitative Single Genes.” San Antonio Breast Meeting, San Antonio, TX, December 2011.

Chadha M, Boolbol SK, Boachie-Adjei K, Portenoy J, Kirstein L, Harrison LB ——“The Impact of Body Mass Index (BMI) on Outcome among Patients with Ductal Carcinoma in Situ.” ASTRO, Miami, FL, October 2011.

Koichi Takahashi, Mariko Yabe, Ilan Shapira, Mala Varma ——“Distinct Clinical Characteristics of Myelodysplastic Syndrome in Human Immunodeficiency Virus-Infected Patients.” Abstract 118:3821, ASH Annual Meeting, San Diego, CA, December 2011.

W. Mourad, K. Hu, L. Harrison, et al ——“Novel Concepts in Dysphagia, Larynx and Pharyngeal Constrictors Tolerance.” Int J of RadiatOncolBiol Phys. 2011 October 1 Vol. 81. Issue 2, Ps 517. ASTRO, Miami, FL, October 2011.

W. Mourad, S. Packianathan, R. Shourbaji, et al ——“Ovarian Radiation Dose during Heterotopic Ossification Radiation Prophylaxis. Int J of RadiatOncolBiol Phys. 2011 October 1 Vol. 81. Issue 2, Ps 640. ASTRO, Miami, FL, October 2011.

2011 Year End Report 214 ContinuumDepartment Cancer of Pain CentersMedicine of and New Palliative York Care

L. Harrison, W. Mourad, K. Hu, et al ——“HDR-IORT for Recurrent Head and Neck Cancer: The Importance of In-Field Control on Survival.” J ClinOncol. 29: 2011 (5593). ASCO, Chicago, IL, June 2011.

S. Rauth, D. Shasha, W. Mourad et al ——“Day 0-D90 of Approximately 70% Correlates with Day 30-D90 of 90% for Patients Undergoing Prostate I-125 Implant.” Int J of RadiatOncolBiolPhys. 2011 October 1 Vol 81. Issue 2, Ps 447-8. ASTRO, Miami, FL, October 2011.

8. Honors/Awards New York Magazine Best Doctors: ——Janice Dutcher, MD ——Michael Grossbard, MD ——Louis Harrison, MD ——Peter Kozuch, MD Castle Connolly Top Doctors in NY Area: ——Ronald Blum, MD ——Janice Dutcher, MD ——Michael Grossbard, MD ——Peter Kozuch, MD ——Stephen Malamud, MD ——Louis Harrison, MD ——Manjeet Chadha, MD ——Ronald Ennis, MD America’s Top Doctors for Cancer: ——Michael Grossbard, MD ——Janice Dutcher, MD ——Louis Harrison, MD ——Manjeet Chadha, MD ——Ronald Ennis, MD

2011 Year End Report 215

Patient Care Services

2011

Patient Care Services

THE BEATRICE RENFIELD DEPARTMENT OF NURSING Patient Care Services, Perioperative Services and Patient Access Services Mary Walsh, MSN, RN, NEA-BC, CEN, Vice President and Chief Nursing Officer

1. New Hires —— Marguerite Corda, RN, Vice President Nursing, Patient Care Services, BI Brooklyn, November 11, 2011. —— Mary Anne Gallagher, RN, Director Nursing Quality Standards and Practice, Patient Care Services, February 7, 2011. —— Georgina Howard, RN, Director, Ambulatory Care Services – PACC, October, 2011. —— Mary Lakaszawski, RN, WOCN Specialist, March 14, 2011. —— Christine Moffa, RN, Nurse Educator, June 6, 2011. —— Janet Collins, RN, Nurse Educator, September 12, 2011. —— Jaime McNally, RN, CNS, March 14, 2011. —— Fay Hart-Denmark, RN, Nurse Manager, August 8, 2011. —— Jose Mitre, RN, Nurse Manager, August 1, 2011. —— Irene Scarlino, RN, Nurse Manager, July 11, 2011. —— Karen DeVries, RN, Nurse Manager, August 2011.

2. Program Enhancements

A. New Programs i. Shared Governance Model and Mission Statement: In recognition of the impact of RN job satisfaction on recruitment, retention and patient satisfaction, BIMC par- ticipates in the National Database of Nursing Quality Indicators (NDNQI) annual RN survey with job satisfaction scales (a score between 40 and 60 represents moderate satisfaction). Results from 2010 and 2011 show that BIMC nurses reported being moderately satisfied in each category and improved in most of the categories over the course of one year. In 2011, we created the BIMC Shared Governance Model, with input from all levels of nursing practice, to allow nurses to have a voice in their

Petrie Division

2010 2011 T-Scores

0 Task RN-RN RN-MD Decision- Autonomy Professional Job Interactions Interactions Making Status Enjoyment

2011 Year End Report 219 Patient Care Services

Beth Israel Brooklyn

2010 2011 T-Scores

0 Task RN-RN RN-MD Decision- Autonomy Professional Job Interactions Interactions Making Status Enjoyment

practice and improve nurse satisfaction, teamwork and patient outcomes. ii. Transforming Care at the Bedside (TCAB) at BI Brooklyn: We implemented this innovative, evidence-based project, run by nurse-led teams and supported by the Institute for Healthcare Improvement, the Robert Wood Johnson Foundation, the American Association, Organization of Nurse Executives and the 1199 Bargaining Unit. An oversight team was formed at BI Brooklyn comprised of leadership and 1199 RN union leaders, and a planning team selected 3 North to participate in the pilot. Over the course of two years, 3 North has successfully established partnerships with other departments; identified issues that prevent the nurse from spending quality time with the patients; achieved significant improvement in multiple measures including HCAHPS; increased patient satisfaction based on NCR Pickers Scores and as measured by the TCAB 19-question Vitality Survey; and decreased “non value-added time” with increased time for “necessary” patient care activities, interruptions from phone calls (across multiple categories), and missing medications. As a result of this success, TCAB will expand to 1 North at BI Brooklyn and 7 Linsky at Petrie.

PDA Study at BI Brooklyn: February 2011 vs Baseline (March 2010)(n=218/424)

Baseline Feb 2011

Necessary Task Increase by 21%

Non-Value Added Task Decrease by 24%

VA NEC

2011 Year End Report 220 Patient Care Services

PDA Study at BI Brooklyn: February 2011 vs Baseline (March 2010)(n=218/424) Waiting Copy/fax Hunting delay machine Baseline -35% +16% Feb 2011 +49%

-122%

+35%

-225%

Charting Daily Discharge assessment process

BI Brooklyn: Interruptions from Calls to/from 3 North (n=408/429)

March 1–8, 2010 Sept 30–Oct 7, 2010 100

94 90 Pharmacy decreased 13.3% 80

70 Food service 70 69 70 decreased 66% 60 63 60

50 52 47 40 38 30 32 29 29 25 25 20 23 22 21 Calls to/from 3 North Distict by 16 10 11 12 11 8 3 7 0 MD Family Pharm. Nursing Other Radiology Other Lab Food Social Page Other office dept unit services service oper. ind. teams/RRT

iii. Interdisciplinary Simulation Training: Implemented in a variety of clinical situations, e.g., code response, obstetrical emergencies. iv. Workplace Violence Committee: Resulted in the development of the 2012 Safety Team and Response (STAR) policy and procedures. B. Program Expansions i. PRISM upgrade ii. CNO Town Hall Meetings and Leadership Rounding: Held to improve communication between staff and nursing administration, in an effort to provide visible leadership, observation and re-enforcement of standards of behavior and clinical practice. iii. Department of Pain Medicine and Palliative Care Program Innovations—Nurse- Led Practice: PACC 2Q2R for chronic pain patients caseload nearing 700 patients.

2011 Year End Report 221 Patient Care Services

iv. Baby-Friendly Initiatives: Three RNs achieved lactation counselor certification. Mothers rooming with newborns increased from 68% in 2010 to 86% in 2011. “Mother breastfeeding exclusively” improved from 27% to 34% between 2010 and 2011.

3. Capital Enhancements

A. Equipment Enhancements i. Defibrillator/AED rollout at BI Brooklyn and Cancer Center West. ii. B Braun Infusion Pumps, Feeding Pumps, Ventilators. iii. Beds and Stretchers: a. New beds in ICU and step-down units and 6 Linsky. b. Four new birthing beds in Labor and Delivery. c. Hill Rom Yellofin Stirrups. d. Three stretchers. B. Facility Enhancements i. Petrie PACU expansion and renovation. ii. Renovation of 6 Karpas. iii. Renovations of PCS administrative office and WOCN office.

4. Quality Initiatives/Achievements

A. The department of PCS is committed to the prevention of pressure ulcers, which impact the quality of life of a patient and family and can lead to multiple complications. Toward this end, BIMC created the Skin Savers Program and has a team of Advanced Practice Nurses that works with patients, families and physicians, and provides mentoring and education for nurses and other disciplines. One of our leaders, Irene Jankowski, WOCN Clinical Manager, is the recipient of the National Nurse Scholar Award and has published and mentored advanced practice nurses in the area on wound care at a national level. Success is about teamwork, collaboration and communication. Skin Savers now comprises more than 500 direct care nurses and patient care associates that are champions on their units in the prevention, management and treatment of pressure ulcers. Unit-based skin saver projects have been designed for specific population/needs at BI Brooklyn. The Emergency Department completed the second phase of a pressure ulcer staging project, for which all staff had NDNQI training to correctly and promptly stage and start appropriate treatments on admission; staging accuracy increased to 93% from 86%.

To correctly identify pressure ulcers vs. incontinence dermatitis, staff on 3 East was educated by the WOCN. Monitoring was conducted for 13 weeks after this education, and all skin assessments were correctly identified as incontinence dermatitis. Christine Dennis, RN, on 3 East created a poster, which has been accepted for presentation at the 2012 WOCN annual national conference in Charlotte, NC. WOCN partnered with the 1 North Skin Savers team to prevent skin tears related to nursing procedures (No Tears for Tears Program). Over eight months, 419 patients (over 70 years old) were monitored and none developed skin tears related to nursing procedures. The data will be presented at a future symposium.

2011 Year End Report 222 Patient Care Services

2011 Hospital Acquired State 2 and above Pressure Ulcers Prevalence

2009 2010 2011 YTD 10 9 8 7 6 Hill Rom 2011 5 Benchmark=3% 4 for Bed size>500 Percentage 3 2 1 5 4 3 9 7 2 0 PTR BIB 2011 BI Improvement, Petrie & BI Brooklyn exceed or at benchmark. Unit skin saver projects.

BIMC Facility Acquired Pressure Ulcer Prevalence Trends 2004–2011

Petrie 18 16 14 16 12 10 8 6.8 8 6 6 4.6 Hill Rom 2011 Benchmark = 3% for Bed Size > 500 3.7 4 2.6

Percent of Patients Percent 2 0 2004 2006 2007 2008 2009 2010 2011 BI Brooklyn 18 16 16 13 14 15 12 10 8 10.6 6.9 6 4.6 Hill Rom 2011 Benchmark = 3% for Bed Size > 500 4 1.7

Percent of Patients Percent 2 0 2004 2006 2007 2008 2009 2010 2011

2011 Year End Report 223 Patient Care Services

B. In 2011, the Department of PCS and the Department of Quality Improvement at BIMC created a multidisciplinary task force to drive the fall prevention process. The task force is comprised of multiple disciplines, including direct care nurses, managers, physicians and pharmacist. Our goal for 2012 is to make “fall” a “never event” at BIMC, and Petrie and BI Brooklyn are consistently improving upon this initiative.

2011 Falls Rate per 1000 Patient Days 2011 NYPORT Falls Rate % Patient Falls with Injury (NYPORTS/Discharges) 2009 2010 2011 YTD 2009 2010 2011 YTD 7 .40

.35 6 NDNQI Mean for Adult Med/Surg .30 NY Benchmark—Top 10 5 Units = 4% % = 0.33 .25 4 .20 3 Percentage .15 2 .10 Rate per 1000 Patient Days Rate per 1000 Patient 1 .05 .02 .01 .02 .01 4 4 4 3 2 3 .08 .03 0 .00 PTR BIB PTR BIB

2011 Petrie and BI Brooklyn Fall Rate unchanged at or below NDNQI 2011 BI, SLR consistently exceeded NY Top 10%. benchmark. SLR at NDNQI benchmark. Initiated safety devices that are NYEE: No falls with injury from 2009 through 2011. alternatives to restraints and diversionary tools. Identified pattern of falls—altered meal breaks to allow consistent and appropriate staffing at all times. Assured that family members received education on safety and falls preventions. NYEEI: 2009 to 2011 consistently below NDNQI benchmark. falls preventions.

Petrie Division Rate of Falls per 1000 Patient Days

6 4.75 4.68 4.81 5 4.35 4 4.55 3.45 2.95 3.09 3 3.71 2.96 2 2.65 1.83 1 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Beth Israel Brooklyn Rate of Falls per 1000 Patient Days

5 4.26 4.18 3.95 4.10 3.46 4 3.22 3.66 3.79 3 3.29 2.86 2 2.75 2.12 1 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2011 Year End Report 224 Patient Care Services

C. BIMC has implemented a standard to reevaluate patients with a pain level of 5 or above within 61 minutes of an intervention. Compliance with this standard is monitored daily by staff and nurse managers, and unit-specific and hospital-wide data is collected by PRISM and communicated to leadership, physicians and frontline staff. In 2011, BIMC began to focus on patients with sustained pain, which is a pain score >5 for three or more days.

2009–2011 PRISM Pain Reassessment within 61 Minutes for Pain Level > 5

Petrie BI Brooklyn

98 90 90 89 87 87 87 87 84 84 84 85 81 82 76 74 % of Patients Reassessed % of Patients

2010 2010 2010 2010 2011 2011 2011 2011 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

D. Joint Commission Accreditation. E. We implemented a Nurse Managers Book Club for nurse leaders. The featured book was The HCAHPS Handbook: Hardwire Your Hospital for Pay-for-Performance Success. Nurse leaders presented a chapter to their colleagues highlighting initiatives to improve HCAHPS. Initiatives were then implemented on the unit level. F. We improved patient handoff by developing and implementing a shift-to-shift handoff tool and a ticket to ride to improve patient safety. G. We initiated simulation training for shoulder dystocia and postpartum hemorrhage. MDs and RNs were educated together.

5. Academic Appointments —— Jessica Chan, RN, appointed Clinical Instructor at Phillips Beth Israel School of Nursing. —— Marjorie Cooke, RN, appointed Clinical Instructor at Phillips Beth Israel School of Nursing. —— Karen Doblin, RN, appointed Associate Professor Clinical Adjunct at Hunter Bellevue College. —— Carmen Feliciano, RN, appointed Adjunct Instructor at Phillips Beth Israel School of Nursing. —— William Hansen, RN, appointed Clinical Adjunct Professor at St Paul’s School of Nursing.

2011 Year End Report 225 Patient Care Services

—— Fay Hart-Denmark, RN, appointed Adjunct Instructor at Dominican College and Clinical Instructor, Columbia University School of Nursing. —— Boris Molchanskiy, RN, appointed Clinical Adjunct Professor at St Paul’s School of Nursing. —— Barbara Ravida, RN, appointed Adjunct Professor at Hunter College CUNY. —— Mylen Razon, RN, appointed Adjunct Instructor at Phillips Beth Israel School of Nursing, New York University and Helene Fuld College of Nursing. —— Deb Miller Saultz, RN, appointed Associate Professor Clinical Adjunct at Hunter Bellevue College. —— Dolores Weber, RN, appointed Associate Professor at Queens Borough Community College. —— Alfred Zimmer, RN, appointed Instructor at Pace University.

6. Peer-Reviewed Publications and Presentations

A. Peer-Reviewed Publications —— Gallagher, M. “Does Pay for Performance Improve Patient Care?” The American Journal of Maternal/Child Nursing. Sept/Oct 2011 (36): 278-279. —— Smith EL, PhD, Bakitas MA, Homel P, Piehl, M, Kingman L, Fadul CE, Bookbinder M. “Preliminary Assessment of a Neuropathic Pain Treatment and Referral Algorithm for Patients with Cancer.” J Pain Symptom Manage. Dec 2011 42 (6): 822-38.

B. Presentations Dhingra L, Thakker D, Lo G, Lam K, Chen J, Chang V, Chan S, Homel P, Bookbinder M, Cheng S, Portenoy R ——“Symptom Control in Underserved Chinese American Cancer Patients.” Poster Presentation, Annual Meeting of the American Pain Society, Austin, TX, May 2011.

Fleishman S, Bookbinder M, Silen E, Buddhdev B, Shah S, Homel P, Nabatian J, Rosenwald V, Blum R ——“Feasibility of Implementing a Personalized Electronic Health Record for Patients with Head and Neck Cancer.” McCormick Place Convention Center, Chicago, IL, June 2011.

7. Honors/Awards Marilyn Bookbinder —— Faculty Assistant Professor of Neurology and Anesthesia, AECOM. —— Cochair of Nursing Research Committee, BIMC (2011-present). —— Executive Council for Advanced Practice Nurses, BIMC (2011-present). —— Shared Governance Steering Committee, BIMC (2011-present). Carol Fazio, RN, BSN, CEN —— Treasurer of Brooklyn/Staten Island Chapter of the Emergency Nurses Association. Robert Freeman, RN BC —— Nurse Novice of the Year 2011 Nurse of Distinction Award.

2011 Year End Report 226 Patient Care Services

Susan Gador, RN —— President of New York City Chapter, PNA Association. Mary Anne Gallagher, MA, RN-BC —— Board Member of New York Organization of Nurse Executives. —— AONE Committee Member of Hospital in Pursuit of Excellence. Hyacinth Hamilton Gayle, RN MSN, PNP —— Nurse Advisory Panel, OSASAS. Janet Mackin, EdD, RN, and Linda Luy, RN —— 2011 NYONE Best Practice Award. Mary Walsh, MSN, RN, NEA-BC, CEN —— GNYHA CNO Council. A. Circle of Excellence Awards Thelma Myers-Navarro, RN —— Beatrice Renfield 2011 Gold Circle of Excellence Award. Wayde Binder, BSN, RN —— Excellence in Nursing Leadership. Karen Doblin, NP, and Leonel Medina, NP —— Finalists Spectrum Nursing Excellence Awards, New York and New Jersey regions. Robbie Freeman, RN-BC —— Novice Nurse Award for Excellence in Patient-Centered Care. Victoria Lyddy, RN, PACC; Garcia Myers, RN, 5 Linsky; Lorraine O’Connor, RN, BI Brooklyn ED; Laura Rodriguez, RN, Pediatrics, Petrie Division; and Arlene Speer, RN, CSICU, Petrie Division —— Excellence in Patient-Centered Care. Deloris Whynne —— Award for Excellence in Patient-Centered Care by a Preceptor. Beth Israel Brooklyn’s 2 West Orthopedic Unit, Nurse Manager Catherine Leota, RN, and The Robert Mapplethorpe Residential Treatment Facility nursing team, led by Director of Nursing Marilyn Guntzler, RN —— Multidisciplinary Team Collaboration Award. B. BIMC Heart Awards —— Fe Aguilar, RN, BI Brooklyn —— Roxanna Badiu, RN, Nurse Manager —— Frank Cefali, Nurse Manager —— Rebecca Esquioja, ICU —— Karen Goodwin, RN, PACC —— Thelma Myers-Navarro, RN —— Lorraine O’Connor, RN, BI Brooklyn —— Barbara Ravid, RN, Cardiac Surgery —— Arleene Speer, RN C. National Nursing Certifications —— Angela Causing, RN, BC —— Angela Victoriano, RN, CARN

2011 Year End Report 227 Patient Care Services

—— Ann O’Neill, BSN, RN, MBA, CEN —— Annie Manzano, RN, CNOR —— Aracely Leiva, RN, BC —— Atinuke Olusanya, BSN, CCRN —— Carlos Resurrecion, RN, Neonatal CCRN —— Christina Barbato, RN, BC —— Deborah Breeding, RN, MA, OCN —— Didar Demir, RN, OCN —— Dorota Rybicka, RN, CMSRN —— Easter Lopez, RN Neonatal, CCRN —— Eileen Foster, RN, CARN —— Elaine Meszaros, RN, MSN, CNS, OCN —— Elisa Zulich, BSN, RN, CCRN —— Elizabeth Lynch, PMHNP, BC —— Elizabeth Metz, PMHCNS, BC —— Ella Kidanov, RN, BC —— Ellen Deane-Ferguson, AS, CRRN —— Elsa Quitos, BSN, CRRN —— Eteri Agyeyeva, RN, CMSRN —— Eun Ah Lee, RN, Neonatal CCRN —— Evelyn Dominguez, RNC, MNN —— Gladys Cruz, BSN, RN, BC —— Joaquin Valdez, BSN, CRRN —— Joseph Pollock, RN, CCRN —— Jung Yi, RN, CNOR —— Kathleen Duignan, RN, CCRN —— Laura Sklar, RN, ONC —— Lauren Emmerich, RN, OCN —— Lizbeth Keller, RN, CCRN —— Lizza Padua, BSN, RN, BC —— Margo Guzman, RN, BC —— Marie Denise, RN, BC —— Marie Louis, RN, CCRN —— Mary Ann Binas, RN, BC —— Mary Ann Licah, RN, CNOR, CRNFA —— Mary Cahill, RN, OCN —— Mary Walsh, MSN, RN, NEA-BC, CEN —— Michael Lucine, RN, CARN —— Michelle Small, AS, CRRN —— Natasha Ashton, MSN/NP —— Norma Chong, BSN, CRRN —— Patrick Mothersil, BS, RN, ONC —— Paula Gayle, BSN, RN —— Pilar Baker, RN, CCRN —— Robert Freeman, AS, RNC —— Robin Prince, RN, BC —— Susan Brindisi, AS, CRRN —— Tricia N. Deocampo, BSN, RN, CCRN —— Victoria Rosenwald, RN, OCN —— Wioletta Izdbeska, RN, BC

2011 Year End Report 228 Patient Care Services

8. Grants Communities Putting Prevention to Work —— $50,000 for 2010-2012 to Hyacinth Hamilton-Gayle, RN, to address smoking cessation and obesity (and support breastfeeding initiative).

Mayday Foundation —— $150,000 for 2011-2013 to Marilyn Bookbinder, RN, PhD, FPCN, Coinvestigator, “Mayday NP in Pain Management.” Principle investigator Russell K Portenoy, MD.

2011 Year End Report 229

Year End Activity Report/ Faculty Listing

2011

Year End Activity ReportReport/Faculty Listing

new faculty

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

ANESTHESIOLOGY

Celis, Edgar G., MD BI-Petrie Anesthesiology General Anesthesia Provisional Voluntary 7/5/11

Guttikonda, Veeranjaneya V., MD BI-Petrie Anesthesiology General Anesthesia Provisional Voluntary 7/5/11

Leffe, Sabatino, DO BI-Petrie Anesthesiology Pain Medicine Provisional Voluntary 11/3/11

Searles, Kenneth Jess, MD BI-Petrie Anesthesiology General Anesthesia Provisional Full Time 2/14/11

Yang, Roy, MD BI-Petrie Anesthesiology General Anesthesia Provisional Voluntary 1/5/11

DERMATOLOGY

Cook-Bolden, Fran Elesha, MD BI-Petrie Dermatology General Dermatology Provisional Voluntary 9/28/11

Jamal, Sumayah, MD, PhD BI-Petrie Dermatology General Dermatology Provisional Voluntary 4/27/11

Kil, Erin Hyun Sun, MD BI-Petrie Dermatology General Dermatology Provisional Voluntary 2/23/11

Osei-Tutu, Achiamah, MD BI-Petrie Dermatology General Dermatology Provisional Voluntary 6/29/11

Raklyar, Eduard, MD BI-Brooklyn Dermatology General Dermatology Provisional Voluntary 3/30/11

Spizuoco, Amy L., DO BI-Petrie Dermatology General Dermatology Temporary Privileges Voluntary 12/26/11

Urman, Felix, MD BI-Petrie Dermatology General Dermatology Provisional Voluntary 2/23/11

EMERGENCY MEDICINE

Frank, Rachel A., MD BI-Petrie Emergency Medicine Pediatric Emergency Medicine Provisional Per Diem 5/25/11

Griffin, Mervin I. J., MD BI-Brooklyn Emergency Medicine Provisional Per Diem 1/25/12

Hack, Clare Marie, MD BI-Petrie Emergency Medicine Pediatric Emergency Medicine Provisional Full time 6/29/11

Kopolovich, Harry, MD BI-Brooklyn Emergency Medicine General Emergency Medicine Provisional Per Diem 6/29/11

Lim, Czer Anthoney E., MD BI-Petrie Emergency Medicine Pediatric Emergency Medicine Provisional Per Diem 4/27/11

Park, Jay Hoon, MD BI-Petrie Emergency Medicine General Emergency Medicine Provisional Part Time 9/9/11

Roberts, Robin D, MD BI-Petrie Emergency Medicine General Emergency Medicine Temporary Privileges 2/13/12

Sanghani, Nipa Vijay, MD BI-Petrie Emergency Medicine Pediatric Emergency Medicine Provisional Per Diem 1/25/12

Voskoboynik, Diana, MD BI-Petrie Emergency Medicine Pediatric Emergency Medicine Provisional Per Diem 3/17/11

FAMILY MEDICINE

Alvarez, Dimitri, MD BI-Petrie Family Medicine General Family Medicine Provisional Part Time 5/25/11

Dadarwala, Aashish D., DO BI-Petrie Family Medicine General Family Medicine Provisional Per Diem 7/27/11

Dao, Liana T., MD BI-Petrie Family Medicine General Family Medicine Provisional Voluntary 2/29/12

Eng, Colleen S., DO BI-Petrie Family Medicine General Family Medicine Provisional Voluntary 10/26/11

Enschede, Elizabeth Brightstar, MD BI-Petrie Family Medicine General Family Medicine Provisional Full Time 9/13/11

Greenberg, Keith H., DO BI-Petrie Family Medicine General Family Medicine Active Voluntary 1/26/11

Kabak, Jennifer Amy, DO BI-Petrie Family Medicine General Family Medicine Provisional Full Time 12/14/11

Karp, Sara Beth, MD BI-Petrie Family Medicine General Family Medicine Provisional Part Time 6/27/11

Le, Jimmy Chung, MD BI-Petrie Family Medicine General Family Medicine Provisional Voluntary 3/30/11

Mahmud, Pamela, MD BI-Petrie Family Medicine General Family Medicine Provisional Full time 12/14/11

Nguyen, James K., DO BI-Petrie Family Medicine General Family Medicine Provisional Voluntary 5/25/11

Poroger, Emma, DO BI-Brooklyn Family Medicine General Family Medicine Provisional Voluntary 4/27/11

Roth, Rachel Anna, MD BI-Petrie Family Medicine General Family Medicine Temporary Privileges 2/14/12

Sastre, Jorge, MD BI-Petrie Family Medicine General Family Medicine Provisional Full time 10/26/11

Silberlicht, Jonathan Stone, MD BI-Petrie Family Medicine General Family Medicine Provisional Full time 10/26/11

Suley, Elhan, DO BI-Petrie Family Medicine General Family Medicine Provisional Voluntary 1/25/12

2011 Year End Report 233 Year End Activity ReportReport/Faculty Listing

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

MEDICINE

Cardiology

Chan, Jacqueline, MD BI-Petrie Medicine Cardiology Provisional Part Time 10/4/11

Chen, Thomas T., MD BI-Petrie Medicine Cardiology Provisional Voluntary 1/27/11

Danilov, Tatyana Alexandra, MD BI-Petrie Medicine Cardiology Provisional Full time 8/16/11

Ghalchi, Michael N, MD BI-Petrie Medicine Cardiology Provisional Voluntary 3/30/11

Gujja, Karthik Reddy, MD, MPH BI-Petrie Medicine Cardiology Provisional Per Diem 2/23/11

Hlaing, Thinn, MD BI-Petrie Medicine Cardiology Provisional Voluntary 12/14/11

Huang, Yili, DO BI-Petrie Medicine Cardiology Provisional Part Time 8/12/11

Kuniyil, Jesheeja (Jesse), MD BI-Petrie Medicine Cardiology Active Per Diem 2/10/11

Lau, David Hai-Pong, MD, PhD BI-Petrie Medicine Cardiology Provisional Voluntary 7/13/11

Lay, Lori Vales, MD BI-Petrie Medicine Cardiology Provisional Voluntary 9/14/11

Mailloux, Lynn Marie, MD BI-Petrie Medicine Cardiology Provisional Full Time 12/14/11

Song, Jason J., MD BI-Brooklyn Medicine Cardiology Temporary Privileges Voluntary 12/7/11

Traube, Elie, MD BI-Brooklyn Medicine Cardiology Provisional Voluntary 7/1/11

Wu, Henry D., MD BI-Petrie Medicine Cardiology Provisional Voluntary 1/26/11

Endocrinology

Halberstam, Meyer S., MD BI-Petrie Medicine Endocrinology Provisional Voluntary 10/26/11

Khalfin, Alla, DO BI-Petrie Medicine Endocrinology Provisional Voluntary 2/23/11

Nandi, Anindita, MD BI-Petrie Medicine Endocrinology Temporary Privileges Part Time 11/18/11

Pareek, Ashutosh S., DO BI-Petrie Medicine Endocrinology Provisional Per Diem 1/4/11

Gastroenterology

Ascunce, Gil I., MD BI-Petrie Medicine Gastroenterology Provisional Full time 8/3/11

Attia, Lawrence, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 6/29/11

Chang, Peter K., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 2/29/12

Cooper, Robert B., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 2/29/12

George, James, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 2/29/12

Khodadadian, Shawn, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 3/30/11

Lax, James D., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 5/25/11

Lewis, Blair S., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 1/25/12

Loria, Jeffrey Michael, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 2/29/12

Matin, Ayaz, MD BI-Petrie Medicine Gastroenterology Provisional Per Diem 10/26/11

Miskovitz, Paul F., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 12/14/11

Oneto Araya, Caterina M., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 12/14/11

Palmon, Ron, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 12/14/11

Sanghavi, Moushumi B., MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 8/3/11

Shvarts, Alexander, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 4/27/11

Wong, Timothy, MD BI-Petrie Medicine Gastroenterology Provisional Voluntary 4/27/11

Geriatric Medicine

Levine-Tanco, Karen L., MD BI-Petrie Medicine Geriatric Medicine Temporary Privileges Part Time 1/3/12

Nichols, Jeffrey N., MD BI-Petrie Medicine Geriatric Medicine Provisional Voluntary 2/4/11

Yen, Ya-Hsiu, MD BI-Petrie Medicine Geriatric Medicine Provisional Full-Time 10/26/11

Hematology/Oncology

Dutcher, Janice P, MD BI-Petrie Medicine Hematology/Oncology Provisional Full Time 2/23/11

Mastan, Alina, MD BI-Petrie Medicine Hematology/Oncology Provisional Voluntary 4/27/11

2011 Year End Report 234 Year End Activity ReportReport/Faculty Listing

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

Talcott, James Austin, MD BI-Petrie Medicine Hematology/Oncology Provisional Full Time 4/4/11

Wiernik, Peter H., MD BI-Petrie Medicine Hematology/Oncology Provisional Full Time 2/23/11

Infectious Diseases

Murayama-Greenbaum, Robert, MD BI-Petrie Medicine Infectious Diseases Provisional Voluntary 7/27/11

Internal Medicine

Arcuri, Joseph John, MD BI-Petrie Medicine Internal Medicine Provisional Full time 7/26/11

Bellutta, Henry Patrick, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 2/23/11

Chernyavsky, Svetlana, DO BI-Petrie Medicine Internal Medicine Provisional Per Diem 7/19/11

Collazo, Marcel Ramiro, MD BI-Petrie Medicine Internal Medicine Temporary Privileges Full Time 11/7/11

Donegan, Kerry A, MD BI-Petrie Medicine Internal Medicine Provisional Per Diem 9/19/11

Esposito, Amy Rose, MD BI-Petrie Medicine Internal Medicine Provisional Full time 9/7/11

Glen, Clarisse J, MD BI-Petrie Medicine Internal Medicine Provisional Per Diem 7/1/11

Goldberg, Eric, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 9/28/11

Green, Patrice P., MD BI-Petrie Medicine Internal Medicine Provisional Full Time 10/13/11

Halkias, George C., MD BI-Petrie Medicine Internal Medicine Provisional Full Time 5/26/11

Imam, Asim E., MD BI-Petrie Medicine Internal Medicine Provisional Locum Tenens 9/19/11

Kletsman, Igor, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 10/26/11

Kochin, Anna K., MD BI-Petrie Medicine Internal Medicine Provisional Full Time 10/19/11

Koduru, Sunaina, MD BI-Petrie Medicine Internal Medicine Provisional Locum Tenens 9/21/11

Korman, Andrew S, MD BI-Petrie Medicine Internal Medicine Provisional Full time 8/10/11

Kostanyan, Sofya, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 12/14/11

Lu, Li, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 1/25/12

Markovic, Slavisa, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 12/14/11

Mazurek, Jonathan Nachman, MD BI-Petrie Medicine Internal Medicine Provisional Full time 8/9/11

Mecca, Joanna E., MD BI-Petrie Medicine Internal Medicine Provisional Full time 6/28/11

Menczelesz, Gabor, MD BI-Brooklyn Medicine Internal Medicine Provisional Voluntary 12/14/11

Mui, Wingtat, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 9/28/11

Nori, Venkatesh, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 7/27/11

Parikh, Palak S., MD BI-Petrie Medicine Internal Medicine Provisional Full time 7/7/11

Parks, Trevor Paul, MD BI-Brooklyn Medicine Internal Medicine Provisional Per Diem 10/26/11

Peng, Charles Yenwei, MD BI-Petrie Medicine Internal Medicine Provisional Full time 10/26/11

Raykher, Aleksandra, MD BI-Brooklyn Medicine Internal Medicine Provisional Voluntary 7/27/11

Sacolick, Ben, MD BI-Brooklyn Medicine Internal Medicine Active Voluntary 4/25/11

Samra, Faraj, MD BI-Brooklyn Medicine Internal Medicine Provisional Full Time 7/1/11

Tso, Alan Y., MD BI-Petrie Medicine Internal Medicine Provisional Full Time 7/15/11

Wysoczanski, Mariusz W., MD BI-Petrie Medicine Internal Medicine Temporary Privileges Per Diem 1/30/12

Zheng, Yixiu, MD BI-Petrie Medicine Internal Medicine Provisional Voluntary 9/28/11

Zuckerman, Tehila T., MD BI-Petrie Medicine Internal Medicine Provisional Full Time 7/20/11

Methadone Maintenance Treatment Program

Hwang, Irene, MD BI-Petrie Medicine Methadone Maintenance Provisional Full time 8/11/11 Treatment Program

Nephrology

Liang, Elizabeth Q., MD BI-Petrie Medicine Nephrology Provisional Full Time 1/25/12

Occupational Health

Bottner, Joseph, MD BI-Petrie Medicine Occupational Health Provisional Part Time 4/27/11

Pulmonary Medicine/Critical Care

Goldklang, Monica Prasad, MD BI-Petrie Medicine Pulmonary Critical Care Provisional Full time 9/13/11

2011 Year End Report 235 Year End Activity ReportReport/Faculty Listing

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

NEUROLOGY

Gao, Weiyi, MD BI-Petrie Neurology General Neurology Provisional Full time 7/1/11

Khodabakhsh, Kashyar, MD BI-Petrie Neurology General Neurology Provisional Full time 7/1/11

Ravitz, Risa M., MD BI-Petrie Neurology General Neurology Provisional Voluntary 1/25/12

NEUROSURGERY

Goodman, Robert R., MD, PhD BI-Petrie Neurosurgery General Neurosurgery Provisional Full Time 3/3/11

OBSTETRICS/GYNECOLOGY

Finkelstein, Seth Adam, MD BI-Brooklyn Obstetrics/Gynecology Provisional Voluntary 10/26/11

Khatamee, Masood A., MD BI-Petrie Obstetrics/Gynecology Gynecology Provisional Voluntary 3/30/11

Mulligan, Kathleen, MD BI-Petrie Obstetrics/Gynecology Gynecology Provisional Voluntary 3/30/11

Orbuch, Iris K., MD BI-Petrie Obstetrics/Gynecology Gynecology Provisional Voluntary 4/1/11

Rybak, Eli A., MD, MPH BI-Brooklyn Obstetrics/Gynecology Gynecology Leave Of Absence Voluntary 2/24/11

Sondhi, Parveen R, MD BI-Petrie Obstetrics/Gynecology Gynecology Temporary Privileges Full Time 1/9/12

Wahl, Eric M., MD BI-Petrie Obstetrics/Gynecology Gynecology Provisional Voluntary 3/30/11

Wang, Jian, MD BI-Petrie Obstetrics/Gynecology Provisional Full Time 12/14/11

Yunayev, Shawn I., MD BI-Brooklyn Obstetrics/Gynecology Provisional Voluntary 1/25/12

Zhang, Katie Yadhua, MD BI-Petrie Obstetrics/Gynecology Provisional Voluntary 2/28/11

ORTHOPEDIC SURGERY

Frances, Jenny M., MD, MPH BI-Petrie Orthopedic Surgery Pediatric Orthopedics Provisional Voluntary 1/25/12

Jacobs, Sharone, MD BI-Petrie Orthopedic Surgery General Orthopedic Surgery Provisional Voluntary 3/24/11

Mangonon, Michael L., DO BI-Petrie Orthopedic Surgery Hand Surgery Temporary Privileges Voluntary 1/18/12

Otsuka, Norman Y., MD BI-Petrie Orthopedic Surgery Pediatric Orthopedics Provisional Voluntary 1/17/12

Patel, Munkund, MD BI-Brooklyn Orthopedic Surgery Hand Surgery Provisional Voluntary 10/26/11

Pearlman, Charles J., MD BI-Brooklyn Orthopedic Surgery Temporary Privileges Voluntary 12/20/11

Rodriguez, Juan Carlos, MD, PhD BI-Petrie Orthopedic Surgery General Orthopedic Surgery Provisional Voluntary 1/25/12

Weber, Renata V., MD BI-Brooklyn Orthopedic Surgery Hand Surgery Active Voluntary 9/19/11

OTOLARYNGOLOGY

Adler, Terence J., DDS BI-Petrie Otolaryngology General Dentistry Provisional Voluntary 6/29/11

Bernstein, Joseph M., MD BI-Petrie Otolaryngology Head and Neck Surgery Provisional Full Time 4/27/11

Cho, Steven H., DDS BI-Petrie Otolaryngology Oral and Maxillofacial Surgery Provisional Voluntary 3/30/11

Engelhard, Gwen M., DDS BI-Petrie Otolaryngology General Dentistry Provisional Voluntary 2/23/11

Lee, Edward Jung Kyun, MD BI-Petrie Otolaryngology Head and Neck Surgery Active Voluntary 2/23/11

Madnani, Dilip D., MD BI-Petrie Otolaryngology Head and Neck Surgery Active Voluntary 3/30/11

Marshall, Michael D., MD,DDS BI-Petrie Otolaryngology Oral and Maxillofacial Surgery Provisional Voluntary 10/26/11

Montazem, Andre H., DMD, MD BI-Petrie Otolaryngology Oral and Maxillofacial Surgery Provisional Voluntary 12/14/11

Schaberg, Madeleine Rita, MD BI-Petrie Otolaryngology Head and Neck Surgery Provisional Voluntary 1/25/12

Silver-Karcioglu, Amanda, MD BI-Petrie Otolaryngology Head and Neck Surgery Provisional Voluntary 10/21/11

Stein, Mark, MD, DDS BI-Petrie Otolaryngology Oral and Maxillofacial Surgery Provisional Voluntary 10/26/11

Turner, Michael D., MD, DDS BI-Petrie Otolaryngology Oral and Maxillofacial Surgery Provisional Full time 8/15/11

2011 Year End Report 236 Year End Activity ReportReport/Faculty Listing

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

PAIN MED AND PALLIATIVE CARE

Aydin, Steve Matthew, DO BI-Petrie Pain Medicine and Provisional Voluntary 2/23/11 Palliative Care

Balotti, Richard F., MD BI-Petrie Pain Medicine and Pain Medicine Provisional Voluntary 7/29/11 Palliative Care

Horowitz, Steven Craig, MD BI-Brooklyn Pain Medicine and Active 3/24/11 Palliative Care

Mogilevsky, Mila, DO BI-Petrie Pain Medicine and Provisional Voluntary 2/23/11 Palliative Care

Patel, Nirmal, MD BI-Petrie Pain Medicine and Provisional Voluntary 4/27/11 Palliative Care

Ribeiro, Sady, MD BI-Petrie Pain Medicine and Provisional Voluntary 4/27/11 Palliative Care

Sackheim, Kimberly Ann, DO BI-Petrie Pain Medicine and Pain Medicine Provisional Voluntary 1/25/12 Palliative Care

Sakae, Mayuko, MD BI-Petrie Pain Medicine and Provisional Voluntary 4/27/11 Palliative Care

Soto, Eliezer, MD BI-Petrie Pain Medicine and Pain Medicine Provisional Full time 7/1/11 Palliative Care

PATHOLOGY

Wang, Beverly Y., MD BI-Petrie Pathology Anatomic Pathology Provisional Full time 6/26/11

PEDIATRICS

Brick, David H., MD BI-Petrie Pediatrics Pediatric Cardiology Provisional Voluntary 10/5/11

Cohen, Matthew S., MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 10/26/11

Martinez, Matthew N., MD BI-Petrie Pediatrics Pediatric Cardiology Provisional Voluntary 10/5/11

Pawlik, Anna, MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 10/26/11

Pappas, John, MD BI-Petrie Pediatrics General Pediactrics Provisional Per Diem 9/2012

Polizzi, Laura N., MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 10/26/11

Trocola, Talia, MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 1/25/12

Vomvolakis, Maria A., MD BI-Petrie Pediatrics General Pediatrics Provisional Full Time 6/2/11

Wang, Cai Ling, MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 1/25/12

Zheng, Jean Q., MD BI-Petrie Pediatrics General Pediatrics Provisional Voluntary 10/26/11

PSYCHIATRY

Bhutia, Phintso P.D., MD BI-Petrie Psychiatry General Psychiatry Active Voluntary 1/26/11

Ditzell, Jeffrey S., DO BI-Petrie Psychiatry General Psychiatry Provisional Part Time 5/25/11

Edgcomb, David Bernal, MD BI-Petrie Psychiatry General Psychiatry Provisional Full Time 11/8/11

Khaysman, Yelena, MD BI-Brooklyn Psychiatry Provisional Voluntary 12/14/11

Krysko, Michael John, MD BI-Brooklyn Psychiatry General Psychiatry Provisional Voluntary 12/14/11

Latoussakis, Vassilios, MD BI-Petrie Psychiatry Active Per Diem 1/26/11

Ozden, Aykut, MD BI-Petrie Psychiatry Active Voluntary 1/26/11

Redondo, Robert Mark, MD BI-Petrie Psychiatry General Psychiatry Provisional Voluntary 3/30/11

Rosas, Michael Eric, MD BI-Petrie Psychiatry General Psychiatry Provisional Per Diem 1/16/12

Toma, Mirela E, MD BI-Petrie Psychiatry Geriatric Psychiatry Provisional Per Diem 11/14/11

Towey, Eldene Gwen, MD BI-Petrie Psychiatry Addiction Psychiatry Active Part Time 1/26/11

Vincent, Philip E., MD BI-Petrie Psychiatry General Psychiatry Provisional Voluntary 1/26/11

2011 Year End Report 237 Year End Activity ReportReport/Faculty Listing

RADIOLOGYPRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

Gebara, Nathalie V., MD BI-Petrie Radiology Provisional Voluntary 11/16/11

Goldfine, Susan L., MD BI-Petrie Radiology Diagnostic Radiology Provisional Voluntary 3/30/11

Halpert, Eliezer, MD BI-Petrie Radiology Interventional Radiology Provisional Voluntary 7/27/11

Jhanwar, Yuliya S., MD BI-Petrie Radiology Diagnostic Radiology Active Full time 7/29/11

Lempert, Leonid, MD BI-Petrie Radiology Diagnostic Radiology Provisional Voluntary 7/5/11

Lipschitz, Sherman S., MD BI-Petrie Radiology Diagnostic Radiology Provisional Voluntary 3/30/11

SURGERY

Breast Surgery

Radzio, Agnes, MD BI-Petrie Surgery Breast Surgery Active Full Time 1/26/11

Wellner, Rachel Beth, MD BI-Petrie Surgery Breast Surgery Temporary Privileges Voluntary 1/23/12

Colon/Rectal Surgery

Aronoff, Jeffrey S, MD BI-Petrie Surgery Colon/Rectal Surgery Temporary Privileges Per Diem 1/10/12

Melstrom, Kurt Allan, MD BI-Petrie Surgery Colon/Rectal Surgery Provisional Full Time 7/8/11

General Surgery

Blumenthal, Jesse Arthur, MD BI-Petrie Surgery General Surgery Provisional Part Time 2/28/11

Brower, Steven T., MD BI-Petrie Surgery General Surgery Provisional Full Time 9/9/11

Butler, Toni C., MD BI-Brooklyn Surgery General Surgery Provisional Per Diem 2/23/11

Gulmatico, Constantino, MD BI-Brooklyn Surgery General Surgery Temporary Privileges Voluntary 1/10/12

Hall, Duane S., MD BI-Brooklyn Surgery General Surgery Provisional Per Diem 1/25/12

Hussain, Syed Asif, MD BI-Brooklyn Surgery General Surgery Provisional Per Diem 2/23/11

Kahn-Kapp, Evelina L., MD BI-Brooklyn Surgery General Surgery Provisional Per Diem 12/14/11

Kopatsis, Anthony, MD BI-Petrie Surgery General Surgery Temporary Privileges Per Diem 10/3/11

Mahtemework, Yohannes, DO BI-Brooklyn Surgery General Surgery Provisional Per Diem 3/30/11

Marti, Jennifer L., MD BI-Petrie Surgery General Surgery Provisional Full Time 10/14/11

Ophthalmology

Banik, Rudrani, MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 3/30/11

Gentile, Ronald C., MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 7/27/11

Kedhar, Sanjay R., MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 2/28/11

Landa, Gennady B., MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 3/30/11

Lowe, Robert James, MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 3/30/11

Ponce, Estuardo Alfonso, MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 6/29/11

Samson, C Michael Arenas, MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 10/26/11

Tai, Tak Yee Tania, MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 3/30/11

Wen, Angie E., MD BI-Petrie Surgery Ophthalmology Provisional Voluntary 6/29/11

Pediatric Surgery

Tomita, Sandra S., MD BI-Petrie Surgery Pediatric Surgery Temporary Privileges Per Diem 1/10/12

Podiatry

Baird, William T., DPM BI-Brooklyn Surgery Podiatry Temporary Privileges Voluntary 1/12/12

Belcastro, Louis P., DPM BI-Brooklyn Surgery Podiatry Active Voluntary 4/6/11

Gefter, Janna, DPM BI-Brooklyn Surgery Podiatry Active Voluntary 4/6/11

Gitlin, David, DPM BI-Petrie Surgery Podiatry Temporary Privileges Full time 9/19/11

Karpenko, Oleg, DPM BI-Brooklyn Surgery Podiatry Temporary Privileges Voluntary 12/1/11

Minara, Ryan P., DPM BI-Petrie Surgery Podiatry Temporary Privileges Voluntary 9/19/11

Vader, Bonnie, DPM BI-Brooklyn Surgery Podiatry Active Voluntary 5/9/11

2011 Year End Report 238 Year End Activity ReportReport/Faculty Listing

PRACTITIONER PRIM FAC DEPARTMENT SPECIALTY CURRENT STATUS CLIN STATUS START DATE

UROLOGY

Freyle, Jaime, MD BI-Petrie Urology General Urology Provisional Part Time 10/21/11

Goluboff, Erik T., MD BI-Petrie Urology General Urology Provisional Full Time 4/28/11

Motola, Jay Alan, MD BI-Petrie Urology General Urology Provisional Part Time 4/27/11

Schlussel, Richard Norman, MD BI-Petrie Urology General Urology Provisional Voluntary 4/27/11

Schwartz, Alexander Michael, MD BI-Petrie Urology General Urology Provisional Voluntary 5/16/11

Stember, Doron S., MD BI-Petrie Urology General Urology Provisional Full Time 7/27/11

Subramaniam, Arumbi, MD BI-Petrie Urology General Urology Provisional Voluntary 10/6/11

Zelikovsky, Gerald, MD BI-Petrie Urology General Urology Provisional Voluntary 4/27/11

TOTAL PHYSICIANS = 226

2011 Year End Report 239 Year End Activity ReportReport/Faculty Listing BETH ISRAEL MEDICAL CENTER - PETRIE DIVISION MONTHLY ACTIVITY REPORT: PERIOD ENDING DECEMBER 31, 2011

DISCHARGES PATIENT DAYS AMBULATORY SURGERIES YTD 2010 ACTUAL ACTUAL BUDGET VARIANCE ACTUAL BUDGET VARIANCE ACTUAL BUDGET VARIANCE PAT. AMB SERVICE MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD DISCHS DAYS SURGS Anesthesiology 0 0 0 0 — — 0 0 0 0 — — 0 0 0 0 — — 0 0 0 Cardiac Surgery 29 311 37 440 (8) (129) 317 3,238 431 5,134 (114) (1,896) 1 34 1 20 ~ 14 322 3,739 30 Cardiology 410 4,762 359 4,341 51 421 1,118 14,630 985 11,938 133 2,692 154 1,862 164 1,974 (10) (112) 3,956 12,081 1,922 Colon Rectal Surgery 12 225 20 250 (8) (25) 76 1,096 101 1,240 (25) (144) 15 199 15 169 ~ 30 227 1,101 188 Dentistry 7 55 6 71 1 (16) 11 128 17 201 (6) (73) 2 83 9 117 (7) (34) 66 171 94 Dermatology 0 0 0 0 — —— 0 0 0 0 — — 0 1 0 0 — 1 0 0 0 General Surgery* 205 2,221 197 2,350 8 (129) 894 10,902 931 11,118 (37) (216) 203 2,601 295 3,530 (92) (929) 2,177 10,826 3,136 Gynecology 30 460 50 597 (20) (137) 60 1,127 136 1,605 (76) (478) 124 1,529 108 1,296 16 233 642 1,641 1,321 Medicine — Family 107 1,397 127 1,522 (20) (125) 585 6,355 508 6,088 77 267 0 0 0 0 — — 1,385 5,593 1 Medicine** 1,220 14,895 1,265 15,433 (45) (538) 6,855 81,112 7,028 85,752 (173) (4,640) 730 9,912 803 9,629 (73) 283 14,510 80,636 9,504 Medicine — Pediatric 79 744 76 898 3 (154) 247 2,448 262 3,108 (15) (660) 1 2 1 2 — — 847 2,893 2 Neurology 123 1,778 152 1,805 (29) (27) 370 5,545 487 5,794 (117) (249) 0 0 0 0 ~ ~ 1,688 5,502 2 Neurosurgery 15 182 16 178 (1) 4 75 894 69 751 6 143 4 54 5 73 (1) (19) 192 900 72 NICU 40 312 31 336 9 (24) 527 4,411 463 5,038 64 (627) 0 0 0 0 — — 343 5,067 0 Obstetrics 369 4,087 337 4,072 32 15 1,002 11,308 933 11,258 69 50 2 9 0 0 2 9 4,043 11,108 28 Ophthalmology 0 1 0 0 — 1 0 10 0 0 — 10 0 0 0 0 — — 0 0 102 Orthopedic Surgery 140 1,679 152 2,013 (12) (334) 505 6,187 485 6,441 20 (254) 379 5,409 516 6,200 (137) (791) 1,751 5,744 5,658 Spine Surgery 36 457 43 500 (7) (43) 130 1,664 172 2,000 (42) (336) 9 156 13 160 (4) (4) 483 1,892 154 Spine Rehab 0 0 0 0 — — 0 0 0 0 — — 164 2,057 179 2,150 (15) (93) 0 0 2,284 Otolaryngology 94 943 74 880 20 63 413 4,036 311 3,711 102 325 107 1,589 126 1,504 (19) 85 922 3,619 1,454 Pain Medicine & Palliative Care 20 290 23 251 (3) 39 143 4,894 159 1,755 (16) 3,139 435 5,321 462 5,551 (27) (230) 188 1,457 4,974 Pediatric Surgery 0 3 3 17 (3) (14) 0 6 6 34 (6) (28) 1 40 2 13 (1) 27 3 24 15 Plastic Surgery 2 98 11 137 (9) (39) 8 402 71 861 (63) (459) 13 174 16 192 (3) (18) 123 754 174 Podiatry 0 0 0 0 — — 0 0 0 0 — — 48 712 60 726 (12) (14) 2 4 769 Psychiatry Detox 0 90 34 400 (34) (310) 0 454 200 2,344 (200) (1,890) 0 0 0 0 — — 298 1,713 0 Radiation Therapy 1 16 1 11 — 5 1 45 9 99 (8) (54) 53 921 104 1,248 (51) (327) 22 60 1,307 Stuy. Square Detox 296 4,234 333 4,024 (37) 210 1,098 15,866 1,332 16,096 (234) (230) 0 0 0 0 — — 4,002 15,811 0 Thoracic Surgery 23 244 36 430 (13) (186) 207 2,288 324 3,870 (117) (1,582) 3 33 5 51 (2) (18) 163 1,360 17 Urology 52 548 54 657 (2) (109) 83 1,293 120 1,465 (37) (172) 108 1,422 122 1,473 (14) (51) 574 1,277 1,373 Vascular Surgery 58 610 62 756 (4) (146) 291 3,386 288 3,530 3 (144) 28 409 36 433 (8) (24) 488 2,757 334 Medical Rehab 5 49 3 31 2 18 44 570 30 327 14 243 0 0 0 0 — — 153 1,562 0 Non—Exempt Subtotal: 3,373 40,691 3,502 42,400 (129) (1,709) 15,060 184,295 15,858 191,558 (798) (7,263) 2,584 34,529 3,042 36,511 (458) (1,982) 39,570 179,292 34,915 Psychiatry 152 1,877 146 1,764 6 113 2,222 32,738 2,716 32,807 (494) (69) 58 684 58 705 — (21) 1,663 31,964 719 Medicine — Rehab 68 705 57 701 11 4 687 8,100 720 8,861 (33) (761) 0 107 16 203 (16) (96) 563 7,113 221 Stuy. Square Rehab 51 652 55 683 (4) (31) 799 10,401 886 11,030 (87) (629) 0 0 0 0 — — 632 10,373 0 Exempt Subtotal: 271 3,234 258 3,148 13 86 3,708 51,239 4,322 52,698 (614) (1,459) 58 791 74 908 (16) (117) 2,858 49,450 940 TOTAL (Excluding Nursery) 3,644 43,925 3,760 45,548 (116) (1,623) 18,768 235,534 20,180 244,256 (1,412) (8,722) 2,642 35,320 3,116 37,419 (474) (2,099) 42,428 228,742 35,855 Nursery 301 3,559 275 3,321 26 238 699 8,703 679 8,199 20 504 3,513 8,518 0 ER VISITS Admitted(Excluding L&D) 2,089 24,288 2,037 23,983 52 305 22,527 Billable 7,244 83,805 6,832 80,443 412 3,362 74,573 Treated & Released 7,285 84,319 6,902 81,278 383 3,041 75,347 TOTAL ER VISITS (Admitted/Billable) 9,333 108,093 8,869 104,426 464 3,667 97,100

Cases are categorized to service lines based on the discharge physician’s specialty and department and each case’s specific discharge service. The physician’s specialty and department are assigned during the credentialing process. * General Surgery includes Endoscopy cases. ** Medicine includes the cases from Endocrinology, Gastrointestinal Med., Hematology, Immunology, Geriatric and Internal Med., Infectious Dis., Nephrology, Pulmonary Disease and Rheumotology. 2011 Year End Report 240 Year End Activity Report

YTD 2010 ACTUAL BETH ISRAEL MEDICAL CENTER - BETH ISRAEL BROOKLYN MONTHLY ACTIVITY REPORT: PERIOD ENDING DECEMBER 31, 2011

DISCHARGES PATIENT DAYS YTD 2010 ACTUAL

ACTUAL BUDGET VARIANCE ACTUAL BUDGET VARIANCE PAT.

SERVICE MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD MTD YTD DISCHS DAYS

Medicine 858 10,271 908 10,296 (50) (25) 5,793 65,601 5,617 63,701 176 1,900 10,326 64,382

Surgery 64 731 60 768 4 (37) 320 3,837 332 4,235 (12) (398) 756 4,311

Urology 27 222 23 250 4 (28) 79 636 57 628 22 8 225 579

Orthopedic Surgery 10 192 18 240 (8) (48) 46 824 66 900 (20) (76) 219 864

Gynecology 12 129 9 117 3 12 35 322 25 344 10 (22) 117 384

Ear, Nose, & Throat 2 49 11 86 (9) (37) 2 75 13 109 (11) (34) 42 57

Ophthalmology 0 0 0 0 — — 0 0 0 0 — — 0 0

GRAND TOTAL 973 11,594 1,029 11,757 (56) (163) 6,275 71,295 6,110 69,917 165 1,378 11,685 70,577

AMBULATORY SURGERIES

Hospital 323 4,364 410 4,912 (87) (548) 4,376

Surgicenter 94 948 0 0 94 948 353

TOTAL 417 5,312 410 4,912 7 400 4,729

ER VISITS

Treated & Released 1,714 23,373 1,933 22,767 (219) 606 23,229

Admitted 927 11,088 942 11,099 (15) (11) 11,175

TOTAL 2,641 34,461 2,875 33,866 (234) 595 34,404

Patient days are defined as the total length of stay for patients discharged during the period, regardless of when they were admitted.

2011 Year End Report 241