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BRONX-LEBANON HOSPITAL CENTER

HOSPITAL DAYNOVEMBER 10, 2013

HOSPITAL DAY PROGRAM

8:15Welcome and Opening Remarks

Daniel T. Farkas, MD, Department of SurgeryHospital Day Program Moderator

8:25 a.m. – 10:15 a.m.PAPER SESSION

1. Community Gardens Presented by: Nina M Hicks, M.D., MBA Family Medicine Department

2. Bike Share in South Bronx, NY – Health and Community Benefits. Presented by: Mohammad Jabr, M.D. (Resident); Neha Jain, M..S; A Levine, Ph.D Department of Family Medicine

3. Troubleshooting during Intra-Operative Nerve Monitoring ( IONM ) for Thyroid surgeryPresented by: Vemuru Sunil K Reddy M.D.; Ajay K Shah FACS; Ramasamy

Govindarajan M.D. Harish N Nirujogi M.D.; Christopher L Chang M.D.; John M

Cosgrove, M.D. FACS; Mathew M John M.D.; Vellore S Parithivel, M.D. FACS,

Department of Surgery, Department of Anesthesiology.

4. Betadine Irrigation For Treatment Of Acute Epidemic Keratoconjunctivitis Presented by: Zimei Zhou M.D. Ph.D., Martin Mayers M.D., Department of Ophthalmology

5. Improving Transition of care in a Residency Program Presented by: Naeem Abbas M.D., Carlos A Navarro M.D., Associate, Molham Abdulsamad M.D., Chaitanya K Chandrala M.D., Hafiz Hashmi M.D., Abayomi Salako M.D., Sridhar Chilimuri M.D., Physician-In- Chief, Chairman, Department of Medicine Program Director, Internal Medicine Residency Program

6. Internet Use for Oral Health Related Information by Parents of Pediatric Dental PatientsPresented by: Rajni Singh, D.D.S.; Selene Wun, D.D.S.; Ngozi Ubu, D.D.S.,MPH; Paul Gates, D.D.S.,M.B.A., Department of Dentistry, Bronx Lebanon Hospital, Bronx NY

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7. The Effectiveness Of The Primary Care Based Diabetes Educator program at a Federally Qualified Health Center in the South BronxPresented by: Crystal Vidal, (Medical Student), Chaitanya Chandrala, M.D., Chief Resident, Dept. of Medicine, Dr. Isaac Dapkins, M.D., Department of Medicine

8. Farmers' Market: A Hidden JewelPresented by: Fallon Andrea Mattis, M.D. (PGY2), Doug Reich, M.D. , Chairman, Department of Family Medicine, Jose Dr. Tiburcio, M.D. Program Director, Department of Family Medicine

9. Spirituality and HealthPresented by: El-Sherif, Dana M.D., Department of Family Medicine

10.Operative management of huge pelvic mass of unknown origin (preoperatively).Presented by: Priya Prasad, M.D. Vardui Asiryan, M.D. Oksana Pylypiv,M.D. Larry Ham, M.D. Patrick Anderson, M.D. Magdy Mikhail, M.D., Chairman and Residency Program Director, Dept. of OB/GYN

11.Prevalence of Delirium in Medical Patients referred to Psychosomatic Medicine Consultation Service. Presented by: Ketankumar Bodarya, M.D., Maria M. Perez-Coste, M.D., Victoria Paz , M.D., Vicente Jose Liz Defillo, M.D., Connie Chan, M.D., & Ali Khadivi, Ph.D. Department of Psychiatry, Division of Psychosomatic Medicine.

12. Department of Nursing Education & Research, Patient Care Services Presented by: Sally Francisco, MSN, RN, ABD (EdD) Education Manager

13.A Patient Event Diary Improves Self-Management in Pediatric Sickle Cell Disease PatientsPresented by: Kranthi N. Seelaboyina, MBBS, Jennifer Busse, C.N.P., M.P.H., Grace Malonga, M.P.H. and Thomas Moulton, M.D. Department of Pediatrics

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10:15 a.m. – 10:30 a.m.

10:30 a.m. – 12:00 p.m.PAPER SESSION

14.Factors predicting International Medical Graduates Pediatric Board Certification Pass RatesPresented by: Yusra Khan, M.D., Sudershan Subedi, .M.D., Jessica Calvo, M.D., Jessica Berrios, MIS, Fernando Matos, Stefan Hagmann, M.D .MSc, Richard Neugebauer, Ph.D, Ayoade Adeniyi, M.D.

15.Wedge Resection versus Lobectomy for Stage 1A Non-Small Cell Lung Cancer (NSCLC) in the elderly: A Surveillance, Epidemiology and End Results (SEER) Database analysis. Presented by: Syed Razi, M.D., Mohan Mathew John, M.D., Sandeep Sainathan, M.D., Christos Stavropoulos, M.D.

16.Induction of labor at 41 weeks of pregnancy among primiparas with an unfavorable Bishop scorePresented by: Guillermo A Marroquin M.D,. Nicolae Tudorica M.D., Carolyn M Salafia M.D. M.S., Robert Hecht M.D., Magdy Mikhail M.D., Chairman and Program Director, Department of Obstetrics and Gynecology

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17.Hypertension Effect on Left Ventricular Remodeling and Systolic Function is Greater in African-American than in Caribbean-Hispanic AdultsPresented by: Richard Peralta, M.D., Karomibal Mejia, M.D., , Hussein Shaqra, M.D., FACC, Jonathan N. Bella, M.D., FACC

18.Coronary Artert Disease-Department Of Internal MedicinePresented by: Aisha Siraj, M.D, Maryam Afshar, M.D, Manoj Bhandari, M.D, Harish Patel, M.D, Chase Celeb, MPH, Narendra Balodkar, M.D, Dr. Sridhar S. Chilimuri, M.D. Physician-In- Chief, Chairman, Department of Medicine Program Director, Internal Medicine Residency Program

19.Comparison of Early versus Late Tracheotomy in an Inner City Medical Intensive Care UnitPresented by: Nupur Sinha M.D., Ijaz Mohsin M.D., Sindhaghatta Venkatram M.D., FCCP, Gilda Diaz-Fuentes M.D., FCCP, Department of Internal Medicine, Pulmonary Division

20.Underrepresented Minority Dentist in the United States 2013Presented by: Paul Gates, D.D.S., M.B.A. 3,, Elizabeth Mertz, Ph.D., MA1, Cynthia Wides, M.A.2, Alexis Cooke, M.P.H.2

1. Assistant Professor in Residence, Preventive and Restorative Dental Sciences, Center for the Health Professions, UCSF School of Dentistry. 2. Research Analyst, Preventive and Restorative Dental Sciences, Center for the Health Professions, UCSF School of Dentistry. 3. Chairman, Bronx Lebanon Hospital Center Dental Department

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12:00 P.M. - Lunch

12:45 P.M. - Award Presentations-

ANNUAL MEETING OF THE MEDICAL STAFF

ORGANIZATION

1:00 p.m. – 2:00 p.m.

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ABSTRACTS

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Title:Food Nutrition: Are Ogden patients aware of community gardens in the South Bronx?

Author:Nina M Hicks, M.D., MBA Family Medicine Department

Introduction:Community gardens are a potential source to increase consumption of fruits and vegetables in neighborhoods. In addition to being a food source, community gardens also revitalize neighborhoods and strengthen community ties. There are over 18,000 community gardens in the United States and Canada. There are over 1,000 gardens in New York State, about 500 gardens in New York City. With this number of community gardens, are they being utilized? What are the obstacles to using this food source?

Methods: First, a survey was given in English and Spanish at Ogden Clinic asking three questions. 1) Do you know what a community garden is? 2) Did you know there are community gardens around Ogden Clinic? 3) Would you be interested in joining a community garden, if no, why not? Then a presentation was given explaining about community and container gardening. Flyers were handed out with the location of the nearest community garden along with listings of websites about community gardens.

Results: Fifteen surveys were returned. Three did not know the definition of a community garden. Eight did not know the location of community gardens in the neighborhood. Six were not interested in joining a garden and the most common listed reason was being too busy.

Conclusions: Most of the people surveyed did not know they had community gardens available to

them. However, many were interested in joining the gardens. If we advertise in our clinics the availability of fresh fruits and vegetables that are available at these gardens, we may be able to increase healthy eating and exercise; both of which have been shown to be associated with community gardening. For those that are busy we can offer alternatives such as container gardening. Future studies may look into bringing these community resources directly into the clinic in alliance with nutritionists.

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Title:Bike Share in South Bronx, NY – Health and Community Benefits

Author(s)Mohammad Jabr, M.D. (Resident); Neha Jain, M.S; A Levine, Ph.DDepartment of Family Medicine

Introduction: Physical inactivity is a major health problem in USA, including South Bronx, New York. Health benefits of physical activity have been well documented in medical literature. However, counseling patients on exercising has poor evidence of compliance. A proposed solution is development of a program that is low cost, increases physical activity, tracks performance and compliance, and is managed by PMD routinely. A bike share program in South Bronx paid for by advertisers and health insurance benefits could be a possible solution.

Methods:We are proposing to study the cost effectiveness, limitations, health benefits, and positive effects on the community of starting a bike share program in South Bronx. We propose to establish eligibility & exclusion criteria’s, provide safety information, suggest possible locations for bike kiosks, and develop follow up guidelines with PMD. Financial limitations of the South Bronx residents are major concerns for accessibility to such a program, and we wish to address that with several alternate suggestions.

Conclusion:Addition of bike share benefits in insurance plans of South Bronx residents could reduce incidence of obesity, prevent complications of coronary artery disease, cardiovascular disease, hypertension and diabetes. Additionally it makes South Bronx community a safer, fun place for all residents to enjoy and increase their physical activity.

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Title:Troubleshooting during Intra-Operative Nerve Monitoring ( IONM ) for Thyroid surgery

Author(s):Vemuru Sunil K Reddy M.D. ; Ajay K Shah FACS; Ramasamy Govindarajan M.D.; Harish N Nirujogi M.D.; Christopher L Chang M.D.; John M Cosgrove FACS; Mathew M John M.D.; Vellore S Parithivel FACS, Department of Surgery, Department of Anesthesiology ( A division of NAPA- North American Partners in Anesthesia ), Bronx Lebanon Hospital center, 1650 Grand Concourse, Bronx, NY, 10457

Introduction:IONM is rapidly becoming a standard of care in many institutions across the country. Ability to interpret the events during IONM will greatly enhance the value of this useful monitoring tool.

Methods:60 years old female with nontoxic multi nodular goiter was scheduled for near total thyroidectomy with planned Intra operative nerve monitoring (IONM) employing endotracheal tube (ETT) mounted surface electrodes. Within a few minutes of the commencement, the surgery was frequently held up by episodes of swallowing and bucking on the ETT. Increasing the depth of anesthesia to counteract these troublesome reflexes resulted in profound hemodynamic instability, necessitating the use of large doses of sympathomimetic amines. Lidocaine infusion was started @ 1.5mg/kg/hr after a bolus dose of 1mg/kg. The laryngo tracheal reflexes were successfully blunted and we were able to moderate the depth of anesthesia resulting in stable hemodynamics. A Bi spectral index (BIS) monitor was connected to ensure absence of recall during lighter plane of anesthesia and a train of four (TOF) monitor was employed to guard against inadvertent neuromuscular blockade. During surgery there was loss of signal (LOS) on left recurrent laryngeal nerve (RLN) after initial identification and later visual confirmation. ETT electrode position was checked with Glidescope visually and the ETT was rotated on its long axis to bring the electrode in better contact, which restored the signal strength. Further surgery proceeded smoothly with uneventful post operative course.

Results:The surgery was completed uneventfully with nerve monitoring and stable hemodynamics

Conclusion:Lidocaine infusion provides optimal conditions for intra operative nerve monitoring and also decreases the requirement of inhalational anesthesia and opioids during surgery with better hemodynamic stability.

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Title:Betadine Irrigation For Treatment Of Acute Epidemic Keratoconjunctivitis

Author(s)Zimei Zhou M.D. Ph.D, Martin Mayers M.D., Department of Ophthalmology Purpose: To test the efficacy of 5% Betadine irrigation for the treatment of acute epidemic keratoconjunctivitis (EKC).

Methods: This is a retrospective chart review study. Patients with EKC were enrolled into Betadine treatment or control groups. The treatment group received 5% Betadine irrigation at the first clinical encounter in addition to conservative treatment using cool compressesion and artificial tears. The patients in the control group were only treated conservatively. During the initial and 1-week follow-up visits, each patient was graded for symptom scores (ranged from 0-9) based on the severity of self- reported symptoms, as well as sign scores (ranged from 0-15) based on clinically observed severity of signs. The higher scores indicated worse clinical outcomes. The number of patients in each group who reported improved clinical symptoms at the 1-week follow-up visit was compared using Chi-square analysis. The changes of sign scores in the two consecutive visits between the two groups were analyzed using Mann Whitney U test.

Results: 15 patients were enrolled into the study (n=7 in the Betadine group and n=8 in the control group). 6 out of the 7 Betadine treated patients reported improved clinical symptoms during the 1-week follow-up visit, as compared to 6 out of 8 patients in the control group (p=0.60). The medium sign score change was an 5 point decrease (initial vs 1-week follow-up visit) in the Betadine treatment group vs 2.5 point decrease in the control group (p=0.33). Although there was a trend towards more rapid improvement in clinical signs in the Betadine vs control groups, our results were not statistically significant.

Conclusions: 5% Betadine irrigation failed to show statistically significant short-term clinical efficacy for the treatment of EKC. A study of larger sample size may be necessary to further elucidate the role of Betadine irrigation in the setting of EKC.

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Title:Improving Transition of care in a Residency Program

Author(s)Carlos A Navarro M.D., Associate, Naeem Abbas M.D., Molham Abdulsamad M.D., Chaitanya K Chandrala M.D., Hafiz Hashmi M.D, Abayomi Salako M.D., Sridhar Chilimuri M.D., Physician- I n- Chief, Chairman , Department of Medicine Program Director , Internal Medicine Residency Program Bronx-Lebanon Hospital Center, Bronx, New York, 10457

Introduction: Due to residency training schedules, transition of care from inpatients to ambulatory clinics is often unsatisfactory. We implemented a new system wide transition of care model to improve follow-up care in our large residency training program.

Methods:In January 2012, we implemented a new discharge process taking advantage of our completely implemented unified EMR (Inpatient and Ambulatory care). This system mandates all patients discharged from the medicine teaching service with an appointment within one week after discharge. The appointment request is imbedded into the allscripts discharge order set and completed within one hour by a central appointment desk and posted into the system. This is followed with an interactive automated phone call (Cipher Health) within 48 hours of discharge. This phone call focuses on transition of care – appointments, discharge medications and visiting nurse services. Patients who have concerns and questions during the automated call are followed with an additional phone call to resolve and reinforce follow-up care. All in-patients discharges from January 2010 to June 2013 were analyzed about their follow up visits.

Results:Total of 45,514 patients were discharged over 42 months period of which 3030 patients were seen by residents for follow-up care.

In 2010, there were total of 163 clinic patient visits per quarter by residents. In 2011 there were 169 patient visits per quarter by residents. This number increased to 252 patient visits per quarter by 2012. During the first 6 months of 2013, patient visits increased to 350 visits per quarter nearly doubling from baseline. During this period there was no significant change in the number of discharges per quarter from the hospital. The total resident complement in the training program was constant during this study period. The new discharge process clearly contributed to gains in residency clinic follow-up care.

Conclusion:A comprehensive discharge process using well designed order sets, patient interactive automated telephone technology and an efficient appointment scheduling system can significantly improve transition of care in residency training programs.

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Title:Internet Use for Oral Health Related Information by Parents of Pediatric Dental Patients

Rajni Singh, D.D.S.; Selene Wun, D.D.S.; Ngozi Ubu, D.D.S.,MPH; Paul Gates, D.D.S.,MBA, Department of Dentistry, Bronx Lebanon Hospital, Bronx NY 10457

Introduction: Parents are increasingly using the Internet to obtain health related information. Understanding the impact of parental Internet use in relationship to dental treatment is useful for dentists and parents alike. It will help to establish practice models that use internet resources for patient/parent education. The purpose of this study is to (1) measure the prevalence of internet use to access oral health information by parents of pediatric dental patients (2) To examine the effects on user attitudes, and activities with regard to Internet use for oral health-related information.

Methods: Survey of parents of pediatric dental patients who receive dental services at BLHC pediatric dental clinic was conducted. Data was collected using a questionnaire administered to a convenience sample of 122 parents. Parents returned completed form in a drop box. The study was conducted from July 2013 to September 2013. Descriptive analysis was done using counts and proportions.

Results: Total of 122 parents were included in the study: 116 (91 %) had access to internet. 82 (70 %) used internet to access medical information. 65 (54 %) used internet to access dental (oral health) information. Sixty-four percent of parent discusses information with their pediatric dentist to verify accuracy. 86 % felt that the information on the internet helped them discuss alternative treatments with their child’s pediatric dentist. 86 % of parents felt that oral health information they find on the internet makes them more knowledgeable.

Conclusion : Based on high percentage of parents that access internet for oral health information, it is essential for pediatric dentists to be prepared to offer suggestions for Web-based health resources. Dentists should assist patients in evaluating the quality of dental information available on the Internet. Health professionals should educate the patients about acquiring health information online and provide tools to navigate to the highest-quality information.

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Title:The effectiveness of the primary care based diabetes program at a federally qualified health center in the south Bronx.

Author(s)Presented by: Crystal Vidal, (Medical student), Dr. Chaitanya Chandrala, M.D., Chief Resident, Dept. of Medicine, Dr. Isaac Dapkins, M.D., Department of Medicine, Bronx Lebanon Hospital Center.

Introduction:

South Bronx has one of the highest prevalence of Diabetes mellitus (DM) in New York City. Many patients in our clinics have poorly controlled DM. We evaluated the impact of a primary care based Diabetes Self Management Education (DSME) program by dedicated Certified Diabetic Educators in a urban inner city FQHC .

Methods:

In January 2012 we implemented a system wide primary care based diabetes education program. This program involved primary care physicians and Certified Diabetic educators (CDE). All patients with Diabetes were referred by primary care physicians to CDE. DSME involves two dedicated sessions conducted by CDE per patient. In the first session patient is educated about diabetes, medications, diet and lifestyle changes and setting up self directed goals. In the second session CDE assesses achievement of self directed goals and reinforces diabetic education. Data is collected on all patients who completed the two sessions of the program. Data includes HbA1c, BMI, BP and LDL cholesterol.

Results:

A total of 164 patients completed the program. HbA1c levels obtained before and after DSME showed an average improvement from 8.7% to 7.7%. A paired t- test evaluation showed a p value of <0.0001. LDL cholesterol levels showed a decrease by an average of 10 mg/dl with a similar statistical significance. BMI and Blood pressure levels did not show significant change.

Conclusion:

Our study suggests that primary care based diabetes education program with a dedicated CDE improves diabetes management in this urban socioeconomic disadvantaged population. Efforts must be made to enroll more patients into DSME program.

Table 1:

Lab Parameter Number of patients Change after completing program

P value.

HbA1C 164 -0.99 0.0001LDL 124 -10.58 0.0037BMI 266 0.20 0.22Systolic BP 257 0.98 0.43Diastolic BP 257 -0.36 0.62

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Title: Farmers' Market: A Hidden Jewel?

Author(s)Fallon Andrea Mattis, M.D. (PGY2), Doug Reich, M.D. Chairman to the Departmet of Family Medicine, Jose Dr. Tiburcio, M.D. (Program Director, Department of Family Medicine) Bronx Lebanon Hospital-Family Medicine

Introduction: Farmers’ markets are opportunities for consumers to buy products, particularly fruits and vegetables, directly from farmers. The clinical question posed for this project is the following: If given appropriate education, what percentage of outpatient family medicine patients are likely to visit a farmers market in this community?

Method: Literature research on the history/benefits of farmers markets was done. A pre-survey was developed in order to determine what proportion of family medicine clinic patients had an understanding of farmers’ markets. An educational hand out was also developed as an interventional tool. Ten patients were randomly selected and given the pre-survey, followed by the handout which they read. A post survey was given to each patient in order to assess whether the patient’s knowledge of farmers’ markets increased and how likely the patient would be to actually attend this kind of market.Results:Pre-survey Questions Question

NumberAnswer: yes

Answer: no

No Response

Do you think farmers’ markets are useful to the community?

1 80% 20% 0%

Do you think farmer’s markets are useful for you as the consumer?

2 100% 0% 0%

Do you know that there is a weekly farmer’s market near Bronx Lebanon hospital?

3 50% 40% 10%

Have you ever been to a farmers’ market? 4 70% 30% 0%Are you likely to visit a Farmer’s market within the next year, now that you have more information about it?

5 70% 30% 0%

Educational Intervention

Post Survey ResponseDo you think farmers’ markets are useful to the community?

1 100% 0% 0%

Do you think farmer’s markets are useful for you as the consumer?

2 100% 0% 0%

Do you know that there is a weekly farmer’s market near Bronx Lebanon hospital?

3 70% 30% 0%

Have you ever been to a farmers’ market? 4 70% 30% 0%

Are you likely to visit a Farmer’s market within the next year, now that

5 90% 10% 0%

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you have more information about it?Conclusion:1. The vast majority of the sample family medicine Fulton patients had a reasonable

understanding of farmers markets.

2. The vast majority of the sample family medicine Fulton patients believed that farmers markets were possibly useful to the communities and for themselves.

3. Fifty percent of the patients did not know that a local farmers market existed near Bronx Lebanon Hospital, suggesting that a lack of awareness of these opportunities may contribute to its underutilization.

4. Seventy percent of the patients have never been to a farmers’ market, suggesting that its underutilization may actually be multifactorial. Although many farmers markets accept EBT cards, health bucks, and other means of payment, patients who have extreme financial difficulties may find it difficult to be a regular farmers’ market consumer. Another factor is reasonable access (via transportation) to a local market. These factors and of course many more require further investigation and research.

5. After appropriate education about these markets, there was a twenty percent increase in the number of patients who believed they would visit a market within the next 12 months. This suggests that consistent education might produce a reliable increase in the percentage of family medicine patients who become consumers at farmers’ markets.

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Title: Spirituality and Health

Author: El-Sherif, Dana M.D., Department of Family Medicine

Introduction: Spirituality can be defined as the way a person finds meaning, hope,

comfort, and inner peace in his or her life. Some of the spiritual practices and beliefs

have a positive impact on a patient’s health. Others can cause harm, and illness.

Studies have found that incorporating spirituality with medical health provide

improved quality of care, and health management, and better patient satisfaction.

Method:

60 patients from the community of Bronx were asked to complete the FICA tool and

identify the aspects in their lives that provide spiritual support. They were also

asked to express their opinion on the affect of incorporating spiritual assessment

with health management. Furthermore four Botonica managers in the area of

Bronx were provided with education related to the danger of using mercury in

spiritual practices.

Results:

100% of the patients answered yes when asked if the spiritual assessment can

improve doctor patient relationship. After discussing the FICA tool with the patients

who completed it, the patients agreed that the tool can be used to help them

recognize spiritual and emotional challenges that may be affecting their physical

and mental health. In addition, participants agreed that the FICA tool can be used to

aid doctors gain a better understanding of their patients, and to strengthen the trust

between them. All four Botanica managers who were provided with education

related to the danger of using mercury in spiritual practices expressed verbal

understanding, and agreed to stop encouraging mercury use.

Conclusion:

In the population of Bronx, Spirituality plays an important element in the way

patients face chronic illness, loss, and death. Incorporation of the patient’s cultural

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identity, spiritual beliefs, and practices to their health management lead to

improved quality of care, and improved patient satisfaction.

Title: Operative management of huge pelvic mass of unknown origin (preoperatively).

Author(s): Priya Prasad, M.D. Vardui Asiryan, M.D. Oksana Pylypiv,M.D. Larry Ham, M.D. Patrick Anderson, M.D. Magdy Mikhail, M.D., Chairman and Residency Program Director, Dept. of OB/GYN-Bronx Lebanon Hospital Center

Introduction:To describe the management of huge pelvic mass of undetermined origin.

METHOD: Case report

Results: A 44 year old gravida 6, para 4-0-2-4 presenting with history of rapidly enlarging abdominal girth for past three months, bilateral leg swelling for past one month, fatigue, difficulty breathing and sleeping, was admitted to CCU. She had normal menstrual cycles with history of sterilization. She had history of fibroid uterus and one year back, was told she had a small clementine sized fibroid. On physical examination, an abdominal mass about 37-38 weeks of gestation in size and non-tender, was noted. On pelvic examination, cervix was normal and origin of mass could not be delineated. Tumor markers were all normal except CA 125, which was 136.3. CT scan showed large abdominopelvic mass 34 x 21 x 29cms with ovaries not well visualized, moderate to large pericardial effusion with no pleural effusion. Ejection fraction on echocardiogram was 68.11 %. CT chest with contrast indicated pericardial effusion suggestive of an inflammatory process. On the day of exploratory laparotomy, (with surgical team and cardiothoracic surgeon on stand-by), approximately 35 cms pelvic mass was found attached to posterior wall of an enlarged uterus by a thick stalk. Total abdominal hysterectomy was performed after frozen section showed spindle cell neoplasm, likely benign. Final pathology report showed negative peritoneal cytology for malignant cells, uterus weighing 9420 grams with the largest subserosal fibroid 35 x 22x 12cms with extensive edema cystic degeneration and multiple other fibroids. Postoperative period was uneventful with pericardial effusion decreasing by post-operative day three. Conclusion:

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A benign fibroid uterus can mimic malignancy, which can lead to cardiorespiratory symptoms with rapid enlargement. Frozen section is instrumental in deciding the course of management in such cases.

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Title: Prevalence of Delirium in Medical Patients referred to Psychosomatic Medicine Consultation Service.

Authors:Maria M. Perez-Coste, M.D., Victori Paz , M.D., Vicente Jose Liz Defillo, M.D., Ketankumar Bodarya, M.D. Connie Chan, M.D., & Ali Khadivi, Ph.D., Department of Psychiatry, Division of Psychosomatic -Presenter: Marie M. Perez-Coste, M.D. (Attending )

Introduction:Delirium is a frequent complication seen in medical settings, and can often be missed or misinterpreted by the medical team as a psychiatric disorder. A mistaken diagnosis potentially can prolong and exacerbate the symptoms of delirium. Few studies have examined the prevalence of delirium in patients who have been referred for psychiatric consultation. The goal of the study was to examine the rate of misidentification of delirium by comparing the initial reason for consultation to the final outcome of consultation.Method: The study is IRB approved and is designed as a retrospective Chart Review study that includes all adult patients admitted to Bronx-Lebanon Hospital Center, Grand Concourse Medical Division, in the period of September 2011-May 2012. The study included patients who are assessed by the Psychosomatic Medicine Service during the study period. The reason for consultation is compared to the outcome of psychosomatic consult. The patients are selected from a log of all psychosomatic consults ordered. A sample of 118 subjects were selected based on power analysis. In additon to the demographic variables, the study examined the reason for consult, psychiatric diagnoses, medical problems, substance abuse, and the final diagnosis by psychosomatic medicine.

Results: The results indicate that 49% of the sample were male, and 51% were female. Most of the referrals to Psychosomatic Medicine Consultation Service came from Medicine (59%). More than half the sample (56%) had a postive urine toxicology. The patients were referred to psychosomatic service for a variety of psychiatric reasons; however, only 7.6% of the intial reasons for consult were for altered mental status. None of the initial referrals to psychosomatic medicine service were because of delirium The psychosomatic consultation service diagnosed 26% of the sample as having delirium. Conclusion: Misidentification of delirium in medically ill patients referred for psychiatric consultation is common. Reserved for nursing

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Title: The Effects of Nurses’ Cultural Competency upon Patient Satisfaction

Author: Sally Francisco, MSN, RN, ABD (EdD) Education Manager, Department of Nursing Education & Research, Patient Care Services

Introduction:Describe a research study that looked at correlation between the staff nurses’ cultural competency and patient satisfaction in the (6) medical-surgical units of BLHC.

Method:The researcher measured the cultural competency of staff nurses and analyze the results side-by-side the HCAHPS scores 118 out of 180 nurses participated. The Transcultural Self-Efficacy Tool or TSET (Jeffreys, 2006a; Jeffreys, 2006b; & Jeffreys, 2010) was used to measure the nurses’ cultural competency. TSET was uploaded in the intranet. Recruitment flyers were posted on units and recruitment letters were distributed during change of shifts. BLHC 2012 HCAHPS scores (Hospital Care Quality Information from the Consumer Perspective, 2010) were used to identify correlations.

Results: Results showed differences in cultural competency related to age, number of years worked in BLHC, and gender. There were several cultural competency statements that were predictors of increased in patient satisfaction scores. The results were submitted to Dr. Frumenti, VP/CNO and Dr. Kurtz, Director of Education. The results will be used to design a cultural competency program for the staff nurses. This can also assist the hospital in looking at one factor that may or may not affect the patient satisfaction scores.

ReferencesHospital Care Quality Information from the Consumer Perspective. (2010). News and notes from the HCAHPS project team. Hospital care quality information from the consumer perspective. Retrieved from http://www.hcahpsonline.org/executive_insight/.Jeffreys, M. R. (2006a). Teaching cultural competence in nursing and health care. New York, NY: Springer. Jeffreys, M. (2006b, February/March). Cultural competence in clinical practice. NSNA Imprint, I, 37-41. Jeffreys, M. R. (2010). The cultural competence education resource toolkit. New York, NY: Springer.

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Title:A Patient Event Diary Improves Self-Management in Pediatric Sickle Cell Disease Patients

Author(s)

Jennifer Busse, C.N.P., M.P.H. , Kranthi N Seelaboyina, M.B.B.S., Grace Malonga, M.P.H. and Thomas Moulton, M.D. Department of Pediatrics

Promotion of chronic illness self-management is crucial to improve outcomes of children with sickle cell disease (SCD). Through the use of an event diary, our pediatric SCD patients are able to track significant health events and health care appointments. This study seeks to validate the effectiveness of the patient event diary as a tool for improvement in self management, allowing for improvement in medication and clinic compliance, as well as in a reduction in number of emergency room visits.

Method: Our sample included a population of 46 sickle cell disease patients aged 0 to 21. We assessed patients’ medication compliance on vitamin D and hydroxyurea through 25-hydroxyvitamin D (25-OHD) and MCV (mean corpuscular volume) levels, respectively.

Results: 25-OHD data showed significantly improved compliance with vitamin D treatment (M = 47, SD = 20) as compared to before receiving the event diary (M = 26, SD = 15, p < 0.05). There was a statistically significant improvement in MCV levels after receiving the event diary (M=101.6, SD=9.6), as opposed to before (M=97.7, SD=5.6, p<0.05). There was an improvement in appointment compliance, however not statistically significant, between one year before (M=33.3%, SD=41.7%) and one year after patients received the diary (M= 27.2%, SD=30.3%, p=0.2). Emergency department visits did decrease before receiving the event diary (M=1.8, SD=2.5) to one year after (M= 1.3, SD=1.9, p=0.17).

Conclusion: These data suggest the patient event diary has significantly improved patient self-management. We believe this effect is through enhanced understanding of disease processes and increased confidence and skills in self-management. In the future, we hope to see that with improved patient knowledge of sickle cell disease and self-management facilitated by use of the event diary, there will be significantly fewer emergency room visits, fewer hospital admissions, and most important, improved quality of life.

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Title:Factors predicting International Medical Graduates Pediatric Board Certification Pass Rates

Author(s)Sudershan Subedi, .MD., Yusra Khan, M.D., Jessica Calvo, M.D., Jessica Berrios, MIS, Fernando Matos, Stefan Hagmann, M.D .MSc, Richard Neugebauer, Ph.D, Ayoade Adeniyi, M.D.

Introduction:Of 3,000 pediatric residents taking the the American Board of Pediatrics (ABP) certification exam each year 18% are international medical graduates (IMGs). Program directors face the challenge of selecting candidates that are most likely to pass the ABP exam from a wide array of applicants with diverse academic backgrounds. The aim of study is to identify the demographic and educational factors that influence board pass rates on first attempt.

Methods:Bronx-Lebanon Hospital Center (BLHC) is a large community teaching hospital serving the South-Central Bronx. The pediatric residency program graduates 15 residents annually, exclusively IMGs.   Demographic and academic records of 157 trainees who graduated between 2000-2011 were reviewed.

Results: A total of 135 trainees graduated with available board exam results (76.3% passed on first attempt). About half were females (53%) with a mean age (SD) of 32y (7), 59% were from Asia, 59% had H1B visa, and 66% had prior post-graduate training. Among demographic variables, only region of origin (Europe, 100%; Africa, 85%; Asia, 72%; Latin America, 33%; p=0.003) and visa status (H1B, 80% ; Green card, 75%; J1,73%; American citizens, 0%; Other, 92%; p<0.001) were significant predictors. Marital status had borderline significance (married, 82%; singles, 68%; p=0.066).Further, there was significant linear association with rising USMLE Step 1 and 2 scores and ABP-exam pass rates (p=0.028) but not with USMLE 3 (p=0.242). Likewise, there was significant linear correlation with rising ITE exam scores and ABP-exam pass rates (p<0.005).

Conclusions: Performance on USMLE Step 1 and 2, and ITE exam results have strong predictive values for ABP-exam success. Additional multivariate analysis will be done to evaluate to further investigate the role of demographic factors.

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Title:Wedge Resection versus Lobectomy for Stage 1A Non-Small Cell Lung Cancer (NSCLC) in the elderly: A Surveillance, Epidemiology and End Results (SEER) Database analysis.

Authors:Presented by: Syed Razi, Mohan Mathew John, Sandeep Sainathan, Christos Stavropoulos

Introduction:There is limited data available regarding the long-term outcomes of lung resection for non-small cell lung cancer (NSCLC) in the elderly population (>75 years).  We investigated the prognostic significance of wedge resection versus lobectomy in this group of patients with stage IA NSCLC using the SEER database.

Methods:The SEER database was queried for patients >75 years of age who were diagnosed with stage IA squamous cell carcinoma and adenocarcinoma of the lung from 1998 to 2005. Overall and cancer-specific survival rates were calculated and compared.

Results:A total of 1401 patients >75 years of age with stage IA NSCLC were analyzed. Lobectomy was performed in 1000 patients, and 401 patients underwent wedge resection. Age, female gender, black race and poorly differentiated tumors were found to be independent negative predictors of overall survival. The overall survival was lower in the wedge resection group (HR 1.37, CI 1.02-1.57, p<0.05). However, there was no significant difference in cancer-specific survival between the two groups (HR 1.13, CI 0.93-1.37, p=0.21).

Conclusions:Wedge resection is not inferior to lobectomy for stage IA NSCLC in the elderly, and should be considered a viable alternative in this high-risk population.

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Title:

Induction of labor at 41 weeks of pregnancy among primiparas with an unfavorable

Bishop score

Author(s)

Guillermo A Marroquin M.D, Nicolae Tudorica M.D., MD Carolyn M Salafia M.S.,

Robert Hecht M.D., Magdy Mikhail M.D. , Chairman and Program Director,

Department of Obstetrics and Gynecology-Bronx Lebanon Hospital Center, Bronx,

New York.

Introduction:

Induction of labor (IOL) is one of the most commonly performed obstetrical

procedures in the United States and refers to the iatrogenic stimulation of uterine

contractions before the onset of spontaneous labor to accomplish vaginal delivery.

[An unfavorable cervix is defined by ACOG as a Bishop score of 6 or less [2]. In our

institution is offered to the patients at 41 weeks of gestational age to avoid

undesirable outcomes from a prolonged pregnancy.

The modified Bishop score is based on the station of the presenting part and four

characteristics of the cervix: dilation, effacement, consistency, and position. If the

Bishop score is high, the likelihood of vaginal delivery is similar whether labor is

spontaneous or induced. In contrast, a low Bishop score is predictive that induction

will fail and result in cesarean delivery. These relationships are particularly strong in

nulliparous women who undergo induction.

Methods:

This was a retrospective analysis that included nulliparous patients who presented

to the Labor and Delivery unit at the Bronx Lebanon Hospital Center between 2011

and 2012 for elective IOL at 41 weeks of GA. The Bishop score was assessed upon

admission and IOL agents were used in compliance with ACOG guidelines in

different combinations, based on the obstetrical team preference.

Results:

The overall successful rate was 51.32%.

Factors associated with successful IOL were younger age [22.3 years vs.

25.1(p=0.015)], lower BMI [25 vs. 28.1(p=0.46)] and lower maternal weight

[64.75kg vs. 74.02 (p=0.28)]. Maternal height was not a contributing factor; the

artificial rupture of membranes, epidural anesthesia and the prostaglandins used

26

did not contribute. Use of cervical balloon and oxytocin was associated with failed

IOL.

Conclusions:

Patients undergoing IOL at 41 weeks with an unfavorable cervix had a successful

rate of 51.32%. Maternal age, weight, and BMI were associated with successful IOL.

References:

1. Gabbe S , Niebyl J , Galan H , Jauniaux E , Landon M, Simpson J, et al. Obstetrics:

Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Saunders Elsevier;

c2012. Chapter 14, Abnormal Labor and Induction of labor; p. 287-310.

2. American College of Obstetricians and Gynecologists: Induction of Labor. Practice

Bulletin number 107, August 2009.

3. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S and TJ.

Mathews, M.S., et al. Division of Vital Statistics Births: final data for 2006. Natl Vital

Stat Rep 2009;57:1–102.

4. Calder AA, Brennand JE: Labor and normal delivery: induction of labor. Curr Opin

Obstet Gynecol 1991; 3:764.

5. Xenakis EM, Piper JM, Conway DL, Langer O: Induction of labor in the nineties:

conquering the unfavorable cervix. Obstet Gynecol 1997; 90:235.

6. Johnson DP, Davis NR, Brown AJ: Risk of cesarean delivery after induction at term

in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol 2003;

188:1565.

7. Vrouenraets FP, Roumen FJ, Dehing CJ, et al: Bishop score and risk of cesarean

delivery after induction of labor in nulliparous women. Obstet Gynecol 2005;

105:690

TABLE 1. Patient Demographics vaginal delivery and no vaginal delivery

Vaginal deliveryNo Yes

Mean SD N Mean SD N SignificanceBishop score 2.89 1.93 37.00 2.56 2.26 39.00 0.50Height in meters 1.62 0.08 1.61 0.06 0.35BMI 28.08 7.57 25.01 5.52 0.05Maternal age in years

25.14 5.19 22.33 4.63 0.02

Maternal Weight in Kg

74.02 20.71 64.75 15.08 0.03

Neonatal Weight in g

3508.30 413.98 3305.20 655.65 0.11

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IOL duration (days)

1.07 0.52 0.98 0.54 0.47

Title:Hypertension Effect on Left Ventricular Remodeling and Systolic Function is Greater in African-American than in Caribbean-Hispanic Adults

Author(s)Richard Peralta, M.D., Karomibal Mejia, M.D., , Hussein Shaqra, M.D., FACC, Jonathan N. Bella, M.D., FACC, Bronx Lebanon Hospital Center, Bronx, NY

Introduction:There are no studies comparing the effect of hypertension on LV remodeling and systolic function between Caribbean-Hispanics (CH) and African-Americans (AA). Our objective identify hypertension effect on left ventricular (LV) remodeling and systolic function in hypertensive (HT) CH and AA adults.

Methods:Accordingly, echocardiograms were performed in 144 CH (46 % men, mean age=56 years [95% CI, 52- 60]), mean BMI (28.3 kg/m2, [95% CI, 25.1- 31.4]) and 137 AA (48 % men, mean age=59 years [95% CI, 55-62]), mean BMI (26 kg/m2 [95% CI, 24.5-27.6]) patients consecutively.

Results:After adjusting for age and sex, and BMI relative wall thickness (0.42 [95% CI: 0.41-0.44]), (0.39 [95% CI: 0.38-0.48], (p=0.02) were slightly but statistically significantly higher in CH normotensive (NT) compared to AA NT respectively. LV fractional shortening (35 [95% CI: 31-38]), (33 [95% CI: 30-36]); Ejection fraction (57 [95% CI: 50-64]), (54 [95% CI: 45-64]; and mitral E/A Ratio (1.2 [95% CI: 1.1-1.4]), (1.1 [95% CI: 1-1.3] were similar in CH and AA NT respectively. E/e’ Ratio, a measure of LV filling pressure, was slightly but statistically significantly higher CH NT (9.3 [95% CI: 8-11]) than in AA NT (8.6 [95% CI: 8-10] (p<0.001).

However, the magnitude of increase in LV mass (249 [95% CI: 233-263]), 235 [95% CI: 222-247]); E/e’ (12.5 [95% CI: 11-14]), (11.5 [95% CI 10-13]); and relative wall thickness (0.46 [95% CI: 0.44-0.47]), (0.43 [95% CI: 0.42-0.45]) associated with HT was greater in AA than CH respectively (p=0.003).

Conclusions:HTN effect on LV remodeling and diastolic function is greater in AA HT than CH HT. These echocardiographic differences may be used to further risk-stratify AA and CH HT noninvasively.

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Title:Correlation between hemoglobin AC1C Values and severity of Coronary artery disease.

Author(s)Maryam Afshar, M.D,. Aisha Siraj, M.D., Manoj Bhandari, M.D., Harish Patel, M.D., Chase Celeb, MPH, Narendra Balodkar, M.D., Dr. Sridhar S. Chilimuri, M.D., Physician-I n- Chief, Chairman , Department of Medicine , Program Director , Internal Medicine Residency Program Bronx-Lebanon Hospital Center, Bronx, New York, 10457

Objective:Our objective is to study the correlation between hemoglobin A1C (HbA1C) values and severity of Coronary artery disease (CAD) on coronary angiography among patient who have Transient ischemic dilatation (TID) on their myocardial perfusion images in an inner city population.

Background:DM increases the risk of developing cardiovascular disease and is considered as CAD equivalent. Atherosclerotic CAD claims many lives in this population. One way to assess the control of DM is by measuring HbA1C level. It is known that DM can impair subendocardial perfusion, which can in turn cause TID on SPECT imaging. TID has been validated to be a marker for extensive and severe CAD.TID ratio is generated using an automated computer software and a ratio of ≥ 1.2 is considered abnormal.

Methods:A retrospective analysis of patients referred for exercise or vasodilation nuclear stress testing from 2007 to 2010 was conducted. TID was found in 168 patients. Of these 168 patients, 102 underwent coronary angiography and were included in our study; 68 patients were diabetic and 34 were non diabetics. We then compared three groups (non-diabetics, diabetics with HbA1c <7, and >7) based on their HbA1C done within 6 months of their myocardial perfusion scan. Significant CAD was defined as presence of ≥ 50% Left main coronary artery or ≥70% stenosis in any other major vessel on coronary angiography. We did not evaluate other risk factors for development of CAD.

Results:The mean age was 65.01± 11.03 years, 48% male, 54% Hispanics and 28% non-Hispanics and 12% were others. The mean LVEF was 53.67±11.23, 76% underwent pharmacological stress test and 24% exercise stress testing. Patients in the elevated HbA1c (>7) group had the highest incidence of obstructive CAD (n=52/59). In patients with controlled HbA1c (<7) only 1 of 9 patients and in non-diabetics 8 of 34 patients had significant CAD. This was statistically significant (p = 0.006) using Kruskal-Wallis test.

Conclusion:

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In our inner city population, patients with DM and Transient ischemic dilation on myocardial perfusion images, HbA1C is not only a gauge of diabetic control but also predictor of severityTitle:Comparison of Early versus Late Tracheotomy in an Inner City Medical Intensive

Care Unit

Author(s)

Nupur Sinha M.D., Ijaz Mohsin M.D., Sindhaghatta Venkatram M.D. FCCP, Gilda Diaz-

Fuentes M.D. FCCP. Department of Internal Medicine, Pulmonary Division

Introduction:Tracheotomy is performed to replace the endotracheal tube in patients needing

prolonged mechanical ventilation (MV). Studies have compared early versus late

tracheotomy in a variety of clinical settings. There is no clear consensus regarding

the definition of “early tracheotomy”. Most of the outcomes reported have used 6-10

days as a cut-off of early tracheotomy in medical ICU. Tracheotomy practices in an

inner-city ICU’s are still largely unknown. The aim of our study was to characterize

the patients and compare the outcomes of early versus late tracheotomy in our ICU

setting.

Methods:

Retrospective review of patients admitted to MICU that underwent tracheotomy

from January 2009 to January 2013. Demographics, select laboratory parameters,

and reasons for initiating MV were analyzed. Early tracheotomy was defined as

tracheotomy performed ≤7 days after initiating MV. Patients were classified in two

groups: Early tracheotomy (≤7 days) and late tracheotomy group (> 7 days).

Primary end points of the study were ICU length of stay (LOS) and hospital

mortality. Secondary end points included hospital LOS, percentage weaned and

immediate tracheotomy related complications.

Results:

A total of 660 tracheotomies were performed during the study period. 54 elective

tracheotomies performed on the day of admission were excluded. Of the remaining

606, 137 (22.6%) were early and 469 (77.4%) were delayed tracheotomies. There

was no difference in demographic characteristics of patients and reasons for

initiating MV between 2 groups (Table 1). ICU LOS was lower in the early

30

tracheotomy group (9.7±7.0 vs 17.4±12.4; p=< 0.0001), and so was hospital LOS

(36.4 ± 33.5 vs. 44.6± 28.8). There was no difference in other outcomes (Table 1).

Conclusions:

In our MICU population, early tracheotomy significantly decreases ICU LOS as well

as hospital LOS. However timing of tracheotomy has no impact on mortality,

complications, and weaning rate. In effect, early tracheotomy allows better

utilization of ICU and healthcare resources without affecting patient outcome. ble 1

Early Tracheotomy ( ≤ 7 days)n=137

Late Tracheotomy( > 7 days)

n=469

PValue 95% CI

Demographics and Selected Baseline Characteristics

Age 62.5± 14.4 63.3 ± 14.3 0.5654 -3.533 to 1.933Gender Male % 74 (54%) 242 (52%) 0.6284EthnicityAfrican Americans HispanicsOthers

655814

20820358

0.5585 0.92190.5511

Smoker/Ex smoker 68 (50%) 255 (54%) 0.3324Substance abuse 37 (27%) 175 (37%) 0.0322Weight 107.1 ± 83.6 104.7 ± 51.6 0.6821 -9.107 to 13.907

Serum Creatinine 2.0 ± 1.9 2.2 ± 2.5 0.3869 -0.654 to 0.254Albumin 3.0 ± 0.8 2.9 ± 0.9 0.2416 -0.068 to 0.268Hemoglobin 10.5 ± 1.9 11.4 ± 1.6 0.0001 -1.219 to -0.581

Reasons for Intubation

Airway protection 15 26 0.0333Cardiac arrest 5 18 1.0000Type I & II Respiratory Failure

99 328 0.6705

Type IV Respiratory Failure

9 57 0.0851

Others 9 40 0.5931

Primary and Secondary outcomes

Days on mechanical ventilation before tracheotomy (mean)

5.1 ± 1.6 14.0 ± 7.7 < 0.0001 -10.301 to -7.699

ICU LOS 9.7 ± 7.0 17.4± 12.4 < 0.0001 -9.877 to -5.523Hospital LOS 36.4 ± 33.5 44.6± 28.8 0.0049 -13.909 to -2.491Mortality 51(37%) 164(35%) 0.6849Immediate tracheotomy complications

1 (3.3%) 3 (3%) 1.0

Weaned of ventilator 13 (9.5 %) 47 (10.1%) 1.0000

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Decanulation 13 (9.5%) 43 (9%) 0.8682

Title:Underrepresented Minority Dentist in the United States 2013

Author(s)Elizabeth Mertz, Ph.D., MA 1 , Cynthia Wides, M.A. 2 , Alexis Cooke, M.P.H. 2 , Paul Gates, D.D.S., M.B.A. 3 1. Assistant Professor in Residence, Preventive and Restorative Dental Sciences, Center for the Health Professions, UCSF School of Dentistry. 2. Research Analyst, Preventive and Restorative Dental Sciences, Center for the Health Professions, UCSF School of Dentistry. 3. Chairman, Bronx Lebanon Hospital Center Dental Department

Background :

In dentistry, African Americans (AA), Hispanic/Latinos (H/L), and American Indian/Alaska Natives (AI/AN) are historically underrepresented. Despite numerous initiatives over the last decade addressing the cultural competence of dentists and diversifying the profession, outcome data remains scarce. The number of minority providers remains significantly below parity. Our goal was to assess the outcomes of efforts to improve the dental workforce diversity and their relationship to improvements in access to care and reductions in oral health disparities.

Methods :

A stratified sample survey of licensed URM dentists in the United States was conducted between 9/2012 and 3/2013. An expert advisory committee informed survey development. Researchers partnered with the National Dental Association, Hispanic Dental Association, Society of American Indian Dentists and the American Dental Education Association for outreach. Focus groups with minority dentists were completed prior to survey development. The survey was piloted with 6 providers, 2 from each racial/ethnic group, using the online and hard copy versions. Final survey was 12 pages, 8 sections, and approximately 150 questions. The sample was 5078 providers.

Results :

The American Dental Association Masterfile included 12,983 URM providers listed as having a US address and an active license; 471 AI/AN, 6586 AA, and 5926 H/L dentists, approximately 7% of the total dentist workforce. Our outreach identified 692 individuals ineligible with 14 not located in the US, 19 deceased, 39 retired/unlicensed, 266 non-URM, or 321 not located. This rendered our sample at 4389 with a 34% response rate. URM dentists are more likely to see racially concordant patients: 42% of AA dentists' patients are AA; 17% of AI/AN dentists' patients are AI/AN; and 36% H/L dentists' patients are H/L.

Conclusions :

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URM dentists represent a small proportion of the dental workforce; these providers see a disproportionate number of URM patients compared to the overall population and to their peers.

33