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News Article | June 15, 2017
Site: www.prnewswire.com

"The opportunity to interact with a transgender patient in a low-stakes setting during medical training increased trainees' comfort during future real-world outpatient encounters," says Richard E. Greene, MD, lead author of the study, from NYU Langone Medical Center. "Even those who had baseline knowledge of care for transgender patients before the study found that learning in this safe, simulated way added value in helping them provide more sensitive care for transgender patients," adds Greene, an assistant professor in the Department of Medicine at NYU Langone. As NYU Langone's director of gender and health education, Greene designed the current study after many conversations with transgender patients who reported feeling discomfort, discrimination, and insensitivity in health care settings. To study the problem, the research team employed a common teaching strategy that uses a "standardized patient," an average person trained to consistently portray a patient in a certain medical situation. Each trainee in a class interviews the patient, seeking to determine the person's medical needs, communicate options, and offer reassurance. The new NYU research is one of the first published studies to employ transgender persons as standardized patients. For the study, a transgender actress/standardized patient, who acted out a common outpatient scenario, rated the 23 internal medicine residents on their ability to communicate and to leave the patient satisfied with the interaction. The average scores using a newly designed behavioral measure achieved by the residents were 89 percent for overall communication and 85 percent for satisfaction. Interestingly, the scores did not differ significantly from those achieved in nine control cases in which the standardized patients were not transgender. "This suggests that transgender standardized patients can be just as effective as straight cisgender (or non-transgender) patients in teaching doctors," says Greene. In the specific clinical scenario used in the study, the transgender actress was taking the anti-androgen hormone spironolactone for reducing masculinization, along with the feminizing hormone estradiol. She also came in for hypertension and had dangerously high blood levels of potassium, a condition known as hyperkalemia. The patient then expressed the desire to undergo an orchiectomy, a procedure for removing the testicles. The residents were tasked with exploring and respecting the patient's treatment goals, given her hormonal transition hormone therapy, and to make a plan for managing her hypertension and hyperkalemia. Additionally, the researchers wanted to see whether the residents asked questions that indicated sensitivity, like a patient's preferred pronoun and gender identity, as well as to learn whether the discussion covered sexuality, sexual activity, and associated risks. The results indicate that good communications skills helped some residents overcome their lack of transgender-specific clinical acumen and that going through this scenario training with a transgender actress helped them to shed preconceptions and be better prepared for the clinic. On the other hand, most residents in the study did not directly address the patient's gender identity and long-term goals of care, says Greene. "This underscores the need to include transgender standardized patients in our teaching and curricula. Without them, a substantial gap in care remains." A 2016 Williams Institute analysis of federal data found that 1.4 million adults identify as transgender across the United States. This figure is double that found a decade earlier. In addition to Dr. Greene, Kathleen Hanley, MD, Tiffany E. Cook, BGS, Colleen Gillespie, PhD, and Sondra Zabar, MD, all from NYU, were study coauthors. Health Resources Services Administration Grant #T0BHP285770100 provided funding for this research. About NYU Langone Medical Center:   NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of five hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center's dedicated inpatient orthopaedic hospital; NYU Lutheran Medical Center, a full-service, 450-bed teaching hospital located in Brooklyn, and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the Medical Center. Also part of NYU Langone is NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history, and the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute–designated cancer center. The Medical Center's trifold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to www.NYULangone.org, and interact with us on Facebook, Twitter, YouTube, Instagram, and Google+. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/transgender-actors-effective-in-teaching-new-doctors-to-provide-respectful-care-300474692.html


News Article | June 15, 2017
Site: www.eurekalert.org

By acting out scenarios commonly seen in the clinic, real-life transgender actors can help residents learn to provide more sensitive care to people with a different gender identity than the one they were assigned at birth. This is the main finding of a study published online June 15 in the Journal of Graduate Medical Education. "The opportunity to interact with a transgender patient in a low-stakes setting during medical training increased trainees' comfort during future real-world outpatient encounters," says Richard E. Greene, MD, lead author of the study, from NYU Langone Medical Center. "Even those who had baseline knowledge of care for transgender patients before the study found that learning in this safe, simulated way added value in helping them provide more sensitive care for transgender patients," adds Greene, an assistant professor in the Department of Medicine at NYU Langone. As NYU Langone's director of gender and health education, Greene designed the current study after many conversations with transgender patients who reported feeling discomfort, discrimination, and insensitivity in health care settings. To study the problem, the research team employed a common teaching strategy that uses a "standardized patient," an average person trained to consistently portray a patient in a certain medical situation. Each trainee in a class interviews the patient, seeking to determine the person's medical needs, communicate options, and offer reassurance. The new NYU research is one of the first published studies to employ transgender persons as standardized patients. For the study, a transgender actress/standardized patient, who acted out a common outpatient scenario, rated the 23 internal medicine residents on their ability to communicate and to leave the patient satisfied with the interaction. The average scores using a newly designed behavioral measure achieved by the residents were 89 percent for overall communication and 85 percent for satisfaction. Interestingly, the scores did not differ significantly from those achieved in nine control cases in which the standardized patients were not transgender. "This suggests that transgender standardized patients can be just as effective as straight cisgender (or non-transgender) patients in teaching doctors," says Greene. In the specific clinical scenario used in the study, the transgender actress was taking the anti-androgen hormone spironolactone for reducing masculinization, along with the feminizing hormone estradiol. She also came in for hypertension and had dangerously high blood levels of potassium, a condition known as hyperkalemia. The patient then expressed the desire to undergo an orchiectomy, a procedure for removing the testicles. The residents were tasked with exploring and respecting the patient's treatment goals, given her hormonal transition hormone therapy, and to make a plan for managing her hypertension and hyperkalemia. Additionally, the researchers wanted to see whether the residents asked questions that indicated sensitivity, like a patient's preferred pronoun and gender identity, as well as to learn whether the discussion covered sexuality, sexual activity, and associated risks. The results indicate that good communications skills helped some residents overcome their lack of transgender-specific clinical acumen and that going through this scenario training with a transgender actress helped them to shed preconceptions and be better prepared for the clinic. On the other hand, most residents in the study did not directly address the patient's gender identity and long-term goals of care, says Greene. "This underscores the need to include transgender standardized patients in our teaching and curricula. Without them, a substantial gap in care remains." A 2016 Williams Institute analysis of federal data found that 1.4 million adults identify as transgender across the United States. This figure is double that found a decade earlier. In addition to Dr. Greene, Kathleen Hanley, MD, Tiffany E. Cook, BGS, Colleen Gillespie, PhD, and Sondra Zabar, MD, all from NYU, were study coauthors. Health Resources Services Administration Grant #T0BHP285770100) provided funding for this research. NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of five hospitals--Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center's dedicated inpatient orthopaedic hospital; NYU Lutheran Medical Center, a full-service, 450-bed teaching hospital located in Brooklyn, and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the Medical Center. Also part of NYU Langone is NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history, and the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute-designated cancer center. The Medical Center's trifold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to http://www. , and interact with us on Facebook, Twitter, YouTube, Instagram, and Google+.


Rosenkrantz A.B.,NYU Langone Medical Center
American Journal of Roentgenology | Year: 2016

OBJECTIVE. The purpose of this study was to characterize trends related to retracted publications within radiology journals. MATERIALS AND METHODS. PubMed was queried to identify all articles with the publication type "retracted publication" or "notification of retraction." Articles published within radiology journals were identified using Journal Citation Reports' journal categories. Available versions of original articles and publication notices were accessed from journal websites. Citations to retracted publications were identified using Web of Science. Overall trends were assessed. RESULTS. Forty-eight retracted original research articles were identified within radiology journals since 1983, which included 1.1% of all PubMed "retracted publication" entries. Distinct PubMed entries were available for the retracted publication and retraction notification in 39 of 48 articles. The original PDF was available for 37 articles, although the articles were not watermarked as retracted in 23 cases. In six cases with a watermarked PDF, further searches identified nonwatermarked versions. Original HTML versions were available for 13 articles but 11 were not watermarked. The mean (± SD) delay between publication and retraction was 2.7 ± 2.8 years (range, 0-16 years). The mean number of citations to retracted articles was 10.9 ± 17.1 (range, 0-94 citations). Reasons for retraction included problematic or incorrect methods or results (although it typically was unclear whether these represented honest errors or misconduct) in 33.3% of cases, complete or partial duplicate publication in 33.3% of cases, plagiarism in 14.6% of cases, a permission issue in 8.3% of cases, the publisher's error in 6.3% of cases, and no identified reason in 6.3% of cases. One or no retractions occurred annually from 1986 to 2001, although two or more retractions occurred annually in nine of the 12 years from 2002 through 2013. CONCLUSION. Retraction represents an uncommon, yet potentially increasing, issue within radiology journals that publishers have inconsistently and insufficiently addressed. Greater awareness and training in proper biomedical research conduct, as well as establishment and enforcement of standardized publishers' policies, are warranted. © American Roentgen Ray Society.


Axsom K.,NYU Langone Medical Center
Current atherosclerosis reports | Year: 2013

The ability for statins to reduce major cardiovascular events and mortality has lead to this drug class being the most commonly prescribed in the world. In particular, the benefit of these drugs in type 2 diabetes (T2D) is well established. In February 2012, the Food and Drug Administration released changes to statin safety label to include that statins have been associated with increases in hemoglobin A1C and fasting serum glucose levels. This has stirred much debate in the medical community. Estimate for new onset diabetes from statin treatment is approximately one in 255 patients over four years. The number needed to treat for statin benefit is estimated at one in 40 depending on the population. The mechanism of this link remains unknown. Statins may accelerate progression to diabetes via molecular mechanisms that impact insulin resistance and cellular metabolism of carbohydrates. It remains clear that the benefit of statin therapy outweighs the risk of developing diabetes.


As health care reform continues to evolve, there will need to be an emphasis on generating value, quality improvement, and cost control. In 2011, the Centers for Medicare and Medicaid Services (CMS) initiated a new Bundled Payment for Care Improvement initiative. Early results from this CMS bundled payment initiative at an urban, tertiary, academic medical center demonstrate decreased length of stay and increased discharge to home, with decreasing readmission rates, which can result in cost-savings without compromise of the quality of care. Changes in care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the bundled payment for care initiative, thus bringing increased value to our total joint arthroplasty patients. © 2015 Elsevier Inc.


Both oxytocin and oxytocin receptors are implicated in neuropsychiatric disorders, particularly autism which involves a severe deficit in social cognition. Consistently, oxytocin enhances social cognition in humans and animals. The infralimbic medial prefrontal cortex (IL-mPFC) is believed to play an important role in the regulation of social cognition which might involve top-down control of subcortical structures including the amygdala. However, little is known about whether and how oxytocin modulates synaptic function in the IL-mPFC. The effect of oxytocin on excitatory neurotransmission in the IL-mPFC was studied by examining both the evoked and spontaneous excitatory neurotransmission in the IL-mPFC layer V pyramidal neurons before and after perfusion with oxytocin. To investigate the effect of oxytocin on synaptic plasticity, low-frequency stimulation-induced long-lasting depression was studied in oxytocin-treated brain slices. Oxytocin produced a significant suppression of glutamatergic neurotransmission in the IL-mPFC layer V pyramidal neurons which was mediated by a reduction in glutamate release. Activation of the cannabinoid CB1 receptors was involved in this pre-synaptic effect. Treatment of brain slices with oxytocin for 1 h converted long-lasting depression into long-lasting potentiation of glutamatergic neurotransmission. This oxytocin-mediated plasticity was NMDA receptor-dependent and was mediated by the synaptic insertion of calcium-permeable α-amino-3-hydroxy-5-methyl- 4-isoxazole propionic acid receptors. The aforementioned suppression of basal glutamatergic neurotransmission and facilitation of activity-dependent synaptic plasticity in the IL-mPFC might be critical for the effect of oxytocin on social cognition. © 2011 International Society for Neurochemistry.


Bosniak M.A.,NYU Langone Medical Center
Radiology | Year: 2012

In the past 25 years, there have been continuous advances in the diagnosis of disease throughout the body owing to the introduction of new technology and the experience gained with its use. However, the imaging and evaluation of complicated cystic lesions of the kidneys frequently remains a difficult problem. The classification of renal cystic lesions suggested 25 years ago, now referred to as the Bosniak renal cyst classification, remains pertinent to the diagnosis and management of these difficult-to-diagnose complicated cystic masses. © RSNA, 2011.


Gourevitch M.N.,NYU Langone Medical Center
Academic Medicine | Year: 2014

Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and "nonmedical" determinants of patients' health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations.


Erlebacher A.,NYU Langone Medical Center
Annual Review of Immunology | Year: 2013

The immune cells that reside at the interface between the placenta and uterus are thought to play many important roles in pregnancy. Recent work has revealed that the composition and function of these cells are locally controlled by the specialized uterine stroma (the decidua) that surrounds the implanted conceptus. Here, I discuss how key immune cell types (natural killer cells, macrophages, dendritic cells, and T cells) are either enriched or excluded from the decidua, how their function is regulated within the decidua, and how they variously contribute to pregnancy success or failure. The discussion emphasizes the relationship between human and mouse studies. Deeper understanding of the immunology of the maternal-fetal interface promises to yield significant insight into the pathogenesis of many human pregnancy complications, including preeclampsia, intrauterine growth restriction, spontaneous abortion, preterm birth, and congenital infection. © Copyright 2013 by Annual Reviews. All rights reserved.


Megibow A.J.,NYU Langone Medical Center
AJR. American journal of roentgenology | Year: 2012

OBJECTIVE: The purpose of this perspective is to document an experience with the adoption of dual-energy CT (DECT) for routine clinical imaging. CONCLUSION: Successful implementation of DECT requires that technologists understand standards of image quality, be empowered to select appropriate patients, and understand networks for image routing. Radiologists need minimal facility with workstations to access the information embedded in DECT. DECT can be performed at a reduced effective radiation dose compared with single-energy CT and with lower doses of IV contrast material.

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