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Article ; Online: Needs assessment of essential anatomy: The perspective of adult primary care resident physicians.

Hankin, Mark H / Harmon, Derek J / Martindale, James R / Niculescu, Iuliana / Aschmetat, Adrienne / Mertens, Amy N / Hanke, Rachel E / Koo, Andrew S / Kraus, Anthony E / Payne, James A / Feldman, Michael J / Soltero Mariscal, Enrique

Anatomical sciences education

2023 Volume 16, Issue 3, Page(s) 504–520

Abstract: Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, ... ...

Abstract	Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, pose challenges and impose restrictions within medical school curricula. In order to make anatomy education effective and efficient, it is important to determine the anatomy considered essential for medical education through a targeted needs assessment. In this study, 50 adult primary care resident physicians in family medicine (FM) and internal medicine (IM) were surveyed to assess the importance of 907 anatomical structures, or groups of structures, across all anatomical regions from a curated list based on the boldface terms in four primary anatomy texts. There were no statistically significant differences in the ratings of structures between the two groups for any anatomical region. In total, 17.0% of structures, or groups of structures, were classified as essential, 58.0% as more important, 24.4% as less important, and 0.7% as not important. FM residents rated tissues classified as skeleton, nerves, fasciae, anatomical spaces, blood vessels, lymphatics, and surface anatomy (p < 0.0001) significantly higher than IM residents, but there were no differences in the rating of muscles or organs (p > 0.0056). It was notable that 100.0% of cranial nerves were classified as essential, and 94.5% of surface anatomy structures were classified as essential or more important. It is proposed that results of this study can serve to inform curricular development and revision.
MeSH term(s)	Humans ; Adult ; Needs Assessment ; Anatomy/education ; Curriculum ; Physicians ; Primary Health Care
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483491-9
ISSN	1935-9780 ; 1935-9772
ISSN (online)	1935-9780
ISSN	1935-9772
DOI	10.1002/ase.2252
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Article ; Online: Life-Threatening Massive Hemoptysis After Cryoablation for Atrial Fibrillation.

Jayaschandran, Vivek / Mertens, Amy N / Patel, Vishal K / Dalal, Bhavinkumar

Journal of bronchology & interventional pulmonology

2018 Volume 25, Issue 1, Page(s) 67–69

Abstract: A 59-year-old man developed massive hemoptysis, 1 month after undergoing cryoablation procedure for atrial fibrillation. He underwent emergent bronchoscopy that revealed massive, active bleeding with clots requiring repeated suctioning, epinephrine, and ... ...

Abstract	A 59-year-old man developed massive hemoptysis, 1 month after undergoing cryoablation procedure for atrial fibrillation. He underwent emergent bronchoscopy that revealed massive, active bleeding with clots requiring repeated suctioning, epinephrine, and cold saline injection. The source of bleeding was identified in a follow-up bronchoscopy performed few days later-a 2×3 cm area of ulceration of the left main stem bronchus which was missed in the initial bronchoscopy owing to blood obscuring the field of vision. Considering the timeline, the ulcer most likely resulted from cryoablation-induced bronchial injury. Patient remained asymptomatic after stabilization and 2 months following discharge, another bronchoscopy was performed which showed the ulcer to be healing. Hemoptysis following cryoablation is quite rare with a reported incidence <2%. The cases of hemoptysis reported thus far have all been mild and self-limiting and manifesting within hours to days following the procedure. To our knowledge, this is the first reported case of massive hemoptysis associated with cryoballoon ablation, presenting 1 month after procedure.
MeSH term(s)	Atrial Fibrillation/surgery ; Bronchial Diseases/diagnostic imaging ; Bronchial Diseases/etiology ; Bronchoscopy ; Cryosurgery/adverse effects ; Hemoptysis/etiology ; Humans ; Male ; Middle Aged ; Ulcer/diagnostic imaging ; Ulcer/etiology
Language	English
Publishing date	2018-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0000000000000417
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Zs.A 4027: Show issues

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Article ; Online: Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection.

Schott, Jason P / Mertens, Amy N / Bloomingdale, Richard / O'Connell, Thomas F / Gallagher, Michael J / Dixon, Simon / Abbas, Amr E

Echocardiography (Mount Kisco, N.Y.)

2020 Volume 37, Issue 10, Page(s) 1551–1556

Abstract: Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients commonly have elevated troponin and D-dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose ...

Abstract	Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients commonly have elevated troponin and D-dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose of this study was to report transthoracic echocardiographic (TTE) findings in SARS-CoV-2 patients with correlating troponin and D-dimer levels. Methods: We identified 66 SARS-CoV-2 patients (mean age 60 ± 15.7 years) admitted within a large, eight-hospital healthcare system over a 6-week period with a TTE performed. TTE readers were blinded to laboratory data with intra-observer and inter-observer analysis assessed. Results: Sixty-six of 1780 SARS-CoV-2 patients were included and represented a high-risk population as 38 (57.6%) were ICU-admitted, 47 (71.2%) had elevated D-dimer, 41 (62.1%) had elevated troponin, and 25 (37.9%) died. Right ventricular (RV) dilation was present in 49 (74.2%) patients. The incidence and average D-dimer elevation was similar between moderate/severe vs. mild/no RV dilation (69.6% vs 67.6%, P = 1.0; 3736 ± 2986 vs 4141 ± 3351 ng/mL, P = .679). Increased left ventricular (LV) wall thickness was present in 46 (69.7%) with similar incidence of elevated troponin and average troponin levels compared to normal wall thickness (66.7% vs 52.4%, P = .231; 0.88 ± 1.9 vs 1.36 ± 2.4 ng/mL, P = .772). LV dilation was rare (n = 6, 9.1%), as was newly reduced LV ejection fraction (n = 2, 3.0%). Conclusion: TTE in SARS-CoV-2 patients is scarce, technically difficult, and reserved for high-risk patients. RV dilation is common in SARS-CoV-2 but does not correlate with elevated D-dimer levels. Increased LV wall thickness is common, while newly reduced LV ejection fraction is rare, and neither correlates with troponin levels.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus Infections/epidemiology ; Echocardiography/methods ; Female ; Heart Ventricles/diagnostic imaging ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Ventricular Dysfunction/diagnosis ; Ventricular Dysfunction/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-09-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.14835
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Zs.A 2170: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: A case of hypermucoviscous Klebsiella pneumoniae liver abscess syndrome in an Iraqi male.

Kazanji, Noora / Klein, Rachel E / Lohani, Sadichhya / Mertens, Amy N / Le, Julie

QJM : monthly journal of the Association of Physicians

2016 Volume 109, Issue 7, Page(s) 493–494

Abstract: A 53-year-old man presented with fevers, productive cough and decreased appetite. He emigrated from Iraq 4 years ago. Chest x-ray revealed a left lung consolidation. Respiratory cultures and two sets of blood cultures grew out pan-susceptible Klebsiella ... ...

Abstract	A 53-year-old man presented with fevers, productive cough and decreased appetite. He emigrated from Iraq 4 years ago. Chest x-ray revealed a left lung consolidation. Respiratory cultures and two sets of blood cultures grew out pan-susceptible Klebsiella pneumoniae Liver ultrasound revealed a 6.4-cm complex lesion in the left hepatic lobe. A biopsy of the liver lesion produced bloody purulent aspirate; abscess cultures yielded a highly viscous pan-susceptible K. pneumoniae Klebsiella pneumoniae liver abscess syndrome is a newly described invasive syndrome due to a hypermucoviscous phenotype associated with serotypes K1 and K2 of Klebsiella. Although it is more commonly endemic to the Asian-Pacific region, it has been increasingly reported as an emerging global disease. We present the first case of this syndrome in a patient of middle-eastern descent. We also present pictorial evidence of the microbe's unique viscous, muculent texture grown on agar.
Language	English
Publishing date	2016-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1199985-8
ISSN	1460-2393 ; 0033-5622 ; 1460-2725
ISSN (online)	1460-2393
ISSN	0033-5622 ; 1460-2725
DOI	10.1093/qjmed/hcw049
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Article: Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection

Schott, Jason P / Mertens, Amy N / Bloomingdale, Richard / O039, / Connell, Thomas F / Gallagher, Michael J / Dixon, Simon / Abbas, Amr E

Echocardiography

Abstract: INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients commonly have elevated troponin and D-dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose ... ...

Abstract	INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected patients commonly have elevated troponin and D-dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose of this study was to report transthoracic echocardiographic (TTE) findings in SARS-CoV-2 patients with correlating troponin and D-dimer levels. METHODS: We identified 66 SARS-CoV-2 patients (mean age 60 ± 15.7 years) admitted within a large, eight-hospital healthcare system over a 6-week period with a TTE performed. TTE readers were blinded to laboratory data with intra-observer and inter-observer analysis assessed. RESULTS: Sixty-six of 1780 SARS-CoV-2 patients were included and represented a high-risk population as 38 (57.6%) were ICU-admitted, 47 (71.2%) had elevated D-dimer, 41 (62.1%) had elevated troponin, and 25 (37.9%) died. Right ventricular (RV) dilation was present in 49 (74.2%) patients. The incidence and average D-dimer elevation was similar between moderate/severe vs. mild/no RV dilation (69.6% vs 67.6%, P = 1.0; 3736 ± 2986 vs 4141 ± 3351 ng/mL, P = .679). Increased left ventricular (LV) wall thickness was present in 46 (69.7%) with similar incidence of elevated troponin and average troponin levels compared to normal wall thickness (66.7% vs 52.4%, P = .231; 0.88 ± 1.9 vs 1.36 ± 2.4 ng/mL, P = .772). LV dilation was rare (n = 6, 9.1%), as was newly reduced LV ejection fraction (n = 2, 3.0%). CONCLUSION: TTE in SARS-CoV-2 patients is scarce, technically difficult, and reserved for high-risk patients. RV dilation is common in SARS-CoV-2 but does not correlate with elevated D-dimer levels. Increased LV wall thickness is common, while newly reduced LV ejection fraction is rare, and neither correlates with troponin levels.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #780846
Database	COVID19

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Article ; Online: Transthoracic echocardiographic findings in patients admitted with SARS‐CoV‐2 infection

Schott, Jason P. / Mertens, Amy N. / Bloomingdale, Richard / O’Connell, Thomas F. / Gallagher, Michael J. / Dixon, Simon / Abbas, Amr E.

Echocardiography ; ISSN 0742-2822 1540-8175

2020

Keywords	Radiology Nuclear Medicine and imaging ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
DOI	10.1111/echo.14835
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Article ; Online: Monomicrobial vs Polymicrobial Clostridium difficile Bacteremia: A Case Report and Review of the Literature.

Kazanji, Noora / Gjeorgjievski, Mihajlo / Yadav, Siddhartha / Mertens, Amy N / Lauter, Carl

The American journal of medicine

2015 Volume 128, Issue 9, Page(s) e19–26

MeSH term(s)	Adult ; Bacteremia/diagnosis ; Bacteremia/microbiology ; Clostridium Infections/diagnosis ; Clostridium Infections/microbiology ; Clostridium difficile ; Fatal Outcome ; Humans ; Male
Language	English
Publishing date	2015-09
Publishing country	United States
Document type	Case Reports ; Letter ; Review
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2015.05.014
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Article ; Online: Reliable gene expression measurements from fine needle aspirates of pancreatic tumors: effect of amplicon length and quality assessment.

Anderson, Michelle A / Brenner, Dean E / Scheiman, James M / Simeone, Diane M / Singh, Nalina / Sikora, Matthew J / Zhao, Lili / Mertens, Amy N / Rae, James M

The Journal of molecular diagnostics : JMD

2010 Volume 12, Issue 5, Page(s) 566–575

Abstract: Background and aims: Biomarker use for pancreatic cancer diagnosis has been impaired by a lack of samples suitable for reliable quantitative RT-PCR (qRT-PCR). Fine needle aspirates (FNAs) from pancreatic masses were studied to define potential causes of ...

Abstract	Background and aims: Biomarker use for pancreatic cancer diagnosis has been impaired by a lack of samples suitable for reliable quantitative RT-PCR (qRT-PCR). Fine needle aspirates (FNAs) from pancreatic masses were studied to define potential causes of RNA degradation and develop methods for accurately measuring gene expression. Methods: Samples from 32 patients were studied. RNA degradation was assessed by using a multiplex PCR assay for varying lengths of glyceraldehyde-3-phosphate dehydrogenase, and effects on qRT-PCR were determined by using a 150-bp and a 80-bp amplicon for RPS6. Potential causes of and methods to circumvent RNA degradation were studied by using FNAs from a pancreatic cancer xenograft. Results: RNA extracted from pancreatic mass FNAs was extensively degraded. Fragmentation was related to needle bore diameter and could not be overcome by alterations in aspiration technique. Multiplex PCR for glyceraldehyde-3-phosphate dehydrogenase could distinguish samples that were suitable for qRT-PCR. The use of short PCR amplicons (<100 bp) provided reliable gene expression analysis from FNAs. When appropriate samples were used, the assay was highly reproducible for gene copy number with minimal (0.0003 or about 0.7% of total) variance. Conclusions: The degraded properties of endoscopic FNAs markedly affect the accuracy of gene expression measurements. Our novel approach to designate specimens "informative" for qRT-PCR allowed accurate molecular assessment for the diagnosis of pancreatic diseases.
MeSH term(s)	Animals ; Base Sequence ; Biopsy, Needle ; DNA Primers ; Gene Expression ; Glyceraldehyde-3-Phosphate Dehydrogenases/genetics ; Humans ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Pancreatic Neoplasms/enzymology ; Pancreatic Neoplasms/genetics ; Pancreatic Neoplasms/pathology ; Reproducibility of Results ; Reverse Transcriptase Polymerase Chain Reaction
Chemical Substances	DNA Primers ; Glyceraldehyde-3-Phosphate Dehydrogenases (EC 1.2.1.-)
Language	English
Publishing date	2010-08-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2000060-1
ISSN	1943-7811 ; 1525-1578
ISSN (online)	1943-7811
ISSN	1525-1578
DOI	10.2353/jmoldx.2010.090107
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Zs.A 5146: Show issues

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Article ; Online: Alcohol and tobacco lower the age of presentation in sporadic pancreatic cancer in a dose-dependent manner: a multicenter study.

Anderson, Michelle A / Zolotarevsky, Eugene / Cooper, Kristine L / Sherman, Simon / Shats, Oleg / Whitcomb, David C / Lynch, Henry T / Ghiorzo, Paola / Rubinstein, Wendy S / Vogel, Kristen J / Sasson, Aaron R / Grizzle, William E / Ketcham, Marsha A / Lee, Shih-Yuan / Normolle, Daniel / Plonka, Caitlyn M / Mertens, Amy N / Tripon, Renee C / Brand, Randall E

The American journal of gastroenterology

2012 Volume 107, Issue 11, Page(s) 1730–1739

Abstract: Objectives: The objective of this study was to examine the association between tobacco and alcohol dose and type and the age of onset of pancreatic adenocarcinoma (PancCa).: Methods: Prospective data from the Pancreatic Cancer Collaborative Registry ... ...

Abstract	Objectives: The objective of this study was to examine the association between tobacco and alcohol dose and type and the age of onset of pancreatic adenocarcinoma (PancCa). Methods: Prospective data from the Pancreatic Cancer Collaborative Registry were used to examine the association between age of onset and variables of interest including: gender, race, birth country, educational status, family history of PancCa, diabetes status, and tobacco and alcohol use. Statistical analysis included logistic and linear regression, Cox proportional hazard regression, and time-to-event analysis. Results: The median age to diagnosis for PancCa was 66.3 years (95% confidence intervals (CIs), 64.5-68.0). Males were more likely than females to be smokers (77% vs. 69%, P=0.0002) and heavy alcohol and beer consumers (19% vs. 6%, 34% vs. 19%, P<0.0001). In univariate analysis for effects on PancCa presentation age, the following were significant: gender, alcohol and tobacco use (amount, status and type), family history of PancCa, and body mass index. Both alcohol and tobacco had dose-dependent effects. In multivariate analysis, alcohol status and dose were independently associated with increased risk for earlier PancCa onset with greatest risk occurring in heavy drinkers (HR 1.62, 95% CI 1.04-2.54). Smoking status had the highest risk for earlier onset pancreatic cancer with a HR of 2.69 (95% CI, 1.97-3.68) for active smokers and independent effects for dose (P=0.019). The deleterious effects for alcohol and tobacco appear to resolve after 10 years of abstinence. Conclusions: Alcohol and tobacco use are associated with a dose-related increased risk for earlier age of onset of PancCa. Although beer drinkers develop pancreatic cancer at an earlier age than nondrinkers, alcohol type did not have a significant effect after controlling for alcohol dose.
MeSH term(s)	Adenocarcinoma/epidemiology ; Age of Onset ; Aged ; Alcohol Drinking/adverse effects ; Body Mass Index ; Chi-Square Distribution ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Pancreatic Neoplasms/epidemiology ; Proportional Hazards Models ; Prospective Studies ; Registries ; Risk Factors ; Smoking/adverse effects
Language	English
Publishing date	2012-08-28
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.1038/ajg.2012.288
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