Important Clinical Links
Soarian (on campus or on VPN only - for off campus use App Store above)
Columbia Library (for access to journal articles off campus)
Latest News from AIM
Flu vaccine is here! For patients that are registered for scheduled or walk in clinic visits, please enter the vaccine order from the AIM common order set: “influenza virus vaccine inj > 3 years old” (this allows the nurse to give either the trivalent or tetravalent vaccine depending on what is available at the practice) or “HIGH DOSE influenza virus vaccine inj >= 65 years old” for patients who are 65 years or older. There will be updates during morning huddles about when our walk-in “flu station,” which uses the standing order, will be up and running. Our flu agency nurse, Angelita Persaud, is currently orienting and should be ready to start next week.
With the departure of Dr. Atkeson several months ago, the Columbia Sleep Clinic has closed. The pulmonary/critical care department is working to recruit new physicians to reopen the lab, but at this point, they do not expect to find a replacement this academic year. We have put together a list of potential resources (also at medicineclinic.org/sleep), but please understand this is a work in progress. If you have success, or encounter difficulties, please let me (and the admin team) know. For patients that have difficulty with their existing equipment, please send an SHM to Emilia Castrellos and Ingrid Brown, or refer to your module social worker.
Diabetes Management Clinic and DSME Reminders
There are two AIM diabetes resources:
1) Diabetes Management clinic: visit with a resident to adjust medications AND Angelica for education.
How to refer: “Diabetes Management and Diabetes Self-Management Education/Training” order in AIM order set
Who to refer: Patients with poorly controlled diabetes (A1c >9)
When does it meet: Every morning
2) Diabetes Self-Management Education (DSME): individual visits with Angelica for self-management education that targets patient specific barriers (medication adherence, glucose monitoring, healthy eating, exercise, etc)
How to refer: “Diabetes self-management education/training (DSME/T)” order in AIM order set
Who to refer: Any patient with diabetes
When does it meet: Every afternoon (except Thursday)
See medicineclinic.org/diabetes for more information
After Hours Call Center (Tunstall)
If you are paged and need to return a call, please use 212 439 1239 which is a prioritized line and connected directly to our accounts – you may want to put it into your cell phone address book now. Do not use the number which shows up on your caller ID, 212 879 5700, because wait times will be long and it is not directly linked to our account.
As you probably already know, the CDC, the FDA, and state and local health departments are investigating a multistate outbreak of lung injury associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use. The CDC website has up to date information.
In AIM, we almost exclusively see localized zoster in immunocompetent patients and the risk of transmission is quite low. The attached NYP guideline (which differs from CDC guidelines) requires that once an immunocompetent patient is identified as having localized zoster, the patient should be moved to a single room with the door closed (rather than wait in the waiting room). We screen for rashes in walk in clinic upon registration with the PFA or vitals with the MA. For patients who have a continuity visit, there are signs telling patients to let the staff know that they have a rash, but in reality might not be aware of the rash until the patient reaches your office. The module RN can help facilitate finding an unused a room for patients who are identified at triage. The guidelines for the more contagious disseminated zoster, zoster in immunocompromised patients or primary varicella are also attached.
SCAN-MP (Screening for Cardiac Amyloidosis using Nuclear Imaging in Minority Populations) Study
Dr. Mat Maurer and his team are enrolling participants in a prospective cohort study in order to facilitate early identification of cardiac amyloidosis. Their goal is to change the approach to this disorder through early diagnosis, at a time when emerging therapies are most effective. Participant must be black or Hispanic, >60 and have a diagnosis of heart failure not causes by ischemia or valve disease. Participants will complete a medical history, exam, EKG, echocardiogram, PYP scintigraphy as well as questionnaires and functionality testing to determine the presence or absence of TTR cardiac amyloidosis. The study is funded by the NHLBI and there will be compensation for patients. See attached for inclusion criteria, study details and contact information.
Ambulatory Read of the Week
Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge
In this retrospective cohort study of 4056 patients 65+ with hypertension admitted to VA hospitals for non-cardiac conditions from 2011-2013, intensification of antihypertensive regimen at time of discharge was associated with increased 30 day readmission rates (HR 1.23, NNH 27) and serious adverse events (HR 1.41) and NO difference in systolic BP or CV events at one year (HR 1.18 trend towards INCREASED events with intensification) compared to propensity-matched controls. As with all VA studies, this is limited by the applicability of the population (97.7% male), and the fact that the intensification group didn't actually ACHIEVE better control doesn't rule out a benefit in cases that actually achieved better control (likely many outpatient docs pulled off the intensifications when they were seen in the office). Worth noting that over half the patients who received intensification had well controlled BPs prior to admission. A sensitivity analysis demonstrated that patients with poor control prior to admission did not experience the same increased readmissions and adverse events. However, it's a good lesson that changing chronic meds in an acute care setting is fraught with the possibility of adverse events, and should be done only with a very, very good reason and coordination with the outpatient PMD. Or, as the authors say, "Shifting practice from intensifying antihypertensive regimens during hospitalization to communicating concerns about patients’ long-term BP control to outpatient practitioners for close follow-up may provide a safer treatment path for patients."