Browsing by Author "Kara, Areeba"

Now showing 1 - 10 of 22
  • Thumbnail Image
    Item
    Abdominal Pain at an Altitude
    (Elsevier, 2022-04) Russ, Jason; Kara, Areeba; Medicine, School of Medicine
    A 29-year-old man presented for evaluation to the Emergency Department with 3 days of worsening abdominal pain. The pain was described as severe and was located in the left lower quadrant without radiation. It improved with assuming the supine position and was exacerbated by movement. On the day of presentation, he developed nausea, vomiting, and diarrhea. He was traveling in Peru when the pain began and thought it was related to something he ate, so he did not initially seek medical attention. Upon returning to the United States, he sought evaluation as his symptoms escalated. He had no known chronic medical problems and was not taking any prescription medications.
  • Thumbnail Image
    Item
    Acute Tension Pneumatocele Due To Radiation Induced Osteonecrosis and Squamous Cell Cancer
    (Brown Digital Repository, 2022) Warren, Gavin; Ladd, Lauren; Blanton, Hannah Langley; Kara, Areeba; Medicine, School of Medicine
    The patient had an acute tension pneumatocele, resulting from a calvarial bone defect and infection related to squamous cell cancer.
  • Thumbnail Image
    Item
    Advancing Equity in Graduate Medical Education Recruitment Through a Diversity Equity and Inclusion (DEI) Toolkit for Program Directors
    (Sage, 2023-10-09) Nabhan, Zeina M.; Scott, Nicole; Kara, Areeba; Mullis, Leilani; Dams, Travis; Giblin, Mark; Williamson, Francesca; Wright, Curtis; Pediatrics, School of Medicine
    Objectives: To increase diversity and inclusion in graduate medical education (GME), the Accreditation Council for Graduate Medical Education (ACGME) issued new diversity standards requiring programs to engage in practices that focus on systematic recruitment and retention of a diverse workforce of trainees and faculty. The literature on how program directors (PDs) can incorporate and prepare for this standard is limited. Methods: We developed a diversity, equity, and inclusion (DEI) toolkit for PDs as an example of an institutional GME-led effort to promote inclusive recruitment and DEI awareness among residency and fellowship programs at a large academic center. Results: A survey was sent to 80 PDs before the launch of the toolkit and 6 months afterwards with response rates of 27% (22/80) and 97% (78/80), respectively. At baseline, 45% (10/22) anticipated that the DEI toolkit might provide better resources than those currently available to them and 41% (9/22) perceived that the toolkit might improve recruitment outcomes. At 6 months, 63% (49/78) found the toolkit helpful in the 2021-2022 recruitment season. By contrast, 2% (2/78) of PDs did not find the toolkit helpful, and 33% (26/78) said they did not access the toolkit. When asked if a PD changed their program's recruitment practices because of the toolkit, 31% (24/78) responded yes. Programs that changed recruitment practices started to require unconscious bias training for all faculty and residents involved in the residency interviews and ranking. Others worked on creating a standardized scoring rubric for interviews focused on four main domains: Experiences, Attributes, Competencies, and Academic Metrics. Conclusion: There is a need to support PDs in their DEI journey and their work to recruit a diverse workforce in medicine. Utilizing a DEI toolkit is one option to increase DEI knowledge, skills, awareness, and self-efficacy among PDs and can be adopted by other institutions and leaders in academic medicine.
  • Thumbnail Image
    Item
    African Americans Possessed High Prevalence of Comorbidities and Frequent Abdominal Symptoms, and Comprised A Disproportionate Share of Covid-19 Mortality among 9,873 Us- Hospitalized Patients Early in the Pandemic
    (Fortune Journals, 2024) Ashktorab, Hassan; Pizuorno, Antonio; Chirumamilla, Lakshmi Gayathri; Adeleye, Folake; Dalivand, Maryam Mehdipour; Sherif, Zaki A.; Oskrochi, Gholamreza; Challa, Suryanarayana Reddy; Jones-Wonni, Boubini; Rankine, Sheldon; Ekwunazu, Chiamaka; Banson, Abigail; Kim, Rachel; Gilliard, Chandler; Ekpe, Elizabeth; Shayegh, Nader; Nyaunu, Constance; Martins, Chidi; Slack, Ashley; Okwesili, Princess; Abebe, Malachi; Batta, Yashvardhan; Ly, Do; Valarie, Ogwo; Smith, Tori; Watson, Kyra; Kolawole, Oluwapelumi; Tahmazian, Sarine; Atoba, Sofiat; Khushbakht, Myra; Riley, Gregory; Gavin, Warren; Kara, Areeba; Hache-Marliere, Manuel; Palaiodimos, Leonidas; Mani, Vishnu R.; Kalabin, Aleksandr; Gayam, Vijay Reddy; Garlapati, Pavani Reddy; Miller, Joseph; Jackson, Fatimah; Carethers, John M.; Rustgi, Vinod; Brim, Hassan; Medicine, School of Medicine
    Background and aim: Identifying clinical characteristics and outcomes of different ethnicities in the US may inform treatment for hospitalized COVID-19 patients. Aim of this study is to identify predictors of mortality among US races/ethnicities. Design setting and participants: We retrospectively analyzed de-identified data from 9,873 COVID-19 patients who were hospitalized at 15 US hospital centers in 11 states (March 2020-November 2020). Main Outcomes and Measures: The primary outcome was to identify predictors of mortality in hospitalized COVID-19 patients. Results: Among the 9,873 patients, there were 64.1% African Americans (AA), 19.8% Caucasians, 10.4% Hispanics, and 5.7% Asians, with 50.7% female. Males showed higher in-hospital mortality (20.9% vs. 15.3%, p=0.001). Non- survivors were significantly older (67 vs. 61 years) than survivors. Patients in New York had the highest in-hospital mortality (OR=3.54 (3.03 - 4.14)). AA patients possessed higher prevalence of comorbidities, had longer hospital stay, higher ICU admission rates, increased requirement for mechanical ventilation and higher in-hospital mortality compared to other races/ethnicities. Gastrointestinal symptoms (GI), particularly diarrhea, were more common among minority patients. Among GI symptoms and laboratory findings, abdominal pain (5.3%, p=0.03), elevated AST (n=2653, 50.2%, p=<0.001, OR=2.18), bilirubin (n=577, 12.9%, p=0.01) and low albumin levels (n=361, 19.1%, p=0.03) were associated with mortality. Multivariate analysis (adjusted for age, sex, race, geographic location) indicates that patients with asthma, COPD, cardiac disease, hypertension, diabetes mellitus, immunocompromised status, shortness of breath and cough possess higher odds of in-hospital mortality. Among laboratory parameters, patients with lymphocytopenia (OR2=2.50), lymphocytosis (OR2=1.41), and elevations of serum CRP (OR2=4.19), CPK (OR2=1.43), LDH (OR2=2.10), troponin (OR2=2.91), ferritin (OR2=1.88), AST (OR2=2.18), D-dimer (OR2=2.75) are more prone to death. Patients on glucocorticoids (OR2=1.49) and mechanical ventilation (OR2=9.78) have higher in-hospital mortality. Conclusion: These findings suggest that older age, male sex, AA race, and hospitalization in New York were associated with higher in-hospital mortality rates from COVID-19 in early pandemic stages. Other predictors of mortality included the presence of comorbidities, shortness of breath, cough elevated serum inflammatory markers, altered lymphocyte count, elevated AST, and low serum albumin. AA patients comprised a disproportionate share of COVID-19 death in the US during 2020 relative to other races/ethnicities.
  • Thumbnail Image
    Item
    Antisynthetase Syndrome in a Patient with Pulmonary Embolism and Nonbacterial Thrombotic Endocarditis
    (Hindawi, 2023-01-31) Vege, Anusha; Beery, Jesse; Kara, Areeba; Medicine, School of Medicine
    Antisynthetase syndrome is a rare autoimmune disease within the subset of idiopathic inflammatory myopathies. The diagnostic criteria include the presence of an aminoacyl-tRNA synthetase antibody, and typical clinical findings, including myositis, mechanic's hands, Raynaud phenomenon, unexplained fever, and interstitial lung disease. We describe a case of a 59-year-old male who presented with a 1-month history of progressive purplish discoloration and pain of the fingertips, dyspnea, cough, weight loss, fatigue, and who developed progressive proximal muscle weakness and dysphagia. Investigations revealed pulmonic valve and mitral valve marantic endocarditis, pulmonary embolism, myositis, organizing pneumonia, and elevation of anti-OJ antibodies. He was diagnosed with antisynthetase syndrome and treated with high dose corticosteroids and mycophenolate mofetil with a fair response.
  • Thumbnail Image
    Item
    Bedside Interprofessional Rounding: The View From the Patient's Side of the Bed
    (Sage, 2017-03) Burdick, Kailee; Kara, Areeba; Ebright, Patricia; Meek, Julie; School of Nursing
    BACKGROUND: Bedside interprofessional rounding is gaining ground as a means to improve collaboration and patient outcomes, yet little is known regarding patients' perceptions of the practice. METHODS: This descriptive study used individual patient interviews to elicit views on interprofessional rounding from 35 patients at a large, urban hospital. RESULTS: The findings identified three major categories: 1) about the rounding process; 2) clinical information; and 3) the impact/value of bedside inter-professional rounding. DISCUSSION: Intentionally eliciting and responding to our patients' views of interprofessional rounding may help us design methods that are patient centered and effective.
  • Thumbnail Image
    Item
    “Clinical Characteristics, Outcomes and Prognosticators in Adult Patients Hospitalized with COVID-19”
    (Elsevier, 2020-07-08) Gavin, Warren; Campbell, Elliott; Zaidi, Adeel; Gavin, Neha; Dbeibo, Lana; Beeler, Cole; Kuebler, Kari; Abdel-Rahman, Ahmed; Luetkemeyer, Mark; Kara, Areeba; Medicine, School of Medicine
    Background: COVID-19 is a novel disease caused by SARS-CoV-2. Methods: We conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into three groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV and those who received MV and died during hospitalization. Results: There were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8 , 55.8 and 72.7 years respectively (p=.0001). Of those who received MV and died, 61% were male (p=.01). More than half the patients ( n=90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, LDH > 445.6 units/L and BNP > 104.75 pg/mL had odds ratios of 10.5, 5 , 4.5 and 2.9 respectively forMV (p < .05 for all). Peak BNP > 167.5 pg/mL had an odds ratio of 6.7 for inpatient mortalitywhen mechanically ventilated (p= .02).Conclusions: Age and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, LDH and BNP may serve as early indicators of disease trajectory.
  • Thumbnail Image
    Item
    Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists:Workflow Analysis Based on Semistructured Interviews
    (JMIR Publications, 2022) Savoy, April; Saleem, Jason J.; Barker, Barry C.; Patel, Himalaya; Kara, Areeba
    Background: The hospitalist workday is cognitively demanding and dominated by activities away from patients’ bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use. Objective: The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists’ workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps. Methods: We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results: Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions: Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists’workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.
  • Thumbnail Image
    Item
    Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting
    (Springer, 2022-09) Kara, Areeba; Kashiwagi, Deanne; Burden, Marisha; Medicine, School of Medicine
    Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting-leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.
  • Thumbnail Image
    Item
    Correction: Symptomatic, clinical and biomarker associations for mortality in hospitalized COVID-19 patients enriched for African Americans
    (BMC, 2022-08-29) Ashktorab, Hassan; Pizuorno, Antonio; Adeleye, Folake; Laiyemo, Adeyinka; Dalivand, Maryam Mehdipour; Aduli, Farshad; Sherif, Zaki A.; Oskrochi, Gholamreza; Angesom, Kibreab; Oppong-Twene, Philip; Challa, Suryanarayana Reddy; Okorie, Nnaemeka; Moon, Esther S.; Romos, Edward; Jones-Wonni, Boubini; Kone, Abdoul Madjid; Rankine, Sheldon; Thrift, Camelita; Scholes, Derek; Ekwunazu, Chiamaka; Banson, Abigail; Mitchell, Brianna; Maskalo, Guttu; Ross, Jillian; Curtis, Julencia; Kim, Rachel; Gilliard, Chandler; Ahuja, Geeta; Mathew, Joseph; Gavin, Warren; Kara, Areeba; Hache-Marliere, Manuel; Palaiodimos, Leonidas; Mani, Vishnu R.; Kalabin, Aleksandr; Gayam, Vijay Reddy; Garlapati, Pavani Reddy; Miller, Joseph; Chirumamilla, Lakshmi Gayathri; Jackson, Fatimah; Carethers, John M.; Kamangar, Farin; Brim, Hassan; Medicine, School of Medicine
    Correction to: BMC Infectious Diseases (2022) 22:552 https://doi.org/10.1186/s12879-022-07520-1