Summer Research Programs at Albert Einstein Medical Center

Summer research programs at Albert Einstein Medical Center are available to any student who has successfully completed the first year of medical school. A monetary stipend will be given with the expectation that the student will be at AEMC Monday through Friday and work through the summer. Please contact Carina Sundstrom, residency program administrator ( sundstrc@einstein.edu or 215-456-8520) for more information or to apply. Additional information is also available on Jeffline - TJU Student Research Resources.

Cardiology: Diagnosis of Myocardial Contusion Injury
Mentor: Aman Amanullah, MD
Blunt thoracic trauma represents 25% of all traumatic fatalities commonly associated with work related injuries and motor vehicle accidents. Myocardial contusion injury (MCI) is a complication of blunt thoracic trauma. Current modalities utilized in the assessment of blunt chest trauma include ECG, cardiac markers, echocardiography, and nuclear imaging. Institutional algorithms are in place for the acute management and diagnosis of myocardial contusion injury. We have reviewed the current literature on MCI diagnosis and imaging. We propose an alternative revised algorithm for the management of patients presenting to the emergency room with blunt chest trauma & possible MCI.

Cardiology: Differentiating Constrictive Pericarditis from Restrictive Cardiomyopathy in the New Millennium
Mentor: Aman Amanullah, MD
Constrictive pericarditis and restrictive cardiomyopathy are two forms of diastolic dysfunction with similar presentation but different treatment options. While constrictive pericarditis has the potential of being cured with pericardiotomy, restrictive cardiomyopathy is usually incurable. It is therefore crucial to differentiate the two disorders from each other. In the last few years, new diagnostic advances have become available to differentiate these causes of diastolic dysfunction. This review provides a complete in depth comparison of the two disorders with regard to their symptoms and clinical features, etiology, pathophysiology, hemodynamic and echocardiographic presentation and finally different management options available.

Cardiology: Presentation of Hypertensive Crisis in Inner City Teaching Hospital
Mentor: Aman Amanullah, MD
Poorly controlled hypertension remains a major health problem, particularly among the minority population, those with lower socioeconomic circumstance, and with limited access to medical care. Hypertensive emergencies and urgencies are the most severe form of poorly controlled hypertension, and continue to be problem in inner city hospitals. The prevalence and clinical presentation of hypertensive urgencies and emergencies are not well defined. The study examines why some patients with severe hypertension develop acute end-organ damage whereas as others stay relatively asymptomatic. Also studied is that fact that there is no clear-cut correlation established so far between the degree of elevated blood pressure and risk of end-organ damage.

Group Registry of the use of Angiomax for the Performance of Peripheral Angioplasty
Mentor: Gary Ledley, MD, Associate Director, Section of Invasive, Diagnostic and Interventional Cardiology and Associate Director of the Cardiac Catheterization Lab.
This is a prospective registry of patients undergoing peripheral arterial angioplasty in the cardiac catheterization laboratory using the new direct anti-thrombin agent Angiomax, for anticoagulation.

Hepatology: Can a Hepatology Database Improve Rates of Hepatitis A and B Vaccinations Screening for Hepatoma in a Large Outpatient Hepatology Practice?
Hepatitis A and B vaccinations are indicated for all patients with chronic liver disease if immunity is not already present. Cirrhotic patients are at high risk for development of hepatocellular carcinoma; therefore, screening is recommended every 6 months with an ultrasound and alpha-fetoprotein (AFP). However, in reality, it is difficult for a busy hepatology practice to follow these recommendations in all patients despite the fact that they constitute the current standard of care. There will be 2 parts to the project, each of which require the use of a summer research intern.

• The first is to randomly screen 100 patients with chronic liver disease to see if vaccination was needed, requested and performed. 100 patients with cirrhosis will then be randomly screened to see if bi-annual screening has been performed. This will allow us to see how effective our current practice in implementing these recommendations.
• The second part of the project will consist of data entry concerning vaccination and hepatology screening into our newly formed hepatology database. Our premise is that the use of a hepatology database will be able to ensure that every cirrhotic patient will be screened every 6 months for hepatoma.

Impact of a Clinical Pathway for Community Acquired Pneumonia (CAP)
Mentor: Steven L. Sivak, MD; Paul J. Johnson, MD,Chairman, Department of Medicine, Albert Einstein Medical Center
In February 2002, Albert Einstein Medical Center implemented a clinical pathway for CAP. This study will measure its impact on compliance with quality criteria, length of stay and cost of care. The student who participates will collect data via chart review and access of the hospital's electronic patient management database. Statistical analysis of this data before and after implementation will be measured. The student will also be involved in the design of the study, learn about the ideal management of patients with CAP and gain an understanding of systems based practice.

Internal Medicine: Patient Understanding of Medications in a Primary Care Setting
Patients often have difficulty remembering what medicines they are taking. Even more frequently, they do not have an understanding of the indications for their prescribed medication. We propose initiating a telephone- and/or personal interview-based study in which patients are asked about their medications. We will try to identify patient characteristics which may predispose to knowledge deficits. We will use this also as an opportunity to provide patients with educational materials and counselling which may improve their understanding.

Internal Medicine: Comparison of 2 Techniques for Metered-dose-inhaler Instruction
Many patients in our primary care setting use MDI's for prevention and relief of respiratory symptoms. Proper technique is crucial to provide maximal benefit, while minimizing side effects. We propose measuring patient performance at baseline and after instruction. Instruction will be either by a descriptive handout or by a brief video. Patients will be brought back at a later date to test retention.

Nephrology: Effect of Metabolic Alkalosis on EPO Resistance and Nutritional Status in Patients with ESRD
Investigators will review lab data in patient charts, then look for a statistical correlation between the above parameters. This project will be done in conjunction with one of the Renal Fellows.

Nephrology: Predictive Value of Slow-Flow Pressure Measurements on Future AV Access Thrombosis in Patients with ESRD
The investigator will note pressure measurements while the patient is on the dialysis machine. The goal is to determine whether elevated pressures are an early predictor of AV Graft Thrombosis or whether these pressures can predict the presence of moderate to severe stenosis before the graft clots.

Pulmonary Studies:

• Prospective Study of Pain Sensation During Fiberoptic Bronchoscopy
  Conducted with Drs. Murali and Lippmann
• Incidence of Sepsis Due to Central Vein Catheters by Chart Review and Data Extraction
• Prospective Study of the Rate of Resolution of Atelectasis on CXR after Fiberoptic Bronchoscopy
• Incidence of Lactic Acidosis in Asthmatics

A Prospective Registry of Direct Coronary Angioplasty for Acute Myocardial Infarction using the Glyco-protein 2B/3A Platelet Receptor Blocker Integrilin
Mentor: Gary Ledley, MD, Associate Director, Section of Invasive, Diagnostic and Interventional Cardiology and Associate Director of the Cardiac Catheterization Lab.

A Prospective Assessment of Fasting Lipid Profiles of Patients having Coronary Angiographic Procedures, to Assess the Percentage of Patients at the NCEP 3 Goals
In addition methods to improve lipid therapy post procedures will be assessed.
Mentor: Gary Ledley, MD, Associate Director, Section of Invasive, Diagnostic and Interventional Cardiology and Associate Director of the Cardiac Catheterization Lab.

Retrospective Study of Hospitalized Patients with Venous Thromboembolism
The purpose is to identify potentially preventable cases of venous thromboembolism that should have received appropriate prophylactic measures. Data collection through chart reviews will quantify and characterize the factors contributing to inappropriate prophylactic measures. Identifying and analyzing the missed opportunities for appropriate prophylaxis may then lead to systems to avoid such omissions.

Risk Adjustment
Using patient records, this project will compare the risk adjustment predicted by the Commonwealth of Pennsylvania's methodology against literature based standards of risk adjustment for those same DRGs.
Investigators will also compare the methodology to a model that analyzes the effect of DNR status and admission from a nursing home.

WARCEF (Warfarin, Aspirin Reduced Cardiac Ejection Fraction Study)
Preceptor: Dr. Larry Jacobs, Director of Echocardiography, Albert Einstein Medical Center ( JacobsL@einstein.edu)
This is a randomized double placebo controlled study that looks at the role of Warfarin versus Aspirin in patients with an ejection fraction of less than 30%. There is a position available for a medical student to screen for an NIH funded multi-center trial. In this NIH funded multi-center trial study, the medical student will screen patients presenting to the Einstein Echo Lab for inclusion in the study. Ejection fraction will be calculated from echocardiography and clinical data will be reviewed