Department of
Internal Medicine at Highland Hospital
A member of Alameda Health System

Resident Research


Sub-Specialty

Topics of Interest

Attendings

Gastroenterology

  • Viral hepatitis

  • Nonalcoholic fatty liver disease

  • Hepatocellular carcinoma

  • Liver-transplantation-related outcomes

Robert Wong

Primary Care

  • Patient chronic disease management and education

  • Colorectal and breast cancer screening outcomes

  • Patient education in drug (i.e. opioids) and alcohol addiction prevention/management

  • Cancer prevalence among patients in Same-Day Clinic

  • Torture victims & trauma-informed care

  • Improving patient outcomes among Spanish speakers

Neha Gupta

Jenny Cohen

David Tian

Blake Gregory

Palav Babaria

Nick Nelson

Alex Diaz

Cardiology

  • Novel non-invasive cardiovascular techniques

  • Evaluation of methamphetamine & cardiologic outcomes

Sophie Barbant

Pulmonary/ Critical Care

  • Evaluation of rapid response team activity

  • Scoring methods in trauma care patients

Colin Feeney

Palliative Care

  • Quality improvement in patient outcomes and referrals

John Hayward

Hematology/Oncology

  • Alternative medicine interventions

Amy Matecki

Infectious Disease

  • Treatment of antiretroviral naïve HIV-infected patients

Howard Edelstein

 

PRIMARY CARE

PI

Ongoing Projects

Jenny Cohen
  1. Panel Outreach
    Co-Investigators: Clinical Pharmacist from Chronic Care Clinic
    Residents will receive training in core General Internal Medicine topics and engage in outreach to primary care patients to improve health outcomes. Patient-level outcomes will be assessed pre and post outreach. 
    MA Empowerment Series
     
  2. Co-Investigators: Primary Care Faculty
    A short didactic session will be given to the medical assistants in our Primary Care Clinic housed at Highland Hospital. The goal of the intervention is to improve preventative care associated metrics. Based on preliminary findings from Year 1 and Year 2, we hope to collect patient-experience data and change the curriculum to focus on social determinates of health, health disparities, and structural inequity in order to foster a sense of advocacy and empowerment among the MAs.
     
  3. Provider Reports
    Co-Investigators: Interested Residents
    The overarching goal of this study is to improve both provider and patient experience via creation of a novel and user-friendly dashboard tool for the providers. Baseline data will be collected via in-person surveys given to clinicians and patients from multiple sites throughout the year. The dashboard intervention will then be validated among the population and implemented in futures studies. 
     
  4. HTN QI
    Co-Investigators: Cristina Nguyen and Anita Roberts
    Primary care based QI project using a multidisciplinary team and tenants of team-based practice and primary care re-design to improve our control of blood pressure in K6 Adult Medicine Clinic.
 

Publications/ Abstracts

  • Ghooray K, Cohen JK. “Chronic disease and cancer screening in an underserved community: Improving population health programming through medical assistant (MA) empowerment and education. Abstract submitted to Regional SGIM 2017.
    • Soi R, Kandahari N, Cohen JK. “PAP-Apocalypse: Using Population Health and Panel Management to Improve Low Rates of Cervical Cancer Screening in a Safety-Net Resident Clinic.” Innovations in Quality Improvement. California-Hawaii Regional SGIM 2017.
  • Ramesh R, Ohri R, Cohen JK. “A multidisciplinary approach to close quality gaps in colorectal cancer screening in a community clinic”. Abstract submitted to Regional SGIM 2017.
  • Cohen JK, Yen IH. "Chapter 1. Understanding Study Design for Clinical Epidemiology Studies". Clinical Epidemiology of Chronic Liver Diseases. Ed. Robert Wong. Springer Nature. Publication Pending.
  • Cohen JK, Bakamjian A, Leng L, Adhikari M, Flattery D, Berry L. No ifs, ands, or butts: Leveraging population health to focus on the care of patients who smoke. Journal of Medical Education and Curricular Development. Accepted and publication is pending revisions.
Nick Nelson

A Retrospective Study of Torture and Abuse Reported by Eritrean Asylum Seekers

Co-Investigators: Alex Diaz, Suzanne Portnoy, Emily Tatel, Daniela Kantorova

Thousands of Eritreans enter the United States every year seeking asylum from forced labor, military conscription, and torture. Since the last presidential election, these asylum cases have faced increased scrutiny, with more cases being denied. Alameda County has a vibrant Eritrea community primarily composed of an older generation of refugees from the Eritrean War of Independence, and a younger generation of asylum seekers fleeing torture and military conscription. The Highland Human Rights clinic long-served this community by providing hundreds of forensic asylum exams used corroborate asylum claims. This project is a retrospective analysis of the types of torture and abuse reported by Eritrean asylum seekers. We will conduct a detailed audit of around 100 forensic evaluations. Findings will contribute to the global understanding of the nature of human rights violations occurring in Eritrea.

 

Publications/ Abstracts

  • Nick Nelson, Kweku Hayfron, Alejandro Diaz , Scott Lynch, Irene Yen, Allison Bakamjian , and Indhu Subramanian. Terry’s Nails: Clinical Correlations in Adult Outpatients. J Gen Intern Med. April 2018.
    DOI: 10.1007/s11606-018-4441-7
  • Neff J, Knight K, Satterwhite S, Nelson N, Matthews J, Holmes S. “Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians.” JGIM 32(4), 430-433 (2017)
David Tian Impacts of universally co-prescribing naloxone to patients receiving chronic opioids in a safety net primary care setting

Co-Investigators: Kenny Hahn, Abraham Vela, Mariann Torres

This study addresses a priority public health epidemic of opioid-related overdose deaths. Naloxone is a life-saving medication that can be offered in conventional medical settings for patients prescribed opioids for pain. The proposed project will advance our understanding of best practices for implementing naloxone in busy safety-net settings through a quality improvement lens and observational pre-pose questionnaires that capture patient experience, attitudes and behaviors with a naloxone prescription.

Neha Gupta/

Blake Gregory

Clinical Outcomes among Patients with Uncontrolled Diabetes Managed by an Interdisciplinary Care Team at a Safety Net Adult Medicine Clinic

Co-Investigators: Blake Gregory, Katherine Dang, John Habibi, Kala Mehta

We set out to describe the clinical experiences and outcomes of patients with DM being managed by an interdisciplinary team/clinical pharmacy service model in an adult primary care clinic within a public hospital setting. The Chronic Care Clinic (CCC) of the Alameda County Medical Center in Oakland, CA is staffed by clinical pharmacists, nurses and registered diabetes educators, to provide interdisciplinary, comprehensive diabetes care to patients with uncontrolled diabetes.

Palav Babaria/

Dipankar Ghosh­

Health system delays in cancer diagnosis treatment for uninsured and underinsured populations

Co-Investigators: Mercedes Charles, Kala Mehta, Allison Bakamijan

Cancer mortality is very high in specific subgroups in the US, including, but not limited to, race ethnic minority patients and those with public insurance. The difference in survival is believed to be due in large part to differential access to timely and high-quality medical care. The aim of the current study is to evaluate a cohort of patients at the Alameda Health System- Same Day Clinic with a view towards understanding diagnostic delays for all cancers seen. It will be the first study of its kind to ‘track’ patients through the system evaluating the specific levers that act upon the overall ‘diagnostic delay’.

 

GASTROENTEROLOGY

Robert Wong

  • Viral hepatitis
  • Nonalcoholic fatty liver disease
  • Hepatocellular carcinoma
  • Liver-transplantation-related outcomes
 

Publications/ Abstracts

Global HBV burden: guesstimates and facts.
Ginzberg D, Wong RJ, Gish R.
Hepatol Int. 2018 Jul;12(4):315-329. doi: 10.1007/s12072-018-9884-8. Epub 2018 Jul 27. Review.
PMID: 30054801

Similar articles
Low Rates of Retention Into Hepatocellular Carcinoma (HCC) Surveillance Program After Initial HCC Screening.
Robinson A, Tavakoli H, Cheung R, Liu B, Bhuket T, Wong RJ.
J Clin Gastroenterol. 2018 Apr 6. doi: 10.1097/MCG.0000000000001024. [Epub ahead of print]
PMID: 29629906

A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital.
Campbell B, Lopez A, Liu B, Bhuket T, Wong RJ.
Dig Dis Sci. 2018 Jan;63(1):242-247. doi: 10.1007/s10620-017-4870-x. Epub 2017 Dec 5.
PMID: 29209920

African-Americans with Cirrhosis Are Less Likely to Receive Endoscopic Variceal Screening Within One Year of Cirrhosis Diagnosis.
Robinson A, Tavakoli H, Liu B, Bhuket T, Cheung R, Wong RJ.
J Racial Ethn Health Disparities. 2018 Aug;5(4):860-866. doi: 10.1007/s40615-017-0432-3. Epub 2017 Oct 19.
PMID: 29052175

Race/Ethnicity-Specific Disparities in the Severity of Disease at Presentation in Adults with Ulcerative Colitis: A Cross-Sectional Study.
Castaneda G, Liu B, Torres S, Bhuket T, Wong RJ.
Dig Dis Sci. 2017 Oct;62(10):2876-2881. doi: 10.1007/s10620-017-4733-5. Epub 2017 Aug 30.
PMID: 28856475

Low serum high density lipoprotein is associated with the greatest risk of metabolic syndrome among U.S. adults.
Castaneda G, Bhuket T, Liu B, Wong RJ.
Diabetes Metab Syndr. 2018 Jan - Mar;12(1):5-8. doi: 10.1016/j.dsx.2017.08.002. Epub 2017 Aug 11.
PMID: 28826579

Medicaid and Uninsured Hepatocellular Carcinoma Patients Have More Advanced Tumor Stage and Are Less Likely to Receive Treatment.
Wang J, Ha J, Lopez A, Bhuket T, Liu B, Wong RJ.
J Clin Gastroenterol. 2018 May/Jun;52(5):437-443. doi: 10.1097/MCG.0000000000000859.
PMID: 28723861

Cirrhosis Patients with Nonalcoholic Steatohepatitis Are Significantly Less Likely to Receive Surveillance for Hepatocellular Carcinoma.
Tavakoli H, Robinson A, Liu B, Bhuket T, Younossi Z, Saab S, Ahmed A, Wong RJ.
Dig Dis Sci. 2017 Aug;62(8):2174-2181. doi: 10.1007/s10620-017-4595-x. Epub 2017 May 4.
PMID: 28474143

Black Patients with Colorectal Cancer Have More Advanced Cancer Stage at Time of Diagnosis: A Community-Based Safety-Net Hospital Experience.
Chan C, Lopez A, Castaneda G, Bhuket T, Liu B, Yee S, Irwin D, Wong RJ.
J Community Health. 2017 Aug;42(4):724-729. doi: 10.1007/s10900-016-0309-0.
PMID: 28040840

Significant disparities in risks of diabetes mellitus and metabolic syndrome among chronic hepatitis C virus patients in the U.S.
Banks DE, Bogler Y, Bhuket T, Liu B, Wong RJ.
Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S153-S158. doi: 10.1016/j.dsx.2016.12.025. Epub 2016 Dec 13.
PMID: 27989517

The Need for an Integrated Patient Navigation Pathway to Improve Access to Colonoscopy After Positive Fecal Immunochemical Testing: A Safety-Net Hospital Experience.
Thamarasseril S, Bhuket T, Chan C, Liu B, Wong RJ.
J Community Health. 2017 Jun;42(3):551-557. doi: 10.1007/s10900-016-0287-2.
PMID: 27796633

Improvements in hepatitis B virus screening before rituximab therapy: A community-based, safety-net hospital experience.
Junus K, Aguilar M, Patel P, Irwin D, Yee S, Liu B, Bhuket T, Wong RJ.
Cancer. 2017 Feb 15;123(4):650-656. doi: 10.1002/cncr.30381. Epub 2016 Oct 3.
PMID: 27696389

Older Patients With Hepatocellular Carcinoma Have More Advanced Disease, Lower Rates of Treatment, and Lower Survival.
Yan M, Ha J, Aguilar M, Liu B, Frenette CT, Bhuket T, Wong RJ.
J Clin Gastroenterol. 2017 Apr;51(4):378-383. doi: 10.1097/MCG.0000000000000590.
PMID: 27380460

 

CARDIOLOGY

Sophie Barbant

  1. Left Atrial Strain for the Evaluation of Left Ventricular Filling Pressure. A Comparison with Standard Echocardiographic Criteria Using Mitral Valve and Tissue Doppler
    Co-Investigators: Matthew Auyoung
    Direct measurement of ventricular pressures by indwelling catheters is invasive and has risk of complications, which precludes its routine use in all patients. There has been ample research exploring non-invasive estimates of LV filling dynamics using Doppler echocardiographic assessment. This prospective study compares left atrial strain by speckle tracking echocardiography (STE) to mitral valve and tissue Doppler indices in a cohort of consecutive cardiac patients with echocardiography laboratory data in a community hospital.

  2. Systematic Review of Methamphatimine and Cardiac Outcome

 

PULMONARY / CRITICAL CARE

Colin Feeney

Review of a Rapid Response Team Activity in a Safety Net Hospital
Co-Investigators: Leslie Littlefield, Katherine Leger

The concept of a medical emergency response team was first described in 1995, but proliferated in the US after the 100,000 lives campaign in 2005. Many U.S. hospitals have now developed response teams (RRT’s) to identify deteriorating patients, intervene, and prevent catastrophic outcomes in non-critical care settings. The rapid response system at Highland Hospital follows the RRT model of most US hospitals. It is composed of a single CCRN chosen for his/her experience, communication skills and teaching ability. This study reviewed all RRT activations over a one-year period. The ultimate goal would be to use this information to develop an optimal RRT design.

 

HEMATOLOGY / ONCOLOGY

Amy Matecki

  1. Exploring the Benefit of Acupuncture in the Emergency Department: A retrospective review in a public teaching hospital
    Co-Investigators: Gabrielle LeCompte, Berenice Perez, Byron Lu
    This is a retrospective chart review of patients that consented to acupuncture treatment in the Emergency Department (ED) of Highland Hospital from February 23 2017 to February 23 2018. The goals of this study are to evaluate the safety of acupuncture, quantify acupuncture efficacy and identify how acupuncture influences health resource utilization in an acute care setting.
     
  2. K6 DIM Adult Medicine Retrospective Chart Review
    Co-Investigators: Gabrielle LeCompte, Palav Babaria
    The aims of this study are to 1) demonstrate that acupuncture is accessible for all regardless of sociodemographic characteristics; 2) to gather more comprehensive data on patients treated with acupuncture at the Highland Hospital K6 Adult Medicine Acupuncture Clinic.