Showing papers by "Lincoln Hospital published in 2006"
TL;DR: Gender-based differences on PFT results should be considered during the screening of lung cancer, because the stratification of high-risk patients based on the presence of COPD may miss a significant proportion of women with lung cancer.
189 citations
TL;DR: The results suggest that nicotine may modestly enhance attention and spatial working memory in schizophrenic patients who are cigarette smokers and have been abstinent overnight.
172 citations
TL;DR: There are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening Colonoscopy rates in the general population, and efforts to increase the number of screening colonoscopies were highly successful.
Abstract: Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two “patient navigators” were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6, 95% CI 2.2–3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9–4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.
138 citations
TL;DR: Improvements include increased potency of newer agents, agents sensitive to a highly resistant virus, improved adverse‐effect profile (e.g., less gastrointestinal effects, improved lipid profiles), as well as protease inhibitor boosting with ritonavir, which takes advantage of the potent cytochrome P450 inhibitory action of ritonvir.
Abstract: The human immunodeficiency virus (HIV) was discovered in 1982, but treatment strategies were not introduced until 5 years later. Early regimens consisted of one or two drugs and often led to treatment failure. Since the advent in 1995 of highly active antiretroviral therapy (HAART), which consists of at least three agents, a dramatic improvement has been seen in the number of patients attaining undetectable viral loads, improved CD4 counts, and improved survival. However, early HAART often consisted of drugs with complex dosing schedules, strict food requirements, treatment-limiting adverse effects, and the need to take 16-20 pills/day. These treatment barriers often led to patient nonadherence, with subsequent treatment failure and development of resistant strains. The CD4 count and viral load are the most important surrogate markers used to determine if treatment is indicated. Current guidelines suggest starting treatment in patients who are symptomatic with an acquired immunodeficiency syndrome-defining illness regardless of CD4 count or viral load, as well as in asymptomatic patients with a CD4 count of 350 cells/mm(3) or below. In patients with CD4 counts above 350 cells/mm(3) and viral loads above 100,000 copies/ml, some clinicians prefer to defer treatment, whereas others will consider starting therapy; treatment is deferred in patients with CD4 counts above 350 cells/mm(3) and viral load s below 100,000 copies/ml. If therapy is started, the selection of appropriate agents is based on comorbidities (liver disease, depression, cardiovascular disease), pregnancy status, adherence potential (dosage regimen, pill burden, dosing frequency), food restrictions (dosing with regard to meals), adverse drug effects, and potential drug-drug interactions. Within the last 8 years, newer antiretroviral agents have focused on ways to improve adherence, such as convenient dosing (fewer pills), pharmacokinetic and formulation changes to reduce dosing frequency or pill burden, and coformulated dosage forms that contain two or three drugs in one convenient pill. Other improvements include increased potency of newer agents, agents sensitive to a highly resistant virus, improved adverse-effect profile (e.g., less gastrointestinal effects, improved lipid profiles), as well as protease inhibitor boosting with ritonavir, which takes advantage of the potent cytochrome P450 inhibitory action of ritonavir. This review focuses on the concepts of antiretroviral therapy, barriers to successful antiretroviral treatment, developments to limit treatment barriers, and new drug entities for the treatment of HIV.
130 citations
TL;DR: Nitrite presence was the best indicator of infection but was not a reliable clinical test due to a sensitivity of 29.5% and positive and negative likelihood ratios of 3.52 and 0.56, respectively.
Abstract: Objective
To determine the utility of urinalysis and dipstick results in predicting urinary tract infections in catheterized ICU patients.
42 citations
TL;DR: An infant who was presented with an ALTE and subsequently determined to have subdural hematoma caused by nonaccidental injury is reported.
Abstract: Children with apparent life-threatening events (ALTEs) often pose a diagnostic and management dilemma in a pediatric emergency department. Although the term ALTE is nonspecific and symptoms are vague, it may have alarming connotations and may signal serious life threatening conditions. It may be a subtle presentation of child abuse. We report an infant who was presented with an ALTE and subsequently determined to have subdural hematoma caused by nonaccidental injury.
18 citations
TL;DR: A 78‐year‐old overweight woman with diabetes mellitus, bronchial asthma, and Sheehan's syndrome on chronic steroid therapy presented with mild short‐lived hematemesis, significant hypotension disproportionate to the degree of bleeding and radiographic evidence of cardiomegaly, which illustrates a potential pitfall of 2D‐echocardiography in the diagnosis of PE.
Abstract: A 78-year-old overweight woman with diabetes mellitus, bronchial asthma, and Sheehan's syndrome on chronic steroid therapy presented with mild short-lived hematemesis, significant hypotension disproportionate to the degree of bleeding and radiographic evidence of cardiomegaly. Endoscopy showed duodenal ulcer. During evaluation of the unexplained brief hypotension and cardiomegaly, 2D-echocardiogram demonstrated anterior and posterior echo-free spaces consistent with large pericardial effusion (PE). However, subsequent elective surgical pericardiotomy unexpectedly revealed large amounts of pericardial fat. Pericardial fat was also noted on magnetic resonance imaging of the chest. Our case illustrates a potential pitfall of 2D-echocardiography in the diagnosis of PE.
11 citations
TL;DR: A 64-year-old female with a history of myocardial infarction after angioplasty presented with jaundice, abdominal distention, and 6-week weight loss and showed evidence of a malignant obstruction at the common bile duct.
Abstract: A 64-year-old female with a history of myocardial infarction (MI) after angioplasty presented with jaundice, abdominal distention, and 6-week weight loss. The initial work-up revealed an old inferior Q-wave MI on the admission ECG (Figure 1) and evidence of a malignant obstruction at the common bile duct. On day 7, while waiting for surgery, the patient developed chest pain and …
7 citations
TL;DR: The data suggest that repeating testing after initiation of HIV therapy, regardless of CD4 cell change, is warranted and if serial testing is undertaken, initial 2-step testing should be performed to allow for accurate interpretation of subsequent tests and earlier identification of persons with latent Mycobacterium tuberculosis infection.
Abstract: OBJECTIVE To define the incidence of tuberculin skin test (TST) conversion and to evaluate the yield of annual testing in an era of declining tuberculosis incidence rate in the United States. METHODS Annual TSTs were performed on initially TST-negative women (HIV infected, 995; uninfected, 260) from October 1995 through March 2002. RESULTS A total of 4,622 repeat TSTs were performed during 5,530 person-years. The incidence of TST conversion was 0.8 case per 100 person-years for HIV-infected and 1.0 case per 100 person-years for uninfected women. Non-Hispanic blacks, women younger than 40 years of age, and HIV-infected women who had recently initiated active therapy were more likely to experience TST conversion. The incidence of conversion decreased over the course of the study from a peak of 21 cases per 937 tests in 1996 to 1 case per 179 tests in 2002 (P = 0.046 for trend). Twenty-one of 47 conversions occurred on the second TST, implying that boosting accounted for a number of conversions. CONCLUSIONS The yield of annual skin testing diminished from 1996 to 2002. Our data suggest that repeating testing after initiation of HIV therapy, regardless of CD4 cell change, is warranted. If serial testing is undertaken, initial 2-step testing should be performed to allow for accurate interpretation of subsequent tests and earlier identification of persons with latent Mycobacterium tuberculosis infection.
7 citations
TL;DR: A case of massive dilatation of the colon due to fecal impaction is reported and means for distinguishing constipation from alternative diagnoses are discussed.
Abstract: Pediatric abdominal complaints are common presentations in emergency departments, and emergency physicians are challenged every day with a vast array of gastrointestinal disorders. Differentiating the child with a benign abdominal process from the child with a more serious condition can be difficult. We report a case of massive dilatation of the colon due to fecal impaction. Means for distinguishing constipation from alternative diagnoses are discussed.
6 citations
TL;DR: A life-threatening anaphylactic reaction to latex in a patient with spina bifida even with latex-free precautions is reported, suggesting a unique challenge in the emergency department.
Abstract: Allergy to natural rubber latex presents a unique challenge in the emergency department. Latex allergy in children is most commonly identified in patients who have undergone multiple operations for neural tube defects or genitourinary anomalies. We report a life-threatening anaphylactic reaction to latex in a patient with spina bifida even with latex-free precautions.
TL;DR: An elderly patient is presented with a life-threatening unusual cause of acute shortness of breath, a diaphragmatic hernia with sepsis, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician.
Abstract: Dyspnea is an alarming symptom for both the patient and the emergency physician. There are many causes of dyspnea, some of which are life-threatening, especially in the elderly patient. In addition to the usual cardiac and pulmonary causes such as congestive heart failure, asthma exacerbation, COPD, pneumonia, and pulmonary embolism, there are less common causes of dyspnea, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician. We present a case of an elderly patient with a life-threatening unusual cause of acute shortness of breath, a diaphragmatic hernia with sepsis.
TL;DR: Whether parent/guardian self-report of insurance status agrees with hospital administrative data is examined and the relationship of patient characteristics with any observed discordance is examined.
Abstract: We screened nearly 10,000 consecutive parents presenting to EDs throughout the United States and examined whether parent/guardian self-report of insurance status agrees with hospital administrative data. We also examined the relationship of patient characteristics with any observed discordance.
TL;DR: This review focuses on the latest advancements in the management of secondary hyperparathyroidism and beta-2 microglobulin amyloidosis.
Abstract: People treated with prolonged hemodialysis now survive longer and increasingly develop musculoskeletal complications. Significant advances have been made in the management of musculoskeletal manifestations in patients undergoing hemodialysis for endstage renal disease. Noncalcium-based phosphate binders are preferred for the management of hyperphosphatemia. Vitamin D therapy is based on intact parathyroid hormone levels. Newer Vitamin D sterols and calcimimetic agents seem to control secondary hyperparathyroidism without increasing the calcium–phosphorous product. Use of biocompatible dialyzers for hemodialysis may delay articular manifestations of beta-2 microglobulin amyloidosis. Beta-2 microglobulin adsorption columns when used along with hemodialysis may lead to lower beta-2 microglobulin levels and improvement in articular manifestations of beta-2 microglobulin amyloidosis. In this review, we focus on the latest advancements in the management of secondary hyperparathyroidism and beta-2 microglobulin amyloidosis.
TL;DR: The cases of 2 adolescents with ectopic pregnancies who were treated successfully with methotrexate are reported and Methotrexate has been shown to be effective in the management of ectopic pregnancy.
Abstract: An ectopic pregnancy is a life-threatening form of pregnancy that is increasing in frequency especially in adolescents. Whenever a woman of childbearing age, including adolescents, presents with abdominal pain, the diagnosis of ectopic pregnancy must be considered as a possibility because if it is not diagnosed and treated expediously and appropriately, there will be considerable morbidity and mortality. Methotrexate has been shown to be effective in the management of ectopic pregnancy, but few reports are described in the literature regarding its use in teenagers. We report the cases of 2 adolescents with ectopic pregnancies who were treated successfully with methotrexate.
TL;DR: Using a simple mnemonic, SHAPE UP, a program for comprehensive care of patients with CKD is outlined and it is believed that implementing this program in medical and renal clinics will enhance the care of CKD patients.
Abstract: Chronic kidney disease (CKD) is a disease of epidemic proportions, affecting 11% of the population and having far-reaching consequences in quality of life, mortality, and overall cost of health. So far, CKD care has been suboptimal. Evidence-based guidelines for management of patients with CKD have been established by the National Kidney Foundation. Early recognition of CKD and its associated complications and timely referral to a nephrologist are the key components of management. Coordinated care and effective communication between the primary care physician, the nephrologist, and other providers are critical to improve the outcome. Using a simple mnemonic, SHAPE UP, we outline a program for comprehensive care of patients with CKD. We believe that implementing this program in medical and renal clinics will enhance the care of CKD patients.
TL;DR: This poster explains why radial neck fractures in children often have poor outcomes, especially if not reduced, and even after open reduction.
Abstract: Radial neck fractures in children are not uncommon. Most are minimally displaced or nondisplaced. Severely displaced fractures or angulated radial neck fractures in children often have poor outcomes, especially if not reduced, and even after open reduction.
TL;DR: A case of young child with lymphoma who presented with isolated supraclavicular node enlargement with anterior mediastinal mass underscores the need to consider a malignant etiology in the evaluation of cervical lymphadenopathy.
Abstract: L ymphadenopathy is a common clinical finding in pediatric emergency department and is frequently benign. We report a case of young child with lymphoma who presented with isolated supraclavicular node enlargement with anterior mediastinal mass. This report underscores the need to consider a malignant etiology in the evaluation of cervical lymphadenopathy. A rapid algorithm to evaluate cervical lymphadenopathy is outlined. We believe that this case illustrates the use of a chest radiograph when confronted with supraclavicular adenopathy.