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Showing papers by "Lincoln Hospital published in 2007"


Journal ArticleDOI
TL;DR: The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT, and aims to create astarting point for future work and discussions in the realm of KT and GM.
Abstract: This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM.

50 citations


Journal ArticleDOI
TL;DR: Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.
Abstract: Evidence regarding the effect of tuberculosis (TB) disease on progression of human immunodeficiency virus (HIV) disease is inconclusive. The authors estimated the effect of time-varying incident TB on time to acquired immunodeficiency syndrome (AIDS)-related mortality using a joint marginal structural Cox model. Between 1995 and 2002, 1,412 HIV type 1 (HIV-1)-infected women enrolled in the Women's Interagency HIV Study were followed for a median of 6 years. Twenty-nine women incurred incident TB, and 222 died of AIDS-related causes. Accounting for age, CD4 cell count, HIV-1 RNA level, serum albumin level, and non-TB AIDS at study entry, as well as for time-varying CD4 cell count, CD4 cell count nadir, HIV-1 RNA level, peak HIV-1 RNA level, serum albumin level, HIV-related symptoms, non-TB AIDS, anti-Pneumocystis jiroveci prophylaxis, antiretroviral therapy, and household income, the hazard ratio for AIDS-related death comparing time after incident TB with time before incident TB was 4.0 (95% confidence interval (CI): 1.2, 14). The effect of incident TB on mortality was similar among highly active antiretroviral therapy (HAART)-exposed women (hazard ratio = 4.3, 95% CI: 0.9, 22) and non-HAART-exposed women (hazard ratio = 3.9, 95% CI: 0.9, 17; interaction p = 0.91). Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.

45 citations


Journal ArticleDOI
TL;DR: A study of colonoscopies demonstrates lower odds of Colonoscopy after adjusting for visit volume and greater predilection for colorectal cancer among urban minority men, which supports colonoscopy as the preferred method for cancer screening in the urban minority population in New York City.
Abstract: BACKGROUND Data on gender- and age-specific predisposition to colorectal tumors and colorectal tumor location and stage among the urban minority population in Northeastern United States is limited.

22 citations



Journal ArticleDOI
TL;DR: The most important risk factors for asthma in the South Bronx pediatric population are Hispanic ethnicity, family history of asthma, and exposure to tobacco smoke.
Abstract: We identified main asthma risk factors for children living in the South Bronx, where asthma rates are eight times higher than the national average. This case-control study enrolled 261 children at Lincoln Medical and Mental Health Center from 2002 to 2003. We questioned the mothers on medical history and home environment. The most important risk factors for asthma in the South Bronx pediatric population are Hispanic ethnicity, family history of asthma, and exposure to tobacco smoke. South Bronx children limited to breast-feeding during the first 3 months of age are less likely to develop asthma.

14 citations




Journal ArticleDOI
TL;DR: Routine monitoring of serum pH, Ca2+ and Mg2+ especially in the late third trimester, may have potential in the early detection of patients at risk for pre-eclampsia, and monitoring the progress of diverse therapeutic regimens during clinical management.

8 citations


Journal ArticleDOI
TL;DR: Outcome of all live births at 21–28 weeks' gestation (GA) and/or <1250 g birth weight (BW) over an eight-year period were reviewed and compared with other outcome data.
Abstract: Outcome of all live births at 21-28 weeks' gestation (GA) and/or <1250 g birth weight (BW) over an eight-year period were reviewed and compared with other outcome data. Causes of mortality were ascertained for all deaths. Significant morbidities were reviewed among <25 weeks GA and/or <800 g survivors over a two-year period. NICU admissions log book, monthly morbidity-mortality reports, medical records and autopsy findings were used to obtain outcome data. A total of 23,046 infants were born alive during the study period, including 339 (1.47%) at 21-28 weeks or <1250 g. Eighty of the 339 (23.6%) died. Of these 80 deaths 32.5% were extremely immature, 15% died from RDS, 15% from infection, 10% from pulmonary hemorrhage and 8% had lethal malformations. Survival outcome in each weight group except <500 g were similar to that reported by the Pediatrix Medical Group (2003-04) and 2002 US National Vital Statistics. Of the extremely low gestational age infants, 79% survived to discharge, and among these, the incidence of serious neuro-morbidity, severe chronic lung disease or retinopathy of prematurity requiring treatment was 52%; 18.5% had more than one major morbidity.

7 citations



Journal ArticleDOI
TL;DR: A young asthmatic adolescent who presented with vasculitis, eosinophilia, and peripheral neuropathy is reported, which may increase the morbidity from the complications of Vasculitis.
Abstract: Children frequently visit emergency departments with asthma exacerbations. Many of these asthmatic children may have fever and/or pneumonia, but when associated with eosinophilia or evidence of vasculitis, other diagnoses should be considered. Churg-Strauss syndrome is a rare form of systemic vasculitis, which usually occurs in patients with asthma in association with eosinophilia. The diagnosis of Churg-Strauss syndrome can be difficult because this syndrome may arise at first as a common association between asthma and allergic rhinitis. A delay in diagnosis and treatment may increase the morbidity from the complications of vasculitis. We report a young asthmatic adolescent who presented with vasculitis, eosinophilia, and peripheral neuropathy.

Journal ArticleDOI
TL;DR: 3 children who presented to emergency department with different initial manifestations of systemic lupus erythematosus are presented.
Abstract: Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that is often difficult to diagnose in the emergency department. It is an autoimmune disease with great variability in presentation and course. Moreover, the atypical or incomplete presentation is common in children and can result in delay in diagnosis. Consideration of the possibility of SLE is important when evaluating a patient with symptoms and/or signs suggesting multisystem disease. The emergency physician must maintain a high degree of suspicion for the early diagnosis and management of this important condition. We present 3 children who presented to emergency department with different initial manifestations of SLE.


Journal ArticleDOI
TL;DR: The intentional delivery of Bacillus anthracis spores through mailed letters or packages established the clinical reality of bioterrorism in the United States in autumn 2001.
Abstract: The intentional delivery of Bacillus anthracis spores through mailed letters or packages established the clinical reality of bioterrorism in the United States in autumn 2001. An understanding of the epidemiology, clinical manifestations, and management of the more credible biologic agents is critical to limiting morbidity and mortality from a bioterrorism attack.1-5 Children may be particularly vulnerable to a bioterrorist attack for several reasons.6 They have a more rapid respiratory rate, a lower breathing zone, increased skin permeability, higher ratio of skin surface area to mass, and less fl uid reserve than adults. Accurate and rapid diagnosis may be more diffi cult in children because of their inability to describe symptoms. Their caretakers may become ill or require quarantine during a bioterrorist event. Preventive and therapeutic agents recommended for adults exposed or potentially exposed to agents of bioterrorism have not been studied in infants and children.7



Journal ArticleDOI
TL;DR: A case of an adolescent who presented to the emergency department in respiratory distress and subsequent evaluation was consistent with the diagnosis of Goodpasture syndrome, which is a leading cause of alveolar hemorrhage in association with glomerulonephritis.
Abstract: When alveolar hemorrhage occurs in association with glomerulonephritis, one of the leading causes is Goodpasture syndrome. We report a case of an adolescent who presented to the emergency department in respiratory distress. Subsequent evaluation was consistent with the diagnosis of Goodpasture syndrome.

Journal ArticleDOI
TL;DR: The authors of the 4 letters to the editor raise the interesting and important issue of lead misplacement, which is indeed suggested when one compares the morphology of the P waves in the limb leads in Figure 2 against Figure 1 and Figure 3 in the authors' article.
Abstract: We thank the authors of the 4 letters to the editor for their interest in our work.1 All of the letters raise the interesting and important issue of lead misplacement, which is indeed suggested when one compares the morphology of the P waves in the limb leads in Figure 2 against Figure 1 and Figure 3 in our article. However, the authors of the letters might not have considered other elements on the ECG tracings that do not support such an interpretation. In extensive anterior myocardial injury, there is concordant ST elevation in lead I and aVL; only in high lateral MI might the ST elevation be limited to lead I and aVL. The concordance is clearly seen …