Alberg A.J.,Medical University of South Carolina |
Brock M.V.,Johns Hopkins University |
Ford J.G.,Brooklyn Hospital Center |
Samet J.M.,University of Southern California |
Spivack S.D.,Yeshiva University
Chest | Year: 2013
Background: Ever since a lung cancer epidemic emerged in the mid-1900s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research. Methods: A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk. Results: Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application. Conclusions: Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers. Copyright © by the American College of Chest Physicians 2013.
News Article | November 21, 2016
In what is considered a victory for patient safety, hospitals across the U.S. have reduced deadly, but highly preventable, central-line bloodstream infections by 50 percent since 2008. In a new investigation of nearly 2,000 hospitals, Consumer Reports looks at the five-year track record of teaching hospitals to see which have successfully reduced these infections, and which have not. The report, available in the January issue of Consumer Reports and online at CR.org, identifies 31 U.S. teaching hospitals on its lowest-performing “zero tolerance” list and 32 on its list of top performers. The story and Ratings are free, in addition to an interactive look-up tool showing hospitals in your area and their five-year track record (go to CR.org/central-line-infections for the tool). “Because teaching hospitals are teaching our next generation of physicians, we think it’s critical to monitor them closely. Our review of their performance on controlling central-line infections is very sobering,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center. “Central-line infections are highly preventable and there are no excuses for poor performance on this metric. It’s unfortunate to see so many well-known hospitals, some who tout their top rankings and awards, sitting on the sidelines of one of the biggest triumphs in patient safety.” Central-line infections derive from the intravenous lines used to supply medication, nutrients, and fluids to patients who need them the most. When not handled properly, central lines can become host to bacteria, pumping germs straight into the bloodstream of the patient. Once there, the bacteria – including deadly strains such as MRSA that aren’t easily managed with antibiotics – can spread to the heart and other organs. About 650,000 people develop infections after they are admitted to hospitals each year, and 75,000 patients die, according to the latest data from the Centers for Disease Control and Prevention. That makes hospital acquired infections the eighth leading cause of death, just behind diabetes. Central-line infections account for roughly 5 percent of all hospital infections, but are considered a critical subset because: While other hospital infections have stayed steady or declined only slightly in recent years, those linked to central lines were cut in half between 2008 and 2014, according to the CDC. “It’s one of the nation’s greatest patient safety success stories ever,” says Arjun Srinivasan, M.D., associate director for Healthcare Associated Infection Prevention Programs at the CDC. “Hospitals are moving in the right direction, but progress is slowing and too many hospitals have not adequately addressed the problem over the past five years,” says Consumer Reports’ Peter. What Can Be Done Consumer Reports’ nine-page investigation outlines the Pronovost principles developed 15 years ago to prevent central-line infections. It also includes profiles of two hospitals, Shore Medical Center in New Jersey and Mount Sinai St. Luke’s-Roosevelt in New York, that give insight into how they successfully battled this infection, and how they continue to be vigilant and improve. The story also includes 15 steps that consumers can take to stay safe in the hospital (see sidebar). From a policy standpoint, CR has worked successfully at the state level to get laws passed that require hospitals to publicly report hospital infections for more than a decade. And while President Barack Obama’s Affordable Care Act included a provision that lowered Medicare payments to hospitals that had too many infections, more can be done at the federal government to give the public more timely and actionable information, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project (SafePatientProject.org). “We think there are many requirements that could keep patients safe. For example, the federal government should require hospitals to immediately report infection outbreaks or infection-control breaches to patients, healthcare providers, state and federal agencies, and the public. In essence, we’re saying that when there is an outbreak, if the hospital knows, then everyone should know,” says McGiffert. Complete hospital lists and Ratings are available in the magazine story and online. The list below reveals the 31 lowest scoring U.S. teaching hospitals at preventing central-line infections in intensive care units from January 1, 2011 to December 31, 2015. Hospitals appear in alphabetical order. Atlanta Medical Center (Atlanta, GA) Banner- University Medical Center Tucson (Tucson, AZ) Brooklyn Hospital Center (Brooklyn, NY) Community Regional Medical Center (Fresno, CA) Cooper University Health Care (Camden, NJ) Dartmouth – Hitchcock Medical Center (Lebanon, NH) Emory University Hospital Midtown (Atlanta, GA) Eskenazi Health (Indianapolis, IN) George Washington University Hospital (Washington, DC) Grady Memorial Hospital (Atlanta, GA) Holy Cross Hospital (Silver Spring, MD) Howard University Hospital (Washington, D.C.) Hurley Medical Center (Flint, MI) Indiana University Health University Hospital (Indianapolis, IN) Interim LSU Public Hospital (New Orleans, LA) Long Beach Memorial Medical Center (Long Beach, CA) MacNeal Hospital (Berwyn, IL) Maine Medical Center (Portland, ME) Maricopa Integrated Health System (Phoenix, AZ) Nebraska Medicine - Nebraska Medical Center (Omaha, NE) Palmetto Health Richland (Columbia, SC) Robert Wood Johnson University Hospital (New Brunswick, NJ) Ronald Reagan UCLA Medical Center (Los Angeles, CA) SUNY Downstate Medical Center University Hospital (Brooklyn, NY) Truman Medical Center - Hospital Hill (Kansas City, MO) Tulane Medical Center (New Orleans, LA) UC San Diego Health (San Diego, CA) UF Health Jacksonville (Jacksonville, FL) University Hospital (Newark, NJ) University Medical Center of El Paso (El Paso, TX) University of Iowa Hospitals and Clinics (Iowa City, IA) About Consumer Reports Consumer Reports is the world’s largest and most trusted nonprofit consumer organization, working to improve the lives of consumers by driving marketplace change. Founded in 1936, Consumer Reports has achieved substantial gains for consumers on food and product safety, financial reform, health reform, and many other issues. The organization has advanced important policies to prohibit predatory lending practices, combat dangerous toxins in food, and cut hospital-acquired infections. Consumer Reports tests and rates thousands of products and services in its 50-plus labs, state-of-the-art auto test center, and consumer research center. It also works to enact pro-consumer laws and regulations in Washington, D.C., in statehouses, and in the marketplace. An independent nonprofit, Consumer Reports accepts no advertising, payment, or other support from the companies that create the products it evaluates. _______________ JANUARY 2017 © 2016 Consumer Reports. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports®, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our permission. Consumer Reports will take all steps open to it to prevent commercial use of its materials, its name, or the name of Consumer Reports®.
News Article | February 20, 2017
The International Nurses Association is pleased to welcome Marie Lois Haran, RN, MSN, to their prestigious organization with her upcoming publication in the Worldwide Leaders in Healthcare. Marie is a Registered Nurse with 44 years of experience in her field and an extensive expertise in all facets of nursing, especially nurse consulting. Marie is currently working as a Nurse Consultant for “Ask A Nurse” in Acra, New York, a company she founded in 1996. Marie Lois Haran graduated with her initial Nursing Diploma in 1952 from the Brooklyn Hospital Center, becoming a registered nurse. An advocate for continuing education, she went on to earn her Bachelor of Science Degree in Nursing from St. John’s University in 1960, followed by her Master of Science Degree in Medical and Surgical Nursing from Hunter College in 1967. Furthermore, Marie is a Basic Cardiac Life Support Instructor. During her long and successful career, Marie has worked in many fields of nursing in increasingly senior positions, and is the recipient of several awards and recognitions. As a nurse consultant, she reviews medical records for adult and pediatric patients involved in malpractice lawsuits, testifies as a nurse expert witness, and meets with attorneys to review issues prior to trial. By founding “Ask A Nurse”, Marie has provided an important nursing legacy for years to come. Learn more about Marie Lois Haran here: http://inanurse.org/network/index.php?do=/4135439/info/ and be sure to read her upcoming publication in Worldwide Leaders in Healthcare.
Giancarelli A.,Brooklyn Hospital Center |
Davanos E.,Brooklyn Hospital Center |
Davanos E.,Long Island University
Journal of Parenteral and Enteral Nutrition | Year: 2015
Background: The purpose of this study was to determine the number and types of interventions performed by our nutrition support service (NSS) pharmacists that were not directly related to the nutrition formula prescription. Methods: This was an institutional review board-approved retrospective study of all adult pharmacy NSS consultations from January 1, 2011 to December 31, 2011. All interventions assessed were categorized as the following: fluids and electrolytes, glucose management, alternate therapy, diagnostics, general laboratory result monitoring, vitamin and trace element monitoring, discontinuing medication, adding medication, dose adjustment, and other. The primary endpoint was to determine the total number of interventions and their acceptance rates. The secondary endpoint was to determine which categories had the most accepted and most denied interventions. Results: There were 132 adult consults evaluated with a total of 383 interventions performed. The overall acceptance rate was 84%, and the top 3 accepted intervention categories were general laboratory result monitoring (96%), fluids and electrolytes (96%), and other (100%). The top 3 denied intervention categories were dose adjustment (60%), diagnostics (50%), and adding medication (22%). Conclusions: The interventions performed by the pharmacists demonstrate the unique perspective, knowledge, and importance of a pharmacist on nutrition support teams. © 2014 American Society for Parenteral and Enteral Nutrition.
Freed J.,Brooklyn Hospital Center |
Kelly K.M.,Columbia University
Pediatric Drugs | Year: 2010
Hodgkin lymphoma is one of the few cancers that affect both adults and children. Cure rates for Hodgkin lymphoma remain among the best for pediatric cancers. However, cure is often associated with significant delayed effects of therapy, including an elevated risk for second malignancies, cardiotoxicity, pulmonary toxicity, and gonadal and non-gonadal endocrine dysfunction. Therefore, the aim of current treatment strategies is to further improve outcomes while minimizing therapy-related complications.At diagnosis, patients are classified into risk groups based on disease stage, and the presence of clinical, biologic, and serologic risk factors. In general, the most recent trials have intensified therapy in those patients with high-risk disease to improve disease control, and have limited therapy in those patients with low-risk disease to avoid secondary effects. In low-risk patients, multiple studies have been conducted to investigate limiting either radiation therapy or chemotherapy to prevent long-term side effects without affecting the excellent cure rate. In intermediate- and high-risk patients, many studies have examined intensifying therapy to improve event-free survival rates. In addition, response assessment by fluorine-18-2-fluoro-2-deoxy-D-glucosepositron emission tomography (FDG-PET) may be particularly important in pediatric Hodgkin lymphoma; it may allow modification of treatment to maximize treatment efficacy and minimize late effects of chemotherapy and radiation therapy. Despite the improvements in treatment for all stages of Hodgkin lymphoma, there is still a subgroup of patients who do not enter remission with initial therapy or relapse after initial response to therapy. Unfortunately, standard-dose salvage chemotherapy for relapsed disease has disappointing results in terms of overall survival since patients have typically already received intensive therapy. While there is no standard of care in terms of salvage chemotherapy, high-dose chemotherapy with autologous stem cell transplant (ASCT) rescue has become the standard of care for the majority of children with relapsed Hodgkin lymphoma. The use of allogeneic transplantation is controversial in relapsed or refractory Hodgkin lymphoma; because of the high transplant-related mortality, allogeneic transplant has not been associated with improved overall survival over ASCT.As more has been learned about the biologic mechanisms involved in Hodgkin lymphoma, biologically-based therapies are being investigated for use in this disease, both at initial diagnosis and relapse. Both immunotherapy and small molecules are being studied as possible therapeutic agents in Hodgkin lymphoma. Unfortunately, the vast majority of investigations of novel agents have occurred exclusively in adult patients. However, since pediatric Hodgkin lymphoma and adult Hodgkin lymphoma are similar, these results may potentially be extrapolated to pediatric Hodgkin lymphoma. © 2010 Adis Data Information BV. All rights reserved.
Lakhi N.A.,Brooklyn Hospital Center |
Jones J.,Brooklyn Hospital Center
Archives of Gynecology and Obstetrics | Year: 2010
Introduction: We describe a patient with a known diagnosis of Takayasu's arteritis who presented late in the third trimester. She was delivered by caesarean section and her postpartum course was complicated by aortic dissection. Method: This report is the first to describe peripartum aortic dissection in a patient with known Takayasu's arteritis. Conclusion: Takayasu's arteritis should be regarded as a risk factor for aortic dissection. It is important to treat systemic hypertension in Takayasu's arteritis patients and suspect the diagnosis of aortic dissection in any pregnant patient complaining of chest pain as dissection is a leading cause of maternal mortality in the developed world. © 2009 Springer-Verlag.
Hayes D.P.,Brooklyn Hospital Center
Biogerontology | Year: 2010
Within the past three to four decades a revolution has occurred in our understanding of vitamin D and its effects. Sundry laboratory and epidemiologic studies have revealed that the active metabolite of vitamin D controls and/or ameliorates various pathologies. As presented here, there is substantive evidence that vitamin D may play a positive and important role in the ageing process. This evidence arises from detailed consideration of various biological mechanisms and processes by which vitamin D operates as well as specific examples of its exerting control/amelioration of various human maladies which contribute to ageing. Arguments are advanced that vitamin D appears to play a major positive role in biogerontology by reducing susceptibility in the elderly to chronic degenerative diseases. It is strongly recommended that the positive role of vitamin D in ageing be taken into account by gerontologists and biogerontology researchers. © 2009 Springer Science+Business Media B.V.
Wadhera P.,Brooklyn Hospital Center
Nature Reviews Urology | Year: 2013
Intra-acinar and peri-acinar pressures in the prostate might be key factors in the evolution of its zonal morphology and the pathogenesis of BPH and cancer. Herein, I hypothesize that intra-acinar pressures lead to a decrease in apoptosis by distending or stretching acinar epithelium and its surrounding stroma. Increased prostatic smooth muscle content and tone might generate peri-acinar pressures, which could, in the long-term, counteract intra-acinar pressures and decrease epithelial stretch. Thus, it is proposed that BPH (characterized by increased prostatic smooth muscle and, therefore, raised peri-acinar pressures) might decrease the risk of prostate cancer progression by counteracting intra-acinar pressures. In the context of this theory, the transition zone might have evolved as a specialized region within the prostate that can mount a concerted stromal-epithelial response to increased urethral and intra-acinar pressures (BPH), and the urethral angulation, anterior stroma and the prostatic capsule have an adjunctive evolutionary role in this phenomenon. © 2013 Macmillan Publishers Limited. All rights reserved.
Patel S.,Brooklyn Hospital Center |
Xiao P.,Brooklyn Hospital Center
Archives of Pathology and Laboratory Medicine | Year: 2013
Primary effusion lymphoma is a large cell non-Hodgkin lymphoma localized predominantly in body cavities and occasionally in extracavitary regions. It presents with characteristic lymphomatous effusions in the absence of solid tumor masses, and pleural, peritoneal, and pericardial spaces are most often involved. It is typically associated with human herpesvirus 8 infection in immunocompromised individuals, in the setting of human immunodeficiency virus infection, organ transplantation, or in rare cases advanced age. Histologically, primary effusion lymphoma is characterized by atypical lymphoid cells of B-cell lineage with large nuclei and prominent nucleoli. Demonstration of human herpesvirus 8 latent antigens is required for diagnosis, and treatment modalities are limited at this time. In this review, we aim to summarize clinicopathologic features of this rare and unique entity. Copyright © 2013 College of American Pathologists.
Tun N.M.,Brooklyn Hospital Center |
Villani G.M.,Brooklyn Hospital Center
Journal of Thrombosis and Thrombolysis | Year: 2012
Idiopathic thrombotic thrombocytopenic purpura (TTP) occurs primarily due to the formation of autoantibody against ADAMTS13, a specific von Willebrand factor-cleaving protease, resulting in low ADAMTS13 activity and subsequent accumulation of large vWF multimers, platelet aggregation and thrombus formation in the microvasculature of tissues. Limited clinical data suggest that the administration of anti-CD20 antibody (rituximab) may be useful in treating acute refractory or chronic relapsing idiopathic TTP. We carried out a systematic review with pooled data analysis using individual patient data to evaluate the efficacy of rituximab in these settings. Fifteen case series and 16 case reports comprising 100 patients were eligible for the study. Median age was 39 years. Male constituted 31 % and female 69 %. Complete remission was seen in 98 %, non-response in 2 % and relapse after complete remission in 9 %. For patients with complete remission, median follow-up was 13 months. Median platelet recovery from the first dose of rituximab was 14 days. ADAMTS13 inhibitor positivity and severe ADAMTS13 deficiency were highly predictive of the response to rituximab, implying that these can be useful markers in predicting response to rituximab in acute refractory or chronic relapsing idiopathic TTP. © Springer Science+Business Media, LLC 2012.