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Smith C.B.,Tisch Cancer Institute | Smith C.B.,Institute of the Brookdale | Nelson J.E.,Institute of the Brookdale | Nelson J.E.,Mount Sinai School of Medicine | And 5 more authors.
Annals of Oncology | Year: 2012

Background: Integration of palliative care with standard oncologic care improves quality of life and survival of lung cancer patients. We surveyed physicians to identify factors influencing their decisions for referral to palliative care. Methods: We provided a self-administered questionnaire to physicians caring for lung cancer patients at five medical centers. The questionnaire asked about practices and views with respect to palliative care referral. We used multiple regression analysis to identify predictors of low referral rates (<25%). Results: Of 155 physicians who returned survey responses, 75 (48%) reported referring <25% of patients for palliative care consultation. Multivariate analysis, controlling for provider characteristics, found that low referral rates were associated with physicians' concerns that palliative care referral would alarm patients and families [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21-0.98], while the belief that palliative care specialists have more time to discuss complex issues (OR 3.07, 95% CI 1.56-6.02) was associated with higher rates of referral. Conclusions: Although palliative care consultation is increasingly available and recommended throughout the trajectory of lung cancer, our data indicate it is underutilized. Understanding factors influencing decisions to refer can be used to improve integration of palliative care as part of lung cancer management. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

El-Sadr W.M.,The New School | El-Sadr W.M.,Columbia University | El-Sadr W.M.,Harlem Hospital Center | Affrunti M.,The New School | And 2 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2010

The use of antiretroviral therapy (ART) has been associated with significant improvement in morbidity and survival of persons living with HIV. In addition, recently, there has also been intense interest in the potential impact of ART on HIV transmission and consequently on the trajectory of the HIV epidemic globally. Evidence from mathematical modeling analyses and observational and ecological studies supports the potential for ART as prevention. However, definitive data from clinical trials are awaited. In the United States, the feasibility and potential of using ART as a prevention strategy presents particular challenges: the large number of individuals with undiagnosed HIV; the predominance of disenfranchised individuals affected by the epidemic; evidence of delay in engagement in HIV care after diagnosis with attendant late initiation of ART; and difficulties with consistent long-term adherence to ART and concerns regarding long-term risk-behavior change. Thus, for this novel effort to succeed, a multidimensional approach is necessary that must include policy changes, social mobilization, and improved access to clinical and supportive services for persons living with HIV, with a particular focus on the unique needs of at-risk populations, combined with engagement of all cadres of health care providers and community constituencies. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Hodder S.L.,The New School | Justman J.,Columbia University | Hughes J.P.,University of Washington | Wang J.,Fred Hutchinson Cancer Research Center | And 11 more authors.
Annals of Internal Medicine | Year: 2013

Background: Women account for 23% of newly diagnosed HIV infections in the United States, but there are few recent, wellcharacterized cohorts of U.S. women in whom behavior characteristics and HIV acquisition have been well-described. Objective: To evaluate HIV incidence and describe behaviors among U.S. women residing in areas of high HIV prevalence. Design: Multisite, longitudinal cohort of women who had HIV rapid testing and audio computer-assisted self-interviews at baseline and every 6 months for up to 12 months. (ClinicalTrials.gov: NCT00995176) Setting: 10 urban and periurban communities with high HIV prevalence and poverty rates, located in the northeastern and southeastern United States. Patients: Venue-based sampling was used to recruit women aged 18 to 44 years who recently had unprotected sex and had 1 or more additional personal or partner risk factors and no self-reported previous HIV diagnosis. Measurements: HIV prevalence and incidence, frequency of HIV risk behaviors, and health status perceptions. Results: Among 2099 high-risk women (85.9% black and 11.7% of Hispanic ethnicity), 32 (1.5%) were diagnosed with HIV infection at enrollment. Annual HIV incidence was 0.32% (95% CI, 0.14% to 0.74%). Older age, substance use, and knowing a partner had HIV were associated with HIV prevalence. Ten women died during the study (0.61% per year). Limitations: Longitudinal assessment of risk behaviors was limited to a maximum of 12 months. There were few incident HIV infections, precluding identification of characteristics predictive of HIV acquisition. Conclusion: This study enrolled a cohort of women with HIV incidence substantially higher than the Centers for Disease Control and Prevention national estimate in the general population of U.S. black women. Concerted efforts to improve preventive health care strategies for HIV and overall health status are needed for similar populations. Primary Funding Source: National Institutes of Health. © 2013 American College of Physicians. Source

Peart O.,Harlem Hospital Center
Radiologic Technology | Year: 2015

Breast cancer is the second leading cause of death among women in the United States. Although controversy has emerged in recent years regarding the diagnosis and treatment of this disease, it remains important to detect and treat breast cancer before it has metastasized. This article provides an overview of breast biopsy techniques, biopsy specimen imaging, and treatment options for breast cancer patients, including surgery, radiation therapy, chemotherapy, and molecular treatments. Finally, breast reconstruction options are presented. © 2015 American Society of Radiologic Technologists. Source

Brangman G.,Harlem Hospital Center
AANA Journal | Year: 2015

In September 1958 the Rev Dr Martin Luther King Jr was stabbed and nearly assassinated. Surgeons at Harlem Hospital in New York City removed a 17.8-cm (7-in)-long letter opener from Dr King's chest. Certified Registered Nurse Anesthetist Goldie Brangman remembers this event because she participated in Dr King's anesthetic. This article correlates Brangman's memories with published accounts of the event. It also places the event within the context of the modern civil rights movement that Dr King led. Source

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