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Chin R.L.,New York Medical College | Sander H.W.,St Vincents Hospital Manhattan | Sander H.W.,New York Medical College | Brannagan T.H.,Columbia University | And 2 more authors.
Journal of Clinical Neuromuscular Disease | Year: 2010

Infection with hepatitis C virus (HCV) can be associated with demyelinating polyneuropathy that may be responsive to immunomodulatory therapy. In this case report series, we review four patients (all male, ages 47-60 years) with HCV and demyelinating polyneuropathy. Two of the four patients were diagnosed with HCV during the course of initial neuropathy evaluation. All patients had sensory loss, absent/diminished reflexes, lower extremity weakness (except for one patient), and demyelinating electrodiagnostic features. Three patients had polyclonal hypergammaglobulinemia and one patient had IgM monoclonal gammopathy. Intravenous immunoglobulin resulted in improvement in three patients; one patient had no benefit from rituximab therapy, but his symptoms have been stable. Demyelinating neuropathy may develop in patients with HCV unrelated to antiviral therapy. Immunomodulatory therapy may be beneficial in some cases. Testing for HCV should be considered, especially in patients with hypergammaglobulinemia or IgM monoclonal gammopathy. © Copyright 2010 by Lippincott Williams & Wilkins.


Sulmasy D.P.,University of Chicago | Astrow A.B.,Maimonides Medical Center | He M.K.,St Vincents Hospital Manhattan | Seils D.M.,Duke University | And 3 more authors.
Cancer | Year: 2010

BACKGROUND: Patients' estimates of their chances of therapeutic benefit from participation in early phase trials greatly exceed historical data. Ethicists worry that this therapeutic misestimation undermines the validity of informed consent. METHODS: The authors interviewed 45 patients enrolled in phase 1 or 2 oncology trials about their expectations of therapeutic benefit and their reasons for those expectations. They used a phenomenological, qualitative approach with 1 primary coder to identify emergent themes, verified by 2 independent coders. RESULTS: Median expectations of therapeutic benefit varied from 50% to 80%, depending on how the question was asked. Justifications universally invoked hope and optimism, and 27 of 45 participants used 1 of these words. Three major themes emerged: 1) optimism as performative, that is, the notion that positive thoughts and expressions improve chances of benefit; 2) fighting cancer as a battle; and 3) faith in God, science, or both. Many participants described a culture in which optimism was encouraged and expected, such that trial enrollment became a way of reflecting this expectation. Many reported they had been told few patients would benefit and appeared to understand the uncertainties of clinical research, yet expressed high expected personal therapeutic benefit. More distressed participants were less likely to invoke performative justifications for their expectations (50% vs 84%; P=.04). CONCLUSIONS: Expressions of high expected therapeutic benefit had little to do with reporting knowledge and more to do with expressing optimism. These results have implications for understanding how to obtain valid consent from participants in early phase clinical trials. © 2010 American Cancer Society.


Ollar R.A.,St Vincents Hospital Manhattan | Cooperman A.M.,St Vincents Hospital Manhattan | Wayne M.E.,St Vincents Hospital Manhattan | Barrecchia J.F.,St Vincents Hospital Manhattan | And 3 more authors.
Biochemical Genetics | Year: 2010

Molecular-based methods to monitor point mutations require special and expensive equipment unavailable in most hospitals. Colorimetric-based analysis is an ideal platform for K-ras codon 12 gene point mutations because it uses commonly found hospital equipment. The colorimetric assay is sensitive and specific, detecting mutated DNA levels as low as 1% in a wild-type background. Paired genomic DNA extracts of fixed tissue and cellular fractions of peripheral blood are more sensitive and accurate than unpaired samplings. This approach has the potential to improve K-ras point mutation scans as well as to detect micrometastases in circulating tumor cells. © 2010 Springer Science+Business Media, LLC.


Yi H.,Columbia University | Sandfort T.G.M.,Columbia University | Shidlo A.,St Vincents Hospital Manhattan
Health Psychology | Year: 2010

Objective: This study examined how disengagement coping with HIV risk mediated the association between internalized homophobia and unprotected anal intercourse (UAI) and how sexual encounters in public venues (public sex) and drug use moderated the association between disengagement coping and UAI among HIV-negative gay men. Disengagement coping included fatalistic beliefs about maintaining HIV-negative seronegative serostatus (fatalism), optimistic attitudes toward medical seriousness of HIV infection and reduced concern about HIV risk due to highly active anti-retroviral therapies (optimism), and negative affective states associated with sexual risk (anxiety). Design: A survey was conducted among 285 HIV-negative gay men at an HIV prevention counseling program in New York City. Main Outcome Measures: Sexual risk was defined as having had UAI with nonprimary partners in the past 6 months. Results: In addition to the positive association between internalized homophobia, disengagement coping, and UAI, fatalism mediated the association between internalized homophobia and UAI; and optimism mediated the association between anxiety and UAI. A significant moderation effect of public sex was found between fatalism and UAI. Conclusions: The findings highlight the importance of understanding disengagement coping as it affects sexual risk practices among HIV-negative gay men in the continuing epidemic. © 2010 American Psychological Association.


PubMed | St Vincents Hospital Manhattan
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

8630 Background: Prior studies have shown much interest in spirituality among patients in the rural South, but little is known about the spiritual needs and views of urban cancer patients.In Jan-Feb 2005, consecutive outpatients were asked to complete a questionnaire at the St. Vincents Comprehensive Cancer Center in New York City. The instrument included the QUEST satisfaction scale, demographic and clinical information, and questions about spiritual and religious beliefs and needs. Tests of association included correlation, t-tests, and Of the 891 eligible patients, 81 refused, 428 cancelled their appointments or left before being approached. 13 were excluded because of incomplete questionnaires. The 369 participants had a mean age of 57.5 years; 65% were women, 67% white, 65% college-educated, 32% had breast cancer, and 67% were privately insured. Forty-seven percent were Catholic, 19% Jewish, 16% Protestant, and 6% atheist or agnostic. Sixty-six percent reported being spiritual but not religious, and 29% attended religious services at least once per week. Nine percent reported that staff had inquired about their spiritual or religious beliefs (0.6% by an MD), and 6% reported inquiries about their spiritual needs (0.9% by an MD). But, 82% reported that their spiritual needs were being met, and being asked about neither religious beliefs (p = .37) nor spiritual needs (p = .72) was associated with satisfaction. Still, 52% thought it appropriate for physicians to inquire about their religious beliefs and 58% thought it appropriate for physicians to inquire about their spiritual needs. Patients who described themselves as spiritual but not religious were less likely to think it appropriate for an MD to inquire about their religious beliefs (OR = 0.48, CI = 0.28 to 0.84), while those who attended religious services at least weekly were more likely to think it appropriate (OR = 2.86, CI = 1.45 to 5.62).A majority of patients thought it appropriate to be asked about their spiritual and religious beliefs and needs, but less than that reported in other settings. Few had these needs addressed by staff, especially by MDs. More religious patients were more likely to think such inquiries appropriate. No significant financial relationships to disclose.


PubMed | St Vincents Hospital Manhattan
Type: Journal Article | Journal: Biochemical genetics | Year: 2010

Molecular-based methods to monitor point mutations require special and expensive equipment unavailable in most hospitals. Colorimetric-based analysis is an ideal platform for K-ras codon 12 gene point mutations because it uses commonly found hospital equipment. The colorimetric assay is sensitive and specific, detecting mutated DNA levels as low as 1% in a wild-type background. Paired genomic DNA extracts of fixed tissue and cellular fractions of peripheral blood are more sensitive and accurate than unpaired samplings. This approach has the potential to improve K-ras point mutation scans as well as to detect micrometastases in circulating tumor cells.

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