Buffalo General Hospital Research Articles

Patients' Perspectives on Emergency Department COVID-19 Vaccination and Vaccination Messaging Through Randomized Vignettes.

Objectives:Emergency departments (EDs) could play an important role in the COVID-19 pandemic response by reaching patients who would otherwise not seek vaccination in the community. Prior to expanding COVID-19 vaccination to the acute care setting, we assessed ED patients’ COVID-19 vaccine status, perspectives, and hypothetical receptivity to ED-based vaccination.Methods:From January 11 through March 31, 2021, we conducted a multisite (Albany Medical Center, Boston Medical Center, Buffalo General Hospital, University of Cincinnati Medical Center, and Upstate Medical Center), cross-sectional survey of ED patients, with embedded randomization for participants to receive 1 of 4 vignette vaccination messages (simple opt-in message, recommendation by the hospital, community-oriented message, and acknowledgment of vaccine hesitancy). Main outcomes included COVID-19 vaccination status, prior intention to be vaccinated, and receptivity to randomized hypothetical vignette messages.Results:Of 610 participants, 122 (20.0%) were vaccinated, 234 (38.4%) had prior intent to be vaccinated, 111 (18.2%) were unsure as to prior intent, and 143 (23.4%) had no prior intent to be vaccinated. Vaccine hesitancy (participants who were vaccine unsure or did not intend to receive the vaccine) was associated with the following: age <45 years, female, non-Hispanic Black, no primary health care, and no prior influenza vaccination. Overall, 364 of 565 (64.4%; 95% CI, 60.3%-68.4%) were willing to accept a hypothetical vaccination in the ED. Among participants with prior vaccine hesitancy, a simple opt-in message resulted in the highest acceptance rates to hypothetical vaccination (39.7%; 95% CI, 27.6%-52.8%).Conclusions:EDs have appropriate patient populations to initiate COVID-19 vaccination programs as a supplement to community efforts. A simple opt-in approach may offer the best messaging to reach vaccine-hesitant ED patients.

How Will You Respond to the Next Emergency?

Features| April 2022 How Will You Respond to the Next Emergency? Stacey Watt, MD, MBA, MHPE, FASA; Stacey Watt, MD, MBA, MHPE, FASA Search for other works by this author on: This Site PubMed Google Scholar Terrence R. Burns, MD, D.ABA; Terrence R. Burns, MD, D.ABA Search for other works by this author on: This Site PubMed Google Scholar Zachary Fetter, DO; Zachary Fetter, DO Search for other works by this author on: This Site PubMed Google Scholar Kenneth Todd, DO; Kenneth Todd, DO Search for other works by this author on: This Site PubMed Google Scholar Vincent Bargnes Vincent Bargnes Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2022, Vol. 86, 26–30. https://doi.org/10.1097/01.ASM.0000826976.66246.ae Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Stacey Watt, Terrence R. Burns, Zachary Fetter, Kenneth Todd, Vincent Bargnes; How Will You Respond to the Next Emergency?. ASA Monitor 2022; 86:26–30 doi: https://doi.org/10.1097/01.ASM.0000826976.66246.ae Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: internship and residency, mass casualty setting, surgical procedures, operative Any hospital can be impacted by a mass casualty event regardless of the size, location, or capabilities of the facility. A coordinated response cannot be developed between the first warning of a mass casualty event and the arrival of the first patient. This two-part series of articles explains the fundamentals of developing an Incident Command System (ICS). In this second part, we analyze key components of the ICS as well as provide an example of an ICS structure for the perioperative setting of a mass casualty event. Our plan has been tailored to meet the needs of our health care system (Buffalo General Hospital) based upon the core principles of ICS. As we discussed in part 1, the ICS is a standardized approach to the command, control, and coordination of on-scene crisis management (asamonitor.pub/3HRxkD2). This approach provides a common hierarchy where personnel can be integrated across health care... You do not currently have access to this content.

A Case of Smoldering Multiple Myeloma with Simultaneous Increase of a Polyclonal Immunoglobulin

Anwarul Islam1* and Joanne Becker2 Author Affiliations 1Clinical Associate Professor of Medicine, Division of Hematology/Oncology, Department of Medicine, Buffalo General Hospital, Buffalo, New York 14203, USA 2Associate Professor and Clinical Chief, Division of Laboratory Medicine, Department of Pathology and Laboratory Medicine, Medical Director, Blood Bank and Therapeutic Apheresis Unit, Roswell Park Cancer Center, Buffalo, New York 14203, USA Received: April 08, 2020 | Published: April 23, 2020 Corresponding author: Anwarul Islam, Clinical Associate Professor of Medicine, Division of Hematology/Oncology, Department of Medicine, Buffalo General Hospital, Buffalo, New York 14203, USA DOI: 10.26717/BJSTR.2020.27.004468

NCMP-19. STROKE IN CANCER PATIENTS

Abstract Patients with malignancy have an increased tendency for venous and arterial embolism, and for increased risk for bleeding. Clinical decisions regarding anticoagulation in this population has been challenging and complicated by the availability of various anticoagulants. Currently, there is no evidence-based guideline available for the prevention of arterial embolism and thrombosis, such as stroke, in cancer patients. The aim of the study is to assess the use of anticoagulant medications in cancer patients who suffer a stroke. ICD-9/-10 codes were used to identify patients with cancer who were admitted between September 1, 2017 and November 30, 2017 to the Buffalo General Hospital with the diagnosis of stroke. Chart review was used to verify the history of cancer and stroke and to collect additional information. The diagnosis of acute stroke and cancer were verified in 87 patients. Among them, 31 patients had active malignancy. Of the 31 patients, 9 were diagnosed with intracranial hemorrhage and 22 with ischemic strokes. Of the 9 patients with intracranial hemorrhage,3 were anticoagulated and 1 patient was off anticoagulation. Of the 22 patients with ischemic stroke, 4 patients were anticoagulated, although 1 patient was underdosed based on INR. Seven of the 22 patients were taken off of anticoagulation; 3 had side effects and 4 were awaiting a surgical procedure. Five of the 9 patients with intracranial hemorrhage and 10 of the 22 patients with ischemic stroke were made comfort care and passed away shortly after the diagnosis of stroke.

Abstract TP321: Strokes Occurring in the Hospital; Quality of Care and Outcome in a Tertiary Academic Medical Center

Introduction: Studies have shown that 4-17% of acute ischemic strokes (AIS) occur in the patients hospitalized for another reason.We present one of the largest single center data in the US on quality of care and outcome of in-hospital strokes from our large volume comprehensive stroke center at Buffalo general Hospital, Buffalo, NY. Methods: In a retrospective study, all patients who suffered an AIS after being admitted for another reason to our center from January 2006 till June 2015 were included in the study. Variables studied included demographics, comorbid illness, NIHSS on admission, clinical presentation and NIHSS at the time of stroke, location of infarction on brain imaging, location of the patient while stroke occurred, treatment undertaken, quality of care measures and outcome on discharge using modified Rankin Scale( mRS). Results: We found 53 patients who suffered AIS proven on brain imaging after being hospitalized for another reason in the study period. Twenty seven were females (51 %). Mean age was 69.4 (±13.1). Mean NIHSS on admission was 0. Mean NIHSS at the time of stroke was 10.1 (±9.72). Mean Time of symptom recognition to neuroimaging was 7 hours (±14.4 hours). Only in 4 patients (7.5%) head CT scans were done within 25 minutes from symptom recognition. Forty two (79%) underwent brain imaging within 6 hours of symptom recognition, out of them 11(26%) received intravenous thrombolysis (IVT) within the first 4.5 hours and 7 (17%) underwent intra-arterial thrombolysis (IAT). The patients admitted in the emergency room(ER) for other reasons or intensive care units(ICU) had more chance of being eligible for IVT or/and IAT from timing stand point compared to the patients admitted to the regular floors ( 44 % vs 25% ) . In 15 patients (28%), there was a delay in symptom recognition or treatment due to diagnosis uncertainty . The mean MRS on discharge 2.37 (± 2.16) with a mortality rate of 13%. Conclusion: Due to logistical problems, only a small number of patients with in-hospital strokes received brain imaging within the time window recommended by ASA/AHA guideline. We need to improve awareness of stroke symptoms among medical staff including nurses and non-neurology physicians which might leads to a more timely initiation of treatment and better outcome.

Ensuring safe and effective medication use in pediatric patients.

This is a tremendous honor to receive peer recognition carrying the name of late Dr Sumner Yaffe. I was fortunate to have worked with him over many years through professional organizations and as a part of the pediatric pharmacology research units (PPRUs). Dr Yaffe established pediatric pharmacology programs in Buffalo and Philadelphia and made important contributions to enhance pediatric care with his research, practice, and teaching. He led the development of PPRUs and the neonatal networks, and was a force behind the framing of what became the Best Pharmaceuticals for Children Act (BPCA) and Pediatric Research Equity Act (PREA). He was indeed a visionary leader and mentor in the field of pediatric pharmacology. The objectives of my presentation today are to briefly share my background, reflect on our work, and discuss potential opportunities to advance pediatric pharmacy, pharmacology, and therapeutics.

Intrathecal Medications in Post-Herpetic Neuralgia: Table 1

Intrathecal Medications in Post-Herpetic Neuralgia: Table 1

Kenneth P. Johnson, MD (1932–2011)

Kenneth P. Johnson, MD, one of the pioneers in the use of disease-modifying therapies in the management of multiple sclerosis (MS), died in Baltimore, Maryland, on September 3, 2011, at age 79. Ken grew up in Jamestown, New York, the son of an engineer and a nurse. He received his BA from Upsala College in East Orange, New Jersey, in 1955 and his MD from Thomas Jefferson University Medical School in 1959. He completed a medicine internship and began neurology residency at Buffalo General Hospital, but left to enter the Navy in 1961. After completing his service at the Portsmouth Virginia Naval Hospital in 1963, he moved to the Case Western Reserve University, where he finished his neurology residency and then a neurovirology fellowship with Dr. Richard T. Johnson. His first publication was in Science and he continued to produce important research in neurovirology leading to his promotion to the …

Refinements of surgical technique in oncologic surgery

Journal of Surgical OncologyVolume 101, Issue 8 p. 647-648 Editorial Refinements of surgical technique in oncologic surgery Constantine P. Karakousis MD, PhD, Corresponding Author Constantine P. Karakousis MD, PhD [email protected] Buffalo General Hospital, Buffalo, New YorkProfessor of Surgery/SUNY at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203.Search for more papers by this author Constantine P. Karakousis MD, PhD, Corresponding Author Constantine P. Karakousis MD, PhD [email protected] Buffalo General Hospital, Buffalo, New YorkProfessor of Surgery/SUNY at Buffalo, Buffalo General Hospital, 100 High Street, Buffalo, NY 14203.Search for more papers by this author First published: 24 May 2010 https://doi.org/10.1002/jso.21572AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume101, Issue8Special Issue: Seminars in Surgical Oncology: Quality of Refinement of Surgical Treatment15 June 2010Pages 647-648 RelatedInformation

Cerebellar Mutism in Acute Disseminated Encephalomyelitis

Researchers at a pediatric multiple sclerosis clinic, the Neurological Institute, Buffalo General Hospital, New York, report six (32%) of 19 patients diagnosed with acute disseminated encephalomyelitis (2005-9) who had protracted speech and language deficits and 3 having cerebellar mutism after follow-up from 6 months to 4 years.

Papers Presented at the 2005 Meeting of the Musculoskeletal Tumor Society

Papers Presented at the 2005 Meeting of the Musculoskeletal Tumor Society

Lawrence D. Jacobs, MD (1938-2001).

On November 2, 2001, the field of neurology lost Lawrence D. Jacobs, MD, a leading figure in MS research. At the time of his death, Dr. Jacobs was Director of the William C. Baird Multiple Sclerosis Research Center, Chief of Neurology at Buffalo General Hospital, and Irvin and Rosemary Smith Professor of Neurology and Chairman of the Department of Neurology at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. Dr. Jacobs earned his undergraduate degree at Niagara University, Niagara Falls, NY, and his medical degree at St. Louis University. After neurology training at Mt. Sinai School of Medicine, he returned to Buffalo. He founded the William C. Baird Multiple Sclerosis Research Center in 1987 to focus on coordinated care for patients with MS and cutting-edge clinical research. Dr. Jacobs—Larry to his many friends—authored more than 200 publications and was an editorial board member of several journals. …

Stepping Back Stepping Forward: Woman's Health Care in Bosnia-Herzegovina

Little has been written about the health care system of the former Yugoslavia. In 1996, the U.S. Agency for International Development (US AID) awarded a 2 million grant to Buffalo General Hospital and The Children's Hospital of Buffalo, two of the five hospitals that now form Kaleida Health in Buffalo, NY, to provide training, education and supplies to the Tuzla Clinical Center in Bosnia. The funds were targeted at

Clinical Suspicion of Fatal Pulmonary Embolism

BackgroundLess than one third of patients with fatal pulmonary embolism (PE) are identified prior to autopsy. ObjectiveTo determine whether the clinical syndromes of acute PE are effective at identifying patients who die of this condition. MethodSeven hundred seventy-eight autopsy reports at the Buffalo General Hospital from 1991 to 1996 inclusive were reviewed. Inpatient medical records of 67 patients who were identified as having PE as the primary or major cause of death then were analyzed. ResultsThirty patients (45% [95% confidence interval, 33 to 57%]) had received a diagnosis of PE prior to death, which was marginally higher than the number previously reported (p < 0.05). The diagnosis of PE was significantly lower (13%; p < 0.01) in patients with COPD or coronary artery disease (33%; p < 0.01). In contrast to the prospective investigation of PE diagnosis data, only a minority of patients (6%) presented with pleuritic pain or hemoptysis, while a significantly larger proportion (24%; p < 0.01) of our patients experienced circulatory collapse. Only 55% were identified as having PE from the following clinical syndromes of PE: isolated dyspnea; pleuritic pain and/or hemoptysis; and circulatory collapse. Among the 30 patients suspected of having PE, only 14 (47%) received IV heparin in therapeutic doses, despite clinical suspicion. ConclusionOur results show a modest increase in the correct antemortem diagnosis of fatal PE. The current clinical syndromes used as markers for suspecting PE are not sufficient to detect patients who ultimately die of PE. Physicians should maintain a higher index of suspicion since fatal PE does not always present as one of the three clinical syndromes of PE. Once PE is suspected, heparin therapy should be started early.

Expression of p27Kip1 and bcl-2, cigarette smoking, and colorectal cancer risk

Although a positive association between cigarette smoking and colorectal adenoma development is consistently found, the association with colorectal cancer remains controversial. We evaluated the potential roles of p27Kip1 and bcl-2 protein expressions in conjunction with cigarette smoking exposure and colorectal cancer risk in a hospital-based case-control study. A total of 163 colorectal cancer patients from Roswell Park Cancer Institute and Buffalo General Hospital and 326 healthy controls responded to a standardized questionnaire on colorectal cancer risk factors including detailed information on their history of cigarette smoking; 110 of the patients' tumours were available for immunohistochemical analysis of p27Kip1 and bcl-2 protein overexpression. An avidin-biotin immunoperoxidase procedure was used to determine expression after incubation with mouse monoclonal p27Kip1 and mouse monoclonal bcl-2 antibodies, respectively. A statistically significant trend for total pack-years of smoking was found when p27Kip1 positive cases were compared with p27Kip1 negative cases (trend test, p = 0.007). Although a weak inverse association was observed with smoking exposure among p27Kip1 negative tumour cases in comparison to controls, a significant dose-response association was seen with p27Kip1 positive tumours. The relative risk of developing a p27Kip1 positive tumour was estimated to be 1.17 (95% CI 0.54-2.54) for those with less than 20 pack-years, 1.95 (95 % CI 0.95-3.97) for those with 20-39 pack-years, and 2.25 (95% CI 1.14-4.45) for those with greater than 39 pack-years of smoking exposure (trend test, p = 0.009) when compared with controls. When cases with bcl-2 expression were compared with cases without bcl-2 expression, suggestion of a trend was also observed with pack-years smoked (trend test, p = 0.09). In our study of 110 patients with sporadic colorectal cancer and 326 controls, we observed differences in associations between cigarette smoking and expressions in p27Kip1 and bcl-2. Our data suggest that bcl-2 overexpression (or a bcl-2 dependent pathway) is associated with cigarette smoking in the development of colorectal cancer, whereas a loss of p27Kip1 expression is not. These associations indicate that there is aetiological heterogeneity in colorectal cancer development, and that they can indirectly allude to where these changes in protein expression occur in the adenoma-carcinoma sequence (i.e. early versus late events).

Introduction

Introduction

Necrotizing pancreatitis.

Abstract There is no single diagnostic test available to confirm the need to operate on a patient with sterile pancreatic necrosis. How should the surgeon decide whether a patient needs surgery? After debridement should the abdomen be closed, drained, lavaged or left open? Professor Bradley of Buffalo General Hospital replies.

The Empty Cradle: Infertility in America From Colonial Times to the Present

'This 1883 photo shows Matthew D. Mann, professor of obstetrics and gynecology, at right, performing surgery in the first operating room in Buffalo equipped with electric lights. Buffalo General Hospital was one of the first buildings in town to be electrified. Courtesy Buffalo General Hospital Archives." From<i>Another Era: A Pictorial History of the School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 1846-1996</i>, by Ronald Elmer Batt, Harold Brody, Shonnie Finnegan, et al, 192 pp, with illus, $39.95, ISBM 0-89865-963-9, Buffalo, NY, SUNY Buffalo, School of Medicine (716-829-2775), 1996; reproduced by permission. Portrait of William Scott, MD, professor of anatomy 1856-1883. From<i>McGill Medicine, vol 1: The First Half Century 1829-1885</i>, by Joseph Hanaway and Richard Cruess, 219 pp, with illus, $45, ISBN 0-7735-1324-8, Montreal, Quebec, Canada, McGill-Queen's University Press, 1996; reproduced by permission of the publisher. The volumes in my medical library interest me

Oral contraceptive effects on methylprednisolone pharmacokinetics and pharmacodynamics*

Oral contraceptive (OC) steroids alter the disposition of numerous drugs, including corticosteroids. We investigated the pharmacokinetics and pharmacodynamics of methylprednisolone. Twelve women (six women used OC steroids and six women did not) received intravenous methylprednisolone (0.6 mg/kg ideal body weight). Methylprednisolone disposition was assessed from plasma concentrations. Pharmacodynamic parameters measured were plasma cortisol, whole blood histamine (reflecting basophils), and blood helper T lymphocytes. Methylprednisolone clearance was significantly decreased in the women who used OC steroids (0.298 versus 0.447 L/hr/kg), resulting in a longer elimination half-life (2.20 versus 1.72 hours). With use of indirect response models, significant differences were observed with the cortisol and basophil responses. A larger value for the concentration that inhibits the zero-order production rate by 50% (0.37 versus 0.11 ng/ml) was observed in the women who used OC steroids for suppression of cortisol secretion, indicating less sensitivity to the suppressive effects of methylprednisolone. Greater net suppression of basophils was observed in the users of OC steroids (area under the response curve, 694 versus 401 ng x hr/ml). No differences were observed for helper T-cell responses. OC steroids appear to inhibit methylprednisolone metabolism. However, mixed changes in several responses occur, indicating that women can probably receive similar doses of methylprednisolone irrespective of OC steroid use.

The Buffalo General Hospital

The Buffalo General Hospital