Champlain Valley Physicians Hospital

The New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants' experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites.

This article describes the results of a national survey regarding the preparation of entry‐level school counseling students. The questionnaire asked counselor educators about credit hours, screening methods, previous faculty experiences in a school setting, course content, and fieldwork requirements. Survey results revealed similarities and differences among school counselor preparation programs.

Pulmonary vein stenosis (PVS) is a luminal narrowing of extrapulmonary pulmonary veins. In pediatric patients, it arises following repair of congenital heart disease, particularly anomalous pulmonary venous return; in lung disease, especially prematurity; and rarely in isolation. The etiology is unknown and the course often fatal without lung transplantation. We hypothesized that systematic clinicopathologic review of pediatric PVS could provide further pathogenic insight. We included patients who underwent first resection of pulmonary venous tissue for symptomatic PVS at our pediatric referral center from 1995 to 2014. Clinical records and hematoxylin and eosin slides were reviewed. Subsets were immunostained for smooth muscle actin, Ki-67, β-catenin, estrogen receptor, and other markers and analyzed for USP6 gene rearrangement. A total of 97 patients (57% male; median age: 6 mo) were identified. Overall, 59 (61%) had prior congenital heart disease repair, 35 involving pulmonary vein manipulation. Samples included 213 separate anatomic sites (median: 2/patient). Histologically, all showed sparsely cellular intimal expansion composed of haphazardly arranged fibroblasts with slender nuclei in myxoid matrix. This tissue merged with underlying collagen. Most samples had a variably continuous sheath of cardiomyocytes. Ancillary tests supported a reactive fibroblastic proliferation; in particular, fibroblasts showed cytoplasmic β-catenin localization, no estrogen receptor expression, and no USP6 rearrangement. At last follow-up (mean: 2.3 y), 46% of patients had died of disease. Pediatric PVS uniformly consists of a paucicellular fibrointimal proliferation, irrespective of clinical scenario. It may be best conceived of as a form of reactive hyperplasia. As with other forms of vascular remodeling, trauma (iatrogenic or occult) is likely an inciting factor. A comprehensive understanding of the surgical pathology of PVS may further inform therapeutic strategies in this lethal disease.

Abstract Anthropogenic inputs of nutrients threaten water quality around the world, causing eutrophication and altering phytoplankton communities. In freshwater systems, certain physiochemical conditions, including high TP, low TN:TP, and warm temperatures, can lead to problematic cyanobacteria blooms. Cyanobacteria can decrease phytoplankton diversity and phytoplankton diversity has been positively linked to zooplankton diversity, suggesting that cyanobacteria may have indirect negative effects on zooplankton diversity. Using monitoring data from Lake Champlain, we tested three hypotheses: (1) cyanobacteria density and phytoplankton diversity are inversely related; (2) phytoplankton diversity and zooplankton diversity are positively related; and by extension (3) cyanobacteria density and zooplankton diversity are inversely related. Relationships were investigated separately at shallow (4–15 m) and deep (25–100 m) sites using several diversity metrics. At deep sites, cyanobacteria density was only related (positively) to zooplankton Shannon diversity. At shallow sites, all three hypotheses were supported by three of four diversity metrics; low phytoplankton richness appears to be the link between high cyanobacteria density and low zooplankton diversity. Our results suggest that cyanobacteria may indirectly reduce zooplankton diversity by decreasing resource heterogeneity, although our results based on observational data were also consistent with well‐known direct pathways. Because low biodiversity can alter ecosystem processes and impair functioning, our results suggest that shallow systems may be more responsive to global change than deeper systems.

We present visible, near infrared and mm-wave observations of RCW 108, a molecular cloud complex in the Ara OB1 association that is being eroded by the energetic radiation of two O-type stars in the nearby cluster NGC 6193. The western part of the RCW108 molecular cloud, for which we derive a mass of ~8000 , contains an embedded compact HII region, IRAS 16362-4845, ionized by an aggregate of early-type stars for which we estimate a mass of ∼210 . The spectral type of the earliest star is O9, as confirmed by the visible spectrum of the compact HII region. We notice a lack of stars later than A0 in the aggregate, at least having the moderate reddenings that are common among its B-type stars, and we speculate that this might be a consequence of the extreme youth of the aggregate. We also note the existence of a dense ionized clump ( cm-3) appearing near the main ionizing star of the compact HII region. We examine the distribution of stars displaying infrared excesses projected across the molecular cloud. While many of them are located in the densest ( cm-3) area of the molecular cloud near the position of IRAS 16362-4845, we also find a group concentrating towards the edge of the cloud that faces NGC 6193, as well as some other stars beyond the edge of the molecular cloud. The intense ionizing radiation field by the O stars in NGC 6193 is a clear candidate trigger of star formation in the molecular cloud, and we suggest that the existence and arrangement of stars in this region of the molecular cloud supports a scenario in which their formation may be a consequence of this. However, infrared excess stars are also present in some areas of the opposite side of the cloud, where no obvious candidate external trigger is identified. The existence of such tracers of recent star formation scattered across the more massive molecular cloud associated with IRAS 16362-4845, and the low star formation efficiency that we derive, indicate that it is in a state to still form stars. This is in contrast to the less massive cloud (∼660 ) close to NGC 6193, which seems to be more evolved and mostly already recycled into stars, and whose internal kinematics show hints of having been perturbed by the presence of the massive stars formed out of it.

Blastomycosis was diagnosed in 6 dogs living in New York state. To our knowledge, blastomycosis has not been previously reported in dogs in this area, and maps that indicate the prevalence of blastomycosis in North America often partially or completely exclude the state of New York. Environmental characteristics implicated in previous blastomycosis outbreaks in people can be found in New York state, and this may explain how these dogs became infected. Blastomycosis develops in people as well as in dogs, and an understanding of the ecologic and clinical features of blastomycosis can help veterinarians counsel their clients in matters of public health.

An estimated 11.1 million Americans are living with cancer. Many have received chemotherapy, and a portion of patients treated with chemotherapy develop cognitive difficulties, often referred to as "chemo brain". Chemotherapy-induced cognitive impairment can impact all areas of a patient's life. Yet little education is given to patients and families regarding the potential side effect prior to initiation of cancer treatment. This is, in part, because nurses may struggle with understanding the scientific causes behind the cognitive disabilities. This article will describe hypothesized pathophysiology, signs and symptoms, and potential contributing factors of chemotherapy-induced cognitive impairment. Potential treatment strategies, including pharmacologic and nonpharmacologic interventions, also will be discussed.

AIMS: Different pacing sites and various algorithms have been utilized to prevent atrial fibrillation (AF) in pacemaker recipients. However, the optimal pacing rate settings have not yet been established. In this randomized, prospective, multicentre, single-blinded, cross over study, rate-adaptive pacing at a high base rate (BR) in patients, age 60 years or above, or a history of paroxysmal AF, who underwent dual-chamber (DDD) pacemaker implantation for standard pacing indications, was evaluated for prevention of AF. METHODS AND RESULTS: In the study cohort of 145 patients implanted with DDD pacemakers with a programmable rest rate (RR) feature, the BR/RR settings were sequentially but randomly adjusted as follows: 60 bpm/Off for the baseline quarter (initial 3 months) and then to either 'A-B-C' or 'C-B-A' settings (A = 70/65 bpm, B = 70/Off, C = 80/65 bpm) for the subsequent quarters each of 3 months duration. Data on automatic mode switch episodes, device diagnostics, and a questionnaire evaluating pacemaker awareness and palpitations were collected. Ninety-nine patients, mean age 77 +/- 10 years, who completed the study protocol and followed for 12 months did not show significant differences in the number of mode switch episodes between any settings used. The percentage of atrial pacing was lower during baseline pacing compared to settings A, B, and C (P < 0.0001). Setting C produced a higher percentage of atrial pacing than A and B (P < 0.01). Although a higher percentage of atrial pacing correlated with a lower incidence of mode switch episodes, there was no statistically significant difference in the number of mode switch episodes between settings A, B, and C. There were no significant differences in the questionnaire scores relating to pacemaker awareness or palpitation. CONCLUSION: Overdrive single-site pacing in the right atrium achieved by programming analysed settings in the present study did not reduce AF as assessed by mode switch episodes. Additionally, no change in the symptoms of arrhythmia or awareness of pacing was seen.

BACKGROUND: Family history is important for identifying candidates for high risk cancer screening and referral for genetic counseling. We sought to determine the percentage of individuals who would be eligible for high risk cancer screening or genetic referral and testing if family history includes an extended (vs limited) family history. METHODS: Family histories were obtained from 626 women at UVMMC associated mammography centers from 2001 to 2002. ACS guidelines were used to determine eligibility for high risk breast or colon cancer screening. Eligibility for referral for genetic counseling for hereditary breast and colon cancer was determined using the Referral Screening Tool and Amsterdam II screening criteria, respectively. All family histories were assessed for eligibility by a limited history (first degree relatives only) and extended history (first and second degree relatives). RESULTS: Four hundred ninety-nine histories were eligible for review. 18/282 (3.6 %) and 62/123 (12 %) individuals met criteria for high risk breast and colon cancer screening, respectively. 13/18 (72 %) in the high risk breast cancer screening group and 12/62 (19 %) in the high risk colon cancer screening group met criteria based upon an extended family history. 9/282 (1.8 %) and 31/123 (6.2 %) individuals met criteria for genetic counseling referral and testing for breast and colon cancer, respectively. 2/9 (22 %) of individuals in the genetic breast cancer screening group and 21/31 (68 %) individuals in the genetic colon cancer screening group met criteria based upon extended family history. CONCLUSIONS: This is one of the first studies to suggest that first degree family history alone is not adequate for identification of candidates for high risk screening and referral for genetic counseling for hereditary breast and colon cancer syndromes. A larger population is needed to further validate this data.

Background: Candida dubliniensis is closely related to Candida albicans and rarely isolated in clinical specimens. C. dubliniensis is increasingly recognized as a pathogen in immunocompromised hosts. We present the third known case of Candida dubliniensis meningitis in a young immunocompetent host. Case Presentation: A 27-year-old female with a history of intravenous heroin use and chronic hepatitis C presented with a 10-month history of headaches and progressive bilateral vision loss. On physical examination, visual acuity was 20/20 in her right eye and grade II papilledema was noted. Examination of her left eye revealed complete loss of vision and grade IV papilledema. An MRI with and without contrast revealed increased leptomeningeal enhancement involving the posterior fossa and spinal cord. After multiple lumbar punctures, cerebrospinal fluid fungal cultures grew Candida dubliniensis . The patient was successfully treated with a combination of liposomal amphotericin and fluconazole for 6 weeks with complete resolution of her CNS symptoms, with the exception of irreversible vision loss. Conclusion: We report a case of chronic meningitis due to Candida dubliniensis in an immunocompetent woman with hepatitis C and a history of intravenous heroin use. Additional studies are needed to confirm risk factors for Candida dubliniensis colonization, which likely predisposes individuals to invasive candidiasis.

Desipramine, an active metabolite of imipramine, was administered to 129 patients with severe depressive disorders. The majority had a history of 1 to 4 depressive attacks. In most cases, the drug was given for 2 to 4 months in daily doses of 75 or 100 mg. (i.m.) for a few days, followed by 100 to 150 mg. orally, thereafter. Tranquilizers were given concurrently as required to control agitation, anxiety or insomnia. Desipramine produced a satisfactory clinical response in 99 (76.4%) patients. Compared to imipramine, used in previous studies, the new drug seems to be slightly more potent on a dose-size basis; it has a faster onset of action, evident in 2 to 7 days, and side effects appear to be milder and of shorter duration. Because of its rapid onset of action and mild side effects, desipramine may prove particularly useful in reducing the need for prolonged hospitalization in severe depressive conditions.

Psychiatric consultation services are still inadequate and their usefulness still unrecognized. They seem more numerous and more sophisticated in those countries where the supply of psychiatrists is more satisfactory, where general hospitals have psychiatric services, where psychosomatic orientation exists, and where planning for services is more experimental than empirical. Psychiatric consultation service should be rendered by specially trained personnel working in a special service. The psychiatrists rendering such service must be eclectic and possess a satisfactory knowledge of other medical subjects. The consultations must supply instruction about referred cases, so that the knowledge acquired will help in the future management of such cases.

Consultation psychiatry, an outgrowth of the tenets of psychosomatic medicine that followed the departure from mental-hospital psychiatry to the general-hospital-based psychiatric units, is similar to those consultation services in other specialties available on medical-surgical wards. Its primary aim is to interpret the psychosocial phenomena of health and illness and to redirect the physician from disease- to patient-orientation and to a comprehensive approach. Its functions are diagnostic-therapeutic, instructional and research directed. The psychosomatic orientation is a sine qua non in the understanding of the psychosocial meaning of physical illness, its effect on psychic disability, the psychosocial adjustment of the patient and his family and his ability to adapt to illness and the hospital. An essential feature is the evaluation of the doctor-patient relationship, especially when severe illness requires serious interventions, including the consultation and its reciprocal effect upon the doctor-patient relationship. Liaison activity consists of interpretive-therapeutic mediation between the patient and the therapeutic team when strain endangers their satisfactory cooperation. The therapeutic activity must be short-term and so construed as not to interfere with the primary treatment. The instructional aspect is for the sake of the usual recipients of the service, as well as residents and students. Teaching the interview techniques, especially to students, should demonstrate the holistic approach, comprehensive diagnosis and the need of avoiding orthodox one-sidedness. This paper reviews briefly the scope and role of consultation psychiatry, compares its North American model with its status elsewhere and explores the resistances to it.

botfly larvae in a man from northern New York with no tropical travel. The authors discuss the epidemiology, life-cycle, and diagnosis of non-tropical botfly infection.

BACKGROUND: Cardiac perforation with tamponade is an infrequent occurrence during an electrophysiologic procedure. The customary approach to management includes volume resuscitation followed by pericardiocentesis. Such a procedure, however, is not without its own risk, especially when performed emergently. We hypothesized that some patients experiencing this type of complication can be managed successfully in a conservative fashion, without the need for an additional invasive procedure. METHODS: We retrospectively analyzed the clinical outcomes and echocardiographic features of 33 consecutive patients who experienced this complication during cardiac electrophysiology (EP) procedures performed at our institution from 1988 to 2007. Nineteen patients (58%) were managed conservatively with intravenous fluids and vasopressors (Group A). Fourteen patients (42%) were managed invasively with pericardiocentesis (Group B). RESULTS: The mean systolic blood pressure at diagnosis did not differ between the two groups (64 vs 71 mmHg, P = 0.134). The mean lengths of hospitalization (4.7 vs 4.9 days, P = 0.75) and survival to hospital discharge (100% in both groups) were also similar. A large pericardial effusion (>or=2 cm) was seen predominantly among Group B patients. There was a statistically significant temporal trend toward managing this type of complication invasively (P = 0.038). CONCLUSION: Among patients who experience cardiac perforation as an acute complication of EP procedure, there appears to be a role for conservative management in a subset of patients who do not have echocardiographic evidence of a large effusion and who respond well to initial stabilizing measures consisting of fluids and vasopressors.

The Hospital Library Caucus of the Medical Library Association (MLA) follows the practice established in 1953 of developing quality indicators and best practices in the newly developing and fast-changing world of hospital libraries. As these libraries increased in number and prominence, the Joint Commission on the Accreditation of Hospitals (JCAHO) included in 1978 a hospital library standard developed in collaboration with MLA. Subsequent changes in JCAHO, then The Joint Commission (TJC) knowledge management criteria as well as technological changes in the curation and delivery of evidence-based resources influenced standards changes over the years. The 2022 standards mark the most recent edition, replacing the 2007 standards.

An epidemiological survey was carried out in Montreal (Canada). Plattsburgh (USA) and Lodz (Poland) to test the hypothesis that certain psychosomatic disorders show a low lifetime prevalence in schizophrenic patients (total n = 665). The same method for collection and evaluation of demographic and clinical data was used in order to establish the lifetime prevalence of peptic ulcer (PU), bronchial asthma (BA), neurodermatitis (ND) and rheumatoid arthritis (RA) in the patients as well as in their nuclear families. Low values of lifetime prevalence were found in schizophrenic patients in chronic hospitals as compared with those in general-university hospitals. Similarities were found in age- and sex-related patterns of these psychosomatic disorders in both samples. However, PU showed higher prevalence, and BA, ND and RA showed lower prevalence in the Polish sample.

To the Editor: The recently published ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery (1) provides an algorithm that can easily be followed in the decision-making process when presented with a patient possibly requiring further cardiac workup. I would like to offer an alternative to this algorithm that utilizes the same thought process, but is easier to memorize. As with the algorithm, three assignments have to be made: clinical predictors (Table 1), functional capacity, and surgical risk (Table 2).Table 1: Clinical PredictorsTable 2: Surgery-Specific RiskEach patient then gets a point score from each of the three columns in Table 3. The total score for the three columns is added. A point score of 4 or more would suggest the need for further cardiac evaluation. A patient with 3 points or fewer could proceed safely to the operating room.Table 3: Point Score SummaryThis table is best understood in the context of the referenced article, which should be read. The principle advantage of Table 3 is that it is easily memorized. David K. Stinson, MD

1. Through a community based program, nurses were hired by a rural medical center to facilitate care for injured workers in the community. This placed the nurses outside the industrial and insurance arenas. 2. Rapid access to care and expedited return to work were made possible largely through improved communication, facilitated by the nurse case coordinators, among all involved parties (i.e., workers, employers, health care providers, insurance carriers). 3. The program provides access to occupational health nurses, or case managers, to a large number of rural workers--many of whom work for small employers and would not have these services otherwise. 4. The simple administrative model has resulted in increased numbers of workers returning to work with decreasing numbers of transitional or modified duty days.

Letters1 February 1992Postmenopausal Estrogen and Prevention BiasMaryann NapoliMaryann NapoliSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-3-268_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: When citing the improved prognosis for breast cancer among estrogen-treated women, Barrett-Connor (1) offers the plausible explanation that their cancers were diagnosed earlier, presumably due to increased surveillance. I offer another plausible explanation: The increased incidence of breast cancer among estrogen-treated women is falsely inflated by overdiagnosis. The increased rate of breast cancer (and absence of an increased death rate) among these women may be caused by the more frequent diagnosis of noninvasive lesions, 75% of which would not have progressed to malignant disease if left untreated (2).Women who use estrogen have a higher rate of...References1. Barrett-Connor E. Postmenopausal estrogen and prevention bias. Ann Intern Med. 1991;115:455-6. LinkGoogle Scholar2. Physicians Data Query. Database of the National Cancer Institute. Bethesda, Maryland; 1991. Google Scholar3. Dupont W. Estrogen replacement therapy and the risk of breast cancer. JAMA. 1991;265:1824. CrossrefMedlineGoogle Scholar4. RiesHankeyMillerHartmanEdwards LBBAB. Cancer statistics review: 1973-1988. National Cancer Institute, NIH Pub. no. 91-2789, 1991. Google Scholar5. KetchamMoffat AF. Vexed surgeons, perplexed patients, and breast cancers which may not be cancer. Cancer. 1990;65:378-83. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Center for Medical Consumers New York, NY 10012 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHORMONE REPLACEMENT THERAPY AND RISK FOR BREAST CANCER 1 February 1992Volume 116, Issue 3Page: 268-268KeywordsBreast cancerCancer preventionDeath ratesEstrogensLesions Issue Published: 1 February 1992 PDF DownloadLoading ...