PubMed Health⌕ Search

Biomedical subjects

D G Federman

Publications and source records attributed to D G Federman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Skin cancer screening in primary care: prevalence and barriers.

BACKGROUND: Skin cancer incidence is increasing, but whether primary care providers routinely screen for skin cancer is not known. OBJECTIVE: We assessed whether primary care practitioners are performing skin cancer screening within the context of primary care and whether barriers exist that might act as impediments to the implementation of this practice. METHODS: A total of 465 primary care providers belonging to their respective county medical societies in either New Haven County, Connecticut, or Miami-Dade County, Florida were randomly selected and surveyed by mailed questionnaire regarding their skin cancer screening practices. RESULTS: Only 31% of responding physicians reported performing skin cancer screening on all of their adult patients. Of those not performing skin cancer screening on all adult patients, only 31% report performing screening on high-risk patients. Almost half of physicians reported that they do not perform skin cancer screening. We found that physicians' lack of confidence in identifying suspect lesions was a common barrier. Fear of patient embarrassment, inadequate lighting, or lack of studies demonstrating mortality benefits were not frequent deterrents. Furthermore, there was no statistical difference in screening rates between the more northern latitude and the more southern latitude. CONCLUSION: Skin cancer screening is not being performed within the context of primary care visits. Barriers exist that may impede skin cancer screening.

Adult↗
PubMed1998

Video display terminals: risk of electromagnetic radiation.

BACKGROUND: Technologic advances have led to increased use of computers at home and in the workplace. It is estimated that more than 100 million workers in the United States and Canada will be using computers daily by the year 2000. Anecdotal reports have suggested a link between video display terminals (VDTs) and disease. This has generated much concern about whether electromagnetic radiation (EMR) emitted by VDTs cause illness among users. METHODS: We reviewed pertinent articles in the literature. RESULTS: Several studies have addressed the role of VDTs in disease causation, specifically whether EMR causes skin or ocular disease or obstetric complications. The data reviewed were inconsistent or methodically flawed. Therefore, a definitive conclusion cannot be drawn to support the hypothesis that EMR produced by VDTs causes disease. CONCLUSIONS: We believe continued research should be done to further define and elucidate the risk of EMR produced by VDTs.

Computer Terminals↗
PubMed1998

The rationale for skin cancer screening and prevention.

Skin cancer, the most common malignancy in the United States, accounts for considerable morbidity and mortality. Efforts at lessening the burden of this disease are possible through both primary and secondary prevention, although some barriers may detract from the ability of primary care physicians to perform skin cancer screening. Public education combined with increased vigilance by physicians and other health professionals may significantly alter the morbidity and mortality associated with this disease entity.

Europe↗
PubMed1998

The ethical dilemma of population-based medical decision making.

Over the past several years, there has been a growing interest in population-based medicine. Some elements in healthcare have used population-based medicine as a technique to decrease healthcare expenditures. However, in their daily practice of medicine, physicians must grapple with the question of whether they incorporate population-based medicine when making decisions for an individual patient. They therefore may encounter an ethical dilemma. Physicians must remember that the physician-patient relationship is of paramount importance and that even well-conducted research may not be applicable to an individual patient.

Community Health Planning↗
PubMed1998

Epidemiology of peripheral vascular disease: a predictor of systemic vascular disease.

It is estimated that peripheral vascular disease (PVD) affects 30 percent of the adult population, and two-thirds of all cases are asymptomatic. Detecting PVD can be relatively easy and inexpensive, and based either on subjectively supplied historical information (claudication) or upon physical examination findings [ankle-brachial index (ABI)]. The ABI may serve as a marker for increased risk for systemic vascular disease as an abnormally low ABI has been shown to be associated with systemic vascular disease. Epidemiology of and risk factors for PVD are in similar to coronary heart disease. PVD is uncommon until middle age and then increases dramatically. Prevalence of PVD is slightly higher in men than women, yet this tends to diminish with age. Cigarette smoking is probably the most important risk factor for PVD. Hypertension, hypercholesterolemia, and diabetes are also risk factors for the development of symptomatic PVD. Conversely, the presence of a high degree of physical activity and higher levels of HDL-cholesterol as well as a lower body mass index (BMI) are protective. Patients who have vascular disease in one organ system often exhibit evidence of vascular disease elsewhere. Presence of coronary artery disease among patients with symptomatic PVD is between two and four times higher than those without PVD, and PVD is also associated with cerebrovascular disease.

Adult↗
PubMed1997

Chemotherapy-induced myocardial necrosis in a patient with chronic lymphocytic leukemia.

Cardiac toxicity following the administration of chemotherapeutic agents is well documented. Vinca alkaloids, as well as high-dose cyclophosphamide, have been associated with myocardial ischemia. The present report describes a case of acute myocardial infarction occurring in a patient with no antecedent cardiac history who received both vincristine and conventional chemotherapeutic doses of cyclophosphamide for the treatment of chronic lymphocytic leukemia. Physicians should possess a heightened awareness of this potentially serious complication.

Aged↗
PubMed1997

Cutaneous clues to systemic disease.

Scleroderma, psoriasis, lichen planus, and other skin disorders may signal a more serious internal disease. Physicians who recognize such clues can initiate early treatment while disease is in its early stages. The authors of this article describe several of the more common dermatologic conditions linked to systemic disease, including connective tissue, inflammatory, immunobullous, and infectious diseases.

Acute Disease↗
PubMed1997

The abilities of primary care physicians in dermatology: implications for quality of care.

Quality of care in medicine has become an increasingly important issue as the nature of healthcare delivery has changed. Many managed care systems rely on the primary care physician to serve as a gatekeeper, thereby limiting access to specialist care. Controversy has arisen regarding the abilities of primary care physicians in one such specialty: dermatology. We reviewed the many studies conducted in the United States evaluating primary care physicians' abilities in dermatology. Despite inherent flaws in many of the studies, one can conclude that primary care providers are inferior to dermatologists in the diagnosis and treatment of skin disease. Whether these process-based data predict outcome is not known.

Clinical Competence↗
PubMed1997

Pica: are you hungry for the facts?

Pica, the persistent and compulsive ingestion of particular food items or nonnutritive substances, has been associated with iron deficiency, zinc deficiency, geophagia, mental deficiency, developmental delay, and a family history of pica. Nutritional, sensory physiologic, psychosocial, and cultural theories have been advanced to explain this phenomenon, but the etiology of pica is poorly understood. Pica, secondary to iron deficiency, is relatively common and remits after iron therapy. Complications of pica include abdominal problems (sometimes necessitating surgery), lead poisoning, hypokalemia, hyperkalemia, mercury poisoning, phosphorus intoxication, and dental injury. Pica is an underdiagnosed problem that can be caused by a variety of disorders and can lead to serious complications.

Adult↗
PubMed1997

Screening for skin cancer in primary care settings.

OBJECTIVE: To estimate the frequency of recorded screening for skin cancer in primary care settings. DESIGN: Retrospective observational cohort study. SETTING: Two academically affiliated Department of Veterans Affairs Medical Centers. SUBJECTS: Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics. MAIN OUTCOME MEASURE: Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period. METHODS: Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits. RESULTS: Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination. CONCLUSION: Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.

Aged↗