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Biomedical subjects

D Lubeck

Publications and source records attributed to D Lubeck.

10 recordsLinked to original sources
PubMed2000

Patterns of treatment of patients with prostate cancer initially managed with surveillance: results from The CaPSURE database. Cancer of the Prostate Strategic Urological Research Endeavor.

PURPOSE: We determined the demographic and clinical profile of men who elect surveillance as the initial management of prostate cancer as well as the incidence and predictors of secondary treatment of these patients. MATERIALS AND METHODS: The Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) is a national disease registry of patients with various stages and treatments of prostate cancer. Using this database of 4,458 men we identified 329 (8.2%) who elected surveillance as the initial management of prostate cancer. Patients choosing watchful waiting were compared to other CaPSURE participants using the chi-square test. The likelihood of treatment initiation in the watchful waiting group was calculated using the Kaplan-Meier method. After adjusting for patient age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage and total Gleason score the Cox proportional hazards regression model was used to determine significant predictors of treatment initiation. RESULTS: Compared with others in the database, patients on watchful waiting were more likely to be 75 years old or older (51% versus 16%, p <0.001), white (93% versus 85%, p <0.001), and have lower serum PSA (p <0.001), organ confined disease (97% versus 88%, p <0.001) and a total Gleason score of 7 or less (97% versus 88%, p <0.001). In the watchful waiting group there was a 52% likelihood of treatment initiation within 5 years of the diagnosis. Significant predictors of secondary treatment were age younger than 65 years and elevated serum PSA at diagnosis. Neither race, extraprostatic stage cT3 disease nor higher total Gleason score was a significant predictor of treatment. CONCLUSIONS: Men who elect initial watchful waiting for prostate cancer tend to be older, have lower serum PSA and more favorable disease characteristics than those who seek treatment. PSA at diagnosis is the dominant factor for predicting secondary treatment.

Aged↗
PubMed1998

Longterm health outcomes of patients with rheumatoid arthritis treated in managed care and fee-for-service practice settings.

OBJECTIVE: To compare health care utilization and longterm health outcomes among patients with rheumatoid arthritis (RA) treated in managed care and fee-for-service practice settings. METHODS: We compared levels of health care utilization, treatments, and health outcomes between 57 patients with RA treated predominantly in managed care settings and 125 patients with RA treated predominantly in fee-for-service practice settings. These patients were participants in a community based cohort study of health outcomes in RA, and had been followed prospectively for up to 13 years (mean followup 10.3 yrs). Information on physician visits, hospitalizations, diagnostic testing, treatments, and 3 measures of health status (global arthritis status, pain, functional disability measures of the Health Assessment Questionnaire) was collected using biannual mailed questionnaires. RESULTS: All measures of health care utilization were similar between the managed care and fee-for-service groups, as was the use of the major types of arthritis treatments. Average global arthritis status scores, pain scores, and functional disability scores were closely comparable in the 2 groups. Over time, global arthritis status scores and disability scores worsened in both groups, but the rates of worsening did not differ between groups. CONCLUSION: In this cohort, longterm health outcomes, as well as treatments and health care utilization, were similar among persons with RA who were treated in managed care and fee-for-service practice settings.

Adult↗
PubMed1992

Cryopreservation of rabbit and cat corneas at -18 to -24 degrees C.

A simple method of corneal cryopreservation, in which corneas were frozen at -18 to -24 degrees C, was examined. Rabbit and cat corneas were placed successively in solutions of 50% fetal calf serum in McCarey-Kaufman medium with an increasing glycerol and glucose content. They were then frozen and stored in a -20 degrees C domestic freezer. Rabbit corneas stored in this way were examined in vitro by light and scanning electron microscopy, and both rabbit and cat corneas were also assessed after orthotopic allotransplantation into adult recipient animals. Functional corneal grafts were obtained with rabbit and cat tissue that had been cryopreserved for 3-4 weeks and 1 week, respectively. Endpoint analysis (by light and scanning electron microscopy) of grafts that had survived for 50 days indicated the presence of an intact corneal endothelial monolayer. The corneal endothelium slowly degenerated as the storage time was increased. Importantly, however, the endothelium appeared to withstand the freezing and thawing processes and we conclude that it may be possible to store corneas at temperatures above -196 degrees C, without the need for complex, low-temperature cryopreservation systems.

Animals↗
PubMed1989

The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change.

Evaluation of the Arthritis Self-Management Course revealed significant positive changes in the practice of behaviors that were taught and in health outcomes. However, utilizing a variety of statistical techniques, we were able to demonstrate only weak associations between changes in behavior and changes in health status. This suggests the need to examine the mechanisms by which health education affects health status.

Aged↗
PubMed1988

Penetrating ocular injuries.

Penetrating ocular and orbital trauma present the emergency medicine physician with ongoing challenges. A suspicion of their occurrence with understanding and prompt recognition of presenting signs ultimately will give the patient the best possible visual outcome.

Corneal Injuries↗
PubMed1988

Corneal injuries.

The article on corneal injuries illustrates the means by which mechanical, chemical, and radiant energies interrupt the normal anatomy and physiology of the cornea. Methods of diagnosis and management of such problems, including those caused by contact lenses, are presented.

Burns, Chemical↗
PubMed1987

The impact of rheumatoid arthritis and osteoarthritis: the activities of patients with rheumatoid arthritis and osteoarthritis compared to controls.

We measured the impact of rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the activities of patients with these illnesses to controls matched for age, sex, and community of residence. Our results indicate that patients with RA experience more losses than controls in every domain of human activity and that patients with OA experience more losses in the performance of household chores, shopping and errands, and leisure activities. The methods described here provide a simple, reliable way to assess the impacts of illness in the same terms for all dimensions of human activity.

Activities of Daily Living↗
PubMed1985

Outcomes of self-help education for patients with arthritis.

Behavioral and health status outcomes of an unreinforced, self-help education program for arthritis patients taught by lay persons were examined in 2 ways: a 4-month randomized experiment and a 20-month longitudinal study. At 4 months, experimental subjects significantly exceeded control subjects in knowledge, recommended behaviors, and in lessened pain. These changes remained significant at 20 months. The course was inexpensive and well-accepted by patients, physicians, and other health professionals.

Adult↗
PubMedDate not supplied

Glycoconjugates, cellular differentiation, and congenital glaucoma.

Studies of congenital glaucoma have described and debated the disease process in cellular and structural terms, yet the functional aspects of the disease remain poorly understood. This paper presents an attempt to look at the disease from a different perspective: the role of glycoconjugates and their influence on morphogenesis of the corneoscleral angle. Extracellular and cell-surface complex carbohydrates and trabecular meshwork development were observed in normal C-57 BL/6J mice with light and electron microscopy. Lectin-stained fixed tissues were evaluated by fluorescein light microscopy and with computer-controlled scanning microspectrophotometry. The appearance and type of specific glycoconjugates was related to morphogenesis and differentiation, with specific reference to the development of the trabecular meshwork. Our results suggest that glycoconjugates are: (1) important in the morphogenesis of the corneoscleral angle, and (2) provide some of the required signals for the differentiation of the cells of the trabecular meshwork. These findings emphasize the possibility that a complex series of morphological and biological events in the normal development of the trabecular meshwork ultimately leads to a functionally competent trabecular meshwork, that is, capacitation.

Animals↗