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Biomedical subjects

Daniel G Federman

Publications and source records attributed to Daniel G Federman.

At least 19 recordsLinked to original sources
PubMed2006

Full-body skin examinations and the female veteran: prevalence and perspective.

OBJECTIVES: To determine the frequency of full-body skin examinations (FBSEs) among female veterans and to determine whether patient risk factors for skin cancer alter the frequency of screening. Subjects were also queried as to attitudes about FBSE. DESIGN: Questionnaires pertaining to whether patients underwent regular FBSE, their opinions and attitudes about this screening test, and their risks for developing skin cancer. SETTING: A primary health care clinic for female veterans at a Veterans Affairs medical center. PARTICIPANTS: A convenience sample of 245 patients awaiting clinic appointments. Of those asked to participate, 201 agreed, for a participation rate of 82%. MAIN OUTCOME MEASURES: Patient report of undergoing FBSE, attitudes regarding FBSE, and risk factors for cutaneous malignancy. RESULTS: Eighteen percent of all respondents reported undergoing regular FBSE by their primary care provider, whereas 9 (45%) of the 20 with a history of skin cancer reported undergoing FBSE. Fifteen percent of subjects reported embarrassment with FBSE. Seventy-nine percent reported that their primary care provider would be considered thorough by performing FBSE, and 69% would like their primary care provider to perform FBSE regularly. We found that 16% of subjects would refuse the examination if the primary care provider were of the opposite sex, whereas 38% would not refuse but be less willing to be examined. CONCLUSIONS: Female veterans report a low incidence of FBSE, although those with a personal history of skin cancer are more likely to undergo screening. Despite embarrassment expressed about a sex difference between the patient and examiner, female veterans have a strong preference to undergo FBSE.

Adult↗
PubMed2006

Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease.

BACKGROUND: Patients with peripheral arterial disease (PAD) have increased mortality compared with patients without PAD. Coronary artery disease (CAD) accounts for almost 75% of deaths in PAD patients. Studies suggest that PAD is underdiagnosed and atherosclerotic risk factors undertreated when compared with CAD. OBJECTIVE: To determine whether cholesterol guidelines are being met in patients with PAD and to determine whether any independent factors increase the likelihood of reaching goal low-density lipoprotein (LDL). DESIGN: A retrospective chart review of subjects diagnosed with PAD in 2001 at 2 Veterans Affairs Medical Centers. MEASUREMENTS: Univariate analysis compares baseline characteristics between those reaching goal and those who do not. Multivariate logistic regression analysis identified predictors of meeting LDL goal among PAD patients. RESULTS: Of 315 patients, 62% reached goal LDL. Those more likely to reach goal were older, had hypertension, and a history of CAD and stroke. Positive predictors of LDL goal were age and CAD, while smoking was a negative predictor. CONCLUSION: The majority of veterans with PAD received lipid-lowering medication and achieve goal LDL, but they are more likely to do so if they are older than 70 and have a history of CAD.

Aged↗
PubMed2006

The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer.

BACKGROUND: Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO). METHODS: We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001. RESULTS: Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer. CONCLUSIONS: Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.

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PubMed2006

Plasmablastic lymphoma presenting as an arm mass in an individual negative for human immunodeficiency virus: a case report.

Plasmablastic lymphoma is an aggressive diffuse large B-cell lymphoma classically arising in the oral cavities and jaws of individuals infected with the human immunodeficiency virus (HIV). More recently, cases of plasmablastic lymphoma have been identified in individuals negative for HIV. We report a case of plasmablastic lymphoma presenting as a rapidly expanding upper extremity mass in a 66-year-old individual negative for HIV. Aggressive multiple-agent chemotherapy resulted in a dramatic improvement of all symptoms. Increasing awareness of plasmablastic lymphoma in individuals who are HIV negative can allow for a better understanding of its clinical course and for specific chemotherapeutic regimens to be developed.

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PubMed2005

The association of Medicare health care delivery systems with stage at diagnosis and survival for patients with melanoma.

OBJECTIVE: To evaluate differences in the stage at diagnosis and survival for melanoma between the 2 most common types of Medicare health care delivery systems, fee-for-service (FFS) and managed care (health maintenance organizations [HMOs]), in the United States during the period from January 1, 1985, through December 31, 1994. DESIGN: We used a linkage of 2 national databases, ie, the Medicare database from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the National Cancer Institute Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival for melanoma between the HMO and FFS groups. Patients A population of 4608 patients (62% men; 92% white). RESULTS: We found an earlier stage of diagnosis for the HMO group compared with the FFS group for melanoma as the first cancer diagnosis, but this did not persist when melanoma was the second or a later cancer diagnosis. For patients with melanoma as the first cancer diagnosis, improved survival was related to earlier stage at diagnosis. CONCLUSIONS: Differences exist in stage at diagnosis between patients in HMOs compared with those in FFS health care plans. This is likely due in part to utilization of services or access to care for patients in HMOs, and may be similar to that of patients in FFS plans with a previous cancer diagnosis before their diagnosis of melanoma. We did not find an increased risk of diagnosis with a late-stage cancer among patients with vs those without a previous cancer diagnosis. Improved survival appears to be related to earlier stage at diagnosis.

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PubMed2005

Toxoplasmosis in pregnancy.

Pregnant women who acquire infection from Toxoplasma gondii usually remain asymptomatic, although they can still transmit the infection to their fetuses with severe consequences. Given the asymptomatic nature of most Toxoplasma infections, primary prevention in pregnant women may lower the risk of congenital toxoplasmosis. Both consumption of undercooked meat and unprotected contact with soil are independent risk factors for T. gondii seroconversion during pregnancy, while contact with cat litter may pose a risk in certain situations. However, many pregnant women lack knowledge of these risk factors. This article reviews toxoplasmosis infection in pregnancy, with an emphasis on risk factors and appropriate counseling of pregnant women.

Animals↗
PubMed2005

Prevention of toxoplasmosis in pregnancy: knowledge of risk factors.

BACKGROUND: Infection with Toxoplasma gondii is common and usually asymptomatic, although it can have catastrophic consequences in a pregnant woman if passed to her developing fetus. Counseling of pregnant women about risk factor reduction may reduce the risk of congenital toxoplasmosis. This study was undertaken to assess and compare the knowledge of obstetricians and internists or family practitioners regarding well-established risk factors for toxoplasmosis infection. METHODS: The study surveyed 102 obstetricians, internists and family practitioners to assess their knowledge of risk factors for toxoplasmosis infection as well as their practices for primary prevention counseling of pregnant women. Responses were analyzed for differences. RESULTS: Obstetricians were more likely than internists or family practitioners to provide appropriate counseling on reducing the two most common risk factors for toxoplasmosis infection (undercooked meat consumption and gardening without gloves). However, over one quarter of all participants inappropriately advised pregnant women to avoid all cat contact. Obstetricians, internists and family practitioners were all likely to fail to identify undercooked meat consumption as the primary risk factor for toxoplasmosis transmission. CONCLUSIONS: Obstetricians appear to provide more appropriate counseling for primary prevention of toxoplasmosis than internists and family practitioners, but both groups of physicians inappropriately advised avoidance of all cat contact. Education of obstetricians, internists and family practitioners on risk factors for toxoplasmosis transmission is needed and may lower the rate of congenital toxoplasmosis as well as decrease the frequency of cat abandonment during pregnancy.

Animals↗
PubMed2005

Use of cyclooxygenase inhibitors and risk of melanoma in high-risk patients.

BACKGROUND: Results from in vitro and animal studies suggest that cyclooxygenase (COX) inhibitors may reduce the risk of melanoma, but among humans, the evidence remains limited. OBJECTIVE: In a pilot retrospective cohort, to determine the relationship between the use of COX inhibitors and the incidence, recurrence, and metastases of melanoma in high-risk patients. METHODS: Reviewing computerized records at the Miami Veterans Affairs Medical Center, we retrospectively examined the association between COX inhibitor use and melanoma incidence, recurrence, and metastases in high-risk subjects: white subjects previously diagnosed with melanoma (1996-2003). We evaluated three potential outcomes: new melanoma diagnosis, recurrence of a previous melanoma, and melanoma metastasis. RESULTS: Eighty-three subjects with melanoma were included. There was one metastasis among 28 subjects prescribed COX inhibitors, whereas four new melanomas (7.3%), two melanoma recurrences, and six metastases (10.9%) occurred among 55 patients not prescribed COX inhibitors. Although no individual outcomes measures reached statistical significance, combining the three measures, these were significantly lower in users of COX inhibitors compared with nonusers (1 vs 12; p = .05). After adjustment for age and tumor depth of invasion, COX inhibitor users had significantly lower rates of melanoma outcome measures (odds ratio 0.08; 95% confidence interval 0.01-0.77; p = .03). CONCLUSION: Potential exists for chemoprevention of melanoma among high-risk patients.

Aged↗
PubMed2005

The effect of Medicare health care systems on women with breast and cervical cancer.

OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 national databases: the Medicare database from the Centers for Medicare and Medicaid Services and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database to evaluate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

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PubMed2005

Skin cancer and non-Hodgkin's lymphoma: examining the link.

BACKGROUND: The incidence rates of melanoma and non-Hodgkin's lymphoma (NHL) have increased substantially worldwide over the past several decades. It has been hypothesized that ultraviolet light exposure through sunlight may be a common environmental risk factor shared by both skin cancer and NHL. OBJECTIVE: The purpose of this study was to better understand the association between skin cancer and NHL and to evaluate its implication in clinical practice. METHODS: We reviewed the current literature on the link between the two malignancies and on the role of ultraviolet light in the development of NHL. Publications were selected using a PUBMED search with the terms "non-Hodgkin's lymphoma" and "skin cancer." Epidemiologic studies in English and published after 1995 were the focus. CONCLUSIONS: Large population-based studies support an increased risk of subsequent NHL among patients with skin cancers (both melanoma and nonmelanoma skin cancers) and a risk of skin cancer development in patients with NHL, although support for a direct relationship between ultraviolet light and the incidence of NHL is weak and inconsistent. Given their increased risk of developing skin cancers, patients with a history of NHL may benefit from a full-body examination during their visits.

Humans↗
PubMed2005

Accuracy and predictors of basal cell carcinoma diagnosis.

BACKGROUND: Basal cell carcinoma (BCC) is the most common cancer in the United States. Therefore, prospective assessment of dermatologists' acumen in diagnosing BCC is important but, unfortunately, is lacking. OBJECTIVE. We sought to determine the positive predictive value (PPV) for clinically diagnosing BCC based on how confident the physician is of the diagnosis. We also sought to determine which clinical and historical factors most influence a dermatologist's perception that a tumor is a BCC and to determine which factors are correlated with a lesion being a BCC. METHODS: Dermatology attending faculty at the University of Miami performing biopsies on their patients in whom BCC was a consideration were asked to complete a questionnaire. They recorded how confident they were of their clinical diagnosis of BCC. They also recorded various clinical and historical factors about the patients and the lesions biopsied. RESULTS: The PPV for clinically diagnosing BCC when the clinician was most confident was 80%. Age (> 64 years) and the presence of pigmentation, telangiectasias, and a pearly border were statistically associated with a greater confidence level and a histologic diagnosis of BCC. Sunscreen use was associated with fewer diagnoses of BCCs. CONCLUSION: This is the first study to determine a relevant PPV for the clinical diagnosis of BCC because the PPV was based on clinical confidence level. These results highlight the role of diagnostic biopsies, could improve patient referral, and may help increase the PPV in the future.

Adult↗
PubMed2005

Whittling away at obesity and overweight. Small lifestyle changes can have the biggest impact.

The epidemic of obesity in the United States has spread at such an alarming rate over the last decade that most adults are now overweight or obese. The association of obesity with mortality and a broad range of significant medical comorbidities portends staggering healthcare, social, and economic costs. Treatment should be directed at the fundamental imbalance between energy intake and expenditure in the context of an environment that increasingly favors excess weight. Therefore, treatment plans need to address the multiple factors that contribute to obesity, including high-calorie diets, sedentary lifestyles, and weight-sustaining behaviors. Primary care physicians would do well to focus on helping willing patients make small changes motivated more by health promotion and fitness than by weight loss.

Appetite Depressants↗
PubMed2005

Update in thrombosis: answers to perplexing questions.

Recent clinical trials are answering some of the perplexing clinical questions about venous thromboembolism (VTE), such as the length and intensity of anticoagulation needed to prevent recurrence. We review some of these clinical trials and their implications for physicians and patients.

Anticoagulants↗
PubMed2005

Lipid-lowering therapy in patients with peripheral arterial disease: are guidelines being met?

OBJECTIVES: To determine the proportion of patients with lower extremity peripheral arterial disease (PAD) who reach recommended low-density lipoprotein cholesterol (LDL-C) levels (<100 mg/dL) and to identify the patient characteristics that are independently associated with attaining the LDL-C goal (<100 mg/dL). PATIENTS AND METHODS: Eligible patients were identified from a roster of patients who had undergone testing at a nonvascular laboratory between September 1, 2001, and January 31, 2002, and were found to have evidence of PAD, defined as an ankle-brachial index of 0.9 or less. We thoroughly reviewed patients' electronic medical records. Backward elimination multivariate logistic regression modeling was used to Identify factors associated with reaching the goal LDL-C level. RESULTS: Among 143 patients with PAD, 105 (73%) met the goal LDL-C level. Lipid-lowering therapy was prescribed for 109 (76%). Lower diastolic blood pressure and lower weight were independently associated with an LDL-C level of less than 100 mg/dL. CONCLUSION: We found higher rates of lipid-lowering therapy in patients with PAD than reported previously. Patients with diabetes mellitus or coronary artery disease were not more likely to meet the goal LDL-C level than those without these comorbidities. Clinical practice may be catching up to clinical guidelines.

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