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Robert S Kirsner

Publications and source records attributed to Robert S Kirsner.

At least 19 recordsLinked to original sources
PubMed2026

Efficacy of an Adhesive Hydrocolloid Bandage on Wound Healing: Findings of a 28-Day, Single-Centre, Randomised, Controlled Study.

This single-centre, randomised, controlled study assessed the wound healing efficacy of adhesive bandages in eligible healthy adults (N = 36) aged 25-55 with Fitzpatrick skin types II and III using a model of laser-induced wounds. Here, we report data for wounds that were randomised to treatment with either a hydrocolloid bandage for multi-day use (BAND-AID Adhesive Bandage Hydroseal), standard of care (SoC) (BAND-AID Adhesive Bandage Tru-Stay Sheer) or an uncovered control. Primary endpoints included the time to complete healing and a composite wound healing score. Hydrocolloid bandage-treated wounds healed twice as fast as the uncovered control or SoC-treated wounds. Median time (days) to complete healing was significantly faster for the hydrocolloid bandage-treated wounds (6.9) versus SoC (11.9) and uncovered control (11.8). Hydrocolloid bandage-treated wounds had significantly better composite wound healing scores versus SoC and versus uncovered control over 2 weeks. At Day 28, cosmesis was better with hydrocolloid bandage treatment (0.3) versus SoC (0.6) and uncovered control (2.1) (change from baseline in a composite scar score; higher score = worse outcome). Multi-day wound occlusion with a hydrocolloid bandage promoted faster healing and improved cosmesis compared with daily SoC dressings or uncovered control.

Humans↗
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.

Aged↗
PubMed2005

Treatment of Venous Ulcers.

Underlying the pathogenesis of venous ulceration is venous hypertension. Therefore, the use of multilayered compression therapy is the gold standard in the treatment of a venous ulcer. As treatment progresses, an important determinant of response is wound assessment, which should be performed on initial visit and subsequently thereafter. Among the methods to assess improvement are digital photography and planimetry, which are objective methods to measure response to treatment and rate of wound healing. Lack of improvement over a 2- to 4-week period is predictive of eventual lack of response to therapy and suggests the need for adjunctive methods to achieve success, such as oral pentoxifylline, tissue-engineered skin, or skin grafting.

Journal Article↗
PubMed2005

Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis.

BACKGROUND: Methotrexate (MTX) is a folate analogue used in the treatment of moderate to severe psoriasis and rheumatoid arthritis (RA). It oppositely affects inflammation and hyperhomocysteinemia-two independent risk factors for vascular disease. To date, there are no published reports evaluating the impact of these potentially paradoxical action of MTX. OBJECTIVE: The purpose of this study was to evaluate the effect of MTX therapy on the incidence of vascular disease in patients with psoriasis and RA. METHODS: We conducted a retrospective cohort study in which we analyzed computerized records of 7,615 outpatients diagnosed with psoriasis and 6,707 with RA at the Veterans Integrated Service Network 8. RESULTS: Patients prescribed MTX therapy had a significantly reduced risk of vascular disease compared to those who were not prescribed MTX (psoriasis: RR = 0.73, 95% CI = 0.55-0.98; RA: 0.83, 0.71-0.96). This reduction was most evident for patients prescribed a low cumulative dose of MTX (psoriasis: RR = 0.50, 95% CI = 0.31-0.79; RA = 0.65, 0.52-0.80). Concomitant use of folic acid (FA) with MTX also reduced the incidence of vascular disease in patients prescribed MTX (psoriasis: RR = 0.56, 95% CI = 0.39-0.80; RA: 0.77, 0.38-1.56). CONCLUSIONS: MTX therapy reduced the incidence of vascular disease in veterans with psoriasis or RA. Low to moderate cumulative dose appears more beneficial than the higher dose. We hypothesize that this effect is caused by its anti-inflammatory properties. In addition, a combination of MTX and FA led to a further reduction in the incidence of vascular disease.

Aged↗
PubMed2005

Use of a bioengineered skin equivalent for the management of difficult skin defects after pediatric multivisceral transplantation.

BACKGROUND: Primary wound closure is not always possible after pediatric multi-visceral transplantation because of oversized donor organs and/or intestinal or graft edema. We report our experience evaluating the safety and efficacy of Graftskin (Apligraf, Organogenesis, Canton, Mass), a bioengineered bi-layered human skin equivalent, for the management of difficult skin abdominal defects after multivisceral transplantation in a pediatric population. METHODS: A retrospective chart review was performed of pediatric multivisceral transplantation patients who were treated with Graftskin. Adverse events, course of wound reepithelialization, and time for complete closure were recorded. RESULTS: Four patients, 7 to 29 months old, were treated with Graftskin. One patient died because of unrelated reasons. Stimulation of the granulation, reepithelialization, and rapid reduction of the wound surface and depth occurred in the other 3 patients. Complete reepithelialization occurred within 5 months. No adverse events were noted. CONCLUSION: Graftskin was a successful treatment for difficult abdominal skin defects after liver and multivisceral transplantation in children.

Biomedical Engineering↗
PubMed2005

Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results from 3 randomized, comparative studies.

OBJECTIVE: To compare the efficacy and safety of tacrolimus ointment and pimecrolimus cream in adult and pediatric patients with mild to very severe atopic dermatitis (AD). METHODS: One thousand and sixty-five patients were randomized to treatment in 3 multicenter, randomized, investigator-blinded, 6-week studies. RESULTS: Based on the Eczema Area Severity Index (EASI), tacrolimus ointment was more effective than pimecrolimus cream at the end of the study in adults (54.1% vs. 34.9%, respectively; P < .0001), in children with moderate/severe disease (67.2% vs. 56.4%, respectively; P = .04), in the combined analysis (52.8% vs. 39.1%, respectively; P < .0001), and at week 1 in children with mild disease (39.2% vs. 31.2%, respectively; P = .04). Tacrolimus was also more effective than pimecrolimus based on the Investigator Global AD Assessment (IGADA), improvement in percentage of total body surface area affected, and improvement in itch scores (P < or = .05), with a faster onset of action. There was no significant difference in the incidence of adverse events (AEs), including application site reactions in the 2 studies involving 650 children. Adults treated with tacrolimus experienced a greater number of local application site reactions on day 1; both groups reported a similar incidence of application site reactions thereafter. More pimecrolimus-treated patients than tacrolimus-treated patients withdrew from the studies because of a lack of efficacy (P < or = .03) or adverse events (P = .002; pediatric mild). CONCLUSION: Tacrolimus ointment is more effective and has a faster onset of action than pimecrolimus cream in adults and children with AD; their safety profiles are similar.

Adolescent↗
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.

Aged↗
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

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.

Aged↗