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Biomedical subjects

Daniel G Federman

Publications and source records attributed to Daniel G Federman.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2005

Relationship between provider type and the attainment of treatment goals in primary care.

OBJECTIVE: To determine the relationship between provider type (eg, resident, mid-level practitioner, attending physician) and attainment of clinical goals with respect to the treatment of dyslipidemia, diabetes mellitus, and hypertension. STUDY DESIGN: Using electronic medical records, we identified all patients seen in the Veterans Affairs Connecticut Health Care System in a 6-month period with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code corresponding to a diagnosis of coronary artery disease, diabetes mellitus, or hypertension. METHODS: We recorded the most recent low-density lipoprotein cholesterol level for patients with diabetes or coronary artery disease, glycosylated hemoglobin level for patients with diabetes, and blood pressure for patients with hypertension. We then examined the relationship between these measures and provider type. RESULTS: After controlling for patient age and practice site, no significant differences were noted between attending physicians and residents in attaining treatment goals for dyslipidemia (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.96-1.38) or diabetes (OR 1.05, 95% CI 0.82-1.33). However, attending physicians were significantly more likely to attain blood pressure goals than were residents (59% vs 54%, P = .002; OR 1.23, 95% CI 1.08-1.39). Controlling for additional patient characteristics did not alter the findings. CONCLUSIONS: Internal medicine residents may quickly develop expertise in managing dyslipidemia and diabetes mellitus. Residents in our sample, however, were less likely than attending physicians to reach goal blood pressure for patients with hypertension. Educational efforts aimed at house staff to improve the treatment of hypertension are warranted.

Blood Pressure↗
PubMed2004

Full-body skin examinations: the patient's perspective.

OBJECTIVES: To determine (1). primary care practitioner (PCP) and dermatologist full-body skin examination (FBSE) rates by using a patient questionnaire and (2). whether patient risk factors for skin cancer alter these rates. DESIGN: Questionnaires pertaining to whether participants underwent regular FBSE, their feelings about this screening test, and their risks for developing skin cancer. SETTING: The primary care and dermatology clinics at the West Haven Veterans Affairs Medical Center. PARTICIPANTS: A convenience sample of 356 patients awaiting clinic appointments. Of those asked to participate, 251 (71%) agreed. MAIN OUTCOME MEASURES: Patient report of undergoing FBSE, attitudes regarding this examination, and risk factors for cutaneous malignancy. RESULTS: Thirty-two percent of all respondents reported undergoing regular FBSE by their PCP, whereas 55% of those with a history of skin cancer reported undergoing FBSE. Eight percent of participants reported embarrassment with FBSE, 83% reported that their PCP would be considered thorough by performing FBSE, and 87% would like their PCP to perform FBSE regularly. Only 2% of participants would refuse the examination if the PCP were of the opposite sex, whereas 8% would be more willing to be examined. CONCLUSIONS: Although patients report a low incidence of FBSE, those with a personal history of skin cancer are more likely to be screened. A low rate of embarrassment and a high rate of perceived PCP thoroughness are associated with FBSE. Patients have a strong preference to undergo FBSE. A sex difference between the PCP and the patient should not be a barrier to this examination.

Connecticut↗
PubMed2004

Vogt-Koyanagi-Harada syndrome and ulcerative colitis.

The Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon disorder characterized by uveitis and neurologic and cutaneous abnormalities, including tinnitus, vertigo, headache, meningoencephalitis, vitiligo, alopecia, and poliosis. The VKH syndrome has been reported to occur in association with other autoimmune disorders. We report a case of a patient with severe ulcerative colitis who developed VKH syndrome. We postulate that the patient's history of a traumatic brain injury might have been responsible for an abnormal "immunologic milieu" and the occurrence of ulcerative colitis, VKH syndrome, and severe reactive arthritis.

Adult↗
PubMed2004

Documenting dermatology practice: ratio of cutaneous tumors biopsied that are malignant.

BACKGROUND: Skin biopsy is an important part of dermatology practice. Little is known regarding dermatologist biopsying practices. OBJECTIVE: The objective was to assess the ratio of malignant lesions biopsied in practice and factors that influence this ratio. METHODS: Using a dermatopathology database, we analyzed tumors biopsied by dermatologists to determine the ratio of malignant to all tumors (malignancy ratio). Additional analyses were performed for factors influencing this ratio. RESULTS: Over 6 months, 11,072 tumors were submitted. Overall, the malignancy ratio was 41.7%, 3.8% for pigmented lesions. Practice type, location, or use of dermatoscopy did not influence this ratio; provider age was positively correlated with a higher malignancy ratio (r=0.51; p=0.02) and was a predictor of malignancy ratio (b=0.02; p=0.04). CONCLUSION: Approximately 40% of biopsied tumors were malignant. Dermatologists exhibit a wide range in their individual practice patterns. Increasing provider age predicted higher malignancy ratios with a 2% increase for each incremental year.

Biopsy↗
PubMed2004

Necrotizing fasciitis and cardiac catheterization.

Necrotizing fasciitis (NF) is an uncommon, life-threatening soft tissue infection characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous tissue, and fascia. We report a case of NF as a complication of cardiac catheterization. Familiarity with this entity may lead to earlier diagnosis and initiation of appropriate therapy.

Anti-Bacterial Agents↗
PubMed2004

Peripheral arterial disease. A systemic disease extending beyond the affected extremity.

Peripheral arterial disease (PAD) is a manifestation of the atherosclerotic process and is associated with an increased risk of cerebrovascular disease, cardiovascular disease, and death. Clinicians should consider screening both asymptomatic and symptomatic patients with the ankle-brachial index, a test with a high sensitivity and specificity. For those patients with PAD, atherosclerotic risk factors (such as smoking, dyslipidemia, hypertension, and diabetes mellitus) should be aggressively treated. In addition to exercise therapy, there is evidence available to support the use of aspirin, clopidogrel, lipid-lowering agents, pentoxifylline, and cilostazol.

Aged↗
PubMed2003

A rash decision.

Explore the source record for details and available documents.

Diagnostic Errors↗
PubMed2003

Managing the patient with venous ulcers.

Venous disease is the most common cause of leg ulcers. The refractory nature of venous ulcers affects the quality of life and work productivity of those persons afflicted. This, in combination with the high costs of long-term therapy, makes venous ulcers a major health problem in developed countries. Management of venous leg ulcers is based on understanding pathophysiologic abnormalities. In recent years, identifying prognostic factors for healing and developing novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder.

Aged↗
PubMed2003

The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria.

BACKGROUND: Several small trails looking at antibiotic therapy targeted at Helicobacter pylori for the treatment of chronic urticaria have been published and have had conflicting results. We conducted a systematic review of existing studies to help answer the clinical question of whether this therapy has a role in the treatment of chronic urticaria. METHODS: We identified studies published in the English language with searches of MEDLINE, PREMEDLINE, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effectiveness, and Cochrane Libraries using the key words "Helicobacter pylori" and "urticaria." Relevant studies from bibliography reviews were also included. Studies included met the following criteria: (1) patients had urticaria for at least 6 weeks; (2) other known causes of urticaria were excluded by appropriate testing; (3) the initial diagnosis of H pylori infection was made by either serology, urea breath test, or upper endoscopy; and (4) an adequate trial of an antibiotic with known activity against H pylori was completed. RESULTS: In all, 10 studies met our inclusion criteria. The rate of remission of urticaria when H pylori was eradicated was 30.9% (59/191) compared with 21.7% (18/83) when H pylori was not eradicated; the background remission rate among control subjects without H pylori infection was 13.5% (10/74). When data from the 10 studies were combined, eradication of H pylori was both quantitatively and statistically associated with remission of urticaria (odds ratio 2.9; 95% confidence interval 1.4-6.8; P =.005). CONCLUSION: We found that resolution of urticaria was more likely when antibiotic therapy was successful in eradication of H pylori infection than when patients who were infected did not achieve eradication. These results suggest that clinicians, after considering other causes of urticaria, should constitute (1) testing for H pylori; (2) treating with appropriate antibiotics if H pylori is present; and (3) confirming successful eradication of infection.

Chronic Disease↗
PubMed2003

Valproic acid-induced eosinophilic pleural effusion.

Valproic acid is a carboxylic acid used for the treatment of both seizure and mood disorders. Its association with pleural fluid eosinophilia has been reported once in the English language literature. We present another case of valproic acid-induced pleural fluid eosinophilia associated with fever and peripheral blood eosinophilia. Extensive evaluation failed to reveal any other cause of eosinophilic pleural effusion, and the effusion resolved with discontinuance of valproic acid. Rechallenge with valproic acid produced recurrent symptoms. Valproic acid should be considered a possible cause of eosinophilic pleural effusion.

Adult↗
PubMed2002

Cat-associated zoonoses.

Cats co-occupy one third of all residences in the United States. As common household pets, they serve as sources of joy and companionship for their owners. However, feline ownership also comes with its own inherent risks, as cats can transmit an array of diseases to their owners, ranging from trivial to fatal ailments. By understanding the pathogenesis of cat-associated diseases, owners and their pets can live together with little risk of disease transmission. This article reviews cat-related diseases, with an emphasis on their prevention and management.

Animals↗
PubMed2002

Over-the-counter sports supplements: what clinicians need to know.

Sports supplements have gained popularity, especially after endorsements by well-known professional athletes. Since these supplements are thought of as being "natural", users often think of them as being safe. We discuss 4 popular supplements: creatine, androstenedione, dehydroepiandrosterone, and chromium.

Androstenedione↗
PubMed2002

Skin cancer screening by dermatologists: prevalence and barriers.

BACKGROUND: The incidence of skin cancers is increasing at an alarming rate, and there is currently no consensus by major health policy organizations regarding skin cancer screening. It has previously been shown that primary care physicians do not screen a majority of patients for skin cancer. OBJECTIVE: This study was undertaken to determine the prevalence of skin cancer screening among dermatologists and to detect barriers to screening. As a secondary objective, we set out to determine the prevalence of dermatoscopy use. METHODS: With the use of membership data from the 1999-2000 directory of the American Academy of Dermatology, a random sample of 464 American dermatologists was surveyed to assess their skin cancer screening practices and perceived obstacles to this practice. We then determined whether differences in knowledge of skin cancer screening recommendations, emphasis of skin cancer screening in training, or physician age affected the prevalence of screening. RESULTS: A total of 190 dermatologists responded (41%). Fifty-seven respondents (30%) reported performing full-body skin cancer screening on all of their adult patients and 93 more (49%) reported screening only patients perceived to be at increased risk. Eighty respondents (42%) reported lack of time as an impediment to screening. Only 18 (9%) did not screen patients because of potential patient embarrassment, whereas 17 (9%) did not perform screening because of lack of financial reimbursement. Sixty-two dermatologists (33%) reported being aware of official skin cancer screening recommendations, but they were not more likely to screen all patients (P =.64) or partake in screening of all patients or only those at increased risk (P =.84). One hundred nineteen respondents (63%) reported that skin cancer screening was emphasized during their medical training and they were more likely to screen all patients (P =.04) or either all or high-risk patients (P =.02). Younger age groups of dermatologists were significantly more likely to screen all patients for skin cancer (P =.03). Twenty-two percent of respondents reported using dermatoscopy for suspicious lesions. CONCLUSION: Dermatologists report a high rate of screening for skin cancer despite not having knowledge of skin cancer screening recommendations. Inadequate time to perform full-body skin examinations and lack of emphasis during training were identified as possible barriers to this practice.

Adult↗
PubMed2002

The patient with skin disease: an approach for nondermatologists.

Dermatologists and other healthcare professionals frequently encounter patients with skin disease in their daily practice. Developing an approach to these patients that will lead to accurate and timely diagnosis is important for all healthcare providers. Increased awareness of the potential benefits and pitfalls of a dermatologic history, knowledge of the fundamentals of a dermatologic examination, the ability to provide a potential differential diagnosis, and improved communication with dermatologists will improve care of patients with skin disease.

Dermatology↗
PubMedDate not supplied

Peripheral arterial disease. A marker of morbidity and mortality.

Peripheral arterial disease of the lower extremities is a common manifestation of the atherosclerotic process. A heightened awareness of symptomatic and asymptomatic disease, as well as screening of at-risk patients, is imperative because of the increased risk of cardiovascular disease, cerebrovascular disease, and even death. This article describes the various symptoms, diagnostic tests, and therapies for this common, underdiagnosed, undertreated disease.

Exercise Therapy↗