Papers by Daniel Federman
Southern Medical Journal, Oct 1, 2018
Southern medical journal, 2018
To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture... more To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture (BFA) on self-reported pain intensity in a relatively large cohort of veterans to assess whether a more comprehensive clinical trial evaluation is warranted. The treatment, in an outpatient group setting, consisted of up to five auricular semipermanent needles inserted into each ear at prespecified points. Efficacy of treatment was measured by self-reported pain, using the Defense and Veterans Pain Rating Scale, just before treatment and at posttreatment days 0, 1, 7, and 30. A total of 112 patients attended the group clinics. The mean pretreatment pain score was 6.8, with an immediate postprocedure decrease of 2.4 points. The proportion of patients reporting decreased pain was 88.4%, 80.7%, 52.4%, and 51% at posttreatment days 0, 1, 7, and 30, respectively. The short- and intermediate-term beneficial effect of BFA on chronic pain is clinically meaningful. The large proportion of patien...
The Journal of Emergency Medicine, 2015
Six years after becoming the first and greatest Superhero in the world, Kara Danvers' demons have... more Six years after becoming the first and greatest Superhero in the world, Kara Danvers' demons have only gotten worse. The rage that she hoped to kill with Astra and Non has only grown. Now a power from across the universe wants to use that rage for his own gains as she self destructs. This is an AU story based off Kara's alternate origin story in Survivors. A very dark Kara Danvers. Notes Just a quick note before we start. Obviously Kara and all the heroes being on one Earth has changed some things and as it goes along you will see how. This story starts after Season 2 of the Flash with the only difference being he never ran back in time and caused Flashpoint. Supergirl never interferred in either of the first two seasons of the Flash. At the start, for reference Kara is 24, Alex 25, and Clark 11.
The Journal of emergency medicine, Jan 10, 2015
As the Christchurch rebuild gathers momentum industry professionals are worried substandard asses... more As the Christchurch rebuild gathers momentum industry professionals are worried substandard assessments of quake-damaged houses are a ticking time bomb akin to the leaky building saga 20 industry issue August | september 2012 Add in growing dissatisfaction with the Fletcher EQR contracting system, and the picture is an unhappy one Architects, builders, engineers and homeowners are not short of horror stories about serious earthquake damage missed in EQC assessments. Take the resident told to move out for six weeks while his large tilt slab house underwent cosmetic repairs. Dubious about the thoroughness of the EQC inspection, he acted on the advice of builder friend Daryl Hewitt and asked an architect to take laser levels. They revealed sections of the house had dropped by more than 60 mm, something confirmed by a further $7000 worth of sophisticated testing. The ridge in the lounge, dismissed by the EQC assessor as "carpet bunching," was where the thick concrete slab foundation had split. Hewitt has personally checked about 100 homes for clients. Eight of those destined for superficial "scrape, stop and paint" fixes turned into on enquiry card or via info-link.co.nz circle 33
Postgraduate Medicine, 2009
Screening men aged 65 to 75 years who have ever smoked for abdominal aortic aneurysm (AAA) has be... more Screening men aged 65 to 75 years who have ever smoked for abdominal aortic aneurysm (AAA) has been recommended to reduce AAA-related mortality. However, it is unknown whether the evidence-based recommendation has been implemented within primary care. The aim of this study was to determine whether screening for AAA is being performed within a large Veterans Affairs (VA) primary health care system. This was a retrospective cohort study examining AAA screening practices within the VA Connecticut Healthcare System. Any of the following imaging procedures were considered screening tests for AAA: abdominal ultrasound, computed tomography (CT) of the abdomen, CT colography, or magnetic resonance imaging of the abdomen. A total of 279 patients were included in the cohort: 83 (30%) were offered screening for AAA or had recent imaging performed that would have allowed for detection of an AAA. Seventy-three patients (26%) underwent AAA screening or had recent imaging of their abdomens, while 10 patients either refused imaging or were awaiting ultrasonographic screening at the time of this study. Of the 73 patients who had undergone screening or other abdominal imaging evaluations, 9 (12.3%) were found to have AAAs. There appears to be a low rate of screening for AAA within 1 primary care setting in a large VA health care system. If this finding is replicated within other VA primary health care settings, then the VA health care system should consider implementing a performance metric within primary care to improve AAA screening rates.
Medical Acupuncture, 2022
Pain Medicine, 2021
Exploring sociodemographic subgroup differences in multiple mini-interview (MMI) performance base... more Exploring sociodemographic subgroup differences in multiple mini-interview (MMI) performance based on MMI station type and the implications for the predictive fairness of the Hamburg MMI. BMC Med Educ 2019; 19(1):243. 10. Henderson MC, Kelly CJ, Griffin E, et al. Medical school applicant characteristics associated with performance in multiple mini-interviews versus traditional interviews: A multiinstitutional study. Acad Med 2018;93(7):1029-34. 11. Rauf A, Tayyab A, Masrur A. Relationship between student performances in non-cognitive skills in multiple mini interview and integrated practical examination.
PLOS ONE, 2020
Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne. [https://apropos.erudit.org/fr/usagers/politiquedutilisation/] Cet article est diffusé et préservé par Érudit.
BackgroundThe global pandemic of Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-Co... more BackgroundThe global pandemic of Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV2) has resulted in unprecedented challenges for healthcare systems. One barrier to widespread testing has been a paucity of traditional respiratory viral swab collection kits relative to the demand. Whether other sample collection kits, such as widely available MRSA nasal swabs can be used to detect SARS-CoV-2 is unknown.MethodsWe compared simultaneous nasal MRSA swabs (COPAN ESwabs ® 480C flocked nasal swab in 1mL of liquid Amies medium) and virals wabs (BD H192(07) flexible mini-tip flocked nasopharyngeal swabs in 3mL Universal Transport Medium) for SARS-CoV-2 PCR testing using Simplexa COVID-19 Direct assay on patients over a 4-day period. When the results were discordant, the viral swab sample was run again on the Cepheid Xpert Xpress ® SARS-CoV-2 assay.ResultsOf the 81 included samples, there were 19 positives and 62 negatives in viral media and 18 positives and 63 negative in the ...
Medical acupuncture, 2018
The Department of Veterans Affairs trained primary-care providers to deliver Battlefield Acupunct... more The Department of Veterans Affairs trained primary-care providers to deliver Battlefield Acupuncture (BFA), a subset of auricular acupuncture, to patients. However, little is known about BFA effectiveness in group or individual sessions or repeated administrations versus singular use. The aim of this study was to examine the use and effectiveness of BFA for back pain and four pain-comorbid conditions in group and individual sessions at a large Veterans Affairs (VA) medical center. This cross-sectional study was conducted at the West Haven VA Medical Center, in West Haven CT. Between October 2016 and December 2017, 284 veterans with pain received BFA. The BFA was administered in group clinics or in individual encounters. The Defense and Veterans Pain Rating Scale was used to assess self-reported pain immediately before and after each BFA administration. Over the study period, an average of 57 (range: 50-66) new patients per month received BFA. Of 753 total patient encounters, an imme...
Medical acupuncture, 2018
Battlefield Acupuncture (BFA) is an auricular needling protocol for pain. More than 1300 Veterans... more Battlefield Acupuncture (BFA) is an auricular needling protocol for pain. More than 1300 Veterans Health Administration (VHA) clinicians have been trained in BFA delivery. However, little is known about how well BFA has been implemented at the VHA. The aim of this research was to identify the challenges providers experience in implementing BFA and to look for any successful strategies used to overcome these challenges. Semistructured telephone interviews were conducted from June 2017 to January 2018, using an interview guide informed by the integrated Promoting Action on Research Implementation in Health Services framework to address several implementation domains: knowledge and attitudes about BFA; professional roles and training in BFA; organization of BFA delivery and resources to provide BFA; and implementation challenges and strategies to address challenges. The interviews were analyzed, using a grounded theory-informed approach. This research was conducted at 20 VHA facilities...
The American journal of medicine, Jan 24, 2016
JAMA Surgery, 2016
IMPORTANCE Abdominal aortic aneurysms are associated with chronic inflammation within the aortic ... more IMPORTANCE Abdominal aortic aneurysms are associated with chronic inflammation within the aortic wall, and previous studies have suggested that chronic inflammation may be a consequence of a dysregulated and persistent autoimmune response. Persistent aortic remodeling after aneurysm repair could place the patient at risk for endoleak or sac rupture. OBJECTIVE To determine whether patients with systemic inflammatory disease and large aneurysms have persistent aortic remodeling after endovascular aneurysm repair (EVAR). DESIGN, SETTING, AND PARTICIPANTS The records of all patients who underwent EVAR between July 2002 and June 2011 at the Veterans Affairs Connecticut Healthcare System were included in this retrospective review. Patients were considered to have a systemic inflammatory disease when confirmed by a referring specialist. Post-EVAR surveillance was performed by yearly imaging. INTERVENTION Endovascular aneurysm repair. MAIN OUTCOMES AND MEASURES Significant endoleak, defined as endoleak and sac diameter increase of 0.5 cm or greater. RESULTS A total of 51 of 79 patients (65%) had a systemic inflammatory disease. These patients had similar comorbid conditions compared with patients without inflammation but significantly greater numbers of major postoperative complications after EVAR (23.5% vs 3.6%; P = .02) and overall postoperative complications after EVAR (27.5% vs 7.1%; P = .03). Patients with a history of systemic inflammatory disease developed more endoleaks (45.1% vs 17.9%; P = .02) and late sac expansion (51.0% vs 21.4%; P = .01) and required more interventions (21.6% vs 3.6%; P = .03) during long-term follow-up. Systemic inflammatory disease was significantly associated with significant endoleak (odds ratio, 5.18; 95% CI, 1.56-17.16; P = .007). CONCLUSIONS AND RELEVANCE Patients with systemic inflammatory disease are at high risk for postoperative complications, type II endoleak, sac expansion, and additional interventions after EVAR. Additional strategies for improving the efficacy of EVAR in these patients may be warranted.
The American journal of managed care, 2005
To determine the relationship between provider type (eg, resident, mid-level practitioner, attend... more 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. 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. 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. After controlling for patient age and practice site, no significant differences were noted between attending physicians ...
Mayo Clinic Proceedings, 2006
I laud the editorial decision of including the well-written and informative article relating to a... more I laud the editorial decision of including the well-written and informative article relating to androgenetic alopecia in men, 1 which was published in the October 2005 issue of Mayo Clinic Proceedings. In my opinion, many busy clinicians toiling to prevent or treat life-threatening maladies, such as malignancy or cardiovascular disease, sometimes fail to realize the psychological impact of disorders considered "cosmetic." The authors pointed out several studies showing the negative self-perception and societal perception of those with hair loss. When discussing potential treatment with finasteride, the authors refer to the Prostate Cancer Prevention Trial (PCPT). 2 Although, as they correctly point out, the dose used in the trial, 5 mg, is higher than the dose used in the treatment of androgenetic alopecia, the authors state that there was a near 25% reduction in the prevalence of prostate cancer relative to placebo during the 7-year follow-up period. However, they fail to
Stroke, 2011
Background and Purpose— Stroke is a leading cause of disability. Rehabilitation robotics have bee... more Background and Purpose— Stroke is a leading cause of disability. Rehabilitation robotics have been developed to aid in recovery after a stroke. This study determined the additional cost of robot-assisted therapy and tested its cost-effectiveness. Methods— We estimated the intervention costs and tracked participants' healthcare costs. We collected quality of life using the Stroke Impact Scale and the Health Utilities Index. We analyzed the cost data at 36 weeks postrandomization using multivariate regression models controlling for site, presence of a prior stroke, and Veterans Affairs costs in the year before randomization. Results— A total of 127 participants were randomized to usual care plus robot therapy (n=49), usual care plus intensive comparison therapy (n=50), or usual care alone (n=28). The average cost of delivering robot therapy and intensive comparison therapy was $5152 and $7382, respectively ( P <0.001), and both were significantly more expensive than usual care ...
Respiratory Medicine, 1997
Cardiac toxicity following the administration of chemotherapeutic agents is well documented. Vinc... more 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.
New England Journal of Medicine, 2010
Background Effective rehabilitative therapies are needed for patients with long-term deficits aft... more Background Effective rehabilitative therapies are needed for patients with long-term deficits after stroke. Methods In this multicenter, randomized, controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke, we randomly assigned 49 patients to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care. Therapy consisted of 36 1-hour sessions over a period of 12 weeks. The primary outcome was a change in motor function, as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale. Secondary analyses assessed the treatment effect at 36 weeks. Results At 12 weeks, the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care (difference, 2.17 points; 95% confidence interval [CI], −0.23 to 4.58) and worse than that for patients receiving intensive comparison therapy (difference, −0.14 points; 95% CI, −2.94 to 2.65), but the differences were not significant. The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care (difference, 7.64 points; 95% CI, 2.03 to 13.24). No other treatment comparisons were significant at 12 weeks. Secondary analyses showed that at 36 weeks, robot-assisted therapy significantly improved the Fugl-Meyer score (difference, 2.88 points; 95% CI, 0.57 to 5.18) and the time on the Wolf Motor Function Test (difference, −8.10 seconds; 95% CI, −13.61 to −2.60) as compared with usual care but not with intensive therapy. No serious adverse events were reported. Conclusions In patients with long-term upper-limb deficits after stroke, robot-assisted therapy did not significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy. In secondary analyses, robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy. (ClinicalTrials.gov number, NCT00372411.
Neurorehabilitation and Neural Repair, 2009
Background. Chronic upper extremity impairment due to stroke has significant medical, psychosocia... more Background. Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective. To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods. The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results. A total of 127 participa...
Infectious Diseases in Obstetrics and Gynecology, 2005
Background. Infection with Toxoplasma gondii is common and usually asymptomatic, although it can ... more 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.
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Papers by Daniel Federman