Person: Cohen, Jeffrey Marcus
Loading...
Email Address
AA Acceptance Date
Birth Date
Research Projects
Organizational Units
Job Title
Last Name
Cohen
First Name
Jeffrey Marcus
Name
Cohen, Jeffrey Marcus
5 results
Search Results
Now showing 1 - 5 of 5
Publication Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis(American Medical Association (AMA), 2017) Weng, Qing Yu; Raff, Adam; Cohen, Jeffrey Marcus; Gunasekera, Nicole; Okhovat, Jean-Phillip; Vedak, Priyanka; Joyce, Cara; Kroshinsky, Daniela; Mostaghimi, ArashQuestion What is the national health care burden of misdiagnosed lower extremity cellulitis in patients admitted to the hospital from the emergency department? Findings In this cross-sectional study that included 259 patients, 30% were misdiagnosed with cellulitis, of which 85% did not require hospitalization and 92% received unnecessary antibiotics. Combining these findings with previously published data, cost estimates, and and projections indicate that cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations in the United States and $195 million to $515 million in avoidable health care spending annually. Meaning Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.Publication Cost-effectiveness of Confirmatory Testing Before Treatment of Onychomycosis(American Medical Association (AMA), 2016) Mikailov, Anar; Cohen, Jeffrey Marcus; Joyce, Cara; Mostaghimi, ArashImportance Onychomycosis is the most common disease of the nail in adults. International guidelines urge health care professionals to perform confirmatory diagnostic testing before initiating systemic therapy. This approach was determined to be cost-effective in studies from the late 1990s but has not been evaluated more recently. The effect of testing on the costs of efinaconazole, 10%, topical solution treatment is unknown. Objective To evaluate the cost and potential harm associated with 3 approaches to onychomycosis evaluation before treatment with oral terbinafine or efinaconazole, 10%. Design, Setting, and Participants A decision analysis that compared the costs of 3 onychomycosis management algorithms based on recently published data of test statistics, disease prevalence, and relevant costs: (1) empirical therapy without confirmatory testing, (2) pretreatment confirmatory testing with potassium hydroxide (KOH) stain followed by periodic acid–Schiff (PAS) evaluation if KOH testing is negative, and (3) pretreatment testing with PAS. There was no direct patient evaluation. Selection of included studies was based on outcome variables and the quality of study design. The study was conducted from April 1, 2014, to September 1, 2015. Main Outcomes and Measures Primary outcomes included direct cost of onychomycosis testing and therapy and cost to avoid harm when treating patients with oral terbinafine. Results At a disease prevalence of 75%, per-patient cost savings of empirical terbinafine therapy without confirmatory testing was $47 compared with the KOH screening model and $135 compared with PAS testing. The cost of testing necessary to prevent a single case of clinically relevant liver toxic effects related to terbinafine at a prevalence of 75% was between $18.2 million and $43.7 million for KOH screening and between $37.6 million and $90.2 million for PAS testing. At a prevalence of 75%, KOH screening and PAS testing before treatment with efinaconazole, 10%, saved $272 and $406 per patient per nail, respectively. Conclusions and Relevance These results show that empirical treatment with terbinafine for patients with suspected onychomycosis is more cost-effective than confirmatory testing across all prevalence of disease, with minimal effect on patient safety. In contrast, confirmatory testing before treatment with efinaconazole, 10%, is associated with reduced costs. Blanket recommendations for confirmatory testing before systemic therapy should be reconsidered and replaced with recommendations tailored to specific therapies.Publication Sleep Disordered Breathing and Sleep Duration and the Risk of Psoriasis and Melanoma in the United States(2015-05-13) Cohen, Jeffrey MarcusSleep disordered breathing (snoring and obstructive sleep apnea (OSA)) has been associated with negative health outcomes including diabetes mellitus, cardiovascular disease, and reduced quality of life, presumably due to systemic inflammation. Long and short sleep duration have been associated with morbidity, all-cause mortality, and cancer-specific mortality. No large prospective studies exist to explore the relationship between sleep disordered breathing and sleep duration and psoriasis and melanoma risk. This study prospectively evaluated the association between OSA and snoring and incident psoriasis in the Nurses’ Health Study (NHS; 1997-2008) and the association between sleep duration and melanoma risk in the NHS (1986-2012), NHS II (2001-2009), and Health Professionals Follow-Up Study (HPFS; 2000-2012). Cox proportional hazards were used to calculate age-adjusted and multivariate risk ratios. Over the follow-up period, there were 524 cases of psoriasis among the women who were assessed for sleep apnea. Women with OSA were more likely to have a higher BMI, be hypertensive, work night shifts, and have type 2 diabetes mellitus. The age-adjusted relative risk (RR) of psoriasis among women with OSA was 2.19 (95% CI, 1.39-3.45). The multivariate RR adjusting for night shift work and hypertension, cardiovascular disease, and type 2 diabetes mellitus was 1.91 (95% CI, 1.20-3.05). There was no effect modification by BMI (p=0.52), hypertension (p=0.34), or snoring (p=0.91). Sleep apnea was not associated with an increased risk of psoriatic arthritis. Although women with sleep apnea were more likely to be snorers, we did not find a statistically significant relationship between snoring and psoriasis risk. In the three cohorts, there was no relationship between sleep duration and melanoma risk. The multivariate RRs were 0.90 (95% CI, 0.67-1.20) for ≤6 hours, 1.30 (95% CI, 1.08-1.56) for 8 hours, and 0.76 (95% CI, 0.51-1.12) for ≥9 hours (p trend=0.09) in the NHS and NHS II and 1.08 (95% CI, 0.77-1.51) for ≤6 hours, 0.95 (95% CI, 0.69-1.30) for 8 hours, and 1.06 (95% CI, 0.68-1.67) for ≥9 hours (p trend=0.71) in the HPFS. In the NHS, there was no association between OSA and melanoma risk (RR 1.04 (95% CI, 0.42-2.55)) and there was also no association between snoring status and melanoma risk in the three cohorts. In this prospective study, we found that OSA was associated with an approximately two-fold increased risk of psoriasis among US women and we found no association between sleep duration, sleep apnea, or snoring and melanoma risk among US women and men.Publication Hypersensitivity Reaction as a Harbinger of Acute Myeloid Leukemia: A Case Report and Review of the Literature(Korean Dermatological Association; The Korean Society for Investigative Dermatology, 2015) Cohen, Jeffrey Marcus; Cheng, Carol E.; DeSouza, Aieska; Nandi, Tina R.; Buzney, Elizabeth; Larson, Allison; Lee, Winston Y.; Mostaghimi, ArashCutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.Publication Therapeutic Intervention for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): A Systematic Review and Meta-Analysis(Public Library of Science, 2012) Cohen, Jeffrey Marcus; Fagin, Adam Peter; Hariton, Eduardo; Niska, Joshua Ryan; Pierce, Michael Wolfe; Kuriyama, Akira; Whelan, Julia S; Jackson, Jeffrey L.; Dimitrakoff, Jordan D.Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been treated with several different interventions with limited success. This meta-analysis aims to review all trials reporting on therapeutic intervention for CP/CPPS using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). Methods We searched Medline, PubMed, the Cochrane Pain, Palliative & Supportive Care Trials, the Cochrane Register of Controlled Trials, CINAHL, ClinicalTrials.gov, and the NIDDK website between 1947 and December 31, 2011 without language or study type restrictions. All RCTs for CP/CPPS lasting at least 6 weeks, with a minimum of 10 participants per arm, and using the NIH-CPSI score, the criterion standard for CP/CPPS, as an outcome measure were included. Data was extracted from each study by two independent reviewers. Gillbraith and I-squared plots were used for heterogeneity testing and Eggers and Peters methods for publication bias. Quality was assessed using a component approach and meta-regression was used to analyze sources of heterogeneity. Results: Mepartricin, percutaneous tibial nerve stimulation (PTNS), and triple therapy comprised of doxazosin + ibuprofen + thiocolchicoside (DIT) resulted in clinically and statistically significant reduction in NIH-CPSI total score. The same agents and aerobic exercise resulted in clinically and statistically significant NIH-CPSI pain domain score reduction. Acupuncture, DIT, and PTNS were found to produce statistically and clinically significant reductions in the NIH-CPSI voiding domain. A statistically significant placebo effect was found for all outcomes and time analysis showed that efficacy of all treatments increased over time. Alpha-blockers, antibiotics, and combinations of the two failed to show statistically or clinically significant NIH-CPSI reductions. Conclusion: Results from this meta-analysis reflect our current inability to effectively manage CP/CPPS. Clinicians and researchers must consider placebo effect and treatment efficacy over time and design studies creatively so we can more fully elucidate the etiology and role of therapeutic intervention in CP/CPPS.: