J Spandorfer

Thomas Jefferson University, Philadelphia, PA, United States

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Publications (7)68.46 Total impact

  • J Spandorfer
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    ABSTRACT: Patients maintained on warfarin for atrial fibrillation, mechanical heart valves, or deep venous thrombosis may occasionally need to stop their anticoagulation during invasive procedures. This article reviews the literature on bleeding risks of certain procedures, thrombosis risks of stopping anticoagulation, and heparin and warfarin pharmacokinetics. Recommendations regarding how to manage anticoagulated patients are discussed.
    Medical Clinics of North America 10/2001; 85(5):1109-16, v. · 2.61 Impact Factor
  • J M Spandorfer, Y Israel, B J Turner
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    ABSTRACT: The effects of patients' abuse of and dependence on alcohol are well known, but screening for problem drinking by primary care physicians has been limited. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends that all patients be screened for alcohol use, all users be screened with the CAGE questionnaire, and all nondependent problem drinkers be counseled. We evaluated primary care physicians' screening methods for alcohol use and their management of problem drinkers to determine if they were following the NIAAA guidelines. We mailed a questionnaire to 210 internists and family physicians to assess their alcohol screening and management methods. Only 64.9% of the respondents reported screening 80% to 100% of their patients for alcohol abuse or dependence during the initial visit; even less (34.4%) screened that many patients during an annual visit. Nearly all respondents (95%) reported "frequently" or "always" using quantity-frequency questions to screen for alcohol abuse, but only 35% "frequently" or "always" used the CAGE questionnaire. Only 20% of the respondents rated treatment resources as adequate for early problem drinkers, and 72% preferred not to counsel these patients themselves. A belief that a primary care physician could have a positive impact on an alcohol abuser was less likely to be held by respondents who were older, in a nonurban setting, or had more years in practice (P = .05). A substantial proportion of the physicians in our survey sample were not following NIAAA recommendations. Most physicians preferred not to do the counseling of nondependent problem drinkers themselves, but to refer those patients to a nurse trained in behavioral interventions.
    The Journal of family practice 12/1999; 48(11):899-902. · 0.67 Impact Factor
  • J M Spandorfer, S Lynch, H H Weitz, S Fertel, G J Merli
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    ABSTRACT: Patients who require chronic anticoagulation and a procedure have been traditionally managed either by stopping warfarin and starting intravenous standard heparin or by adjusted dose subcutaneous standard heparin or taken off all anticoagulation for a week before the procedure. Enoxaparin may be useful as an alternative method of anticoagulation, avoiding hospitalization and the need for frequent monitoring.
    The American Journal of Cardiology 09/1999; 84(4):478-80, A10. · 3.21 Impact Factor
  • J Spandorfer, G Merli
    New England Journal of Medicine 10/1997; 337(13):938-9; author reply 939-40. · 54.42 Impact Factor
  • John M. Spandorfer, Geno J. Merli
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    ABSTRACT: Increasingly, primary care providers are caring for patients who require anticoagulation. In this article the indications for, complications of, and methods of dosing and monitoring warfarin in the outpatient setting are reviewed. Heparin use among ambulatory patients also is discussed.
    Medical Clinics of North America 04/1996; 80(2):475-91. · 2.61 Impact Factor
  • G J Merli, J Spandorfer
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    ABSTRACT: Approaching the patient with unilateral leg swelling presents a challenge to the physician in ambulatory practice. Contributing to the difficulty is the lack of studies that have assessed a population of patients presenting with unilateral leg swelling. The purpose of this article is to discuss unilateral leg swelling with respect to the chronicity of the presentation and the most common differential diagnoses based on a review of the current literature and personal clinical experience.
    Medical Clinics of North America 04/1995; 79(2):435-47. · 2.61 Impact Factor
  • G J Merli, L Robinson, J Spandorfer, R Paluzzi
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    ABSTRACT: Ulcers of the lower extremities are a common problem in ambulatory care. Patients with lower extremity ulcers tend to be treated by physicians in a variety of specialties which often opens their care to a multitude of interventions. It has been estimated that between 400,000 and 500,000 people have had leg ulcers in the United States.1 The prevalence of disease requires accurate assessment and management strategies in light of managed care constraints on health care dollars. The purpose of this article is to review the differential diagnosis of lower extremity ulceration and the approach to its assessment.
    Clinics in Dermatology 01/1994; 12(1):11-7. · 2.34 Impact Factor