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Biomedical subjects

D Tepper

Publications and source records attributed to D Tepper.

At least 19 recordsLinked to original sources
PubMed2000

The use of antiplatelet agents in cardiac disease.

In this clinical review, the authors focus on the process of platelet activation and thrombosis in acute and chronic coronary syndromes. New antithrombotic therapies have emerged for various cardiovascular diseases, based on the evolving concept of vascular injury and platelets and the knowledge of the pathophysiology of the underlying disease states. An understanding of these mechanisms is crucial to therapeutic decision making with antiplatelet regimens, which are also discussed in detail.

Acute Disease↗
PubMed2000

Roundtable discussion: Part I--Epidemiologic, demographic, and treatment challenges in hypertension.

Hypertension is one of the most pervasive medical disorders in this country. As the nation's population ages, the number of patients with hypertension can be expected to rise substantially. On December 9, 1999, a panel of managed care medical directors, pharmacy directors, clinicians, and health economists convened in Irvine, Texas to discuss aspects of hypertension management and economic analysis. This roundtable is presented in three parts, including (1) a summary of the challenges of hypertension management from the point of view of the clinician, (2) the introduction of a pharmacoeconomic model of hypertension management, and (3) a discussion of how health plans approach this insidious disorder.

Aged↗
PubMed2000

Roundtable discussion: Part II--Development of a pharmacoeconomic model in hypertension.

Antihypertensive medications are targeted by most health plans as a major cost center. However, the efficacy of these medications, their side effects, and their resulting ability to prevent serious long-term complications must be factored into the value equation. To illustrate the possible economic effects of a single antihypertensive agent's inclusion on a health plan's drug formulary, an innovative pharmacoeconomic model was developed. In this portion of the roundtable, the design, results, and caveats of this model are discussed.

Antihypertensive Agents↗
PubMed2000

Roundtable discussion: Part III--Hypertension management in health plans.

In the final section of the roundtable discussion, participants describe how their individual managed care plans approach hypertension from the standpoints of disease management targeting, strategies to combat noncompliance, and how these plans utilize pharmacoeconomic information in drug formulary decision making.

Antihypertensive Agents↗
PubMed1997

Effect of a screening profile on the diagnosis of nonaccidental burns in children.

STUDY OBJECTIVE: To determine if awareness of factors associated with burn abuse increases recognition and reporting by emergency physicians. DESIGN: The study consisted of a retrospective chart review and a subsequent intervention. SETTING: An urban pediatric emergency department (ED). PARTICIPANTS: All patients with the diagnosis of burn seen in the ED. INTERVENTION: The retrospective chart review (October 1, 1990, to September 30, 1991) determined the number of patients seen in the ED, diagnosed with burns, and reported to the department of social service. We then determined whether or not the department of social service, after completion of their investigation, "verified" that abuse had occurred. In addition, other services provided to the family by the department of social services were determined. The prospective study (April 1, 1992, to March 30, 1993) introduced a checklist of 13 factors associated with abusive burns into the history and physical examination of all burn victims presenting to the ED. Changes in overall referrals to the department of social service as well as in the numbers of cases in which abuse were verified or services offered were then determined. RESULTS: Prior to any intervention, 3% (3/87) of burns presenting to the ED from 1990 to 1991 were reported to the department of social service. This contrasted with 12.1% (26/215) of burns presenting after introduction of the checklist. Burn victims, 1/87 (1%), in the retrospective study and 16/215 (7.4%) burn victims in the prospective study received social service intervention after a report was initiated by the ED staff (P < .002). Burn injuries 1/87 (1%) and 7/215 (3.3%), reported during the two studies were substantiated as abusive by social services. CONCLUSION: We conclude that the use of the checklist increased effective social service referral for burn abuse.

Adolescent↗
PubMed1993

Identification of patients with high risk of arrhythmic mortality. Role of ambulatory monitoring, signal-averaged ECG, and heart rate variability.

This article discusses the roles of 24-hour ambulatory Holter monitoring, left ventricular function, the signal-averaged electrocardiogram (ECG), and heart rate variability for identification of high risk patients following myocardial infarction. Because these noninvasive tests have low positive predictive value, a combination of noninvasive tests is recommended for risk stratification.

Algorithms↗
PubMed1992

Adenosine and its cardiovascular effects.

Adenosine is a new antiarrhythmic agent recently released with the permission of the Food and Drug Administration. It is an endogenously occurring nucleoside indicated for use in the diagnosis and treatment of supraventricular tachycardia. Its greatest utility is in patients with AV nodal reentry. Its antiarrhythmic action is mediated at the cellular level through the potassium channel, causing hyperpolarization of the myocyte membrane potential. In addition to its current indication as an antiarrhythmic agent, adenosine is now being used under an investigational protocol for pharmacologic stress testing. It can be given in conjunction with thallium or used in echocardiography as an imaging tool for patients who can not be adequately exercised. Adenosine's side effect profile is relatively benign and the agent's extremely short half-life makes most adverse reactions clinically insignificant. In this report we attempt to highlight this agent's clinical utility and discuss its future in the cardiovascular pharmacopeia.

Adenosine↗
PubMed1992

The radioprotective effects of WR-2721 on radiation-induced goblet cell loss.

We assessed the efficacy of the radioprotective effects of WR-2721 in radiation-induced goblet cell loss. Fourteen female New Zealand white rabbits were divided into radioprotected, radiounprotected, and control groups. Ten rabbits received 5,000 rad of beta irradiation to the temporal conjunctiva of both eyes. The right eyes were pretreated with topical applications of WR-2721 30 minutes and 1 minute before irradiation. The left eyes received irradiation only. Four additional rabbits received neither irradiation nor pretreatment with WR-2721. After a 2-month waiting period, each animal was killed and goblet cell densities per high-power field (GCD/HPF) were determined over the areas in question and compared using paired sample t tests. The mean GCD/HPF for the radioprotected, unprotected, and control groups were 10.93, 4.68, 23.15 (right eye), and 26.25 (left eye). Paired sample t tests showed a significant radioprotective effect when comparing WR-2721-treated animals with those receiving radiation only (p less than 0.003). Independent sample t tests showed significant goblet cell loss in both the radioprotected (p less than 0.018) and radiounprotected eyes (p less than 0) when compared with control groups. These data suggest a radioprotective effect of WR-2721 in radiation-induced goblet cell loss.

Amifostine↗
PubMed1991

Determinants of pace-terminable ventricular tachycardia: implications for implantable antitachycardia devices.

The next generation of implantable antitachycardia devices incorporate antitachycardia pacing for the treatment of ventricular tachycardia. To evaluate the potential determinants of pace terminability, we analyzed 62 episodes of induced monomorphic ventricular tachycardia. We found that the tachycardia cycle length and cycle length variability are the major determinants of pace terminability. These findings should be considered in the designing of ventricular tachycardia detection and termination algorithms.

Aged↗
PubMed1990

Prevalence, incidence and prognosis of recognized and unrecognized myocardial infarction in persons aged 75 years or older: The Bronx Aging Study.

The prevalence, incidence and prognosis of recognized and unrecognized Q-wave myocardial infarction (MI) was assessed in an 8-year prospective study of 390 community-based subjects (age 75 to 85 years at entry, mean 79 years). Subjects were studied at baseline and with annual follow-up electrocardiographic (ECG) exams. At baseline, 7.9% had a history of MI without ECG evidence, 6.4% had ECG evidence of Q-wave MI without clinical history, 4.1% had both clinical history and ECG evidence and 81.5% had neither history nor ECG evidence (control subjects). After an average follow-up period of 76.2 months, the total mortality rate was 5.9/100 person-years for subjects with some evidence of MI at baseline versus 3.9 in the control group (p = 0.059). The incidence of cardiovascular disease in subjects with evidence of MI was 8.8/100 person-years versus 4.7 among control subjects (p = 0.002). During the follow-up period, 115 new Q-wave MIs occurred (50 unrecognized, rate 2.4/100; 65 recognized, rate 3.2/100). There was no difference in mortality and morbidity outcome between subjects with recognized and unrecognized MIs. Those with only a history of MI at baseline had a threefold greater risk of a new MI (recognized and unrecognized) than the control group (p = 0.003). Unrecognized Q-wave MI is a common occurrence in the "old old" with subsequent morbidity and mortality prognosis comparable to that of recognized MI. History of MI alone in this age group is also associated with an increased risk of MI, suggesting the need for better diagnostic markers of myocardial ischemia in the old.

Aged↗
PubMed1990

Betaxolol: a new long-acting beta 1-selective adrenergic blocker.

Betaxolol (Searle, Skokie, Illinois) is a new beta 1-selective adrenergic blocker with no partial agonist action and minimal membrane stabilizing activity. Its pharmacokinetic profile is characterized by a long serum half-life and excellent oral bioavailability, with little first-pass metabolism. The mean 16-hour half-life of betaxolol has been shown to provide full 24-hour control of blood pressure and heart rate. Betaxolol has been proven to be a safe and effective antihypertensive agent, and was recently approved for clinical use in the United States for this indication.

Adult↗
PubMed1990

Driving safety after brain damage: follow-up of twenty-two patients with matched controls.

Driving after brain damage is a vital issue, considering the large number of patients who suffer from cerebrovascular and traumatic encephalopathy. The ability to operate a motor vehicle is an integral part of independence for most adults and so should be preserved whenever possible. The physician may estimate a patient's ability to drive safely based on his own examination, the evaluation of a neuropsychologist, and a comprehensive driving evaluation--testing, driving simulation, behind-the-wheel observation--with a driving specialist. This study sought to evaluate the ability of brain-damaged individuals to operate a motor vehicle safely at follow-up. These patients had been evaluated (by a physician, a neuropsychologist, and a driving specialist) and were judged able to operate a motor vehicle safely after their cognitive insult. Twenty-two brain-damaged patients who were evaluated at our institution were successfully followed up to five years (mean interval of 2.67 years). Patients were interviewed by telephone. Their driving safely was compared with a control group consisting of a close friend or spouse of each patient. Statistical analysis revealed no difference between patient and control groups in the type of driving, the incidence of speeding tickets, near accidents, and accidents, and the cost of vehicle damage when accidents occurred. The patient group was further divided into those who had, and those who had not experienced driving difficulties so that initial neuropsychologic testing could be compared. No significant differences were noted in any aspect of the neuropsychologic test battery. We conclude that selected brain-damaged patients who have passed a comprehensive driving assessment as outlined were as fit to drive as were their normal matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗