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Biomedical subjects

R Sadovsky

Publications and source records attributed to R Sadovsky.

At least 19 recordsLinked to original sources
PubMed2001

Three-year update of sildenafil citrate (Viagra) efficacy and safety.

In the three years since its launch, sildenafil citrate (Viagra), an oral agent for the treatment of erectile dysfunction (ED), has been prescribed to more than 10 million patients worldwide and has been further evaluated in clinical studies in diverse patient populations. Significant improvements in erectile function have been demonstrated in double-blind, placebo-controlled trials in patients with ED and underlying diabetes, cardiovascular disease, minor depression, spinal cord injury and multiple sclerosis. Promising results have also been reported for patients with treated prostate cancer, end-stage renal failure, Parkinson's disease, and spina bifida and in multiple organ transplant recipients. Accounts of sildenafil use in clinical practice and postmarketing data reflect clinical trial findings of effectiveness in a broad spectrum of ED aetiologies and overall good tolerability. As in the clinical trials, most adverse events associated with sildenafil use have been transient, mild or moderate effects that rarely lead to treatment discontinuation.

Erectile Dysfunction↗
PubMed2000

Integrating erectile dysfunction treatment into primary care practice.

Erectile dysfunction (ED) is a highly prevalent medical disorder. Nearly 1 of 3 men in the United States between the ages of 18 and 59 years report dissatisfaction with some aspect of their sexual function. These problems contribute to anxiety, depression, loss of self-esteem, and diminished quality of life. The availability of sildenafil, the first safe and effective oral agent for ED, has greatly increased the number of men seeking treatment and shifted much of the management of ED to primary care physicians. As a result, primary care physicians now need to add questions about sexual functioning and satisfaction with sex to their initial patient workups. Patients with ED can be treated by the primary care physician or referred to mental health professionals, endocrinologists, urologists, or sex therapists, depending on the problem presented. First-line treatments that can be easily prescribed and recommended by primary care clinicians include sildenafil, counseling, lifestyle changes, medication changes, and vacuum-constriction devices. The responsibilities of treating patients with ED include educating the patient about sexually transmitted diseases, providing general sex education and counseling to the patient and his partner, and providing a treatment that is appropriate for the cause of the problem. The rewards of treatment will be a happier and more functional patient, an enhanced physician-patient relationship, and great professional satisfaction.

Erectile Dysfunction↗
PubMed1999

Multiple myeloma: recognition and management.

Multiple myeloma is the malignant proliferation of plasma cells involving more than 10 percent of the bone marrow. The multiple myeloma cell produces monoclonal immunoglobulins that may be identified on serum or urine protein electrophoresis. Bone pain related to multiple lytic lesions is the most common clinical presentation. However, up to 30 percent of patients are diagnosed incidentally while being evaluated for unrelated problems, and one third of patients are diagnosed after a pathologic fracture, commonly of the axial skeleton. Multiple myeloma must be differentiated from other causes of monoclonal gammopathy, including monoclonal gammopathy of undetermined significance, heavy chain disease, plasmacytoma and Waldenstrom macroglobulinemia. Chemotherapy with melphalan-prednisone is the standard treatment for multiple myeloma. Other treatment modalities include polychemotherapy and bone marrow transplantation. Only 50 to 60 percent of patients respond to therapy. The aggregate median survival for all stages of multiple myeloma is three years.

Diagnosis, Differential↗
PubMed1997

The initial assessment of the HIV-infected patient.

The initial assessment of the patient with HIV disease requires clinical staging, identification of HIV-related and nonrelated illness, discussion of specific psychosocial issues, initiation of the process of patient education, and initiation of a sustained partnership between patient and clinician. The clinical content of the assessment depends on knowledgeable history-taking, focused physical examination, and specific laboratory tests. Partnering increases the likelihood of early recognition of important signs and symptoms and the institution of appropriate therapeutic measures. Successful and satisfying clinician-patient relationships help produce better patient outcomes.

Anti-HIV Agents↗
PubMed1992

Initial clinical assessment and management of HIV infection.

Management of HIV infection by the primary care physician can be easily integrated into the usual practice setting. The physician who understands the epidemiology of HIV disease, stays current with basic therapeutic concepts, and knows the patient and his or her living environment is in the best position to help the HIV-infected individual have a constructive and fulfilling life. When the primary care physician has a network of appropriate specialists for consultation and has appropriately integrated office and community-based nonmedical professionals into patient care, the health care team is complete.

Female↗
PubMed1991

Psychosocial issues in symptomatic HIV infection.

Psychosocial issues are a major factor in the quality of life of a patient with advanced human immunodeficiency virus infection. To provide effective, supportive care, the physician must assess the patient's psychosocial needs, with an understanding of the patient's sociocultural background. Good communication and a multidisciplinary team approach are essential aspects of successful management. Unconditional emotional support and both verbal and nonverbal expressions of caring increase patient compliance and comfort. Appropriate treatment of neuropsychiatric syndromes and debilitating physical symptoms also add significantly to the patient's quality of life. Most importantly, the patient must be given the opportunity to be an active participant in decisions about treatment and lifestyle.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A descriptive analysis of emergency visits to an inner city family practice center.

A six-month prospective study of daily emergency visits was performed at an inner city family practice center in order to understand the utilization pattern of emergency services. 487 visits were identified during the study period. In general, patients of junior residents made more visits. The majority of visits (97%) were nonemergent. The most common presenting complaint was a general symptom (17%), although the most frequent diagnosis was in the supplementary category (17%) that includes medication renewals, the completion of forms and maternal and child health care. Females, the unemployed, the elderly, and individuals with poverty levels of income were most frequently seen in the emergency setting. The reasons for these patterns and the need for further investigations in this area are discussed.

Community Health Centers↗
PubMed1989

HIV-infected patients: a primary care challenge.

Ambulatory management of patients infected with human immunodeficiency virus (HIV) is rapidly becoming a necessity for both financial and staffing reasons. Many primary care physicians are anxious about providing care for these patients, perhaps because of inadequate clinical training or because of perceptions of personal and employee risk. The willingness of physicians to care for HIV-infected patients may be increased by the clarification of issues of risk and the institution of effective, ongoing physician education programs. It is also important for physicians to understand their own anxieties and emotions. Because medicine is viewed as a profession that provides care for all segments of the population, physicians have an obligation to accept an appropriate level of risk in caring for HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Promotion of family enrollment in an urban family practice residency program.

Although a basic goal of family practice is to provide care for all members of the family, few studies have been done to test the ease of accomplishing this goal. At the Downstate Medical Center Department of Family Practice in Brooklyn, New York, an attempt was made to increase family enrollment by introducing several educational interventions directed at patients and resident physicians. Family enrollment levels were documented during a study period from June 1981 to September 1982, and again in June 1984. Both before and after the intervention efforts, family enrollment levels remained the same. It was concluded that the educational interventions used were unsuccessful in both short-term and long-term follow-up. Only one subgroup that participated in a specific educational intervention (patient orientation groups) showed an increase in family enrollment.

Family↗
PubMed1980

Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States.

We assessed the efficacy of an inactivated hepatitis B vaccine in a placebo-controlled, randomized, double-blind trial in 1083 homosexual men known to be at high risk for hepatitis B virus infection. The vaccine was found to be safe and the incidence of side effects was low. Within two months, 77% of the vaccinated persons had high levels of antibody against the hepatitis B surface antigen. This rate increased to 96% after the booster dose and remained essentially unchanged for the duration of the trial. For the first 18 months of follow-up, hepatitis B or subclinical infection developed in only 1.4 to 3.4% of the vaccine recipients as compared with 18 to 27% of placebo recipients (P < 0.0001). The reduction of incidence in the vaccinees was as high as 92.3%; none of the vaccinees with a detectable immune response to the vaccine had clinical hepatitis B or asymptomatic antigenemia. A significant reduction of incidence was already seen within 75 days after randomization; this observation suggests that the vaccine may be efficacious even when given after exposure.

Adult↗