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Biomedical subjects

E Saunders

Publications and source records attributed to E Saunders.

At least 55 records · Page 3Linked to original sources
PubMed1988

Drug treatment considerations for the hypertensive black patient.

In prior years the major differences noted between hypertension in black and white patients have been mostly epidemiological, with some suggestion that the differences were primarily quantitative and probably not qualitative. Recently, certain pathophysiological aberrations in hypertensive patients have been shown to be different in blacks and whites. Whether these differences are primary (genetic) or secondary has yet to be resolved. Nevertheless, certain racial differences may have therapeutic implications. Diuretics remain the mainstay of therapy for most hypertensive black patients. beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors have not shown great efficacy when used as monotherapy in black hypertensive patients. The combination of a diuretic with beta-blockers or ACE inhibitors, however, has been shown to abolish black-white differences in drug response. More recently, the calcium channel blockers have been shown to be potentially effective in black hypertensive patients. In spite of the effective drug therapy that is available for hypertensive patients in general, economic and social considerations continue to contribute to the low rate of detection, treatment, and control of hypertension in the black population.

Black or African American↗
PubMed1987

Sustained-release diltiazem compared with atenolol monotherapy for mild to moderate systemic hypertension.

The daily administration of 240 to 360 mg of diltiazem lowered blood pressure in a dose-related pattern similar to that seen in patients taking a daily dosage of 50 to 100 mg of atenolol. Sustained-release diltiazem was administered twice daily and atenolol once. Goal blood pressure was defined as less than 90 mm Hg or a reduction of greater than or equal to 10 mm Hg for patients with baseline pressures of 95 to 99 mm Hg in the supine position and was achieved in 60% of diltiazem-treated and 63% of atenolol-treated patients. The mean diltiazem dosage at the end of the study was 329 mg daily; for atenolol it was 80 mg daily. Adverse reactions considered possibly or probably drug related were reported by 26% of diltiazem patients and 38% of atenolol patients. Although both drugs were associated with a slower heart rate, atenolol patients showed a significantly greater negative chronotropic effect. Diltiazem, in a sustained-release form taken twice daily, is as effective as atenolol as a sole antihypertensive agent. It has a favorable side-effect profile and may be a useful alternative antihypertensive medication compared with existing beta-blocker therapy with atenolol.

Atenolol↗
PubMed1987

Hypertension in blacks.

Hypertension represents a problem of special importance in the black patient primarily because of frequency and increased severity. Differences between hypertension in blacks and whites in the United States seem to be mostly epidemiological, pathophysiological, and in responsiveness to drug therapy. Black hypertensives seem to have more of a salt-sensitive, volume-dependent type of hypertension and, therefore, diuretic therapy appears to be particularly useful. Agents that seem to depend more on a stimulated renin-angiotensin-aldosterone system are generally less effective as monotherapy in this group of patients. However, proper combinations of low dose diuretics, with almost any other therapeutic agent, seems to produce a responsiveness in the black hypertensive that is equal to comparable white patients.

Age Factors↗
PubMed1987

Labetalol compared with propranolol in the treatment of black hypertensive patients.

A double-blind parallel group study was conducted to examine the effects of oral labetalol, in doses from 100 to 800 mg BID, and propranolol, 40 to 320 mg, in patients with mild to moderate hypertension. The doses of labetalol (n = 74) and propranolol (n = 79) were titrated weekly to achieve a sitting diastolic blood pressure (DBP) of less than 90 mmHg or at least a 10-mmHg decrease from placebo baseline on two consecutive visits. A 2-month fixed-dose maintenance phase followed in which a diuretic could be added if the sitting DBP was greater than or equal to 100 mmHg on maximum doses of either drug. BP and heart rate were measured 8-12 hours after a dose in the sitting and standing positions. Labetalol was significantly more effective at the end of monotherapy than propranolol was in lowering both the sitting (p less than .05) and standing (p less than .04) DBP. The reduction in the systolic, although more pronounced for those on labetalol, was not significantly different; 53% of patients had a "good" response to labetalol compared with 30% of the propranolol group. Propranolol significantly (p less than 0.01) lowered heart rate compared with labetalol. Nine patients in the labetalol group and 10 in the propranolol group required a diuretic. The decrease in BP after the addition of a diuretic was comparable. Changes in plasma lipids were not significant, but HDL increased 9% with labetalol and decreased 2% with propranolol. Triglycerides increased 25% with labetalol and 31% with propranolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Postmarketing survey of the effects of an atenolol/chlorthalidone combination in the treatment of hypertension.

A large-scale postmarketing survey was conducted in the United States to evaluate the antihypertensive efficacy and safety of a combination of 50 mg of the long-acting cardioselective beta-blocker atenolol and 25 mg of the monosulfonamyl diuretic chlorthalidone. The program included 28,585 patients (of whom 26,892 provided sufficient information by questionnaire for an assessment of efficacy and race), and the participation of 7,009 primary-care physicians. After four weeks of treatment, patients had a mean reduction in systolic blood pressure of 21 mmHg and in diastolic blood pressure of 13 mmHg. The magnitude of these reductions did not differ appreciably with respect to age, sex, race, or previous therapy. Diastolic blood pressure was reduced by at least 11 mmHg in 55% of patients and systolic blood pressure was reduced by at least 16 mmHg in 59% of patients. Physicians' assessments indicated that 86% of patients achieved satisfactory control of blood pressure by the end of the study. The physicians' global assessment of the effectiveness of treatment indicated that the combination was better than previous therapy in 82% of patients; 91% of physicians planned to continue treatment with the fixed combination. There were no adverse experiences that had not been reported previously, and only dizziness exceeded an incidence of 1%. It was concluded that the fixed combination provides added blood pressure control and the convenience of a simplified once-daily regimen without added side effects, regardless of age, sex, race, or prior antihypertensive therapy.

Adolescent↗
PubMed1986

Stepped care and profiled care in the treatment of hypertension: considerations for black Americans.

The stepped-care approach to the treatment of hypertension has proved to be effective in helping control hypertension and in reducing morbidity and mortality associated with hypertension and related cardiovascular disease. Nevertheless, modifications to the stepped-care approach can provide more effective care for certain patient subgroups. By applying the best principles of stepped care to a more individualized methodology, a "profiled-care" approach to treating hypertension has been made available. Profiled care may prove particularly valuable in treating hypertensive patients in black urban communities where all forms of hypertension are disproportionally represented because of various physical, psychosocial, and socioeconomic factors. Along with efforts by the government and private sectors to eliminate barriers to effective hypertension control in poor black communities, profiled care can help achieve control equal to that achieved in more affluent communities.

Adult↗
PubMed1986

Male adolescent sexual offenders: the offender and the offense.

A group of male adolescent sexual offenders were divided into three groups: Courtship Disorders (Exhibitionism, Toucherism and Obscene Phone Calls), Sexual Assaults, and Pedophilic Offenses. Group I offenders tended to come from a less disorganized family background, were better adjusted to school and in the community and were seen by clinicians as less seriously disturbed than the adolescents in the other two groups. In addition, these adolescents did not experience the offense as a sexual act. Group II offenders (Sexual Assaulters) came from a more disturbed family background characterized by a high rate of long-term parent-child separations, committed more violent offenses and had a higher frequency of intellectual functioning in the Borderline Range of Intelligence. Group III offenders (Pedophilic Offenses) were Canadian born, had witnessed physical violence between their parents, were described as having been infants who did not enjoy being cuddled and had siblings who were truant. This study suggests that classifying adolescent sexual offenders along the line suggested in adult literature seems to be justified.

Adolescent↗
PubMed1985

Allocation of feeding pumps: an ethical question.

Situations arise in clinical practice that force the dietitian to make a moral/ethical decision. Traditional undergraduate dietetic programs have not routinely included learning activities on ethical decision making. Therefore, a dietitian confronted with such an issue may defer to someone else the responsibility for finding a viable ethical solution. If the dietitian does accept the challenge, she/he must develop a systemic way to solve the problem. This case study demonstrates how a nutrition support dietitian solves a complex ethical problem involving the allocation of two enteral feeding pumps to seven critically ill patients. The three tools used to aid in the decision making were the Standards of Professional Responsibility of The American Dietetic Association, the Four-Step Process of Moral Judgment and Action of Purtilo and Cassel, and the Nutrition Support Team. It is hoped that this case example will provide some insight to other dietitians faced with similar ethical dilemmas.

Adult↗
PubMed1982

Serological survey of the prevalence of Toxoplasma gondii antibodies in rams in sheep flocks in New South Wales.

Serum samples from 5724 rams on 534 farms in New South Wales were tested in the indirect fluorescent antibody test for toxoplasmosis. Nine per cent of rams had titres of 64 or higher and 41% of flocks had either one or more rams with a titre of 64 or higher. There were significant differences in the geographical distribution of infected flocks, ranging from 57.8% of flocks infected on the tablelands to 41% on the slopes and 22.4% on the plains. There were significantly more infected commercial flocks (47.5%) than stud flocks (32.9%). The results indicated that the prevalence of infection was influenced by management, with a higher prevalence of infection in flocks kept under an intensive or semi-intensive system of management.

Animals↗
PubMed1978

The stroke area: feasibility of adoption in community hospitals.

Pioneering efforts to establish what are known as stroke areas in community hospitals were made primarily by Dr Charles Bonner at Youville Hospital in Cambridge, Massachusetts, and Dr. Bertram Howard at St. Luke's Hospital in New Bedford, Massachusetts during the early 1960s. Analysis of comparative data collected in subsequent years from 15 or more hospitals that followed their lead suggests that the stroke unit concept has become recognized as a medically sound approach to the management of stroke victims toward enhancing, rather than simply trying to save lives.

Cerebrovascular Disorders↗