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Biomedical subjects

Richard Sadovsky

Publications and source records attributed to Richard Sadovsky.

6 recordsLinked to original sources

Identifying migraine in primary care settings.

Migraine disorders are largely unrecognized and untreated, despite the heavy burden they impose on individuals and society. Studies have shown that the symptom severity and disability associated with undiagnosed migraine are as burdensome as those associated with diagnosed migraine. Of those persons with migraine identified in population-based surveys, many were previously unaware that they had migraine. Furthermore, coexisting headache types and comorbid conditions contribute to misdiagnosis among those who consult a physician for headache. Patients who do seek medical attention for headaches usually visit their primary care providers. The purpose of this review is to highlight the distinguishing characteristics of migraine compared with other headache disorders, based on the new International Classification of Headache Disorders. To aid in diagnosis, simple screening tools, such as ID Migraine (Pfizer Inc., New York, NY), are recommended. The clinical interview and headache diary aid in refining the diagnosis or suggesting the need for further evaluation. Improved recognition of migraine in primary care will increase the rate of successful treatment with effective migraine-specific therapies. This will result in improved functionality and decreased pain, and may help prevent disease progression.

Comorbidity↗

Erection quality scale: initial scale development and validation.

OBJECTIVES: The Erection Quality Scale (EQS) is a new, self-report measure for assessing the quality of penile erections. It is intended to complement existing diagnostic and outcome measures (eg, International Index of Erectile Function, Sexual Encounter Profile) in both clinical practice and outcomes research in erectile dysfunction (ED). METHODS: The initial phases of development and psychometric validation of the EQS are described. Specifically, qualitative research in patients and healthy men was used to generate relevant constructs. On the basis of the findings from these phases, and recommendations from an expert panel, seven constructs were selected for inclusion. Multiple items with different formats were drafted to measure each of the key constructs. An iterative process of cognitive testing, item revision, and item reduction was used to identify the 15 most appropriate items and their optimal response scales. This version of the scale was tested in a 200-subject discriminant validity study designed to gather data for a psychometric evaluation. Participants were classified into ED-untreated, ED-treated, and healthy control groups to evaluate the discriminant validity of the measure in men with different levels of erectile function. RESULTS: The study results supported a robust single-factor structure, indicating that the EQS provides an overall index of erection quality. An intraclass correlation coefficient of 0.85 denotes adequate test-retest reliability. Furthermore, the EQS correlated well with existing measures and differentiated patients from the three ED classifications, a preliminary indication of discriminant validity. CONCLUSIONS: The findings presented provide evidence of the scale's potential utility for measuring erection quality in future studies.

Adult↗

Evaluation of dysuria in adults.

Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. Although urinary tract infection is the most frequent cause of dysuria, empiric treatment with antibiotics is not always appropriate. Dysuria occurs more often in younger women, probably because of their greater frequency of sexual activity. Older men are more likely to have dysuria because of an increased incidence of prostatic hyperplasia with accompanying inflammation and infection. A comprehensive history and physical examination can often reveal the cause of dysuria. Urinalysis may not be needed in healthier patients who have uncomplicated medical histories and symptoms. In most patients, however, urinalysis can help to determine the presence of infection and confirm a suspected diagnosis. Urine cultures and both urethral and vaginal smears and cultures can help to identify sites of infection and causative agents. Coliform organisms, notably Escherichia coli, are the most common pathogens in urinary tract infection. Dysuria can also be caused by noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders. Although radiography and other forms of imaging are rarely needed, these studies may identify abnormalities in the upper urinary tract when symptoms are more complex.

Adult↗

Health care clinicians in sexual health medicine: focus on erectile dysfunction.

A consensus guidelines model was developed for managing erectile dysfunction (ED) by urology nurses and other health care clinicians. The model emphasizes identification of ED in all males older than 40, education and counseling as keys to intervention, and inclusion of partners whenever possible. These guidelines are intended to provide a comprehensive care model for ED patients and their partners, which would be optimally cost effective and clinically relevant. If successful, this new model will allow quality sexual health care to be provided to increasing numbers of patients and their partners.

Counseling↗