29 results on '"Saltiel E"'
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2. ¿Qué aprendemos de las semejanzas entre las ideas históricas y el razonamiento espontáneo de los estudiantes?
- Author
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Saltiel, E., primary and Viennot, L., additional
- Published
- 2006
- Full Text
- View/download PDF
3. Un ejemplo de aportación de la didáctica de la física a la enseñanza: los ejercicios cualitativos y los razonamientos funcionales
- Author
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Saltiel, E., primary
- Published
- 2006
- Full Text
- View/download PDF
4. Research in Science Education at the University of Paris VII.
- Author
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Closset, J. L., Fauconnet, S., Saltiel, E., and Viennot, L.
- Published
- 1982
- Full Text
- View/download PDF
5. Prevalence of Potential Proton-Pump Inhibitor Drug Interactions: A Retrospective Review of Prescriptions in Community Pharmacies
- Author
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Saltiel, E. and Fask, A.
- Published
- 1999
- Full Text
- View/download PDF
6. Felodipine
- Author
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Saltiel, E., Gray Ellrodt, A., Monk, Jon, and Langley, Mark
- Abstract
Felodipine is a dihydropyridine calcium antagonist which selectively relaxes vascular smooth muscle. By acting at peripheral arterioles, it lowers systemic vascular resistance and thereby produces substantial decreases in blood pressure and increases in cardiac output. Felodipine is indicated for the management of hypertension, and in patients with mild to moderate disease felodipine monotherapy markedly lowers blood pressure. It proved as effective as atenolol, and equivalent to hydrochlorothiazide, either with or without amibride in terms of antihypertensive activity. Comparative studies also demonstrated that once daily administration with an extended-release formulation provides equivalent anti-hypertensive efficacy to the same amount of drug administered twice daily as the standard tablets. As a second- or third-line treatment for patients with moderate to severe hypertension refractory to standard drug combinations, felodipine produced considerable reductions in blood pressure when added to β-blockers and diuretics, either alone or in combination, in studies lasting up to 48 weeks. In comparative studies of multiple-drug treatments felodipine was found to have superior efficacy to hydralazine and prazosin, and was at least as effective as nifedipine, minoxidil and propranolol, when used with diuretics and/or β-blockers. As an alternative to hydrochlorothiazide, in combination with β-blockers, felodipine consistently controlled blood pressure in a greater percentage of patients and usually provided greater decreases in blood pressure. The main side effects with felodipine are ankle oedema, headache and flushing. Although the overall incidence of effects is quite high, they are usually mild in nature. Nevertheless, withdrawal due to side effects has been necessary in about 7% of patients overall. Thus, the efficacy offelodipine has been demonstrated in mild, moderate and severe hypertension. At the present time it seems particularly suitable as a second- or third-line treatment in refractory hypertension, but it also can be used as monotherapy for mild to moderate disease. Felodipine is a calcium channel antagonist of the dihydropyridine class, chemically related to nifedipine, nitrendipine, nimodipine, nisoldipine and nicardipine. The primary effect of felodipine is dilation of peripheral arterioles, and in vitrostudies showed it to have a much greater selectivity for vascular smooth muscle than myocardial muscle when compared with either nifedipine or verapamil. Single oral doses offelodipine reduced resting systolic blood pressure by up to 40mm Hg and diastolic blood pressure by up to 27mm Hg in untreated hypertensive patients, and similar reductions were seen in patients also taking β-blockers. Sub-acute and long term studies have demonstrated that these effects are sustained. Reductions in blood pressure are the result of a considerable decrease in systemic vascular resistance (up to 40%); in hypertensive patients there are secondary increases in cardiac output and stroke volume. Acute administration of felodipine produced reflex tachycardia, but this is not sustained during long term treatment. Similar haemodynamic effects occur when felodipine is given to patients with angina pectoris or congestive heart failure. In the latter patients, single oral doses of felodipine increased stroke volume index by up to 58%. In patients with angina pectoris, single oral or intravenous doses of felodipine reduced coronary vascular resistance by 35 to 56% with subsequent increases in coronary sinus blood flow and oxygen saturation of up to 43 and 64%, respectively. Similarly, felodipine reduced coronary vascular resistance and improved coronary blood flow in patients with heart failure. Felodipine is devoid of any negative inotropic actions at therapeutic dosages and there is evidence that it may in fact slightly increase myocardial contractility. In some studies, treatment with felodipine increased exercise tolerance in patients with angina pectoris or heart failure. Administration offelodipine did not significantly affect renal blood flow or glomerular filtration rate in normotensive volunteers. Short term treatment did increase renal plasma flow in hypertensive patients, although in a longer study renal plasma flow and glomerular filtration rate were unchanged by felodipine. However, in hypertensive patients with established renal insufficiency treatment with felodipine for 6 months produced a significant improvement in glomerular filtration rate, except where the initial renal impairment was severe. In both normotensive volunteers and hypertensive patients administration of felodipine produces transient increases in urine production and sodium excretion for up to 8 hours postdose, although 24-hour excretion rates are not altered. With longer term treatment natriuresis and diuresis were only observed during the first 4 days of active treatment, although the negative sodium balance seems to be sustained. In most studies felodipine administration has been associated with increases in plasma renin activity, and in some instances increases in plasma angiotensin II concentrations. Felodipine is well absorbed from the gastrointestinal tract but undergoes extensive first-pass metabolism, resulting in an absolute bioavailability of 13 to 16% in fasted individuals. Oral administration offelodipine 10mg or 0.1 mg/kg as a solution produced peak plasma concentrations of 30 to 47 nmol/L within 30 to 90 minutes postdose, and 10mg doses in tablet form produced mean maximum plasma concentrations of 22 to 25 nmol/L with a slower rate of absorption (time to maximum concentration ranged from 45 to 120 minutes). With each of these formulations a linear relationship was found between dose offelodipine and both maximum plasma concentration and area under the plasma concentration-time curve (AUC). In a comparison between 10mg doses in standard and extended-release tablets, maximum plasma concentrations were considerably lower (7 vs22 nmol/L) and time to maximum concentration was longer (174 vs66 minutes) with the extended-release formulation, but the total amount of drug absorbed over a 24-hour period was approximately the same in each case. The pharmacokinetic disposition of felodipine following both intravenous and oral administration appears to be best described using a 3-compartment model, although in some studies 2-compartment models have been employed. Distribution occurs in 2 phases; the first, rapid phase has a half-life of 6 minutes and probably represents the distribution of felodipine into total body water, while the second distribution phase is slower (halflife of 1.6 hours) and may result from the redistribution of felodipine into slowly equilibrating tissues. The volume of distribution in the central compartment was between 0.6 and 1.5 L/kg, and the best estimate of the volume of distribution in the terminal phase was 9.7 L/kg. Felodipine is extensively bound to plasma proteins (>99%). Felodipine is metabolised to a variety of end-products, the first and major step being oxidation by hepatic cytochrome P-450 to the inactive pyridine analogue. About onethird of all metabolites are excreted as conjugates. The terminal elimination half-life of felodipine ranged from 7 to 21 hours following single intravenous doses in normal volunteers, while a mean value of 18 hours was obtained after single intravenous doses given to hypertensive patients. Mean steady-state values of elimination half-life assessed during multiple-dose studies have been between 22 and 27 hours, and individual values of up to 36 hours have been reported. The mean plasma clearance of felodipine was 49 to 65 L/h, and its intrinsic clearance has been estimated as 324 L/h. Felodipine pharmacokinetics are largely unaffected by renal disease, whereas plasma clearance is reduced in the elderly and in patients with hepatic disease. The therapeutic efficacy of felodipine as monotherapy for mild to moderate hypertension has been demonstrated in a number of non-comparative studies, with daily dosages of 10 to 20mg usually providing substantial decreases in blood pressure. In comparative studies with placebo, daily doses of felodipine 2.5 to 20mg produced statistically significant reductions in systolic and diastolic blood pressure of up to 25 and 20mm Hg, respectively. When compared with other drugs, felodipine 5 to 10mg twice daily was as effective as atenolol 100mg once daily, and a dose of 5mg twice daily was equivalent to hydrochlorothiazide 25mg once daily, either alone or in combination with amiloride 2.5mg. In 2 comparative studies felodipine 10mg once daily as the extended-release formulation was as effective in lowering blood pressure as 5mg twice daily in the form of the standard tablets, either as monotherapy or when used in combination with a β-blocker. Felodipine has also been investigated as second- or third-line antihypertensive treatment in patients with moderate to severe hypertension refractory to their existing treatment. In non-comparative studies felodipine 5 to 25mg twice daily reduced systolic and diastolic blood pressures by 26 and 15mm Hg, respectively, after 48 weeks of treatment in combination with a β-blocker and a diuretic, and in another study effective treatment with the same combination was continued for up to 18 months. Double-blind comparative studies demonstrated that felodipine 5 to 15mg twice daily in addition to β-blockers and diuretics, either alone or in combination, significantly reduced blood pressures when compared with placebo. Using a ‘target’ diastolic blood pressure of 90 or 95mm Hg, response rates of between 45 and 97% have been achieved using doses of felodipine between 2.5 and 10mg twice daily. When used in combination with a β-blocker, felodipine 2.5 to 20mg twice daily reduced blood pressures to a greater degree than did prazosin 0.5 to 4mg twice daily, while when it was used together with a diuretic felodipine 5 to 10mg twice daily was at least as effective as propranolol 80 to 160mg twice daily. In studies where patients taking β it blockers also received felodipine 5 to 10mg or hydrochlorothiazide 25 to 50mg twice daily, greater reductions in blood pressure occurred in the felodipine group, while in a similar study where the hydrochlorothiazide dosage was 25 to 50mg oncedaily, blood pressures were reduced by the same amount in each group. However, in this study response rates were better with felodipine treatment. Additionally, felodipine 5 to 10mg twice daily added to a β-blocker provided greater reductions in diastolic (but not systolic) blood pressure than triple therapy using a β-blocker, hydralazine (50mg twice daily) and hydrochlorothiazide (12.5 to 50 mg/day). As a third-line treatment (i.e. added to a regimen of a β-blocker plus a diuretic) in patients with refractory hypertension, felodipine 15 to 30 mg/day was more effective than nifedipine 30 to 60 mg/day, and felodipine 5 to 20mg twice daily was equivalent to minoxidil 10 to 45 mg/day and superior to hydralazine 25 to 100mg twice daily. Preliminary reports suggest that felodipine may also be beneficial for patients with hypertension secondary to renal disease and in individuals with pulmonary hypertension. A number of drug interactions have been reported with felodipine. Most of these are of no clinical importance, but a major interaction does occur between felodipine and anticonvulsant drugs which are inducers of hepatic microsomal enzymes. Treatment with these drugs increases considerably the extent of first-pass metabolism of felodipine, and phenytoin, carbamazepine and phenobarbitone all reduced plasma concentrations of felodipine by about 80%. AUC values were decreased similarly, and the oral bioavailability of felodipine in these circumstances was estimated at 1%. The most commonly reported side effects during felodipine therapy are related to its arteriodilating properties, such as ankle oedema (4 to 30% of patients in larger studies), headache and flushing (0 to 30% each). Ankle oedema is usually not associated with increases in bodyweight and is thought to occur as a result of local increases in fluid filtration from blood into tissues (due to increases in capillary hydrostatic pressure), rather than because of water retention per se.Other effects that have been reported include dizziness, fatigue, insomnia, palpitations, dyspnoea and muscle pain. The overall incidence of reactions has been quite high (60% or more in some studies), but usually the symptoms are mild. Withdrawal rates have been greater than 10% in some studies, and in pooled data covering 1,165 patients the overall rate was 7.4%. The normal daily dose of felodipine is 10 mg/day, whether it is used as monotherapy or in combination with other antihypertensive drugs. The maximum recommended daily dosage is 20mg, while in the elderly and in patients with liver disease a reduced starting dose of 5 mg/day may be more appropriate. Felodipine can be taken as a once daily dosage using the extended-release formulation, or as a divided twice-daily dosage with the standard tablets.
- Published
- 1988
- Full Text
- View/download PDF
7. Felodipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension
- Author
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Ellrodt Ag, Langley Ms, Saltiel E, and Monk Jp
- Subjects
Felodipine ,business.industry ,Metabolic Clearance Rate ,Nitrendipine ,Propranolol ,Pharmacology ,Hydralazine ,Atenolol ,Blood pressure ,medicine.anatomical_structure ,Hydrochlorothiazide ,Nifedipine ,Hypertension ,Vascular resistance ,medicine ,Humans ,Pharmacology (medical) ,business ,medicine.drug - Abstract
Felodipine is a dihydropyridine calcium antagonist which selectively relaxes vascular smooth muscle. By acting at peripheral arterioles, it lowers systemic vascular resistance and thereby produces substantial decreases in blood pressure and increases in cardiac output. Felodipine is indicated for the management of hypertension, and in patients with mild to moderate disease felodipine monotherapy markedly lowers blood pressure. It proved as effective as atenolol, and equivalent to hydrochlorothiazide, either with or without amiloride, in terms of antihypertensive activity. Comparative studies also demonstrated that once daily administration with an extended-release formulation provides equivalent antihypertensive efficacy to the same amount of drug administered twice daily as the standard tablets. As a second- or third-line treatment for patients with moderate to severe hypertension refractory to standard drug combinations, felodipine produced considerable reductions in blood pressure when added to beta-blockers and diuretics, either alone or in combination, in studies lasting up to 48 weeks. In comparative studies of multiple-drug treatments felodipine was found to have superior efficacy to hydralazine and prazosin, and was at least as effective as nifedipine, minoxidil and propranolol, when used with diuretics and/or beta-blockers. As an alternative to hydrochlorothiazide, in combination with beta-blockers, felodipine consistently controlled blood pressure in a greater percentage of patients and usually provided greater decreases in blood pressure. The main side effects with felodipine are ankle oedema, headache and flushing. Although the overall incidence of effects is quite high, they are usually mild in nature. Nevertheless, withdrawal due to side effects has been necessary in about 7% of patients overall. Thus, the efficacy of felodipine has been demonstrated in mild, moderate and severe hypertension. At the present time it seems particularly suitable as a second- or third-line treatment in refractory hypertension, but it also can be used as monotherapy for mild to moderate disease.
- Published
- 1988
8. 'Spontaneous' ways of reasoning in elementary kinematics
- Author
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Saltiel, E, primary and Malgrange, J L, additional
- Published
- 1980
- Full Text
- View/download PDF
9. Patchy alopecia in a young girl. Tinea capitis (most likely a Trichophyton tonsurans infection)
- Author
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Zoberman-Saltiel, E., primary
- Published
- 1989
- Full Text
- View/download PDF
10. Cost comparison of recombinant human erythropoietin and blood transfusion in cancer chemotherapy-induced anemia
- Author
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Sheffield, R.E., Sullivan, S.D., Saltiel, E., and Nishimura, L.
- Subjects
Transplantation of organs, tissues, etc. -- Economic aspects ,Anemia -- Causes of -- Complications and side effects ,Blood transfusion -- Economic aspects ,Chemotherapy -- Economic aspects ,Cancer -- Chemotherapy ,Health ,Economic aspects ,Complications and side effects ,Causes of - Abstract
Sheffield, R.E.; Sullivan, S.D.; Saltiel, E.; Nishimura, L. 'Cost Comparison of Recombinant Human Erythropoietin and Blood Transfusion in Cancer Chemotherapy-Induced Anemia.' Annals of Pharmacotherapy, January 1997;31(1):15-22. According to the authors' [...]
- Published
- 1997
11. Colistin- and polymyxin-induced nephrotoxicity: focus on literature utilizing the RIFLE classification scheme of acute kidney injury.
- Author
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Pike M and Saltiel E
- Subjects
- Acute Kidney Injury classification, Colistin adverse effects, Humans, Acute Kidney Injury chemically induced, Anti-Bacterial Agents adverse effects, Colistin analogs & derivatives, Polymyxin B adverse effects
- Abstract
With the reintroduction of colistimethate and polymyxin B into clinical practice, a review of their individual and comparative nephrotoxicity attributes as reported in contemporary literature was undertaken. Given variability in definitions used for acute kidney injury, a particular focus was placed on studies utilizing the Risk-Injury-Failure-Loss-End Stage Kidney Disease (RIFLE) criteria of assessment to provide for standardized comparison. Primary risk factors examined included the influence of dosing and the receipt of concomitant nephrotoxins. The typical severity and time course of renal injury that develops were also analyzed. Nephrotoxicity rates with colistimethate appear to approach 50%, and could be of lower frequency and severity with polymyxin B based on limited literature. Acute kidney injury generally appears to be mild to moderate in magnitude and reversible in nature, though as many as 20% of patients experiencing it may require renal replacement therapy of some duration. The majority of studies showed some relationship with dosing- variably reported as being associated with daily dose or cumulative exposure. Traditional nephrotoxic agents did not appear to confer additional risk individually in the majority of investigations, though receipt of multiple concurrent nephrotoxins did yield a relationship in several. Further studies will be required to better characterize the renal adverse effect profile of these agents, particularly in the case of polymyxin B., (© The Author(s) 2014.)
- Published
- 2014
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12. Clostridium difficile-associated diarrhea: role of the pharmacist in the health system.
- Author
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Saltiel E
- Subjects
- Clostridium Infections epidemiology, Clostridium Infections microbiology, Cross Infection microbiology, Diarrhea microbiology, Humans, Pharmaceutical Services organization & administration, Professional Role, Clostridioides difficile isolation & purification, Clostridium Infections therapy, Diarrhea therapy, Pharmacists organization & administration
- Published
- 2013
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13. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial.
- Author
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Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, Archi J, Deutsch S, and Weingarten SR
- Subjects
- Aged, Algorithms, Blood Pressure Determination, California, Costs and Cost Analysis, Evidence-Based Medicine, Female, Health Services for the Aged, Humans, Hypertension economics, Interprofessional Relations, Male, Middle Aged, Primary Health Care, Prospective Studies, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Patient Care Team, Pharmacists, Physicians
- Abstract
Objective: To compare the effectiveness of an evidence-based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension., Methods: Patients in a staff model medical group with uncontrolled hypertension were randomized to either a usual care (UC) or a physician-pharmacist comanagement (PPCM) group. All physicians in the study received both group and individual education and participated in the development of an evidence-based hypertension treatment algorithm. Physicians were then given the names of their patients whose medical records documented elevated blood pressures (defined as systolic > or = 140 mm Hg and/or diastolic > or = 90 mm Hg for patients aged < 65 yrs, and systolic > or = 160 mm Hg and/or diastolic > or = 90 mm Hg for those aged > or = 65 yrs). Patients randomized to the UC group were managed by primary care physicians alone. Those randomized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist, who provided patient education, made treatment recommendations, and provided follow-up. Blood pressure measurements, antihypertensive drugs, and visit costs/patient were obtained from medical records., Results: One hundred ninety-seven patients with uncontrolled hypertension participated in the study. Both PPCM and UC groups experienced significant reductions in blood pressure (systolic -22 and -11 mm Hg, respectively, p < 0.01; diastolic -7 and -8 mm Hg, respectively, p < 0.01). The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups (p < 0.01). More patients achieved blood pressure control in the PPCM than in the UC group (60% vs 43%, p = 0.02). Average provider visit costs/patient were higher in the UC than the PPCM group ($195 vs $160, p = 0.02)., Conclusions: An evidence-based, systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension resulted in improved blood pressure control and reduced average visit costs/patient.
- Published
- 2003
- Full Text
- View/download PDF
14. Cost comparison of recombinant human erythropoietin and blood transfusion in cancer chemotherapy-induced anemia.
- Author
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Sheffield R, Sullivan SD, Saltiel E, and Nishimura L
- Subjects
- Costs and Cost Analysis, Decision Trees, Erythropoietin economics, Humans, Anemia chemically induced, Anemia therapy, Antineoplastic Agents adverse effects, Blood Transfusion economics, Economics, Pharmaceutical, Erythropoietin therapeutic use
- Abstract
Objective: To compare the cost of recombinant human erythropoietin (rHuEPO) with that of blood transfusion in the treatment of chemotherapy-induced anemia from a healthcare system perspective., Design: A decision analytic model. Baseline estimates were obtained from a review of clinical trials data and economic evaluation studies., Subjects: Secondary data analyses of patients with advanced malignancies, excluding hematologic malignancies and metastasized solid tumors., Interventions: Patients received either leukocyte-depleted packed red blood cells (PRBCs) or rHuEPO 150 units/kg s.c. three times per week for 6 months (24 wk). After 6 weeks, if rHuEPO recipients did not display a response, they received rHuEPO 300 units/kg s.c. three times weekly for the duration of therapy. If rHuEPO recipients still exhibited no response, they were given blood transfusions., Measurements and Main Results: For a treatment period of 24 weeks, approximately 64% of rHuEPO recipients responded at an average expected cost of $12971 per patient. One hundred percent of transfusion recipients responded at a cost of $481; this resulted in a cost savings of $8490. Variation of response rates for rHuEPO or PRBCs did not appreciably lower costs. Lower rHuEPO dosages and higher numbers of transfused units of PRBCs yielded approximately equivalent costs; however, these strategies may not be clinically prudent., Conclusions: From a healthcare system cost and outcome perspective, blood transfusion is the preferred strategy for chemotherapy-induced anemia. However, rHuEPO may be considered an effective blood-sparing alternative for patients with non-stem cell disorders. Future cost-effectiveness analyses are needed to assess more completely both the clinical and quality-of-life benefits rHuEPO may contribute to individual patients' lives and to society overall.
- Published
- 1997
- Full Text
- View/download PDF
15. Potential cost savings using GnRH agonists as preoperative therapy for uterine leiomyomas.
- Author
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Saltiel E
- Subjects
- Adult, Antineoplastic Agents, Hormonal economics, Combined Modality Therapy, Female, Gonadotropin-Releasing Hormone agonists, Humans, Hysterectomy economics, Hysterectomy methods, Leiomyoma economics, Leiomyoma surgery, Length of Stay economics, Leuprolide economics, Megestrol economics, Megestrol therapeutic use, Megestrol Acetate, Sick Leave economics, United States, Uterine Neoplasms economics, Uterine Neoplasms surgery, Antineoplastic Agents, Hormonal therapeutic use, Cost Savings statistics & numerical data, Drug Costs statistics & numerical data, Leiomyoma drug therapy, Leuprolide therapeutic use, Megestrol analogs & derivatives, Uterine Neoplasms drug therapy
- Abstract
Women with large uterine leiomyomas traditionally have had just one choice for therapy--abdominal hysterectomy. Recently, gonadotropin-releasing hormone (GnRH) agonist therapy has been introduced as an option to shrink tumors before surgery. When administered preoperatively, usually for 2 months, GnRH therapy has been shown to reduce tumor size enough to permit an endoscopic myomectomy or a vaginal hysterectomy. It has also been shown to reduce blood loss associated with the tumors and increase hemoglobin levels. When assessed for its economic impact, preoperative GnRH therapy reduces both direct and indirect costs associated with a hysterectomy.
- Published
- 1995
16. Critical pathway experience at Cedar-Sinai Medical Center.
- Author
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Saltiel E
- Subjects
- California, Community-Acquired Infections drug therapy, Coronary Artery Bypass, Embolism drug therapy, Hip Prosthesis, Hospitals, Teaching, Humans, Myocardial Infarction drug therapy, Pain, Postoperative drug therapy, Patient Care Planning, Pneumonia drug therapy, Health Plan Implementation, Managed Care Programs, Patient-Centered Care, Pharmacy Service, Hospital
- Abstract
Critical pathways provide an excellent tool for promoting multidisciplinary efforts to develop optimal, cost-competitive plans for managing patient care. The pharmacy department can play a variety of roles in developing and implementing critical pathways. In advocating optimal drug selection and monitoring, pharmacists can help their institutions reduce costs while maintaining or improving quality of care.
- Published
- 1995
- Full Text
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17. A team approach to adverse drug reaction surveillance: success at a tertiary care hospital.
- Author
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Saltiel E, Johnson E, and Shane R
- Subjects
- Forms and Records Control, Hospital Bed Capacity, 500 and over, Humans, Interdepartmental Relations, Joint Commission on Accreditation of Healthcare Organizations, Los Angeles, Adverse Drug Reaction Reporting Systems, Concurrent Review, Pharmacy Service, Hospital standards
- Abstract
A retrospective adverse drug reaction (ADR) reporting system has been in place at Cedars-Sinai Medical Center for 7 years. Initially, the system identified 300 to 400 ADRs per year. After adding a checklist, that number increased to 750 to 850 per year, an ADR rate of about 2% of total patient admissions. To increase the ADR reporting rate, we initiated a concurrent surveillance program in conjunction with the retrospective system. In the first year of the program, the combined systems identified 1,174 ADRs. In addition, the ADR rate per 100 patient days increased to between 0.5 and 0.7, and the ADR per admission rate increased to 4%. As a result of the more effective ADR surveillance program, the P & T Committee has additional data from which to develop guidelines and educational programs to increase ADR awareness and prevention, and thus, to improve patient outcomes.
- Published
- 1995
18. Comment: enoxaparin--the low-molecular-weight heparin for prevention of postoperative thromboembolic complications.
- Author
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Saltiel E and Saya F
- Subjects
- Humans, Thrombophlebitis prevention & control, Warfarin therapeutic use, Enoxaparin therapeutic use, Postoperative Complications prevention & control, Thromboembolism prevention & control
- Published
- 1994
- Full Text
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19. Drug treatment of pneumonia in the elderly: efficacy and costs.
- Author
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Saltiel E and Weingarten S
- Subjects
- Administration, Oral, Aged, Ambulatory Care economics, Anti-Bacterial Agents economics, Cost-Benefit Analysis, Health Care Costs, Humans, Infusions, Parenteral economics, Pneumonia microbiology, Treatment Outcome, United States, Anti-Bacterial Agents therapeutic use, Pneumonia drug therapy, Pneumonia economics
- Published
- 1993
- Full Text
- View/download PDF
20. Prospective physician review of orders for colony-stimulating factors.
- Author
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Nishimura LY, Shane RR, and Saltiel E
- Subjects
- Colony-Stimulating Factors economics, Drug Costs, Hospital Bed Capacity, 500 and over, Hospitals, Teaching, Humans, Los Angeles, Neutropenia drug therapy, Peer Review, Prospective Studies, Colony-Stimulating Factors therapeutic use, Drug Utilization economics, Medical Staff, Hospital standards
- Abstract
A program is described in which physicians prospectively review orders for the use of colony-stimulating factors (CSFs) at a tertiary-care private teaching hospital. Hospital officers and administrators and the heads of medical subspecialties were presented with three options for managing the use of CSFs. Prospective review by physicians was selected, and a task force of medical subspecialists was established to develop criteria for use and to review orders. Initially, every order was prospectively reviewed, but criteria were developed under which some orders do not require physician review. CSF use is documented retrospectively by a drug-use evaluation pharmacist and reviewed for appropriateness by the physician task force. Between March and October 1991, 115 patients were given courses of CSFs, and the use of the physician review system resulted in appropriate use of the drugs for 98% of the oncology patients and 61% of the patients infected with the human immunodeficiency virus. The prospective physician reviewer system has been accepted by the medical staff at the facility and has helped to ensure appropriate use of CSFs.
- Published
- 1992
21. SK tray: a device to encourage streptokinase use.
- Author
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Saltiel E, Chun CO, and Shane RR
- Subjects
- Drug Utilization, Humans, Myocardial Infarction drug therapy, Streptokinase administration & dosage, Streptokinase therapeutic use, Thrombolytic Therapy
- Published
- 1992
22. Using documentation of pharmacists' clinical activity.
- Author
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Shane R, Saltiel E, White JY, and Flascha ST
- Subjects
- Forms and Records Control, Hospital Bed Capacity, 500 and over, Humans, Los Angeles, Medical Staff, Patient Care Team, Documentation, Pharmacists, Pharmacy Service, Hospital organization & administration
- Published
- 1991
23. An adverse drug reaction reporting system as an integral part of a drug-usage evaluation program.
- Author
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Saltiel E and Shane R
- Subjects
- Digoxin adverse effects, Evaluation Studies as Topic, Hospital Bed Capacity, 500 and over, Humans, Los Angeles, Drug Utilization, Drug-Related Side Effects and Adverse Reactions, Pharmacy and Therapeutics Committee organization & administration, Product Surveillance, Postmarketing
- Abstract
The Adverse Drug Reaction program at CSMC identifies patients whose charts have been encoded with an ICD-9 code of E930 through E949, inclusively. Incidences per drug or drug category have permitted the Department of Pharmacy, acting through the Pharmacy and Therapeutics Committee, to review patient charts, identify trends and risk factors, and subsequently develop usage criteria for DUE studies. It is hoped that these activities will result in an improvement in usage of these drugs and a reduction in adverse drug reactions to them.
- Published
- 1991
24. Pharmacologic management of endometriosis.
- Author
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Saltiel E and Garabedian-Ruffalo SM
- Subjects
- Contraceptives, Oral administration & dosage, Contraceptives, Oral therapeutic use, Danazol adverse effects, Endometriosis epidemiology, Endometriosis etiology, Endometriosis surgery, Female, Gonadotropin-Releasing Hormone adverse effects, Gonadotropin-Releasing Hormone analogs & derivatives, Gonadotropin-Releasing Hormone therapeutic use, Humans, Menopause, Nafarelin, Pseudopregnancy etiology, Danazol therapeutic use, Endometriosis drug therapy
- Abstract
The incidence, pathogenesis, staging, and treatment of endometriosis are reviewed, with an emphasis on pharmacologic management of this condition. Endometriosis--the presence of ectopic endometrial tissue--can be found in 15-25% of infertile women and may be found in 1-5% of all women between menarche and menopause. Although the pathogenesis of endometriosis is uncertain, the most tenable etiologic theory is a combination of celomic metaplasia and retrograde menstruation. Staging is based on the American Fertility Society classification scheme, with stage I being the mildest and stage IV the most severe form of the disease. The management of endometriosis depends on the extent of the disease, the severity of the symptoms, the age of the patient, and the patient's desire for future fertility. Treatment modalities include expectant management, surgery, induction of a pseudopregnancy state with hormonal therapy (e.g., oral contraceptives), or induction of a pseudomenopausal state. The induction of a pseudomenopausal state with the use of oral danazol gained widespread favor in the 1970s as the treatment of choice in patients with endometriosis, but therapy is often associated with unpleasant adverse effects. Gonadotropin-releasing hormone (GnRH) agonists may provide a safe and clinically effective alternative to danazol therapy in patients with endometriosis. Results of a multicenter study comparing nafarelin with danazol for treatment of endometriosis indicated no significant differences between treatment groups with respect to improvements in disease state and symptomatology. The most common adverse effect associated with nafarelin therapy is hot flashes. The GnRH agonist nafarelin is as effective as danazol or oral contraceptives for the treatment of endometriosis and causes fewer adverse reactions. GnRH agonists may replace danazol as the treatment of choice in patients with endometriosis.
- Published
- 1991
25. The neuropsychiatric manifestations of systemic lupus erythematosus: an overview.
- Author
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Adelman DC, Saltiel E, and Klinenberg JR
- Subjects
- Adrenal Cortex Hormones adverse effects, Adrenal Cortex Hormones therapeutic use, Antibodies, Monoclonal therapeutic use, Antigen-Antibody Complex metabolism, Brain diagnostic imaging, Cranial Nerve Diseases etiology, Electroencephalography, Humans, Lupus Erythematosus, Systemic psychology, Lupus Erythematosus, Systemic therapy, Lymphoid Tissue radiation effects, Magnetic Resonance Spectroscopy, Mental Disorders diagnosis, Mental Disorders therapy, Nervous System Diseases diagnosis, Nervous System Diseases therapy, Plasmapheresis, Seizures etiology, Tomography, Emission-Computed, Tomography, X-Ray Computed, Lupus Erythematosus, Systemic complications, Mental Disorders etiology, Nervous System Diseases etiology
- Published
- 1986
- Full Text
- View/download PDF
26. Generalized motor seizure following metrizamide cisternography.
- Author
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Saltiel E, Adelman DC, Ellis JC, and Young WI
- Subjects
- Cerebrospinal Fluid Rhinorrhea diagnostic imaging, Electroencephalography, Epilepsy, Tonic-Clonic chemically induced, Female, Humans, Middle Aged, Risk, Metrizamide adverse effects, Myelography adverse effects, Seizures chemically induced
- Abstract
Metrizamide is a water-soluble contrast medium used as a diagnostic tool in myelography and cisternography. Despite its accepted safety, its use has been associated with generalized motor seizures, and several cases of this toxicity have been reported. Risk factors include phenothiazine ingestion, seizure history, and large doses of the contrast material. Abnormal electroencephalographic wave patterns, as well as seizure activity, are less frequent after cisternography than myelography. A case of a metrizamide-induced generalized motor seizure following cisternography is reported in a patient with none of the above risk factors. The need for a thorough medication history and the use of prophylactic anticonvulsants in selected patients is discussed.
- Published
- 1984
- Full Text
- View/download PDF
27. Cefonicid. A review of its antibacterial activity, pharmacological properties and therapeutic use.
- Author
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Saltiel E and Brogden RN
- Subjects
- Cefamandole pharmacology, Cefamandole therapeutic use, Cefonicid, Humans, Bacterial Infections drug therapy, Cefamandole analogs & derivatives
- Abstract
Cefonicid is a 'second generation' cephalosporin administered intravenously or intramuscularly. It is similar to cefamandole in its superiority to first generation cephalosporins against several enterobacteriaceae as well as its activity against Haemophilus influenzae, including beta-lactamase-producing strains. Its activity against Staphylococcus aureus is similar to that of cefoxitin and inferior to cefamandole and first generation cephalosporins. It has excellent in vitro activity against Neisseria gonorrhoeae, but is inactive against Pseudomonas, Acinetobacter, Serratia, and Bacteroides fragilis. Due to high achievable plasma concentrations and a relatively long half-life, in most clinical trials cefonicid has been administered once daily. It was comparable in efficacy with cefamandole or cefazolin in the treatment of patients with urinary tract, lower respiratory tract, and soft tissue and bone infections. It has also been compared with penicillin in the treatment of uncomplicated gonorrhoea. Results from a small series of patients with endocarditis appear to indicate that cefonicid should not be used in patients with serious staphylococcal infections. Single doses of cefonicid given preoperatively appear to offer a similar degree of protection against post-surgical infection as multiple doses of other antibiotics, but further data from studies involving larger numbers of patients are needed to confirm these impressions. Patients who require prolonged antibiotic therapy, such as those with osteomyelitis being treated as outpatients after a relatively short inpatient course, could benefit from the once daily dose regimen of cefonicid.
- Published
- 1986
- Full Text
- View/download PDF
28. Doxorubicin (adriamycin) cardiomyopathy.
- Author
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Saltiel E and McGuire W
- Subjects
- Biopsy, Cardiomyopathies pathology, Cardiomyopathies prevention & control, Dose-Response Relationship, Drug, Doxorubicin pharmacology, Endocardium pathology, Heart Function Tests, Humans, Myocardium pathology, Risk, Cardiomyopathies chemically induced, Doxorubicin adverse effects
- Abstract
Despite its vast utility in clinical oncology, the use of doxorubicin hydrochloride (Adriamycin) is limited by a potentially fatal cardiomyopathy. The following critical review, which examines the natural course, histopathologic effects, risk factors and monitoring indicators of this toxicity, also analyzes recent research of proposed mechanisms, including free radical formation with depletion of detoxifying enzymes, inhibition of vital enzyme systems and alterations in relative calcium concentrations. Prevention of the adverse reaction has been attempted by using such agents as alpha-tocopherol, selenium sulfide, coenzyme Q(10), sulfhydryl donors, nucleosides and razoxane, and via liposomal carriage and alternative methods of administration.
- Published
- 1983
29. Ticlopidine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in platelet-dependent disease states.
- Author
-
Saltiel E and Ward A
- Subjects
- Hematologic Diseases blood, Humans, Kinetics, Platelet Aggregation, Ticlopidine adverse effects, Ticlopidine metabolism, Ticlopidine therapeutic use, Blood Platelets physiology, Hematologic Diseases drug therapy, Ticlopidine pharmacology
- Abstract
Ticlopidine is an inhibitor of platelet action that has been used in the treatment of a variety of disease states in which platelets play a prominent role. Studies in animals and man have demonstrated that ticlopidine is a potent inhibitor of platelet aggregation induced by adenosine diphosphate (ADP), and variably inhibits aggregation due to collagen, adrenaline (epinephrine), arachidonic acid, thrombin, and platelet activating factor. Inhibition of platelet aggregation is both dose- and time-related, with its onset of activity being 24 to 48 hours, its maximal activity occurring after 3 to 5 days, and its activity still being present 72 hours after a final dose. Ticlopidine also inhibits the release reaction of platelets, prolongs bleeding time, reduces plasma levels of platelet factor 4 and beta-thromboglobulin in patients in whom these proteins are elevated, and may also inhibit platelet adhesion, increase red cell filtrability and decrease whole blood viscosity. In a large number of animal models, ticlopidine markedly inhibits thrombus formation or graft occlusion. Ticlopidine is well absorbed after oral administration. It is extensively metabolised and at least one of its metabolites is pharmacologically active. Therapeutic trials in patients with chronic arterial occlusion due to thrombangitis obliterans or arteriosclerosis obliterans, post-myocardial infarction, cerebrovascular thromboembolic disease, subarachnoid haemorrhage, vascular shunts or fistulas for haemodialysis, and sickle cell disease have shown promise for the use of ticlopidine. However, trials of patients with intermittent claudication, angina pectoris, diabetes mellitus with microvascular disease, aortocoronary bypass grafts, and vascular prostheses have had conflicting results or have shown an unfavourable side effect profile. Further studies are clearly required to establish the role of ticlopidine in many of these areas, some of which are already in progress. Overall, side effects occur in 10 to 15% of patients receiving ticlopidine. The most common side effects are gastrointestinal disturbances and skin rashes. Neither of these necessarily require discontinuation of therapy in most patients. Agranulocytosis, thrombocytopenia, and cholestatic jaundice have also been reported. Bleeding is infrequent except possibly in patients receiving ticlopidine prior to some surgical procedures.
- Published
- 1987
- Full Text
- View/download PDF
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