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Biomedical subjects

B McGowan

Publications and source records attributed to B McGowan.

At least 19 recordsLinked to original sources
PubMed2006

Recombinant human erythropoietin is associated with increased overall survival in patients with multiple myeloma.

BACKGROUND: Recombinant human erythropoietin (rhEPO) is effective for the treatment of anemia associated with multiple myeloma. Data from animal studies and case reports suggest that rhEPO has antineoplastic properties. METHODS: Two hundred and ninety-two patients enrolled on different chemotherapy clinical trials at the Cleveland Clinic Myeloma Program between 1997 and 2003 were the subjects of this study. Information on erythropoietin use as well as baseline prognostic variables were collected retrospectively. RESULTS: The population consisted of 257 patients with multiple myeloma treated at the Cleveland Clinic Foundation from 1997 to 2003 and followed for at least 1 month. Thirty-five patients were excluded from this analysis because information on erythropoietin use was not available. One hundred and twenty-seven patients received rhEPO for at least 1 month and the rest did not received rhEPO. On average, patients who received rhEPO were older, had a higher Southwest Oncology Group (SWOG) stage, higher serum creatinine, lower serum hemoglobin, higher beta2-microglobulin, lower platelet counts, and a longer time from diagnosis to enrollment at the myeloma program (p < 0.001 for all). After adjusting for age, months from diagnosis to enrollment, serum creatinine, hemoglobin, platelet count, and beta2-microglobulin, the use of rhEPO was associated with improved overall survival (hazard ratio = 0.6; 95% CI = 0.38-0.94) in patients with SWOG stages II, III and IV but not in patients with SWOG stage I. CONCLUSION: rhEPO was associated with improved overall survival in this population of anemic multiple myeloma patients with SWOG stages of II, III and IV. A prospective randomized trial is warranted to corroborate this finding.

Aged↗
PubMed2006

The rising cost of glaucoma drugs in Ireland 1996-2003.

BACKGROUND: Glaucoma affects approximately 2% of the population in developed countries and is estimated to affect 67 million people worldwide. The authors investigated the effect of the introduction of new medications on the volume and cost of drugs for glaucoma in two countries, Northern Ireland (NI, population approximately 1.7 million) and the Republic of Ireland (ROI, population approximately 3.9 million) in the 8 years from 1996 to 2003. They also looked at the surgical rates for glaucoma within the same time period for the two countries. METHODS: A retrospective analysis was performed of drug costs, prescribing data, and operation rates for glaucoma in Ireland from January 1996 to December 2003. Information regarding costs and volume were obtained for each type of glaucoma drug and these were then grouped into the glaucoma treatment subsections as found in the British National Formulary. The drug information was obtained from the Central Services Agency in NI and IMS Health in the ROI and included both public and private prescriptions. The information on surgical rates for glaucoma was obtained from the Department of Health and Social Services in NI and the Hospital In-patient Enquiry (HIPE) data national files in the ROI. RESULTS: There was a 30% increase in prescription items for glaucoma in NI and a 59% increase in the ROI from 1996 to 2003. The costs increased more rapidly than the number of items: 227% in the ROI and 78% in NI from January 1996 to December 2003. In the ROI, there was an average 19% year on year increase in costs. In NI, new drugs accounted for 40% of the quantity of prescription items for glaucoma and 63% of the market cost in 2003. In the ROI new drugs accounted for 57% of the quantity and 77% of the market cost for glaucoma in 2003; prostaglandin analogue drugs alone accounted for 53% of the cost. The number of trabeculectomies performed decreased by more than 60% in both countries. CONCLUSION: Volume and cost of glaucoma drugs increased dramatically in both NI and the ROI from 1996 to 2003, probably the result of a combination of changing demographics and a changing approach towards the management of patients with glaucoma and ocular hypertension. In 2003 in the ROI, prostaglandin analogues were the most commonly prescribed class of drug for patients with glaucoma and/or ocular hypertension causing a profound rise in drug expenditure.

Adrenergic beta-Antagonists↗
PubMed2005

Cost effective prescribing of proton pump inhibitors (PPI's) in the GMS Scheme.

Total expenditure under the Community Drugs Schemes in Ireland on the proton pump inhibitors (PPI's) used for the management of patients with dyspepsia was approximately 64 million Euro in 2002, an 8-fold increase since 1995. As PPI maintenance therapy accounts for the majority of this expenditure we determined potential cost savings to the GMS scheme should the prescribing of these drugs for maintenance therapy follow published clinical and cost effectiveness guidelines. Substitution, in accordance with therapeutic indication, of the PPI with the greatest individual cost i.e. omeprazole (Losec Mups) with any of the alternative agents particularly the generic omeprazole preparations Ulcid & Lopraz, rabeprazole (Pariet) and pantoprazole (Protium) would be expected to produce cost savings in excess of 5 million Euro per annum. These savings may be further enhanced by increasing the step down from healing to maintenance doses of these drugs.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Generic drug utilisation on the General Medical Services (GMS) scheme in 2001.

Expenditure on medicines under the Community Drug Schemes was Euro 674.8 million in 2001, a 27% increase as compared with the year 2000. Prescribing less expensive generic drugs is one method of reducing costs whilst maintaining therapeutic efficacy. In this study the cost and quantity of generic drugs dispensed and the potential savings for GMS prescribing in 2001 that could be made by increasing utilisation of generic drugs was investigated. Twenty two per cent of prescription items were dispensed generically (branded generics (17%) and non-branded generics (5%)) in 2001. This represented approximately 13% of the total ingredient cost of drugs dispensed in that period. Eighteen per cent of prescription items were dispensed as proprietary preparations when a generic equivalent was available. Eleven of the top 30 drugs, of highest cost to the GMS scheme, had a generic equivalent which if substituted could produce savings in the region of Euro 5.65 million. The results of this study highlight the potential for cost savings to be made by generic substitution, facilitating the most efficient use of the limited drugs budget.

Drug Prescriptions↗
PubMed2003

Cost of treating stroke in an Irish teaching hospital.

In contrast to CHD and cancer, the burden of stroke lies with long term disability as opposed to death and it is the most common cause of neurological disability in the western world. Consequently such patients frequently require longer acute hospital stays followed by lengthy periods of rehabilitation where such services are available, long term nursing care or indefinite dependency on community care. Inevitably stroke is a major economic burden on healthcare systems. It has been estimated that approximately 6% of total healthcare resources are consumed in the management of this condition a figure which is expected to grow with an increasing elderly population. Due to the high level of disability caused by stroke, patients often require longer and therefore costly periods of acute hospital stay. The aim of this study is to determine the cost of treating an acute episode of ischaemic stroke in an Irish teaching hospital. The costing evaluation was from the hospital admission perspective and the strategy used was a microcosting detailed collection of resources used on patients admitted to St. James's hospital between January 1999 and March 2000. The average cost of a hospital admission for the treatment of an episode of acute ischaemic stroke was 6,722 euros. The average cost per day was calculated at 263 euros. Approximately 83% of hospital costs were associated with ward costs whereas medications accounted for just 1% of total costs. The projected cost for the treatment of stroke in euros using the consumer price index for October 2002 would be 7,686 euros. The availability of Irish cost data is essential for the assessment of the cost effectiveness of therapeutic interventions for the treatment of stroke in our healthcare system.

Aged↗
PubMed2001

Cost of treating acute myocardial infarction in an Irish teaching hospital.

Recent figures indicate that there are approximately 6,500 patients admitted to hospital following acute myocardial infarction (AMI) in Ireland each year. As hospital admission is frequently the most expensive component of healthcare we determined the costs associated with treatment of AMI in a teaching hospital. The costing evaluation was from the hospital perspective and the strategy used was a micro-costing detailed collection of resources used. The average cost of hospital admission for the treatment of AMI was Pound Sterling 3,976. The average cost per day was calculated at Pound Sterling 501. Approximately 50% of hospital costs were associated with ward costs. Procedures accounted for 35% of costs whereas medications contributed just 7% of total costs.

Aged↗
PubMed1998

Late hypotony after cataract extraction due to a scleral fistula: a technique for surgical correction.

The authors report the use of a surgical procedure for the correction of a scleral fistula in a patient with late hypotony after cataract surgery. Trephination of necrotic tissue lining the scleral fistula with a double scleral patch technique was performed. Four months later, the patient's vision had improved to 20/40, with improvement of the macular folds and an intraocular pressure of 10 mm Hg. The authors conclude that the use of a double-patching technique is effective in the repair of scleral fistulas. The technique allows one to avoid more risky repair procedures that involve a greater area of tissue excision.

Aged↗
PubMed1986

Is a male infertility clinic of any use?

Two methods of statistical analysis were used to evaluate the results from an infertility clinic (the couple-months method and Cox regression analysis). The results were in general agreement and validated the couple-months method. The total trying time, sperm motility, sperm density and results of the wife's investigation were all shown to be highly significant prognostic factors. The age of either husband or wife, semen volume, sperm morphology, size of the testes, presence of a varicocele, serum LH and serum testosterone all failed to give significant additional prognostic information. High serum FSH and testis asymmetry both gave weak additional prognostic information. The benefit of attendance at the infertility clinic was evaluated in two ways: firstly by testing whether the event of clinic attendance altered prognosis and secondly by examining the results of a broad range of treatments. The results showed that attendance at the clinic with subsequent treatment did not improve the chance of fertility. The main benefit from clinic attendance was that the couple could be given an accurate prognosis and supportive counseling.

Adult↗
PubMed1983

Milkborne outbreak of Mycoplasma mycoides subspecies mycoides infection in a commercial goat dairy.

A commercial goat dairy comprised of about 300 lactating does suddenly began to have a problem with polyarthritis in the kids and clinical mastitis in the does. The problem began 3 to 4 weeks following the introduction of 27 lactating does from a herd with a history of mastitis caused by Mycoplasma mycoides subsp mycoides (Mmm). Over 2 kidding seasons (about 12 months), approximately 170 kids and 70 does died or were euthanatized. Affected kids were 2 to 8 weeks old, had multiple warm swollen joints, body temperature of 40.8 to 41.5 C, marked weight loss, and pneumonia. All were lame and some experienced so much discomfort that they were unable to get up. The predominant necropsy finding was severe fibrinopurulent polyarthritis, but fibrinous pleuritis, fibrinous pericarditis, interstitial pneumonia, and bronchopneumonia also were found in some kids. Culturing of affected joints and of bulk tank milk yielded large numbers of Mmm. The outbreak was terminated by feeding heat-treated colostrum (56 C for 1 hr) and pasteurized milk to kids. Milk from the does was cultured repeatedly; by this procedure, the does shedding Mmm in the milk were identified and culled.

Animals↗
PubMed1983

Purification, characterization, and serologic characteristics of Bacteroides nodosus pili and use of a purified pili vaccine in sheep.

Hair-like appendages (pili) were isolated and purified from Bacteroides nodosus, the etiologic agent of foot rot disease in sheep. Microscopic and biochemical analyses indicated that pili from organisms isolated in Australia, New Zealand, and the United States are morphologically and structurally similar. Pili are filamentous assemblies of identical protein subunits. Using specific antisera raised in rabbits against pili, 7 antigenic types were identified. A geographic pattern in the distribution of the pilus serotypes was not evident. In a preliminary vaccine trial, sheep vaccinated with purified pili developed resistance to challenge exposure to B nodosus. Protection was correlated positively with the serum anti-pilus antibody titers.

Amino Acids↗
PubMed1981

Epizootiologic study of bluetongue: virologic and serologic results.

Heparinized blood and serum samples were obtained from 1,295 ruminants in herds or flocks with bluetongue virus (BTV) infection in 4 western states. Submissions were from herds or flocks with clinical bluetongue (BT), as well as from animals on premises with no history of BT disease. Insects, including Culicoides variipennis, were collected in areas enzootic for BT disease. Viral isolations were in 10-day-old embryonating chicken eggs that were then adapted to Vero cells for serotyping. Sera were tested from group-specific antibody to BTV by the micro agar gel precipitin (AGP) test. Viral isolations were from cattle (81), sheep (122), goats (9), antelope (2), and C varipennis (5). There were 7 isolates of serotype 120, 114 of serotype 11, 42 of serotype 13, and 56 of serotype 17. In herds or flocks from which BTV was isolated, 51% of cattle, 56% of sheep, 21% of goats, and 52% of antelope had AGP antibodies. Virus was isolated from 43% of the cattle and 23% of the sheep that had no demonstrable evidence of AGP antibodies. Viral isolations were seasonal, occurring from August until December. Approximately 30% of the herds or flocks from which virus was isolated had more than one serotype of virus causing infection.

Animals↗
PubMed1979

Epididymitis in rams: effect of vaccination and culling on the clinical incidence of the disease.

Ram epidiymitis caused by Brucella ovis can be effective controlled by an annual program combining rigorous culling clinically affected animals and appropriate vaccination of the remaining animals. Yearling rams purchased or saved as replacement breeders should be immunized at 4-5 months of age by two injections of Br. ovis bacterin spaced 3-6 weeks apart. Annually, approximately one month prior to the breeding season, all rams, replacements and older breeders as well, should be carefully examined by palpation of the scrotal contents. Every ram evidencing an abnormality should be culled as a breeder. All the remaining rams should receive a "booster" injection of Br. ovis bacterin.

Animals↗
PubMed1979

Epididymitis in rams: studies on vaccine efficacy.

Simultaneous inoculation with Br. ovis bacterin plus Br. abortus strain 19 produced the greatest immunity. This procedure was not permitted, however, as widespread use of Br. abortus in sheep might pose a hazard to the brucellosis eradication program in cattle. Subsequent work demonstrated that an aluminum hydroxide adsorbed bacterin, administered as two injections spaced 3-6 weeks apart, conferred a significant and acceptable level of immunity.

Animals↗