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Biomedical subjects

Bruce Arroll

Publications and source records attributed to Bruce Arroll.

45 records · Page 3Linked to original sources
PubMed2002

Pentoxifylline for treatment of venous leg ulcers: a systematic review.

INTRODUCTION: Venous ulcers are usually treated with compression therapy, but, because this treatment may not be effective for some people, adjuvant therapy could be beneficial. We did a systematic review of randomised controlled trials that compared pentoxifylline (with and without compression treatment) with placebo, or other treatments, in patients with venous leg ulcers. METHODS: We identified eight trials (547 adults), five of which compared pentoxifylline and compression with placebo and compression (n=445), and three of which compared pentoxifylline alone with placebo (102). Our main aim was to determine whether pentoxifylline, with or without compression, was effective in treatment of venous leg ulcers. Analysis was by intention to treat. FINDINGS: Pentoxifylline was more effective than placebo in complete healing or substantial improvement of venous leg ulcers (relative risk 1.49, 95% CI 1.11-2.01). Pentoxifylline with compression was also more effective than placebo and compression in complete healing (1.30, 1.10-1.54). Patients taking pentoxifylline had no more adverse events than those on placebo (1.25, 0.87-1.80). The most frequent adverse event was mild gastrointestinal disturbance (43%). INTERPRETATION: Our results suggest that pentoxifylline gives additional benefit to compression for venous leg ulcers, and is possibly effective for patients not receiving compression.

Administration, Oral↗
PubMed2002

Depression in patients in an Auckland general practice.

AIM: To measure the rate of detected and undetected depression in patients attending an Auckland general practice. METHOD: At their consultation conclusion, general practitioners (GPs) asked all consecutive patients over sixteen years attending for consultation to participate in a health and mood questionnaire. A researcher administered the Beck Depression Inventory (BDI) to consenting participants. The GPs previously recorded whether they considered these patients depressed. RESULTS: Response rate among patients was 81% (253/314). The BDI found a 13.8% (35/253) 95% CI (9.6-18.5) depression prevalence among patients. GPs picked up 51% of cases (sensitivity 0.51 and specificity 0.91). Mäori patients were no more likely to be depressed than non-Mäori but they were less likely to be receiving or have received treatment with antidepressants. CONCLUSION: The rate of depression in this practice was higher than an earlier study suggesting the true rate may be >10%. GPs see more depressed patients than other health professionals, therefore improvement in detection and management of depression in primary care is important. More work is needed on the difference between Mäori and non-Mäori in the use of antidepressants.

Adolescent↗
PubMed2002

Termination of pregnancy following panic-stopping of oral contraceptives.

This study assessed characteristics of women presenting for termination of pregnancy subsequent to stopping combined oral contraceptive use in response to publicity-mediated fears regarding venous thromboembolism. Records of 400 women attending for pregnancy termination assessment were reviewed retrospectively. Panic-stopping of oral contraceptives was implicated in 9.5%. Nearly 50% of combined pill users claimed their pregnancy resulted from panic-stopping because of media-promoted fear of health risks, especially 'clots.' Panic-stoppers had significantly lower identified risk factors for venous thromboembolism than pill users who had not panic-stopped. The relative safety of third-generation pills is under debate. The risk-benefit ratio of contraceptive pills is overwhelmingly positive but practitioners must be vigilant in screening for risk factors and contraindications. Panic-stopping results in unwanted pregnancies with concomitant psychological distress and potential physical morbidity. In future situations where research findings may precipitate drug scares, we recommend recall of patients by their health provider, funded by the relevant health authority or pharmaceutical companies, to allow discussion of risks before the media is enabled to have access to the information.

Abortion, Induced↗
PubMed2002

Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients?

OBJECTIVE: To explore the experiences and opinions of family physicians and patients regarding the delay of antibiotic prescriptions, to be dispensed if symptoms persist or worsen over time, in treating upper respiratory tract infections. STUDY DESIGN: Qualitative study using semistructured interviews conducted in family practice in Auckland, New Zealand. POPULATION: Thirteen physicians recruited from a study of family physicians' reported antibiotic prescribing and 13 patients recruited from the intervention arm of a randomized controlled trial on delayed antibiotic prescribing. OUTCOMES MEASURED: Patients' and physicians' experiences of delayed antibiotic prescriptions for upper respiratory tract infections. RESULTS: The primary themes identified were value judgments of antibiotics, decreased antibiotic use, patient-centered factors, effects on the physician-patient relationship, patient convenience, adverse effects of delaying prescription, and selectivity for use of antibiotics. Many themes were common to both patients and physicians. Physicians valued empowering patients' decision making about their health care management more highly than did patients. Decreasing antibiotic use was not a key factor for most patients. Both groups acknowledged the value in saving patients time and money. Physicians viewed the strategy as giving patients reassurance and meeting their expectations for antibiotics. Negative implications included perception of physician incompetence and physician loss of management control. Opinions were mixed regarding which patients, under which conditions, were suitable for delayed antibiotic prescriptions. CONCLUSIONS: Although delayed antibiotic prescriptions are effective in decreasing antibiotic use for conditions not clinically warranting antibiotics, neither patients nor physicians universally endorsed this strategy. Research to establish formalized recommendations for patient suitability and instructions for use would be of value.

Adult↗
PubMedDate not supplied

Physician-patient relationship and medication compliance: a primary care investigation.

PURPOSE: We assessed the relationship between 4 attributes of the physician-patient relationship and medication compliance. METHODS: We conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation. RESULTS: Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were significantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confidence interval, 1.04-1.72). CONCLUSIONS: Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefit outcomes in primary care.

Adult↗
PubMedDate not supplied

What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management.

BACKGROUND: We undertook a literature review to produce evidence-based recommendations for nonsurgical family physician management of carpal tunnel syndrome (CTS). METHODS: Study design was systematic review of randomized controlled trials (RCTs) on CTS treatment. Data sources were English publications from all relevant databases, hand searches, and guidelines. Outcomes measured were nonsurgical management options for CTS. RESULTS: We assessed 2 systematic reviews, 16 RCTs, and 1 before-and-after study using historical controls. A considerable percentage of CTS resolves spontaneously. There is strong evidence that local corticosteroid injections, and to a lesser extent oral corticosteroids, give short-term relief for CTS sufferers. There is limited evidence to indicate that splinting, laser-acupuncture, yoga, and therapeutic ultrasound may be effective in the short to medium term (up to 6 months). The evidence for nerve and tendon gliding exercises is even more tentative. The evidence does not support the use of nonsteroidal anti-inflammatory drugs, diuretics, pyridoxine (vitamin B6), chiropractic treatment, or magnet treatment. CONCLUSIONS: For those who are not able to get surgery or for those who do not want surgery, there are some conservative modalities that can be tried. These modalities include ones for which there is good evidence. It would be reasonable to try some of the techniques with less evidence if the better ones are not successful. Reconsideration of surgery must always be kept in mind to avoid permanent nerve damage.

Adult↗
PubMedDate not supplied

Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis.

PURPOSE: Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. METHODS: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the final mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2. RESULTS: There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of efficacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective. CONCLUSION: This systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo.

Antidepressive Agents, Tricyclic↗