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Biomedical subjects

C Brewer

Publications and source records attributed to C Brewer.

At least 19 recordsLinked to original sources
PubMed1992

The benefits of treating hyperlipidemia to prevent coronary heart disease. Estimating changes in life expectancy and morbidity.

OBJECTIVE: To evaluate the lifetime benefits of reducing total serum cholesterol levels to prevent coronary heart disease (CHD). DESIGN: We developed a CHD primary prevention computer model to estimate the benefits associated with lifelong risk factor modification. We validated the model by comparing the computer estimates with the observed results of three primary CHD prevention trials. PATIENTS: Men and women age 35 to 65 years who are free of CHD, with total serum cholesterol levels ranging from 5.2 to 7.8 mmol/L (200 to 300 mg/dL), with or without additional CHD risk factors. INTERVENTIONS: Serum cholesterol reduction through dietary modification or diet and medications. MAIN OUTCOME MEASURES: Changes in life expectancy and the delay of symptomatic CHD. RESULTS: The computer forecasts for CHD end points closely matched the observed results of the Lipid Research Clinics Trial, the Helsinki Heart Study, and MRFIT. We then applied the computer model to low-risk and high-risk men and women with total serum cholesterol levels between 5.2 and 7.8 mmol/L (200 and 300 mg/dL) and estimated that, after reducing serum cholesterol levels 5% to 33%, the average life expectancy would increase by 0.03 to 3.16 years. We also forecast that the average onset of symptomatic CHD would be delayed among these patient groups by 0.06 to 4.98 years. CONCLUSION: We conclude that this computer model accurately estimates the results of clinical trials and can be used to forecast the changes in life expectancy and morbidity (the development of CHD) associated with specific CHD risk reduction interventions. The wide variation surrounding these estimates underscores the need to better define which groups of individuals will gain the most from cholesterol reduction.

Adult↗
PubMed1992

Controlled trials of Antabuse in alcoholism: the importance of supervision and adequate dosage.

Methods of using Antabuse have changed since its introduction over 40 years ago. Several randomised controlled trials have shown that Antabuse can make a statistically and clinically significant contribution to treatment outcome in alcoholism but only if its administration is carefully supervised. The recent literature is reviewed. Adequate dosage is important and the recommended maximum in some countries is often insufficient. Both prescribers and supervisors of Antabuse need to be aware of the ways in which some patients try to evade medication.

Adult↗
PubMed1990

Combining pharmacological antagonists and behavioural psychotherapy in treating addictions. Why it is effective but unpopular.

Supervised administration of disulfiram is one of the very few treatments that can significantly reduce alcohol consumption, yet it is rarely used, despite being simple and cheap. Disulfiram is not 'aversion therapy', but a technique for facilitating exposure and response prevention, and it fits comfortably into a behavioural, social-learning model of addiction (or dependence) and its treatment. The availability of other effective antagonists, notably to opiates, suggests that an approach that is demonstrably effective in alcohol dependence may be helpful in treating other addictions. The reasons for the unpopularity of this approach appear to be largely ideological.

Alcoholism↗
PubMed1989

Coping with patients' problem drinking.

Confronting patients appropriately is a difficult skill to master. The practitioner must first overcome his own inherent biases and feelings of discomfort before tackling the patient on threatening issues. This problem is compounded by delay when a patient has seen his GP for a number of years before a review of the notes reveals the hitherto unsuspected diagnosis.

Adult↗
PubMed1989

Helping students respond to stressful interactions with cancer patients and their families: a pilot program.

This pilot program was designed to help medical students improve their ability to respond to the psychological needs of cancer patients and their families. Third-year students on the hematology/oncology rotation were offered a series of seminars dealing with the psychological and social impact of cancer on patients and their families. The goal of these seminars was to help the students develop working knowledge, understanding, and skills for dealing with cancer patients and families. The seminars used didactic input, videotaped interactions, and guided discussion. Experienced counselors, with the help of an oncologist, led the seminars. Findings from this pilot program suggest that medical students can benefit from specific training in the psychosocial aspects of cancer.

Communication↗