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Biomedical subjects

C Fraser

Publications and source records attributed to C Fraser.

155 records · Page 9Linked to original sources
PubMedDate not supplied

Nonadherence with ACE inhibitors is common and can be detected in clinical practice by routine serum ACE activity.

Our objective was to assess whether serum angiotensin-converting enzyme (ACE) activity during routine clinical practice accurately reflects patient adherence to ACE inhibitor treatment in chronic heart failure (CHF). During 1994-95, ACE was measured in 73 CHF patients who were routinely attending the heart failure clinic at Ninewells Hospital. At the same time, the Medicines Monitoring Unit collected data on whether and when prescriptions for ACE inhibitors were redeemed at community pharmacies, which enabled each patient's adherence over a prolonged period to be assessed. We then correlated whether an elevation in serum ACE was associated with poor adherence with ACE inhibitor treatment. In total, 18% of CHF patients appeared to exhibit less than 70% adherence with their ACE inhibitor treatment, with 34% exhibiting less than 85%adherence and 58% exhibiting less than 100% adherence. A serum ACE activity of more than 12 U/L gave 91% positive predictive accuracy that the patient was less than 100% adherent with his or her ACE inhibitor treatment. At the other extreme, a serum ACE less than 6.5 U/L gave 81% positive predictive accuracy that the patient was more than 85% adherent with ACE inhibitor treatment. Nonadherence with ACE inhibitor treatment, therefore, was found to be common in patients with CHF. The simple, inexpensive test of serum ACE activity can be used in CHF patients to identify many, although not all, nonadherent patients so that adherence-enhancing strategies can be targeted toward them. Further work is clearly required to explore the precise clinical utility of this promising test. (c)2001 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Screening seniors for risk of functional decline: results of a survey in family practice.

OBJECTIVE: To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments. DESIGN: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was "at risk" for functional decline. A random sample (n = 73) of "at risk" subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse. RESULTS: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD = 5.5) years. Self-reported risk, based on activities of daily living (ADLs), was associated with impairment in at least one basic ADL (p < 0.0005) using a standardized instrument. The positive predictive value of the survey for ADL impairment was 65%. CONCLUSION: Response to a mailed survey was high and self-reported ADL risks were consistent with findings from standardized assessment tools.

Activities of Daily Living↗
PubMedDate not supplied

63Nickel-constituents in renal cytosol of rats after injection of 63nickel chloride.

Chromatographic and electrophoretic fractionations of 63Ni-constituents were performed upon renal cytosol samples from rats that were killed following administration of 63NiCl2. At 0.5 to one hr after i.v. injection of 63NiCl2 (0.1 to 0.5 mumole per kg body wt., N = 6), renal cytosol contained 11 percent (SE +/- 2 percent) of the 63Ni-dose. An average of 68 percent (SE +/- 4 percent) of 63Ni in these cytosol samples was associated with low molecular weight components (mol. wt. less than 2,000). The remainder was bound to five macromolecular constituents, with molecular weights of greater than 130,000 (Peak A), approximately 70,000 (Peak B), approximately 55,000 (Peak C), approximately 30,000 (Peak D), and approximately 10,000 (Peak E), based upon column chromatography on Sephadex G-200. The 63Ni that was present in Peaks A to E averaged, respectively, 1.8 percent, 10.7 percent, 7.5 percent, 10.0 percent and 1.6 percent of total 63Ni in renal cytosol. At one to fours hrs after i.m. injection of 63NiCl2 (100 mumol per kg body wt., N = 17), renal cytosol contained 2.2 percent (SE +/- 0.1 percent) of the 63Ni-dose; ultrafiltrable 63Ni averaged 57 percent (SE +/- 3 percent) of total 63Ni in renal cytosol. Macromolecular 63Ni-constituents in these samples were separated by electrophoresis in agarose gel and visualized by autoradiography. Peak D (mol. wt. approximately 30,000) was the most prominent of the five 63Ni-constituents. This study demonstrates that renal cytosol of 63NiCl2-treated rats contains five macromolecular 63Ni-constituents that may be involved in renal uptake, transport, storage, and excretion of 63Ni(II).

Animals↗