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Biomedical subjects

D A Henry

Publications and source records attributed to D A Henry.

At least 73 records · Page 4Linked to original sources
PubMed1992

Perforated peptic ulcer in the Hunter region: a review of 174 cases.

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979-86 is presented. Among the female admissions, the proportion of patients greater than 70 years of age was twice that in males. One-third of all perforations were in females who accounted for two-thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.

Adolescent↗
PubMed1992

Aspirin use in children: heeding the warning?

In 1986, the Australian Government issued warnings about the use of aspirin for children and adolescents after the link had been established between aspirin use and Reye's syndrome in America. This study questioned a representative community sample of parents in Newcastle, New South Wales, about their awareness of this caution, and their recent aspirin use for children under 18 years. While 65% of women and 47% of men reported that they were aware of the Government recommendations, only 8% of women and 9% of men reported obtaining this information from the printed warning on the medicine container or packet. Despite awareness of the warnings, almost one third of parents reported administering aspirin to their children. When it is necessary to caution patients about the use of over-the-counter medications, it is not sufficient to use package labelling as the main site of information.

Adolescent↗
PubMed1991

The benefits of reducing cholesterol levels: the need to distinguish primary from secondary prevention. 1. A meta-analysis of cholesterol-lowering trials.

OBJECTIVE: To use meta-analysis to estimate the benefits of drug treatment to lower cholesterol levels in the primary and secondary prevention of coronary heart disease (CHD) events. DATA SOURCES: MEDLINE search from 1967 to 1990; bibliographies of review articles. STUDY SELECTION: Nine trials met the entry criteria: they were monofactorial, randomised and controlled. DATA EXTRACTION: Two independent, unblinded observers. DATA SYNTHESIS: The odds ratio (and 95% Cl) for death from CHD was 0.85 (0.64, 1.14) in primary prevention and 0.84 (0.75, 0.95) in secondary prevention studies when calculated by the method of Peto. The event rate in the secondary prevention studies was higher than that in the primary prevention studies, and the absolute risk reduction achieved by therapy in the former (3.2%) was much higher than that in the latter (0.1%). The number of subjects needing to be treated to prevent one death from CHD was 38 in secondary prevention and 675 in primary prevention. Results with the method of DerSimonian and Laird were similar. CONCLUSIONS: The benefits of cholesterol lowering to prevent death from CHD are substantially greater in the secondary prevention setting than in primary prevention.

Aged↗
PubMed1991

The benefits of reducing cholesterol levels: the need to distinguish primary from secondary prevention. 2. Implications for heart disease prevention in Australia.

OBJECTIVE: To estimate the number of coronary heart disease (CHD) events arising from the primary and secondary prevention populations of middle-aged Australian men, and the potential impact in each setting of lipid-lowering therapy on death from CHD. DESIGN: Analysis based on results of a meta-analysis of drug trials to lower cholesterol levels and data from the Hunter Region Heart Disease Prevention Programme. MAIN OUTCOME MEASURE: Death from CHD. RESULTS: Over a five-year period, 1520 fatal CHD events would be expected in a population of 100,000 men aged 35 to 69 years. Approximately 52% would arise from subjects already known to suffer from CHD. We predict that treating everyone in the secondary prevention group who has a blood cholesterol level of greater than 5.2 mmol/L (approximately 5000 subjects) would prevent 118 deaths, compared with 51 deaths prevented by treating those in the primary prevention group who have cholesterol levels of greater than 6.2 mmol/L (approximately 30,000 subjects). The outcome is maintained in several sensitivity analyses. CONCLUSIONS: The majority of persons in whom death from CHD might be prevented by treatment to lower cholesterol levels can be identified by targeting subjects for secondary prevention. Therapy in the secondary prevention setting is much more efficient than in primary prevention.

Adult↗
PubMed1991

Intravenous contrast media: use and associated mortality.

OBJECTIVE: To determine the extent of use and mortality associated with peripheral intravenous injections of radiocontrast media. DESIGN: A retrospective study of injection data was made for the three and a half year period from January 1987 to June 1990 using the Health Insurance Commission database and the records of public hospital x-ray departments. Information about deaths associated with the injections was obtained from a survey of all radiologists and from other relevant sources. SETTING AND PARTICIPANTS: The study related to the entire population of New South Wales and the Australian Capital Territory, approximately 6 million people. INTERVENTIONS: Intravenous injections of radiographic contrast medium for computed tomographic scans, intravenous pyelograms and venograms. MAIN OUTCOME: A comprehensive record of intravenous contrast usage and associated mortality in a large community. RESULTS: Between January 1987 and June 1990, 613 581 intravenous injections of radiocontrast media were administered in New South Wales and the Australian Capital Territory. The overall annual incidence of use was estimated to be 2.9% and was markedly age dependent being more than 7% in subjects over 65 years. Eight deaths were documented, representing an overall mortality of 13 per million injections (95% confidence interval [CI], 5.6-25.7). Mortality appeared to be age related being 35 per million (95% CI, 12.7-75.6) in those over 65 years compared with 4.5 per million (95% CI, 0.6-16.4) in those under 65 years. Two of the deaths involved low osmolar contrast media. CONCLUSIONS: Death after injection of intravenous contrast medium is a rare event. There was no evidence that mortality was lower with the newer, low osmolar media than with the older, high osmolar media.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Recent trends in the prescribing of cholesterol lowering drugs in Australia. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee.

OBJECTIVE: To determine the recent pattern of use of hypolipidaemic drugs in the Australian community. DESIGN: Drug utilisation study employing prescription data collected during the operation of the Australian Pharmaceutical Benefits Scheme (PBS). SETTING: Non-hospital drug use in Australia. PATIENTS: All patients, pensioners and non-pensioners, who received prescriptions for hypolipidaemic agents under the PBS between January 1987 and December 1989. MAIN OUTCOME MEASURES: The total number of prescriptions, average quantity dispensed with each prescription, defined daily doses (DDD) and Australian population figures for pensioners and non-pensioners were used to express the consumption of hypolipidaemic agents as DDD/1000 individuals/day. RESULTS: Between the March quarter 1987 and the December quarter 1989 prescribing of hypolipidaemics for the Australian community increased from 68,120 to 304,760 prescriptions per quarter, which translates to a rise in use from 1.2 to 5.2 DDD/1000 inhabitants/day. This included a rise in the use of clofibrate from 0.6 to 2.6 DDD/1000 inhabitants/day, and of cholestyramine from 0.6 to 1.9 DDD/1000 inhabitants/day. Prescribing of hypolipidaemics for pensioners increased from 29,569 to 123,440 prescriptions per quarter. This translated into a rise in use from 3.7 to 14.8 DDD/1000 pensioners/day. Notable rises were seen for clofibrate, 1.9 to 8.1 DDD/1000 pensioners/day, and cholestyramine, 1.6 to 4.7 DDD/1000 pensioners/day. In comparison published data from the Nordic countries and the United States showed a lower overall use of hypolipidaemics and declining consumption of clofibrate. CONCLUSIONS: The trend in Australia was unusual in that the use of clofibrate increased to a greater extent than that of the resins, cholestyramine and colestipol which are generally preferred for treatment of hypercholesterolaemia. Possible reasons for this include: the better tolerability of clofibrate; its readier availability during the study period; the recommendation by the Pharmaceutical Benefits Advisory Committee that clofibrate was the preferred drug when triglyceride levels were also elevated and the limited availability of newer hypolipidaemic agents.

Aged↗
PubMed1991

The safety and cost-effectiveness of low osmolar contrast media. Can economic analysis determine the real worth of a new technology?

OBJECTIVES: To estimate the reduction in mortality associated with a reduced adverse reaction rate following the substitution of older high osmolar radiocontrast media (HOCM) by the newer and more expensive low osmolar contrast media (LOCM), and to assess the cost-effectiveness of switching from HOCM to LOCM in patients with and without underlying risk factors for adverse reactions from radiocontrast agents. DATA SOURCES: Data from large prospective studies of adverse reactions to HOCM and LOCM were used to estimate the expected number of deaths and severe non-fatal reactions in a hypothetical population receiving one million intravenous radiocontrast injections with HOCM, and the expected reduction in the frequency of these outcomes after substitution by LOCM in high-risk and low-risk groups respectively. Life-years lost with each radiocontrast-related death were estimated from an audit of fatal adverse reaction reports submitted to the Adverse Drug Reactions Advisory Committee. The direct costs considered in the study were the increased costs of LOCM and the hospital costs of treating radiocontrast reactions which were estimated from an audit of cases admitted to public hospitals in Newcastle. STUDY SELECTION: The literature search included Medline (1966-1989) and bibliographies of original and review articles. We included only studies which were prospective, monitored patients in a formal way, described a mechanism for the recording of adverse events and were of sufficient size to have been capable of detecting severe reactions to radiocontrast agents. DATA EXTRACTION: Data were extracted independently by two investigators, unblinded, with disagreements resolved by consensus. DATA SYNTHESIS: Mortality data from individual reports were pooled and exact confidence intervals were calculated on the assumption of a Poisson distribution. In the case of comparative studies the relative risks of severe reactions in low-risk versus high-risk patients and with LOCM compared with HOCM were treated for homogeneity, and pooled odds ratios and 95% confidence intervals (CI) were calculated by combining the logarithms of the odds ratios weighted by their variances. RESULTS: The mortality after intravenous administration of HOCM was estimated from all studies to be 23.3 (95% CI, 2.4-33.1) per million injections. However, the mortality was 11.7 per million (95% CI, 2.4-34.1) in studies published since 1986. The mortality after the use of LOCM was estimated as 3.9 per million (95% CI, 0.1-21.7).(ABSTRACT TRUNCATED AT 400 WORDS)

Australia↗
PubMed1991

Comparison of silver sulphadiazine 1 per cent, silver sulphadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent and mafenide acetate 8.5 per cent for topical antibacterial effect in infected full skin thickness rat burn wounds.

Silver sulphadiazine 1 per cent (SS), silver sulphadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent (SS + CD 0.2 per cent) and mafenide acetate 8.5 per cent (MA) were compared to assess the antibacterial effect of once daily application on experimental rat 20 per cent full skin thickness burn wounds seeded 24 h earlier with 10(8) microorganisms originally isolated from infected wounds of burned patients. Separate series evaluated Staph. aureus, Enterococcus faecalis, Enterobacter cloacae and Ps. aeruginosa. The mean concentration of all four organisms recovered after 1 week from full thickness biopsies of eschar and from separate biopsies of subjacent muscle was less in MA and SS + CD 0.2 per cent treated animals compared with those treated with SS alone. The mean concentration in muscle and eschar following treatment with MA was less for wounds seeded with Staph. aureus and Ps. aeruginosa than with SS + CD 0.2 per cent treatment, while the mean concentration in eschar application of SS + CD 0.2 per cent was less than with MA for E. faecalis seeded wounds.

Administration, Topical↗
PubMed1991

Agreement between two measures of drug use in a low-prevalence population.

The present study examined the agreement between two measures of prevalence of drug use in the community: self-report and specific pharmacological analyses of urine samples. The data were collected in the context of a random community survey of health practices and attitudes. A random 20% of the households participating in the health study were targeted for biochemical assay. Compliance with urine delivery was relatively high at 79%. Urine samples were screened qualitatively for cannabinoids and benzodiazepines using the enzyme multiplied immunoassay technique (EMIT) (Syva Diagnostics, Palo Alto, CA). Screening for pharmaceuticals used a standard thin-layer chromatography (TLC) technique. Agreement between the self-report and biochemical assay estimates of prevalence was statistically significant (p less than .05). While self-report of substance use is not a perfect measure of consumption, it remains a relatively economical and reasonably accurate method of obtaining estimates of substance use in community samples.

Adolescent↗
PubMed1990

Plasma noradrenaline, platelet alpha 2-adrenoceptors, and functional scores during ethanol withdrawal.

Plasma noradrenaline and platelet alpha 2-adrenoceptor density (sites/cell using 3H-rauwolscine with and without phentolamine) were correlated with withdrawal score in 23 hospitalized patients undergoing ethanol withdrawal. Control groups for plasma noradrenaline were 25 patients admitted to hospital for elective gastroscopy and 12 laboratory workers accustomed to venipuncture. Controls for platelet alpha 2-adrenoceptor measurements were a separate group of 31 normal subjects with a mean age close to that of the patients' withdrawing from ethanol. Plasma noradrenaline was significantly higher in the patients undergoing ethanol withdrawal than in patients admitted to hospital for elective endoscopy. Twelve laboratory controls had plasma noradrenaline levels significantly lower than either patient group. A significant though poor statistical correlation existed between ethanol withdrawal score and simultaneously determined plasma noradrenaline level. Platelet alpha 2-adrenoceptor sites/cell were reduced in ethanol withdrawal compared with the normal controls. Platelet alpha 2-adrenoceptor sites/cell increased over the first 24 hr of ethanol withdrawal but remained significantly lower than control values. The change in platelet adrenoceptors was accompanied by a fall in mean plasma noradrenaline. Thus, the stress of hospital admission itself is associated with an increase in plasma noradrenaline, but ethanol withdrawal enhances this increase, which is accompanied by and probably causes a reduction in platelet alpha 2-adrenoceptor numbers. These changes begin to return towards normal within 24 hr as the withdrawal reaction subsides.

Adult↗
PubMed1990

Disk elution method for MICs and MBCs.

A MIC macrodilution broth method in which routine antimicrobial susceptibility testing disks were used as a source of antibiotic was compared with the M7A reference method of the National Committee for Clinical Laboratory Standards for accuracy and reproducibility over five test runs. Gentamicin, piperacillin, and oxacillin were tested by using American Type Culture Collection quality control strains and laboratory isolates for which the MIC of each agent was known. An optimum time for elution of 1 h was first determined by timed elution in broth, confirming levels determined by the TDX method (Abbott, North Chicago, Ill.) for gentamicin and bioassay for piperacillin and oxacillin. MICs determined by the disk elution method demonstrated a reproducibility rate of 97% as well as 97% agreement with the reference method to within +/- 1 dilution; MBCs showed 93% agreement. The disk elution method is reproducible and provides a reliable test system that can be used by any laboratory in which disk susceptibility testing is performed.

Anti-Infective Agents↗
PubMed1989

Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage.

OBJECTIVE: To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage. DESIGN: Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect. SETTING: Inpatient care in hospitals in the United Kingdom, Sweden, and Australia. PATIENTS: 1267 Patients admitted to hospital with primary diagnosis of acute upper gastrointestinal haemorrhage. Five of the six trials included a high proportion of elderly patients. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43-88%) or gastric erosions (4-23%). A variable proportion had a degree of clinical shock at entry. INTERVENTIONS: Tranexamic acid 3-6 g/day given intravenously for two or three days followed by 3-6 g/day by mouth for a further three to five days (four trials) or 4.5-12 g/day by mouth for two to seven days (two trials). END POINTS: Frequency of recurrent haemorrhage, need for surgery, and death. MAIN RESULTS: Treatment with tranexamic acid was associated with a 20-30% reduction in the rate of rebleeding, a 30-40% reduction (95% confidence interval 10% to 60%) in mortality. CONCLUSIONS: Treatment with tranexamic acid may be of value to patients considered to be at risk of dying after an upper gastrointestinal haemorrhage.

Clinical Trials as Topic↗