Search PubMed⌕ Search

Biomedical subjects

D Henry

Publications and source records attributed to D Henry.

At least 109 records · Page 6Linked to original sources
PubMed1992

Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals.

Factors governing the entry of new drugs into clinical practice are changing, with increasing emphasis on economic issues. In future, organisations that subsidise the use of pharmaceuticals are likely to require sponsors to provide evidence of the cost-effectiveness of their products. The first national government to signal such an intention is the Commonwealth Government of Australia, which from January 1993 will require economic analyses in support of applications for listing of new pharmaceutical products on its schedule of pharmaceutical benefits. This move is underpinned by legislation that requires the country's Pharmaceutical Benefits Advisory Committee (PBAC) to consider costs and effectiveness when recommending listing of new drugs. The approach that has been recommended to the Committee is based on advice from a group of consultants, health economists and clinicians. The PBAC will use economic analyses as an aid to decision-making that will remain within a clinical framework; the viewpoint will be societal, and analyses will include costs that fall outside the pharmaceutical benefits scheme. The preferred approach is comparative cost-effectiveness analysis with a particular emphasis on the marginal costs of obtaining additional health benefits with new drugs, compared with existing therapies. The use of analyses that are restricted to potential cost savings with new drugs is discouraged, as is the inclusion of indirect costs and benefits. To facilitate the conduct of economic analyses, it is planned to hold meetings with specialist clinicians to obtain consensus on a range of intermediate clinical outcome indicators, and to publish lists of 'standard' Australian costs that will be updated regularly. The approach being followed in Australia has implications for both the government and the pharmaceutical industry. The responsibility for monitoring the effects of this new policy lie with the government. The success, or otherwise, of the policy should not be gauged simply by the effects on the price of new drugs which, historically, have been relatively low in Australia. A full evaluation will require that more effort be put into clinical outcomes research and the development of population databases, an area in which Australia lags behind other countries.

Australia↗
PubMed1992

Status epilepticus. Recent experience at the Port-of-Spain General Hospital, Trinidad.

In this retrospective study, experience in status epilepticus (SE) over an 18-month period at the Port-of-Spain General Hospital is reported. Sixty-three episodes in 41 patients were studied. Fifty-one per cent of patients were under 10 years of age. Fifty-one per cent of patients were classified as remote symptomatic, 29% idiopathic, 15% acute symptomatic and 5% febrile. Bolus doses of diazepam were used in 62 of 63 episodes, phenytoin in 18, diazepam infusion in 9, paraldehyde in 12 and phenobarbitone in 9. Seizures were controlled within half-hour of starting treatment in 55 episodes (87%). In 3 episodes in 2 patients (5%), control was poor and exceeded 18 hours. No deaths were recorded. Two neurological deficits and 8 other morbid events were recorded. Mean hospital stay was 2.9 days. No patient was ventilated or admitted to the Intensive Care Unit. Current drug therapy is highly effective in SE even in institutions where modern intensive care technology is limited. Prognosis is excellent in patients in whom the underlying aetiology is benign.

Adolescent↗
PubMed1991

The efficacy and safety of terazosin for the treatment of symptomatic BPH.

At least 16 clinical investigations have documented the effectiveness of alpha blockade for BPH. In the present review, four clinical studies evaluating the efficacy and safety of terazosin, a selective long-acting alpha 1 blocker, for symptomatic BPH are reviewed. The unique features of these clinical investigations are: the study designs established detailed inclusion and exclusion criteria, the outcome assessments were based upon quantitative outcome parameters, large cohorts of homogeneous patients were enrolled, and appropriate statistical methods were utilized. The dose of terazosin was titrated to maximal doses ranging between 5-20 mg. Only four of the 163 patients developed orthostatic hypotension. Overall, the peak and mean uroflow rates increased 50% and 46%, respectively (P less than 0.001). The cumulative improvement in the mean obstructive, irritative, and total symptom scores was 67%, 35%, and 54%, respectively (P less than 0.001). The present review of terazosin in males with symptomatic BPH supports the following conclusions: (1) the dose of terazosin can be safely titrated to 10 mg in normotensive and hypertensive patients with symptomatic BPH; (2) the adverse events associated with doses of terazosin up to 10 mg are relatively mild and reversible; and (3) the improvements in the outcome parameters (symptom scores and urinary flow rates) are clinically and statistically significant. Although the ultimate role of terazosin for symptomatic BPH will be determined by multi-center randomized placebo-controlled studies, the present review provides further evidence that selective alpha 1 blockers are effective and safe for the treatment of symptomatic BPH.

Adrenergic alpha-Antagonists↗
PubMed1991

Organizational and family systems factors in stress among ministers.

Forty-one Protestant ministers completed measures of stress-related symptoms, family of origin contact, church governing body density, history of pastor-parish conflict in the church, and a measure of Bowen's (1959b/1985) concept of emotional triangles. A denominational executive provided ratings of each church's history of pastor-parish conflict. Path analysis using multiple regression showed support for a model in which governing body density and history of conflict predicted emotional triangles, and emotional triangles predicted stress symptoms. Contact with the pastor's family of origin moderated the relationship between emotional triangles and stress symptoms. Results suggest that the organizational and family ecology of the ministerial role can be important in understanding occupational stress among ministers.

Administrative Personnel↗
PubMed1991

Late complications involving the ascending aorta after cardiac surgery: recognition and management.

Pseudoaneurysms and dissecting aneurysms of the ascending aorta after cardiac surgery are uncommon but important complications. Pseudoaneurysms, which result from extravasation of blood into the mediastinum, most commonly occur at the site of aortotomy or aortic cannulation. Infection may play an important role. Dissecting aneurysms after cardiac surgery usually occur at the site of aortic incision or cross clamping, especially in atherosclerotic aortas. Both conditions may be clinically silent but more frequently are seen with significant symptoms. Noninvasive techniques including CT scan, MRI, and echocardiography are very useful in the diagnosis of both complications, with contrast aortography remaining the definitive method. Surgical repair is necessary for dissecting aneurysms and for enlarging and symptomatic pseudoaneurysms, with improving morbidity and mortality.

Aged↗
PubMed1991

Pharmacoepidemiology as a focus for clinical epidemiology in developing countries.

We present a concept of pharmacoepidemiology as a branch of clinical epidemiology having particular relevance to public health in developing countries. Planning to incorporate pharmacoepidemiology into the clinical epidemiology curriculum of the International Clinical Epidemiology Network (INCLEN) is discussed and an outline of training programs in pharmacoepidemiology at INCLEN universities is given.

Curriculum↗
PubMed1991

Diclofenac hepatitis.

The characteristics of liver damage associated with the use of diclofenac, a popular nonsteroidal anti-inflammatory drug, were investigated by reviewing adverse drug reaction reports for Australia. Twenty six patients were reported for whom diclofenac was the sole suspected drug cause of their liver damage. The average age of the patients was 64 years (range 37-84 years); 19 (70%) were women. The most common clinical features were jaundice, hepatomegaly, anorexia, and nausea. Features of drug hypersensitivity were not reported. Duration of treatment with diclofenac before the onset of the illness ranged from 6-417 days (median 76 days). The most prominent biochemical abnormalities were raised serum aspartate transaminase and alanine transaminase activity of up to 30 to 40 times the upper limit of the normal range. Recovery generally started soon after withdrawal of diclofenac and the decrease in aspartate transaminase and alanine transaminase for the group was exponential, with half lives of around 13 days. The average total dose taken by 18 patients for whom accurate data were available was 8.7 g (range 1.4-63.5 g) and, unexpectedly, there was a significant relation between the logarithm of the dose of diclofenac and the logarithms of the peak and mean transaminase levels. Hepatocellular damage during treatment with diclofenac seems to be a rare event. From this analysis of Australian reports it seems that in a small subgroup of patients liver injury may be a direct toxic effect of diclofenac or a metabolite.

Aged↗
PubMed1990

Neutrophil-derived relaxing factor relaxes vascular smooth muscle through a cGMP-mediated mechanism.

Neutrophils harvested from the peritoneal cavities of rats have been shown to release a factor that relaxes precontracted aorta and has a pharmacologic profile similar to that previously reported for endothelium-derived relaxing factor (EDRF). The present study was designed to determine if this neutrophil-derived relaxing factor (NDRF) relaxes rat aortic smooth muscle by affecting the intracellular cGMP levels. Aortic sheets (endothelium removed) were incubated in organ chambers in a physiological salt solution containing phenylephrine (1 x 10(-7) M) and superoxide dismutase (10 or 100 U/ml). Basal cGMP levels (10-15 pmoles/g tissue) were not affected by the incubation reagents. Neutrophils (3 x 10(6) to 1 x 10(8) cells/10 ml) increased cGMP, but not cAMP, levels in a cell number-dependent manner. Peak induction occurred at 5 min of incubation. Methylene blue (1 x 10(-5) M) inhibited and zaprinast (1 x 10(-5) M) potentiated the neutrophil-induced increases in cGMP. The data thus support the hypothesis that neutrophil-induced vascular smooth muscle relaxation is mediated through a factor, NDRF, which increases intracellular cGMP levels.

Animals↗
PubMed1990

Cognitive behavioral treatment for sexually abused children suffering post-traumatic stress: preliminary findings.

The present investigation examined the effectiveness of a cognitive behavioral treatment program designed for sexually abused children suffering post-traumatic stress disorder. Nineteen girls who suffered contact sexual abuse and met DSM-III-R criteria for post-traumatic stress disorder were included in the study. Subjects ranged in age from 3 to 16 years old. Structured interviews were conducted to assess the presence or absence of post-traumatic stress disorder symptoms before, during, and following the abuse. Additionally, parents completed the Child Behavior Checklist, and subjects at least 6 years of age were administered the Child Depression Inventory and the Spielberger State-Trait Anxiety Inventory at the initial evaluation and again approximately 2 to 3 weeks later before the initiation of treatment. The baseline data collected at these two points were compared, and no significant changes were found over time. The above measures were readministered following 12 treatment sessions. The results revealed significant improvements at post-treatment on all measures.

Adaptation, Psychological↗
PubMed1990

Clinical comparison of isolator and BACTEC 660 resin media for blood culture.

The 10-ml Isolator system (E.I. du Pont de Nemours & Co., Inc., Wilmington, Del.) was compared with the BACTEC 16A-17A nonradiometric resin system (Johnston Laboratories, Inc., Towson, Md.) for isolation of organisms from 6,839 paired blood cultures. Equal volumes of blood (6 to 10 ml for each Isolator and 3 to 5 ml for each BACTEC bottle) were cultured in parallel in the two systems, and 600 isolates that were judged to be clinically significant by chart review were recovered during the study. The BACTEC resin system detected 510 (85%) and the Isolator system detected 435 (72%) of the clinically significant isolates (P less than 0.001). Of 45 polymicrobial blood cultures, the BACTEC system detected 32 (71%) and the Isolator system detected 21 (47%) (P less than 0.05). Of 253 gram-negative bacilli isolated during the study, 30% were detected only in the BACTEC system and 16% were detected only in the Isolator system (P less than 0.001), and of 56 nonfermentative or fastidious gram-negative bacilli detected, 46% were recovered only in the BACTEC system, while 14% were detected only in the Isolator system (P less than 0.001). Of 86 streptococci isolated during the study, 30% were detected only in the BACTEC system, and 4% were detected only in the Isolator system (P less than 0.001). Recoveries of anaerobic bacteria, staphylococci, and yeasts were equivalent in the two systems. Organisms judged to be contaminants were detected in approximately 1% of the cultures in each system. The results suggest that use of resin media renders the BACTEC nonradiometric system equivalent or superior to the Isolator system for detection of clinically significant organisms in blood cultures.

Blood↗
PubMed1990

Assessing the benefits and risks of drugs. The example of NSAIDs.

Although NSAIDs are among the most familiar drugs to general practitioners, an assessment of their likely benefits and risks should be made for every prescription. The most important risk factors for 'predictable' reactions are old age and a history of peptic ulcer, cardiovascular and renal disease, and asthma. The presence of uncomplicated peptic ulcer is not an absolute contraindication to an NSAID so long as the use of the drug is necessary. These drugs reduce symptoms rather than modify diseases and patients should be involved in the prescribing decision and be empowered to stop treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Randomized clinical trial comparing mitoxantrone with doxorubicin in previously treated patients with metastatic breast cancer.

Three hundred twenty-five women with metastatic adenocarcinoma of the breast who had failed one prior chemotherapeutic regimen for advanced disease were randomized to receive 14 mg/m2 of mitoxantrone or 75 mg/m2 of doxorubicin intravenously (IV) every 3 weeks. Enrollment was closed on October 31, 1984, after 165 patients were randomized to mitoxantrone and 160 patients to doxorubicin. Patients randomized to the two treatment groups were compared for response rate, duration of response, time to progression or death, time to treatment failure (TTF), and survival. The response rate to mitoxantrone was 20.6%, to doxorubicin 29.3% (P = .07). The median response duration was 151 days for the mitoxantrone group and 126 days for the doxorubicin group (P = .16). The median TTF was 70 days in the mitoxantrone group and 104 days in the doxorubicin group (P = .36). The median survival of patients initially randomized to receive mitoxantrone was 273 days; for doxorubicin 268 days (P = .40). There were three responses among 77 patients crossed over to mitoxantrone after initial treatment with doxorubicin. The major dose-limiting toxicity for both drugs was leukopenia. There was significantly less severe and less frequent toxicity with mitoxantrone administration. Severe nausea and vomiting occurred in 9.5% of mitoxantrone patients and 25.3% of doxorubicin patients (P less than .001). The incidence of severe stomatitis and mucositis was 0.6% in the mitoxantrone group and 8.4% in the doxorubicin group (P = .001). Severe alopecia occurred in 5.1% of mitoxantrone patients and 61.0% of doxorubicin patients (P less than .001). A life-table comparison of the cumulative dose to the development of a cardiac event showed that mitoxantrone had significantly less cardiotoxicity than doxorubicin (P = .0005). This study demonstrates that mitoxantrone is active as a single agent in the treatment of metastatic breast cancer. Compared with doxorubicin it appears to be marginally less active and significantly less toxic. We conclude that mitoxantrone can be used alone or with other standard drugs to palliate the symptoms of metastatic breast cancer, especially in settings where drug toxicity is an important consideration.

Adenocarcinoma↗
PubMed1988

Comparison of standard and chlorhexidine-derivative topical antibacterial agents on the infected burned rat wound.

The effect of daily treatment with three current topical antibacterial agents and four experimental formulations of chlorhexidine was evaluated after 1 week in rats with full thickness burns. The burn was seeded with 1 x 10(8) colony forming units (CFU) of a strain of P. aeruginosa isolated from the infected wound of a burn patient. Mafenide acetate resulted in the lowest incidence of muscle invasion and yielded the lowest mean eschar and muscle concentrations. Mafenide acetate, gentamicin, and chlorhexidine diphosphanilate (0.5 per cent) had lower mean eschar and muscle concentrations than silver sulphadiazine 1 per cent alone. Addition of chlorhexidine digluconate (0.5 per cent or 1.0 per cent) to silver sulphadiazine reduced mean eschar concentrations but not muscle concentrations compared to silver sulphadiazine alone. All treatments effectively suppressed systemic invasion of lung and blood and prevented death compared with controls. Mafenide acetate, gentamicin sulphate and chlorhexidine disphosphanilate 0.5 per cent were most effective against this patient strain of P. aeruginosa.

Administration, Topical↗
PubMed1988

Brugia malayi microfilariae share epitopes with Aedes aegypti.

Shared antigens between Brugia malayi and Aedes aegypti were studied. The experiments carried out with sera from infected Mastomys natalensis indicated that an immunological response against A. aegypti antigens (Mr 185, 35, 32 kDa) appeared often when animals became microfilaraemic and increased progressively in intensity during the time-course of infection. Sera of animals immunized with B. malayi reacted with the crude extract of mosquitoes and conversely, antibodies from animals immunized with A. aegypti reacted with the surface of B. malayi microfilariae. The implications of these findings of the natural history of B. malayi infection are discussed.

Aedes↗