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Biomedical subjects

K A Rickard

Publications and source records attributed to K A Rickard.

At least 37 records · Page 2Linked to original sources
PubMed1999

Fluticasone alone or in combination with salmeterol vs triamcinolone in asthma.

OBJECTIVES: To compare the efficacies of medium-dose fluticasone propionate (FP), medium-dose triamcinolone acetonide (TAA), and combined low-dose FP plus salmeterol (SL). DESIGN: Randomized, double-blind, triple-dummy, multicenter, 12-week clinical trial. SETTING: Allergy/respiratory care clinics. PATIENTS: Six hundred eighty patients with asthma previously uncontrolled with low-dose inhaled corticosteroids. INTERVENTIONS: FP, 220 microg bid; TAA, 600 microg bid; or FP, 88 microg plus SL, 42 microg bid. MEASUREMENTS AND RESULTS: Outcome measures included FEV1, peak expiratory flow (PEF), supplemental albuterol use, nighttime awakenings, asthma symptoms, and physician global assessment. Compared with TAA, 600 microg bid, treatment with FP 220, microg bid, significantly increased FEV1, morning and evening PEF, and percent symptom-free days, and significantly reduced rescue albuterol use, number of nighttime awakenings, and overall asthma symptom scores (p < or = 0.035). Improvements with low-dose FP, 88 microg, plus SL, 42 microg bid, were significantly (p < or = 0.004) greater than TAA, 600 microg bid, in all the aforementioned efficacy measures as well as percent of rescue-free days. Combined low-dose FP, 88 microg, plus SL, 42 microg bid, also significantly increased FEV1 and percent of rescue-free days, and significantly reduced albuterol use compared with medium-dose FP, 220 microg bid (p < or = 0.018). At endpoint, both FP, 220 microg bid, and FP, 88 microg, plus SL, 42 microg bid, significantly increased FEV1 by 0.48 L and 0.58 L, respectively, compared with 0.34 L with TAA, 600 microg bid. CONCLUSION: In patients who are symptomatic while taking low-dose inhaled corticosteroids, medium-dose FP (440 microg/d) and combination treatment with low-dose FP (176 microg/d) plus SL (84 microg/d) are both more effective than medium-dose TAA (1200 microg/d) in improving pulmonary function and asthma symptom control.

Administration, Inhalation↗
PubMed1999

Salmeterol added to inhaled corticosteroid therapy is superior to doubling the dose of inhaled corticosteroids: a randomized clinical trial.

This randomized, double-blind, double-dummy, parallel group clinical trial compared the efficacy and safety of adding salmeterol xinafoate to concurrent inhaled beclomethasone dipropionate therapy with doubling the dose of beclomethasone dipropionate in patients experiencing symptoms on low-dose beclomethasone. Salmeterol added to low-dose beclomethasone was superior (p < or = 0.05) to doubling the dose of beclomethasone in improving peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV1), and in reducing symptoms of asthma, sleep loss, nighttime awakenings, and use of albuterol. Both treatment regimens had comparable safety profiles. In asthma patients inadequately controlled despite the use of low-dose inhaled corticosteroids (i.e., less than 400 microg per day), the addition of salmeterol may be a more effective treatment option than doubling the dose of inhaled corticosteroids.

Administration, Inhalation↗
PubMed1998

Lower glycemic response to sucrose in the diets of children with type 1 diabetes.

OBJECTIVE: To compare glycemic responses of isocaloric mixed meals containing 2% and 17% sucrose in children with type 1 diabetes who had fasting euglycemia. STUDY DESIGN: Nine children (11 to 16 years) with type 1 diabetes were randomized in a crossover design to receive 2 isocaloric diets (2% or 17% sucrose) in the Clinical Research Center. In the 2% sucrose diet, starch isocalorically replaced sucrose. RESULTS: Fasting euglycemia was comparable on both study days (mean +/- SEM: 2% sucrose, 5.0 +/- 0.3 mmol/L or 90 +/- 5 mg/dL; 17% sucrose, 5.0 +/- 0.3 mmol/L or 91 +/- 6 mg/dL). The 17% sucrose diet resulted in a lower glycemic response than the 2% sucrose diet over the 4-hour study period (area under glucose response curve: mean +/- SEM, 37 +/- 3.5 mmol/L x 4 h vs 42 +/- 4.7 mmol/L x 4 h, P = .01). Peak blood glucose response was earlier and lower (2.2 to 2.8 mmol/L, 40 to 50 mg/dL) with the 17% sucrose diet. CONCLUSIONS: Sucrose in moderate amounts, isocalorically exchanged for starch, lowered glycemic response between breakfast and lunch in children who were euglycemic before breakfast. These data refute concerns about adverse glycemic effects of sucrose and support the use of sucrose-containing foods in the context of a healthy meal plan.

Adolescent↗
PubMed1998

The transfer of technology from the developed to the developing world.

The treatment of haemophilia in both the developed and developing world countries need not be complicated. The person with haemophilia can be treated and managed by common sense and the application of basic knowledge and understanding of the physiology and pathology. Emphasis needs to be placed on training people rather than on technology in the areas of clinical medicine, laboratory medicine and blood transfusion medicine. Within these specialties, there are a number of practical aspects in which a critical degree of expertise is required. Such expertise may not be available in the developing country and hence there is a very justifiable reason for the exchange of knowledge, technology and goodwill.

Blood Transfusion↗
PubMed1998

Continuous and intermittent infusion of coagulation factor concentrates in patients undergoing surgery: a single centre Australian experience.

BACKGROUND: Haemophilia patients require large doses of coagulation factor concentrates to optimise haemostasis at the time of surgery. The superior pharmacokinetic profile of continuous infusion over intermittent bolus administration may be more advantageous. AIMS: We report our experience using coagulation factor concentrates delivered by continuous infusion in patients undergoing surgery. METHODS: A retrospective case notes review of all patients treated by continuous infusion at Royal Prince Alfred Hospital (RPAH) over a two year period and a comparison of two cohorts of patients undergoing orthopaedic surgery using either continuous infusion or bolus factor VIII (FVIII) replacement therapy. Patients received a pre-operative bolus of factor concentrate (AHF, Immunine or Recombinate) followed by a continuous infusion calculated according to weight, clearance and target plasma concentration. RESULTS: Twenty-one (19 M, two F) with haemophilia or von Willebrand's disease underwent 26 surgical procedures between July 1995 and July 1997. The mean total consumption of concentrate per patient was 36,676 units (range 6750-82,000) infused over a mean period of 7.6 days (range one-16). One patient experienced minor surgical bleeding on treatment and one patient developed severe bleeding into the replaced joint off infusion requiring additional boluses of treatment. In a separate analysis, ten of these patients who underwent major orthopaedic surgery were compared to a historic cohort (n = 8) of patients who received bolus injections for similar types of operations. CONCLUSIONS: Coagulation factor concentrates delivered by continuous infusion have major clinical and economic advantages in the surgical management of patients with haemophilia.

Adult↗
PubMed1998

Salmeterol compared with current therapies in chronic asthma.

BACKGROUND: Therapy with salmeterol, a long-acting, selective, inhaled beta 2-adrenergic agonist, is effective and safe for patients with persistent asthma; however, few long-term studies comparing salmeterol with current combination treatment regimens have been reported. METHODS: A multicenter, randomized, placebo-controlled, double-blind study was conducted in 386 patients over 41 to 46 weeks in 27 medical centers (two thirds of the investigators were primary care physicians). Patients were randomized to receive either salmeterol or placebo, and further randomized to weaning or nonweaning from current asthma therapies (except inhaled corticosteroids). Treatment groups were: salmeterol/weaning (S + W), placebo/weaning (P + W), salmeterol/no weaning (S + NW), and placebo/no weaning (P + NW). Attempts at active weaning were carried out at the discretion of the investigator for 2 to 6 weeks. Pulmonary function, albuterol use, and asthma symptoms were measured. RESULTS: The clinical benefits of salmeterol occurred despite weaning off existing nonsteroidal asthma medications. The mean morning peak expiratory flow rate was significantly increased in the S + W group (32.3 L/min) compared with both the P + W (4.9 L/min) and P + NW (6.8 L/min) groups (P < .001). Compared with the P + W and P + NW groups, the S + W group experienced significant (P < .05) improvements in overall mean asthma symptom scores, mean number of puffs of supplemental albuterol, the percentage of days with no supplemental albuterol use, and the mean number of awakenings caused by asthma (except for the P + NW comparison, P = .090). No significant differences were noted between treatment groups in any safety evaluation, including 12-lead electrocardiograms. CONCLUSIONS: The addition of salmeterol in the treatment of persistent asthma resulted in sustained improvement in pulmonary function and symptoms. The long-term use of salmeterol is safe and improves the clinical course and stability of asthma following reductions in nonsteroidal asthma therapy.

Adolescent↗
PubMed1995

Haemophilia A management in Victorian, New South Wales and South Australian haemophilia centres.

OBJECTIVE: To examine the management of haemophilia A in Australia and to compare it with international trends. METHODS: Six haemophilia centres treating most patients in Victoria, New South Wales and South Australia were surveyed in 1993 by means of a written questionnaire followed by an "on site" interview. RESULTS: The centres were treating 739 patients; 234 (32%) had severe haemophilia. Factor VIII inhibitors were present in 5.9% of all patients and in 19% of those with severe disease. Twenty-three per cent were human immunodeficiency virus (HIV) antibody-positive and 74% were hepatitis C virus (HCV) antibody-positive. The main treatment was "on demand" therapy for acute bleeds (average use of factor VIII: 1350 IU/kg per year for children; and 780 IU/kg per year for adults). Prophylactic therapy was used in only 17 patients, with doses of 3000-4500 IU/kg per year. One million IU was used for three patients with high titre inhibitors who had "tolerising" therapy. While most developed countries have a factor VIII supply of 2-5 IU per capita, the total supplied to the States represented 1.46 IU per capita, while use at the centres represented 1.1 IU per capita. CONCLUSION: Because supply of factor VIII is limited, use was less than half that recommended internationally. Shortage of factor VIII has compromised prophylactic therapy and virtually prevented "tolerising" therapy.

Acute Disease↗
PubMed1995

The play approach to learning in the context of families and schools: an alternative paradigm for nutrition and fitness education in the 21st century.

An alternative paradigm for nutrition and fitness education centers on understanding and developing skill in implementing a play approach to learning about healthful eating and promoting active play in the context of the child, the family, and the school. The play approach is defined as a process for learning that is intrinsically motivated, enjoyable, freely chosen, nonliteral, safe, and actively engaged in by young learners. Making choices, assuming responsibility for one's decisions and actions, and having fun are inherent components of the play approach to learning. In this approach, internal cognitive transactions and intrinsic motivation are the primary forces that ultimately determine healthful choices and life habits. Theoretical models of children's learning--the dynamic systems theory and the cognitive-developmental theory of Jean Piaget--provide a theoretical basis for nutrition and fitness education in the 21st century. The ultimate goal is to develop partnerships of children, families, and schools in ways that promote the well-being of children and translate into healthful life habits. The play approach is an ongoing process of learning that is applicable to learners of all ages.

Adult↗
PubMed1994

Alternative snack system for children and teenagers with diabetes mellitus.

An alternative snack system facilitates diabetes management and provides a teaching tool for age-appropriate nutrition education of children and teenagers with diabetes mellitus. The system consists of four snack sizes: Mini--7 to 10 g available glucose, Little--15 to 20 g, Big--30 to 35 g, and Super-Big--50 to 55 g. Within each category, several snack patterns are equivalent to each other in terms of available glucose and energy. By using this system, a child or teenager can eat snacks that contain different food groups and still adhere to the overall meal plan. When additional carbohydrate is needed for exercise or the prevention of nighttime hypoglycemia, a snack from the next largest category will increase available glucose by approximately 15 g and energy intake by approximately 100 kcal. Generally, for every hour of extra physical activity, a Little snack is added. When blood glucose concentrations before a nighttime snack are 4.4 to 6.7 mmol/L, a Little Snack is added to the usual bedtime snack, and when levels are less than 4.4 mmol/L, a Big snack is added. Further adjustments are made for children younger than 5 years old. The alternative snack system is a valuable nutrition education tool for the management of diabetes in children and teenagers.

Adolescent↗
PubMed1994

Effectiveness of two feeding methods in improving energy intake and growth of infants with cleft palate: a randomized study.

OBJECTIVE: To compare two feeding methods advocated for infants with cleft palate: (a) a squeezable plastic container with a narrow, long crosscut nipple (squeezable cleft palate nurser); and (b) a standard nipple with a crosscut (crosscut nipple). The effectiveness of a nutrition intervention protocol for these infants was also documented. DESIGN: Thirty-one infants (median age = 15 days) were randomized to one of two feeding methods (18 infants, squeezable cleft lip/palate nurser; 13 infants, crosscut nipple) within sex (21 boys, 10 girls) and palatal defect (22 cleft lip and palate, 9 isolated cleft palate) categories. The intervention included feeding technique instructions, nutrition counseling at each clinic visit, use of the same 20 kcal/oz standard formula for 12 months, and introduction of infant and soft table foods at 6 months. Four-day food records and growth data were obtained. MAIN OUTCOME MEASURES: Mean energy and protein intakes at 3 and 6 months of age and growth measurements during the first 18 months of life were obtained. STATISTICAL ANALYSES: A repeated measures analysis of variance for intakes was performed with time as the repeated measure and feeding method as the covariable. Similar analyses were completed for growth measures with sex and feeding method as covariates. RESULTS: Mean energy intake at 3 and 6 months of age (P = .24) and growth measurements during the first 18 months of life (P values: weight gain [grams per day], .73; weight, .21; length, .07; head circumference, .18; triceps and subscapular skinfolds and mid-arm circumference, .47, .48, and .69, respectively) were not significantly different. Both feeding methods were effective in supporting normal growth. APPLICATIONS: With adequate instruction related to the use of either feeding technique and close nutrition follow-up early in infancy, a dietitian or other health care practitioner may advise the use of either feeding method. These data support the need for feeding and nutrition education and early nutrition intervention.

Anthropometry↗
PubMed1993

Migration of bovine bronchial epithelial cells to extracellular matrix components.

Migration of epithelial cells is an important feature of wound healing. Components of extracellular matrix stimulate migration of other cells, and we hypothesized that basement membrane components, laminin and type IV collagen, stimulate migration of bovine bronchial epithelial cells (BBEC). BBEC cultured for 3 days were used in migration assays using the blindwell chamber technique. BBEC migrated in a concentration-dependent manner to laminin, type IV collagen, and fibronectin. "Checkerboard" analysis demonstrated that the migration was directional for each of the components studied. We also evaluated the stimulatory activity of fibronectin fragments. A fragment containing the RGDS peptide was stimulatory of migration while other fragments were much less so, suggesting a role for RGDS-sensitive, integrin-mediated mechanisms. In order to evaluate whether bound or soluble matrix components were required to direct cell migration, we performed haptotaxis assays with precoated filters in the migration chambers. Fibronectin-precoated filters demonstrated significant stimulation of migration, suggesting that some of the migration in our original assays with fibronectin present in the lower chambers could be termed haptotactic. laminin- and type IV collagen-precoated filters were less active. When insulin was used as a chemoattractant, the fibronectin-precoated filters were more facilitatory of migration than the other matrix coatings. In summary, BBEC can chemotactically migrate to extracellular matrix components. Thus, the composition of the provisional matrix that forms at sites of epithelial injury may play an important role in the repair processes that occur after injury to the bronchial epithelium.

Amino Acid Sequence↗
PubMed1993

The bronchitis index. A semiquantitative visual scale for the assessment of airways inflammation.

Flexible fiberoptic bronchoscopy has been proven to be an effective tool for the assessment and characterization of airway inflammation. Visual inspection of airways affected by chronic bronchitis discloses an abnormal appearance characterized by erythema, edema, secretions, and friability. It was hypothesized that the visual appearance of airway inflammation could be assessed in a semiquantitative manner. A bronchitis index (BI) was developed that scores the visual appearance of airways according to the presence or absence of abnormal edema, erythema, secretions, and friability (0 = normal, 3 = remarkably abnormal). The BI was determined in three study groups: 86 subjects with chronic bronchitis, 15 subjects who smoked cigarettes, but did not have chronic bronchitis, and 25 normal, nonsmoking control subjects. The reproducibility of the BI was determined by comparing the results from pairs of two independent observers assessing 249 subjects undergoing fiberoptic bronchoscopy under various investigative protocols. In total, nine investigators scored the airways. For the three observer pairs with more than six observations, there were no differences noted in the BI (p = 0.43, 0.67, 0.82). To control for the effect of cough upon the BI, lidocaine usage was recorded. No correlation was found between lidocaine usage and BI. As previously noted for a smaller group of subjects, the BI was found to be elevated in those with chronic bronchitis (13.2 +/- 0.53) compared with both asymptomatic smokers (8.5 +/- 0.89, p < 0.0005) and normal volunteers (2.3 +/- 0.55, p < 0.0001); the latter two groups also differed significantly (p < 0.0001). The BI was also found to correlate significantly with bronchial sample lavage fluid neutrophil content in lavage fluid obtained after determination of the BI and with cigarette smoking as quantitated by pack years. Conversely, the BI correlated negatively with the spirometric measures of airway obstruction, FEV1, FEV1/FVC, FEV25-75, and FEFmax. Thus, the BI appears to be a reproducible, semiquantitative assessment of the visual appearance of airway inflammation. It may be a useful bronchoscopic adjunct for the assessment of airway inflammation in clinical investigations.

Adult↗
PubMed1993

Development and maintenance of hemophilia programs in developing countries.

A hemophilia care program should be able to provide comprehensive medical care to the person with hemophilia and fundamental to the provision of such care is the ability to provide adequate hemostatic support to the hemophilic person with his congenital hemorrhagic diathesis. Development of such a program depends on the presence and commitment of key medical and paramedical personnel and on the recognition of the fact that hemophilia exists in a particular country or community. Support programs ultimately require government assistance for provision of diagnostic facilities and most importantly for a blood transfusion service where production of blood and preparation of blood components for therapy can be undertaken. To maintain a hemophilia care program there should be viability and education of staff and an undertaking by governments for the provision of an on-going infrastructural financial support. As patients mature, new problems will arise, some of which may be a direct complication of hemophilia. Involved medical staff require support and continuing education to continue to provide essential support to the people with hemophilia. Finally, it must be stressed that hemophilia care does not stand alone but must be incorporated into the network of provision of health care based on an efficient and viable blood transfusion service.

Blood Banks↗
PubMed1993

Transforming growth factor-beta increases adhesion but not migration of bovine bronchial epithelial cells to matrix proteins.

We have evaluated the effect of transforming growth factor-beta (TGF-beta) on migration and adhesion characteristics of bovine bronchial epithelial cells. TGF-beta was a chemoattractant for bronchial epithelial cells; however, prior treatment of primary cultures of bovine bronchial epithelial cells with TGF-beta did not increase their migration when fibronectin, vitronectin, laminin, and type IV collagen were used as attractants in blind-well chamber migration assays. Similarly, treatment with TGF-beta reduced the sheet migration of bovine bronchial epithelial cells over matrix-coated dishes. However, treatment of bovine bronchial epithelial cells with TGF-beta did increase their attachment to matrix-coated dishes. Using antisera to integrins for fibronectin and vitronectin, flow cytometry analysis, and immunoprecipitation, we demonstrated that the expression of these receptors on bovine bronchial epithelial cells was enhanced by TGF-beta. Adhesion to a 60 kd tryptic fragment of fibronectin that is not involved in integrin-mediated cell binding was also increased by TGF-beta. Thus TGF-beta has important effects on bronchial epithelial cells that enhance the ability of these cells to adhere to matrix proteins but not to migrate to these same proteins.

Amino Acid Sequence↗
PubMed1992

Acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome.

OBJECTIVE: To present a case of acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome (HITTS), an important though rare complication of heparin therapy. CLINICAL FEATURES: A 69-year-old woman developed HITTS secondary to low dose heparin administered subcutaneously as prophylaxis against deep venous thrombosis. This followed a revision of a knee replacement. The first manifestation of HITTS was the development of pulmonary emboli in the setting of a falling platelet count. Bilateral adrenal haemorrhages complicated her course resulting in acute adrenal insufficiency. Non-specific symptoms dominated the clinical picture, with fever, nausea, abdominal pain and vomiting. Symptomatic postural hypotension was noted later in the course of her illness. INTERVENTION AND OUTCOME: The diagnosis of adrenal insufficiency was confirmed by short Synacthen test plus computed tomographic scanning which demonstrated bilateral adrenal haemorrhages. Steroid replacement resulted in rapid clinical improvement. CONCLUSIONS: This case demonstrates one of the life threatening complications that may occur with heparin even in prophylactic doses. Regular platelet counts are essential to detect heparin-induced thrombocytopenia at an early stage.

Acute Disease↗
PubMed1992

The low risk of hepatitis C virus transmission among sexual partners of hepatitis C-infected hemophilic males: an international, multicenter study.

To study the transmission rate of hepatitis C virus (HCV) in the female sexual partners of antibody-positive hemophilic males, 106 partners from three hemophilia centers located in Europe, America, and Australia were tested for HCV seropositivity using a first-generation enzyme-linked immunosorbent assay (ELISA-1) and, subsequently, a second-generation ELISA (ELISA-2) and a supplemental recombinant immunoblot assay. Additionally, the cohort was tested for the presence of antibody to the human immunodeficiency virus type-1 and hepatitis B virus markers. No female partner was HCV antibody-positive using the ELISA-1 test, whereas five were seropositive by the ELISA-2 test. Three of these five female partners were seropositive on the supplemental test, the remaining two having indeterminate results, for an overall prevalence of 2.7%. Thus, even with the use of sensitive testing, the prevalence of HCV infection remains low in this cohort, showing that the efficiency of heterosexual transmission of HCV is poor.

Enzyme-Linked Immunosorbent Assay↗