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Biomedical subjects

L D Edwards

Publications and source records attributed to L D Edwards.

At least 19 recordsLinked to original sources
PubMed2001

Improved asthma control after changing from low-to-medium doses of other inhaled corticosteroids to low-dose fluticasone propionate.

OBJECTIVE: To evaluate the efficacy and safety of changing from low-to-medium doses of other inhaled corticosteroids to low-dose fluticasone propionate. METHODS: Data from 11 randomized, double-blind, parallel-group trials in adults (>= 12 years; n = 1453; % predicted FEV1 = 42% to 89%) and 4 trials in children (4-11 years; n = 161; % predicted FEV1 = 50% to 112%) with chronic asthma were retrospectively analyzed. Symptomatic adults (n = 1181) treated with low-to-medium doses of beclomethasone dipropionate (168-672 mcg/day), triamcinolone acetonide (400-1200 mcg/day), or flunisolide (>=1000 mcg/day) were switched to low-dose fluticasone propionate (176 or 200 mcg daily) for 6-26 weeks. Patients (n = 272) remaining on low-dose beclomethasone dipropionate (336 mcg daily) served as controls. Pediatric patients previously treated with low doses of triamcinolone acetonide (4-8 puffs/day), or low-to-medium doses of beclomethasone dipropionate (4-8 puffs/day) or flunisolide (2-6 puffs/day), were changed to low-dose fluticasone propionate (100 mcg daily) for 12-52 weeks. RESULTS: Improvements in FEV1, morning and evening peak expiratory flow (PEF), rescue albuterol use, asthma symptom scores, and symptom-free days were significantly greater in adults who changed from low-to-medium doses of beclomethasone dipropionate or triamcinolone acetonide to low-dose fluticasone propionate (P <.001). Regardless of the degree of asthma severity, these improvements were 1.5- to 4-fold greater in adult patients changed to low-dose fluticasone propionate vs those remaining on low-dose beclomethasone dipropionate. Significant improvements in lung function, albuterol use, and asthma symptoms (P <=.002) were also seen in pediatric patients who changed from beclomethasone dipropionate, flunisolide, or triamcinolone acetonide to a much lower dose of an inhaled corticosteroid (100 mcg fluticasone propionate daily). Drug-related adverse events were low in adults and children, and were comparable among adults receiving low-dose fluticasone propionate or beclomethasone dipropionate. CONCLUSIONS: Results indicate that patients with persistent asthma can change from other inhaled corticosteroids to a lower dose of fluticasone propionate and still maintain or improve asthma control.

Adult↗
PubMed2001

Use of changes in symptoms to predict changes in lung function in assessing the response to asthma therapy.

BACKGROUND: The majority of adult patients with asthma are managed by primary care providers. Although there is no generally accepted gold standard for the assessment of asthma severity in general practice, treatment decisions and modifications to therapy are strongly influenced by patients' symptoms and history of asthma medication use. OBJECTIVES: The primary goal of this study was to determine whether there is a correlation between changes in asthma symptoms during treatment and changes in lung function, as measured by peak expiratory flow (PEF). A secondary goal was to compare the relative efficacy (in terms of improvement in asthma symptoms and lung function) of 3 commonly used asthma treatments: inhaled fluticasone propionate, inhaled salmeterol xinafoate, and oral zafirlukast. METHODS: This was a retrospective comparison employing regression analyses of asthma symptom and lung function data from 2890 male and female adolescent and adult patients with persistent asthma who were enrolled in 8 randomized, double-blind, double-dummy, parallel-group studies. Data on patients' self-rated symptoms, PEF, supplemental albuterol use, nighttime awakenings, and frequency of asthma exacerbations were used to ascertain whether there was a correlation between changes in asthma symptoms and changes in pulmonary function, and to compare treatment effects. RESULTS: Changes in patients' ratings of asthma symptoms after treatment with study medications showed a strong correlation with changes in lung function. Similarly, changes in lung function were strongly correlated with changes in supplemental beta-agonist use and quality of life. In addition, fluticasone or salmeterol treatment resulted in significantly greater increases in mean morning PEF (P < 0.001), significantly greater decreases in symptom scores (P < or = 0.004), significantly fewer nights with awakenings due to symptoms (P < or = 0.017), and significantly greater reductions in supplemental beta-agonist use (P < 0.001) compared with zafirlukast treatment or placebo. Patients treated with fluticasone or salmeterol also experienced significantly lower rates of asthma exacerbation (3%) during treatment than did those receiving zafirlukast (7%) or placebo (12%) (P < 0.001 and P = 0.015, fluticasone and salmeterol, respectively). CONCLUSION: These findings support the validity of primary care practitioners' basing asthma-management decisions on patients' symptoms.

Adolescent↗
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↗
PubMed1990

Symbolic interactionism: a framework for the care of parents of preterm infants.

Because of stressors surrounding preterm birth, parents can be expected to have difficulty in early interactions with their preterm infants. Care givers who work with preterm infants and their parents can positively affect the early parental experiences of these mothers and fathers. If care givers are consciously guided by a conceptual model, therapeutic care for distressed parents is more likely to be provided. A logical framework, such as symbolic interactionism, helps care givers to proceed systematically in assessing parental behaviors, in intervening appropriately, and in evaluating both the process and outcome of the care. Selected aspects of the symbolic interaction model are described in this article and applied to the care of parents of preterm infants.

Humans↗
PubMed1989

Comparison of dilevalol and enalapril administered once daily for mild hypertension.

This was a multicenter, randomized, double-blind, parallel-group study of the efficacy and safety of dilevalol, 200 mg (n = 86), compared with enalapril, 20 mg (n = 92), administered once daily to patients with mild hypertension. Three weeks of placebo washout were followed by 4 weeks of comparative treatment. Beginning with the first week of treatment, both drugs substantially decreased blood pressure from baselines of approximately 160/100 mm Hg. Decreases in systolic pressure were comparable throughout treatment, but dilevalol tended to have a greater effect on diastolic pressure. At the end of double-blind treatment, average decreases in blood pressure with dilevalol and enalapril were 16/13 and 16/11 mm Hg supine and 15/13 and 15/10 mm Hg standing (p = 0.03 for between-group comparisons of standing diastolic pressure). More dilevalol- than enalapril-treated patients achieved a diastolic pressure less than 90 mm Hg; 73 vs 55% (p = 0.02) supine, and 69 vs 43% (p less than 0.01) standing. The safety profiles of the 2 drugs were comparable. The incidence of adverse effects was low, and few patients discontinued treatment. Headache and gastrointestinal discomfort were reported in both groups. Average postural changes in blood pressure were similar to baseline. Electrocardiographic changes were rare and not treatment related. Changes in laboratory test results were minor. Heart rate decreased modestly with dilevalol relative to enalapril (6 vs 2 to 3 beats/min; p less than 0.01), but no bradycardia was observed.

Adult↗
PubMed1989

Evaluation of three LPS-specific monoclonal antibodies for the immunodiagnosis of bovine brucellosis.

Bovine sera collected during the Australian brucellosis eradication campaign were used to assess the value of three monoclonal antibodies (MAb Bruce 1, 4 and 7) for the immunodiagnosis of bovine brucellosis in a competitive enzyme immunoassay (CEIA). Each MAb reacted to a different epitope of lipopolysaccharide molecules on the cell surface of Brucella abortus. When the sensitivity of the CEIA was set at 100 per cent so that all infected animals were identified, the specificity of the test using MAb Bruce 1 and Bruce 7 was 69 per cent and 52 per cent, respectively. On the other hand, a quarter of the sera from infected cattle did not inhibit the binding of MAb Bruce 4 to the antigen. With a maximum sensitivity of 75 per cent, the specificity of the CEIA using MAb Bruce 4 was 94 per cent. However, all three MAb cross reacted with sera from sheep infected with Bovis, Histophilus ovis and Actinobacillus seminis.

Animals↗
PubMed1988

Restriction endonuclease analysis of Brucella abortus.

The restriction endonuclease profiles of bacterial DNA from Brucella abortus isolates were evaluated. It was not possible to distinguish between vaccine strain 19 and virulent (biotype 1 and biotype 2) strains of B abortus. Restriction endonuclease analysis is therefore not a suitable epidemiological tool in bovine brucellosis investigations. The genetic homogeneity of the Brucella genus was reinforced by these findings.

Animals↗
PubMed1985

Peripheral blood white cell responses during concurrent copper deficiency and gastro-intestinal nematodiasis in sheep.

Sheep experimentally depleted of copper (Cu) and infected with Trichostrongylus axei and Trichostrongylus colubriformis were studied for changes in white blood cell (WBC) populations, anti-parasite antibody responses and in vitro proliferative response to phytohaemagglutinin (PHA), lipopolysaccharide (LPS) and Trichostrongylus spp. antigens. Increases in circulating total WBC, lymphocyte, monocyte and neutrophil leucocyte numbers had a bimodal distribution which was related to the different developmental stages of the nematode. Eosinophil leucocyte numbers were generally lower than those of uninfected control sheep and could be associated with parasite-induced selective unresponsiveness of PHA responsive cells. The in vitro blastogenic responses of lymphocytes to PHA stimulation increased rapidly soon after infection, reaching a peak at 2 weeks, but then declined rapidly and from 5 weeks after infection responses to PHA were barely detectable. The patterns of proliferative response against LPS and Trichostrongylus spp. antigens were identical and correlated with the appearance of anti-parasite antibodies in the serum. These last three responses reached their maxima 5 weeks after infection and then stabilized at a plateau around peak levels. It was concluded that, although the changes in the host immune response could not be consistently associated with interactions between Cu deficiency and infection, the results nevertheless suggest that Cu, as a micro-nutrient, has a role in the mechanism of cell-mediated immunity in sheep infected with Trichostrongylus spp.

Animals↗
PubMed1984

Cost-effective method of triple-site culturing for Neisseria gonorrhoeae.

The efficacy of the use of a single modified Thayer-Martin triplate versus that of three separate modified Thayer-Martin plates for the recovery of Neisseria gonorrhoeae from pharyngeal, anal, and genital sites were studied. A total of 98 males and 74 females who showed intracellular gram-negative diplococci on genital Gram stain were studied. Of 172 patients, 164 had gonorrhea at one or more sites. In the first group of 45 males and 21 females, a single swab from each site was used to inoculate randomly both a standard plate (100 mm in diameter) and one-third of a triplate. In the second group of 53 males and 53 females, two swabs were used for collection from each site. One of each pair of swabs was randomly inoculated onto a standard plate and a triplate. There was no significant difference between the results obtained by inoculation with single swabs and those obtained by inoculation with two swabs. There were no significant differences between the positivity rates obtained with the triplate and those obtained with three standard plates used at each site. Cost (39% that of three separate plates) and acceptance by clinic and laboratory personnel make the triplate method an economical, accurate, and effective triple-site screening system.

Anal Canal↗
PubMed1984

Comparison between bacampicillin and amoxycillin in treating genital and extragenital infection with Neisseria gonorrhoeae and pharyngeal infection with Neisseria meningitidis.

Sixty three patients presumed to have genital gonorrhoea who gave histories of extragenital sexual practices were randomly treated with amoxycillin 3 g or bacampicillin 4.8 g (equivalent to 3.5 g ampicillin) with probenecid 1 g to compare the efficacy of the drugs in treating gonorrhoea at all sites. Three patients were initially culture negative, and seven failed to return for follow up. Twenty seven of 28 patients receiving bacampicillin and all 25 receiving amoxycillin gave negative genital cultures for Neisseria gonorrhoeae five to nine days after treatment. Twenty two of 60 patients had extragenital gonorrhoea. One failed to return, but all eight who had received amoxycillin and 12 of 13 who had received bacampicillin gave negative pharyngeal and anorectal cultures after treatment. N meningitidis was isolated from the pharynx in 17 of 60 patients on initial attendance. Three of 14 were still colonised with the meningococcus after treatment. Two of 32 patients receiving amoxycillin and 12 of 31 receiving bacampicillin reported experiencing gastrointestinal side effects.

Amoxicillin↗
PubMed1983

Comparative culture methods on 101 intravenous catheters. Routine, semiquantitative, and blood cultures.

Broth cultures and semiquantitative cultures (SQCs) were done on 101 intravenous (IV) catheters from 82 patients. Catheters were in place an average of ten days (range, one to 40 days). Twenty-eight catheters yielded 15 colonies or more to SQCs of transcutaneous catheter segments. Staphylococcus epidermidis was the most common microbial isolate found on 21 of the 28 catheters on SQC. Broth tip cultures, SQCs on tips and transcutaneous segments, qualitative blood cultures (QIBCs), and quantitative blood cultures (QnBCs) drawn via the catheters were significantly associated with peripheral bacteremia. The presence of systemic antimicrobials made no significant difference in SQC, QIBC, or QnBC positivity. With the exception of gross pus, local inflammation was not significantly associated with catheter infection. Local site care by a special team of nurses resulted in significantly fewer catheter infections than did care given by ward nurses.

Catheterization↗
PubMed1982

Semiquantitative cultures and routine tip cultures on umbilical catheters.

One hundred and fourteen umbilical catheters (79 arterial and 35 venous) were cultured with a semiquantitative technique. Twelve cultures were SQC positive with greater than or equal to 15 colonies, and all but two of these had greater than or equal to 100 colonies. Organisms usually considered to be pathogens were associated with SQC positive catheters, whereas organisms generally considered nonpathogens were associated with less than 15 colonies on SQC. Therefore SQC may help to differentiate between contamination and infection related to umbilical catheters. The one case with purulence at the cord base grew 100 colonies of Staphylococcus epidermidis on SQC. S. epidermidis showed a bimodal distribution in colony count and should be considered as a pathogen when high colony counts are present. Duration of catheterization was longer in SQC positive catheters. Empiric antibiotic use was associated with negative SQC. Further study is indicated in a newborn population with a lower rate to antibiotic use for correlation of SQC results with catheter-induced bacteremia and sepsis.

Anti-Bacterial Agents↗