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M J Monaghan

Publications and source records attributed to M J Monaghan.

At least 37 records · Page 2Linked to original sources
PubMed1998

Are pharmacists and pharmaceutical care having an impact on diabetes?

This study sought to identify pharmacy services offered to patients with diabetes and demonstrate patients receiving pharmaceutical care services had better glucose control as measured by laboratory values and medication compliance. Two hundred randomly selected patients with diabetes were identified from a pharmacy benefits manager's database. Their pharmacists were mailed a survey requesting information concerning morbidity risk factors, concomitant disease states, concomitant medications, diabetes pharmacotherapy, blood glucose concentrations, and percent hemoglobin A1c values. Information concerning diabetes cognitive services offered was also requested. A statistically significant correlation between diabetes cognitive services and improved disease control was not demonstrated secondarily to the small number of responses returned with glucose control information. Our results indicate pharmacists must improve documentation of their services and the impact these interventions have on disease control in order to prepare for reimbursement for cognitive services.

Blood Glucose↗
PubMed1996

Do market components account for higher US prescription prices?

BACKGROUND: Although only 7-8% of US healthcare expenditures are spent on prescription drug products, the pharmaceutical industry's profitability and high cost of prescriptions to consumers make prescription drugs a visible target for reform. When compared with other products, it appears as if unfair pricing tactics are used. The pharmaceutical industry cites costs of research and development and a short patent life as justifiable grounds for high prices, but the reason why US drug prices appear to be so high has yet to be answered. OBJECTIVE: To examine identified components of the pharmaceutical industry that allow US prescription drugs to appear to be highly priced and to review the apparent factors that affect pricing policies for pharmaceuticals. DATA SOURCES: The literature was reviewed to identify current research regarding the pharmaceutical market. Sources included MEDLINE, Econolit, Business Periodical Index, International Pharmaceutical Abstracts, the Wall Street Journal, New York Times, and the F-D-C Pink Sheet. SUMMARY: Key factors account for the fact that US prescription drug prices are higher and that price discrimination occurs in the pharmaceutical industry within the US and among other countries. These factors include the unique market structure of the pharmaceutical industry, asymmetry of information, research and development costs, numerous channels of distribution and the differences among them, and government laws and regulations of prescription drugs. Pricing policies of pharmaceutical companies are based on manufacturing, promotion, and distribution costs; drug characteristics; and economic goals of the parent company.

Drug Costs↗
PubMed1995

Echocardiographic assessment of systolic and diastolic left ventricular function using an automatic boundary detection system. Correlation with established invasive and non invasive parameters.

Systolic and diastolic left ventricular function was assessed using an echocardiographic automatic boundary detection system (ABD) in 50 unselected patients undergoing left cardiac catheterisation. Automatic boundary detection system derived parameters (fractional area change [FAC], peak positive rate of area change [+dA/dt] and peak negative rate of area change [-dA/dt]) were compared with invasively (left ventricular angiography and pressures) and non invasively (Doppler mitral filling velocities and isovolumic relaxation time) acquired conventional indices of ventricular function. Adequate detection of endocardial boundaries and subsequent measurements using the ABD system were achieved in 40/50 (80%) patients in the short axis parasternal view, in 41/50 (82%) in the apical four chamber view and in 34/50 (68%) in both views. For the whole group of patients the FAC (maximal left ventricular diastolic area--minimal left ventricular systolic area/maximal left ventricular diastolic area) estimated in the short axis view correlated with the angiographic ejection fraction (EF) measured in the right oblique projection (r = 0.51, p < 0.001). There was only a weak correlation of the FAC estimated in the apical four chamber view with the EF (r = 0.36, p < 0.01). The mean FAC (mean value of the FAC in the short axis and apical four chamber views) correlated reasonably with the EF (r = 0.62, p < 0.0001). There was no correlation between ABD derived parameters and left ventricular end diastolic pressure (LVEDP) in these patients. In a subgroup of patients with normal coronary arteries and left ventricular function (n = 17), although there was no correlation between EF and FAC, there was a strong positive correlation between FAC (apical four chamber and mean) and LVEDP (r = 0.77, p < 0.01 and r = 0.87, p < 0.01 respectively). No correlation was found in these patients between EF and LVEDP. In a further subgroup of patients with angiographically abnormal left ventricular function (EF < 45%), there was a positive correlation between FAC (short axis, apical four chamber and mean) and EF (r = 0.52, p < 0.05, r = 0.83, p < 0.0001 and r = 0.80, p < 0.001 respectively) and a negative correlation between FAC (short axis and mean) and LVEDP (r = -0.52, p < 0.05 and r = -0.60, p < 0.01 respectively). There was also a negative correlation between LVEDP and EF in the same subgroup of patients (r = -0.65, p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Digital radiofrequency echocardiography in the detection of myocardial contrast following intravenous administration of Albunex.

Conventional contrast echo techniques have proved inadequate for the detection of myocardial perfusion using intravenously injected echo contrast agents because of the limitations and relative insensitivity of standard echocardiographic equipment. In order to avoid these problems, we have obtained pure digital radiofrequency ultrasound data from the left ventricle and myocardium during i.v. contrast myocardial perfusion echo studies. In 30 patients, following coronary arteriography, i.v. injections of the echo contrast agent Albunex (sonicated human serum albumin) in two doses of 0.08 and 0.22 ml.kg-1 were administered during digital radiofrequency echocardiography sampling of data from the myocardium and left ventricular cavity. Analysis of mean integrated backscatter (MIB, a measure of the total ultrasound energy) was performed before, during and after Albunex injection. The data were also analysed for a shift in frequency spectrum which could be caused by resonance of the Albunex contrast microspheres in the heart, a phenomenon which has been previously demonstrated in vitro. Digital radiofrequency ultrasound data were successfully obtained and analysed in 23 patients. In 31 segments where reasonable resting perfusion was expected, there was a significant increase in MIB from 0.644 to 1.245, P < 0.001 and time intensity curves could be constructed showing wash-in and wash-out of contrast from the myocardium. In 10 segments supplied by significantly diseased vessels, MIB intensity increased from 1.044 to 1.874, P = 0.054. In myocardial segments supplied by non-diseased vessels, microsphere resonance also caused a drop in mean frequency of 140 KHz, P < 0.001, and permitted similar temporal analysis of myocardial perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Echocardiographic restenosis after successful balloon dilatation of the mitral valve with the Inoue balloon: experience of a United Kingdom centre.

OBJECTIVES: (a) To assess the echocardiographic incidence of restenosis after successful balloon dilatation of the mitral valve at a mid-term follow up of one year among a population of predominantly United Kingdom patients. (b) To identify any factors, assessed before or during dilatation, which may predict the development of restenosis. DESIGN: Successful dilatation of the mitral valve was defined as an increase in mitral valve area of > 25% and a final valve area of at least 1.5 cm2. Echocardiographic restenosis was defined at follow up as a loss of 50% of initial gain and a valve area of less than 1.5 cm2. Mitral valve area was assessed by transthoracic echocardiography before, during, 48 hours after, and one year after successful balloon dilatation of the mitral valve. Echo score before dilatation (an assessment of valvar and subvalvar calcification, thickening, and mobility), age, rhythm, echocardiographic mitral valve area before and after dilatation, left atrial pressure before and after dilatation, and end diastolic mitral valve gradient before and after dilatation were compared in those patients with and without echocardiographic restenosis at one year. SETTING: A regional cardiothoracic centre in the United Kingdom that performs 20-30 balloon dilatations of mitral valves each year. PATIENTS: 39 patients, with symptomatic dominant mitral stenosis, who had undergone successful balloon dilatation of the mitral valve, and in whom echocardiographic assessment of mitral valve area was available at one year. 92% of patients were citizens of the United Kingdom. INTERVENTIONS: Balloon dilatation of the mitral valve by the Inoue technique. MAIN OUTCOME MEASURES: Mitral valve area and patient symptom class (New York Heart Association) one year after successful dilatation of the mitral valve. RESULTS: The incidence of echocardiographic restenosis was eight of 39 patients (21%). Of the eight patients with restenosis four underwent mitral valve replacement, two had repeat dilatation of the mitral valve, and two remained on medical treatment. With univariant analysis, factors associated with restenosis were increased age, higher echo score before dilatation, and a lower mitral valve area immediately after the operation. The only independent risk factor for restenosis, shown by multivariant analysis, was a high echo score before dilatation. There was no significant fall in mitral valve area at one year in those patients without restenosis. Most (28/31) of these patients had echocardiographic evidence of splitting of at least one commissure after dilatation compared with only two of eight patients who developed restenosis. Of 10 patients with an echo score before dilatation > or = 10 only two had an initially successful operation and no restenosis at one year. CONCLUSIONS: The echocardiographic incidence of restenosis after dilatation of the mitral valve by the Inoue technique in patients of the United Kingdom is 21%. The principal factor associated with restenosis is a high echo score before dilatation. Increases in mitral valve area are maintained in those patients without restenosis and it is likely that the mechanism of initial increase in valve area is different in the two groups, being commissural splitting in those patients who do not get restenosis and valve stretching in those that do. In patients with an echo score > or = 10 dilatation of the mitral valve should be considered only as a palliative procedure.

Adult↗
PubMed1992

Residual atrial septal defects following balloon mitral valvuloplasty using different techniques. A transthoracic and transoesophageal echocardiography study demonstrating an advantage of the Inoue balloon.

The incidence and severity of atrial septal defects following balloon mitral valvuloplasty have been assessed using transthoracic and transoesophageal echocardiography in 20 patients 3-36 months following the procedure. In eight patients (group A) the atrial septum was dilated with an 8 mm Olbert balloon and either a double or bifoil balloon used to dilate the mitral valve. In 12 patients (group B) the Inoue balloon, with a slimmer deflated profile, was used following dilatation of the interatrial septum with a 14 French vessel dilator. In group A, using transthoracic echocardiography, one atrial septal defect was imaged and transatrial flow detected by colour flow Doppler in five patients. In seven of the eight patients transoesophageal echocardiography clearly imaged an atrial septal defect and left-to-right shunting was demonstrated by colour flow Doppler. Valsalva contrast studies revealed residual transatrial flow in all eight patients. The mean width of the colour flow jet was 5.8 mm. In group B patients, using transthoracic echocardiography, only one patient had evidence of residual transatrial flow (demonstrated by Valsalva contrast). Using transoesophageal echocardiography Valsalva contrast studies, transatrial flow was seen in 11 of the 12 patients. However, no defects were imaged and colour flow Doppler indicated left-to-right shunting in only two patients. The mean width of the colour flow jet was 1.5 mm. Transoesophageal echocardiography with colour flow Doppler and Valsalva contrast studies therefore provides a sensitive method for the detection of residual atrial septal defects following balloon mitral valvuloplasty. Transatrial flow persists in the majority of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Comparative value of transthoracic and transoesophageal echocardiography before balloon dilatation of the mitral valve.

OBJECTIVE: To assess the relative merits of transthoracic and transoesophageal echocardiography before balloon dilatation of the mitral valve. DESIGN: Transthoracic and transoesophageal echocardiograms were prospectively performed in 35 patients being considered for balloon dilatation of the mitral valve. Echocardiograms were analysed for image quality, the assessment of valve morphology, the detection of left atrial thrombus, and the assessment of mitral regurgitation and other valvar pathology. PATIENTS: 35 consecutive patients with symptomatic dominant mitral stenosis. INTERVENTIONS: 30 eventually underwent balloon dilatation of the mitral valve by the Inoue technique. Five patients had mitral valve replacement. MAIN OUTCOME MEASURES: Echocardiographic and surgical detection of left atrial thrombus and successful, uncomplicated balloon dilatation of the mitral valve. RESULTS: Left atrial thrombus was detected in 1/35 patients by transthoracic studies compared with 6/35 from transoesophageal studies. Otherwise both techniques gave comparable results. Thrombus was confirmed at mitral valve replacement in five patients. Successful dilatation of the mitral valve was performed in 30 patients. CONCLUSIONS: Transthoracic echocardiography is a useful screening procedure but transoesophageal echocardiography is mandatory before balloon dilatation of the mitral valve for the detection of left atrial thrombus.

Adult↗
PubMed1990

Echocardiographic appearance of pulmonary artery stenosis.

Colour flow Doppler mapping can show abnormalities of flow even when the echocardiographic image is equivocal. Routine echocardiography in two patients who were thought to have pulmonary valve stenosis and a ventricular septal defect initially appeared to be normal. Colour flow Doppler mapping, however, showed multiple flow aliasing within the pulmonary artery, approximately 1.5 cm downstream from the pulmonary valve. More detailed examination by cross sectional echocardiography showed a membrane at this level in both patients. It is possible that more cases of this uncommon anomaly will come to light with increasing use of Doppler techniques.

Adult↗
PubMed1989

Doppler colour flow mapping: technology in search of an application?

Although Doppler colour flow mapping may considerably reduce the need for conventional pulsed Doppler examination, quantitative flow measurements (particularly by continuous wave Doppler) are still essential in the evaluation of many conditions such as aortic stenosis. Doppler colour flow mapping is an important addition to the accurate non-invasive evaluation of several haemodynamic disorders of the heart and, as the technology improves, the range of applications will undoubtedly increase. Any technique that provides additional diagnostic information, makes an examination easier and quicker to perform, and at the same time provides data in a more comprehensible format has surely found a niche.

Color↗
PubMed1988

Echocardiography.

Imaging echocardiography is an important extension of the clinical examination and will answer most questions in an emergency-for example, whether an enlarged cardiac shadow on the chest radiograph represents ventricular dilatation or an effusion. Doppler ultrasonography is essential for hospitals with an interest in cardiology because it provides direct haemodynamic data that are complementary to imaging. It requires more skill than imaging and may also be time consuming. Colour flow Doppler mapping is speedy and simple to use and aids the interpretation of continuous wave Doppler. It is therefore a natural companion to conventional Doppler, but there would have to be a high clinical load to justify its purchase.

Cardiomyopathies↗