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Biomedical subjects

M M Devlin

Publications and source records attributed to M M Devlin.

At least 19 recordsLinked to original sources
PubMed1998

Adrenocortical activity with repeated administration of one-daily inhaled fluticasone propionate and budesonide in asthmatic adults.

OBJECTIVE: The aim of this study was to evaluate the steady-state effects of once-daily inhaled fluticasone propionate (FP) and budesonide (BUD) on adrenocortical activity in asthmatic patients. METHODS: Ten asthmatic patients with a mean age of 31.2 years, a mean forced expiratory volume in 1 s (FEV1) of 91% predicted and a forced mid-expiratory flow (FEF25-75) of 62.3% predicted were studied in a single-blind randomised crossover design comparing placebo (PL), FP (375 microg per day and 750 microg per day) and BUD (400 microg per day and 800 microg per day) all given once daily for 4 days at each dose via a pressurised metered dose inhaler (pMDI) at 0800 hours. After 4 days of treatment, plasma cortisol was measured at 0800 hours (24 h after the last dose) and a 10-h overnight urine collection was taken, 14 h after the last dose (2200-0800 hours) for analysis of cortisol and creatinine excretion. RESULTS: Plasma cortisol levels (nmol.l(-1), as geometric mean) at 0800 hours demonstrated a significant difference between the highest doses of FP and BUD (424.1 vs 510.3 nmol.l(-1), respectively) but not between the low doses (506.8 vs 514.9 nmol.l(-1); PL 532.2 nmol.l(-1)). For the highest dose FP (750 microg) this equated to 20% suppression of 0800 hours plasma cortisol. Likewise, for overnight urinary cortisol output (nmol.10 h(-1) as geometric mean), there was a significant difference at the high doses of FP and BUD (25.5 vs 38.2 nmol.10 h(-1)), but not at the low doses 31.3 vs 34.8 nmol.10 h(-1); PL 32.0 nmol.10 h(-1). For the overnight urinary cortisol/creatinine ratio (nmol.mmol(-1), as geometric mean) there was a similar trend; 4.5 vs 6.1 nmol.mmol(-1) for high dose and 5.6 vs 6.3 nmol.mmol(-1) for low dose; PL 5.9 nmol.mmol(-1). CONCLUSION: Repeated doses of FP 750 microg once daily caused greater adrenal suppression than BUD 800 microg once daily, when comparing effects on plasma cortisol levels at 0800 hours, 24 h after the last dose, as well as effects on overnight urinary cortisol output. Neither FP 375 microg once daily nor BUD 400 microg once daily produced detectable adrenal suppression.

Adult↗
PubMed1998

Subsensitivity to bronchoprotection against adenosine monophosphate challenge following regular once-daily formoterol.

Regular treatment with inhaled long-acting beta2-agonists leads to subsensitivity to their bronchoprotective effects, although the effect of dosing frequency on this subsensitivity is not known. The aim of this study was to assess whether a once-daily dosing regimen with formoterol might be associated with a lesser degree of subsensitivity. In a randomized placebo-controlled double-blind, double-dummy crossover study 10 asthmatics treated with inhaled steroids (mean age 31 yrs, forced expiratory volume in one second (FEV1) 82% predicted) received 1 week of treatment with: formoterol dry powder 24 microg twice daily (08:00 and 20:00 h); formoterol 24 microg once daily (20:00 h); or identical placebo. Adenosine monophosphate (AMP) bronchial challenge was performed 12 h after the first and the last dose of each treatment. There was significant loss of protection with formoterol twice daily between the first and last dose (geometric mean provocative concentration causing a 20% fall in FEV1 (PC20)): 475 versus 129 mg x mL(-1) (a 3.7-fold loss, p=0.006) and with formoterol once daily: 367 versus 127 mg x mL(-1) (a 2.9-fold loss, p=0.005), compared with placebo: 71 versus 75 mg x ml(-1) (nonsignificant). There was no significant difference in the degree of loss of protection between formoterol once and twice daily. For first-dose protection there was a significant difference between active treatments and placebo, but after the last dose the residual protection between active treatments and placebo was not significant. Thus, in patients taking inhaled corticosteroids, regular formoterol 24 micreog once daily induces a similar degree of subsensitivity to adenosine monophosphate bronchial challenge as with formoterol 24 microg twice daily. This in turn suggests that even with a 24-h dosing interval there is the development of tolerance to formoterol by prolonged occupancy of airway beta2-adrenoceptors.

Adenosine Monophosphate↗
PubMed1996

Quill v. Vacco.

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Adult↗
PubMed1996

Lee v. State of Oregon.

HELD: Oregon's Death with Dignity Act, Measure 16, which legalizes physician-assisted suicide for certain terminally ill persons, violates the equal protection clause of the fourteenth amendment to the United States Constitution. Measure 16 fails to withstand even the lowest level of judicial scrutiny because the disparate treatment afforded the class of terminally ill persons does not further any legitimate state interest.

Adult↗
PubMed1996

In re Fiori.

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Advance Directives↗
PubMed1992

Federal laws govern the conduct of peer review.

The U.S. Supreme Court has ruled that an antitrust plaintiff does not need to prove that defendant physicians and hospitals engaged in interstate commerce in order to assert federal jurisdiction over his claim that peer review proceedings against him violated the law.

Antitrust Laws↗
PubMed1988

Florida's new approach to the medical liability crisis.

A new Florida medical liability insurance act went into effect on February 8, 1988. It would allow for prompt resolution of claims with mandatory presuit investigation of all claims and defenses and voluntary arbitration. A cap of $250,000 is placed on noneconomic damages without punitive awards. Refusal to arbitrate leads to a loss on limit on damages awardable at trial. Special provisions are made for birth-related neurological injury compensation.

Florida↗
PubMed1987

Patient abandonment.

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Continuity of Patient Care↗
PubMed1987

Cost containment and medical judgment.

A physician should not allow financial criteria to influence his decision to discharge a patient from the hospital despite pressures that may exist to do so. If injury to the patient is attributable to a premature discharge approved by a physician, the physician can expect to be held accountable. Under Wickline, a physician should protest to a third-party payor whose prospective utilization review decision would result in the withholding of necessary medical care. Such protests should be documented. Where a patient requires continued hospitalization, it would be advisable to so inform the patient and the hospital administrator so that arrangements for care in an appropriate facility can be made.

Adult↗
PubMed1985

In the Matter of Claire C. Conroy, No. A-108 (N.J. Jan. 17, 1985).

Life-sustaining treatment, such as artificial respiration, nutrition, or hydration, may be withheld or withdrawn from a competent patient who declines such treatment. Such treatment may also be withheld or withdrawn from an incompetent patient when it is clear that the patient would have refused the treatment under the particular circumstances. In the absence of evidence of what the patient would have done in the specific situation, life sustaining treatment or support may be withdrawn from an incompetent person when it is clear that the treatment would merely prolong suffering. No such decision may be based upon an assessment of the personal worth or social utility of an incompetent patient's life.

Aged↗