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Biomedical subjects

M S Kochar

Publications and source records attributed to M S Kochar.

At least 37 records · Page 2Linked to original sources
PubMed1994

The provision of patient and family education.

Health-care professionals no longer have the option on whether or not to include patient health education into patient care. The U.S. Joint Commission on Accreditation of Health Care Organizations (JCAHO) requires that patient and family education is provided in specifically identified areas. In order for health providing institutions to be approved, these standards must be met. Health-care providers, however, should realize that patient health education (PHE) can be delivered in a variety of ways and JCAHO does not set conditions as to which methods of delivery are applied. Several modes of PHE approaches are cited in this article, along with an example as to how to put them into practice.

Delivery of Health Care↗
PubMed1993

Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.

BACKGROUND: Characteristics such as age and race are often cited as determinants of the response of blood pressure to specific antihypertensive agents, but this clinically important issue has not been examined in sufficiently large trials, involving all standard treatments, to determine the effect of such factors. METHODS: In a randomized, double-blind study at 15 clinics, we assigned 1292 men with diastolic blood pressures of 95 to 109 mm Hg, after a placebo washout period, to receive placebo or one of six drugs: hydrochlorothiazide (12.5 to 50 mg per day), atenolol (25 to 100 mg per day), captopril (25 to 100 mg per day), clonidine (0.2 to 0.6 mg per day), a sustained-release preparation of diltiazem (120 to 360 mg per day), or prazosin (4 to 20 mg per day). The drug doses were titrated to a goal of less than 90 mm Hg for maximal diastolic pressure, and the patients continued to receive therapy for at least one year. RESULTS: The mean (+/- SD) age of the randomized patients was 59 +/- 10 years, and 48 percent were black. The average blood pressure at base line was 152 +/- 14/99 +/- 3 mm Hg. Diltiazem therapy had the highest rate of success: 59 percent of the treated patients had reached the blood-pressure goal at the end of the titration phase and had a diastolic blood pressure of less than 95 mm Hg at one year. Atenolol was successful by this definition in 51 percent of the patients, clonidine in 50 percent, hydrochlorothiazide in 46 percent, captopril in 42 percent, and prazosin in 42 percent; all these agents were superior to placebo (success rate, 25 percent). Diltiazem ranked first for younger blacks (< 60 years) and older blacks (> or = 60 years), among whom the success rate was 64 percent, captopril for younger whites (success rate, 55 percent), and atenolol for older whites (68 percent). Drug intolerance was more frequent with clonidine (14 percent) and prazosin (12 percent) than with the other drugs. CONCLUSIONS: Among men, race and age have an important effect on the response to single-drug therapy for hypertension. In addition to cost and quality of life, these factors should be considered in the initial choice of a drug.

Age Factors↗
PubMed1993

Coffee. Facts and controversies.

In this article, we review current literature on coffee, both regular and decaffeinated, and its potential effects in humans. Moderate coffee consumption is believed to have no persistent effect on blood pressure. Large intake of coffee may increase total cholesterol levels; boiled coffee increases cholesterol levels more than filtered coffee. Consuming more than four cups per day may be associated with increased risk of acute myocardial infarction. There appears to be an association between urinary bladder cancer and coffee consumption. No association was found between ingestion of coffee and incidence of duodenal ulcer and ulcerative colitis. Increased coffee consumption by pregnant women appears to decrease fetal birth weight. Fetal heart rate, respiration, and both maternal and fetal anemia are increased with coffee consumption but coffee has not been shown to be teratogenic. Coffee consumption appears to pose no particular threat in most people if consumed in moderation. Naturally decaffeinated, filter-brewed coffee further diminishes its potential harmful effects.

Animals↗
PubMed1993

Hypertension in obese patients.

Obesity and hypertension often coexist. The waist-hip ratio has been found to be a more accurate predictor of hypertension than either body weight or body mass index. A waist-hip ratio of 0.85 or more in men and 0.75 or more in women is a significant cardiovascular risk factor. Insulin also probably has an important role in the pathogenesis of hypertension in obese patients. Treatment of hypertension in overweight patients begins with weight loss, which is frequently achieved by combining caloric restriction and exercise. Such commonly used drugs as angiotensin-converting enzyme inhibitors, calcium blockers, alpha blockers, and beta blockers are appropriate for medical treatment of these patients.

Body Mass Index↗
PubMed1992

Hypertension in elderly patients. The special concerns in this growing population.

Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.

Aged↗
PubMed1992

A comparison of the safety of therapeutically equivalent doses of isradipine and diltiazem for treatment of essential hypertension.

We compared the safety of a new dihydropyridine calcium entry blocker, isradipine, with an equipotent dose of diltiazem in 174 mild hypertensives (diastolic blood pressure [DBP] 95 to 105 mm Hg). After appropriate washout and placebo periods, patients were randomly assigned to receive either 1.25 mg isradipine twice daily (Group I) or 40 mg diltiazem thrice daily (Group D). If DBP remained above 90 mm Hg, doses were increased to a maximum of 5 mg isradipine twice daily or 120 mg diltiazem thrice daily. Active therapy was given for a total of 12 weeks. Only 18 patients (nine from each group) did not complete the protocol. The patients were well-matched at baseline with a mean BP of 149/100 mm Hg for those who were randomized to isradipine and completed the protocol and 153/99 mm Hg for the diltiazem group. The responses to each drug were excellent with 72% of the isradipine patients and 73% of the diltiazem group having DBP less than 90 mm Hg at the completion of the study. Of the 156 patients who completed the protocol, only 18 patients (ten in Group I and eight in Group D) failed to respond. Both drugs were well-tolerated. No adverse reactions were reported by 68 percent of the patients in Group I and 65% of those in Group D. The most common side effect was headache (9.0% in Group I and 7.8% in Group D) followed by fatigue (5.2% in Group I and 3.9% in Group D). Age and race did not predict response to either agent but men responded slightly better to diltiazem than women. We conclude that isradipine and diltiazem are equally well tolerated and can be used successfully as a monotherapy to treat hypertension in a wide variety of patients.

Adult↗
PubMed1990

Effects of reduction in dose and discontinuation of hydrochlorothiazide in patients with controlled essential hypertension.

We studied the effects of a reduction in dose of hydrochlorothiazide from 50 to 25 mg/d, and its discontinuation for up to 22 months in 36 well-controlled hypertensive patients. Hydrochlorothiazide was discontinued if the diastolic blood pressure remained less than or equal to 94 mm Hg after a 6-month period on the lower dose of hydrochlorothiazide. No other changes were made in medications or diet. Sitting systolic blood pressure rose from 135 +/- 15 mm Hg to 140 +/- 14 mm Hg on reduction of the hydrochlorothiazide dose and rose still further to 145 +/- 20 mm Hg on discontinuation. Even greater increases in standing blood pressure were observed. There were no significant effects on the diastolic blood pressure with reduction of dose or discontinuation of hydrochlorothiazide. A significant decrease in the serum uric acid and a rise in serum potassium occurred. There were no changes in serum glucose or lipids on reduction in the dose of hydrochlorothiazide; whereas, with discontinuation, the serum lipids and hemoglobin A1C fell significantly. These results suggest that the benefits of a reduced dose of hydrochlorothiazide may not be as great as considered heretofore.

Adult↗
PubMed1990

Mentors in graduate medical education at the Medical College of Wisconsin.

In 1988, 40 senior faculty members at the Medical College of Wisconsin were surveyed to determine their perceptions of the extent and benefits of mentor relationships between faculty and residents. Seventy-eight percent thought mentor activity was feasible in their own departments; however, only 18% felt that a majority of residents in their departments had a mentor. Seventy-five percent reported having been a mentor, and 90% indicated they had a mentor either currently or previously. All 25 faculty who reported having a mentor felt that this arrangement had assisted them in their career advancement, 88% reported it had enhanced their personal development, and 72% indicated the relationship had helped them deal with stress. The mentor relationship appears to have significant benefits for the medical trainee and should be promoted.

Attitude of Health Personnel↗
PubMed1990

Control of hypertension among diabetic patients.

We reviewed the data on 100 randomly selected patients who were treated for diabetes as well as hypertension in the Hypertension Clinic of the Zablocki VA Medical Center. We found that, while normal blood pressure (diastolic BP less than 90 mmHg) was achieved in 82% of the patients during the 3-year follow-up, diabetes control (fasting serum glucose less than 140 mg/dL during all follow-up visits) was achieved in only 17% of the patients. Despite extensive and repeated dietary counselling by dietitians, most patients failed to lose weight. The current methods employed to get the patients to lose weight are inadequate. Better methods are needed to achieve weight loss which could accomplish greater control of diabetes as well as hypertension.

Aged↗
PubMed1989

Suicide and the stress of residency training: a case report and review of the literature.

Suicide rates among physicians have been reported to be twice that of the general adult population. Few data are available, however, regarding suicide among resident physicians. A case study of the suicide of a male intern is discussed. The literature is reviewed to elucidate potential contributory factors including reported causes and manifestations of stress among resident physicians, suicide rates among physicians including house staff with considerations of sex, and common personality characteristics of physicians and medical students. Recommendations are extended which may assist in early recognition and treatment of individuals at risk of impairment and suicide.

Adult↗
PubMed1989

An evaluation of mood states among first-year residents.

To examine the need for preventive and treatment interventions, a prevalence study was conducted to ascertain the rate of depressive symptomatology and other negative mood states among 112 first-year residents. The participation rate was 54%. Subjects (N = 61) were administered the Beck Depression Inventory and Profile of Mood States in personal interview sessions. The Profile measures five negative mood states, namely, "tension-anxiety," "depression-dejection," "anger-hostility," "fatigue-inertia," "confusion-bewilderment," and one positive state, "vigor-activity." A 15.5% rate of depression was found, which is lower than a rate of 23.5%, also measured by Beck's inventory, among a sample of university undergraduates and 19.9% among an adult sample from the general population. No differences were observed among residency programs or sex on Beck's scale; however, significantly higher scores were found for women on the "depression-dejection" dimension of the Profile. The mean scores on all negative mood dimensions of the Profile were below the mean for university undergraduate norms. Neither sleep nor hours worked over the past week were associated with increased Beck scores. These results indicate that sleep deprivation and long work hours did not contribute to depression among the subjects who participated in the study. Female interns, however, appear to be at increased risk of depression, and adequate support systems need to be provided.

Depression↗