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Biomedical subjects

P Joubert

Publications and source records attributed to P Joubert.

52 records · Page 3Linked to original sources
PubMed1977

Experience with a clinical pharmacological service in a teaching hospital.

The clinical functions of our Pharmacology department involves teaching, research and patient service. Patient service is rendered at two levels. 1. Clinical Pharmacologists: These are medically trained people and one of them is available for 24 hours a day for therapeutic and toxicological consultation, for channeling requests for laboratory aid and for interpretation and distribution of laboratory results. At the time of preparing this report we received an average of 34 consultations per day (1/3 therapeutic, 2/3 toxicological) of which about 38% are personally seen. 2. Laboratory based Pharmacologists: These people have basic training in Pharmacology, Chemistry and Biochemistry and are involved in qualitative and quantitative investigation of body fluids in cases of poisoning and therapeutic problems. A laboratory-based pharmacologist is available for 24 hours per day but clinicians do not have direct access to him but have to channel their requests through the clinical pharmacologist on call. The laboratory handled 2302 specimens of body fluids during 1975 of which about 75% were of a therapeutic and 25% of a toxicological nature.

Education, Pharmacy↗
PubMed1976

Oral contraceptive patient information. A questionnaire study of attitudes, knowledge, and preferred information sources.

A questionnaire was designed to assess attitudes, knowledge, and views and sources of drug information on oral contraceptives, with particular attention to the role of the patient-oriented package insert. An analysis of 828 completed questionnaires shows that many women are apprehensive about the safety of oral contraceptives. The impact of the patient-oriented oral contraceptive insert on the women surveyed appears to be positive. The present labeling is read and found useful by most oral-contraceptive users. Patients were variably informed about the correct use and side effects discussed in current labeling, suggesting a need for improved transmission of important drug information. Patients preferred information from health professionals and printed sources over media sources. Balanced label information about risks of oral contraceptives should be made available to improve the likelihood of sound risk-benefit judgments.

Adolescent↗
PubMed1976

Correlation between electrocardiographic changes, serum digoxin, and total body digoxin content.

Serial electrocardiograms and serum digoxin levels were obtained in four healthy volunteers receiving daily doses of digoxin, 0.25 mg for the first two weeks and 0.5 mg for two more weeks. We found a linear relationship between serum digoxin levels and the "PTQ index" (a function of the PR-interval, corrected QT-time, and T-wave depression). In 3 of the 4 subjects the correlation was statistically significant. The degree of linear correlation was improved when PTQ was correlated with the computer-calculated total body burden of digoxin.

Adult↗
PubMed1976

The selection of healthy volunteers for clinical investigation: the case for volunteer pools.

Discussions on the healthy volunteer in clinical investigation do not attempt to define normality. In 34 healthy volunteers, 1653 biochemical and haematological tests were performed. The incidence of abnormal results was 11%. Only 4 subjects had all tests within normal limits and when these repeated only 1 subject still had all results within normal limits. The authors recommend that a stable volunteer pool, with regular physical examinations and blood tests, would provide a large, serial data base for use in subject selection for clinical trials. Attention should be given to human error. Protocols should be realistic, while ensuring the safety of volunteers.

Adult↗
PubMed1975

Commentary. The normal volunteer in clinical investigation: how rigid should selection criteria be?

Twenty-nine healthy young male volunteers were screened by history, physical examination, urinalysis, 24 different blood tests, and electrocardiography for admission to a Phase I drug study. The protocol submitted to, and approved by, the FDA listed the normal ranges for the local laboratories and stipulated that the test results for any volunteers accepted should all be within these ranges. During screening 46 abnormal values were found in the laboratory tests. Only 4 subjects had all their test data within "normal" range, a result that could have been anticipated simply form the number of tests performed. These findings indicate the need for deciding on realistic protocol criteria for studies involving healthy volunteers.

Adult↗
PubMed1975

Commentary: Patient package inserts. I. Nature, notions, and needs.

A total of 137 completed questionnaires were obtained from several population samples in an attempt to assess drug knowledge, information sources, and views on drug information with particular attention to the possible role of a patient-oriented package insert. The results indicated that the study population was variably informed and could make fairly accurate assessments by this knowledge. Responders placed great importance on the doctor and pharmacist as preferred and actual drug information sources. The mass media were accorded little prominence. Great emphasis was placed on the adequate provision of information, and this appears to be a crucial function in an adequate doctor-patient relationship. The results appear to indicate a favorable climate for establishing a patient-oriented package insert that should have summarized as well as detailed information to complement the doctor and pharmacist as primary information sources.

Adult↗
PubMed1975

Patient package inserts. II. Toward a rational patient package insert.

Analysis of the response to a questionnaire on various aspects of drug information showed several significant trends. The importance of the physician as an information source varied directly with age and inversely with educational level of patients. The doctor's importance as a source of information was also greater for those who visited physicians' offices or clinics more and if they were on long-term treatment. Younger persons, those with higher levels of education, and those who were not in regular contact with a physician placed greater importance on non-physician sources. Persons consulting physicians regularly desired less information and knew less about drugs than those who did not regularly see a physician. These findings suggest that the educational role of the physician could be improved and should be directed particularly at the low-income, older patient. In the design of the package insert, particular attention should be given to self-prescribed medications where no other information sources will be operating.

Adult↗
PubMed1975

Serial serum digoxin concentrations and quantitative electrocardiographic changes.

Four elderly female patients in sinus rhythm and with mild congestive cardiac failure were treated with digoxin and studied over a 6-month period. There were significant linear correlations between serum digoxin concentrations and several quantitative electrocardiographic (ECG) parameters. T-wave amplitude was the most important ECG variable. ECG changes reverted to baseline values when digoxin was discontinued. These findings suggest that quantitative ECG changes are potentially useful in clinical and research situations involving digitalis glycosides.

Aged↗
PubMedDate not supplied

A population approach to the forecasting of amikacin plasma and urinary levels using a prescribed dosage regimen.

We retrospectively analyzed amikacin pharmacokinetics in 19 critically ill patients who received amikacin intravenously. Fourteen subjects (577 serum amikacin concentrations, 167 urine measurements) were studied to obtain data for population modeling, while 5 patients (267 serum amikacin concentrations, 68 urine measurements) were studied for the assessment of predictive performance. The population analysis was performed using serum and urine amikacin measurements; the renal clearance of amikacin was expressed as a function of creatinine clearance. A two-compartment model was fitted to the population data by using NONMEM. The population characteristics of the pharmacokinetic parameters (fixed and random effects) were estimated using the FOCE method. The population pharmacokinetic parameters with the interindividual variability (CV%) were as follows: slope (0.254, 126%) and intercept (3 l/h, 59.6%) of the linear model which relate the amikacin renal clearance to the creatinine clearance, initial volume of distribution (17.1 l, 22.2%), intercompartment clearance (5.22 l/h, 104%), steady state volume of distribution (55.2 l, 64.1%) and urinary elimination (67.5%, 36.3%). The Bayesian approach developed in this study accurately predicts amikacin concentrations in serum and urine and allows for the estimation of amikacin pharmacokinetic parameters, minimizing the risk of bias in the prediction.

Amikacin↗
PubMedDate not supplied

Comparing women's assessment of midwifery and medical care in Québec, Canada.

In 1990, the province of Québec, Canada, adopted a law that authorized the evaluation of the practice of midwifery through pilot projects before its legalization. A key objective of this evaluation, as defined by the law, was the documentation of women's assessment of maternity care, especially with regard to humanization and continuity of care. Two to 3 months after birth, 933 midwifery clients and 1,000 physicians' clients, matched on several characteristics, responded to a mailed questionnaire (response rates were 93% and 76%, respectively). Results showed that women from both groups were generally satisfied with the care they received, although women who received midwifery care were assessed as more positive on every issue surveyed. Objective measures supported impressions that were also confirmed through qualitative data analysis: midwifery clients had a greater number of and longer prenatal visits, their care was perceived to be more personalized, and a greater number of midwives' clients breastfed their infants. However, the interpretation of these results must take into account that the two groups had different personal expectations and values with regard to health and health care. These findings are enlightening in evaluating women's needs, expectations, and satisfaction with health care services and should be included in future development of maternity care, including idwifery services, in Québec and other locations.

Cohort Studies↗
PubMedDate not supplied

An in vivo investigation of the negative chronotropic effect of cholic acid in the rat.

1. Experimental obstructive jaundice in the Wistar rat causes a significant decrease in heart rate. 2. Intravenous administration of cholic acid in vivo elicits a dose-dependent negative chronotropic effect. 3. Atropine or vagotomy significantly reduces, but does not abolish, the negative chronotropic effect of cholic acid. 4. Ganglion blockade and decerebration diminishes the negative chronotropic effect of cholic acid, but to a lesser extent than atropine or vagotomy. 5. Sympathetic depletion by reserpine slightly potentiates the response to cholic acid. 6. The effect of cholic acid injected cranially into the common carotid artery is less than when administered into the jugular vein. 7. The haemolysis caused by cholic acid does not appear to be involved in the negative chronotropic effect. 8. It is concluded that cholic acid causes both a direct as well as a vagally mediated negative chronotropic effect in the Wistar rat.

Animals↗
PubMedDate not supplied

Cholic acid and the heart: in vitro studies of the effect on heart rate and myocardial contractility in the rat.

1. Cholic acid has a dose-dependent negative chronotropic effect on isolated atria of Wistar rats. 2. The positive inotropic effect of cholic acid is the result of a negative chronotropic effect and can be eliminated by electrical pacing. 3. Cholic acid does not appear to exert its negative chronotropic effect through cholinoceptors and alterations in bath concentrations of calcium and potassium does not influence this effect significantly. 4. Cholic acid is a functional antagonist of isoprenaline. 5. It is suggested that cholic acid exerts its negative chronotropic effect by forming a monolayer on the surface of the cell membrane, thereby mechanically interfering with membrane function.

Animals↗
PubMedDate not supplied

Isolation of ornithobacterium rhinotracheale from turkeys in Quebec, Canada.

In the spring of 1997, three large white hybrid turkey layer flocks of 52 wk of age experienced a severe respiratory condition. During the outbreak, the turkeys showed respiratory signs, an increased mortality rate, and an important drop in egg production. Macroscopic and histopathologic examinations were carried out on several carcasses, as well as bacteriologic analyses on different tissues. Colonies of Ornithobacterium rhinotracheale (OR) were detected after 24 hr of incubation, and the isolate appeared to be serotype A. The identification of the species was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins. Since 1993, several cases of OR infection have been diagnosed in the United States and more recently in Canada. Monitoring of this emerging infection is recommended.

Animals↗
PubMedDate not supplied

Evaluation of the midwifery pilot projects in Quebec: an overview. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birth centres outside hospitals, started operating in 1994. The objectives of the evaluation were 1) to compare midwives' services to current physician services with regard to maternal and neonatal mortality and morbidity, the use of obstetrical intervention, individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the health care system. A mixed evaluative design was used: a multiple case study with each pilot project representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were matched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were favourable to midwifery practice, while some were favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.

Birthing Centers↗