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Biomedical subjects

P McManus

Publications and source records attributed to P McManus.

At least 37 records · Page 2Linked to original sources
PubMed1996

Prescription drug utilization following patient co-payment changes in Australia.

In November 1990 major patient co-payment changes were introduced into the Pharmaceutical Benefits Scheme (PBS), which accounts for around 90% of all community prescriptions in Australia. Interrupted time series analyses were performed to assess the impact of these co-payment changes on the prescription levels of defined groups of 'discretionary' and 'essential' drugs for both the general community and for a subgroup comprising elderly returned servicemen and women. While the co-payment changes themselves had a significant immediate effect on lowering the use of both categories of drugs, the effects were substantially larger for the 'discretionary' groups in both cases. Notably there was a clear post-intervention trend for increased prescriptions of 'essential' drugs after the initial decline, which was not evident for the 'discretionary' drugs. The introduction of programmes to compensate high risk groups in Australia may have enabled the co-payment to become a more selective policy instrument than has been shown in other settings.

Journal Article↗
PubMed1996

A collaborative community approach to homeless care.

Homelessness is a social, economic, and public health problem of increasing magnitude in the United States. The past methods and approaches to delivering health care to those without homes have been inadequate because of the many complex problems faced by homeless persons today. To facilitate a discussion of a collaborative community approach to homeless care, it is helpful to include a definition of homelessness, describe the homeless population and the health status of homeless individuals, and explain what is meant by health care for the homeless.

Community Health Centers↗
PubMed1995

Base of skull and cervical spine chordomas in children treated by high-dose irradiation.

PURPOSE: To evaluate the outcome of children with base of skull or cervical spine chordomas treated by high dose irradiation. METHODS AND MATERIALS: Eighteen children, 4 to 18 years of age, with base of skull or cervical spine chordomas, received fractionated high-dose postoperative radiation using mixed photon and 160 MeV proton beams. The median tumor dose was 69 Cobalt Gray-equivalent (CGE) with a 1.8 CGE daily fraction. RESULTS: The median follow-up was 72 months. The 5-year actuarial survival was 68% and the 5-year disease-free survival (DFS) was 63%. The only significant prognostic factor was the location: patients with cervical spine chordomas had a worse survival than those with base of skull lesions (p = 0.008). The incidence of treatment-related morbidity was acceptable: two patients developed a growth hormone deficit corrected by hormone replacement, one temporal lobe necrosis, and one fibrosis of the temporalis muscle, improved by surgery. CONCLUSION: Chordomas in children behave similarly to those in adults: children can receive the same high-dose irradiation as adults with acceptable morbidity.

Adolescent↗
PubMed1995

Modelling the market uptake of new drugs following listing for subsidy in Australia. A report from the Drug Utilisation Subcommittee of the Australian Pharmaceutical Benefits Advisory Committee.

The market uptake of five drugs following subsidy listing in Australia during the period 1990 to 1992 has been modelled using the sigmoid Emax model for drug-receptor binding. Utilisation trends for simvastatin, omeprazole, budesonide, fluoxetine and moclobemide in defined daily dose (DDD) per 1000 population per day were smoothed by expressing as rolling annual averages. The results indicate good fits of the model to the data except for omeprazole, with good estimates of uptake rate and eventual maximum utilisation. Substantial differences between the drugs occurred in uptake rate which may be related to public education campaigns on asthma and coronary heart disease occurring during the release period. The very slow uptake of omeprazole relative to other drugs is likely to be due to restrictions on subsidised use. Modelling the market uptake rate and eventual utilisation of new drugs is useful as an aid to regulatory, quality use of medicines and financial decisions and allows comparisons between drugs to investigate factors important in market uptake.

Australia↗
PubMed1994

RFLP characterization of the upstream regulatory region of the HLA-DQA1 gene.

We have performed population and family studies of the distribution of DNA restriction length polymorphisms (RFLPs) in the 5' region of the HLA-DQA1 gene using a probe which corresponds to a sequence of the 5' flanking region of HLA-DQA1. Southern analysis detected four polymorphic fragments (X1, X2, X3 and X4) with XbaI and three fragments (E1, E2 and E3) with EcoRI. Family segregation studies showed that these RFLPs segregated in cis with the parental HLA haplotypes. Analysis of haplotypic associations of the X and E polymorphisms with each other and with HLA-DQA1 alleles demonstrates that DQA1 alleles can be further subtyped according to the particular XE combination which they carry. Hence, definition of these alleles provides new markers for HLA haplotyping and allows further splitting of otherwise identical DQA1 alleles. This information may be helpful for studies of association of disease susceptibility and autoimmunity with HLA haplotypes.

Alleles↗
PubMed1993

Drug utilisation.

Explore the source record for details and available documents.

Australia↗
PubMed1993

Benzodiazepine utilisation in Australia: report from a new pharmacoepidemiological database.

This study surveys the total community prescription use of benzodiazepine agents in Australia for the years 1990 and 1991. Also included is information on the utilisation of these agents on the Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes (PBS/RPBS) over the period 1987 to 1991. The Australian data are from the Drug Utilization Subcommittee (DUSC) database, which is derived from two sources: the PBS/RPBS (subsidized prescriptions), and a national sample of Pharmacy Guild of Australia pharmacies (private and under-copayment general prescriptions). The data are converted to defined daily doses per 1000 inhabitants per day (DDD/1000/day) in accordance with the unit of measurement for drug utilisation studies approved by the World Health Organization. Benzodiazepine utilisation was 33.96 DDD/1000/day for 1990 and 29.31 DDD/1000/day for 1991. The four drugs listed on the Pharmaceutical Benefits Scheme, namely diazepam, oxazepam, nitrazepam and temazepam, constituted 82 per cent of the Australian market. The availability of government subsidy appears to influence benzodiazepine- prescribing behaviour. Benzodiazepine utilisation has been falling in recent years. The fall may be related to the impact of new guidelines and community awareness campaigns. There are major differences in the composition of the market between Australia and the Nordic countries.

Anti-Anxiety Agents↗
PubMed1992

Population and family studies of HLA-DR4 by use of oligonucleotide typing.

Using PCR and DR4 group-specific primers and SSO's we have examined DRB1*04 nucleotide polymorphisms in a population of 123 DR4-positive individuals (86 NAC, 27 Hispanics and 10 African Americans) from New York carrying a total of 134 DR4 haplotypes. We found that the distribution of DRB1*04 alleles on DR4 haplotypes differs in these three ethnic groups. In this relatively small population, certain alleles such as DRB1*0406 and 0411 were encountered only in Hispanics, while others such as DRB1*0403, 0408 and 0409 were found only in NAC (North American Caucasians). Such differences may be important in studies of HLA-DR4 and disease associations. Evidence from MLC and PLT studies of an HLA-B/DR crossover family, which was informative for the segregation of HLA-DRB1*0406 and DRB1*0407, supports the concept that subtypes of HLA-DR4 and/or associated HLA-DP alleles elicit T-cell alloreactivity, and may thus play a role in transplantation.

Amino Acid Sequence↗
PubMed1992

Polymorphism of HLA in the Romanian population.

We have investigated the HLA-class I and class II polymorphism in a population of 83 Romanians using conventional serology together with PCR amplification and oligonucleotide typing of HLA-class II genes. Romanians show a higher frequency of HLA-A11, B13, B18, B37, B39, B51 and DR2 than other European populations. HLA-DRB1*1501 and 1601 account for the high frequency of the serologic specificity DR2. In Romanians, HLA-DR2 is in linkage disequilibrium with HLA-B18 and HLA-Bw52 rather than with HLA-B7 as in the case in other Europeans. Unexpected HLA-DR2 haplotypes include HLA-DRB1*1502, DQA1*0102, DQB1*0601; HLA-DRB1*1602, DQA1*0102, DQB1*0502. Other unusual haplotypes include HLA-DRB1*0405, DQA1*03, DQB1*0302; HLA-DRB1*1305, DQA1*0103, DQB1*0603; and HLA-DRB1*1405, DQA1*0101, DQB1*05032. Analysis of the genetic distance between Romanians and other Europeans who have been studied serologically are consistent with the hypothesis that Romanians descend from Roman ancestors who colonized Dacia between the 1st century B.C. and 1st century A.D.

Base Sequence↗
PubMed1991

RFLP analysis of HLA-DR5 haplotypes.

The analysis of HLA-DR5 haplotypes unravelled a new DRB3 polymorphism and permitted the identification of various associations between alleles of the DRB1 and DRB3 loci. This new polymorphism consists of a 10.5 kb Taq1 restriction fragment which was encountered in an African-American family (JS). In Caucasoids, the DRw11 allele has been previously observed only in association with the DRw52b allele. RFLP and oligonucleotide typing of HLA-DRw52 alleles associated with DRw11 showed, however, that 4 Caucasoid individuals from our panel carried the DRw52a allele and 1 the DRw52c allele. Similarly, DRw12, which is usually associated with DRw52b, was encountered with DRw52a in 1 Chinese and with DRw52c in an African-American and a Chinese panel member. The study of DRB3 alleles associated with DRw11 and DRw12 indicates that, similar to serology, RFLP studies become particularly informative when individuals of different races and ethnic origins are studied.

Alleles↗
PubMed1990

Rubeosis capsulare.

Two patients with diabetes had extracapsular cataract extraction with intraocular lens (IOL) implantation. Both developed rubeosis iridis and neovascularization within the lens capsule supporting the IOL, a condition we have termed rubeosis capsular. Argon laser treatment was ineffective in both patients. One patient was successfully treated by virectomy with endophotocoagulation. The other patient had a vitrectomy which was followed by a fibrinoid reaction, continued inflammation, rubeosis, and phthisis bulbi.

Cryosurgery↗
PubMed1989

Conservative treatment of uveal melanoma: local recurrence after proton beam therapy.

Twenty-three of 1006 (2.3%) uveal melanoma patients treated with proton beam therapy at the Harvard Cyclotron Laboratory between July 1975 and December 31, 1986 received additional treatment for documented (15 patients) or suspected (eight patients) tumor growth in the irradiated eye. Growth within the initially irradiated volume was documented at Massachusetts Eye and Ear Infirmary in 12 patients. Documented growth occurred in nine of 665 (1.4%) patients with small and intermediate size tumors, at times after treatment ranging from 6 to 48 months (median 16 months), and in three of 341 (.9%) patients with large tumors at 7, 11, and 12 months after treatment. Melanoma growing totally outside the treated volume was also documented in three additional patients at 7, 9, and 45 months; two of these were thought to be "ring melanomas". Eight patients had the treated eye removed elsewhere for suspected tumor growth. The additional treatment in these 23 patients was conservative in nine patients (repeat proton irradiation in five and laser photocoagulation in four). Thirteen underwent immediate enucleation and one had orbital exenteration. Ultimately, 17 of the 23 eyes (74%) were removed. Estimated probability of local control of the melanoma within the irradiated eye at 60 months was 96.3 +/- 1.5%. Dose distributions to the 12 patients with documented local failure within the irradiated volume were analyzed. Ten tumors recurred marginally in an area receiving less than the prescribed dose of 70 CGE (CGE = Cobalt Gray Equivalents = proton Gy X RBE 1.1), whereas only two recurred in the volume receiving full dose. Based on these data, it appears that a dose of 70 CGE in five fractions is associated with very high rates of local control in human uveal melanoma. It is reasonable to consider initiating studies using a lower total dose or a more protracted course, to determine if some of the observed complications are dose-related.

Adult↗
PubMed1989

Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull.

Sixty-eight patients with chordoma or low-grade chondrosarcoma at the base of the skull received fractionated high-dose postoperative radiation delivered with a 160-MeV proton beam. Protons have favorable physical characteristics which allow the delivery of high doses of radiation to these critically located tumors. The methods employed for these treatments are described. These patients have been followed for at least 17 months and for a median of 34 months. The median tumor dose was 69 CGE (cobalt Gy equivalent): CGE is the dose in proton Gy multiplied by 1.1, which is the relative biological effectiveness for protons compared to cobalt-60. The daily dose was 1.8 to 2.1 CGE. For this group the 5-year actuarial local control rate is 82% and disease-free survival rate is 76%. The incidence of treatment-related morbidity has been acceptable.

Adolescent↗