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Biomedical subjects

R G Finch

Publications and source records attributed to R G Finch.

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

Patient education and communication in non-inpatient intravenous therapy--a review.

This paper reviews patient education and communication elements of non-inpatient intravenous therapy schemes in the United States and the United Kingdom. Common characteristics of these services include: definition of the components of the scheme at all levels; patient selection; patient education; and good communications. A metaplan carried out among UK healthcare professionals highlighted education and communication issues as important factors for ensuring successful therapy. Communication issues are difficult to define or modify. Specific experience from the United States and the United Kingdom is presented and the common elements in these programmes are emphasized. Results of the assessment of patient education are presented. This collective experience may prove useful for other centres setting up similar therapy schemes.

Ambulatory Care↗
PubMed1998

Pneumonia: the impact of risk factors on the outcome of treatment with meropenem and ceftazidime.

This analysis comprises data pooled from two clinical trials of meropenem (0.5 g 8-hourly) versus ceftazidime (1 g 8-hourly) in hospitalized patients with community-acquired pneumonia. The clinical and bacteriological responses to treatment were assessed in relation to a range of risk factors previously linked to a poor clinical outcome. 393 patients (198 meropenem, 195 ceftazidime) were clinically evaluable while 230 (113 meropenem, 117 ceftazidime) were bacteriologically evaluable. Meropenem was highly effective, independent of associated risk factors, producing overall satisfactory clinical and bacteriological response rates at the end of therapy of 91.4% and 94.7%, respectively, similar to those produced by ceftazidime (90.3% and 92.3%, respectively). Clinical and bacteriological treatment outcome were similar in patients with up to three of the following key risk factors: age > or =65 years, male gender, serum urea >7 mmol/L, serum albumin <35 g/L and difficult-to-treat pathogens. Meropenem also achieved high clinical (85.7%) and bacteriological (89.3%) success rates in patients requiring ventilation, as did ceftazidime (81.6% and 87.1%, respectively). Both agents were highly effective against both Gram-negative and Gram-positive causative pathogens, including those organisms normally considered difficult to treat and typical of nosocomial pneumonia (e.g. Enterobacteriaceae, Staphylococcus aureus, Pseudomonas aeruginosa). Thus, meropenem and ceftazidime were highly effective in patients hospitalized with community-acquired pneumonia, irrespective of a number of concurrent risk factors (including those regarded as key risk factors). Furthermore, the analysis points to a role for meropenem 0.5 g 8-hourly in the treatment of nosocomial pneumonias that do not require intensive care unit admission and/or mechanical ventilation. Overall, this novel analysis of trial data suggests that incorporation of key risk factor endpoints into the initial design of pneumonia studies may prove to be a useful approach in defining appropriate antibiotic treatment for specific patient groups.

Adolescent↗
PubMed1998

Practical considerations and guidelines for the management of community-acquired pneumonia.

Community-acquired pneumonia (CAP) is a common condition which has a significant mortality. The management of a patient with CAP is centred around assessment and correction of gas exchange and fluid balance together with administration of appropriate antibiotics. Up to 10 different pathogens regularly cause CAP, of which Streptococcus pneumoniae is the most important. These different pathogens cannot be distinguished by clinical features or simple laboratory tests. Microbiological tests are slow and insensitive, so empirical therapy is necessary, at least initially. Accurate assessment of illness severity is the most important factor determining initial management, since this assists the decision of whether to admit the patient to hospital in addition to guiding antibiotic choice and route of administration. Two different approaches to severity assessment are outlined. Our antibiotic recommendation for empirical therapy for the patient managed at home and the previously fit patient admitted to hospital is amoxicillin. Amoxicillin/clavulanate plus a macrolide is our choice for the severely ill previously fit patient and a third-generation cephalosporin plus a macrolide is recommended for the severely ill patient with comorbidity. Alternative pathogens and specific treatment regimens are also described. There may be several causes of treatment failure, and in patients who fail to respond to therapy, it is essential to review all the initial clinical and laboratory information, which if necessary must be repeated.

Adult↗
PubMed1997

Medical decompression of vertebral hydatidosis.

STUDY DESIGN: A case report from one of the longest follow-up studies of survivors with spinal hydatid disease. This patient was treated with a combination of albendazole and praziquantel chemotherapy; the results of this form of treatment are reported. OBJECTIVES: To demonstrate the efficacy of combination albendazole and praziquantel drug treatment for spinal hydatidosis. SUMMARY OF BACKGROUND DATA: Although echinococcal infestation in humans is a world-wide problem, it is rarely seen in the United Kingdom. Between 1% and 2% of all cases involve bone, and 50% of these involve the spine. The condition has a reported mortality rate of more than 50%. The average length of survival of patients with echinococcal infestation in Britain after the onset of symptoms is 5 years, and the average age at death is 41 years. METHODS: The patient in this report had undergone multiple spinal debridement operations alongside internal fixation and presented with increasing paraparesis from recurrent disease. Surgery for disease recurrence carries a high risk of mortality. The patient was treated with a preoperative combination of albendazole and praziquantel drug therapy, a novel combination for this condition. RESULTS: Response to treatment was monitored clinically, biochemically, and with serial computed tomography. No serious side effects were observed. Results were very encouraging. After 2 months of treatment she had improved and was able to walk with the aid of a walking frame; therefore, surgery was deferred. CONCLUSION: The combination of albendazole and praziquantel drug therapy appears to be effective in the conservative treatment of patients with inoperable spinal hydatidosis.

Aged↗
PubMed1997

Conservative management of osteomyelitis in the feet of diabetic patients.

Experience of conservative management of osteomyelitis in a specialized, multidisciplinary, diabetic foot clinic was reviewed. The records of all patients attending the clinic over a 10-year period were examined retrospectively, and 22 patients with overt osteomyelitis were identified. Median age was 66 (31-87) years. In 12 cases the bone infection was a complication of a pre-existing ulcer; the most prevalent organism cultured from swabs was Staphylococcus aureus. The main site of infection was the first toe. The total duration of antibiotic treatment was 12 weeks (median, range 5-72), and clindamycin was the most commonly used oral agent. Four patients did not respond to initial conservative therapy and proceeded to amputation, while 1 patient responded clinically but had a recurrence of osteomyelitis at the same site 6 years later. In the remaining 17 patients resolution of osteomyelitis was achieved with conservative management over a median period of follow-up of 27 (range 5-73) months. The success of conservative therapy with prolonged courses of oral antibiotics challenges conventional advice that excision of infected bone is essential in the management of osteomyelitis affecting the foot in diabetes.

Administration, Oral↗
PubMed1997

A comparison of mucosal inflammatory responses to Giardia muris in resistant B10 and susceptible BALB/c mice.

In the first three weeks of primary Giardia muris infections B10 mice clear infection more rapidly than BALB/c mice. There is evidence that interferon-gamma contributes to the relative resistance of B10 mice. The nature of the functional contribution of interferon-gamma is unclear and does not relate to the secretory or serum antibody response. Mucosal inflammatory events in these strains have been studied. Apart from a small rise in both strains of goblet cell and mucosal mast cell numbers, associated with release of mast cell protease-1 in serum, no inflammatory infiltrate was observed at the time trophozoites were cleared from the intestinal lumen. Inhibition of mast cell products (5-hydroxytryptamine and histamine) by cyproheptadine enhanced the intensity of infection in both strains. The relative resistance of B10 mice could not be explained in terms of the mucosal inflammatory response.

Animals↗
PubMed1996

Response to oral and intravenous azithromycin in a patient with toxoplasma encephalitis and AIDS.

We present a patient with AIDS and toxoplasma encephalitis who was unable to tolerate established therapy with sulphadiazine or clindamycin but responded to oral azithromycin and pyrimethamine. The patient was maintained on oral azithromycin but subsequently relapsed after 8 months. The recurrence was successfully treated with intravenous azithromycin. The case illustrates that azithromycin can be used to treat patients with toxoplasma encephalitis who are unable to tolerate or fail to respond to other therapeutic agents. Failure of oral azithromycin may be due to inadequate tissue concentrations and patients may further benefit from intravenous administration.

AIDS-Related Opportunistic Infections↗
PubMed1996

A multinational European survey on the in-vitro activity of rufloxacin and other comparative antibiotics on respiratory and urinary bacterial pathogens.

The antibacterial activity of rufloxacin was confirmed against a large number of respiratory and urinary tract pathogens collected in five European countries. In terms of both MIC90 values and percentages of susceptible isolates found, this new quinolone showed useful in-vitro activity against Mycoplasma catarrhalis, Haemophilus influenzae and Klebsiella pneumoniae, with a large proportion of Staphylococcus aureus also covered, while, as expected Streptococcus pneumoniae and Streptococcus pyogenes were not included in its antibacterial spectrum. Rufloxacin was comparable with the other antibiotics against these pathogens with the exception of streptococci. Against these microorganisms, beta-lactams were the most active agents. Against the urinary pathogens the in-vitro activity of rufloxacin is similar to that of norfloxacin although this latter drug is more active in terms of MIC90 values and in percentages of strains inhibited. In many cases more isolates were susceptible to the remaining comparator agents than to rufloxacin. However, there were no significant differences between the numbers of microorganisms inhibited by the various drugs and rufloxacin. The findings of this survey do not seem to modify the general picture which emerged in previous studies and further confirms its useful spectrum in different geographic settings.

Anti-Bacterial Agents↗
PubMed1996

International sepsis trial (INTERSEPT): role and impact of a clinical evaluation committee.

OBJECTIVE: Several large clinical trials have recently evaluated a variety of potential therapeutic interventions for sepsis and have yielded negative results based on analyses of intention-to-treat cohorts. The present study was undertaken to evaluate the importance of a Clinical Evaluation Committee. DESIGN: Prospective, double-blind evaluation of a prospective, controlled, double-blind, randomized, multinational trial. SETTING: Forty medical centers. PATIENTS: Five hundred fifty-three infused patients with severe sepsis and septic shock. METHODS: As part of an international trial (INTERSEPT) of antitumor necrosis factor therapy, a Scientific Extramural Review Committee prospectively defined and excluded patients with confounding events that objectively interfered with the potential of any intervention for sepsis to exercise its therapeutic effect. These confounding events included inappropriate antimicrobial therapy, inadequate medical-surgical management, underlying disorders, and forgoing life-sustaining therapies before management had failed. Patients who met all inclusion and exclusion criteria and who had no confounding events were defined as the Scientific Extramural Review Committee group. MEASUREMENTS AND MAIN RESULTS: Five hundred fifty-three patients were enrolled in INTERSEPT. Seventy-seven patients did not meet inclusion and exclusion criteria. Sixty patients had confounding events, including inappropriate antimicrobial therapy (n = 28), inadequate medical-surgical management (n = 16), underlying disorders (n = 17), and forgoing life-sustaining therapies (n = 7). Four hundred sixteen patients were in the Scientific Extramural Review Committee group and their mortality rates were different from the mortality rates of the intent-to-treat cohort. In the intent-to-treat analysis among shock patients, low-dose anti-tumor necrosis factor reduced 28-day mortality by 14.5% (p = .34), whereas in the Scientific Extramural Review Committee group, the study drug reduced mortality by 26.5% (p = .16). More patients in the high dose anti-tumor necrosis factor treatment arm (31/176) were in the invalid Scientific Extramural Review Committee group than in the other two arms (16/157 and 13/143, respectively, p < .05). CONCLUSIONS: In large trials of sepsis, in addition to analyzing the intent-to-treat cohort, patients in compliance with the protocol and with no confounding events should also be analyzed. These results should assist in determining whether treatment groups are comparable and provide a greater likelihood of demonstrating the potential efficacy of a new therapy for sepsis. A Clinical Evaluation Committee is important to properly assess a clinical sepsis trial.

Adult↗
PubMed1996

Comparison of antibody and cytokine responses to primary Giardia muris infection in H-2 congenic strains of mice.

The course of primary infections with Giardia muris differs between BALB and B10 H-2 congenic strains of mice. In the first 3 weeks of infection, there is a more rapid decline in intestinal trophozoite and fecal cyst counts in B10 strains than in BALB strains. To determine whether this difference could be explained by variation in specific antibody responses, both secretory immunoglobulin A (IgA) and serum antibody responses were compared between these strains. No significant differences in the timing, titer, or specificity of secretory or serum antibodies were found. However, on comparing specific anti-G. muris serum IgG subclass responses, we found that B10 strains produced IgG2a while BALB strains produced IgG1, suggesting differential involvement of T helper 1 and 2 subsets of lymphocytes. When cells harvested from mesenteric lymph nodes were stimulated with concanavalin A in vitro, both gamma interferon and interleukin-5 were secreted by cells from B10 mice, but only interleukin-5 was secreted by cells from BALB/c mice. Specific blockade of gamma interferon by monoclonal antibody administered to B10 mice resulted in an enhanced intensity of infection.

Animals↗
PubMed1996

Antibacterial activity of quinupristin/dalfopristin. Rationale for clinical use.

Most Gram-positive organisms are highly susceptible to the streptogramin, quinupristin/dalfopristin (RP 59500; Synercid). Minimum inhibitory concentrations for 90% of isolates (MIC90) were < or = 1 mg/L for Staphylococcus aureus, S. epidermidis, S. haemolyticus, Streptococcus pneumoniae, S. pyogenes and Listeria monocytogenes. Importantly, quinupristin/dalfopristin shows similar activity against methicillin-susceptible and -resistant strains of S. aureus, and streptococci with benzylpenicillin (penicillin G)- or erythromycin-acquired resistance. Enterococci have varying susceptibility to quinupristin /dalfopristin, although most isolates tested are susceptible to the drug, including vancomycin-resistant and multiresistant Enterococcus faecium. E. faecalis are generally the least susceptible. Among the Gram-negative respiratory pathogens Moraxella catarrhalis is susceptible and Haemophilus influenzae is moderately susceptible to quinupristin/ dalfopristin; however, Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. are resistant. The drug is active against anaerobic organisms tested, including Clostridium perfringens, Lactobacillus spp., Bacteroides fragilis and Peptostreptococcus. Synergy has been demonstrated in vancomycin-resistant and multiresistant E. faecium, and methicillin-sensitive and -resistant S. aureus with the combination of vancomycin and quinupristin/ dalfopristin. Quinupristin/dalfopristin shows antibacterial activity in vivo in animal models of infection, including methicillin-sensitive and -resistant S. aureus infection in rabbits, S. aureus and S. pneumoniae in mice, and erythromycin-sensitive and -resistant viridans group streptococci infections in rats. The drug is rapidly bactericidal against Gram-positive organisms (with the exception of enterococci) at concentrations similar to or within 4-fold of the MIC, and it has a long postantibiotic effect both in vitro and in vivo.

Animals↗
PubMed1995

Pneumonia: the impact of antibiotic resistance on its management.

Pneumonia in the community affects between 1 and 5 per 1000 per year. The microbial aetiology is diverse and influenced by preexisting disease, seasonality, as well as animate and inanimate environmental sources; pneumococci, Legionella spp., Mycoplasma pneumoniae, and more recently Chlamydia pneumoniae are the predominant bacterial pathogens. Gram-negative enteric bacteria although less common are particularly virulent. Antibiotic resistance is well established for Haemophilus influenzae and Gram-negative bacillary infections, but has been a recent phenomenon in the case of Streptococcus pneumoniae, which is numerically the leading pathogen. Despite the concerns raised by this reduced susceptibility to penicillin, evidence that this has been translated into increased clinical failures is currently difficult to establish. Macrolide and tetracycline resistance among pneumococci is more common. beta-Lactamase production by H. influenzae has now reached levels where, in those with severe pneumonia, beta-lactamase stable agents are preferred. Consensus Guidelines on the treatment of community acquired pneumonia have been published by the British Thoracic Society, the American Thoracic Society, and from Expert Panels in Canada and France. These emphasize severity assessment and differentiate management in the community or hospital setting. The recommended regimens are compared and contrasted. In conclusion, mild/moderate pneumonia, when pneumococcal in nature, is likely to still respond to amoxycillin or penicillin G, but in higher dosages where pneumococcal resistance is documented. However, in severe infection where pneumococcal resistance, other beta-lactamase-producing pathogens, or an atypical infection could be operating, it is important that initial empirical therapy be broad spectrum and promptly administered. Treating multiresistant pneumococcal disease in those allergic to beta-lactams presents a particular dilemma. Glycopeptides are currently preferred.

Anti-Bacterial Agents↗
PubMed1995

Experimental infection of human nasal mucosal explants with Neisseria meningitidis.

The interaction of Neisseria meningitidis with rhinopharyngeal epithelium was studied by experimental infection of explants of human nasal turbinate mucosa with two wild strains: a fully capsulate case isolate, and an epidemiologically related non-capsulate nasopharyngeal isolate. After incubation for 4 h, epithelial cells of infected explants changed conformation from tall columnar morphology towards cuboidal, and there was increased discharge of mucus globules from goblet cells. By 24 h there was significant damage to infected epithelia, including projection of cells out of the surface, cytoplasmic blebbing and mitochondrial abnormalities. Meningococci were associated with surface non-ciliated cells by 4 h after infection. By 24 h after infection they were associated extensively with all cell types exhibiting damage. There was little association with secreted mucus. In areas of cell damage, penetration between surface cells was observed. Endocytosis into non-ciliated cells was observed in only a minority of explants studied and only in those infected for 24 h. From this intracellular site there was apparent migration to adjacent cells and to intercellular locations. No organisms were observed within or beneath basement membrane collagen in any explants but internalisation into mononuclear phagocytes was observed occasionally.

Cilia↗
PubMed1995

Diagnostic and management problems in a complex case of connective tissue disease.

A 28-year-old Nigerian woman presented with persistent pyrexia, marked pruritus, eosinophilia, myalgias, flitting arthralgias, serositis and massive splenomegaly. Intensive investigation for an infective or neoplastic aetiology proved negative. Empirical treatment for helminthic infections and tuberculosis was unhelpful. Although there were no specific clues to suggest an underlying connective tissue disease, a trial of steriods and azathioprine was introduced, with no obvious response. Her condition deteriorated to a point where it was decided that intravenous immunosuppressive therapy was needed and subsequently, her condition improved remarkably. This patient illustrates the problems in the diagnosis and management of complex disorders, particularly when classical tests for connective tissue diseases are absent. Also, we would like to report that marked pruritus can be associated with connective tissue disease.

Adult↗
PubMed1995

The role of new quinolones in the treatment of respiratory tract infections.

Infections of the respiratory tract are the leading cause of antibacterial prescribing in both hospital and community practice. The microbial aetiology is diverse in both of these settings and differs in the distribution and virulence of the pathogens. Furthermore, in recent years the antibacterial susceptibility of many of the common pathogens has changed significantly. In particular, penicillin resistance has emerged among pneumococci, while beta-lactamase production among Haemophilus influenzae and many Gram-negative bacilli has led to alterations in first-line therapy options. The fluoroquinolone antibacterials have been used in selected respiratory tract infections, but concerns have remained with regard to their efficacy in infections caused by marginally susceptible organisms, and in particular pneumococcal infections. The availability of a number of quinolones with enhanced Gram-positive activity, which includes Streptococcus pneumoniae, is of considerable interest. In vitro data and preliminary clinical experience with sparfloxacin suggest that managing pneumococcal lung disease with this and future agents is a distinct possibility. One caveat must be considered, and that is the potential for more resistant strains of pneumococci emerging, against which even these new quinolones could prove less effective.

4-Quinolones↗