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Biomedical subjects

A J Gillies

Publications and source records attributed to A J Gillies.

At least 19 recordsLinked to original sources
PubMed1998

A massively connected subthalamic nucleus leads to the generation of widespread pulses.

A composite model of the subthalamic nucleus is developed from physiological and anatomical considerations. First, study of a geometric model of the anatomical arrangements of projection neurons within the nucleus indicates that they form a massively connected network. Second, given the excitatory nature of these neurons, their threshold and peak firing rates, a simple model of neuron responses reveals that large regions of this highly interconnected nucleus can respond to excitatory input in the form of a wide-spread uniform pulse. Such widespread pulses of activity may act as a braking signal that resets the major basal ganglia output nuclei.

Animals↗
PubMed1987

A dose response study comparing Duovent vs salbutamol.

The dose response profiles of Duovent (fenoterol 0.1 mg/ipratropium 0.04 mg per puff) and salbutamol (0.1 mg per puff) were determined in a double-blind, controlled study. Twenty-one patients with asthma and nine patients with chronic bronchitis received 1, 2, 4, and 6 puffs of either Duovent or salbutamol on separate days. FEV1, pulse and tremor were recorded at baseline and up to 360 minutes after inhalation of test medication. Duovent and salbutamol produced an effective bronchodilator response at all dose levels, however, at 2, 4 and 6 puffs, the improvement with Duovent was significantly greater than with salbutamol alone in both asthmatic and chronic bronchitic patients. Two puffs of Duovent produced a significantly greater bronchodilation than all doses of salbutamol. There was no difference in the bronchodilator response between 1-6 puffs of salbutamol indicating maximal dose was achieved with one puff. There was an incremental improvement in FEV1 with 1, 2, and 4 puffs of Duovent but no difference between 4 and 6 puffs. There was no difference in pulse rate or tremor between salbutamol or Duovent at any dose level. We conclude that Duovent produces a greater and more prolonged bronchodilator response than salbutamol in both asthmatic and chronic bronchitic patients.

Adult↗
PubMed1987

Lessons from the national asthma mortality study: deaths in hospital.

The circumstances surrounding 38 deaths from asthma in hospital in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed. Twelve deaths did not appear to be preventable, all but one occurring in chronic severe asthmatics despite apparently optimal therapy. Critical delays by patients or relatives in seeking medical help occurred in six cases, and inadequate assessment of severity and undertreatment by medical practitioners prior to the patient reaching hospital was a major contributing factor in a further six deaths. In four cases, insufficient speed and indecisive treatment in the accident and emergency department appeared to contribute to death. Ten patients died after many hours or days in hospital wards in circumstances where assessment, monitoring and treatment were deficient. There were no deaths in intensive care units. Urgent expert assessment is necessary in A & E departments, and more severe cases should be managed in intensive care units. Patients with acute severe asthma may need continuous oxygen, intravenous therapy and close objective assessment for a week or more after hospitalisation.

Adolescent↗
PubMed1987

75 deaths in asthmatics prescribed home nebulisers.

The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.

Adolescent↗
PubMed1987

Lessons from the national asthma mortality study: circumstances surrounding death.

The circumstances surrounding all deaths from asthma in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed from information recorded or recalled by doctors or relatives of the deceased. Factors which may have reduced the time available for effective treatment of these severe attacks are described to draw attention to ways in which mortality might be reduced. For almost half of the 271 deaths medical help had not been called before the patient was in extremis. When medical help was summoned in sufficient time doctors commonly did not give corticosteroids or used them inadequately. Difficulties in using medical care and noncompliance with asthma management were common particularly in Polynesian patients. In 38% of patients some medical inadequacy appeared to contribute to poor long-term care and education. Failure of patients to attend for ongoing medical care, education and preventative treatment, or a medical failure to deliver these may have led to chronically reduced lung function. Any further deterioration may then have more rapidly led to a fatal outcome. Lack of patient or family awareness about how to detect and cope with an unusually severe attack was found and contributed to avoidable fatalities.

Asthma↗
PubMed1986

Asthma mortality: comparison between New Zealand and England.

Causes for the high mortality from asthma in New Zealand were investigated by comparing deaths from asthma in caucasian subjects aged 15-64 in New Zealand with those from asthma in the same age group in two regions in England. There were no significant differences in the accuracy of death certification. The verified asthma mortality in New Zealand (4.2/100,000) was over twice that in England. Many characteristics of patients and management, including poor compliance with treatment and deficiencies in long term and emergency care, were qualitatively similar in the two countries. New Zealand had an apparently higher rate of non-preventable deaths from asthma, suggesting a greater severity of asthma in New Zealand. In both countries, however, most deaths were associated with poor assessment, underestimation of severity and inappropriate treatment (over-reliance on bronchodilators and underuse of systemic corticosteroids), and delays in obtaining help. A greater frequency of some of these deficiencies in management remains a possible additional explanation for part of the excess mortality in New Zealand.

Adolescent↗
PubMed1986

Accuracy of certification of deaths due to asthma. A national study.

In a two-year study of asthma mortality in New Zealand conducted between August 1981 and July 1983, the certified cause of death and its subsequent statistical coding was compared with the opinion of a panel of respiratory physicians who had made detailed enquiry into the medical history and circumstances surrounding the death of each patient. When the panel's opinion was taken as the reference standard, the national health statistics overestimated asthma mortality for all age groups by 26.0%. For patients aged 15-64 years, the net overestimate was 12.9%, no greater than that found in a similar study in this age group in the United Kingdom. Failure of certifying doctors and coroners to follow appropriate procedures for identification of the primary condition leading to death, or misdiagnosis of other lung disease as asthma, accounted for most inaccuracies in certification. In patients under age 35 years, certification and statistical coding of asthma death was considered accurate in 97.8% of all cases, but accuracy declined with increasing age. The high New Zealand asthma mortality rate, especially in young people, could not be explained by inaccuracies in death certification or statistical coding.

Adolescent↗
PubMed1986

Deaths from asthma in New Zealand.

We report the first complete population based study of childhood deaths due to asthma. All deaths ascribed to asthma in New Zealand children aged 0-14 were investigated as part of a two year national study of mortality from asthma. The 16 children who died from asthma all developed asthma by the age of 4; 15 had a family history of asthma, and 12 had associated atopic disorders. Disturbed pyschosocial relationships were evident in eight families. Seven children died in less than three hours from the onset of their final attack. All children died outside hospital. Mortality from asthma in Maori children (3.14 per 100 000) was five times that of European children. With hindsight, factors which if avoided could have led to a different outcome were identified in eleven cases. The circumstances surrounding these deaths were similar to those described for adults with asthma; this study, however, underlines the importance of parental care and knowledge in the management of children with asthma. Inadequate long term medical care, underassessment of severity by family and doctors, failure of the family to call for help when required, and inadequate responses of medical services contributed to the fatalities. Excess beta2 sympathomimetic dosage or overreliance on home nebulisers were uncommon. Most childhood deaths from asthma should be prevented by increased family awareness, better assessment of severity, improved long term treatment, and rapid access to emergency medical care.

Adolescent↗
PubMed1985

Asthma mortality in New Zealand: a two year national study.

The epidemic of deaths from bronchial asthma in New Zealand was investigated by a two-year national review of all deaths of persons under 70 years where "asthma" appeared in part I of a death certificate or in a coroner's report of cause of death. Information about the patients, the characteristics and management of their asthma and the circumstances of the fatal episode was obtained by interviewing relatives and general practitioners and perusal of hospital records. The reviewing panel of the asthma task force of the Medical Research Council considered 271 of the 342 deaths studied were due to asthma. A high national asthma mortality rate (5.1 per 100 000) was confirmed, with rates for Maoris (18.9) and Pacific Islanders (9.4) considerably higher than that for Europeans (3.4 per 100 000). After standardising for age and ethnic groups, there remained a threefold variation in mortality rates among health districts suggesting regional differences in prevalence, severity or management of asthma. No single cause for these high mortality rates was found. One-quarter of the deaths occurred in patients who had had previous life threatening attacks. Excessive use of bronchodilator drugs did not account for the high mortality rates, but inappropriate prolonged use of a home nebuliser may have delayed institution of other therapy in a few cases.

Adolescent↗
PubMed1979

Acute arsenical poisoning in Dunedin.

Four cases of acute poisoning with arsenic are described. Although no new approach to therapy is proposed it is suggested from the data of arsenic recovery from the dialysate of one of the patients studied, that peritoneal dialysis is unlikely to be satisfactory.

Acute Disease↗
PubMed1977

Analgesic efficacy of an orally administered combination of pentazocine and aspirin. With observations on the use and statistical efficiency of GLOBAL subjective efficacy ratings.

The analgesic efficacy of a combination of pentazocine and aspirin (PA) in the ration 1:13 was compared with that of 650 mg of aspirin alone (A650) and with placebo (PBO), in 98 patients with postoperative pain. Two dose levels of the combination were compared: the lower dose (PA-L) consisted of pentazocine 25 mg and aspirin 325 mg, while the higher dose (PA-H) consisted of pentazocine 50 mg and aspirin 650 mg. All active treatments performed significantly better than PBO. PA-L performed as well as A650, while PA-H performed significantly better than A650. In addition to the usual subjective measures of analgesia, we obtained in 74 patients an evaluation of the overall (GLOBAL) performance of the treatment. This was rated on an ordinal scale of 1 ("poor") to 5 ("excellent"). On the GLOBAL scale, PBO had a mean score of 2.4 (fair-good); A650 and PA-L had scores of 3.6 and 3.9 respectively (good-very good): and PA-H had a score of 4.5 (very good-excellent). In five of six comparisons between treatment means, GLOBAL had the best discriminating power of all six measures. In the two comparisons of greatest interest (A650 against PBO and PA-H against A650), GLOBAL was more than twice as efficient as the TOTAL (summed pain score) measure. In comparing the statistical efficiency of different measures of the same analgesic effect, there is a problem in determining what are "clinically equivalent differences" on the various analgesic scales employed. We propose the use of the observed sample differences and the safeguard of repeating the comparisons over several studies to minimize the effect of random-origin bias.

Adult↗