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Biomedical subjects

A Veale

Publications and source records attributed to A Veale.

16 recordsLinked to original sources
PubMed2006

Long-acting beta2-agonists for poorly reversible chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by partially reversible airflow limitation. Many patients have little reversibility to short acting bronchodilators, but long acting bronchodilators are frequently advocated. OBJECTIVES: To determine the effectiveness of long acting beta-2 adrenoceptor agonists (LABAs) in COPD patients demonstrating poor reversibility to short-acting bronchodilators. SEARCH STRATEGY: The Cochrane Airways Group Specialised Register was searched ('all years' to 2005) along with the reference lists from identified randomised controlled trials (RCTs). SELECTION CRITERIA: All RCTs comparing inhaled LABAs (salmeterol or formoterol) with placebo in the treatment of patients with stable, poorly reversible COPD. Studies were a minimum of four weeks in duration. DATA COLLECTION AND ANALYSIS: Two authors independently performed data extraction and study quality assessment. If we required additional data, we contacted authors and pharmaceutical companies sponsoring the identified RCTs. MAIN RESULTS: Twenty-three published and unpublished studies (6061 participants) were included in the review. There was a significant change in forced expiratory volume in 1 second (FEV1) in favour of salmeterol 50 mcg twice daily (BID) of 51 mls (95% confidence intervals (CI) 32 to 70), end of study morning peak expiratory flow (PEF) 14.89 L/min (95% CI 10.86 to 18.91). Supplemental short-acting bronchodilator usage was reduced by just under one puff per day. There were significant differences in the total, activity and impact domain scores of the St George's respiratory questionnaire in favour of salmeterol 50 mcg BID. Findings from other health status measurements and symptom scores were conflicting. There was no significant difference in exercise tolerance. The number of participants experiencing exacerbations was significantly reduced with salmeterol 50 mcg treatment compared with placebo (numbers needed to treat to benefit 21). AUTHORS' CONCLUSIONS: This review shows that the treatment of patients with COPD with salmeterol 50 mcg produces modest increases in lung function. There were varying effects for other important outcomes such as health related quality of life or reduction in symptoms. However, there was a consistent reduction in exacerbations which may help people with COPD who suffer frequent deterioration of symptoms prompting healthcare utilisation. The strength of evidence for the use of salmeterol 100 mcg, formoterol 12 mcg, 18 mcg, 24 mcg was insufficient to provide clear indications for practice.

Adrenergic beta-Agonists↗
PubMed2006

Providing patients with reviews of evidence about COPD treatments: a controlled trial of outcomes.

Studies in many countries have identified gaps between what is known from research evidence and what is done in clinical practice. Merely making research evidence available to practitioners does not cause much change in their behaviour, and researchers are now looking for more effective ways to improve the implementation of evidence. We report outcomes at three months of a parallel group trial of an evidence based patient manual designed to improve implementation of evidence by the patient's doctors. The patient manual was produced with extensive patient and professional input. It contained summaries of the evidence for treatments used in COPD (chronic obstructive pulmonary disease) and prompted discussion of evidence with doctors. Participants in the intervention arm of the trial (n = 125) were supplied with the manual and participants in the control arm (n = 124) were supplied with a pamphlet about COPD produced by the Australian Lung Foundation. The primary outcome measure (rates of current influenza vaccination and bone density testing) was an indicator of evidence based management of COPD. Secondary outcomes were quality of life (mastery component), satisfaction with information, communication with usual doctor, and anxiety. At three months no pattern of benefit in outcome measures was found for either group. Process measures showed high levels of personal use of the manual but progression to conversations with doctors for fewer than half of participants, and little treatment change. The findings highlight the difficulties of promoting changes in health behaviour and show that even when all stakeholders are consulted success is not guaranteed. Further research is required to identify those patients most likely to use manuals such as the one reported here, and how to make patient mediated interventions more effective for a greater proportion of the target population.

Aged↗
PubMed2005

Printed patient education interventions to facilitate shared management of chronic disease: a literature review.

BACKGROUND: Printed materials for patient self-education are a comparatively low cost, flexible and potentially useful aid for dealing with the growing burden of chronic disease in our society. A comprehensive review of existing trials is required. AIMS: We conducted a comprehensive review which aimed to (i) evaluate the evidence for effectiveness of print-only interventions in increasing patient participation in chronic disease management and (ii) identify disease or intervention characteristics associated with success. METHODS: Medline, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL were searched for the period 1992 to January 2005 for reports of controlled trials of printed patient materials in chronic disease. The quality of both studies and interventions was assessed. RESULTS: Seven studies were found. They focussed on inflammatory bowel disease, arthritis, asthma and diabetes. Few studies named primary outcomes, continued beyond 6 months or included process evaluations. Few reports gave the behaviour-change rationale of the intervention. Few interventions were reported as having been designed using testing and improvement, psychosocial theory, checks of patient understanding or other patient input. A variety of outcomes was measured. Statistically significant change was found for few. Knowledge improved in three studies, adherence improved in two and quality of life declined in one. CONCLUSIONS: We found that printed interventions as currently designed appear to produce, at best, modest benefits. The design of interventions, studies and study reports all need improvement before decisions can be made about effectiveness and characteristics associated with success.

Arthritis↗
PubMed2004

'Papillomatization' and 'malignant transformation' of an abscess cavity in a 25-year old man with recurrent respiratory papillomatosis who may have had Lemierre syndrome.

We report here an unusual case of a 25-year old male with juvenile onset recurrent respiratory papillomatosis who developed an infestation of papillomata 'papillomatization' of an old abscess cavity that, when removed, was coincidently found to contain a 2 cm well differentiated squamous cell carcinoma. The abscess cavity had been caused by a previous Fusobaterium necrophorum infection that probably developed as a result of septic emboli from his internal jugular veins. This once common but now rare occurrence was first reported by Dr Lemierre in 1936 (Lemierre syndrome).

Adult↗
PubMed2001

Impact and aetiology of respiratory infections, asthma and airway disease in Australian Aborigines.

In this review, we describe the burden of respiratory illness in Australian indigenous communities and examine evidence of aetiology. We have reviewed the results from studies of respiratory infections and asthma-like symptoms conducted in remote and non-remote indigenous communities and contrasted them with data from comparable studies in non-indigenous communities. Although bias cannot be controlled and generalizability is an issue, the data are the only information available and, as such, provide a basis for a hypothesis generating approach to better health care. The evidence suggests that many indigenous people, especially those who live in non-remote regions, have asthma-like symptoms that are largely of an infectious rather than an allergic origin. Moreover, indigenous communities continue to be exposed to low immunisation rates, to have low rates of breastfeeding and to have high rates of cigarette smoking, all of which have the potential to increase the prevalence of respiratory illnesses. It is important to identify the most effective treatments and preventive strategies for respiratory symptoms that are prevalent in indigenous children. Respiratory symptoms that are largely of a bacterial-infectious origin may not benefit from commonly prescribed asthma therapies and, without appropriate treatment, may lead to ongoing health problems.

Adolescent↗
PubMed2000

Long-acting beta2-agonists for chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation which is only partially reversible. Long acting beta2-agonists, effective in the management of asthma,are also recommended for COPD management so it is important to establish whether these drugs are effective in reducing COPD symptoms in view of the potential side effect and cost burden. OBJECTIVES: To determine the effectiveness of long acting beta2-adrenoceptor agonists in improving lung function and quality of life and reducing dyspnoea in patients with COPD. SEARCH STRATEGY: A search was carried out using the Cochrane Airways Group register. Bibliographies of identified RCTs were searched for additional relevant RCTs. Authors of identified RCTs were contacted for other published and unpublished studies. In addition, unpublished studies were also obtained from the pharmaceutical companies that manufacture long acting beta2- adrenoceptor agonists. SELECTION CRITERIA: All randomised controlled trials over four weeks in duration comparing treatment with long-acting beta2-adrenoceptor agonists (salmeterol and formoterol) with placebo in patients with stable non-reversible COPD. Outcome measures included forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), symptom scores, six minute walk distance, quality of life scores, Borg scores for dyspnoea and rescue bronchodilator use. DATA COLLECTION AND ANALYSIS: Data extraction and study quality assessment was performed independently by two reviewers. Where further or missing data were required, authors of studies were contacted. MAIN RESULTS: Thirty three abstracts were identified as potentially relevant. Of these, four randomised controlled trials (RCTs) were included in this review. Two were parallel group studies of 16 week duration and two were cross-over studies with four week treatment arms. All four RCTs assessed the efficacy of salmeterol in COPD. In a 16 week study of salmeterol 50 mcg and 100 mcg twice daily treatment, a significant increase in FEV1 was seen in both treatment groups. The weighted mean difference (WMD) for the increase in FEV1 for the 50 mcg group was 0.10 litre (95% CI: 0.05;0. 15) and in the 100 mcg group the WMD was 0.12 litre (95% CI: 0.06; 0. 17 ). In the two cross-over studies of four weeks treatment, salmeterol 50 mcg twice daily treatment did not show significant increases in FEV1 (WMD = 0.04 litre, 95% CI: -0.06; 0.15). Similarly, morning and night time PEFR was not significantly improved with salmeterol treatment. In a 16 week study, disease-specific quality of life, measured using the St. George's Respiratory Questionnaire (SGRQ), showed a significant improvement after 50 mcg twice daily, but not after 100 mcg twice daily. This improvement exceeded the threshold for a clinically significant change with this questionnaire. General health status, as measured by the Medical Outcomes Short Form 36, did not improve in any of the eight components with either salmeterol dose. No significant difference was demonstrated in the mean change from baseline in the six minute walk distance (WMD = 1.9 metres, 95% CI: -15.4;19.3). Breathlessness was reduced in one study in patients receiving salmeterol 50 mcg twice daily group. Significantly more patients in this group had Borg scores for breathlessness less than three (a score of three indicating moderate dyspnoea) compared to the placebo treated group (Peto Odds Ratio = 0.60, 95% CI: 0.40; 0.88). Neither dose of salmeterol influenced the incidence of COPD exacerbations, (50 mcg: Peto Odds Ratio = 0.74, 95% CI: 0.47, 1.15) and (100 mcg: Peto Odds Ratio = 0.98, 95% CI: 0.64, 1.52). REVIEWER'S CONCLUSIONS: Treatment of patients with COPD with long acting beta2-agonists produces only small increases in FEV1. In one study, a dose of salmeterol 50 mcg twice daily produced a reduction in breathlessness and a clinically significant improvement in quality of life. (ABSTRACT TRUNCATED)

Adrenergic beta-Agonists↗
PubMed1998

Comparative clinical and physiological features of Maori, Pacific Islanders and Europeans with sleep related breathing disorders.

UNLABELLED: Recent studies have suggested that there is a familial association of sleep apnoea syndrome and that this is not entirely explained by inheritance of known risk factors. Maori (M) and Pacific Islanders (PI) have many of the body habitus features associated with sleep apnoea and therefore might be expected to exhibit more severe disease than Europeans (E). OBJECTIVE: To compare the clinical and physiological characteristics of the different ethnic groups and to determine if race was an independent predictor of severity of sleep apnoea. METHODOLOGY: A prospective evaluation of patients attending the Sleep Disordered Breathing Clinic which serves the whole of Auckland (population 1.1 million), New Zealand was conducted for the period July 1994 to August 1995. The evaluation included history including a 26 question questionnaire, Epworth sleepiness score, examination, and where indicated, full polysomnography. RESULTS: A total of 233 patients (154 E, 48 M and 33 PI), underwent full polysomnography. Forty-one (85%) of the M and 31 (94%) of PI had obstructive or mixed sleep apnoea compared with only 74 (49%) of the E (P < 0.0001; chi 2). There were few racial differences in the responses to the sleep questionnaire. M and PI were shown to have much greater neck and waist circumference and body mass indices. Severity parameters (apnoea-hypopnoea index, wake and minimum oxygen saturation, and apnoea duration) were greater for both M and PI compared with E (P < 0.001; Mann-Whitney U-test). Stepwise regression identified neck size, body mass index and age as independent predictors of severity. CONCLUSION: When other factors were controlled for, race was not an important independent predictor of severity of sleep apnoea.

Adult↗
PubMed1993

Compressed air diving and respiratory disease. A discussion document of the Thoracic Society of Australia and New Zealand.

OBJECTIVE: To review the pathophysiology and respiratory complications of compressed air diving, and to formulate guidelines for assessing respiratory fitness to dive so that diving candidates can be advised of the risks associated with respiratory disease, in particular asthma. DATA SOURCES: Specialist medical journals in the areas of respiratory medicine, physiology and diving medicine. Morbidity and mortality statistics were obtained from international diving bodies, diving medicine scientific meetings, and papers. SYNTHESIS: The major complications of underwater diving in subjects with compromised respiratory function are drowning, pulmonary barotrauma and arterial gas embolism. Diving candidates with a history of asthma, pneumothorax, obstructive or restrictive lung disease, lung cysts or thoracic trauma should be advised not to dive in view of these risk factors. CONCLUSIONS: Several respiratory diseases carry an increased risk of morbidity and mortality from compressed air diving. An accurate history and measurement of lung function are an essential part of assessing fitness to dive, both to advise potential divers appropriately and to reduce risks associated with this increasingly popular recreational activity.

Asthma↗
PubMed1988

Trends in the use of an urban accident and emergency department by asthmatics.

To examine the possible relationship between the increase in asthma admission rates and the use of the accident and emergency department (A & E) for the management of asthma, a retrospective study of asthma admissions and A & E attendances was undertaken at Middlemore Hospital. Admission rates for adult asthma doubled between 1974 and 1985 (p less than 0.001). Yearly A & E attendance rates for adult asthma also doubled between 1977 (when data collection began) and 1985 (p less than 0.01), and could be largely explained on the basis of increased reattendance (p less than 0.001). These trends suggest that the hospital is being used in a primary care role for the treatment of acute asthma and that self-referral is encouraged. A dependence on A & E by frequent attenders may be a barrier to nonacute ongoing medical care in the community and may lead to the seeking of care for attacks later than if a general practitioner (GP) was used. Dependence on and attendance at A & E may lead to an increased risk of admission and thus may have contributed to the increase in the admission rate for asthma.

Adolescent↗
PubMed1979

Effects of stopping smoking for 48 hours on oxygen availability from the blood: a study on pregnant women.

The effects of stopping smoking for 48 hours on factors governing the availability of oxygen from the blood--that is, carboxyhaemoglobin (COHb), haemoglobin-oxygen (HbO2) affinity, and haemoglobin concentration--were measured in women in the last trimester of pregnancy. Three groups were studied: smokers, smokers who stopped smoking for 48 hours, and non-smokers. The 22 smokers had higher initial COHb values and greater HbO2 affinity than the 10 non-smokers, but their total haemoglobin concentrations were also higher, so that their oxygen availability was not significantly reduced. In the 11 smokers who stopped the reduction in COHb and decrease in HbO2 affinity led to a significant increase of 8% in "available oxygen" in 48 hours. Since even small improvements in oxygen delivery to the tissues may confer critical benefit to the fetus, particularly during labour or when exposed to general anaesthesia, smoking should be discouraged for 48 hours before elective deliveries. The same consideration might reasonably be applied to patients undergoing general anaesthesia for all elective operations.

Carboxyhemoglobin↗