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Biomedical subjects

C K Connolly

Publications and source records attributed to C K Connolly.

At least 19 recordsLinked to original sources
PubMed1992

Steroid-induced bone disease. Conflicting views of respiratory and bone physicians.

Physician members of the Thoracic Society and the Bone and Tooth Society were circularised about their views on the prophylaxis, screening and treatment for steroid osteoporosis. Bone physicians were more active than respiratory physicians in screening and prophylaxis and were more likely to favour bone densitometry in assessment and bisphosphonates in treatment. Further studies are required to establish the value of prophylactic agents in steroid osteoporosis but meanwhile respiratory physicians should appreciate the value of the relatively simple technique of bone densitometry in assessment and consider whether they should be more active in prophylaxis.

Adult↗
PubMed1991

The relationship between work done and pulmonary function; validation of a method.

A two-stage bicycle exercise test with logarithmic intervals of load has been described, and the results reported in 760 patients. The test is now validated in a second group of 553 subjects. Performance data and FEV1 were available in all subjects and forced vital capacity in 366 of them. Regression equations of pulmonary function on work done stratified by sex and age were similar to those previously reported. Multiple regression showed that more than 57.8% of the variance could be explained in terms of vital capacity, height and age, with small contributions from weight and sex; with more than half being accounted for by vital capacity alone (R2 = 0.53). In an alternative equation predicted vital capacity, age (independently), percentage deficit of vital capacity below predicted, sex and weight/height2 explained 58.7% of the variance. In this approach, the percentage of vital capacity below predicted accounts for 25% of the variance after allowance for predicted vital capacity. It is confirmed that the first logarithmic stage of the test predicts a work rate that can be maintained for more than 5 minutes, producing a pulse rate of greater than 130 in two-thirds of the subjects. As the majority of those who failed to achieve this work rate had poor pulmonary function and were elderly, it is recommended that the second phase is set at a lower work load for these subjects.

Adult↗
PubMed1991

Infection in exacerbations of asthma: views of different groups of practitioners.

A questionnaire designed to elucidate views on the frequency of infection in asthma and its management was circulated to general practitioners, general physicians, paediatricians and respiratory physicians in the north of England. On the whole, general practitioners agreed with the general physicians and paediatricians with respiratory physicians. The generalists, and to a lesser extent the specialists, tended to overestimate the risk of bacterial infection, which was perceived to be a particular risk following viral infection in intrinsic asthma. This resulted in more frequent prescription of antibiotics than is justified by the published evidence. There was a tendency for frequent prescribers of antibiotics to withhold corticosteroids. If prescribing habits are to be altered, education will have to be directed at those responsible for acute admissions to hospital as well as at general practitioners.

Acute Disease↗
PubMed1990

NHS trusts.

Explore the source record for details and available documents.

State Medicine↗
PubMed1990

Investigation, treatment and prognosis of bronchial carcinoma in the Yorkshire Region of England 1976-1983.

We studied all cases presenting during life with carcinoma of the bronchus and registered at the Yorkshire Regional Cancer Registry 1976-1983. During this period fibreoptic bronchoscopy became more widely available in the region, and multiple drug chemotherapy became first line treatment for small cell carcinoma. Although there was little change in the overall incidence of lung cancer during the study period, the proportion of females increased by 4.8% and the mean age at presentation rose by 2.3 years. The histological confirmation rate rose by 29% from 45% to 58%. The proportion of patients with small cell carcinoma treated by chemotherapy increased from 17% to 39%. With this exception therapeutic intervention rates were unaltered. The prognosis of patients with small cell carcinoma treated by chemotherapy improved, particularly so for those less than 60 years. There was a consistent trend for an overall improvement in survival in other groups, and this was significant for those aged 70 and over where it appeared to be related to more appropriate management of squamous cell carcinoma. We conclude from this regional study that increased diagnostic activity in District General Hospitals has allowed an improvement in prognosis both for patients with small cell carcinoma treated by chemotherapy, and in patients over 70 with non-small cell cancer. These trends can be expected to continue over the next few years.

Aged↗
PubMed1990

Pulmonary function and drug regimens in asthmatics.

Overall function, persistent obstruction and control of potentially reversible wheeze were related to drug regimen in 624 patients attending review clinics. Pulmonary function before and after correction for the effects of age, duration of asthma and social factors was studied for each drug regimen. The performance of those on regular bronchidilators only, particularly non-smokers, was disappointing, particularly with regard to control of potentially reversible wheeze. There was a group of patients who expressed dissatisfaction with their condition in whom no change in management was made despite objective evidence of poor control of potentially reversible wheeze. Subjective assessment of control bore little relationship to actual function in those patients on oral steroids. Nevertheless, throughout the clinics as a whole, subjects recorded pulmonary function which was on average 80 per cent of their potential.

Adolescent↗
PubMed1989

The influence of social factors on the control of asthma.

The relationships of pulmonary function with age, duration of asthma and social factors were studied in 630 asthmatics. Pulmonary function was assessed by peak flow rate at routine attendance (actual function). Persistence of obstruction was demonstrated by a trial of corticosteroids where necessary. The best obtainable peak flow rate was recorded (maximum function). Unrelieved potentially reversible obstruction was assessed by actual/maximum function. Age and duration of asthma were directly associated with poor control of reversible wheeze as well as with persistent obstruction. In addition poor control of potentially reversible wheezè was related to lower social class, current cigarette smoking and lack of central heating. Persistent obstruction was related to life time amount smoked, passive smoking and lack of central heating.

Adult↗
PubMed1989

Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee.

The selection of initial antimicrobial treatment in a patient with community acquired pneumonia is an important clinical decision. Because this decision is usually made before the results of specific microbiological tests are available, we attempted to determine how well the presenting clinical features would allow prediction of microbial aetiology in 441 adults admitted to hospital with pneumonia. Five of 90 variable available on admission were selected for inclusion in a multivariate discriminant function analysis because of their strong association with one or more of the major aetiological subsets (Mycoplasma pneumoniae, Streptococcus pneumoniae, "other," and undetermined). These variables were age, number of days ill before admission, presence or absence of bloody sputum and of lobar infiltration on chest radiograph, and white blood cell count. The microbial aetiology was correctly predicted by this discriminant function analysis in only 42% of cases, which gives a quantitative estimate of the degree of difficulty encountered in determining the microbial aetiology at the time of admission for pneumonia. When a similar discriminant function analysis was applied to the third of patients in whom the microbial aetiology was never determined, most of these cases were predicted to be due to Streptococcus pneumoniae.

Adolescent↗
PubMed1989

Nedocromil sodium in adults with asthma dependent on inhaled corticosteroids: a double blind, placebo controlled study.

Eighty nine adults with asthma who were receiving inhaled corticosteroid and bronchodilator treatment took part in a double blind, randomised, placebo controlled trial of nedocromil sodium, 4 mg four times daily by inhalation. During a run in period of two to four weeks corticosteroid treatment was reduced when possible to produce a comparable level of symptoms across the trial population. The test treatment was then taken for four weeks, with the severity of asthma recorded daily by patients and assessed at two weekly hospital visits. There was an improvement in symptoms in the patients taking nedocromil sodium by comparison with those having the placebo, the differences being significant for diary card PEF readings, asthma symptom scores, and bronchodilator usage at night. The mean difference between the two groups was 18 l/min for PEF, 0.42 for daytime asthma score, and 1.73 puffs in 24 hours for bronchodilator usage. These results suggest that asthmatic patients who require inhaled steroids show better control of their asthma with the addition of nedocromil sodium than of placebo over a four week period after reduction of the dosage of their inhaled steroids.

Adolescent↗
PubMed1988

The relationship between age and duration of asthma and the presence of persistent obstruction in asthma.

Persistent obstruction was assessed in 630 asthmatic subjects by measurement after bronchodilator of the maximum potential peak flow rate and forced vital capacity. Persistent obstruction was directly related to duration of asthma. The fit was slightly better after logarithmic transformation, suggesting that the early stages of asthma may be as important as the later ones in the development of persistent obstruction. On multivariate analysis age was an additional factor in males, but made no significant difference to females. Atopy did not prove relevant. Measurements of peak flow suggested a more rapid deterioration in males of social classes III, IV and V than classes I and II. Although current smokers had lower peak flow rate and vital capacity than non-smokers, there was no evidence of a steeper decline in smokers than non-smokers suggesting that the effect of cigarette smoking was at most additive to that of duration of asthma.

Adolescent↗
PubMed1987

Salbutamol and ipratropium in partially reversible airway obstruction.

Thirty-six patients with a combination of reversible and persistent airway obstruction were treated with ipratropium bromide, salbutamol and a combination of both in high dose by nebulizer after a control period of rimiterol. The ipratropium and salbutamol were given double blind in random order and the dose of each was the same during the combination periods. Although there was a significant increase in pulmonary function in all treatment periods over the control, only the 6-minute walking distance was significantly improved in the combination period over treatment with salbutamol and ipratropium individually. This was not due to a progressive rise with time irrespective of the therapy. The results are compatible with a small number of patients benefiting from combination therapy.

Adult↗