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Biomedical subjects

D Downing

Publications and source records attributed to D Downing.

At least 19 recordsLinked to original sources
PubMed1998

When the morning after is Sunday: pharmacist prescribing of emergency contraceptive pills.

Pharmacists are well positioned to play a major role in increasing access to emergency contraceptive pills (ECPs). A pilot project in Washington State is testing direct pharmacist prescribing. Through a collaborative drug therapy agreement, a licensed prescriber, such as a physician, delegates to a pharmacist the authority to prescribe ECPs directly to women who meet the assessment criteria. Currently pharmacists at 111 Washington State pharmacies have collaborative agreements in place, and the number of participating pharmacies continues to increase. The response to this initiative has been extremely positive. Women who have received ECPs directly from pharmacists rate their interactions with the pharmacists positively and overwhelmingly cite convenience as the primary reason for going directly to the pharmacy. Physicians and other providers with independent prescribing authority can play a pivotal role by working with pharmacists to replicate the Washington State initiative in the states that allow it.

Contraceptives, Postcoital↗
PubMed1996

Adverse effect of treatment gaps in the outcome of radiotherapy for laryngeal cancer.

BACKGROUND AND PURPOSE: A correlation has been demonstrated between unplanned prolongation of radiotherapy and increased local relapse. This review was performed to assess the importance of overall time on the outcome of curative radiotherapy of larynx cancer. MATERIALS AND METHODS: Retrospective analysis was performed of 383 patients with laryngeal cancer managed by elective radiotherapy between 1976-1988 in the Department of Clinical Oncology, University of Edinburgh, Western General Hospital, Edinburgh All cancers were confirmed histologically to be squamous cell carcinomas. All subjects received radiotherapy in 20 daily fractions (except Saturdays and Sundays), employing individual beam direction techniques and computer dose distribution calculations. Main outcome measures were complete resolution of the cancer in the irradiated volume; local relapse; survival and cause-specific survival rates. RESULTS: Radiotherapy was completed without any unplanned interruption (28 +/- 2 days) in 230/383 (60%) of patients. A statistically significant two-fold increase in local relapse rates was observed when treatment was given in 31 days or more. There also was a statistically significant four-fold increase in laryngeal cancer deaths when the treatment time exceeded 30 days. CONCLUSIONS: In patients with laryngeal cancer, accelerated repopulation of cancer cells probably occurs after the start of radiotherapy. When the overall treatment time is 4 weeks or less, gaps at weekends are not detrimental. However, long holiday periods or gaps in treatment longer than 4 days increase the risk of laryngeal cancer relapse and cancer-related mortality. Significant gaps in treatment should be avoided. If treatment has to be prolonged, additional radiation dose should be prescribed to compensate for increased tumour cell proliferation.

Carcinoma, Squamous Cell↗
PubMed1989

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors.

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward one's illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Connecticut↗
PubMed1986

Acute osteomyelitis in children: combined Tc-99m and Ga-67 imaging.

This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis.

Adolescent↗
PubMed1985

The effect of methylene diphosphonate on the tissue distribution of gallium-67.

Nonradiolabeled methylene diphosphonate (MDP) was administered intravenously to CFW Swiss outbred female mice 2 hr prior to i.v. injection of [67Ga]citrate. The dose of MDP ranged from that usually administered for bone scanning (17.9 micrograms/kg) to 1,000 times the usual bone scan dose (17.9 mg/kg). The animals were killed 24 hr after administration of [67Ga]citrate and organ distribution determined as compared to control animals who received no MDP. At MDP doses one to ten times usual bone scan dose, the only organ showing significantly different 67Ga uptake was the lung and this difference in pulmonary uptake was accounted for by incidental pulmonary infection. At MDP doses 100 to 1,000 times usual bone scan dose, significantly altered 67Ga uptake was noted in lung, spleen, kidney, and gastrointestinal tract. The only consistent pattern of association of MDP administered dose and alteration in 67Ga uptake, however, was noted in the spleen where uptake was augmented with increased dose, and the bone where increased MDP dose depressed 67Ga uptake. Even this effect, however, was modest. It is concluded that at usual MDP dose levels used in bone imaging, no significant alterations occur in 67Ga distribution in normal mouse tissue. It is inferred that 67Ga scans performed following bone scans can be interpreted as if both radiopharmaceuticals had been administered separately.

Animals↗
PubMed1983

Auscultatory indirect measurement of blood pressure in dogs.

An indirect method of measuring blood pressure (cuff plus stethoscope) was evaluated in 70 dogs weighing 15 to 30 kg (17.5 +/- 8.8 kg; mean +/- standard deviation). A cuff 12 cm wide was used. The measurements were most audible with the cuff on the upper foreleg of the dog and with the stethoscope placed in the medial epicondylar region just distal to the cuff. The cuff was inflated to greater than systolic pressure and allowed to deflate slowly. In 70 lightly sedated dogs, systolic blood pressures averaged 145 +/- 25 mmHg (mean +/- standard deviation) and diastolic blood pressures averaged 84 +/- 14 mmHg. Indirect measurements were compared to direct measurements (femoral arterial catheter). Systolic pressures obtained by this direct method averaged 138 +/- 29 mmHg (mean +/- standard deviation) and diastolic pressures averaged 84 +/- 17 mmHg. The correlation coefficient for systolic pressure was 0.96 and for diastolic pressure 0.97.

Animals↗
PubMed1979

Unsaturated fatty acid effect on cyclic AMP levels in human embryo lung fibroblasts.

The addition of arachidonic acid at 250 muM to cultures of human embryo lung fibroblasts (IMR-90) increases cellular cyclic AMP levels within 5 minutes to approximately 15-fold over basal. Other unsaturated fatty acids, 11, 14, 17-eicosatrienoic, linoleic, 8, 11, 14-eicosatrienoic and oleic also cause similar rapid elevation of cellular cyclic AMP. During this time interval, no detectable conversion of the added linoleic or arachidonic acids to prostaglandin is observed. These cells produce prostaglandins at measurable concentrations in response to treatment with ascorbic acid or bradykinin. Saturated fatty acids have no influence on cyclic AMP levels in these cells. This effect of unsaturated fatty acids on cellular cyclic AMP levels varies with the cell type. For example, smooth muscle and endothelial cells obtained from the calf pulmonary artery show very little or no increase in cellular cyclic AMP upon exposure to arachidonic acid.

Animals↗
PubMed1979

Nonspecific factors and side effect complaints. Factors affecting the incidence of drowsiness in drug and placebo treated anxious and depressed outpatients.

Discriminant function analyses were applied to data obtained from anxious psychiatric outpatients treated with either chlordiazepoxide (n = 353) or placebo (n = 259) and depressed outpatients treated with either amitriptyline (n = 310) or placebo (n = 328), who had participated in controlled drug trials of 4 weeks' duration, in an attempt to identify factors associated with complaints of drowsiness made by these patients. Although the magnitude of the relationships between individual predictors and drowsiness was small, several factors emerged which had consistent impact across treatment groups. Predictors of complaints of drowsiness attributed to active drugs arose primarily from demographic attributes probably reflective of life style, and from illness and treatment history. In contrast, predictors of drowsiness attributed to placebo were almost exclusively confined to indices of the severity of several aspects of presenting symptomatology. In particular, more frequent complaints of drug-induced drowsiness were found among better educated individuals with an illness of long duration. Complaints of placebo-induced drowsiness were more common among patients with more severe emotional (phobic-obsessive) symptomatology and more frequent headaches and among those individuals in whom hypochondriasis was less severe.

Adult↗
PubMed1976

A randomized technique of constant-pressure infusion.

A population study of measured inflow values of eyes of a group of adult male rhesus monkeys was done with a randomized technique of constant-pressure infusion. Each eye was presented with a sequence of 18 4-minute runs, consisting of three infusion runs for each of six pressures, in which the order of appearance of a given pressure had been randomized. A statistical analysis of the results indicates that only the independent variables of infusion pressure, type of anesthetic, and position in the sequence of the 18 infusion runs had a significant effect upon measured inflow.

Animals↗