Biomedical subjects

D Edmonds

Publications and source records attributed to D Edmonds.

At least 19 recordsLinked to original sources

PubMed2004

Parental perceptions of the therapeutic effect from osteopathic manipulation or acupuncture in children with spastic cerebral palsy.

Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.

Acupuncture Therapy↗

PubMed1993

Benzodiazepine utilisation in Australia: report from a new pharmacoepidemiological database.

This study surveys the total community prescription use of benzodiazepine agents in Australia for the years 1990 and 1991. Also included is information on the utilisation of these agents on the Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes (PBS/RPBS) over the period 1987 to 1991. The Australian data are from the Drug Utilization Subcommittee (DUSC) database, which is derived from two sources: the PBS/RPBS (subsidized prescriptions), and a national sample of Pharmacy Guild of Australia pharmacies (private and under-copayment general prescriptions). The data are converted to defined daily doses per 1000 inhabitants per day (DDD/1000/day) in accordance with the unit of measurement for drug utilisation studies approved by the World Health Organization. Benzodiazepine utilisation was 33.96 DDD/1000/day for 1990 and 29.31 DDD/1000/day for 1991. The four drugs listed on the Pharmaceutical Benefits Scheme, namely diazepam, oxazepam, nitrazepam and temazepam, constituted 82 per cent of the Australian market. The availability of government subsidy appears to influence benzodiazepine- prescribing behaviour. Benzodiazepine utilisation has been falling in recent years. The fall may be related to the impact of new guidelines and community awareness campaigns. There are major differences in the composition of the market between Australia and the Nordic countries.

Anti-Anxiety Agents↗

PubMed1992

[Effect of halving the dosage of atenolol in essential hypertension].

In the present study the effect of halving the dose of atenolol in 41 essential hypertensives was analyzed. Prereduction dosage of atenolol was 100 mg in 26 and 50 mg in 15 patients. In 16 cases the beta-blocker was administered as monotherapy and in the remaining patients atenolol was combined with a calcium antagonist and/or a diuretic. Dosage of these drugs was constant throughout the whole study. During an observation period of 12 weeks after halving atenolol from a mean dose of 82 mg to 41 mg, no significant changes in systolic and diastolic blood pressure or in response rate (defined as a diastolic blood pressure of 95 mm Hg or less) were observed. In view of our results and those of other authors, it is recommended that in patients with mild hypertension whose blood pressure has been kept below 140/85 mm Hg by treatment for at least one year, betablockers may be reduced in a step-wise fashion.

Atenolol↗

PubMed1992

[Practical and clinical aspects of multifactorial therapy in obesity].

In the present study the effect of a combination of protein-restricted modified hypocaloric diet and a behavioural therapy in 125 obese patients was analyzed. Patients were divided in two groups: 96 patients were instructed and controlled by practitioners (group 1) and 29 patients were followed in our out-patient clinic (group 2). After 14 weeks on diet a mean weight reduction of 10.6 kg in group 1 and of 9.8 kg in group 2 was observed. Furthermore, a significant decrease in systolic and diastolic blood pressure and in mean cholesterol and triglyceride values was seen. Our results show the good effect of a modified protein-sparing fast in obese patients. However, it has to be emphasized that the most promising results have been those utilizing not only a nutritional but also a behavioral approach.

Adult↗

PubMed1992

[Blood pressure measurement using the fingers].

An increasing number of devices for self-assessment of blood pressure has been developed over the past years. Accepted international standards for evaluation of such devices are still lacking. A new apparatus (T88, Marshall Electronics) measuring blood pressure on digital arteries by oscillometry was tested for accuracy. Comparative measurements in 36 patients indicated position-dependent results with a reasonable correlation with the measurements taken on the upper arm only if the device was used at the level of the heart. Significant differences for systolic values were noted on different phalanges. In a last series of measurements, comparing values obtained about the basal phalanges of the index positioned at the level of the heart, significant differences were found for systolic and diastolic values compared to the traditional measurement. The use of this device for evaluation of hypertension, monitoring of treatment or use in studies is thus not recommended.

Arteries↗

PubMed1992

Betablocking drugs in essential hypertension: transdermal bupranolol compared with oral metoprolol.

In the present study the antihypertensive efficacy and tolerability of transdermal bupranolol (30 mg once-daily) was compared with oral metoprolol (100 mg once-daily). Blood pressure measurements were performed in the office, at home, and with ambulatory 24-h blood pressure devices. Systemic and local side-effects, as well as compliance and acceptance, were evaluated every two weeks. The treatment period lasted eight weeks. The results showed a significant decrease in blood pressure under the bupranolol transdermal therapeutic system in the office, at home, and with 24-h blood pressure measurements day- (08h00-20h00) and night-time (20h00-08h00). Under oral metoprolol there was a significant blood pressure decrease in the office, at home, and in the mean daytime values of the 24-h blood pressure measurements. The night-time values, however, demonstrated only a slight decrease in blood pressure, being significant only for diastolic values. Systemic side-effects were comparable in both groups. 69% of the patients had local side-effects at the patch side (erythema, papulous exanthema, pruritus). Six patients dropped out because of localized urticarial exanthema (five patients treated with transdermal bupranolol, one patient treated with oral metoprolol). In comparison to the oral form, twice as many patients had admitted to have been non-compliant with the patches (13 versus 7 patients). At the end of the study, 24 out of 32 patients preferred to be treated with capsules.

Administration, Cutaneous↗

PubMed1991

[Performing self-measurement of blood pressure: a patient survey].

In the present study the knowledge of 200 patients of our hypertension clinic about the technique of blood-pressure self-measurement was investigated using a questionnaire of 22 questions. 44-66% of the patients in different age groups measured their own blood-pressure, showing that self-measurement is commonly used, regardless of the age. 73% of the patients had bought a device on their own, but only 17% on the physician's advice. Possible causes for erroneous measurements were rarely known and underestimated by the patients. Due to lacking or insufficient instruction a relatively high percentage of the patients did not perform correct measurements. 45% did not measure the blood-pressure at the same time of day, 45% did not read systolic and diastolic pressures to the nearest 2 mmHg mark of the manometer scale, 59% did not count the pulse rate and 52% did not document the blood-pressure values. About half of the patients adjusted their medication on the ground of self-measured blood-pressure determinations. 45% of the elderly patients felt that their compliance had improved by self-measurement in contrast to 17% in the younger group. Given the increasing use of blood-pressure self-measurement we conclude that education of patients and physicians on possibilities and limitations of self-measurement as well as optimal training in the correct technique seem advisable.

Adult↗

PubMed1990

Casual versus ambulatory twenty-four-hour blood pressure measurement in a comparative study with bisoprolol or nitrendipine.

In a double-blind, placebo-controlled, randomly allocated study, the 24-h efficacy of a single morning dose of 10 mg of the beta-blocker bisoprolol (n = 17) versus 20 mg of the calcium channel antagonist nitrendipine (n = 19) was assessed using two different methods of blood pressure determination: (1) casual blood pressure determinations in the morning before the dose; and (2) ambulatory day-time (6 a.m. to 6 p.m.) and night-time (6 p.m. to 6 a.m.) blood pressure monitoring using a non-invasive automatic device (Spacelabs 90202). After 4 weeks both agents induced significant blood pressure reductions compared to the placebo period as assessed by both casual and ambulatory day-time readings, without significant differences in the blood pressure reductions induced by the two drugs (P less than 0.05). Ambulatory night-time values, however, showed a significant blood pressure reduction only for bisoprolol (from 138 +/- 16/84 +/- 12 to 129 +/- 15/77 +/- 11 mmHg); nitrendipine did not induce any significant systolic or diastolic blood pressure changes during this period (140 +/- 11/87 +/- 10 to 136 +/- 13/86 +/- 10 mmHg). Individual response rates were 47% for nitrendipine and 71% for bisoprolol. The incidence of side effects was comparable under both drugs. Our results indicate that bisoprolol was more effective over 24 h than nitrendipine. We also conclude that the value of casual blood pressure readings for the evaluation of therapeutic agents given once a day seems to be limited in comparison to 24-h ambulatory monitoring.

Adrenergic beta-Antagonists↗

PubMed1990

Self-measured blood pressures at home and during consulting hours: are there any differences?

Home blood pressures are lower than casual blood pressures and this difference is probably due to physician-patient interaction in a clinical stress situation. In order to prove this assumption we compared the casual blood pressures of 127 subjects, measured by a physician and by the subjects themselves in the presence of the physician, with self-measured values obtained at home over a 7-day observation period. The casual pressures were higher than the home pressures (delta = 7.6/3.9 mmHg) regardless of whether they were taken by the physician or by the subjects themselves in the presence of the physician. The subjects' casual readings (132.9 +/- 17.5/87.6 +/- 12 mmHg) were slightly, but significantly, higher than those measured by the physician (131.9 +/- 18.4/86.3 +/- 12.6 mmHg) and both systolic and diastolic self-measured casual values were highly significantly correlated with the physician's readings (r = 0.92 and 0.91, respectively; P less than 0.01).

Adult↗

PubMed1990

Individualizing antihypertensive therapy with enalapril versus atenolol: the Zurich experience.

With the present increasing concern for compliance and quality or life during antihypertensive treatment, drug therapy tailored optimally for the individual patient is becoming increasingly important. The aim of the present double-blind crossover study was to analyse the individual as well as the group blood pressure response under enalapril and atenolol. Our results show that the group effects of these drugs did not differ significantly. However, individually, two-thirds of the responding patients showed a preference for either enalapril or atenolol. A response to one drug did not predict a comparable response to the other drug. We conclude that double-blind crossover studies are a possible way of individualizing antihypertensive treatment. However, no appropriate methodology or definitions of terms for these studies have yet been established.

Adult↗

PubMed1989

[ Self measurement of blood pressure. Equipment and comparison of equipment].

Precision is the primordial criterion for the evaluation of a blood pressure measuring device. While traditionally devices based on the auscultation technique have dominated semiautomatic devices have recently gained acceptance. The latter permit to reduce procedure-related errors. They are simpler to use and require less demanding instruction but are more expensive than stethoscopic devices.

Auscultation↗

PubMed1989

[Self measurement of blood pressure: patient education].

Many patients measure their blood pressure without any instruction due to the availability of modern measuring devices. Although the technique can be mastered by most of the patients, some sources of error have to be eliminated. The aim of such an instruction is to explain these sources of error to the patients and to give them opportunity to practise the self measurement under medical supervision. An instruction sheet is handed out as a pamphlet. The patients are also directed to keep a record of all measurements which is periodically controlled by the physician. It is also advisable to reexamine the measuring technique of the patient from time to time and to check the accuracy of the patients measuring device.

Blood Pressure Determination↗

PubMed1989

[Why are blood pressure values higher in the doctor's office than at home?].

Blood pressure values measured by the patients at home are lower than those measured during medical consultation. To test whether the person measuring the blood pressure is responsible for this difference, the blood pressure of 127 patients was measured first by the doctor and then by the patients themselves during the consultation. There was a good agreement and no significant difference between the two measurements. Values taken at home were however significantly lower. Our results indicate, that difference between clinic and home blood pressure values does not depend on the person performing the measurement.

Blood Pressure↗

PubMed1989

[Diagnostic and prognostic aspects of home blood pressure measurement].

Up to now the diagnosis of hypertension has been based on a few casual blood pressure measurements in the physician's office according to WHO guidelines. Blood pressure measurements at home in the recent years have gained increasing popularity as a supplementary diagnostic tool. The establishment of an everyday blood pressure profile and exclusion of "white coat" hypertension are the main diagnostic indications. In borderline hypertension those patients with elevated home blood pressures can be identified. However world-wide epidemiologic studies are urgently needed to develop definitions of normal and pathological values for self-recorded blood pressure readings. From our experience diastolic home-recorded values higher than 90 mm Hg should be regarded as pathological.

Blood Pressure Determination↗

PubMed1989

[The therapeutic significance of home blood pressure measurement].

Optimization of antihypertensive therapy during the initial dose titration as well as the long term follow-up of chronic therapy constitute the main therapeutic indications of blood pressure measurement at home. Furthermore home blood pressure measurements may be of value in patients with unsatisfactory blood pressure response in whom poor compliance is suspected. Finally patients may adjust their antihypertensive therapy according to the level of self-recorded blood pressure measurements.

Antihypertensive Agents↗

PubMed1989

[The ambulatory patient history: an attempt at quality control].

At the medical outpatient clinic of the university of Zurich a sample of 200 records, 100 each from male and female patients was taken and analyzed to assess the quality of record-keeping. An average to acceptable quality was found regarding history, physical examination, diagnostic evaluation and treatment. Next to incomplete registration of anamnestic and clinical data deficiencies consisted in neglect of outdated or less important items of the check-list. Time-consuming or disagreeable procedures such as ophthalmoscopy or rectal examination could hardly be analyzed since the physician had often not indicated whether he had performed the procedure or found a normal state. Although evaluation of fitness to work was expected it was rarely documented and could not be analyzed. Check-lists for medical records should thus be adapted more frequently to meet changing demands. Periodic reviews of record-quality should serve to periodically inform doctors about deficiencies in their practice of patient work-up. Physicians should also be coerced to identify procedures that were not performed or which yielded normal findings.

Ambulatory Care↗

PubMed1989

[Using drugs: experiences with a slide show program and patient questionnaires].

200 patients were surveyed by questionnaire while attending the medical outpatient service at the university hospital of Zürich. Questions related to a slide show on the usage of prescribed drugs presented at the same time in the attending room but also to general personal habits and attitudes regarding pharmacotherapy. Appreciation of the slide show was remarkable. This was substantiated by the observation that next to the physician media such as news papers, television and broadcast serve as source of information on drugs. Patient-compliance was in part related to lack of correct information. While older patients discontinued treatment because of side-effects, younger patients stopped drugs often because of improvement under therapy. In depth information could improve compliance in the latter population since particularly these individuals complained about insufficient instruction. The personal preference of "natural" over "chemical" drugs was surprisingly at variance with the admission of regular intake of prescription drugs--possibly a sign of an ultimately greater confidence in "chemical" drugs.

Audiovisual Aids↗

PubMed1988

The neglected time factor and antihypertensive therapy. A pitfall in evaluating side effects in a cross-over study.

The aim of this study was to examine the influence of a time factor that may lead to inaccurate interpretation of data on the incidence of side effects in a double-blind study with drug cross-over. After a washout period, 58 patients with essential hypertension received either 20 mg of enalapril or 50 mg of atenolol. After two weeks, the dosage was doubled (to 40 mg of enalapril and 100 mg of atenolol) in those patients with diastolic blood pressure higher than 95 mm Hg. After four weeks of active treatment and a second two-week washout period, patients received the alternative antihypertensive agent under the same procedure and time schedule as in the first treatment phase. Four patients dropped out. Side effects were evaluated by questionnaire at weeks 2, 4, 8, and 10. In the 54 patients who completed the study, enalapril and atenolol led to almost identical blood pressure reduction in both treatment phases, indicating that pooling these data is a sound method. However, incidence of side effects was twice as high in phase 1 as in phase 2 and markedly decreased in each treatment phase, with no differences being observed between enalapril and atenolol. These results clearly demonstrate that pooling side effects data from a cross-over study may lead to quite wrong interpretations.

Antihypertensive Agents↗