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Biomedical subjects

D L Uden

Publications and source records attributed to D L Uden.

At least 19 recordsLinked to original sources
PubMed2001

Newness of drugs and use of HMO services by asthma patients.

OBJECTIVE: To define newness of drug technology and show associations between two measures of newness and health service utilization. METHODS: Healthcare use and changes in severity at each office visit were assessed for 1309 asthma patients from six health maintenance organizations (HMOs) during 1992. The age of each drug product, derived by subtracting its Food and Drug Administration (FDA) approval date from January 1, 1992, was used to construct two newness measures: the average age of all asthma drugs and, separately, all non-asthma drugs a patient used during the year and the percentages of a patient's asthma drugs from each of four time intervals of asthma drug breakthroughs. Service utilization variables included all primary care provider (PCP) visits, total prescription costs, emergency department (ED) visits, and hospitalizations. RESULTS: Using either measure of drug newness, multivariate analyses showed an association between greater use of newer asthma drugs and lower overall drug costs and fewer PCP visits. A trend was found between greater use of newer asthma drugs and fewer hospitalizations and ED visits. Newer non-asthma medications were associated with fewer ED visits. CONCLUSIONS: After controlling for patient and site variables, greater use of newer asthma drugs was associated with significantly lower drug costs and fewer PCP visits; associations with hospitalization rates and ED visits, although lower, were not significant.

Adult↗
PubMed1996

Stability of epinephrine hydrochloride in an extemporaneously compounded topical anesthetic solution of lidocaine, racepinephrine, and tetracaine.

The stability of lidocaine, epinephrine (as racepinephrine, or racemic epinephrine), and tetracaine (LET) in a topical anesthetic solution under various conditions was studied. The LET solution was prepared by mixing together 100 mL of 20% lidocaine hydrochloride, 50 mL of 2.25% racepinephrine (as the hydrochloride salt), 125 mL of 2% tetracaine hydrochlorides 315 mg of sodium metabisulfite, and 225 mL of water. The solution was stored in three amber glass and two clear glass bottles. One amber container and one clear container were stored at 35 degrees C, one amber and one clear container were stored at room temperature (approximately 18 degrees C), and the third amber container was stored at 4 degrees C. Except for the refrigerated container, each bottle was subjected to continuous room light. Each of the five solutions was sampled at 0, 1, 2, 3, 4, 8, 16, and 26 weeks for visual inspection and high-performance liquid chromatography (HPLC). The HPLC assay was shown to be stability indicating for epinephrine only. All the drugs in the LET solution had no more than a 5% reduction from initial concentration, according to the assay, when stored for 4 weeks in amber or glass containers at 4 or 18 degrees C and when stored for 26 weeks in amber containers at 4 degrees C. Solution stored in clear containers discolored more quickly than solution stored in amber containers. Epinephrine in an extemporaneously prepared LET solution was stable in amber glass bottles for 4 weeks at 18 degrees C and for 26 weeks at 4 degrees C.

Anesthetics, Local↗
PubMed1995

Tetracaine, epinephrine (adrenalin), and cocaine (TAC) versus lidocaine, epinephrine, and tetracaine (LET) for anesthesia of lacerations in children.

STUDY OBJECTIVE: To compare the duration of anesthesia experienced with lidocaine, epinephrine, and tetracaine (LET) solution and that with tetracaine, epinephrine (Adrenalin), and cocaine (TAC) solution during suturing of uncomplicated lacerations on the face or scalp. DESIGN: Double-blind, randomized, controlled trial. SETTING: The emergency department of a university-affiliated private children's hospital. PARTICIPANTS: One hundred seventy-one children with lacerations on the face and scalp requiring suturing. INTERVENTIONS: After standard application of the anesthetic solution, patients were assessed for signs of discomfort before and during laceration repair. Duration of anesthesia during laceration repair was determined on the basis of the length of time after removal of the anesthetic solution to the first sign(s) of discomfort that required additional anesthesia. RESULTS: There was no statistical difference between TAC and LET in adequacy of anesthesia before suturing or in duration of anesthesia during suturing. CONCLUSION: LET is an effective alternative to TAC for topical anesthesia during suturing of uncomplicated lacerations on the face and scalp in children.

Adolescent↗
PubMed1994

Prematurity prevention programs: an analysis of successes and failures.

OBJECTIVE: Our purpose was to assess the long-term results of established prematurity prevention programs. STUDY DESIGN: A population cohort of pregnant women from two major urban health care organizations were examined. Rates and cost-benefit analysis of prematurity and patient, system, or physician failures were analyzed. During 1990 1143 pregnant women were prospectively reviewed. RESULTS: A total of 11.8% of the mothers were high risk and responsible for 108 (50.2%) of the preterm deliveries. The preterm birth rate of all enrollees was 4.6%. One percent of the preterm neonates required level III care for complications. The average charge for a 35 week infant was 18 times, and a 36 week infant was five times more costly than a term infant. Patient, physician, and health care system failures occurred at different rates. CONCLUSIONS: This preterm prevention program resulted in low preterm birth rates. Potentially preventable preterm births most often occurred as a result of patient and physician failures.

Adolescent↗
PubMed1994

Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials.

OBJECTIVE: To reconcile conflicting published reports concerning the absolute and comparative clinical efficacy of antimicrobial drugs for acute otitis media in children. STUDY SELECTION: Articles were identified by MEDLINE search, Current Contents, and references from review articles, textbook chapters, and retrieved reports. Randomized, controlled trials of therapeutic antimicrobial drugs used in the initial empiric therapy for simple acute otitis media were selected by independent, blinded observers, and scored on 11 measures of study validity. Thirty English and three foreign-language articles met all inclusion criteria. DATA EXTRACTION: Data were abstracted for an end point of complete clinical resolution (primary control), exclusive of middle ear effusion, within 7 to 14 days after therapy started. DATA SYNTHESIS: The spontaneous rate of primary control--without antibiotics or tympanocentesis--was 81% (95% confidence interval, 69% to 94%). Compared with placebo or no drug, antimicrobial therapy increased primary control by 13.7% (95% confidence interval, 8.2% to 19.2%). No significant differences were found in the comparative efficacy of various antimicrobial agents. Extending antimicrobial coverage to include beta-lactamase-producing organisms did not significantly increase the rates of primary control or resolution of middle ear effusion. Pretreatment tympanocentesis was positively associated with individual group primary control rates, negatively associated with the ability to detect differences in clinical efficacy and unassociated with resolution of MEE. CONCLUSIONS: Antimicrobial drugs have a modest but significant impact on the primary control of acute otitis media. Treatment with beta-lactamase-stable agents does not increase resolution of acute symptoms or middle ear effusion; initial therapy should be guided by considerations of safety, tolerability, and affordability, and not by the theoretical advantage of an extended antibacterial spectrum.

Acute Disease↗
PubMed1993

Cefpodoxime proxetil vs. penicillin V in pediatric streptococcal pharyngitis/tonsillitis.

This multicenter, randomized, parallel treatment, observer-blinded study was designed to evaluate the safety and efficacy of cefpodoxime proxetil (5 mg/kg twice daily for 10 days) compared with penicillin V (13.4 mg/kg three times daily for 10 days) for treatment of Group A streptococcal pharyngitis and tonsillitis in pediatric patients. Clinical and microbiologic results were evaluated before therapy, during therapy (Study Days 3 to 5), at the end of therapy (Study Days 14 to 18) and at long term follow-up (Study Days 30 to 32). Both drugs were well-tolerated in 578 patients evaluable for safety. Mild gastrointestinal complaints were noted in 6.7% of 386 cefpodoxime-treated patients and in 5.2% of 192 penicillin-treated patients. In 413 patients evaluable for efficacy, both treatment regimens resulted in comparably favorable clinical outcome; cure rates were 83.8% for 275 cefpodoxime-treated patients and 77.5% for 138 penicillin-treated patients. However, eradication of S. pyogenes at end of therapy was significantly higher with cefpodoxime (93.1%) than with penicillin (81.2%) (P < 0.01). Cefpodoxime proxetil provides an effective alternative to penicillin V for the treatment of streptococcal pharyngitis and tonsillitis.

Adolescent↗
PubMed1992

Substance use in rural Midwestern pregnant women.

OBJECTIVE: To determine the rate of prenatal use of cocaine, cannabis, amphetamines, opiates, and cigarettes in rural midwestern women by analysis of reported use of cigarettes, maternal urine drug screening at admission to labor and delivery, and newborn meconium screening. DESIGN: The cohort of all women presenting to labor and delivery and their newborns were screened by urine and meconium analysis. Demographic information was also collected and matched to the urine and meconium samples. SETTING: Four primary care hospitals in rural Minnesota. Hospitals range in size from 66 to 140 beds, with 400 to 780 deliveries each year. PARTICIPANTS: All women presenting to labor and delivery for evaluation of term or preterm labor between April 4, 1991, and October 4, 1991. MEASUREMENTS/MAIN RESULTS: Overall, drugs not administered during labor were found in a mean (+/- SD) of 3.2% +/- 1.1% of all urine screens. Cannabis was found in 1.2% +/- 0.7% of maternal urine samples, amphetamines in 0.8% +/- 0.58%, opiates in 1.2% +/- 0.7%, and cocaine in 0% +/- 0.3%. Meconium samples were positive in 1.8% +/- 0.9% of cases. Cannabis was found in 1.1% +/- 0.7% of meconium samples, opiates in 0.6% +/- 0.5%, and cocaine in 0.1% +/- 0.1%. No urine samples were positive for more than one drug. One meconium sample tested positive for both cocaine and cannabis. Nearly 4% of patients had either a positive urine specimen or a positive meconium specimen. By history, 24.5% of women admitted to smoking during pregnancy. CONCLUSION: The use of cocaine, cannabis, opiates, and amphetamines was uncommon in this rural population. However, one quarter of the women admitted to smoking during pregnancy, exposing their fetuses to a dangerous substance.

Adult↗
PubMed1990

Inactivation of heparin during extracorporeal circulation in infants.

Heparin anticoagulation is necessary to prevent clotting during procedures involving the extracorporeal circulation of blood. Our preliminary observations suggested that heparin was inactivated in the extracorporeal circuit during extracorporeal membrane oxygenation. We tested this hypothesis by comparing heparin pharmacokinetics in five infants during extracorporeal circulation with kinetics, respectively determined in each patient and in the isolated circuit immediately after discontinuation of the procedure. Heparin clearance was 1.6 +/- 0.5 ml/kg/min in the patient and 2.1 +/- 0.8 ml/kg/min in the separated circuit. In each patient, the total of heparin clearances in the patient and circuit, 3.7 +/- 1.0 ml/kg/min, was virtually identical with the heparin clearance during the procedure, 3.8 +/- 1.9 ml/kg/min (r = 0.94, p less than 0.01). We conclude that more than one half of the heparin administered to infants during extracorporeal membrane oxygenation is eliminated by the extracorporeal circuit itself or by blood components in the circuit. These data explain the relatively large heparin doses needed to maintain anticoagulation in infants during extracorporeal circulation. In light of these findings, a reexamination of the normal mechanisms of elimination of heparin activity appears to be warranted.

Blood Coagulation↗
PubMed1990

Evaluation of a rapid monitoring system to study heparin pharmacokinetics and pharmacodynamics.

The pharmacokinetic and pharmacodynamic characteristics of heparin were studied in 10 healthy volunteers using the Hepcon/System B-10. This coagulation-monitoring system uses each patient's body weight, height, baseline activated clotting time (ACT), and heparin dose response values to determine initial heparin doses. We administered a calculated mean +/- SD heparin doses of 85 +/- 14 U/kg to 10 subjects to achieve a mean +/- SD target ACT of 364 +/- 29 seconds. This dose produced a mean +/- SD measured peak ACT of 337 +/- 53 seconds from a mean +/- SD baseline of 121 +/- 10 seconds. The measured peak ACT values resulting from the individualized heparin doses were within 20% of the desired peak in 9 (90%) of the subjects. Using the ACT values, the average mean residence time for heparin effect was 1.2 hours and half-life was 0.8 +/- 0.2 hours, with all the subjects' values returning to within 10% of baseline by 4 hours after the dose. Using the protamine-derived heparin concentrations, heparin total-body clearance ranged from 43 to 99 ml/hr/kg (mean +/- SD 73.3 +/- 14.5 ml/hr/kg). A linear relationship was found between heparin concentration and change in ACT that was described by delta ACT = 16.85 + 136.7.(heparin concentration). We conclude that this method is easy to perform and accurate for determining initial heparin dosage requirements, and could be an important improvement over existing approaches. In addition, it is a valuable research tool for studying heparin pharmacodynamics and pharmacokinetics.

Adult↗
PubMed1989

The effect of paraldehyde on intravenous tubing sets.

Paraldehyde is used in the treatment of status epilepticus, alcohol withdrawal, and delirium tremens. Because it is a solvent, concerns have been raised about infusing it through plastic intravenous tubing sets. In a three-phase study, 4% paraldehyde in 5% dextrose solution was analyzed over 24 hours for photodegradation, adsorption to polyvinylchloride- (PVC) and polyethylene- (PE) lined intravenous tubing, and the presence of di(2-ethylhexyl) phthalate (DEHP). Paraldehyde and DEHP samples were quantified by gas chromatography, and DEHP was confirmed by mass spectral analysis. On exposure to light for 24 hours, the concentration of paraldehyde decreased from 100 to 97%. This decrease is statistically significant but clinically insignificant. A 24-hour continuous infusion of paraldehyde through the two types of tubing revealed a decrease in concentration attributable to adsorption of 4% with PE and 13% with PVC tubing at 2 hours. In addition, there was no appreciable leaching of DEHP over 24 hours with either type of tubing. Concerns about paraldehyde's light instability and effects on tubing integrity appear to be unwarranted with commercially available intravenous administration sets.

Catheterization↗
PubMed1989

Bronchodilation from intravenous theophylline in patients with cystic fibrosis: results of a blinded placebo-controlled crossover clinical trial.

Most patients with cystic fibrosis (CF) eventually develop chronic obstructive pulmonary disease and theoretically could benefit from theophylline therapy. The purpose of this study was to investigate the pharmacologic response to intravenous theophylline by pulmonary function tests (PFT) and the theophylline pharmacokinetics in patients with CF. A randomized, double-blind, placebo-controlled, crossover trial was conducted in 10 ambulant patients with CF (5 females, 5 males), aged 11 to 21 years. Each patient received an intravenous dose of theophylline and normal saline over 1/2 hour on consecutive days. Spirometry and whole-body plethysmography were performed at baseline, 1, 3, 5, and 7 h after the theophylline dose, and 10 blood samples were collected over 9 h on both study days. The percent change of PFT from the baseline was recorded. Analysis of variance for balanced two-period crossover design was used to evaluate the effectiveness of theophylline therapy. The serum concentration (Conc.) vs. time data were fitted using nonlinear least-squares regression analysis. The theophylline dose administered was 7.9 +/- 0.4 (mean +/- SD) mg/kg, which produced a maximal Conc. (Cmax) of 14.6 +/- 2.7 microgram/ml. The half-life (T1/2), volume of distribution (Vd), and total body clearance (TBC) were 4.9 +/- 1.9 h, 537 +/- 124 mL/kg, and 80 +/- 16 ml/h/kg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Procedural variables which affect activated clotting time test results during extracorporeal membrane oxygenation therapy.

Hemorrhage secondary to heparin therapy is one of the most serious risks of extracorporeal membrane oxygenation (ECMO). This study determined those variables which affect the precision of activated clotting time (ACT) measurements used to monitor heparin therapy. Heparin therapy of eight neonatal lambs was monitored during ECMO with two Hemochron 400 machines to determine the effects of intermachine variability, test volume, speed and direction of agitation, and interpersonnel variability on ACT values. Test volume (0.25 vs. 0.4 ml) and agitation speed (2 shakes/sec vs. one shake/sec) resulted in significantly different ACT values (p less than .05). The mean matched ACT values determined from different agitation directions (vertical vs. horizontal) or the use of a stepper pipette to measure test volume vs. visual estimation of test volume were not significantly different. Variability in ACT test results is significantly increased by variations in test volume or agitation (speed and direction), intermachine variability, and by interpersonnel technique. These variables should be considered when devising protocols for ACT monitoring and management of heparin therapy.

Animals↗
PubMed1987

Apparent inconsistent theophylline absorption from sustained release capsules.

Sustained release theophylline products can improve compliance and symptom control in children with asthma. This study examines theophylline serum concentration monitoring in pediatric patients. Fifteen children with documented asthma were randomized to receive either Slo-bid Gyrocaps or Theo-dur Sprinkle for 1 month, and then crossed over to the other product. On the last day of each study period, theophylline serum concentrations were obtained prior to the morning dose and 4 hours later. In two patients receiving Theo-dur Sprinkle and six with Slo-bid Gyrocaps, the 4-hour serum concentration was lower than the pre-dose concentration. The change between the pre-dose and post-dose serum concentrations for Theo-dur Sprinkle ranged from a decrease of 2.8 mg/L to an increase of 4.9 mg/L, and, for Slo-bid Gyrocaps, from a decrease of 4.6 mg/L to an increase of 10.5 mg/L. The inconsistent theophylline absorption with each product makes dosage adjustment difficult.

Absorption↗
PubMed1987

Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine.

In a prospective study we compared propranolol, placebo, and self-hypnosis in the treatment of juvenile classic migraine. Children aged 6 to 12 years with classic migraine who had no previous specific treatment were randomized into propranolol (at 3 mg/kg/d) or placebo groups for a 3-month period and then crossed over for 3 months. After this 6-month period, each child was taught self-hypnosis and used it for 3 months. Twenty-eight patients completed the entire study. The mean number of headaches per child for 3 months during the placebo period was 13.3 compared with 14.9 during the propranolol period and 5.8 during the self-hypnosis period. Statistical analysis showed a significant association between decrease in headache frequency and self-hypnosis training (P = .045). There was no significant change in subjective or objective measures of headache severity with either therapy.

Analysis of Variance↗
PubMed1985

Intravenous KCl supplementation in pediatric cardiac surgical patients.

A total of 31 pediatric cardiac patients (mean age 19 1/2 months) who required surgery for repair of various congenital heart defects were prospectively studied in the postoperative period to determine potassium (K) dose-response characteristics. All patients received supplementary K when the serum K was less than 4.0 meq/liter. A total of 100 administrations of intravenous potassium chloride (KCl) were evaluated. KCl, 0.5 meq/kg, was infused over 2 h by syringe pump. This infusion was repeated as necessary to achieve a serum K greater than or equal to 4.0 meq/liter. The KCl was administered in addition to the K in the patients' maintenance solution. Blood samples for serum K determination were collected 15-30 min before and after the KCl infusion. The mean K dose administered was 0.72 +/- 0.23 meq/kg. This produced a mean rise in serum K of 0.61 +/- 0.48 meq/liter. Of 100 administrations, 11 resulted in no change or a decrease in serum K. Four of 100 administrations resulted in serum K greater than 5.0 meq/liter. Intravenous KCl supplementation in a dose of 0.5 meq/kg administered over 2 h is safe and effective for pediatric postoperative cardiac patients. Serum K should be measured to monitor therapy, due to variable response.

Adolescent↗
PubMed1985

Comparison of nebulized terbutaline and subcutaneous epinephrine in the treatment of acute asthma.

Nineteen children who presented for treatment of acute asthma symptoms were studied. They were randomized to receive either subcutaneous epinephrine 0.01 mg/kg (0.3 mg maximum) or nebulized terbutaline 1 mg in 2 mL normal saline. The drugs were administered using the double-blind method. Each patient received either subcutaneous epinephrine with concurrent nebulized normal saline or nebulized terbutaline with a concurrent subcutaneous injection of normal saline. Depending on the patient's clinical status, up to three doses of the same drug and placebo were administered. Pulmonary functions (FEV1, FVC, FEF25-75), heart rate, respiratory rate, and pulmonary index were obtained before treatment, at 20 minutes, and at one hour after the final treatment. Except for the baseline respiratory rate, the mean number of treatments, pulmonary index, heart rate, and respiratory rate (at 20 minutes and one hour) were not statistically different. Pulmonary functions were not significantly different at any time. The one-hour post-treatment pulmonary functions (percentage of predicted normal) for terbutaline and epinephrine were FEV1, 49.2 +/- 18.4% and 49.4 +/- 16.9%; FVC, 72.7 +/- 23.4% and 62.7 +/- 21.6%; and FEF25-75, 31.8 +/- 18.6% and 39.0 +/- 12.2%, respectively. The data presented support our hypothesis that terbutaline by nebulization is at least as effective as epinephrine in the management of children with similar degrees of pulmonary obstruction.

Acute Disease↗