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Biomedical subjects

D M Cummings

Publications and source records attributed to D M Cummings.

49 records · Page 3Linked to original sources
PubMed1986

Nonsteroidal anti-inflammatory agents: an update.

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide potent analgesic, anti-inflammatory activity as a result of their inhibition of prostaglandin synthesis. They are highly bound to plasma proteins and have half-lives that vary from two hours to more than 24 hours. While gastrointestinal reactions are well known, the renal and hepatic toxicities of NSAIDs have only recently been characterized. Elderly patients in general may be at risk of toxicity and should be evaluated frequently.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

The effect of tolmetin on the chronic pain and decreased functional capacity associated with degenerative joint disease.

Degenerative joint disease (DJD) is a common disorder characterized by chronic pain and limitation of activity, for which treatment with a nonsteroidal anti-inflammatory drug (NSAID) is often useful. The anti-inflammatory activity of the NSAID tolmetin sodium has been well described, being comparable in efficacy to indomethacin and effective for the relief of the acute and chronic symptoms that accompany DJD. To examine specifically the effect of tolmetin in controlling the pain and functional limitation in DJD of the spine, tolmetin was tested against placebo in a double-blind, two-segment, crossover study. Twenty-six patients (mean age, 62.5 years; range, 42-79 years) received three weeks of tolmetin 1,200 mg/d and three weeks of placebo. The results showed that tolmetin provided significantly greater relief of symptoms than placebo in virtually all measurements of joint pain and stiffness: tenderness, pain at rest, pain on motion, intensity of joint pain (P less than 0.001), and duration of morning stiffness (P = 0.002). Statistically significant improvement was noted in two of the three measures of cervical range of motion (P less than or equal to 0.01) and in all assessments of daily living activities (P = 0.001 in four parameters; P = 0.02 in a fifth parameter). Global evaluations of response to treatment by both patients and investigator also demonstrated significant effects (P less than or equal to 0.002). Significantly more placebo patients (13 of 26) than tolmetin patients (two of 26) found the medication ineffective and discontinued treatment prematurely (P = 0.01). No serious or limiting adverse reactions were seen during placebo or tolmetin therapy. The most frequently reported side effects on both therapies were gastrointestinal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Antihypertensive drug withdrawal syndrome.

After discontinuation of antihypertensive medications, patients may experience symptoms associated with catecholamine excess, with or without a rapid rise in blood pressure; this is referred to as antihypertensive drug withdrawal syndrome. Though most often associated with the discontinuation of clonidine, this syndrome has been reported to follow the withdrawal of many other antihypertensives. Proposed mechanisms for the syndrome, depending on the drug involved, include enhanced activity of (1) the sympathoadrenal system, (2) the renin-angiotensin-aldosterone system, and (3) the thyroid hormones. The typical patient at risk is a younger person with severe hypertension, who has been on multiple drugs in high doses for a long period. Guidelines are provided for minimizing the occurrence of the syndrome and for treating the reaction, should it occur.

Adrenergic beta-Antagonists↗
PubMed1975

Radiometric detection of the metabolic activity of Mycobacterium tuberculosis.

A radiometric test capable of detecting the metabolic rate of M. tuberculosis within 18 hr after inoculation has been developed. The technique is based on the measurement of 14CO2 produced by the bacterial metabolism of 14C-U-glycerol of 14C-U-acetate. The test is an important first step in the development of rapid radiometric techniques for clinical study of Mycobacterium tuberculosis.

Bacteriological Techniques↗
PubMedDate not supplied

Predictors of screening mammography: implications for office practice.

BACKGROUND: The completion of annual screening mammography and other preventive health services among women aged 50 years and older remains an important quality of care indicator. METHODS: A biracial sample of 843 rural women (aged > or =50 years) from a population-based sample reported demographic and preventive health services utilization in the last year including the completion of screening mammography. Bivariate analysis and logistic regression were used to investigate the extent to which completion of other screening examinations, including Papanicolaou (Pap) smears and clinical breast examination, is associated with successful completion of mammography relative to demographic and health service variables. RESULTS: The completion of mammography was associated with age, race, education, health insurance, and the presence of a regular primary care physician, but the strongest predictors were the completion of a clinical breast examination and/or a Pap smear. CONCLUSIONS: Women who receive a clinical breast examination and/or a Pap smear appear far more likely to receive screening mammography, suggesting a synergy in screening services. The relative efficacy of interventions to increase the completion of clinical breast examinations as well as other age-appropriate preventive services during routine office visits or during a single preventive services office visit should be further explored in primary care settings. Residency programs should provide training on the successful incorporation of such services into office practice patterns in an effort to continually improve quality of care.

Aged↗
PubMedDate not supplied

Are some subjects better taught in block rotation? A geriatric experience.

BACKGROUND AND OBJECTIVES: This study characterizes the progress in and effectiveness of learning geriatric medicine during longitudinal and block phases of a family practice residency program. METHODS: A structured second-year geriatric block rotation was added to a residency longitudinal curriculum. To assess learning, a Geriatric Assessment Instrument (GAI) consisting of 50 multiple choice questions was administered to three classes offamily practice residents (n=33)five times during training: entry into the program, beginning of the second year, pre- andpost-geriatric block rotation, and at graduation. Improvement between individual residentfirst- and third-year in-training exam scores in geriatrics of the intervention classes were compared with the four classes that preceded the introduction of the block rotation (n=38). RESULTS: Scores on the GAI improved significantly before and after the rotation but not during any other interval of training during the residency. In-training exam scores improved significantlyfor the classes taught with the block rotation over those without it. CONCLUSIONS: Most of the geriatric learning occurred during the 1-month geriatric block rotation during the residency. In-training geriatric exam scores improved significantly with a geriatric block rotation. The use of structured repetitive learning experiences during the rotation to emphasize the common clinical issues and the skewed exposure to geriatric patients in the random nature of residency clinic and inpatient encounters accountfor this result.

Aged↗
PubMedDate not supplied

Office-based evaluation of renal function in elderly patients receiving nonsteroidal anti-inflammatory drugs.

Elderly patients with multiple diseases who are receiving diuretics are at risk for renal dysfunction from nonsteroidal anti-inflammatory drugs (NSAIDs). Fifty-two elderly patients (mean age = 72 years, range = 63-87 years) with degenerative joint disease and multiple concomitant illnesses were randomly selected to receive ibuprofen suspension (400 mg) or aspirin (650 mg) 4 times a day. Serum creatinine (Cr), blood urea nitrogen (BUN), weight, and blood pressure were measured at baseline and at weekly intervals for 6 weeks. There were no significant changes from baseline in any tests reflective of renal function, no significant differences between ibuprofen and aspirin, and no influence of concomitant diuretic therapy. Ibuprofen and aspirin administered in the doses examined for 6 weeks appear to have little effect on renal function as measured by serum Cr and BUN in a sample of elderly patients for whom these drugs are commonly employed. Concomitant diuretic therapy does not appear to increase the risk. While these drugs are contraindicated in patients with severe hemodynamic insult, they should not be withheld from elderly patients who require this therapy for analgesic/anti-inflammatory effects because of concern for renal impairment. Further prospective research should be undertaken to clarify levels of patient risk and to define appropriate monitoring in such patients.

Aged↗
PubMedDate not supplied

Failure of prostatitis treatment secondary to probable ciprofloxacin-sucralfate drug interaction.

Metal cations such as aluminum, magnesium, ferrous sulfate, and zinc are thought to form chelation complexes with fluoroquinolone antibiotics and prevent the drugs from being absorbed. Sucralfate, which has a high aluminum content, reduces the bioavailability of ciprofloxacin to approximately 4%. The concomitant administration of ciprofloxacin and sucralfate resulted in treatment failure for a patient with prostatitis and a subsequent 5-day hospitalization. Fluoroquinolone antibiotics should be administered at least 2 hours before agents containing metal cations to allow for their absorption. In addition, sucralfate should not be administered less than 6 hours before fluoroquinolone antibiotic administration.

Adult↗