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D R Mottram

Publications and source records attributed to D R Mottram.

At least 19 recordsLinked to original sources
PubMed2006

Adverse drug reactions in hospital in-patients: a pilot study.

BACKGROUND: About 6.5% of admissions to hospital are related to an adverse drug reaction (ADR). There are no recent large studies, which explore the burden of ADRs on hospital in-patients. The aim of this pilot study was to assess the feasibility of, and establish the methodology for, conducting a large prospective study to fully assess the impact of ADRs on in-patients and the National Health Service (NHS). METHODS: Patients admitted to five wards in a university hospital over a 2-week period were assessed for ADRs through a daily ward visit by a pharmacist. Suspected ADRs were analysed for causality, severity and avoidability using appropriate scales. RESULTS: Twenty-four of 125 patients (19.2%, 95% CI 12-26%) were categorized as having suffered one or more ADRs. A total of 27 ADRs were identified. Patients with ADRs spent longer in hospital than those without ADRs. Causality assessment showed that 17 (63%) ADRs were possibly drug-related, whereas 10 (37%) were classified as probably or definitely related to the drug. Almost two-thirds of reactions were potentially avoidable. Intervention was required in all ADRs and reactions indirectly contributed to the death of two patients. CONCLUSIONS: Almost one-fifth of patients suffered an ADR as an inpatient. Methodology tested using this pilot will enable the design of a larger study, involving over 3000 patients, which will allow the ADR burden and vulnerable patient groups, to be more accurately characterized. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Physiological, subjective and performance effects of pseudoephedrine and phenylpropanolamine during endurance running exercise.

The aim of the study was to assess the effect of maximal therapeutic dosing of sympathomimetic amines found in over-the-counter (OTC) decongestant preparations on endurance running. Following familiarisation and a graded exercise test to determine maximal oxygen uptake (VO2 max), trained male runners (n = 8) completed four exercise sessions each separated by a minimum of one week. Each session was comprised of 20 min of sub-maximal treadmill running (70 % VO2 max) followed by a 5,000-m time trial on the treadmill under drug, placebo or control conditions. Drugs were administered in their commercial format over the 36-hour period prior to testing in the manufacturer's recommended maximal doses (i. e. 25 mg of phenylpropanolamine and 60 mg of pseudoephedrine four times daily). During sub-maximal endurance running no statistical differences were observed in heart rate, VO2, minute ventilation, respiratory exchange ratio, blood lactate, glucose or non-esterified fatty acids (NEFA) or ratings of perceived exertion with respect to the treatment administered. Similarly there were no statistical differences according to the condition during the 5,000-m running time trial, in terms of heart rate, ratings of perceived exertion, time of completion and pre and post exercise blood lactate, glucose or NEFA. The results indicate that in maximal, multiple therapeutic doses both pseudoephedrine or phenylpropanolamine as present in common OTC decongestant formulations do not affect, nor possess any ergogenic properties with regard to, endurance running.

Adult↗
PubMed2003

Over-the-counter drug use amongst athletes and non-athletes.

AIM: Many over-the-counter (OTC) drugs used in the symptomatic relief of upper respiratory tract (URT) conditions are banned by sports governing bodies. It would appear therefore that athletes are being penalised for practising conventional pharmacological methods in the management of common ailments. The aim was to identify any differences between athletes and non-athletes and amongst athletic groups, with respect to the prevalence of URT conditions and the use of OTC drugs to treat such conditions. METHODS: Questionnaires were distributed at domestic and international athletics meetings and at university lectures and tutorials. Respondents (n=401) represented both track and field athletes (n=199) and non-athletes (n=202). RESULTS: No differences were found between athletes and non-athletes and between elite and non-elite athletes in terms of the frequency of episodes of URT conditions reported in the previous year. A higher proportion of elite, as opposed to non-elite athletes did not take OTC medicines (p=0.028) and of those that did take OTC medicines a higher proportion of elite athletes (68%) as opposed to non-elite (32%) took those not containing sympathomimetics, banned by the International Olympic Committee (IOC). Athletes were found to have greater knowledge of IOC banned OTC drugs (p=0.002) and within this group, elite athletes were most knowledgeable (p=0.0003). Although most respondents (81%) believed that OTC drugs should not be prohibited in sport, athletes made up the greatest proportion in support of prohibition (23.5% as opposed to 14.4% of non-athletes) with elite as opposed to non-elite most in favour (p=0.0181). CONCLUSION: These results suggest that URT conditions are no more prevalent between athletes and non-athletes or between endurance and power athletes. Athletes competing at the highest level tended to avoid OTC medicines or those containing IOC banned drugs and were most knowledgeable in terms of banned OTC drugs and most in favour of their prohibition suggesting that the control mechanisms in place are only reaching elite athletes.

Adult↗
PubMed2001

Attitudes and knowledge of hospital pharmacists to adverse drug reaction reporting.

AIMS: To investigate the attitudes of UK hospital pharmacists towards, and their understanding, of adverse drug reaction (ADR) reporting. METHODS: A postal questionnaire survey of 600 randomly selected hospital pharmacists was conducted. RESULTS: The response rate was 53.7% (n = 322). A total of 217 Yellow Cards had been submitted to the CSM/MCA by 78 (25.6%) of those responding. Half of those responding felt that ADR reporting should be compulsory and over three-quarters felt it was a professional obligation. However, almost half were unclear as to what should be reported, while the time available in clinical practice and time taken to complete forms were deemed to be major deterrents to reporting. Pharmacists were not dissuaded from reporting by the need to consult a medical colleague or by the absence of a fee. Education and training had a significant influence on pharmacists' participation in the Yellow Card Scheme. CONCLUSIONS: Pharmacists have a reasonable knowledge and are supportive of the Yellow Card spontaneous ADR reporting scheme. However, education and training will be important in maintaining and increasing ADR reports from pharmacists.

Adult↗
PubMed2000

Adverse drug reactions as a cause of admission to an acute medical assessment unit: a pilot study.

BACKGROUND: In this pilot study, we have investigated the frequency of adverse drug reaction (ADR)-related admissions to an acute medical assessment unit. Although ADRs are thought to be responsible for 5% of hospital admissions, there have been no recent studies in the U.K. OBJECTIVE: To pilot such a study for estimating the incidence of ADR-related admissions to an acute medical assessment unit. METHOD: Data were collected for 200 patients including details of concurrent illness, drug usage and reasons for admission. ADRs were assessed for causality using two previously published classification systems. RESULTS: ADRs were responsible for admission in 15 (7.5%) patients, were present in an additional three (1.5%) patients and may have contributed to the deaths of two (1%) patients. Of the 15 ADRs suspected of causing an admission, three were considered to be 'possible' or 'unlikely', with the remaining 12 considered to be 'probable' or 'certain'. The proportion of patients identified in this study with ADR-related admissions is either similar to or larger than that found in comparable studies carried out in other hospitals. Nearly all ADRs were Type A reactions in that they were predictable and therefore potentially preventable. CONCLUSION: This study suggests that the proportion of ADR-related admissions has not decreased in the last decade and, given the increasing numbers of acute medical admissions, the absolute numbers may have actually increased. Furthermore, the nature of drugs causing admissions has not changed substantially over the last 20 years. Strategies to reduce the burden of ADR-related admissions are urgently needed.

Adolescent↗
PubMed2000

Anabolic steroids.

Anabolic steroids are synthetic derivatives of testosterone modified to enhance the anabolic rather than the androgenic actions of the hormone. The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis. There are numerous side-effects to anabolic steroids, including hypertension and atherosclerosis, blood clotting, jaundice, hepatic carcinoma, tendon damage, psychiatric and behavioural effects and, in males, reduced fertility and gynaccomastia. Anabolic steroids were added to the International Olympic Committee's list of banned substances in 1975. The majority of 'evidence' concerning the efficacy of anabolic steroids as performance enhancing agents is anecdotal. In the main, experimental investigations have been poorly designed scientifically, clinically and statistically. The percentage of positive test results from IOC accredited laboratories has remained consistently low. However, athletes take their steroids during training and out-of-competition testing is not conducted in all countries, although international co-operation is now under consideration. Despite the lack of conclusive evidence, steroids users will continue to hold the view that their effects are efficacious and they are therefore unlikely to be persuaded to curtail their use.

Anabolic Agents↗
PubMed1999

Communication regarding adverse drug reactions between secondary and primary care: a postal questionnaire survey of general practitioners.

GPs are not always informed that their patient suffered an adverse drug reaction (ADR) while in hospital. We have conducted a postal questionnaire survey of 270 GPs in order to elicit their views regarding provision of information from secondary care regarding ADRs. Of the 141 (52.2%) GPs that replied, 127 (90.1%) saw patients that had experienced an ADR in hospital. Of these GPs, 113 (89%) stated that they encountered instances where no record of the ADR existed in patients' discharge documentation. Where written information was absent, GPs are reliant on information given to them by patients. Of those responding, none were 'very confident' of this information, while 92 (78.6%) were 'uncertain' or 'very uncertain' of this information. A sample notification form was developed. GPs were generally satisfied with its content and 110 (82.7%) thought that patients should receive a copy. Almost all GPs (135 (97.8%)) felt that it would be appropriate to provide patients with ADR warning cards. Ensuring that patients and their carers are aware of drugs to which they may be allergic or intolerant through verbal and written methods should minimize the unnecessary risks of inadvertent re-exposure.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Banned drugs in sport. Does the International Olympic Committee (IOC) list need updating?

The International Olympic Committee (IOC) published the first list of doping classes in 1967. Since that time, there have been significant problems associated with doping control in sport. Sport is a high profile, internationally recognised activity. However, operational inconsistencies exist between countries and between sports federations. Endogenous substances, such as testosterone, human growth hormone (hGH) and erythropoietin (Epo) present particular problems in determining what constitutes 'normal' levels in athletes. In addition, there is no reliable method available for the detection of hGH and Epo through urine testing. Athletes continue to test positive for banned drugs that are available over-the-counter despite their having been taken inadvertently, without intent to enhance performance. Marijuana use is becoming widespread in society and the impact of this in sport is becoming evident. Doping control, through the IOC list, must continue as a primary objective for the IOC and the sports federations. Constant vigilance and a continued willingness to respond rapidly to change is a prerequisite for such a list. The IOC appears to recognise this need. There are, however, more fundamental issues to be considered. The concept of doping control must be supported by high quality research, effective education and international collaboration. More research is needed into the factors which induce an athlete to take drugs and into the effect, if any, that education on drugs is having on competitors. The most important area for change is the overriding need for international collaboration between the IOC, governments and sports federations. This applies to uniformity in the rules and regulations, consistency in the application and level of sanctions and cooperation on the dissemination of information and development of education policies.

Doping in Sports↗
PubMed1998

Prescribing of ACE inhibitors for cardiovascular disorders in general practice.

OBJECTIVE: To investigate the prescribing patterns for angiotensin converting enzyme (ACE) inhibitors in the management of patients with heart failure and other cardiovascular disorders as part of a local project on heart failure using information collected from a Primary Care Information Initiative. METHOD: Patients from a large city-centre practice, who were receiving an ACE inhibitor or with a diagnosis of heart failure at the time of the study, were identified from medical records. Details of concomitant medical conditions and drug treatment were also recorded. RESULTS: There was extensive prescribing of ACE inhibitors alone, in the treatment of patients with hypertension, where no contraindications for the use of thiazide diuretics or beta-blockers could be identified. ACE inhibitors were being prescribed for post-myocardial infarction patients, but the time for the initiation of treatment was rarely within that recommended in the literature. For those patients diagnosed with heart failure, 60% were not being treated with ACE inhibitors even where there were no contraindications. CONCLUSION: It is clear from the results of this study that overall prescribing patterns for ACE inhibitors are not always in accord with evidence from the literature. These findings provide valuable information for the initiation and development of clinical guidelines for prescribers.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Comparative evaluation of patient information leaflets by pharmacists, doctors and the general public.

This study was undertaken to compare and contrast the views of pharmacists, general practitioners (GPs) and the general public on the value or otherwise of pharmacy-generated patient information leaflets. All three groups perceived these leaflets to be useful and an aid to improving compliance. Concerning the information included in leaflets, GPs rated the inclusion of a section on side-effects as being the least important, whilst pharmacists and the general public rated information on the storage of medicines as being least important. Pharmacists' estimates on what percentage of patients actually read leaflets were significantly lower than estimates by the general public. General practitioners and pharmacists generally concurred on the types of patients for whom leaflets are considered unsuitable, although a significantly higher percentage of pharmacists than GPs identified unsuitable patients. There were reservations by the pharmacists concerning the cost-effectiveness of leaflet facilities and on the value of leaflets compared with verbal counselling. The general public expressed the view that a leaflet facility would affect their choice of pharmacy and that they would be prepared to wait an additional short time to receive such a leaflet. Almost all GPs thought that it was in the patient's best interest to receive an information leaflet.

Adolescent↗
PubMed1990

Intra-habenular injection of 6-hydroxydopamine produces impaired acquisition of DRL operant behavior.

The anatomical connections of the habenula complex indicate it provides a relay between limbic forebrain and midbrain. Somewhat paradoxically, consequences of nonspecific lesion of the habenula are ambiguous with little change in basic response evident within simple behavioral paradigms. However, the potential functional importance for this relay has more recently been indicated by the demonstration of deficits in the ability of lesioned animals to alter behavior appropriate to both internal and external stimuli in more demanding behavioral tasks. Doubts concerning the importance of the habenula remain because of the large number of descending fibers of passage through the habenula. To provide more substantive evidence, 6-hydroxydopamine was injected into the habenula of rats to provide more limited lesion of catecholaminergic terminals. Animals were subsequently trained on an operant DRL 20-s schedule for which deficits have been reported following nonspecific lesion of the habenula. Lesioned animals showed a tendency to overrespond and were significantly less efficient on the schedule with decreased number of reinforcements received relative to controls. While the neurotoxic lesion procedure used does not differentiate noradrenergic and dopaminergic damage, the importance of intact catecholaminergic systems within the habenula for effective DRL acquisition is consistent with the suggested importance of the habenula for feedback regulation of dopamine within the ventral tegmental area through ascending dopamine fibers to the habenula.

Animals↗
PubMed1988

Agonists at presynaptic receptors on sympathetic nerves differentially affect two phases of the contractile response in the rat vas deferens.

A series of adrenoceptor agonists were investigated for their prejunctional effects on field stimulated rat vas deferens. Tissues were stimulated in 10 s trains of impulses, frequency 10 Hz, every 100 s. This produced a biphasic response comprising an initial twitch followed by a prolonged, plateau phase of contraction. The order of potency for a series of alpha 2-agonists against the twitch phase of contraction was UK14304 greater than clonidine greater than noradrenaline = alpha-methyl noradrenaline greater than B-HT920. The same order of potency was observed against the plateau phase, but approximately 10 fold higher concentrations of agonist were needed. Surprisingly, B-HT920 was inactive against the plateau phase of contraction. Characteristic differences in the slopes and maximum responses of the dose-response curves to the imidazolines (UK14304 and clonidine) and the beta-phenethylamines (noradrenaline and alpha-methyl noradrenaline) were seen against both phases of contraction. It is concluded that the two phases of contraction are influenced by activation of two distinct heterogeneous populations of prejunctional alpha 2-adrenoceptors.

Adrenergic alpha-Agonists↗
PubMed1985

Cirazoline, an alpha 2-adrenoceptor antagonist in guinea-pig ileum.

Prejunctional effects of cirazoline have been investigated in guinea pig ileum. At high concentrations cirazoline has been shown to have antimuscarinic activity, pA2 5.25 +/- 0.29. At concentrations below those producing blockade of acetylcholine, cirazoline blocks the prejunctional alpha 2-adrenoceptor activity of clonidine, pA2 6.81 +/- 0.22, and alpha-methylnoradrenaline. Results are discussed in the light of controversial evidence for the activity of cirazoline on alpha-adrenoceptors.

Acetylcholine↗
PubMed1984

The action and interaction of beta-phenethylamines and imidazolines on prejunctional alpha 2-adrenoceptors of guinea-pig ileum in the presence of the non-competitive antagonist benextramine.

The effects of benextramine, a selective non-competitive, irreversible antagonist of alpha-adrenoceptors, against alpha 2-adrenoceptor agonists has been investigated in isolated field-stimulated guinea-pig ileum. Benextramine was equipotent against the imidazoline, clonidine and the thiazoloazepine B-HT920, however, higher concentrations of benextramine were required for an equivalent non-competitive antagonism of the beta-phenethylamine, alpha-methylnoradrenaline. Using benextramine to differentially block the agonist effects of clonidine but not alpha-methylnoradrenaline it was shown that clonidine can competitively antagonize the effects of alpha-methylnoradrenaline. From these and previous results on the differential effects of imidazoline-like and beta-phenethylamine-like drugs on alpha 2-adrenoceptors, it is proposed that two distinct populations of these receptors exist.

Adrenergic alpha-Agonists↗
PubMed1983

Pre-junctional alpha 2-adrenoceptor activity of B-HT920.

An in-vitro study has been carried out on the pre-junctional alpha 2-adrenoceptor activity of the thiazoloazepine derivative B-HT 920 (6-allyl-2-amino-5,6,7,8-tetrahydro-4H-thiazolo[4,5-d]-azepine) using field-stimulated rat vas deferens and guinea-pig ileum. The alpha 2-selective agonists clonidine (an imidazoline derivative) and alpha-methyl noradrenaline (a beta-phenethylamine derivative) were compared. Results show that B-HT 920 is a potent agonist on pre-junctional alpha 2-adrenoceptors and is competitively antagonized by the selective alpha 2-adrenoceptor antagonist yohimbine. The characteristics of the pharmacological responses obtained with B-HT920 indicate that it interacts with the receptor in an imidazoline-like, rather than a beta-phenethylamine-like, manner.

Adrenergic alpha-Agonists↗
PubMed1983

Pharmacological evidence for high affinity and low affinity a2-adrenoceptor binding sites in rat vas deferens.

Differential antagonistic activity against imidazoline- and phenethylamine-induced inhibition of field stimulated rat vas deferens is described. Competitive antagonism of the imidazolines, chlonidine and B-HT 920, was produced by the a2-selective antagonists yohimbine and phentolamine, whereas, only partial antagonism of a-methyl noradrenaline and adrenaline was observed. Higher concentrations of yohimbine (above 2 microM) and phentolamine (above 20 microM) failed to produce a further shift in the dose-response curves of these agonists. The rate of recovery of the twitch response following clonidine- or B-HT 920-induced inhibition was very slow, even after repeated washing of the tissue. On the other hand recovery following a-methyl noradrenaline or adrenaline was extremely rapid. The present results provide pharmacological evidence in support of the previously proposed existence of high and low affinity binding site on the a2-adrenoceptor.

Animals↗