Biomedical subjects

D T Kennedy

Publications and source records attributed to D T Kennedy.

At least 19 recordsLinked to original sources

PubMed2001

Results of a community pharmacy-based breast cancer risk-assessment and education program.

We tested the hypothesis that an education program addressing breast cancer screening schedules and modalities coupled with a breast cancer risk assessment provided by community pharmacists can increase women's confidence in performing screening practices endorsed by the American Cancer Society (ACS). This randomized, paired, pre-post study was conducted in six community pharmacies and two health-screening fairs; subjects were 140 women over 18 years of age. The pharmacist-administered program used the Breast Cancer Risk-Assessment Tool (Gail model) software provided by the National Cancer Institute of the National Institutes of Health. In addition, pharmacists provided education and training on breast self-examination (BSE), clinical breast examination (CBE), and mammography. Adherence to ACS guidelines for monthly BSE increased from 31% to 56% (p<0.001) for all women 6 months after the program. Performance of monthly BSE by women considered at high risk for developing breast cancer increased from 20% to 60% (p<0.005). The mean number of BSEs performed over 6 months increased from 2.69 to 4.09 (p<0.001). Women's confidence performing correct BSE improved from 6.41 to 7.04 (p<0.001) on a scale of 0-10. Adherence to ACS guidelines for CBE and mammography did not reveal statistically significant improvements except for better adherence to CBE in women aged 40-49 years (81% to 97%, p<0.025). The strength of the pharmacists' intervention may not appear as manipulation of high-risk patients' behavior but as improvement of self-directed behaviors, such as BSE, across all age groups.

Adolescent↗

PubMed2001

Role of coenzyme Q10 in chronic heart failure, angina, and hypertension.

PURPOSE: Coenzyme Q10 (CoQ10) has a pathophysiologic role in many disease states. The purpose of this review is to provide recommendations regarding the safety, efficacy, and dosing of CoQ10 in the management of chronic heart failure (CHF), angina, and hypertension. DATA SOURCES: Literature pertaining to the safety and efficacy of CoQ10 specifically in cardiovascular indications was reviewed. We used relevant clinical trials, articles, reviews, and letters that were selected from a literature search of the MEDLINE database (1974-2000), Micromedex Healthcare Series, and the Natural Medicines Comprehensive Database. FINDINGS: Coenzyme Q10 administered orally has favorable actions in the described cardiovascular conditions and appears to be safe and well tolerated in the adult population. Issues concerning optimum target dosages, potential interactions, monitoring parameters, and the role of CoQ10 as a monotherapeutic agent need to be investigated further. Favorable effects of CoQ10 on ejection fraction, exercise tolerance, cardiac output, and stroke volume are demonstrated in the literature; thus, the use of CoQ10 as adjuvant therapy in patients with CHF may be supported. CONCLUSIONS: Coenzyme Q10 therapy in angina and hypertension cannot be substantiated until additional clinical trials demonstrate consistent beneficial effects. However, CoQ10 may be recommended as adjuvant therapy in selected patients with CHE At this time, CoQ10 should not be recommended as monotherapy or first-line therapy in any disease state.

Angina, Unstable↗

PubMed2000

Pharmacists' knowledge and attitudes toward herbal medicine.

OBJECTIVE: The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications. METHODS: A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion. RESULTS: Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacist's professional responsibility (p = 0.02 and p = 0.01, respectively). CONCLUSIONS: The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.

Adult↗

PubMed2000

Cost-effectiveness of sevelamer versus calcium carbonate plus atorvastatin to reduce LDL in patients with chronic renal insufficiency with dyslipidemia and hyperphosphatemia.

We conducted a cost-effectiveness analysis to compare costs and clinical outcomes of sevelamer versus calcium carbonate plus atorvastatin for treatment of dyslipidemia in patients with chronic renal insufficiency. The model was from the third-party payer perspective. Efficacy and adverse event rates for each regimen were obtained from published clinical trials. Drug costs were based on average wholesale prices; monitoring costs were based on Medicare reimbursement rates. Our model suggests that the combination of calcium carbonate plus atorvastatin is substantially more cost-effective than sevelamer in reducing low-density lipoprotein (LDL) in these patients. One-way sensitivity analyses were performed to assess if 25% and 50% price reductions in sevelamer affected overall cost-effectiveness results. A 50% sevelamer price reduction was less expensive than combination therapy but remained less cost-effective. A two-way sensitivity analysis on the probability that a patient achieves the goal of a 35% LDL reduction resulted in calcium carbonate plus atorvastatin remaining more cost-effective. Further cost-effectiveness studies are necessary to corroborate our data.

Atorvastatin↗

PubMed2000

Evaluation of echinacea for treatment of the common cold.

Considered to have immunostimulating activity, echinacea is a widely used phytomedicinal for treatment of the common cold and upper respiratory tract infections (URTIs). We reviewed the literature from the MEDLINE database (January 1966-July 1999), International Pharmaceutical Abstracts (IPA) online database, Cambridge Scientific Abstracts Biological Sciences online database, Alt-Health Watch online database, EMBase CD-ROM database, and references from published articles, reviews, and letters to evaluate evidence from clinical trials of echinacea's purported efficacy for treating or preventing URTIs. Twelve clinical studies published from 1961-1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URTI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodologic uncertainties, such as small populations and use of noncommercially available, nonstandardized dosage forms. Although evidence for echinacea's efficacy is inconclusive, it appears to be safe. Patients without contraindications to it may not be dissuaded from using an appropriate preparation to treat the common cold.

Clinical Trials as Topic↗

PubMed1998

Selection of peak flowmeters in ambulatory asthma patients: a review of the literature.

The National Asthma Education and Prevention Program recently published updated guidelines that stress the importance of peak flow monitoring for patients with moderate-to-severe persistent asthma. In this specific patient population, a peak flowmeter provides a simple, quantitative, objective measurement of large airway function. The purpose of this article is to describe indications for peak flow monitoring in asthmatic patients, review technical requirements for peak flowmeters as described by the National Heart, Lung, and Blood Institute, and evaluate the literature on commercially available peak flow devices to aid the health professional in selecting an appropriate meter for the patient with moderate-to-severe persistent asthma.

Asthma↗

PubMed1996

Azathioprine and allopurinol: the price of an avoidable drug interaction.

OBJECTIVE: To report the price of a drug interaction between azathioprine and allopurinol that resulted in pancytopenia in a patient who had undergone a heart transplant. CASE SUMMARY: A 63-year-old white man who received an orthotopic heart transplant in 1987 was hospitalized in June 1991 with a diagnosis of pancytopenia. His immunosuppressive medications on admission included cyclosporine 125 mg bid, azathioprine (AZA) 200 mg/d, and prednisone 2.5 mg/5 mg every other day. Six weeks prior to admission, the patient's local physician prescribed allopurinol for left wrist pain suspected to be gout. It was determined that the pancytopenia was caused by the drug interaction between AZA and allopurinol, both of which were withheld on admission. During hospitalization, the patient's white blood cell count dropped to 1.1 x 10(3)/mm3 with an absolute neutrophil count of less than 0.5 x 10(3)/mm3, a platelet count of less than 20 x 10(3)/mm3, and a hemoglobin of 3.7 g/dL. Four units of packed red blood cells were transfused and regramostim (GM-CSF) therapy was begun on hospital day 3 to speed the marrow recovery process. The patient was discharged on hospital day 8 and AZA, which had been withheld since admission, was restarted. The dosage was titrated to 200 mg/d over the following 2 weeks. The price of this patient's hospital stay was $13,042. DISCUSSION: Not included in this price was the effect this drug interaction had on the patient's quality of life. Even after discharge from the hospital, it was estimated that it would take up to 3 months for the patient to fully recover his previous level of strength and functional capability. This interaction between AZA and allopurinol could easily have been avoided. Both the physician and the pharmacist missed this well-documented and potentially life-threatening drug interaction. Also, the patient failed to notify the transplant team when allopurinol was prescribed by his local physician. The importance of patient responsibility for medication therapy must be stressed to help avoid unnecessary drug interactions. CONCLUSIONS: Undetected drug interactions can be life-threatening to patients as well as costly to the healthcare system. Drug interactions also can have a profound negative effect on the patients' quality of life, the price of which cannot be measured in dollars alone. It is vital that the physician, pharmacist, and patient work together to optimize therapeutic outcomes and avoid unnecessary drug interactions.

Allopurinol↗

PubMed1991

Hygienists and operating auxiliaries: the opinions of New Zealand dental practitioners.

A postal survey was sent to the 1,122 members of the New Zealand Dental Association holding practising certificates in 1989. Replies were received from 53 percent, of whom 80 percent were general dental practitioners, and 45 percent had previously experienced working overseas with hygienists. Only 1 percent of respondents were opposed to any type of auxiliary working in New Zealand. At the time of the survey, 16 percent were already employing auxiliaries under Section 11 of the 1988 Dental Act. Six percent were employing hygienists and 10 percent were employing NZDA operating auxiliaries. A further 16 percent wanted to employ hygienists in the near future and 10 percent would consider employing NZDA operating auxiliaries. Altogether, 42 percent were employing or wished to employ auxiliaries (22 percent hygienist and 19 percent NZDA operating auxiliary). Dentists responding in this survey spent little time pursuing important hygienist-type duties themselves, but indicated that these were the tasks most likely to be delegated to auxiliaries. Most respondents thought that hygienists should be trained in New Zealand, and 60 percent felt the training should be at the School of Dentistry. The majority were of the opinion that the course should last 18-24 months. Eighty-one percent of respondents thought that former school dental nurses required additional training before being allowed to become auxiliaries, and 42 percent thought such additional training should be up to 3 months long and comprise a block course. Eighty-five percent thought there should be an examination at its completion. Approximately one-third of respondents were not prepared to be involved in training a person to perform auxiliary clinical duties.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1978

Auditory nerve fiber response to wide-band noise and tone combinations.

1. Responses of single auditory nerve fibers to combinations of noise and tone were obtained. The results were found to depend on the relative effectiveness of each stimulus when presented alone. 2. When the response rate to one stimulus presented alone was considerably greater than the response rate to the other stimulus presented alone, the more effective stimulus dominated the responses when the two stimuli were combined. The more effective stimulus captured the response of the neuron. Thus, intense noise was found to mask responses to weaker tones, and intense tones were found to mask responses to weaker noise. This masking of the weaker stimulus is thought to enhance the signal-to-noise ratio of the most prominent response component. 3. When the two stimuli had similar effectiveness, complex interactions occurred. When the tone was near best (characteristic) frequency, partial summation effects occured. The tone partially suppressed the responses to the noise if other frequencies were used. Tones above best frequency caused particularly powerful suppression. 4. The bandwidth of the noise was varied somewhat. While bandwidth affected the effectiveness of the noise, it did not affect the types of interactions observed. 5. For a neuron which was essentially silent in the absence of acoustic stimuli, adding a weak level of noise lowered the threshold of responsiveness to the tone.

Animals↗

PubMed1974