PubMed Health⌕ Search

Biomedical subjects

D W Clark

Publications and source records attributed to D W Clark.

At least 19 recordsLinked to original sources
PubMed1992

General practitioners' views on the role of the community pharmacist.

AIM: to determine the views of general practitioners on the roles and activities of community pharmacists. METHOD: the views of 137 general practitioners in Otago and Southland were canvassed by postal questionnaire. RESULTS: one hundred and three completed questionnaires were returned. All of the general practitioners reported that their professional contact with pharmacists was useful. Seventy-five percent expressed a desire for greater cooperation. Nearly all respondents (99%) accepted that pharmacists have a role in screening prescriptions for possible problems and preparing and dispensing medicines. They also accepted that pharmacists were capable of treating and advising in the management of minor illnesses. Providing drug information to general practitioners, information about previously diagnosed conditions to patients, and advice on personal and home hygiene were less widely accepted activities. The majority indicated that they considered it inappropriate for pharmacists to undertake screening programmes (blood pressure (70.6%), cholesterol (70.6%), glucose (60.8%), haemoglobin (72.5%)). Younger general practitioners objected more often than older general practitioners to reclassification of Acetopt eye drops from prescription only to availability through pharmacies (p < 0.05). Female general practitioners were more often in favour of reclassification of Gyno-Daktarin than their male colleagues (p < 0.05). CONCLUSION: this study shows that general practitioners accept several aspects of the current role of pharmacists in providing primary health care. However, there is room for improved communication between general practitioners and pharmacists to ensure optimum patient care.

Adult↗
PubMed1991

Technical aspects of the use of the Russell-Taylor reconstruction nail.

The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is, however, complicated. Some technical difficulties encountered during its use are presented, together with guidance to allow these problems to be avoided.

Adult↗
PubMed1991

Knowledgeable non-compliance with prescribed drugs in elderly subjects--a study with particular reference to non-steroidal anti-inflammatory and antidepressant drugs.

Knowledgeable non-compliance with non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressant drugs was investigated in a community-based sample of elderly people. Everyone 70 years and over living in a defined area and taking one of the above drugs, and at least one other prophylactic or symptomatic drug, was studied. Non-steroidal anti-inflammatory drugs and antidepressant drugs are commonly regarded as symptomatic only and knowledgeable non-compliance is consequently high. They are also regarded as less important than drugs which produce no immediate relief of symptoms but which the patient recognizes as needing to be taken regularly to maintain health. In our study, compliance with non-steroidal anti-inflammatory drugs and antidepressant drugs was highest in those who were compliant with a prophylactic drug and were also taking a symptomatic drug. The greater the number of tablets the patient was taking the more likely he or she was to be compliant with the NSAID. Compliance with NSAIDs and antidepressant drugs requires clear label instructions and the patient knowing the purpose of the medication.

Aged↗
PubMed1990

Medication use in nine year olds: types of medicines used and recall of advice given.

Use of medications was investigated in 819 nine year old children living in Dunedin. Twenty-four percent of the cohort (199 children) were given medications during the week prior to interview, mainly on prescription (68%). The majority of medicines used were said to be for respiratory illnesses and oral antibiotics represented a high proportion of prescribed medicines. Most medicines were obtained through a pharmacy (91%), and side effects were noted by nine percent of those taking medications. Some counselling was recalled with 70% of items although, as recalled by the parent, less than 25% of medicines obtained from pharmacies were dispensed or sold with any advice or instruction. The prescriber must ensure that adequate information is provided for the patient. Pharmacists may reinforce this information and provide additional advice on optimum methods of administration. It is debatable whether antibiotics should be used to the extent indicated by this study.

Child↗
PubMed1990

Treatment of unstable intertrochanteric fractures of the femur: a prospective trial comparing anatomical reduction and valgus osteotomy.

A series of 100 consecutive patients with unstable intertrochanteric fractures were treated by compression hip screw fixation; 55 patients had an anatomical reduction (Group 1) and 45 patients a Sarmiento osteotomy and valgus reduction (Group 2). Group 1 spent an average of 10 days less in hospital than Group 2 (21 days compared with 31 days) (P less than 0.02). They also had a greater chance of returning to their pre-injury accommodation and of achieving their pre-injury walking capability. Radiological failure of fracture fixation, with varus angulation of the femoral head by cutting out of the screw, was seen seven times in Group 1 but only once in Group 2. Anatomical reduction provides better clinical results than valgus osteotomy in the patient with an unstable intertrochanteric fracture stabilized by a compression hip screw. The capacity for failure of fracture fixation is greater, however, in the former. Valgus osteotomy provides a simple means of securing a stable reduction of the fracture which cannot be satisfactorily reduced by closed means.

Aged↗
PubMed1990

First-choice antihypertensive drug use in the Glasgow Blood Pressure Clinic.

The evolution of antihypertensive drug use in the Glasgow Blood Pressure Clinic between 1969 and 1986 was determined, from computerized data, by extracting percentages of new patients prescribed different drugs at their first clinic visit. Prescribing of adrenergic neuron blockers and centrally acting drugs (methyldopa and clonidine) was common in the early years but declined rapidly until, after 1975 and 1980, respectively, it remained at 10% or less. Diuretics, mainly thiazides, were prescribed for 20% of patients in 1969 to a peak of 55% in 1980. beta-Blockers were first used during the early 1970s and their use peaked in 1980, when they were prescribed for over 60% of new patients. They remained a first-choice treatment in more than 40% of patients. Calcium channel blockers were first used in 1980 and by 1986 were prescribed for 15% of new patients. Angiotensin-converting enzyme inhibitors were used from 1982 and in 1986 were prescribed for 7% of new patients. These two classes of drugs are more expensive than older drugs. However, because of their low usage, this did not greatly influence treatment costs up to 1986, as beta-blockers and thiazides remained widely used.

Adrenergic beta-Antagonists↗
PubMed1989

Variability in the elimination of mianserin in elderly patients.

1. Two studies of the elimination of mianserin are reported. 2. In the first study, the oral clearance of mianserin was measured in 15 elderly patients at steady state. In a sub-group of eight patients who completed studies at two different doses there was evidence of enhanced oral clearance at the higher dose. 3. In the second study, the elimination half-life was estimated in 12 patients who were observed to have disproportionately high mianserin concentrations with respect to dose. All had half-lives greater than or equal to 2.5 days with a mean of 6 +/- 2.8 (s.d.) days. In six of the patients the profile of elimination was suggestive of saturable elimination. 4. The sparteine oxidation status was measured in seven of the patients showing slow mianserin elimination. Only one was a 'poor oxidiser' of sparteine, suggesting no concordance with this phenotype. 5. It is concluded that there is marked variability in the elimination of mianserin in elderly patients.

Aged↗
PubMed1989

Treatment of periscaphoid osteoarthritis by Silastic scaphoid implant.

Periscaphoid osteoarthritis may arise de novo or as a sequel of an established non-union of a scaphoid fracture. The treatment of resultant pain and disability often presents a difficult problem since internal fixation and/or bone grafting of the pseudoarthrosis may fail to relieve the symptoms due to degenerative change. Many methods of alleviating these symptoms have been suggested in the past. We have reviewed the experience of the Windsor Orthopaedic group in the use of Silastic scaphoid implants.

Adult↗
PubMed1989

[Respiratory function in idiopathic scoliosis in adolescents treated by Harrington instrumentation with or without sublaminar segmental wiring].

The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) of 40 adolescents with idiopathic scoliosis were studied before and after surgery. The values obtained are expressed as percentages of the predicted normal. Twenty-one patients underwent surgical correction of the curve with Harrington rods followed by cast and brace immobilisation for one and a half years (Group A). In the other 19 patients the Harrington rod was contoured in the sagittal plane and supplemented with segmented sublaminar wires to allow rapid post-operative mobilisation free of any orthosis (Group B). A negative correlation was found pre-operatively between the magnitude of the curve and the FEV1 and FVC. The post-operative pulmonary function showed no statistically significant improvement. Contouring the Harrington rod to improve kyphosis in Group B did not affect the outcome.

Adolescent↗
PubMed1989

[Surgical treatment of scoliosis using Harrington instrumentation and arthrodesis. A comparison of 2 series with and without sublaminar segmental wiring].

The use of sublaminar segmental wires to enhance the stability of Harrington instrumentation was assessed in a review of our experience in the treatment of scoliosis over the last 6 years. Thirty patients were treated by spinal fusion, Harrington instrumentation and a prolonged postoperative period of immobilisation, initially in a plaster cast and then in a brace (Group 1). A further 29 patients have been treated by augmenting the Harrington instrumentation with sublaminar segmental wires (Group 2). Post-operatively, this group was left free of any brace or cast and early mobilisation was allowed. We observed no neurological complication in either group. The blood loss and the duration of the operation were greater in Group 2, but the period of hospitalisation and time to return to school has been markedly reduced. There has been no significant difference in the degree of correction of the scoliosis between the groups, but the improvement in kyphosis was greater with the use of sublaminar wires. There were no pseudoarthroses in either group during a minimum follow up of 18 months.

Adolescent↗
PubMed1987

How well do New Zealand patients understand and manage their asthma? A community study.

Patient understanding of the nature of asthma and of its management was assessed using an interviewer administered questionnaire in a community sample of asthmatics identified through prescriptions at randomly selected Dunedin city pharmacies. Of 135 subjects whose histories, and lung function data where available, were consistent with asthma, 20 did not know they had asthma. Only half could give a simple explanation of asthma, and many were confused about therapies, especially the use of corticosteroids. Only half demonstrated satisfactory aerosol inhalation technique. Deficiencies in medical management including lack of lung function monitoring, regular followup and provision of a crisis plan for severe attacks were noted. Patients previously hospitalised more often had a crisis plan and recalled advice on management of asthma, but had little knowledge about the nature of the condition. The continuing high asthma mortality rate in New Zealand may in part reflect management deficiencies both in long term care and in recognition and management of severe attacks. These may be compounded by poor patient understanding of asthma.

Administration, Inhalation↗
PubMed1987

Use of anti-asthma drugs in New Zealand.

Increased sales of anti-asthma drugs, and a second "epidemic" of asthma mortality, raised concerns about the management of asthma in New Zealand. To study this, prescriptions were obtained from randomly selected pharmacies to identify 235 patients receiving one common anti-asthma drug, 175 of whom were willing to be interviewed. The authors considered that 80% had asthma, and only 20% suffered primarily from chronic bronchitis or emphysema. The increased sales of anti-asthma drugs could not therefore be explained by their increasing use in treatment of other respiratory disorders. One third of the identified asthmatic subjects experienced daily symptoms despite regular drug treatment. Inhaled corticosteroids were used by only 42% of this group with persistent symptoms. Regular or short course oral corticosteroids, with or without inhaled steroids, had been required by 49%. All patients with domiciliary nebulisers appeared to use these appropriately, and most had peak expiratory flow meters. Despite the increased sales of anti-asthma drugs, corticosteroids appear to be as much underused in patients with chronic asthma in the community as in those who die of their disease.

Adolescent↗
PubMed1987

Orthopaedic problems in the elderly.

Orthopaedic problems affecting the elderly are discussed and related to basic bone and joint pathology. The treatment of these problems is outlined with a special call for the highest standards of medical and surgical care, by a multidisciplinary team. Early internal fixation of pathological fractures is recommended to allow early mobilisation. Total replacement arthroplasty similarly allows an early return to normal mobility in patients disabled by osteoarthrosis of a major weight bearing joint. Some aspects of the medical treatment of metabolic bone disease are also discussed.

Aged↗
PubMed1986

Psychological preparation influences nitrous oxide analgesia: replication of laboratory findings in a clinical setting.

In an earlier laboratory study, administration of 33% nitrous oxide yielded lower, not higher, pain thresholds when combined with appropriately altered expectations of enhanced creativity and sensitivity. The present study was undertaken in an attempt to replicate this finding in a group of clinical dental patients. It was expected that anxiety would play a significant role in our findings. The present study experimentally confirms that controlled psychological preparation of the clinical subject prior to administration of conventional dental dosages of nitrous oxide can significantly modify the perception of tooth pulp pain, neutralizing and even reversing its analgesic efficacy without increasing anxiety.

Adolescent↗
PubMed1986

Diminished hepatic triiodothyronine production in Gunn rats.

The liver is a major site of conversion of thyroxine (T4) to the more active thyroid hormone 3,5,3'-triiodothyronine (T3). Hepatic T4 to T3 conversion is altered by a variety of pathological processes and pharmacological agents. We studied T4 to T3 conversion in glucuronyl transferase deficient homozygous Gunn rats because they have a hepatic enzyme abnormality which leads to hyperbilirubinaemia, and also because they have been reported to have alterations in thyroid hormone metabolism. An in vitro incubation system employing the 10,000 X g supernatant of liver homogenate was used, and T3 production was measured by radioimmunoassay. Experiments were done using substrate concentrations ranging from 0.56 to 20 microM, tissue protein in concentrations ranging from 0.625 to 20 mg and incubation times of 15 to 60 min. T3 production by liver homogenates from homozygous Gunn rats in these studies ranged from 29 to 70% of that produced by liver homogenates from phenotypically normal heterozygous Gunn rats. The deficit in hepatic T3 production by homozygous rats could not be overcome by increasing cofactor concentrations. After ultracentrifugation at 100,000 X g, T4-5'-deiodinase activity was found primarily in the 100,000 X g sediment fraction. Homozygous rat liver 100,000 X g sediment T3 production was 55% of that of the heterozygous rat liver 100,000 X g sediment. Liver cytosol from both homozygous and heterozygous rats inhibited microsomal T4-5'-deiodinase activity similarly. Addition of unconjugated bilirubin to liver homogenates resulted in reduction of T3 production in livers from both homozygous and heterozygous rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Genetically determined variability in acetylation and oxidation. Therapeutic implications.

The clinical significance of two separate genetic polymorphisms which alter drug metabolism, acetylation and oxidation is discussed, and methods of phenotyping for both acetylator and polymorphic oxidation status are reviewed. Particular reference is made to the dapsone method, which provides a simple means of distinguishing fast and slow - and possibly intermediate - acetylators, and to the sparteine method which allows a clear separation of oxidation phenotypes. Although acetylation polymorphism has been known for some time, definite indications for phenotyping are few. It is doubtful whether acetylator phenotype makes a significant difference to the outcome in most isoniazid treatment regimens, and peripheral neuropathy from isoniazid in slow acetylators is easily overcome by pyridoxine administration. However, in comparison with rapid acetylators, slow acetylators receiving isoniazid have an increased susceptibility to phenytoin toxicity, and perhaps also to carbamazepine toxicity. It is also possible that rapid acetylators receiving isoniazid attain higher serum fluoride concentrations from enflurane and similar anaesthetics than do similarly treated slow acetylators. Thus, when drug interactions of these types are suspected, phenotyping for acetylator status may be advisable. If routine monitoring of serum procainamide and N-acetylprocainamide concentrations is practised, phenotyping of subjects prior to therapy with these agents should not be necessary. Although acetylator phenotype influences serum concentrations of hydralazine, when this drug is given in combination with other drugs acetylator phenotype has not been shown to influence the therapeutic response. Slow acetylator phenotype along with female gender and the presence of HLA-DR antigens appear to be risk factors in the development of hydralazine-induced systemic lupus erythematosus (SLE). Determination of acetylator phenotype may therefore help determine susceptibility to this adverse reaction. In the case of sulphasalazine, adult slow acetylators require a lower daily dose of the drug than fast acetylators in order to maintain ulcerative colitis in remission without significant side effects. It is therefore advisable to determine acetylator phenotype prior to sulphasalazine therapy. Work on the association of acetylation polymorphism with various disease states is also reviewed. It is possible that a higher incidence of bladder cancer is associated with slow acetylation phenotype - especially in individuals exposed to high levels of arylamines. The question as to whether idiopathic SLE is more common in slow acetylators remains unresolved. There appears to be no difference between fa

Acetylation↗