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Biomedical subjects

G S Kellaway

Publications and source records attributed to G S Kellaway.

At least 19 recordsLinked to original sources
PubMed1993

A comparison of the efficacy of cilazapril versus cilazapril plus hydrochlorothiazide in patients with mild to moderate essential hypertension. Inhibace General Practice Study Group.

The efficacy of cilazapril monotherapy and in combination with hydrochlorothiazide 12.5 mg was compared in a multicentre, double blind, randomised parallel group study in 87 patients with mild to moderate essential hypertension over 8 weeks. After a 2 week single blind placebo run-in period, patients received either 2.5 mg cilazapril or 2.5 mg cilazapril plus 12.5 mg hydrochlorothiazide once daily. At Week 4 the cilazapril dose was increased from 2.5 mg to 5.0 mg if the mean sitting diastolic blood pressure was greater than 90 mmHg or had not decreased by more than 10 mmHg. After 8 weeks treatment 72% of patients responded to 2.5 mg cilazapril increasing to 88% with cilazapril 5.0 mg. For cilazapril plus hydrochlorothiazide, 83% responded to 2.5 mg cilazapril increasing to 96% on 5.0 mg cilazapril. The high response rate to low dose cilazapril monotherapy and hydrochlorothiazide combination therapy has important implications for minimising the cost of therapy with ACE inhibitors.

Adolescent↗
PubMed1986

A community-based trial of transdermal antihypertensive therapy with clonidine (Catapres-TTS).

The effectiveness of transdermally administered clonidine using Catapres-TTS patches applied once a week was assessed in the control of mild to moderate hypertension by 16 general practitioners in 135 subjects. Following two weeks on placebo patches, subjects with mean seated diastolic pressures 90 to 104 mmHg were titrated to one, two or three patches and blood pressure responses measured at monthly intervals for three months. Satisfactory response of blood pressure to 90 mmHg or lower was obtained in 85% of patients who completed the maintenance phase; in 20 patients whose blood pressure responses did not reach 90 mmHg, a significantly higher blood pressure (mean 158/103 mmHg) occurred at entry into the trial (145/96 mmHg). Withdrawal from the trial was mainly for reasons of inadequate blood pressure control (15%) or localised skin reactions (15%). Dryness of the mouth was the only systemic side effect encountered with significant frequency and resulted in the withdrawal of three patients. Localised skin reactions were encountered in 51% of subjects, in the majority these were mild and subjects elected to continue with transdermal clonidine because of the convenience of once a week administration. Severe or generalised skin reactions were not encountered. Serum biochemical measurements, including serum lipid levels, remained unaltered. Transdermal clonidine therapy provided satisfactory blood pressure control in the majority of subjects and apart from the localised skin reactions which were largely of nuisance value, proved safe and acceptable to patients.

Administration, Cutaneous↗
PubMed1986

Intensive hospital monitoring study of intravenous cimetidine.

We studied the frequency of adverse reactions occurring in 1189 patients who received cimetidine intravenously, based on data collected as part of a hospital-based monitoring study of recently marketed drugs. There were 40 patients (3.4%) with adverse reactions, 23 of whom were considered to be "definitely" or "probably" related to cimetidine use and 17 patients in whom a causal association was possible. The most frequently reported reactions were neuropsychiatric disorders in 19 patients (1.6%) and leukopenia in eight patients (0.7%).

Age Factors↗
PubMed1983

Compliance failure and counselling in paediatric drug therapy.

Compliance-failure with expected drug therapy was recognised at interview in 56 percent of non-counselled and 24 percent of counselled paediatric patients returning to medical out-patient clinic at Princess Mary Hospital. Default from prescribed treatment was more common in Polynesians than caucasians and more often due to patient error than non-compliance. Drug counselling was more effective in minimising compliance-failure due to patient error than non-compliance. Failure to take drugs as intended was due to doctor generated causes in 8 percent of patients.

Child↗
PubMed1983

Pharmacokinetics of digoxin in pregnancy.

Digoxin-renal-clearance, creatinine-clearance, 24-h urine elimination of digoxin and serum digoxin were studied in 15 patients in the third trimester of pregnancy and 6 to 12 weeks post-partum. There was significant fall post-partum in the first three. There was also a significant fall post-partum in serum digoxin levels. This finding was unexpected, but may be due to heightened absorption exceeding increased elimination because of the physiological status in pregnancy.

Creatinine↗
PubMed1982

Drug monitoring of surgical patients.

Intensive drug monitoring of surgical patients was carried out on selected wards in five hospitals in the United States, Scotland, and New Zealand from 1977 through 1981. This report describes the methods and some findings from the monitoring of 5,232 such patients. Patients received, on the average, nine drugs on the ward, and adverse reactions were associated with 2.2% of these drug orders. Of the 1,150 drug-attributed adverse reactions, only 62 were considered "major" by the attending physician, and 35 (affecting 20 patients) were termed "life threatening." There were no drug-attributed deaths.

Adolescent↗
PubMed1982

Antihypertensive treatment and fetal welfare in essential hypertension in pregnancy: a retrospective survey of experience with various regimes at National Women's Hospital, Auckland, 1970-80.

A series of 184 pregnancies in 161 hypertensive women was classified according to the regimen of antihypertensive treatment used during pregnancy. In 72 pregnancies management was with bed rest alone, attaining a mean gestation of 37.8 +/- 0.4 weeks, a mean birthweight of 2941 +/- 97 g with 38 percent of infants below the 25th percentile. Late deterioration of hypertension with development of proteinuria occurred in 16.6 percent with fetal mortality of 6.9 percent. Antihypertensive therapy involved methyldopa, thiazide diuretics, sympathetic ganglion blockers, hydralazine, beta-adrenergic blockers and the combination of oxprenolol and prazosin. Fetal growth was compared in pregnancies that reached term on the various regimens. Significantly better growth was achieved where debrisoquine plus a thiazide were used (3617 +/- 113 g in six subjects) and oxprenolol/prazosin (3411 +/- 72 g in 14 subjects) compared to 11 comparably hypertensive patients on bed rest alone (2975 +/-87 g). Therapy with the ganglion blocker plus thiazide was complicated by the deterioration of hypertension with proteinuria in 37.2 percent of women; this did not occur in patients receiving oxprenolol/prazosin. Maternal age had no effect on fetal growth, but smoking more than 10 cigarettes per day caused significant growth retardation.

Antihypertensive Agents↗
PubMed1980

Attendance failure at paediatric medical outpatient clinics.

Failure in attendance at medical out-patient clinics at Princess Mary Paediatric Hospital occurred in 46 percent of patients. This was due to patient error, administration error and patient non-compliance. Failure in attendance by Polynesians was due to error and non-compliance; caucasians mainly non-compliance. Hospital administrative errors accounted for default in 6 percent of all patients. Methods of reducing the problem of failure in attendance at out-patient clinics are considered. The aim of this study was to determine the incidence of failure in attendance at Princess Mary Paediatric Hospital (PMH) medical out-patient clinics (OPC) and to establish the reasons for default.

Appointments and Schedules↗
PubMed1979

The effect of counselling on compliance-failure in patient drug therapy.

This paper reports the results of a study to determine the effects of counselling on patient compliance-failure in expected drug therapy. In patients discharged from acute general medical wards, counselling reduced compliance-failure for both patient non-compliance and error by approximately 40%. It was especially effective in reducing compliance-failure due to non-compliance where reasons were either the occurrence of adverse drug effects or patient belief that therapy was ineffective, and patient-error where this resulted from misinterpretation. The use of drug calendar cards did not minimise the incidence of non-compliance but was effective at reducing error, especially with Polynesian patients. It is concluded that prescribing clinicians can reduce compliance-failure by active drug-counselling.

Counseling↗
PubMed1977

A pilot trial of labetalol (AH 5158A): a combined alpha and beta blocker in treatment of hypertension.

Labetalol (5-1 hydroxy-2 (1-methyl-3 phenyl amino salicylamide hydrochloride)) is a new antihypertensive agent having partial alpha- and beta-adrenoreceptor-blocking properties. Nine patients with mild, moderate or severe hypertension have been given this drug over periods ranging from 6-29 weeks. Labetalol was given as replacement for a beta-blocking drug providing less than satisfactory control. Adequate control of blood pressure was achieved in all nine patients. The only side-effect of note was postural hypotension which necessitated withdrawal of the drug in one patient.

Antibodies, Antinuclear↗
PubMed1976

Adverse drug reactions during treatment of hypertension.

Adverse drug reactions (ADRs) can be broadly classified as either "a nuisance" or "life-threatening". Voluntary reporting systems gradually accumulate a quite impressive list of suspected ADRs with antihypertensive drugs as their use becomes widespread. Such data gives no clue to true or relative incidence. The absolute and comparative incidence of ADRs can only be determined fairly by a system of unbiased general data collection of ADRs from which the data for antihypertensive drugs is then selected. The Boston Collaborative Drug Surveillance Program provides such a source of information. Data from the Boston Program reveals that most of the listed ADRs with antihypertensive drugs occur very infrequently, that "nuisance" ADRs occur in 10 to 29% of patients in whom they are used, and that "life-threatening" ADRs occur in less than 1%. ADRs tend to discourage patient compliance with medication aims. In selecting specific antihypertensive therapy the clinician should be mindful not only of the severity of the hypertension to be treated, but also of the nature, type, and severity of potential ADRs, the personality and likely complicance of the patient, and the need for patient education regarding drug effects, possible unwanted effects, and what measures should be taken when ADRs occur.

Adrenergic beta-Antagonists↗
PubMed1975

Non-compliance and errors of drug administration in patients discharged from acute medical wards.

Three hundred and fifteen patients discharged from acute general medical wards over an 18-month period were studied prospectively to determine deficiencies in medication ingestion from that expected by the hospital clinicians. Thirteen percent did not receive an entirely correct written prescription at the time of discharge from hospital. In 4.5 percent this was the sole reason for treatment failure. Excluding these patients, 40.5 percent of the remainder admitted to medication variations over a 1-6 week period. Non-compliance proved to be a cause of drug default by patients three times as frequently as simple error. Where all errors were considered the ratio was 2 : 1. Whereas non-compliance (indicating volitional intent) was a more common basis for medication variation in Europeans, simple error was a more common cause in Polynesians. Two out of every five of the latter group took incorrect or incomplete therapy because of misinterpretation of instructions, either provided by hospital clinical staff, or printed upon their medication containers. The reasons for non-compliance and simple error are elucidated and the problem of non-delivery of expected medication is discussed. In devising methods for improving accuracy of drug self-administration after discharge from hospital the entities of simple error and non-compliance warrant individual attention.

Drug Prescriptions↗