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Biomedical subjects

J Feely

Publications and source records attributed to J Feely.

At least 37 records · Page 2Linked to original sources
PubMed2001

Initial uptake in use of sildenafil in general practice.

OBJECTIVE: To assess the initial uptake in use and co-prescribing patterns of sildenafil. METHODS: We examined prescription details of the Eastern Health Board Region (including Dublin) of the General Medical Services (GMS) in Ireland, which provides detail on prescriptions dispensed in primary care for this population (n = 334,031). We identified 1422 patients who received 3740 prescriptions for sildenafil over a 6-month period (July 1999-December 1999) and determined the percentage of patients who were co-prescribed nitrate therapy, medications which may interact with sildenafil and medications associated with impotence. RESULTS: We identified 1422 (1.4% of the male population over 16 years who might be expected to suffer from erectile dysfunction given an overall prevalence of 10%) who received a prescription for sildenafil over the study period at a cost of 0.14% of the annual drug budget. Up to 2.5%, 6% and 25% of patients were co-prescribed, respectively, nitrate therapy, potentially interacting drugs and drugs associated with impotence. CONCLUSION: The initial uptake and cost associated with sildenafil was lower than expected. The rate of prescribing of nitrates and other potentially interacting medications was found to be low. Medication use may also contribute to erectile dysfunction in this population of patients.

Adolescent↗
PubMed2001

Effect of sildenafil on blood pressure and arterial wave reflection in treated hypertensive men.

As the effects of sildenafil are in part mediated by enhancing the action of nitric oxide and nitrates given acutely markedly reduce early wave reflection, we explored the effects of a single oral dose of sildenafil citrate (50 mg) on blood pressure and arterial wave reflection in treated hypertensive men in a single-blind randomised placebo controlled crossover study. Eight men (aged 57-76 years) with well controlled hypertension and erectile dysfunction and no contraindications to the use of sildenafil, were given either sildenafil 50 mg or placebo orally, with the second drug being given 2 weeks later. Blood pressure and heart rate with an automated digital oscillometric device (Omron) HEM-705 CP) and the augmentation index, a measure of arterial wave reflection in the aorta derived using radial applanation tonometry, were measured before and at 15-min intervals for 2 h thereafter. The extent of individual maximum reductions (mm Hg) from baseline in systolic (24 +/- 10 vs. 6 +/- 8, P < 0.05) and diastolic blood pressure (8 +/- 5 vs. 3 +/- 2, P < 0.05) occurred on the sildenafil study day. On average the brachial blood pressure at 75 min following sildenafil was 17/11 mm less than on the placebo day (P < 0.01). Augmentation index was also reduced significantly at 90 min (P < 0.05) suggesting reduced vascular tone in the arteries. The area under the brachial and aortic blood pressure and augmentation index time curve (by the trapezoidal rule corrected for baseline reading) was significantly lower (P < 0.05) on the sildenafil study day. The study shows that the peripheral vasodilatory effects of sildenafil, possibly related to nitric oxide, are accompanied by a fall in systemic blood pressure and reduced arterial wave reflection.

Aged↗
PubMed2001

Preferential prescribing of oral corticosteroids in Irish male asthmatic children.

AIMS: To determine if there is a gender difference in the prescription of oral corticosteroids in asthmatic children (< 15 years). METHODS: 8072 asthmatics were identified on the basis that they received a prescription for either an inhaled beta-adrenoceptor agonist, an inhaled corticosteroid, inhaled cromoglycate/nedocromil sodium, oral xanthines or leukotriene antagonist. Odds ratios (OR) and 95% confidence intervals (CI) were determined for the different asthma treatments for males compared with females. RESULTS AND CONCLUSIONS: Male asthmatic children were more likely (OR = 1.37, 95% CI = 1.21,1.55, P < 0.001) to receive a prescription for an oral corticosteroid compared with their female counterparts suggesting a possible increased severity of their condition, rather than a different management of their disease. Male asthmatic children were less likely to be prescribed an antibiotic over the study period (OR = 0.85, 95% CI = 0.77, 0.93, P < 0.001).

Administration, Oral↗
PubMed2001

Lack of symptom benefit following presumptive Helicobacter pylori eradication therapy in primary care.

BACKGROUND: Helicobacter pylori eradication regimens have failure rates under 10%, however little information is available on the effect of treatment success in reducing the subsequent prescription of anti-ulcer medications in primary care. AIMS: To determine, using a large prescription database in eastern Ireland, the success of presumptive eradication therapy in improving symptoms of dyspepsia in primary care, as judged by a reduction in the subsequent prescription of anti-ulcer medications. METHODS: In a cross-sectional study, we identified 3847 patients who received a prescription for eradication therapy for Helicobacter pylori, including 826 who were followed for 9-11 months. Those who subsequently received anti-ulcer medications were deemed failures to obtain symptom relief. RESULTS: For 3847 patients with a median follow-up of 8 months, the failure rate was 49%. Of 826 patients, followed for a longer period (9-11 months), the overall failure rate was 56% (range 44-62% depending on the eradication regimen used). Age over 65 years (hazard ratio=1.57, 95% confidence interval= 1.29-1.91, P < 0.001), prior use of anti-ulcer medications (hazard ratio=1.97, 95% confidence interval=1.63-2.37, P < 0.001) and prior use of aspirin/NSAIDs (hazard ratio=1.43, 95% confidence interval=1.18-1.73, P < 0.001) all predicted failure to obtain relief of symptoms of dyspepsia from eradication therapy. CONCLUSIONS: Such high failure rates of eradication therapy in reducing the subsequent consumption of anti-ulcer medications have both clinical and economic implications for the use of eradication therapy for Helicobacter pylori in primary care.

Adult↗
PubMed2001

Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message.

AIMS: The sources of prescribing information are legion but there is little knowledge about which are actually used in practice by doctors when prescribing. The aims of this study were to determine the sources of prescribing information considered important by doctors, establish which were used in practice, and investigate if hospital and primary care physicians differed in their use of the sources. METHODS: Two hundred general practitioners (GPs) and 230 hospital doctors were asked to rate information sources in terms of their importance for prescribing 'old' and 'new' drugs, and then to name the source from which information about the last new drug prescribed was actually derived. RESULTS: Among 108 GPs, the Drugs and Therapeutics Bulletin and medical journal articles were most frequently rated as important for information on both old and new drugs while pharmaceutical representatives and hospital/consultant recommendations were more important for information on new drugs, as opposed to old. In practice, information on the last new drug prescribed was derived from pharmaceutical representatives in 42% of cases and hospital/consultant recommendations in 36%, with other sources used infrequently. Among 118 hospital doctors, the British National Formulary (BNF) and senior colleagues were of greatest theoretical importance. In practice, information on the last new drug prescribed was derived from a broad range of sources: colleagues, 29%; pharmaceutical representatives, 18%; hospital clinical meetings, 15%; journal articles, 13%; lectures, 10%. GPs and hospital doctors differed significantly in their use of pharmaceutical representatives (42% vs 18%) and colleagues (7% vs 29%) as sources of prescribing information (P < 0.0001 for both). CONCLUSIONS: The sources most frequently rated important in theory were not those most used in practice, especially among GPs. Both groups under-estimated the importance of pharmaceutical representatives. Most importantly, the sources of greatest practical importance were those involving the transfer of information through the medium of personal contact.

Communications Media↗
PubMed2001

Acute effect of caffeine on arterial stiffness and aortic pressure waveform.

Caffeine acutely increases blood pressure and peripheral vascular resistance, in part because of sympathetic stimulation. Its effects on large artery properties are largely unknown. In a double-blind crossover study, 7 healthy subjects 26+/-2.6 years of age (mean+/-SEM) were studied for 90 minutes while in the supine position on 2 occasions separated by a week in random order after ingestion of 250 mL caffeinated (150 mg) and decaffeinated (<2 mg) coffee. Compared with baseline, arterial stiffness measured by carotid femoral pulse wave velocity increased progressively from 7.2+/-0.41 to 8.0+/-0.6 m/s (P<0.05) at 90 minutes after caffeine intake, an effect that may be independent of changes in blood pressure. In addition, arterial wave reflection, measured by applanation tonometry from the aortic pressure waveform, also increased from -5.7+/-7.6% to 5.28%+/-5.6 (P<0.01). No such changes were seen with decaffeinated coffee intake. Although the integral of the brachial systolic and diastolic blood pressure values over the 90 minutes was larger (P<0.05) after caffeinated than decaffeinated coffee intake, the effect on aortic systolic and diastolic blood pressures was more pronounced (P<0.05) than on the brachial artery. These results show a significant effect of caffeine intake on arterial tone and function and suggest that caffeine acutely increases arterial stiffness.

Adult↗
PubMed2001

The urinary excretion of gamma-hydroxybutyric acid in man.

gamma-Hydroxybutyric acid (GHB) has been widely associated with drug-facilitated sexual assault (DFSA). However, its excretion profile in man has not been well characterized. To assess the detectability of GHB for forensic cases and to correlate urinary levels with dose, we have examined the excretion profiles of 1- and 2-g doses of GHB (sodium salt) in a healthy male volunteer. The urinary levels were measured by a novel, simple and highly reproducible method. The drug was found to be excreted in small amounts in the free form (0.86 and 1.16% for 1- and 2-g doses, respectively) rapidly in urine (< or = 10 h). The urinary levels were found to be in the low mg L(-1) range (up to 29.1 mg L(-1)). The work presented demonstrates that it is of the utmost importance to collect the samples as soon as possible following the alleged assault.

Adult↗
PubMed2001

Cost of treating acute myocardial infarction in an Irish teaching hospital.

Recent figures indicate that there are approximately 6,500 patients admitted to hospital following acute myocardial infarction (AMI) in Ireland each year. As hospital admission is frequently the most expensive component of healthcare we determined the costs associated with treatment of AMI in a teaching hospital. The costing evaluation was from the hospital perspective and the strategy used was a micro-costing detailed collection of resources used. The average cost of hospital admission for the treatment of AMI was Pound Sterling 3,976. The average cost per day was calculated at Pound Sterling 501. Approximately 50% of hospital costs were associated with ward costs. Procedures accounted for 35% of costs whereas medications contributed just 7% of total costs.

Aged↗
PubMed2000

Effect of menopause on low-density lipoprotein oxidation: is oestrogen an important determinant?

OBJECTIVES: Significantly increased risk for developing cardiovascular disease in post-menopausal women is linked with the fall of oestrogen. Although supraphysiological levels of oestrogen may inhibit oxygen free radical mediated low-density lipoprotein (LDL) oxidation, the effect of physiological level of oestrogen on LDL oxidation is unknown. METHODS: The present study compared oxidizability of LDL in healthy pre- and post-menopausal women by using a commonly employed copper ion-dependent method. RESULTS: Pre-menopausal women (n=20, mean age 27) had significantly higher serum oestradiol level (576+/-109 pmol/l) in comparison to post-menopausal women (n=23, mean age 51, oestradiol 64+/-18 pmol/l, P<0.001). The oxidation of LDL in two groups was not different by measuring either the lag phase of conjugated dienes formation (54+/-12 vs. 55+/-14 min, P0.05) or the generation of thiobarbituric acid reactive substances over 4 h of oxidation. The major lipid soluble antioxidant in LDL, vitamin E (determined as alpha-tocopherol) is similar in two groups (2.34+/-0.48 vs. 2.40+/-0. 56 nmol/mg LDL, pre- and post-menopausal subjects, respectively, P0. 05). Linear regression analysis found a weak but significant correlation between LDL vitamin E level and oxidizability of LDL in both groups but did not show effect of serum oestradiol levels. CONCLUSION: The results suggest that physiological levels of oestrogen may not be able to affect in vitro LDL oxidation.

Adult↗
PubMed2000

Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension.

OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors have beneficial effects on arterial compliance and distensibility and favourably modify the arterial pressure waveform in hypertensive patients. The objective of our study was to explore the possible effects of adding an ATII AT1 receptor antagonist to an ACE inhibitor on augmentation pressure, a measure of arterial stiffness, and pulse pressure amplification in patients with poorly controlled essential hypertension. DESIGN AND METHODS: We studied a group of 18 patients with poorly controlled hypertension, despite at least three antihypertensive drugs including an ACE inhibitor, before, at 2 h and 2 weeks following the administration of 80 mg of valsartan, an ATII AT1 receptor antagonist. Haemodynamic responses were measured by cuff sphygmomanometry, arterial pulse-wave analysis and the pulse pressure gradient was calculated as the difference between the brachial pulse pressure (cuff sphygmomanometry) and derived aortic pulse pressure (arterial pulse wave analysis). RESULTS: Blood pressure decreased significantly (P<0.001) and the effect was more pronounced on central (aortic) pulse pressure than peripheral (brachial) pulse pressure. The pulse pressure amplification increased significantly (from 8+/-3 at baseline vs 12+/-7 at 2 h to 14+/-5 mm Hg at 2 weeks, P<0.01) and the augmentation pressure decreased from a baseline value of 21+/-8 to 11+/-7 at 2 h and 10+/-5 at 2 weeks, (P<0.01) following valsartan. CONCLUSION: The results of our study show that in a group of poorly controlled hypertensives, combining an ATII AT1 receptor blocker to an ACE inhibitor induced a significant fall in blood pressure. The decrease in blood pressure was accompanied by a decrease in augmentation pressure in the ascending aorta with a greater decrease in the central pulse pressure than in the peripheral, favourably increasing pulse pressure amplification between central and peripheral arteries. This effect on arterial stiffness and amplification suggests that combined angiotensin II blockade by adding an AT1 receptor blocker to an ACE inhibitor may have more beneficial effects on the blood pressure curve than simple blood pressure reduction.

Aged↗
PubMed2000

Drug interactions avoided-a useful indicator of good prescribing practice.

AIMS: To develop an index of quality prescribing in general practice by investigating the incidence of potential drug interactions when medicines were coprescribed within the State supported General Medical Services (GMS) in Ireland. METHODS: We determined an odds ratio (OR), as a measure of the relative risk of being exposed to a potential interaction, comparing the use of the H2-receptor antagonist, cimetidine, with that of the noninteracting agents ranitidine, famotidine and nizatidine in users and nonusers of warfarin, phenytoin and theophylline. RESULTS AND CONCLUSIONS: In 86 510 prescriptions for the H2-receptor antagonists potentially interacting drugs were dispensed to 8188 (9%) patients in the Eastern Health Board Region of the GMS. We found that prescribers were significantly less likely to use cimetidine (OR = 0.20,95% CI 0. 17-0.21, P < 0.001) in those patients who were coprescribed warfarin, suggesting good prescribing practice within the GMS. Similarly there was preferential use of the noninteracting H2-receptor antagonists in patients receiving phenytoin or theophylline and the extent of this selective prescribing was in keeping with the rank order of severity of interaction with these drugs. This novel pharmacological index may be a sensitive marker of good prescribing practice.

Anticoagulants↗
PubMed2000

Growth in use of statins after trials is not targeted to most appropriate patients.

OBJECTIVE: To determine whether growth in the use of lipid-lowering drugs after publication of studies in the primary and secondary prevention of coronary heart disease is in the population in which benefit was established, particularly middle-aged men. METHODS: We performed a series of pharmacoepidemiologic surveys of community prescribing in Ireland over 4 years. RESULTS: Nationally, the use of lipid-lowering drugs (92% statins) increased approximately fourfold from 1994 to 1998. In the Eastern Health Board region, the number of monthly recipients increased from 447 in April 1994 to 3530 in March 1998. Although use increased steadily after publication of Scandinavian Simvastatin Survival Study (4S) and West of Scotland Coronary Prevention Study (WOSCOPS) in 1994 and 1995, respectively, this occurred to a greater extent in women. However, after the Cholesterol and Recurrent Events (CARE) study in 1996 and subsequent recommendations that targeted statin use, particularly in men from 35 to 69 years old, there was a relatively greater increase in that population but, at 2.3%, it was well short of the target population of 5.8%. More women than men older than 65 years are receiving statins. The 10-mg dosage (a fourth or half that used in studies) is the most frequently dispensed. CONCLUSION: The use of statins, although rising rapidly, is below targets and was initially not directed at the population likely to benefit most or in the recommended dosage. Consequently, the benefits projected from clinical trials may not be seen in clinical practice.

Adult↗
PubMed1999

The therapeutic gap--compliance with medication and guidelines.

Hospitals, clinics and cardiologists have a significant impact on prescribing in general practice. Physicians in primary care rank hospital recommendations as one of the most important sources of information on new drugs. However, recent surveys of coronary heart disease (CHD) prevention paint a depressing picture about the current evidence-based management of risk factors, such as hypercholesterolaemia and hypertension, in both secondary- and primary-care settings. European guidelines have identified secondary prevention as the top priority in patients with established CHD and lowered cholesterol thresholds in light of evidence, not only from the 4S study, but also from the CARE and LIPID studies, which highlighted the risks posed by even normal or moderately elevated cholesterol levels. There is a clear need for those involved in quality assurance in hospital care to take ownership of such guidelines. Cardiologists can play a key role - they do not face the problem alone, but evidence suggests that they can have a significant positive impact on the management of CHD risk factors in primary care.

Anticholesteremic Agents↗
PubMed1999

Combined oestrogen-progestogen replacement therapy does not inhibit low-density lipoprotein oxidation in postmenopausal women.

AIMS: The use of oestrogen containing hormone replacement therapy (HRT) is related to a significantly reduced atherosclerotic cardiovascular risk in postmenopausal women. Oestrogen is thought to be antioxidant and may inhibit low-density lipoprotein (LDL) oxidation in vitro. We investigated the effect of combined oestrogen and progestogen HRT on LDL oxidation in postmenopausal women. METHODS: Eighteen healthy women were given oestrogen/progestogen, and the susceptibility of LDL to oxidation was measured as the level of autoantibody to oxidative modified LDL and the production of conjugated dienes during copper-dependent oxidation after 3 and 6 months HRT. The levels of vitamin E, the major antioxidant in LDL, were also measured. RESULTS: After HRT, the anti-oxidatively modified LDL antibody level remained unchanged [1.58+/-0.16, 0.10 (-0.10, 0.26), and 0.08 (-0.09, 0.19), mean+/-s.d. at baseline, and mean change with 95% confidence intervals for differences at 3 and 6 months, respectively, P>0.05] as did the production of conjugated dienes when determined as lag phase [51.2+/-7.5, -0.3 (-3.9, 3.3), and 1.5 (-3.4, 6.4) min, P>0.05]. The LDL vitamin E content, measured as alpha-tocopherol, was also not altered [2.34+/-0.54, -0.07 (-0.27, 0.13), and -0.07 (-0.33, 0.16) nmol mg(-1) LDL, P>0.05] by treatment. CONCLUSIONS: Combined oestrogen and progestogen therapy for 6 months in postmenopausal women does not protect LDL against oxidation.

Cholesterol↗
PubMed1999

Vitamin E supplementation in hyperlipidaemic patients: effect of increasing doses on in vitro and in vivo low-density lipoprotein oxidation.

BACKGROUND: Vitamin E supplementation is associated with a reduced risk of developing atherosclerotic events; probably because it inhibits low-density lipoprotein (LDL) oxidation, an initial step in atherosclerosis. Metal ion-dependent LDL oxidation is a commonly used method to estimate oxidizability of LDL, but the effect of antioxidant supplementation on the levels of autoantibodies to oxidised LDL (ox-LDL), an in vivo indicator of LDL oxidation, is unknown. DESIGN: This double-blind, placebo-controlled study investigated the susceptibility of LDL to copper induced oxidation and malondialdehyde (MDA) derivatized-LDL (MDA-LDL) in hyperlipidaemic patients on supplements of vitamin E. The vitamin E group (n = 20) took vitamin E 100 IU daily and the dose was doubled at six-weekly intervals to 1600 IU daily. The control group (n = 17) received placebo in the same fashion. Blood samples were obtained at baseline and each subsequent visit to measure vitamin E status and oxidation of LDL. RESULTS: A significant increase in both alpha-tocopherol levels and the lengths of lag phase was seen in the vitamin E group after first week of supplementation (100 IU day-1). This continued to rise in a dose-dependent fashion with a doubling of the lag phase on 1600 IU daily. However, the titre of antibodies to MDA-LDL was not altered. CONCLUSIONS: The results suggest that although regarded as an in vivo marker of LDL oxidation, antibodies to MDA-LDL may not be a suitable measure to evaluate the effect of short-term antioxidant supplementation. The failure of autoantibody titres to fall despite reduced oxidizability of LDL may possibly be attributable to a long half-life of the antibody or, once initiated, a continuous immunological response to ox-LDL contained in atherosclerotic lesions of the arterial wall.

Antioxidants↗
PubMed1999

The influence of hospital-based prescribers on prescribing in general practice.

OBJECTIVE: To document the influence of hospital prescribers on prescribing in general practice. DESIGN AND PARTICIPANTS: Five percent of members of the Irish College of General Practitioners (n = 92) prospectively recorded 40 consecutive prescriptions. INTERVENTIONS: The name, dose and amount of medicine prescribed as well as the indication for therapy, details of their practice, distribution of private/GMS patients, and the number of years since qualification were recorded. The cost of individual prescriptions was calculated based on the ingredient cost and the number of days of treatment. This was subsequently correlated with the origin of the prescription. Each prescription was classified as either new or repeat. MAIN OUTCOME MEASURES AND RESULTS: Of 3286 prescriptions, 69% were for the state-supported General Medical Services (GMS) patients and 31% for private patients. Repeat prescriptions constituted 51%; 49% were new prescriptions. While hospital doctors initiated only 8% of private prescriptions, they initiated 38% of GMS prescriptions, particularly repeat prescriptions and those for cardiovascular, hormonal and centrally-acting agents. Prescriptions for anti-infectives, oral contraceptives, dermatological preparations and musculoskeletal drugs were mostly initiated in general practice. The median cost for hospital-initiated GMS prescriptions (5.93 Pounds) was greater than the cost of general practitioner (GP)-initiated prescriptions (3.49 Pounds; p < 0.01). Prescriptions from GPs who were qualified for less than 10 years and those with a mixed urban and rural practice were less costly (p < 0.05) than those issued by doctors qualified for over 10 years or working predominantly in an urban or rural area. These findings may also reflect differences in patient population, morbidity and demography. CONCLUSIONS: Our study indicates that hospital-initiated prescriptions are responsible for a significant proportion, both in volume and cost of GP prescribing.

Drug Prescriptions↗