PubMed Health⌕ Search

Biomedical subjects

J T Fish

Publications and source records attributed to J T Fish.

5 recordsLinked to original sources
PubMed1996

Magnitude and nature of noncompliance with treatment using isosorbide dinitrate in patients with ischemic heart disease.

Isosorbide dinitrate is one of the most commonly prescribed medications for the treatment of ischemic heart disease. It has been demonstrated to be ineffective relative to placebo when taken inappropriately. This study objectively documents the magnitude and nature of compliance in 68 ambulatory patients who were prescribed isosorbide dinitrate three times a day. Each patient received a 9-week supply of medication in a vial equipped with a computerized monitor (MEMS-4 cap; APREX Corporation, Fremont, CA) and were informed as to the purpose of the study. Of the patients, 74% were classified into the low and 16% into the high compliance category, defined as compliant < 70% and > or = 85% of study days, respectively. The mean (+/- SD) percent days in which isosorbide dinitrate was taken three times was 66% (+/- 29), and the mean number of days in which it was taken three times with a 10-hour "nitrate free period" was 53% (+/- 31). It is concluded that the magnitude of noncompliance in patients prescribed isosorbide dinitrate three times daily is substantial (74%). The nature of this noncompliance is often due to failure to observe a 10- to 12-hour nitrate free period. Given the need to take isosorbide dinitrate appropriately and given the demonstrated magnitude of noncompliance, physicians should take these factors into consideration when selecting this agent for the management of coronary artery disease relative to other pharmacologic options.

Aged↗
PubMed1995

Influence of freshwater sediment on the survival of Escherichia coli and Salmonella sp. as measured by three methods of enumeration.

Growth and survival of enteric bacteria in freshwater sediments should be of concern to public health officials because of potential contributions of bacteria to the water column. Bacteria densities were measured in sediment and water using direct counts (DC), direct viable counts (DVC) and standard plate counts (PC). Both Salmonella sp. and Escherichia coli survived in microcosms containing autoclaved water and sediment for at least 28 d, as measured by all three methods of enumeration. Moreover, when bacteria were enumerated from sediment-containing microcosms, the DC, DVC and PC values were equivalent. Plate counts showed that both organisms were present at high densities on day 56. In addition, parallel platings on MacConkey agar of E. coli from microcosms containing sediment gave results identical to PC values, indicating that E. coli was not stressed in these microcosms. In microcosms containing water only, E. coli densities declined gradually over 2 weeks by all three measures of enumeration. By day 14, only 58% of total DC was viable as measured by DVC. Due to the protective nature of sediments, the use of standard media may be adequate to enumerate E. coli from some freshwater sediments.

Colony Count, Microbial↗
PubMedDate not supplied

Antihypertensive drug use in the long-term care facility: a pilot study and review of the literature.

The overuse and cost of drugs in long-term care facilities are of significant concern. To quantify potential overuse of antihypertensive agents, we conducted a retrospective chart review in four long-term care facilities. We analyzed data in 550 patient records to identify residents receiving drugs for the sole indication of hypertension. Of the 550 records, 49 (9%) residents qualified. Of these, 20 (41%) had all recorded blood pressures less than 140/90 mm Hg for the 6 months before review, and 32 (65%) had all blood pressures less than 160/90 mm Hg. Given this degree of blood pressure control and the reported success of withdrawing antihypertensive drugs from the elderly in whom the disorder is well controlled, a reevaluation of antihypertensive therapy in residents of long-term care facilities appears to be justified.

Aged↗
PubMedDate not supplied

Patient self-reporting of compliance does not correspond with electronic monitoring: an evaluation using isosorbide dinitrate as a model drug.

STUDY OBJECTIVE: To assess the accuracy of patient-kept diaries relative to electronic monitoring of compliance with isosorbide dinitrate prescribed 3 times/day for ischemic heart disease. DESIGN: Unblinded, prospective, three-phase study. METHODS: Patients with coronary artery disease prescribed isosorbide dinitrate 3 times/day were asked to record the time of administration of each dose in a pocket diary while being monitored for compliance with a computerized Medication-Event Monitoring System (MEMS-4) vial that electronically recorded the date and time the vial was opened. RESULTS: Sixty-eight stable outpatients with documented coronary artery disease who were prescribed isosorbide dinitrate 3 times/day were evaluated. Based on a prospectively chosen definition including a nitrate-free period, the mean (+/-SD) overall compliance rates were 71% (+/-30) versus 55% (+/-32) for the patient-kept diaries and the MEMS vials respectively (p = 0.001). The concordance between patient-kept diaries and MEMS data indicate that 67% of patients overestimate their compliance when using a self-recording tool. An average of 30% of diary entries were in error compared with the MEMS vial recordings. CONCLUSIONS: Patient-kept diaries statistically overestimate actual compliance relative to that determined by MEMS devices. Given the prevalence of the use of diaries as the predominant tool on which researchers depend to document compliance with study drugs, our findings suggest that this practice should be reevaluated specifically when the time of the dose and documentation of administration are critical to qualifying the outcome of drug therapy. Such is the case with isosorbide dinitrate use in patients with ischemic heart disease. Furthermore, the overall poor compliance documented in this study suggests that the utility of isosorbide dinitrate prescribed 3 times/day be reevaluated as a clinically effective antianginal drug.

Administration, Oral↗