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Biomedical subjects

M N Dukes

Publications and source records attributed to M N Dukes.

At least 19 recordsLinked to original sources
PubMed1997

The menopause and the pharmaceutical industry.

Since 1975, pharmaceutical firms specializing in the endocrine field have made a vigorous attempt to develop a large market in estrogens for the long-term treatment of postmenopausal women. The success of the contraceptive 'pill' had demonstrated the commercial attractiveness of developing products for an essentially healthy population. The scientific challenge was to demonstrate the value of such treatment, e.g. in countering osteoporosis; another problem was the generally poor compliance observed when patients receive drugs other than for the relief of acute conditions. Techniques used included the selective emphasis to physicians of those research findings pointing to the value of hormonal replacement, the development of direct approaches to the public to stimulate interest in a treatment which might prolong life or delay some parts of the ageing process ('feminine forever'), and the creation of intermediary institutes to undertake selective research and influence opinion.

Advertising↗
PubMed1993

Drug use in pregnancy: a comparative appraisal of data collecting methods.

We have compared the reliability of the information about drug therapy and pregnancy retrieved by interviewing patients with that distilled from pharmacy records. In the initial phase of each interview we used the internationally accepted open-ended technique, and extended this with an indication-oriented set of questions and then a set of specific drug-oriented questions. These data were then compared with those from pharmacy records on dispensing for the same patients during their pregnancy. The results suggest that if drug consumption during pregnancy is evaluated by interview, one should not restrict oneself to open-ended questions but should include indication-oriented and, when appropriate, drug-oriented questions. Such specific questions offer the opportunity of detecting the use of over-the-counter medication and of constructing drug use/complaint profiles. By contrast, pharmacy records will give better information in case of long recall periods and in patients with multiple and/or repeated drug use. Investigators should use the complementary elements of both techniques where appropriate.

Adult↗
PubMed1992

Handling of risk-bearing drugs during pregnancy. Do we choose less risky alternatives?

The drug use of nearly 2,000 pregnant women was evaluated at the level of the individual patient for the drugs belonging to the Australian risk categories B3, C and D. The pattern of changes in the use of these drugs is studied in terms of women who discontinue (d), continue (c) or begin (b) using the drug during pregnancy. The ratios d/(c+b) and d/b were the highest for the drugs belonging to the high-risk groups and the lowest for drugs from the low-risk categories. This suggests a congruence between theoretical knowledge and daily practice. Patients who had already been using a drug for a long time before pregnancy, more frequently continued using that drug than patients who had been using the drug only incidentally before. The described daily dose for the riskful drugs was approximately 20% lower in patients who started to use a drug during pregnancy compared to those who continued drug use. The data from this analysis indicate that the prescribing physician is generally aware of the possible risks of drug use during pregnancy. The d/(b+c) and d/b ratios are shown to be a good measure of prescribing behaviour in relation to pregnancy and can be used to compare knowledge of theory and daily practice.

Female↗
PubMed1991

Investigating drug use in pregnancy. Methodological problems and perspectives.

In this study the use of prescribed drugs before, during and after pregnancy is described. The study is based on data obtained from pharmacy records of 1,948 women who delivered a live-born infant. Different measures to evaluate drug exposure are used. During the nine months of pregnancy 86% of the women used on average 4.2 prescriptions. During the course of pregnancy the use of gastro-intestinal and blood-forming drugs increased, whereas the use of cardiovascular, antiphlogistic and central nervous system drugs decreased. Anti-emetics were predominantly used in the first trimester, and antacids in the last trimester, whereas laxatives were especially used after delivery. The percentage of women who used a treatment for vaginal infections increased from 2 to 7 during pregnancy. Most of the women (73%) received one or more iron prescriptions during the course of pregnancy, however, the prescribed daily dose was low (prescribed daily dose/defined daily dose = 0.6). At least 1% of the women filled a new prescription for anticonceptives in the first trimester of pregnancy. Most likely, our data reflect the general prescribing pattern for Dutch pregnant women who delivered a live-born baby. Therefore, they form a good and detailed base for further studies, for instance, on the exposure to drugs with known or suspected risks or on the use of drugs in patients with chronic concomitant diseases. Such studies may lead to recommendations that may improve prescribing behaviour.

Adult↗
PubMed1990

The teaching and organisation of clinical pharmacology in European medical schools (W.H.O. Working Group on Clinical Pharmacology).

A World Health Organisation (European Regional Office) working party has been established to review the progress of clinical pharmacology in European countries. As part of this review a questionnaire on the teaching of clinical pharmacology was sent to the Deans of all 350 medical schools in the region. Very few replies were received from U.S.S.R., Greece and Portugal and these countries' returns were not analysed further. The overall compliance rate (excluding these countries) was 82% with a figure of 84% from Western Europe and 74% from Eastern Europe. An average time of 96 h (range 0-320) was devoted to pharmacology teaching in the medical curriculum in Western Europe with 124 (0-240) h in Eastern Europe. In contrast 28 h (0-210) was devoted to clinical pharmacology teaching in Western Europe and 27 h (0-90) in Eastern Europe. On average in Western Europe each medical school had 2 individuals trained in clinical pharmacology with 1.3 posts in the subject and the figures for Eastern Europe were 2.3 and 1.1 respectively. However these figures hide a wide variance in the teaching of clinical pharmacology. Particularly in Western Europe there are a number of medical schools in Italy, Spain and the Federal Republic of Germany (FRG) where clinical pharmacology is not taught and there is a dearth of individuals trained in the subject. Every effort to encourage clinical pharmacology and its teaching should be made, particularly in these countries.

Curriculum↗
PubMed1990

Health implications of drug interactions.

The awareness of the digoxin-quinidine interaction in the mid-70s led to increased interest in drug interactions. Much has been published on the subject in the form of interaction reports, handbooks, lists, cards, discs etc. However, only a few interactions in the literature have clinical significance and can be remembered by thinking in terms of groups, pharmacokinetics and probabilities. It is important to realise that drugs in a given class will have similar properties. Thus, phenylbutazone, like any other nonsteroidal anti-inflammatory drug (NSAID), is likely to potentiate the effects of warfarin. A knowledge of drug pharmacokinetics is also essential; a highly protein-bound drug may displace another when they are administered together. Remembering those drugs which induce liver enzyme formation will prevent their co-administration with drugs which have a critical dose-range. If a general practitioner can remember the few drugs in clinical practice with a narrow therapeutic index, he can consult a handbook before anything else is prescribed. Some interactions will rarely be encountered in daily general practice, i.e. those associated with tuberculosis treatment or anesthetic agents. Other interactions, e.g. the interaction between antihypertensive treatment and over-the-counter medication containing phenylpropanolamine, are more common. While most drug interactions can be avoided by thinking in terms of groups, pharmacokinetics and probabilities, some learning by rote is required, e.g. the potential for heart failure with concomitant beta-blocker and nifedipine therapy. In general, a schematic approach using thinking in terms of groups, pharmacokinetics and probabilities will prevent most clinically significant drug interactions; the rest can be avoided by consulting appropriate handbooks and specialists.

Animals↗
PubMed1982

Review of restrictive actions under the Australian drug regulatory system.

An analysis of restrictive measures taken by the Australian Drug Evaluation Committee (ADEC) over the period of 27 months (from March, 1976, to June, 1978) was made by two non-Australian observers. During this period, the ADEC took 32 useful restrictive measures (a little more than one a month). The analysis was limited only to cases in which ADEC took substantial action; if less comprehensive measures were included, the number of valid actions to counter the occurrence of iatrogenic complications would be much greater. It is concluded that, although it is an undisputed fact that many pharmaceutical companies maintain the highest ethical standards, there is a need for the type of objective and dispassionate control exercised by the Australian Drug Evaluation Committee.

Animals↗
PubMed1981

The regulatory control of non-steroidal anti-inflammatory agents.

The number of marketed non-steroidal anti-inflammatory agents varies widely from one European country to another, partly as a consequence of differing regulatory policies. During a four-year period, nine of 18 applications to market such drugs in the Netherlands failed; the remaining nine compounds were all licenced; in all, 22 single drug entities of this type are currently on sale. In Norway during the same period none of the 15 applications received was granted, though five cases are still pending; only seven such drugs are currently licenced for sale. The reasons for the national decisions and for the discrepancies between them are analyzed. A study of the prescribing practice of rheumatologists in the two countries suggests that some 10 to 15 products of this type are in fact needed in order to provide a reasonable choice. Current registration trends could markedly discourage further research investment in this field unless in the near future a basis is found for developing non-steroidal anti-inflammatory drugs with distinct advantages as compared with all those so far known.

Anti-Inflammatory Agents↗