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Biomedical subjects

P A Atkin

Publications and source records attributed to P A Atkin.

13 recordsLinked to original sources
PubMed2003

Oral mucosal lesions in a UK HIV/AIDS oral medicine clinic. a nine year, cross-sectional, prospective study.

PURPOSE: To investigate changes in presentation of oral mucosal lesions in patients with HIV/AIDS attending a dedicated oral medicine clinic over a nine year period. MATERIALS AND METHODS: 358 Patients with HIV/AIDS attending a dedicated oral medicine clinic, contained within a genitourinary medicine clinic. Data was collected prospectively for all patients attending the oral medicine clinic, and entered into a database. Lesions were recorded according to the EEC-WHO diagnostic criteria 1991/1993. RESULTS: In 358 patients with 542 lesions, over 54% of the lesions belong within one of the five categories of ulcers, warts, candidiasis, OHL and Kaposi's sarcoma. The major differences in the presentation of the lesions over time were between the ulcers and the warts, but in this series the introduction of HAART did not make a statistical difference. CONCLUSIONS: There has been a large reduction in the presentation of oral ulcers, and there appears to be a relative increase in viral papillomata, and a decrease of other mucosal diseases over the period of study. Many of the warts biopsied showed dysplastic changes, and continued follow-up of these patients will be important to determine whether these patients are at increased risk for developing oral squamous carcinoma. Also, proposals are put forward suggesting a need for alteration of the three groups of HIV/AIDS lesions classification suggested by the EEC-WHO consensus.

AIDS-Related Opportunistic Infections↗
PubMed2002

Minor recurrent aphthous stomatitis and smoking: an epidemiological study measuring plasma cotinine.

OBJECTIVE: To compare blood cotinine levels between a group of patients with minor recurrent aphthous stomatitis (RAS) and a group representative of the general population, matched for age and gender. SETTING: Although smoking has been implicated as a protective factor in RAS, few studies have compared the prevalence of smoking in RAS patients with population controls. Cotinine is a smoking derivative with a long half-life in the circulation. Measurement of plasma cotinine levels provides an accurate and objective measurement of an individual's cigarette consumption. METHODS: Blood samples were taken from 84 RAS patients and 81 controls. A microplate enzyme immunoassay (EIA) was used to detect plasma cotinine levels. RESULTS: The number of RAS patients [2 (2.4%)] who were smokers (plasma cotinine > 25 microg ml(-1) was significantly lower than in the control group [12 (14.8%); P = 0.00102]. Furthermore, the mean cotinine level amongst smokers in the RAS group was significantly lower than in smokers in the control group (P = 0.0068). CONCLUSION: This study shows that a group of RAS patients is significantly less likely to contain smokers than a matched control population, and among smokers the level of cigarette use was significantly lower in RAS patients than the control population. The perceived negative association between RAS and smoking was supported by this epidemiological study.

Adult↗
PubMed1999

The epidemiology of serious adverse drug reactions among the elderly.

Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.

Age Factors↗
PubMed1998

The influence of information provided by patients on the accuracy of medication records.

OBJECTIVE: To assess two interventions for improving the accuracy of doctors' information about their patients' medication. DESIGN AND SETTING: A 12-month two-armed (parallel designed) prospective study among elderly patients of four general practitioners (GPs) in two local government areas of Sydney's North Shore. PATIENTS: 206 elderly, ambulant, self-caring patients (69 men, 137 women; median age, 75 year; range, 60-94 years). INTERVENTION: Patients were issued with a medication record card (MRC), filled in by their GPs with what they believed to be the patient's current medications, and were asked to produce it at all subsequent consultations. Patients of two of the GPs were additionally asked to bring their currently used medications to all scheduled appointments. MAIN OUTCOME MEASURE: Accuracy of the MRC, determined by confirmatory home visits and inspection of medications by a pharmacist. RESULTS: The proportion of patients with regimens recorded accurately on their MRCs improved significantly (from 25.9% to 42.0%) only in the group asked to bring their medications to consultations (P = 0.03). Most errors of recording were of omission, with patients taking a median of two medications (range, 0-10) of which their GPs were not aware. CONCLUSION: Requesting that patients bring their medications to consultations, in conjunction with the use of medication record cards, can improve information for doctors about their patients' medications.

Aged↗
PubMed1995

Are medication record cards useful?

OBJECTIVE: To assess the use of patient-held medication record cards and their acceptability to patients and doctors. DESIGN: Prospective 12-month study with data collection at baseline and on three subsequent occasions at four-monthly intervals. PATIENTS AND SETTING: 187 patients with a mean age of 78.4 years (range, 60-101) were taking a mean of 5.8 medications each (range, 1-18). They lived on Sydney's lower north shore and were able to care for themselves. MAIN OUTCOME MEASURES: Availability of card on request, frequency of use, status of recorders and accuracy of records (checked by inspection of medications at home). RESULTS: Most patients retained their cards, but the proportion who presented it to their doctor fell from 61% to 23% over the 12 months (P < 0.0001), and the proportion with accurately recorded drug regimens ranged from 20% down to 16%. Of the 75 regimens written exclusively by general practitioners in the 12 months, only 19 (25%) were consistent with what the patients were actually taking. CONCLUSION: Medication record cards introduced into the doctor-patient relationship by a "third-party" are unlikely to result in better quality use of medicines.

Aged↗
PubMed1994

Functional ability of patients to manage medication packaging: a survey of geriatric inpatients.

This study measured the prevalence of difficulty experienced by elderly inpatients in opening and removing tablets from a range of common commercial medication packagings and in breaking a bar-scored tablet in half. One hundred and twenty elderly patients admitted to a teaching hospital acute geriatric service were tested for their ability to open the container and remove a tablet from it. They were rated as 'able' or 'unable' to do so. In all, 94 patients (78.3%) were unable to break a tablet or open one or more of the containers. Of the 111 patients taking medication at the time of their admission, 46 (41.4%) were unable to perform one or more tasks necessary to gain access to medications in their own treatment regimen. The factors that were significantly and independently associated with inability to open containers were poor vision, impaired general cognitive function, and female sex. Many of the drug packagings in common use significantly impede access by elderly patients to their medications.

Activities of Daily Living↗