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Biomedical subjects

P E McBride

Publications and source records attributed to P E McBride.

At least 19 recordsLinked to original sources
PubMed2001

Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction.

BACKGROUND: Human immunodeficiency virus protease inhibitors (HIV PIs) are associated with hyperlipidemia, hyperglycemia, and obesity; however, it is not known whether they increase risk of atherosclerotic vascular disease. The purposes of this study were to characterize the lipoprotein abnormalities associated with use of HIV PIs in individuals with HIV infection and to determine the pathophysiological significance of these changes by assessing their effect on endothelial dysfunction. METHODS AND RESULTS: This was a cross-sectional study of 37 adults with HIV-1 infection who were receiving antiretroviral therapy. Twenty-two were taking HIV PIs (group 1); 15 were not (group 2). Lipids and lipoproteins were measured by enzymatic techniques and nuclear magnetic resonance spectroscopic analysis. Flow-mediated vasodilation (FMD) of the brachial artery was measured by high-resolution ultrasound. Subjects in both groups were similar in regard to age, time since diagnosis of HIV infection, and CD4 cell count. Group 1 subjects had higher total cholesterol (5.68 versus 4.42 mmol/L, P=0.007) and triglyceride (4.43 versus 1.98 mmol/L, P=0.009) levels, characterized by elevated levels of IDL and VLDL. Subjects in group 1 had impaired FMD (2.6+/-4.6%), indicative of significant endothelial dysfunction. Group 2 subjects had normal FMD (8.1+/-6.7%, P=0.005). In group 1, chylomicron, VLDL, IDL, and HDL cholesterol levels predicted FMD. CONCLUSIONS: Use of HIV PIs is associated with atherogenic lipoprotein changes and endothelial dysfunction. Because these metabolic and vascular changes predispose to atherosclerosis, monitoring and treatment of dyslipidemia in patients taking these medications is warranted.

Adult↗
PubMed2001

Organization development strategies for continuing medical education.

BACKGROUND: The purpose of this study was to identify organizational strategies for improving staff performance in primary care practices. The study rationale was based on theory, research, and practice regarding educational interventions that help people help themselves. Analysis of qualitative and quantitative data produced both plausible explanations of organizational change and implications for future efforts. METHODS: The Health Education and Research Trial (HEART) Project was an experimental study designed to improve prevention services for cardiovascular disease. Primary care clinics were randomized into four experimental treatments. Two representative practices from each treatment arm were chosen for an in-depth cross-case analysis. Extensive data from each selected practice included patient medical record reviews and questionnaires, interviews and questionnaires from physicians and clinic staff, project records, and follow-up interviews. After detailed case descriptions were created for each practice, a cross-case analysis was performed. RESULTS: Each practice improved cardiovascular prevention services somewhat. However, there was a great range of impact, likely reflecting both experimental intervention and local contingencies. Eight positive influences were identified: effective leadership, priority setting, joint planning, cooperation and teamwork, acquisition of resources, increased support and ownership, accomplishment of improvements, and personal changes. Major influences that hindered improvement included patient load, turmoil related to reorganization, lack of wide-spread routines, hospital-affiliated practice, poor communication, and fragmentation within a clinic. FINDINGS: Continuing medical education providers can enhance preventive services to improve patient health status by promoting organizational change. Suggested strategies supported by this study include selecting able leaders, focusing on accomplishments, obtaining agreement on prevention priorities, addressing local contingencies, increasing teamwork, engaging in joint planning, emphasizing quality improvement, acquiring resources, encouraging persistence, and reducing hindrances.

Cardiovascular Diseases↗
PubMed2001

The effects of lipid-lowering and antioxidant vitamin therapies on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemia.

OBJECTIVES: The goal of this study was to determine the long-term effects of statins and antioxidant vitamins on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemia. BACKGROUND: Lipid-lowering therapy and antioxidant vitamins improve endothelium-dependent vasodilation in young and middle-aged adults with hypercholesterolemia, but their effects in older adults are not known. METHODS: Two double-blind, placebo-controlled studies were performed in individuals > or =70 years old with low-density lipoprotein cholesterol (LDL-C) > or =140 mg/dl. In the first study, 37 subjects were randomized to receive (group 1) pravastatin for six months then pravastatin and vitamin E for six additional months or (group 2) vitamin E for six months, then pravastatin and vitamin E for six additional months. In the second study, additional 17 subjects sequentially received simvastatin for six months, then simvastatin and vitamins C and E for six additional months. Flow-mediated vasodilation of the brachial artery was measured by high-resolution ultrasound. RESULTS: At baseline, subjects in both studies were similar in age (mean +/- SD, 75.8 +/- 4.2 years), gender, systolic blood pressure, total cholesterol (261.6 +/- 37.4 mg/dl), LDL-C (180.3 +/- 28.1 mg/dl), high-density lipoprotein cholesterol and triglycerides levels. Flow-mediated vasodilation was severely impaired (2.2 +/- 3.9%). Both statins reduced total and LDL-C levels (p < 0.001); however, neither statin, antioxidant vitamin regimen nor the combination of statins and antioxidant vitamins improved flow-mediated vasodilation of the brachial artery. At baseline, nitroglycerin-mediated vasodilation also was impaired (10.7 +/- 5.6%) and did not change in either study. CONCLUSIONS: Older adults with hypercholesterolemia have impaired flow-mediated vasodilation of the brachial artery that does not improve after one year of therapy with statins and antioxidant vitamins, despite significant lipid-lowering.

Aged↗
PubMed2001

Translation of nutritional sciences into medical education: the Nutrition Academic Award Program.

For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts.

Awards and Prizes↗
PubMed1999

Antioxidant vitamins and the prevention of coronary heart disease.

Clinical use of antioxidant vitamin supplementation may help to prevent coronary heart disease (CHD). Epidemiologic studies find lower CHD morbidity and mortality in persons who consume larger quantities of antioxidants in foods or supplements. Clinical trials indicate that supplementation with certain nutrients is beneficial in reducing the incidence of CHD events. Recent studies show that supplementation with antioxidant vitamins E and C have benefits in CHD prevention; however, supplementation with beta-carotene may have deleterious effects and is not recommended. Current evidence suggests that patients with CHD would probably benefit from taking vitamin E in a dosage of 400 IU per day and vitamin C in a dosage of 500 to 1,000 mg per day. Clinicians may also want to consider vitamin supplementation for CHD prevention in high-risk patients. Folate lowers elevated homocysteine levels, but evidence for routine supplemental use does not yet exist. Other nutritional supplements are currently under investigation.

Antioxidants↗
PubMed1999

Managing dyslipidemia in older adults.

OBJECTIVES: To summarize and critically review clinical trial data regarding dyslipidemia as a risk factor for coronary heart disease (CHD) and the efficacy and safety of lipid-lowering interventions in older adults. Based on these data, clinical recommendations for diagnosing and managing dyslipidemia in older adults are provided. METHODS: Peer-reviewed journal articles were identified by a MEDLINE search and a review of journal article references. Studies that were performed exclusively in subjects older than 65 years or that included a large subgroup of older adults were included. CONCLUSIONS: Elevated low density lipoprotein and total cholesterol levels are independent risk factors for CHD events in patients aged older than 65 years. Older adults have a higher risk of mortality attributable to hypercholesterolemia. Diet and lipid-lowering medications safely and effectively lower cholesterol levels in this age group. Exercise increases high-density lipoprotein cholesterol levels and decreases triglyceride levels. If accompanied by weight loss, exercise may reduce low-density lipoprotein and total cholesterol levels. Improving lipid levels in older adults with CHD decreases the risk of future coronary events by up to 45%, and significant effects on outcome measures may be observed within 2 years of the initiation of therapy.

Aged↗
PubMed1998

Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. off.

Hyperhomocysteinemia has recently been identified as an important risk factor for atherosclerotic vascular disease. This article reviews homocysteine metabolism, causes of hyperhomocysteinemia, the pathophysiological findings of this disorder, and epidemiological studies of homocysteine and vascular disease. Screening for hyperhomocysteinemia should be considered for patients at high risk for vascular disease or abnormalities of homocysteine metabolism. For primary prevention of vascular disease, treatment of patients with homocysteine levels of 14 micromol/L or higher should be considered. For secondary prevention, treatment of patients with homocysteine levels of 11 micromol/L or higher should be considered. Treatment is most conveniently administered as a folic acid supplement (400-1000 microg) and a high-potency multivitamin that contains at least 400 microg of folate. Higher doses of folic acid and cyanocobalamin supplements may be required in some patients. Until prospective clinical trial data become available, these conservative recommendations provide a safe, effective, and evidence-based approach to the diagnosis, evaluation, and management of patients with hyperhomocysteinemia.

Arteriosclerosis↗
PubMed1997

Homocysteine: a new risk factor for atherosclerosis.

The accumulating evidence for the role of homocysteine as a risk factor for atherosclerosis is persuasive. A high plasma homocysteine concentration induces pathologic changes in the arterial wall and thus is strongly associated with an increased risk of atherosclerosis, manifested as cardiovascular, cerebrovascular and peripheral vascular events. Studies are being conducted to determine whether lowering homocysteine levels prevents occlusive events. At present, testing for elevated homocysteine concentrations should be considered in patients with premature atherosclerosis or a strong family history of atherosclerosis, since hyperhomocysteinemia is a common risk factor in these patients. Treatment of hyperhomocysteinemia is straightforward and associated with minimal risk. This disorder is usually correctable with vitamin supplements containing folic acid.

Algorithms↗
PubMed1996

Recruitment of private practices for primary care research: experience in a preventive services clinical trial.

BACKGROUND: Recruitment of community primary care practices for studies to improve health service delivery is important to many health care organizations. Prior studies have focused on individual physician recruitment or academic settings. METHODS: This descriptive study evaluated the efficiency and utility of three different recruitment methods to encourage community practice participation in a preventive services research trial. Primary care practices in four midwestern states were recruited using different sources for initial mailings (physician lists, practice lists, and a managed care organization's primary care network) and different recruiting methods. Outcome measures included response rates, participation rates, and comparative costs of each method. RESULTS: Of the 86 eligible practices contacted, 52 (60%) consented to participate. Mailing to individual physicians was the most cumbersome and expensive method and had the lowest response rate. Initial contacts with practice medical directors increased the participation rate substantially, and practice recruitment meetings improved both study participation and practice-project communication. CONCLUSIONS: Experience with these three methods suggests that the most efficient way to recruit practices for participation in a preventive services research trial involves targeted mailings and phone calls to medical directors, followed by on-site practice meetings.

Adult↗
PubMed1994

Management of older adults with hypercholesterolaemia.

Although the strength of total cholesterol levels as a relative risk factor for coronary heart disease (CHD) declines with age, the prevalence of CHD increases dramatically with age. Data from cholesterol treatment trials, although sparse in older adults, suggest that dyslipidaemia treatment has the potential to prevent CHD. In particular, dyslipidaemia treatment appears to be most beneficial in older adults with a history of CHD or who have several other CHD risk factors. Dyslipidaemia screening should be selective in the elderly, reserved for those whose health status would be amenable to nutritional or pharmacological therapy, and in whom several CHD risk factors or a history of CHD are present. Since high density lipoprotein cholesterol (HDL) levels retain their inverse association CHD in old age, cholesterol subfractions should be measured in persons being screened in order to adequately assess the severity of dyslipidaemia. Treatment decisions should be guided by the patient's dyslipidaemic class, which is determined by the cholesterol subfractions and serum triglycerides (TG). As in younger persons, nutritional therapy remains the first step in dyslipidaemia management in high risk, nondebilitated older adults. An array of cholesterol modifying medications are available which vary widely in treatment effects, adverse effects and cost. Extra care needs to be taken in prescribing these agents in older adults because of greater potential for adverse effects and interactions with other medications. The cost-effectiveness of pharmacological treatment decreases with age and increases with the severity of dyslipidaemia, a history of CHD, or the presence of multiple CHD risk factors. When comparing elderly to middle-aged adults, the relative cost-effectiveness of different cholesterol-lowering medications may be altered due to age-related changes in therapeutic efficacy and adverse effects.

Aged↗
PubMed1993

A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management.

Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as "high risk"; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.

Aged↗