PubMed Health⌕ Search

Biomedical subjects

R A Moore

Publications and source records attributed to R A Moore.

At least 19 recordsLinked to original sources
PubMed1992

Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia.

There is controversy about whether the lack of response of some chronic pain to opioid treatment is absolute or relative. It is widely believed that nociceptive pain is responsive to opioids whereas neuropathic pain tends not to be. We have used a method of patient-controlled analgesia (PCA) with simultaneous nurse-observer measurement of analgesia, mood, and adverse effects to address these issues. Ten patients with chronic pain were given morphine at two concentrations (10 and 30 mg/ml) by PCA in two separate sessions in a double-blind randomised crossover study. Before the study a clinical judgment was made as to whether each pain was nociceptive or neuropathic. Seven patients showed good analgesic responses (more than 70 mm pain relief on a visual-analogue scale) of pain at rest, two patients poor responses (less than 30 mm pain relief), and one a moderate response with both concentrations (30-70 mm pain relief). The response to morphine was consistent (greater and faster relief with the higher concentration) in nine patients. Two patients had pain on movement that responded moderately to low-concentration morphine and well to the higher concentration. All patients with pains judged to be nociceptive showed good analgesic responses compared with half of those with neuropathic pain. There was no evidence that analgesic responses in patients with neuropathic pain were due to changes in mood. This PCA method is a quick and efficient tool to determine the consistency of the analgesic response. Such consistency can guide the clinician as to whether continued or higher-dose opioid treatment will produce good analgesia. An inconsistent response points to the use of other pain-relieving strategies.

Adult↗
PubMed1992

A multiple dose comparison of combinations of ibuprofen and codeine and paracetamol, codeine and caffeine after third molar surgery.

In a randomised, double-blind, double-dummy, multiple dose, crossover study in 30 patients we compared an ibuprofen/codeine combination (400 mg ibuprofen/25.6 mg codeine phosphate) with a paracetamol/codeine/caffeine combination (1 g paracetamol/16 mg codeine phosphate/60 mg caffeine) for pain relief over 6 days after two-stage bilateral lower third molar removal. The ibuprofen combination produced significantly greater analgesia than the paracetamol combination, both on single-dose analysis of the first and second days and on multiple-dose measures for days 1, 2, 3 and 4. The mean incidence of adverse effects over the 6 days was 20% for both combinations. This trial design (crossover with multiple dosing in outpatients) is a sensitive way of testing for analgesia, and is potentially more predictive of adverse effect problems than single-dose studies. It confirms that multiple dosing may show increased efficacy.

Acetaminophen↗
PubMed1992

Opioid sensitivity of chronic pain: a patient-controlled analgesia method.

Twenty-two patients with chronic pain of malignant or nonmalignant origin were given intravenous morphine by patient-controlled analgesia. A prestudy judgment was made from the characteristics of the pain as to whether it was nociceptive or neuropathic. Analgesic efficacy was assessed by a nurse-observer; adverse events were noted and plasma morphine and metabolitie concentrations measured. Three categories of opioid response were distinguished. Good responders obtained > 70 mm relief on the visual analogue scale, with minimal or manageable adverse events. Moderate responders obtained < 70 but > 30 mm relief with more problematic adverse events, and poor responders had < 30 mm relief with troublesome adverse events. This method for the study of opioid sensitivity allowed a wide dosage range to be studied. The simultaneous analgesic and adverse event measurements showed that the spectrum of observed response was wide, and response category could be judged for the majority by 4 h. In those with poor or moderate response, adverse event severity limited further dose increment. The relationship between pain characteristics and response showed that some pains judged to be neuropathic had a good response to opioid (5/13), and some pains judged to be nociceptive did not (5/14). The study suggests that the pattern of response is not as black and white as the prediction of good response from nociceptive pain and poor from neuropathic pain would suggest, although nociceptive pain was more likely than neuropathic pain to show a good response. For the moderate responders opioid titration may, in the absence of other effective treatments, be useful, but the analgesic endpoint may not be totally satisfactory. The method provides an operational definition of opioid sensitivity.

Adult↗
PubMed1979

Improved glucose control in maturity-onset diabetes treated with high-carbohydrate-modified fat diet.

Fourteen patients with established maturity-onset diabetes were treated as outpatients with a high-carbohydrate-(about 60% of total daily energy requirements)-modified fat diet (ratio of polyunsaturated fatty acids to other fatty acids greater than or equal to 1:1) for six weeks. Commercially available and acceptable cereal foods and tuberous vegetables high in both digestible and non-digestible carbohydrates were used. Simple sugars were restricted. Compared with their usual, low-carbohydrate diabetic diet this diet resulted in a fall in basal plasma glucose concentration (average of values measured at 0300, 0500, and 0700), mean preprandial plasma glucose concentration (average of values measured at 0800, 1230, and 1730), and percentage of glycosylated haemoglobin. Modifying dietary fat also decreased the fasting plasma cholesterol concentration. The findings suggest that it is no longer justifiable to prescribe a low-carbohydrate diet for maturity-onset diabetes.

Blood Glucose↗
PubMed1979

High-density lipoprotein, lipid, and carbohydrate metabolism during increasing fitness.

Eleven unfit bank executives in sedentary employment exercised daily for 10 weeks according to the Canadian Air-Force 5BX Exercise Programme. Over this period no changes were observed in the glucose or insulin responses to a standard breakfast or to intravenous glucose, or in the glucose response to intravenous insulin. There was a significant reduction in high-density-lipoprotein cholesterol, but total plasma triglyceride and cholesterol levels were unaffected by exercise.

Adult↗
PubMed1979

Conjunctivitis in children. A refresher survey of diagnosis and contemporary treatment.

The management of acute conjunctivitis need not be confusing. In the newborn period the common etiologic agents are chemical, TRIC, and bacterial. The latter two causes are effectively treated with sulfacetamide ophthalmic preparations. Dacryostenosis should be suspected in any child with recurrent conjunctivitis in the first six months of life. With older children the major causes can be classified as viral, allergic, foreign bodies, and bacterial. Bacterial conjunctivitis almost always responds to sulfacetamide ophthalmic preparations.

Anti-Bacterial Agents↗
PubMed1979

Computerized tomography in central pontine myelinolysis.

We describe an autopsy-proven case of central pontine myelinolysis (CPM) with premortem computerized tomographic (CT) visualization of the lesion on two scans, performed with an interval of 2 weeks. This case demonstrates the capability of CT to support the clinical diagnosis of central pontine myelinolysis. Identification of the condition should facilitate prompt initiation of aggressive supportive care.

Brain Diseases↗
PubMed1979

Hyperlipidaemia following renal transplantation. A study of the prevalence, 'natural history' and dietary treatment.

In a study of 70 renal transplant patients, the prevalence of hyperlipidaemia eight to 28 months following transplantation was found to be 59 per cent. High density lipoprotein (HDL) cholesterol levels were normal but low-density-lipoprotein (LDL) cholesterol levels were significantly elevated compared with controls. Lipid levels, measured before and sequentially after transplantation for 22 months in 10 patients were elevated over the first six to 10 months. Thereafter the lipid values returned to normal in most patients. This change coincided with the attainment of maintenance steroid dosage (usually prednisolone 10 mg. daily; mean 12.5 mg). A diet designed to decrease cholesterol and increase polyunsaturated fat intake, resulted in a significant reduction of serum cholesterol levels but not of triglyceride values over a four week period. The results suggest that the hyperlipidaemia in the initial months after transplantation may well be related to the high dose steroid therapy during this period, and the levels of lipid return to normal once low dose maintenance therapy is attained. Lipid profiles and levels in the first eight to 12 months are variable and should not form the basis for therapy or assessment. Dietary modification alone is unlikely to be an effective form of treatment of severe hyperlipidaemia in these patients.

Adolescent↗
PubMed1978

Ethics in the practice of psychiatry--origins, functions, models, and enforcement.

The author points out that psychiatric ethics are coming under increasing critical scrutiny by psychiatrists and by those outside of the profession. On the basis of an examination of APA Ethics Committee records, he concludes that criticism of psychiatry's inability to police itself might have some merit but cautions that the critics might be expecting too much from a code of ethics, which has the job of sensitizing psychiatrists to an ethical way of professional life and helping sort out ethical conflicts. After outlining a number of the problems in the self-policing aspect of ethics, the author makes suggestions for their resolution.

Codes of Ethics↗
PubMed1977

Consultations in internal medicine: a training program resource.

At the Milton S. Hershey Medical Center of the Pennsylvania State University an internal medicine consulting resident sees all medical consultation requests not directed to a specific subspecialty division. An audit of a nine-month experience on the consult service was compared with that of a general medicine ward service. The audit revealed that consulting residents were exposed to a quantitatively and qualitatively different spectrum of medical problems than were found on the ward service. The interdisciplinary aspects of the experience expand the consulting internist's fund of knowledge and complement outpatient exposure to other specialties, such as surgery and obstetrics-gynecology. Chief medical residents at 36 university medical centers were surveyed regarding the nature of the internal medicine consultation programs in their institutions. The survey indicated that half the programs were service oriented rather than educational and were not felt to be of profit to the medicine residents.

Adolescent↗