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Biomedical subjects

R Doughty

Publications and source records attributed to R Doughty.

16 recordsLinked to original sources
PubMed2001

Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group.

OBJECTIVES: We sought to assess plasma concentrations of the amino (N)-terminal portion of pro-brain natriuretic peptide (N-BNP) and adrenomedullin for prediction of adverse outcomes and responses to treatment in 297 patients with ischemic left ventricular (LV) dysfunction who were randomly assigned to receive carvedilol or placebo. BACKGROUND: Although neurohormonal status has known prognostic significance in heart failure, the predictive power of either N-BNP or adrenomedullin in chronic ischemic LV dysfunction has not been previously reported. METHODS: Plasma N-BNP and adrenomedullin were measured in 297 patients with chronic ischemic (LV) dysfunction before randomization to carvedilol or placebo, added to established treatment with a converting enzyme inhibitor and loop diuretic (with or without digoxin). The patients' clinical outcomes, induding mortality and heart failure events, were recorded for 18 months. RESULTS: Above-median N-BNP and adrenomedullin levels conferred increased risks (all p < 0.001) of mortality (risk ratios [95% confidence intervals]: 4.67 [2-10.9] and 3.92 [1.76-8.7], respectively) and hospital admission with heart failure (4.7 [2.2-10.3] and 2.4 [1.3-4.5], respectively). Both of these predicted death or heart failure independent of age, New York Heart Association functional class, LV ejection fraction, previous myocardial infarction or previous admission with heart failure. Carvedilol reduced the risk of death or heart failure in patients with above-median levels of N-BNP or adrenomedullin, or both, to rates not significantly different from those observed in patients with levels below the median value. CONCLUSIONS: In patients with established ischemic LV dysfunction, plasma N-BNP and adrenomedullin are independent predictors of mortality and heart failure. Carvedilol reduced mortality and heart failure in patients with higher pre-treatment plasma N-BNP and adrenomedullin.

Adrenergic beta-Antagonists↗
PubMed2000

An audit of phase II cardiac rehabilitation at Auckland hospital.

AIM: To audit Phase II cardiac rehabilitation services available to patients admitted to Auckland Hospital in order to assess patient uptake and to identify problems with patient recruitment to the service. METHODS: We performed a retrospective review from 1/8/ 97 to 30/9/97 of all patients admitted to the coronary care/ cardiology departments in Auckland Hospital. RESULTS: There were 289 patient admissions in this two month period, of which 22 (8%) were readmissions. 154 (54%) were admissions with provisional diagnoses of chest pain, of whom eight were readmissions. A total of 113 (39%) patients were felt to be suitable for the rehabilitation programme, of whom 50 (44%) attended one or more sessions and 22 (19%) completed the six week programme. 63 (56%) of the eligible patients did not attend any session. Reasons for non-attendance included the distance to be travelled, availability of transport and problems associated with taking time off work. A major finding of the audit was that the systems currently in place to follow patients are inadequate to allow formal audit and evaluation of the rehabilitation service. CONCLUSIONS: Although a reasonable rehabilitation service exists for Auckland Hospital patients, less than half of suitable patients attend a single session. There is a need for better collection and recording of patient data in order to facilitate the development of evaluation and audit tools.

Aged↗
PubMed1999

Neurohumoral prediction of benefit from carvedilol in ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group.

BACKGROUND: Plasma neurohormones were analyzed for prediction of adverse outcomes and response to treatment in 415 patients with ischemic left ventricular dysfunction randomly assigned to receive carvedilol or placebo. METHODS AND RESULTS: Atrial natriuretic peptide, brain natriuretic peptide (BNP), or norepinephrine (NE) levels above the group median were associated with increased mortality rates and heart failure. On multivariate analysis, both BNP and NE interacted with treatment to predict death or heart failure independent of age, New York Heart Association class, and left ventricular ejection fraction. For placebo, supramedian levels of BNP were associated with 3-fold the mortality rate of inframedian levels (20/104; 19% vs 6/99; 6%; P<0.01). For carvedilol, mortality rate was comparable in these 2 subgroups (12/109; 11% vs 8/94; 9%; NS). Corresponding rates for heart failure were 29/104 (28%) versus 3/99 (3%; P<0.001) for placebo and 16/109 (15%) versus 7/94 (7%; NS) for carvedilol. High NE levels did not predict additional benefit from carvedilol, which significantly reduced heart failure admissions only in those with NE levels below the median (13.1% to 4. 0%; P<0.01). In the 23% of the study population with supramedian BNP but inframedian levels of NE, carvedilol reduced hospital admission with heart failure by >90% (P<0.001). CONCLUSIONS: Carvedilol reduced mortality rates and heart failure in those with higher pretreatment BNP levels but lesser activation of plasma NE. Neurohumoral profiling may guide introduction of beta-blockade in heart failure.

Arginine Vasopressin↗
PubMed1997

Optimal treatment of heart failure in the elderly.

Heart failure is a common condition in the elderly and one that is likely to become more prevalent as the population ages. Many drugs have been developed for the treatment of heart failure, but because clinical trials of these agents have often not included elderly patients their results need to be extrapolated from younger to older patients. Age-related physiological changes that affect how the available treatments are used occur in many organ systems. Effective management strategies can be implemented in elderly patients as well as in younger age groups, and these can improve both functional status and quality of life as well as reducing hospital admission and improving survival. This article reviews the physiological changes that occur in the elderly and the treatment approach that can be taken in elderly patients with heart failure.

Aged↗
PubMed1996

ISBT Code 128 and code changes as part of the implementation of a national IT system for the English National Blood Service.

The implementation of PULSE within the NBS will bring considerable advantages to the Service and to hospitals. A system of dual labelling has been developed to overcome intrinsic constraints identified with the ABC Codabar system. This should not, however, impact directly on hospitals which will be able to continue to utilize the ABC Codabar system. The dual labelling system incorporates the use of the ISBT Code 128 barcode system for transfusion centre use. This must be clearly differentiated from the implementation of ISBT code 128 within the UK. This latter development would bring considerable benefit to transfusion practice, increasing the overall safety of blood transfusion. It is, however, recognized that extensive discussion with appropriate stakeholders will be necessary before any implementation date can be determined for this initiative, particularly so given the significant logistical and financial implications inherent in such a change.

Blood Banks↗
PubMed1995

Hospital admissions and deaths due to congestive heart failure in New Zealand, 1988-91.

AIMS: Congestive heart failure is believed to be a major public health problem in most Western countries; however, little is known about the extent of morbidity and mortality from congestive heart failure in New Zealand. This paper reports data on hospital admissions and mortality due to congestive heart failure in New Zealand during the years 1988-91. METHODS: All data were obtained from the New Zealand Health Information Service. Deaths from congestive heart failure were identified from ICD-9 codes indicating a primary diagnosis of congestive heart failure. Hospitalisations for congestive heart failure were identified both from ICD-9 codes indicating a primary diagnosis of congestive heart failure and from codes indicating a diagnosis of congestive heart failure secondary to chronic rheumatic heart disease, ischaemic heart disease or valvular heart disease (nonrheumatic). RESULTS: Each year there was an average of about 850 deaths ascribed to heart failure; two-thirds of these occurred in patients over the age of 75 years. Each year there was also an average of about 8000 hospital admissions of about 5000 patients for congestive heart failure; 75% of these admissions involved patients over 65 years old. The mean duration of hospital stay for congestive heart failure was 16 days. On this basis, it is estimated that hospital admissions for congestive heart failure are likely to cost about NZ$50 million each year, or about 1% of the total health budget. CONCLUSIONS: Congestive heart failure is clearly a major public health problem in New Zealand with high hospitalisation and mortality rates. Several strategies have been proven to reduce mortality and hospital admissions for congestive heart failure and these should be utilised widely in patients at risk.

Aged↗
PubMed1995

Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay.

AIM: Thrombolytic treatment when given early in acute myocardial infarction is beneficial. This study was initiated to firstly, document the existing time delays in the administration of thrombolysis at Auckland Hospital, and secondly, prospectively assess the effect of a staff education programme to reduce in-hospital delay. The goal was a "door to needle time" of less than 30 minutes. METHODS: The time delays in the administration of thrombolysis to patients with acute myocardial infarction admitted to the coronary care unit at Auckland Hospital were established. This was done with a retrospective chart review over a six month period January to June 1993. This was followed by a staff education programme to fast track the management of patients eligible for thrombolysis. A prospective assessment was performed from February to May 1994 to audit the effectiveness of the programme. RESULTS: Most of the delay in the administration of thrombolysis occurred in the community prior to arrival at hospital (median delay 2.5 hours). However there was still a significant delay in hospital with a median door to needle time of 59 minutes in 1993. Following the education programme in 1994 the median door to needle time was reduced by 32% to 40 minutes (p = 0.03). The proportion of patients with a door to needle time of less than 30 minutes doubled from 13% in 1993 to 27% in 1994 (p = 0.18). CONCLUSION: Staff training and thrombolysis guidelines are effective in reducing in-hospital treatment delay but additional strategies may be warranted. Thrombolysis should be administered in the coronary care unit or emergency department to avoid delay. Ongoing assessment of standards will be required in the general hospital setting as a quality indicator.

Adult↗
PubMed1991

Pulmonary functions in children with progressive systemic sclerosis.

The patterns of pulmonary involvement in 13 children with progressive systemic sclerosis were investigated. Eight patients (61%) had respiratory symptoms or signs and 7 patients (55%) had abnormalities on chest roentgenogram. Twelve patients (92%) had abnormal pulmonary function tests: 7 had restrictive disease, 2 had obstructive disease, 2 had small airway disease, and 1 had an isolated reduction in the diffusing capacity of carbon monoxide. Nine patients had the test performed during the first year of illness, 3 during the second year, and 1 at 5 years. All patients had abnormal pulmonary function tests when first studied. Subsequent pulmonary function tests over a period of 3 to 10 years (mean 6.2 years) showed substantial changes in only 2 patients (1 patient had initial worsening of diffusing capacity of carbon monoxide followed by normalization and another patient showed improvement of obstructive disease). Two patients died during follow-up, 1 of pulmonary hypertension, the other of severe restrictive lung disease and myocardial fibrosis. The major findings of this study were (1) high frequency of pulmonary disease in children with progressive systemic sclerosis, (2) early involvement of the lungs, (3) relatively indolent progression of lung disease, and (4) the prognostic importance of the severity of pulmonary disease. Pulmonary manifestations of progressive systemic sclerosis in children appear to be similar to those of affected adults.

Adolescent↗
PubMed1985

Macroaggregate formation in optimal additive red cells.

The formation of macroaggregates weighing up to 9 g was observed in optimal additive red cells. Such aggregates, with a mean wet weight of 3 g, formed progressively during storage and were present in up to 85% of units. They were composed of leucocyte and platelet debris, together with some fibrin. Macroaggregates formation was halved by less stringent centrifugation during preparation and was reduced by use of an optimal additive system in which the additive solution contained citrate. Extra mixing during transfer of the additive solution only delayed aggregate formation. Partial leucocyte depletion or addition of 200,000 KIU of the enzyme inhibitor aprotinin did not prevent macroaggregate formation.

Blood Preservation↗
PubMed1983

The cervical spine in juvenile rheumatoid arthritis.

Clinical and roentgenographic follow-up examinations of patients with juvenile rheumatoid arthritis (JRA) suggest that neurologic complications are less likely to develop in these patients than in patients with adult rheumatoid arthritis (RA). A review of the charts of 92 patients treated for JRA during the period from 1970 to 1976 revealed that 29 (31%) had clinical evidence of cervical spine involvement. Follow-up examinations in 15 of these 29 patients revealed that all had limited cervical spine motion, 14 had neck pain and stiffness, and two had torticollis. Roentgenographic evidence of atlantoaxial subluxation was present in five patients and ankylosis of the facet joints in four. Two patients with atlantoaxial subluxation had hypereflexia and clonus, but both long tract signs and subluxation spontaneously resolved in one of these patients. None of these patients had basilar invagination or subaxial instability, which can occur in adult RA.

Adolescent↗
PubMed1982

Reflex sympathetic dystrophy in children.

Six patients with reflex sympathetic dystrophy were investigated during the period between 1973 and 1978. Children do not develop the severe, disabling pain nor the patchy osteoporosis (Sudeck's atrophy) which are considered essential features of reflex sympathetic dystrophy in adults. In contrast to the adult variety, reflex sympathetic dystrophy in children is a self-limiting condition which usually responds well to mild analgesics and physical therapy. Frequently it may be necessary to administer the physical therapy in an intensive, inpatient program, both to break the pain-disability cycle and to remove the patient from a stressful family environment that may have initiated or prolonged the syndrome. The use of steroids (dexamethasone) had no appreciable effect on the clinical course in these children.

Adolescent↗
PubMed1981

An enzyme linked immunosorbent assay for leucocyte and platelet antibodies.

An enzyme linked immunosorbent assay (ELISA) method for the detection of antibodies to platelets and leucocytes is presented. The method can be used for large numbers of samples. The method is objective when photometers are used. Approximately 50% of all cases of possible autoimmune thrombocytopenic purpura (A.T.P.) and unexplained neutropenia showed positive results. The results obtained using ELISA and standard tests for leucocyte and platelet antibodies are compared. The ELISA tests may also detect immune complexes.

Acute Disease↗
PubMed1979

Intensive plasma exchange in rhesus isoimmunisation.

Intensive plasma exchanges were carried out in a 34-year-old pregnant woman to lower the level of circulating anti-D. The patient proved interesting from a number of serological aspects. The possible protective effect of coexistent ABO incompatibility is discussed. The effect of plasma exchanges on cytotoxic HLA antibodies is also demonstrated.

Adult↗
PubMedDate not supplied

Validity and reproducibility of color enhancement of B-mode ultrasound images of far wall thickness of the common carotid artery.

Ultrasound measurement of wall thickness of the carotid artery is used in large cardiovascular clinical trials and epidemiologic studies. Improvements in measurement reproducibility could have important implications for study design and sample size calculations. This study examined the effects of B-mode color on the validity and reproducibility of measurements of far wall thickness of the common carotid artery. Six color maps were compared with normal and inverted gray scales. The validity of B-mode color was assessed by comparing histologic measurements from 20 excised human common carotid arteries with measurements made using each map. No differences were noted in the average far wall thickness measured by any method (all p > 0.99). The reproducibility of duplicate measurements was assessed using each of the B-mode color maps. The coefficient of variation between the two measurements ranged from 6.7% to 9.7%. These variations were not significantly different between each map or gray scale (p > 0.24). In conclusion, B-mode color maps do not distort ultrasound measurements of far wall thickness of the common carotid artery. The reproducibility of these measurements is neither significantly nor usefully improved by using different color maps. Because no additional information is obtained, the use of color may not be warranted.

Adult↗