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Biomedical subjects

R W Watts

Publications and source records attributed to R W Watts.

At least 19 recordsLinked to original sources
PubMed2000

Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study.

OBJECTIVES: To assess and compare the effects of candesartan or lisinopril, or both, on blood pressure and urinary albumin excretion in patients with microalbuminuria, hypertension, and type 2 diabetes. DESIGN: Prospective, randomised, parallel group, double blind study with four week placebo run in period and 12 weeks' monotherapy with candesartan or lisinopril followed by 12 weeks' monotherapy or combination treatment. SETTING: Tertiary hospitals and primary care centres in four countries (37 centres). PARTICIPANTS: 199 patients aged 30-75 years. INTERVENTIONS: Candesartan 16 mg once daily, lisinopril 20 mg once daily. MAIN OUTCOME MEASURES: Blood pressure and urinary albumin:creatinine ratio. RESULTS: At 12 weeks mean (95% confidence interval) reductions in diastolic blood pressure were 9.5 mm Hg (7.7 mm Hg to 11.2 mm Hg, P<0.001) and 9.7 mm Hg (7.9 mm Hg to 11.5 mm Hg, P<0.001), respectively, and in urinary albumin:creatinine ratio were 30% (15% to 42%, P<0.001) and 46% (35% to 56%, P<0.001) for candesartan and lisinopril, respectively. At 24 weeks the mean reduction in diastolic blood pressure with combination treatment (16.3 mm Hg, 13.6 mm Hg to 18.9 mm Hg, P<0. 001) was significantly greater than that with candesartan (10.4 mm Hg, 7.7 mm Hg to 13.1 mm Hg, P<0.001) or lisinopril (mean 10.7 mm Hg, 8.0 mm Hg to 13.5 mm Hg, P<0.001). Furthermore, the reduction in urinary albumin:creatinine ratio with combination treatment (50%, 36% to 61%, P<0.001) was greater than with candesartan (24%, 0% to 43%, P=0.05) and lisinopril (39%, 20% to 54%, P<0.001). All treatments were generally well tolerated. CONCLUSION: Candesartan 16 mg once daily is as effective as lisinopril 20 mg once daily in reducing blood pressure and microalbuminuria in hypertensive patients with type 2 diabetes. Combination treatment is well tolerated and more effective in reducing blood pressure.

Adult↗
PubMed1999

Asthma management in rural Australia.

This article explores the question of whether rural location influences the diagnosis, management and outcome for patients with asthma. Three cases of asthma respiratory arrest are presented to highlight some of the difficulties of asthma management in rural communities, followed by a review of the current literature relevant to rural asthma.

Adolescent↗
PubMed1998

A placebo-controlled comparison of diltiazem and amlodipine monotherapy in essential hypertension using 24-h ambulatory monitoring.

Thirty patients (17 females, median age 55 years) with mild/moderate hypertension (sitting diastolic blood pressure 95-110 mmHg over 2 consecutive weeks) participated in a study of the efficacy and tolerability of once-daily diltiazem "controlled delivery" 180 mg-360 mg and amlodipine 5-10 mg compared with placebo (using clinic and 24-h ambulatory blood pressure measurement (Accutraker II). The study was conducted in a general practice setting using a randomized double-blind crossover design with Latin square allocation of treatment order within subjects. During each phase, doses were titrated to achieve a predose clinic sitting diastolic blood pressure of 90 mmHg. Three patients withdrew while taking amlodipine and 3 while taking placebo. The numbers of patients receiving the higher dose in each phase were as follows: placebo 22, diltiazem 12 and amlodipine 19. End-of-phase mean clinic sitting blood pressures were as follows: placebo 152/100, diltiazem 146/95 and amlodipine 140/93. End-of-phase mean 24-h ambulatory blood pressures were as follows: placebo 151/93, diltiazem 143/86 and amlodipine 137/84. Both clinic and ambulatory blood pressures were therefore significantly reduced (p < 0.01) in both active phases compared with placebo, and systolic blood pressure was also significantly lower with amlodipine compared with diltiazem. Heart rate was increased with amlodipine. Both drugs were well tolerated, and adverse events were predictable for each agent, with amlodipine causing more vasodilator side effects. Thus both amlodipine and diltiazem once-daily are effective in reducing blood pressure. While amlodipine is more potent than diltiazem in reducing systolic blood pressure, it causes more vasodilator side effects.

Adolescent↗
PubMed1998

Undergraduate education in anaesthesia: the influence of role models on skills learnt and career choice.

Undergraduate teaching of anaesthesia occurs in about two-thirds of Australian departments of anaesthesia: however, student contact hours are limited compared with those of other disciplines. Seventy-five directors of anaesthesia were surveyed by written questionnaire concerning the time devoted in their department to undergraduate study and teaching of practice/skills to undergraduate students (40 responded). One hundred and sixty final year students were surveyed regarding career choice, anaesthesia skills taught them and role models identified during their training (101 responded). Most final year students had been taught and had learnt the basic skills of life support such as bag and mask ventilation, cardiopulmonary resuscitation and intravenous cannulation. However, fewer were taught more specialized skills such as induction of anaesthesia and spinal anaesthesia. Positive role models in teaching anaesthetists were identified by 66% of students, more commonly if they were taught advanced skills, and were significantly associated with satisfaction with theoretical and practical training. For those students intending a career in anaesthesia (18%), 94% identified a positive role model compared to 65% who did not (P = 0.03).

Anesthesiology↗
PubMed1997

Training, skills and approach to high-risk obstetrics in rural GP obstetricians.

One hundred and sixty seven (82%) of the 204 practising South Australian rural GP obstetricians responded to a questionnaire on training, skills and approach to high-risk obstetrics. The mean length of training was 8.5 months; 78% of GP obstetricians held a diploma. There was a mean of 13 years experience and 22 deliveries per year. However, 26.3% of practitioners had stopped obstetrics in the previous 12 months and cited indemnity insurance and lifestyle factors as the main reason for stopping. The GPs practised a wide range of skills; forceps (96%), Caesarean section (42%) and had good access to epidural services (83.6%), blood transfusions (91%) and specialist advice. High-risk obstetrics such as twin pregnancy, fetal growth retardation, insulin-dependent diabetes and preterm labour, are avoided by most rural GP obstetricians. The mean visual analogue comfort score for providing obstetric care was 7.46 (2.16) and correlated with length of training (p = 0.008) and number of deliveries per year (p = 0.02). Health authorities must continue to support and encourage country GP obstetricians to provide this essential service to rural women.

Attitude of Health Personnel↗
PubMed1997

Do patients with asthma fill their prescriptions? A primary compliance study.

OBJECTIVE: To examine primary noncompliance in patients suffering with asthma. METHOD: A prospective matching of prescriptions written and then dispensed for patients with asthma. The subjects were patients who were given a general practitioner's prescription for asthma during a 3 month period (1993) in an isolated rural setting. RESULTS: During the period of the study, participating GPs documented 359 prescriptions and of these only 251 (70%) were dispensed by the pharmacies. Primary noncompliance was therefore 30%. The relative risk (RR) of mild asthmatics not filling their prescriptions is 0.81 (95% CI; 0.771 < RR < 0.92) when compared to severe asthma. Compared to patients of high socioeconomic status; patients of low and medium socioeconomic status have decreased relative odds of filling their prescriptions, that is, RR = 0.84 (95% CI; 0.71 < RR < 1.00). Gender and age had no bearing on primary compliance. CONCLUSIONS: Primary noncompliance is high in patients with asthma and is another factor contributing to morbidity. GPs should spend more time counselling patients on the need for treatment and not only its correct use. Patients with mild to moderate asthma and those in lower socioeconomic groups may need more intensive counselling.

Anti-Asthmatic Agents↗
PubMed1996

Selective renal transplantation in primary hyperoxaluria type 1.

Primary hyperoxaluria type I (PHI) is a cause of end-stage renal disease in young people. It is caused by deficient activity of hepatic peroxisomal alanine:glyoxylate aminotransferase (AGT), which results in hyperoxalemia and hyperoxaluria. The consequent urolithiasis and nephrocalcinosis result in renal impairment, with further reduction in oxalate excretion and eventual systemic oxalosis. Historically, renal transplantation has yielded very poor results in these patients because of recurrent oxalosis of the graft. Within the last 10 years, combined hepatorenal transplantation has been successfully applied, simultaneously correcting the metabolic lesion in the liver and replacing the damaged kidneys. It has, however, become apparent that medical therapy with vigorous hydration, inhibitors of stone formation and pyridoxine (AGT co-factor), may be successful at delaying, and occasionally in preventing, urolithiasis in some hyperoxaluric patients, particularly those whose hyperoxaluria is reduced by pyridoxine. This, together with intensive perioperative management and modern surgical methods of stone management such as lithotripsy, laser or ultrasound stone fragmentation, and percutaneous nephrolithotomy, means that renal transplantation alone may be feasible in selected patients. We describe a patient with PHI with clinical and biochemical evidence of significant residual AGT activity who underwent a successful live-related renal transplantation with excellent renal function and no stone recurrence 1 year posttransplantation. The appropriate transplantation strategies for these complex patients are discussed and include isolated renal transplantation for those patients who are without significant systemic oxalosis and have evidence of residual AGT activity.

Adult↗
PubMed1995

Clinical equivalence of two tablet formulations of felodipine. A placebo-controlled study of 24-hour blood pressure control and tolerability.

OBJECTIVE: This study was performed to assess whether a new formulation of felodipine extended release (FER) tablets with a 9 mm diameter is similar to the presently used 11 mm diameter FER formulation with respect to antihypertensive effect and tolerability in patients with essential hypertension. A randomised, double-blind, placebo controlled, three-way cross-over study design was used. PATIENTS: Twenty-four patients with a supine diastolic blood pressure (DBP) of 95-115 mmHg after a 4-week placebo run-in period were given FER 5 mg 9 mm tablets, FER 5 mg 11 mm tablets and placebo in randomised order. The tablets were given once daily and each double-blind treatment period lasted for two weeks. METHODS: Twenty-four hour ambulatory blood pressure monitoring was performed at the end of each treatment period. The primary effect variable was mean DBP over 24 hours. Nineteen patients had 24-hour blood pressure data valid for analysis using an analysis of variance with patient, treatment, period and carry-over as factors. RESULTS: Both formulations of FER 5 mg tablets significantly reduced the mean 24-hour DBP compared to placebo. The 9 and 11 mm tablets resulted in, on average, 4.7 and 3.4 mmHg lower mean 24-hour DBP than placebo. There was, however, no significant difference between the two different FER formulations. Both FER formulations were well tolerated and similar to placebo in this respect. CONCLUSION: Both FER 5 mg tablet formulations (9 and 11 mm diameter), given once daily, were clinically equivalent with respect to antihypertensive effect and tolerability in patients with mild to moderate essential hypertension.

Adolescent↗
PubMed1995

The introduction of patient-controlled analgesia into an isolated rural hospital.

This study investigated the feasibility of using patient-controlled analgesia (PCA) effectively in a small 70 bed isolated rural hospital. The first 50 patients to use a Bard PCA 1, in the Port Lincoln Hospital, South Australia, were studied. The patients consumed morphine at a mean rate of 1.24 mg/h and used PCA for a mean of 48 h. Thirty-eight per cent of patients required treatment for nausea and other complications which is similar to the rate of those in other published series. Visual analogue pain scores showed excellent pain control, generally without evidence of oversedation; however, there was one episode of respiratory depression. Seventy-eight per cent of patients reported that their pain was relieved most or all of the time. The study demonstrated that a PCA service provided by nursing staff, the GP anaesthetist and rural surgeons is feasible in an isolated rural hospital.

Adult↗
PubMed1995

A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica.

The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief ( > 75% improvement) to 2.61 (95% CI 1.90-3.77) when compared with placebo. Despite some variations in trial characteristics there was little evidence of significant heterogeneity (P = 0.07). When the trials were analysed for near or total relief of pain in the short-term the OR is 2.79 (95% CI 1.92-4.06), for heterogeneity (P = 0.07). For longterm relief of pain (up to 12 months) the OR is 1.87 (95% CI 1.31-2.68). Efficacy is independent of the route of injection; for caudal epidural steroid the OR is 3.80 (95% CI 1.36-10.6) and for the lumbar epidural steroid 2.43 (95% CI 1.77-3.74). Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.

Adrenal Cortex Hormones↗
PubMed1994

Training, skills and approach to potentially difficult anaesthesia in general practitioner anaesthetists.

Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. Thirty-three per cent trained exclusively overseas and 13% hold a Diploma in Anaesthesia. A total of 11,400 anaesthetics were performed by 76 general practitioners in 1992 at an average of 152 (range 2 to 1500). The mean visual analog "comfort score" in performing anaesthesia was 6.6 and correlated best with the number of procedures per year (r = 0.32, P = 0.03). Forty-six per cent of general practitioners provided anaesthesia for the 0 to 12 month age group, and only 35% had regional skills to use in obstetric anaesthesia. Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.

Adult↗
PubMed1994

Mono- and combination therapy with felodipine or enalapril in elderly patients with systolic hypertension.

Using a randomised double-blind crossover design with Latin square allocation of treatments in 20 subjects (7 male, 13 female-ages: 61-87 years) with systolic hypertension, we investigated the efficacy and tolerability of once daily felodipine (extended release) 5-20 mg, enalapril 5-20 mg and their combination compared with placebo in four treatment phases each of 6 weeks duration. During each phase, doses were titrated to achieve a predose clinic supine systolic blood pressure of 140 mmHg or to a predetermined maximum dose. In both the felodipine and combination phases, predose supine and standing systolic and diastolic pressures were significantly reduced compared with the placebo phase (decrease in supine pressure: -13/-5 and -18/-7, respectively). Only predose supine diastolic pressure was significantly reduced (-3 mmHg) compared to placebo in the enalapril phase. In combination the effects of the two drugs on predose blood pressure were additive. There was a 40-60% increase in reported symptoms in the felodipine and combination phases compared with the placebo and enalapril phases. Thus, in elderly subjects with systolic hypertension, felodipine effectively reduces blood pressure throughout the dose interval but with vasodilator adverse effects. In contrast, enalapril is well tolerated but is less effective in reducing blood pressure throughout the whole dose interval.

Aged↗