Biomedical subjects

S D Whicker

Publications and source records attributed to S D Whicker.

6 recordsLinked to original sources

PubMed2005

Co-morbidity in general practice.

BACKGROUND: Co-morbidity, or the presence of more than one clinical condition, is gaining increased attention in epidemiological and health services research. However, the clinical relevance of co-morbidity has yet to be defined. In general practice, few studies have been conducted into co-morbidity, either at a single health care encounter, an episode of care, or for a defined time period. AIMS: To describe the major co-morbidity cluster profiles recorded by general practitioners. Another aim of this study is to describe the common clusters of co-prescribing. METHODS AND RESULTS: Twelve month data from patients attending 156 GPs from 95 practices around a six month period of January to June 2003 were analysed. This represented 840,961 encounters from about 200,000 individual patients at these participating practices. Co-morbidity and co-prescribing cluster profiles are represented by problems managed and reasons for prescribing for the top 10 presentations and top 10 prescribed drugs in the study period. CONCLUSIONS: By analysing the 10 most prevalent problems and 10 most prevalent drugs prescribed in consultations in a community sample, other co-morbidities that are particular to general practice, for example hypertension and lipid disorders, can be uncovered. Whether these clusters are causally related or occur by chance requires further analysis.

Adult↗

PubMed1997

Antibiotic use in the Australian community, 1990-1995.

OBJECTIVE: To determine the pattern of antibiotic use in the Australian community, 1990-1995, and compare it with the pattern in other developed countries. DESIGN: Survey of data from the national database on drugs dispensed in Australia (1990-1995), an international database on retail drug sales (1985-1994), and Australian prescriber surveys (1994, 1995). MAIN OUTCOME MEASURES: National and international retail sales of oral antibiotics (defined daily doses [DDDs]/1000 population/day) and antibiotic prescriptions dispensed through community pharmacies by drug type; antibiotic prescribing profiles for common conditions. RESULTS: Antibiotic use in Australia remained steady between 1990 and 1995, with an estimated 24.7 DDDs/1000 population/day dispensed through community pharmacies in 1990 and 24.8 DDDs/1000 population/day in 1995. Amoxycillin, although declining in use, remained the most dispensed antibiotic. Compared with the other countries surveyed, Australia had the highest percentage use of tetracyclines, such as doxycycline, and the lowest percentage use of fluoroquinolones. Use of trimethoprim-sulfamethoxazole and flucloxacillin declined in Australia. In new cases of upper respiratory tract infection or pharyngitis, an antibiotic prescription was recorded for 57% of urban patient encounters and 73% of rural patient encounters. CONCLUSIONS: Antibiotic use in Australia is high, as in many other developed countries, but did not increase between 1990 and 1995. The overall profile of antibiotic use in Australia by drug class was similar to that in the United Kingdom. Antibiotics were still commonly prescribed for upper respiratory tract infection (which is usually viral), more commonly by rural than by urban general practitioners.

Administration, Oral↗

PubMed1993

Benzodiazepine utilisation in Australia: report from a new pharmacoepidemiological database.

This study surveys the total community prescription use of benzodiazepine agents in Australia for the years 1990 and 1991. Also included is information on the utilisation of these agents on the Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes (PBS/RPBS) over the period 1987 to 1991. The Australian data are from the Drug Utilization Subcommittee (DUSC) database, which is derived from two sources: the PBS/RPBS (subsidized prescriptions), and a national sample of Pharmacy Guild of Australia pharmacies (private and under-copayment general prescriptions). The data are converted to defined daily doses per 1000 inhabitants per day (DDD/1000/day) in accordance with the unit of measurement for drug utilisation studies approved by the World Health Organization. Benzodiazepine utilisation was 33.96 DDD/1000/day for 1990 and 29.31 DDD/1000/day for 1991. The four drugs listed on the Pharmaceutical Benefits Scheme, namely diazepam, oxazepam, nitrazepam and temazepam, constituted 82 per cent of the Australian market. The availability of government subsidy appears to influence benzodiazepine- prescribing behaviour. Benzodiazepine utilisation has been falling in recent years. The fall may be related to the impact of new guidelines and community awareness campaigns. There are major differences in the composition of the market between Australia and the Nordic countries.

Anti-Anxiety Agents↗

PubMed1991

Beta-adrenoceptors in human airway tissue: relationship between functional responsiveness and receptor number.

Functional organ bath experiments and radiolabelled ligand binding studies were used to investigate the relationship between beta-adrenoceptor-mediated relaxation and the total number of beta-adrenoceptors in human lung parenchymal tissue and bronchial tissue. Sensitivity to the beta-adrenoceptor agonist isoprenaline (pD2) varied almost 10-fold (pD2 values 6.00 to 6.85) for lung parenchymal preparations and 35-fold for bronchial preparations (pD2 values 6.16 to 7.67) between patients. The total number of [3H] DHA labelled beta-adrenoceptors (Bmax) varied almost 6-fold for lung parenchymal membrane preparations (Bmax 164 to 936 fmol/mg protein) and less than 2-fold for bronchial tissue membrane preparations (Bmax 188 to 342 fmol/mg protein) between patients. Comparison of sensitivity to isoprenaline and beta-adrenoceptor number for lung parenchymal tissue from the same patient demonstrated a negative correlation (r = -0.80 [95% confidence intervals: -0.13, -0.96], 6 d.f., P less than 0.05), suggesting that beta-adrenoceptor-mediated sensitivity of lung parenchymal tissue is inversely related to the number of beta-adrenoceptors. However, there was an absence of correlation between sensitivity to isoprenaline and beta-adrenoceptor number in bronchial tissue from the same patient. Thus, the findings of the present study do not support the possibility of a direct relationship between the beta-adrenoceptor-mediated responsiveness and the beta-adrenoceptor number of human airway preparations.

Aged↗

PubMed1990

Effect of sensitization and aerosol antigen challenge in guinea-pigs--studies of airway receptor function and characteristics.

Immunological sensitization of guinea-pigs and subsequent antigen inhalation challenge has provided an animal model which has several features in common with human asthma. Impairment of beta-adrenoceptor-mediated function and mechanisms have been postulated to contribute to the hyperreactivity to contractile agonists demonstrated in vivo and in vitro in these animals. Functional and receptor radioligand binding studies were carried out on airway tissue from: non-sensitized; sensitized; sensitized saline challenged; sensitized antigen challenged guinea-pigs. Sensitization did not alter responsiveness of airway tissue to carbachol, although subsequent antigen challenge did increase carbachol sensitivity of peripheral airway tissue six-fold. Neither sensitization itself nor subsequent antigen challenge altered binding characteristics of the muscarinic cholinoceptor ligand [3H]quinuclidinyl benzilate ([3H]QNB) to peripheral airway tissue, suggesting that mechanisms responsible for increases in carbachol sensitivity are distal to these receptors. Relaxation of airway preparations to isoprenaline was not altered by sensitization or further antigen challenge of the animals. However, sensitization significantly reduced affinity but not the total number of binding sites in peripheral airway tissue for the beta-adrenoceptor ligand [3H]dihydroalprenolol ([3H]DHA). Antigen challenge of the animals did not further alter beta-adrenoceptor ligand binding characteristics. These results suggest that airway hyperreactivity in this model is not a function of alteration in receptor characteristics, or impairment of relaxation mechanisms.

Aerosols↗

PubMed1988

Responsiveness of bronchial smooth muscle from asthmatic patients to relaxant and contractile agonists.

The mechanism underlying airway hyperresponsiveness in asthma is unknown although an abnormality in the airway smooth muscle resulting in decreased relaxation or increased contractile response has been proposed. The present study was designed to demonstrate any differences in the in vitro sensitivity of airway smooth muscle between asthmatic patients and non-asthmatic patients. Using bronchial tissue obtained by resection from mild to moderate asthmatic patients and from non-asthmatic patients, we have shown that the altered airway responsiveness seen in asthmatic patients is not reflected in airway smooth muscle sensitivity in vitro. Sensitivity of the bronchial smooth muscle to isoprenaline and aminophylline or theophylline did not differ between asthmatic patients and nonasthmatic patients, while sensitivity to carbachol and histamine was significantly reduced in tissue from asthmatic patients. These results suggest that the abnormality in asthma may not lie at the level of the airway smooth muscle.

Adult↗