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Biomedical subjects

S J Coles

Publications and source records attributed to S J Coles.

At least 19 recordsLinked to original sources
PubMed2004

A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes.

BACKGROUND & AIMS: Malnutrition is common in sick elderly people on admission to hospital and in the community. We conducted a randomised controlled trial to determine if nutritional supplementation after discharge from hospital improved nutritional status and functional outcomes, or reduced health-care costs. METHODS: Elderly malnourished subjects were randomised to 8 weeks of supplementation or no supplementation post discharge, and followed up for 24 weeks. Weight, body mass index, anthropometrics, handgrip strength, quality of life and requirements for health-care professionals' services and social services were measured throughout the study. RESULTS: Nutritional status improved significantly from baseline to week 24 in the intervention group (P<0.05), but not in the control group. There was no significant difference in nutritional status between groups at week 24. Handgrip strength improved significantly in the intervention group during supplementation, and was significantly different from that of the control group at week 8, but decreased thereafter. There was no significant difference in quality of life or health economic outcomes between groups at week 24. CONCLUSIONS: In already malnourished elderly subjects, it may be too late to expect to improve function or quality of life or to reduce health-care costs simply by providing nutritional supplements after hospitalisation. Prevention is key. All elderly patients should be nutritionally assessed as part of their routine care, and appropriate intervention initiated early.

Aged↗
PubMed2001

2-amidopyrroles and 2,5-diamidopyrroles as simple anion binding agents.

Four new 2-amidopyrroles and 2,5-diamidopyrroles have been synthesized and their anion complexation properties investigated. The crystal structures of these receptors have been elucidated and reveal hydrogen bonding in the solid state leading to dimer and network formation. Selectivity for oxo-anions has been demonstrated by (1)H NMR titration techniques.

Journal Article↗
PubMed2001

trans-4-[(4-dimethylaminophenyl)-iminomethyl]-N-methyllpyridinium para-toluenesulfonate.

In the title compound, C15H18N3+*C7H7O3S-, the phenylene and pyridyl rings are somewhat twisted with respect to each other, forming a dihedral angle of 23.49 (6) degrees. The compound contains a dipolar chromophoric cation, but crystallizes in the centrosymmetric space group P2(1)/n and is thus not expected to display quadratic non-linear optical effects.

Journal Article↗
PubMed2001

Patterns of prescribing of nutritional supplements in the United Kingdom.

BACKGROUND AND AIMS: A large number of prescriptions are issued for nutritional supplements under British National Formulary classifications 9.4.1 (foods for special diets) and 9.4.2 (enteral feeds), but little is known about the characteristics of the patients who receive them. We used the General Practice Research Database to examine patterns of prescribing of these supplements. METHODS: We selected patients who had been prescribed supplements under classifications 9.4.1 and 9.4.2 during 1996-1997. Descriptive statistics were used to examine how prescribing varied. RESULTS: 28644 patients received prescriptions during 1996-1997. Among the 27413 (96%) patients prescribed supplements for oral use, 14750 received supplements for enteral nutrition alone, 8122 received supplements for special diets alone and 4541 had both types of supplement. 51% of patients receiving supplements for special diets were <18 years. The commonest diagnoses among such children were milk intolerance (24%) and malnutrition (17%). 94% of patients receiving supplements for enteral nutrition were adult, 52% of whom had cancer or cardiovascular disease. Only 4% of patients had weight and height recorded prior to first prescription. CONCLUSIONS: The GPRD provides valuable information on the characteristics of patients prescribed nutritional supplements. But because only limited data are available on their nutritional status prior to supplementation, it is hard to assess whether general practitioners are prescribing these supplements appropriately.

Adolescent↗
PubMed2000

tert-Butyl 2-[2-(ethoxycarbothioylamino)-3-pyridyloxy]acetate and tert-butyl 2-(3-thioxopyrido[2,1-c][1,2,4]thiadiazol-8-yloxy)acetate.

Compounds (I), C(14)H(20)N(2)O(4)S, and (II), C(12)H(14)N(2)O(3)S(2), are two minor products of the same reaction. Both structures contain identical ester functionalities in similar orientations. Both independent molecules of (I) contain an ethoxycarbothioylamine moiety, whilst (II) possesses a novel exocyclic thione system fused with a pyridine ring.

Journal Article↗
PubMed2000

Charge densities from high-resolution synchrotron X-ray diffraction experiments.

The combination of intense X-ray sources, especially synchrotron radiation, with area-detector technology has accomplished an enormous advance in the experimental conditions available for charge-density analysis by single-crystal high-resolution X-ray diffraction. Such experiments can now be carried out in a time measured in hours rather than weeks. Some features of these experiments are examined and preliminary results are reported for charge-density studies of 2-hydroxy-5-nitrobenzaldehyde N-cyclohexylimine (1), octakis(m-tolylthio)naphthalene (2), and 7-fluoro-4-styrylcoumarin (3). Weak interactions in crystals of (1) and (3) are found to have similar charge-density characteristics. Cages in the crystal lattice of (2) have a complex charge distribution.

Journal Article↗
PubMed2000

Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.

AIMS: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. METHODS: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. RESULTS: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. CONCLUSIONS: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.

Adolescent↗
PubMed1999

Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease.

Public health concern has tended to focus on the dangers of obesity, but there is evidence that undernutrition may also pose a risk to physical and mental well-being, particularly in those who are already ill. Using the General Practice Research Database (see office for Population Censuses and Surveys, 1995), we followed up 10,128 men and women aged 18 years and over who had been diagnosed with cancer or cardiovascular disease to examine whether nutritional status, as indicated by BMI, affected rates of use of health care resources and mortality. In both diagnostic groups, patients with a BMI below 20 kg/m2 had higher rates of consultation with GP, higher rates of prescription and higher death rates during the follow-up period compared with those with a BMI of 20-< 25 kg/m2. In men and women with cardiovascular disease, poor nutritional status was associated with a sharply increased risk of hospital admission. Patients whose BMI was 30-< 40 kg/m2 also tended to have increased rates of GP consultation and prescription, and if they were under the age of 65 years, they had an increased risk of death. The results of the present study suggest that in men and women with cancer or cardiovascular disease, even minor degrees of undernutrition are associated with a marked increase in morbidity and mortality.

Adult↗
PubMed1998

Effect of nutritional status on use of health care resources by patients with chronic disease living in the community.

The prevalence of malnutrition in patients with chronic disease living in the community in the UK is around 8%. Whether such patients experience greater morbidity and mortality or make increased use of health care resources is unknown. The aim of this study was to investigate how the use of health care resources by patients with chronic disorders of the respiratory, gastrointestinal and neurological systems varied by nutritional status. We used longitudinal data, collected since 1987, which formed part of the General Practice Research Database in the UK. Subjects were 11 357 men and women aged 18 years or over. Main outcomes were consultation rates in general practice, prescription rates, hospital referral rates, hospital admission rates and mortality. Consultation and prescription rates were lowest amongst patients whose body mass index (BMI) was between 20 and 25. Rates were higher in patients whose BMI was below 20, or 25 and above. There was no statistically significant relation between rate of hospital outpatient referral and nutritional status, but both hospital admission rate and mortality were greatest in those people whose BMIs were below 20 and declined as BMIs increased. In patients with differential use of health care resources in both primary care and hospital practice, and with differences in mortality.

Adolescent↗
PubMed1993

A single-blind, randomised, comparative study of clarithromycin and amoxycillin suspensions in the treatment of children with lower respiratory tract infections.

One hundred and forty-five children with signs and symptoms of lower respiratory tract infections were entered into this multicentre, General Practice, investigator-blind study, designed to demonstrate equivalent efficacy between clarithromycin and amoxycillin suspensions. Seventy one children were randomised to treatment with clarithromycin suspension 7.5 mg/kg bodyweight twice daily and 74 to treatment with amoxycillin suspension 125 mg (bodyweight < 25 kg) or 250 mg (bodyweight > or = 25 kg) three times a day according to bodyweight. Duration of therapy was 5-10 days as determined by the investigator. Clinical evaluations were performed pretreatment, during treatment and post-treatment within 72 hours of cessation of therapy. Fifty two children in the clarithromycin group and 57 in the amoxycillin group were clinically evaluable. Both study medications were effective and there were no significant differences between the groups with respect to clinical cure rate (60% for clarithromycin and 63% for amoxycillin), clinical success rate (cure plus improvement, 96% for clarithromycin and 95% for amoxycillin) or rate of resolution of clinical signs and symptoms in clinically evaluable patients. The intention to treat analysis for all patients entered similarly showed no significant differences in efficacy. The two treatment groups did not differ significantly with respect to incidence or severity of adverse events which were generally mild and associated with the gastrointestinal system. Therapy was withdrawn because of adverse events in three children on clarithromycin and one on amoxycillin. Bacteriological cure rates could not be determined because of an insufficient number of evaluable pre-treatment sputum samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Amoxicillin↗
PubMed1992

A comparison of the effects of the selective peripheral alpha 1-blocker terazosin with the selective beta 1-blocker atenolol on blood pressure, exercise performance and the lipid profile in mild-to-moderate essential hypertension.

The effects of six weeks of treatment with the selective peripheral alpha 1-adrenoceptor blocker terazosin, or the selective beta 1-adrenoceptor blocker atenolol on blood pressure, exercise performance and blood lipid profile were compared in a single-blind, randomized, crossover study of 17 patients with mild-to-moderate essential hypertension. Although both drugs significantly reduced blood pressure at rest, atenolol caused a larger fall in supine blood pressure (11/11 and 7.5/7.0 mmHg, atenolol and terazosin, respectively; p < 0.001). Both treatments controlled the pressor response to exercise, although a greater reduction in diastolic blood pressure was observed at the end of exercise on terazosin (74.0 +/- 5.7 and 91.6 +/- 4.0 mmHg, terazosin and atenolol, respectively; p < 0.01). Alpha 1-blocker therapy was not associated with any measurable improvement or deterioration in cardiopulmonary performance and exercise duration. Unlike atenolol, terazosin therapy had the potentially beneficial effect of reducing serum total cholesterol levels and increasing the high-density lipoprotein-cholesterol/low-density lipoprotein-cholesterol ratio.

Adult↗
PubMed1992

Effect of carbohydrate rich versus fat rich loads on gas exchange and walking performance in patients with chronic obstructive lung disease.

BACKGROUND: High calorie intakes, especially as carbohydrate, increase carbon dioxide production (VCO2) and may precipitate respiratory failure in patients with severe pulmonary disease. Energy obtained from fat results in less carbon dioxide and thus may permit a reduced level of alveolar ventilation for any given arterial blood carbon dioxide tension (PaCO2). METHODS: Ten patients with stable severe chronic obstructive lung disease underwent a six minute walk before and 45 minutes after taking 920 kcal of a fat rich drink, an isocalorific amount of a carbohydrate rich drink, and an equal volume of a non-calorific control liquid on three separate days, in a double blind randomised crossover study. Borg scores of the perceived effort to breathe were measured at the beginning and end of each six minute walk. Minute ventilation (VE2), VCO2, oxygen consumption (VO2), respiratory quotient (RQ), arterial blood gas tensions, and lung function were measured before and 30 minutes after each test drink. RESULTS: Baseline measurements were similar on all three test days and the non-calorific control drink resulted in no changes in any of the measured variables. The carbohydrate rich drink resulted in significantly greater increases in VE, VCO2, VO2, RQ, PaCO2, and Borg score and a greater fall in the distance walked in six minutes than the fat rich drink (mean fall after carbohydrate rich drink 17 m v 3 m after fat rich drink and the non-calorific control). The increase in VCO2 correlated significantly with the decrease in six minute walking distance and the increase in Borg score after the carbohydrate rich drink. The only significant change after the fat rich drink when compared with the non-calorific control was an increase in VCO2. CONCLUSIONS: Comparatively small changes in the carbohydrate and fat constitution of meals can have a significant effect on VCO2, exercise tolerance, and breathlessness in patients with chronic obstructive lung disease.

Aged↗
PubMed1991

A multicentre, hospital study of the efficacy and safety of terazosin and its effects on the plasma cholesterol levels of patients with essential hypertension.

The safety, efficacy and the effect on the plasma total cholesterol of once-daily terazosin hydrochloride administered either as monotherapy or in combination with other antihypertensive therapy were evaluated in patients with mild-moderate uncontrolled essential hypertension in this U.K., open, multicentre hospital, 3-month study. Patients initially received 1 mg of terazosin as monotherapy or in addition to their current antihypertensive therapy followed by dose titration, if necessary, to a maximum of 10 mg over the first 6 weeks depending upon blood pressure control. Patients then continued treatment for a further 6 weeks on their optimum dosage. There were highly significant mean reductions in systolic and diastolic blood pressures at the end of 12 weeks for 439 patients of 18.5 and 14.0 mmHg (P less than 0.001), respectively, and were similar to the reductions shown when subgrouping the patients into either those 197 patients who were treated with terazosin as monotherapy (17.6/13.7 mmHg, P less than 0.001) or those 242 patients treated with terazosin in combination with other antihypertensive agents (19.3/14.2 mmHg, P less than 0.001). In addition, in a sub-group of 132 patients who had their mean total cholesterol measured at the end of 12 weeks' treatment, there was a significant reduction of -0.4 mmol/l (P less than 0.01). A similar significant mean reduction for total cholesterol was also shown when this subgroup was divided into those 50 patients who were treated with terazosin as monotherapy (-0.56 mmol/l, P less than 0.01), but not for those 82 patients treated with terazosin in combination with other antihypertensive agents (-0.3 mmol/l, P greater than 0.05 less than 0.1). No serious toxicity or safety problems were observed. Once daily administration of terazosin, either as monotherapy or in combination with other antihypertensive agents, proved to be safe and effective in reducing the blood pressure of patients with uncontrolled mild-moderate essential hypertension and favourably reduced the total plasma cholesterol level.

Adolescent↗
PubMed1991

Safety and efficacy of Clarithromycin in the treatment of acute mild to moderate respiratory tract infections.

A total of 2,351 adult patients were recruited into a multi-centre open general practice study to investigate the safety and efficacy of Clarithromycin 250 mg b.d. for seven days in the management of acute mild to moderate respiratory tract infections. Overall a clinical success rate of 93.2% was seen with respect to assessment of the response of the respiratory tract infection to Clarithromycin therapy. Summary statistics are presented for each diagnosis recorded. A total of 110 (4.7%) adverse events were reported. Of these 71 (3%) were related to the gastrointestinal tract e.g. nausea, vomiting etc. The above results demonstrate that Clarithromycin in a dose of 250 mg b.d. is a well tolerated and effective therapy in the management of acute mild to moderate respiratory tract infections.

Adolescent↗
PubMed1990

Distribution of haemoglobin in patients presenting to their general practitioner, and its correlation with serum ferritin.

We have conducted a survey in the United Kingdom in order to evaluate the prevalence of anaemia and of iron deficiency in elderly male and female patients and in female patients of child-bearing age presenting to their general practitioner. Although haemoglobin values were approximately normally distributed, there was evidence of a bimodal distribution of serum ferritin values, particularly in elderly men. A correlation between serum ferritin and haemoglobin values was found to exist, both in the elderly and in younger women. The overall prevalence of anaemia in the study population was 14.3%, although it was higher for elderly men (20.1%) than either elderly women (13.7%) or women of child-bearing age (11.9%). Iron deficiency associated with anaemia was more common in elderly men (45.2% of those anaemic) than elderly women (28.6%) or women of child-bearing age (25.6%). This survey indicates that the prevalence of anaemia among certain groups of high risk patients presenting for consultation to their general practitioner is about 1 in 7, although the prevalence is as high as 1 in 5 in elderly men.

Adolescent↗
PubMed1988

Characterization of airway mucus from a fatal case of status asthmaticus.

We used density gradient methods to analyze mucus recovered from the airways of a patient who died from status asthmaticus. At postmortem the mucus that plugged the length of the bronchial tree could only be removed by cutting with forceps. It was dispersed in cesium bromide (CsBr) and examined in the analytical ultracentrifuge. Surprisingly, no macromolecular component was seen in the buoyant density region typical of mucus glycoprotein (at 1.5 g/ml). The gelatinous material migrated to the region of lowest density, typical of lipids, and thin-layer chromatography indicated that besides neutral lipids, a variety of phospho- and glycolipids (including gangliosides) were present. The residue left after the lipid extraction contained all sugar components of mucus glycoprotein, and alkaline borohydride cleaved oligosaccharides three to 12 sugars long, indicating that the sugars were O-glycosidically linked as in mucus glycoproteins. Prior desulfation of the residue increased the number of oligosaccharides released by borohydride; analysis showed the presence in these of components (glucose, methylmannuronate) not present in epithelial glycoprotein. A trace component of high buoyant density was also present: Glucose was the predominant component in this, but glycoprotein sugars were also present. The above results suggest that in status asthmaticus plugging of the airways with mucus can occur even in the absence of typical epithelial glycoprotein and that lipids play a crucial role in such plugging.

Adolescent↗