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Biomedical subjects

T Delmore

Publications and source records attributed to T Delmore.

14 recordsLinked to original sources
PubMed1989

A randomized controlled trial of prednisone in patients with idiopathic membranous nephropathy.

We conducted a prospective randomized study in which patients with biopsy-confirmed idiopathic membranous nephropathy were assigned to receive either a six-month course of prednisone given on alternate days (45 mg per square meter of body-surface area; n = 81) or no specific treatment (n = 77). The mean duration of follow-up was 48 months. Patients in the prednisone group (median age, 46 years) entered with a mean disease duration of 15 months, a median creatinine clearance of 1.2 ml per second per 1.73 m2 (range, 0.25 to 2.6), and a median rate of urinary protein excretion of 6.8 g per day (0.3 to 26). The annual change in the corrected creatinine clearance at six months did not differ between the prednisone group and the control group (0.10 vs. 0.06 ml per second; P = 0.8), or at the last follow-up evaluation (-0.07 vs. -0.02 ml per second; P = 0.2; 95 percent confidence interval on the difference, -0.03 to 0.13). The proportion of patients with complete remission of proteinuria was also similar in the groups at 6 and 12 months and after a mean of 48 months. Outcomes were similar in the two groups with respect to progression to renal failure (3 vs. 4 patients), death (3 vs. 1 patient), complete remission of proteinuria at 36 months (16 vs. 19 patients), and a decline of 25 percent or more in the creatinine clearance at 60 months (32 vs. 25 percent of patients). A multivariate analysis, which adjusted for differences at entry in sex distribution, urinary protein excretion, and creatinine concentration, as well as other prognostic variables, failed to provide an explanation for the lack of effect of prednisone. We conclude that a six-month course of therapy in which prednisone is given on alternate days is of no benefit to patients with idiopathic membranous nephropathy.

Adolescent↗
PubMed1987

Evidence suggesting under-treatment in adults with idiopathic focal segmental glomerulosclerosis. Regional Glomerulonephritis Registry Study.

During the past 11 years, the Metro Toronto Glomerulonephritis Registry has prospectively followed all cases of glomerulonephritis starting from the time of biopsy. Focal segmental glomerulosclerosis was diagnosed by strict histologic criteria in 103 patients. Exclusion of patients with follow-up of less than 12 months reduced the number to 93 (55 adults and 38 children). Mean length of follow-up from the time of biopsy was 61 months. Ninety percent of children, but only 33 percent of adults received treatment with steroids, with or without cytotoxic drugs (p less than 0.001). Complete remission, defined as daily proteinuria of less than 250 mg, was not different in adults (39 percent) from that in children (44 percent), with a mean remission duration for all patients of 38 months. Chronic renal insufficiency, defined as a creatinine clearance of less than 0.8 ml/second/1.73 m2 for more than 12 months, was similar in adults (40 percent) and children (34 percent). Five-year renal actuarial survival, defined as the absence of chronic renal insufficiency, was 96 percent for patients with a history of complete remission, and 55 percent for those without (p less than 0.0002). Logistic regression analysis showed treatment to be the only significant factor for complete remission (p less than 0.001). Complete remission, in turn, was important for renal preservation, defined as the absence of chronic renal insufficiency (p less than 0.001). Age did not affect the treatment response or long-term renal outcome in focal segmental glomerulosclerosis. yet, the percent of adults treated was much lower than that of children, despite the fact that the majority of the untreated adults had the same clinical parameters as the treated adults and children. Thus, a judicious course of treatment is as much indicated in adults as in children with this disorder.

Adolescent↗
PubMed1986

Effect of ankle position on isometric quadriceps strengthening.

A prospective study of 20 normal subjects was undertaken to determine the effect of three ankle positions (active dorsiflexion, active plantar flexion, natural or rest position) on comfort and facilitation of quadriceps contraction in isometric strengthening in a supine position with the hip and knee fully extended. Surface EMG activity was found to be greatest for the vastus lateralis followed by the vastus medialis and least for the rectus femoris. Equal facilitation was apparent with either active ankle dorsiflexion or plantar flexion. Both were superior to the natural (rest) position. In situations where isometric quadriceps exercises are required, the authors recommend either active ankle dorsiflexion or plantar flexion to facilitate quadriceps strengthening. The choice between the two positions should be based on patient comfort.

Adult↗
PubMed1982

Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis.

Previously, we compared fixed low doses of heparin with adjusted doses of warfarin for the long-term treatment of venous thrombosis; in that study low-dose heparin was ineffective in preventing recurrence in patients with proximal-vein thrombosis. We have now completed a randomized trial comparing adjusted doses of heparin and of warfarin for prevention of recurrent venous thromboembolism in patients with proximal-vein thrombosis. One hundred six consecutive patients with acute proximal-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Two of 53 patients receiving heparin, as compared with one of 53 receiving warfarin, had new episodes of objectively documented venous thromboembolism. Nine patients taking warfarin had bleeding complications (which were major in three patients), as compared with one patient taking heparin (P = 0.008). Our data indicate that adjusted-dose subcutaneous heparin therapy provides an effective alternative to warfarin sodium and is associated with a lower risk of bleeding.

Clinical Trials as Topic↗
PubMed1979

Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis.

Acute deep-vein thrombosis is usually treated with intravenous heparin for a number of days, then with oral anticoagulants for weeks to months. We have compared adjusted-dose warfarin sodium with fixed low-dose subcutaneous heparin in the prevention of recurrent deep-vein thrombosis. Sixty-eight patients with acute deep-vein thrombosis confirmed by venography were treated with intravenous heparin and then randomized to secondary prophylaxis. Nine of 35 patients receiving subcutaneous heparin, but none of 33 receiving warfarin sodium, had new episodes of objectively documented venous thromboembolism (P = 0.001). Seven patients on warfarin sodium experienced bleeding complications (of which four were major), as compared with no patients receiving subcutaneous heparin (P less than 0.005). Thus, adjusted-dose warfarin sodium is more effective than low-dose subcutaneous heparin in preventing recurrent venous thromboembolism, but its use is accompanied by a significant risk of bleeding.

Acute Disease↗
PubMed1976

Nurse practitioners in primary care. V. Development of the utilization and financial index to measure effects of their deployment.

The new Utilization and Financial Index (UF-Index) was developed to measure the economic effects of deployment of new health professionals or of other changes in the provision of health services. By means of several steps, information on concurrent use of various categories of health service is converted into a single quantitative index. The index has been used to evaluate the financial effects of introduction of nurse practitioners into primary care practices by means of two complementary studies.

Cost-Benefit Analysis↗
PubMed1976

Nurse practitioners in primary care. VI. Assessment of their deployment with the Utilization and Financial Index.

The impact of multidisciplinary teams that incorporate nurse practitioners on total use of health services was measured with the new Utilization and Financial Index (UF-Index). The data from two studies, a randomized controlled trial and a before-and-after study, showed that, in spite of large increases in use of ambulatory services by practice populations served by family physician-nurse practitioner teams, the ultimate effect has been a substantial reduction in total use of health services. The effect was associated with major reductions in hospital care for the same populations. Such economic advantages to society proved feasible within a fee-for-service context and in settings where rigorous evidence demonstrated no concurrent deterioration in health status of patients or in quality of care.

Ambulatory Care↗
PubMed1976

Patterns of medical drug use - a community focus.

The pattern and extent of medical use of drugs was examined by survey in a rural Ontario community (Smithville) and a suburban (Burlington) family practice. Changes in established patterns of drug use that occur after the introduction of a nurse practitioner were also examined in the suburban practice. In both surveys 60% of respondents were using at least one medication and 30% were taking at least one medication prescribed or suggested by a doctor. There were consistently high rates of use of nonprescribed drugs at all ages, especially among females. Vitamins and tonics were the most commonly used drugs, and were taken by 25 to 28% of the respondents, 40% of whom used them on the advice of a physician. From 8.8 to 10.5% of respondents used sedatives or tranquillizers, and reduction in the prescribed use of these drugs was found among patients managed by the nurse practitioners. Self-medication is apparently unrelated to the frequency of medical consultation.

Child↗
PubMedDate not supplied

Nutritional assessment of continuous ambulatory peritoneal dialysis patients.

This study revealed the following. Malnutrition was frequent (41.6%) in patients on CAPD for less than three months and was present in 18.1% of patients on CAPD for longer than 3 months. Fifty percent of these malnourished patients returned to normal on conventional nutritional management within 2 to 6 months, but 10% remained malnourished throughout the study period. There was increased mortality among malnourished patients, but we were unable to demonstrate that the state of nutrition was an independent risk factor, because of the increased prevalence of other co-morbid risk factors known to influence survival and because of the limitation of a small sample size. The influence, if any, of nutritional state as an independent risk factor on the survival of CAPD patients should be answered, because malnutrition is potentially reversible with aggressive nutritional interventions, such as enteral, parenteral, or intraperitoneal supplementation.

Humans↗