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Biomedical subjects

T Pullar

Publications and source records attributed to T Pullar.

At least 37 records · Page 2Linked to original sources
PubMed1995

Assessment and referral patterns of patients admitted after deliberate self-poisoning.

The assessment and referral patterns of adult patients after deliberate self-poisoning in Dundee were examined. Questionnaires were completed by the admitting physicians and assessing psychiatrists over a 3 month period. Demographic data concerning the patients and the nature of self-harm were similar to previous studies. Initial referral rate was 95% but dropped to between 70% and 81% after the post receiving round. Up to 2 hours/day could be required for assessment and 75% of the cases required some form of psychiatric follow-up. Although both groups of doctors considered that the majority of patients required or would benefit from psychiatric referral, there was poor agreement when patients were independently categorised into high or low suicide risk (kappa = 0.04). Agreement was also low regarding whether referral was essential or not (kappa = 0.06). Although junior medical staff can play an important role in screening of patients, the psychiatric service, including trained nurses, may be best placed to provide a full assessment, where required.

Adult↗
PubMed1993

The relationship of haemoglobin to serum erythropoietin concentrations in the anaemia of rheumatoid arthritis: the effect of oral prednisolone.

Previous studies of the erythropoietin response to anaemia in RA have yielded conflicting findings. Some have found the response to be impaired and others have found a normal response. We have compared erythropoietin (EPO) levels measured by radioimmunoassay, in 54 anaemic rheumatoid patients and 55 patients with iron deficiency anaemia but no inflammatory disease. The erythropoietin response in the rheumatoid patients was impaired compared with the control group (P < 0.025) but only seven rheumatoid patients showed a response which fell below the 95% confidence intervals predicted for the control group. Rheumatoid patients who fell within the highest quartile for serum ferritin concentrations (i.e. those most likely to have anaemia of chronic disease) had significantly lower EPO levels compared with the control group (P < 0.01). EPO levels in rheumatoid patients within the lowest quartile for ferritin (i.e. those with iron deficiency anaemia) were not significantly different from the control group (P = 0.670). The difference in EPO response between the RA patients in the upper and lower quartile for ferritin approached but did not achieve significance (P = 0.056). In a second study 15 anaemic RA patients were given a 5-day course of oral prednisolone 1.5 mgkg-1. Hemoglobin did not rise significantly until day 4 but EPO levels fell by day 1 (P < 0.005) and remained lower than pretreatment values throughout the study. Thus, in RA patients, anaemia of chronic disease is associated with inappropriately low EPO concentrations but this does not appear to be the major cause of the anaemia and Hb response to prednisolone does not depend upon an increase in EPO concentration.

Administration, Oral↗
PubMed1992

Variations among rheumatologists in prescribing and monitoring of disease modifying antirheumatoid drugs.

One hundred consultant rheumatologists were sent a questionnaire on their prescribing pattern, and dose and monitoring schedules of four disease modifying antirheumatoid drugs (DMARDs). Seventy-five completed questionnaires were received. Sulphasalazine was the most popular first choice DMARD. There was general agreement on dose schedules which were similar to those recommended in the data sheets although for each drug a minority used different dose schedules. There was, however, marked variation among respondents in what was accepted as an adequate trial of therapy, in monitoring schedules and in the interpretation of results of toxicity monitoring. In many cases these practices differed significantly from the data sheet recommendations. These differences in stated practice could have financial and medicolegal as well as clinical implications.

Antimalarials↗
PubMed1991

A study of adjunctive copper sulphate treatment in patients with rheumatoid arthritis who have relapsed while taking D-penicillamine.

Formation of a D-penicillamine-copper complex may be necessary for the anti-rheumatic effect of D-penicillamine. Thus, depletion of copper stores by D-penicillamine may eventually lead to relapse in D-penicillamine treated patients. Twenty-one patients who relapsed on D-penicillamine were randomised to copper sulphate 20 mg daily (n = 13) or matched placebo (n = 8) in addition to penicillamine daily for 16 weeks. Urinary copper was increased in the copper treated patients but no statistically significant or clinically important improvement occurred in either group.

Adult↗
PubMed1991

The prediction of steady-state plasma phenobarbitone concentrations (following low-dose phenobarbitone) to refine its use as an indicator of compliance.

1. A model for predicting the steady-state plasma concentration of phenobarbitone following low-dose phenobarbitone used as an indicator of compliance was derived using data for 10 healthy volunteers. 2. Each volunteer was given a single 30 mg oral dose of phenobarbitone and the pharmacokinetics were described. Subsequently, volunteers were given phenobarbitone 2 mg daily for 28 days and a further pharmacokinetic profile determined during and after this period. 3. An initial predicted estimate of steady-state plasma drug concentration was made using each volunteer's demographic details. This estimate was revised by Bayesian analysis using single timed samples (24, 48, 72 or 96 h) following the single dose. 4. The model was tested on a further 10 healthy volunteers given a single 8 mg dose and who were subsequently given 2 mg daily for 28 days. 5. The revised estimate of peak steady-state plasma phenobarbitone concentration utilising the 96 h post-single dose concentration (356 ng ml-1) was least biased (mean prediction error +/- 95% CI = 10.6 +/- 19.8 ng ml-1) and most precise (root mean square error +/- 95% CI = 28.3 +/- 19.0 ng ml-1). In all cases the peak or trough steady-state drug concentration was within 13% of the predicted value. 6. The model reflected compliance accurately in a further eight volunteers with simulated partial (two-thirds) compliance. 7. The use of a predictive model using Bayesian analysis to estimate expected steady-state plasma phenobarbitone concentrations could increase further the usefulness of low-dose phenobarbitone as an indicator of compliance.

Adult↗
PubMed1991

Compliance with drug therapy.

Although no single method is ideal for measuring compliance the methods now available allow accurate assessment of compliance in most settings. Studies using new and more accurate methods of measuring compliance have shown poor compliance to be an even greater problem than was previously thought. Using these methods, efforts in the future should be directed at relating compliance to treatment outcome, and investigating whether manoeuvres aimed at improving compliance actually improve patient outcome.

Aged↗
PubMed1990

What do patients and rheumatologists regard as an 'acceptable' risk in the treatment of rheumatic disease?

A questionnaire designed to ascertain the risk of adverse effects which patients with rheumatic conditions would accept for a particular therapeutic outcome was administered to 50 patients. The same questionnaire together with 'potted' histories of five of the patients was sent to 10 consultant rheumatologists. The willingness of both patients and doctors to risk side-effects varied with both the severity of the side-effect and the potential therapeutic benefit. Doctors were more willing than patients to risk death or serious disability (Wilcoxon, P less than 0.01) for a particular expected benefit. Doctors were also more willing to risk side-effects in treating seropositive rheumatoid arthritis than in treating non-articular rheumatism. No correlation was seen for patients between acceptable risk and diagnosis, pain or smoking habits. The risks which both groups stated they were willing to accept were less than those apparently associated with antirheumatic therapy. The results disagreed markedly with those of a previous study, demonstrating the importance of the methods used in this type of work.

Attitude of Health Personnel↗
PubMed1990

A comparison of a short half-life marker (low-dose isoniazid), a long half-life pharmacological indicator (low-dose phenobarbitone) and measurements of a controlled release 'therapeutic drug' (metoprolol, Metoros) in reflecting incomplete compliance by volunteers.

1. Although, long half-life compounds appear to be more appropriate pharmacological indicators of compliance with treatment, short half-life markers or measurements of short half-life therapeutic drugs are frequently used. 2. We have compared the usefulness of low-dose phenobarbitone (a long half-life indicator), low dose isoniazid (a short half-life marker) and controlled release metoprolol (Metros) (a controlled release formulation of a short half-life 'therapeutic' drug) in seven volunteers with simulated partial (two thirds) compliance. 3. Detection of isoniazid metabolites in urine had an 83% sensitivity and 94% specificity for detecting ingestion within the previous 24 h and 100% sensitivity and 82% specificity for detecting ingestion within the past 6 h but gave no indication of the longer term pattern of compliance. 4. At 28 days (a time when steady-state would be obtained for all three drugs) phenobarbitone plasma levels were 70% (66-76%)--median and interquartile range--of the expected steady-state level if compliance had been complete. Corresponding figures for metoprolol were 82% (37-100%). 5. Measurement of phenobarbitone was much superior to isoniazid or metoprolol measurements in reflecting partial compliance over the previous 1 to 4 weeks.

Administration, Oral↗
PubMed1990

Patterns of out-patients non-steroidal anti-inflammatory drug prescribing in two teaching hospital rheumatology units--implications for post-marketing surveillance.

Patterns of prescriptions or recommendations for non-steroidal anti-inflammatory drugs (NSAIDs) were examined in the out-patient departments of two teaching hospital rheumatology units [The General Infirmary, Leeds (n = 140), and Musgrave Park Hospital, Belfast (n = 77)]. In both units four drugs accounted for over 80% of prescriptions/recommendations (diclofenac, indomethacin, ibuprofen and naproxen in Leeds and flurbiprofen, nabumetone, ibuprofen and diclofenac in Belfast). In Leeds patients with pre-existing upper gastrointestinal problems were more likely to receive diclofenac whereas in Belfast they were more likely to receive nabumetone or ibuprofen. In Leeds, patients who received indomethacin tended to be young males with seronegative arthritis. These differences between drugs and between centres could have important implications for cost, design and interpretation of studies of post-marketing surveillance.

Adolescent↗