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Biomedical subjects

W B Applegate

Publications and source records attributed to W B Applegate.

At least 109 records · Page 6Linked to original sources
PubMed1990

Coffee consumption and serum lipids: a randomized, crossover clinical trial.

PURPOSE: The purpose of this study was to determine the effect of consuming three or more cups of filter-brewed coffee per day on levels of serum lipids. SUBJECTS AND METHODS: A prospective, randomized crossover clinical trial was performed. Twenty-one healthy white male subjects completed the trial, and consumed an average of 3.6 cups of coffee a day. Data were evaluated by analysis of variance for repeated measures and t-test for paired means. RESULTS: No effect of coffee consumption on serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or apolipoprotein B was found. Diet, creamer use, and cigarette use as well as group assignment and time factors were controlled for in the analysis. CONCLUSION: We found no effect of moderate consumption of filter-brewed coffee on serum levels of atherogenic lipids. This study supports previous work that filtered coffee has no adverse effect on serum lipids. This has far-reaching implications given the widespread use of coffee and the current concern over coronary risk factors.

Adult↗
PubMed1990

An index for estimating probabilities of surgical success for cataract patients with retinal disease.

Patients with cataracts and coincident retinal disease are at increased risk for unsuccessful cataract surgery. We developed a method for estimating probabilities of surgical success for older cataract patients with retinal disease. Using data from a prospective study of cataract surgery outcomes, 36 patients with both cataracts and retinal disease were identified, 13 of whom attained surgical success with 20/40 or better vision 4 months after surgery. Age, presurgical Snellen letter acuity, location of retinal lesions, and presurgical visual function in everyday life (newspaper reading or television viewing) were all reliable correlates of surgical outcome. These data were analyzed using multiple logistic regression to develop a clinical index combining presurgical Snellen letter acuity, location of retinal lesions, and age to predict surgical success. The resulting index demonstrated 83% sensitivity and 85% specificity in sample data, correctly predicting 83% of patients (predictive value positive: 73%; predictive value negative: 90%).

Activities of Daily Living↗
PubMed1990

Designing and executing randomized clinical trials involving elderly persons.

Although randomized clinical trials are the most scientifically rigorous design for evaluating a clinical intervention, the methodology involved is intricate, particularly when elderly subjects are involved. Special attention must be paid to framing precise primary and secondary study hypotheses, adjusting for the potential confounding effects of comorbidity and disability, and analyzing multiple outcomes. When the sample or study cohort is chosen, there will be an inevitable trade-off between internal and external validity. Because elderly study cohorts are more prognostically heterogeneous, consideration should be given to enrolling an "at-risk" cohort and possibly to stratified randomization.

Aged↗
PubMed1989

Hypertension in elderly patients.

PURPOSE: To synthesize and analyze new information on the epidemiology, pathophysiology, and management of hypertension in the elderly to guide physicians making treatment decisions. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1972-1988) and bibliographic reviews of textbooks and review articles. STUDY SELECTION: Primary research articles on the epidemiology, pathophysiology, and management of hypertension in the elderly were reviewed. Particular emphasis was placed on large randomized clinical trials. DATA EXTRACTION: Study design and quality were assessed, with particular attention to subject selection, sample size, definition of outcome variables, and applicability of the results to management of the elderly hypertensive patient. RESULTS OF DATA SYNTHESIS: Epidemiologic studies confirm that elevated systolic blood pressure in the elderly is more highly correlated with subsequent cardiovascular morbidity and mortality than is elevation of diastolic blood pressure. Results of several large randomized trials of the treatment of diastolic hypertension in elderly patients indicate that treatment is beneficial, at least up to age 80. For instance, the European Working Party on Hypertension in the Elderly reported that drug treatment resulted in a significant relative reduction (27%) in overall cardiovascular mortality, or an absolute reduction of 29 fewer cardiovascular events per 1000 person-years of treatment. Data from well-designed studies are not available to make a definitive statement about the treatment of isolated systolic hypertension. CONCLUSION: The cardiovascular risk reduction from treating mild to moderate diastolic hypertension in the elderly is significant, but the magnitude of absolute risk reduction is not so great that treatment should invariably be pursued if serious side effects cannot be avoided.

Aged↗
PubMed1989

Treatment of hypertension in the elderly with labetalol.

Elderly and young hypertensive patients differ with regard to clinical and pathophysiologic profiles. In the elderly, hypertension is generally characterized by elevated peripheral vascular resistance and decreased cardiac output. To establish an individualized or patient-specific approach to their treatment, antihypertensive agents must be evaluated specifically in this subpopulation. Labetalol, an alpha- and beta-blocking agent, has been shown to lower blood pressure in young and elderly hypertensive patients primarily by reducing peripheral vascular resistance without compromising cardiac output. Examination of recent reports on the pharmacokinetics and pharmacodynamic effects, and on the efficacy and safety of labetalol in elderly persons with hypertension, leads us to conclude that the drug appears to be well suited for use in these patients.

Aged↗
PubMed1989

The Systolic Hypertension in the Elderly Program (SHEP): an intervention trial on isolated systolic hypertension. SHEP Cooperative Research Group.

The Systolic Hypertension in the Elderly Program (SHEP) is a randomized double-blind placebo-controlled trial to determine if antihypertensive treatment of isolated systolic hypertension (ISH) [systolic blood pressure (SBP) greater than or equal to 160 mmHg, diastolic blood pressure (DBP) less than 90 mmHg] reduces the 5 year incidence of fatal and nonfatal stroke. Between March 1, 1985 and January 15, 1988, 4736 persons (target 4800) with ISH, age 60 years and over, were enrolled. Potential participants met blood pressure (BP) and age criteria. Those on antihypertensive medication prior to enrollment without documented diastolic hypertension had their medication tapered and discontinued, and then met BP criteria (33% of cohort). Stepped-care therapy with chlorthalidone and atenolol (alternative, reserpine) or matching placebos was initiated as first and second steps. At baseline the trial population was 43.1% male, 56.9% female; 13.9% black, 86.1% non-black. Also, the mean age was 71.6 years; the mean SBP was 170.3 mmHg and the mean DBP was 76.6 mmHg; 59.8% had codeable resting electrocardiographic abnormalities. The trial is now in follow-up phase with scheduled termination in 1991.

Aged↗
PubMed1989

Choice of antihypertensive medication regimen.

Because increased peripheral vascular resistance is one of the primary pathophysiologic processes involved in hypertension in elderly persons, drugs that decrease peripheral resistance are conceptually preferred in elderly hypertensive patients. Adequate clinical studies are needed, however, to determine if this conceptual approach is superior to an empiric approach. Data available to date still indicate that diuretics are effective agents to treat elderly hypertensive patients.

Aged↗
PubMed1988

A clinical index for predicting visual acuity after cataract surgery.

We developed a clinical index for predicting postoperative visual acuity of cataract patients and cross-validated it using data from 182 patients aged 70 years and older. The index consisted of four statistically combined indicators: age, preoperative visual acuity, frequency of reading, and comorbidity. Validation of the index included comparisons to two standard technical instruments for measurement of retinal visual acuity. For the clinical index, 72% of predictions were accurate within one Snellen line of postoperative visual acuity compared to 37% using a laser interferometer and 33% using a potential acuity meter. Testing of the clinical index's external validity using data from 111 patients in a different ophthalmology clinic disclosed 61% of predictions accurate within one Snellen line.

Aged↗
PubMed1988

Predictions of outcomes from cataract surgery in elderly persons.

To determine how well visual outcomes of cataract surgery can be predicted from acuity estimations by visual instruments and an ophthalmologist, the authors compared predictions of postsurgical visual acuity with the measured acuity at 4 months in 82 elderly persons. Comparisons were made between the potential acuity meter (PAM), laser interferometer (LI), and an ophthalmologist, who predicted the final vision before surgery using screening visual information, including PAM, LI data, and results of the patient's examination. Neither instrument alone was successful in predicting postsurgical acuity +/- 1 contiguous Snellen chart line (bivariate correlation [r] = 0.03 for PAM and 0.07 for LI). The ophthalmologist was the most accurate predictor of acuity within 1 line (r = 0.41, p less than or equal to 0.001). These results indicate that the PAM and LI did not independently predict postsurgical vision in elderly cataract patients, but results of a clinical examination markedly improved the accuracy of predictions.

Aged↗
PubMed1988

Functional outcome one year following cataract surgery in elderly persons.

We conducted a prospective study of 164 patients aged 70 and over who had undergone cataract removal and intraocular lens implantation to determine variables which predicted change in physical function experienced by the patients one year after cataract surgery. Path analysis was used to estimate direct and indirect effects of ADL change. Direct effects were estimated for mental status (-.35), mental status change (.51), binocular visual disability (-.39), binocular visual disability change over one year (.51), and baseline ADL (.36), with 45% of variance explained. Age and baseline mental status had important indirect effects through mental status change, and presurgical visual disability had important indirect effects through both visual disability change and mental status change. In summary, change in level of function one year after cataract surgery was not explained solely by change in vision, but was conditional on baseline function and baseline mental status and mediated in part by change in mental status.

Activities of Daily Living↗
PubMed1988

Double-blind comparison of amlodipine and hydrochlorothiazide in patients with mild to moderate hypertension.

Amlodipine, a new long-acting dihydropyridine calcium antagonist, was compared with hydrochlorothiazie (HCTZ) in 145 patients with mild to moderate hypertension. After 4 weeks of single-blind placebo runin, patients were randomly allocated to receive amlodipine (2.5-10 mg once daily, n = 97) or HCTZ (25-100 mg once daily, n = 48). At study week 12 response rates for amlodipine and HCTZ were 61.5 and 60.5%, respectively. There were clinically significant reductions in 24-h postdose blood pressures with both amlodipine (-18/-11 mm Hg supine: -14/-10 mm Hg standing) and HCTZ (-18/-10 mm Hg supine, -18/-9 mm Hg standing). After study week 12, atenolol (50-100 mg once daily) was added to the regimen of those patients whose hypertension was not controlled with monotherapy. Neither amlodipine nor HCTZ produced clinically significant changes in pulse rate, electrocardiogram, or chest x-ray film. Although amlodipine increased and HCTZ decreased the high-density lipoprotein (HDL)/total cholesterol ratio and the HDL/(low-density lipoprotein + very-low-density lipoprotein) ratio, the difference between the two treatments was not statistically significant. The incidence of side effects and the rate of patient withdrawal was comparable in the two groups. The incidence of laboratory abnormalities was 56% with HCTZ (mainly hypokalemia and hyperuricemia) and 16% with amlodipine. Amlodipine was an effective, well-tolerated agent for treatment of mild-to-moderate hypertension in this study, as single-daily-dose monotherapy and in combination with atenolol.

Adolescent↗
PubMed1987

Impact of cataract surgery with lens implantation on vision and physical function in elderly patients.

We conducted a prospective study of 293 elderly patients undergoing cataract surgery with intraocular lens implantation to determine the impact of the surgery on vision and on subjective and objective measures of patient function. Visual acuity in the surgical eye improved from a mean of 20/100 before surgery to 20/40 four months after surgery; improvement was maintained at one year. Positive changes occurred in some subjective measures of patient function, such as reported activities of daily living and patient report of vision-dependent activities, but these changes were modest. The most marked changes in patient function occurred in objective measures of function. Mental status had improved not quite significantly at four months but significantly at one year. Timed manual performance improved dramatically and significantly at four months and one year. Cataract surgery was associated with improved vision and improved objective function in most patients by four months after surgery, and these improvements were maintained at one year.

Activities of Daily Living↗
PubMed1987

Use of assessment instruments in clinical settings.

In recent years, increased emphasis has been placed in the field of geriatric medicine on the need for multidimensional assessment of elderly patients. There is an increasing tendency to use standardized structured assessment instruments or questionnaires in this process. Frequently, the exact question or set of questions to be answered by the instrument has not been carefully analyzed. Although comprehensive structured multidimensional instruments allow the collection of large amounts of data in multiple domains (physical, social, psychologic, economic), these instruments may require excess data collection and may not be reliable in clinical settings. Clinicians considering using a variety of assessment instruments should carefully consider their goals for data collection and carefully review the validity, reliability, and population sampled for any assessment instruments under consideration. Also, the clinical setting in which the instrument is to be used can have a negative impact on either instrument validity or reliability.

Aged↗
PubMed1987

A geriatric assessment and rehabilitation unit in a rehabilitation hospital.

This paper presents process and outcome data for a geriatric assessment unit in a rehabilitation hospital whose focus is on short-term rehabilitation. While the results presented here are positive, they are descriptive and do not prove a cause and effect relationship between the geriatric assessment and rehabilitation unit care and the outcomes described. This unit is currently being evaluated by a prospective randomized controlled clinical trial.

Aged↗
PubMed1986

Physician management of patients with adverse outcomes.

The incidence of iatrogenic complications of medical or surgical care is increasing. Such adverse events may severely strain the patient/physician relationship. The nature of the underlying patient/physician relationship in terms of the style of interaction and the handling of uncertainty and decision making may influence the impact of adverse events on the relationship. Physicians may manage these situations poorly because of perceived threats to their self-image or sense of control, or because of fear of malpractice suits. Patients may consciously or subconsciously blame the physician, fall to express their concerns, or exaggerate their complaints. If possible, continuity of the patient/physician relationship should be maintained through full disclosure of all medical facts, frank and open communication, and a renewed commitment to the therapeutic relationship.

Communication↗
PubMed1985

Comparison of the use of reserpine versus alpha-methyldopa for second step treatment of hypertension in the elderly.

A retrospective chart analysis was conducted on all new elderly hypertensive patients referred to a community hypertension clinic who were being treated with either reserpine or alpha-methyldopa plus a diuretic. There were no significant differences between the two groups on entry in age, gender, co-morbid diagnoses, or systolic or diastolic blood pressure. There were no significant differences between the two groups in terms of side effects over three years, but the proportion of persons having compliance problems was significantly lower in the reserpine group. Mean diastolic pressures were significantly lower after one, two, and three years, and systolic pressures were lower after one and two years in the reserpine group. Reserpine is at least as effective as alpha-methyldopa in treating hypertension in the elderly and is associated with fewer problems in compliance.

Aged↗