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Biomedical subjects

W K Simmons

Publications and source records attributed to W K Simmons.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of the use of evidence-based angiotensin-converting enzyme inhibitor criteria for the treatment of congestive heart failure: opportunities for pharmacists to improve patient outcomes.

BACKGROUND: The under-utilization and under-dosing of angiotensin-converting enzyme inhibitors (ACEIs) in patients with congestive heart failure (CHF) continues to be a problem observed in clinical practice. OBJECTIVE: To develop and implement drug use evaluation (DUE) criteria for the use of ACEIs in patients with CHF which could be used by pharmacists to ensure that all eligible patients receive an ACEI at an appropriate dose. METHODS: A retrospective chart review of all patients discharged from the study institution with a diagnosis of CHF during the period of March 1 to July 31, 1998 was conducted using the DUE criteria developed. RESULTS: Of the 138 patients evaluated, only 68.6% were discharged on ACEI therapy. Additionally, only 40% of those discharged on an ACEI achieved target dose. Multiple regression analysis revealed that males were 2.43 times more likely to be discharged on an ACEI than females, while those on concomitant diuretics or digoxin were less likely to be discharged on an ACEI (25% and 18%, respectively). CONCLUSIONS: The application of these DUE criteria by pharmacists in hospital and community practice has the potential to improve utilization and dosing of this important class of medications for the management of the symptoms and progression of CHF.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Marked reduction of anemia during pregnancy over a 10-year period in Montserrat.

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90% of all women giving birth on Montserrat in 1980 and 1985, as well as 80% of those giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82% of the study women in 1980 to 23% in 1985 and 19% in 1990) and also a marked drop at three days postpartum (from 91% in 1980 to 41% in 1985 and 39% in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of the study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities.

Adolescent↗
PubMed1994

Control of iron and other micronutrient deficiencies in the English-speaking Caribbean.

Most micronutrient deficiencies affect relatively few people in the Caribbean; however, many Caribbean residents are affected by anemia that appears due primarily to a lack of dietary iron. While generally substantial, the prevalences of such anemia have differed a good deal from place to place and study to study, observed rates ranging from 27% to 75% in pregnant women, 19% to 55% in lactating women, and 15% to 80% in young children. Severe anemia, defined by a blood hemoglobin concentration below 8 g/dl, has been found in approximately 6% of the pregnant women and 11% of the preschool children in some Caribbean countries. The principal ways of controlling iron deficiency anemia are through food fortification, control of intestinal parasites, direct oral supplementation, and dietary modification. Progress has been made in iron fortification of wheat flour and wheat products (the principal foodstuffs consumed by the general public in most of the English-speaking Caribbean). Data on control of relevant parasites in the Caribbean (primarily hookworm and to a lesser extent whipworm) are limited. Health services throughout the English-speaking Caribbean have been providing direct iron supplementation for pregnant women, but high levels of anemia during pregnancy still exist because of coverage, monitoring, and compliance problems. All the Caribbean countries also have education programs, which mainly advise pregnant women about iron-rich foods and iron absorption inhibitors and enhancers.

Anemia, Iron-Deficiency↗
PubMed1994

An evaluation of the HemoCue for measuring haemoglobin in field studies in Jamaica.

The HemoCue system utilizes the principle of oxidation of haemoglobin to hemiglobin by sodium nitrite and the subsequent conversion of hemiglobin to hemiglobinazide by sodium azide. The reagents for these reactions are contained within a small disposable microcuvette of approximately 10 microliters in volume. A venous or capillary sample is introduced into the microcuvette by capillary action and, after reaction with the reagents, the absorbance is read in the HemoCue photometer at 565 and 880 nm. The haemoglobin concentration is then displayed as a digital reading, in either g/dl or mmol/l in 15-45 seconds. We compared haemoglobin values obtained by the HemoCue system with those from the Coulter Counter S-Plus IV in 366 pregnant women in urban Jamaica, and found a highly significant correlation (r = 0.78, P < 0.01). However, because of the convenience and ease of use of this instrument and considering the relatively high cost, we recommend it for use only as a research tool in field studies where accurate and rapid haemoglobin determinations are required.

Adolescent↗
PubMed1993

Evaluation of a gastric delivery system for iron supplementation in pregnancy.

The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system (GDS). Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present (hemoglobin concentration 80-110 g/L). The participants were randomly assigned to one of three study groups given no iron, two FeSO4 tablets (100 mg Fe) daily, or one GDS capsule (50 mg Fe) daily. Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes, including serum transferrin receptor. There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement. We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily, a GDS offers significant advantages for iron supplementation of pregnant women.

Administration, Oral↗
PubMed1984

An evaluation of methods of screening for anaemia.

Screening methods for anaemia were selected for testing on the grounds of cheapness, simplicity, sturdiness, accuracy and independence of mains electricity or batteries. The methods evaluated were the copper sulfate method, the Dare haemoglobinometer, the Lovibond comparator, the A. O. Spencer haemoglobinometer, and the Tallqvist method. A new device, the Carib haemoglobin comparator, was developed. The Dare and Lovibond instruments were found to be inaccurate in the laboratory. The other instruments were tested by primary health care workers in clinics in Jamaica. The Carib haemoglobin comparator and the copper sulfate method were found to be accurate, easy to use, and cheap. Both methods are considered to be useful for screening for anaemia at primary health care level.

Anemia↗
PubMed1982

A survey of the anemia status of preschool age children and pregnant and lactating women in Jamaica.

An island-wide anemia survey was conducted in Jamaica on pregnant and lactating women and preschool age children. The results indicate that anemia is a serious public health problem in Jamaica. Of pregnant women, 61.6% had Hb levels below 11.0 g/dl. Of lactating women 58.7% had Hb levels below 12.0 g/dl. Of preschool age children 69.1% had Hb levels below 11.0 g/dl. Public health and fortification programs for the control of anemia have been implemented by the government and are currently being reviewed.

Anemia↗
PubMed1982

Nutritional anemia in the English-speaking Caribbean and Suriname.

Anemia is a problem in all countries of the English-speaking Caribbean where data are available. It affects mostly preschool age children and pregnant and lactating women. The most common cause is a deficiency of iron. This is probably due to an adequate intake with a low absorption. A deficiency of folate is also probably a responsible factor in the pathogenesis of some of the anemias. Anemias associated with parasitic infestations such as hookworm and whipworm and hemoglobinopathies such as sickle cell anemia are also noted.

Adolescent↗
PubMed1976

Xerophthalmia and blindness in Northeast Brazil.

Dietary and biochemical data have indicated that hypovitaminosis A is a public health problem in Northeast Brazil. However, there are few reports regarding clinical signs of hypovitaminosis A. Therefore, an epidemiological study was designed to study this problem. The study as done was primarily a review of hospital records of xerophthalmia in each state with attention paid to other nutrition factors. It was found that xerophthalmia is a problem in Northeast Brazil and a cause of blindness in certain areas. However, the number varied greatly from some states to others. Around 1,000 preschool-age children were recorded as blind from vitamin A deficiency in a 1-year period. It was also noted that the peak incidence of xerophthalmia and blindness was around 1 year of age. The government of Brazil is taking urgent measures to combat this deficiency with such measures as the supplementation of sugar with vitamin A and the distribution of massive doses of vitamin A.

Adult↗