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Biomedical subjects

W N Jones

Publications and source records attributed to W N Jones.

At least 19 recordsLinked to original sources
PubMed1992

Current trends in the pharmacotherapy for gastroesophageal reflux disease.

Medical therapy for gastroesophageal reflux disease should entail a multistep approach. After life-style changes, many patients will require histamine2 receptor antagonists in conventional doses with repeated therapeutic courses, if not continuous maintenance. Prokinetic agents are potentially useful in those patients with impaired motor function of the esophageal or gastric smooth muscle. Combination therapy with histamine2 receptor antagonists and prokinetic agents or sucralfate provides modest healing benefit, if any, over that by histamine2 receptor antagonists alone. For patients with more severe refractory disease, omeprazole has provided unequaled healing rates and accelerated symptomatic relief. High-dose (twofold or more standard dose) histamine2 receptor antagonist therapy may also heal high-grade esophagitis, but the reported experience is small. After healing is achieved, an attempt should generally be made to "step down" therapy to standard-dose histamine2 receptor antagonist as maintenance. Finding the least amount of drug to control symptoms and maintain the integrity of the esophageal mucosa would minimize cost and potential long-term risk.

Costs and Cost Analysis↗
PubMed1992

Current trends in the pharmacotherapy for peptic ulcer disease.

A variety of options are available for the medical treatment of peptic ulcer disease, including antacids, histamine2 receptor antagonists, omeprazole, prostaglandin analogues, and sucralfate and bismuth formulations. Seventy percent to 90% of peptic duodenal and gastric ulcers will heal after 4 to 8 weeks of therapy. Combination regimens using these agents have not been demonstrated to be superior to single-agent therapy. Aggressive acid suppression with "high-dose" histamine2 receptor antagonists or omeprazole accelerates healing of ordinary ulcers and promotes healing of previously refractory ulcers. Although ulcer recurrence is diminished by continuous "maintenance" therapy with the aforementioned agents, recurrence seems to be dramatically suppressed after eradication of Helicobacter pylori from the gastroduodenal mucosa.

Anti-Ulcer Agents↗
PubMed1991

Attitudes among Department of Veterans Affairs pharmacists toward postgraduate education and training.

The results of a survey of the attitudes of Department of Veterans Affairs (VA) pharmacists toward postgraduate education and training are reported. In January 1990 an anonymous questionnaire was mailed to 800 randomly selected VA pharmacists. The mailing occurred one month after the announcement of new policies for recruiting and retaining VA pharmacists that allow salaries to be determined on the basis of education, job responsibilities, publishing, and other professional activities and accomplishments. Recipients were asked to provide educational and demographic data, information on their work settings and job responsibilities, and their perceptions of the benefits of and barriers to additional education and training. Of the 800 questionnaires mailed, 310 (38.8%) usable responses were received. The majority (77%) of the pharmacists held B.S. degrees only. One-day to one-week training programs had been attended by 74.5% of the respondents; at least 61.6% desired to attend such programs, and many indicated the desire to attend longer training programs. Some 48.3% of the B.S.-level pharmacists had expressed an interest in earning another pharmacy-related degree. More than 40% of the respondents saw time, money, and the location of programs as barriers. Perceived benefits included personal development, enhanced job satisfaction, and improved patient care; only 1.9% perceived no benefit. Seventy-seven percent believed that salary should reflect the level of professional training. VA pharmacists desire additional education and training and believe that such programs may enhance patient care and reduce staff turnover.

Attitude of Health Personnel↗
PubMed1989

The effect of sucralfate on the steady-state serum concentrations of phenytoin.

The effect of sucralfate on steady-state phenytoin concentrations was evaluated in 6 normal volunteers. The subjects took phenytoin at bedtime until steady-state was confirmed (8 to 9 days) and then took in addition sucralfate 1g four times daily for a further 7 days. Serum phenytoin concentrations were measured on days 1, 3, and 7 of sucralfate administration. Measured phenytoin concentrations were 10.9 +/- 3.0 mcg/ml and 11.0 +/- 3.1 mcg/ml before sucralfate and 10.8 +/- 3.1 mcg/ml, 11.4 +/- 3.2 mcg/ml, and 11.1 +/- 2.5 mcg/ml during sucralfate administration (p greater than 0.05; ANOVA). These results suggest there is not a significant drug interaction between sucralfate and phenytoin.

Adult↗
PubMed1988

Lipid and lipoprotein changes during the seven days off oral contraception in women using two triphasic preparations.

This study was designed to determine whether mean values for lipids and lipoproteins changed during the 21 days on oral contraceptive (OC) preparations and during the seven days off the pills. The design allowed for comparison of the effects of Triphasil and Ortho 777 and for examining the consistency over two pill cycles. The mean values for total cholesterol, HDL-cholesterol, LDL-cholesterol and HDL3-subfraction were consistently lower on Day 20 when compared to Day 2 (p less than 0.05) for the two cycles and higher on Day 2 of Cycle II when compared to Day 20 of Cycle I. This fall-rise-fall pattern was consistent for cholesterol in 17 out of 28 of the women studied and these women were heavier (p less than 0.05), had a greater mean Quetelet Index (p less than 0.05) and had been using OCs for a shorter mean period of time (p less than 0.05). Consistently higher apolipoprotein A1 mean values were found on Day 20 of both cycles for Triphasil users compared to Ortho 777 users (p less than 0.02). This paper discusses the importance of these findings in relation to study design when measuring for differences between OC preparations and changes over time.

Adolescent↗
PubMed1987

Time course of gentamicin serum concentration rebound following hemodialysis.

The rebound in gentamicin serum concentration following hemodialysis was studied in six patients with chronic renal failure. The patients were not infected at the time of the study and received a single dose of gentamicin 2 mg/kg before hemodialysis. Serum samples were obtained immediately after dialysis and at 0.5, 1, 2, and 3 hours following hemodialysis. The average increases in gentamicin serum concentrations were 3.6 percent at 0.5 hour, 12.6 percent at 1 hour, and 6.6 percent at 2 hours. An average decline of 4.2 percent occurred at three hours. Only the increase seen at one hour was significantly different from the gentamicin serum concentration immediately following hemodialysis. This rebound was of small magnitude, though, and may not be clinically significant.

Aged↗
PubMed1986

Digoxin-diltiazem interaction: a pharmacokinetic evaluation.

The pharmacokinetics of digoxin were studied before and after a 2 week course of diltiazem, 30 mg four times daily, in 7 healthy volunteers. Each subject received an IV dose of digoxin before starting diltiazem and again on day 15 of the study. Diltiazem was continued until all sera and urine were collected. During the control and diltiazem phases, respectively, the terminal elimination rate constants were 0.0231 +/- 0.007 h-1 and 0.0254 +/- 0.007 h-1, the volumes of distribution were 10.5 +/- 3.95 l/kg and 10.2 +/- 3.26 l/kg, and the total body clearances were 3.72 +/- 0.78 ml X min-1 X kg-1 and 4.09 +/- 0.94 ml X min-1 X kg-1. None of these pharmacokinetic parameters of digoxin were significantly different before or during diltiazem administration. Overall, there does not appear to be an interaction between digoxin and diltiazem.

Adult↗
PubMed1985

Theophylline serum concentrations in ambulatory patients with chronic obstructive pulmonary disease.

A two-part study was designed to investigate the application of theophylline serum concentration data at a Veterans Administration Medical Center. The investigation was unique in its use of ambulatory patients instead of hospitalized patients as study subjects for assessing the use of laboratory tests. As has been found in other studies that examined different drugs and involved hospitalized subjects, this investigation discovered significant problems in the ordering, application, and documentation of these data when judged against established criteria. There was no significant difference in the appropriate use of these drugs between physicians specializing in pulmonary versus general medicine. Of clinical importance also are the findings that confirm a positive correlation between the proper use of these tests and improvement in patient outcome, and the demonstrated relationships between clinical symptoms and subtherapeutic and toxic serum concentrations of theophylline.

Aged↗
PubMed1984

Intravenous aminophylline in the treatment of acute bronchospastic exacerbations of chronic obstructive pulmonary disease.

Often chronic obstructive pulmonary disease (COPD) patients treated for acute exacerbations receive intravenous (IV) aminophylline in addition to inhaled bronchodilators that may raise serum levels of theophylline into the toxic range. A double-blind, randomized study of 52 men with COPD who came to the emergency department for treatment of exacerbations was initiated to establish the efficacy and safety of this common practice. After history and physical examination, patients were treated with 28% oxygen by Venturi mask and 0.3 cc metaproterenol sulfate in 2.5 cc saline by nebulizer; an IV line was started and patients received either aminophylline or D5W. Measurements included baseline and two-hour serum theophylline levels, pulmonary function tests, and symptom questionnaires. Mean values from the entire group showed decreases in respiratory rate, cardiac rate, and pulsus paradoxus, and increases in forced expiratory volume in one second (FEV1) and vital capacity (VC) over a two-hour treatment period (P less than .01). Despite the increase in serum theophylline in the treatment group, the demographic, clinical, pulmonary function, and outcome data were found to have no statistically significant differences when compared to control patients. The data were then analyzed according to serum theophylline levels. Theophylline level greater than 20 micrograms/mL occurred in 15 patients with no untoward effects; premature ventricular contractions (PVCs) were no more frequent in this group than in those with lower serum theophylline levels. A theophylline level greater than 10 micrograms/mL after two hours of treatment resulted in the following differences, which were not statistically significant: mean FEV1 response less than or equal to 10 micrograms/mL vs greater than 10 micrograms/mL, 20% vs 28%; mean VC change, 17% vs 30%; or mean emergency department returns in one week, 0.1 vs 0.26. In our experience, oxygen and inhaled metaproterenol are effective treatment for exacerbations of COPD.

Aged↗
PubMed1980

Angiographic demonstration of gastrointestinal bleeding through the pancreatic duct.

This article describes the angiographic findings in the case of a bleeding stump of the left gastric artery, following subtotal gastrectomy, into a pancreatic pseudocyst with instantaneous opacification of the pancreatic duct and duodenum. This is the first reported case to demonstrate a frank bleed with total opacification of the pancreatic duct. Based on our experience and previously reported cases, we conclude that subselective catheterization of the bleeding vessel is necessary to demonstrate total opacification of the pancreatic duct in such cases.

Aged↗