1
|
Meehan M, Shah A, Lobo J, Oates J, Clinton C, Annapureddy N, Xie F, Zhuo J, Danila MI, England BR, Curtis JR. Validation of an algorithm to identify incident interstitial lung disease in patients with rheumatoid arthritis. Arthritis Res Ther 2022; 24:2. [PMID: 34980225 PMCID: PMC8722182 DOI: 10.1186/s13075-021-02655-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background/purpose Interstitial lung disease (ILD) is an important problem for patients with rheumatoid arthritis (RA). However, current approaches to ILD case finding in real-world data have been evaluated only in limited settings and identify only prevalent ILD and not new-onset disease. Our objective was to develop, refine, and validate a claims-based algorithm to identify both prevalent and incident ILD in RA patients compared to the gold standard of medical record review. Methods We used administrative claims data 2006–2015 from Medicare to derive a cohort of RA patients. We then identified suspected ILD using variations of ILD algorithms to classify both prevalent and incident ILD based on features of the data that included hospitalization vs. outpatient setting, physician specialty, pulmonary-related diagnosis codes, and exclusions for potentially mimicking pulmonary conditions. Positive predictive values (PPV) of several ILD algorithm variants for both prevalent and incident ILD were evaluated. Results We identified 234 linkable RA patients with sufficient data to evaluate for ILD. Overall, 108 (46.2%) of suspected cases were confirmed as ILD. Most cases (64%) were diagnosed in the outpatient setting. The best performing algorithm for prevalent ILD had a PPV of 77% (95% CI 67–84%) and for incident ILD was 96% (95% CI 85–100%). Conclusion Case finding in administrative data for both prevalent and incident interstitial lung disease in RA patients is feasible and has reasonable accuracy to support population-based research and real-world evidence generation. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02655-z.
Collapse
Affiliation(s)
- M Meehan
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, AL, Birmingham, USA
| | - A Shah
- Duke University, Durham, NC, USA
| | - J Lobo
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Oates
- Medical University of South Carolina, Charleston, SC, USA
| | - C Clinton
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, AL, Birmingham, USA
| | - N Annapureddy
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - F Xie
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, AL, Birmingham, USA
| | - J Zhuo
- Bristol Myers Squibb, New York, USA
| | - M I Danila
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, AL, Birmingham, USA
| | - B R England
- University of Nebraska Medical Center, Omaha, NE, USA.,Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - J R Curtis
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, AL, Birmingham, USA.
| |
Collapse
|
2
|
Fiore S, Chen L, Clinton C, Yun H, Praestgaard A, Ford K, Curtis J. POS0638 DISEASE SEVERITY AND OUTCOMES AMONG PATIENTS WITH RHEUMATOID ARTHRITIS WHO RECEIVE A NEWLY APPROVED BIOLOGIC: REAL-WORLD US EXPERIENCE WITH SARILUMAB FROM THE ACR RISE REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) who have received multiple biologics or targeted therapies over time tend to have more refractory and more severe disease, which may lead to worse clinical response to treatment.Objectives:We used data from the ACR RISE registry to assess whether disease severity was greater in those who received sarilumab shortly after its FDA approval (May 2017) than in subsequent time periods and to evaluate the effectiveness of sarilumab in populations with various degrees of disease severity.Methods:Patients with RA who initiated sarilumab treatment in the period 2017-2020 were identified in the ACR RISE registry and divided into Cohort 1 (2017, year of the FDA approval) and the calendar year-based Cohorts 2-4 (2018-2020). Patient demographics, RA-related features, and comorbidities were determined using data prior to sarilumab initiation. The cohorts were compared using chi-square test (categorical variables) and a nonparametric test (continuous variables). Sarilumab effectiveness was assessed using 3 cohorts assembled based on progressively restrictive criteria: Active Disease cohort (Clinical Disease Activity Index [CDAI] >10 or Routine Assessment of Patient Index Data 3 [RAPID3] >6, and C-reactive protein, if measured, ≥8 mg/L), TARGET Eligibility cohort (patients who satisfied enrolment criteria for TARGET,1 a Phase 3 sarilumab trial in patients with RA and an inadequate response to TNF inhibitors), and TARGET Baseline cohort (patients from TARGET Eligibility cohort with characteristics weighted to match those from the TARGET trial baseline,1 using the matching-adjusted indirect comparison method2). In all 3 effectiveness cohorts, mean changes in CDAI and RAPID3 at 6 and 12 months post-initiation of sarilumab were evaluated using a model adjusted for baseline score, age, sex, race, calendar year, and seropositivity.Results:A total of 2949 patients, treated by 585 rheumatologists, initiated sarilumab treatment in the period 2017–2020. The 4 yearly cohorts were relatively similar in terms of patients’ age, sex, race, and most clinical characteristics. However, patients receiving sarilumab shortly after FDA approval (Cohort 1) had more ambulatory visits, a greater number of previously used non-TNFi biologics (particularly tocilizumab), and a higher comorbidity burden, and were more likely to be current users of glucocorticoids or opioids than sarilumab initiators in the subsequent 3 years. In the 3 cohorts used to assess sarilumab effectiveness, the greatest improvement was observed in the TARGET Baseline cohort, which also had the greatest mean baseline CDAI score (43), compared with the other two (24 both).Conclusion:In this real-world cohort, we observed modest evidence for channeling of patients with greater RA severity and greater prior exposure to non-TNFi biologics to sarilumab shortly after its FDA approval. This cohort effect did not diminish the effectiveness of sarilumab. All cohorts showed improvement, with the greatest clinical improvement observed in the cohort with the highest baseline CDAI score who most closely resembled those enrolled in a phase 3 trial of patients with an inadequate response to TNF inhibitors.References:[1]Fleischmann R, et al. Arthritis Rheumatol 2017;69:277-290.[2]Signorovitch JE et al. Value Health 2012;15:940-7.Figure 1.Adjusted improvements in CDAI and RAPID3Acknowledgements:This study was sponsored by Sanofi. Medical writing support was provided by Vojislav Pejović, PhD (Eloquent Medical Affairs, division of Envision Pharma Group) and funded by Sanofi.Disclosure of Interests:Stefano Fiore Employee of: Sanofi, Lang Chen: None declared, Cassie Clinton Consultant of: Information available in profile, Huifeng Yun Grant/research support from: Research support for Pfizer, Amy Praestgaard Employee of: Sanofi, Kerri Ford Employee of: Sanofi, Jeffrey Curtis Consultant of: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB, Grant/research support from: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB
Collapse
|
3
|
Nowell WB, Curtis J, Xie F, Zhao H, Curtis D, Gavigan K, Venkatachalam S, Stradford L, Boles J, Owensby J, Clinton C, Lipkovich I, Calvin A, Haynes VS. THU0564 PARTICIPANT ENGAGEMENT IN AN ARTHRITISPOWER REAL-WORLD STUDY TO CAPTURE SMARTWATCH AND PATIENT-REPORTED OUTCOME DATA AMONG RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Clear characterization of how different types of patient-generated data reflect patient experience is needed to guide integration of electronic patient-reported outcome (ePRO) measures and biometrics in generating real-word evidence (RWE) related to rheumatoid arthritis (RA).Objectives:To characterize the level of participant (pt) engagement/adherence and data completeness in an ongoing study of 250 RA pts enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study1of the ArthritisPower real-world registry.Methods:ArthritisPower pts with RA were invited to join a digital RWE study with 14-day lead-in and 12-week main study period. In the lead-in, pts were required to electronically complete: a) two daily single-item Pain and Fatigue numeric rating scales and b) longer weekly sets of ePROs. Successful completers of the lead-in were mailed a smartwatch (Fitbit Versa) and study materials. The smartwatch collected activity, heart rate, and sleep duration/quality biosensor data; a study-specific customization of the ArthritisPower mobile application collected ePROs. The main study period included automated and manual reminders/prompts about completing ePROs, wearing the smartwatch and regularly syncing it. Study coordinators monitored pt data and contacted pts via email, text and/or phone to resolve adherence issues during the conduct of the study based on pre-determined rules triggering pt contact. Rules were based chiefly on consecutive spans of missing data. Pts were considered adherent in giving complete data for each week if providing (1) daily ePROs for ≥5 of 7 days/week, (2) weekly ePROs and (3) ≥80% of synced activity data for ≥5 of 7 days/week. Composite adherence for the first month of the main study period required meeting >70% weekly adherence parameters during the first 30 days, ie completing daily ePROs for ≥5 of 7 days/week, weekly ePROs ≥3 of 4 weeks and ≥80% of synced activity data for ≥5 of 7 days/week.Results:As of December 2019, 170 ArthritisPower members enrolled and completed at least 30 days of the main study period; 92.9% female with mean (SD) age 52.5 (10.7) and 10.5 (10.4) years since diagnosis. The overall conversion rate from initial interest to successful completion of the lead-in period was 49.0%. Pts who advanced to the main study were significantly more likely than those who did not to be currently employed (52.9% vs. 41.8%, p=0.038) and be on biologic DMARD monotherapy (64.7% vs. 47.5%, p=0.001). Overall, daily ePRO data had the lowest adherence with 70.0% of pts providing >70% of the requested data consistently across the first 30 days of the main study period (Figure 1). Composite adherence was met by 66.5% of pts. The most common time of day to provide ePRO data was morning, in the hours around scheduled app and email notifications at 10 a.m. in pt’s local time zone. Activity data had the highest adherence and persistence, with 92.9% of pts providing 80% or more of activity data for each 24-hour period in the first 30 days (Figures 1 & 2). Observed weekly adherence did not decline over time. Of 5100 possible person days in the study at day 30, we observed 643 days (91.0% of actual to maximum possible total patient days) where activity data was provided for at least 80% of the 24-hour period.Conclusion:RWE studies involving passive data collection in RA require pt-centric implementation and design to minimize pt burden, promote longitudinal engagement and maximize adherence. Passive data capture via activity trackers such as smartwatches, along with regular contact such as automated reminders, may facilitate greater pt adherence in providing longitudinal data for clinical trials.References:[1]Nowell WB, et al. JMIR Res Protoc. 2019;8(9):e14665.Disclosure of Interests:W. Benjamin Nowell: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Hong Zhao: None declared, David Curtis: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jessica Boles: None declared, Justin Owensby: None declared, Cassie Clinton: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Amy Calvin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company
Collapse
|
4
|
Clinton C, Post A, Truong T, Hughes B. Assessing patient perceptions of cytomegalovirus infection in pregnancy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
5
|
Clinton C, Smith M, Gillespie N, Weaver K, Heine R. Improvement in ideal antibiotic usage after implementation of a penicillin allergy testing program. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Tucker A, Hopkins M, Hammett E, Clinton C, Heine R. Penicillin skin testing in pregnant women with a history of penicillin allergy. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Berman D, Clinton C, Limb R, Somers EC, Romero V, Mozurkewich E. Prenatal Omega-3 Supplementation and Eczema Risk among Offspring at Age 36 Months. ACTA ACUST UNITED AC 2016. [PMID: 28649675 DOI: 10.21767/2471-304x.100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Long-term follow-up was completed in 84 mother-infant pairs of 118 women who completed a randomized controlled trial of prenatal supplementation with EPA- or DHA-rich fish oil or soy oil placebo. The goal of this study was to determine whether prenatal omega-3 fatty acid supplementation protects offspring against development of early childhood allergies. METHODS AND FINDINGS Assessment of childhood allergic/atopic disease among offspring at age 36 months was performed by maternal interview using the National Health Interview Survey (NHIS) questions for childhood digestive allergies, wheezing, eczema or skin allergy, and respiratory allergy. Multiple logistic regressions examined the association between prenatal supplementation and childhood outcomes, adjusted for covariates. Eczema was reported in 26/84 (31%) of offspring at age 36 months, and was significantly more prevalent in the omega-3 supplementation groups vs. placebo: EPA 13/31 (41.9%); DHA 10/26 (38.5%); placebo 3/27 (11.1%), p=0.019. Compared to placebo, EPA and DHA were associated with ≥5 times risk of offspring eczema [odds ratios (ORs): EPA 5.8 (95% CI 1.4-23.3); DHA 5.0 (95% CI 1.2-21.0)]. After adjusting for other potential risk factors (race, birth weight, vaginal/Cesarean delivery, and maternal eczema) the magnitudes of association for omega-3 supplementation increased: EPA OR 8.1 (95% CI 1.4-45.6); DHA OR 9.6 (95% CI 1.6-58.5). Maternal eczema was also significantly associated with offspring eczema in the adjusted model: OR 10.8 (95% CI 2.1-54.3). CONCLUSION Contrary to our hypothesis, acids supplementation compared to soy oil was associated with a substantial increase in risk of childhood eczema. This association was not observed on childhood respiratory or digestive outcomes. It is unclear if these findings were driven by unfavorable effects of omega-3s, or whether there may have been unanticipated protective effects of the soy-based placebo with regards to eczema.
Collapse
Affiliation(s)
- D Berman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - C Clinton
- Department of Obstetrics and Gynecology, Cornell University, New York NY, United States
| | - R Limb
- University of Michigan, Ann Arbor, MI, United States
| | - E C Somers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - V Romero
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Michigan State University, College of Human Medicine, Grand Rapids, MI, United States
| | - E Mozurkewich
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of New Mexico, Albuquerque, NM, United States
| |
Collapse
|
8
|
Clinton C, Boyd DP. Response from C. Clinton and D.P. Boyd. Cytopathology 2013; 24:207. [PMID: 23858528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
9
|
Abstract
An in situ 'lift-out' technique for preparing transmission electron microscopy specimens, which is performed using secondary electron imaging within the chamber of a focused ion beam-SEM system is presented. The main advantage of this in situ approach, relative to the ex situ lift-out technique, is that secondary electron imaging enables higher magnifications to be used than is possible with optical microscopy. This makes the lift-out procedure more controllable and thus increases the overall success rate especially for inexperienced users. The technique is also compared with another in situ lift-out approach, the 'wedge' technique.
Collapse
Affiliation(s)
- R M Langford
- SFI Trinity Nanoscience Laboratory, Department of Physics, Trinity College Dublin, Dublin 2, Ireland.
| | | |
Collapse
|
10
|
Abstract
AIM A survey was carried out to identify the education and training needs of psychiatric intensive care staff and the preferred type of training course. Demand for a specific psychiatric intensive care unit (PICU)/lowsecure training course was also examined. METHOD A convenience sample was taken from delegates attending a National Association of Psychiatric Intensive Care Units (NAPICUs) conference. Questionnaires were given to 130 delegates and a mail-shot was sent to ward managers on 13 PICUs in London. RESULTS The findings were that staff wanted further training in four main areas: the management of violence and aggression; psychological therapies; communication and engagement skills; and rapid tranquillisation. Most respondents indicated that they would like a course developed specifically for PICU staff at degree level in modular format. CONCLUSION This small-scale study highlights the need for further provision of training for PICU staff and provides an insight into their education and training needs. The findings could have significant implications for developing new approaches to education and training for practitioners working with severely ill psychiatric patients.
Collapse
Affiliation(s)
- C Clinton
- Pathways PICU, Goodmayes Hospital, Essex
| | | | | |
Collapse
|
11
|
Sanders JE, Zachariah SG, Baker AB, Greve JM, Clinton C. Effects of changes in cadence, prosthetic componentry, and time on interface pressures and shear stresses of three trans-tibial amputees. Clin Biomech (Bristol, Avon) 2000; 15:684-94. [PMID: 10946102 DOI: 10.1016/s0268-0033(00)00026-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of changes in cadence, prosthetic componentry, and time on interface pressures and resultant shear stresses in trans-tibial amputee case studies. DESIGN Interface stresses were monitored using custom-designed instrumentation at 13 sites on three subjects with unilateral trans-tibial amputation walking with patellar-tendon-bearing prosthetic limbs. BACKGROUND Previous studies suggested that week-to-week residual limb changes altered interface stresses more than did alterations in prosthetic alignment. No studies investigating effects of changes in cadence or componentry on interface stress distributions nor comparing their influence with week-to-week changes have been conducted previously. METHODS Five different prosthetic componentry configurations were tested at each of three cadences in four sessions. Data were analysed for the magnitudes and timings of peak pressures and resultant shear stresses as well as corresponding resultant shear angles. RESULTS None of the three cadences or five componentry configurations consistently induced significantly (P<0.05) higher or lower interface stress magnitudes for all subjects. However, an Aluminium Pylon/SACH Foot combination compared with an AirStance (pneumatic shank)/Seattle LightFoot unit induced later peak interface stress timings as a percentage of stance phase. Higher and more frequent interface stress changes were seen between the weekly sessions than between different cadences or between different componentry configurations. CONCLUSION The amputees' capabilities to compensate for week-to-week residual limb changes were less than those for intra-session cadence or componentry alterations. RELEVANCE Results suggest that effective techniques to accommodate week-to-week residual limb fluctuations could have a greater impact on maintaining consistent interface stress distributions than do adjustments in cadence or componentry.
Collapse
Affiliation(s)
- J E Sanders
- Department of Bioengineering, University of Washington, Box 357962, Harris 309, Seattle, WA 98195, USA.
| | | | | | | | | |
Collapse
|
12
|
Abstract
Interface stresses and stump shape were measured during sessions over a two-month interval on a trans-tibial amputee subject. Results from thirteen transducer sites monitored during four sessions showed greater interface pressure changes over time at anterior sites than at lateral or posterior locations. There was a trend of decreased pressure with stump swelling and increased pressure for stump atrophy. During one session in which stump shape was monitored over a 23.1 min interval after ambulation, stump swelling was localised. Swelling tended to increase in the regions of initial enlargement, as opposed to redistributing through different areas over time. Regions of swelling were anterior lateral and posterior proximal, areas of thick underlying soft tissue. Identification of localised areas of swelling and atrophy and understanding of their effects on interface pressures could be used to improve individual socket design.
Collapse
Affiliation(s)
- J E Sanders
- Department of Bioengineering, University of Washington, Seattle 98195, USA.
| | | | | | | |
Collapse
|
13
|
Stillings M, Havlik I, Chetty M, Clinton C, Schall R, Moodley I, Muir N, Little S. Comparison of the pharmacokinetic profiles of soluble aspirin and solid paracetamol tablets in fed and fasted volunteers. Curr Med Res Opin 2000; 16:115-24. [PMID: 10893655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The aim of this study was to investigate the absorption of popular preparations of two common analgesics--soluble aspirin and solid paracetamol tablets. An open, randomised, crossover study design was used to compare the pharmacokinetic parameters of soluble aspirin and solid paracetamol tablets in 16 healthy, male volunteers from the University of the Witwatersrand, South Africa, in both fed and fasted states. Plasma concentrations of paracetamol, aspirin and salicylic acid were measured. It was found that the rate of absorption was significantly faster for soluble aspirin than for solid paracetamol, regardless of fed or fasting state, considering time to maximum concentration (p < 0.01), time to first quantifiable concentrations (p < 0.05) and absorption rate (p < 0.01). Absorption rate was significantly affected by food for both soluble aspirin (p = 0.028) and for solid paracetamol (p = 0.0003). Time to maximum concentration was not significantly affected by food for soluble aspirin (p = 0.17) but significantly lengthened for solid paracetamol (p = 0.0003). The extent of absorption was affected by food in terms of maximum concentration for both drugs (p = 0.0001), with a reduction of 49% in the fed state for solid paracetamol compared to 18% for soluble aspirin, the difference between the drugs being statistically significant (p = 0.0024). The overall bioavailability of soluble aspirin was unaffected by food and the bioavailability of salicylic acid was increased in the fed state, whereas that of solid paracetamol was lowered in the fed state. Greater inter-individual variation was seen in paracetamol concentrations compared with aspirin or salicylic acid levels. In conclusion, these results show that the absorption of soluble aspirin is largely unaffected by food, whereas, in the same volunteers, the absorption of solid paracetamol tablets is greatly affected. In some volunteers, maximum plasma concentrations of paracetamol following food did not reach levels previously reported to be required for effective analgesia, and this may have implications for pain relief in some individuals. The practice in some individuals of taking aspirin tablets after food to minimise potential gastric disturbance should not affect the level of analgesia.
Collapse
Affiliation(s)
- M Stillings
- Department of Experimental and Clinical Pharmacology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
A thin-layer twin-electrode electrochemical cell in which the working and auxiliary electrodes are facing each other and which contains the appropriate enzyme and a mediator was used for the determination of cholesterol or glucose. A steady-state diffusion-controlled response was obtained for cholesterol whereas for glucose the response was limited by diffusion and kinetics. Simulation of the system showed that a steady-state response is obtained, in the absence of kinetic complications, after a time of 0.01 d2/Ds, where d is the distance between the two electrodes and D is the diffusion coefficient of the mediator. Linear plots of steady-state current versus concentration were obtained for cholesterol and glucose. The results were compared with those expected theoretically and a thin-layer capillary fill device is proposed.
Collapse
Affiliation(s)
- J F Cassidy
- Chemistry Department, Dublin Institute of Technology, Ireland
| | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- C Clinton
- Accident and Emergency Department, Jersey General Hospital, Channel Islands
| |
Collapse
|
16
|
Hesdorffer CS, Milne JF, Meyers AM, Clinton C, Botha R. The value of Swan-Ganz catheterization and volume loading in preventing renal failure in patients undergoing abdominal aneurysmectomy. Clin Nephrol 1987; 28:272-6. [PMID: 3442956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A prospective analysis of 61 patients undergoing abdominal aneurysmectomy is presented. When compared with 87 historical controls we have shown that the incidence of hypotensive episodes (31 out of 62 patients in the original study compared with 13 out of 44 patients in the prospective analysis) is significantly reduced when fluid balance is monitored invasively using the pulmonary artery wedge pressure and keeping it at 10 mm H2O (p less than 0.03). Renal dysfunction, defined as a significant drop in urine output and a doubling of the serum creatinine, occurred in only 10% of patients compared with 33% in the controls (p less than 0.001). The decreased prevalence of renal failure accounts for the reduction in mortality noted (p less than 0.01). There were 27 deaths (31%) amongst the patients in the earlier study compared with 9 (15%) in the prospective analysis. The pathogenetic mechanisms responsible for the development of renal failure following surgical manipulation of the abdominal aorta are reviewed.
Collapse
Affiliation(s)
- C S Hesdorffer
- Department of Medicine, Johannesburg Hospital, South Africa
| | | | | | | | | |
Collapse
|
17
|
Abstract
The diagnostic yield and risks of transbronchial biopsy (TBB) during mechanical ventilation were assessed in 13 patients with progressive pulmonary infiltrates. TBB was of considerable diagnostic value in ten patients and useful in excluding potentially treatable infections in the remaining three patients. Complications included two pneumothoraces, pulmonary hemorrhage in one case, and supraventricular tachycardia in another. No fatalities were attributable to TBB. TBB proved to be a relatively safe procedure, with a high diagnostic yield in these critically ill patients.
Collapse
Affiliation(s)
- P S Pincus
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | |
Collapse
|
18
|
Schmittling G, Clinton C, Tsou C. Entry of U.S. medical school graduates into family practice residencies: 1983-84. Fam Med 1986; 18:296-300. [PMID: 3556882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study is the third of a series from the American Academy of Family Physicians to report on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 12.5% of the 15,739 graduates of United States medical schools between July 1982 and June 1983 were residents in family practice in December 1983. The Mountain and Pacific regions report the highest percentage of medical school graduates who were residents in family practice programs in December 1983; the New England and Middle Atlantic regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be residents in family practice in December 1983 as were graduates from privately funded schools. The independent variable indicated by the presence of a family practice department in the medical school is the only variable which entered into a step-wise linear regression on a transformation of the dependent variable, percentage of graduates entering an FP residency program.
Collapse
|
19
|
Clinton C, Schmittling G, Brunton S. Entry of U.S. medical school graduates into family practice residencies: a national study, December 1983. Fam Med 1985; 17:155-8. [PMID: 3870705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study is the second in a series of reports from the American Academy of Family Physicians on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 12.9% of the 15,985 graduates of United States medical schools between July 1981 and June 1982 were first-year residents in family practice in December 1982. The West North Central region reports the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1982; the New England and Middle Atlantic regions had the lowest percentage. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1982 as were graduates from privately funded medical schools.
Collapse
Affiliation(s)
- C Clinton
- Education Division, American Academy of Family Physicians, Kansas City, Mo
| | | | | |
Collapse
|
20
|
Schmittling G, Clinton C, Brunton S. Entry of US medical school graduates into family practice residencies: a national study. J Fam Pract 1983; 17:283-291. [PMID: 6875486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
No authoritative source has reported the percentage of each medical school's graduates who enter family practice residency programs. This study is the first of a series of reports from the American Academy of Family Physicians to report such data. Approximately 12.8 percent of the 15,667 graduates of United States medical schools between July 1980 and June 1981 were first-year residents in family practice in December 1981. The West North Central Region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1981; the New England and Middle Atlantic regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1981 as were graduates from privately funded medical schools.
Collapse
|
21
|
Stern TL, Schmittling G, Clinton C, Black RR. Hospital privileges for graduates of family practice residency programs. J Fam Pract 1981; 13:1013-1020. [PMID: 7310351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In 1979 the American Academy of Family Physicians, as the first phase of a long-range study of family practice residency outcomes, surveyed graduates for the years 1970 through 1978 who were diplomates of the American Board of Family Practice. This report is limited to an overview analysis of the hospital admission and practice privileges of the 3,021 respondents actively practicing family medicine in the United States. A higher percentage of respondents in census regions west of the Mississippi River were more likely to have privileges in obstetrics and surgery than were respondents in eastern regions. Respondents in nonmetropolitan areas were more likely to have hospital privileges than were respondents in metropolitan areas.
Collapse
|
22
|
Clinton C, Schmittling G, Stern TL, Black RR. Hospital privileges for family physicians: a national study of office based members of the American Academy of Family physicians. J Fam Pract 1981; 13:361-371. [PMID: 7276846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In 1980 the American Academy of Family Physicians sampled those active members who were nonfederal, office based physicians in direct patient care to ascertain the characteristics of their hospital practices. The sample was stratified by the nine US census regions: 83.7 percent of the 5,216 active members in the sample responded. The vast majority of family physician/general practitioners in direct patient care in an office based setting have hospital admission privileges in one or more hospitals. A higher percentage of family physicians/general practitioners in census regions west of the Mississippi River were likely to have privileges in obstetrics and surgery than those in eastern regions. Moreover, family physicians/general practitioners in the nonmetropolitan areas of each census region were more likely to have hospital privileges at any level than were their colleagues in the metropolitan areas of the same region. Although there were disparities in the proportions of family physician/general practitioners with certain hospital privileges among regions, the vast majority in each region indicated that the privileges afforded them were appropriate.
Collapse
|
23
|
Abstract
The purpose of this study was to examine the practice location patterns of 1970-1978 graduates of family practice residency programs. Comparisons were made between the number of graduates practicing in a region in 1979 with the number of all graduates during 1970-1978 from family practice residency programs in that region and with the number of all graduates from medical schools in that region who eventually completed family practice residencies elsewhere. The Middle Atlantic and West North Central regions showed marked decreases, while the Mountain, Pacific, and New England regions showed increases. The majority practiced more than 100 miles from their residency program. Most respondents practicing in a nonmetropolitan area moved outside of a 100-mile radius from their residencies. Most respondents practicing in a metropolitan area practiced within the 100-mile radius. Physicians were likely to be practicing in a community similar to their backgrounds.
Collapse
|
24
|
Jacobson RJ, Klappenbach RS, Clinton C, de Moor NG, Wong O. Hodgkin's disease in South African children. S Afr Med J 1981; 59:133-7. [PMID: 7455844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Thirty South African children with Hodgkin's disease were studied over a 7-year period (1970 - 1977). Males outnumbered females by 5:1. The most frequent histological pattern encountered was mixed cellularity (72%). Fourteen patients with stage I, II or IIIA disease were treated with radiation therapy alone, and all achieved a complete remission with a median duration of remission in excess of 48 months. Sixteen patients with stage III or IV disease received combination chemotherapy (MOPP regimen), and 13 achieved a complete remission with a median duration of remission in excess of 48 months. The overall median survival was in excess of 60 months. Seven patients died during the study period, 4 of Hodgkin's disease and 3 of other causes. There was no significant difference in treatment response or survival between Black and White children.
Collapse
|
25
|
Furman KI, Clinton C. Ferritinaemia in haemodialyzed patients and in chronic renal failure. S Afr Med J 1972; 46:850. [PMID: 4561758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|