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British journal of clinical practice. Supplement最新文献

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Metered dose inhalers: current and future uses. 计量吸入器:目前和未来的用途。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
M L Levy
{"title":"Metered dose inhalers: current and future uses.","authors":"M L Levy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Respiratory disease poses an enormous burden on individuals and society. Asthma and chronic obstructive pulmonary disease (COPD), the diseases discussed here, contribute towards a substantial proportion of ill health and cost to the NHS and the economy. Most health professionals consider the inhaled route to be the best method of delivering drugs to the respiratory system. Four types of inhaled delivery system are in use: pressurised metered dose inhalers (pMDIs); dry powder devices; pMDIs and large volume spacers in combination; and nebulisers. In the UK pMDIs are the cheapest type of device on the market and are usually the method of choice for those patients able to use them. International agreement to phase out CFCs has led to the development of alternative propellants for pMDIs. The role of pMDIs is predicted to increase in the future. Demand for pMDIs to treat asthma is likely to increase as the introduction of clinical guidelines extends best practice, and their use to treat patients with COPD is increasing. Novel drugs for the respiratory system, including gene therapy and drugs for non-respiratory disorders, may well employ pMDIs as a delivery system in the future.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"16-21"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The biological effects of ozone depletion. 臭氧损耗的生物效应。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
A R Young
{"title":"The biological effects of ozone depletion.","authors":"A R Young","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thinning of the ozone layer is predicted to result in increased levels of ultraviolet (UV) B radiation at the earth's surface. This effect has been confirmed by measurements made in relatively unpolluted areas such as Antarctica, the southern part of South America and at mid-to-high latitudes in the northern hemisphere. It has been harder to show in populated northern latitudes because of a number of confounding factors, notably weather systems and low level ozone pollution. Although UVB forms only a small proportion of the UV spectrum it has potent biological effects so that a small increase in penetration of UVB to the earth's surface has profound effects on a wide range of life forms. Most attention has been paid to the effects of an increase in UVB on human health, particularly the effects on skin cancer, resistance to infectious diseases and cataract formation. However, the effects of increased levels of UVB on other parts of the ecosystem, particularly on the primary producers in aquatic and terrestrial food chains, may be of even.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"10-5"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
CFCS and the ozone layer. 氯氟烃和臭氧层。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
G D Hayman
{"title":"CFCS and the ozone layer.","authors":"G D Hayman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ozone is an important constituent of the atmosphere. Ozone forms a distinct layer in the lower stratosphere known as the ozone layer. The ozone layer acts as a fragile shield because it protects man and other life forms from exposure to harmful short-wavelength ultraviolet (UV) radiation. The agents, particularly chemical, which affect the amount of ozone present in the atmosphere have been a source of concern for more than 20 years. This has been reinforced by the dramatic decline of stratospheric ozone levels first measured in Antarctica and now apparent worldwide. The combination of routine measurements of ozone depletion, careful laboratory studies and mathematical modelling of ozone in the atmosphere, has demonstrated that the reactive fragments produced when chlorofluorocarbons (CFCs), halons and other halogenated compounds break down in the stratosphere are responsible for the ozone loss. As CFCs have widespread and sometimes apparently essential uses in modern society, there has been an intense effort to develop safe, effective replacements which have a negligible or much smaller impact on the environment. The Montreal Protocol, signed by over 140 nations, has been implemented to control and phase out the chemical compounds responsible for ozone loss.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"2-9"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The transition in practice: health professionals and patients. 实践中的过渡:卫生专业人员和患者。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
M R Partridge
{"title":"The transition in practice: health professionals and patients.","authors":"M R Partridge","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The transition to CFC-free pressurised metered dose inhalers (pMDIs) raises issues for health professionals and patients. Health professionals need to be aware of any differences between old and reformulated products. The currently available reformulated salbutamol is equivalent to the old product so no dosage adjustment is implicated in the changeover. Available information on the new reformulated steroids suggests significantly smaller doses may be required for some reformulations as a result of improved drug deposition. This should not pose a problem if health professionals follow current asthma guidelines and titrate treatment against effect. Patients must be well prepared for transition, be aware of key facts about the new formulation and be aware of the reason their physician recommends change. The likelihood of a seamless transition to the new inhalers will be enhanced if health professionals coordinate the transition in a planned way in each district.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"32-6"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20442208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The transition in practice: policy makers and purchasers. 实践中的转变:政策制定者和购买者。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
B Bevan
{"title":"The transition in practice: policy makers and purchasers.","authors":"B Bevan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The transition to CFC-free pressurised metered dose inhalers (pMDIs) is not optional and cannot be ignored. The UK Government intends that CFCs will be removed from all medicinal products by the end of 1999. An overall strategy is needed to guide health professionals and patients through the transition process. Collaborative working between the pharmaceutical industry, health authorities and relevant health professionals is essential to ensure a smooth transition with minimal disruption to patients. The factors that need to be taken into consideration for a smooth transition and the role of national and local drivers in this process are outlined. The main focus around change must be on patients' confidence in their medication.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20442207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The technical transition to CFC-free inhalers. 向无氟氯化碳吸入器的技术过渡。
British journal of clinical practice. Supplement Pub Date : 1997-05-01
I Tansey
{"title":"The technical transition to CFC-free inhalers.","authors":"I Tansey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pressurised metered dose inhalers (pMDIs) provide essential therapy for a large proportion of the 70 million people in the world affected by asthma. However, current pMDIs contain chlorofluorocarbons (CFCs) and will have to be phased out. Several classes of propellants have been considered as alternatives to CFCs and the pharmaceutical industry has taken forward two hydrofluoroalkanes (HFA)--HFA-134a and HFA-227--for development in non-CFC pMDIs. The development of non-CFC pMDIs to date has resulted in the worldwide introduction of a salbutamol pMDI (with a HFA-134a propellant) which is identical both in vitro and in vivo to CFC pMDIs. The beclomethasone pMDI under development has superior lung deposition and much reduced oropharyngeal deposition compared with the CFC pMDI, with the potential for significant benefits for patients.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"89 ","pages":"22-7"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20442206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Monotherapy with nifedipine GITS compared with atenolol in stable angina pectoris. The Working Group on Cardiovascular Research (WCN). 硝苯地平与阿替洛尔单药治疗稳定型心绞痛的比较。心血管研究工作组(WCN)。
British journal of clinical practice. Supplement Pub Date : 1997-04-01
R J de Vries, P H Dunselman
{"title":"Monotherapy with nifedipine GITS compared with atenolol in stable angina pectoris. The Working Group on Cardiovascular Research (WCN).","authors":"R J de Vries,&nbsp;P H Dunselman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This double-blind, randomised multicentre study compares nifedipine gastrointestinal therapeutic system (GITS) with atenolol in 129 male patients, with exercise-induced angina pectoris. At 4 weeks, there was no significant difference between nifedipine GITS 60 mg o.d. and atenolol 100 mg o.d., in respect of improved time to onset of 0.1 mV ST-segment depression, time to onset of pain, and total exercise time. Atenolol, but not nifedipine, significantly reduced heart rate and systolic blood pressure at rest and during exercise. There were significantly more vasodilator-related side effects with nifedipine. Nifedipine GITS and atenolol as once-daily monotherapy are equally effective and safe, but have different effects on exercise parameters.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"88 ","pages":"6-9"},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nifedipine GITS versus diltiazem in chronic stable angina: a randomised multicentre study. 硝苯地平GITS与地尔硫卓治疗慢性稳定型心绞痛:一项随机多中心研究
British journal of clinical practice. Supplement Pub Date : 1997-04-01
L Zanolla, L Franceschini, L Rossi, M Ochan, S Amigoni, P Zardini
{"title":"Nifedipine GITS versus diltiazem in chronic stable angina: a randomised multicentre study.","authors":"L Zanolla,&nbsp;L Franceschini,&nbsp;L Rossi,&nbsp;M Ochan,&nbsp;S Amigoni,&nbsp;P Zardini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In order to compare the efficacy of nifedipine gastrointestinal therapeutic system (GITS) with diltiazem, 99 patients with chronic stable angina were studied in a parallel-group randomised trial. According to the results of the two exercise tolerance tests (ETTs) performed during the placebo run-in, patients were divided into a fixed threshold group if the variability in time to 1 mm ST-segment depression was 20%, or a variable threshold group if it was higher. Efficacy was assessed by comparing the time to 1 mm ST-depression on a bicycle ETT after 4 weeks of treatment, adjusting for the baseline value. The adjusted means were 7.44 min for nifedipine GITS and 7.68 min for diltiazem; the difference was -0.24 min, with a lower 90% confidence limit of -0.90, which is within the stated interval for equivalence. The same result was confirmed by the 'intention-to-treat' analysis, and comparable results were obtained both in fixed and in variable threshold groups. The incidence of side effects was 12% with nifedipine GITS and 8.2% with diltiazem. Nifedipine GITS and diltiazem were found to be equally effective in increasing exercise tolerance in chronic stable angina patients.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"88 ","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence of coronary calcification in relation to age, gender and risk factor profile in the insight population. 在insight人群中，冠状动脉钙化的患病率与年龄、性别和危险因素有关。
British journal of clinical practice. Supplement Pub Date : 1997-04-01
M Motro, J Shemesh
{"title":"Prevalence of coronary calcification in relation to age, gender and risk factor profile in the insight population.","authors":"M Motro,&nbsp;J Shemesh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Calcium controls numerous events within the vessel wall. Permeability of the endothelium is calcium dependent. Calcium is also essential for penetration of low-density lipoprotein particles through the endothelium as well as the monocytes that travel through the subendothelial space. Other calcium-dependent processes include platelet activation and adhesion, vascular smooth muscle proliferation and migration, and synthesis of fibrous connective tissue in the subendothelial space. Current evidence indicates that calcium channel blockers retard the development of atherosclerosis in monkeys and rabbits. Human trials have evaluated sequential coronary angiograms in patients undergoing coronary angiography for symptomatic coronary artery disease. Double helix computerised tomography is a non-invasive technique that can detect, measure and compare calcification in the coronary arteries. Our objectives are to determine whether the use of nifedipine vs diuretics in hypertensive patients at high risk of coronary calcification will arrest or slow the progression of calcification in the coronary arteries, and to assess the effect of the two drugs on left ventricular hypertrophy, and left ventricular mass as well as on changes in left ventricular function.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"88 ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Action: a 30,000 patient-years double-blind, placebo-controlled trial of nifedipine GITS in stable angina. ACTION Research Group. 行动:一项30,000患者年的硝苯地平GITS治疗稳定性心绞痛的双盲、安慰剂对照试验。行动研究小组。
British journal of clinical practice. Supplement Pub Date : 1997-04-01
J Lubsen, P A Poole-Wilson
{"title":"Action: a 30,000 patient-years double-blind, placebo-controlled trial of nifedipine GITS in stable angina. ACTION Research Group.","authors":"J Lubsen,&nbsp;P A Poole-Wilson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To assess the overall balance between efficacy and safety of the long-action calcium antagonist nifedipine gastrointestinal therapeutic system (GITS) in patients with stable symptomatic coronary artery disease (CAD), a large multicentre placebo-controlled double-blind trial called ACTION has been mounted (A Coronary Disease Trial Investigating Outcome with Nifedipine GITS). Patients are eligible if they have proven CAD on antianginal treatment in stable clinical condition for at least 3 months without heart failure. The left ventricular ejection fraction must be above 40%. Patients not already on lipid-lowering therapy will be evaluated and such treatment will be started based on current guidelines before randomisation. After washout of an already given calcium antagonist, more than 6000 patients in total will be randomised in equal proportions to either nifedipine GITS 60 mg once daily or placebo. The mean clinical follow-up will be 5 years, with no restrictions on concomitant medication (with the exception of digitalis, calcium antagonists and class III antiarrhythmics). The primary end-point will be survival free of major cardiovascular events (i.e. survival free of acute myocardial infarction, emergency coronary angiography, overt heart failure, stroke and peripheral revascularisation). The study has 95% power to detect a significant (p < 0.05) 18% improvement of this end-point and is of sufficient size to exclude an excess mortality of 3.1 per 1000 patient-years. In this first stable angina trial of this size and scope, 185 centres in Canada, Europe, Israel, Australia and New Zealand will participate. Recruitment will start in November 1996 and is planned to be completed in 2 years.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"88 ","pages":"23-6"},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20444861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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