... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales Col... more ... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, Wales Anthony Bayer: Department of ... More articles in PharmacoEconomics from Wolters Kluwer Health | Adis Series data maintained by Remco Bouckaert (). ...
There are numerous methods available for assessing patients with Alzheimer's disease (AD) or ... more There are numerous methods available for assessing patients with Alzheimer's disease (AD) or other forms of dementia. Quality-of-life (QOL) assessment is unique among these methods. The subjective nature of quality of life provides healthcare professionals with the opportunity of incorporating the value systems of patients and their carers into their assessments. A systematic review was carried out to assess the
British Journal of Clinical Pharmacology, Feb 1, 1989
The effects of intravenous boluses of adenosine on respiration and heart rate were compared in yo... more The effects of intravenous boluses of adenosine on respiration and heart rate were compared in young and elderly individuals. Respiratory stimulation and biphasic changes in heart rate were confirmed. The dose-response relationship for the effects of adenosine on respiration and heart-rate did not differ significantly between 10 young (mean age 25.2 + 4.9 years) and 10 elderly (mean age 66 ± 3.1 years) drug-free individuals, indicating that age is unlikely to be a major determinant of adenosine responsiveness.
medRxiv (Cold Spring Harbor Laboratory), Nov 23, 2020
Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing demen... more Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing dementia is uncertain. Aim: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. Design and Se ing: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had symptoms of possible dementia. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. Conclusion: GP judgement is more likely to under identify rather than over identify dementia.
Although these preliminary data appear to be promising, the Brugada criteria should be applied wi... more Although these preliminary data appear to be promising, the Brugada criteria should be applied with caution to patients who present with wide-complex tachycardia while receiving IC antiarrhythmic agents. Whether they will be as specific in such patients as they are in the drug-free state awaits further investigation.
Aim\ To investigate the in vitro release and pharmacokinetic parameters (AUC, Cmax, T1/2) oftwo d... more Aim\ To investigate the in vitro release and pharmacokinetic parameters (AUC, Cmax, T1/2) oftwo different formulations of nitrendipine, a reference tablet(Bayotensin) and a tablet produced in China (Zishou Nitrendipine) were compared.\ Results\ The in vitro dissolution demonstrated that the Chinese tablet had a significantly slower release than the standard tablet. The calculated similarity factor, f 2, was equal to 23.8 suggesting that the dissolution profiles were dissimilar.The two formulations were administered according to a randomized two way cross over design to nine healthy Chinese volunteers. Nitrendipine serum concentrations were determined by high performance liquid chromatography(HPLC).The values of the mean ratio and their 90 % confidence intervals[(Zishou Nitrendipine (test product) / Bayotensin (reference product)]for pharmacokinetic parameters were 0.989 (0.663～1.476) for AUC and 0.794 (0.641～0.988) for Cmax. The AUC of both tablets were comparable, whereas the statistically significantly lower Cmax (about 20%) and also increased Tmax for the Chinese tablet seem to reflect its slower in vitro release characteristics.The number and type of side effects were similar after administration of both formulations.\ Conclusion\ although the Zishou Nitrendipine tablets demonstrated a significant slower in vitro release, these tablets had a comparable bioavailability as the reference Bayotensin.
Background: Patients with vascular dementia (VaD) benefit from treatment with donepezil. Objectiv... more Background: Patients with vascular dementia (VaD) benefit from treatment with donepezil. Objective: To compare the cognitive effects of donepezil versus placebo, in patients with evidence on imaging suggestive of cortical or subcortical VaD. Methods: A subanalysis of data from two randomized, double-blind, placebo-controlled, 24-week, parallel-group studies in patients with probable or possible VaD. Patients received placebo or donepezil (5 or 10 mg/day). Results: A total of 1219 VaD patients were enrolled: 131 (11%) had predominant cortical lesions (cortical VaD); 625 (51%) had predominant subcortical lesions and white matter disease without cortical lesions (subcortical VaD). 90% of cortical patients had abrupt onset, while 57% of subcortical patients had slowly progressive symptoms. Donepezil treatment was associated with significant benefits in cognition versus placebo in patients with both cortical and subcortical VaD. In patients with cortical VaD, the ADAS-cog least squares (LS) mean change from baseline scores at week 24 LOCF were: 0.204 in the placebo group, –2.29 in the donepezil 5 mg/day group (P < 0.05 versus placebo), and –2.57 in the donepezil 10 mg/day group (P < 0.05 versus placebo). In patients with subcortical VaD, the corresponding ADAS-cog scores were: placebo group 0.128, donepezil 5 mg/day – 1.05 (P < 0.05 vs. placebo), and donepezil 10 mg/day )1.12 (P < 0.05 vs. placebo). Conclusions: Donepezil significantly improved cognition in patients with VaD, with cortical or with subcortical vascular lesions. Placebo-treated patients with cortical or subcortical VaD did not show a decline in cognition over 24 weeks. These results indicate that donepezil is an effective treatment for the cognitive symptoms of both cortical and subcortical VaD.
sociated with hypoventilation, hypoxaemia, cardiac arrhythmia, pulmonary hypertension, and erythr... more sociated with hypoventilation, hypoxaemia, cardiac arrhythmia, pulmonary hypertension, and erythrocytosis. These episodes recur nightly and produce secondary polycythaemia.I-3 Smokers have increased carboxyhaemoglobin concentrations, which are associated with secondary polycythaemia.4 It is important to recognise that there are two types ofobese patients with sleep apnoea. One type has apnoea during sleep but normal ventilation and drive to breathe when awake. The other type has hypoventilation when awake as well as apnoea during sleep.5 Dr Moore-Gillon and colleagues encouraged their patients to drink alcohol before the studies, but alcohol-precipitates hypoventilation, hypoxaemia, and secondary polycythaemia.6 Measurements taken during the night after alcohol has been drunk are not suitable for drawing such conclusions. We studied 20 obese subjects with normal pulmonary and biochemical changes. Eight developed hypoventilation with intermittent hypoxaemia and secondary polycythaemia. In patients presenting with unexplained polycythaemia it is important to rule out respiratory irregularities, particularly hypoventilation and intermittent hypoxaemia, during the night.
Journal of the American Geriatrics Society, Sep 1, 1988
The clinical features and outcome were determined for 100 consecutive patients aged 65 years or o... more The clinical features and outcome were determined for 100 consecutive patients aged 65 years or older with a history of diabetes mellitus who presented to hospital with acute myocardial infarction. Each case was compared with an age‐ and sex‐matched nondiabetic control also admitted to hospital with acute myocardial infarction. Chest pain was equally common in both groups and was the main presenting symptom. Cardiac failure was a more frequent accompaniment in the diabetics, despite the lack of evidence for greater infarct size in this group. The outcome was worst for female diabetics, of whom 46% died. Contrary to popular teaching, painless myocardial infarction is not a specific feature of elderly diabetics.
International Journal of Epidemiology, Jul 14, 2011
Background Cross-sectional studies have suggested that elevated cortisol is associated with worse... more Background Cross-sectional studies have suggested that elevated cortisol is associated with worse physical performance, a surrogate of ageing. We examined the relationship between repeat cortisol measures over 20 years and physical performance in later life.
Aims Expanding prevalence of diabetes has a major health impact on older people and the burden ex... more Aims Expanding prevalence of diabetes has a major health impact on older people and the burden experienced by their informal carers. We report research which aimed to examine the burden on carers and highlight their input into diabetes care. Methods Of 98 diabetes patients aged over 59 years, 89 regularly received help with day-today activities or looking after from someone else and, of these, 83 carers consented to interview. Patients and carers were administered questionnaires related to the management of diabetes and personal strain (including Diabetes Knowledge Questionnaire, EuroQol, Caregiver Strain Scale and General Health Questionnaire). Results A substantial unmet need of older people with diabetes mellitus, in relation to domestic activities and diabetes care, was highlighted. Patient and carer diabetes knowledge was low. Primary carers were generally female relatives from the same household, not in paid employment. Twenty-seven carers (33%) provided ‡ 35 h of care work each week. Most carers experienced a moderate level of stress, but 11 (14%) regularly felt overwhelmed. Thirty-three carers (40%) said they had never received any information on diabetes from professionals. Help most frequently wanted was advice and support in relation to accessing community services and about finances, benefits and ⁄ or allowances. Conclusions Both patient and carer diabetes education strategies are required. Instruction for carers in the basic care of patients with diabetes is also needed and should be targeted. As many as one in seven carers felt regularly overwhelmed and lacked adequate support. Finally, 26 carers (31%) were entitled to benefits which they did not claim.
Journal of the American Geriatrics Society, Apr 1, 1986
The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized ... more The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the T he variable presentation of acute myocardial infarction in the elderly is generally well recognized, with the absence of chest pain said to be characteristic.'-3 Recent studies, however, have reported myocardial infarction to be painless in only a minority of older patient^,^-^ and Tinker7 suggested that if all cases are taken into account and patients are not preselected by symptomatology for admission to specialized units, the spectrum of presentation in the elderly may be similar to that of the young adult. We report here the clinical presentation of acute myocardial infarction in a large unselected group of elderly hospitalized patients and, in particular, the changing pattern of presentation with increasing old age.
... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales Col... more ... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, Wales Anthony Bayer: Department of ... More articles in PharmacoEconomics from Wolters Kluwer Health | Adis Series data maintained by Remco Bouckaert (). ...
The effect of captopril on inducible sustained ventricular tachycardia (VT) one week after myocar... more The effect of captopril on inducible sustained ventricular tachycardia (VT) one week after myocardial infarction was studied in 6 Yorkshire swine. In 24 pigs, controlled myocardial infarction (MI) was produced by reversible occlusion of the left anterior descending artery during 60 minutes using an inflatable balloon catheter. Four animals died during this procedure and another 4 during the first week. After 7 days, programmed electrical stimulation (PES) was performed in the surviving animals. Seven animals showed inducible VT, which could not be terminated in one. Subsequently, intravenous captopril (0.6-1.2 mg/kg) was administered as a rapid bolus injection. PES was repeated after 5 minutes and VT was no longer inducible in all 6 pigs (P less than 0.05). Right ventricular refractoriness decreased from 253 to 228 ms (n.s.). Blood pressure and heart rate were not significantly changed. We conclude that captopril can protect the heart against PES-induced VT late after MI. It is suggested that inhibition of angiotensin II and subsequent inhibition of noradrenaline may be responsible for this effect.
... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales Col... more ... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, Wales Anthony Bayer: Department of ... More articles in PharmacoEconomics from Wolters Kluwer Health | Adis Series data maintained by Remco Bouckaert (). ...
There are numerous methods available for assessing patients with Alzheimer's disease (AD) or ... more There are numerous methods available for assessing patients with Alzheimer's disease (AD) or other forms of dementia. Quality-of-life (QOL) assessment is unique among these methods. The subjective nature of quality of life provides healthcare professionals with the opportunity of incorporating the value systems of patients and their carers into their assessments. A systematic review was carried out to assess the
British Journal of Clinical Pharmacology, Feb 1, 1989
The effects of intravenous boluses of adenosine on respiration and heart rate were compared in yo... more The effects of intravenous boluses of adenosine on respiration and heart rate were compared in young and elderly individuals. Respiratory stimulation and biphasic changes in heart rate were confirmed. The dose-response relationship for the effects of adenosine on respiration and heart-rate did not differ significantly between 10 young (mean age 25.2 + 4.9 years) and 10 elderly (mean age 66 ± 3.1 years) drug-free individuals, indicating that age is unlikely to be a major determinant of adenosine responsiveness.
medRxiv (Cold Spring Harbor Laboratory), Nov 23, 2020
Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing demen... more Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing dementia is uncertain. Aim: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. Design and Se ing: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had symptoms of possible dementia. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. Conclusion: GP judgement is more likely to under identify rather than over identify dementia.
Although these preliminary data appear to be promising, the Brugada criteria should be applied wi... more Although these preliminary data appear to be promising, the Brugada criteria should be applied with caution to patients who present with wide-complex tachycardia while receiving IC antiarrhythmic agents. Whether they will be as specific in such patients as they are in the drug-free state awaits further investigation.
Aim\ To investigate the in vitro release and pharmacokinetic parameters (AUC, Cmax, T1/2) oftwo d... more Aim\ To investigate the in vitro release and pharmacokinetic parameters (AUC, Cmax, T1/2) oftwo different formulations of nitrendipine, a reference tablet(Bayotensin) and a tablet produced in China (Zishou Nitrendipine) were compared.\ Results\ The in vitro dissolution demonstrated that the Chinese tablet had a significantly slower release than the standard tablet. The calculated similarity factor, f 2, was equal to 23.8 suggesting that the dissolution profiles were dissimilar.The two formulations were administered according to a randomized two way cross over design to nine healthy Chinese volunteers. Nitrendipine serum concentrations were determined by high performance liquid chromatography(HPLC).The values of the mean ratio and their 90 % confidence intervals[(Zishou Nitrendipine (test product) / Bayotensin (reference product)]for pharmacokinetic parameters were 0.989 (0.663～1.476) for AUC and 0.794 (0.641～0.988) for Cmax. The AUC of both tablets were comparable, whereas the statistically significantly lower Cmax (about 20%) and also increased Tmax for the Chinese tablet seem to reflect its slower in vitro release characteristics.The number and type of side effects were similar after administration of both formulations.\ Conclusion\ although the Zishou Nitrendipine tablets demonstrated a significant slower in vitro release, these tablets had a comparable bioavailability as the reference Bayotensin.
Background: Patients with vascular dementia (VaD) benefit from treatment with donepezil. Objectiv... more Background: Patients with vascular dementia (VaD) benefit from treatment with donepezil. Objective: To compare the cognitive effects of donepezil versus placebo, in patients with evidence on imaging suggestive of cortical or subcortical VaD. Methods: A subanalysis of data from two randomized, double-blind, placebo-controlled, 24-week, parallel-group studies in patients with probable or possible VaD. Patients received placebo or donepezil (5 or 10 mg/day). Results: A total of 1219 VaD patients were enrolled: 131 (11%) had predominant cortical lesions (cortical VaD); 625 (51%) had predominant subcortical lesions and white matter disease without cortical lesions (subcortical VaD). 90% of cortical patients had abrupt onset, while 57% of subcortical patients had slowly progressive symptoms. Donepezil treatment was associated with significant benefits in cognition versus placebo in patients with both cortical and subcortical VaD. In patients with cortical VaD, the ADAS-cog least squares (LS) mean change from baseline scores at week 24 LOCF were: 0.204 in the placebo group, –2.29 in the donepezil 5 mg/day group (P < 0.05 versus placebo), and –2.57 in the donepezil 10 mg/day group (P < 0.05 versus placebo). In patients with subcortical VaD, the corresponding ADAS-cog scores were: placebo group 0.128, donepezil 5 mg/day – 1.05 (P < 0.05 vs. placebo), and donepezil 10 mg/day )1.12 (P < 0.05 vs. placebo). Conclusions: Donepezil significantly improved cognition in patients with VaD, with cortical or with subcortical vascular lesions. Placebo-treated patients with cortical or subcortical VaD did not show a decline in cognition over 24 weeks. These results indicate that donepezil is an effective treatment for the cognitive symptoms of both cortical and subcortical VaD.
sociated with hypoventilation, hypoxaemia, cardiac arrhythmia, pulmonary hypertension, and erythr... more sociated with hypoventilation, hypoxaemia, cardiac arrhythmia, pulmonary hypertension, and erythrocytosis. These episodes recur nightly and produce secondary polycythaemia.I-3 Smokers have increased carboxyhaemoglobin concentrations, which are associated with secondary polycythaemia.4 It is important to recognise that there are two types ofobese patients with sleep apnoea. One type has apnoea during sleep but normal ventilation and drive to breathe when awake. The other type has hypoventilation when awake as well as apnoea during sleep.5 Dr Moore-Gillon and colleagues encouraged their patients to drink alcohol before the studies, but alcohol-precipitates hypoventilation, hypoxaemia, and secondary polycythaemia.6 Measurements taken during the night after alcohol has been drunk are not suitable for drawing such conclusions. We studied 20 obese subjects with normal pulmonary and biochemical changes. Eight developed hypoventilation with intermittent hypoxaemia and secondary polycythaemia. In patients presenting with unexplained polycythaemia it is important to rule out respiratory irregularities, particularly hypoventilation and intermittent hypoxaemia, during the night.
Journal of the American Geriatrics Society, Sep 1, 1988
The clinical features and outcome were determined for 100 consecutive patients aged 65 years or o... more The clinical features and outcome were determined for 100 consecutive patients aged 65 years or older with a history of diabetes mellitus who presented to hospital with acute myocardial infarction. Each case was compared with an age‐ and sex‐matched nondiabetic control also admitted to hospital with acute myocardial infarction. Chest pain was equally common in both groups and was the main presenting symptom. Cardiac failure was a more frequent accompaniment in the diabetics, despite the lack of evidence for greater infarct size in this group. The outcome was worst for female diabetics, of whom 46% died. Contrary to popular teaching, painless myocardial infarction is not a specific feature of elderly diabetics.
International Journal of Epidemiology, Jul 14, 2011
Background Cross-sectional studies have suggested that elevated cortisol is associated with worse... more Background Cross-sectional studies have suggested that elevated cortisol is associated with worse physical performance, a surrogate of ageing. We examined the relationship between repeat cortisol measures over 20 years and physical performance in later life.
Aims Expanding prevalence of diabetes has a major health impact on older people and the burden ex... more Aims Expanding prevalence of diabetes has a major health impact on older people and the burden experienced by their informal carers. We report research which aimed to examine the burden on carers and highlight their input into diabetes care. Methods Of 98 diabetes patients aged over 59 years, 89 regularly received help with day-today activities or looking after from someone else and, of these, 83 carers consented to interview. Patients and carers were administered questionnaires related to the management of diabetes and personal strain (including Diabetes Knowledge Questionnaire, EuroQol, Caregiver Strain Scale and General Health Questionnaire). Results A substantial unmet need of older people with diabetes mellitus, in relation to domestic activities and diabetes care, was highlighted. Patient and carer diabetes knowledge was low. Primary carers were generally female relatives from the same household, not in paid employment. Twenty-seven carers (33%) provided ‡ 35 h of care work each week. Most carers experienced a moderate level of stress, but 11 (14%) regularly felt overwhelmed. Thirty-three carers (40%) said they had never received any information on diabetes from professionals. Help most frequently wanted was advice and support in relation to accessing community services and about finances, benefits and ⁄ or allowances. Conclusions Both patient and carer diabetes education strategies are required. Instruction for carers in the basic care of patients with diabetes is also needed and should be targeted. As many as one in seven carers felt regularly overwhelmed and lacked adequate support. Finally, 26 carers (31%) were entitled to benefits which they did not claim.
Journal of the American Geriatrics Society, Apr 1, 1986
The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized ... more The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the T he variable presentation of acute myocardial infarction in the elderly is generally well recognized, with the absence of chest pain said to be characteristic.'-3 Recent studies, however, have reported myocardial infarction to be painless in only a minority of older patient^,^-^ and Tinker7 suggested that if all cases are taken into account and patients are not preselected by symptomatology for admission to specialized units, the spectrum of presentation in the elderly may be similar to that of the young adult. We report here the clinical presentation of acute myocardial infarction in a large unselected group of elderly hospitalized patients and, in particular, the changing pattern of presentation with increasing old age.
... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales Col... more ... College of Medicine, Cardiff, Wales Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, Wales Anthony Bayer: Department of ... More articles in PharmacoEconomics from Wolters Kluwer Health | Adis Series data maintained by Remco Bouckaert (). ...
The effect of captopril on inducible sustained ventricular tachycardia (VT) one week after myocar... more The effect of captopril on inducible sustained ventricular tachycardia (VT) one week after myocardial infarction was studied in 6 Yorkshire swine. In 24 pigs, controlled myocardial infarction (MI) was produced by reversible occlusion of the left anterior descending artery during 60 minutes using an inflatable balloon catheter. Four animals died during this procedure and another 4 during the first week. After 7 days, programmed electrical stimulation (PES) was performed in the surviving animals. Seven animals showed inducible VT, which could not be terminated in one. Subsequently, intravenous captopril (0.6-1.2 mg/kg) was administered as a rapid bolus injection. PES was repeated after 5 minutes and VT was no longer inducible in all 6 pigs (P less than 0.05). Right ventricular refractoriness decreased from 253 to 228 ms (n.s.). Blood pressure and heart rate were not significantly changed. We conclude that captopril can protect the heart against PES-induced VT late after MI. It is suggested that inhibition of angiotensin II and subsequent inhibition of noradrenaline may be responsible for this effect.
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