Hypertension: Harris M

Anonymous00047, Fitzgerald DA, Massie RJ, Nixon GM, Jaffe A, Wilson A, Landau LI, Twiss J, Smith G, Wainwright C, Harris M. · Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia. · Med J Aust. · Pubmed #19012558 links to  free full text

Abstract: Chronic neonatal lung disease (CNLD) is defined as a supplemental oxygen requirement beyond 36 weeks' postmenstrual age, with more severely affected infants requiring oxygen beyond a full-term-equivalent age. Low-flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who develop hypoxia in air. There is a lack of data on the most appropriate minimum mean target oxygen saturation (Spo(2)) level. Reflecting a variety of clinical practices and infant comorbidities (frequency of oxygen desaturation, presence of pulmonary hypertension, retinopathy of prematurity, and adequacy of growth), the minimum mean target range for Spo(2) during overnight oximetry should be 93%-95%. The effect of supplemental oxygen on carbon dioxide retention should be considered before deciding on an oxygen flow. Most infants with CNLD are not ready for discharge until their supplemental oxygen requirement is < or = 0.5 litres per minute delivered through a nasal cannula. The safety of short-term disconnection from supplemental oxygen should be assessed before discharge. Assessment of oxygenation during sleep with continuous overnight oximetry or polysomnography is recommended when weaning infants from supplemental oxygen. Discontinuation of oxygen therapy is based on clinical assessments and documentation of adequate oxygenation in room air. There is limited objective evidence on which to base recommendations.

Harris M, Wan Q. · Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales. · Aust Fam Physician. · Pubmed #15931402 links to  free full text

Abstract: BACKGROUND: Cardiovascular disease (CVD) is an important and preventable complication and major cause of death in diabetes. OBJECTIVE: This article outlines the prevention and early detection of CVD in people with type 2 diabetes. DISCUSSION: Diabetes is a major risk factor for CVD, both independently and because it tends to occur in association with other behavioural and physiological risk factors. There is good evidence that careful control of these risk factors can significantly delay the development of heart disease, and that this is possible to achieve in general practice. Key interventions are smoking cessation; diet and physical activity; targeted use of medications to achieve glycaemic, blood pressure and lipid control; and aspirin. Interventions require a whole practice approach involving practice staff, practice systems and links with other care providers.

Hofman PL, Regan F, Harris M, Robinson E, Jackson W, Cutfield WS. · Liggins Institute, University of Auckland, 2-6 Park Avenue, Auckland, New Zealand. · Growth Horm IGF Res. · Pubmed #15135796 No free full text.

Abstract: An association between low birth weight, commonly a reflection of an adverse in utero environment, and the subsequent development of diseases such as type 2 diabetes and hypertension in later life is now generally accepted - as is an association between an adverse perinatal environment and a permanent reduction in insulin sensitivity. This and other metabolic abnormalities have been demonstrated from childhood through to adulthood in subjects who were born full-term but small for gestational age (SGA). Less is known about children born prematurely into an adverse neonatal environment. We present data demonstrating that premature infants also have metabolic abnormalities similar to those observed in full-term, SGA children, and that these occur irrespective of whether the premature infants are SGA or appropriate for gestational age (AGA).

Barton C, Proudfoot J, Amoroso C, Ramsay E, Holton C, Bubner T, Harris M, Beilby J. · Department of General Practice, University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia. · Prim Care Respir J. · Pubmed #18830522 links to  free full text

Abstract: OBJECTIVE AND BACKGROUND: We investigated the quality of primary care asthma management in a sample of Australian general practices. METHODS: 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. RESULTS: Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. CONCLUSION: Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Proudfoot J, Jayasinghe UW, Infante F, Beilby J, Amoroso C, Davies GP, Grimm J, Holton C, Bubner T, Harris M. · Centre for Primary Health Care and Equity, School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia. · BMC Fam Pract. · Pubmed #17442118 links to  free full text

Abstract: BACKGROUND: This article describes the development and psychometric evaluation of an interview instrument to assess provider-reported quality of general practice care for patients with diabetes, cardiovascular disease and asthma--the Australian General Practice Clinical Care Interview (GPCCI). METHODS: We administered the GPCCI to 28 general practitioners (family physicians) in 10 general practices. We conducted an item analysis and assessed the internal consistency of the instrument. We next assessed the quality of care recorded in the medical records of 462 of the general practitioners' patients with Type 2 diabetes, ischaemic heart disease/hypertension and/or moderate to severe asthma. This was then compared with results of the GPCCI for each general practice. RESULTS: Good internal consistency was found for the overall GPCCI (Cronbach's alpha = 0.75). As far as the separate sub-scales were concerned, diabetes had good internal consistency (0.76) but the internal consistency of the heart disease and asthma subscales was not strong (0.49 and 0.16 respectively). There was high inter-rater reliability of the adjusted scores of data extracted from patients' medical notes for each of the three conditions. Correlations of the overall GPCCI and patients' medical notes audit, combined across the three conditions and aggregated to practice level, showed that a strong relationship (r = 0.84, p = 0.003) existed between the two indices of clinical care. CONCLUSION: This study suggests that the GPCCI has good internal consistency and concurrent validity with patients' medical records in Australian general practice and warrants further evaluation of its properties, validity and utility.

A Foo J, Wilson S, Williams G, Harris M, Cooper D. · School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia 4072. · Conf Proc IEEE Eng Med Biol Soc. · Pubmed #17281140 No free full text.

Abstract: Studies have shown that an increase in arterial stiffening can indicate the presence of cardiovascular diseases like hypertension. Current gold standard in clinical practice is by measuring the blood pressure of patients using a mercury sphygmomanometer. However, the nature of this technique is not suitable for prolonged monitoring. It has been established that pulse wave velocity is a direct measure of arterial stiffening. However, its usefulness is hampered by the absence of techniques to estimate it non-invasively. Pulse transit time (PTT) is a simple and non-intrusive method derived from pulse wave velocity. It has shown its capability in childhood respiratory sleep studies. Recently, regression equations that can predict PTT values for healthy Caucasian children were formulated. However, its usefulness to identify hypertensive children based on mean PTT values has not been investigated. This was a continual study where 3 more Caucasian male children with known clinical hypertension were recruited. Results indicated that the PTT predictive equations are able to identify hypertensive children from their normal counterparts in a significant manner (p<0.05). Hence, PTT can be a useful diagnostic tool in identifying hypertension in children and shows potential to be a non-invasive continual monitor for arterial stiffening.

Yoo HY, Eustace JA, Verma S, Zhang L, Harris M, Kantsevoy S, Lee LA, Kalloo AN, Ravich WJ, Thuluvath PJ. · Department of Medicine and Biostatistics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Gastrointest Endosc. · Pubmed #12397275 No free full text.

Abstract: BACKGROUND: There is no consensus regarding the endoscopic classification of the severity of portal hypertensive gastropathy. This study compared the accuracy and reproducibility of the 2-category classification system (2-CCS) with the 3-category classification system (3-CCS). METHODS: Ninety-eight endoscopic pictures of portal hypertensive gastropathy and 22 of nonspecific gastritis were selected. Eight duplicate sets were generated, each in a different random order. These were shown to 6 experienced endoscopists during 2 sessions 1 week apart with 4 slide sets at each session. Each picture was scored by using either the 2-CCS or 3-CCS. Kappa statistics and percent agreement were used to estimate the reproducibility and agreement. RESULTS: The mean percentage agreement among the 4 separate readings for each observer was significantly lower for the 3-CCS compared with the 2-CCS (mean [standard deviation] = 33.5% [8.9%] vs. 64.9% [9.1%]; p = 0.0001). The mean (SD) interobserver kappa values were 0.44 (0.03) for the 3-CCS and 0.52 (0.04) for the 2-CCS (p = 0.02), and the respective intraobserver kappa values were 0.43 (0.1) and 0.63 (0.06) (p = 0.002). CONCLUSIONS: Even though both the 2-CCS and 3-CCS have substantial limitations with regard to specificity and reliability, there were better agreement and reproducibility with the simpler classification system for portal hypertensive gastropathy.