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Biomedical subjects

A O Frank

Publications and source records attributed to A O Frank.

17 recordsLinked to original sources
PubMed1992

Urinary incontinence among patients with arthritis--a neglected disability.

Urinary tract pathology may be no more common in patients with arthritis than among the general population, but its impact may be enhanced by disability. In this survey of 247 patients, as many as 38% of patients with rheumatoid arthritis (RA), 47% of patients with osteoarthritis (OA) and even 34% of patients with soft tissue rheumatism (STR) reported difficulty controlling their urine, confirming that incontinence is a widespread and often under-reported problem. More detailed enquiry in a sample of 90 patients with OA or RA did not suggest specific urinary tract pathology related to the underlying arthritis. Those who reported problems with urinary control were more disabled, and took longer to get to the toilet in their own environment than those without control problems. Twenty-seven per cent of patients felt that their problems would be solved by provision of a downstairs toilet. Timing of tasks performed by patients within their home is suggested as a method for assessing functional ability which encompasses both patient disability and environmental factors.

Age Factors↗
PubMed1990

Terminal cancer care and patients' preference for place of death: a prospective study.

OBJECTIVE: To assess the preference of terminally ill patients with cancer for their place of final care. DESIGN: Prospective study of randomly selected patients with cancer from hospital and the community who were expected to die within a year. Patients expected to live less than two months were interviewed at two week intervals; otherwise patients were interviewed monthly. Their main carer was interviewed three months after the patient's death. SETTING: District general hospital, hospices, and patients' homes. MAIN OUTCOME MEASURE: Stated preferred place of final care; actual place of death; reason for final hospital admission for those in hospital; community care provision required for home care. RESULTS: Of 98 patients approached, 84 (86%) agreed to be interviewed, of whom 70 (83%) died during the study and 59 (84%) stated a preferred place of final care: 34 (58%) wished to die at home given existing circumstances, 12 (20%) in hospital, 12 (20%) in a hospice, and one (2%) elsewhere. Their own home was the preferred place of care for 17 (94%) of the patients who died there, whereas of the 32 patients who died in hospital 22 (69%) had stated a preference to die elsewhere. Had circumstances been more favourable 67% (41) of patients would have preferred to die at home, 16% (10) in hospital, and 15% (9) in hospice. CONCLUSION: With a limited increase in community care 50% more patients with cancer could be supported to die at home, as they and their carers would prefer.

Consumer Behavior↗
PubMed1990

Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.

OBJECTIVE: To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN: Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING: Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS: 741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS: Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES: Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS: Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS: For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Adolescent↗
PubMed1990

Disability medicine.

Rehabilitation/disability medicine has become big business in the USA, Europe and Scandinavia but has yet to establish firm footing as a specialty in the UK. Under the reforms of the Government's White Paper, however, time in hospital becomes money. The need for early re-integration and maintenance of patients in the community may well provide the cue for disability medicine to emerge as a specialty in its own right. But what is the nature of this specialty and who should do it?

Humans↗
PubMed1990

Care of a severely handicapped person over eight years: implications for the future pattern of community care.

This case report describes eight years practical experience of community support for a quadriplegic woman with progressive multiple sclerosis. Key factors in avoiding institutional care were the close collaboration between general practitioner, hospital consultant and social services, and the recognition by the doctors that the social dimension was the dominant requirement for support. Other important points were the identification of one key worker from the many professionals involved, and the use of separate NHS and social service funds to employ care attendants. This funding allowed community nurses to utilize their professional skills while the care attendants solved the problems of dependency. The mechanisms of community support for the individual are discussed in the light of proposed changes in the organization of care for the disabled.

Adult↗
PubMed1989

The family and disability--some reflections on culture: discussion paper.

Severe congenital impairments in one child will affect the whole family, possibly for a generation if the child remains at home as an adult. Disability acquired in adult life will affect both partners as roles are gained or relinquished. For children this may result in a loss of parenting. The adjustment process to any psychological or personality changes may be very painful, particularly if children have no one outside the family to provide informed support. Acquired illness or disability in children may have enormous consequences for siblings, the health of the parents and the whole fabric of family life, often resulting in family isolation. In some Asian families, the feeling that the extended family unit is self sufficient and able to provide care may conflict with the ideal of increasing independence fostered by the professionals, and limit the possibility of support from social workers or psychologists. The extended family may reduce the need for statutory support. The expectation that care will be provided to old people by their daughters or daughters-in-law may be frustrated if the younger generation of women are disabled or otherwise engaged, resulting in possible family strife or rejection.

Asia↗
PubMed1987

Problems in the assessment of outcome in a back pain clinic.

A sample of 72 patients attending the rheumatological back pain clinic of a district general hospital were interviewed at home, before their visit, about their expectations of the clinic. They also completed a Back Pain Disability Questionnaire. Fifty of the patients were recontacted by mail 3 months after their first clinic attendance and asked to complete the Back Pain Disability Questionnaire together with satisfaction questionnaires. Patients' reports, both with regard to expectations and satisfaction, particularly emphasized the importance of communication. One-third of the follow-up sample rated their clinic attendance as unhelpful, and although such views correlated with lack of improvement in pain and disability, other factors are involved in patients' evaluations. Significant correlations were obtained between subjective outcomes and health locus of control, social class and previous hospital treatment. Patient satisfaction may be a valuable measure of outcome in assessing the efficacy of back pain treatment.

Adult↗
PubMed1987

Relationship between alcohol abuse and low back pain.

One hundred and forty-two consecutive referrals attending a low back pain clinic were assessed with questionnaires and blood tests for their alcohol consumption and the severity of their low back pain. Alcohol abuse was found by questionnaires in 11% of patients and 24% had abnormal blood tests. These are higher than reported in the general population. However, the level of alcohol consumption or presence of abnormal tests did not correlate with the severity of the low back pain as assessed by the degree of disability. Nevertheless, the increased consumption of alcohol may contribute to the syndrome complex.

Adolescent↗
PubMedDate not supplied

Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial.

STUDY OBJECTIVE: To compare a community support scheme using care attendants with standard aftercare for their effects on independence and morale of elderly patients discharged from hospital and on their use of health and social services. DESIGN: Randomised controlled study of cohort of patients over 75 discharged to their own homes. SETTING: District general hospital and community. PATIENTS: Total of 903 patients (mean age 82, 25% over 85). INTERVENTIONS: Total of 464 patients received support from care attendants on first day at home and for up to 12 hours a week for two weeks. Support comprised practical care, help with rehabilitation, and organising social help. The remaining 439 patients received standard aftercare. END POINT: Difference between two groups of 7% in hospital readmission rates or one point on activities of daily living scale (power 80%, significance level 5%). MEASUREMENTS AND MAIN RESULTS: Three months after the initial discharge 763 patients were interviewed (84%). There were no significant differences between the two groups in physical independence (activities of daily living scale), in measures of morale (Philadelphia scale), or in death rates. Hospital readmission rates within 18 months of discharge, however, were significantly higher in the control group and they spent more days in hospital (mean; control group 30.6 days, support group 17.1 days; p = 0.014). Of the patients living alone who were followed up for 18 months 21 (15%) receiving standard aftercare were readmitted more than twice compared with 6 (5%) supported by care attendants (p less than 0.01). CONCLUSIONS: If the findings are confirmed, and the policy extended to all patients over the age of 75 living alone, an average health district might expect either to save about 23 hospital beds at a net annual saving of about pounds 220,000 in the short term or to increase available beds by this number.

Activities of Daily Living↗