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Biomedical subjects

A Treloar

Publications and source records attributed to A Treloar.

At least 19 recordsLinked to original sources
PubMed2005

Capacity, consent, and selection bias in a study of delirium.

OBJECTIVES: To investigate whether different methods of obtaining informed consent affected recruitment to a study of delirium in older, medically ill hospital inpatients. DESIGN: Open randomised study. SETTING: Acute medical service for older people in an inner city teaching hospital. PARTICIPANTS: Patients 70 years or older admitted to the unit within three days of hospital admission randomised into two groups. INTERVENTION: Attempted recruitment of subjects to a study of the natural history of delirium. This was done by either (a) a formal test of capacity, followed by either a request for consent or an attempt at obtaining assent from a proxy, or (b) a combined informal capacity/consent process. MAIN OUTCOME MEASURES: Prevalence and severity of delirium, and, as case mix measures, length of hospital stay and destination on discharge. RESULTS: Recruitment of subjects through establishing formal capacity and then informed consent was less successful (43.9% v 74% of those approached) and, compared with those recruited through the usual combined capacity/consent approach, yielded a sample with less cognitive impairment, lower severity of delirium, lower probability of case note diagnosis of delirium and lower rate of entering a care home. CONCLUSIONS: Methods of obtaining informed consent may significantly influence the case mix of subjects recruited to a study of delirium. Stringent testing of capacity may exclude patients with delirium from studies, thus rendering findings less generalizable. A different method is necessary to achieve an ethical balance between respecting autonomy through obtaining adequate informed consent and avoiding sample bias.

Aged↗
PubMed2002

Barriers to the use of electroconvulsive therapy in the elderly: a European survey.

A postal survey was carried out to determine the clinical and legal guidelines governing the use of electroconvulsive therapy (ECT) in the countries of the wider Europe. Respondents from 23 of the 33 countries returned completed questionnaires. Considerable variation was found in the availability of ECT, the frequency of its use and associated legal procedures. However, there was a broad consensus with regard to the clinical indications. Access to the treatment was most frequently limited by financial or other resource constraints, political or legal restrictions.

Aging↗
PubMed2000

A pill in the sandwich: covert medication in food and drink.

The covert administration of medicines in food and drink has been condemned by some and condoned by others. We used questionnaires to ascertain the views of people caring for patients with dementia in institutions and in the community. In 24 (71%) of 34 residential, nursing and inpatient units in south-east England, the respondent said that medicines were sometimes given in this way. It was often done secretly and without discussion, probably for fear of professional retribution. Few institutions had a formal policy on the matter. Of 50 people caring for demented patients in the community, 48 (96%) thought the practice sometimes justifiable, but 47 believed that doctors should consult with carers before deciding. Even if, as most carers and some authorities believe, covert medication can be justified, the poor recording and secrecy surrounding the practice in institutions are cause for concern.

Attitude to Health↗
PubMed1998

The relationship between the female menopause and serum sialic acid, a known cardiovascular risk factor.

Serum total sialic acid (SA) has recently been reported as a cardiovascular risk factor. The risk of cardiovascular disease increases after the menopause in females. However, there are little data looking at the relationship between serum SA and the menopause. Overall 92 females were studied. The women were divided into five groups: the first three groups were age-matched pre-menopausal (n = 20), peri-menopausal (n = 10) and post-menopausal women (n = 20). In order to study serum SA changes with adult female age we also studied 14 young pre-menopausal women and 28 elderly women. There was no significance difference between the serum SA concentration in the age-matched pre-, peri- or post-menopausal women (62.7 +/- 10.4 mg/dl, 61.7 +/- 4.5 mg/dl, 62.9 +/- 7.0 mg/dl respectively). Furthermore, there was no significant difference between the serum SA in the "young" women (64.7 +/- 9.8 mg/dl) and that of the peri-, pre- or post-menopausal women. However, in the elderly women the serum SA was elevated (75.6 +/- 16.6 mg/dl) with P < 0.05 for each comparison group. In conclusion, serum SA does not seem to change at the time of the female menopause although in elderly women (average age 75.6 +/- 16.6 years) it increases. The reason for this increase is not known and may merit further research.

Adolescent↗
PubMed1997

Expression of human hepatic glucokinase in transgenic mice liver results in decreased glucose levels and reduced body weight.

Glucokinase is the predominant hexokinase in pancreatic beta-cells and liver parenchymal cells and functions as a critical component of the glucose-sensing apparatus in these glucose-responsive cell types. In the beta-cells, the sensing leads to insulin secretion, while the role in hepatocytes is thought to be in hepatic glucose uptake. To determine the physiological response to an increase in hepatic glucokinase expression, transgenic mice expressing the human hepatic glucokinase gene under the control of a liver-specific human apolipoprotein A-I gene enhancer were generated. Transgenic mice had twofold higher total fasting hepatic glucokinase mRNA, which resulted in a modest 20% increase in fasting glucokinase activity. These animals showed lower fasting plasma glucose, insulin, and lactate levels and improved tolerance to glucose. In addition, glucokinase transgenic animals weighed less and had lower BMI than nontransgenic animals. Thus, glucokinase transgenic animals demonstrate that a modest change in hepatic glucokinase activity enhances the metabolism of glucose.

Animals↗
PubMed1996

Stories from mental health.

Mental health nursing has always been a particularly challenging area in which to work. Not only in providing quality nursing care for clients who can be unpredictable, demanding and at times aggressive, but also in adjusting to changes in philosophy, focus and even contexts of work. It would be fair to say that mental health services in NSW are in a state of crisis. Mental health nurses are feeling the effects, but despite the difficulties remain strongly committed to their speciality. The Association and the membership benefit greatly from the energy, enthusiasm and ideas that mental health nurses generate. This issue of The Lamp acknowledges the important contribution of mental health nurses to the profession of nursing.

Humans↗
PubMed1994

Serum total sialic acid and acute phase proteins in elderly subjects.

Serum total sialic acid has gained recent interest as a cardiovascular risk factor. We measured serum total sialic acid and three acute phase proteins; C-reactive protein, alpha 1-antichymotrypsin and alpha 1-acid glycoprotein in 37 geriatric patients (age 80.1 +/- 7.0 years) and 50 younger subjects (age 40.3 +/- 11.4 years). Serum total sialic acid was higher in the geriatric subjects 2.41 +/- 0.39 mmol/l versus 2.04 +/- 0.35 mmol/l, P < 0.04. Serum alpha 1-acid glycoprotein, alpha 1-antichymotrypsin and C-reactive protein were also elevated in the geriatric patients; serum alpha 1-acid glycoprotein being 1.16 +/- 0.32 g/l versus 0.41 +/- 0.28 g/l, P < 0.0001, serum alpha 1-antichymotrypsin being 0.80 +/- 0.20 g/l versus 0.52 +/- 0.10 g/l, P < 0.0001 and serum C-reactive protein being 9.71 +/- 21.0 mg/l versus 4.73 +/- 1.30 mg/l, P < 0.04. There was a correlation with serum total sialic acid and serum alpha 1-acid glycoprotein and alpha 1-antichymotrypsin in the geriatric subjects and with alpha 1-acid glycoprotein, alpha 1-antichymotrypsin and C-reactive protein in the younger group.

Acute-Phase Proteins↗
PubMed1992

Two consecutive thunderstorm associated epidemics of asthma in the city of Melbourne. The possible role of rye grass pollen.

OBJECTIVE: To document the clinical impact and identify the meteorological and environmental circumstances surrounding two epidemics of asthma exacerbations associated with thunderstorms in the city of Melbourne and to find a possible aetiology for these events. DESIGN: Collection of meteorological and environmental data from the Victorian Bureau of Meteorology and the Environment Protection Authority; collection of clinical data from metropolitan emergency departments and the Victorian Ambulance Service; and study of a cohort of affected patients with asthma and a control group of asthmatics who were not affected by the storms. SETTING: Tertiary institution. PATIENTS: Twelve storm-affected patients with asthma and 16 asthmatics not affected by the storms. INTERVENTION: Administration of a questionnaire, medical interview, pulmonary function tests and skin prick tests with common allergens. MAIN OUTCOME AND RESULTS: Both epidemics caused a major increase in the number of hospital attendances and admissions because of asthma exacerbation (five to ten fold rise). These events could not be related to atmospheric pollution or specific meteorological features of the storms. Patients affected by the second storm were significantly more likely to suffer from hay fever (P less than 0.05), rye grass pollen allergy (P less than 0.05) and allergy to rainfall released rye grass starch granules (P less than 0.025). CONCLUSIONS: Late spring thunderstorms in the city of Melbourne can trigger epidemics of asthma attacks. The seasonal nature of the phenomenon and the pattern of allergic responses found in affected patients suggest a possible aetiological role for rye grass pollen.

Air Pollution↗