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Biomedical subjects

C W Roy

Publications and source records attributed to C W Roy.

18 recordsLinked to original sources
PubMed2000

Disability in young people and adults one year after head injury: prospective cohort study.

OBJECTIVE: To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. DESIGN: Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. SETTING: Five acute hospitals in Glasgow. SUBJECTS: 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. MAIN OUTCOME MEASURES: Glasgow outcome scale and problem orientated questionnaire. RESULTS: Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. CONCLUSION: The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.

Adolescent↗
PubMed1998

Eligibility criteria for NHS long stay care: the relationship between clinical need, dependency, and staff perception.

A study was undertaken by a Scottish Health Authority to determine future provision of NHS long stay in-patient beds for young physically disabled people (aged < 65), and eligibility criteria for admission to such care. As part of the development of care in the community, only patients requiring specialist medical and nursing care should continue to be placed in NHS care. Resources freed from the resulting closure of NHS beds will be transferred to Social Services to develop alternative packages of care in the community, based on need rather than precedent. Achieving the balance, in terms of the correct level of continuance of NHS long stay care and redeployment of resources, requires careful planning. This study, involving all young physically disabled patients in NHS care in Argyll and Clyde Health Board, combined the assessment of dependency using validated scales (CAPE, FIM, and ERSS), with staff perception of dependency and with clinical criteria developed for a series of balance of care studies in this authority. These clinical criteria indicate the need for specialist medical and nursing care. By examining the relationship between dependency and staff perception, it has been possible to plan long stay provision on a population basis. The criteria for admission have been adopted for local clinical use and form the basis for appeals procedures for patients deemed appropriate for discharge.

Activities of Daily Living↗
PubMed1996

What happens to patients awaiting arthritis surgery?

The length of orthopaedic waiting lists attracts much interest, but the needs of patients awaiting surgery gain little attention. We studied 97 patients awaiting lower-limb surgery (49 osteoarthritis, 41 rheumatoid arthritis, seven other diagnoses). Ninety had pain; 44 significant night pain. Psychological and social problems were common (44 and 45 cases respectively). Only 11 were employed full-time. Sixty-eight required help with daily activities, usually from relatives and neighbours. Forty-three patients walked less than 120 metres in 12 minutes. After review we recommended further aids in 32, medication changes in 27, and additional professional support in six cases. Clinical changes whilst on the waiting list caused alterations in the priority for surgery in 32 cases; the planned procedure was no longer appropriate in 12 of these. We suggest that patients awaiting surgery require clinical review to maintain quality of life; and that waiting lists require administrative review so that patients in need of surgery receive it as soon as possible.

Activities of Daily Living↗
PubMed1993

Predicting hours of care needed.

This study investigated whether the number of hours of care needed by a person with disability could be predicted by his or her score on the Functional Independence Measure (FIM) or the Edinburgh Rehabilitation Status Scale (ERSS). Seventy-five subjects (age range, 19 to 65), from a variety of residential services, with neurological disabilities, were visited by an experienced observer to estimate the number of hours of care per week required, from whatever source, for the subject to manage adequately. A second observer, blind to the observations of the first, assessed the subjects' FIM and ERSS scores by interview with the subjects and their carers. Wide ranges of scores on both scales suggested that subjects with many different dependency levels were surveyed, confirmed by "required care hours" varying between 0 and 168 per week (median 18). Pearson's correlation coefficients were 0.36 for ERSS (p < 0.002) and -0.39 for FIM (p < 0.001). Analysis of the scattergrams identified three aberrant cases. Investigation of these showed they each had a high level of dependency due to supervision rather than physical care; exclusion of these cases resulted in much stronger correlations for the remaining 72 cases (ERSS, 0.61; FIM, -0.76). Both ERSS and FIM correlate well with hours of care required, but their association with hours of supervision is poor.

Activities of Daily Living↗
PubMed1992

Is "handicap" affected by a hospital based rehabilitation programme?

"Handicap", categorised according to the ICIDH, and "Disability", measured by the Smith Activities of Daily Living (ADL) Index, were assessed in over 300 patients (suffering from strokes, lower limb amputations, cardiac disorders, low back pain and other diseases) on admission to and after discharge from a hospital based rehabilitation programme. Statistically significant improvements were found in Physical Independence and Mobility Handicaps which correlated with improvements in ADL Self-care (R = 0.58, p less than 0.001) and ADL Mobility (R = 0.53, p less than 0.001) averages. Small but significant improvements were also found in Orientation, Occupation and Social Integration Handicaps but there was no change in Economic Self Sufficiency Handicap. Thus it is possible to use the Handicap categorisations to assess disabled people sequentially during a rehabilitation programme. The problems of data collection, however, are so formidable that its usefulness must be limited.

Activities of Daily Living↗
PubMed1991

An integrated community and hospital service for adults with physical disability: two years experience.

This article describes a service for adults, below the age for geriatric services, who have severe physical disability. This service combines a well developed community service with two specially adapted hospital units, totalling 33 beds, used for assessment, rehabilitation, intermittent care, and, for a few patients, residential placement. Over two years, 167 mean and 129 women (median age 42 years) were referred for registration; 82% were accepted. Ninety-three percent suffered from neurological disease, with the most common diagnosis being multiple sclerosis. Registration requests were most commonly for rehabilitation or community support; only 5% were for continuing inpatient care. In spite of physical decline for patients with progressive disorders (26%), most patients were perceived to have maintained or improved their social and psychological status after being registered with the service (92% and 89% respectively); whilst 51% of those admitted for rehabilitation improved. Although there are many recommendations for a close integration of hospital and community services for people with physical disability, this report is one of the few to describe the day-to-day working of such a service.

Adolescent↗
PubMed1988

Work of a rehabilitation medicine service.

The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those convalescing after heart surgery. Most patients had several problems. Many were referred so that they could obtain wheelchairs or other appliances, or for assessment of their ability to drive. Only 3% of the referrals were considered inappropriate. Of the inpatients, 455 (87%) returned home after treatment, but 13 (2%) did not respond satisfactorily to rehabilitation. Twelve per cent (18% of the inpatients) were referred from other health boards, suggesting a need for similar facilities elsewhere.

Persons with Disabilities↗
PubMed1988

Rehabilitation status: a measure of medicosocial dysfunction.

The Edinburgh Rehabilitation Status Scale (ERSS) measures four dimensions in which changes may occur in the course of a disabling illness or during rehabilitation: independence; activity; social integration; and effects of symptoms on lifestyle. It provides a profile of measures, the scores of which can be summated to indicate the overall level of performance of individuals or groups. Studies of its inter-observer reliability and of its application in various disability groups indicate that the ERSS reliably defines the characteristics of individual patients and of groups. The scale can be used conveniently by professional staff working independently or by a multiprofessional rehabilitation team to assess status and changes in patients. It can also be used for measurement of the effectiveness of services and for purposes of research, teaching, and administration.

Activities of Daily Living↗
PubMed1986

The causes and consequences of minor head injury in the elderly.

The majority of patients admitted to hospital after head injury are young men and the characteristics of this group tend to dominate accounts of cranial injury. All patients of 65 years or more admitted to the Edinburgh Royal Infirmary neurotrauma unit over a 1-year period were studied and 146 suffering minor head injury were identified. In this group the sex incidence was equal and falls were responsible for two-thirds of the injuries. Alcohol was a contributory factor in over half of the male patients. The incidence of other noteworthy medical and social factors was high and the length of stay in hospital was twice that of younger persons. It is suggested that the elderly represent a group with special needs which might most effectively be met by an overnight observation ward served by neurosurgeons and specialists in geriatric medicine.

Accidents, Home↗
PubMed1986

Baclofen pseudopsychosis: case report.

Sudden withdrawal of baclofen has been shown to provoke hallucinations. There has been no documented case showing hallucinations persisting during treatment over several years and responsive to subsequent reductions in dosage. Such a case is now reported. The chronicity of the symptoms originally suggested a psychotic illness, but this proved to be incorrect. The literature on baclofen toxicity is reviewed.

Adult↗
PubMed1986

Head injury in the elderly.

Accounts of head injury tend to be dominated by the findings in young males who constitute the majority of victims. We compare 1571 patients aged under 65 years admitted to the Head and Spinal Injury Unit, Edinburgh in one calendar year with 449 patients aged 65 years or over admitted during two one-year periods. In the elderly group: the sex ratio was equal; falls accounted for the great majority of cases, with pedestrian accidents responsible for serious injuries; alcohol was commonly involved in males; injuries were most frequent on Thursdays; intracranial haematomas and mortality rates were higher; and the length of hospital stay more prolonged. The provisions necessary to meet the needs of the elderly within a head injury service are discussed.

Accidents, Home↗
PubMed1985

Methylene dianilene: a new toxic cause of visual failure with hepatitis.

A 28-year-old man ingested methylene dianilene in potassium carbonate and gamma-butyrolactone. He developed toxic optic neuritis, with severe visual dysfunction (not previously reported in humans), prolonged toxic hepatitis, with disturbed liver-function tests 18 months after the incident, and other more transient effects. The course of his illness is described and the literature on methylene dianilene toxicity is reviewed.

Adult↗
PubMedDate not supplied

Vocational Rehabilitation Index assessment of rehabilitation medicine service patients.

Only a minority of working-age patients referred to rehabilitation medicine services return to work, but could more be helped? A first step is identifying those potentially able to do so. This paper describes the retrospective application of the Vocational Rehabilitation Index (VRI) to 223 patients of working age and with various diagnoses referred to one rehabilitation medicine service. The VRI discriminates between patients who return to work and those who do not, as well as between groups with apparently differing degrees of need for vocational rehabilitation assistance. It also has good face validity. Results suggest that it is feasible to apply the VRI in rehabilitation medicine settings and that further prospective evaluation and practical applications should be undertaken.

Abstracting and Indexing↗