PubMed Health⌕ Search

Biomedical subjects

D Barer

Publications and source records attributed to D Barer.

13 recordsLinked to original sources
PubMed1990

A hospital study of community acquired pneumonia in the elderly.

Studies on community acquired pneumonia in the United States in patients over the age of 65 years have shown that Gram negative bacilli account for an appreciable proportion of cases, in addition to usual pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. There have been no reports of community acquired pneumonia in the elderly in the United Kingdom. We undertook such a study to determine the clinical features, aetiology, and outcome. Seventy three patients (38 men) with ages ranging from 65 to 97 (median 79) years were studied prospectively. Pneumonia was defined as an acute lower respiratory tract infection with new, previously unrecorded shadowing on a chest radiograph. Patients with severe chronic illness in whom pneumonia was an expected terminal event were excluded. Nearly all the patients (96%) had respiratory symptoms or signs but many had features that might obscure the true diagnosis of pneumonia. Over half the patients had non-respiratory symptoms and over a third had no systemic signs of infection. A pathogen was identified in 43% of patients, most commonly Streptococcus pneumoniae, Haemophilus influenzae and influenza B virus. Gram negative bacilli were not seen. The mortality rate was high (33%). Early deaths were due to infection whereas later deaths were associated with other factors, such as stroke (two patients) and pulmonary embolism (two patients). Prognostic indicators for mortality were apyrexia, systolic hypotension, increasing hypoxaemia, and new urinary incontinence. As the range of pathogens causing pneumonia was the same in the elderly in this study as in other age groups it is suggested that initial antibiotic treatment for patients in this age group should always cover S pneumoniae and H influenzae.

Aged↗
PubMed1989

Vitamin C status and other nutritional indices in patients with stroke and other acute illnesses: a case-control study.

Sixty-three patients with acute thrombotic stroke were compared with 47 age and sex-matched patients admitted concurrently with acute ischaemic cardiac pain and a further 44 with acute noncardiovascular illnesses. Overall the stroke patients scored highest on a questionnaire designed to estimate mean daily intake of vitamin C before hospital admission. There were problems with this retrospective dietary assessment, however, and the diet scores of the 27 stroke patients able to answer the questionnaire themselves fell between those of the other two groups. There were no significant differences between the three patient groups in plasma ascorbic acid or uric acid levels, but plasma magnesium and albumin levels were higher in the stroke patients. These findings were similar for patients aged over and under 70 but intergroup differences in magnesium and albumin levels were more marked in the elderly. These results do not support the postulated inverse relationship between vitamin C status and the risk of stroke.

Acute Disease↗
PubMed1987

Affective illness after stroke.

Mood assessments were made after six months of 149 survivors taken from a register of all patients admitted to hospital with acute stroke. Using a General Health Questionnaire score of 12 or more as a criterion of important affective illness, its prevalence was 23%. There was no difference in risk of affective illness between left and right hemisphere strokes. Affective illness was strongly associated with functional ability, with limb weakness and with longer hospital stay in those with good functional recovery. Only 15% of those with high scores were receiving antidepressant drugs. The general practitioner is in the best position to detect psychiatric illness in stroke survivors; the use of mood rating scales such as the GHQ, in conjunction with clinical assessment, may improve detection.

Cerebrovascular Disorders↗
PubMed1987

An audit of follow-up services for stroke patients after discharge from hospital.

A register was kept of all patients admitted to hospital in Nottingham with acute stroke, and survivors were followed up at 1 and 6 months. A quarter of the 183 survivors seen at home 6 months after their strokes were still unable to perform some everyday activities. Only 18% of discharged patients ever received outpatient occupational therapy but 42% received physiotherapy. Those attending outpatient rehabilitation were more likely to improve in functional ability between 1 and 6 months. A third of patients interviewed had not seen their GP since discharge and many with severe disabilities did not receive potentially useful therapy or aids.

Activities of Daily Living↗
PubMed1986

Use of the Nottingham Health Profile with patients after a stroke.

The Nottingham Health Profile (NHP) is easy to use with stroke patients and may be used with those who cannot manage more complicated mood questionnaires, such as the General Health Questionnaire (GHQ). Stroke patients rate their health, and especially emotions and feelings of social isolation, as much worse than that of people of similar age. NHP emotion scores correlate with objective measures of disability, length of hospital stay, and GHQ scores. The NHP is a valid indicator of depressed mood, and combining its components into a total score gives the greatest accuracy in detecting depression. Patients with high scores at one month continued to report large numbers of problems at six months after their stroke. Many patients experienced pain, disturbed sleep, and social isolation, which are important, potentially treatable problems not usually considered in the management of stroke patients. Many patients with problems did not see their general practitioner or any other source of help, and additional follow up was needed.

Cerebrovascular Disorders↗
PubMed1985

Cognitive impairment after stroke.

Cognitive ability was assessed in a consecutive series of 189 six-month survivors of an acute stroke. Twenty-two patients were cognitively impaired at six months. Amongst 10 patients whose cognitive ability deteriorated between one and six months, four also had marked depressive symptoms. Age and severity of stroke were the factors most strongly associated with cognitive impairment at six months. Patients with left hemisphere damage had significantly more difficulty with short-term recall and those with bilateral hemisphere signs were most at risk of cognitive impairment. Patients with cognitive impairment after a stroke should be carefully assessed for depressed mood which may benefit from treatment.

Age Factors↗
PubMed1985

Measuring disability after a stroke.

A ranked activities of daily living (ADL) scale has been developed for stroke patients, on which an individual's score predicts his/her overall function ability. With an unranked scale the same total score can be obtained from different combinations of items and gives little idea of the patient's general pattern or degree of disability. The items in the scale are easy to assess on both inpatients and outpatients, and accepted criteria for valid ranking are fulfilled. A strong relation was found between scale score one month post-stroke and length of stay in hospital. Low scores at one month were also associated with high mortality during the subsequent five months. "Formal" and "informal" methods of ADL assessment were compared, and only small and unimportant differences were found. Assessments by postal questionnaire were also evaluated and agreed well with formal assessments carried out by visiting the patients' homes. Use of some or all of these methods would help to simplify and standardise follow up records for both routine care and research.

Activities of Daily Living↗
PubMed1983

Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinal-tract bleeding.

We studied the effects of tranexamic acid (an antifibrinolytic agent) and cimetidine on acute upper-gastrointestinal-tract bleeding in a double-blind randomized placebo-controlled trial in 775 patients with hematemesis or melena or both. Mortality was significantly reduced in patients receiving either tranexamic acid (mortality, 6.3 per cent) or cimetidine (7.7 per cent), as compared with patients receiving placebo (13.5 per cent) (P = 0.0092 for tranexamic acid vs. placebo, P = 0.045 for cimetidine vs. placebo). Ninety-nine patients were withdrawn before the code was broken, mainly because their primary illness was considered not to be due to acute upper-gastrointestinal-tract bleeding. Mortality among those withdrawn was high (22 per cent), and their exclusion reduced death rates to 4 per cent in those given tranexamic acid, 8 per cent in those given cimetidine, and 11 per cent in those given placebo (P = 0.0072 for tranexamic acid vs. placebo, P greater than 0.50 for cimetidine vs. placebo). The reduced mortality associated with tranexamic acid was detectable at both participating hospitals and in most of the main subgroups of patients classified according to site of bleeding. However, treatment with this agent was not associated with any decrease in the rate of rebleeding or the need for operation.

Acute Disease↗