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Biomedical subjects

D L Farquhar

Publications and source records attributed to D L Farquhar.

15 recordsLinked to original sources
PubMed1995

The characteristics of respite patients.

A prospective study of planned respite admissions, comparing them to admissions to continuing care. The characteristics, dependency and CAPE scores of each patient were noted, as was medical intervention during the respite admissions. Twelve month follow-up provided data on long-term prognosis. Fifty three (30 females) respite patients; mean age 80.3 years (range 63-97) were compared with 31 (18 females) continuing care patients; mean age 82.6 (range 74-94). There was no difference in the physical dependency between the two groups, except that continuing care patients were significantly more incontinent of urine and had significantly worse cognitive function. Only eight (15%) respite patients needed medical intervention during their admission and one patient died. One year follow-up revealed that 26% of respite patients had died against 48% of continuing care patients (p < 0.01). A further 33% of respite patients had been admitted to institutional care.

Aged↗
PubMed1992

Prospective study of necropsy audit of geriatric inpatient deaths.

AIMS: To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. METHOD: Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. RESULTS: Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. CONCLUSION: Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.

Aged↗
PubMed1990

Phenytoin dosage individualization--five methods compared in the elderly.

Five methods to predict phenytoin dosage have been compared in nine continuous care elderly patients. For each patient three steady-state plasma concentrations were obtained at three different doses. The data were used to estimate the 'optimum' dose for each patient by direct linear plot. The optimum dose for each patient was predicted from each plasma concentration using five dosage prediction methods based on the Michaelis-Menten equation using: (i) the population mean Vmax, (ii) the population mean KM, (iii) the linearized Bayesian method, (iv) the Rambeck nomogram, and (v) two plasma concentration-dose data pairs to estimate both Vmax and KM. The predictive precision was similar for each of methods (i-iv). Ninety-six out of 126 dosage predictions with the five methods were within 25 mg of the optimum dose. Methods (ii) and (iv) tended to overpredict dosage, particularly when used to interpret low plasma phenytoin concentrations.

Aged↗
PubMed1988

Non-Hodgkin's lymphoma of the lung.

Non-Hodgkin's lymphoma (NHL) commonly presents with extensive disease involving extranodal tissues. Involvement of the mediastinal and hilar lymph nodes, pleura and lung parenchyma are recognised complications although their incidence is uncertain. However, pulmonary involvement is undoubtedly much less common than involvement at other extra nodal sites. Histologically proven NHL limited to the lung parenchyma, after full staging including computerised tomography and marrow trephines, is extremely rare. We report on two such cases and review the literature.

Female↗
PubMed1987

Pre-conceptual dietary management for maternal phenylketonuria.

Experience of preconceptual dietary management of maternal hyperphenylalaninaemia is limited. Two Edinburgh mothers with hyperphenylalaninaemia and borderline IQ have received dietary advice to maintain normal plasma Phe concentration both before conception and during pregnancy, in an attempt to prevent foetal abnormality. Satisfactory compliance was only obtained after intensive in-patient instruction and the diets were maintained for long periods prior to conception. Intellectual and psychological factors were very important and the availability of "same day" biochemical reports useful in encouraging the mothers. Both infants have normal Phe concentrations and satisfactory growth and development parameters at present. Further follow-up continues but these cases provide further evidence in favour of the use of preconceptual dietary advice in the management of maternal hyperphenylalaninaemia.

Adolescent↗
PubMed1987

Long term amantadine treatment. The danger of withdrawal.

Three elderly Parkinsonian patients on long term amantadine therapy (mean nine years) are presented. In each case abrupt withdrawal of amantadine resulted in rapid deterioration in the patient's condition which was corrected by reintroduction of amantadine.

Aged↗
PubMed1986

Placebo controlled double-blind trial of fluvoxamine maleate in the obese.

Obesity and depression are common disorders which may co-exist. The management of the combination is complicated because some antidepressants cause weight gain fenfluramine, an effective antiobesity agent, may cause depression. Fluvoxamine is an antidepressant which, like fenfluramine, inhibits serotonin re-uptake within the brain. Forty obese female subjects with refractory obesity participated in a double-blind placebo controlled trial. During the twelve week study, those subjects receiving fluvoxamine achieved a mean weight loss greater than, but not significantly different from, that of the placebo group. The result suggests that fluvoxamine may be particularly useful in the management of obese patients requiring treatment with an antidepressant.

Adolescent↗
PubMed1986

Intermittent protein-sparing fasting with abdominal belting.

In an attempt to minimize the weight regain that often follows effective weight reduction, a programme has been evaluated which involved the use of a nylon waist cord which could be readily tightened but not lengthened, during a regime of alternating periods of a liquid diet and a high-fibre natural diet combined with behavioural modification. Forty subjects completed the initial cycle of a liquid regime with an overall weight loss of 7.7 kg during the treatment period. Thirty-six of these subjects have been followed up for a mean of 12 months after the completion of the treatment programme. Five subjects are difficult to categorize having worn the cord for some but not all of this time. Fourteen have continued to wear the waist cord throughout and have achieved a further mean weight loss of 4.8 kg. This differs significantly from the 17 subjects who cut off the cord and who have regained a mean of 6.6 kg. The results suggest that an adjustable waist cord is a valuable aid to achieving successful and permanent weight reduction in some subjects.

Adult↗
PubMed1984

Ketoconazole and fungal sinusitis.

A case of a young man with chronic sinusitis. After many years and multiple surgical procedures, fungal hyphae were noted. The patient made a complete recovery with oral ketoconazole.

Adolescent↗
PubMed1984

The current status of antiobesity drugs.

The currently available antiobesity drugs will produce an additional mean weight loss of approximately 0.5 lb (0.23kg) per week for a limited period of time. There is no major difference between the weight losing properties of the various drugs, and choice of drug depends in part on other factors such as cost and side effects. Those drugs affecting catecholaminergic pathways such as phentermine and diethylpropion can be prescribed intermittently because this is as effective, cheaper and presumably less likely to result in dependence than continuing therapy. Fenfluramine however is best given continuously, the dose being built up and reduced stepwise to avoid the dangers of withdrawal depression. Individual response may depend partly upon drug compliance and metabolism but cannot be predicted except by trial and error. Once a drug is discontinued, weight regain is the rule and there is no evidence that drug therapy helps to re-educate faulty eating habits. It follows that therapy can be most easily justified if there is a short term need to achieve weight loss, e.g. prior to elective surgery. In some patients, weight regain may be prevented by giving the drug long term but the complications of long-term administration have yet to be evaluated. If it can be justified at all, it is in those subjects with complicated obesity. The development of a non-pharmacological way of preventing weight regain following drug therapy would enhance the potential usefulness of an antiobesity agent.

Adult↗