Biomedical subjects

E Briffett

Publications and source records attributed to E Briffett.

4 recordsLinked to original sources

PubMed1996

Predicting outcomes of community-based continuing care. Four-year prospective study of functional assessment versus clinical judgment.

OBJECTIVE: To compare the predictive power of functional assessment for death and institutionalization with the clinical judgment of continuing care nurses; to determine the rates of functional impairment in elderly community-based continuing care clients; to describe long-term group trends in this population. DESIGN: A prospective cohort study, which lasted 4 years. SETTING: Community-based continuing care nursing program. PARTICIPANTS: Two hundred thirty-seven elderly (65 years or older) clients of the program. MAIN OUTCOME MEASURES: Activities of daily living (ADL), cognitive function, and affective function were assessed when clients entered the program (using the Barthel Index, the Canadian Mental Status Questionnaire, and the Memorial University Scale of Happiness). Home care nurses were asked to predict whether individual clients would have died or dropped out of the program at 1 year after entry. RESULTS: Cognitive function and ADL function tests were significant predictors of both death and drop-out from the program; they were better than clinical judgment. Rates of cognitive and ADL functioning were as expected; the rate of affective impairment (53.6%) was much higher than anticipated. At the end of 4 years, only 22.5% of the cohort were still receiving continuing care. CONCLUSIONS: Functional assessment of cognitive and ADL domains was a better predictor of outcomes than clinical judgment. Studying the cohort enabled us to describe group trends, which could be valuable for program managers.

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PubMed1994

Radioallergosorbent testing for penicillin allergy in family practice.

OBJECTIVES: To determine (a) the prevalence of patients supposedly allergic to penicillin who have a positive radioallergosorbent test (RAST) result for penicillin G or V and (b) the predictive power of family physicians' clinical judgement that a patient who is supposedly allergic to penicillin will have a positive RAST result. DESIGN: Prospective multicentre cross-sectional observational study. SETTING: Eleven primary care practices in Newfoundland; 10 were in a rural setting. PATIENTS: Of 110 consecutive adult patients with a supposed allergy to penicillin 97 agreed to participate in the study; 92 underwent RAST. INTERVENTIONS: Patients helped physicians complete a questionnaire and had a venous blood sample taken for the RAST. Physicians examined the clinical history and judged whether the patient was likely to have a positive RAST result. MEAN OUTCOME MEASURES: Rates of positive and negative RAST results for penicillin V and G. RESULTS: Of the 92 patients 8 had a positive RAST result and 84 a negative one. The positive predictive power of a "good" clinical history (e.g., urticaria, swollen eyes, tongue or lips, or an anaphylactic reaction witnessed by a physician) was low (10%); the negative predictive power of a "poor" clinical history (e.g., nausea, vomiting, diarrhea, fever, nonspecific rash or fainting) was 92%. CONCLUSIONS: Less than 10% of primary care patients with a supposed allergy to penicillin will have a positive RAST result. In addition, physicians' predictions of allergy in such patients are imprecise.

Adolescent↗

PubMed1994

Cognitive function among the elderly. Comparison of home care clients and independent seniors.

A cross-sectional survey from the Centre for Rural Health Studies of 210 elderly clients in a rural home care program found that 18.1% had severe or moderate cognitive impairment, yet only 6.6% of 167 elderly community residents living independently in a rural community had similar impairment. While the difference was significant, our methodology could not determine whether a causal association existed.

Activities of Daily Living↗

PubMed1993

Effect of type II diabetes mellitus on cognitive function.

BACKGROUND: As people with diabetes mellitus suffer from peripheral and autonomic neuropathy, we thought it possible that deficits in cognitive function might also be found. Our objective was to compare the cognitive function of elderly persons with non-insulin-dependent diabetes mellitus (NIDDM) with a matched sample of persons without NIDDM: METHODS: Ninety outpatients over 50 years of age with NIDDM and 90 matched nondiabetic patients were recruited for the study. The Modified Mini-Mental State (3MS) and the Delayed Word Recall (DWR) test were used to assess cognitive function. RESULTS: On the 3MS test, the mean score of persons with NIDDM was 75.6, and that of nondiabetic persons was 79.5 (two-tailed t = 3.04, P = .013). On the DWR, the mean score of persons with NIDDM was 3.9, and that of persons without NIDDM was 4.7 (two-tailed t = 3.52, P = .012). CONCLUSIONS: Persons with NIDDM had significantly poorer scores on two tests of cognitive function. Physicians should be aware of this association between type II diabetes and a small but definite impairment of cognitive function.

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