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Biomedical subjects

H M Hodkinson

Publications and source records attributed to H M Hodkinson.

At least 19 recordsLinked to original sources
PubMed1991

Determinants of forearm bone density in premenopausal women: a study in one general practice.

Predictors of distal and proximal forearm bone density, measured by photon absorbtiometry, were investigated in 248 premenopausal women aged 39-56 years. Only one strong predictor of lower bone density was found--history of previous fracture at any site (P less than 0.001). Two other factors showed a weaker association with density, but only at the distal site--history of diuretic use showed a positive association (P less than 0.02) whereas alkaline phosphatase level was inversely correlated with density (P less than 0.01). Other factors were not significant predictors: these included age, calcium intake, level of exercise, anthropometric measures of obesity, serum calcium level, parity, lactation history, a menopausal symptom history, use of the contraceptive pill, smoking and alcohol intake. These results contrast with the far stronger predictors found for postmenopausal women and suggest that genetic endowment rather than lifestyle may be the major determinant of bone density before the menopause.

Adult↗
PubMed1990

Relationships between happiness, behavioural status and dependency on others in elderly patients.

Feelings of dependency on others were measured, by different scales, in two different samples of elderly people: 33 acute in-patients and 25 attenders at a geriatric day hospital. Findings were similar in each location. Dependent attitudes increased with the duration of patients' previous in-patient experience, and correlated negatively with subjective well-being but not at all with behavioural status. These results are consistent with theories which attribute low morale to feelings of dependence and this, in turn, to the experience of residential care. They are inconsistent with the view that dependence on others is a positive feature of old age. In addition, patients' subjective well-being was completely unrelated to nurse ratings of their behavioural status, and subjective ratings by nurses correlated somewhat with patients' behavioural status but not at all with their subjective well-being.

Aged↗
PubMed1988

The first year of a geriatric-orthopaedic liaison service: an alternative to 'orthogeriatric' units?

The use of orthopaedic beds by large numbers of elderly patients with multiple pathology will increase and already exceeds the provision of orthopaedic-geriatric rehabilitation units. A cross-specialty multidisciplinary ward round improved the quality of care of orthopaedic patients without requiring expenditure on equipment, facilities or staff, and abolished the need to transfer patients to geriatric beds for rehabilitation, this being achieved on the orthopaedic unit. The liaison service provided excellent medical training in acute and rehabilitative aspects of geriatric medicine, enhanced the role of other disciplines in the care of the elderly orthopaedic patient and facilitated communication between departments.

Geriatrics↗
PubMed1988

Quantification of dietary intake in long-stay geriatric patients: do we need seven days observation?

Nutrient intake was assessed for 15 long-stay elderly patients by 7-d weighed inventory. Analysis revealed neither significant day-to-day nor weekday/weekend variations for any studied nutrient except fibre. It would appear that acceptable indications of customary intake in this population can be achieved by measurement over a shorter period than 7 d, such as 3 or 4 consecutive weekdays.

Aged↗
PubMed1987

Confirming long-stay status.

This paper discusses an assessment procedure for the formal identification of patients requiring long-stay geriatric care. It was introduced immediately prior to the reorganization of geriatric in-patient care at St Pancras Hospital which saw the abolition of mixed wards of acute, rehabilitation, and long-stay patients and their replacement by six specialized wards, three of which are long-stay wards accommodating 51 patients. The formal assessment and referral for long-stay care is itself one outcome of deliberations made by a multidisciplinary panel formed a few months before the hospital reorganization to examine the kind of care and environment that might best enable the long-stay elderly to enjoy, within the limits of their disabilities, as dignified and worthwhile lives as possible. The paper begins by outlining the reasons why an assessment procedure came to be seen as a necessary and important element in the new system of continuing care of geriatric patients. This is followed by a brief consideration of how the procedure operates. An example of the assessment form is included.

Forms and Records Control↗
PubMed1987

Anticonvulsant drugs and bone disease in the elderly.

Elderly psychiatric inpatients were studied to find the prevalence of osteomalacia in those taking anticonvulsant medication (n = 19) and a comparison group not taking these drugs (n = 37). Only one biopsy-proven case was discovered among the anticonvulsant group, and none in the comparison group. This was an unexpectedly low rate. The clinical and biochemical data (including alkaline and acid phosphatase isoenzymes) were further analysed to detect subclinical osteomalacia, but none was found. A difference between the two subgroups was found for total and liver alkaline phosphatase only. The possible explanations for these unexpected findings are discussed. The effect of anticonvulsants on vitamin D and bone metabolism is reviewed and the hypothesis that drug-induced changes in vitamin D metabolism are responsible for the bone changes described in earlier series is questioned.

Aged↗
PubMed1986

Real-time measurement of serum C-reactive protein in the management of infection in the elderly.

The serum concentration of C-reactive protein (CRP), a nonspecific acute phase reactant which responds sensitively to bacterial infection, was measured by homogeneous enzyme immunoassay in all patients admitted to a general hospital geriatric unit. It was then monitored frequently in those in whom infection was suspected. Results were reported rapidly to the clinical team and particularly in the context of a patient population with complex multisystem pathology, often without pyrexia, leucocytosis or other classical signs of infection, they made a significant contribution to patient management. Very high CRP levels were most commonly due to infection (75% of those over 50 mg/l and 94% of those over 100 mg/l) and the pattern of the CRP response during antimicrobial therapy provided a sensitive, objective index of its efficacy. Failure of CRP levels to fall promptly stimulated additional diagnostic investigations, revealing resistant infection, localized pus or serious noninfective pathology, particularly malignancy, and led to appropriate management. Furthermore the CRP results on admission were of considerable prognostic significance, being significantly higher (median 70 mg/l) in those patients who did not survive than in those who did (18 mg/l).

Aged↗
PubMed1985

A comparison of the erythrocyte sedimentation rate and serum C-reactive protein concentration in elderly patients.

Fifty-five consecutive admissions to an acute geriatric unit were studied prospectively. Individuals were classified according to the obvious presence or absence of an active disease process on admission and their serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured then and five days later. There was no significant difference between the ESR values in the two groups either on admission or at day 5, nor was there any significant change between admission and day 5. In contrast, CRP values were very significantly higher in the active than in the non-active group and there were marked changes over the 5-day period corresponding to changes in clinical condition. These results indicate that the serum CRP concentration is superior to the ESR as an objective, non-specific marker for disease activity in the elderly.

Aged↗
PubMed1985

Late infection of joint prostheses.

Late infection of an orthopaedic prosthesis can cause serious illness in elderly patients. Four cases are described to show the importance of recognizing this condition.

Aged↗
PubMed1979

Fractured neck of femur in the elderly: an attempt to identify patients at risk.

1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.

Aged↗
PubMed1979

Beta-thromboglobulin and the diagnosis of thrombosis in elderly patients.

The plasma concentration of beta-thromboglobulin was estimated in elderly in-patients using a radio-immuno-assay technique. There were highly significance differences between the mean values of patients with arterial or venous thrombosis, as compared with controls. The ability of the test to detect thrombosis above the inguinal ligament means that it is a useful addition to the existing battery of tests for detecting thrombosis.

Aged↗
PubMed1979

Prediction of outcome of patients admitted to a geriatric department.

The reliability of a clinical prognosis of outcome at six weeks has been investigated in a series of 1092 consecutive admissions to a geriatric department. The prognosis was made within a day of admission and made use only of the history and clinical findings. The results for discharge were good but categorization of patients who died or who stayed longer than six weeks was less reliable. Unpredicted deaths were often sudden or related to disease with developed after assessment. Other errors were due to over-optimism in forecasting response to medical treatment or rehabilitation. In other cases progressive deterioration had not been clearly recognized at our assessment based on a single point in time.

Aged↗
PubMed1979

The clinical pathology of heart failure and atrial fibrillation in old age.

The factors associated with the development of heart failure and of atrial fibrillation in elderly patients were studied in a prospective clinico-pathological series of 171 cases. Multiple logistic analyses allowed the contributions of multiple factors to be assessed simultaneously. Senile cardiac amyloidosis, ischaemic heart disease and atrial fibrillation were significantly associated with heart failure and had additive effects. Senile cardiac amyloidosis, ischaemic heart disease, mitral valve ballooning and higher age were significantly associated with atrial fibrillation but their additive effects were modified by significant interactions between ischaemic heart disease and mitral valve ballooning (whose effects were multiplicative) and senile cardiac amyloidosis and age (the age effect being confined to those without amyloidosis).

Aged↗
PubMed1978

Capillary fragility in elderly in-patients.

Capillary fragility has been examined in 110 elderly patients, excluding those patients who might have been expected to have abnormal fragility. Nonetheless, fragility appeared to be greater in elderly patients than in younger subjects. It was much increased in the non-paralysed arm of hemiplegic patients but not in the paralysed arm--perhaps because petechiae were obscured by trophic changes. Capillary fragility was significantly correlated with systolic blood pressure but not with age. This suggests that higher values in elderly patients may be related to the high prevalence of arteriosclerosis rather than to age itself.

Aged↗