Biomedical subjects

Hazel W Fraser

Publications and source records attributed to Hazel W Fraser.

3 recordsLinked to original sources

PubMed2006

A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland.

OBJECTIVE: The aim of this study was to investigate patterns of oral care, dental attendance and oral health-related quality of life among adults who had suffered a stroke. BACKGROUND: Stroke is the most common cause of adult disability in the UK. Seventy per cent of strokes occur in adults over 65 years of age. A mild stroke may leave little residual disability but in cases of moderate or severe stroke the disability may be significant and may impact on oral health and function. MATERIALS AND METHODS: A cross-sectional survey was conducted among adults surviving 1 year after stroke, between January and July 2001. A medical screening was carried out which included an assessment of disability and handicap using the modified Rankin scale. A structured interview was conducted to identify normal patterns of oral care and dental attendance and to elicit if since suffering a stroke any changes had occurred or were likely to occur. The Short Form Oral Health Impact Profile (OHIP-14) was administered prior to an oral examination. Analysis used SPSS 11.0 for Windows. Parametric and nonparametric tests were undertaken (t-tests and chi-squared tests with Yates correction where appropriate). RESULTS: Forty-one adults were recruited into the study comprising 21 female and 20 male. They ranged in age from 50 to 87 years and the mean age was 69 years (SD = 9.8). Forty per cent of participants experienced moderate disability or greater following their stroke. Thirty-seven per cent had difficulty with tooth cleaning. The most frequently reported problem was being unable to use one hand properly as a result of the stroke. There was a significant association between the degree of disability following stroke and difficulty with tooth cleaning (P = 0.015). Disability as a result of the stroke was cited as the main reason for reported or projected attendance pattern change. The most frequently experienced OHIP-14 dimension was functional limitation (39%). CONCLUSION: Individuals who have been left disabled after a stroke may require help with or advice on oral care and information on how to access dental services in a setting appropriate to their disability. Further research is needed to identify the dental needs of adults with stroke and to identify appropriate interventions to meet these needs.

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PubMed2003

Orlistat enhances warfarin effect.

OBJECTIVE: To report a case of increased international normalized ratio (INR) associated with the addition of orlistat to the drug regimen of a patient receiving warfarin therapy. CASE SUMMARY: A 66-year-old white man with a history of chronic atrial fibrillation (treated with a stable dose of warfarin), hypertension, and diet-controlled type 2 diabetes mellitus was started on orlistat for weight reduction. An increased INR was reported after the introduction of orlistat; there had been no other recent changes to medication or medical conditions. Warfarin was withheld and the dose reduced to allow INR control to be reestablished. According to the Naranjo probability scale, this reaction was probable. DISCUSSION: Control of the INR within therapeutic limits is always a challenge. Dietary intake of vitamin K, intercurrent illness, concomitant medication, herbal remedies, and other factors can interfere with warfarin dosing. Orlistat use may be associated with patient alteration of diet to compensate for adverse effects or other mechanisms by which orlistat alters warfarin control, including direct effect on absorption of vitamin K. CONCLUSIONS: The introduction of chronic dosing of orlistat may reduce the absorption of fat-soluble vitamins, including vitamin K, with the result that a lower dose of warfarin may be required. This may be due in part to change to a lower fat diet with decreased amounts of vitamin K. It may also be due to an effect on vitamin K absorption. Caution should be exercised when these 2 drugs are used concurrently.

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PubMed2002

Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. METHODS: This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between 1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. RESULTS: The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine <124 micromol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance > or =51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine > or =119 micromol/L "relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92", urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or > or =9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine > or =0.08573 mmol/micromol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders. CONCLUSIONS: After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.

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