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Biomedical subjects

I R Lawson

Publications and source records attributed to I R Lawson.

14 recordsLinked to original sources
PubMed1982

Utilization of specialized ambulatory care by the elderly. A study of a clinic.

Specialized ambulatory geriatric care remains an understudied topic. This article analyzes the organization of one special clinic that was established in an apartment block of elderly housing. The findings indicated that as the number of nurse practitioners and case workers' visits rose steadily during the first four years of the clinic's existence, visits to the clinic physicians declined by approximately one visit per client per year. The clinic population utilized less inpatient hospital care than other nonusing residents, and less than other residents of similar age in Connecticut. There was reduced usage of intermediate nursing home care (as opposed to skilled nursing care). Hence, how geriatric ambulatory care is delivered affects institutionalization. In the interests of general well-being and economy, more attention should be paid to this extramural phase of medical care of the elderly.U

Activities of Daily Living↗
PubMed1982

Estimating steady state desipramine levels in noninstitutionalized elderly patients using single dose disposition parameters.

Clearances calculated from single oral dose data have been utilized to predict steady state levels of desipramine in 12 noninstitutionalized depressed elderly patients. Observed steady state plasma levels correlated very well (r = 0.967, p less than 0.0005) with those predicted from single dose clearances, but not with plasma levels obtained 20 hours after a single oral dose (r = 0.24, p greater than 0.2). The mean half-life of desipramine (20.9 hours) in this group of elderly (mean age, 72 years) was considerably less than values of "apparent disappearance" half-life previously reported for elderly patients receiving imipramine. The single dose clearance technique yielded a precise criterion for quantitating early compliance with and adjusting drug dosing regimens.

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PubMed1981

Theophylline pharmacokinetics in advanced age.

1 Theophylline kinetics following a single oral dose were characterized and compared in non-institutionalized ambulatory elderly and young gender-matched control subjects. Study design stressed stringent, yet realistic, control of several external factors known to influence theophylline metabolism. 2 Plasma levels of total drug were significantly higher in the elderly only at early sampling times (0.5 and 1 h) and at 36 h, while unbound theophylline levels were significantly higher (P less than 0.05) at all sampling times resulting in a 45% greater AUC for unbound drug. 3 While no significant differences in volume of distribution (Vd) or overall plasma clearance were observed when calculations were based on total plasma theophylline, a 37% reduction in Vd (P less than 0.005) and a 30% reduction in overall plasma clearance (P less than 0.02) in the elderly became apparent when plasma protein binding was taken into account. 4 When urinary excretion patterns were compared, the elderly were found to have excreted a significantly higher fraction of the recovered dose as 1-methyluric acid (P less than 0.01) and a lower fraction as unchanged theophylline (P less than 0.02). A 47% reduction in the renal clearance of unbound theophylline (P less than 0.005) was also observed in the elderly. 5 Results were consistent with less viable metabolism and renal excretion pathways for theophylline elimination in the elderly and serve to reemphasize the importance of including an assessment of plasma protein binding in studies of drug disposition in the elderly.

Adult↗
PubMed1980

Reliability of palpation of pedal pulses as ascertained by the kappa statistic.

An improved statistic (weighted Kappa) was tested for reviewing the reliability of the palpation of pedal pulses by three observers. Significant improvement was noted after training. Reliability also persisted with respect to a reduced form of the conventional ordinal grading system. The findings indicated that problems of usefulness or reliability may arise when more than five distinctions are made in describing the pulses or when the data are completely reduced to only a dichotomous (present-absent) system.

Foot↗
PubMed1978

Medical direction in long-term care.

This report presents the views of over 1000 administrators, nurses and physicians with respect to the responsibilities, authority and impact of the medical director in a long-term care facility (LTCF), as well as the nature and future of long-term care and geriatric medicine in the USA. Nurses, administrators and physicians were more able to agree on the bureaucratic functions of the medical director than on the functions which might be considered more clinical or activist in terms of the total needs of the LTCF. There was no consensus about the external factors which might determine the future of LTC, i.e. alternatives to institutionalization, public attitudes or community hospital relations. Instead, concern seemed to focus upon the "low level" of funding for LTC. With respect to the nature of LTC itself, most respondents felt that the area was clinically challenging. However, only 40 percent of the physicians believed that clinical skills were more important than a sympathetic regard for patients. As a corollary, physicians were the least supportive of geriatrics as a new specialty in medicine.

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PubMed1975

A survey of the prescribing and administration of drugs in a long-term care institution for the elderly.

The prescription and administration of drugs (especially of the neuroactive class) was observed in 131 patients in an extended care facility. The average number of neuroactive drugs prescribed (2.1) was distinctly different from the average number administered (1.3) because of the large number of pro re nata (prn) prescriptions. More neuroactive substances were prescribed for patients with superior mentation and minimal physical disability; the difference between low and high groups was 1.7 (mentation) and 2.8 (physical status). The most common neuroactive drugs prescribed were: 1) analgesics, 2) major tranquilizers, and 3) hypnotics. Questionable prescribing practices were demonstrated by the fact that 30 patients had prescriptions for 38 "not-recommended"drugs; 23 of these prescriptions were for propoxyphene compound. After requiring physicians to rewrite drug orders every thirty days, a survey made ten months later showed that there was a decline (0.8) in the number of drugs prescribed per patient and a slight increase (0.45) in the number of drugs administered. Professional drug surveillance is crucial for improving the therapeutic process. At least two modifications of current prescribing practices are recommended: 1) a record should always be made of the precise condition(s) under which a drug prescribed "prn" is to be administered; and 2) a strong effort should be made to reduce the total number of drug prescriptions. The results of this survey suggest that certain procedural matters necessitating change are not in themselves the most substantive factors in improvement. Present "third party" review mechanisms likely will not ameliorate the current situation. It will be necessary to implement complex organizational changes in most extended care facilities.

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