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Biomedical subjects

J G McConnell

Publications and source records attributed to J G McConnell.

16 recordsLinked to original sources
PubMed1998

A prospective study of the process of assessment and care management in the discharge of elderly patients from hospital.

Assessment and care management (ACM) of elderly patients prior to discharge from hospital has been in place since 1993. It involves a complex multi-disciplinary assessment of needs which may delay discharge from hospital. We prospectively studied the process of ACM in a group of patients discharged from hospital over a three month period. The times taken for completion of the necessary reports, and any delays in the process were recorded. The times of each individual step in the process were correlated to overall length of stay and to the length of the care management process. The effect of intercurrent illnesses or other delays was studied. Of the available sample (n = 83), 16 patients died and two required long term hospital care. The median length of stay of the remainder (n = 65) was 36 days (range 5-149 days). The median time from the start of the ACM process to discharge was 22 days (0-89 days). The strongest correlation with total length of stay was the time from admission until ACM commenced (rho = 0.661, p < 0.0001). The time spent in the ACM process was related strongly to the time taken for the Care Manager to process the applications (rho = 0.682, p < 0.0001). Delay was recorded in 17 (24%) cases, resulting in an increased length of stay (p < 0.001). While care management may help in appropriate placement after hospital discharge, these results suggest that it is prone to delays outside the hospital setting. Such delays result in patients waiting in hospital for care packages to be set up in the community. This has implications for acute hospital services.

Aged↗
PubMed1995

Severe hyponatraemia associated with selective serotonin reuptake inhibitors.

Depression in the elderly is a common problem, cited as occurring in up to 10% of elderly people living at home, half of whom may need specialist referral. The introduction of selective serotonin reuptake inhibitors has been reported as a major advance in the treatment of depression in that they are less sedating, have fewer anticholinergic effects and are less toxic in overdose. We report three cases of severe hyponatraemia, seen in the past 12 months, associated with the selective serotonin reuptake inhibitors fluoxetine and sertraline. Hyponatraemia has been reported as a rare adverse effect of selective serotonin reuptake inhibitors.

1-Naphthylamine↗
PubMed1995

Patterns of admission and discharge in an acute geriatric medical ward.

Patients admitted to a 30 bedded acute geriatric medical ward in 1993 were followed up to discharge. The admission rate on weekend days was half that for weekdays. Six percent of ward discharges occurred at weekends, over half being due to death. Respiratory, cardiovascular and central nervous systems disorders were the commonest reasons for admission (56%) and death (73%). Greater emphasis should be placed on discharging patients at weekends.

Acute Disease↗
PubMed1994

Geriatric medicine: the anatomy of change.

We have studied workloads and patterns of care in geriatric medicine from 1982 to 1993 in the Ulster Hospital. There was a 137% rise in admissions, a 16% reduction in domiciliary visits and a 31% increase in ward assessments. The continuing care waiting list fell to zero in 1993. The number of new outpatients rose by a factor of 8.6 between 1987 and 1993. Between 1990 and 1993 there was an increased admission rate from nursing homes and of patients suffering from respiratory system diseases. Mortality rates fell from 27.8% in 1982 to 19.3% in 1990 and to 12.1% in 1993. Mean age and sex ratios remained unchanged over the years while the average length of stay halved from 43.3 to 22.6 days between 1990 and 1993. 81% of admissions in 1993 were emergencies. Care of the elderly in hospital and the interface with general medicine are changing.

Aged↗
PubMed1994

Admission of nursing home patients to geriatric medical wards.

Comparison was made between patients admitted from a nursing home and all other patients admitted to a geriatric medical unit in 1990 and 1993. The number of nursing home patient admissions rose from 26 in 1990 to 106 in 1993. Nursing home patients were frailer both physically and mentally with a dementia rate of 78% (in those who survived, 1993) and a mortality rate of 19.8% (1993), compared with a dementia rate of 19% and a mortality rate of 11.3% in all other admissions in 1993. Male patients admitted from a nursing home were more likely to die than females (33% versus 14.5%, 1993). Lengths of stay of nursing home patients were shorter, largely due to the availability of a 'safe environment' when discharged, but also related to shorter survival times. 61% of patient admissions from nursing homes in 1993 were considered 'unnecessary' and could have been avoided if specialist advice had been available before admission.

Aged↗
PubMed1994

'Assessment and care management'--a hospital perspective.

Patients placed from hospital to nursing or residential homes or to home under the intensive domiciliary care scheme were compared before and after the introduction of 'assessment and care management' on the 1st April 1993. In geriatric medical wards there was a 69% increase in the average length of stay for patients assessed and care managed and a 52% increase in the length of stay for self-funding patients compared with patients placed before the introduction of assessment and care management. Care managed patients discharged on the intensive domiciliary care scheme had a 66% increase in their length of hospital stay compared with care managed patients placed in private nursing homes. In contrast, the length of stay for care managed patients in other hospital wards was half that for geriatric medical wards.

Aged↗
PubMed1993

Pancreatic polypeptide and exocrine pancreatic function in the elderly.

The relationship between exocrine pancreatic function and plasma pancreatic polypeptide levels was studied in 14 normal elderly subjects and in ten elderly patients with exocrine pancreatic insufficiency determined by the para-amino-benzoic acid test. There was a decrease in the total pancreatic polypeptide response after a standard mixed meal in the group with pancreatic insufficiency (t = 2.753, p = 0.01). An increase above basal of less than 100% in plasma pancreatic polypeptide levels 30 min after a standard mixed meal is strongly associated with exocrine pancreatic insufficiency (Fisher's exact test, p = 0.005).

4-Aminobenzoic Acid↗
PubMed1992

Steady state pharmacokinetic profile of indomethacin in elderly patients and young volunteers.

The steady-state pharmacokinetic profile of indomethacin was examined in twelve healthy volunteers (4 m, 8 f; 20-34 y) and in 12 elderly subjects (7 m, 5 f; 70-88 y). Two formulations of indomethacin were examined, providing duplicate data for each subject group. The subjects received each formulation of indomethacin (25 mg tid) for 6 days in a single blind crossover fashion. On day 7, after an overnight fast, a final 25 mg dose of indomethacin was given and plasma concentrations measured over the following 12 h. Kinetic parameters Cpmin, Tmax and AUC (0-12 h) were determined. There were no differences in the pharmacokinetic parameters between young and elderly subjects or between data for the two formulations of indomethacin. AUC values (micrograms.ml-1.h), for example, for the two formulations in the young subjects were 5.85 and 6.85 while the values for the elderly subjects were 6.55 and 6.50 respectively. When each treatment period was considered independently there was a significant difference between young and elderly subjects with regard to compliance. The rates of non compliance (over and under compliance) using a capsule count technique were, however, low with a mean maximum value of 5.8% being recorded for the elderly subjects.

Adult↗
PubMed1992

Exocrine pancreatic insufficiency in presumed healthy elderly subjects.

A pilot study on exocrine pancreatic function, using the 2-day para-aminobenzoic acid (PABA) test, was performed on 21 healthy elderly and 26 healthy young subjects. A PABA excretion index (PEI) less than 55%, indicating moderate to severe exocrine pancreatic insufficiency (EPI), was found in 19% of the elderly group (95% confidence limits 5-42%). While the mean value of the PEI was significantly lower in the elderly compared with the young group (Mann-Whitney Z = 2.8, p less than 0.01), there was no significant difference when the elderly subgroup with PEI less than 55% was excluded. There was no evidence of a generalized moderate to severe decline in pancreatic exocrine function with increasing age; a mild to moderate decline cannot be excluded.

4-Aminobenzoic Acid↗
PubMed1988

Multidisciplinary assessment of applicants for residential accommodation.

Fifty of 62 applicants for residential accommodation underwent assessment at a geriatric day hospital. Twenty-five were suitable, 11 were suitable following rehabilitation and 14 were unsuitable for placement in residential accommodation. Around 35% of all applicants were not assessed. Seventy-nine per cent of assessed applicants, without dementia, either were unsure of how their application had been initiated or did not understand the implications of a move to residential accommodation. Twenty-two per cent of all applicants assessed were taking four or more drugs. To maximise the use of residential accommodation, all applicants should be assessed to reduce inappropriate referrals.

Aged↗
PubMed1983

The effect of age and sex on the response of enteropancreatic polypeptides to oral glucose.

Enteropancreatic polypeptide responses during a 50 g oral glucose tolerance test were studied in 10 young men, 10 young women, 10 elderly men and 10 elderly women. Elderly females had higher gastric inhibitory polypeptide (GIP) responses to oral glucose than elderly males. Elderly males and females had higher fasting and post-glucose human pancreatic polypeptide (HPP) levels than young males and females. N-Glucagon-like immunoreactivity (N-GLI) responses differed between the young and elderly. In the young, N-GLI levels fell after oral glucose but in the elderly they rose. Post-glucose C-glucagon-like immunoreactivity (C-GLI) responses were higher in elderly females than in young females. The significance of the higher plasma levels of GIP, N-GLI and C-GLI following oral glucose in elderly females compared to elderly males is unclear.

Adult↗
PubMed1982

Glucose tolerance in the elderly: the role of insulin and its receptor.

Oral glucose tolerance tests were performed in young and elderly subjects with minimal risk factors for diabetes mellitus. Compared to the normal glucose tolerance in the young there was a 45% rate of impaired tolerance in the elderly. Fasting insulin levels were significantly lower in the elderly but post-glucose insulin responses in the first hour were similar in young and elderly subjects. Peripheral insulin action was assessed in terms of the 125 monoiodoinsulin binding to specific insulin receptor sites on circulating lymphocytes in the young, the elderly and a group of age and sex matched obese maturity-onset diabetics. Specific insulin binding was not significantly different in the elderly than in the young but was significantly lower in the diabetics than the young and the elderly. The results suggest that neither defective insulin binding are major causative factors in the reduced glucose tolerance of the elderly.

Adult↗