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Biomedical subjects

J Lavan

Publications and source records attributed to J Lavan.

11 recordsLinked to original sources
PubMed1997

The prognostic significance of delirium in older hospital patients.

OBJECTIVES: To determine whether delirium is an independent predictor of adverse outcomes of hospitalization in older patients. DESIGN: Cohort study. PATIENTS: A total of 225 people admitted as an emergency to an acute geriatric unit in a university teaching hospital. METHODS: Subjects were screened for delirium, defined by Diagnostic and Statistical Manual, 3rd Edition criteria, every 48 hours. Outcome measures included mortality, duration of hospital stay, hospital-acquired complications, and institutional placement. The influence of delirium on these outcomes was calculated after adjusting for age, illness severity on admission, burden of comorbidity, prior cognitive impairment, and level of disability. RESULTS: Delirium was present on admission in 41 patients (18%) and developed after admission in a further 53 patients (24%). Patients with delirium were more likely than non-delirious patients to have chronic cognitive impairment, severe acute illness, multiple comorbid conditions, and functional disability. Nevertheless, in multivariate analyses adjusting for these factors, delirium was independently associated with prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital-acquired complication, and with increased admission to long-term care. CONCLUSION: Delirium is an independent predictor of adverse outcomes in older hospital patients.

Aged↗
PubMed1991

Rehabilitation of the elderly amputee.

A rehabilitation service based in a department of geriatric medicine and dealing exclusively with amputees aged 65 years or over, is described. Provision of prostheses has been expedited, and the multi-disciplinary approach of the department has been beneficial in rehabilitation especially of the amputee with multiple pathology. The experience of the first 146 patients with an average age of 74.1 years is reviewed. Discharge home was achieved in 77.6% of the patients provided with a prosthesis and in a small multi-centre study of the post discharge status of 20 elderly amputees it was found that over 90% used their prosthesis regularly and the great majority were independent in the activities of daily living. Although BKA (Below knee amputation) is preferable to AKA (Above knee amputation), the functional benefit in this age group is not always as significant as traditional attitudes would suggest whereas a failed BKA has serious consequences in terms of psychological impact, morbidity and length of hospital stay. In order to minimise the number of BKA's requiring revision or re-amputation every effort should be made to ensure that the initial procedure is carried out by a surgeon with experience of amputation in this age group. Limb provision is cost effective and the frequent difficulty with regard to the financing of prostheses for elderly amputees is counter-productive.

Aged↗
PubMed1988

Chronic dose urinary and serum pharmacokinetics of norfloxacin in the elderly.

1. Norfloxacin was administered as two daily 400 mg oral doses to eight elderly patients requiring treatment for urinary tract infections. Blood specimens were obtained for pharmacokinetic profiles following the first and fifteenth doses. Further specimens were obtained before each morning's dose of norfloxacin. Specimens of urine were obtained to ascertain if adequate antimicrobial concentrations were reached in these patients with diminished renal function. 2. Norfloxacin half-life was consistent with that expected in mild renal impairment and was not different between the first and fifteenth doses. Based on ratios of AUC values, accumulation is probably related to renal function, being greatest for creatinine clearance values below 30 ml min-1. 3. On the great majority of occasions, the urinary concentrations of norfloxacin exceeded 20 micrograms ml-1. On days 2-7, the mean percentage 12 h renal elimination of norfloxacin was 18.6 +/- 1.47 (mean of 82 separate observations). Norfloxacin 400 mg twice daily was well tolerated in this group of elderly patients and produced adequate antimicrobial concentrations in urine.

Aged↗
PubMed1985

Protein binding and disposition of lignocaine in the elderly.

Single dose studies were performed in six young and six elderly nonsmokers using lignocaine as a model drug with high intrinsic clearance. Subjects received lignocaine 250 mg orally and 50 mg intravenously in random order and drug concentrations in blood and plasma were measured for up to 8 h after dose. Protein binding was estimated at 37 degrees C by equilibrium dialysis. Indocyanine green kinetics were also calculated in each individual following 0.15 mg/kg intravenously. Bioavailability of lignocaine was greater in the elderly but there was no apparent difference in the rate of absorption. Intrinsic clearance of lignocaine was lower in the aged. Elimination half-life was longer in the elderly but there was no significant difference in apparent volume of distribution or systemic clearance of lignocaine. Plasma clearance of indocyanine green showed no correlation with systemic lignocaine clearance and was lower in the aged subjects. Blood/plasma lignocaine ratio was less than unity in both groups. Binding of lignocaine to plasma proteins showed concentration-dependence and was higher in the geriatric group. Maximum binding capacity of lignocaine was greater in the elderly but the binding affinity did not significantly change with age. Greater oral bioavailability of drugs like lignocaine may produce higher plasma concentrations in the elderly. Unlike indocyanine green, the systemic clearance of lignocaine was unaltered by age in this group of non-smokers. The protein-binding of lignocaine, like many other basic drugs, is increased in elderly subjects.

Adult↗
PubMed1984

Use of computed tomography in the percutaneous drainage of abdominal abscesses.

The technique of computed tomographic guided drainage of abdominal abscesses is simple, and is becoming increasingly available. Obvious advantages include the avoidance of general anaesthesia and major surgery. Three illustrative cases of the drainage of abscesses in different locations are presented together with a description of the technique.

Abdomen↗
PubMed1980

Theophylline kinetics in relation to age: the importance of smoking.

1 Single dose studies of theophylline kinetics were compared in groups of young and elderly smokers and non-smokers to assess the effect of age on theophylline absorption and the effect of smoking on drug metabolising enzyme activity in old age. 2 The rate and extent of absorption was not affected by age. Distribution and elimination kinetics were similar in young and elderly non-smokers. 3 In young subjects the elimination half-life of theophylline was shorter and clearance was significantly greater in smokers than in non-smokers. 4 In the elderly mean elimination half-life was significantly shorter in smokers and their plasma clearance was 40% higher than in non-smokers. The statistical difference for clearance was at the 7% level of significance. 5 These data indicate that ageing per se does not affect theophylline elimination and also that induction of theophylline metabolism due to smoking occurs in old age. Smoking is a variable that should be taken account of when assessing drug metabolism in elderly patients.

Absorption↗
PubMed1979

Digoxin in the elderly: pharmacokinetic consequences of old age.

A study of single-dose digoxin kinetics was performed in 6 young and 7 elderly patients. The rate of absorption, determined by the time to peak concentration after an oral dose, was more rapid in the younger group. The extent of absorption, as measured by comparison of the area under the plasma concentration/time curve after oral and intravenous administration, was similar in both groups. Mean plasma half-life was longer and individual values were more variable in the elderly patients. The absolute apparent volume of distribution was reduced in the older patients and correlated inversely with age. When corrected for weight, however, the difference in the apparent volume of distribution did not approach significance. Both absolute and weight-corrected values for plasma clearance of digoxin were reduced in the elderly subjects.

Administration, Oral↗
PubMedDate not supplied

CT-guided percutaneous biopsy.

Percutaneous biopsy procedures using current imaging methods are becoming increasingly popular. The result of a percutaneous biopsy may lead to a total rejection of surgery, and dictate appropriate palliative therapy in a patient with incurable malignant disease; in others, it will allow more precise preoperative planning. The techniques of percutaneous computed tomographic biopsy procedures is discussed, along with its advantages and disadvantages in comparison with other imaging methods.

Biopsy, Needle↗