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Biomedical subjects

K J Fullerton

Publications and source records attributed to K J Fullerton.

11 recordsLinked to original sources
PubMed2000

Correctable visual impairment in stroke rehabilitation patients.

BACKGROUND: after stroke, visual impairment may exacerbate the impact of other impairments on overall disability and negatively influence rehabilitation. OBJECTIVE: to examine the visual status of patients after stroke and determine whether this can be improved by simple interventions. DESIGN: prospective study. SETTINGS: stroke rehabilitation unit in a Belfast teaching hospital. SUBJECTS: 77 consecutive patients admitted for rehabilitation after acute stroke. METHODS: full optometric and ophthalmic assessment within 2 weeks of admission. RESULTS: of 70 patients with glasses, 19 did not have their glasses in hospital before prompting and 18 had glasses in unacceptable condition. Twenty patients had impaired visual acuity (6/12 or worse) with existing glasses (if helpful); 11 of these improved to better than 6/12 with refractive correction. CONCLUSIONS: stroke professionals need to enquire about patients' spectacles and assess their condition. Patients with reduced visual acuity in the absence of significant non-refractive disease should be referred to an optometrist: in this series 14% of patients had visual impairment which benefited from refractive correction.

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PubMed1999

The winter bed crisis--quantifying seasonal effects on hospital bed usage.

Winter bed crises are a common feature in NHS hospitals, and have given rise to great concern. We set out to determine the relative contribution of seasonal effects and other factors to bed occupancy in a large teaching hospital over one year. There were 190,804 occupied bed-days, which we analysed by specialty groupings. There was considerable variability in bed occupancy in each specialty. A significant winter peak occurred for general medicine and orthopaedics together with a significant increase on 'take-in' days. Virtually all specialties showed a significant variation in occupancy between weekdays. Geriatric Medicine had a high and fairly constant occupancy, with some seasonal effect. We conclude that seasonal trends in bed occupancy occur in 'front door' specialties and are predictable. In these specialties, admission policies also make a contribution to bed usage and are amenable to modification. There is no surge in occupancy in the immediate post-Christmas period, except that attributable to the seasonal trend. In the 'elective' specialties, bed occupancy fluctuates widely, with reduced occupancy at weekends and at Christmas. These differences are entirely amenable to modification. More effective bed management would make a very significant contribution to avoiding winter bed crises.

Bed Occupancy↗
PubMed1992

Fluid balance in elderly patients following acute stroke.

We studied the relationship between plasma osmolality, arginine vasopressin (AVP), and fluid input in patients during the acute phase of a first stroke. Fifteen consecutive patients were studied (median age 79) and their blood sampled on days 0, 1, 2, 3, 7 and 14. Plasma osmolality was related to fluid input over days 0-3 (p = 0.0013) and AVP over 14 days (p less than 0.001). Patients with a poor outcome had higher AVP concentrations (p = 0.02). Those on intravenous fluids received a higher volume (p less than 0.01) and had a lower plasma osmolality (p = 0.04). The results of this preliminary study indicate that a standard regime for fluid input is inappropriate.

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PubMed1991

Stress hormone and blood glucose response following acute stroke in the elderly.

We studied the relation of reactive hyperglycemia, stress hormone response, and outcome in 23 consecutive elderly patients (median age 80 [range 75-92] years) following an acute first stroke. The median delay from the onset of the stroke to the first blood sample (day 0) was 9 (range 4-22) hours. Subsequent blood samples were taken, after fasting, for the determination of blood glucose, cortisol, catecholamine, insulin, C-peptide, glucagon, and lactate concentrations on days 1, 2, 3, 7, 14, 30, and 90. For all 23 patients, a significant relation was found between the blood glucose concentration and survival (p = 0.03) and the blood glucose concentration decreased with time (p less than 0.001). There was also a significant relation between blood glucose concentration and outcome (p = 0.02). For the 15 patients with complete data, the major determinants of the blood glucose concentration were the cortisol, insulin, and glucagon concentrations (all p less than 0.001), which accounted for 42% of the variance. When all the indexes were analyzed together by logistic regression, only the cortisol concentration was related to outcome (p = 0.02). Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response. We have confirmed that hyperglycemia is a predictor of outcome in persons with stroke.

Acute Disease↗
PubMed1988

Blood glucose and prognosis of acute stroke.

To study the relation of blood glucose soon after the onset of stroke and outcome in terms of fatality and functional recovery 6 months later, two prospective studies were performed. Fasting blood glucose measured within 48 hours of onset was significantly higher in those who died than in those who survived. However, random blood glucose, mean daily blood glucose and HbA1 were not related to fatality or functional recovery. Fasting blood glucose levels soon after the stroke were significantly higher than those in the same patients measured 1 month later. These results suggest that the hyperglycaemia related to decreased survival is a stress response rather than an indication of preexisting diabetes mellitus but do not support the view that a high blood glucose level is itself harmful to the brain.

Cerebrovascular Disorders↗
PubMed1988

Osteitis pubis in a 78 year old female.

Osteitis pubis has been reported following pelvic surgery, childbirth and in athletes. We describe a case involving an elderly woman, in which none of the predisposing factors were present. Difficulties in diagnosis, with particular reference to the elderly, are highlighted.

Acute Disease↗
PubMed1988

Prognostic indices in stroke.

Two hundred and six patients with acute stroke admitted consecutively to District General Hospitals, were studied for a period of six months. Significance tests conducted singly detected 21 factors present during the first 48 h of stroke, which were related to outcome six months later in terms of both mortality and functional recovery. Among these significant factors were various measures of perceptual dysfunction, including Albert's Test. Multivariate statistical analysis which included discriminant analysis and linear logistic modelling, revealed six factors (Albert's Test Score, leg function, level of consciousness, arm power, weighted mental score and ECG changes) which were significantly and independently related to outcome. A statistical model based on these factors predicted functional outcome with an overall accuracy of 67 per cent and mortality with an accuracy of 83 per cent. This model provides a useful basis for stratification in future randomized controlled trial in stroke, and may have a role in the management of the individual stroke patient.

Acute Disease↗
PubMed1986

Albert's test: a neglected test of perceptual neglect.

Disorders of perception are thought to be important in predicting the outcome from stroke, but their exact significance is difficult to define because of lack of standardised terminology and diagnostic methods. In a prospective study of 205 unselected stroke patients, perceptual neglect, assessed by a standardised test battery, was found in 49% of patients with lesions of the non-dominant hemisphere and in 25% with lesions of the dominant hemisphere. One component of the test battery was a simple test described by Albert in which patients cross out lines ruled in a standard fashion on a sheet of paper; this was easy to administer and related closely to neglect diagnosed by the test battery as a whole. Results of Albert's test were a significant predictor of both mortality and functional activity six months after the stroke, independent of the influence of other clinical, neurological, laboratory, and social factors. The full test battery for perceptual neglect was of no significant additional predictive value.

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PubMed1986

Postprandial blood pressure reduction in healthy elderly.

Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiovascular homeostasis, we measured sitting systolic blood pressure and heart rate before and at intervals after a noon meal, and in identical fashion without a meal, in 21 healthy, community-dwelling elderly subjects (73 +/- 6 years of age) attending a nutrition program. Systolic blood pressure changed a maximum of -11 +/- 9 (SD) mmHg (P = .006, analysis of variance) by 60 minutes after the meal, in contrast to 1 +/- 7 mmHg (NS) by 60 minutes, when no meal was given (P less than .0001, meal versus control studies). There was a highly significant inverse correlation between postprandial and basal sitting systolic blood pressure changes (R = -0.60, P = .004). Healthy community-dwelling elderly demonstrate postprandial reductions in systolic blood pressure which correlate with basal sitting systolic blood pressure. This is consistent with age- and hypertension-related impairment in baroreflex compensation for the hypotensive stress of eating.

Aged↗