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Biomedical subjects

M E McMurdo

Publications and source records attributed to M E McMurdo.

18 recordsLinked to original sources
PubMed1992

A cost-effectiveness study of the management of intractable urinary incontinence by urinary catheterisation or incontinence pads.

STUDY OBJECTIVE: The aim was to compare the costs and effects of management of intractable urinary incontinence by urinary catheterisation or incontinence pads. DESIGN: This was a prospective, randomised study comparing catheterisation with pads, supplemented by additional data collected from patients with chronic indwelling catheters. Main outcome measures were costs of equipment, nursing time, patient preference, nursing preference, and clinical and bacteriological assessment of urinary infection. SUBJECTS: 78 intractably incontinent elderly female patients were randomly allocated to management by urinary catheter or pads and toileting. Supplementary data on equipment costs and nursing time were collected from 27 patients, of whom 22 were already catheterised at the time of the randomisation and five were catheterised by the nursing staff after the last date for entry into the randomisation. MAIN RESULTS: Of the 38 patients randomised to catheterisation, 14 refused consent so only 24 were catheterised on day 1 of the study. There was a rapid removal of catheters, especially in the first six weeks of the study and only four of the randomised catheter patients completed the full 26 weeks of the study. However, eight of the pads patients were catheterised between the 7th and 22nd week because of deteriorating general condition and all retained their catheters for the remainder of the study period. Of 35 patients who had experienced catheters and pads, 12 expressed a clear preference for catheters, 12 for pads, and 11 were undecided. Nurses were in favour of the use of pads, mainly because of concerns about urinary infection with catheters. Comparing costs for patients managed with catheters (532 patient weeks) or pads (903 patient weeks), catheter patients required less nursing time (15.4 v 29.0 h per patient per week) but equipment costs were higher (19.20-24.65 pounds v 8.79-11.35 pounds per patient per week), mainly because of the cost of catheter care (12.75 pounds per patient per week). Asymptomatic bacteriuria was prevalent in both groups but 73% of catheterised patients received treatment for clinical signs of infection compared with 40% of pads patients. Only 30% of patients who were treated had any generalised symptoms of infection. CONCLUSIONS: Use of catheters reduces nursing time but may increase weekly equipment costs depending on the cost of laundry. Despite the high dropout rate among patients randomised to catheters a minority of patients (12/35) expressed a clear preference for catheters and we believe that more patients with intractable incontinence should be given a trial of catheterisation to assess acceptability. Bacteriuria was prevalent in pads or catheter patients but no major episodes of invasive infection were noted in either group.

Aged↗
PubMed1992

Randomised controlled trial of exercise in the elderly.

Eighty-seven healthy volunteers aged 60-81 years were randomly allocated to either an aerobic exercise class or a health education group. Only 6 subjects dropped out during the 32-week study, and the average compliance with the interventions was 83% for exercise (on average 83/100 individual exercise sessions were attended) and 71% for health education. The health education group showed improvements from the baseline in physical activity levels, pulse rate, blood pressure and self-rating of mood. The exercise group improved from baseline in knee and spine flexibility, leg and back strength, pulse rate, blood pressure, maximum physical exertion levels, self-rating of mood and perceived health status. Between group comparison at the end of the study showed the exercise group significantly better than the health education group in terms of spine flexion (p < 0.0001), perceived health status (p < 0.05), life satisfaction (p = 0.05) and maximal physical exertion (p = 0.01). This study has demonstrated the acceptability and effectiveness of an aerobic exercise class for the elderly, and the effectiveness of health education for this age group.

Aged↗
PubMed1991

Factors affecting physicians' decisions on caring for an incompetent elderly patient: an international study.

OBJECTIVES: To determine what treatment decisions physicians will make when faced with a hypothetical incompetent elderly patient with life-threatening gastrointestinal bleeding and to examine the relative importance of physician characteristics and factors (legal and ethical concerns, hospital costs, level of dementia, patient's age, physician's religion, patient's wishes and family's wishes) in making those decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. MAIN OUTCOME MEASURES: A self-administered questionnaire describing the elderly patient. Respondents were asked to choose one of four levels of care and to identify the level of importance factors had in making that decision. Older physicians, those less concerned about litigation, those for whom the level of dementia was important and those for whom the patient's age was important were expected to give less aggressive care than the other physicians. MAIN RESULTS: Supportive care was chosen by 8.1% of the respondents, limited therapeutic care by 41.5%, maximum therapeutic care without admission to the intensive care unit (ICU) by 32.2% and maximum care with admission to the ICU by 18.2%. The patient's wishes were reported by 91.0% as being extremely or very important in choosing the treatment. Stepwise logistic regression analysis revealed that the following variables independently predicted the level of treatment: level of dementia, country of residence, duration of practice, legal concerns, patient's age and ethical concerns. These factors were significantly correlated with the physicians' treatment choices (p less than 0.05). CONCLUSIONS: The importance that the physicians placed on the level of dementia was the strongest predictor of the level of care that would be provided. A societal consensus on the influence of cognitive function on the appropriate level of care as well as training of physicians in ethical issues are required.

Adult↗
PubMed1991

Variability in physicians' decisions on caring for chronically ill elderly patients: an international study.

OBJECTIVES: To determine what treatment decisions physicians will make when faced with an incompetent elderly patient with life-threatening gastrointestinal bleeding and to identify the factors that affect their decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. OUTCOME MEASURE: A self-administered questionnaire containing three case vignettes. Each provided the same details on an incompetent elderly patient; however, one gave no information about the wishes of the patient and his family (no directive), the second provided a do-not-resuscitate (DNR) request, and the third included a detailed therapeutic and resuscitative effort chart (DTREC) requesting maximum therapeutic care without admission to the intensive care unit (ICU). The four treatment options were supportive care only, limited therapeutic care, maximum therapeutic care without admission to the ICU and maximum care with admission to the ICU. MAIN RESULTS: Treatment decisions varied and were systematically related to age, level of training and country (p less than 0.001). The older physicians and those in family medicine were less likely than the others to choose aggressive treatment options. Brazilian and US physicians were the most aggressive; Australian physicians were the most conservative. The DNR request resulted in a significant decrease in the number of physicians choosing aggressive options (p less than 0.001). The DTREC resulted in a move toward more aggressive treatment, as outlined in the directive (p less than 0.001). Overall, however, about 40% of the physicians chose a level of care different from what had been requested. Furthermore, over 10% would have tried cardiopulmonary resuscitation despite the DNR request. CONCLUSION: Treatment of incompetent elderly patients with life-threatening illness varies widely within and between countries. Uniform standards should be developed on the basis of societal values and be communicated to physicians.

Advance Directives↗
PubMed1991

Dark adaptation and falls in the elderly.

The human eye is capable of adjusting to wide variations in light intensity by altering the pupil size and the sensitivity of the retina to light. Falls are one of the commonest problems of old age, and the causes are multifactorial. As falls often occur at night, this study was designed to compare dark adaptation in groups of elderly fallers and non-fallers. Twenty-two female patients in a geriatric assessment ward were included in the study and classified as 'fallers' or 'non-fallers'. A full ophthalmic examination was performed on each subject, and dark adaptation measured, in a single-blind fashion, using the Friedmann visual field analyser; following initial bleaching of the retinal photoreceptors, the room was placed in total darkness and retinal sensitivity measured every minute for 20 min. The values, expressed as log filter density, were plotted against duration of time in the dark. The mean values at 5 min were 0.9 in the fallers and 1.4 in the non-fallers (p less than 0.02 unpaired t test) and at 20 min 2.2 and 3.2, respectively (p less than 0.04). These results indicate reduced retinal sensitivity and hence impaired dark adaptation in the falling group. Lighting levels in the homes of many old people have been shown to be inadequate. Impaired dark adaptation may leave an elder person virtually blind for a minute or more on moving from a bright room to a darker area. The provision of night lights in the homes of recurrent fallers may offset the influence of impaired dark adaptation.

Accidental Falls↗
PubMed1991

A novel approach to the assessment of drug compliance in the elderly.

A reliable drug history is not always available, and the constant accurate updating of patients' current medication at a Day Hospital may be difficult. This pilot study examined the use of a qualitative thin-layer chromatographic technique (Toxi-Lab system) applied to urine specimens in assessing drug compliance in the elderly. The system proved capable of detecting 36% of prescribed drugs in a group of elderly patients, and offers a novel and inexpensive approach to monitoring compliance with certain medications.

Aged↗
PubMed1989

Sustained-release verapamil: multiple-dose pharmacokinetic comparison of 120-mg and 240-mg tablets and the effect of halving a 240-mg tablet.

Ten healthy male volunteers, aged 18-37 years, entered a balanced crossover comparison of the pharmacokinetic profiles of (a) one 240 mg verapamil HCl sustained-release tablet (Isoptin SR 240, Securon SR) (1 X 240 mg) and (b) either: two half 240-mg verapamil HCl sustained-release tablets (2 X half 240-mg tablets, Study 1) or two 120-mg verapamil HCl sustained-release tablets (Isoptin SR 120) (2 X 120 mg, Study 2). Each phase of the two studies consisted of once-daily administration of verapamil for 8 days with a 1-week washout period between phases. Plasma samples were collected for 24 h after dosing on day 8 of each phase and assayed for verapamil and norverapamil by high-performance liquid chromatography. In both studies there were no significant differences between the mean Cmax, Tmax, and area under curve values observed after the two treatments. There were no significant differences between mean verapamil plasma concentrations at any time during the dose interval. The mean bioavailability of the 120-mg tablet relative to the 240-mg tablet was 107%, with 95% confidence limits of 81 and 142%, indicating that the amount of verapamil available from the two tablets was similar. This investigation indicates that both tablet sizes appear to have similar sustained-release properties and that the formulation retains its sustained-release properties when the tablet is broken.

Adolescent↗
PubMed1988

Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients.

The results of applying the Wartenberg pendulum test to the assessment of muscle tone in populations of stroke and Parkinsonian patients are described. The test was able to distinguish between increased muscle tone of the spastic or rigid type. The Parkinsonian patients showed a marked reduction of the maximum velocity of the leg swing, with the relaxation index tending to a value of about one. In contrast the affected limb of stroke patients showed a lesser reduction of the velocity of the swing, the relaxation index tending to a value of less than one.

Aged↗
PubMed1987

Prolactin response to low dose sulpiride.

1 Prolactin levels in response to sulpiride were studied in healthy volunteers. 2 Oral doses of 1 mg-50 mg sulpiride or placebo were given. 3 A 3 mg sulpiride dose produced similar levels to those achieved with both 10 mg and 50 mg. 4 Circadian effects were studied showing no significant differences in the prolactin response to sulpiride. 5 Acute or chronic responses showed an attenuation with chronic sulpiride treatment to 50% of the peak levels attained with acute treatment. 6 These results indicate that sulpiride retains its potent ability to produce prolactin release even at the low doses studied here.

Adolescent↗
PubMed1986

Survival after severe self poisoning with sodium valproate.

A 48 year old patient deliberately poisoned herself with 25 g of sodium valproate and survived with supportive measures only. This case contradicts the experience of those who advocate aggressive management of such severe overdoses.

Female↗
PubMedDate not supplied

Multiple dose comparison of a whole 240 mg verapamil sustained-release tablet with two half tablets.

Twelve healthy male volunteers were studied in a balanced crossover comparison of an intact 240 mg verapamil sustained-release tablet (Securon SR, Isoptin Forte Retard) given once daily for 7 days, and the same dose given as two half tablets. One subject was withdrawn because of asymptomatic second degree heart block on day 3 of verapamil treatment. The mean Cmax after dosing with whole tablets, 143 (95 per cent confidence limits 91.6-223) ng ml-1 was lower than after dosing with half tablets, 160 (107-241) ng ml-1, but this was not significant (p = 0.49). The mean steady-state Cmin values after whole and half tablets were also similar: 22.2 (12.6-39.4) ng ml-1 and 22.0 (16.2-29.9) ng ml-1, respectively (p = 0.96). The mean (+/- S.D.) tmax, AUC0-24 and t 1/2 were not significantly different: whole tablet 3.5 +/- 1.2 h, 1733 +/- 1125 ng.h ml-1 and 10.5 +/- 3.4 h, respectively, and half tablets 3.6 +/- 1.0 h, 1780 +/- 1057 ng.h ml-1 and 9.6 +/- 2.3 h, respectively. The findings for plasma norverapamil were generally similar to those for the parent drug. This investigation indicates that the formulation is sufficiently robust to retain its sustained-release properties when the tablet is halved.

Adult↗
PubMedDate not supplied

The effects of once-daily dosing with ranitidine and cimetidine on theophylline pharmacokinetics.

Twelve healthy non-smokers (7M and 5F) completed a balanced three-way crossover investigation designed to characterise the influence of oral cimetidine (800 mg), ranitidine (300 mg) and placebo pretreatment for 7 days on the pharmacokinetics of a 250 mg single oral dose of theophylline. The oral clearance of theophylline after ranitidine pretreatment, 4.55 +/- 1.69 l/h (mean +/- SD) was indistinguishable from that after placebo, 4.78 +/- 1.96 l/h, but cimetidine was associated with a significant 21% reduction in theophylline clearance, 3.58 +/- 1.07 l/h (P = 0.006). There was a correspondingly significant increase in the terminal half-life of theophylline following cimetidine, 6.11 +/- 1.29 h (P = 0.017), compared with 5.05 +/- 1.43 h and 4.88 +/- 1.45 h for placebo and ranitidine, respectively. There was no change in maximum theophylline concentration or time to maximum but following cimetidine the plasma theophylline levels between 4 and 12 hours were 15-50% higher than following placebo (P less than 0.002). These data indicate a significant interaction between 800 mg cimetidine given once daily and theophylline which is likely to be the result of enzyme inhibition. Once-daily dosing with 300 mg ranitidine had no significant effect on theophylline pharmacokinetics.

Administration, Oral↗