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N Coni

Publications and source records attributed to N Coni.

11 recordsLinked to original sources
PubMed1999

An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea.

BACKGROUND: antibiotic-associated diarrhoea caused by Clostridium difficile is increasing in hospitals, and older people are at particular risk. OBJECTIVE: to establish whether reducing patient exposure to injectable third-generation cephalosporins by substituting alternative antibiotics can produce a cost-effective reduction in the incidence of antibiotic-associated diarrhoea. DESIGN: we prospectively investigated 2157 patients admitted to the department of elderly medicine in the year before introduction of antibiotic restrictions and 2037 patients admitted in the following year. Patients admitted to other wards, where antibiotic prescribing was unchanged, acted as controls. SETTING: a 900-bed teaching hospital in Cambridge, UK. MEASUREMENTS: use and cost of injectable antibiotics prescribed in the department of elderly medicine and the other wards studied; occurrence of C. difficile-associated diarrhoea. RESULTS: in the wards for older people, consumption of injectable cephalosporins fell by 92% (compared with 8% on other wards) and cases of C. difficile-associated diarrhoea fell from 98 to 45 (cases in other wards rose from 213 to 253; P < 0.001). The Pound Sterling 8062 increase in injectable antibiotic costs on the elderly wards were offset by the release of 1087 wasted bed-days attributable to the 53 fewer cases, with potential savings of Pound Sterling 212,000. CONCLUSIONS: restricting the consumption of injectable third-generation cephalosporins is a cost-effective method of reducing the incidence of C. difficile-associated diarrhoea.

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PubMed1998

A rude awakening: post-take ward round in the department of medicine for the elderly.

This paper describes the post-take ward round of a department of medicine for the elderly (DME), to portray the nature of the medical admissions and their immediate management. The data concern the patients seen by one consultant in 28 such ward rounds during the last four months of 1997, in a teaching hospital where the DME is separate from the department of general internal medicine. 254 patients were seen, 107 men and 147 women, with an average age of 82.4 years (range 73-102). The decisions taken included diagnosis, further investigations, treatment, referral, discharge, and resuscitation status. Very few admissions were judged inappropriate, particularly among the majority referred by general practitioners. 101 patients were thought suitable for transfer to the department of general internal medicine, 109 definitely unsuitable. These findings support the view that, if medical beds are to be freed, the initiative must come from facilitating discharge rather than curtailing admission. Generalists are needed to sort and manage these patients. In the UK, these will often be general internal medicine consultant geriatricians, while the younger patients are seen by consultants practising general internal medicine in addition to one of the specialties. Sizeable numbers of these consultants are needed if the post-take ward round is to be efficient and not conflict with their fixed commitments.

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PubMed1996

Tetanus immunisation in the elderly population.

OBJECTIVE: To emphasise that tetanus still occurs in the United Kingdom, particularly in elderly people-as illustrated by two case reports-and to examine the state of tetanus immunity in elderly people. METHODS: 111 elderly people (over 65 years) were studied: 43 males, mean age 77.7 years, range 67-94; 68 females, mean age 81.3 years, range 67-95. They were either attending the accident service or were hospital inpatients. An attempt was made to obtain an immunisation history and antitetanus antibody titres were measured. RESULTS: Immunisation history was uncertain and unreliable. Measurement of antibody titres showed that they were inadequate to ensure protection in 50% of those studied. Low levels were particularly prevalent in the over 80 age group and in females. Questioning about military service confirmed that this had predominantly involved males. CONCLUSIONS: Elderly people are at risk of contracting tetanus and should be targeted for community immunisation. Extra precautions in the form of passive immunisation with human anti-tetanus immunoglobulin should be used in this age group in addition to the usual wound management measures when the elderly sustain tetanus prone injuries.

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PubMed1992

Prevalence of lower extremity arterial disease among elderly people in the community.

To estimate the prevalence of lower extremity arterial disease, all patients aged over 65 years registered with a rural general practice near Cambridge were invited to attend for examination of the circulation to the lower extremities; 265 subjects (80%) accepted. Three methods were used to investigate the presence of lower extremity arterial disease - enquiring about symptoms of intermittent claudication; clinical examination (and particularly the detection of arterial bruits); and pressure index calculations from measurements of the ankle and brachial systolic blood pressure using a Doppler ultrasound probe. When examining the legs, the presence of a bruit was taken as stronger evidence of disease than inability to palpate the pulses which may be difficult or impossible to detect for a number of reasons. Forty seven of the 264 patients examined (18%) showed evidence of lower extremity arterial disease. Seven patients showed unequivocal evidence of lower extremity arterial disease as demonstrated by all three criteria, 12 by two criteria and 28 patients on one criterion alone. While the pressure index followed a normal distribution curve, there was a tendency for it to decline with age. Other risk factors which showed a correlation with evidence of disease including current, but not previous, cigarette smoking, and a history of stroke. The significance of the findings is discussed in the context of some degree of arterial pathology in many British subjects in this age group.

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PubMed1990

Magnetic resonance imaging of the brain and brain-stem in elderly patients with dizziness.

Twenty elderly patients (mean age 82 years) with dizziness were examined by magnetic resonance imaging (MRI). The findings have been compared with those from nine healthy subjects of similar age who acted as a control group. The technique proved acceptable to all these patients, and in the majority (65%) the overall radiographic quality of the resulting images was adequate, good or excellent. Nineteen of the 20 patients showed evidence of abnormal high signal intensity within white matter, often close to the frontal horns but also more widely scattered within the cerebral hemispheres; similar lesions were seen in the brain-stem in eight of the patients. However these white matter changes were equally prevalent in the control group. No cause for dizziness has been shown by MRI.

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PubMed1985

Alive and well: geriatric medicine in the U.K. in 1984.

The function of the hospital geriatric service in the U.K. is described within the context of the overall support for the frail, disabled, and sick elderly in this country. It plays an important part in the secondary care of the very old, and perhaps an even more important part educating the public and the profession to the needs of this rapidly expanding section of the population. A short account is given of the nature of geriatric medicine and the role of the consultant geriatrician. The history, achievements, and current status of the specialty are briefly reviewed, and some of the directions which future developments may take are indicated. Whether or not a comprehensive separate service on the U.K. model emerges in other countries, it is certain that they will need centres of geriatric expertise to pursue research and to provide education and enlightenment for all concerned with the medical problems of old age.

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