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Biomedical subjects

N Foley

Publications and source records attributed to N Foley.

6 recordsLinked to original sources
PubMed2001

Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients.

OBJECTIVE: To determine the characteristics of and complications in the rehabilitation of stroke patients in whom percutaneous gastrojejunostomy (PGJ) feeding tubes have been placed. DESIGN: Retrospective cohort study. SETTING: A rehabilitation unit in a tertiary care hospital. PARTICIPANTS: Stroke patients (n = 563) admitted to a tertiary care hospital over a 10-year period. INTERVENTION: PGJ feeding tubes. MAIN OUTCOME MEASURES: Evidence of aspiration in all videofluoroscopic modified barium swallow (VMBS) studies was noted. For patients with a PGJ feeding tube, the following were recorded: stroke location; results of subsequent VMBS reports; length of time from stroke onset to PGJ feeding tube insertion; total time the PGJ feeding tube remained in situ; discharge disposition; and concurrent feeding status. Follow-up was at 1-year poststroke. Complications during the inpatient stay attributable to the PGJ feeding tube were recorded. RESULTS: Thirty-two of all 563 (5.7%) stroke patients admitted and 28 of the 115 (24.3%) proven aspirators, as shown on VMBS studies, had a PGJ feeding tube inserted. Twenty-one of the 563 (3.7%) stroke patients were discharged to the community with PGJ feeding tubes in place. The tubes were inserted on average 37 days after stroke onset. Seventeen of all 88 (19.3%) brainstem stroke patients and 15 of all 29 (51.7%) brainstem stroke patients with documented aspiration had feeding tubes inserted, whereas only 15 of 475 (3.2%) hemispheric stroke rehabilitation patients received a tube. Eleven of 32 (34.3%) patients with a feeding tube were able to resume oral feedings at discharge; within 1 year of discharge, 24 of 32 (75%) had done so. Although there were no serious complications resulting from tube insertions, minor complications were documented in more than 50% of the cases. The tubes were associated with prolonged institutionalization in only 1 case; most patients were discharged on a home tube-feeding program. CONCLUSIONS: PGJ feeding tubes were placed in approximately 1 of every 20 of our stroke rehabilitation patients. One third of the tubes were removed before the patients were discharged from rehabilitation and 75% were removed within 1 year. Insertion of the tubes was most common in patients with evidence of aspiration and in patients with brainstem strokes. Complications caused by the tube were minor and all patients but 1 who were discharged with feeding tubes were able to manage the home tube-feeding program.

Cohort Studies↗
PubMed2001

Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients.

OBJECTIVE: To examine factors associated with the use of ankle-foot orthoses (AFOs) in stroke patients undergoing rehabilitation. DESIGN: Retrospective cohort study of the frequency of AFO use. SETTING: Inpatient rehabilitation unit. PARTICIPANTS: Consecutive stroke patients (n = 423) admitted to an inpatient rehabilitation unit over a 10-year period. INTERVENTION: Discharge with AFO. MAIN OUTCOME MEASURES: Functional outcome measurement scores of patients who were and who were not prescribed an AFO were examined. The groups were compared by using admission and discharge Chedoke-McMaster Stroke Impairment Inventory (CM; each measure analyzed separately), FIMtrade mark instrument (walking, stairs, overall measures), and Berg Balance Scale scores. RESULTS: Ninety-three of the 423 patients (22%) were discharged with an AFO. Overall, they scored consistently lower than patients who were discharged without an AFO. Statistically significant differences (p <.001) were noted between AFO users and nonusers in admission and discharge scores in the arm, hand, leg, and foot components of the CM and the FIM stairs and walking component scores. Average admission and discharge Berg scores differed between the 2 groups (p =.005, p =.013, respectively). Overall FIM scores were also significantly different both at admission and discharge (p <.001, p =.025, respectively). CONCLUSION: Use of AFOs at discharge was associated with significantly lower admission and discharge CM scores of the arm, hand, leg, and foot; FIM walking and stairs scores; total FIM scores; and Berg Balance Scale scores.

Activities of Daily Living↗
PubMed1990

An inhibitor of the toxicity of tumour necrosis factor in the serum of patients with sarcoidosis, tuberculosis and Crohn's disease.

The activated macrophages present in the T cell-dependent granulomata of sarcoidosis and tuberculosis are primed for enhanced release of cytokines including tumour necrosis factor (TNF or cachectin). Release of this cytokine can induce an acute-phase response, fever, and necrosis in suitably prepared sites of inflammation; if chronic, its presence may contribute to weight loss. These clinical features are characteristic of tuberculosis, but not of sarcoidosis, though alveolar macrophages from both diseases release large quantities of TNF in vitro. We therefore postulated the presence in sarcoidosis patients of an inhibitor of TNF. We have studied levels of TNF inhibitory activity by determining the quantity of TNF required to give 50% kill of L929 cells in the presence of 20% heat-inactivated serum derived from various disease states (37 sarcoidosis, 13 tuberculosis, 13 Crohn's disease, 17 healthy donors). Normal sera used in this way do not inhibit significantly, but inhibition of TNF toxicity is caused by most sera from both sarcoidosis and tuberculosis. Used at 20%, five out of 37 sarcoidosis sera and one out of 13 tuberculosis sera caused complete inhibition of TNF, even when the latter was added at 100 times the concentration required to give 50% kill in control wells. This inhibitor may have an important physiological role.

Acute-Phase Proteins↗
PubMed1989

The role of cytokines in the immunopathology of tuberculosis, and the regulation of agalactosyl IgG.

Tuberculosis is characterised by necrosis in the lesions and in skin-test sites, and by fever and weight loss. In contrast, other diseases with chronic T cell mediated responses, such as uncomplicated leprosy and sarcoidosis, have non-necrotising lesions with little systemic upset. Crude sonicates of M. tuberculosis and M. leprae prepare skin sites for TNF-mediated damage via a pathway which unexpectedly appears to involve CD8+ T cells, and both mycobacteria contain potent triggers of TNF release (lipoarabinomannan and peptidoglycan derivatives). These observations can partially explain the pathology of tuberculosis, but fail to explain why similar events do not normally occur in leprosy. It now seems likely that the answer lies in the existence of novel regulatory pathways. A recently recognised correlate (or consequence) of diseases characterised by T cell-dependent tissue-damaging pathology and cytokine release, is an increase in the level of agalactosyl IgG. This behaves like a T cell-dependent acute phase reactant, and is raised in tuberculosis, rheumatoid arthritis, and Crohn's disease, but not in sarcoidosis or uncomplicated leprosy. Thus it may act as a marker for a type of pathology of very broad significance, though its functional role remains obscure.

Animals↗
PubMedDate not supplied

Energy and protein intakes of acute stroke patients.

BACKGROUND: Although protein-energy malnutrition has been cited as a frequent complication following stroke, there is very little data describing nutritional intake among hospitalized patients. OBJECTIVE: To report: i) the level of protein and energy intake, ii) the adequacy of intake during the first 21 days of hospitalization and iii) to examine the differences in nutritional intake associated with diet type (regular texture, texture-modified and enteral feeding). DESIGN: Prospective observational study of an inception cohort. The energy and protein intakes of well-nourished patients with recent onset of first time stroke were assessed at admission to hospital and at days 7, 11, 14 and 21. Adequacy of energy intake at each of these intervals was expressed as a percentage (actual intake/energy requirement assessed by indirect calorimetry x 100). Adequacy of protein intake was assessed in a similar manner, with 1 g/kg of actual or adjusted body weight used to estimate requirement. The nutritional intakes of patients receiving regular diets, dysphagia diets and enteral tube feedings were compared using one-way ANOVA. RESULTS: The average energy intakes of the entire study group ranged from 19.4-22.3 Kcals/kg/day over five observation points, representing 80.3-90.9% of measured requirements; protein intake and ranged from 0.81-0.90 g/kg day yielding adequacy of intake of 81-90% of requirement. There were significant differences in energy intakes and/or adequacy of intake of patients receiving different diet types at days 11, 14 and 21 (p < 0.05) and differences in protein intake and/or adequacy of protein intake at all intervals except admission (p < 0.05). Patients receiving enteral tube feedings consumed more calories and protein compared to those patients on regular or dysphagia diets. CONCLUSIONS: On average, newly diagnosed, well-nourished, hospitalized patients consumed 80-91% of their both their energy and protein requirements, in the early post stroke period.

Aged↗