PubMed Health⌕ Search

Biomedical subjects

Olav Sletvold

Publications and source records attributed to Olav Sletvold.

15 recordsLinked to original sources
PubMed2006

Randomised trial of in-hospital geriatric intervention: impact on function and morale.

BACKGROUND: In two previous publications, we have shown that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) compared to treatment in the general Medical Wards (MW) reduced mortality and improved the chances of living at home in contrast to living in nursing homes or being dead. OBJECTIVE: The aim of this presentation was to study the impact on function, symptoms of depression and general well-being of treatment in the GEMU as compared to treatment in MW. METHODS: Acutely sick, frail patients aged >or=75 years, admitted as emergencies to the Department of Internal Medicine, were randomised either to treatment in the GEMU (n = 127) or the MW (n = 127). In the GEMU the treatment strategy emphasised comprehensive interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilisation, rehabilitation and discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. Activities of daily living (ADL), instrumental ADL, cognitive function, symptoms of depression and general well-being were assessed 3, 6 and 12 months after discharge from hospital. RESULTS: There was no difference in function, depression or general well-being in the GEMU as compared to the MW group. If the dead were included in the analysis at the highest ADL dependency level, there was better function in the GEMU group at 3 months (p = 0.03). CONCLUSION: Treatment in the GEMU had no measurable beneficial impact on function, morale or symptoms of depression. Taken the previously shown mortality reduction into consideration an additional effect on function was less likely and the overall treatment effect was considered to be positive.

Activities of Daily Living↗
PubMed2005

Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study.

OBJECTIVE: This study's objective was to determine whether patients treated in a geriatric evaluation and management unit (GEMU) had a more appropriate drug profile than patients treated in the general medical wards (MW). METHODS: Frail elderly patients admitted as emergencies to the medical department were randomised to treatment in the GEMU (n=127) or MW (n=127). Drugs used at inclusion and discharge were registered retrospectively and analysed with regard to polypharmacy, number of drugs withdrawn or started, potential drug-drug interactions (DDIs), number of anticholinergic drugs prescribed, and the number of inappropriate drug prescriptions according to Beers' criteria. Utilisation of psychotropic and cardiovascular drugs was compared in detail according to prespecified hypotheses. RESULTS: The number of patients with polypharmacy did not differ significantly between the GEMU and MW. The median number of scheduled drugs withdrawn per patient was higher in the GEMU than in the MW (p=0.005). Drugs with anticholinergic effects (p=0.003); cardiovascular drugs (p<0.001), particularly digitalis glycosides (p<0.001); and antipsychotic drugs (p=0.009) were withdrawn more often in the GEMU. The median number of scheduled drugs started was higher in the GEMU than in the MW (p=0.03). In particular, antidepressants (p<0.001) and estriol (p=0.001) were started more often in the GEMU than in the MW. Fewer GEMU than MW patients had potential DDIs at discharge (p=0.009). CONCLUSION: Drug treatment in the GEMU as compared with the MW was more appropriate in terms of prescription of fewer drugs with anticholinergic effects and fewer potential DDIs. There were distinct differences in treatment patterns of cardiovascular and psychotropic drugs.

Aged↗
PubMed2004

[Side effects off allopurinol].

Allopurinol is generally considered to be a safe and well tolerated drug. We report one patient with a serious effect from allopurinol, a serious exfoliative rash and signs of allopurinol hypersensitivity syndrome. Only after considerable diagnostic delay and patient morbidity, signs and symptoms were associated with the drug. The patient recovered when the medication was withdrawn. Data from the Norwegian reporting system for side effects of drugs for the period 1973-2003 show a wide range of side effects of allopurinol and even some fatalities. The indication for treatment must be carefully considered. Impaired renal function, ampicillin and thiazide diuretics increase the risk of serious hypersensitivity reactions.

Aged↗
PubMed2004

Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study.

BACKGROUND AND AIMS: Exercise in older people may reduce falls and improve functional abilities. Less is known about the optimal amount of training. The aim of this study was to determine the effectiveness of home training, and whether group training in addition to home training enhances the effect. METHODS: This randomized trial included 77 persons aged 75 years and older (mean 81, SD 4.5), living at home. Home training (HT) comprised twice-daily functional balance and strength exercises and 3 group meetings. Combined training (CT) included group training twice weekly and the same home exercises. The trial lasted 12 weeks. Physical therapists ran both programs. Exercises and falls were recorded daily. We assessed function at baseline, 3 and 9 months, and falls at one year. RESULTS: Mean participation for group meetings was 2.5 out of 3 (HT group) and, for group training sessions, 21 out of 24 (CT group). The mean numbers of daily home sessions were 1.29 and 1.35 in the HT and CT groups. Overall improvement, but no group differences, were found at 3 months for walking speed, Figure of Eight, Timed Up & Go, Maximum Step Length, Timed Pick-up and Sit-to-stand (p<0.02). Posturography (p=0.85) and isometric quadriceps strength (p=0.26) showed no improvement. Function at 9 months was equivalent to baseline level. There were no group differences in fall rate (p=0.78) or time to first fall (p=0.84). CONCLUSIONS: Daily home training supervised by physical therapists improved functional abilities. Supplementary individualized group training gave no additional effect. The effect on function was not present 6 months after the end of the intervention.

Accidental Falls↗
PubMed2004

Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study.

BACKGROUND AND AIMS: In a previous publication, we showed that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) reduced mortality considerably when compared with the general Medical Wards (MW). The aim of this presentation was to study the impact of treatment in a GEMU on health care utilization. METHODS: Acutely sick, frail patients, 75 years or older, who had been admitted as emergencies to the Department of Internal Medicine were randomized either to treatment in the GEMU (n=127) or to continued treatment in the MW (n=127). While usual treatment was given in the MW, the GEMU emphasized interdisciplinary and comprehensive assessment of all relevant disorders, early mobilization/rehabilitation, and discharge planning. After discharge from hospital, no specific follow-up was offered to any of the groups. RESULTS: Of all subjects, 101 (80%) GEMU and 79 (64%) MW patients were still living in their own homes at three months (p=0.005); at six months the number was 91 (72%) and 74 (60%) (p=0.04) respectively. Median length of index stay was 19 days in the GEMU and 13 days in the MW group (p<0.001). After the initial stay, there were no statistically significant differences in admissions to or time spent in institutions. CONCLUSIONS: The results indicate the overall positive treatment effect of acutely sick, frail elderly in a GEMU, i.e. patients treated in the GEMU had increased possibilities of living in their own homes, an effect that was mainly related to considerably reduced mortality in the GEMU group.

Aged↗
PubMed2004

Home training with and without additional group training in physically frail old people living at home: effect on health-related quality of life and ambulation.

OBJECTIVE: To test the effect of two exercise regimes on health-related quality of life (HRQoL) and ambulatory capacity. DESIGN: Randomized controlled trial. SUBJECTS: Seventy-seven community-dwelling physically frail people over 75 years of age (mean = 81, SD = 4.5). INTERVENTIONS: Home training (HT, N= 38) comprised twice daily functional balance and strength exercises and three group meetings. Combined training (CT, N= 39) included group training twice weekly and the same home exercises. Interventions lasted 12 weeks. Physiotherapists ran both programmes. Home exercises were recorded daily. MAIN MEASURES: HRQoL was assessed by SF-36, and ambulatory capacity by walking speed and frequency and duration of outdoor walks. RESULTS: Following intervention, CT improved the SF-36 mental health index significantly more than HT (p = 0.01). The SF-36 physical health index (p = 0.002) and walking speed (p = 0.02) demonstrated improvements, but no group differences. Six months after cessation of intervention there was still overall improvements on the mental health index (p = 0.032), borderline overall improvements on the physical health index (p = 0.057), higher weekly number of outdoor walks for the CT group than for the HT group (p = 0.027) and an improved habitual walking speed in the CT group only (p = 0.022). CONCLUSIONS: HT improved HRQoL and walking speed, but additional group training gave larger benefits on mental health. Group training away from home may be beneficial for mental health and ambulatory capacity.

Activities of Daily Living↗
PubMed2003

LMNA mutations in atypical Werner's syndrome.

BACKGROUND: Werner's syndrome is a progeroid syndrome caused by mutations at the WRN helicase locus. Some features of this disorder are also present in laminopathies caused by mutant LMNA encoding nuclear lamin A/C. Because of this similarity, we sequenced LMNA in individuals with atypical Werner's syndrome (wild-type WRN). METHODS: Of 129 index patients referred to our international registry for molecular diagnosis of Werner's syndrome, 26 (20%) had wildtype WRN coding regions and were categorised as having atypical Werner's syndrome on the basis of molecular criteria. We sequenced all exons of LMNA in these individuals. Mutations were confirmed at the mRNA level by RT-PCR sequencing. In one patient in whom an LMNA mutation was detected and fibroblasts were available, we established nuclear morphology and subnuclear localisation. FINDINGS: In four (15%) of 26 patients with atypical Werner's syndrome, we noted heterozygosity for novel missense mutations in LMNA, specifically A57P, R133L (in two people), and L140R. The mutations altered relatively conserved residues within lamin A/C. Fibroblasts from the patient with the L140R mutation had a substantially enhanced proportion of nuclei with altered morphology and mislocalised lamins. Individuals with atypical Werner's syndrome with mutations in LMNA had a more severe phenotype than did those with the disorder due to mutant WRN. INTERPRETATION: Our findings indicate that Werner's syndrome is molecularly heterogeneous, and a subset of the disorder can be judged a laminopathy.

Adolescent↗
PubMed2003

The pentylenetetrazole-kindling model of epilepsy in SAMP8 mice: glial-neuronal metabolic interactions.

Recently, a new experimental model of epilepsy was introduced by the authors [Neurochem. Int. 40 (2002) 413]. This model combines pentylenetetrazole (PTZ)-kindling in senescence-accelerated mice P8 (SAMP8), a genetic model of aging. Since imbalance of glutamate and GABA is a major cause of seizures, the study of glial-neuronal interactions is of primary importance. Nuclear magnetic resonance spectroscopy (NMRS) is an excellent tool for metabolic studies. Thus, we examined whether NMRS when combined with administration of [1-13C]glucose and [1,2-13C]acetate might give valuable insights into neurotransmitter metabolism in this new model of epilepsy and aging. The 2- and 8-month-old SAMP8 were kindled with PTZ alone, received PTZ and phenobarbital (PB), or served as controls. In older animals, PTZ-kindling decreased labeling in glutamate C-4 from [1-13C]glucose, whereas, in the younger mice, labeling in glutamine C-4 was decreased both from [1-13C]glucose and [1,2-13C]acetate. It could be concluded that PTZ-kindling affected astrocytes in younger and glutamatergic neurons in older animals. In the presence of PTZ, phenobarbital decreased labeling of most metabolites in all cell types, except GABAergic neurons, from both labeled precursors in the younger animals. However, in older animals only GABAergic neurons were affected by phenobarbital as indicated by an increase in GABA labeling.

Acetic Acid↗
PubMed2003

Astrocyte metabolism is disturbed in the early development of experimental hydrocephalus.

The proper diagnosis of the arrested or the progressive form of hydrocephalus has a critical impact on treatment, but remains difficult. The assessment of early changes in cerebral metabolism might help in the development of adequate non-invasive diagnostic tools. This study examined the alterations in label incorporation in neurotransmitter amino acids and other compounds in kaolin-induced progressive hydrocephalus in rats by means of magnetic resonance spectroscopy (MRS) combined with the administration of [1-13C]glucose and [1,2-13C]acetate. Some 2, 4 and 6 weeks after kaolin injection into the cisterna magna, cerebrum, brainstem and cerebellum were dissected. Interestingly, labelling of most amino acids derived from [1-13C]glucose showed no alterations, whereas labelling from [1,2-13C]acetate was affected. Two weeks after induction of hydrocephalus the taurine concentration was decreased, whereas the concentration of [1,2-13C]lactate was increased in the cerebrum and that of [1,2-13C]GABA in the brainstem. Furthermore, labelling from [1,2-13C]acetate was significantly decreased in [4,5-13C]glutamate, [1,2-13C]glutamate and [1,2-13C]GABA in cerebrum from 4 weeks after hydrocephalus induction. The concentration of N-acetylaspartate, a neuronal marker, was unchanged. However, labelling of the acetyl group from [1-13C]glucose was decreased in cerebellum and brainstem at 6 weeks after the induction of hydrocephalus. As glucose is metabolized predominately by neurones, whereas acetate is exclusively taken up by astrocytes, these results indicate that mostly astrocytic, and only later neuronal, metabolism is disturbed in the kaolin model of hydrocephalus. If verified in patients using in vivo MRS, impaired astrocyte metabolism might serve as an early indication for operative treatment.

Acetates↗
PubMed2003

Post systolic shortening in nonobstructive hypertrophic cardiomyopathy with delayed emptying of the apex: a Doppler flow, tissue Doppler and strain rate imaging case study.

We report a case of a 92-year-old woman with syncope and exertional dyspnea, who on echocardiographic examination proved to have hypertrophic cardiomyopathy. Doppler flow revealed delayed emptying of the apex, extending into the early filling phase. Tissue Doppler and strain rate imaging illustrated postsystolic shortening corresponding to the apical ejection, demonstrating that the apical flow was due to wall thickening resulting in active ejection. The imaging methods and mechanics of post-systolic shortening are discussed.

Aged↗
PubMed2002

Alterations in brain metabolism, CNS morphology and CSF dynamics in adult rats with kaolin-induced hydrocephalus.

The present study describes the biochemical changes, morphological development and the cerebrospinal fluid dynamics of the kaolin-induced hydrocephalus in the adult rat. Two, 4 and 6 weeks after microsurgical kaolin instillation into the rat cisterna magna the basal intracranial pressure and the cerebrospinal fluid outflow resistance were measured. To determine possible biochemical changes in the rat cerebrum, brain stem and cerebellum the concentrations of glutamine, glutamate, glutathione, aspartate, GABA, alanine and taurine were measured by high pressure liquid chromatography. In addition, ventriculomegaly and syringomyelia were assessed, measuring the lateral ventricles and central canals by means of an image-processing computer program. It could be shown that the acute phase of kaolin-induced hydrocephalus in the first 4 weeks is characterised by a high basal intracranial pressure, a considerably increased CSF outflow resistance and a rise in brain water content in the fourth week. The changes in the concentrations of amino acids were moderate. Glutamine was increased and taurine was decreased in the cerebrum and alanine was increased in the brain stem. The chronic phase, however, is defined by normal basal pressure, declining outflow resistance, progression of ventriculomegaly and distinct changes in the biochemical parameters such as a remarkable decrease of glutamate, glutamine and taurine in the cerebellum, a decrease of taurine and alanine plus an increase in glutamine in the cerebrum and an increase of alanine in the brain stem. Moreover, cerebral metabolism in the adult rat seems to be more resistant to the effects of hydrocephalus than metabolism in neonatal and infantile rats.

Age Factors↗
PubMed2002

Effects of pentylenetetrazole and glutamate on metabolism of [U-(13)C]glucose in cultured cerebellar granule neurons.

This study was performed to analyze the effects of glutamate and the epileptogenic agent pentylenetetrazole (PTZ) on neuronal glucose metabolism. Cerebellar granule neurons were incubated for 2 h in medium containing 3 mM [U-(13)C]glucose, with and without 0.25 mM glutamate and/or 10 mM PTZ. In the presence of PTZ, decreased glucose consumption with unchanged lactate release was observed, indicating decreased glucose oxidation. PTZ also slowed down tricarboxylic acid (TCA) cycle activity as evidenced by the decreased amounts of labeled aspartate and [1,2-(13)C]glutamate. When glutamate was present, glucose consumption was also decreased. However, the amount of glutamate, derived from [U-(13)C]glucose via the first turn of the TCA cycle, was increased. The decreased amount of [1,2-(13)C]glutamate, derived from the second turn in the TCA cycle, and increased amount of aspartate indicated the dilution of label due to the entrance of unlabeled glutamate into TCA cycle. In the presence of glutamate plus PTZ, the effect of PTZ was enhanced by glutamate. Labeled alanine was detected only in the presence of glutamate plus PTZ, which indicated that oxaloacetate was a better amino acid acceptor than pyruvate. Furthermore, there was also evidence for intracellular compartmentation of oxaloacetate metabolism. Glutamate and PTZ caused similar metabolic changes, however, via different mechanisms. Glutamate substituted for glucose as energy substrate in the TCA cycle, whereas, PTZ appeared to decrease mitochondrial activity.

Alanine↗
PubMed2002

The pentylenetetrazole-kindling model of epilepsy in SAMP8 mice: behavior and metabolism.

This work describes a novel epilepsy model, combining pentylenetetrazole (PTZ) kindling with the senescence-accelerated mouse P8 (SAMP8) a model for aging. The 2- and 8-month-old SAMP8 mice were treated with PTZ, phenobarbital plus PTZ or saline every 48 h during a period of 40 days. Both 2- and 8-month-old PTZ-kindled mice showed a behavioral pattern that was very similar to severe chronic epilepsy with secondary generalized seizures. Two out of six 8-month-old animals died in the PTZ group. Interestingly, atypical absence seizures were limited to the 8-month-old PTZ group. Furthermore, 8-month-old mice were more sensitive to the sedative effect of phenobarbital. The concentrations of several amino acids were examined by HPLC. Lower levels of amino acids were found in the 8-month-old compared to the 2-month-old control animals. No biochemical changes were observed between the groups of 2-month-old animals, while in the 8-month-old animals both treatment groups showed significantly higher concentrations of GABA, glutamine and glutathione. Thus, it could be shown that cerebral metabolism of 8-month-old SAMP8 mice was more sensitive to PTZ and phenobarbital than metabolism of 2-month-old mice. Furthermore, it is suggested that glutamate metabolism in brains of 8-month-old SAMP8 mice is altered and that excessive glutamate is transformed, in considerable amounts, into glutamate related metabolites, possibly in astrocytes.

Aging↗
PubMed2002

Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial.

OBJECTIVES: Documentation of treatment effects in acutely sick frail older patients in geriatric evaluation and management units (GEMUs) is scarce. The present study evaluated whether treatment in a GEMU would reduce mortality as compared to traditional treatment delivered in the Department of Internal Medicine. DESIGN: Prospective randomized trial. SETTING: GEMU or general medical ward. PARTICIPANTS: Acutely sick frail patients aged 75 and older who had been admitted to the Department of Internal Medicine were randomly assigned to treatment in the GEMU (n = 127) or to the general medical wards (n = 127). The following inclusion criteria were used to target frail patients: chronic disability, acute impairment of single activity of daily living, mild/moderate dementia, confusion, depression, imbalance/dizziness, falls, impaired mobility, urinary incontinence, malnutrition, polypharmacy, vision or hearing impairment, social problems, or prolonged bedrest. INTERVENTION: In the GEMU, the treatment strategy emphasized interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilization/rehabilitation, and comprehensive discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. MEASUREMENTS: Mortality and causes of death. RESULTS: Mortality in the intervention and control groups, respectively, was 12% and 27% at 3 months (P =.004), 16% and 29% (P =.02) at 6 months, and 28% and 34% (P =.06) at 12 months. The hazard ratio was 0.39 (95% confidence interval = 0.21-0.72) at 3 months. The main cause of death was cardiovascular disease. CONCLUSION: Treatment of acutely sick, frail, older patients in a GEMU substantially reduced mortality.

Activities of Daily Living↗