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Biomedical subjects

P H Millard

Publications and source records attributed to P H Millard.

At least 19 recordsLinked to original sources
PubMed1992

The St. George's dementia bed investigation study: a comparison of clinical and pathological diagnosis.

Sixty-four elderly patients who had been admitted to the St. George's Hospital Alzheimer's disease evaluation project during 1981-1989 were followed up to postmortem examination. Comparison between clinical diagnoses and neuropathological diagnoses indicated positive predictive values for the antemortem diagnoses of 50-67%. Existing clinical criteria may not be accurate enough to permit firm antemortem diagnosis of older people for either research or clinical purposes.

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PubMed1991

Balancing acute and long-term care: the mathematics of throughput in departments of geriatric medicine.

The empirical distribution of length of stay of patients in departments of geriatric medicine is fit extremely well by a sum of two exponentials. Most of the patients in a geriatric department are rehabilitated and discharged or they die within a few weeks of admission, but the few who become long-stay patients remain for months or even years. A model is presented for the flow of patients through a geriatric department, which has analogies to models of drug flow in pharmacokinetics. The theoretical model explains why the empirical pattern of length of stay in the occupied beds fits a sum of two exponentials; conversely, the empirical distribution, obtained from the midnight bed state report, can be used to study the effect of various policy decisions on both immediate and future admission rates for the department, and shows the benefits of policies which reduce long-stay patient numbers by improving long-stay rehabilitation.

Acute Disease↗
PubMed1990

Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions.

Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community. Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0-137.1 mmol/l) was lower than in the 586 not prescribed diuretics (137.1-137.9 mmol/l). The difference was small but statistically significant (95% CI difference = 0.3-1.6 mmol/l; P less than 0.01). Hyponatraemia (serum sodium less than 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others. There was a significant positive correlation between the serum potassium and the log [serum urea] (r = 0.26, P less than 0.001) and a weak negative correlation existed between sodium and potassium (r = -0.14; P less than 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1988

Diagnosing dementia: do we get it right?

To find out whether the diagnosis of dementia agreed with findings at necropsy a detailed assessment of 27 elderly patients (mean age 82 (range 70-94] presenting with dementia was conducted at a combined department of geriatric medicine and psychiatry for the elderly. On the basis of the results the cause of the dementia was diagnosed clinically. Neuropathological examinations were performed after death. The clinical diagnosis made during life was not supported by the findings at necropsy in 11 cases. Alzheimer's disease was overdiagnosed in life (13 cases, of which only six were confirmed at necropsy). Although the clinical investigation was limited by availability of resources, neither cranial computed tomography nor the Hachinski score helped to distinguish between multi-infarct dementia and Alzheimer's disease in this age group. This study confirms the value of neuropathological studies in the precise diagnosis of dementia.

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PubMed1988

Right to die.

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Attitude of Health Personnel↗
PubMed1988

What is ageing?

The absolute numbers and proportion of elderly people within society is increasing and will continue to increase into the next century. An understanding of normal biology, physiology and anatomy of ageing are an essential prerequisite for the treatment of pathology in the elderly. Gerontology is a young scientific discipline where important developments are being made. Progress in increasing longevity has so far been limited, but continuing improvements in the quality of life for the elderly remain an attainable goal.

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PubMed1988

On the carpet.

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PubMed1986

Tardive dyskinesia in the elderly.

Four hundred and twenty-six elderly subjects were assessed for the presence of dyskinetic movements. Dyskinetic movements were present in 49 subjects (11.5%). Ninety-two per cent had orofacial movements, by far the commonest being chewing. Dyskinetic movements were present in 12.5% of women and 7.6% of men. Abnormal movements were present in 8% of the subjects who had never received neuroleptic drugs and in 20.8% of those who had. There was a statistically significant association between developing dyskinetic movements and receiving chlorpromazine and flupenthixol. There was no association between either advancing age or dementia and dyskinetic movements.

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