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Biomedical subjects

P P Barry

Publications and source records attributed to P P Barry.

At least 19 recordsLinked to original sources
PubMed2001

Physician confidence and interest in learning more about common geriatric topics: a needs assessment.

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics. DESIGN: Written survey. SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). PARTICIPANTS: Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members). MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale. RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified. CONCLUSIONS: These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.

Aged↗
PubMed2001

Nutritional risk in an urban homebound older population. The nutrition and healthy aging project.

PURPOSE: To establish the prevalence of nutritional problems and their related socio-demographic and health-related risk factors in the homebound elderly population. METHODS: Subjects included 239 men and women, ages 65 to 105 years. Trained, two-person field teams conducted comprehensive in-home assessments. Medical record reviews assessed co-morbidity and medication use. RESULTS: The majority of these urban study subjects are of very advanced age (mean age 81 years), female (72%), non-white (73%), living alone (51%), of low income (76%), and somewhat socially isolated (26% had no weekly social contact). More older women than men were widowed (60 vs. 33%, respectively) and poor (80 vs. 67%). The disease burden and functional dependency were both high in men and women; 77% had three or more chronic medical conditions; 76% were functionally dependent in one or more ADL's and 95% in one or more IADL's. Poor dietary quality was universal in these older men and women; half or more consumed diets that deviated from recommended standards for at least 13 of the 24 nutritional guidelines studied. Five percent of subjects were underweight (Body Mass Index (BMI) <18.5); 22% were overweight (BMI 25.0-29.9); and 33% were obese (BMI >30.0). Fasting albumin, hemoglobin, and absolute lymphocyte concentrations were borderline to very low in 18-32%. Dyslipidemia was more common in women; however, men and women had similar Total:HDL cholesterol ratios. CONCLUSIONS: Nutritional status is poor in homebound persons of very advanced age with substantial co-morbidity and functional dependency. The complexities of nutritional risk necessitate multi-disciplinary and individualized nutritional intervention strategies.

Activities of Daily Living↗
PubMed2000

An overview of special considerations in the evaluation and management of the geriatric patient.

As the population ages, physicians will care for increasing numbers of older patients. Promoting independence is a major goal of care. Gastrointestinal dysfunction is often caused by chronic disease, medications, and lifestyle exposures, rather than to age alone. A useful approach to the older patient focuses on maintaining function and avoiding complications.

Activities of Daily Living↗
PubMed1996

Patient factors associated with breast cancer screening among older women.

OBJECTIVES: To identify patient factors that influence physicians' decisions to recommend screening mammograms for older women. DESIGN: A cross-sectional survey including clinical case vignettes. PARTICIPANTS: Random sample of Massachusetts internists, obstetrician/gynecologists, family/general practice physicians, and geriatricians. OUTCOME MEASURE: Proportion of screening mammograms recommended for women in different versions of each case vignette. RESULTS: A total of 482 (65%) of the eligible participants responded to a mailed survey of questions about breast cancer screening practices, attitudes toward ACS guidelines, and four clinical vignettes. Vignettes tested the impact of patient's age, cognitive function, nursing home residence, functional limitations, and comorbidity on the physician's decision to recommend a mammogram. Ninety-four percent of physicians reported often performing periodic clinical breast exams and mammograms for women aged 65 to 74. For women aged 75 to 84, 89% of physicians reported often performing periodic clinical breast exams, and 79% recommend mammograms. Only 48% strongly agreed with ACS guidelines for annual mammography for women over 65. Age, dementia, and nursing home residence were patient factors associated with decreased mammogram use, but limited mobility and chronic medical problems were not. Physicians were more likely to recommend a mammogram for a woman aged 65 to 74 than for a woman 75 to 84. (P = .002) Physicians were more likely to recommend a mammogram for a woman without dementia than for a woman with mild dementia (P < .05) and for a woman living with her daughter than a for a woman living in a nursing home (P < .001). CONCLUSIONS: Age older than 75, mild dementia, and nursing home residence are factors that negatively influence physicians' decisions to recommend mammography. Presence of chronic medical problems and functional limitations do not. Physicians appear to be using implicit judgments about quality of life and age rather than life expectancy based on comorbidity to determine breast cancer screening practices.

Age Factors↗
PubMed1996

Healthy aging: guidelines for cancer screening and immunizations.

With increasing life expectancy over the past 50 years, screening for treatable illness and active measures to prevent disease and promote a healthy lifestyle have become increasingly important for older patients. In general, the benefits of such efforts have become more apparent, but depend also upon general health and life expectancy of the individual. Tests for malignancies of the breast, cervix, prostate, colon, skin, and oral cavity are considered to meet screening criteria. Immunization guidelines have been recently updated, and good evidence supports the benefit of protecting older patients from influenza and pneumococcal pneumonia. Counseling on prevention of falls and injuries in the home and on the highways can help reduce the risk of accidents.

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PubMed1994

Geriatric clinical training in medical schools.

The primary purpose of geriatric training in medical school is to improve the care of the elderly by practitioners in every specialty, by increasing their knowledge base and fostering interest in older patients. A secondary goal is to interest some students in geriatrics as a career. For > 10 years, leaders in medicine and medical education have strongly recommended clinical geriatric training for medical students, but only a few programs have been implemented. Geriatrics educational experiences must be required; otherwise, not enough medical students will elect to take these courses. Although we still do not know which model best provides this experience, evaluations of existing programs suggest that geriatrics can be taught in both long-term care and acute settings, involving well-designed curriculum and interested faculty. More studies are needed, but exposure to well elderly and community-based programs may also improve attitudes toward the elderly and thereby further improve their medical care.

Clinical Competence↗
PubMed1994

Evaluation of the demented patient.

Approaching the patient with Alzheimer's disease often requires the participation of a team of collaborating physicians and psychologists as well as others both for diagnosis and for management. This article describes the approach to the disease by a neurologist, geriatrician, psychiatrist, and psychologist. Each describes a specific diagnostic approach, and the reader can appreciate the incremental value to assessment and care that emerges from the aggregate.

Age Factors↗
PubMed1990

Electroconvulsive therapy in octogenarians.

Medical records of 81 older patients (65 years of age and over) who underwent electroconvulsive therapy (ECT) at a university-affiliated private geriatric hospital were reviewed to evaluate the safety and efficacy of this treatment for depression in the "young-old" (65 to 80 years) compared with the "old-old" age group (over 80 years), a group that has not yet been adequately studied. Information was obtained regarding demographics, medical and psychiatric diagnosis, medications, indications for ECT, number and laterality of treatments, outcome, and complications. Thirty-nine patients 80+ years of age (mean age, 85 +/- 3.2) were compared with 42 patients 65 to 80 years of age (mean age, 74 +/- 5.2). Statistical analysis was performed using confidence intervals of the difference in proportions of patients in each group. There were no significant differences in the demographics, number and laterality of ECT treatments, indications for ECT treatment, medical diagnosis, medications, or prior history of falls, but psychiatric diagnoses differed slightly. Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome. This study confirms the role of ECT as a relatively safe and effective treatment, which may be lifesaving in selected depressed older patients. Prospective studies are needed to understand better the long-term outcome and to prevent the morbidity and mortality associated with ECT in this frail, high-risk older group.

Accidental Falls↗
PubMed1989

Decreasing the toxic potential of intravenous regional anaesthesia.

In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of 1.5 mg.kg-1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a non-toxic level and thus increases the safety of IVRA.

Adult↗
PubMed1988

Why elderly patients refuse hospitalization.

To identify important factors in the refusal of hospitalization by elderly patients, a study was conducted of 35 such "refusers" on the Home Medical Service (HMS) of University Hospital and a comparison group of 70 patients who accepted hospitalization. Data were collected from health care providers and patient records at entry and six weeks later. The two groups were compared on the basis of demographic factors, health care factors, medical condition, and outcomes. Reasons for refusal were most commonly related to a negative perception of the health care system or a passive acceptance of death. Refusers were significantly less ill than acceptors and did not change in health or functional status at follow-up. The results suggest that refusal of hospitalization is most often related to interaction with the health care system and that less ill patients may have reasonable outcomes when treated at home.

Aged↗