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Biomedical subjects

P Starer

Publications and source records attributed to P Starer.

18 recordsLinked to original sources
PubMed1996

Sequential outbreak of influenza A and B in a nursing home: efficacy of vaccine and amantadine.

OBJECTIVE: To describe the sequential occurrence of influenza A and B in a nursing home, and to determine the efficacy of influenza vaccine and/or amantadine treatment with respect to incidence and sequelae. SETTING: The Jewish Home and Hospital for Aged, a skilled-care nursing facility. PARTICIPANTS: Of 499 frail older nursing home residents, 139 contracted influenza during the study period (mean age 87.5 years; SD = 6.7). The residents were followed from February through April 1988. INTERVENTION: Influenza vaccine and/or amantadine. MEASUREMENTS: Episodes of influenza and their sequelae, i.e., pneumonia, hospitalization, and death. RESULTS: The vaccine had no effect on the incidence of influenza-like illness, length of illness, or the associated death rate. It reduced the rate of pneumonia secondary to influenza A and B (relative risk = .57; 95% CI: .37 to .89; P = .023). Amantadine did not affect the attack rate of influenza nor the rate of pneumonia secondary to influenza. It was associated with decreased mortality (relative risk = 0; P = .001), and shorter length of influenza A illness (PWilcoxon = .082). Although the combination of amantadine and vaccine did not affect length of influenza (A or B) illness, it was associated with a significantly lower rate of sequelae (relative risk = .58; 95% CI: .36 to .95; P = .024). CONCLUSION: In this epidemic, the combination of amantadine and vaccine was most effective in reducing the rate of influenza-associated sequelae. The possibility of a "biphasic" epidemic prompts consideration of vaccinating nonimmunized nursing home residents, even though it may be late in the influenza season.

Aged↗
PubMed1994

Mental status guide: FROMAJE for use with frail elders.

1. There is no single pathognomonic sign, symptom, or clinical or laboratory test for making the diagnosis of dementia. A key element of the examination must be the inclusion of a mental status evaluation. 2. The FROMAJE--an acronym for Function, Reasoning, Orientation, Memory, Arithmetic, Judgment, and Emotion--Mental Status Guide (FMSG) has the advantage of a clear relationship between the acronym and the characteristics being measured. 3. The FMSG is meant to serve as a guide for the primary care clinician, who may have little experience in formal mental status testing. It is a convenient cognitive screening instrument to detect dementia in the elderly.

Aged↗
PubMed1993

Role of detrusor instability in primary enuresis.

We studied 50 enuretic boys and girls by supine cystometry. Detrusor instability was found in 74 percent of the cases. The mean threshold volume at which detrusor instability was demonstrated was 200 mL. The mean bladder capacity of age-matched nonenuretic children was 325 mL. We consider detrusor instability at this reduced threshold volume to be the main cause of primary enuresis.

Adolescent↗
PubMed1993

Evaluation and management of urinary incontinence in older patients.

The training of health care providers in the diagnosis and management of urinary incontinence is inadequate, and evaluation and management skills are less than optimal. Urinary incontinence volume measurement is difficult to perform accurately in elderly long-term-care inpatients. After incontinence has been noted, the physician needs to select the appropriate studies to determine the cause and choose the correct treatment. Otherwise, treatable causes such as outlet obstruction or fecal impaction may be missed. Subsequent management includes scheduled visits to the toilet, treatment of impaired mobility, use of easily identified and accessible toilet facilities, reevaluation of the need for restraints and side rails, and, if appropriate, the use of drugs to treat the incontinence. Many elderly incontinent patients who are treated in the outpatient setting can be cured or substantially improved.

Aged↗
PubMed1991

Post-prostatectomy incontinence. A urodynamic and fluoroscopic point of view.

Sixty-three male patients suffering from post-prostatectomy incontinence were studied by urodynamics and fluoroscopy. In almost half the patients (49%) the sole cause of incontinence was detrusor instability. Incontinence due to damage of the sphincter mechanism was present in less than half of the patients (47%). However, almost half of these patients (53%) had concomitant detrusor instability. Only a small number of patients (4%) had incontinence due to other causes. It appears that post-prostatectomy incontinence is not always due to a surgical misadventure. Many older patients may have preexisting neurologic disorders (e.g., Parkinson disease, diabetic autonomic neuropathy, alcoholic neuropathy, and various spinal cord disorders) which can profoundly affect the outcome of prostatic surgery. Detrusor instability should be considered when evaluating post-prostatectomy incontinence.

Adult↗
PubMed1990

Analysis of voiding disorders in patients with cerebrovascular accidents.

Urodynamic evaluation was undertaken in 33 patients (15 males and 18 females, age range 48-90 years) with voiding problems following cerebrovascular accidents. In the majority of these patients (26) cystometry revealed involuntary contractions of the bladder. The critical volume for involuntary bladder contractions was approximately 200 mL. The majority of patients with cerebral cortex and/or internal capsule lesions had uninhibited relaxation of the sphincter during involuntary bladder contractions, while all of the patients with lesions only in the basal ganglia or thalamus had normal sphincter function. The remaining 7 patients had poor bladder contractions. Correlation of bladder dysfunction with the area of brain injury was not conclusive, but was suggestive of directions to be taken in future research.

Aged↗
PubMed1990

Cystometric evaluation of bladder dysfunction in elderly diabetic patients.

To select the appropriate treatment for an elderly patient with urinary incontinence, the cause of the incontinence needs to be determined. In diabetic patients who are incontinent, the underlying problem has been described in the past as urinary retention secondary to autonomic neuropathy. In cystometric studies conducted on 23 elderly diabetic nursing home patients (mean age, 80 years; 19 women, 4 men), who presented with symptoms of urinary dysfunction, involuntary contractions were demonstrated in 61% of the subjects. Thirteen percent of the patients had normal voluntary contractions of the bladder, 17% had voluntary contractions of a low magnitude, and 9% had no contractions at all. The majority (76%) of the subjects presenting with urinary incontinence had involuntary bladder contractions, while all of the subjects presenting with urinary retention had either voluntary contractions of a low magnitude or no contractions. It cannot be assumed that all elderly diabetic patients presenting with urinary symptoms have poorly contracting bladders (diabetic bladder). Urodynamic studies can be helpful when choosing therapy for the elderly diabetic patient with urinary dysfunction.

Aged↗
PubMed1989

Urinary incontinence in female Parkinson disease patients. Pitfalls of diagnosis.

There are many causes of urinary incontinence in the female, with stress incontinence reported as the most common. However, a high incidence of detrusor instability has been described in incontinent patients with Parkinson disease. To assess this further, urodynamic studies were performed on 17 female patients with Parkinson disease and complaints of urinary dysfunction. Detrusor instability was demonstrated in the majority of the patients (70.6%). Of the 8 patients with specific symptoms of stress incontinence, 2 were found to have a stable bladder, 3 had a hyporeflexic bladder, and 3 had detrusor instability. Surgical therapy may not be appropriate for all patients in this group. Since it is difficult to determine the causation of urinary incontinence on the basis of symptoms alone, urodynamic studies can be helpful in the evaluation of incontinent patients. This is especially important in female patients with Parkinson disease who may have detrusor instability alone or in addition to anatomic stress incontinence.

Aged↗
PubMed1988

Urinary incontinence during orgasm.

Urinary incontinence occurring during orgasm in women is an infrequently volunteered symptom. We studied 3 such patients to understand the mechanism behind such leakage. Urodynamic studies were performed prior to and during orgasm. It was found that during orgasm, there was involuntary bladder contraction with simultaneous urethral relaxation, resulting in leakage. Similar studies performed prior to orgasm did not reveal any involuntary bladder contraction. We believe that incontinence during orgasm is multifactorial: the most important causes are sphincter incompetence, neuropathic hyperreflexic bladder, and non-neuropathic idiopathic bladder instability.

Adult↗
PubMed1988

Diagnosis and grading of outflow obstruction.

Urodynamic data from 66 male patients with obstruction due to benign prostatic hyperplasia were analyzed. Criteria for grading the severity of outflow obstruction based on uroflowmetry, post void residual urine, maximum bladder contraction (Pmax), and pressure during voiding (Pvoid) were developed. In selected cases, voiding cystourethrography also may be needed. These criteria help determine the need for prostatectomy. Unnecessary prostatectomies can then be avoided and can lead to significant reduction in mortality, morbidity, and health care expenses.

Adult↗
PubMed1988

The measurement of residual urine in the evaluation of incontinent nursing home residents.

Seventy-six nursing home residents with urinary incontinence (59 females, 17 males, Mean age = 84 years) underwent an evaluation which included the measurement of residual urine and cystometric studies. Upon catheterization 18 subjects were found to have urine volumes greater than 100 ml. Only two subjects had urine volumes greater than 250 ml. Cystometry revealed detrusor instability in the majority (83%) of the 76 subjects. Although the measurement of the post-voiding residual urine is a simple method to assess for ineffective bladder emptying, at volumes less than 250 ml, it is not always possible to predict the type of bladder dysfunction without additional studies. There can be problems in obtaining an accurate measurement of the post-voiding residual urine in elderly institutionalized patients. Many of our subjects (36 subjects) experienced difficulty urinating prior to catheterization. The residual urine measurement should not be solely relied upon in the prediction of bladder dysfunction in the elderly. This measurement should be combined with other data to effectively investigate the etiology of urinary incontinence.

Aged↗
PubMed1985

Obscuring urinary incontinence. Diapering of the elderly.

To assess the prevalence, evaluation, and treatment of urinary incontinence in an institutionalized elderly population, the charts of 511 residents in a New York City nursing home were reviewed. Whereas the nurses' notes documented urinary incontinence in 62.4% of the total resident population, the physicians' notes listed this as a problem in only 10% of the residents. Most (90.3%) of the cases of incontinence were not classified as to etiology or pattern. Treatment emphasized the use of diapers in 78.2% of the cases, which was combined with bladder conditioning in most instances. This treatment approach had been initiated, administered, and monitored by the nursing staff. Indwelling catheters were used in 4.0% of the situations, and pharmacologic therapy was used in 2.5% of the cases. It is suggested that adult diapers may not be the optimal treatment for urinary incontinence since they treat the symptom instead of the cause. There should be a systematic approach to the classification and treatment of urinary incontinence prior to the long-term utilization of diapers.

Aged↗
PubMedDate not supplied

Cystometric evaluation of elderly nursing home patients with indwelling urinary catheters.

Due to uncertainties concerning the use of indwelling urinary catheters in institutionalized patients, 15 catheterized nursing home patients (10 women, 5 men, mean age = 85.7 years) were evaluated with cystometric studies in order to determine bladder function. The reasons for indwelling catheter use documented in the medical records were urinary retention (n = 12), urinary incontinence (n = 1) and the promotion of pressure ulcer healing (n = 1). In one case, no reason for catheterization was recorded. Five patients had non-contractile bladders while 2 had voluntary bladder contractions of low amplitude. Three other patients had voluntary bladder contractions, although 2 of them had elevated voiding pressures, suggesting bladder outlet obstruction. All 3 of these patients had their catheters removed. (The 2 patients with elevated voiding pressures received treatment of the obstructions.) The remaining 5 patients had involuntary contractions of the bladder. It is uncertain whether the finding of involuntary bladder contractions can be used to predict the ability of the bladder to empty. Patients with voluntary bladder contractions without evidence of bladder outlet obstruction probably will not experience difficulty after the catheter is discontinued. Patients with evidence of bladder outlet obstruction will need additional intervention prior to catheter removal. Patients with a poorly contractile or a non-contractile bladder would need to be closely monitored for the development of urinary retention after discontinuation of the catheter. An evaluation of urinary function should be undertaken in any nursing home patient with unclear reasons for catheterization.

Journal Article↗
PubMedDate not supplied

The association of fecal impaction and urinary retention in elderly nursing home patients.

The objective of this study was to examine the association of fecal impaction and urinary retention in an elderly nursing home population. Two-hundred and three nursing home patients with urinary dysfunction (77% female, median age: 85 years (range: 61-104)) underwent an evaluation which included rectal examination, measurement of residual urine, and cystometric studies. Bivariate analyses indicated that fecal impaction was not associated with urinary retention. However, dependency in transfer was directly associated with fecal impaction (OR=2.91; P=0.004), and with urinary retention (OR=3.13; P=0.017). There was no association between detrusor underactivity and fecal impaction. When urinary retention and fecal impaction occurred in the same patient, detrusor overactivity was the most common cystometric finding. Rather than implicating an anatomic or neurologic link between poor bladder emptying and poor bowel emptying, a third factor (e.g. immobility) causing both urinary retention and fecal impaction should be sought.

Journal Article↗