Data collection & observer bias.
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Allied Health Personnel↗
Biomedical subjects
R Wears
Publications and source records attributed to R Wears.
Reduced survival with increasing plasma osmolality in elderly continuing-care patients.
The results reported here are from a 2-year follow-up study of 58 elderly patients in a continuing-care unit. Most of these patients were in a hyperosmolar state at the time of entry (mean plasma osmolality 304 +/- 8 mOsmol/kg). The survival of those patients with the highest osmolality (greater than 308 mOsmol/kg) was significantly reduced (p = 0.025), with an increased mortality at 2 years (15/20 patients, p = 0.053). There was no correlation between age and plasma osmolality (r = 0.02) and the effect of osmolality on survival was independent of age. Hyperosmolality was either a marker for, or a cause of, increased mortality in this group of frail elderly patients.
Aged↗
Elderly female patients in continuing care: why are they hyperosmolar?
We have shown that the majority of elderly female patients in continuing care are in a hyperosmolar state. Thirty-two out of thirty-nine subjects had an osmolality greater than 295 mosm/kg and the mean osmolality was 302 +/- 8 mosm/kg (range 280-317 mosm/kg). No significant relationship was found with the degree of confusion (rs = 0.31; p greater than 0.05). In the second part of the study neither the measured degree of hydration, or any acute, small increases in fluid input influenced the plasma osmolality.
Aged↗
Analysis of multiple organ system failure in trauma and nontrauma patients.
Multiple organ failure (MOF), a syndrome of recent evolution, has resulted from advancements in both surgical and trauma care. A prospective study of organ failure (OF) was conducted for 203 consecutive admissions to the surgical intensive care unit (SICU) between September 1986 and June 1987. Diagnosis, operations, age, OF, outcome, and culture data were recorded for each patient. OF definitions consistent with the literature were used to identify pulmonary, renal, hepatic, cardiovascular (CVS), gastrointestinal (GI), hematologic-coagulation, and central nervous system (CNS) failure. Eighty-two patients developed OF (40.4% incidence). The distribution of OF was 65 per cent trauma (T) and 35 per cent nontrauma (NT). Combined mortality for OF was 46 per cent (T = 34% and NT = 69%). The mortality of organ failure increased with the number of failed systems in the total population as well as in both T and NT groups. For the total population, the mortality by number of systems failed was no system, 1.3 per cent; one system, 13 per cent; two systems, 34.5 per cent; three systems, 75 per cent; four or more systems, 92.9 per cent. The incidence and mortality for each system is listed. Sepsis occurred in 62.1 per cent of NT patients (88.9% mortality) and in 30.2 per cent of T patients (31.3% mortality). Mortality was weakly associated with age in groups matched for severity of OF.
Adult↗
Rapid assay of serum theophylline levels.
Many patients with chronic obstructive pulmonary disease (COPD) are symptom free when they receive an oral theophylline regimen. When these patients present to the emergency department with an acute exacerbation of their disease, the emergency physician faces a dilemma regarding appropriate therapy with IV aminophylline. The patient's serum theophylline level is unknown. A blind loading dose may result in inadequate treatment or iatrogenic toxicity. The Ames Seralyzer is an immunoassay photometer that determines serum theophylline levels. We studied 90 patients with uncomplicated exacerbations of COPD treated in our ED before and after the installation of the Seralyzer. Theophylline levels measured by the Seralyzer had a high correlation with those measured by the hospital laboratory Abbott TDX (r = 0.914). Obtaining the theophylline level took a mean of only 0.46 hours with the Seralyzer, compared with 2.13 hours with the hospital laboratory. The time from presentation to theophylline loading was 1.87 hours, compared with 3.28 hours with the hospital laboratory group, resulting in significantly greater relief of respiratory distress at three hours after arrival in the Seralyzer group. The measured theophylline level was very poorly correlated with the physician's estimate of the level based on history (r = 0.353). We conclude that the Seralyzer provided accurate assessment of levels, enabled earlier theophylline loading of patients and lessened delays, and decreased the probability of theophylline toxicity.
Adult↗