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Biomedical subjects

T H Caradoc-Davies

Publications and source records attributed to T H Caradoc-Davies.

At least 19 recordsLinked to original sources
PubMed2005

The work of rehabilitation.

PURPOSE: To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation. METHOD: A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000--2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores. RESULTS: Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM. CONCLUSIONS: The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.

Brain Diseases↗
PubMed1996

Traumatic mutism in severe head injury relieved by oral diazepam.

A 34-year-old woman with a severe closed-head injury had many impairments including apparent global aphasia. After a diazepam premedication for a motor point block she was heard to speak a few words. A trial of oral diazepam succeeded in restoring speech adequate to make her needs known, which persisted on a maintenance dose of 5 mg t.d.s. The possible diagnoses and reasons for this phenomenon are discussed. We suggest that diazepam may be useful in assessing speech in selected people with severe head injuries.

Adult↗
PubMed1995

Hospital morbidity due to head injuries in New Zealand in 1980-1988.

We studied the morbidity in New Zealand using hospital discharge data from 1980 to 1988, and found a reduced head injury (HI) rate over this time overall, but no change in the rate among Maori males and an increased rate among Maori females. In 1988 the rate was 228/100,000 with peaks among males and females aged under 10, males aged 15-25, and both sexes over 84 years old. The rate among young Maori males was higher than in other groups until the age of 55. Motor vehicle crashes caused most head injuries, followed by falls, non-intentional incidents (such as sporting injuries), assaults and pedal cycle accidents. Maori females had a high rate of assault. Hospital stay was longest among pedestrians, and increased with increasing age due to co-morbidity. Prevention strategies were based on the causes of HI.

Adolescent↗
PubMed1995

Do 'social relief' admissions have any effect on patients or their care-givers?

Dependent patients and their care-givers were studied before and 1 week after a social relief admission in order to assess the effects on physical and psychological problems. Data about care-givers stress and mental health were gathered, as well as patient data. Patients' self-care abilities improved slightly but care requirements remained constant. Care-giver stress levels did not change, but there was a highly significant improvement in their mental health. The results suggest that social relief admissions enabled care-givers to continue to look after very dependent people in the community.

Aged↗
PubMed1993

Epidemiology of spinal cord injury in New Zealand.

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been increasing. It occurs most often to young, caucasian men and is typically the result of motor transport crashes. The ethnicity adjusted rates show high rates for Maori males. Children in New Zealand have greater than 4 times the risk of an SCI than American children. The rehabilitation and hospital costs for SCI are among the highest for all injuries. There were a higher number of high cervical injuries than reported in previous series and 92% of SCI were incomplete indicating the high rehabilitation potential of the sample. Some measures are suggested to reduce the incidence of SCI.

Accidents, Traffic↗
PubMed1992

Medications and their monitoring in Parkinson's disease in Dunedin.

AIMS: to establish the patterns of drug administration and monitoring in people with Parkinson's disease. METHOD: a total community sample was obtained. One hundred and one of the 116 people with Parkinson's disease in Dunedin, who were alive on 31 July 1990, had a full medical assessment. RESULTS: the general practitioner made the diagnosis in 51%, a neurologist in 22%, a geriatrician in 18%, and other in 9%. The general practitioner provided prescriptions for 51 of the 68 people living in the community, a neurologist for 11, and a geriatrician in six cases. The general practitioner provided prescriptions for 23 of the 33 living in an institution, and a geriatrician in ten cases. Medical review took place more frequently than three monthly in 49 cases. There were 81 general practitioners in practice on the prevalence day in the study area. Thirty-six had no patients with Parkinson's disease, 30 had one or two, and the other 15 had varying numbers. Fifty-eight of the 90 patients taking levodopa were taking it as the only therapy. Eight patients were taking phenothiazines. There was a high incidence of side effects and 70 patients had long term complications including loss of effectiveness over time, the end of dose and the on-off phenomena, and dyskinesias. CONCLUSIONS: monitoring of treatment appeared satisfactory but major concerns about drug management included the high use of levodopa monotherapy and the concurrent use by general practitioners of phenothiazines in eight cases. Because most general practitioners have very few patients with Parkinson's disease they will not develop the experience to manage complicated drug regimens in people whose management tends to become more difficult with time. With selegiline and controlled release levodopa only being available on specialist prescription, we suggest that all people with Parkinson's disease should have the benefit of a specialist review at least every two years.

Aged↗
PubMed1992

Is the prevalence of Parkinson's disease in New Zealand really changing?

The prevalence of idiopathic Parkinson's Disease (IPD) in Dunedin, New Zealand on 31st July 1990 was 110.4/100,000. When corrected to a standard population based on the 1960 U.S. census, the prevalence fell to 76.0/100,000 due to changes in the age structure of the population. The corrected prevalence in Wellington (another New Zealand city), in 1962 was 99.6 (before the introduction of levodopa), and in Aberdeen, Scotland in 1984 was 102.7. The principal difference was fewer people under 65 years of age in our study. Case finding methods and diagnostic criteria were similar in all three studies, and case ascertainment was adequate. Under representation of younger people could be due to either a lower incidence rate or poorer survival due to treatment with high doses of levodopa compounds. Prospective research is required to explain our findings.

Adult↗
PubMed1991

Informed consent for cardiopulmonary resuscitation in elderly patients.

OBJECT: to determine if a semistructured interview would enable elderly patients to give adequately informed consent for cardiopulmonary resuscitation (CPR). METHOD: one hundred consecutive patients admitted to Wakari assessment and rehabilitation unit for the elderly, who satisfied study criteria, were randomly allocated to receive a detailed discussion on CPR or to act as controls. Subsequently knowledge about CPR was tested in both groups. RESULTS: of the 49 study subjects, 27 (55%) wished to have CPR in the event of a cardiac arrest. After the interview knowledge about the CPR was significantly better in the study group than the controls, but there was still a lack of appreciation of the possible complications and an overly optimistic view of the likely outcome. CONCLUSIONS: careful explanation of the procedures involved in CPR does increase knowledge and assist in making an informed decision. However, the decision may still be based on poor understanding of the likely outcome and possible complications.

Aged↗
PubMed1991

The cost benefit of rehabilitation of injured workers in New Zealand.

A multidisciplinary rehabilitation centre was established to address the needs of people with mild to moderate disability who had not worked for prolonged periods of time. A fitness based programme assisted 10 of the 20 who had been off work for more than six months to return to activity. Six and eighteen month follow up confirmed the durability of placement of most workers who had returned to work, and that projected benefits were achieved. Benefits were defined as savings in earnings related compensation (ERC), and compared to the costs of establishing and running the centre. Sensitivity analysis ascribing between 100% and 50% of benefit to the programme showed a positive benefit cost ratio, with benefits discounted at a rate of 10% over 10 years. With 75% ascribed, the project produced benefit cost ratio of about 1.5:1 in the first year, 2.8:1 in the second year, and rising to 6.2:1 in the fifth year and 10:1 by the tenth year. With only 50% ascribed, the benefit over the same times was 1.0:1, 1.9:1, 4.1:1 and 6.7:1 by the tenth year. These calculations probably underestimate true benefits.

Adult↗
PubMed1991

Stress in caregivers of elderly patients: the effect of an admission to a rehabilitation unit.

OBJECT: to study stress in caregivers of elderly dependent persons after admission to a geriatric assessment and rehabilitation unit. METHOD: in 1986-7 we studied patients admitted to a geriatric assessment and rehabilitation unit in Dunedin to establish the relationship between caregiver stress, their psychological health and social functioning, and patient variables such as physical dependency. RESULTS: of the 64 patients who were admitted from the community and who had a caregiver, 42 were discharged back to the community, and 30 remained there until six weeks. On admission caregiver stress was increased by problems perceived in social function (lack of companionship, excessive responsibilities and financial problems) and decreased when the caregiver had a high sense of psychological wellbeing. It was not associated with high patient dependency or the level of social support. Caregiver stress one week after discharge was lower among those with high emotional support and those with an internal locus of control. If caregiver stress one week after discharge was high there was an increased rate of readmission. CONCLUSION: rehabilitation should include interventions directed towards the psychological health and social function of the caregiver as well as the physical independence of the patient. Improved financial support and the provision of companionship through community support groups may result in reduced caregiver stress, which should help dependent elderly people to continue to live in the community.

Activities of Daily Living↗
PubMed1990

The rehabilitation of injured workers in New Zealand: a pilot study.

At the request of the local office of the Accident Compensation Corporation (ACC) we established a centre which offered a multidisciplinary rehabilitation programme consisting of a full assessment and an eight week individually planned and monitored fitness programme. The clients progressed to occupational therapy, work trials, and later to paid work. The programme included education about back care and health maintenance, and relaxation techniques. Of the 48 injured people who attended the centre, 37 were assessed as suitable to enter the programme, and 32 people took part. Outcome, measured as return to work or change in assessed fitness to work, was not related to age, sex, marital status, length of time since accident, or work category. Only 25% of workers returned to jobs in medium or heavy manual work. Sickness impact profile total and physical scores improved over the programme, but did not correlate significantly with return to work or fitness for work. Client perception of benefit was not significantly related to outcome. We analysed data from the 20 clients with claims longer than 6 months separately because matched case controls could not be provided by the ACC. Six months after completion of the programme, four were in paid employment, four in prolonged work trials, one in a job partly paid by the ACC, and one setting up his own business. Their return to the work force demonstrated the effectiveness of the centre in restoring people to function after prolonged periods of inactivity.

Accidents, Occupational↗
PubMed1989

Benefit from admission to a geriatric assessment and rehabilitation unit. Discrepancy between health professional and client perception of improvement.

To determine differences in perception of benefit from a patient's admission to a geriatric Assessment and Rehabilitation Unit, we asked both medical and nursing staff (health team) and the patient and carer (clients) for their evaluation after discharge. The areas studied were functional ability, relief of the principal symptom, education about the principal problem, and development of coping skills. Of 94 patients studied, 58 patients were discharged to the community (52 to carers, 6 to live alone) and 36 to institutions. In the former group, the health team had a consistently higher perception of benefit than the clients (P less than .001). Factors positively predicting health team perception of benefit were a higher carer happiness, improvement in patient independence, and internalization of the patient's locus of control. A negative predictor was an increase in patients' responsibilities. Client perception of benefit was positively predicted by fewer problems with companionship and communication with others. The health team's perception rated the adequacy of patient education and development of coping skills more highly than did the clients. In the patients discharged to the community, their perception of benefit at 1 week was a good predictor of survival in the community to 6 weeks. The possible reasons for these differences in perception of benefit and their implications are discussed.

Activities of Daily Living↗
PubMed1988

Why are the sensitive TSH assay and TRH stimulation test frequently low in very old euthyroid subjects?

Twelve healthy clinically euthyroid subjects 80 years and over were compared with 19 young controls to determine if the sensitive TSH test was more specific for hyperthyroidism in the elderly than the TRH stimulation test. Four of the 12 elderly subjects had a sensitive TSH level below the lower limit of normal for young subjects and four elderly subjects had a TSH rise of less than five IU after injection of 200 micrograms of TRH. Neither test is specific for hyperthyroidism in the elderly. There was a highly significant correlation between the sensitive TSH levels and the TSH rise after TRH stimulation in the old subjects but not in the young. This may be further evidence of an age related impairment in the hypothalamo pituitary-thyroid axis.

Age Factors↗
PubMed1987

Medical profiles of patients admitted to a geriatric assessment and rehabilitation unit.

A prospective prognostic study of all admissions to a geriatric assessment and rehabilitation unit was carried out which analysed the medical profiles of 205 patients admitted for the first time during a four month period. All patients were followed up for at least six months after discharge. Particularly poor prognosis was noted among patients with renal failure, ischaemic heart disease, depression, pneumonia, congestive cardiac failure, trauma, mental disorder and dementia. Good prognosis was reported in patients with Parkinson's disease, faecal impaction, stroke and adverse drug reactions. Multiple diagnoses were common, and only nine patients had no active medical problems during their admission. The implications for adequate training of geriatricians in medicine are discussed.

Aged↗
PubMed1986

Analysis of the activities of a geriatric assessment and rehabilitation unit.

In a four month period 228 patients were admitted to the Wakari assessment and rehabilitation unit in Dunedin, New Zealand. One hundred and seventy subjects came from the community, 35 were transferred from the local public hospital, and 23 were readmitted. Median lengths of stay were 13, 26 and 10 days respectively. Assessment of activities of daily living (ADL) dependency on admission and discharge showed a significant improvement in ability by discharge, which correlated closely with place to which subjects were discharged, and with survival. There was 5% inpatients death rate which cumulated to 18%, 23%, 34%, 39% and 46% by six weeks, three months, six months, nine months and one year respectively. High discharge dependency was closely related to poor survival after discharge. Use of domiciliary services did not change because the savings from those who moved into institutions were cancelled out by those who were discharged back to the community being in need of increased social support.

Activities of Daily Living↗