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T J Wilkinson

Publications and source records attributed to T J Wilkinson.

49 records · Page 3Linked to original sources
PubMed1992

Elderly people referred for institutional care--is prior assessment necessary?

AIMS: To determine whether requests for placement of an elderly person into rest home or hospital care accurately predicted the final outcome and to identify factors influencing a move to institutional care. METHODS: Three month audit of all referrals to an assessment and rehabilitation unit for the elderly requesting rest home or hospital placement. Requests for medical advice or rehabilitation were excluded. RESULTS: Two hundred patients were studied (24.6% of all referrals). Placement was requested in a rest home in 132 and hospital in 68. Seventy-one (54%) patients referred for rest home placement were able to return to their own home and 64 remained there at six month follow-up. Hospital level care was assessed as appropriate in 62% of requests for this initially and at six month follow up. Age and diagnosis were not significant predictors of patients requiring placement. Overall, of 158 patients living at home referred for rest home or hospital care, 67 (42%) were managing at home six months later. CONCLUSION: Accurate assessment and treatment/management of elderly patients is necessary before recommending higher levels of care. Patients can be maintained in their current environment for longer than perceived by the referring doctor. This has important social and financial benefits.

Aged↗
PubMed1992

Pharmacokinetics and efficacy of rectal versus oral sustained-release morphine in cancer patients.

Sustained-release morphine (MST) given by the rectal route was compared with oral MST in an open randomised cross-over trial in ten patients with cancer who received stable doses of MST. No significant difference was found in the areas under the curve of the concentration-time profiles (AUC) following oral or rectal administration for parent morphine. The AUCs determined for morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) after oral administration were approximately twice those obtained following rectal administration. The maximal concentration achieved was lower and the time to maximal concentration was longer following rectal administration for morphine, M6G and M3G. The relative mean arrival times following rectal administration were significantly longer for morphine and M3G but not for M6G. These findings suggest slower absorption but less first-pass metabolism of MST after rectal administration. No significant difference was noted between the oral and the rectal route in measurements on visual-analogue scales for pain or side effects. We recommend the rectal route as being suitable for MST administration when the oral route is no longer available. In changing from oral to rectal administration, the same dose and dose interval may be used, but dose adjustment may be needed.

Administration, Oral↗
PubMed1992

Neutropenic sepsis complicating treatment of solid tumours, lymphoma and myeloma.

Ninety-three episodes of fever or infection while neutropenic (defined as neutrophil count < 2.0 x 10(9)/l) occurred in 76 patients treated for solid tumours, lymphoma and myeloma over a 4-year period. Most followed the first (39%) or second (18%) cycle of chemotherapy. The neutrophil count at onset of sepsis was < 0.5 x 10(9)/l in 69%. Pathogens were isolated in 32 episodes (34%) and a clinical focus detected in a further 19 (20%). Gram negative bacteria accounted for 51% of pathogens; 49% of bacteria were isolated from blood, 65% of them were Gram negative. The initial antibiotic regimen was cefuroxime with gentamicin or tobramycin in 76 episodes. Fever or infection resolved on first line antibiotics in 78%. The mean duration of antibiotic therapy was 7.6 days. Antibiotic therapy was changed following urine culture in 1.5% of 66 episodes and following chest radiography in 5.8% of 69 episodes, where these tests were performed. Nine (9.6%) patients died from infection, all of whom were receiving second line salvage chemotherapy. Three other patients died of progressive malignancy with sepsis present. In six major diagnostic groups, 56 episodes of infection or fever complicated 4% of chemotherapy cycles.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Increased incidence of germ cell testicular cancer in New Zealand Maoris.

A higher incidence of germ cell testicular cancer was found in Maoris (6.84/100,000) compared with non-Maoris (5.26/100,000) in New Zealand from 1975 to 1986, especially in the 15-49 year age group (Maoris 12.30/100,000, non-Maoris 9.47/100,000; P = 0.04). Previous studies have shown Whites to have the highest incidence of this malignancy. Possible reasons for this and some other epidemiological features are discussed.

Adolescent↗
PubMed1992

Attitudes of medical students to old people: a cross-national comparative study.

Medical students' attitudes to the elderly were compared at the start and finish of a 5-week clinical attachment in health care of the elderly at the Christchurch School of Medicine. The study investigated students in their first clinical year (fourth year of their medical course) over five terms using a questionnaire employing a Rosencranz-McNevin semantic differential scale to measure general attitudes to old age and a Likert scale to measure attitudes to medical care. A question was also asked about career preferences. There was significant improvement in attitudes measured by both scales (Rosencranz-McNevin P less than 0.001, Likert P less than 0.001). Students also showed an increase in interest in health care of the elderly as a career choice. When compared with two cohorts of students from Nottingham Medical School, attitudes were significantly better in the Christchurch group at the commencement of the run. Students at both schools showed an improvement in knowledge but this was more marked for Christchurch students.

Aged↗
PubMedDate not supplied

What is the prognosis of mild normocytic anaemia in older people?

BACKGROUND: There is reduced survival for people with all types of anaemia and it has been shown that there is a low yield from investigations for older people with normocytic anaemia. However, the longer-term outcomes of people with mild normocytic anaemia are not known. AIMS: To determine the 5-year prognosis of older people with mild normocytic anaemia, compared with non-anaemic controls. METHODS: This was a prospective cohort study, with some retrospective data collection, comparing 52 people aged > or =65 years (haemoglobin 100-119 g/L; mean cell volume 80-99 fL) without an obvious cause at presentation with 52 non-anaemic controls. The incidence of death, new malignancies and significant illnesses was compared between the two groups, 5 years later. RESULTS: Anaemic patients were less likely to be living at home at baseline. Although survival was lower for the anaemic group at all follow-up times, these differences were not significantly different. Over 5 years, there were no significant differences between groups in the types of problems that developed. CONCLUSIONS: A mild normocytic anaemia in older people, in the absence of an obvious cause, is not associated with significant differences in outcomes but is associated with poorer independence and a trend to lower survival. We suggest it may therefore be a marker of frailty in older people.

Aged↗
PubMedDate not supplied

Evaluation of a warfarin initiation protocol for older people.

A protocol for initiation of warfarin therapy, targeted specifically for older people and based on individual responses to initial warfarin doses, was evaluated in a case-control study. People within the protocol group: (i) received higher initial doses of warfarin, (ii) reached an international normalized ratio (INR) of 2 more quickly, (iii) spent more time with INR of 2-3 in the first week and (iv) were less likely to be over-anticoagulated. However, the proportion of people who reached an INR of 2 too quickly (in <4 days) was no greater. The protocol correctly predicted the maintenance dose range of warfarin in over 70% of cases.

Aged↗