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Biomedical subjects

A J Bayer

Publications and source records attributed to A J Bayer.

At least 37 records · Page 2Linked to original sources
PubMed1989

Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill.

Decisions concerning the use of intravenous fluids and antibiotics in terminally ill patients are regularly made by hospital doctors, but there is little record of staff attitudes and current practice in Britain. A questionnaire was therefore distributed to 833 Welsh hospital doctors, citing the case of a hypothetical terminally ill patient and asking questions about medical management. Of the 448 (54%) doctors who replied, 346 (77%) had managed a similar patient recently. Intravenous fluids would be administered by 238 (53%), with 206 of these (87%) resiting the cannula as required and 62 (26%) resorting to a central venous line if there was no alternative. With increasing age and seniority doctors become conservative in their approach. Nearly all claimed that 'ensuring the patient's comfort' was the reason for their decision. Only 72 (16%) would use antibiotics if the patient became pyrexial. The results suggest that British doctors are divided in their approach to the medical management of terminally ill patients and there is a need for greater discussion and training so that all the issues involved are fully appreciated.

Anti-Bacterial Agents↗
PubMed1988

Thiamine status, vitamin supplements and postoperative confusion.

In a prospective, randomized, controlled study an intravenous vitamin B complex and vitamin C preparation was administered pre- and post-operatively to 28 elderly patients with a fractured proximal femur and compared with 32 nonsupplemented postoperative controls. Vitamin supplementation significantly, though only transiently, improved postoperative thiamine status (P less than 0.001), but had no influence on mental state or outcome during the postsurgical period. Therefore, the use of parenteral vitamins for postoperative confusion cannot be justified on a routine basis.

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PubMed1988

Bioavailability and acceptability of a dispersible formulation of levodopa-benserazide in parkinsonian patients with and without dysphagia.

The bioavailability of levodopa-benserazide in a standard capsule and a new dispersible tablet was compared in Parkinsonian patients, with (n = 8) and without (n = 8) swallowing difficulties. There was considerable variation within and between subjects, but no significant differences between formulations for any pharmacokinetic parameters, other than an earlier time-peak concentration following the dispersible tablets (P less than 0.01) in non-dysphagic patients. The acceptability of the dispersible tablets in the dysphagic patients was also determined following 7 days regular use. It was felt there were advantages in four of the patients because it was easier to administer or to swallow. The dispersible formulation may offer practical benefits to a minority of Parkinsonian patients without any anticipated loss of therapeutic efficacy.

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PubMed1988

Myocardial infarction in old people. The influence of diabetes mellitus.

The clinical features and outcome were determined for 100 consecutive patients aged 65 years or older with a history of diabetes mellitus who presented to hospital with acute myocardial infarction. Each case was compared with an age- and sex-matched nondiabetic control also admitted to hospital with acute myocardial infarction. Chest pain was equally common in both groups and was the main presenting symptom. Cardiac failure was a more frequent accompaniment in the diabetics, despite the lack of evidence for greater infarct size in this group. The outcome was worst for female diabetics, of whom 46% died. Contrary to popular teaching, painless myocardial infarction is not a specific feature of elderly diabetics.

Acute Disease↗
PubMed1988

Can old people on oral anticoagulants be safely managed as out-patients?

Of 62 patients (mean age 75, range 65-92 years) referred to an out-patient anticoagulant clinic specifically for those aged 65 years or more, treatment was considered unsafe in only one patient and was discontinued. Minor bleeding which did not require a significant change in management was recorded on 25 (7%) of 381 clinic visits and one major haemorrhage occurred requiring emergency hospital admission. Anticoagulation was maintained within the therapeutic range on 284 (75%) visits. The results confirm that with appropriate out-patient care and supervision, the risks of oral anticoagulant therapy in the elderly need be no greater than in younger patients.

Administration, Oral↗
PubMed1988

Presentation and management of myocardial infarction in the elderly.

A greater appreciation of the changing presentation of myocardial infarction with increasing old age should lead to earlier recognition and a more rational approach to management. Recent developments in treatment of the acute phase should not be denied to elderly patients solely on the basis of their age.

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PubMed1988

A geriatric high dependency unit--an innovation in the care of the acutely ill elderly patient?

A geriatric High Dependency Unit has been in operation at Cardiff Royal Infirmary for the past 7 years to provide "special-care" for acutely ill elderly people requiring careful bedside monitoring and intensive nursing and medical treatment. The background to the unit, its present functioning and the results of a prospective study of 432 consecutive admissions are described. The unit offers more appropriate and better continuity of hospital care for many very ill geriatric patients and may be a satisfactory alternative to admission to coronary or intensive care units where resources are not freely available.

Acute Disease↗
PubMed1987

Double-blind randomised trial of intravenous glycerol in acute stroke.

The effects of intravenous glycerol in elderly patients with recent onset of acute ischaemic stroke were evaluated in a double-blind randomised controlled trial. 173 patients received either 500 ml of a 10% solution of glycerol in physiological saline or 500 ml of physiological saline administered intravenously over 4 h daily for 6 consecutive days. The number of deaths within the first week was 10 (12%) in the glycerol group versus 26 (30%) in the controls. Subsequent mortality up to 12 months was similar in the two groups and a survival analysis confirmed a beneficial effect of treatment (p less than 0.02). The neurological and functional recovery of survivors, their length of hospital stay, and the proportion able to return to live in their own home were similar in the two groups. The improvement in survival time with glycerol was achieved without serious adverse effects and without an increase in the proportion of survivors with severe residual disability.

Acute Disease↗
PubMed1987

Acute myocardial infarction: diagnostic difficulties and outcome in advanced old age.

The diagnostic features and outcome of acute myocardial infarction in 100 very elderly (aged 85 years or more) hospitalized patients are reviewed and compared with those in a group of younger elderly (aged 65-84 years). The diagnostic triad of chest pain, sequential ECG changes and raised cardiac enzymes was present in only 24 very elderly patients and in 27 the diagnosis was not initially suspected. Presenting symptoms were often atypical and characteristic ECG changes could not be demonstrated in 25 patients. Very elderly patients had a higher mortality during the first few days in hospital, despite no greater incidence of cardiac failure and similar infarct size to the younger patients. Subsequent in-hospital mortality was similar in both groups. A higher index of suspicion of myocardial infarction in acutely ill very elderly patients should lead to earlier diagnosis, more appropriate management and may improve immediate prognosis.

Aged↗
PubMed1987

The memory clinic. A new approach to the detection of early dementia.

Dementia is commonly diagnosed at a time of major domestic breakdown, when symptoms are severe and family and community patience has been eroded. In order to encourage early referral and identification of patients with treatable conditions, a Memory Clinic is held at the University Hospital in Cardiff. The clinic provides a service for general practitioners, patients and carers, offering a multidisciplinary assessment, early diagnosis, and the planning of an individual 'care package' for each patient. It also has an important educational function and acts as a valuable research resource. A review of 100 consecutive patients recently referred found that 44 had Alzheimer-type dementia and 14 had a probable vascular component to their dementia. This latter group of patients were younger, more likely to be male and had a shorter duration of symptoms. One-third of patients were not dementing, and presenting symptoms in 19 of these dramatically improved with appropriate management, particularly of depression. 43 patients had other previously unrecognised, but treatable, medical conditions. Thus, early diagnosis enables the development of a clear plan for care, existing drug treatment can be rationalised, and appropriate treatment started at a stage when it is potentially of most value.

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PubMed1986

Changing presentation of myocardial infarction with increasing old age.

The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, "atypical" presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.

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PubMed1986

A double-blind controlled study of chlormethiazole and triazolam as hypnotics in the elderly.

This study compared the hypnotic efficacy and the psychometric effects of treatment with either chlormethiazole or triazolam for 9 weeks in elderly patients with sleep disturbance. Chlormethiazole and triazolam were found to be similarly effective in short-term use. However, evidence of sustained hypnotic efficacy throughout the 9 weeks of treatment was obtained for chlormethiazole but not for triazolam. There were daytime withdrawal effects with triazolam, but none with chlormethiazole.

Aged↗
PubMed1986

Plasma electrolytes in elderly patients taking fixed combination diuretics.

Plasma potassium and sodium concentrations were measured in a group of elderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.

Aged↗