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Biomedical subjects

B W Fisher

Publications and source records attributed to B W Fisher.

4 recordsLinked to original sources
PubMed1995

A simple model for predicting postoperative delirium in older patients undergoing elective orthopedic surgery.

OBJECTIVE: To determine the incidence, and severity of postoperative delirium (POD) in older patients undergoing elective orthopedic procedures and to identify potential preoperative risk factors. DESIGN: A prospectively studied cohort of elective orthopedic surgery patients. SETTING: A University teaching hospital. PATIENTS: Eighty patients who attended a preadmission clinic and, subsequently, underwent elective orthopedic surgery. All patients were aged 60 years or older, and all spoke English. MEASUREMENTS: Patients underwent preoperative medical, cognitive, and activities of daily living assessment with standardized instruments and were followed postoperatively with daily visits, telephone interviews with attending nurses using a modified confusion assessment model (CAM), and repeated cognitive testing. Suspected delirium was verified by direct physician assessment. RESULTS: The elective group had 14 (17.5%) cases of POD, of which six (7.5%) were severe. These incidences are low compared with those of nonelective surgery groups reported elsewhere in the literature. Stepwise multiple logistic regression identified two POD risk factors: clock-drawing scores < or = 6 (OR = 9.0, CI, 2.8 to 45.6) and male gender (OR = 5.6, CI 1.9 to 33.8). CONCLUSION: A simple model using clock-drawing scores and male gender for preoperative identification of elective patients at greatest risk for POD appears sensitive, predictive, and practical for the preadmission clinic setting, but it should be validated in a prospective trial.

Aged↗
PubMed1990

Adult heart disease in Mt Hagen: a study of 154 patients.

Although several previous studies have been done on the nature and prevalence of cardiovascular disease in Papua New Guinea no study has looked exclusively at a highlander population. This article reviews 154 cardiac patients who first presented to the Mt Hagen adult outpatient department over a period of one year. The study excluded non-highlanders, patients under 12 years of age, and patients with heart disease secondary to anaemia or diseases of the blood vessels. Heart disease was found to constitute a significant proportion of outpatient visits and admissions. Cor pulmonale secondary to chronic lung disease was the commonest condition seen, occurring in higher frequency than reported elsewhere, and accounting for the majority of cases of congestive heart failure. Valvular heart disease was also common, often presenting in a precocious and severe form. Congenital bicuspid aortic values were important in the generation of aortic valve disease in this population. Arrhythmias and conduction disturbances were also common. Diseases of the myocardium and pericardium occurred infrequently and were of the same nature as those reported in other studies in Papua New Guinea. Hypertension was probably underreported in this study, with renal disease being a contributing factor in the cases seen. Ischaemic heart disease represented a small number of the total cases, but was probably underreported.

Adult↗