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Biomedical subjects

C M Castleden

Publications and source records attributed to C M Castleden.

114 records · Page 7Linked to original sources
PubMedDate not supplied

A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke.

BACKGROUND: Although stroke patients who do not have difficulty swallowing may be at risk of undernutrition and worsening nutritional status during hospitalization, optimum methods for nutrition intervention in stroke patients have not been established. AIM: To examine the feasibility of enteral sip feeding as an effective nutrition intervention after acute stroke. METHODS: Forty-two acute ischemic stroke inpatients with impaired nutritional status who did not have difficulty swallowing within 1 week after the stroke were entered into a single-blind, randomized, controlled, prospective study of enteral sip feeding. Twenty-one patients were randomized to receive daily oral food supplements for 4 weeks in addition to the hospital food, and 21 patients received only the hospital food for the same period. Main outcome measures were energy and protein intakes during the intervention period, change in nutritional status, disability, infective complications, length of stay, and mortality during hospitalization and at 3 months. RESULTS: Two patients, one from each group, were lost to follow-up immediately after randomization. Twenty patients received oral nutritional supplementation. The energy intake was significantly greater in the supplemented group: 1807 +/- 318 vs 1084 +/- 343 kcal/d (mean +/- SD; p < .0001) (estimated treatment effect, 723 kcal/d; 95% confidence interval [CI], 498 to 947), as was protein intake: 65.1 +/- 13.8 vs 44.1 +/- 12.8 g/d (p < .001) (estimated treatment effect, 21.0 g/d; 95% CI, 11.7 to 30.3). There also were significant differences between the two groups in the changes in serum albumin and serum iron concentrations between randomization and at follow-up. There was a trend to lower mortality at 3 months in the supplemented group with two deaths (10%) compared with seven deaths (35%) in the control group (p = .127, relative risk, 0.29; 95% CI, 0.07 to 1.21). CONCLUSIONS: This study suggests that enteral sip feeding is effective in improving nutritional intake and status in stroke patients who do not have swallowing difficulties. There also may be some beneficial effects on clinical outcome, but larger studies are required to confirm this observation and define more precisely the magnitude of any favorable effects.

Brain Ischemia↗
PubMedDate not supplied

Adverse drug reactions. An overview of special considerations in the management of the elderly patient.

The incidence of adverse drug reactions increases with aging, and the elderly are more likely to suffer serious or fatal reactions. Thus, morbidity and mortality are considerable in old patients, with 15% of those in hospital suffering a reaction, and many admitted as a consequence of one. The greater propensity of older patients for adverse drug reactions largely reflects the prescription of drugs to them, although over-the-counter purchases must also play a part. The elderly take more drugs per se (which is a reflection of multiple pathology), and more drugs with a narrow therapeutic index associated with a high risk of dangerous adverse reactions and drug interactions. They also have a reduced ability to withstand any reactions due to concomitant disease, and an altered pharmacokinetic and -dynamic response which tends to increase drug effects. The recommendation must be to use fewer drugs in older patients, perhaps trying alternative medicine first in nonacute conditions. Starting doses can often be reduced in the elderly, and clinical and therapeutic monitoring of effect is mandatory. The use of diuretics, antihypertensives, anti-Parkinsonian drugs and anticoagulants emphasise these points, and is discussed in detail together with digoxin, analgesics and nonsteroidal anti-inflammatory drugs. Clear guidelines are given for the use of each of these classes of drug.

Aged↗
PubMedDate not supplied

Miller Fisher syndrome and anti-GQ1b antibodies.

A case is presented of Miller Fisher syndrome in a 77-year-old woman. The diagnosis was confirmed by the presence of serum IgG antibody to ganglioside GQ1b. Miller Fisher syndrome, although uncommon, enters the differential diagnosis of brainstem stroke.

Aged↗
PubMedDate not supplied

A visit to Germany. Report of a medicine-Gilliland travelling fellowship.

Overall the health system in Britain is better and cheaper than that in Germany. It is a pity that one needs to go away to appreciate how good our system is. The financial problems of the health service in the UK are no different from those in Germany except that the cost of the health system in Germany is much greater. The training of junior doctors is not as good in Germany as in the UK and overspecialisation is introduced too early. There is no supervision or counselling of juniors by hospital or college representatives, no vetting of posts by college representatives, and professional advancement is often in the hands of one consultant. There is evidence of overmanning with widespread unemployment amongst doctors in Germany. Geriatric services in Germany have little to teach the British except for the concept of the importance of care for the elderly which our more acute systems in Britain might have lost. The best German rehabilitation centres are excellent and the lucky patients who are in such units have better treatment and facilities than those in similar centres in Britain. The acute neurological services are most impressive, aggressive and intensive but have no follow-up service for patients. Some practices possibly create more problems than they solve. There is wide interest in research in Germany, with considerable expertise not only in the university but also in community hospitals, and a great desire for cooperation with Britain. There are many interesting observations and comparisons between the Germany and British systems, and each could benefit from incorporating the other's ideas.

Cerebrovascular Disorders↗
PubMedDate not supplied

A prospective study of primary and secondary risk factor management in stroke patients.

Stroke is a common event which often results in death or major loss of independence with immense human and financial costs, so identification of patients at risk, and prevention of stroke at the individual and population levels, is a high clinical and health priority. From August 1993 to July 1994, 468 stroke patients admitted to our hospital were assessed for the presence of stroke risk factors. All patients were followed up in hospital, and on discharge or death all hospital records were reviewed. We show that many risk factors remain uncorrected in stroke patients and that preventive measures are less than ideal at the community and hospital levels alike.

Adult↗