The plantar response: caution in the elderly.
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Aged↗
Biomedical subjects
C S Gray
Publications and source records attributed to C S Gray.
Quality assurance in a rehabilitation facility: a decentralized approach.
Quality assurance (QA) in rehabilitation facilities and units must be tailored to rehabilitation activities, that is, those activities that enable patients to manage conditions and disabilities caused by their injuries or illnesses. Good Samaritan Medical and Rehabilitation Center in Zanesville, Ohio, has developed a system for QA in which managers of departments and services are responsible for QA in their own areas, thereby enabling them to monitor and evaluate the important aspects of care provided by their department or service. This article outlines the steps by which appropriate QA activities are determined and implemented in a rehabilitation facility using this decentralized approach.
Combined Modality Therapy↗
The prognostic value of haematocrit in acute stroke.
One hundred and twenty-two consecutive patients admitted with acute stroke in a carotid distribution had venous blood taken for haematocrit (Hct), haemoglobin (Hb), white cell count (WCC) and urea estimations. Patients were followed for 12 weeks to determine the influence of haematocrit upon fatality. There were 96 patients aged greater than or equal to 65 years and 26 patients less than 65 years. No association could be demonstrated between Hct levels and fatality at 4 or 12 weeks. Regression analysis demonstrated that only increasing age (P less than 0.05) and a raised WCC (P less than 0.005) were independent factors significantly associated with fatality at both 4 and 12 weeks. In the elderly stroke patient (greater than or equal to 65 years) only WCC was significantly associated with fatality (P less than 0.005). Haematocrit levels are of no prognostic value for fatality in acute stroke. A raised white cell count is an important and independent prognostic factor for fatality at both 4 and 12 weeks following stroke.
Adult↗
State-sponsored primary health care in Africa: the recurrent cost of performing miracles.
In this paper the author suggests that the design and execution of ongoing and future primary health care (PHC) interventions in Africa could be improved by more comprehensive and realistic assessments of the recurrent costs of alternative approaches to providing given levels of health care benefits. He develops the distinction between development and recurrent cost elements; distinguishes between marginal and average costs of interventions; identifies elements of social opportunity cost that are frequently overlooked in assessing project costs and shows how their inclusion magnifies the aggregate social cost of interventions featuring recurrent involvement of state agents; suggests that the perception of benefits conveyed by state-sponsored PHC programs to rural populations is limited, especially in relation to the true social costs; and discusses the implications of the above analysis for future PHC strategy.
Community Health Workers↗
The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke.
In a prospective study of 86 patients with acute stroke, blood glucose and HbA1 were estimated within 72 h of onset. The prevalence of previously diagnosed diabetes mellitus was 8% whereas 28% could be assumed to have had unrecognized hyperglycaemia preceeding the acute event as identified by a stable HbA1 raised more than two SD above the mean reference value. Complete functional recovery of the limbs within 4 weeks of the stroke was confined to those patients with a normal admission blood glucose. None of the patients with a raised admission blood glucose regained full functional recovery within 4 weeks. Cumulative mortality at 4 weeks was significantly raised in patients with an elevated blood glucose value irrespective of their HbA1 values (p less than 0.05). The prevalence of unrecognized hyperglycaemia as a risk factor for acute stroke is greater than previously reported in the UK and admission blood glucose concentration is of greatest importance in predicting early mortality and morbidity.
Adult↗
Diastolic heart failure in older people--myth or lost tribe?
Left ventricular diastolic dysfunction occurs due to a variable combination of abnormal myocardial relaxation and reduced ventricular compliance. The diagnosis of diastolic congestive heart failure is controversial. Some studies suggest that up to one-third of older people with symptomatic congestive heart failure (CHF) have echocardiograph evidence of diastolic dysfunction. Other authors have suggested the comorbid diseases often found in persons with suspected diastolic CHF explain the patient's symptoms and hence diastolic CHF is a misdiagnosis in many cases. Many of the characteristic echo features of diastolic dysfunction occur in normal ageing hearts. Unlike in systolic CHF, evidence for disease modifying treatment is lacking. Clinical trials currently in progress to determine the effectiveness of ACE inhibitors and angiotensin II receptor antagonists in the management of diastolic CHF may clarify the prognosis and management of this condition.
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