Search PubMed⌕ Search

Biomedical subjects

C Twomey

Publications and source records attributed to C Twomey.

35 records · Page 2Linked to original sources
PubMed1990

Regular planned respite admissions to a geriatric unit.

A programme of regular planned respite admissions to the geriatric unit in Cork was established in 1984, for dependent elderly being cared for at home. Retrospective analysis of the respite programme sought to establish its bed utilisation, type of patients admitted, factors in their selection process, their outcome and any associated hospital morbidity. Twenty-four patients have used the scheme during the four years since its commencement, with an efficiency of bed utilisation in 1987 of 14 patients occupying a mean of 4.33 beds per month. The median number of medical problems per patients was five; their median age 77 years and the percentage over 80 years was 46%. Twenty-two patients were already receiving intensive rehabilitation before being placed on the programme, mobility problems dominated. Nine patients continue on the programme with a mean of 23.9 months of respites to date, eight were discharged and seven died. There was no significant difference between the number of respite stays in hospital and "at home" stays complicated by morbidity. The results suggest that even for a highly selected group of dependent elderly, a planned programme of respite admissions is an effective form of care, uses hospital beds efficiently without associated morbidity and may provide an alternative to long stay institutional care.

Aged↗
PubMed1989

Effect of selective 5HT3 antagonist (GR 38032F) on small intestinal transit and release of gastrointestinal peptides.

Antagonists of 5-hydroxytryptamine type 3 (5HT3) receptors reduce the nausea induced by cisplatinum, but the effects of these agents on 5HT3 receptors in the human gut remain to be defined. We examined the actions of one of these drugs (Glaxo GR 38032F) on small intestinal transit and mouth-to-cecum transit times in healthy man. We also quantified its effects on the release of peptide YY (PYY), neurotensin, human pancreatic polypeptide, gastrin-cholecystokinin, and motilin. Ten healthy volunteers were enrolled in a randomized, double-blind, placebo-controlled crossover study. Following a single intravenous dose of GR 38032F (0.15 mg/kg), we measured the time to appearance in plasma of sulfapyridine after injection of salicylazosulfapyridine into the duodenum. This was used as a measure of duodenocecal transit. The appearance of hydrogen in breath after ingestion of a meal containing lactulose was also correspondingly used to quantify the mouth-to-cecum transit of the "head" of the meal. Gastrointestinal hormones were assayed in plasma by specific RIAs; samples were drawn fasting (10 min after injection) and after breakfast (358 calories: 15.7 g protein, 55.4 g carbohydrate, 8.1 g fat). The postprandial integrated response and peak release of PYY was decreased by GR 38032F. There was also a trend for the peak release of neurotensin to be reduced. GR 38032F did not significantly alter small intestinal transit times or mouth-to-cecum transit times. We conclude that GR 38032F does not have a major effect on small intestinal transit in health.

Adult↗
PubMed1987

The role of computed tomography brain scan in the diagnosis of acute stroke in the elderly.

In order to document the frequency with which nonvascular pathology may mimic stroke syndromes in the elderly, we prospectively studied 100 such admissions to a geriatric unit. Of 81 patients evaluated with computed tomography (CT) brain scan or autopsy only one patient with tumour (1.2%) was identified and this case is discussed fully. Nineteen patients did not have a CT scan or autopsy, though their presentation and clinical course was consistent with vascular pathology. This paper stresses the importance of documenting a comprehensive history and of regular clinical assessment of patients to identify atypical features which would alert the physician to consider nonvascular pathology. The incidence of nonvascular pathology presenting as stroke in the elderly is low. We conclude that CT brain scan is not indicated in the diagnosis of stroke in patients presenting to a geriatric unit.

Acute Disease↗
PubMed1978

Brain tumours in the elderly.

The incidence of cerebral tumour in a geriatric department over a seven-year period was 0.9% of all admissions. The distribution of benign, malignant and secondary brain tumours and their histological types were similar to those of younger adults. Apart from small asymptomatic tumours found incidentally at post mortem, most symptomatic tumours were recognized from their characteristic history. In particular, only 0.4% of patients diagnosed as stroke were subsequently found to have a cerebral tumour.

Aged↗
PubMedDate not supplied

Anticonvulsant use in elderly patients in long-term care units.

BACKGROUND: Elderly patients in long-term care units are frailer than their community-dwelling peers and may be more at risk from toxic side-effects of anticonvulsant medication at standard doses. AIM: To examine the prescribing of anticonvulsants to patients in elderly care units. METHODS: Drug prescription sheets and case notes were reviewed. Serum anticonvulsant concentration, renal and liver profiles and albumin level were measured. RESULTS: Anticonvulsants were prescribed to twice as many male as female patients (32 vs 14%; p<0.03) and to 33% of those younger than 80 years of age versus 10% of those aged 80 years or older (p<0.0002). No patient had significant hypoalbuminaemia and routine measurement of serum anticonvulsant concentration did not indicate an alteration of dosage. CONCLUSIONS: Anticonvulsants appear to be well tolerated in these patients. The younger age of those receiving anticonvulsants is inadequately explained by the characteristics of the patient cohort and may reflect a shift towards a younger age in patients requiring anticonvulsants due to increased mortality in this group.

Aged↗
PubMedDate not supplied

The financial implications of falls in older people for an acute hospital.

BACKGROUND: Falls are a common occurrence in older people and frequently lead to hospital admission. There is a current lack of cohesive fall prevention strategies in the Republic of Ireland. AIM: To demonstrate the cost of fall-related admissions to an acute hospital. METHODS: A review of Hospital Inpatient Enquiry (HIPE) data and medical case notes was performed for all fall-related admissions over a one-year period. The cost of fall-related admissions was calculated. In addition a detailed cost analysis was performed to determine the true cost of a hip fracture admission. RESULTS: There were 810 fall-related admissions, resulting in 8,300 acute bed days, and 6,220 rehabilitation bed days, costing euros 10.3 million. Fall-related readmissions resulted in 650 bed-days, bringing the total cost to euros 10.8 million. A typical hip fracture incident admission episode costs euros 14,300. CONCLUSION: Fall-related admissions of olderpeople are a significant financial burden to the health service.

Accidental Falls↗
PubMedDate not supplied

The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

INTRODUCTION: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS: To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS: Deranged [Na+] is common among elderly patients admitted to hospital.

Acute Disease↗
PubMedDate not supplied

Cardiac ventricular support. Considerations for psychiatry.

Cardiac ventricular support is fostering additional roles for psychiatric consultation with this vulnerable end-of-life cardiac group. Incidence of premorbid and postsurgical psychiatric disorders (Axis I), psychotropic use, neurologic events, and mortality was obtained for 21 Novacor left-ventricular assist system patients prospectively and 13 Abiomed left/right ventricular-assist device patients retrospectively. This fragile patient population and their families warrant involvement for psychiatry because of the extreme conditions and consequences associated with mechanical cardiac assistance. The authors address psychiatric morbidity and neurobehavioral modifications associated with ventricular support.

Adaptation, Psychological↗
PubMedDate not supplied

Patient throughput in an acute geriatric unit.

This report presents findings from a 3-year investigation of patient turnover, morbidity and mortality in the department of geriatric medicine based at Cork University and St. Finbarr's Hospitals, Cork. A total of 3,977 patients were admitted during the study period. The majority were 70 years or over (89%), referred by a general practitioner (83%) and female (56%). Seventy-one percent of admissions were discharged home, a further 18% died within the unit while 11% were transferred to continuing care. The median duration of stay was ten days. Age, diagnosis and source of referral significantly influenced both patient outcome and duration of stay. Forty-seven percent of discharged patients were followed-up at either the day hospital or outpatient clinic. A morbidity profile was constructed for a representative sample of 318 patients. 52% of this sample had two or more significant diagnoses. Neurological disorders carried a particularly poor prognosis. The median duration of stay for patients transferred to an on-site long stay facility was approximately one year.

Aged↗
PubMedDate not supplied

Rectal examination in hospital patients.

Rectal examination should be part of the initial examination of the patient especially those who are over the age of 50 and/or those with gastro intestinal and genito-urinary symptoms. We assessed the rate of rectal examinations carried out on acute general medical and surgical admissions over the age of 50 years.

Abdominal Pain↗
PubMedDate not supplied

The effects of hospital admission on drug prescribing in an elderly population.

307 consecutive patients admitted to our unit were studied. The reasons for altering patients' drug regimens were noted. The price difference between the patients' drugs on admission to those on discharge was calculated. While over 40% of drugs regimens on admission were unchanged on discharge some adjustments were made in the remainder. The most common reason for stopping a drug was that the hospital physician could find no indication for its use. A 30.3% reduction in price of discharge drugs compared with drugs on admission was achieved.

Aged↗
PubMedDate not supplied

The significance of basal systolic murmurs in the elderly.

Aortic stenosis is common in the elderly. Basal systolic murmurs are also common. We studied 512 patients over the age of 65 years to ascertain the prevalence of basal systolic murmurs and by using echocardiography on those with basal murmurs to determine the prevalence of significant aortic stenosis. 29% (148) of patients had basal systolic murmurs. 81 (55%) patients of this group had echocardiography carried out and 21 (25.9%) had a gradient across the aortic valve of 30 mmHg or more.

Aged↗