Search PubMed⌕ Search

Biomedical subjects

G Worrall

Publications and source records attributed to G Worrall.

35 records · Page 2Linked to original sources
PubMed1996

Predicting outcomes of community-based continuing care. Four-year prospective study of functional assessment versus clinical judgment.

OBJECTIVE: To compare the predictive power of functional assessment for death and institutionalization with the clinical judgment of continuing care nurses; to determine the rates of functional impairment in elderly community-based continuing care clients; to describe long-term group trends in this population. DESIGN: A prospective cohort study, which lasted 4 years. SETTING: Community-based continuing care nursing program. PARTICIPANTS: Two hundred thirty-seven elderly (65 years or older) clients of the program. MAIN OUTCOME MEASURES: Activities of daily living (ADL), cognitive function, and affective function were assessed when clients entered the program (using the Barthel Index, the Canadian Mental Status Questionnaire, and the Memorial University Scale of Happiness). Home care nurses were asked to predict whether individual clients would have died or dropped out of the program at 1 year after entry. RESULTS: Cognitive function and ADL function tests were significant predictors of both death and drop-out from the program; they were better than clinical judgment. Rates of cognitive and ADL functioning were as expected; the rate of affective impairment (53.6%) was much higher than anticipated. At the end of 4 years, only 22.5% of the cohort were still receiving continuing care. CONCLUSIONS: Functional assessment of cognitive and ADL domains was a better predictor of outcomes than clinical judgment. Studying the cohort enabled us to describe group trends, which could be valuable for program managers.

Aged↗
PubMed1994

Results of the DCCT trial. Implications for managing our patients with diabetes.

Results of the Diabetes Control and Complications Trial (DDCT) suggest that intensive therapy can prevent or delay the microvascular complications of diabetes. This article critically appraises evidence from the DCCT and other prospective trials and concludes that the successful results for persons with insulin-dependent diabetes cannot be generalized to most family practice diabetes patients, who have non-insulin-dependent diabetes.

Clinical Trials as Topic↗
PubMed1994

Cognitive function among the elderly. Comparison of home care clients and independent seniors.

A cross-sectional survey from the Centre for Rural Health Studies of 210 elderly clients in a rural home care program found that 18.1% had severe or moderate cognitive impairment, yet only 6.6% of 167 elderly community residents living independently in a rural community had similar impairment. While the difference was significant, our methodology could not determine whether a causal association existed.

Activities of Daily Living↗
PubMed1993

Cognitive function. Survey of elderly persons living at home in rural Newfoundland.

We tested the cognitive function of elderly, community-dwelling residents in rural Newfoundland using the Canadian Mental Status Questionnaire. The prevalence of moderate and severe cognitive impairment was 9.3%. Physicians in the community had recognized those with severe impairment, but had not recognized any of those with moderate impairment. Cognitive function testing should be part of the periodic health examination of older patients.

Aged↗
PubMed1993

Effect of type II diabetes mellitus on cognitive function.

BACKGROUND: As people with diabetes mellitus suffer from peripheral and autonomic neuropathy, we thought it possible that deficits in cognitive function might also be found. Our objective was to compare the cognitive function of elderly persons with non-insulin-dependent diabetes mellitus (NIDDM) with a matched sample of persons without NIDDM: METHODS: Ninety outpatients over 50 years of age with NIDDM and 90 matched nondiabetic patients were recruited for the study. The Modified Mini-Mental State (3MS) and the Delayed Word Recall (DWR) test were used to assess cognitive function. RESULTS: On the 3MS test, the mean score of persons with NIDDM was 75.6, and that of nondiabetic persons was 79.5 (two-tailed t = 3.04, P = .013). On the DWR, the mean score of persons with NIDDM was 3.9, and that of persons without NIDDM was 4.7 (two-tailed t = 3.52, P = .012). CONCLUSIONS: Persons with NIDDM had significantly poorer scores on two tests of cognitive function. Physicians should be aware of this association between type II diabetes and a small but definite impairment of cognitive function.

Aged↗
PubMed1991

Screening healthy people for diabetes: is it worthwhile?

BACKGROUND: The objectives of this study were (1) to estimate the prevalence of previously unknown diabetes mellitus in an apparently healthy population aged 40 years and older, (2) to estimate the ratio of known to unknown diabetics, and (3) from this information, to estimate the true prevalence of diabetes. METHODS: A one in five random sample of healthy patients aged 40 years and older attending six rural family physician offices had their fasting plasma glucose (FPG) level tested with a reflectance glucometer. If the FPG was greater than or equal to 7.8 mmol/L (140.5 mg/dL), a second FPG test was done on a later day. RESULTS: The sample of 1264 patients contained 139 known patients with diabetes. Of the remaining 1125 patients, 936 (83%) were tested. Twenty-three patients had an elevated FPG level on the first test, but only nine of them had an elevated FPG level on the second test. One new patient with diabetes was found for each 15 patients already diagnosed; thus, the prevalence of unknown diabetes in the study population was 0.7%. As a result of this survey, the estimated prevalence of diabetes in the population age 40 years and older rose from 11.0% to 11.7%, and the estimated prevalence for the entire population rose from 4.4% to 4.6%. CONCLUSIONS: Routine screening for diabetes mellitus in otherwise healthy patients aged 40 years and older is not worthwhile. Such screening should be restricted to high-risk groups.

Adult↗
PubMed1990

Early detection of depression by primary care physicians.

The overall prevalence of depression is from 3.5% to 27%. The burden of suffering is high and includes death through suicide. In most cases treatment is effective, but important episodes of depression are being missed. To determine whether a brief, systematic assessment for the early detection of depression should be part of the periodic health examination we searched MEDLINE and the Science Citation Index for randomized controlled trials that evaluated the effectiveness of early detection of depression with a questionnaire. Seven instruments met our quality criteria; the Beck Depression Inventory, the Center for Epidemiologic Studies Depression Scale, the Zung Self-Assessment Depression Scale, the General Health Questionnaire, the Hopkins Symptom Checklist, the Mental Health Inventory and the Hospital Anxiety and Depression Scale. The four randomized controlled trials failed to provide adequate evidence of the benefit of routine screening. Early detection is difficult because of depression's natural history, the role of symptoms, the cultural diversity of Canada and how detection instruments have been developed. Depression deserves careful attention from primary care physicians; however, further research and development is required before the widespread routine use of any detection test can be recommended.

Adult↗
PubMedDate not supplied

The ratio of diagnosed to undiagnosed diabetes in patients 40 years and older.

A cross-sectional survey of a one in five random sample of apparently healthy adults aged 40 years and older was done in 17 family practice clinics in Newfoundland, in order to pick up previously undiagnosed diabetics, by fasting blood sugar (FBS) measurements. From a sample of 2,087 people, 1,767 were tested. Forty-eight persons had an elevated FBS on the first test, but only 19 had a sustained high FBS when a second test was done. There were 16 previously-known diabetics for each new diabetic found; in this population it was not worth screening healthy persons for diabetes. Testing should be restricted to high-risk people only. As a result of this study, the diabetes prevalence in the 40+ population rose from 12.4% to 13.1%.

Adult↗
PubMedDate not supplied

A minimal prevalence study of diagnosed diabetes in Newfoundland and Labrador.

A two-stage random probability sampling survey of the medical charts of family physicians in Newfoundland and Labrador was done; the first stage sampled physicians randomly, in proportion to the 5 health districts of the province; the second stage took a quota sample of the physicians' charts. The survey revealed a total population minimal prevalence rate of diagnosed diabetics of 3.55% (95% confidence limits 2.55, 4.55). This rate is higher than that found in the only other provincial survey done in Canada (the Prince Edward Island survey). Of diagnosed diabetics, 40% were found to be using insulin. This proportion is higher than other rates in North America. The prevalence rate was slightly higher in males (3.7%) than in females (3.4%).

Age Factors↗