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Biomedical subjects

J G Ouslander

Publications and source records attributed to J G Ouslander.

At least 109 records · Page 6Linked to original sources
PubMed1988

Pharmacokinetics and clinical effects of oxybutynin in geriatric patients.

The pharmacokinetics and clinical effects of oxybutynin were examined among 21 elderly (mean age 84 years) patients with urge incontinence and detrusor instability or hyperreflexia. The drug did not accumulate to high levels after a week of treatment at dosages of either 2.5 or 5 mg. 3 times per day, and the mean peak level on 5 mg. among the elderly (12.5 ng. per ml.) was not statistically different than the mean peak level reported after the same dosage in young healthy men (8.9 ng. per ml., p equals 0.4). There were no clinically meaningful changes in heart rate, blood pressure or intraocular pressure during the treatment periods. Two-thirds of the patients suffered at least 1 side effect, most commonly dryness of the mouth that was not severe enough to warrant discontinuation of the drug. These data suggest that oxybutynin chloride at dosages of 2.5 to 5 mg. 3 times per day is safe for use in the elderly, even among octogenarians. Statements about its effectiveness and efficacy in the geriatric population must await controlled clinical trials.

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PubMed1988

Habit training and oxybutynin for incontinence in nursing home patients: a placebo-controlled trial.

In order to determine if a bladder-relaxant drug could enhance the effectiveness of a toileting program for incontinence among functionally impaired nursing home patients, 15 patients with detrusor hyperreflexia were enrolled in a 6-week trial during which they were put on a habit training protocol alone for 2 weeks, habit training (HT) and a placebo for 2 weeks, and then HT and oxybutynin for 2 weeks (2.5 mg three times daily for 1 week, then 5 mg three times daily for 1 week). Bacteriuria, which was present without other symptoms in 11 of the 13 patients who completed the trial, was treated before HT began. Eradication of the bacteriuria resulted in a small, statistically significant increase in cystometric bladder capacity (44 mL; 95% confidence interval 16 to 72 mL), but the detrusor hyperreflexia and frequent episodes of incontinence persisted. HT alone reduced the mean percentage of every-two-hour checks which were wet from 43% to 32% (95% confidence interval of the difference -1% to -21%; P = .04 by a paired t test); addition of placebo and active drug did not result in any further reduction. Cystometric bladder capacity had not changed significantly by the end of the trial (measured while patients were still on active drug), and there was no consistent relationship between changes in bladder capacity and changes in wet checks. Although our sample size is small, the data are consistent with other studies in similar populations. The relatively practical and inexpensive interventions we employed in this study will need to be modified or intensified in order to substantially reduce the frequency of incontinence among functionally disabled nursing home patients.

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PubMed1988

Dynamics and clinical implications of the nursing home-hospital interface.

Nursing homes and hospitals are dynamically interrelated, and there is much that the clinician can do to optimize patient transitions between institutions. This article approaches this topic in three sections: epidemiology of movement between hospitals and nursing homes, impacts of policy changes and financial incentives on patient transfers, and clinical strategies to reduce unnecessary hospitalizations of nursing home patients.

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PubMed1987

Yield of routine annual laboratory tests in a skilled nursing home population.

The yield of routinely performed annual panels of laboratory tests was examined among patients in the skilled nursing facility section of a large, multilevel, long-term-care institution. Of 9270 tests done as part of 336 annual panels in 121 patients over an eight-year period, 17% of the tests yielded abnormal results, and in 36% of the tests, abnormal results were new. Among the 336 panels, 56 (16.7%) had at least one abnormality that was believed to have resulted in some benefit to 30 (24.7%) of the patients. Many of the abnormalities that led to patient benefit could have been detected by periodic monitoring of chronic conditions and their treatment as opposed to true screening tests, and all such abnormalities could have been identified by a complete blood cell count, electrolyte determinations, renal and thyroid function tests, and a urinalysis. The results suggest that a modest panel of annual laboratory tests could limit the potential costs of screening and not result in the loss of potential benefits to patients in skilled nursing facilities.

California↗
PubMed1987

Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study.

We studied prospectively the incidence of symptomatic infections of presumed urinary tract origin requiring antimicrobial therapy among 54 male nursing home patients with chronic indwelling bladder catheters. During 514 patient-months at risk there were 106 episodes of symptomatic infection, for an incidence of 0.21 per patient-month at risk. Of the patients 80 per cent had at least 1 episode and 48 per cent had 2 or more. None of the clinical factors we examined, including age, nutritional status, stool incontinence, diabetes mellitus, episodes of catheter blockage and the use of chronic suppressant antimicrobial therapy, was associated with the development of symptomatic infection. Further research on host and pathogen-related factors that increase the risk for symptomatic infection, and improvements in infection control and catheter care protocols are necessary to decrease catheter-associated morbidity among male nursing home patients who must be managed by chronic indwelling catheterization.

Catheters, Indwelling↗
PubMed1987

Clinical, functional, and psychosocial characteristics of an incontinent nursing home population.

Although urinary incontinence is recognized as a prevalent, disruptive, and costly problem among nursing home residents, the factors associated with this condition have not been carefully studied. We compared clinical, functional, and psychosocial characteristics of 50 incontinent and 50 continent nursing home residents. In spite of a selection bias due to the informed consent process that resulted in the exclusion of many of the most functionally impaired incontinent residents, the incontinent study participants had significantly greater impairments in functional abilities related to toileting and, on average, took longer to perform a timed series of toileting-related tasks than did the continent comparison group. With the exception of bacteriuria, we did not find incontinence to be associated with most of the major clinical conditions and medications we examined, nor did we find differences in morale and most measures of social activities between the incontinent and continent residents. The data highlight the strong association between functional disability and incontinence in the nursing home setting and suggest that a standard functional assessment of toileting skills could make an important contribution to the care of incontinent residents.

Activities of Daily Living↗
PubMed1987

Nursing home rounds as a format for teaching residents and medical students.

The nursing home has become a focus for education as well as patient care. A format was devised for nursing home rounds that provides for discussion among staff members and specialists and is aimed at teaching and the resolution of specific patient-care and administrative issues. This format is outlined, and records from these twice-weekly rounds are reviewed. The nursing home rounds were consistently attended by members of the nursing and medical staffs, trainees, and nursing and medical directors. As is apparent from the records of these rounds, many complex medical problems were handled without transferring the patients to an acute-care facility. The discussion among participants of specific clinical problems at nursing home rounds has proven invaluable as a tool for education and delivery of patient care.

California↗
PubMed1987

Incontinence among nursing home patients: clinical and functional correlates.

This study was undertaken to examine the association of specific medical and genitourinary conditions, medications, and functional disabilities with urinary incontinence (UI) in a nursing home (NH) population. Seventy-six incontinent and 38 continent patients in a Veterans Administration NH were studied. Incontinence was highly associated with each of the physical and mental functional disabilities we examined. However, with the exception of recurrent urinary tract infections and dementia, no specific clinical factors were significantly more common among incontinent than continent patients. Although precise causes for the UI were not determined, these data highlight the potential role of impairments of physical and/or mental function in the pathogenesis of UI among NH patients, and emphasize the need to address these impairments in future research on the assessment and treatment of UI in this population.

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PubMed1987

External catheter use and urinary tract infections among incontinent male nursing home patients.

In order to examine the relative frequency of urinary tract infection (UTI) and bacteriuria among male nursing home patients managed with and without external catheters (EC), we prospectively followed four cohorts of patients (EC worn continuously, N = 30; EC worn at night only, N = 19; incontinent without catheter, N = 13; and continent, N = 30) for a total of 497 patient months at risk. The proportion of patients with EC worn continuously who had at least one episode of bacteriuria (87%) and at least one UTI (40%), and the incidence of UTI (0.08 episodes per patient-month at risk) was significantly higher than among continent or incontinent patients without EC. Patients with EC at night only had an intermediate frequency of these findings. Differences in clinical and functional status characteristics among the four cohorts, in addition to the use of EC, could have contributed to the higher frequencies of bacteriuria and UTI. None of the clinical characteristics we examined were associated with the development of UTI among patients with EC. Further studies are necessary to identify factors associated with UTI among patients who are managed by EC so that effective preventive strategies can be developed and targeted to patients at high risk.

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PubMed1987

Assessment in the nursing home.

Nursing homes are an important component of the health care system for elderly people, and their importance will grow over the next several decades. Although the care provided in nursing homes is improving, it is far from optimal in many facilities. Improving the process of assessment in the nursing home is critical to improving nursing home care. This article provides a clinically oriented framework for the assessment of nursing home patients. It focuses on medical, nursing, and interdisciplinary assessment strategies for the assessment of nursing home patients and attempts to emphasize the unique and often complex issues that arise in the nursing home setting.

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PubMed1987

An accurate method to obtain urine for culture in men with external catheters.

Results of urine cultures from 26 male nursing home patients wearing external catheters, collected by a simple standardized technique, were compared with culture results from the same patients obtained by sterile in-and-out catheterization. The culture results were the same in 22 (85%) of the matched specimens, and specimens collected by the standardized technique were 100% sensitive and 94% specific in detecting significant growth of pathogenic organisms. In contrast, 13 (57%) of 23 specimens collected from patients with external catheters by the nursing home staff using their routine technique yielded three or more organisms and were considered contaminated. These results suggest that it is possible to obtain a urine specimen that reflects bladder urine in the vast majority of patients with external catheters, and thus potentially avoid the need for in-and-out catheterization when diagnosing and planning treatment for urinary tract infections in this population.

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PubMed1986

Organizing an academic nursing home. Impacts on institutionalized elderly.

In March 1984, a program for an academic nursing home was established at the Sepulveda Veterans Administration Medical Center. The program was designed to improve care of nursing home patients, provide interdisciplinary training for medical house staff and allied health students, and stimulate research. Geriatric faculty physicians were appointed, medical house staff were assigned as primary physicians to groups of patients, and geriatric nurse practitioners were hired to provide day-to-day care. A two-phase evaluation of the impact of the academic nursing home on patient care was conducted. Beneficial developments associated with the program in concurrent comparison with the standard nursing home unit included a significant decrease in patient transfers to the acute-care hospital and significant improvements in functional status, patient satisfaction, and morale. A trend toward improved survival was nonsignificant. Longer-term follow-up revealed a significantly increased rate of discharge for patients completing long-term rehabilitation. Overall, the costs of nursing home care were only minimally increased by the program. Results suggest that programs like the academic nursing home can lead to improved process and outcomes of nursing home care.

Academic Medical Centers↗
PubMed1986

Informing the elderly. A comparison of four methods.

Providing elderly persons with understandable information with which they can make informed health care decisions is a difficult, yet critical, task. Four methods of enhancing understanding of the Resident's Bill of Rights were evaluated in residents of the board and care section of a long-term care facility. The methods included the use of large print and simplified language, a storybook, and a videotape. There was no significant improvement for performance on the comprehension test after any of the methods of presentation of the Bill of Rights. A number of subjects were found to be very deficient in short term memory or in verbal knowledge. When these subjects were eliminated from the analyses, significant improvement was demonstrated with the simplified version of the Bill of Rights yielding the most improvement. These findings indicate that many elderly people can benefit from an informed consent procedure that provides information clearly and simply. Furthermore, with relatively simple cognitive screening procedures, it should be possible to identify those unable to process the information necessary to participate in common health care decisions.

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PubMed1986

Genitourinary dysfunction in a geriatric outpatient population.

Clinical and urodynamic findings in 167 women and 96 men, aged 65 years and older evaluated consecutively during a four-year period in an outpatient urodynamic laboratory, are presented and compared with findings from other studies of geriatric populations. Seventy-three percent of the patients (81% of the women and 60% of the men) presented with symptoms of incontinence, most commonly of the mixed type. Although pathological lesions such as tumors and stones were rare, urodynamic abnormalities were common. Urodynamic evidence of sphincter weakness in women and detrusor motor instability were the most common urodynamic findings among patients who presented with incontinence. Close to 20% of patients who presented without incontinence also had one or more of these findings. Approximately one-third of patients had multiple urodynamic findings, emphasizing the complexity of the pathophysiology, diagnosis, and treatment of genitourinary dysfunction in many geriatric patients. Despite the long duration of symptoms in most patients, the majority were substantially improved after diagnosis and treatment of the specific genitourinary and urodynamic abnormalities detected.

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PubMed1986

Development and testing of an incontinence monitoring record.

Bladder records can play an important role in the assessment and treatment of incontinence. Many records currently used in long-term care settings are difficult to read and interpret, and they do not provide for the recording of information that can be of value in the assessment and treatment process. Two versions of an incontinence monitoring record (IMR), one using black and white symbols and the other using colored circles, were developed and tested in a quasiexperimental design in three proprietary nonacademically affiliated nursing homes. The IMRs were well accepted by the nursing staff in these homes. Recordings were made more frequently and interrater reliability was highest with the color version of the IMR. Results of this initial study are promising and suggest that the IMR, or a similarly designed record, will be helpful in nursing homes to assess the bladder and bowel status of new admissions, determine patterns of and factors associated with incontinence, design individualized bladder training programs, and monitor the results of these programs and other treatment modalities. In addition, the IMR can provide an opportunity for nurses' aides to meaningfully participate in the assessment and treatment of a condition they manage on a daily basis.

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