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Biomedical subjects

J Tyrrell

Publications and source records attributed to J Tyrrell.

At least 19 recordsLinked to original sources
PubMed2005

[Videophone assistance and home hospitalization: the ViSaDom program].

OBJECTIVE: The purpose of this project was to study the clinical feasibility of videophone-based communication between patients in their homes, and the care teams who work in the Home Hospitalization department (HH). METHODS: This pilot study of videophone users compared them with a group of control patients also in HH. They came from either the adult, maternity or pediatric departments. Patients who met the inclusion criteria and consented to participate in the study were randomly assigned to one of two groups: those who had a videophone installed in their homes (telemedicine group), and those who received the standard HH care (control group). Sixteen patients in the telemedicine group were matched with 16 from the control group, according to age, Karnofsky Index score, and the reason for HH admission. RESULTS: The mean videophone call lasted six minutes, and patients averaged 23 calls each over the study period (0.7 calls per patient per working day). The videophone enabled better follow-up of wounds: for example, the nurse could transmit photos from the patient's home for real-time coordination. It was also useful for following patients suffering from pain, for technical nursing care, and for educating patients and their caregivers. Anxiety (measured with the Hospital Anxiety and Depression Scale) diminished during the study period for the telemedicine patients, compared with the control group (p=0.048). Within the telemedicine group, all patients and their families were very satisfied or satisfied with their care and with the communication (15/15), although the staff's level of satisfaction was slightly lower (14/16); there were no significant differences between groups. CONCLUSION: The ViSaDom program indicates that videophone communication is feasible and acceptable and could be a useful tool for improving the quality, efficiency and effectiveness of care.

Activities of Daily Living↗
PubMed2005

Home nocturnal hemodialysis in children.

OBJECTIVE: To describe the effect of home nocturnal hemodialysis (NHD) in North American children. STUDY DESIGN: Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistulae for periods of 6 to 12 months. Blood flow approximated 200 mL/min, and dialysate flow was 300 mL/min; the dialysate contained potassium and phosphate. The procedure was remotely monitored. RESULTS: The children had unrestricted diets and fluid allowance and did not require phosphate binders. Persistent relative hypotension developed in 2 of 4 children. Weekly Kt/V urea values were consistently >10; other biochemical measures varied. Quality of life and school attendance improved in 3 of 4 children. The workload and reported emotional burden of NHD was substantial. No significant complications occurred. Dialysate losses of calcium, phosphate and carnitine required supplementation. The annual cost per patient was dollar 64,000 Canadian, which represented a 27% savings compared with thrice weekly in-center hemodialysis. CONCLUSIONS: NHD is feasible in selected children, allows free dietary and fluid intake, and improves patient wellbeing. The burden on the family is substantial, and NHD requires support of a dedicated multidisciplinary team.

Adolescent↗
PubMed2005

Older patients undergoing dialysis treatment: cognitive functioning, depressive mood and health-related quality of life.

An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.

Affect↗
PubMed2003

[Life satisfaction in 28 intellectually gifted persons aged 65 and over].

OBJECTIVE: To date, no French studies have been published concerning intellectually gifted elderly people (over 65 years of age), although they represent more than 200,000 people in France. METHOD: This paper reports the results of a study conducted with members of the Mensa Association, whose membership is open to those who have scored very highly on IQ tests (scores of 132 or higher). Twenty-eight gifted elderly people (aged between 65 and 86 years) were assessed using a life satisfaction index (Neugarten Scale). The results were compared with those obtained from a sample of 394 elderly people who participated in the lcare study, which is recognised as a reference study. RESULTS: Our study indicates that gifted elderly people have significantly higher rates of life satisfaction (past, present and future) than normal elderly people. DISCUSSION: The Neugarten index revealed the great life satisfaction in this population. However, several biases should be taken into account: size of the sample, recruitment method and life satisfaction assessment. Despite these limits, the results of this study are of certain interest since there is little data on follow-up and aging of intellectually gifted people in the literature.

Aged↗
PubMed2001

Dementia in people with Down's syndrome.

OBJECTIVES: To determine the prevalence of dementia in an Irish sample of people with Down's syndrome (DS) and to examine associated clinical characteristics of dementia in this group. METHOD: 285 people with DS (Age 35-74 years, mean age +/- SD 46.5 +/- 8.2 years) were included in this cross-sectional study. The diagnosis of dementia was made using modified DSMIV criteria. Cognitive tests used were the Down's syndrome Mental Status Examination (DSMSE), Test for Severe Impairment (TSI) and adaptive function was measured by the Daily Living Skills Questionnaire (DLSQ). RESULTS: The overall prevalence of dementia was 13.3%. The presence of dementia was associated with epilepsy, myoclonus, and head injury. The demented DS group were significantly older (n = 38, mean age 54.7 years SD +/- 7.5) than the non-demented (n = 246, mean age 45.6, SD +/- 7.3). The TSI and DLSQ had a satisfactory spread of scores without 'floor' or 'ceiling' effects in people with moderate and severe learning disability. Median scores in demented versus the non-demented groups were significantly different for each measure of function. CONCLUSIONS: Dementia had a prevalence of 13.3% and occurred at a mean age of 54.7 years. The combination of DLSQ score, age and presence of epilepsy were found to predict presence of dementia.

Activities of Daily Living↗
PubMed2001

Teleconsultation in psychology: the use of videolinks for interviewing and assessing elderly patients.

Although elderly people are one of the major target groups for telemedicine applications, they remain under-represented in studies of teleconsultation. Videolinks appear to be easily used by many elderly people as a means of communicating with health-care staff, including psychologists and doctors. To date, studies of psychometric teleconsultation have been confined to screening tests, or have used very small numbers of patients. There is a need to examine the reliability of more complex psychometric batteries and to use larger samples of older people. Some recommendations for conducting clinical interviews and psychometric tests are presented, based on clinical experience and a review of the literature. The importance of ergonomic considerations, patient comfort and professional preparation are explained.

Aged↗
PubMed1999

Presenilin 1 and alpha-1-antichymotrypsin polymorphisms in Down syndrome: no effect on the presence of dementia.

As people with Down syndrome (DS) age, they are at greater risk for Alzheimer disease (AD) than the general population. It has been suggested that polymorphisms at the genes for presenilin-1 (PS-1) and alpha-1-antichymotrypsin (ACT) confer an increased risk for AD in the general population, and therefore potentially to AD in people with DS. We obtained DNA from 231 individuals with DS and 233 population controls. People with DS were evaluated for dementia. Allele frequencies at PS-1 and ACT polymorphisms in people with DS were compared to those in age-matched controls. There were no frequency differences between the control sample and DS sample for PS-1 or ACT alleles or genotypes. Similarly, there were no differences in allele frequencies between the demented and age-matched non-demented DS samples. However a higher frequency of PS-1 heterozygotes in the demented DS group was noted. We conclude that unlike the general population, neither PS-1 nor ACT polymorphisms appear to have a similar detrimental effect on dementia in DS. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:616-620, 1999.

Adult↗
PubMed1999

Age at onset of dementia and age of menopause in women with Down's syndrome.

Menstrual status and the age of menopause were investigated in 143 Irish females with Down's syndrome (DS). The average age of menopause in 42 subjects (44.7 years) was younger than in the general population. The age at onset of dementia correlated with the age of menopause. This finding may be a manifestation of accelerated ageing in DS or point to oestrogen deficiency being an independent risk factor for the development of Alzheimer's dementia in DS. The implications of this finding for possible treatments are discussed.

Adult↗
PubMed1999

Determinants of aggression, and adaptive and maladaptive behaviour in older people with Down's syndrome with and without dementia.

In a cross-sectional study of aggression, and adaptive and maladaptive behaviour in 128 subjects with Down's syndrome (DS), 29 of whom had dementia, the current authors found that the presence of dementia was not predictive of aggression or maladaptive behaviour. However, the level of adaptive behaviour was shown to be lower in subjects with dementia, and in those with lower levels of cognitive functioning, as measured on a rating instrument, the Test for Severe Impairment. Although the presence of aggressive behaviours is not higher in subjects with dementia and DS on cross-sectional review, it remains to be seen whether aggression will increase in individual cases with the onset or progression of dementia. The decline in adaptive behaviour shown in the present study confirms the findings of previous studies and indicates a direction for service development for persons with the dual diagnosis of dementia and DS.

Adult↗
PubMed1999

Scoring written material from the Mini-Mental State Examination: a comparison of face-to-face, fax and video-linked scoring.

We assessed the reliability of scoring written items of the Mini-Mental State Examination (MMSE) using different communication modes: face to face, fax and videoconferencing. A total of 99 MMSEs were recovered from the records of a community mental health team for the elderly. The written parts of the examination (sentence and pentagrams) were scored--in person, using a faxed copy or over the video-link--according to published criteria. Relative to in-person scoring, sentences could be scored reliably when faxed (kappa = 0.80), as could pentagrams (kappa = 0.71). Sentences could be reliably scored over the videoconferencing link (kappa = 0.70), but pentagrams could not (kappa = 0.47). Caution is required before accepting the results of scoring such tests over video-links.

Aged↗
PubMed1998

A protective effect of apolipoprotein E e2 allele on dementia in Down's syndrome.

BACKGROUND: The apolipoprotein E (ApoE) e4 allele has been associated with an increased risk for Alzheimer's disease, whereas the e2 allele has been shown to be protective. Similar effects in Down's syndrome (DS) have been postulated but not yet demonstrated. METHODS: We obtained DNA from 221 DS individuals and from 162 population controls, and 77 DS children. Older DS subjects were evaluated for dementia and compared to age-matched DS controls. RESULTS: The DS sample with dementia (n = 31) had a significantly lower frequency of the ApoE e2 allele compared to age-matched nondemented DS controls (0% vs. 8.3%, p = .0136). The older DS population had a significantly lower frequency of ApoE e4 compared to population controls (11.7% vs. 20.6%, chi-square 8.9, p = .0028). CONCLUSIONS: The lower frequency of the e2 allele in demented DS subjects compared to age-matched nondemented DS controls suggests a protective effect for ApoE e2 in the development of dementia in DS. The lower frequency of ApoE e4 in our older DS sample compared to population controls points to a detrimental effect of the e4 allele on longevity.

Adult↗
PubMed1998

Behavioural changes in stabled horses given nontherapeutic levels of virginiamycin.

Abnormal behaviour commonly develops in intensively managed horses. A possible cause is the change in diet occurring when the horse is stabled. An experiment was performed to examine this possibility by manipulating the diet with the feed supplement virginiamycin, as Founderguard. During 4 weeks, 18 horses were fed diets ranging from hay alone to concentrate plus hay in the ratio of 3:1. The rations of half the horses given concentrate were supplemented with Founderguard. Horses eating high concentrate rations displayed abnormal oral behaviours at a higher frequency than those eating only hay. The incidence of these behaviours was reduced when diets were supplemented with Founderguard. The drop in faecal pH of animals on concentrate diets was also reduced by Founderguard. Animals on concentrate diets had an average of 21 kg less gut fill post mortem. Dietary supplementation with virginiamycin as Founderguard apparently lessens some behavioural problems associated with management of stabled horses and the intake of grain. It may allow concentrate to be fed at higher levels than customary without adverse behavioural side effects. The suggested mechanism for the improved behaviour due to Founderguard supplementation is reduced fermentative acidosis in the hindgut.

Animal Feed↗
PubMed1998

Feasibility of orthopaedic teleconsulting in a geriatric rehabilitation service.

Fifteen elderly patients participated in a teleconsultation with an orthopaedic surgeon, which was then followed by a conventional, face-to-face consultation. The comparison between the surgeon's ratings for both types of consultation suggested that the telemedicine consultation was satisfactory in terms of the quality of image and sound, the clinical examination and general simplicity. The telemedicine consultations did not generate a need for any additional clinical investigations, although in two cases a face-to-face consultation was necessary to clarify clinical signs (shortening of a limb and scar tissue). The surgeon's rating of his decision level was superior in the face-to-face situation in four cases, and for 11 patients it was equal. Similarly, the surgeon's level of confidence in decision making was superior in the conventional situation for five patients and equal for 10 patients. Patient attitudes towards teleconsulting were favourable. There was a high level of patient satisfaction. Teleconsulting between orthopaedic surgeons and elderly patients therefore appears to be possible, provided that certain technical, clinical and psychological considerations are addressed.

Aged↗
PubMed1998

Cognitive decline in Down syndrome: a validity/reliability study of the test for severe impairment.

The utility of the Test for Severe Impairment was studied with 60 older persons who had Down syndrome. Construct validity, test-retest reliability, and interrater reliability were established for the full study group and for subgroups based on degree of mental retardation and dementia status. There was no difference in scores by gender. There were some interesting findings for the group with moderate mental retardation and dementia and the group with severe mental retardation without dementia that may signal specific applications and limitations of the test for use with individuals who have Down syndrome. The internal consistency of the instrument was satisfactory. Results suggest that this test is a useful performance-based task for persons with Down syndrome.

Adult↗
PubMed1997

Epidemic of accidental carbon monoxide poisonings caused by snow-obstructed exhaust systems.

We report a case series of accidental carbon monoxide poisonings caused by snow-obstructed automobile exhaust systems. Accumulation of more than 24 inches of snow contributed to the poisoning of 25 patients who were subsequently treated with hyperbaric oxygen therapy. Two illustrative cases are presented in greater detail, illustrating a life-threatening hazard associated with heavy snow accumulations.

Aged↗
PubMed1997

Psychological impact of a remote psychometric consultation with hospitalized elderly people.

Teleconsultation is a potentially useful approach to the psychological assessment of elderly patients. We assessed the psychological impact of a videolinked psychometric consultation in a sample of hospitalized elderly people. The 15 patients, none of whom had a psychiatric history, participated in a video-consultation and a conventional face-to-face consultation. The mean age of the patients was 88 years. Each consultation consisted of a preliminary interview with a psychologist and two psychometric tests which evaluated the patient's cognitive function (the Mini-Mental State Examination and the Clock Face Test). A second psychologist, who acted as an observer, assessed the patients' attitudes to the two types of consultation. Although most patients (11 of the 15) expressed a preference for the face-to-face consultation, the video-consultations were judged to be acceptable by the patients and the psychologists. The experience of teleconsultation could be improved by practice on the consultant's part and by some technical modifications. Finally, some differences in test scores were observed and further work is required to evaluate the reliability of different psychometric tests when used by videolink.

Aged↗