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Biomedical subjects

L Nolan

Publications and source records attributed to L Nolan.

32 records · Page 2Linked to original sources
PubMed1989

The need for a more rational approach to drug prescribing for elderly people in nursing homes.

In order to establish the pattern of drug use in Irish nursing homes and to compare prescribing rates with those in other countries, drugs prescribed during a 1-week period for 301 residents in 11 nursing homes were recorded. A mean of four drugs (range 0-14) was prescribed per patient and 41% of patients were taking five drugs or more. Forty-two per cent of patients were prescribed potentially interacting combinations and in particular the use of drugs with additive sedative or anticholinergic effects was common. The mean number of drugs prescribed ranged from 2.3 to 5.6 in the different nursing homes, the most notable differences being in the use of digoxin, vitamins, hypnotics and psychotropic drugs. Prescribing rates were similar to those reported from the United Kingdom but very different from data for the United States where prescribing rates for laxatives, neuroleptics and analgesics are higher. Marked variation in prescribing both between institutions and between countries as well as the quantity and pattern of prescribing led to the conclusion that prescribing is less than optimal in this clinical setting. However, additional studies linking diagnosis and prescribing are required to test this hypothesis.

Aged↗
PubMed1989

The need for reassessment of digoxin prescribing for the elderly.

1. The prevalence and circumstance of digoxin prescribing was assessed in five private nursing homes. 2. Forty-one patients (21% residents) were taking digoxin. 3. Seventeen patients were in atrial fibrillation and the remainder in sinus rhythm. The ventricular rate exceeded 100 beats min-1 in eight of the 17 patients in atrial fibrillation. 4. Thirty-seven patients were prescribed 0.0625 mg digoxin daily and serum digoxin concentrations were subtherapeutic in 20 of 32 patients in whom concentrations were measured. 5. These data indicate a need for more careful review of the need for maintenance digoxin and illustrate the inappropriateness of routinely prescribing very low doses in all elderly patients.

Aged↗
PubMed1989

Adverse drug reactions in the elderly.

There is limited evidence to suggest that the incidence of adverse drug reactions increases with patient age. Factors which may predispose the elderly to adverse drug reactions include multiple drug therapy and changes in pharmacokinetics and pharmacodynamics associated with ageing. Digoxin, diuretics and psychotropic drugs may be particularly hazardous in this age group.

Aged↗
PubMed1988

Patients, prescribing, and benzodiazepines.

In order to establish the current status of benzodiazepine prescribing and also to assess patients' attitudes towards the use of these drugs, we interviewed 450 consecutive patients in 16 community pharmacies about their use of benzodiazepines. Prescribing rates increased ten-fold from the age of 20 to 70 years and were higher in women than in men. The average dose used in the elderly seemed excessive and the choice of hypnotic often inappropriate. The median duration of benzodiazepine use was 2.5 years (range 0-25) and 66% of the patients had been taking benzodiazepines for one year or more. Most of the patients (97%) found the drugs effective in the treatment of anxiety or insomnia. Twenty-two percent took a lower dose than prescribed and 7.5% a higher dose. These data suggest that benzodiazepines are prescribed for excessively long periods and that greater caution is needed in prescribing benzodiazepines for older patients.

Adult↗
PubMed1987

Age-related prescribing patterns in general practice.

To examine differences in prescribing patterns in relation to patient age, all drugs dispensed during 1 week in a sample of community pharmacies were recorded. The mean number of drugs per prescription increased linearly from 1.5 in children aged 0-9 years to 2.8 in patients 80 years and over. The rate of prescribing of diuretics, benzodiazepines, non-steroidal antiinflammatory agents and drugs acting on the cardiovascular system increased markedly with advancing age. Drugs with a low therapeutic ratio were also prescribed more frequently for patients over 65 years. Psychotropic agents (15.9%), diuretics (13.8%) and cardiovascular drugs (13.7%) were the most commonly prescribed drugs in this age group. While a minority of elderly patients were prescribed a large number of drugs, prescribing rates overall did not appear excessive.

Adolescent↗
PubMed1982

Noninvasive evaluation of peripheral vascular disease using transcutaneous oxygen tension.

Transcutaneous oxygen tension (PtcO2) was used for noninvasive determination of blood supply in 25 patients evaluated for peripheral arterial disease. PtcO2 values were compared with segmental Doppler pressure, pulse volume recording, pulse reappearance time, and angiography in patients being evaluated for wound healing problems, amputations, and peripheral bypass procedures. PtcO2 was measured using a heated (45 degrees C) Clark polarographic electrode to quantitate the oxygen which diffuses from the dermal capillaries to the skin surface. Control PtcO2 values recorded over the chest or shoulder taken while patients were breathing room air were 78 +/- 8 mm Hg. PtcO2 values greater than 50 mm Hg predicted success for levels of amputation and for wound healing without reconstructive procedures; values of 40 mm Hg or less were associated with continued wound problems and complication after amputation. Increased PtcO2 values after vascular reconstruction of the legs predicted improved clinical status on follow-up examinations up to 6 months. PtcO2 predicted the extent of vascular disease as well as the other noninvasive tests and angiography. We conclude that (1) PtcO2 tension is a simple, accurate, noninvasive method to determine the appropriate level of amputation, wound healing potential, and effectiveness of bypass procedures, and (2) PtcO2 values correlate well with angiography and noninvasive evaluations.

Aged↗
PubMedDate not supplied

Pretreatment of urine samples for the analysis of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid using solid-phase extraction.

An extraction and concentration procedure using a unique solid-phase extraction tube was developed for the analysis of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in urine. Absolute and relative recoveries of the drug metabolite were found to be greater than 85% and 92%, respectively. The extraction procedure allows quantitation of the drug metabolite by GC/MS, HPLC with UV detection, or GC with flame ionization detection. The extraction procedure was verified with urine samples obtained from marijuana users as well as spiked urine samples.

Chromatography, Gas↗
PubMedDate not supplied

Differential diagnostic validation: acute and chronic pain.

The authors sought to validate the defining characteristics of acute pain and chronic pain and to compare the differences between them. Expert nurses (N = 125) rated the importance of 55 clinical indicators for each diagnosis (acute pain and chronic pain). Differential diagnostic validity (DDV) scores were calculated for each clinical indicator for both diagnoses. Only acute pain had a DDV score greater than .80, indicating that the characteristic "communication of pain descriptors" was a critical indicator for acute pain. A majority of defining characteristics differentiated between acute pain and chronic pain, thereby supporting the identification of acute pain and chronic pain as separate nursing diagnoses.

Acute Disease↗
PubMedDate not supplied

Adverse effects of antidepressants in the elderly.

Depression is a common problem in old age and the use of antidepressant drugs is particularly prevalent among elderly patients. Limited data suggest that dose requirements may be lower in the elderly because of age-related changes in pharmacokinetics and perhaps also in sensitivity. The side effect profiles of the various antidepressants are reviewed with regard to their potential to cause specific problems in the older patients. Anticholinergic actions, orthostatic hypotension and sedative effects warrant particular care in the elderly.

Aged↗