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Biomedical subjects

M J Denham

Publications and source records attributed to M J Denham.

At least 19 recordsLinked to original sources
PubMed2005

Lord Amulree: an appreciation.

Lord Amulree was unique amongst UK geriatricians in having a 'wide angled' view of the care of elderly people. This resulted from his work at the Ministry of Health, his clinical commitments and his position in the House of Lords, which enabled him to bring the problems of old age, elderly people and infirmity before a much wider audience. It can be argued that his joint Parliamentary Presentation in 1946 stimulated a surge in publications relating to the care of older people. He will be remembered for his maxim 'Adding Life to Years'

England↗
PubMed2000

A model of theta rhythm production in the septal-hippocampal system and its modulation by ascending brain stem pathways.

Recent experimental observations have disclosed the existence of a septal-hippocampal feedback circuit, composed of medial septum diagonal band of Broca (ms-dbB) GABAergic projections to the inhibitory interneurons of the hippocampus, and hippocampal GABAergic projections to the ms-dbB, the major targets of which are the GABAergic septo-hippocampal projection cells. We propose that this feedback circuit provides the mechanism for the rhythmic suppression of interneuronal activity in the hippocampus, which is observed as low-level GABAergic-mediated theta activity. We also propose that this circuit may be the mechanism by which ascending brain stem pathways to the ms-dbB, in particular from the reticular formation, can influence hippocampal information processing in response to particular behavioral states, by exercising control over the level and frequency of theta activity in the hippocampus. In support of these proposals, we describe a minimal computational model of the feedback circuit which uses a set of four coupled differential equations describing the average dynamic activity of the populations of excitatory and inhibitory cells involved in the circuit. We demonstrate through simulations the inherently robust 4-6-Hz oscillatory dynamics of the circuit, and show that manipulation of internal connection strengths and external modulatory influences on this circuit changes the dynamics in a way which closely mimics corresponding manipulations in recent neurophysiological experiments investigating theta activity.

Animals↗
PubMed1998

Drug therapy and the older person: role of the pharmacist.

Older people in the UK receive a disproportionate amount of medication. They comprise 18% of the population but receive 45% of all prescription items. Not surprisingly they experience drug-related illnesses - in 1980, 1 in 10 admissions to acute geriatric units were wholly or partly due to adverse drug reactions. Drugs which should be used with particular care or even avoided in older people include benzodiazepines, warfarin, digoxin, aminoglycosides, tricylic antidepressants, antipsychotics and long-acting oral hypoglycaemic agents. Pharmacists can promote safer prescribing practices by advising both patients and doctors. The community pharmacist can assist in drug compliance by providing patients with additional information about individual drugs, identifying potential adverse drug reactions and interactions, supplying appropriate drug containers or compliance aids, and even arranging home visits for patients unable to visit the pharmacist. Some community pharmacists provide pharmaceutical advice and services to residential and nursing homes. Pharmacists' advice to doctors can include one to one discussions in either primary or secondary care, assisting in medication review, providing information to prescribing committees, compiling drug formularies, assisting in auditing of prescribing practices and organising disposal of unwanted medicines and poisons campaigns.

Aged↗
PubMed1990

Adverse drug reactions.

The elderly have benefitted considerably from the vast increase in the range of drugs available for prescription. However it is now well recognized that the incidence in adverse drug reactions increases with age. This is mainly due to altered pharmacodynamics and pharmacokinetics as well as multiple prescribing and the effect of illness rather than the effect of age per se. Since adverse drug reactions are such a potent cause of illness, it is sensible for doctors to follow simple rules when prescribing for the elderly.

Aged↗
PubMed1988

Evaluation of the safety of enalapril in the treatment of heart failure in the very old.

We have introduced enalapril, in doses equal to or less than the 2.5 mg currently recommended, as an adjuvant to digoxin and diuretics in 17 patients of mean (SD) age 83 (5) years with severe heart failure. Only eleven patients tolerated its introduction. Unlike those reported in younger patients, all but one of the adverse drug reactions occurred 8 h or more after the first dose. Aged patients started on ACE inhibitors should be observed in hospital until stabilized on a maintenance dose. Three patients had an adverse reaction which differed in nature from those previously reported: acute confusional state, ataxia and mesenteric ischaemia. Ten patients were discharged on 5 mg or 10 mg maintenance doses of enalapril. In nine of them improvement on triple therapy was sustained for a minimum of three months. ACE inhibition was lost in the other patient when her compliance with enalapril therapy fell to around 75%: monitoring compliance is essential when ACE inhibitors are used in low dosages. Enalapril was withdrawn during follow up in three patients because of symptoms of mesenteric ischaemia and in four because of dramatic deterioration of renal function. One of the latter was found subsequently to have severe bilateral atheromatous renal artery stenosis. When isosorbide dinitrate was substituted for enalapril, symptoms of mesenteric ischaemia resolved and renal function returned to baseline. Continuing surveillance for adverse effects is essential in patients of this age group with severe heart failure, and the risk of occult renal artery stenosis requires regular biochemical screening during follow up.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Pressure sores: effect of Parkinson's disease and cognitive function on spontaneous movement in bed.

It has previously been shown that the incidence of pressure sores is related inversely to the amount of movement made during the night. The present study of 30 in-patients of geriatric units suggests that the measurement of mean lateral displacement of the centre of gravity may better characterize those at risk than the total amount of movement. The mean displacement was reduced in Parkinson's disease and in dementia. The prevalence of pressure sores was markedly increased where Parkinson's disease and dementia coexisted.

Aged↗
PubMed1988

The paradox of using a 7 day antibacterial course to treat urinary tract infections in the community.

1. We have studied determinants of outcome of 7 day courses of treatment in 77 middle aged and elderly patients, in whom the general practitioner's diagnosis of urinary tract infections had been confirmed microbiologically. Bacteria were sensitive to cephalexin or trimethoprim. Where there was no preference, treatments were allocated randomly. Compliance was monitored using a pill box with a concealed electronic device which recorded openings of the box. 2. Prescribing trimethoprim, 200 mg twice daily, was more effective than cephalexin, 250 mg four times daily (cure rates 93 and 67%) (P less than 0.006). Those cured and not cured were not distinguished by age, gender, genitourinary history, or infecting organism. 3. Compliance as measured by box openings was worse for cephalexin than for trimethopim (P = 0.01). However, both totality and pattern of compliance were similar in patients cured and not cured by cephalexin. Thus rigid adherence to a conventional course did not promote cure: fewer doses could have been prescribed. 4. Estimating compliance is essential to clinical trials where medication is self-administered. Poor compliance may establish over exacting regimens. Counting box openings did overestimate compliance, but counting residual tablets overestimated it grossly: given the number of openings less than the ideal, there should have been 171 residual tablets, only 55 were found.

Aged↗
PubMed1987

Prescribing digoxin in geriatric units: the unexplained variability in dosage requirements.

Some physicians regard patients of Geriatric Units as a homogeneous population with respect to digoxin dosage requirements. Others advocate the use of pharmacokinetic models in prescribing digoxin for the elderly. Sixty in-patients of Geriatric Units were studied and the results compared with those previously obtained from 129 patients of other adult Units; all were receiving maintenance digoxin. For each patient the dose required to achieve a mean steady-state serum digoxin concentration of 1.6 nmol X l-1, the standardized dose, was calculated, assuming proportionality between the dose given and the concentration achieved. A mean of four estimates of standardized dose for each individual was used in the analysis. Threefold ranges of standardized dose covered the requirements of approximately 85% of patients both of Geriatric Units (62.5 to 187.5 micrograms per day) and of other adult Units (125 to 375 micrograms per day). The variables, serum creatinine concentration, sex, age, and body weight were of relatively little value in predicting the standardized dose for the patients in Geriatric Units. There was a sub-group of these in-patients for whom the standardized dose was extremely large.

Adult↗
PubMed1987

A quinine a day keeps the leg cramps away?

A double-blind, placebo-controlled, cross-over trial of quinine in leg cramps occurring at rest was conducted in 22 elderly cramp sufferers. Despite demonstration of impaired quinine elimination in the elderly, prescription of the traditional dose of 300 mg quinine bisulphate at night failed to produce a significant (P = 0.1) reduction in the number or severity of cramps. There was a significant relationship between serum quinine concentration and attenuation of cramps. However, the simple expedient of increasing the nightly dose of quinine may carry the concomitant risk of cinchonism.

Aged↗
PubMed1987

Parkinson's disease in the elderly: response to and optimal spacing of night time dosing with levodopa.

1. Insomnia is an even more frequent complaint in elderly patients with Parkinson's disease than might be expected from the effect of age alone on sleep. 2. A double-blind, placebo-controlled trial in eleven patients with Parkinson's disease of mean (s.d.) age 80(5) years, showed that nocturnal dosing with levodopa produced a clinically significant improvement in sleep both as assessed subjectively and by measurement of number of spontaneous moves in bed. 3. Despite the long interval between tablet administration and morning assessment, walking time was faster on mornings following active treatment.

Carbidopa↗
PubMed1986

Therapeutic drug monitoring of digoxin: help or hindrance?

A major role of therapeutic drug monitoring services is to advise on the dose of a drug which would be required to bring the concentration in the blood to within specific 'therapeutic' limits. Monitoring digoxin usage constitutes a substantial part of the work load. We have examined the potential variability in recommendations for digoxin dosages based on a series of serum digoxin measurements in each of 80 out-patients. In over a third of cases a dose, which seemed to be optimal on the basis of the first assay result, would have produced concentrations outside the conventional therapeutic range when the measurement was repeated. This was despite careful supervision of medication and the timing of the blood sample in relation to its administration. In routine practice the apparent variability in dose requirements would be far greater. Objectives of therapeutic drug monitoring services remain the same, the way forward would seem to lie in their taking on a heavy commitment to counsel and supervise patients before repeated blood sampling. However, effort and resources might be better channelled into producing simple prescribing aids relating the risk of cardiotoxicity directly to the size of the maintenance dose and the individual's renal function.

Aged↗
PubMed1986

Making a rehabilitation hospital for the elderly work.

We report our efforts to make a rehabilitation hospital work. The simple intervention of introducing a patient record system, in which problems, management, achievements and discharge plans were clearly documented, doubled the number of patients who returned home over an eight-month period. This resulted in greater availability of acute geriatric beds at the District General Hospital (DGH), where two thirds of the elderly medical inpatients occupy beds on other units, and in an improvement in morale of patients and staff. Greater co-operation between geriatric and medical teams in selecting those patients who would benefit from continuing rehabilitation is required. The advantages of accommodating such patients separately from patients with a poor prognosis and those requiring long-term care are discussed.

Aged↗
PubMed1982

Prescribing for the elderly patient.

The side-effects of drugs increase steadily in accordance with the age of the patient. This can be the result of incorrect clinical assessment, multiple prescribing, poor drug compliance, inadequate supervision of long-term medication, altered drug handling and increased organ sensitivity with age. Consequently, great care should be taken when prescribing for the elderly. Rules for prescribing are listed.

Aged↗
PubMed1981

Subdural haematoma in the elderly.

A retrospective study of elderly patients admitted with subdural haematoma showed a greater incidence in men. Although a history of falls or head injury was obtained in about two thirds of the patients, the initial diagnosis of subdural haematoma was only made in about one fifth of the cases. In most patients the symptoms were attributed to a cerebrovascular accident or cerebral metastases. However, in those patients where the diagnosis was established at post mortem, it was not the principal cause of death. Only half the patients treated by surgery were well enough to return home, although less severely ill patients treated by medical methods or conservatively were all able to return home.

Aged↗