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Biomedical subjects

M Weatherall

Publications and source records attributed to M Weatherall.

At least 37 records · Page 2Linked to original sources
PubMed2001

Factors influencing rate of Barthel Index change in hospital following stroke.

BACKGROUND AND PURPOSE: Randomized controlled trials of specific interventions in stroke rehabilitation are few. In using this study design to compare different rehabilitation interventions or different intensity of those interventions, measuring disability status at a fixed time point is one outcome option. In order for this approach to be valid, factors that might independently affect the speed of disability change have to be matched at baseline. We sought to investigate the impact of different factors on rate of disability change following stroke. METHODS: A prospective hospital-based study of consecutive patients admitted to each of three general hospitals in Wellington, New Zealand with acute stroke. Patients were assessed using the Barthel Index (BI, scored 0-20) within a few days of stroke and fortnightly until hospital discharge. Strokes were classified using the Oxfordshire Community Stroke Project classification. MAIN OUTCOME MEASURE: Barthel Index rate of change (BRC) computed from the difference between the first and last hospital BI scores divided by the time in weeks between these assessments. RESULTS: Of 104 subjects with two or more disability assessments in hospital, BRC was a mean 1.26 units per week (95% confidence interval (CI) 0.97, 1.56). The only factors significantly associated with BRC on univariate analysis were stroke type, pre-stroke Modified Rankin Scale (MRS) and pre-stroke London Handicap Score. In a general linear model analysis of covariance, stroke type (p = 0.015) and pre-stroke MRS (p < 0.001) remained significant. The mean BRC for lacunar infarcts (1.76 units per week, 95% CI 1.22, 2.30) was over three times that of total anterior circulation infarcts (0.48 units per week, 95% CI 0.20, 0.76). CONCLUSIONS: Future randomized controlled trials of rehabilitation interventions for stroke in hospitalized patients need to allow for pre-stroke level of dependence and stroke type in the study design, either excluding particular patients or ensuring even randomization of these key variables if speed of disability change is to be a valid outcome variable.

Aged↗
PubMed2001

Managing urinary incontinence in the elderly.

Urinary incontinence is a common and unpleasant problem for older people. Age-related changes to the urinary tract, age-related diseases and medications, as well as the underlying bladder problem that contributes to urinary incontinence, should be identified for successful management.

Aged↗
PubMed2000

A meta-analysis of 25 hydroxyvitamin D in older people with fracture of the proximal femur.

AIMS: To perform a meta-analysis on the published studies of serum levels of 25 hydroxyvitamin D in older people with fractures of the proximal femur compared to control groups. METHODS: A 'Medline' literature search using key words vitamin D' and 'hip fractures' for the years January 1966 to June 1999, seeking only papers published in English and available from New Zealand medical libraries, was performed. Bibliographies of identified papers were also searched. Studies which compared 25 hydroxyvitamin D levels in people with a fracture of the proximal femur to an older control group were eligible for inclusion. 30 studies were identified and 28 papers could be found in New Zealand. The method of weighted Z statistics was used in the meta-analysis. RESULTS: The pooled reduction in serum 25 hydroxyvitamin D for the fracture group compared to the controls was 0.66 of a standard deviation with a 95% confidence interval of 0.74 to 0.59. CONCLUSIONS: Although there may be publication bias in this meta-analysis and there was some evidence of heterogeneity in the studies, there is very good evidence that older people with fracture of the proximal femur have reduced levels of vitamin D compared to controls. Older people with fracture of the proximal femur should be treated with vitamin D.

Age Factors↗
PubMed2000

Biofeedback in urinary incontinence: past, present and future.

Recent systematic reviews on the conservative management of urinary incontinence in women have identified a small number of trials that favour conservative management, but the evidence for firm recommendations to include biofeedback in these conservative strategies is lacking and further research is needed to clarify the role of biofeedback.

Biofeedback, Psychology↗
PubMed2000

A randomized controlled trial of the Geriatric Depression Scale in an inpatient ward for older adults.

OBJECTIVES: To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication. DESIGN: Randomized controlled trial. SETTING: Inpatient unit for assessment, treatment and rehabilitation of older adults in a district hospital. SUBJECTS: Consecutive admissions to the inpatient unit were approached. Of 198 people, 100 gave consent and were randomized to receive the intervention. INTERVENTIONS: The Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group. The Nottingham Instrumental Activities of Daily Living questionnaire and the Folstein Mini-mental State Examination were administered to the placebo group. The scores of these instruments and a copy of the completed instrument were placed in the subject's case notes. For those subjects randomized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes. MAIN OUTCOME MEASURES: The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission. Other outcome measures were death, readmission and use of antidepressant medication three months after administration of the instruments. RESULTS: There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52% in the 50 people administered this instrument. Six out of 46 people administered the Geriatric Depression Scale, who were discharged in the study period, were on antidepressant medication at discharge. Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge. The absolute difference in proportions was 6.7%, 95% confidence interval 19 to -5.3%. CONCLUSIONS: A high proportion of patients admitted to an inpatient unit for assessment, treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale; however, use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication. This may be because the instrument is too nonspecific.

Aged↗
PubMed1999

Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review.

OBJECTIVE: To test, by meta-analysis, the conclusion of a systematic review that biofeedback was no more effective than pelvic floor muscle exercises alone for the treatment of female genuine stress urinary incontinence. MATERIALS AND METHODS: Data extracted from the five trials identified in the systematic review were subjected to pooled analysis of odds ratios for the outcome of 'cure'. RESULTS: The odds ratio for biofeedback combined with pelvic floor muscle exercises, compared with pelvic floor muscle exercises alone, leading to cure was 2.1 (95% confidence interval 0.99-4.4). CONCLUSIONS: Biofeedback may be an important adjunct to pelvic floor muscle exercises alone in the treatment of female genuine stress urinary incontinence. A quantitative statistical analysis of the studies identified leads to different conclusions from those in the systematic review.

Biofeedback, Psychology↗
PubMed1999

Contralateral fracture of the proximal femur. Implications for planning trials.

In three consecutive years 462 patients over the age of 60 years presented at Waikato Hospital, Hamilton, New Zealand, with a fracture of the proximal femur. Within two years, 11 (2.4%) returned with a fracture of the contralateral femur. If the effectiveness of any form of treatment aiming at reducing the incidence of contralateral fracture were subjected to a trial, a sample size of 5000, randomly distributed equally between treatment and placebo groups, would be needed for the trial to have a power of 80% to detect a reduction.

Clinical Trials as Topic↗
PubMed1997

A successful rehabilitation service for older amputees at Waikato Hospital.

AIMS: To analyse changes in outcomes following introduction of a new service for older amputees at Waikato Hospital. METHODS: Regular weekly visits by a geriatrician to a vascular surgical ward were made. Patient characteristics and hospital outcomes were recorded. RESULTS: Over 3 consecutive years mean overall hospital length of stay for people seen by the service has fallen from 50.4 days in the first year to 37.4 in the second year and 35.2 days in the third year. CONCLUSIONS: A proactive liaison service for older amputees seems to improve hospital outcomes in this challenging group of patients.

Aged↗
PubMed1994

One year follow up of patients with fracture of the proximal femur.

AIMS: To obtain 6 month and 1 year outcomes for all people over age 60 years admitted in one year to a base hospital with fracture of the proximal femur. METHODS: Telephone follow up of all patients admitted with fracture of the proximal femur and administration of a basic, Barthel, and extended, Nottingham, index of activities of daily living. RESULTS: Six month and 1 year mortality was 16 and 28%. Those people living in an institution at the time of fracture and those with higher prefracture dependency had a higher mortality. Reoperation rate at one year was 9%. Average dependency increased at 6 months and 1 year compared to prefracture dependency. Forty eight percent of survivors regained their prefracture Barthel score and 28% their prefracture Nottingham score at 1 year. CONCLUSIONS: Mortality is similar to other studies. The high levels of permanent disability following fracture suggest on going home support is needed and that domiciliary rehabilitation within the first 6 months of discharge may be needed.

Activities of Daily Living↗
PubMed1994

Depression in Parkinson's disease.

OBJECTIVE: The authors assessed the prevalence of major depression (DSM-III-R) among Parkinson's disease patients and compared this rate with that of matched physically disabled subjects. METHOD: The 30-item General Health Questionnaire and measures of physical disability were completed by all patients in Dunedin, New Zealand, identified as having Parkinson's disease. Patients scoring over 5 on the General Health Questionnaire were interviewed with the Structured Clinical Interview for DSM-III-R--Non-Patient Version. Each patient living in the community was matched for age, sex, and level of physical disability with a comparison subject who did not have a neurological condition. RESULTS: Of the 73 subjects with Parkinson's disease who agreed to participate and were judged not to be demented, 34.2% scored higher than 5 on the 30-item General Health Questionnaire, but only 2.7% met the criteria for major depression. No difference from the comparison group was found. CONCLUSIONS: The prevalence of major depression in patients with Parkinson's disease may be no greater than in age- and sex-matched physically disabled persons.

Adult↗
PubMed1993

Case mix and outcome for patients with fracture of the proximal femur.

AIMS: To analyse the way in which case mix and outcome are related for fracture of the proximal femur in a base hospital. METHODS: All patients over age 60 admitted to Waikato Hospital during one year with fracture of the proximal femur were assessed for premorbid function and comorbidity and were followed to discharge. RESULTS: There was a low frequency of post operative morbid events. Post operative mortality was 3%. Average length of stay was 19.9 days. Increased age and disability, trochanteric fracture, residence in a rest home, previous hypertension or stroke, technical complication, simultaneous fracture of another limb and perioperative myocardial infarction were all associated with increased length of stay. CONCLUSION: Factors are described which will alert clinicians to people likely to have a long length of stay and may need formal rehabilitation. Continuous quality improvement techniques may be a way of improving services such as these further.

Activities of Daily Living↗