Biomedical subjects

Mark Weatherall

Publications and source records attributed to Mark Weatherall.

49 records · Page 3Linked to original sources

PubMed2004

The frequency of executive cognitive impairment in elderly rehabilitation inpatients.

The aim of this study was to determine the frequency of executive cognitive dysfunction in a sample of elderly patients in 2 rehabilitation wards in Wellington, New Zealand. All patients in 2 wards over a 2-month period were approached and invited to complete a brief neuropsychological battery. Sixty-two patients volunteered, of whom 52 completed at least 3 of the 4 measures of executive functioning. The frequency of executive dysfunction in the resulting sample of 52 was determined. Impaired executive function was defined as impaired performance on at least 2 executive function tests. The authors administered the Hayling-Brixton tests, the verbal fluency test, the Trail-Making Test, the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale. Patients' behavior was rated for executive problems on the Dysexecutive Questionnaire by themselves and by a nurse. The frequency of executive impairment was high at 13 out of 52 patients (25%). Only 1 of these 13 patients with executive difficulties was impaired according to their MMSE score. Screening for executive impairment among older rehabilitation inpatients is a necessary part of their medical management and rehabilitation. This should involve more than just administering the MMSE at admission. Several brief methods for screening for executive impairment are now available.

Aged↗

PubMed2004

Avoiding pitfalls of correlation coefficients in the assessment of measurement instruments in rehabilitation research.

OBJECTIVE: To provide a practical guide on how to avoid the pitfalls of correlated correlation coefficients when comparing multiple instruments in rehabilitation research. DESIGN: An observational study comparing a number of instruments measuring quality of life (QoL) compared with an external criterion. SUBJECTS: Sixty-eight patients admitted to a rheumatology ward for intensive treatment of rheumatoid arthritis. METHODS: Patients completed three new (QoL) instruments and an established instrument before and after intensive treatment for rheumatoid arthritis. MAIN OUTCOME MEASURES: Correlation coefficients together with their confidence intervals and a test for the difference between a set of correlated correlation coefficients for the change in the EuroQoL Quality of Life scale (EuroQoL), the World Health Organization Quality Of Life-Abbreviated version (WHOQoL-BREF) and the Quality of Life Profile (QLP) against the Stanford Health Assessment Questionnaire (HAQ). RESULTS: Although the range of correlation between the new instruments and the external criterion was between -0.37 and -0.59 and suggested that one new instrument was far more responsive than the others,; an omnibus test for an overall difference could find no difference in responsiveness. CONCLUSIONS: It is conceptually simple to use correlation coefficients to assess the properties of multiple instruments measured on the same subjects to find a 'best' instrument. However, proper interpretation of results when correlated correlation coefficients are calculated is complex. We recommend analysis includes: (a) that simple plots of the pairs of analysed variables are shown, (b) that simple linear model-fitting statistics, e.g., the R-squared statistic, accompany the plots, (c) that confidence intervals are presented for correlation coefficients, (d) that an omnibus statistical test for the difference between correlated correlation coefficients is presented, and (e) that normal model assumptions are tested.

Arthritis, Rheumatoid↗

PubMed2003

Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial.

BACKGROUND: Intravenous magnesium can cause bronchodilation in treatment of severe asthma, however its effect by the nebulised route is uncertain. We aimed to assess the effectiveness of isotonic magnesium sulphate as an adjuvant to nebulised salbutamol in severe attacks of asthma. METHODS: We enrolled 52 patients with severe exacerbations of asthma presenting to the emergency departments at two hospitals in New Zealand. A severe exacerbation was defined as a forced expiratory volume at 1 s (FEV(1)) of less than 50% predicted 30 min after initial administration of 2.5 mg salbutamol via nebulisation. In this randomised double-blind placebo-controlled trial patients received 2.5 mg nebulised salbutamol mixed with either 2.5 mL isotonic magnesium sulphate or isotonic saline on three occasions at 30 min intervals. The primary outcome measure was FEV(1) at 90 min. Analysis was per protocol. FINDINGS: At 90 min the mean FEV1 in the magnesium group was 1.96 L (95% CI 1.68-2.24) and in the saline group 1.55 L (1.24-1.87). The difference in the mean FEV(1) between the magnesium and saline groups was 0.37 L (0.13-0.61, p=0.003). INTERPRETATION: Use of isotonic magnesium as an adjuvant to nebulised salbutamol results in an enhanced bronchodilator response in treatment of severe asthma.

Administration, Inhalation↗

PubMed2003

Relationship between process and outcome in stroke care.

BACKGROUND AND PURPOSE: Better processes in stroke care are assumed to lead to better stroke outcomes. We sought to test whether current measures of stroke process are related to measures of stroke outcome. METHODS: This was a prospective study of consecutive patients with acute stroke admitted to each of the 3 general hospitals in 1 region who were followed up for 12 months after hospital discharge. Process was measured by use of the Royal College of Physicians Stroke Audit Package, and outcomes were measured with a range of disability, health status, handicap, and independence measures, as well as mortality. RESULTS: One hundred eighty-one patients were recruited. There was evidence for a relationship between some process variables and outcomes at hospital discharge, but the relationships were generally weak. None of the process variables remained in regression models of functional outcomes at 12 months. The hospital with the best process scores had the worst case mix-adjusted outcomes. CONCLUSIONS: The link between stroke process and outcome, through the use of currently available measures of process such as the Royal College of Physicians Stroke Audit Package, is not straightforward. Ongoing work may clarify some of these issues and provide guidance to stroke clinicians on how best to improve existing services.

Acute Disease↗

PubMed2003

Pilot study of the safety and effect of intranasal delipidated acid-treated Mycobacterium vaccae in adult asthma.

OBJECTIVE: There is epidemiological and experimental evidence that exposure to mycobacteria has the potential to suppress the development of atopy and/or asthma. Delipidated, deglycolipidated and arabinogalactan-depleted autoclaved Mycobacterium vaccae (delipidated acid-treated M. vaccae) has been shown to suppress allergen-induced airway eosinophilia in mice. METHODOLOGY: Thirty-seven adults with stable moderately severe asthma who were skin prick test-positive to house dust mite were randomized to receive two doses 2 weeks apart of delipidated acid-treated M. vaccae (first dose 0.4 mg and second dose 0.8 mg) or phosphate buffered saline, given as drops intranasally. Safety, tolerability and markers of asthma severity (including peak flow, FEV1, major and minor exacerbations, symptom scores and beta-agonist use), and nasal symptom scores, blood eosinophil and IgE levels were monitored for 8 weeks. RESULTS: Delipidated acid-treated M. vaccae was safe and well tolerated although there was an occasional mild local reaction. There were no statistically significant differences between the treatment group and placebo for any of the outcome variables. CONCLUSIONS: There is a requirement to elucidate the reasons why mycobacterial-based vaccines have not shown equivalent efficacy in human trials compared with animal models. The role of factors such as duration of disease, route of administration and the active component of mycobacteria need to be addressed.

Administration, Intranasal↗

PubMed2003

Duration of condition is unrelated to health-state valuation on the EuroQoL.

OBJECTIVE: To determine whether health valuations, such as those used in economic evaluation, are affected by duration of a health condition. People with disabling health conditions tend to value health more highly than members of the general population, and one explanation for this is that over time their experience of living with a disabling illness changes the way in which they value health. If this is so, a relationship between the duration of an individual's disabling health condition and the valuation they assign to their health-state might reasonably be expected. DESIGN: A postal survey using the EuroQoL (EQ-5D) instrument to collect descriptions and valuations for health from people who reported a diagnosis of either stroke or multiple sclerosis. Contact with participants was made through national support organizations and questionnaires were returned by mail. RESULTS: Eight hundred and ninety-four people completed the survey. One hundred (11 %) had one health-state indicating moderate problems in all five dimensions of the EQ-5D descriptive profile. For people with this health-state, analysis of covariance showed no relationship between valuation of health-state and time from onset of illness (F = 0.38, p = 0.54). This finding applied irrespective of the diagnosis, and for some other less frequently reported health-states. CONCLUSION: Clinical experience suggests that over time people adapt to long-term disability. However we found no evidence to support the proposition that higher health-state valuations by people with disabling conditions are explained by the actual duration of their condition.

Adaptation, Psychological↗

PubMed2002

Do natural health food stores require regulation?

AIM: To compare advice provided by health food stores (HFS) and pharmacies in relation to medical conditions and assess the need for regulation of HFS. METHODS: We assessed the advice provided by 26 health food stores (HFS) and 26 pharmacies to an individual presenting with symptoms suggestive of moderate to severe asthma who had not seen a general practitioner. RESULTS: The advice provided by the two stores differed markedly. 22/26 pharmacy staff diagnosed asthma/probable asthma, whereas only 15/26 HFS staff reached the same conclusion. 92.3% of pharmacy staff compared to 34.6% of HFS staff referred the investigator to a doctor; 5 HFS advised the investigator against seeing a doctor. A wide variety of remedies were recommended by the HFS, none of which are known to be beneficial in the treatment of asthma. CONCLUSION: HFS promoting herbal products for medical conditions should be regulated in a similar fashion to shops that dispense pharmaceutical products.

Adult↗

PubMed2002

The comparability of resource utilisation for Europeans and non-Europeans following stroke in New Zealand.

AIMS: We sought to explore resource use both in hospital and the community twelve months after hospital discharge for patients of different ethnicity admitted to hospital with acute stroke. METHODS: Resource utilisation data were collected for consecutive patients admitted to each of three general hospitals in the Wellington region over a nine month period. Patients were interviewed, where possible, at three, six and twelve months after hospital discharge. Ethnicity was determined by self report. RESULTS: Non-Europeans had longer hospital stays than Europeans (median 36 days vs 18 days, p = 0.01). Contact with rehabilitation professionals in the community was low for all groups with no significant differences between Europeans and non-Europeans. For the entire cohort, spending on institutional care was around ten times higher than spending on community rehabilitation in the first twelve months following stroke. CONCLUSIONS: Differences in hospital stay after stroke may reflect problems of access to inpatient rehabilitation services for younger people and not relate directly to the ethnicity of the patient. With the projected increasing proportion of Maori and Pacific people in the population, combined with the aging of that population, health policy-makers need to consider the implications of differences in resource utilisation for different ethnic groups in New Zealand. How to manage all the available resources for people with stroke to maximise outcome remains an important issue for health funders.

Cohort Studies↗

PubMed2002

The comparability of community outcomes for European and non-European survivors of stroke in New Zealand.

AIMS: To measure community outcomes for stroke comparing European and non-European survivors. METHODS: This was a prospective, hospital-based study of consecutive patients admitted to three general hospitals in Wellington with acute stroke. Patients were assessed using a range of instruments for prestroke function, function while in hospital, and then followed for twelve months post-hospital discharge. Ethnicity was decided by self-report and Maori, Pacific people and Asians were grouped together as "non-Europeans" for analysis. RESULTS: 181 people with stroke were enrolled of whom 171 (94.5%) were followed up to death or twelve months post hospital discharge. 33 (18%) were non-European with 13 (7%) Maori, 14 (8%) Pacific people and 6 (3%) Asians. Non-European survivors at twelve months post hospital discharge were more likely to be dependent (corrected OR 21.0, 95% CI 3.1, 141), have significantly lower Functional Independence Measure scores, lower London Handicap Scores and lower scores on the Short Form 36 domains of physical functioning and vitality and Physical Component Summary score. CONCLUSIONS: Community outcomes for survivors of stroke may be worse for non-Europeans although this should be confirmed in a larger study.

Activities of Daily Living↗

PubMed2002

Does post-voiding residual volume get less as mobility improves in a rehabilitation ward for older adults?

Impaired bladder emptying is common in frail older adults. This study tests the hypothesis that more complete bladder emptying is associated with better mobility in a rehabilitation ward for older adults. Consecutive admissions to a rehabilitation ward for older adults were considered for inclusion in the study in the week after admission to the ward. Exclusion criteria were cognitive impairment such that consent could not be obtained, non-English speaking, or presence of an indwelling urinary catheter. A post-voiding residual (PVR) bladder volume and Rivermead Mobility Index (RMI) were completed for subjects who gave consent, on a weekly basis until discharge. The BladderScan BVI 3000, Diagnostic Ultrasound, instrument was used. Statistical analysis was by a general linear mixed model. In the study period, 114 people were admitted and 57 approached for consent. Twenty-four people gave consent. Fifty percent of participants had at least one PVR greater than 100 mL. One person was found to be in urinary retention, with a PVR of greater than 700 mL, and was excluded from further analysis. The PVR increased by 1.2 mL (95% CI-4.6 to 7) for each unit improvement in the RMI. This study suggests that PVR does not decline with improvement in mobility in older adults receiving inpatient rehabilitation.

Aged↗

PubMed2002

An inverse correlation between estimated tuberculosis notification rates and asthma symptoms.

BACKGROUND: A recent ecological analysis demonstrated a strong inverse relationship between tuberculosis notification rates and the prevalence of asthma symptoms in 13-14-year-old children as obtained from the International Study of Asthma and Allergies in Childhood (ISAAC). However, the analysis was confined to the 23 countries in which the tuberculosis notification rates were considered to be of sufficient validity. METHODS: A similar analysis was performed using estimated tuberculosis incidence rates obtained from the World Health Organization Global Tuberculosis Programme and asthma symptom prevalence data from ISAAC for both the 6-7 and 13-14 years age groups in 38 and 55 countries, respectively. RESULTS: For the 6-7-year-old children, there was a significant inverse relationship between estimated tuberculosis incidence and the prevalence of key asthma symptoms. However, in the 13-14 year age group, a significant inverse relationship was only demonstrated for 'asthma ever'. CONCLUSION: The present study extends the inverse relationship between tuberculosis rates and asthma prevalence to the 6-7-year-old age group and suggests that the association, if causal, may be stronger at this younger age.

Adolescent↗

PubMed2002

The relationship between FEV1 and PEF in the assessment of the severity of airways obstruction.

OBJECTIVE: International consensus guidelines suggest that in asthma and chronic obstructive pulmonary disease (COPD), measurements of FEV1 and PEF are equivalent in the assessment of the degree of airflow obstruction when expressed as the per cent of predicted values. METHODOLOGY: In this retrospective study, 2,587 paired measurements of PEF and FEV1 performed by 101 adult patients with asthma (n = 56) and COPD (n = 45) attending an outpatient chest clinic were obtained. The mean differences between FEV1 and PEF measurements when expressed as the percentage of predicted values was determined. The level of agreement between the two measurements in the classification of asthma severity (life-threatening, severe, moderate and mild asthma determined by PEF or FEV1 measurements of <30%, 30-60%, 60-80%, and >80% of the predicted values, respectively) was determined. RESULTS: There was considerable variability between measurements of FEV1 and PEF when expressed as % predicted values. In both asthma and COPD, the FEV1% predicted was smaller than the PEF % predicted, with the mean difference being -10.9% (95% CI, -12.8% to -8.9%) with limits of agreement of -35.4% to +13.6%. The weighted Kappa statistic for agreement was 0.59 (95% CI, 48-70%) in the classification of the severity of airflow obstruction. CONCLUSION: When expressed as percentage of predicted values, PEF and FEV1 values are not equivalent. We recommend that guidelines be modified to state that across the spectrum of the severity of airflow obstruction there is considerable variability between measurements of FEV1 and PEF when expressed as % predicted such that the FEV1 may be as much as 35% lower or up to 15% higher than the PEF for patients with obstructive lung diseases.

Adult↗

PubMed2002

The accuracy of clinical assessment of bladder volume.

OBJECTIVE: To determine the usefulness of physical examination in detecting elevated bladder volume. DESIGN: A blinded study of clinical examination by physicians to detect elevated bladder volumes compared with a criterion standard (ultrasonic bladder volume measurement). SETTING: Outpatient department of a general hospital in New Zealand. PARTICIPANTS: Sixteen healthy adult volunteers (age range, 21-37 y; body mass index range, 22.9-37.2 kg/m(2)) and 8 qualified resident physicians with 2 to 6 years of clinical experience. INTERVENTION: Elevated bladder volumes were achieved by randomly allocating the volunteers to void or not to void before the clinical examination. MAIN OUTCOME MEASURE: Clinical examination of the abdomen by abdominal palpation and suprapubic percussion, compared with portable ultrasound findings, to determine whether a healthy adult has a full bladder. RESULTS: For bladder volumes of 400 to 600 mL, physical examination to detect a full bladder was 81% sensitive (95% confidence interval [CI], 54-96), 50% specific (95% CI, 39-68), and 55% accurate (95% CI, 45-65). The likelihood ratio for a positive finding on physical examination was 1.62 (95% CI, 1.17-2.24). CONCLUSION: Physical examination of the abdomen by relatively junior physicians is unreliable in detecting bladder volumes between 400 and 600 mL in healthy volunteers.

Adult↗