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Biomedical subjects

P Finucane

Publications and source records attributed to P Finucane.

At least 37 records · Page 2Linked to original sources
PubMed1995

Thyroid disease in older patients. Diagnosis and treatment.

Thyroid gland dysfunction is a relatively common clinical problem in elderly people and is associated with significant morbidity if left untreated. The clinical features of thyroid disease may be subtle, easily overlooked or misdiagnosed. Therefore, a high index of suspicion is necessary. If potentially serious sequelae are to be avoided, the selection and interpretation of thyroid function tests must be appropriate. It is particularly important to consider both the effect of concurrent illness and the effect of certain drugs on thyroid function tests. With recent methodological advances, thyroid function tests are now more reliable, though in certain situations they still need to be interpreted with caution. Once the diagnosis is established, the management of both hypothyroidism and hyperthyroidism is relatively simple and effective, though there are special considerations relating to elderly patients.

Aged↗
PubMed1994

Attitudes to teaching among teachers at a British medical school.

A random sample of clinical teachers at a British medical school was surveyed by postal questionnaire to assess their attitudes to teaching and to teacher training. The response rate among the 186 teachers sampled was 80%. A high degree of enthusiasm for teaching was detected despite a perception that teaching received neither sufficient priority within the medical school nor due recognition within its reward structure. Feelings were mixed concerning the quality of training which graduates received. However, only 5% of teachers believed their own teaching ability to be below average. This survey revealed considerable support for the concept of training courses for medical teachers, though feelings were mixed as to whether such courses should be compulsory. These findings are discussed and related to recent initiatives to improve both the status of teaching within medical schools and the quality of medical education.

Attitude↗
PubMed1994

Incorporating peer review into routine clinical work: a practical example.

We describe a simple quality assurance (QA) exercise that compared the practices of two physicians providing geriatric consultations at a University teaching hospital. Two hundred consecutive referrals were randomly allocated to either physician. Although the patients referred had similar characteristics, their problems were managed differently. This led to an evaluation of work practices and identification of problems to which solutions were found. As the study was incorporated into routine clinical work, its cost in terms of resources and manpower was minimal. Such simple practical QA exercises should be used more extensively to enhance the practice of medicine.

Aged↗
PubMed1993

"Is she fit to sign, doctor?"--practical ethical issues in assessing the competence of elderly patients.

The competence of elderly people to participate in medical decision-making is often called into question. This article explores the concept of competence as it relates to elderly people, and outlines the guiding ethical principles of autonomy and beneficence. Practical guidelines are offered on how competence can be assessed and some avoidable pitfalls are highlighted.

Activities of Daily Living↗
PubMed1992

Teachers at a British medical school.

Clinical teachers' attributes, beliefs and attitudes to teaching were measured by mailing a questionnaire to a 50% sample of staff at a British medical school. This paper describes the attributes of the 80% who responded. The majority (83%) were male and females were particularly under-represented in the upper echelons of academia. Most (57%) taught at least once weekly, though 20% taught less often than once a month. The 41% who were primarily NHS employees were as active in teaching as those employed by the University. Small group teaching was most frequently undertaken by 73%, though 17% (who were more likely to be University employees) most often lectured. Only 19% of teachers had attended a course in medical education in the previous 5 years--these were more likely to have qualified relatively recently and to be University employees. Few (9%) teachers claimed membership of a medical education society. It is hoped that these findings will stimulate debate on how medical school teachers are selected, how they can be helped to improve their teaching performance and how their enthusiasm for teaching can be fostered.

Curriculum↗
PubMed1991

Variability in physicians' decisions on caring for chronically ill elderly patients: an international study.

OBJECTIVES: To determine what treatment decisions physicians will make when faced with an incompetent elderly patient with life-threatening gastrointestinal bleeding and to identify the factors that affect their decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. OUTCOME MEASURE: A self-administered questionnaire containing three case vignettes. Each provided the same details on an incompetent elderly patient; however, one gave no information about the wishes of the patient and his family (no directive), the second provided a do-not-resuscitate (DNR) request, and the third included a detailed therapeutic and resuscitative effort chart (DTREC) requesting maximum therapeutic care without admission to the intensive care unit (ICU). The four treatment options were supportive care only, limited therapeutic care, maximum therapeutic care without admission to the ICU and maximum care with admission to the ICU. MAIN RESULTS: Treatment decisions varied and were systematically related to age, level of training and country (p less than 0.001). The older physicians and those in family medicine were less likely than the others to choose aggressive treatment options. Brazilian and US physicians were the most aggressive; Australian physicians were the most conservative. The DNR request resulted in a significant decrease in the number of physicians choosing aggressive options (p less than 0.001). The DTREC resulted in a move toward more aggressive treatment, as outlined in the directive (p less than 0.001). Overall, however, about 40% of the physicians chose a level of care different from what had been requested. Furthermore, over 10% would have tried cardiopulmonary resuscitation despite the DNR request. CONCLUSION: Treatment of incompetent elderly patients with life-threatening illness varies widely within and between countries. Uniform standards should be developed on the basis of societal values and be communicated to physicians.

Advance Directives↗
PubMed1991

Thyrotropin response to thyrotropin-releasing hormone in elderly patients with and without acute illness.

The response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH) was measured in 70 clinically euthyroid elderly patients who were acutely ill and in 70 age- and sex-matched euthyroid controls who were free of acute disease. The incremental TSH response (delta TSH) was often blunted (less than 2 mU/l) in both groups, though more often in those with acute illness (30%) than in those without (19%). However, in patients from both groups who had a blunted delta TSH, there was often a substantial proportional rise in TSH. A substantial proportional TSH rise may be useful in differentiating between genuine thyroid disease and euthyroid sick syndrome in elderly patients with a blunted delta TSH.

Acute Disease↗
PubMed1991

The apex cardiac beat: not a reliable clinical sign in elderly patients.

To assess its reliability as a marker of cardiomegaly in elderly patients, we compared a clinical assessment of heart size with that calculated from chest radiography. In 100 hospitalized subjects of median age 78 years, the apex beat was palpable in only 35% and its palpability declined with increasing age. Even when palpable, the apex beat had low specificity (74%) and sensitivity (69%) as a marker of cardiomegaly and its positive predictive value (69%) and negative predictive value (74%) were poor. The clinical assessment of heart size in elderly hospitalized patients should be interpreted with caution.

Age Factors↗
PubMed1991

Percutaneous endoscopic gastrostomy in elderly patients.

Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.

Aged↗
PubMed1991

Percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy is a useful alternative to long-term nasogastric feeding or surgical gastrostomy for dysphagic patients. It is simple to perform and is relatively safe.

Deglutition Disorders↗
PubMed1989

Thyroid function tests in elderly patients with and without an acute illness.

Thyroid function was assessed by measurement of free thyroid hormones and thyrotrophin (TSH) in 78 acutely ill elderly patients and in a control group without acute illness. Abnormal results with any test were more frequently found in the acutely ill group than in controls. In particular, abnormal TSH values were found in 40% of the acutely ill group and in only 8% of controls (p less than 0.001). Seven acutely ill subjects had very low TSH levels (less than 0.04 mU/l) and a blunted response to thyroid-releasing hormone (TRH). With few exceptions these abnormalities could not be attributed to thyroid disease. This suggests that pituitary TSH secretion can be impaired in euthyroid sick old people. High sensitivity TSH assays may therefore be inappropriate as first-line tests of thyroid function, at least in this select group.

Acute Disease↗
PubMed1988

Bioavailability and acceptability of a dispersible formulation of levodopa-benserazide in parkinsonian patients with and without dysphagia.

The bioavailability of levodopa-benserazide in a standard capsule and a new dispersible tablet was compared in Parkinsonian patients, with (n = 8) and without (n = 8) swallowing difficulties. There was considerable variation within and between subjects, but no significant differences between formulations for any pharmacokinetic parameters, other than an earlier time-peak concentration following the dispersible tablets (P less than 0.01) in non-dysphagic patients. The acceptability of the dispersible tablets in the dysphagic patients was also determined following 7 days regular use. It was felt there were advantages in four of the patients because it was easier to administer or to swallow. The dispersible formulation may offer practical benefits to a minority of Parkinsonian patients without any anticipated loss of therapeutic efficacy.

Aged↗
PubMed1988

Markers of the nutritional status in acutely ill elderly patients.

We recorded anthropometric and laboratory data in 98 sick old people on admission to a high-dependency unit. The measurement of triceps skinfold thickness and arm muscle area was feasible even in very ill people, while measurement of the body mass index was difficult and sometimes unreliable. Anthropometric measurements indicated that our study group was better nourished than a local population, with just 3 subjects (3%) being fat depleted and a further 4 (5%) being protein depleted. Serum albumin was the laboratory variable that correlated best with anthropometric parameters. However, it was low in 47% of the subjects, indicating that its lower reference value needs to be redefined in this select group.

Acute Disease↗