Biomedical subjects

P Hanrahan

Publications and source records attributed to P Hanrahan.

30 records · Page 2Linked to original sources

PubMed1993

What is appropriate health care for end-stage dementia?

OBJECTIVE: This study sought to determine the kind of health care that professional and family caregivers viewed as appropriate for end-stage dementia patients. DESIGN: Survey. PARTICIPANTS: All 819 physician members and 1,000 randomly selected non-physician members of the Gerontological Society of America and 500 families of demented relatives from the Alzheimer's Association. MEASURES: Respondents chose the appropriate level of care from five choices on a continuum from highly aggressive to palliative. RESULTS: The majority of physicians who cared for elders (61%), gerontologists from other professions (55%), and families (71%) chose palliative care only. Increased age of the respondent and experience with terminal care choices were associated with the choice of palliative care. The majority favored hospice care for patients with end-stage dementia. CONCLUSIONS: Professional and family members of demented individuals, especially if they have experience in terminal care decisions, strongly favor palliative care for end-stage dementia. These findings may be helpful to professionals and families dealing with these choices.

Adult↗

PubMed1993

A medicare adult day care model: proposed criteria and available supply.

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.

Adult↗

PubMed1993

Factors associated with reduction in antipsychotic medication dosage in adults with mental retardation.

Although antipsychotic medications have been successfully decreased or eliminated for many individuals with mental retardation, a minority suffer significant deterioration when dosages are decreased. Records of individuals residing on a 75-bed unit over a 5-year period were reviewed to determine differences in antipsychotic dosages over time. Presence of a psychotic diagnosis was a significant variable in increased antipsychotic dosage. Use of alternative medication (carbamazepine, buspirone, lithium, and propranolol) was related to decreased antipsychotic dosage. Findings suggest that individuals with mental retardation who do not have psychoses are a suitable group for reduction and that use of alternative medications facilitate this process for individuals with or without psychoses.

Adolescent↗

PubMed1993

Systemic lupus erythematosus.

This condition is composed of a collection of signs and symptoms. The diagnosis has been made easier by more sensitive laboratory tests, the most important of which is still the antinuclear antibody (ANA) test. Prominence is given in this article to clinical features and treatment.

Female↗

PubMed1993

Classification of adult day care: a cluster analysis of services and activities.

Using data from a 1986 national census survey of 774 adult day care (ADC) centers, this study (a) determined whether distinct classes of ADC could be identified based on measures of program services and activities, and (b) delineated the distinguishing characteristics of such classes on other available measures of structure, process, and client population. A cluster analysis of 10 "process" measures of services and activities identified 6 classes of ADC centers: Alzheimer's Family Care, Rehabilitation, High Intensity Clinical/Social, Moderate Intensity Clinical/Social, General Purpose, and Low Scoring. Validity was examined by developing a set of expectations for pairs of classes on other available variables. Of 12 expectations, 11 were supported by the statistical tests. Finally, profiles of the 6 classes were developed to describe the classes on 30 other characteristics. The findings clarify the settings to which previous ADC studies are generalizable and indicate a need for effectiveness studies on special classes of ADC.

Adult↗

PubMed1992

Repetitive behaviors in chronically institutionalized schizophrenic patients.

Repetitive dysfunctional behaviors (e.g., polydipsia, bulimia, hoarding, mannerisms) are frequently observed in chronically institutionalized schizophrenics, cause significant morbidity and are readily reproduced in animal models. The goal of this study was to assess the frequency and severity of these behaviors. Thirty-two chronic schizophrenics on an extended treatment unit were rated on the Elgin Behavioral Rating Scale, which includes eight repetitive behaviors and eight positive and negative symptoms. Forty-seven percent of the patients exhibited at least one severe, or 2 moderate, repetitive behaviors, while 63% exhibited at least one severe or 2 moderate positive or negative symptoms. The mean total score (+/- SD) on the eight repetitive behaviors (10.3 +/- 6.1) was about 2/3 that for the eight positive and negative symptoms (15.3 +/- 8.9, t = 4.1, p = .0001). Interrater reliability for the repetitive behaviors was similar to that for the positive and negative symptoms. Repetitive behaviors were positively related to male gender, white race and total length of hospitalization. Repetitive dysfunctional behaviors are frequently observed and can be reliably rated in chronically institutionalized schizophrenics.

Adult↗

PubMed1992

Are there clinical differences between familial and nonfamilial Alzheimer's disease?

OBJECTIVE: The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. METHOD: Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. RESULTS: Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. CONCLUSIONS: The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

Age Factors↗

PubMed1992

Failure of a binaural comprehension deficit to select responders to earplug use in schizophrenia.

Previous studies have suggested that on the Auditory Comprehension Test, a significant proportion of schizophrenics demonstrate a binaural comprehension deficit. To test whether wearing an earplug in their more poorly performing ear would be beneficial, we studied 34 in-patient schizophrenics and noted a binaural deficit in 12 (35%). Of these, eight patients subsequently wore an earplug in each ear for at least one week. We found no effect of the earplug on psychopathology.

Adult↗

PubMed1990

Survey of adult day care in the United States. National and regional findings.

Before attempting to understand how a relatively new treatment modality such as adult day care (ADC) works, it is useful to understand what it is. To this end, this article describes the structural characteristics of ADC centers and the characteristics of ADC users in the United States and across the four U.S. census regions. A 1986 national census survey of 1,347 ADC centers yielded 974 usable responses (72.3%). Findings indicated that there is great variability in characteristics of ADC across the country. In general, ADC's are well-staffed, well-linked to other agencies, and well-equipped. However, demand and enrollment appeared low. A need for improved oversight and staff in-service training was indicated for a substantial proportion of centers. These and other findings provide the most detailed and comprehensive national and regional descriptions of ADC available to date.

Aged↗

PubMed1988

Effect of intra-articular glucocorticoids on the disposition of sulphadimidine in chronic osteoarthritis patients.

1. The disposition of sulphadimidine (15 mg kg-1 orally) was investigated in six chronic osteoarthritis patients (four slow and two fast acetylators) prior to and 4 days following intra-articular administration of glucocorticoids. 2. The mean (+/- s.e. mean) renal clearance of sulphadimidine was increased from 0.03 +/- 0.01 to 0.07 +/- 0.02 ml min-1 kg-1 (P = 0.01) following the administration of intra-articular steroid. 3. Mean metabolic clearance and volume of distribution data were similar on the two study days. However, two of the slow acetylators showed marked increases (63% and 193%) in metabolic clearance following steroid treatment.

Acetylation↗

PubMed1977

Symptoms and signs among relatives of patients with HLA B27 ankylosing spondylitis: Correlation between back pain, spinal movement, sacroilitis, and HLA antigens.

In order to determine the prevalence of ankylosing spondylitis and the prevalence and pattern of back pain amongst the relatives of patients with ankylosing spondylitis, 63 first degree relatives of 14 propositi were assessed by means of questionnaire, physical examination, and radiology. There were no significant differences in the responses of the B27 positive and negative relatives in relation to prevalence, severity and character of back pain. Ankylosing spondylitis was found in 6.5 per cent of B27 positive relatives and 3.1 per cent of B27 negative relatives; sacroilitis being present in 12.9 per cent of B27 positive relatives and 6.3 per cent of B27 negative relatives. A family studied is presented as a possible corssover between HLA B locus and disease "predisposition" genes. It is suggested patterns of back pain may not be as discriminating as has been thought.

Adolescent↗

PubMedDate not supplied

Criteria for enrolling dementia patients in hospice: a replication.

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used--as opposed to our previous study, which only examined initial treatment plans. Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.

Aged↗