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Biomedical subjects

R Burns

Publications and source records attributed to R Burns.

At least 55 records · Page 3Linked to original sources
PubMed1995

Impact of continued geriatric outpatient management on health outcomes of older veterans.

BACKGROUND: Although previous trials have proved inpatient-based geriatric assessment to be beneficial, to our knowledge, the effectiveness of outpatient geriatric assessment has not been established. We examined the effectiveness of an outpatient geriatric evaluation and management (GEM) clinic. METHODS: Hospitalized veterans aged 65 years or older with impairment of activities of daily living, chronic disease, polypharmacy, or two or more hospitalizations in the previous year were randomized to an outpatient GEM team clinic (n = 60) or usual care (n = 68). After an initial comprehensive assessment, they received long-term management in the geriatric clinic. Principal outcomes included health status (mortality, hospitalizations, health perception, and medications), function (activities of daily living, instrumental ADL, and social activity), affect (Center for Epidemiologic Studies-Depression test score and life satisfaction), and cognition (Mini-Mental State examination score). RESULTS: At randomization, no significant differences were noted between the groups. The average age of the patients was 71 years (range, 65 to 93 years). At 1 year following randomization, GEM clinic patients compared with subjects receiving usual care had significantly improved health perception, took fewer medications despite increased number of diagnoses, reported greater social activity, had improved Center for Epidemiologic Studies-Depression scale scores, and had higher life satisfaction scores. There was a trend toward improved performance of activities of daily living for GEM clinic patients. The GEM clinic patients had a 54% lower mortality (6.8% vs 14.9%). Overall, no differences were observed in the total number of hospitalizations between the groups. CONCLUSIONS: The combination of long-term management following comprehensive outpatient assessment significantly improved aspects of health status (including health perception and medications), function (including social activity), and affect (including depression and life satisfaction) for older veterans and may influence mortality and function.

Activities of Daily Living↗
PubMed1995

Application of multivariable optimal discriminant analysis in general internal medicine.

OBJECTIVE: To illustrate the use of multivariable optimal discriminant analysis (MultiODA). DESIGN: Data from four previously published studies were reanalyzed using MultiODA. The original analysis was Fisher's linear discriminant analysis (FLDA) for two studies and logistic regression analysis (LRA) for two studies. MEASUREMENTS AND MAIN RESULTS: In Study 1, FLDA achieved an overall percentage accuracy in classification (PAC) for the training sample of 69.9%, compared with 73.5% for MultiODA. In Study 2, the LRA model required three attributes to achieve a 76.1% overall PAC for the training sample and a 79.4% overall PAC for the hold-out sample. Using only two attributes, the MultiODA model achieved similar values. In Study 3, the FLDA model achieved an overall PAC of 82.5%, compared with 87.5% for the MultiODA model. In Study 4, MultiODA identified a two-attribute model that achieved a 93.3% overall training PAC, when an LRA model could not be developed. CONCLUSIONS: MultiODA identified: a superior training model (Study 1); a more parsimonious model that achieved superior overall training and identical hold-out PAC (Study 2); a model that achieved a higher hold-out PAC (Study 3); and a two-attribute model that achieved a relatively high PAC when a multivariable LRA model could not be obtained (Study 4). These findings suggest that MultiODA has the potential to improve the accuracy of predictions made in general internal medicine research.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Assessing performance-related disability in patients with knee osteoarthritis.

This investigation describes the development and validation of a test battery for evaluating physical activity restrictions (PAR) in patients with knee osteoarthritis (OA). The tasks on the final version of the PAR include (a) a 6-min walk; (b) a stair climb; (c) a lifting and carrying task; and (d) getting into and out of a car. Data from patients with knee OA revealed that the four tasks loaded highly on a single unrotated principal component yielding an alpha internal consistency reliability of 0.92. These data suggest that investigators may choose to use an aggregate score and/or responses from individual tasks. Two week test-retest reliabilities for the four tasks were all in excess of 0.85 and there was support for their concurrent and convergent validity. Specifically, performance on the tasks correlated with time on treadmill, difficulty with self-reported ADLs, and ratings of difficulty following the performance of each task. Additional research is needed on the predictive validity of the measure and its sensitivity to change.

Activities of Daily Living↗
PubMed1995

Long-term effects of cognitive-behavioural therapy and lithium therapy on depression in the elderly.

BACKGROUND: We examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients. METHOD: The study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy. RESULTS: Receiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy. CONCLUSIONS: CBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

Aged↗
PubMed1995

The evaluation of pain in patients with knee osteoarthritis: the knee pain scale.

OBJECTIVE: To develop and validate a knee pain scale (KPS) for use with osteoarthritis (OA) of the knee. METHODS: Patients with documented evidence of knee OA completed the KPS and a test battery including measures of physical functioning, physical performance, and depression. Analyses were conducted to confirm the 4-factor structure of the measure, determine alpha reliabilities, assess the test-retest reliability, and examine the construct validity of the KPS. RESULTS: Confirmatory factor analysis revealed that the KPS has 4 subscales, including frequency and intensity of pain experienced during both ambulation/climbing and transfer activities. All reliabilities were in excess of 0.80 and the subscales of the KPS shared expected variance with both self-reported and objective indices of dysfunction. CONCLUSION: The KPS has good psychometric properties for assessing pain experienced in conjunction with the performance of activities of daily living. Although at present it is a research tool, with further study it should prove valuable in clinical practice as well.

Activities of Daily Living↗
PubMed1995

Psychosocial morbidity in bone marrow transplant recipients: a prospective study.

Previous work has demonstrated that psychosocial morbidity may occur following bone marrow transplantation (BMT), but few prospective quantitative data are available, especially in adults. We have conducted a prospective psychological assessment of 36 patients accepted onto our BMT programme, of whom 31 proceeded to transplant. Patients were assessed shortly before admission for BMT and again at about 4 and 8 months after the procedure, using the following tools: Hospital Anxiety and Depression Scale (HAD), Social Adjustment Scale-Self Report and the Present State Examination (PSE). A 54% incidence of psychosocial morbidity (as assessed by either an abnormal HAD or PSE result) was found among those cases assessed both before and at least once after BMT. Significant psychosocial morbidity was still present 6-9 months following BMT. Cases scoring abnormally following BMT in general also scored abnormally before transplant, suggesting a predictive value of pre-BMT psychological assessment. Psychological morbidity was unrelated to the type of transplant. Patients with chronic myeloid leukaemia had a higher incidence of post-BMT psychosocial morbidity than patients with other diagnoses; it is suggested that this may be due to their lack of previous experience of intensive haematological therapy. Psychological evaluation may help in identifying patients at risk of post-BMT psychosocial problems.

Adolescent↗
PubMed1994

Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race.

OBJECTIVES: Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial differences existed in a delivery plan in which access is not determined by patient finances. BACKGROUND: Prior studies have demonstrated significant differences in utilization of cardiac diagnostic and therapeutic resources by white and black patients. Reasons for the reduced utilization by black patients include socioeconomic, biologic and sociocultural effects. METHODS: Computerized discharge records of 30,300 patients with coronary artery disease and 1,335 patients with valvular heart disease who were discharged from any of 172 VA Medical Centers between October 1, 1990 and September 30, 1991 were studied. RESULTS: For patients with coronary artery disease, utilization rates of cardiac catheterization were significantly greater for white patients (503.4 procedures/1,000 patients) than for black patients (433.2/1,000 patients), with a relative odds ratio of 1.33. Rates for surgery (179.0 vs. 124.5/1,000 patients) were also greater for whites than for blacks, with a relative odds ratio of 1.53. For the subset with valve disease, the catheterization rate was significantly greater for whites than for blacks (575.4 vs. 432.6 procedures/1,000 patients), with a relative odds ratio of 1.78. Surgical rates were not significantly different (423.8 vs. 354.6 operations/1,000 patients). Racial differences for both catheterization and surgery varied widely as a function of geographic region and the level of complexity of the local VA facility. CONCLUSIONS: Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes.

Black or African American↗
PubMed1994

Neurological involvement in Worth type endosteal hyperostosis: report of a family.

We present the first Australian family known with autosomal dominant endosteal hyperostosis affecting a mother and her 2 children. Neurological involvement comprising chronic intracranial hypertension and cranial nerve palsies were found in the mother; computerised tomography and magnetic resonance imaging of the head demonstrated symmetrical sclerosis of the cranial vault, narrow internal auditory meati and canals, inferior herniation of the cerebellar tonsils into the foramen magnum, and encroachment of occipital bone into the foramen magnum posteriorly. This is the fifth report of significant neurologic involvement in this condition and supports the view that severe forms of endosteal hyperostosis are not confined to the autosomal recessive variant, as individuals with the autosomal dominant form may also show progression with neurological involvement in adulthood.

Adult↗
PubMed1994

Post-hospital home health care for Medicare patients.

Medicare patients in five diagnosis-related groups (DRGs) associated with heavy use of post-hospital care discharged from 52 hospitals in 3 cities were followed up at 6 weeks, 6 months, and 1 year to determine the factors associated with their being discharged home with or without home health care and the correlates of improvement in their functional status. Models correctly predicted those discharged home from those going to institutions in a range from 54 to 82 percent of cases. The amount of the variance in the change in function for those who went home (with or without home health care) explained by the models tested ranged from 19 percent to 73 percent. Total Medicare costs for the patients who went home were considerably less in the year subsequent to the hospitalization compared with those discharged to institutional care.

Activities of Daily Living↗
PubMed1993

Tropical spastic paraparesis in an aborigine.

OBJECTIVE: To present the first documented case of human T-lymphotropic virus type I (HTLV-I) associated myelopathy/tropical spastic paraparesis in the Australian population. CLINICAL FEATURES: A 31-year-old Aboriginal man with an 18-month history of progressive weakness of the legs was found to have an upper motor neurone weakness of all limbs associated with sphincteric disturbance and impotence. HTLV-I antibodies were detected in his serum and no other cause for the patient's myelopathy could be found. INTERVENTION AND OUTCOME: He was counselled regarding HTLV-I associated myelopathy/tropical spastic paraparesis. CONCLUSION: This is the first description of HTLV-I associated myelopathy/tropical spastic paraparesis in an Australian. In cases of spinal cord disorder without evidence of compression we recommend serological testing for HTLV-I, especially in Aboriginal patients. Additionally, testing of blood donors for this retrovirus needs consideration.

Adult↗
PubMed1993

Impedance cardiography: the failure of sternal electrodes to predict changes in stroke volume.

A study was conducted on 26 healthy male adults comparing the stroke volume (SV) and cardiac output (CO) measured with green dye and impedance cardiography in supine, sitting and during 50 W bicycle exercise. The impedance voltage pick-up electrodes were modified from the standard band location and placed at the suprasternal notch and 10 cm below. The percentage change of SV going from supine to sitting was -27.2 +/- 7.4% and -16.9 +/- 22% for the dye and impedance values respectively. The percentage change of SV going from sitting to exercise was 20.9 +/- 11.9% and 36.7 +/- 32.9% for the dye and impedance values respectively. The percentage change in SV determined by impedance shows poor correlation (supine to sitting R = 0.16 and sitting to exercise R = 0.42) with dye values. The individual impedance values for a given change in position or exercise showed considerably more variation compared with the dye. Impedance determination of SV using electrodes on the sternum does not appear to be a valid method for SV and CO measurements.

Adult↗
PubMed1993

Perception of the stop/glide contrast in infancy.

Much of the published research in infant speech perception has emphasized how well infants have done with a number of speech contrasts, and have noted similarities in pattern of discrimination of adults and infants. Often it has been suggested that infants begin life with the ability to perceive any speech contrast, and that the process of acquiring a language involves inhibition of the ability to perceive contrasts not present in the target language. Indeed some studies have shown infants able to discriminate contrasts on which adults fail if the contrasts are not drawn from the native language of the adults. Other studies, however, have suggested that infants may not always be so perceptually capable. The present work focusses on the stop-glide contrast. The results are inconsistent with the prevalent view and with previously reported studies on the perception of the stop-glide contrast by infants. The results indicate that in a vigilance paradigm adapted for both infant and adult testing, infants perform poorly on the contrasts when compared with adults. Furthermore the pattern of relative perception observed in the adults on stimuli with long or short vowels is quite unlike that of the infants. It is concluded that much work remains in order to evaluate the relative performance of infants and adults in speech perception, since it appears that changes in experimental paradigm or particular stimulus parameters may affect outcomes in fundamental ways.

Acoustic Stimulation↗
PubMed1993

Mortality in a public and a private hospital compared: the severity of antecedent disorders in Medicare patients.

OBJECTIVES: The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. METHODS: Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. RESULTS: Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. CONCLUSIONS: The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations.

Adult↗