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Biomedical subjects

R H Fisher

Publications and source records attributed to R H Fisher.

18 recordsLinked to original sources
PubMed1991

On the clinical value of the London Psychogeriatric Rating Scale.

The London Psychogeriatric Rating Scale (LPRS) was administered to 76 probable Alzheimer's patients, 59 patients with dementia unrelated to Alzheimer's, 102 neurologically normal subjects, and 27 patients with symptoms of both Alzheimer's and dementia of other etiologies. By examining the relationships among the four subscales of the LPRS and conducting factor analyses, it was demonstrated that the four subscales were not measuring different phenomena. The internal consistency of the full 36-item scale was high (Cronbach's Alpha = 0.96) indicating the total LPRS score provided a reliable global index of behavioral function. The total LPRS scores correlated with the independently administered Goldfarb Mental Status Examination scores (r = -0.79). The LPRS differentiated between the normals and the combined demented groups and between inpatients and outpatients. The LPRS continues to have clinical value for functional assessments in a non-intrusive manner. The LPRS may be particularly useful in situations where direct assessment of mental status is not practical.

Aged↗
PubMed1990

Should living wills be legalized?

Living wills allow patients to state their wish to die and not be kept alive through the use of medications, artificial means or "heroic" measures. They have been made legal documents in 38 states in the United States. Living wills permit advance expression of a patient's wishes, promote effective communication and demonstrate respect for the patient as a person. Problems with legal recognition of such wills include the need for agreement on fundamental terms, possible restriction of patients' rights, limitation of options in decision-making and possible negative effects on the physician-patient relationship. Before legislation is enacted, public and professional attitudes toward the care of terminally ill patients should be assessed. All health care professionals should receive better education in this area, and palliative care services should be made more widely available. Only if these measures fail should living wills be made legal documents in Canada.

Attitude of Health Personnel↗
PubMed1989

WAIS-R test-retest reliability in a normal elderly sample.

We examined the 1-year test-retest reliability of WAIS-R Verbal, Performance, and Full-Scale IQs in a sample of 101 older normal individuals (mean age = 67.1). The respective Pearson rs were .86, .85, and .90. The median retest reliability coefficient for the WAIS-R subtests was .71. The test-retest reliability for the Verbal-Performance Discrepancy was .69. These data indicate that IQ scores are reliable in older normal individuals for this retest interval, but less confidence can be placed in the reliability of subtest scores and the Verbal-Performance Discrepancy.

Aged↗
PubMed1989

Dementia diagnosis.

Explore the source record for details and available documents.

Alzheimer Disease↗
PubMed1988

The NINCDS-ADRDA Work Group criteria for the clinical diagnosis of probable Alzheimer's disease: a clinicopathologic study of 57 cases.

Neuropathologic confirmation is required to validate the NINCDS-ADRDA Work Group criteria for the clinical diagnosis of Alzheimer's disease (AD). Neuropathologic inclusion and exclusion criteria for AD, however, are not uniform. The purpose of this investigation was to examine the confirmation rate for the Work Group criteria against differing neuropathologic criteria for AD. The sample consisted of 57 cases, 22 of which had received a clinical diagnosis of AD. Nine neuropathologic criteria for AD were applied in a blind fashion to each of the 57 cases. Our results indicated that, depending on the neuropathologic criteria applied, the clinicopathologic agreement ranged from 64% to 86%. These findings demonstrate the need for universally accepted neuropathologic and clinical criteria for AD.

Aged↗
PubMed1987

The clinical case against tube feeding in palliative care of the elderly.

The terminal stages of many neurological illnesses occurring in the elderly produce feeding and swallowing problems. These difficulties lead to ethical, religious, philosophical, and medico-legal conflicts when decisions about starting or stopping tube feedings are considered. We present the case against all forms of tube feeding in a particular subset of elderly palliative patients. These are individuals who are in the end-stage of a progressive neurological disease who are noncommunicative, and spend all or most of their time in a recumbent position. We discuss the physiological phenomena existing in these patients that make the probability of aspiration pneumonia as great or possibly greater than with careful spoon feeding. If tube feeding results in the outcome that it is thought to prevent (ie, aspiration pneumonia) then decisions regarding nutritional support in these patients become clinically clearer.

Aged↗
PubMed1986

Geriatric psychiatry in the general hospital: the integration of services and training.

This article describes the development of a new psychiatric service for the elderly based in a university general hospital. The service aims to provide and coordinate comprehensive psychiatric care for a defined population and also to serve as a tertiary care unit with academic responsibilities. As part of the Department of Psychiatry, this specialized service is fully integrated into all the major clinical and teaching components of the department. As the demand for more geriatric psychiatry services and training increases over the next decade, innovative ways of responding to this need will have to be developed. This integrative model in a general hospital setting has enhanced the quality of health care delivery to the elderly at the same time as improving training and recruitment.

Aftercare↗
PubMed1978

Postural hypotension and mental function in the elderly.

The effect of 3 hours of ambulatory activity on the mental function of 12 elderly persons with postural hypotension was examined. There was little difference between the mean combined mental status and set test scores when the subjects were supine (42.3) and when they were erect after 3 hours of ambulatory activity (42.2). A control group of persons of similar age and health who did not have hypotension also exhibited little difference in mean scores (49.9 v. 51.5 respectively). The mean scores of the two groups of subjects did not differ significantly. After 6 months the mean scores of the two groups were 40.9 and 44.7 respectively. It appears that elderly individuals with postural hypotension do not exhibit any appreciable deterioration in mental function with ambulation or after a 6-month period.

Age Factors↗
PubMed1978

Postural hypotension and diuretic therapy in the elderly.

Blood pressures were recorded in 319 ambulatory subjects, largely men, age 50 to 99 years. The mean systolic pressures were maximal in the seventh and eighth decades (136.0 and 132.1 mm Hg with the subjects supine and erect, respectively), whereas the mean diastolic pressures fell progressively after age 69. The distribution of postural changes in mean blood pressure was similar in each decade; a decrease of 20 mm Hg on more was noted in 3.4% of the subjects aged 80 to 99 years and in 4.1% of those aged 50 to 79 years. The frequency of postural hypotension was 4.6% in subjects treated with diuretics and 3.4% in those not so treated. Blood pressures and the frequency of postural hypotension did not progressively increase in age in this elderly population.

Age Factors↗
PubMedDate not supplied

Chronic rhinitis: an underrecognized association with fibromyalgia.

We prospectively studied 47 consecutive patients with either seasonal or perennial allergic rhinitis or nonallergic rhinitis in a general allergy clinic. A diagnostic questionnaire was administered for symptoms of rhinitis and fibromyalgia, and patients were examined for tender points. A history of congestion was present in 91%, rhinorrhea in 87%, and postnasal drip in 83%. Forty-nine percent had a history of diffuse, aching pain, or tiredness for at least 3 months; 49% percent had 11 or more tender points; and 38% had both a history of widespread pain plus 11 or more tender points (the 1990 criteria of the American College of Rheumatology for fibromyalgia). This frequency is much higher than the expected 4 to 5% prevalence of fibromyalgia in a general population. Seventy-nine percent of all subjects were skin-test positive to inhalant allergens, but positive skin tests alone did not correlate with the number of tender points or criteria for fibromyalgia. Rhinitis, rather than atopy, is associated with fibromyalgia and may be an underdiagnosed, but important causative factor.

Chronic Disease↗