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Biomedical subjects

R W Stout

Publications and source records attributed to R W Stout.

At least 73 records · Page 4Linked to original sources
PubMed1988

Active-life expectancy and terminal dependency: trends in long-term geriatric care over 33 years.

To determine whether medical advances will result in an increasing number of dependent elderly people, or whether postponement of disability in a finite lifespan will lead to a decrease in terminal dependency, an analysis was made of 24,117 admissions to a geriatric unit from 1954 to 1986. During this period, the average age on admission for long-term care rose by 0.24 years per year for women and by 0.09 years per year for men. The median length of stay also increased, more for women than for men, as did the proportion of the total lifespan spent in long-term care. Active-life expectancy became longer and terminal dependency was postponed, but the duration of terminal dependency increased. Active-life expectancy increased more rapidly in women than in men, as did the length of terminal dependency. As life expectancy continues to increase, high priority will have to be given to reduction of disability and dependency in advanced old age.

Aged↗
PubMed1988

VCTS chart evaluation as a screening test.

Contrast sensitivity curves of 211 randomly selected patients were drawn using the VCTS chart. Depending on the type of curve obtained, patients were grouped in different diagnostic categories following the instructions supplied with the chart. Clinical examination revealed that the VCTS chart curves indicated a false diagnosis of cataract in 65.5% patients and in 54.2% patients a false diagnosis of glaucoma. In a number of additional patients, VCTS chart testing had failed to indicate the presence of cataract or glaucoma. Contrary to the claims of the manufacturer our results demonstrate that the VCTS chart has no value as a screening device in a clinical practice.

Adolescent↗
PubMed1988

Disability and dependency in elderly people in residential and hospital care.

Physical dependency and mental impairment were assessed in 143 residents of residential accommodation for the elderly and 125 patients in geriatric continuing-care wards in South Belfast. Although dependency, immobility and incontinence were more common in the hospital patients, there was considerable overlap in the disability levels in the two types of care. There was evidence of dementia in 51% of the residents and 71% of the patients, while 29% of residents and 70% of patients were incontinent. Overall, less than 1% of the elderly population was in each of residential or geriatric hospital care but the proportion rose with age and was greater in older women. About 17% of elderly people in South Belfast with dementia were in residential or geriatric hospital care. The projected increase in the number of oldest people, particularly women, and the increased risk of dementia in this age group, means that the need for residential and continuing hospital care for the elderly will continue to increase.

Age Factors↗
PubMed1988

Blood glucose and prognosis of acute stroke.

To study the relation of blood glucose soon after the onset of stroke and outcome in terms of fatality and functional recovery 6 months later, two prospective studies were performed. Fasting blood glucose measured within 48 hours of onset was significantly higher in those who died than in those who survived. However, random blood glucose, mean daily blood glucose and HbA1 were not related to fatality or functional recovery. Fasting blood glucose levels soon after the stroke were significantly higher than those in the same patients measured 1 month later. These results suggest that the hyperglycaemia related to decreased survival is a stress response rather than an indication of preexisting diabetes mellitus but do not support the view that a high blood glucose level is itself harmful to the brain.

Cerebrovascular Disorders↗
PubMed1988

Multidisciplinary teaching in a formal medical ethics course for clinical students.

A successful feature of the 4th-year curriculum in the Medical Faculty of the Queen's University, Belfast has been the development of interdisciplinary teaching in a three-week joint course to which several clinical departments contribute...Co-ordinated teaching of topics of common interest in small groups included, until the academic year 1987/88, a three-hour session on medical ethics. In the spring of 1987 the authors approached the Department of Philosophy at Queen's; subsequently proposals for a formal multidiscipinary course in medical ethics for 4th-year clinical students in the Medical Faculty, for the academic year 1987/88, were approved by the Education Committee of the Medical Faculty.

Curriculum↗
PubMed1988

Prognostic indices in stroke.

Two hundred and six patients with acute stroke admitted consecutively to District General Hospitals, were studied for a period of six months. Significance tests conducted singly detected 21 factors present during the first 48 h of stroke, which were related to outcome six months later in terms of both mortality and functional recovery. Among these significant factors were various measures of perceptual dysfunction, including Albert's Test. Multivariate statistical analysis which included discriminant analysis and linear logistic modelling, revealed six factors (Albert's Test Score, leg function, level of consciousness, arm power, weighted mental score and ECG changes) which were significantly and independently related to outcome. A statistical model based on these factors predicted functional outcome with an overall accuracy of 67 per cent and mortality with an accuracy of 83 per cent. This model provides a useful basis for stratification in future randomized controlled trial in stroke, and may have a role in the management of the individual stroke patient.

Acute Disease↗
PubMed1987

Effects of insulin and glucose on the cells of the arterial wall: interaction of insulin with dibutyryl cyclic AMP and low density lipoprotein in arterial cells.

It has been suggested that elevated levels of insulin may be related to the development of atherosclerosis in both diabetics and non diabetics. Although insulin receptors are present on the cell membranes of both arterial endothelial and smooth muscle cells, insulin has growth-promoting and metabolic activities only on smooth muscle cells. In the present study, dibutyryl cAMP at concentration 0-1.0 mM decreased insulin binding in bovine aortic smooth muscle cells but had no effect on endothelial cells. At 2.0 mM dibutyryl cAMP had no effect on either cell type. The effect of dibutyryl cAMP was paralleled by its analogue 8-Br-cAMP and by MIX, a phosphodiesterase inhibitor. To test whether LDL receptor activity is influenced by insulin in arterial smooth muscle cells, the effect of insulin on LDL binding, uptake and degradation in bovine aortic smooth muscle cells was studied. Pre-incubation for 24 h with insulin at concentration 0-100 microU/ml resulted in a doubling of LDL binding, whereas pre-incubation for 4 h had no effect. Thus the differential effect of insulin on arterial endothelial and smooth muscle cells is similar to the effect of cAMP on insulin binding in these cells. Insulin increases binding of LDL to smooth muscle cells.

Arteries↗
PubMed1986

Elderly patients in acute medical wards: factors predicting length of stay in hospital.

A prospective study of 419 patients aged 70 and over admitted to acute medical wards was carried out by medical staff from a geriatric unit. Data, including presenting problem, housing, social support, mental state, continence, and degree of independence before and after admission, were recorded. Of the 419 patients, 143 remained in hospital after 14 days and 65 after 28 days. The major factors associated with prolonged stay in hospital included advanced age, stroke, confusion and falls as reasons for admission to hospital, incontinence, and loss of independence for everyday activities. Social circumstances did not predict length of stay. Although these factors are interrelated, the most important influence on length of stay was the medical reason for admission. Early contact with the geriatric medical unit in these patients may speed up the recovery or result in more appropriate placement.

Age Factors↗
PubMed1986

Albert's test: a neglected test of perceptual neglect.

Disorders of perception are thought to be important in predicting the outcome from stroke, but their exact significance is difficult to define because of lack of standardised terminology and diagnostic methods. In a prospective study of 205 unselected stroke patients, perceptual neglect, assessed by a standardised test battery, was found in 49% of patients with lesions of the non-dominant hemisphere and in 25% with lesions of the dominant hemisphere. One component of the test battery was a simple test described by Albert in which patients cross out lines ruled in a standard fashion on a sheet of paper; this was easy to administer and related closely to neglect diagnosed by the test battery as a whole. Results of Albert's test were a significant predictor of both mortality and functional activity six months after the stroke, independent of the influence of other clinical, neurological, laboratory, and social factors. The full test battery for perceptual neglect was of no significant additional predictive value.

Aged↗
PubMed1986

Effect of a meal on blood pressure in the elderly.

As post-prandial hypotension may be a cause of falls in older people, blood pressure was measured for one hour following a test meal in 22 elderly patients. There was a small fall in both systolic and diastolic blood pressure but no change in heart rate. Although the changes were small and no symptoms occurred, post-prandial hypotension might be important in elderly patients who had other abnormalities in blood pressure regulation.

Aged↗
PubMed1985

Effects of solutions used for storage of size-exclusion columns on subsequent chromatography of peptides and proteins.

The effects of storage of size-exclusion column packing materials in methanolic or azide-water solutions on subsequent separations were tested. Three commercially available columns were used in these studies; the Toyo-Soda Bio-Sil TSK 125, Bio-Sil TSK 250 and the DuPont Bio-Series GF-250. Upon initial chromatography, all three columns bound up to 760 micrograms of cytochrome c tryptic peptides. Sample binding to packing material is probably a function of the positively charged basic groups on peptides or proteins interacting with silanol groups. The larger the peptide, the less the opportunity for silanol-charged group interaction, hence, less binding. Initial samples introduced to a new column occupy the binding sites. Equilibration with neat methanol removes the bound protein revealing sites which bind sample. After absorption of peptides to binding sites on the packing material, storage in neat methanol regenerates the binding sites. Storage in 10% methanol diminished the binding phenomenon, but storage in azide-water reduced binding to a range below detection at the microgram level. Our recommendation to users of size-exclusion chromatographic columns is that one satisfy the absorption capacity of a new column by injecting a sufficient quantity of a basic peptide standard or other convenient sample to reduce available binding sites before using the column for important separations. Store columns in azide-water or 10% methanol to prevent the regeneration of exposed silanol groups.

Chromatography, Gel↗
PubMed1985

Overview of the association between insulin and atherosclerosis.

The suggestion that insulin is associated with atherosclerosis is based on clinical, epidemiologic, and experimental evidence. In general, atherosclerosis of the coronary, cerebral, and peripheral arteries is associated with abnormally high insulin responses to oral glucose. This hyperinsulinemia is not related to acute injury or to tissue necrosis, does not occur in response to intravenous glucose or tolbutamide, and is independent of other cardiovascular risk factors. Populations who are at high risk for cardiovascular disease have higher insulin responses to oral glucose than those at lower risk. Prospective studies carried out in Australia, Finland, and France have shown that elevated insulin levels, either fasting or in response to oral glucose, have a predictive role in the development of cardiovascular disease. This association is independent of the effects of other cardiovascular risk factors. In experimental animals, insulin deficiency retards the development of diet-induced arterial disease, whereas administration of insulin promotes lesion development and prevents lesion regression. Insulin stimulates lipid synthesis in isolated arteries and stimulates proliferation and lipid accumulation in cultured arterial smooth muscle cells. The evidence linking insulin with atherosclerosis has been gathered from nondiabetic subjects; this evidence is unavailable in diabetics. As it is clear that hyperinsulinemia is often present in diabetes, either in relation to mild glucose intolerance or obesity (in noninsulin-dependent diabetes mellitus) or because of insulin therapy (in insulin-dependent diabetes mellitus), it is essential that further consideration should be given to the possibility that hyperinsulinemia may have harmful effects on the arterial wall.

Adult↗
PubMed1985

Hyperinsulinaemia--a possible risk factor for cardiovascular disease in diabetes mellitus.

Diabetes mellitus is associated with severe and premature cardiovascular disease. The reasons for this have not been identified. It is now apparent that diabetics often have elevated circulating insulin levels compared to non-diabetics. In non-insulin dependent diabetes this is due to the associated obesity while in insulin treated diabetics exogenous insulin is responsible for hyperinsulinaemia between meals and at night. Two reports of high insulin levels in non-insulin dependent diabetics with cardiovascular disease are consistent with clinical and epidemiological studies linking hyperinsulinaemia with coronary, cerebral and peripheral arterial disease in non-diabetics. The arterial wall is an insulin sensitive tissue. Insulin promotes proliferation of arterial smooth muscle cells and enhances lipid synthesis and low density lipoprotein receptor activity. Insulin also promotes experimental atherosclerosis in a number of species. The evidence linking hyperinsulinaemia to the cardiovascular complications and diabetes is suggestive but incomplete and much more information on predictive factors for arterial disease in diabetes is urgently required. Diabetes mellitus is associated with severe and premature cardiovascular disease (reviewed by Stout 1982). Ischaemic heart disease, stroke and peripheral vascular disease are all more common in diabetics, particularly diabetic women. Although there is evidence for the existance of a specific diabetic cardiomyopathy, much of the cardiovascular disease in diabetics is due to atherosclerosis and its complications. Arterial disease in diabetics in distinct from microvascular disease affecting capillaries, and does not differ morphologically or biochemically from atherosclerosis in non-diabetics. The reason for the increased incidence of atherosclerosis in diabetes has not been established. Both non-insulin dependent and insulin dependent diabetes appear to be associated with cardiovascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗