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Biomedical subjects

S Ebrahim

Publications and source records attributed to S Ebrahim.

At least 235 records · Page 13Linked to original sources
PubMed1989

Treatment of adult asthma: is the diagnosis relevant?

The diagnosis and management of chronic respiratory symptoms was studied in all adults aged 40-70 years in a group general practice. A respiratory symptoms screening questionnaire was sent to 2387 men and women, of whom 1444 (85% of those who had not moved or died) responded. The 509 subjects reporting symptoms were sent a detailed questionnaire and invited to have their respiratory function tested. Of these, 324 (64%) responded, of whom 256 (79%) had spirometry. A diagnosis of chronic bronchitis was reported by 3.9% of the men and 2.1% of the women, and a diagnosis of asthma by 4.7% of the men and 3.3% of the women. Wheezing in the preceding year was reported by 18% of the men and 15% of the women, and 16.7% of the men and 7.1% of the women satisfied the Medical Research Council criteria for chronic bronchitis. Bronchodilator treatment was being taken by 12% of the patients with symptoms, regular cough linctus by 10%, and regular antibiotics by 5%. After the frequency and severity of respiratory symptoms had been controlled for wheezing patients reporting a diagnosis of asthma were prescribed bronchodilatory drugs three times more often than those labelled as having chronic bronchitis and 12 times more often than those without a diagnostic label. Eleven per cent of general practitioner consultations resulted in a referral to hospital. Referral was unrelated to the diagnosis given, but depended on the degree of respiratory disability and handicap experienced by the patient. Our findings confirm the relevance of the diagnostic label to the drug management of chronic wheezing disorders, but further investigation of the diagnostic process is needed to establish why some patients with severe wheeze remain untreated.

Adult↗
PubMed1989

Bacterial resistance to trimethoprim in geriatric medical wards.

Urinary tract infections (UTI) caused by organisms resistant to trimethoprim (TMP), as well as their faecal carriage were studied in two geriatric wards. TMP-resistant UTI was common (26 and 50% of admission and ward-acquired infections, respectively) and was associated with male sex, recurrent and transferred admissions and length of stay. There was a strong relationship between faecal carriage and isolation of TMP-resistant organisms from urine. Antimicrobial exposure was the major determinant of TMP-resistant faecal carriage.

Aged↗
PubMed1988

Prevalence, frequency, and duration of hypnotic drug use among the elderly living at home.

Details of consumption of hypnotic drugs derived from a nationally representative sample of elderly people were analysed in terms of the prevalence, duration, and likely frequency of use. Of 1020 randomly selected subjects aged 65 and over 16% (166) reported using (mainly benzodiazepine) hypnotic drugs, and of these 89% reported having taken such a drug the night before the interview. Most of these users (73%) had been taking hypnotic drugs for more than one year, with 25% reporting drug use for more than 10 years. These results suggest that for most elderly users of hypnotic drugs, patterns of consumption encourage the development of cumulative effects and benzodiazepine dependence.

Aged↗
PubMed1988

Characteristics of subjective insomnia in the elderly living at home.

Profiles of sleeping habits, subjective sleep quality, and mental and physical well-being were obtained from 1023 elderly individuals randomly sampled from the Nottinghamshire Family Practitioner Committee's records. Subjective insomnia at least 'sometimes' was reported by 37.9% of the sample. Discriminant analysis of selected health and demographic variables indicated that symptoms of anxiety, sex and self-ratings of health were the factors most influential in predicting reports of problem sleep. Thus, respondents classified as subjective insomniacs tended to have significantly higher anxiety scores, to be women, and to rate their health as below average. Relative to the non-insomniac respondents, those complaining of sleep problems also perceived their sleep latency as longer, and their total sleep as shorter. These results emphasize that, in addition to apparently 'normal' age-related changes in the structure of sleep, subjective insomnia in old age may often be mediated by the physical and psychological disorders which can accompany ageing.

Aged↗
PubMed1988

Prospective study of mortality associated with chronic lung disease and smoking in Papua New Guinea.

In Papua New Guinea a 15-year mortality follow-up was carried out among 2026 highlanders and 1734 coastal dwellers on whom data on respiratory symptoms and signs, and lung function had been obtained by prevalence surveys in 1970/71. Survival status was established in 99%, of whom 9.8% had died, the rate being higher in the highland (12.2%) than in the coastal population (7.0%). All abnormalities indicative of chronic lung disease were associated with increased mortality though this was statistically significant only for chronic shortness of breath (SMR 195) and wheezing (SMR 183) in coastal females. In those aged 25 years or more there was a strong association between reduced lung function (FEV1, FVC, FEV1/FVC%) and mortality, after controlling for age and height. The associations observed were as strong as those reported from prospective studies in developed countries. The most striking difference was that in Papua New Guinea mortality showed no association whatever with tobacco smoking; this may be because the traditional type of tobacco and method of smoking it resembles pipe/cigar smoking in developed countries.

Adolescent↗
PubMed1987

Interviewing the elderly about their health: validity and effects on family doctor contacts.

Health-related questions in a large interview schedule (designed to examine relationships between customary physical activity, physical and psychological well-being among the elderly) were found to be repeatable (overall agreement was 93%) when used by two independent interviewers. The sensitivity and specificity of the interview in discriminating between people with and without health problems were 80% and 92%, respectively, when compared with a physician's independent assessments. Family doctor case notes under-recorded many of the common health problems of elderly people and could not be used to validate the interviewees' responses. Comparisons between 41 interviewees and 75 age-, sex- and practice-matched controls demonstrated that interviewees were only slightly more likely to consult or request a repeat prescription in the week following the interview (19%) than controls (11%). The 95% confidence intervals of this 8% difference were wide (-6% to 22%) and it might well have occurred by chance. Practices intending to use screening or research interviews with elderly people should be reassured such activities are not associated with large increases in demand for their services.

Aged↗
PubMed1987

Elderly immigrants--a disadvantaged group?

Asian, Caribbean and British born Nottingham hospital discharge rates of people of pensionable age for a variety of diagnoses and elective surgery were compared. No evidence of under-utilization of services by immigrants was found, but marked excess discharges were observed for tuberculosis, diabetes, asthma, gastrointestinal bleeding and cataract surgery. Increased hospital use for most diagnoses probably reflects true differences in disease risk between immigrants and the indigenous population.

Aged↗
PubMed1987

Affective illness after stroke.

Mood assessments were made after six months of 149 survivors taken from a register of all patients admitted to hospital with acute stroke. Using a General Health Questionnaire score of 12 or more as a criterion of important affective illness, its prevalence was 23%. There was no difference in risk of affective illness between left and right hemisphere strokes. Affective illness was strongly associated with functional ability, with limb weakness and with longer hospital stay in those with good functional recovery. Only 15% of those with high scores were receiving antidepressant drugs. The general practitioner is in the best position to detect psychiatric illness in stroke survivors; the use of mood rating scales such as the GHQ, in conjunction with clinical assessment, may improve detection.

Cerebrovascular Disorders↗
PubMed1987

Caring for stroke patients at home.

The extent and type of care provided by relatives and friends living with a stroke patient was studied among 120 6-month survivors. Eighty-one (68%) carers felt that they had to give more help than before the stroke. The patients looked after by these 81 carers were more functionally disabled, more cognitively impaired, more often had speech impairment and urinary incontinence than the 39 patients whose companions did not give any extra help. Only a third of patients had been left unattended for all or part of the day prior to the interview and 18 per cent required attention every night. The majority (85%) of patients receiving help from companions were under regular review by health or social services. Over two-thirds of carers felt that providing support had had an adverse effect on their lives.

Aged↗
PubMed1987

An audit of follow-up services for stroke patients after discharge from hospital.

A register was kept of all patients admitted to hospital in Nottingham with acute stroke, and survivors were followed up at 1 and 6 months. A quarter of the 183 survivors seen at home 6 months after their strokes were still unable to perform some everyday activities. Only 18% of discharged patients ever received outpatient occupational therapy but 42% received physiotherapy. Those attending outpatient rehabilitation were more likely to improve in functional ability between 1 and 6 months. A third of patients interviewed had not seen their GP since discharge and many with severe disabilities did not receive potentially useful therapy or aids.

Activities of Daily Living↗
PubMed1986

Use of the Nottingham Health Profile with patients after a stroke.

The Nottingham Health Profile (NHP) is easy to use with stroke patients and may be used with those who cannot manage more complicated mood questionnaires, such as the General Health Questionnaire (GHQ). Stroke patients rate their health, and especially emotions and feelings of social isolation, as much worse than that of people of similar age. NHP emotion scores correlate with objective measures of disability, length of hospital stay, and GHQ scores. The NHP is a valid indicator of depressed mood, and combining its components into a total score gives the greatest accuracy in detecting depression. Patients with high scores at one month continued to report large numbers of problems at six months after their stroke. Many patients experienced pain, disturbed sleep, and social isolation, which are important, potentially treatable problems not usually considered in the management of stroke patients. Many patients with problems did not see their general practitioner or any other source of help, and additional follow up was needed.

Cerebrovascular Disorders↗
PubMed1986

The effect of an antibiotic policy on bacterial resistance in patients in geriatric medical wards.

In an effort to reduce levels of trimethoprim resistance amongst urinary isolates and faecal organisms two antibiotic policies (policy 1, erythromycin, nitrofurantoin substituted for trimethoprim and ampicillin; policy 2, Augmentin (ampicillin + clavulinic acid) substituted for trimethoprim and ampicillin) were used for 50 weeks on two geriatric acute/rehabilitation wards. The policies were evaluated by comparison with the pre-policy period and between policies. The policies were applied successfully and both were associated with a fall in the proportion of trimethoprim-resistant faecal coliforms and urinary isolates. Policy 1 appeared to affect plasmid-mediated resistance to a greater extent than policy 2. There were no differences in outcome for patients during policy periods. Control of antibiotic usage by formal policies is a viable means of controlling bacterial resistance in geriatric wards. The mode of action of such policies requires further elucidation.

Aged↗
PubMed1986

Opportunities for anticipatory care with the elderly.

Contacts made by the elderly in a group general practice were monitored over seven months to describe how the elderly use services and to consider how a program of anticipatory care might be instituted. Eighty-four percent (1,562) of the patients aged over 65 years were seen during this period, and there were 4,315 contacts logged. Contact rates and the proportion of home visits were higher for patients aged over 75 years. More than three quarters of contacts were with a physician, one fifth with a nurse, and only 11 (0.3 percent) were with a health visitor. Referral and investigation rates were very low. Almost three quarters of elderly patients contacted were functionally independent. The most common diagnoses were osteoarthritis, hypertension, heart failure, and depression. Prescribing levels were relatively high, but people aged over 75 years were given fewer medicines than those aged 65 to 74 years. There is great scope for case finding by general practitioners provided good use is made of each contact. Health visitor case finding or screening would require either a major change in existing work patterns or recruitment of extra staff.

Activities of Daily Living↗
PubMed1985

Cognitive impairment after stroke.

Cognitive ability was assessed in a consecutive series of 189 six-month survivors of an acute stroke. Twenty-two patients were cognitively impaired at six months. Amongst 10 patients whose cognitive ability deteriorated between one and six months, four also had marked depressive symptoms. Age and severity of stroke were the factors most strongly associated with cognitive impairment at six months. Patients with left hemisphere damage had significantly more difficulty with short-term recall and those with bilateral hemisphere signs were most at risk of cognitive impairment. Patients with cognitive impairment after a stroke should be carefully assessed for depressed mood which may benefit from treatment.

Age Factors↗
PubMed1985

Measuring disability after a stroke.

A ranked activities of daily living (ADL) scale has been developed for stroke patients, on which an individual's score predicts his/her overall function ability. With an unranked scale the same total score can be obtained from different combinations of items and gives little idea of the patient's general pattern or degree of disability. The items in the scale are easy to assess on both inpatients and outpatients, and accepted criteria for valid ranking are fulfilled. A strong relation was found between scale score one month post-stroke and length of stay in hospital. Low scores at one month were also associated with high mortality during the subsequent five months. "Formal" and "informal" methods of ADL assessment were compared, and only small and unimportant differences were found. Assessments by postal questionnaire were also evaluated and agreed well with formal assessments carried out by visiting the patients' homes. Use of some or all of these methods would help to simplify and standardise follow up records for both routine care and research.

Activities of Daily Living↗