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T J Wilkinson

Publications and source records attributed to T J Wilkinson.

18 recordsLinked to original sources
PubMed1995

Stroke units.

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Cerebrovascular Disorders↗
PubMed1995

The effete in the heat: heat-related hospital presentations during a ten day heat wave.

BACKGROUND: Severe heat-related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Australia high environmental temperatures are common. AIMS: To identify (i) possible risk factors for hospital attendance with heat-related illness during a heat wave, (ii) problems with diagnosis and therapy, (iii) issues in prevention, and (iv) areas for further study. METHODS: A retrospective descriptive survey from four major teaching hospitals in Adelaide, South Australia (SA), was conducted during a ten day period of exceptional heat in February 1993, in order to review all emergency department presentations (i.e. deaths, casualty treatment or hospital admissions) with a heat-related illness as determined by attending doctors' documentation. Demographic, clinical, management and outcome data were collected. RESULTS: Ninety-four patients were classified as having a heat-related illness of whom 78% had heat exhaustion. Eighty-five per cent were age 60 years or over; 20% came from institutional care; 48% lived alone; 30% had poor mobility. Peak presentation followed high daily temperatures for four consecutive days. Severity was related to pre-existing cognitive impairment, diuretic use and presenting temperature, heart rate, blood pressure, plasma sodium and plasma creatinine. Treatment tended to be non-standardised. Mortality was 12%. Seventeen per cent required a more dependent level of residential care upon discharge. CONCLUSION: Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co-existing illnesses. Treatment could be more standardised.

Adult↗
PubMed1994

Do the clinical years change medical students' attitudes to old people?

Students at the Christchurch School of Medicine have previously been shown to demonstrate a significant improvement in attitudes and knowledge about old people after a 5-week attachment in their first clinical year (fourth year of their medical course). The original cohort were retested between 1 and 3 years after graduation. A modified version of the Rosencranz-McNevin Semantic Differential Scale was used to measure general attitudes to old age and a Likert scale to measure attitudes to medical care and knowledge. Attitudes measured by the Rosencranz-McNevin Scale showed no change between the completion of the fourth-year attachment and graduation. The Likert scale showed no change in knowledge but the attitude score showed a worsening (P < 0.001). Knowledge and attitudes of graduates who had completed a house office attachment in health care of the elderly were better than those who had not (knowledge P < 0.01, attitude P < 0.06).

Aged↗
PubMed1993

Asymptomatic low bone mineral density in otherwise healthy people: four year follow up.

AIM: To determine the effect of screening a normal population for low bone density on lifestyle, subsequent bone density and fracture risk. METHOD: A cross sectional study of 726 subjects screened for low bone density identified 60 with bone density greater than one standard deviation below an age and sex matched mean. Those who accepted further assessment were followed clinically and with repeat bone densitometry for up to four years. Those declining assessment were contacted four years later and questioned about lifestyle changes and fractures. They were offered repeat bone densitometry. RESULTS: Twenty five subjects accepted intervention and were advised on lifestyle modification and treated with calcium supplements (18) calcitriol (5) or oestrogen (1). 22 of the 35 subjects who initially declined intervention volunteered to have their bone density repeated. Bone density increased in the group accepting intervention compared to the 22 subjects in the group who initially declined assessment (p < 0.05). Several laboratory investigations had a low yield. Lifestyle modification in the group declining assessment did not significantly affect subsequent bone density. Fractures occurred infrequently in both groups. CONCLUSION: After screening the normal population for low bone density, significant improvements in bone density can be achieved in patients accepting further intervention.

Adult↗
PubMed1992

Elderly people referred for institutional care--is prior assessment necessary?

AIMS: To determine whether requests for placement of an elderly person into rest home or hospital care accurately predicted the final outcome and to identify factors influencing a move to institutional care. METHODS: Three month audit of all referrals to an assessment and rehabilitation unit for the elderly requesting rest home or hospital placement. Requests for medical advice or rehabilitation were excluded. RESULTS: Two hundred patients were studied (24.6% of all referrals). Placement was requested in a rest home in 132 and hospital in 68. Seventy-one (54%) patients referred for rest home placement were able to return to their own home and 64 remained there at six month follow-up. Hospital level care was assessed as appropriate in 62% of requests for this initially and at six month follow up. Age and diagnosis were not significant predictors of patients requiring placement. Overall, of 158 patients living at home referred for rest home or hospital care, 67 (42%) were managing at home six months later. CONCLUSION: Accurate assessment and treatment/management of elderly patients is necessary before recommending higher levels of care. Patients can be maintained in their current environment for longer than perceived by the referring doctor. This has important social and financial benefits.

Aged↗
PubMed1992

Pharmacokinetics and efficacy of rectal versus oral sustained-release morphine in cancer patients.

Sustained-release morphine (MST) given by the rectal route was compared with oral MST in an open randomised cross-over trial in ten patients with cancer who received stable doses of MST. No significant difference was found in the areas under the curve of the concentration-time profiles (AUC) following oral or rectal administration for parent morphine. The AUCs determined for morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) after oral administration were approximately twice those obtained following rectal administration. The maximal concentration achieved was lower and the time to maximal concentration was longer following rectal administration for morphine, M6G and M3G. The relative mean arrival times following rectal administration were significantly longer for morphine and M3G but not for M6G. These findings suggest slower absorption but less first-pass metabolism of MST after rectal administration. No significant difference was noted between the oral and the rectal route in measurements on visual-analogue scales for pain or side effects. We recommend the rectal route as being suitable for MST administration when the oral route is no longer available. In changing from oral to rectal administration, the same dose and dose interval may be used, but dose adjustment may be needed.

Administration, Oral↗
PubMed1992

Neutropenic sepsis complicating treatment of solid tumours, lymphoma and myeloma.

Ninety-three episodes of fever or infection while neutropenic (defined as neutrophil count < 2.0 x 10(9)/l) occurred in 76 patients treated for solid tumours, lymphoma and myeloma over a 4-year period. Most followed the first (39%) or second (18%) cycle of chemotherapy. The neutrophil count at onset of sepsis was < 0.5 x 10(9)/l in 69%. Pathogens were isolated in 32 episodes (34%) and a clinical focus detected in a further 19 (20%). Gram negative bacteria accounted for 51% of pathogens; 49% of bacteria were isolated from blood, 65% of them were Gram negative. The initial antibiotic regimen was cefuroxime with gentamicin or tobramycin in 76 episodes. Fever or infection resolved on first line antibiotics in 78%. The mean duration of antibiotic therapy was 7.6 days. Antibiotic therapy was changed following urine culture in 1.5% of 66 episodes and following chest radiography in 5.8% of 69 episodes, where these tests were performed. Nine (9.6%) patients died from infection, all of whom were receiving second line salvage chemotherapy. Three other patients died of progressive malignancy with sepsis present. In six major diagnostic groups, 56 episodes of infection or fever complicated 4% of chemotherapy cycles.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Increased incidence of germ cell testicular cancer in New Zealand Maoris.

A higher incidence of germ cell testicular cancer was found in Maoris (6.84/100,000) compared with non-Maoris (5.26/100,000) in New Zealand from 1975 to 1986, especially in the 15-49 year age group (Maoris 12.30/100,000, non-Maoris 9.47/100,000; P = 0.04). Previous studies have shown Whites to have the highest incidence of this malignancy. Possible reasons for this and some other epidemiological features are discussed.

Adolescent↗
PubMed1992

Attitudes of medical students to old people: a cross-national comparative study.

Medical students' attitudes to the elderly were compared at the start and finish of a 5-week clinical attachment in health care of the elderly at the Christchurch School of Medicine. The study investigated students in their first clinical year (fourth year of their medical course) over five terms using a questionnaire employing a Rosencranz-McNevin semantic differential scale to measure general attitudes to old age and a Likert scale to measure attitudes to medical care. A question was also asked about career preferences. There was significant improvement in attitudes measured by both scales (Rosencranz-McNevin P less than 0.001, Likert P less than 0.001). Students also showed an increase in interest in health care of the elderly as a career choice. When compared with two cohorts of students from Nottingham Medical School, attitudes were significantly better in the Christchurch group at the commencement of the run. Students at both schools showed an improvement in knowledge but this was more marked for Christchurch students.

Aged↗