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Rhyl, United Kingdom

Curran D.,Elderly Medicine | Chattopadhyay I.,Care of the elderly
Clinical medicine (London, England) | Year: 2015

Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references. © Royal College of Physicians 2015. All rights reserved. Source

Toschke A.M.,Kings College London | Tilling K.,University of Bristol | Cox A.M.,Kings College London | Rudd A.G.,Care of the elderly | And 4 more authors.
European Journal of Neurology | Year: 2010

Background and purpose: Data on patient-specific recovery after stroke are lacking and the effects of complex healthcare interventions on the course of recovery were not reported. To quantify the recovery pattern up to 1 year post-stroke and assess effects of evidence-based treatments on the patient-specific course of recovery allowing its prediction. Methods: A total of 355 patients after first-ever stroke from the population-based South London Stroke Register (source population >270 000) participated in a substudy between August 2002 and October 2004. At 1, 2, 3, 4, 6, 8, 12, 26, and 52 weeks post-stroke, Barthel Index (BI; ranging from 0 to 20) was documented. Multilevel growth models allowing predictions for patients with specific characteristics were calculated. Results: Mean age was 70 years, 48% were male and 23% died within the first year. The age-, gender- and stroke subtype-adjusted BI curve sharply increased until week 8 to 24 depending on patient characteristics and subsequently plateaued. Multivariable analysis identified stroke unit care, appropriate secondary prevention and physiotherapy for those with disabilities as independent predictors of improved functional ability over time (P < 0.05). Patients receiving stroke unit care additionally gained 4 BI points within 6 months compared with their counterparts (P = 0.004). Conclusions: Functional outcome in the general population showed an increase followed by a plateau. Care parameters reflecting guideline treatment independently improved recovery illustrating the beneficial effects of evidence-based interventions on recovery in an unbiased population. © 2009 EFNS. Source

Marrinan S.,Northumbria University | Pearce M.S.,Care of the elderly | Jiang X.Y.,Northumbria University | Waters S.,Northumbria University | Shanshal Y.,Northumbria University
Age and Ageing | Year: 2015

Objective: to study the implications of osteoporotic pelvic fractures in older patients in terms of mortality, length of hospital stay and independent living.Methods: the study included 110 consecutive patients, aged over 60 years, with osteoporotic pelvic fractures admitted to the Queen Elizabeth Hospital, Gateshead, between July 2009 and March 2011. Demographic and routine clinical data were collected prospectively until date of discharge, and vital status data were collected up to 3 months post-fracture. These data were analysed to assess associations with outcomes such as length of hospital stay, mortality and loss of independence (according to changes in residential housing status).Results: fourteen patients died either in hospital, or within 3 months of fracture. Length of hospital stay was associated with age (b = 0.77 days per year, 95% CI 0.001, 1.54, P = 0.05) and was significantly longer in those with acute medical problems on admission (b = 21.2 days, 95% CI 8.72, 33.73, P = 0.001). The odds of changing from independent to institutionalised accommodation were significantly associated with age (OR 1.08 per year, 95% CI 1.01, 1.04, P = 0.007) and length of hospital stay (OR 1.12 per day, 95% CI 1.01, 1.04, P = 0.007).Conclusion: in-hospital mortality rates in this patient group are similar to those seen for hip fractures, yet pelvic fractures in older people receive relatively little in the way of attention or funding. Guidelines to improve the management of such fractures in older people are important to improve care while in hospital, reduce time spent in hospital and reduce the impact on independent living. © The Author 2014. Source

Mccusker L.,Care of the elderly | Platt J.,Middlesex University
Age and Ageing | Year: 2012

Older patients referred for further investigation of anaemia are common in a geriatric medicine clinic and it is important to consider a wide range of underlying diagnoses. We present an unusual case of anaemia in an octogenarian in whom a diagnosis of visceral leishmaniasis was made. This is a rare and unusual diagnosis in this cohort of patients, especially within the UK; however, it is important to identify it, given its high mortality if left untreated. Our case, presumably contracted while in Andalucia, Spain, highlights the need for awareness in this group of patients, especially when travel within Europe is becoming commonplace. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. Source

Kamali F.,Northumbria University | Wynne H.,Care of the elderly
Annual Review of Medicine | Year: 2010

Warfarin is a drug with a narrow therapeutic index and a wide interindividual variability in dose requirement. Because it is difficult to predict an accurate dose for an individual, patients starting the drug are at risk of thromboembolism or bleeding associated with underdosing or overdosing, respectively. Single nucleotide polymorphisms in the cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKOR) genes have been shown to have a significant effect on warfarin dose requirement. Other genes mediating the action of warfarin make either little or no contribution to dose requirement. Although the polymorphisms in CYP2C9 and VKORC1 explain a significant proportion of the interindividual variability in warfarin dose requirement, currently available evidence based on a few small studies relating to the use of pharmacogenetics-guided dosing in the initiation of warfarin therapy has not shown improved outcomes in either safety or efficacy of therapy. Better clinical evidence of beneficial effects on patient outcome, particularly at the extremes of the dose requirements in geographically and ethnically diverse patient populations, is needed before the role of a pharmacogenomic approach to oral anticoagulation therapy in clinical practice can be established. © 2010 by Annual Reviews All rights reserved. Source

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