Ann Capewell

Ann CapewellSt Helens and Knowsley Hospitals NHS Trust · Medicine for Older People

27.97
· MB BS., FRCPE, FRCP
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    Tobacco and processed food companies typically deny scientific evidence of harm1 by using SLEAZE tactics:Scientific conspiracies are alleged (but which are a …
    The members of The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of faecal incontinence is also discussed. Evidence based and consensus committee report. The chapter 'Dynamic Testing' is a continuation of previous Consultation-reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. This first part of a series of three articles summarizes the committees recommendations about the innovations in urodynamic study techniques 'in general', about the test characteristics and normal values of urodynamic studies as well as the assessment of female with signs and or symptoms of incontinence and includes only the most recent and relevant literature references.
    The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of fecal incontinence is also discussed. Evidence based and consensus committee report. The chapter 'Dynamic Testing' is a continuation of previous Consultation reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. This second part of a series of three articles summarizes the committee's recommendations about: 'Urodynamic testing of male patients with symptoms of incontinence, of patients with relevant neurological abnormalities, testing of children and of frail elderly with symptoms of incontinence' and includes only the most recent and relevant literature references.
    The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses testing methods for patients with signs and or symptoms of incontinence. Testing of patients with signs and or symptoms of urinary as well as testing of patients with fecal incontinence is discussed. Evidence based and consensus committee report. The chapter 'Dynamic Testing' is a continuation of previous Consultation-reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. This third part of a series of three articles summarizes the recommendations given in the paragraph: 'Anorectal physiology studies' with regard to fecal incontinence (whether or not in combination with urinary incontinence) and includes only the most recent and relevant literature references.
    A number of elderly cancer patients do not receive standard surgery for solid tumors because they are considered unfit for treatment as a consequence of inaccurate estimation of the operative risk. To tailor treatment to onco-geriatric series, oncologists are now beginning to use a comprehensive geriatric assessment (CGA). This study investigates the value of an extended CGA in assessing the suitability of elderly patients for surgical intervention. Preoperative assessment of cancer in the elderly (PACE) incorporates validated instruments including the CGA, an assessment of fatigue and performance status and an anaesthesiologist's evaluation of operative risk. An international prospective study was conducted using 460 consecutively recruited elderly cancer patients who received PACE prior to elective surgery. Mortality, post-operative complications (morbidity) and length of hospital stay were recorded up to 30 days after surgery. Poor health in relation to disability (assessed using the instrumental activities of daily living (IADL)), fatigue and performance status (PS) were associated with a 50% increase in the relative risk of post-operative complications. Multivariate analysis identified moderate/severe fatigue, a dependent IADL and an abnormal PS as the most important independent predictors of post-surgical complications. Disability assessed by activities of daily living (ADL), IADL and PS were associated with an extended hospital stay. PACE represents a valuable tool in enhancing the decision process concerning the candidacy of elderly cancer patients for surgical intervention and can reduce inappropriate age-related inequity in access to surgical intervention. It is recommended that PACE be used routinely in surgical practice.
    To evaluate two quality of life measures for urinary incontinence (UI) in Scottish females. Three groups with UI from two regions in Scotland were studied. Two groups were receiving treatment for incontinence; the third was not. Women completed the UDI and IIQ twice to allow assessment of test-retest reliability and validity. Treatment groups completed the questionnaires again, postintervention, to assess ability of the measures to detect change. Other measures used to assess validity were the SF-36, HADS, weight of urine leaked, and number of incontinence episodes. By design, the three subject groups differed significantly in their characteristics, ensuring a diverse sample of women. Analysis of reliability showed a clinically trivial but statistically significant decrease in total UDI (mean, -6.1; 95% CI, -11.0 to -1.5) and IIQ (mean, -9.7; 95% CI, -15.5 to -3.9) scores between test and retest assessments, possibly due to a research effect. Most items of the UDI (18 of 19) and IIQ (28 of 30) performed very well on test-retest. The UDI and IIQ were valid in that higher scores (indicating more bothersomeness of symptoms/impact on daily living) were associated with greater severity of UI. Additionally the IIQ showed the expected associations with measures of anxiety and health status. Both the UDI and IIQ detected changes in women's conditions due to intervention. The measures had good psychometric properties, including test-retest reliability, across subject groups.
    District Nurses and Continence Advisors were surveyed by post to audit their management of long-term indwelling catheters. They were asked to outline, anonymously, their management strategies in response to common specified catheter-related problems. The responses to each question were graded for the appropriateness of strategy from A (best) to E (worst) by previously formulated criteria. Completed questionnaires were returned from all 10 Welsh Continence Advisors and 73 of 139 (53%) District Nurses in South Glamorgan regularly involved in catheter care. A greater proportion of Continence Advisors' than District Nurses' responses were graded A or B in all problem areas specified. In patients with marked bacteriuria, 60% of Continence Advisors but only 11% of District Nurses would assess whether the patient was ill; 53% of District Nurses would treat with antibiotics without such assessment. Whereas most nurses investigating suprapubic pain would consider catheter blockage, only one-third would consider further history taking or examination, and only 1 District Nurse considered constipation or detrusor spasm. Although two-thirds of nurses sometimes used bladder washouts, few considered them effective and most were aware of the potential risks. Thus wide variations were found in the community nursing management of indwelling catheters and care may frequently be suboptimal. Appropriate management guidelines should be developed and disseminated.
    The diagnosis of post-menopausal atrophy should preferably be confirmed before any trial of oestrogen treatment for genito-urinary symptoms. The ideal method, cytological analysis of a vaginal wall smear, is not always feasible in elderly women. Might physical examination alone be sufficient? This study aimed to determine which clinical features might best predict atrophy on the smear. Of 120 consecutive women admitted to an acute geriatric unit (mean age 82 years), satisfactory smears were obtainable from 70 (58%). Sixty per cent of these showed severe atrophy but almost one-fifth showed no atrophic changes. Degree of atrophy correlated with physical thinness (p less than 0.01), low parity (p less than 0.01) and dryness on vaginal examination (p less than 0.001). However, none of the other physical findings traditionally thought to indicate atrophy were found to be associated, nor were age or medication. In contrast, severe atrophy was present in only one of nine women with breast cancer (p less than 0.01). This merits further study.
    Details of medication prescribed to 400 elderly patients in 18 registered nursing homes and 233 patients in 11 long-stay geriatric wards were obtained. Excluding laxatives, there was a mean of 2.15 medications prescribed for the long-stay patients, compared to 2.62 items for the nursing-home population. There was apparent over-prescribing of certain drugs within the nursing-home population.
    There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly.
    Between February and November 1984, 18 registered nursing homes in Edinburgh were visited and information was obtained about their 400 patients. Details of the facilities provided by these homes are presented here. Admission and biographical details were obtained for each patient and the dependency of the nursing home population was determined; 28% of the total population appeared to be independent in self-care, though there were large variations between homes. Forty-two patients (10.5%) were found to be receiving Department of Health and Social Security supplementary benefit. The characteristics of this group are compared with those of the rest of the nursing home population. The implications of these observations and recent legislative developments are discussed.
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