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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A restraining device for nonhuman primates was designed which effectively prevented the animal from touching the eyes and thereby transferring a topically applied drug from 1 eye to the other. This permitted use of 1 eye of the same animal as a reliable control for observation of pharmacologic effects. The design permitted self-feeding by the animal. It did not produce chafing or pressure sores and resulted in no psychologic depression. The device has been used successfully for a 5-mo period.
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PMID:Nonhuman primate restraint device for ocular drug studies. 80 76

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.
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PMID:Malnutrition in the institutionalized older adult. 151 70

The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.
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PMID:Femoral neck fractures in patients receiving long-term dialysis. 222 28

Computed analysis showed that 23 of 100 patients immobilized by cerebrovascular accidents (CVA) and 33 (42.3%) of 78 postoperative patients had pressure sores (PS). Mean ages of those with PS in these 2 groups were 70.3 +/- 7.5 and 76.2 +/- 6.5 years, respectively; 31.1% and 38.5% were males and 27.4% and 36.1% were married. The presence of family did not prevent development of PS nor improve results of treatment, perhaps due to low patient motivation caused by poor general condition and depression. Immobilization of CVA patients with and without PS, was 97.6 +/- 154.7 and 34.7 +/- 95.8 days, respectively, and in the postoperative group 50.4 +/- 149.9 and 29.1 +/- 78.1 days. The number of PS in each patient was 2.2 +/- 1.2 and 1.6 +/- 1.0, respectively. PS were localized mostly on buttocks in both groups, but the lateral aspects of the body (trochanters, shoulders) and the heels were affected more often in the CVA than in the postoperative patients. Despite the higher incidence of PS in the postoperative patients and their greater age, their prognosis was better: treatment and hospitalization were shorter, results of treatment, including functional status on discharge, were better; a greater proportion were discharged to home; and mortality was significantly lower. This difference seems to be related to the fact that in the postoperative patients PS were mostly acute decubiti related to surgical stress and drug sedation, while in the post-CVA patients they resulted from the much more prolonged periods of immobilization.
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PMID:[General and epidemiologic aspects of pressure sores]. 238 64

International competitions for the wheelchair-confined are now a major feature of the world of sport. They are helpful in improving both mood state and physiological function, while improving long term prognosis. Immediate medical problems are much as in other types of competition, but there are also specific problems (bladder infections, pressure sores, intolerance of environmental extremes, and injuries related to wheelchair use). Disability classification, based on the anatomical or functional level of a lesion, provides a reasonably fair basis for competition. Most of the functional data to date relate to strength (isometric and isokinetic) and aerobic power (measured in a wheelchair or on an arm ergometer). While the inactive patient is often severely limited, wheelchair athletes may have a greater functional capacity than sedentary normals. The principles of training for the wheelchair-confined are much as in the able-bodied, although because the arm muscles are small, much of the training response may be peripheral rather than central. The margin between an effective stimulus and overtraining is also reduced. Involvement in a training programme not only increases physiological function, but also counters depression, increasing the subject's sense of self-efficacy. Biomechanicians are now contributing increasingly to wheelchair sport, improving the design of competitive wheelchairs, improving the mechanical efficiency of participants, and helping to reduce the risks of injury. The benefits of wheelchair sport are now clearly established, and family physicians should do more to encourage the involvement of the wheelchair-confined.
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PMID:Sports medicine and the wheelchair athlete. 296 33

The present work was performed in order to assess the differences in electrocardiographic and hemodynamic responses to supine and upright dynamic exercise of patients with coronary artery disease. Changes in heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, rate-pressure product (RPP) and ST segment depression during supine and upright bicycle stress test were compared in twenty patients suffering from stable effort angina and without previous myocardial infarction. In the supine posture lower values of HR were observed at rest, during stress test and during three minutes of the recovery period. Conversely, in all patients both SBP and DBP were higher during the stress test in the supine position decubitus. No significant changes in RPP was observed between the two different postures. Finally, ST segment didn't show differences at rest between the upright and supine position. All the patients had a lower ischemic threshold during exercise in the supine position than in the upright one. In fact an ST segment depression greater than 1 mm was observed during stress test in the supine position at lower work-load levels and at lesser HR values. Consequently for given HR, SBP and DBP ST segment, depression was greater in the supine rather than in the upright position.
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PMID:[Influence of posture on exercise-induced electrocardiographic and hemodynamic changes in patients with stable effort angina pectoris]. 324 16

Wheelchair bound paraplegics tend to spend a sedentary life. They seem to be vulnerable to prolonged strenuous exertion because of their many physical handicaps such as metabolic depression, cardiovascular instability, urinary incontinence, pressure sores and so on. In commemoration of The International Year of the Disabled, The First Oita International Wheelchair Marathon was held in Autumn of 1981. This paper is to review the results of an experiment made at this half marathon. The course length was 21.1 km. Ten competitors were selected at random as the subjects for measuring energy expenditure during the race. As a preliminary examination, a work load test was performed by using a wheelchair treadmill to obtain a regression equation of the individual relationship between oxygen uptake and heart rates. The oxygen uptake of individuals during the race was estimated from the heart rates which were recorded by the small memory box fixed beneath the wheelchair. Six subjects were successfully examined. The results revealed that paraplegics safely tolerated the prolonged strenuous exercise. Their average oxygen uptake, mean heart rate and the lap time during the race were 34.17 +/- 8.11 ml/kg/min (mean +/- SD), 167.6 +/- 15.8 beats/min and 87.1 +/- 9.1 min respectively. Heart rate of the subjects was always very high during the race, although oxygen consumption was fairly low in comparison to able-bodied elite marathon runners.
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PMID:Energy expenditure of paraplegic marathon runners measured during a wheelchair marathon. 648 67

A cross-sectional study design was used to document perception of pressure ulcer pain in 132 patients in an acute care setting. Subjects were evaluated by means of the Folstein Mini-Mental State Examination, Beck's Depression Inventory, the Faces Pain Rating Scale, and the Visual Analog Scale for pain intensity. Charts were reviewed for demographic data and related medical treatments. The group comprised 44 subjects (33.3%) who were able to respond to the evaluation instruments and 88 subjects (66.7%) who were unable to respond to the evaluation tools. Forty-one percent of the respondents denied pressure ulcer pain and 59% reported pain of some type. According to the Faces Rating Scale, 32% of this group reported no pain and 68% reported some degree of pain. The respondents included 48% who scored below 24 on the Folstein Mini-Mental State Examination, indicative of cognitive impairment, and 52% who were found to be cognitively intact, with scores of 24 or above. Only 2% (n = 3) were given analgesics for pressure ulcer pain within 4 hours of the interview.
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PMID:Pressure ulcer pain: assessment and quantification. 755 Jul 76

Urinary incontinence (UI)--the involuntary loss of urine sufficient to be a problem for the patient or caregivers--affects an estimated 15%-30% of persons aged > or = 60 years in the United States and is a major cause of admittance to nursing homes. UI may be associated with a variety of medical (e.g., rashes, skin infections, pressure sores, urinary tract infections, and falls) and psychosocial problems (e.g., depression, embarrassment, restricted social interaction, reduced activities outside the home, reduced sexual activity, and sleep disturbances). Despite the dissemination of clinical practice guidelines for UI by the Agency for Health Care Policy and Research (AHCPR), many physicians do not know how to diagnose or treat UI. Beginning in 1992, CDC and AHCPR funded demonstration projects in Massachusetts and Oklahoma to educate the public, patients, and health-care professionals about UI. In both projects, physicians were assessed regarding baseline attitudes toward UI, knowledge of the causes and treatment of UI, preparedness to evaluate and treat UI, and current practices regarding UI. This report summarizes findings from the two projects during 1993.
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PMID:Knowledge, attitudes, and practices of physicians regarding urinary incontinence in persons aged > or = 65 years--Massachusetts and Oklahoma, 1993. 756 56

The aim of elective neurotraumatology is to outline new and valid therapeutic strategies in early post-trauma in order to obtain a more favourable long-term outcome for cranial and spinal trauma patients than usually achieved with conventional intensive therapies. After a critical review of all drugs and measures currently used for the treatment of damage due to cerebral trauma and a brief mention of new agents still being studied, the results of a retrospective study of 128 patients with severe head injury are reported. For all patients a complete clinical and pharmacological history of their traumatic event, which had occurred from 5 to 14 years before the present evaluation, was available. Eighty-nine had undergone traditional therapies and 39 had been given complementary neuroprotective drugs, variously associated with traditional therapies. There was no statistically significant difference between the groups in terms of the global clinical outcome, (assessed by a 5-point scale: death, worsening, unchanged condition, improvement, recovery), and some sequelae, such as decubitus, impairment of sphincter control, neurological focal deficits and post-traumatic epilepsy. On the contrary, cognitive impairment and depression resulted statistically less frequent in patients who underwent conventional therapies and early complementary neuroprotective treatments than in the controls. In conclusion it would be very interesting to perform controlled clinical studies to confirm these preliminary results and the effectiveness of early neuroprotection on the long-term clinical outcome of patients with severe head injury. The therapeutic approach in early post-trauma is still not completely standardised and the purpose of elective neurotraumatology is to emphasise and promote the importance of such a standardisation.
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PMID:Elective neurotraumatology and therapeutic strategies in early post-trauma. 923 43


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