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Swan L, Horgan F, Cummins V, Doyle F, Galvin R, Burton E, Sorensen J, Jabakhanji SB, Skelton D, Townley B, Rooney D, Jackson G, Murphy L, Warters A, O'Sullivan M. 199 EMBEDDING PHYSICAL ACTIVITY WITHIN HOME CARE SERVICES FOR OLDER ADULTS IN IRELAND—A QUALITATIVE STUDY OF BARRIERS AND FACILITATORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme.
Methods
We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.
Results
Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme.
Conclusion
Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.
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Affiliation(s)
- L Swan
- Trinity College Dublin , Dublin, Ireland
| | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - V Cummins
- Health Service Executive , Dublin, Ireland
| | - F Doyle
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
| | - E Burton
- Curtin University , Curtin, Australia
| | - J Sorensen
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - D Skelton
- Glasgow Caledonian University , Glasglow, United Kingdom
- Later Life Training, Northumberland , United Kingdom
| | - B Townley
- Later Life Training, Northumberland , United Kingdom
| | - D Rooney
- North Dublin Home Care , Dublin, Ireland
| | - G Jackson
- North Dublin Home Care , Dublin, Ireland
| | - L Murphy
- North Dublin Home Care , Dublin, Ireland
| | - A Warters
- Health Service Executive , Dublin, Ireland
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Stanmore E, Mavroeidi A, Meekes W, Skelton D, Sutton C, Benedetto V, Todd C, de jong L. EXERGAMES TO REDUCE FALLS RISK IN OLDER PEOPLE IN UK ASSISTED LIVING FACILITIES: A MULTI-CENTRE, CLUSTER RCT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - C Sutton
- University of Central Lancashire
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Harvey J, Chastin S, Skelton D. Improving physical function in older adults through a sedentary behaviour intervention: the SOS pilot study. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4
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Mitchell S, Skelton D. Does Tinetti score influence onward exercise referral on completion of a falls prevention programme for older adults? Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Hamilton DL, Skelton D. Faulty ephedrine prefilled polypropylene syringe. Anaesthesia 2017; 72:1158-1159. [DOI: 10.1111/anae.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. L. Hamilton
- County Durham & Darlington NHS Foundation Trust; Darlington UK
| | - D. Skelton
- County Durham & Darlington NHS Foundation Trust; Darlington UK
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Abstract
We present a case of necrotising pancreatitis following ampullary biopsy in a patient with Barrett's oesophagus. The patient needed multiple necrosectomies and several admissions to the intensive care unit. This report is only the third and most severe case of pancreatitis following ampullary biopsy, highlighting its importance as a complication.
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Affiliation(s)
- D Skelton
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - J Barnes
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - J French
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Heseltine R, Skelton D, Kendrick D, Morris RW, Griffin M, Haworth D, Masud T, Iliffe S. 58 * SEDENTARY OLDER PARTICIPANTS WHO VOLUNTEER FOR STRUCTURED EXERCISE PROGRAMMES ARE NOT LIKE OTHER COMMUNITY DWELLING OLDER SEDENTARY PEOPLE. Age Ageing 2014. [DOI: 10.1093/ageing/afu130.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bottomley J, Bussmann H, Skelton D, Laventure B, van Meeteren N. SS1.01: Innovations in Physical Activity (PA) Promotion - New physiological, technological and behavioural innovations for clinical practice. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stanmore E, Todd C, Oldham J, O'Neill T, Skelton D. Falls and their effects on people with rheumatoid arthritis. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Hawley H, Skelton D, Todd C. Understanding how we can engage and maintain older adults in exercise classes: the role of the exercise instructor. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Skelton D. Physical Dimensions of Ageing. Edited by Spirduso, Francis and MacRae.Human Kinetics, 2005, ISDN 0-7360-3315-7. 45. Age Ageing 2006. [DOI: 10.1093/ageing/afl136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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James L, Onambele G, Woledge R, Skelton D, Woods D, Eleftheriou K, Hawe E, Humphries SE, Haddad F, Montgomery H. IL-6?174G/C genotype is associated with the bone mineral density response to oestrogen replacement therapy in post-menopausal women. Eur J Appl Physiol 2004; 92:227-30. [PMID: 15083368 DOI: 10.1007/s00421-004-1092-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2004] [Indexed: 10/26/2022]
Abstract
A reduction in interleukin-6 (IL-6) activity may contribute to the beneficial effects of hormone replacement therapy (HRT) on the menopausal decline in bone mineral density (BMD). We have examined this hypothesis using a genetic strategy. The -174C (rather than G) IL-6 gene variant is associated with lower IL-6 expression. As such, we might anticipate the C allele to be associated with a greater response to HRT. We have tested this hypothesis. Mean three-site [spine (L1-L4), neck of femur, and Ward's triangle] BMD was measured in 65 women in a 1-year randomised controlled trial of HRT with 0.625 mg oestrogen/day and 0.15 mg norgestrel (n=30). Baseline BMD was genotype-independent for both the control and HRT group. In the control group, the percentage change in BMD after 1 year was similar between genotypes (P=0.45). In contrast, in the HRT group, the rise was genotype-dependent. Those homozygous for the G allele showed a 3.62 (2.14)% increase in BMD compared with 10.44 (4.68)% for the C-homozygous group. Heterozygotes had an intermediate BMD increase of 5.6 (2.82)% [ P=0.006 ( P value for interaction between HRT and genotype was 0.04)] Although the study was limited by its small sample size, these are the first data to demonstrate the importance of IL-6 genotype in determining response to oestrogen therapy, rather than its physiological withdrawal.
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Affiliation(s)
- L James
- Department of Orthopaedic Surgery, University College London NHS Trust, Mortimer Street, London, W1N 8AA, UK
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Woods D, Onambele G, Woledge R, Skelton D, Bruce S, Humphries SE, Montgomery H. Angiotensin-I converting enzyme genotype-dependent benefit from hormone replacement therapy in isometric muscle strength and bone mineral density. J Clin Endocrinol Metab 2001; 86:2200-4. [PMID: 11344227 DOI: 10.1210/jcem.86.5.7514] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Low bone mineral density (BMD) and muscle weakness are major risk factors for postmenopausal osteoporotic fracture. Hormone replacement therapy (HRT) reverses the menopausal decline in maximum voluntary force of the adductor pollicis and reduces serum angiotensin-I converting enzyme (ACE) levels. The insertion (I) allele of the ACE gene polymorphism is associated with lower ACE activity and improved muscle efficiency in response to physical training. Therefore, we examined whether the presence of the I allele in postmenopausal women would affect the muscle response to HRT. Those taking HRT showed a significant gain in normalized muscle maximum voluntary force slope, the rate of which was strongly influenced by ACE genotype (16.0 +/- 1.53%, 14.3 +/- 2.67%, and 7.76 +/- 4.13%, mean +/- SEM for II, ID, and DD genotype, respectively; P = 0.017 for gene effect, P = 0.004 for I allele effect). There was also a significant ACE gene effect in the response of BMD to HRT in Ward's triangle (P = 0.03) and a significant I allele effect in the spine (P = 0.03), but not in the neck of femur or total hip. These data suggests that low ACE activity associated with the I allele confers an improved muscle and BMD response in postmenopausal women treated with HRT.
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Affiliation(s)
- D Woods
- Department of Cardiovascular Genetics, Rayne Institute, University College London, London WC1E 6JJ, United Kingdom
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15
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Simey P, Skelton D. A healthy old age: realistic or futile goal? Older people need to be encourage to exercise. BMJ 2001; 322:796. [PMID: 11282851 PMCID: PMC1119968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
Green fluorescent protein (GFP) is a widely used intracellular reporter molecule to assess gene transfer and expression. A potential use for GFP is as a co-expressed marker, to select and enrich gene-modified cells by flow cytometry. Processed peptides derived from GFP and presented by the major histocompatibility complex on the cell surface could potentially induce T cell immune responses against GFP+ cells. Thus, clinical application of GFP is premature, since in vivo studies on its immunogenicity are lacking. Therefore, we investigated immune responses against EGFP (enhanced-GFP) in two transplantable murine models: the BALB/c (H-2d) BM185 pre-B leukemia and the C57BL/6 (H-2b) EL-4 T cell lymphoma. BM185 and EL-4 cell lines modified to express high levels of EGFP showed drastic reduction of disease development when transplanted into immunocompetent mice. BM185/ EGFP did lead to rapid development of disease in immunodeficient Nu/Nu mice. Mice surviving BM185/EGFP leukemia challenge developed high cytotoxic T lymphocyte (CTL) responses against EGFP-expressing cells. Furthermore, immune stimulation against BM185/EGFP cells could also be induced by immunization with EGFP+ transduced dendritic cells. The effects of the co-expression of EGFP and immunomodulators (CD80 plus GM-CSF) were also investigated as an irradiated leukemia vaccine. EGFP co-expression by the vaccine did not interfere with the development of CTLs against the parental leukemia or with the anti-leukemia response in vivo. These results indicate that the immune response against EGFP may interfere with its applicability in gene insertion/replacement strategies but could potentially be employed for leukemia cell vaccines.
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Affiliation(s)
- R Stripecke
- Division of Research Immunology/Bone Marrow Transplantation, Childrens Hospital Los Angeles, CA 90027, USA
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Challita PM, Skelton D, el-Khoueiry A, Yu XJ, Weinberg K, Kohn DB. Multiple modifications in cis elements of the long terminal repeat of retroviral vectors lead to increased expression and decreased DNA methylation in embryonic carcinoma cells. J Virol 1995; 69:748-55. [PMID: 7815539 PMCID: PMC188638 DOI: 10.1128/jvi.69.2.748-755.1995] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Infection by murine retroviruses in embryonic carcinoma (EC) and embryonic stem cells is highly restricted. The transcriptional unit of the Moloney murine leukemic virus (MoMuLV) long terminal repeat (LTR) is inactive in EC and embryonic stem cells in association with increased proviral methylation. In this study, expression in F9 EC cells was achieved from novel retroviral vectors containing three modifications in the MoMuLV-based retroviral vector: presence of the myeloproliferative sarcoma virus LTR, substitution of the primer binding site, and either deletion of a negative control region at the 5' end of the LTR or insertion of a demethylating sequence. We conclude that inhibition of expression from the MoMuLV LTR in EC cells is mediated through the additive effects of multiple cis-acting elements affecting the state of methylation of the provirus.
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Affiliation(s)
- P M Challita
- Department of Microbiology, University of Southern California School of Medicine, Los Angeles
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19
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Gurley BJ, Zermatten S, Skelton D. Determination of antipyrine in human serum by direct injection restricted access media liquid chromatography. J Pharm Biomed Anal 1994; 12:1591-5. [PMID: 7696384 DOI: 10.1016/0731-7085(94)00101-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B J Gurley
- Department of Pharmaceutics, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205
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20
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Subramony C, Scott-Conner CE, Skelton D, Hall TJ. Familial juvenile polyposis. Study of a kindred: evolution of polyps and relationship to gastrointestinal carcinoma. Am J Clin Pathol 1994; 102:91-7. [PMID: 8037173 DOI: 10.1093/ajcp/102.1.91] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Familial juvenile polyposis is a rare intestinal polyposis that has recently been associated with gastric and colonic adenocarcinoma. The authors report a kindred of 41 members, 11 of whom have familial juvenile polyposis. In these patients, random sections of otherwise grossly normal-appearing colonic mucosa showed a dense population of mixed inflammatory cell infiltrates in the superficial third of the lamina propria. Fine nodular mucosa was noted focally and diffusely in six of eight colons resected. These consisted of foci of dense inflammatory cell infiltrates in the mucosa with slight crypt architectural abnormalities. The majority of lesions were typical juvenile polyps. Dysplastic changes were noted in the polyps that were 1-2.9 cm or larger. The largest polyps contained foci of villous adenoma and juvenile polyp. A focus of adenocarcinoma of the colon was noted at the base of the villous adenoma portion of the largest polyp. The gastric polyps were histologically identical to hyperplastic polyps of the stomach. This report represents the largest number of patients (eight) in a single family with familial juvenile polyposis studied histologically. This is also the first time that the changes in the nonpolypoid colonic and gastric mucosa have been reported. The pattern of inheritance in this family suggests that the trait for familial juvenile polyposis segregates as an autosomal dominant.
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Affiliation(s)
- C Subramony
- Department of Pathology, University of Mississippi Medical Center, Jackson 39216
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Abstract
OBJECTIVE In a preliminary study in our laboratory, healthy elderly people had a higher heart rate during treadmill walking than during corridor walking at the same speed. The objective of this study was to determine whether this initial observation, (1) persisted after repeated testing, (2) was present in younger adults, (3) was due to wearing a mouthpiece during treadmill walking, or (4) was due to a change in gait. DESIGN A study of elderly and young volunteers undergoing repeated testing, with comparison of treadmill walking with corridor walking. SETTING The Royal Free Hospital School of Medicine. PARTICIPANTS Twelve healthy elderly (71-80 years) and 12 healthy young (21-37 years) volunteers. MAIN OUTCOME MEASURES Heart rate (beats/min) and step rate (steps/min) during comfortable self-paced corridor walking and during treadmill walking at the same speed. MAIN RESULTS The elderly subjects had higher heart rates during treadmill walking than during corridor walking at the same speed (mean difference = 6 beats/min, 95% Confidence Interval (CI) = 1 to 10). This difference increased (to a mean of 11 beats/min, 95% CI = 5 to 16) when a mouthpiece was worn on the treadmill. These differences persisted after repeated testing. The young subjects did not have higher heart rates on the treadmill, (with or without the mouthpiece). In both groups, step rate was lower (95% CI = -9 to -2, elderly; -5 to -2, young) during treadmill walking, corresponding to a 3% increase in stride length. CONCLUSION The heart rate response to treadmill walking in healthy elderly people may be less representative of the "real life" situation than in younger adults.
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Affiliation(s)
- C Greig
- Human Performance Laboratory, Royal Free Hospital School of Medicine, London, United Kingdom
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22
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Chandra RK, Imbach A, Moore C, Skelton D, Woolcott D. Nutrition of the elderly. CMAJ 1991; 145:1475-87. [PMID: 1959109 PMCID: PMC1336040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The progressively increasing number of elderly people in the Canadian population and the disproportionate expenditure on their health care has stimulated interest in prevention of common illnesses observed in this age group. It is now recognized that nutrition plays an important role in health status, and both undernutrition and overnutrition are associated with greater risk of morbidity and mortality. Nutritional problems in the elderly can be suspected if there are several high-risk factors present--for example, living alone, physical or mental disability, recent loss of spouse or friend, weight loss, use of multiple medications, poverty, and high consumption of alcohol. Physical examination, anthropometry, and measurements of serum albumin levels and hemoglobin and lymphocyte counts are simple but helpful tools in confirming the presence of nutritional disorders. The prevention and correction of nutritional problems is likely to prove beneficial in the management of common geriatric illnesses. In these efforts, it is desirable to have a team approach in which the physician, the dietitian and the nurse each have a defined interactive role. Home care support services are important adjuncts in continuing care. Nutrition should receive a greater emphasis in the training of physicians and other health professionals.
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Affiliation(s)
- R K Chandra
- Department of Medicine, Memorial University of Newfoundland, St. John's
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Kneedler E, Smith KE, Skelton D, Kevan SD. Surface electronic structure and dynamical interactions on Ta(011) and H/Ta(011). Phys Rev B Condens Matter 1991; 44:8233-8242. [PMID: 9998757 DOI: 10.1103/physrevb.44.8233] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
Tetrabenazine has been used for treatment of tardive dyskinesia sporadically over the past twenty years. Dose has usually been decided empirically without assaying blood levels. This report describes 23 cases treated successfully with tetrabenazine. Our method of measuring levels of tetrabenazine and its metabolites in biological samples is described briefly.
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Affiliation(s)
- M W Watson
- Mentally Dysfunctioning Elderly Unit, Edmonton Rural Auxiliary Hospital and Nursing Home, Alberta
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Mehvar R, Jamali F, Watson MW, Skelton D. Pharmacokinetics of tetrabenazine and its major metabolite in man and rat. Bioavailability and dose dependency studies. Drug Metab Dispos 1987; 15:250-5. [PMID: 2882986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The pharmacokinetics of tetrabenazine (TBZ), a catecholamine and serotonin depletor, and its major metabolite, dihydrotetrabenazine (HTBZ), were studied in four patients affected by tardive dyskinesia, who were under treatment with different doses of TBZ (12.5-37.5 mg, t.i.d.), and in the rat. In the patients, the steady-state area under the plasma concentration-time curves (AUCs) of the metabolite were 82.6-199-fold higher than those of TBZ. The drug showed a small and erratic bioavailability (F = 0.06 +/- 0.026, mean +/- SD). It appears to be extensively metabolized, as no unchanged TBZ could be detected in the urine of the patients. Single oral doses of 0.5-10 mg/kg and single iv dose of 1 mg/kg of TBZ were each administered to four to six rats. The clearance of the drug following iv administration to the rat (mean +/- SD, 58.9 +/- 6.01 ml X min-1 X kg-1) was very close to the rat hepatic blood flow indicating a perfusion-limited clearance. An F value of 0.17 was obtained following iv and po doses of 1 mg/kg TBZ in the rat. The oral absorption of TBZ seems to be rapid and almost complete. Plots of the AUCs of TBZ and HTBZ vs. five different po doses (0.5-10 mg/kg) were linear with correlation coefficients of 0.998 and 0.986 for TBZ and HTBZ, respectively, suggesting linear kinetics in the examined dosage range. In both the patients and rats, the plasma profile of TBZ followed characteristics of a multiexponential pharmacokinetic model.(ABSTRACT TRUNCATED AT 250 WORDS)
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Skelton D. The future of geriatric medicine in Canada. Gerontion 1986; 1:19-23. [PMID: 3640719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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28
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Mehvar R, Jamali F, Watson MW, Skelton D. Direct injection high-performance liquid chromatography of tetrabenazine and its metabolite in plasma of humans and rats. J Pharm Sci 1986; 75:1006-9. [PMID: 3795018 DOI: 10.1002/jps.2600751021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A convenient, selective, and sensitive reversed-phase HPLC assay was developed to measure concentrations of the dopamine-depleting agent, tetrabenazine (1,3,4,6,7,11b-hexahydro-3-isobutyl-9,10-dimethoxy-2H-benzo(a)quinoli zin-2-one) and its dihydro metabolite in the plasma of patients with tardive dyskinesia receiving therapeutic doses of the drug and in the plasma of rats. The method involves plasma protein precipitation, oxidation of the compounds with mercuric acetate at 110 degrees C for 1 h, addition of internal standard, and injection into the instrument. Fluorescence detection was utilized at excitation and emission wavelengths of 265 and 418 nm, respectively. The peaks from the drug, its metabolite, and at least three other substances were best resolved at 60 degrees C using a mobile phase of water:acetonitrile:acetic acid:triethylamine (65:33:2:0.15) at a flow rate of 0.6 mL/min; the 4.6 mm X 10 cm column contained 5 micron of octadecylsilane packing. To assess the applicability of the assay, the drug was administered intravenously to rats, and plasma concentrations were determined before (by UV-HPLC) and after (by fluorescence-HPLC) the oxidative procedure. In addition, the MS spectra of tetrabenazine and the dihydro metabolite, isolated from biological samples, were identical to those of authentic samples. Excellent linearity was observed between the peak area ratios and concentrations over the ranges 0.5-200 and 2-1000 ng/mL of the drug and the metabolite, respectively. Minimum quantifiable concentrations of the drug and its metabolite were 0.5 and 2.0 ng/mL, respectively. The sensitivity was found to be adequate for pharmacokinetic studies of tetrabenazine in humans and rats.
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Abstract
For serum vitamin B12 levels there was little apparent difference between a geriatric healthy reference group and a hospitalized group for the total population studied; however, the hospitalized males did have an increased prevalence of values less than normal range. The frequency distribution for both sexes of the geriatric reference group gave lower range limits than manufacturer's normal range. (68-632 vs 133-708 pmol/L for Becton Dickinson, and 125-609 vs 179-930 pmol/L for Bio-Rad, using 95% non-parametric limits). For folate there was an increased incidence in values of less than normal in the hospitalized group versus the geriatric reference group, but there was no difference in the ranges calculated for the latter compared to either manufacturer's normal range derived from a younger population. Comparison of results by two manufacturers' kit methods confirmed Bio-Rad's claim to increased low-end sensitivity of standard curve in range of clinical interest.
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Skelton D. Hearing impairment in the elderly. Can Fam Physician 1984; 30:611-615. [PMID: 21279080 PMCID: PMC2154182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hearing impairment is a common but not inevitable accompaniment of aging. It is partly due to the natural involution of irreplaceable neurones; environment also plays a large role. Although they may have difficulty in hearing all frequencies of sound, elderly people have particular difficulty with high-pitched sounds. They find it hard to focus on sounds, and serious social problems may arise as a result. Elderly people with hearing losses are particularly vulnerable to psychological sequelae, many of which are serious, but may also be correctable. Unfortunately, there is limited understanding of the causes of hearing handicaps, their prevalence, incidence and implications for the elderly, health professionals and the health care system.
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Skelton D. The hospice movement: a human approach to palliative care. Can Med Assoc J 1982; 126:556-8. [PMID: 7066812 PMCID: PMC1863046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Skelton D. Gee, thanks! Can Fam Physician 1982; 28:192. [PMID: 21286037 PMCID: PMC2306337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Skelton D. Age is not a disease. Can Fam Physician 1979; 25:353-357. [PMID: 21297697 PMCID: PMC2382957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Skelton D. Implementation--the challenge. Newsl Am Acad Health Adm 1977; 27:Q1-4. [PMID: 10238772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
Problems facing the modern health care worker are examined. These include population changes, the changing pattern of disease, the psychosocial aspects of aging, and altered pathophysiologic mechanisms. The major future requirements in health care for the elderly are outlined. Greater emphasis should be placed upon education in the disciplines of Gerontology and Geriatric Medicine. Society needs to be made more aware of the realities of aging. Health care professionals need to develop their communication skills and to practice more effective teamwork. Greater coordination of the components of health care delivery systems will be needed in order to provide comprehensive and continuing health services. Research into the true and changing needs of the elderly recipients of health care should be emphasized. Prevention and early detection of disease is an important focus in Geriatric Medicine for the future.
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Coates E, Rigg B, Saville B, Skelton D. 1045. Complexes of amines with zinc dialkyldithiocarbamates. Part II. A study of the influence of amine structure on the stability of complexes of zinc dimethyldithiocarbamate. ACTA ACUST UNITED AC 1965. [DOI: 10.1039/jr9650005613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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