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Marshall-McKenna R, Campbell E, Ho F, Banger M, Rowe P, McAlpine C, McArthur K, Quinn TJ, Gray SR. 36 Feasibility of Resistance Exercise to Failure at Different Loads in Frail and Healthy Older Adults? Age Ageing 2021. [DOI: 10.1093/ageing/afab029.15] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Resistance training (RT) is the most effective way to increase muscle mass and function in older adults both with/without sarcopenia/frailty. In younger adults, when RT is performed to muscle failure the load lifted does not mediate the magnitude of response, but there are no studies in older adults. We aimed to determine the feasibility of recruitment to a RT intervention working to muscle failure at different loads in frail and healthy older adults.
Methods
We performed an 8-week randomised feasibility trial of lower limb RT to volitional muscular failure, at high and low load. Participants were recruited via hospital outpatient clinics and newspaper advertisements. Outcomes included: frailty assessment (Fried criteria); muscle strength (maximum voluntary contraction/one-repetition maximum); functional abilities (Short Physical Performance Battery); safety/adverse events were recorded via a log, and patient experiences from focus groups.
Results
110 people were assessed for eligibility, and 58 randomised (frail n = 6, prefrail n = 20, robust n = 32) to either high (n = 30) or low load (n = 28) groups. Mean age of participants was 72 years (range 65–93), 36 were female, 22 male. Session attendance was 95% (high load) and 90.4% (low load). Most participants were recruited via advertisements. All participants reported feeling safe and reassured in the RT sessions. Two participants had a serious adverse event, one related to RT (hypotension) and several had adverse events (three intervention-related). Pain was reported at both loads (high n = 9, low n = 8) yet all completed. There were no differences (P > 0.05) in effects of RT outcome variables between low and high load groups.
Conclusion
In this feasibility trial the recruitment of frail patients via clinics was limited. Performing supervised RT to muscle failure in older adults was safe/acceptable and the load at which RT was performed did not influence its efficacy. Future research into the effectiveness of such RT is warranted.
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Affiliation(s)
| | - E Campbell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow
| | - F Ho
- Institute of Health and Wellbeing, University of Glasgow
| | - M Banger
- Biomedical Engineering, University of Strathclyde
| | - P Rowe
- Biomedical Engineering, University of Strathclyde
| | - C McAlpine
- Department of Medicine for the Elderly, Glasgow Royal Infirmary
| | - K McArthur
- Department of Medicine for the Elderly, Glasgow Royal Infirmary
| | - T J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow
- Department of Medicine for the Elderly, Glasgow Royal Infirmary
| | - S R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow
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Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [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: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
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Kendall M, Cowey E, Murray SA, Barber M, Borthwick S, Boyd K, McAlpine C, Stott D, Mead G. 162Experiences And Multi-Dimensional Needs of People With Major Stroke And Their Family Carers. Age Ageing 2017. [DOI: 10.1093/ageing/afx070.162] [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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Abstract
This study aimed to assess the value of periodic review by an occupational therapist (OT) of elderly patients with rheumatoid arthritis (RA). Twenty-four patients aged over 65 years who had longstanding RA and had had at least one previous contact with an OT completed a modified health assessment questionnaire (HAQ)1.2 to give an assessment of their self perceived functional ability then had a formal OT assessment. Two months later the patients completed a second HAQ to assess the effect of the OT assessment and assistance. Only three of the 24 patients were felt by the OT to have no need of intervention by her; 17 of the patients felt that the OT contact had been useful. Possible intervention to improve quality of life was not predicted by the patient's perception of limitations nor by the HAQ score. There were no significant changes in HAQ scores despite OT assessment and intervention. Other assessments of disability or wellbeing merit investigation in the context of OT intervention but the need for OT review of elderly patients with RA is clear.
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Affiliation(s)
- CH McAlpine
- Department of Rheumatology, Gathavel General Hospital
| | - E. Woodhouse
- Department of Occupational Therapy, Gatrtnavel General Hospital
| | - J. MacDonald
- Department of Geriatric Medicine, Gartnavel General Hospital
| | - J. Hunter
- Department of Rheumatology, Gartnavel General Hospital, Glasgow
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McAlpine C, Werstuck G. PKR-LIKE ENDOPLASMIC RETICULUM KINASE (PERK) AND GLYCOGEN SYNTHASE KINASE (GSK)-3α/β SIGNALING REGULATE ATHEROSCLEROSIS DEVELOPMENT. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.589] [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: 10/24/2022] Open
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6
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McAlpine C, Werstuck G. Investigating the Role of Glycogen Synthase Kinase (GSK)-3α/β in Pro-Atherogenic Endoplasmic Reticulum (ER) Stress Signaling. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.440] [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: 10/26/2022] Open
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7
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McAlpine C, Shi Y, Werstuck G. 419 Investigating the Role of Glycogen Synthase Kinase (GSK)-3 in Pro-Atherogenic Endoplasmic Reticulum (ER) Stress Signaling. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.394] [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: 10/27/2022] Open
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8
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McAlpine C, Bowes A, Khan M, Shi Y, Werstuck G. 485 Endoplasmic Reticulum stress and Glycogen Synthase Kinase-3 beta activation in apolipoprotein e-deficient mouse models of accelerated atherosclerosis. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.406] [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: 10/16/2022] Open
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11
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Egerton T, Maxwell D, Granat M, Wellwood I, Langhorne P, McAlpine C, McDonald J. Measurement of Upright Activity of Patients in Stroke Units. Physiotherapy 2002. [DOI: 10.1016/s0031-9406(05)60564-0] [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: 11/24/2022]
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12
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McAlpine C, Marshall CC, Doran NH. Combining child welfare and substance abuse services: a blended model of intervention. Child Welfare 2001; 80:129-149. [PMID: 11291898] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Montgomery County, Maryland's Child Welfare Services (CWS) and Adult Addiction Services (AAS) developed an initiative to address the requirements of the Adoption and Safe Families Act (ASFA) while meeting the needs of families and the community of providers. A blended model of intervention was determined to be the best strategy to achieve the dual mandates of CWS and alcohol and other drugs (AOD) providers. Drawing from criminal justice, systems theory, social work, and addiction treatment, the approach made use of graduated sanctions or levels of intensity in providing services, engaging client participation, and engendering motivation. This article proposes strategies at client and organizational levels to understand the process of adaptation to ASFA and to guide planning for blending services.
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Affiliation(s)
- C McAlpine
- Addiction Services Coordination, Montgomery County Department of Health and Human Services, Rockville, MD, USA
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Abstract
BACKGROUND AND PURPOSE This prospective, multicenter study was performed to determine the frequency of symptomatic complications up to 30 months after stroke using prespecified definitions of complications. METHODS We recruited 311 consecutive stroke patients admitted to hospital. Research nurses reviewed their progress on a weekly basis until hospital discharge and again at 6, 18, and 30 months after stroke. RESULTS Complications during hospital admission were recorded in 265 (85%) of stroke patients. Specific complications were as follows: neurological-recurrent stroke (9% of patients), epileptic seizure (3%); infections-urinary tract infection (24%), chest infection (22%), others (19%); mobility related-falls (25%), falls with serious injury (5%), pressure sores (21%); thromboembolism-deep venous thrombosis (2%), pulmonary embolism (1%); pain-shoulder pain (9%), other pain (34%); and psychological-depression (16%), anxiety (14%), emotionalism (12%), and confusion (56%). During follow-up, infections, falls, "blackouts, " pain, and symptoms of depression and anxiety remained common. Complications were observed across all 3 hospital sites, and their frequency was related to patient dependency and duration after stroke. CONCLUSIONS Our prospective cohort study has confirmed that poststroke complications, particularly infections and falls, are common. However, we have also identified complications relating to pain and cognitive or affective symptoms that are potentially preventable and may previously have been underestimated.
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Affiliation(s)
- P Langhorne
- Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, Scotland, UK.
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14
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McAlpine C, Dick F. Developing a Stroke Service. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_1.p69-b] [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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16
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Abstract
This study considered the management of first seizures in adults in Stirling Royal Infirmary over a six month period. Thirty-four patients presented of whom 19 were admitted to medical wards. Alcohol was implicated in 35% of cases. Blood tests were done in many but provided little useful information. CT Scan was performed in 53% and was abnormal in 15% (five patients). EEG was requested for 21% and failed to influence management in any. Six patients (18%) were started on anticonvulsant therapy. It was recorded in only three cases that advice on driving had been given. The literature concerning single seizures is complex, especially with regards to recurrence risk and treatment benefits. We await with interest the publication of the SIGN (Scottish Intercollegiate Guidelines Network) guidelines for seizure investigation and treatment in Scotland.
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Affiliation(s)
- A D Morrison
- Department of Medicine, Stirling Royal Infirmary
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17
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Johnson J, McAlpine C. Audit of Referrals for Carotid Duplex Scanning. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_1.p43-a] [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: 11/12/2022] Open
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18
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Yip B, Cassidy D, Rowell H, Bone I, McAlpine C. Is Asking a Trained Nurse About a Patient's Functional Ability as Reliable as Asking the Patient? Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_1.p35-c] [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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19
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Yip B, Cassidy D, Rowell H, Bone I, McAlpine C. Consumer Satisfaction with Stroke Services. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_3.p26-b] [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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20
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Wilkieson CA, Campbell AM, McWhirter MF, McIntosh IB, McAlpine CH. Standardization of health assessments for patients aged 75 years and over: 3 years' experience in the Forth Valley Health Board area. Br J Gen Pract 1996; 46:307-8. [PMID: 8762749 PMCID: PMC1239641] [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: 02/02/2023] Open
Abstract
BACKGROUND The new contract for general practitioners (GPs) was introduced in 1990. This required all GPs to offer their patients aged 75 years of over an annual assessment. AIM The study aimed to determine if 3 years' experience had resulted in standardization of the way in which health assessments for patients aged 75 years and over are carried out. METHOD The study was carried out in 1993. Questionnaires were sent to the principal partners of all 55 general practices in the Forth Valley Health Board (FVHB) area. The main outcome measures were the fulfilment of contractual requirements and standardization of the health assessment process. RESULTS Completed questionnaires were returned by 49 practices (89%) Eighty per cent (39 practices) had drawn up their own assessment programme in 1990. Responsibility for assessments was most often (41 practices) shared between different members of the primary care team (84%). Although most practices satisfied contractual requirements, there were wide variations in approach, potentially influencing outcome. CONCLUSION Despite three years' experience, no standardized approach to the health assessment of patients aged 75 years and over has been developed. Purchasers of health care require information on the needs of their client population, and this should be available in an accessible, standardized form. There is an urgent need for a review of the way in which the 1990 contract has been implemented to standardize health assessments and improve effectiveness in meeting its original aims.
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22
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McAlpine CH. Management of stroke patients. BMJ 1995; 310:531. [PMID: 7888910 PMCID: PMC2548902 DOI: 10.1136/bmj.310.6978.531b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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23
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Cooper C, Crome P, Lewis P, Vetter N, Dunn R, McAlpine CH, Rein J, Milnes JP, Smith I, Easton PM, Oliphant JB. Effect of NHS and Community Care Act Problem with interpretation. BMJ 1994. [DOI: 10.1136/bmj.309.6954.605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McAlpine CH, Reid J. Effect of NHS and Community Care Act. No significant improvement. BMJ 1994; 309:605. [PMID: 8086959 PMCID: PMC2541425] [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: 01/28/2023]
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25
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Yip B, McAlpine CH. Managing stroke. BMJ 1994; 308:343-4. [PMID: 8124135 PMCID: PMC2539259 DOI: 10.1136/bmj.308.6924.343c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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26
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Yip B, McAlpine CH. Do stroke units save lives? Lancet 1993; 342:992. [PMID: 8105240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Walker J, Morison M, Bote E, Cotonoa J, Dorald N, Fletcner N, Henrrie J, Inree J, Nitson P, McAlpine C. Seating for Patients in Containing Care. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_3.p40-d] [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: 11/14/2022] Open
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McAlpine C, Singh NN, Kendall KA, Ellis CR. Recognition of facial expressions of emotion by persons with mental retardation. A matched comparison study. Behav Modif 1992; 16:543-58. [PMID: 1417713 DOI: 10.1177/01454455920164006] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [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: 12/26/2022]
Abstract
Children and adults with mental retardation were tested on their ability to recognize facial expressions of emotion. The sample consisted of 80 children and adults with mental retardation and a control group of 80 nonhandicapped children matched on mental age and gender. Ekman and Friesen's normed photographs of the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) were used in a recognition task of facial expressions. Subjects were individually read two-sentence stories identifying a specific emotion, presented with a randomized array of the six photographs of the basic facial expressions of emotion, and then asked to select the photograph that depicted the emotion identified in the story. This procedure was repeated with 24 different stories, with each of the six basic emotions being represented four times. Results showed that, as a group, individuals with mental retardation were not as proficient as their mental-age-matched nonhandicapped control subjects at recognizing facial expressions of emotion. Although adults with mild mental retardation were more proficient at this task than those with moderate mental retardation, this finding was not true for children. There was a modest difference between the children with moderate mental retardation and their nonhandicapped matched controls in their ability to recognize facial expression of disgust.
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McAlpine C, Singh NN, Ellis CR, Kendall KA, Hampton C. Enhancing the ability of adults with mental retardation to recognize facial expressions of emotion. Behav Modif 1992; 16:559-73. [PMID: 1417714 DOI: 10.1177/01454455920164007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [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: 12/26/2022]
Abstract
The ability to recognize accurately and respond appropriately to facial expressions of emotion is essential for interpersonal interaction. Individuals with mental retardation typically are deficient in these skills. The ability of 7 adults, 1 with severe and 6 with moderate mental retardation, to recognize facial expressions of emotion correctly was assessed. Then, they were taught this skill using a combination of a discrimination training procedure for differentiating facial movements, directed rehearsal, and Ekman and Friesen's "flashing photograph" technique. Their average increase in accuracy over baseline was at least 30% during the course of the training and over 50% during the last 5 days of the training phase. Further, these individuals were able to generalize their skills from posed photographs to videotaped role plays and were able to maintain their enhanced skills during the 8 to 9 months following the termination of training. This is the first study to show that individuals with mental retardation can be taught skills that enhance their ability to recognize facial expressions of emotion.
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30
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McAlpine CH. Stroke and the carer. Br J Gen Pract 1991; 41:436-7. [PMID: 1777312 PMCID: PMC1371841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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31
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McAlpine C, Kendall KA, Singh NN. Recognition of facial expressions of emotion by persons with mental retardation. Am J Ment Retard 1991; 96:29-36. [PMID: 1878186] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A sample of 511 children and adults with mental retardation or borderline intelligence (1 SD below the mean IQ) and children of average intelligence were tested on their ability to recognize the six basic facial expressions of emotion as they are exemplified in Ekman and Friesen's (1975) normed photographs. Each subject was shown four sets of six photographs, one of each emotion. Subjects were read 24 short stories; after each one they were asked to point to the photograph that depicted the emotion described. Children and adults with mental retardation or borderline intelligence were less proficient at identifying facial expressions of emotion than were children of average intelligence. Among individuals with mental retardation or borderline intelligence, recognition of accuracy of facial emotion increased with IQ. Among individuals with average intelligence, recognition accuracy increased with age.
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Affiliation(s)
- C McAlpine
- Templeton Hospital and Training School, Christchurch, New Zealand
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32
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Abstract
A postal questionnaire sent to all consultant geriatricians in Great Britain and Northern Ireland determined that less than one consultant in five offered influenza vaccine to patients in continuing-care wards. The main reasons given were that vaccine was inappropriate or unnecessary. This information prompted a prospective study of viral illness during the winter months of 1986-87 in eight continuing-care wards with a population of 196 patients. There were 70 episodes of influenza-like illness (ILI), but only 17 viruses were isolated, the commonest being rhinovirus (seven patients). As most cases of ILI in this population were caused by viruses other than influenza, the reluctance of most geriatricians to give influenza vaccine to continuing-care patients appears justified.
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Affiliation(s)
- I M Lennox
- Victoria Geriatric Unit, Glasgow Royal Infirmary
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Macphee GJ, Crowther JA, McAlpine CH. Screening for impaired hearing in the elderly. JAMA 1988; 260:3589-90. [PMID: 3193585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
This study investigated the reliability of simple bedside free-field voice testing in the detection of hearing impairment in patients admitted to a geriatric unit. Sixty-two consecutive admissions were assessed at four graduated levels of loudness by geriatrician and otolaryngologist independently. Pure tone audiometry was then performed blind. Voice testing by both observers was concordant in 88% of all ears and in 100% of ears able to hear a whispered voice (WV) at 2 ft (approximately 0.6 m). The WV at 2 ft was the most discriminant test with a sensitivity of 100%, a specificity of 84% and a predictive value of 92% for hearing impairment likely to benefit from provision of a hearing aid. Free-field voice testing appears a simple, reliable and reproducible test for detecting hearing impairment in elderly patients.
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Affiliation(s)
- G J Macphee
- Department of Otolaryngology, Victoria Infirmary, Glasgow
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35
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McAlpine LG, McAlpine CH, Waclawski ER, Storer AM, Kay JW, Frier BM. A comparison of treatment with metformin and gliclazide in patients with non-insulin-dependent diabetes. Eur J Clin Pharmacol 1988; 34:129-32. [PMID: 3289948 DOI: 10.1007/bf00614548] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Twenty-seven obese non-insulin-dependent diabetic patients, treated with dietary carbohydrate restriction and metformin, were recruited from the diabetic outpatient clinic and entered into an open crossover study with gliclazide. Twenty-one patients completed the study. During three months observation on metformin, the mean weight of the group fell by 1.0 kg with 14 patients losing a mean of 1.8 kg with 14 patients losing a mean of 1.8 kg, 3 remaining unchanged and 4 gaining a mean weight of 1.1 kg. Over the subsequent three months on gliclazide, the mean weight of the group rose by 1.4 kg with 16 patients gaining a mean of 2.2 kg, two remaining unchanged and 3 losing a mean of 2.0 kg. In addition, 10 patients were heavier after gliclazide than at the time of recruitment (mean 2.6 kg), 3 were unchanged and 8 had lost weight since commencing the trial (mean 2.1 kg), mostly due to greater loss on metformin than gain on gliclazide. Glycaemic control did not improve significantly during the observed period on metformin but lower concentrations of fasting glucose and total glycosylated haemoglobin were achieved with gliclazide. Mean plasma insulin concentration was significantly higher and mean serum lactate was significantly lower during treatment with gliclazide. In conclusion, gliclazide does not support weight loss in obese non-insulin-dependent diabetic patients to the same extent as metformin but the difference between the two drugs is small. Gliclazide is a suitable oral hypoglycaemic agent for use in the obese diabetic who cannot be controlled by diet alone.
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Affiliation(s)
- L G McAlpine
- Diabetic Department, Gartnavel General Hospital, Glasgow, U.K
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36
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Abstract
A retrospective study was made of all patients aged over 65 years with hypothermia discharged from or dying in the Victoria Infirmary, Glasgow in the years 1977-81. Full follow-up data were obtained on 81 of the 91 patients identified. Patients were divided into cases of primary and secondary hypothermia. There were no significant differences between the two groups in initial mortality mean age on admission or mean temperature on admission, but there was a highly significant (P less than 0.001) difference in long-term outcome: the 3-year mortality in patients who survived the index admission was 100% in the primary group and 24% in the secondary group.
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37
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McAlpine C. Drug points: Erythema multiforme-like reaction to oxazepam. West J Med 1986. [DOI: 10.1136/bmj.293.6545.510-d] [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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38
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Abstract
This prospective study investigated the common belief that pyrexia is frequently absent in elderly patients with infection. Oral temperature was closely monitored using both a mercury and an electronic thermometer in 150 ill elderly patients (mean age 81 years) of whom 80% were new admissions to this Unit. A scoring system was devised, based on investigation results and excluding temperature, to assess objectively the likelihood of infection. Seventy-one patients (47%) had 'definite' infection: 95% were pyrexial. A further eight of the nine patients with probable infection were pyrexial. There were no significant differences in mean temperature or other indices of infection between those who died of their infection and those who survived. Ten per cent of all pyrexias were detected only on the electronic thermometer, not on mercury measurement. In 12% of pyrexial patients, the pyrexia first appeared more than 12 h after temperature measurement started. With effective monitoring, pyrexia is detectable in the vast majority of infected elderly patients.
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