Irene Turpie - Academia.edu (original) (raw)

Papers by Irene Turpie

PubMed, Feb 15, 1991

Objective: To determine the effectiveness of physician probability estimates calculated on the ba... more Objective: To determine the effectiveness of physician probability estimates calculated on the basis of findings from history-taking and physical examination in the diagnosis of iron deficiency anemia in elderly patients. Design: Prospective study. Setting: Two community hospitals offering secondary and tertiary care. Patients: A total of 259 patients over 65 years of age found to have previously undiagnosed anemia. Measures: Physician estimates of the likelihood of iron deficiency before (pretest probability) and after (post-test probability) the laboratory test results were available. The hemogram was available to the physicians when they made their pretest probability estimates. Because the serum ferritin level proved to be the most powerful of the laboratory test results studied, the likelihood ratios associated with the post-test estimates were compared with the ratios associated with the serum ferritin level. Main results: The post-test probability estimates were influenced by the serum ferritin level and the pretest estimates. The post-test estimates derived from the findings obtained through history-taking and physical examination and the laboratory test results (including the serum ferritin level) were slightly less accurate in predicting iron deficiency than the serum ferritin level alone. Nevertheless, a model in which the pretest estimates were used in addition to the serum ferritin level to predict iron deficiency proved to be more powerful than the serum ferritin level alone (p = 0.006). This indicated that the limitations of the post-test estimates were due to a misinterpretation of the serum ferritin level and that the findings from history-taking and physical examination added important diagnostic information. Conclusions: Physicians must be aware of test properties to provide optimal care to their patients. If test results are properly interpreted, pretest probabilities derived from findings obtained through history-taking and physical examination can add useful information that will lead to more accurate diagnoses.

Journal of the American Geriatrics Society, Dec 1, 2006

DISCUSSION KA is a skin tumor that typically presents with a history of rapid growth over a short... more DISCUSSION KA is a skin tumor that typically presents with a history of rapid growth over a short period of time in people aged 50 and older. Sir Jonathan Hutchinson first described it in 1889 as ''crateriform ulcer of the face.'' 1 This tumor is most often a solitary pink or flesh-colored, dome-shaped nodule with a central keratin plug. A history of rapid growth over a period of 1 to 2 months, size of 1 to 2 cm, and spontaneous involution after 3 to 6 months is typical. Eighty-five percent of older people in the tropics and subtropics with this type of tumor develop it on the extremities, whereas 70% of lesions develop on the head and neck of people in temperate climates. 2,3 Etiology of this tumor is controversial. Viruses have been long suggested as an etiological agent, although the deoxyribonucleic acid sequence of the human papilloma virus has been detected only in a minority of the studied cases. Exposure to excessive sunlight is the most frequently noted incriminating factor in the etiology of KA. Other factors include tar exposure, immunosuppressive states, burns, psoriatic lesions previously treated using psoralen and ultraviolet A therapy, and other dermatoses. In recent years, there have been an increasing number of reports of KA arising at sites of trauma. 4-10 We present the first case of KA arising in an arthropod sting site. Tumorigenesis is a multistep process. We hypothesize that prolonged exposure to sunlight predisposes the development of KA in sites of trauma, and in this case of an elderly gentlemen with a history of a hornet sting, the arthropod sting served as the trigger.

The American Journal of Medicine, Mar 1, 1990

: Thirty-six percent of our patients had no demonstrable marrow iron and were classified as being... more : Thirty-six percent of our patients had no demonstrable marrow iron and were classified as being iron-deficient. The serum ferritin was the best test for distinguishing those with iron deficiency from those who were not iron-deficient. No other test added clinically important ...

Gerontologist, Dec 1, 1987

D. Joan Eagle, M.ScN., MSc, 2 Gordon Guyatt, MD, 34 ... Christopher Patterson, MD, 4 and Irene Tu... more D. Joan Eagle, M.ScN., MSc, 2 Gordon Guyatt, MD, 34 ... Christopher Patterson, MD, 4 and Irene Turpie, MD 4 ... Geriatric day hospitals provide a setting where comprehensive medical assessment and rehabilita-tion for frail elderly patients can be provided by an interdisciplinary team ...

Canadian Medical Association Journal, Sep 15, 1991

Academic Medicine, Oct 1, 1999

Restructuring Canada's Health Systems: How Do We Get There From Here?, 1992

Perspectives (Gerontological Nursing Association (Canada)), 2008

Persistent pain is a significant problem for older hospitalized adults and their health care team... more Persistent pain is a significant problem for older hospitalized adults and their health care team. A better understanding of the approach to pain management in the clinical setting will provide guidance for the development of improvements in clinical management. The purpose of this study was to determine the prevalence of pain and to examine the current state of pain assessment and management in older adults on the six acute medical units of an academic health sciences centre. Findings revealed that 70% of older patients were in pain, nurses had limited awareness of their patients' pain, documentation of pain assessment and management was lacking, and pain was under-treated. Utilization of practice guidelines related to management of persistent pain in older adults in acute care settings is recommended, and an approach to their implementation, including identifying and overcoming the barriers to such best practices, is warranted.

The American Journal of Medicine, 1986

CMAJ: Canadian …, 1986

To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients wi... more To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients with hip fractures, we reviewed the charts of all patients aged 60 years or older who were treated for hip fractures in five hospitals in Hamilton, Ont., between August 1982 and September 1983. We hypothesized that discharge to a different location from that before admission would indicate reduced functional status and classified the reasons for a change in residence as poor patient motivation, need for rehabilitation, compromised ambulation, postoperative complications and inevitable deterioration. We believed that geriatric care would be most beneficial to those in the first three groups. Of the 327 patients with hip fractures 40 (12%) died before discharge. Of the 287 surviving patients 149 (52%) had been discharged by 4 weeks, and only 29 (10%) remained in hospital by 12 weeks. Of the 287, 44 (15%) were discharged to a different location from that before admission: in 75% the cause appeared to be inevitable deterioration (57%) or postoperative complications (18%). The remaining 25% needed rehabilitation and were all sent to appropriate facilities. None of the patients with ambulation problems or poor motivation required an increased level of care. We could not show a need for geriatric care in our population; possible explanations are discussed.

Canadian family physician Médecin de famille canadien, 1992

Annals of internal medicine

Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupt... more Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. Prospective cohort study. Single university hospital. Consecutive patients who had warfarin therapy interrupted before an invasive procedure. Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. Blood anti-factor Xa heparin levels measured shortly before surgery. Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.

Annals of Internal Medicine, 2007

Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupt... more Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. Prospective cohort study. Single university hospital. Consecutive patients who had warfarin therapy interrupted before an invasive procedure. Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. Blood anti-factor Xa heparin levels measured shortly before surgery. Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.

Principles and Practice of Geriatric Medicine, 2005

Page 1. 160 Geriatric Day Hospitals Neil D. Gillespie1 and Irene D. Turpie2 1 University of Dunde... more Page 1. 160 Geriatric Day Hospitals Neil D. Gillespie1 and Irene D. Turpie2 1 University of Dundee, Dundee, UK, and 2 McMaster University, Hamilton, ON, Canada INTRODUCTION Geriatric Day Hospitals (DHs) are key components ...

Developments in Cardiovascular Medicine, 2004

Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!60... more Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!608. 6. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, Varrichio M, Rengo F. Congestive heart failure and cognitive impairment in an older population. ...

Developments in Cardiovascular Medicine, 2004

Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene... more Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene D. Turpie ... 30%, p<O.OOI). In the latter two studies, the severity of cognitive impairment was related to the severity of LV systolic dysfunction. ...

PubMed, Feb 15, 1991

Objective: To determine the effectiveness of physician probability estimates calculated on the ba... more Objective: To determine the effectiveness of physician probability estimates calculated on the basis of findings from history-taking and physical examination in the diagnosis of iron deficiency anemia in elderly patients. Design: Prospective study. Setting: Two community hospitals offering secondary and tertiary care. Patients: A total of 259 patients over 65 years of age found to have previously undiagnosed anemia. Measures: Physician estimates of the likelihood of iron deficiency before (pretest probability) and after (post-test probability) the laboratory test results were available. The hemogram was available to the physicians when they made their pretest probability estimates. Because the serum ferritin level proved to be the most powerful of the laboratory test results studied, the likelihood ratios associated with the post-test estimates were compared with the ratios associated with the serum ferritin level. Main results: The post-test probability estimates were influenced by the serum ferritin level and the pretest estimates. The post-test estimates derived from the findings obtained through history-taking and physical examination and the laboratory test results (including the serum ferritin level) were slightly less accurate in predicting iron deficiency than the serum ferritin level alone. Nevertheless, a model in which the pretest estimates were used in addition to the serum ferritin level to predict iron deficiency proved to be more powerful than the serum ferritin level alone (p = 0.006). This indicated that the limitations of the post-test estimates were due to a misinterpretation of the serum ferritin level and that the findings from history-taking and physical examination added important diagnostic information. Conclusions: Physicians must be aware of test properties to provide optimal care to their patients. If test results are properly interpreted, pretest probabilities derived from findings obtained through history-taking and physical examination can add useful information that will lead to more accurate diagnoses.

Journal of the American Geriatrics Society, Dec 1, 2006

DISCUSSION KA is a skin tumor that typically presents with a history of rapid growth over a short... more DISCUSSION KA is a skin tumor that typically presents with a history of rapid growth over a short period of time in people aged 50 and older. Sir Jonathan Hutchinson first described it in 1889 as ''crateriform ulcer of the face.'' 1 This tumor is most often a solitary pink or flesh-colored, dome-shaped nodule with a central keratin plug. A history of rapid growth over a period of 1 to 2 months, size of 1 to 2 cm, and spontaneous involution after 3 to 6 months is typical. Eighty-five percent of older people in the tropics and subtropics with this type of tumor develop it on the extremities, whereas 70% of lesions develop on the head and neck of people in temperate climates. 2,3 Etiology of this tumor is controversial. Viruses have been long suggested as an etiological agent, although the deoxyribonucleic acid sequence of the human papilloma virus has been detected only in a minority of the studied cases. Exposure to excessive sunlight is the most frequently noted incriminating factor in the etiology of KA. Other factors include tar exposure, immunosuppressive states, burns, psoriatic lesions previously treated using psoralen and ultraviolet A therapy, and other dermatoses. In recent years, there have been an increasing number of reports of KA arising at sites of trauma. 4-10 We present the first case of KA arising in an arthropod sting site. Tumorigenesis is a multistep process. We hypothesize that prolonged exposure to sunlight predisposes the development of KA in sites of trauma, and in this case of an elderly gentlemen with a history of a hornet sting, the arthropod sting served as the trigger.

The American Journal of Medicine, Mar 1, 1990

: Thirty-six percent of our patients had no demonstrable marrow iron and were classified as being... more : Thirty-six percent of our patients had no demonstrable marrow iron and were classified as being iron-deficient. The serum ferritin was the best test for distinguishing those with iron deficiency from those who were not iron-deficient. No other test added clinically important ...

Gerontologist, Dec 1, 1987

D. Joan Eagle, M.ScN., MSc, 2 Gordon Guyatt, MD, 34 ... Christopher Patterson, MD, 4 and Irene Tu... more D. Joan Eagle, M.ScN., MSc, 2 Gordon Guyatt, MD, 34 ... Christopher Patterson, MD, 4 and Irene Turpie, MD 4 ... Geriatric day hospitals provide a setting where comprehensive medical assessment and rehabilita-tion for frail elderly patients can be provided by an interdisciplinary team ...

Canadian Medical Association Journal, Sep 15, 1991

Academic Medicine, Oct 1, 1999

Restructuring Canada's Health Systems: How Do We Get There From Here?, 1992

Perspectives (Gerontological Nursing Association (Canada)), 2008

Persistent pain is a significant problem for older hospitalized adults and their health care team... more Persistent pain is a significant problem for older hospitalized adults and their health care team. A better understanding of the approach to pain management in the clinical setting will provide guidance for the development of improvements in clinical management. The purpose of this study was to determine the prevalence of pain and to examine the current state of pain assessment and management in older adults on the six acute medical units of an academic health sciences centre. Findings revealed that 70% of older patients were in pain, nurses had limited awareness of their patients' pain, documentation of pain assessment and management was lacking, and pain was under-treated. Utilization of practice guidelines related to management of persistent pain in older adults in acute care settings is recommended, and an approach to their implementation, including identifying and overcoming the barriers to such best practices, is warranted.

The American Journal of Medicine, 1986

CMAJ: Canadian …, 1986

To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients wi... more To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients with hip fractures, we reviewed the charts of all patients aged 60 years or older who were treated for hip fractures in five hospitals in Hamilton, Ont., between August 1982 and September 1983. We hypothesized that discharge to a different location from that before admission would indicate reduced functional status and classified the reasons for a change in residence as poor patient motivation, need for rehabilitation, compromised ambulation, postoperative complications and inevitable deterioration. We believed that geriatric care would be most beneficial to those in the first three groups. Of the 327 patients with hip fractures 40 (12%) died before discharge. Of the 287 surviving patients 149 (52%) had been discharged by 4 weeks, and only 29 (10%) remained in hospital by 12 weeks. Of the 287, 44 (15%) were discharged to a different location from that before admission: in 75% the cause appeared to be inevitable deterioration (57%) or postoperative complications (18%). The remaining 25% needed rehabilitation and were all sent to appropriate facilities. None of the patients with ambulation problems or poor motivation required an increased level of care. We could not show a need for geriatric care in our population; possible explanations are discussed.

Canadian family physician Médecin de famille canadien, 1992

Annals of internal medicine

Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupt... more Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. Prospective cohort study. Single university hospital. Consecutive patients who had warfarin therapy interrupted before an invasive procedure. Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. Blood anti-factor Xa heparin levels measured shortly before surgery. Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.

Annals of Internal Medicine, 2007

Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupt... more Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. Prospective cohort study. Single university hospital. Consecutive patients who had warfarin therapy interrupted before an invasive procedure. Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. Blood anti-factor Xa heparin levels measured shortly before surgery. Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.

Principles and Practice of Geriatric Medicine, 2005

Page 1. 160 Geriatric Day Hospitals Neil D. Gillespie1 and Irene D. Turpie2 1 University of Dunde... more Page 1. 160 Geriatric Day Hospitals Neil D. Gillespie1 and Irene D. Turpie2 1 University of Dundee, Dundee, UK, and 2 McMaster University, Hamilton, ON, Canada INTRODUCTION Geriatric Day Hospitals (DHs) are key components ...

Developments in Cardiovascular Medicine, 2004

Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!60... more Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!608. 6. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, Varrichio M, Rengo F. Congestive heart failure and cognitive impairment in an older population. ...

Developments in Cardiovascular Medicine, 2004

Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene... more Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene D. Turpie ... 30%, p<O.OOI). In the latter two studies, the severity of cognitive impairment was related to the severity of LV systolic dysfunction. ...