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Biomedical subjects

A Breull

Publications and source records attributed to A Breull.

9 recordsLinked to original sources
PubMed1999

[Early diagnosis and early treatment of cognitive disorders: a study of geriatric screening of an unselected patient population in general practice].

To investigate the feasibility of early assessment of preventable disabilities in primary care, we developed a geriatric preventive screening examination with various indicators of physical, emotional, and social functions as well as laboratory exams. Cognitive impairment was measured by the modified MMSE. Severe cases of dementia, who would deserve home visits were excluded. Results of the assessment procedure in 446 patients aged 70 and over (71.5% females) were compared to ratings of general practitioners (n = 67). In these patients we found 4250 medical, 374 psychiatric, and 528 social problems. 45.4% of medical, 61.8% of psychiatric, and 56.8% of social problems where hitherto unknown to the GPs. The prevalence of cognitive impairment was 4.6% according to GPs diagnosis and 21% according to the MMSE. The sensitivity of GPs diagnosis was 14%, the specificity 98%, and the overall agreement measured by kappa was 0.17. There were significant (p < 0.05) associations of cognitive impairment with poor health, vascular disease, syncope, weight loss, previous hospitalization, depression, and ADL and IADL-items. Hypertension, or pathological thyroid function, occurred more frequently in the cognitively impaired (p > 0.05). Only 19.5% of dementia cases had severe functional loss, which substantiates our hypothesis that mild dementia was studied. Of all cases with newly identified cognitive impairment (n = 83 of 446 patients), three (3.6%) had reversible disorder such as depression (n = 1), drug toxicity (n = 2) 3 (3.6%) received counseling, and 5 (6%) further diagnostic assessment or treatment. One (1.2%) patient did not accept any treatment. In the remainder of 71 patients (85.5%), the GPs adopted a wait and see strategy with no intervention. In conclusion, memory deficits seem to be underdiagnosed in general practice despite much treatable comorbidity or social problems, and some reversible conditions such as depression and drug adverse effects.

Activities of Daily Living↗
PubMed1999

Changes of laboratory markers of cognitive brain function by thermostimuli in the elderly.

OBJECTIVE: Plain external applications of physical stimuli, which are used quite commonly in geriatric care in Germany, have not been studied for their influence on cognitive brain function. The aim of this randomized crossover study was to examine the influence of dermatoreceptive stimuli on cognitive brain function in healthy geriatric volunteers. METHODS: Twenty-four healthy volunteers (23 women, 1 man) were randomized into two groups (crossover design). Group A (mean age, 68.8+/-6.2 [SD] years) was treated with a 10 degrees C to 12 degrees C cold stimulus for 10 seconds (a so-called "Kneipp face shower"), followed by a cold 10 degrees C to 12 degrees C wetpack at the neck for 1 minute. Group B (mean age, 69.8+/-5.3 [SD] years) was subjected to an identical procedure but with warm to neutral temperatures of 34 degrees C to 36 degrees C. After I week the two groups were interchanged. The parameters of interest were the critical flicker frequency (CFF) and the latencies of the event-related P-300 potentials of the visual evoked potentials (VEP), which can be considered an electroencephalographic marker of the cognitive functional ability. The CFFs and the P-300 latencies and amplitudes were measured directly both before and 10 minutes after the application of the respective stimuli. In addition, the CFFs were recorded 30 and 60 minutes later. RESULTS: After cold water stimuli were applied, the CFF increased from 32.55+/-2.26/sec (mean+/-SD) to 33.06+/-2.25/sec (p = .003) 10 minutes after the stimulus. Thirty minutes later the CFF was still elevated at 32.95+/-2.3/sec (p = .043). The P-300 latencies, after cold water application, decreased by 4.8% (p < .001), from 266.5+/-21.1msec (mean+/-SD) to 253.7+/-16.9msec. After warm stimuli they increased from 258.69+/-14.8msec to 266.17+/-20.1msec (p = .01). The P-300 amplitudes were significantly elevated, by 5% (p = .004), only after cold stimuli. CONCLUSION: Cold water applied locally to the face and neck region can provoke significant changes in electroencephalographic markers as measured by an electroencephalographic marker (VEP and P-300 latency) and, by inference, may help to improve cognitive function in the elderly.

Aged↗
PubMed1999

[Promoting quality and quality circles from the viewpoint of established physicians--representative Bremen and Saxony-Anhalt results].

RESEARCH QUESTION: To study the attitudes of ambulatory care physicians towards quality improvement, the intentions to join quality circles (QCs, peer review groups) and the expectations directed towards them. METHODS/SETTING: Survey with a five-page questionnaire posted to all ambulatory care physicians in the German states of Saxony-Anhalt (n = 3139) and Bremen (n = 1131). RESULTS: Response rates were 61.8% in Saxony-Anhalt and 41.7% in Bremen. 2412 questionnaires were available in this largest survey on that topic in Germany. Necessity of quality improvement (QI) in ambulatory care was approved by the majority of the respondents (1.7 on a 5-point Lickert scale). Concerns existed about a rise in control and the risk of abuse of QI measures. 56.4% in Saxony-Anhalt and 52.3% in Bremen had the intention to join a QC. Motives and impediments of participation in QCs were investigated by content analysis. A causal dominance analysis was performed to identify the key elements for the decision to participate. The main benefits of QC-participation were expected as assistance in daily practice and exchange of experiences. The major obstacles were professional and private duties, fear of control and inefficiency. CONCLUSIONS: Policies that could be adequate to rise motivations and tackle on widespread fears should be purposely adapted to the needs and expectations of the physicians.

Attitude of Health Personnel↗
PubMed1998

[Vision disorders in the elderly].

BACKGROUND: British trials from the 60's reveal that older patients tend to underreport their health problems. They misjudge them as non specific or being caused by old age. In this study we investigate whether standard preventive assessment facilitates the detection and early intervention of ophthalmological problems in old age. METHODOLOGY: For the first time a representative screening trial for older patients visiting their general practitioner was carried out in Germany, 1994. The surgeries as well as the 466 participating patients over 69 years were randomly selected. GPs were asked to examine the visual problems of the participants per standardized questionnaire and visual accuracy test. GPs had to report uncovered problems and planned interventions. RESULTS: Altogether, 75% of the participating patients had some need for a further ophthalmological diagnostic or therapeutic intervention. Every fourth patient had not seen an ophthalmologist within the last two years. 40% of the participants complained of eye problems. 22% had symptoms of a glaucoma. Visual accuracy was low in 17% of the older patients. General practitioners had only been aware of 50% of all visual problems requiring further intervention. About half of the patients with a low visual accuracy and 70% with an indication of glaucoma had been unknown before. For about half of the patients requiring ophthalmological investigation (excluding problems with glasses) an intervention was planned. For every fifth, the general practitioners initiated referrals. CONCLUSION: The standard preventive facilitated to detect a high rate of visual problems in old age. Close cooperation with ophthalmologists is necessary for patients who do not take up the specialists' eye check ups (especially those at risk). Patients with severe eye problems in some cases in spite of specialists' care also require interdisciplinary treatment.

Aged↗
PubMed1989

[A new concept of psychosomatic research exemplified by premature labor].

One of the most serious problems of psychosomatic research is the adequate choice of the method applied to clinical questions. In the past empirical investigations have been based upon univariate and moreover linear correlations. In this study a multivariate nonlinear concept was developed which was generated in a first trial proven and confirmed prospectively in a second one using two sorts of mathematical analyses. The first included 35 patients with premature labour and 25 healthy pregnant women as controls. The latter was conducted with 238 patients being recruited in the first trimester of pregnancy, 30 of whom developed premature labour in the course of the study. Using a questionnaire consisting of the main aetiological variables identified in the basic investigation and using the statistical procedures mentioned above the occurrence of premature labour was predicted in more than 90%. Only one patient who was not suspected to develop premature uterine activity was not classified correctly. Besides clinical usefulness the model of research presented provides evidence for the most important aetiologic conditions of the disease as far as psychosocial factors are concerned and offers a new approach to quantifying research including somatic and non-somatic variables.

Adult↗
PubMedDate not supplied

Cerebral autoregulation during whole-body hypothermia and hyperthermia stimulus.

The purpose of the study contained herein was to investigate the effects of old traditional physiotherapeutic treatments on cerebral autoregulation. Treatment consisted of complete body immersion in cold or warm water baths. Fifteen volunteers were investigated by means of transcranial Doppler sonography and a servo-controlled noninvasive device for blood pressure measuring. One group of 8 volunteers (mean age, 27.2+/-3.5 yr; gender, 3 females/5 males) was subjected to cold baths of 22 degrees C for 20 min Another group of 7 volunteers (mean age, 52.1+/-8.5 yr; gender, 4 females/3 males) took hyperthermic baths at rising water temperatures from 36 degrees to 42 degrees C, increased by 1 degree C every 5 min. Each volunteer in both groups underwent autoregulation tests two to four times before, during, and after the thermic bath. Dynamic autoregulation was measured by the response of cerebral blood flow velocity to a transient decrease of the mean arterial blood pressure, induced by rapid deflation of thigh cuffs. The autoregulation index, i.e., a measure of the speed of change of cerebral autoregulation, was used to quantify the response. Further parameters were core temperature, blood pressure (mm Hg) and CO2et. During hypothermic baths, core temperature decreased by 0.3 degrees C (P = 0.001), measured between preliminary phase and the end of the bath; the autoregulation index decreased significantly (P < 0.05) from 5.3 before the bath to 4.25 during the bath. During hyperthermic baths, the autoregulation index increased from 6.0 to 7.5 and 8.9 (P < 0.001), with an increase of core temperature of 0.4 degrees C. The main cerebral autoregulation system is dependent on changes of core temperature, provoked by hypothermic or hyperthermic whole-body thermostimulus. Application of hyperthermic baths increased the autoregulation index, and hypothermic baths decreased the autoregulation index. Further studies are needed to prove the positive effects of thermo-stimulating water applications on cerebral hemodynamics in patients with cerebral diseases.

Adult↗