Biomedical subjects

Beate Wild

Publications and source records attributed to Beate Wild.

6 recordsLinked to original sources

PubMed2006

[Pain and quality of life following palliative radiotherapy of bone metastases].

BACKGROUND AND PURPOSE: Palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. PATIENTS AND METHODS: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. RESULTS: Radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. CONCLUSION: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects.

Aged↗

PubMed2004

Improvement of the educational process by computer-based visualization of procedures: randomized controlled trial.

BACKGROUND: Before any invasive procedure, physicians have a legal obligation to inform patients. Traditionally, this involves a discussion with a physician, supplemented by written leaflet information directed at the specific procedure. OBJECTIVE: Comparison of the use and effectiveness of computer-based visualization opposed to standardized conversation for providing patients with information of forthcoming procedures (coronary catheters or endoscopy procedures). METHODS: Prospective, randomized trial with 56 participants allocated in two different groups: Visualization Group (standardized information supported by a tool for displaying two-dimensional pictures to explain medical facts as well as informative leaflet) or Control Group (standardized information and informative leaflet only). Detailed information was given about the indication, the probable complications and the details of the forthcoming procedures (coronary catheters or endoscopy procedures). All participants had to reach a Karnofsky Score of 70 points and be able to understand German or English. Main outcome measures were patient's satisfaction with physician-patient conversation, patient's acquired knowledge and duration of the intervention as described above. RESULTS: Patients of the Visualization Group were more satisfied with the conversation and had higher knowledge scores after the conversation. A Mann-Whitney-U-Test between the two groups showed that these differences in satisfaction (P<0.001) and knowledge (P= or <0.006) were statistically significant. Length of time needed for the conversation was slightly higher in the Visualization Group, but this difference was not statistically significant (25 versus 23 min; P= 0.441). No differences could be found due to differing age or educational level in the results of the Visualization and the Control Group. CONCLUSIONS: Using computerized visualization increased the satisfaction and knowledge of the patients. The presentation of the visualized information in the Visualization Group did not demand significantly more time than the standard conversation in the Control Group.

Adult↗

PubMed2004

[Somatoform complaints in the elderly. Prevalence and associations with personality variables, career, and family].

The aim of this study is to determine the prevalence of clinically relevant somatoform complaints in a representative sample of the elderly. For the first time, the job-related development of the elderly is analysed in relation to somatoform complaints. Further, personality variables and family development are examined. The data basis of the evaluation is a partial sample (n = 1002) of the cohort study "Interdisziplinäre Längsschnittstudie des Erwachsenenalters" (ILSE). The assessment included a half-structured interview on the development of work and family, a detailed clinical examination, a psychiatric screening (SCID) and the neuroticism and extraversion scales of the personality test NEO-FFI. A total of 29 participants (2.9%) with clinically relevant somatoform complaints were identified, 20 females and 9 males. They were significantly less satisfied and less involved in their careers than the rest of the sample. They evaluated their partnership as significantly worse, yet the amount of experienced distress did not differ. The index group scored much higher on scales for neuroticism than the other, whereas they scored significantly lower on scales for extraversion.

Age Factors↗

PubMedDate not supplied

Reporting psychosomatic consultations in the discharge letter: an examination of communication between inpatient and primary care physicians.

The discharge letter is the primary means of communication between the inpatient and the outpatient treatment providers in the German health care system. The inclusion of psychosomatic consultation findings within the discharge letter is a critical step for impacting the psychosocial aspects of patient care following discharge. The present retrospective study measured the extent to which psychosomatic consultations conducted at the University of Heidelberg Medical Hospital were mentioned in the discharge letter during a 2-year index period. Psychosomatic consultations (N=605) were requested by a total of 101 inpatient physicians and conducted by 9 consultants. Of the 528 discharge letters that were reviewed, 67.8% referenced the psychosomatic consultation. Results from a stepwise logistic regression analysis found that a reason for referral due to "presumed psychiatric etiology of unexplained physical complaints" was the strongest predictor of whether the consultation was mentioned in the discharge letter (odds ratio=2.27). In contrast, a referral due to "coping and compliance problems" or the identification of psychosocial problems secondary to a somatic illness significantly decreased the chance of communication. The high rate of communication when physicians are confronted with a complex diagnostic picture involving presumed psychiatric comorbidity underscores the perceived usefulness of the consultation. However, consultants may need to take an active role in facilitating the management of psychosocial aspects of care during the inpatient stay and following discharge in an effort to improve concordance.

Adult↗

PubMedDate not supplied

Effect of depressive symptoms on survival after heart transplantation.

OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated. METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome. RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables. CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.

Anxiety↗

PubMedDate not supplied

Predictors of psychiatric comorbidity in medical outpatients.

OBJECTIVE: Psychiatric comorbidity in medical outpatients is associated with personal suffering and reduced psychosocial functioning. Simple clinical indicators are needed to improve recognition and treatment of psychiatric comorbidity. This study aimed to identify predictors of psychiatric comorbidity for diagnostic use in busy medical settings and to describe their criterion validity. METHODS: The SCID was adopted as the independent criterion standard for the presence of a psychiatric comorbidity in 357 patients (68% female; mean age, 43 years) of six internal medicine outpatient clinics and 12 general practices. Potential indicators of psychiatric comorbidity were investigated by means of patient and physician questionnaires. Logistic regression analyses were used to identify independent predictors of psychiatric comorbidity, and their operating characteristics were determined. RESULTS: Of 18 indicators, the four most important predictors of psychiatric comorbidity were identified: a screening question for nervousness, anxiety, or worries (odds ratio, 11.9; p <.001), a screening question for depressed mood (odds ratio, 8.8; p <.001), the self-report of three or more bothersome physical symptoms (odds ratio, 3.2; p =.001), and feeling distressed by partner difficulties (odds ratio, 2.7; p =.006). The combined assessment of the four predictors resulted in positive predictive values as high as 100%, negative predictive values as high as 91%, sensitivities as high as 86%, and specificities as high as 100%. CONCLUSIONS: The identification of mental disorders in medical outpatients could be substantially improved by the knowledge and use of four easily accessible predictors. When the presence of one or more of these predictors can be confirmed, it is suggested that the patient undergo further evaluation to determine more precisely the presence and specific type of psychiatric disorder being identified.

Adult↗