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Biomedical subjects

C Büla

Publications and source records attributed to C Büla.

16 recordsLinked to original sources
PubMed2006

[General internal medicine and geriatrics in the acute care setting: opportunities for collaboration].

The health care system faces a difficult challenge as a result of the demographic evolution. The acute hospital is especially challenged by the steady increase of the elderly population. The collaboration between internal medicine and geriatrics in this setting could prove useful to facilitate the adaptation of the acute care setting and greatly enhance education of the health care professionals. Internists and geriatricians can benefit from each other skills and competencies to develop together new models of acute care that would better match the elderly population needs.

Aged↗
PubMed2006

[How to decide when a situation is too complex?].

Health care professionals frequently face difficult clinical situations where no simple solution is available. In these situations, a pragmatic, structured ethical approach could be very helpful in defining ethical conflicts, systematically listing all possible options, and determining ethical justifications to their decisions.

Aged↗
PubMed2006

[Spirituality and elderly patients].

Spirituality includes notions as diverse as the purpose and meaning of one's life, the feeling of internal peace and harmony. Several epidemiological studies have shown evidence of an association between spirituality and mental, physical, as well as functional health status. These evidences, in conjunction with the high incidence of spiritual distress observed in older patients, increased the interest toward improving the assessment and management of spiritual distress in these older patients. Several ongoing studies investigate the benefits to expect from such intervention.

Aged↗
PubMed2005

[Oral anticoagulation in elderly people].

Oral anticoagulation in elderly people is a complex problem. The decision to initiate anticoagulant therapy in a patient with atrial fibrillation require to balance potential benefits (decreased risk of ischemic stroke) and risks (major hemorrhage, in particular intracranial), in the context of each patient's specific characteristics. Once the patient has been informed, his/her preferences must be integrated into the treatment decision-making process. Current guidelines recommend anticoagulation in all patients aged 75 years and more with atrial fibrillation who do not have counterindications to this treatment. Patients aged 65 to 75 years should also receive an anticoagulation, especially those with cardio-vascular risk factors.

Administration, Oral↗
PubMed2005

[Statins in older patients: limits to prescription?].

Cardio-vascular diseases are a major contributor to mortality, morbidity and functional decline in the elderly population. Hypercholesterolemia remains a major risk factor in older persons, but treatment decisions are difficult because of the paucity of data specific to this segment of the population. While evidence seems strong enough to support treating patients with cardio-vascular diseases (secondary prevention) up to their eighties, the question remains open whether to treat asymptomatic older patients (primary prevention) or those in their nineties.

Age Factors↗
PubMed2005

[Is there a treatment for Alzheimer's disease?].

Alzheimer's disease is a frequent neurodegenerative disease, which affects more than one third of elderly persons over 80 years. No curative treatment is currently available for this disease, but symptomatic treatments have produced significant improvements in patients' condition. Cholinesterase inhibitors should be prescribed for early and moderate stages and memantine for more severe stages of the disease. These drugs have an impact on cognitive performances, may delay functional decline and improve behaviour disturbances. From a preventive perspective, evidence of benefit from early management of vascular risk factors is accumulating. In the near future, the improved comprehension of the underlying mechanisms of Alzheimer's disease will hopefully bring new treatments, thats will delay or modify its course.

Alzheimer Disease↗
PubMed2005

[Gerontology].

What are the benefits of proteino-energetic supplementation in malnourished elderly persons? How many days should lower urinary tract infections be treated in elderly women? Is vitamin D supplementation effective in preventing falls? Does treatment with cholinesterase inhibitors and memantine benefit patients with Alzheimer's disease or Mild Cognitive Impairment (MCI)? This overview presents data from recent studies that attempted to answer these questions and contributed to improving the management of these important conditions in elderly persons.

Aged↗
PubMed2002

Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes.

In this study we describe an ambulatory system for estimation of spatio-temporal parameters during long periods of walking. This original method based on wavelet analysis is proposed to compute the values of temporal gait parameters from the angular velocity of lower limbs. Based on a mechanical model, the medio-lateral rotation of the lower limbs during stance and swing, the stride length and velocity are estimated by integration of the angular velocity. Measurement's accuracy was assessed using as a criterion standard the information provided by foot pressure sensors. To assess the accuracy of the method on a broad range of performance for each gait parameter, we gathered data from young and elderly subjects. No significant error was observed for toe-off detection, while a slight systematic delay (10 ms on average) existed between heelstrike obtained from gyroscopes and footswitch. There was no significant difference between actual spatial parameters (stride length and velocity) and their estimated values. Errors for velocity and stride length estimations were 0.06 m/s and 0.07 m, respectively. This system is light, portable, inexpensive and does not provoke any discomfort to subjects. It can be carried for long periods of time, thus providing new longitudinal information such as stride-to-stride variability of gait. Several clinical applications can be proposed such as outcome evaluation after total knee or hip replacement, external prosthesis adjustment for amputees, monitoring of rehabilitation progress, gait analysis in neurological diseases, and fall risk estimation in elderly.

Adult↗
PubMed2000

[Detection of cognitive disorders in clinical practice].

The detection rate of cognitive impairment by general practitioners in elderly hospitalised and ambulatory population is low, ranging from 50 to 73%, and from 24 to 42%, respectively. This is insufficient regarding the importance of an early diagnosis of dementia and Alzheimer's disease, for the patient and his/her proxies, but also for the primary care physician in charge. Thus, all general practitioners should have a strategy for the evaluation of cognitive impairment in elderly patient.

Aged↗
PubMed2000

[Hip protectors: what is their role in the prevention of femoral fractures?].

In elderly persons, hip fracture is frequent and associated with serious physical, functional and psychological consequences. Hip protectors seem promising for preventing hip fractures, especially in frail, institutionalized elderly persons. Despite methodological limitations, five randomized trials have reported positive results, with up to 85% risk fracture reduction in some trial. Interestingly, although 13 hip fractures occurred in subjects assigned to wear hip protector, only one occurred while the protector was actually worn. Adherence with wearing hip protectors remains a problem. Several ongoing trials will further enhance our knowledge on hip protectors effectiveness and cost-effectiveness to better define their role in hip fracture prevention.

Age Distribution↗
PubMed2000

[Between home and institution: network meetings as a decision aide].

Coordination of care is a critical step toward improvement of health care delivery for elderly persons. Family meetings with hospital and community health care professionals (network meeting) provide a unique opportunity to solve complex situations and improve coordination of care. Because this activity is time- and ressources-consuming a common list of domains to assess and indications to these meetings was developed by a team of hospital and community health care professionals. This article presents these indications and discusses opportunities and pitfalls of these network meetings.

Aged↗
PubMed1996

[Orthostatic hypotension in the elderly].

Orthostatic hypotension is observed in 10 to 20% of all patients aged 65 or over. The elderly is thus at an elevated risk for orthostatic hypotension; however, the relative contributions of normal ageing, of diseases and their respective treatments to its development are unknown. Orthostatic hypotension discovered by chance in a symptomatic or asymptomatic elderly patient has to be considered as risk for falls or syncopes. The most common reversible causes are side effects of various drugs and hypovolemia. Next to a specific therapy of the underlying causes, symptomatic measures are proposed. Pharmacotherapy is limited to patients incapacitated by symptoms.

Accidental Falls↗
PubMed1992

A novel score for predicting the mortality of septic shock patients.

OBJECTIVE: To establish a prognostic scoring system for septic shock patients. DESIGN: The clinical, biological, and hemodynamic data of these patients were retrospectively explored to select variables independently associated with outcome. According to the risk of death, ratings from 0 to 2 points were attributed to each value. SETTING: Medical intensive care service of a 1,000-bed tertiary care university medical center. PATIENTS: Eighty-eight patients in septic shock in whom hemodynamic measurements were performed using pulmonary artery flotation catheters. RESULTS: Fourteen clinical, biological, and hemodynamic variables were selected and rated for each patient. A Simplified Septic Shock Score, available immediately after admission and catheterization, was established by adding the rates of these variables. The mean Simplified Septic Shock Score was 2.5 +/- 1.7 (SD) in 43 survivors and 6.5 +/- 2.3 in 45 nonsurvivors (p less than .0001). Some underlying diseases and characteristics of infections also correlated with the outcome. Further ratings from 0 to 2 points were attributed to these conditions. A Complete Septic Shock Score was calculated by adding these rates to the Simplified Septic Shock Score. The Complete Septic Shock Score had a slightly better prognostic value than the Simplified Septic Shock Score, but it could be determined only after the availability of the microbiological data. The mean Complete Septic Shock Score was 3.1 +/- 1.9 in survivors and 8.4 +/- 2.6 in nonsurvivors (p less than .0001). Both Simplified and Complete Septic Shock Scores showed better association with patient outcome than the Simplified Acute Physiology Score or the Acute Physiology and Chronic Health Evaluation (APACHE II) score. CONCLUSIONS: The Simplified and the Complete Septic Shock Scores are simple scoring systems that appear to predict the outcome of septic shock patients more accurately than general scoring systems, such as the Simplified Acute Physiology Score and APACHE II score. These septic shock scores might be useful in assessing the severity of septic shock patients.

Adult↗