PubMed Health⌕ Search

Biomedical subjects

C H Nolte

Publications and source records attributed to C H Nolte.

10 recordsLinked to original sources
PubMed2006

[Two simple questions to diagnose post-stroke depression].

BACKGROUND AND PURPOSE: Many patients develop a depression after having suffered a stroke. Such a Post-Stroke Depression (PSD) impairs rehabilitation and quality of life. PSD is underdiagnosed in spite of available treatment. Several questionnaires have been created to diagnose a PSD. But questionnaires have been considered cumbersome and time-consuming. The aim of this study was to find out whether two simple, standardised questions will identify those stroke patients, who have developed a PSD. METHODS: The two case-finding questions and the Beck Depression Inventory (BDI) were sent to patients of the Berlin Acute Stroke Study (BASS) four years after their stroke. Incomplete questionnaires were complemented via mail or telephone. Severity of depression was assessed by means of BDI. RESULTS: Out of 211 patients, 199 responded to the questionnaire (94 %). 193 questionnaires were complete (97 %). Forty-two patients affirmed both case-finding questions (22 %). Compared to patients, who did not affirm both questions, these patients had a higher BDI score (19 +/- 8 vs. 7 +/- 5; p < 0.001). The sensitivity and specificity of the two questions were 89 % and 90 %, respectively. The positive and negative predictive value were 60 % and 98 % respectively. The number of confirmed questions (0, 1, 2) correlated well with the BDI score (r (2) = 0.67, p < 0.001). CONCLUSIONS: Two standardized questions can identify patients with PSD for further diagnostic evaluation and therapy. Diagnosis of PSD might be facilitated by using them as screening instrument.

Aged↗
PubMed2006

Emergency department delays in acute stroke - analysis of time between ED arrival and imaging.

We determined the factors leading to emergency department (ED) delays in patients with acute stroke. Data were collected prospectively in four Berlin inner-city hospitals by ED documentation, medical records, imaging files and patient interviews. An extended Cox proportional hazards model was fitted to the data. Analyses were performed in 558 patients with confirmed diagnosis of stroke. Median time from admission at ED to beginning of computed tomography/magnetic resonance imaging (CT/MRI) was 108 min. In a subgroup of patients potentially eligible for thrombolysis with a pre-hospital delay <120 min and a National Institutes of Health Stroke Scale (NIHSS) >4 (n = 74), the median interval to imaging was 68 min. Multivariable analysis revealed that a more severe initial NIHSS, a pre-hospital delay <3 h, admission at two specific hospitals, admission at weekends, and private health insurance were significantly associated with reduced delays. In stroke patients, the time interval between ED admission and imaging depends both on factors that emerge from clinical needs and on factors independent of clinical necessities. Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for both improvement of in-hospital management and of medical and non-medical factors influencing pre-hospital delays.

Aged↗
PubMed2005

Early-onset ALS with long-term survival associated with spastin gene mutation.

The authors report a 73-year-old patient with a natural history of early-onset ALS for 49 years presenting with limb and bulbar amyotrophy and a pyramidal syndrome. Analysis of the locus SPG4 identified a heterozygous duplication mutation (c.304_309dupGCCTCG) within exon 1 of the spastin gene. We propose that sequence alterations of spastin may comprise a genetic risk factor in a greater spectrum of motor neuron disorders including clinical variants of ALS.

Adenosine Triphosphatases↗
PubMed2005

[Symptoms, risk factors, and etiology of transient ischemic attack and stroke].

BACKGROUND: It is unclear whether clinical signs and symptoms differ in the presentation of transient ischemic attack (TIA) and stroke, apart from temporal dynamics. METHODS: Signs and symptoms of patients diagnosed with TIA or stroke were prospectively collected and compared by means of an age-adjusted logistic regression analysis. Risk factors, prehospital medication, and diagnostic workup were obtained from the charts. RESULTS: Four hundred five patients diagnosed with stroke (68+/-12 years old, 45% female) and 143 diagnosed with TIA (64+/-14 years old, 48% female) were included. Signs and symptoms of patients with TIA were less often "classic" such as paresis (48% vs 71%, P<0.001) or sensory loss (38% vs 48%, P=0.03). The etiology of TIA was more often classified as "undetermined" (57% vs 46%, P<0.05). CONCLUSIONS: Transient ischemic attack needs special attention and intensive diagnostic workup, because it bears a considerable risk of death and disability but presents less often with classic signs and symptoms and its etiology often remains undetermined.

Aged↗
PubMed2005

[The reliability of the german version of the barthel-index and the development of a postal and telephone version for the application on stroke patients].

BACKGROUND AND PURPOSES: Aim of the study was to translate the original version of the Barthel-Index (BI) into German and to investigate the reliability of the German version. In addition, a German version of the BI for postal and telephone use was developed. METHODS: Data were collected in four neurological hospitals in Germany. The translation of the BI followed the protocol of the Medical Outcomes Trust. The interrater reliability of the German version of the BI was investigated in 72 patients after acute stroke. The reliability of the postal and telephone version of the BI was compared with face-to-face interview in 147 patients three months after stroke. Reliability was assessed using simple weighted kappa-statistics. RESULTS: The interrater reliability of the German version of the BI was excellent (mean kappa 0.93). The mean kappa coefficient was 0.79 for the postal version of the BI and 0.80 for the telephone version. Thus, the agreement between the postal and the telephone administration of the BI compared to the face-to-face interview was substantial to excellent. CONCLUSIONS: Our study published the first German version of the BI which was investigated for interrater reliability in a standardized way. The development of a postal and a telephone version allows the widespread use of the German BI for the follow up of stroke patients in different access paths.

Acute Disease↗
PubMed2005

Ultrasound perfusion imaging of cysts in the midbrain.

AIM: Cerebral ultrasound perfusion examinations have been focused on the diencephalic plane. We describe perfusion abnormalities in the mesencephalon. METHOD: Phase-Inversion-Harmonic-Imaging (PIHI, Siemens Sonoline Elegra) was performed in a patient with ponto-mesencephalic cysts, that was defined by MRI. The signal increase (bolus kinetics, SonoVue) was quantified for peak-signal-increase (PSI) and time-to-peak (TTP). RESULTS: PSI and TTP could be quantified for the ipsi- and contralateral posterior cerebral arteries, the ipsilateral middle cerebral artery, the mesencephalon and the ipsilateral temporal lobe. The contrast agent influx was diminished or extinct in the area of the cysts. PSI and TTP delineated the area of the cystic structure well. CONCLUSION: PIHI in the mesencephalic plane is feasible and allows identification of pathological structures within the mesencephalon.

Brain Diseases↗
PubMed2005

Medical resource use and costs of health care after acute stroke in Germany.

The purpose of this study was to determine the 12 months medical resource use following admission to hospital with acute stroke and to calculate costs from a societal perspective. Data of consecutive patients with confirmed stroke were analysed. Acute hospital data were taken from medical records, socio-demographic variables from patients' interviews. A follow-up questionnaire about resource utilization was completed by patients or proxies 12 months after acute hospital admission. Costs were calculated by multiplying medical resource units used with cost factors per unit. Mean age of a total of 383 patients was 65 years and 41% were female. The median length of the initial stay in the acute hospital was 12 days at an average cost of 4650 per patient (49% of direct costs). Rehabilitation (16%), readmission (11%), medication (9%), and nursing costs (6%) were other contributors to the direct costs which amounted to a total of 9452 +/- 7599 per patient during 12 months. Indirect cost amounted to a total of 2014 +/- 5312. Patients' age, severity and type of stroke influenced the total stroke-associated costs. The large economic burden of stroke indicates the need for assessing and improving efficient health care for affected patients.

Aged↗