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Biomedical subjects

D Roloff

Publications and source records attributed to D Roloff.

At least 19 recordsLinked to original sources
PubMed2005

Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections.

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.

Aged↗
PubMed2002

Reduced tolerance of simulated altitude (4200 m) in young men with borderline hypertension.

BACKGROUND: Primary hypertensives who are acutely exposed to hypoxic hypoxia show an enhanced reactivity of arterial chemoreceptors as well as an exaggerated response of the sympathetic nervous system. Since these phenomena could influence their ability to tolerate sustained hypoxic hypoxia, this study was performed to determine whether persons predisposed to hypertension have a normal tolerance of simulated high altitude. METHODS: Subjects were 18 young men with a family history of hypertension (sons of hypertensives, SOHT) whose BP values were in the upper normal or borderline hypertensive range. Controls were 15 young men without parental hypertension (sons of normotensives, SONT) who had normal BP values. Each subject underwent both a control and an altitude experiment. The latter consisted of an 8-h exposure to hypobaric hypoxia (equivalent to 4200 m) while resting supine in an altitude chamber. Fluids were administered by mouth and by intravenous line to produce sustained diuresis. Variables measured included heart rate, BP, respiratory rate, O2 saturation, urine flow rate, and sodium excretion. RESULTS: All subjects tolerated the control experiment and all SONT also completed altitude exposure. However, 8 of 18 SOHT developed antidiuresis and had to leave the chamber early due to symptoms of mild acute mountain sickness. Compared with SONT, SOHT exhibited more stable cardiorespiratory parameters at altitude. CONCLUSIONS: The data support the hypothesis that borderline hypertensives have stronger cardiorespiratory responses to altitude than controls, a response that is compatible with higher excitability of their arterial chemoreceptors. However, their altitude tolerance is reduced even at rest, probably because of the renal effects of an exaggerated response in the sympathetic nervous system.

Adaptation, Physiological↗
PubMed2000

Long-term effects of asthma education for physicians on patient satisfaction and use of health services.

This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance. Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1-12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines. Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine. It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care.

Adult↗
PubMed1998

Impact of education for physicians on patient outcomes.

OBJECTIVES: This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1) the treatment practices and communications and education behavior of physicians, 2) the health status and medical care utilization of their pediatric patients with asthma, and 3) the satisfaction with care of the subjects' parents. METHODS: A total of 74 general practice pediatricians were assigned to either a program or a control group in a randomized controlled study. Data were collected from physicians at baseline, and 69 (93%) provided follow-up data 5 months after the program. Data were also collected from 637 of their patients at baseline, and in a 22-month window after the intervention, 472 (74%) of this number provided follow-up data. RESULTS: After the seminar, physicians in the program group were more likely than were control group physicians to address patients' fears about medicines, review written instructions, provide a sequence of educational messages, write down how to adjust the medicines at home when symptoms change, and report that they spent less time with their patients. Parents of the children treated by program physicians were significantly more likely than were control group parents to report that the physician had been reassuring, described as a goal that the child be fully active, and gave information to relieve specific worries. After a visit with the physician, these parents were also more likely to report that they knew how to make management decisions at home. After the intervention compared to controls, patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler. After the intervention, children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms; however, there were no differences in emergency department visits and hospitalizations. Among children who were placed on inhaled corticosteroids during this study, however, children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits, and hospitalizations. CONCLUSIONS: The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.

Asthma↗
PubMed1997

A scale for Assessing Health Care Providers' Teaching and Communication Behavior regarding asthma.

Partnership between health care providers and patients is important for controlling illness. A limited number of studies show how to assess health professionals' communication and partnering behavior. The relationship between these aspects of professional behavior and enhanced management of disease by patients has received little empirical study. The research reported here developed a Health Care Providers' Teaching and Communication Behavior (TCB) scale for assessing the teaching and communication behavior of clinicians treating patients with asthma. Such a tool is needed for research related to provider-patient relationships and for evaluation of professionals' performance.

Adult↗
PubMed1996

Ventricular volume elasticity: a component of cardiovascular control?

According to Koepchen, stimulation of different receptors within a complex network produces typical patterns of effector responses. We investigated whether the dynamical volume elasticity of the heart chamber is an independent component of cardiovascular control. The measurement of the dynamical volume elasticity was calculated by changes of the eigenfrequency of a modified catheter transducer system. The carotid baro- and chemoreflex affected end-diastolic pressure, contractility and calculated diastolic and systolic elasticity to different extents. In conclusion, cardiac volume elasticity is an independent element interacting with other parameters in cardiovascular control.

Animals↗
PubMed1991

[Prerequisites for the transfer of patients with gas gangrene to a specialized facility].

According to the cases reported in the GDR as well as in the FRG, 1-2 persons contract a gas gangrene infection per week. The lethality is alarmingly high. In the GDR more than two thirds of the patients die. Among the numerous factors influencing the prognosis time is a very important one. Through early detection, adequate immediate therapy and subsequent prompt transfer to a treatment centre with facilities for hyperbaric oxygenation, the chances of survival can be improved considerably. Some experiences with the transfer of 275 patients under the tentative diagnosis "gas gangrene" are described, together with the preparation and actual transfer to a specialized centre. For the detection of the disease the clinical symptoms are of greatest importance. The histological findings confirm the diagnosis, bacterioscopy also provides early results. To start treatment early, one cannot wait for the result of the microbiological detection of clostridia which is virtually necessary for exact diagnosis. The initiated treatment (rigorous surgical removal of the gas gangrene focus, antibacterial and intensive therapeutic measures) has to be continued without interruption during transport with a rescue helicopter, aircraft or emergency ambulance. Medical care of the severely ill patient has to be provided throughout transportation. The practical measures are briefly described. The possibility for consultations should be used more frequently.

Gas Gangrene↗
PubMed1991

[Gas gangrene in childhood--a review].

Although gas gangrene in childhood is not mentioned in the paediatric literature, paediatric surgery textbooks included, this toxic wound infection also occurs in children. Prognosis totally depends on the early detection of the disease. Having checked over 2000 relevant literature sources, in which 110 cases of gas gangrene are mentioned, of which 24 are described in detail, this paper points to constellations paving the way for developing or favouring the infection. In aetiologic respect accidents range first, but also in children postoperative clostridial myonecrosis and those resulting from intramuscular injections are possible, but rare. On the basis of case reports the initial symptoms are stressed. In the foreground local (heavy pains, odematous swelling, "dirty" exudate, dyschromia, foetor) and general (tachycardia, rapidly deteriorating condition, shock, icterus) signs are dealt with, which occur after a latent period ranging between some few and 72 (up to 96) hours. Only through quick diagnosis and sufficient immediate therapy it will be possible to improve the prognosis and, in particular, reduce letality. A later publication in this journal will explain that also in children gas gangrene does not belong to those diseases which seldom occur.

Amputation, Surgical↗
PubMed1990

The volume elasticity of the heart: a method for its evaluation under closed chest conditions.

A method is described for measuring the volume elasticity of the heart under closed chest conditions by simply inserting a catheter in the left ventricle. The heart as a system capable of oscillations detunes an external oscillating system. The shift in resonance frequency is a measure of the volume elasticity. The time course of diastolic volume elasticity values during one filling phase shows that active mechanisms are involved in the filling. The method can be applied to human beings: it allows the measurement of the volume elasticity of the whole ventricle and of small areas of the myocardium.

Blood Pressure↗
PubMed1988

The influence of mixed venous pO2 on the natriuretic activity of cat plasma.

Plasma was taken from anaesthetised cats with high or low mixed venous pO2. Different plasma fractions were then administered to anaesthetised rats to examine the effect on sodium excretion. It was found that only the low molecular weight fraction of the plasma from cast with high mixed venous pO2 showed any natriuretic activity. A lipid soluble extract from the same plasma also increased sodium excretion. It is concluded that an increase in mixed venous pO2 in anaesthetised cats leads to the release or activation of a natriuretic factor, which has a molecular weight below 700 and is lipid soluble.

Animals↗
PubMed1986

Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases.

Extracorporeal membrane oxygenation (ECMO) was used in the treatment of 100 newborn infants with respiratory failure in three phases: Phase I (50 moribund patients to determine safety, efficacy, and risks); Phase II (30 high risk patients to compare ECMO to conventional ventilation); and Phase III (20 moderate to high risk patients, the current protocol). Seventy-two patients survived including 54% in Phase I, 90% in Phase II, and 90% in Phase III. The major complication was intracranial bleeding, which occurred in 89% of premature infants (less than 35 weeks) and 15% of full-term infants. Best survival results were in persistent fetal circulation (10, 10 survived), followed by congenital diaphragmatic hernia (9, 7 survived), meconium aspiration (44, 37 survived), respiratory distress syndrome (26, 13 survived), and sepsis (8, 3 survived). There were seven late deaths; in follow-up, 63% are normal or near normal, 17% had moderate to severe central nervous system dysfunction, and 8% had severe pulmonary dysfunction. ECMO is now used in several neonatal centers as the treatment of choice for full-term infants with respiratory failure that is unresponsive to conventional management. The success of this technique establishes prolonged extracorporeal circulation as a definitive means of treatment in reversible vital organ failure.

Catheterization↗
PubMed1986

Long-term effect of repeated short oxygen exposition on blood pressure development and erythrocyte sodium content in SHR and WKY.

Repeated short oxygen exposition (60 min weekly, beginning at the 1st week of age up to the 18th week of age) induced in male spontaneously hypertensive rats (SHR) a diminished blood pressure rise. Oxygen exposed SHR had also lower heart rates than SHR without oxygen exposition. No significant differences were found in both these parameters in normotensive rats (WKY). Furthermore oxygen exposition decreased the erythrocyte sodium content of SHR.

Aging↗
PubMed1985

[Relation of glucose tolerance and intracellular sodium concentration].

In rabbits with standard diet, in cholesterolaemic rabbits, in pregnant women with physiological hyperinsulinism and in a control group with lower peripheral insulin concentrations after glucose load negative correlations were found between the intracellular sodium content and the KG-value of the intravenous glucose tolerance test. The hormonally regulated blood glucose regulating circle was a prerequisite for these relations, since in vitro a high sodium concentration in the erythrocytes was connected with a high glucose uptake rate. The findings in the total organism were explained by cell membrane properties which stabilise the level of the intracellular sodium concentration as well as are important for functions of the blood glucose regulating circle. As a link between the carbohydrate metabolism and the electrolyte metabolism the SH-groups of the cell membrane were discussed. This concept was used for a pathophysiological explanation of the higher erythrocytic sodium concentrations proved in manifest diabetics.

Animals↗
PubMed1985

Venovenous perfusion in ECMO for newborn respiratory insufficiency. A clinical comparison with venoarterial perfusion.

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in the treatment of newborns less than 1 week of age and greater than 2000 gm birthweight with respiratory failure resistant to current medical and surgical management. While VA ECMO supports the heart as well as the lungs, it has the disadvantage of requiring carotid artery ligation and the possibility of perfusing air bubbles or particles into the arterial tree. We have treated 11 newborns with respiratory failure with venovenous (VV) ECMO returning the oxygenated blood to a cannula in the distal iliac vein. We compared these patients with 16 patients treated during the same period of time with VA ECMO. Three of the 11 VV patients required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations. Ten of the 11 VV patients survived. Eleven of the 16 VA patients survived. The better survival in these patients treated with VV ECMO is attributed to their more favorable initial condition compared to patients treated with VA ECMO. The disadvantages of VV ECMO include a longer operative time to place the cannulas, groin wound problems, and persistent leg swelling along with the necessity to convert some patients to VA ECMO. Although this experience demonstrates that newborns with severe respiratory failure can be supported with VV ECMO, the complications and lack of practical advantages over VA lead us to recommend VA ECMO for routine clinical use at present.

Female↗
PubMed1985

[Effect of changes in central venous oxygen partial pressure on kidney function in anesthetized cats].

An extracorporeal veno-venous bypass utilizing an oxygenator to alter mixed venous blood gases was used in experiments on chloralose anesthetized cats. The gas mixture in the oxygenator was alternate 95% O2 or 95% N2 with additional 5% CO2. The produced difference of pO2 in the right ventricle (pO2v-) was 1.3 kPa. The arterial acid base status and the blood gases were not affected by this procedure. Comparing the alterations of pO2v- the higher level of pO2v- was connected with an increase of the mean arterial blood pressure, of the clearances of inulin and PAH, and of the sodium and the potassium excretion. These experiments demonstrate that the alterations of pO2v- have influence on the renal function.

Anesthesia, General↗