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Biomedical subjects

F G Pajonk

Publications and source records attributed to F G Pajonk.

12 recordsLinked to original sources
PubMed2002

[Outcome of long-term intensive therapy of surgery patients].

OBJECTIVE: The treatment of severely ill patients remains a medical and human challenge. The aim of the study was to determine the survival rate of patients with prolonged intensive care unit (ICU) treatment. Additionally, the somatic, psychological, and social sequelae of the survivors should be determined. METHODS: Data of all patients who stayed for at least 30 consecutive days on a surgical ICU were evaluated with respect to age, sex, diagnosis on admission, APACHE II-Score, ISS, pre-existing diseases, therapeutic procedures, complications, organ dysfunctions, and mortality. The survivors passed a follow-up examination after 35 +/- 14 months. This included somatic, psychological, and social parameters. RESULTS: Data of 101 patients were analysed (m/f: 78/23, mean age: 49.9 +/- 18.2 years, mean stay on ICU: 57 +/- 37 days, trauma patients: 46%). 31 subjects died on the ICU. Until the follow-up, another 24 patients deceased. Thus, the total mortality rose to 55%. Age, diagnosis on admission and severity of organ failure influenced the ICU mortality. Concerning the mortality after discharge, age, pre-existing morbidity and diagnosis on admission affected the outcome. 41 of the remaining 46 patients (89%) underwent the follow-up. Nearly half of them showed no or minor signs of impairment in any of the investigated areas. One third had severe handicaps. Trauma patients had the lowest mortality rates but showed worse results in rehabilitation. CONCLUSIONS: The mortality after prolonged ICU-treatment is substantially higher compared to average ICU patients. However, having survived the acute phase of the illness, successful rehabilitation in somatic, psychic as well as social terms could be performed to a considerable extent. This outcome is comparable to the one of other ICU populations. The results encourage to a consequent use of all medical options.

Adult↗
PubMed2001

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs.

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Adult↗
PubMed2001

[Psychiatric emergencies in preclinical emergency service; incidence, treatment and evaluation by emergency physicians and staff].

Preclinical psychiatric emergency situations (PES) rank third in frequency of calls in the German emergency medical system (EMS). However, few data exist concerning relevance and treatment of PES. The aim of this study was to investigate this relevance in preclinical EMS and its appraisal by emergency physicians and paramedics. The protocols filled in by EMS physicians on emergency duty in a German district were evaluated concerning PES. In addition, the emergency physicians and paramedics of the district were asked to complete a validated questionnaire concerning the importance, their own understanding of PES, and interest in training programs. With 9.2%, preclinical PES ranked third in frequency of all EMS calls. The most frequent case was substance abuse disorder (70%), followed by suicide attempts or ideation (33%). Specific therapy for psychiatric disorders is hardly ever performed. Emergency physicians and paramedics estimated the importance of knowledge about PES as high but rated their own knowledge as poor. Assessing five typical PES, emergency physicians gave the correct diagnoses in 71% of cases (paramedics 39%) and the correct therapy in 32% (paramedics 14%). The interest in training programs was significantly higher in experienced EMS physicians. Preclinical PES is a relevant diagnosis within EMS and correct treatment is hampered by limited knowledge. Sufficient training is not yet available, although programs are necessary and the willingness to participate in them is high.

Acute Disease↗
PubMed2001

[Evaluation of a training program "Psychiatry for EmergencyPhysicians"].

OBJECTIVE: Psychiatric education was neglected in emergency medicine until lately. Although measures for assuring the quality of care are established, there are up to now no investigations about the effectiveness of the psychiatric programs which are used in the German Emergency Physicians' Basic Training Program (EPTP-B, "Fachkundenachweis Rettungsdienst"). Herewith a first evaluation of a training program for psychiatric emergencies is presented. METHODS: Participants of the EPTP-B in Hamburg were imparted defined contents to achieve the educational objective. Before and afterwards two semi-structured questionnaires had to be answered asking for previous knowledge, attitudes, educational success and necessity for further training. RESULTS: At the beginning of the course 42 medical doctors (m/f: 22/20, mean age: 32.2 +/- 4.6 years) estimated their knowledge as poor and the necessity for training as high. At the end, the majority rated the program as educative, informative (69%) and practical (81%). However, the training was judged to be too short (81%) and the participants still felt too distant from the educational objective. CONCLUSIONS: There are necessity, demand and interest for an intensified psychiatric education of emergency physicians who are confronted with a high number and variety of psychic disturbances. On-the-job training of the theoretical matters is essential.

Adult↗
PubMed2001

[Psychiatric emergencies in the physician-based system of a German city].

OBJECTIVE: Pre-clinical Psychiatric Emergency Situations (PES) gain more scientific interest. First investigations revealed them to be the third major cause for emergency physician (EP) calls. However, there is still very little data concerning prevalence, diagnosis and therapy. METHODS: A retrospective analysis of all anonymised EP protocols of the year 1995 in the city of Hamburg was performed. Data of each multiple-choice category was evaluated as well as handwritten and personal notes to determine prevalence, diagnoses and therapy of PES. RESULTS: 2550 out of 26,347 protocols (9.7%) revealed to have a psychiatric disturbance as a major cause for the call. The most frequent diagnoses in the overall young (average age: 43.1 +/- 17.6 years) and male (60.3%) population were found to be alcoholic intoxication (34%), state of agitation (23%) and suicide attempts (22%). In 55% the emergencies could be considered as purely psychiatric; in 35% as a combined somatic-psychiatric emergency. A specific psychopharmacological treatment was not performed. CONCLUSIONS: Psychiatric patients are a considerable group in pre-clinical emergency medicine, however, disturbances are much too rarely documented, diagnosed and treated. Training programs are necessary. Psychiatry has to play a more active role in planning and performing these programs.

Adult↗
PubMed2000

[Quality of life after long-term surgical intensive care treatment].

INTRODUCTION: Long-term treatment in surgical intensive care units (SICU) subjects the patient to a high degree of somatic, psychological, and social stress. The aim of this study was to determine their outcome in terms of quality of life and health status. METHODS: All patients from a 4-year period in a SICU with a length of stay (LOS) of 30 days or more were included. All survivors were interviewed and examined after 35 +/- 14 months; they also completed several questionnaires (Munich Inventory for Quality of Life and Health Status, POMS, and Spitzer Quality of Life Index). RESULTS: One hundred one patients fulfilled the inclusion criteria, and 46 survived until follow-up. Forty-one (89%) could be traced and examined. Male:female ratio was 31:10, age 42 +/- 17 years, and LOS 51 +/- 19 days, Diagnoses on admittance were multiple trauma (n = 32) and other (n = 9). When classifying patients according to physical impairment, one third each showed no, mediocre, or severe limitations. Subjective appraisal of quality of life and well-being was sufficient for about half the patients in every test. Trauma victims experienced more severe impairment of quality of life. There were no differences between sex, age, or time until follow-up. CONCLUSION: After prolonged SICU treatment, about half of the patients report limitations in their quality of life as a result of their illness and the subsequent treatment. Some patients, in particular after trauma, exhibit striking psychosocial problems despite satisfactory somatic treatment results. These problems can be positively addressed in rehabilitative efforts.

Adult↗
PubMed2000

[Open studies in comparison to controlled studies in testing of neuroleptics].

OBJECTIVE: Due to methodological reservations, results concerning the efficacy of neuroleptics in open trials are often regarded with doubt. Until now, there are nearly no studies comparing findings of controlled double-blind with those of open trials. Aim of this study was to investigate if results of an open or double-blind approach differ and hereby to gain information about the validity of open trials. METHODS: After a literature research, five neuroleptics were identified for which at least 3 open and 3 double-blind trials exist which met the inclusion criteria and from which either the reduction of the BPRS (Brief Psychiatric Rating Scale)-score or the response rate could be determined. RESULTS: There were no differences in the reduction of the BPRS-score or response rate for all 5 neuroleptics between open and double-blind trials. Furthermore, the efficacy of all 5 neuroleptics was comparable. CONCLUSIONS: Double-blind controlled studies are essential in the investigation of new compounds. But results of methodologically well performed open studies are valid and deserve more attention. Preceding open trials may help in the design of double-blind studies.

Antipsychotic Agents↗
PubMed1999

Long-term results and quality of life after parasuicidal multiple blunt trauma.

OBJECTIVE: This study evaluates the somatic, socioeconomic, and psychiatric long-term results, as well as the factors for adverse outcome, in a significant subset of patients with severe multiple injuries resulting from attempted suicide. DESIGN: The follow-up study 6.1 +/- 3 (SD) yrs after trauma was based on prospectively documented data of patients with multiple injuries. SETTING: Level I university trauma center in a major German city. MEASUREMENTS AND MAIN RESULTS: Data derived from thorough physical and psychiatric evaluations. The Brief Psychiatric Rating Scale and the Global Assessment of Functioning Scale served to describe psychiatric outcome. PATIENTS: In a series of 539 severely injured patients (Abbreviated Injury Score in two regions > or = 3), 65 (12%) attempted suicides were reported (Injury Severity Score, 40 +/- 15; age, 38 +/- 18 yrs). Twenty-one patients of the study cohort died during the hospital stay, and six subjects died thereafter, none because of suicide. Three patients were lost to follow-up, resulting in 35 individuals eligible for examination. None of the latter had reattempted suicide. Seventeen (48%) had good or satisfactory outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings (Brief Psychiatric Rating Scale), and good psychosocial ability (Global Assessment of Functioning Scale). For eight patients (24%), the result was indeterminate. The adverse outcomes in ten patients (28%) were mainly influenced by the presence of chronic schizophrenia (n = 4), affective disorder (n = 2), or severe traumatic brain injury (n = 3). CONCLUSIONS: Despite the parasuicidal origin, the long-term results after severe trauma were good or satisfactory in approximately half the cases and without further suicide attempts in any of the patients. Good recovery of the parasuicidal patients in our study is approximately 20% lower than in an unselected group of patients with multiple injuries and may be attributed mainly to the underlying chronic psychiatric disease.

Adult↗
PubMed1998

Suicide attempts with mirtazapine overdose without complications.

BACKGROUND: One important aim of pharmacotherapy in depressed patients is the prevention of suicide attempts. Therefore, the medication given should be efficient and safe in overdose. RESULTS: We saw two patients after they had overdosed with mirtazapine because of suicidal intention. Both patients had taken 30 and 50 times a normal daily dose and achieved a full recovery without any complications or harm. CONCLUSIONS: Mirtazapine seems to be a safe compound in overdose. Therefore, it is an important therapeutic agent in depressed and suicidal patients.

Adult↗
PubMed1998

[Psychiatric emergencies from the viewpoint of the emergency physician].

OBJECTIVE: In the German physician-based emergency medical system (EMS) psychiatric emergency situations (PES) rank on third place contradictory to it's importance during emergency physician training program. The aim of our study was to examine the relevance of PES and the stress which PES imposes upon EMS physicians. Further, the interest of training programs on that issue was determined. Knowledge about PES was investigated by a short test. METHODS: 952 emergency physicians were sent a questionnaire about following: demographic data, frequency of PES, strain by PES, own knowledge, interest about training programs. Further five typical PES were presented for diagnostic and therapeutic judgement. RESULTS: 222 responded (183 men/37 women/2 without gender data, average age: 40.1 +/- 6.7, qualification as emergency physician: 9.6 +/- 5.1 years, most frequent subspeciality in-hospital physicians: anaesthesiology 67.5%, in-practice physicians: general medicine 72.1%). PES frequence was estimated at 9.4%, personal knowledge judged only by 13% as sufficient, 14.2 felt incapable by PES. 73% saw importance of training, especially expressed by the more experienced (P < 0.05). Test presented 65% correct diagnoses, 33% correct therapy, 26% incorrect decision of hospital admission. CONCLUSION: PES are a frequent problem of pre-hospital patient care for emergency physicians. As personal knowledge was estimated to be insufficient, the interest for courses concerning PES issues is high.

Adult↗
PubMed1994

Human immunodeficiency virus antibody test and seroprevalence in psychiatric patients.

Psychiatric inpatients are at risk for human immunodeficiency virus (HIV) infection. Investigations in the United States revealed seroprevalence rates of 5.5-8.9%. Therefore, inclusion of HIV antibody testing in routine laboratory screening is sometimes suggested. To investigate this issue for inpatients in the Department of Psychiatry, University of Munich, the incidence, reason for HIV testing and results were analyzed. Of 12,603 patients, hospitalized from 1985 to 1993, 4.9% (623 patients, 265 in risk groups) underwent the HIV test after informed consent. Thirty patients (4.8% of those tested) were found to be positive, but only in 5 cases (all of risk groups) was infection newly detected. Data indicate that, in psychiatry, HIV testing is reasonable only in patients in risk groups or if clinical variables suggest HIV infection.

Acquired Immunodeficiency Syndrome↗