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Biomedical subjects

F Raschke

Publications and source records attributed to F Raschke.

At least 19 recordsLinked to original sources
PubMed2003

[Cost-benefit analysis in patients with sleep-related breathing disorders - diagnosis and ncpap therapy during medical rehabilitation].

In a multi-centre study, 745 patients undergoing internal medical rehabilitation (for hypertension, coronary heart disease, gastrointestinal and respiratory diseases) were investigated. The health economic benefit was evaluated during the 3 weeks of medical rehabilitation, during which a sleep-medical diagnostic work-up and treatment were applied. Ambulatory screening for sleep-related breathing disorders was carried out in all patients. In positive cases (Apnoea-Hypopnoea Index > or = 10) transfer to our sleep lab was recommended. 103 patients were found to be positive, of whom 47 attended the lab; 23 of these accepted nCPAP therapy, while 24 did not. The costs of the additional diagnosis and treatment were considered incremental costs--and the benefit identified as the decrease in days off work as revealed by a comparison of the year before with the year after rehabilitation. Days off work decreased by 38.4 days in the treated group, and increased by 25.4 days in the untreated group. The results were extrapolated to all patients in internal medical rehabilitation in Germany, and a cost-benefit analysis showed that the benefit of expanding the additional investigation to cover all patients would far exceed the incremental costs in the first year after rehabilitation by 58.26 Mio [symbol: see text] and in the second year by 81.15 Mio. [symbol: see text].

Continuous Positive Airway Pressure↗
PubMed2000

[Goal-oriented measurement of short-, medium- and long-term effects in pneumological rehabilitation].

UNLABELLED: Assessment of goal-oriented short-, mean-, and long-term effects in pneumological rehabilitation: Despite of increasing quality in rehabilitation, the amount of treatment in pneumological rehabilitation has decreased by 40% in the last few years. A typical mark of quality is determination of individual objectives to reach a goal of therapy. METHODS: In 566 patients (381 male, 185 female, mean age 47.0 year, body mass index 27.5 kg/m2) goals have been assessed by a questionnaire given at the beginning, the end, 6, and 12 months after rehabilitation. The effect size (ES) of single symptoms, defined as difference between initial and following score values, divided by their standard deviation was used as mild (ES < 0.4), mean (ES < 0.8), or strong (ES > = 0.8) effect. Only those patients were considered, who initially rated for "often" and "very often" in a single symptom. RESULTS: At the end of rehabilitation the effect size was strong in 22 of 24 symptoms, mainly nocturnal symptoms. After 12 months 9 symptoms still revealed strong, and 12 mean effect sizes. These mainly again concerned nocturnal symptoms as palpation of the heart, breathlessness, cough, sweating, and headache, but even diurnal tiredness, spontaneously falling asleep, and lack of concentration revealed ES > 0.8. Additionally in 46 patients, who were incapable for work in more than 6 weeks the year before rehabilitation, a reduction of 81 days off job was measured in the year after rehabilitation. DISCUSSION: The definition of aims of therapy is a mark of quality, and ES proves as a sensitive instrument of assessment, giving remarkable effects even one year after medical rehabilitation.

Female↗
PubMed1998

[North Rhine-Westphalia Scientific Rehabilitation Group--"future strategies for rehabilitation"].

This Northrine-Westfalian integrated research system in rehabilitation aims at the development of future strategies for medical rehabilitation. The well known deficits of rehabilitation have led to different complementary projects. These comprise research on the lack of evidence in efficacy, predictors for outcomes, international cooperation, university related curricula in training, implementation of health economics and disease management, and finally the need for an actual adaptation of social legislation. The research topics have been transformed into key themes which will be coherently integrated by additional external expert knowledge acquired in workshops organized by a task force group for the development of future strategies.

Forecasting↗
PubMed1997

[Dynamics of pressure and flow curves of various expiratory pressure valves].

BACKGROUND: Flow dynamics of exhalation valves in home care ventilators (CPAP-, BiLevel-, and autoadjust machines) are determined by their physical properties. The flow characteristic implies distinct curves leading to expiratory increase and inspiratory decay of pressure depending on flow rate. MATERIAL AND METHODS: For examination of pressure/flow characteristic we examined several valves (one and two circular holes, Sullivan-, Whisper-Swivel-, Silence-valve). Expiratory peak and inspiratory trough assessed at constant pressure (10 mbar) were measured with varying flow rates. RESULTS: Valves differ with their pressure characteristics up to 1.2 mbar for inspiratory and 1.0 mbar for expiratory flow at 2.0 1/s. CONCLUSION: The specific characteristic for each valve is part of the total efficiency of a home care ventilator. Their pressure flow relationship has to be taken into account for titration process and for exchange between different machines and accessories.

Equipment Design↗
PubMed1997

Economic and medical significance of sleep-related breathing disorders.

The improvement in outpatient sleep medical care in the Federal Republic of Germany over the last 10 years has been associated with an increase in the costs for diagnosis and therapy of sleep-related breathing disorders. The medical importance of these sleep-related problems consists in their high prevalence, especially in middle-aged men and risk groups, e.g. in patients with cardiovascular conditions. The effect on the performability of patients, which is manifested in the excessive daytime sleepiness at the workplace and in everyday life, are likewise significant. For social insurance agencies, immense costs arise from the sequelae and concomitant illnesses of untreated sleep-related breathing disorders. A comparison of the costs and the benefits of diagnosis, therapy and follow-up of patients with sleep-related breathing disorders over a period of 10 years shows that a mean annual monetary net benefit of DEM 2.3 billion in the Federal Republic of Germany can be assumed. The health economics analysis shows that an appropriate provision of sleep-medical care for the population is of great benefit for the health of the nation and thus for the entire economy.

Activities of Daily Living↗
PubMed1997

[Current concepts and techniques in home ventilation therapy].

Home ventilation of spontaneous breathing during wake and chiefly during sleep has gained great importance in the last 10 years by means of noninvasive nasal pressure support ventilation (PSV). Intensive care and weaning has been complemented, or even replaced by this method. Self-adaptive machines are already available for about 2 years. Historical development is outlined, contrasted by the actual procedures, their advantages and disadvantages. Long term therapy implies functional and probably even morphological adaptation of spontaneous control of breathing which is briefly touched, according to recent investigations.

Critical Care↗
PubMed1995

[Paradoxical respiratory response, changes in heart rate and skin circulation in progressive isocapnic hypoxia in sleep apnea patients].

In 73 patients with sleep apnea syndrome, lung function tests, night-time polysomnography for determining the apnea index (AI), hyperoxic progressive hypercapnia tests under rebreathing conditions, and, after a short pause, isocapnic progressive hypoxia tests were carried out. The objective of these examinations was to study peripheral and central chemosensitivity, changes in heart rate and capillary cutaneous circulation under isocapnic hypoxia in patients with sleep apnea syndrome (SAS). The following linear relationships were presupposed for the evaluation: for peripheral chemosensitivity between SaO2 decrease and the increase in respiratory minute volume (VE) and for central chemosensitivity between PETCO2 rise and VE increase. Of the SAS patients with an AI > or = 10, 22.5% did not react to the hypoxia test with and increase in VE but rather with a decrease in the respiratory minute volume. This patient group exhibited a positive correlation between an increase in capillary cutaneous circulation and an increase in heart rate during the hypoxia test. The hypoxic respiratory response behavior is independent of the hypercapnic respiratory response, age, Broca index, initial heart rate, blood pressure, pulmonary function values, and the size of the apnea index. The results are discussed in the context of a reduced peripheral chemosensitivity and an associated reduced sympathetic activation.

Arousal↗
PubMed1995

[Glucose tolerance, insulin resistance and arterial hypertension in patients with obstructive sleep apnea syndrome].

Each of 51 patients (42 male, 9 female) examined by polysomnography for suspected obstructive sleep apnea syndrome (OSAS) was subjected to a glucose load test with 75 g glucose and determination of blood sugar and blood insulin levels (at 0, 30, 60, 120 and 180 min). The patients were divided into 4 groups; with and without excess weight (Broca index < or = > 110%), and with and without pathological apnea index (< or = > 10). There was no significant difference between the groups with respect to age. The corresponding groups did not show any significant differences with regard to Broca index or apnea index. However, the patient group with a Broca index > or = 110% and a pathological apnea index > or = 10 was significantly different to all other groups with regard to glucose and insulin level after 60 min. This group was also significantly different to all other groups with regard to systolic and diastolic blood pressure. The reduced glucose tolerance and increased insulin resistance in combination with arterial hypertension in this patient group is indicative that a combination of adiposity and OSAS represents a particularly high risk factor for the development of arterial hypertension even though the pathological mechanism responsible for the development of arterial hypertension is also present in members of both the normal weight OSAS group and the overweight group without OSAS who exhibit a metabolic predisposition for the development of hypertension. A synergetic interaction of both pathomechanisms favors the development of arterial hypertension. Overweight patients with OSAS thus constitute a high-risk group for the development of cardiovascular diseases.

Adult↗
PubMed1995

[Prevalence of sleep apnea syndrome with primary arterial hypertension in a cardiologic rehabilitation clinic].

In a group of 132 randomly selected male patients with the admission diagnosis arterial hypertension in a cardiological rehabilitation clinic, nightly monitoring was performed with Mesam 4 with records of the metabolism laboratory values and sleep disturbances longitudinally. Desaturation indexes of > or = 10/h after manual correction for plausibility revealed a total prevalence of 27.3% in the case of breathing disturbances. The prevalence increased to 52% in the over 55 year-old patients with a Broca index of > or = 120% in comparison to merely 15.4% in standard weighted, comparable age group. No differences were found in the laboratory values. These results again show the frequent occurrence of the combination adiposity, hypertension, and sleep apnea syndrome which has often been missed previously in specialist rehabilitation clinics.

Adult↗
PubMed1995

[Comparison of CPAP and BiPAP equipment with reference to work of breathing, pressure and flow constancy].

We have investigated mask pressure curves and nasal flow during nasal C- and BiPAP ventilation in the recumbent position. Nasal spontaneous breathing, C- and BiPAP-applications of 10 and 10/7 cmH2O have been investigated in 7 patients and 4 controls. With aid of an automatic computerised analysis each in- and expiratory phase has been normalized by time and plotted as pressure-volume-loop from pooled data. The ventilators showed significant intra- and inter-machine differences. The investigations are considered as approach to real assessment of patient's work of breathing on home ventilators. They clearly show that ventilators have individual patterns, which should be considered carefully, long term machine-according effects are not yet known.

Adult↗