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G Ullrich

Publications and source records attributed to G Ullrich.

At least 19 recordsLinked to original sources
PubMed2004

The experience of the support person involved in a lung transplant programme: results of a pilot study.

UNLABELLED: In contrast to the high priority most transplant programmes give to the recipient's support system there is a paucity of studies referring to the experience of the respective support persons. This study sought to focus on the subjective burden of support persons and their unmet needs. METHOD: A questionnaire was designed for a cross-sectional study using numerical rating scales and fill-in-the-gap-items concerning subjective burden, stress symptoms, unmet needs, suggestions to improve the support person's situation. Participants were 39 relatives of adult transplant patients (22 cystic fibrosis transplant recipients, 17 recipients with other aetiologies) who had transplants 5 years ago (mean). RESULTS: The acute illness stage was rated as extremely stressful by most of the respondents. However, even during the rehabilitation period, one third described themselves as very stressed. Stress related symptoms at or post transplant were reported by 82% of respondents (more mothers than partners). Symptoms mostly referred to depressive and anxiety states. Most support persons had to tackle organizational difficulties in order to stay with the recipient and faced financial burdens not refunded by agencies. Support persons made suggestions to improve the recipient's situation and those of other support persons. Regarding the recipient their advice referred to enhanced information giving, aspects of communication and better access to psychosocial professionals. Regarding another support person they suggested to be well-informed beforehand and to remain optimistic. CONCLUSIONS: Mothers in this study seemed to be particularly vulnerable as support persons and thus deserve special attention. Few resources may be needed to achieve considerable benefit for the support person, such as arranging accommodation or identifying a team member to relate to.

Adult↗
PubMed2001

Transition of adult patients with cystic fibrosis from paediatric to adult care--the patients' perspective before and after start-up of an adult clinic.

UNLABELLED: Although most patients with cystic fibrosis (CF) survive into adulthood, many CF centres are still run by paediatricians. A transition programme from the paediatric CF unit to a newly established CF clinic at the Department of Internal Medicine was carried out for the whole group of patients > or =18 years. We aimed to evaluate our patients' opinion of the transition by analysing the results of two surveys performed before and after the transition. Nine months before the transition, we mailed an anonymous questionnaire. Statements regarding the forthcoming transition were to be answered on scales from 1 to 4, and the patients had to check a list of adjectives describing the current treatment in the paediatric CF centre as well as the presumed care in the adult unit. Fifteen months after the transition, a second survey with similar questions was carried out. RESULTS: 44 of 68 patients (65%) aged 18 to 33 years replied to the first and 56% of patients to the second questionnaire. Mean duration of treatment at the paediatric CF centre was 7.5 years (range: 1 to 22 years). Twelve patients each were classified as supporters or opponents of the transition, the remaining patients as intermediates. Older patients and those who had not required hospitalisation during the preceding year had a more positive attitude to the transition (p <0.05). There was a linear relationship between the transition attitude score and the presumed quality of care in the Internal Medicine Department (r = 0.62, p <0.001), but no relation to the quality of present paediatric care (r = -0.09, p = 0.59). In the second survey, patients rated the quality of care in the adult CF unit better than prior to the transition. CONCLUSIONS: The transition from paediatric to a newly established adult CF centre was accepted by most adult CF patients. Thorough training of all staff of the new adult unit and a close co-operation between both departments are pre-requisites to guarantee a smooth transition of all patients.

Adolescent↗
PubMed1999

[Cost comparison of hospital and ambulatory i.v. therapy in adult cystic fibrosis patients. Results of a controlled prospective study].

BACKGROUND: The regular i.v.-therapy of adults with cystic fibrosis (CF) on an in-patient basis is regarded as expensive. Home treatment is supposed to be cheaper. During a prospective controlled study to compare in-patient treatment (SIT) with home i.v.-treatment (HIT) in regard to clinical, psychosocial and economic parameters, delivered health services and costs in the German setting were evaluated in a comparable manner. PATIENTS AND METHODS: During the study period 4/95 to 9/96 45 patients with altogether 56 hospital and 40 home i.v.-courses of approximately 14 days were included in the study. Principal instruments to record the resource consumption were documentation sheets kept by the medical staff and the patients. In addition, pharmacy accounts in HIT and patient records and hospital controlling data in SIT were used. RESULTS: The average costs of a course were 14,038 DM for HIT and 18,702 DM for SIT. Striking are the large differences in medication costs. Two main reasons could be identified for the cost difference: 1, the use of a mobile infusion system in HIT and 2, the much higher prices of pharmaceuticals in the ambulatory care sector compared to the hospital sector, where extremely high profits of the home care service firms or the pharmacy can be supposed. The social costs of HIT (when antibiotics are valued to opportunity costs) are estimated at less than 10,500 DM. From a societal perspective HIT is preferable, from the perspective of the statutory health insurance funds hospital therapy is preferable. CONCLUSIONS: 1. The widely accepted hypothesis that ambulatory care is cheaper than hospital care is--at least in the German setting--not a-priori true. 2. In the treatment of CF patients incentive failures exist which induce unnecessary and avoidable hospital stays if the perspective of the statutory sickness funds is dominant. 3. Changes in system conditions as e.g. the permission of mail-order pharmacies might help to implement a more rational allocation of resources.

Adult↗
PubMed1998

Schizophrenia susceptibility loci on chromosomes 13q32 and 8p21.

Schizophrenia is a common disorder characterized by psychotic symptoms; diagnostic criteria have been established. Family, twin and adoption studies suggest that both genetic and environmental factors influence susceptibility (heritability is approximately 71%; ref. 2), however, little is known about the aetiology of schizophrenia. Clinical and family studies suggest aetiological heterogeneity. Previously, we reported that regions on chromosomes 22, 3 and 8 may be associated with susceptibility to schizophrenia, and collaborations provided some support for regions on chromosomes 8 and 22 (refs 9-13). We present here a genome-wide scan for schizophrenia susceptibility loci (SSL) using 452 microsatellite markers on 54 multiplex pedigrees. Non-parametric linkage (NPL) analysis provided significant evidence for an SSL on chromosome 13q32 (NPL score=4.18; P=0.00002), and suggestive evidence for another SSL on chromosome 8p21-22 (NPL=3.64; P=0.0001). Parametric linkage analysis provided additional support for these SSL. Linkage evidence at chromosome 8 is weaker than that at chromosome 13, so it is more probable that chromosome 8 may be a false positive linkage. Additional putative SSL were noted on chromosomes 14q13 (NPL=2.57; P=0.005), 7q11 (NPL=2.50, P=0.007) and 22q11 (NPL=2.42, P=0.009). Verification of suggestive SSL on chromosomes 13q and 8p was attempted in a follow-up sample of 51 multiplex pedigrees. This analysis confirmed the SSL in 13q14-q33 (NPL=2.36, P=0.007) and supported the SSL in 8p22-p21 (NPL=1.95, P=0.023).

Adult↗
PubMed1997

[Why do adults with mucoviscidosis refuse a medically recommended course of intravenous antibiotic therapy?].

BACKGROUND: Regular courses of intravenous antibiotics are recommended for the treatment of chronic Pseudomonas aeruglnosa (PA) infection in patients with cystic fibrosis. We report the results of interviews performed to evaluate why a subgroup of patients vote against regular intravenous (i.v.) antibiotic treatment. METHODS: Structured interviews covering a) the individual's perception of chronic PA infection, b) the patient's expectations regarding the effectiveness of i.v. treatment, c) the patient's personal reasons for refusal of i.v. treatment. STUDY COHORT: 16 out of 18 adult patients treated in the adult CF outpatient clinic at Hannover Medical School who had voted against the physician's recommendation to receive regular i.v. therapy twice a year. RESULTS: More than one half of the patients did not regard chronic PA infection as important due to the lack of specific symptoms. A subgroup of patients had no idea of what their clinical status should be if i.v. antibiotics would be necessary; these patients reported prior experience of treatment courses which had been ineffective and had been instituted after talking into the patients. The most frequent reasons against IV treatment were not being sick enough and fear of adverse drug effects. ASSESSMENT: The results are being discussed considering the physician-patient relationship. The reasons why patients refuse help should be extensively explored rather than simply addressing this attitude as "non-compliance". Patients, too, come to reasonable decisions, and it is important to know their thoughts and reasoning if one intends to influence them.

Adult↗
PubMed1994

Patterns of drug compliance with medications to be taken once and twice daily assessed by continuous electronic monitoring in primary care.

Adherence to drug treatment is difficult to assess in routine medical practice. Therefore, electronic compliance monitoring and a new computer software program, the PC-RDP (Reader, Display, Printer) system was used. It allows instant evaluation of a patient's dosing record, at the patient's return to the practice. Compliance was measured in 24 patients on antihypertensive treatment, either continuous (n = 8) or newly prescribed treatment (n = 16) in primary care, for a total period of 5144 patient days. Fifteen patients received compliance feedback by their physician, 9 did not receive feedback. The drugs prescribed were triamterene plus hydrochlorothiazide, as a single dose, once daily (QD), and nifedipine twice daily (BID). The mean percentages of prescribed doses taken were 89% (QD) and 88% (BID). Partial compliance was 10 times more often (1243 days) than overcompliance (114 days), and days without dosing were observed twice as frequently with the QD than the BID regimen. Omissions of doses occurred more often on weekends than any other day of the week. With the BID regimen, evening doses were omitted twice as often as morning doses. When treatment was initiated, compliance was consistently high until the end of the study period, whereas in patients on continuous treatment, it decreased over time. Both compliance feedback (n = 11/16) and the beginning of treatment may be important factors to explain the difference in compliance behavior. An implementation of compliance monitoring into practical patient care seems to be feasible and promising.

Aged↗
PubMed1993

[Role and responsibilities of psychosocial treatment personnel in the pediatric clinic: (I) Foundations and problem aspects of psycho-somatic cooperation].

Nowadays, the core problems of psychosocial care of pediatric inpatients are those imposed by the chronically ill child and his family. In Germany, these new and complex problems are supposed to be solved by integrating psychosocial specialists and developing a comprehensive, interdisciplinary approach. The first part of this series discusses its problems and pitfalls. To find out their role in the complex network, the new specialists misleadingly may define their task as exclusively devoted to casework. The medical staff may perceive this as a kind of neglect of its town psychosocial competencies. As a consequence, they will become suspicious of the new colleagues, disregarding their potentially, too. Instead of a true cooperation, this may lead to a kind of fragmentation of the professional network.

Child↗
PubMed1993

[Role and responsibilities of psychosocial personnel in the pediatric clinic: (II). Psychosocial management means experimenting].

To prevent possible fragmentation of professional networks, as described in part I, the psychosocial co-worker should be flexible to negotiate his or her role. Therefore main areas of beneficial contributions are described: Ameliorating the context of hospital care (including child-adequate alterations of the physical environment; improving cooperation among the staff; staff-counseling); supportive psychotherapy; educative approaches and programmes; enhancing patient and family members to communicate illness-related issues; and discussing easily omitted aspects of illness among self-help-groups. This description of heterogeneous tasks should remind the (whole group of) psychosocial co-worker(s) that casework is not the only topic, they are good and necessary for, even though these other areas are not very well-established, yet.

Adolescent↗
PubMed1993

[Role and responsibilities of the psychosocial patient care team in the pediatric clinic: (III) Review].

To prevent a possible fragmentation of professional networks, as described in part I, the psychosocial co-worker should be flexible to negotiate his or her role. Therefore part II described areas and problems of clinical engagement, and part III finally adds the scientific inquiry as another relevant task. Apart from gaining professional reputation, clinical studies may as well strengthen personal relationships among the professionals involved. The tendency of psychosocial specialists to isolate themselves is critically resumed with special regard to other psychosocial staff (clinic's kindergarten and school). This leads to a plea for a careful recognition of the competencies of all team members to assure that the positive effects of interdisciplinary cooperation will outweigh its possible negative side-effects.

Adaptation, Psychological↗
PubMed1992

Tidal peritoneal dialysis: preliminary experience.

OBJECTIVES: To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). DESIGN: An open enrollment pilot study. SETTING: The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. PATIENTS: Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. INTERVENTIONS: Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. MEASUREMENTS: Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. RESULTS: Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 +/- 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. CONCLUSION: TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

Adolescent↗
PubMed1992

[Mucoviscidosis in adulthood. An overview of the research on the psychosocial aspects].

Cystic fibrosis patients do have fairly improved life-expectancies today. Therefore, they are confronted with the obstacles and stresses of adult life. The author reviews studies concerning the following aspects of adult cf-patients: psychosocial functioning, separation from home, coping and compliance. Finally, beneficial modes of psychosocial interventions are discussed.

Adaptation, Psychological↗
PubMed1991

[Psychosocial care in medicine and the social code V].

Principles of psychosocial care in medical settings are outlined and will be critically compared with those lawful clinical services, which are well-established and described in the amendment on legal health insurance. This comparison reveals conceptual differences between the integrative and interdisciplinary approach of psychosocial care on the one hand, and the conventional approach on the other, which ins presupposed compulsory by the amendment. Arguments in favour of psychosocial care as a legal part of public health insurance should refer to sections section 70 (2), section 112 (2), section 43 (2), section 40 and section 119 of the amendment. Nevertheless these arguments will remain dependent on benevolent consent.

Child↗
PubMed1990

The effect of ACE inhibition on myocardial energy metabolism.

There are several indications that the oxygen supply to the myocardium is inadequate in chronic heart failure. This is due to an increased intramyocardial vascular resistance, elevated filling pressures, and a shortened diastolic perfusion time. In parallel, the myocardial oxygen demand is heightened due to elevated wall stress, heart rate and contractility. This imbalance between myocardial oxygen supply and demand might be the cause of the adaptive metabolic changes seen in severe chronic heart failure. We showed increased LDH 5, decreased LDH 1 and increased ADP/ATP-carrier concentration in the myocardium from patients with chronic heart failure. After ACE-inhibitor treatment in 33 patients with chronic heart failure, LDH 1 increased from 38.7 +/- 6.7% to 42.3 +/- 5.5% (P less than 0.005) paralleled by a decrease in LDH 5 from 20.8 +/- 7.0% to 15.8 +/- 4.7% (P less than 0.001). The ADP/ATP-carrier concentration also decreased significantly within the normal range. This shift in the LDH isoenzyme pattern and decrease in the ADP/ATP-concentration can be interpreted as an indication for an improvement of myocardial energy balance in chronic heart failure under ACE-inhibitor therapy. This might help interrupt the self-perpetuation of chronic heart failure which is partially caused by a progressive subendocardial perfusion deficit.

Cardiac Output, Low↗
PubMed1990

[Psychosocial management in medicine: a question of "management bias"?].

It was Roth (1962) who first coined the term "management bias". This term served to brand a pervasive, uncritical identification of the social scientist's perspective in his research projects in medicine, with the problem definition of the medical orderer of research. Instead of unbiased findings he thus tended to affirm administrative categories, Roth argued. I will try to point out that problems like "management bias" are not exclusive to psychosocial science, but they may as well be found in the realm of psychosocial care. The chronically ill became more and more important as a person(ality) during the ongoing process of technical perfection of medical treatment. The intensively, technically supported medical treatment produces within its demands towards the patient and his social context a kind of "human failure", that is, the patient tends to not fulfill the highly demanding treatment tasks. Within psychosocial care, failure will rather be attributed to the personality or family pathology instead of the institutional setting, and in that way the scientific patterns of biased attribution will be repeated, thus revealing "management bias", thus supporting the institution's interest of not being blamed for failure. I'll describe the dynamics of the "management bias" and briefly point out aspects to overcome it.

Bias↗
PubMed1989

[Psychosocial management in pediatrics. Do we really mean the patient?].

Due to technological perfection of medical treatment there is an increasing concern about the patient (as a person). As the treatment-demands grow, treatment becomes dependent on the patient's tolerance to adapt to these demands. Instead of this dependence, general discussion focuses on the patient's "failure" or "non-compliance". Without a critical reflection on this context psychological care for the "failing" patient is in danger to exclude the patient's individuality instead of integrating it into the whole treatment plan. It is not the patient who fails, but it is a treatment plan which reduces the patient's individuality to the question whether he complies, or not. It is especially true for the care of the chronically ill that the treatment plan has to be openly negotiated with the patient's individual experiences and purposes.

Adaptation, Psychological↗
PubMed1988

[Development of projective reduplication in psychosomatic patients. II. Attempt at an assessment].

Starting with a clinical description of the "projective reduplication" this construct is being critically evaluated on the basis of recent publications on the psychosomatic patient's "pseudo-normality". These studies cast further doubt on the assumption of a "projective reduplication" mechanism as a valid, specific characteristic of this patient population. Recent research results suggest a non-projective, specific sensibility in perception in psychosomatic patients rather than a deficit. The assumption of non-differentiation between self and others as part of the "projective reduplication" mechanism is finally being interpreted as a sequel to the specific "patient career" of psychosomatic patients and the effects of their being clinically evaluated for psychosomatic illness.

Humans↗
PubMed1988

[Assumption of projective reduplication in psychosomatic patients. I. Results of an empirical study].

The starting position of this study was the striking discrepancy between clinical hypothesis on "projective reduplication" and their empirical validation. Empirical data for the statistical analysis derived from a heterogeneous group of psychosomatically ill persons (N = 33) and a group of normal controls (N = 30). Using the similarity of the image of one's self and the one of others as an experimental analogy of the "projective reduplication", we could not ascertain any verifying hint for this syndrome. The results of the present study do not support the assumption of a clinical phenomenon according to the hypotheses tested. But it still remains uncertain whether these hypotheses are appropriate transformations of clinical experience.

Adult↗