Biomedical subjects

Herbert Mayer

Publications and source records attributed to Herbert Mayer.

13 recordsLinked to original sources

PubMed2005

The occurrence of acute postoperative confusion in patients after cardiac surgery.

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22-91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

Acute Disease↗

PubMed2005

TOUCAN 2: the all-inclusive open source workbench for regulatory sequence analysis.

We present the second and improved release of the TOUCAN workbench for cis-regulatory sequence analysis. TOUCAN implements and integrates fast state-of-the-art methods and strategies in gene regulation bioinformatics, including algorithms for comparative genomics and for the detection of cis-regulatory modules. This second release of TOUCAN has become open source and thereby carries the potential to evolve rapidly. The main goal of TOUCAN is to allow a user to come to testable hypotheses regarding the regulation of a gene or of a set of co-regulated genes. TOUCAN can be launched from this location: http://www.esat.kuleuven.ac.be/~saerts/software/toucan.php.

Algorithms↗

PubMed2005

Pain prevalence in hospitalized patients in a German university teaching hospital.

Forty-eight units were enrolled in a descriptive, cross-sectional study to identify strengths and weaknesses of pain management in a German university teaching hospital. Patients had to be > or =18 years old and able to speak German; intensive care, psychiatric, obstetric and pediatric units were excluded. Structured interviews were conducted by an independent researcher not involved in patient care. Patients were asked about prevalence of pain during the interview at rest, on movement, and during the 24 hours before the interview; patients rated pain intensity at rest and on movement as well as the worst pain 24 hours before the interview by using a 10 cm visual analogue scale (VAS). In addition, patients indicated localization, duration, and causes of pain. Chart analysis was carried out to check for pain medication, ICD-10 diagnoses, and demographic data. To evaluate the adequacy of pain management, the Pain Management Index (PMI) was assessed. A total of 561 of the 825 inpatients who were contacted participated in the study. Fifty percent experienced pain during the interview and 63% reported pain during the preceding 24 hours. Fifty-eight percent had moderate or severe pain (VAS > or = 45 mm) and 36% reported severe pain (VAS > or = 65 mm). Thirty-three percent had pain for more than six months. The most prevalent localization of the strongest pain was in the lower extremities (20%). Fifty percent of patients with pain received pain medication. Patients on the surgical wards (P = 0.002) and those having severe pain (P < 0.001) were more likely to get analgesics. However, 30% of those with VAS> or =65 mm received no analgesic and only 24% had adequate medication. A negative PMI, indicating inadequate pain therapy, was found in 44% (246/559) of the sample. Sex and age did not influence pain prevalence, pain intensity, or pain therapy. Pain prevalence and intensity in this German university hospital were high and pain therapy was inadequate in many cases. Pain management needs to be improved by continuous assessment and adequate pain medication.

Aged↗

PubMed2005

The human HERC family of ubiquitin ligases: novel members, genomic organization, expression profiling, and evolutionary aspects.

The HERC family of ubiquitin ligases is characterized by the presence of a HECT domain and one or more RCC1-like domains. We report the identification of two novel members, HERC4 and HERC6, and subdivide the family into one group of two large and one group of four small members according to protein size and domain structure. The small members share a similar genomic organization, three of them mapping to chromosomal region 4q22, indicating strong evolutionary cohesions. Phylogenetic analysis reveals that the HERC ancestor emerged in nematodes and that the family expanded throughout evolution. The mRNA expression pattern of the small human members was found to be diverse in selected tissues and cells; overexpressed proteins display a similar cytosolic distribution. These data indicate that the HERC family members exhibit similarities in many aspects, but also sufficient differences indicating functional diversity.

Adaptor Proteins, Signal Transducing↗

PubMed2004

Deciphering regulatory patterns of inflammatory gene expression from interleukin-1-stimulated human endothelial cells.

OBJECTIVE: Endothelial cells comprise a key component of the inflammatory response. We set out to obtain a comprehensive overview of the immediate-early to early gene expression program of interleukin-1 (IL-1)-stimulated endothelial cells and to identify novel transcription factors and regulatory elements. METHODS AND RESULTS: Human umbilical vein endothelial cells (HUVECs) were stimulated with IL-1 for 0, 0.5, 1, 2.5, and 6 hours and analyzed using Affymetrix U133 microarrays. A total of 137 genes were found to be regulated >4-fold, including 18 transcription factors. The expression of selected genes was confirmed by real-time polymerase chain reaction. Cluster analysis was performed in order to group genes according to their expression profiles. To identify novel transcription factor-binding sites, the corresponding promoters were extracted from databases and analyzed for regulatory elements that were over-represented in specific clusters. Several potentially novel DNA binding sites were identified, and one was shown to specifically bind an IL-1-inducible protein from HUVEC. CONCLUSIONS: These results demonstrate that in the early phase after stimulation, IL-1 evokes a complex gene expression program that includes positive but also negative (feedback) regulators of diverse endothelial cell functions. Furthermore, the identification of a new promoter regulatory element demonstrates the feasibility of the bioinformatics-driven approach to discover novel regulatory mechanisms.

Binding Sites↗

PubMed2004

[Development of the "Whittener Activity Catalog of Self-Care in Venous Ulcer"].

Poor rates of healing and high rates of re-ulceration are characteristic of venous leg ulcer. The performing of special health-deviation self-care is important for the successful treatment and prevention of this chronic disease. This study aimed to validate a newly designed instrument for the measurement of specific self-care. The "Wittener Aktivitätenkatalog der Selbstpflege bei venös bedingten offenen Beinen" (WAS-VOB) (a catalogue containing self-care activities for venous leg ulcer) was conceptualized on the basis of Orem's theory and on pathophysiological processes. The items were created by using patient interviews (n = 20) and a literature review. An analysis of the reliability was used to reduce the raw scale. The quality of the WAS-VOB was assessed for face-validity (n = 6), feasibility (n = 8), test-retest-reliability (n = 60) and the internal consistency (n = 234). The involvement of patients was based on an informed consent. The WAS-VOB is a self-describing instrument, includes 59 self-care activities and describes those in eight scales which deal with "general compression", "wearing compression bandages", "wearing compression hosiery", "mobility", "temperature", "overload of the venous system", "prevention of skin damage" and "wound healing". The WAS-VOB is practicable and has good psycho-metric characteristics. The test-retest-coefficient (Kendall's tau b) is 0.58, Cronbach's alpha 0.72. The instrument WAS-VOB is suitable for the assessment of self-care deficits.

Adult↗

PubMed2004

[Quality criteria of assessment scales--Cohen's kappa as measure of interrator reliability (1)].

A far spread index for the quantification of the interrater-reliabilty of assessment instruments or procedures is the chance-corrected agreement measure "Cohen's Kappa". Although or even though Cohen's Kappa proves to be a common measure of agreement of two raters, it is increasingly being used uncritically. Many authors, but also readers don't seem to take the central and paradox characteristics of Kappa into consideration for the interpretation of their results. The article intends to introduce Cohen's Kappa to a wide range of readers. The implicit assumptions that are related to the chance correction and to the typical and paradox characteristics of Kappa are presented and explained in detail. This is in particular, when results of an investigation reveal particularly high values of observer agreement but low value of Cohen's Kappa or when differences in the overall assessment can even lead to an increase of Kappa. Only the knowledge about these characteristics makes a meaningful presentation and interpretation of the results of reliability studies possible. In a following second part of this paper, practicable alternatives to the problem areas presented and paradox characteristics of Kappa will be shown.

Data Interpretation, Statistical↗

PubMed2004

[Acute postoperative confusion in heart surgery patients].

Unlike other countries, Germany does not have data about the incidence of acute confusion following heart surgery. However, the occurrence of acute confusion does extend the hospitalization length by up to 13 days. Thus, this phenomenon is of high relevance for the health profession. This incidence study was performed with the goal to obtain exact information on the incidence rate of acute postoperative confusion after heart surgery (bypass and valve operations) through a multi-center evaluation. The data evaluation took place in the form of a convenient sample survey in three different German clinics specialized in heart surgery. The observation period lasted from the day of surgery up to the fifth postoperative day. In the context of this prospective cohort study, suitable study participants were all patients aged 18 or older who underwent heart surgery between February 1st and April 30th, 2000. At the end, 860 patients were included in the study. A total of 152 patients showed symptoms of acute confusion, meaning a total incidence of 17.4% (confidence interval 14-20%). The occurrence of this phenomenon was not symmetrical. A wide-spread occurrence could be observed particularly at night. Patients aged 81-91 were mainly affected, with an incidence of confusion of 43.5% in this group. The results confirm the clinical importance of this issue and require interdisciplinary approaches for solution.

Adult↗

PubMed2002

[Prevalence of ulcus cruris in home care nursing. An epidemiological study in North Rhine-Westphalia].

The aim of this study was to provide reliable data on prevalence of leg ulcers in home-care setting. A descriptive explorative cross-sectional design was used. In March 2000, a randomised sample of 520 community home nursing services in North-Rhine Westphalia was sent a standardised questionnaire. Apart from questions about the type of service provider and its geographical population, demographic patient data and information about duration and cause of ulcer was collected. The findings based on the data gathered from 161 nursing home-care services caring for a total 12,156 patients. The overall prevalence was 2.68% (+/- 0.29%) for leg ulcers in home-care setting. The median age of the 326 affected patients was 77.5 years. Women are more than twice as often affected as men, which could be due to the longer life-expectancy for women. A major problem for home nursing services, however, is the large number of leg ulcers of unknown origin. This was the case in almost a quarter of the sample. Depending on the causal factors, compression therapy is of paramount importance and crucial to the successful outcome of the treatment of the leg ulcer. The markedly chronic nature of leg ulcers is again confirmed by this study. Currently, leg ulcers have an average duration of ten months. However, it is not unusual for affected patients to suffer for years or even decades. Almost 80% of patients had their ulcer dressed once a day by the nursing home-care service.

Adult↗

PubMed2002

[Nursing performance on specialty units, hospital departments and for patient groups--a comparison based on minimal nursing care data].

Nursing in Germany hides behind structural data like quantity and costs of nursing staff. This must be changed in aspect of the transparency of services in hospitals. The aim of this pilot study is to describe nursing services, find main focuses of nursing and point out significant differences between field units, wards and patient groups. On the basis of Belgian Nursing-Data-Sets, which was modified, all in all 2347 inpatient-days of 550 patients were collected. Analogous to the Belgian action, a Ridit Analysis was conducted, which allowed the construction of nursing profiles for every desired aggregation level. The knowledge of experience available regarding the different nursing services in departments and on the stations can at least be made valid, possibly even revised with the existing data equipment for the participating clinic. The easy to handle minimal Nursing Data Set allows the creation of a data basis, that can support decisions regarding the allocation of financial and personnel resources.

Adult↗

PubMed2002

[Wound management in patients with chronic wounds in ambulatory nursing--a pilot study].

Currently relevant data about prevalence of chronic wounds and wound management in home care nursing services are not available for Germany. In this study 38 home care nursing services were surveyed by means of a questionnaire. Response rate was 61%. Results showed that almost 9% of the home care nursing services treated patients suffering from chronic wounds. The most common wound was the pressure ulcer with a prevalence of 4.1%, followed by leg ulcer (2.7%) and the diabetic foot (1%). The questionnaire about wound management was completed for 47 patients of 24 home care services. 29 of the patients were females and 18 males. The average age of the patients was 78 years. Important diagnostic information about the nature and the recurrence rate of the wounds was not available to the nursing staff. The average time that a wound existed was 6.7 years with a range of 3 weeks to 45 years. 87% of the patients had their wound dressings on a daily basis. The average time needed for wound dressing was 17 minutes. Wound management often occurred in a idiosyncratic way and did not always follow evidence based practice. Wound management can be significantly improved by the use of modern wound dressing, reduction of the frequency of wound dressings, standardized wound documentation and better co-operation with doctors, nursing experts and health insurance organisations. Basis on the convenience nature of the sample results of this survey should be generalized and interpreted with caution. This study gives clear indications of the significance of the problem. More studies with representative samples are needed.

Aged↗

PubMed2002

[Interobserver reliability of the "Functional Independence Measure" (FIM) in patients with craniocerebral injuries].

This study was conducted to examine the inter-rater reliability of the "Functional Independence Measure" (FIM). The FIM is an assessment to determine the functional independence of patients with disabilities. It consists of eighteen items to assess activities of daily living. The degree of independence is measured by a seven point ordinal scale. The inter-rater reliability was examined by a convenience sample of 128 assessments with the FIM. Fifteen nurses assessed thirty patients with brain injuries in a centre for rehabilitation. The design was correlational. The degree of agreement between the assessments was calculated by Cohen's Kappa coefficients. The Kappa coefficients of the assessments were between kappa = 0.56 and kappa = 0.78; the median of the Kappa coefficients is kappa = 0.65. This indicates a moderate to high inter-rater reliability of the FIM when used by nurses for the assessment of patients with head injuries.

Activities of Daily Living↗

PubMed2002

[Predictive validity of the original and expanded Norton Scale in geriatric nursing].

Prevention of pressure sores is a central task of nursing. For ethical and economic reasons correct assessment of the risk of pressure sores is a prerequisite of adequate prevention of pressure sores. In Germany the Norton scale is one of the most widespread tools for assessing the risk of pressure sores. For practical purposes the original translated version of the Norton scale is in use, as well as an extended modified version. Validity and reliability of these two versions are in the early stages of examination in Germany. The present descriptive longitudinal study aims at determining the predictive value of both versions of the Norton scale in nursing homes. In a convenience sample of 146 individuals from five nursing homes residents from the age of 60 were assessed by professional nursing staff with the aid of both versions of the Norton scale at weekly intervals. Simultaneously the skin status was recorded on both sampling days. The results exhibit high values of sensitivity (91%-95%) and low specificity (6.2%-20.6%) in both scales. Both scales tend to overrate the risk of pressure sores. The values indicate that the original Norton scale assesses the residents free of pressure sores better than its extended version. Because of the convenience-sample the results are not representative and apply only to the investigated setting and population. The predictive validity of the original and modified version of the Norton scale is insufficiently verified, so there is great need of further investigation of the validity of the two versions. Application of assessment scales in nursing should be supplemented by professional expertise of the nursing staff to counterbalance assessment errors of the tools.

Aged↗