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Biomedical subjects

K Schaefer

Publications and source records attributed to K Schaefer.

At least 19 recordsLinked to original sources
PubMed2003

Congruence on medication between patients and physicians involved in patient course.

OBJECTIVE: To analyse congruence on medication throughout patient courses, including an acute admission to a medical department. DESIGN: A prospective, observational study. Data were collected from patient records in primary health care, hospital departments, from the Health Insurance database and through patient interviews. SETTING: Departments of internal medicine, general practice and patients' homes. MAIN OUTCOME MEASURES: Number, type and character of discrepancies between paired sources of information on patient medication at predefined time points throughout the complete patient course. Assessment of likelihood and severity of potential untoward effects of discrepancies. RESULTS: Data were obtained for 75 of 99 consecutive patients included. Patients stated use of four drugs (median, range 0-17) at admission, five (0-16) at discharge and four (0-15) 1 month after discharge. At admission, 11 patients used no drugs. A median of one (0-20) to three (0-16) discrepancies per patient were identified in seven paired source comparisons with no improvement along patient course. Full agreement throughout the course was found in six patients (8%; 95% confidence interval: 3-17%). No association was found among source discrepancies and number of drugs and age. Of discrepancies, 4-13% were considered serious and likely to cause untoward effects. Discrepancies due to synonymous and analogous drugs accounted for 2-7% of the discrepancies. CONCLUSION: Congruence between sources of information on medication throughout patient courses cannot be obtained with separate medication charts. Discrepancies among patient, general practitioner and hospital give rise to a definitive risk of serious untoward effects.

Adult↗
PubMed2002

The very elderly dialysis patient: indication and discontinuation of dialysis.

1. When the current available data in the literature is summarized it becomes evident that the majority of it supports the position that it is, at least for medical reasons, not advisable to exclude patients over the age of 80 years from chronic dialysis. 2. It is correct to say that the refusal of dialysis therapy for elderly dialysis patients would lead to a not insignificant cutting of costs, although elderly patients are not as 'expensive' as younger dialysis patients. 3. The decision to exclude patients over 80 from dialysis treatment is difficult, in our opinion, to support ethically. 4. The refusal of therapy by a dialysis patient--independent of his age--can only occur with his/her consent, as long as the patient is clearly conscious of the decision. 5. Should the patient no longer be in the condition to exercise his/her autonomy, and there is no AD, the Surrogate's Court must be consulted. 6. AD can be seen as helpful, since they not only make the decisions for physicians easier, but also because they can be seen as an act of care for family members. 7. Whenever dialysis therapy is discontinued the problematic nature of so-called essential care should be carefully considered, especially if no clear position has been taken in an AD.

Advance Directives↗
PubMed2001

[Antibiotic treatment of infections in general practice. Effect of audit assessed by prescriptions data from health insurance registry and physicians' own registration].

The aim was to study whether an audit of treatment of infections in general practice resulted in changed prescribing habits. In 1995-1996 forty-six general practitioners (GP's) from the County of Roskilde participated in an audit regarding infectious diseases (incl. course participation and preparation of treatment guidelines). The effect evaluation was done on the basis of 1) two self-registrations of antibiotic prescriptions carried out with one year's interval, and 2) prescribing data from the National Insurance database collected over two periods, before the first and second self-registration respectively. The number of patients not receiving antibiotics increased significantly from 47.2% to 52.4% after intervention. The self-registration did not show any change in choice of antibiotics, while the registry data showed a shift from broad-spectrum to narrow-spectrum penicillin. This change was, however, also found among the GP's, who did not participate in the audit. The study demonstrated that audit can result in changes in prescribing patterns, but at the same time emphasizes the need for inclusion of external data sources and control groups in the evaluation of intervention effects.

Adult↗
PubMed2001

The relationship of acculturation and gender to attitudes toward counseling in Italian and Greek American college students.

This exploratory study examined attitudes toward professional psychological services and help provider characteristics among 232 self-identified Italian and Greek American college students in 3 Northeast colleges. Regarding general attitudes toward psychological services in the Italian American sample, women had a greater recognition of personal need for help and higher confidence in the ability of mental health professionals to meet these needs than did men. With regard to preferred counselor demographic characteristics, regardless of gender, lower acculturated Italian American students had a stronger preference for seeing an ethnically similar counselor. With the Greek American sample, there was an interaction effect between acculturation level and gender on attitudes toward services. Among the higher acculturated Greek students, women were more open regarding their personal concerns than men; however, within the lower acculturated cohort, no gender differences were found. With regard to counselor characteristic variables, and similar to Italian Americans, regardless of gender, lower acculturated Greek Americans had a stronger preference for seeing an ethnically similar counselor to discuss a personal problem. Limitations and implications for further research are noted.

Acculturation↗
PubMed1998

[Benzodiazepine consumption in Hvalsø. Can it be further reduced in a region in which earlier intervention reduced consumption by 38 per cent?].

Hvalsø is a country town with six general practitioners in five practices. In 1988, as a result of a campaign influencing both doctors and patients, a 38% reduction in the consumption of benzodiazepines, measured as the number of prescribed doses, was achieved. This reduction still persists. We have now attempted to reduce consumption even further by directly influencing the individual users. We gave them written information, insisted on personal attendance for each prescription renewal, and, for use at these consultations, introduced a new benzodiazepine journal for 60% of the users. Registration of the prescribed amounts of benzodiazepines was performed over two three-month periods, before and after the intervention. The final registration was made six months after the intervention period. The number of prescriptions, number of prescriptions per 1000 patients and the number of users remained unchanged. A 20% reduction in the amount of prescribed sedatives (hypnotics) and a 7% reduction in prescribed minor tranquillizers was achieved because of fewer doses per prescription. We conclude, that we did not manage to change the patients' behaviour, expressed as the number of prescriptions per 1000 patients, but the doctors were influenced to write out fewer doses per prescription. Important reductions in consumption may be achieved in primary interventions.

Attitude to Health↗
PubMed1998

Bone fracture history and prospective bone fracture risk of hemodialysis patients are related to apolipoprotein E genotype.

This investigation of 219 hemodialysis patients relates the history and prospective risk of bone fractures to apolipoprotein E (apoE) genotype. A greater percentage of the 41 patients with the E3/4 and E4/4 genotypes than of the 38 patients with the E2/3 and E2/2 genotypes had a history of bone fractures at the time of recruitment (44% versus 16%, P < 0.005). During the 4 years following recruitment, more of the patients with apoE genotypes E3/4 and E4/4 than with apoE genotypes E2/3 and E2/2 suffered bone fractures, but this difference was not statistically significant (17.1 versus 5.3%, P < 0.1). ApoE genotype appears to be an important genetic risk factor for bone fracture, possibly due to its previously reported influence on vitamin K concentrations in blood.

Adult↗
PubMed1998

The elderly dialysis patient: management of the hospital stay.

Our data show that survival times in elderly patients can be achieved, which justify the strain of the therapy on the patient, the medical effort and financial expense. It is therefore not justifiable to withhold dialysis from a person who requires it on the basis of age. It is also wrong to reduce the therapeutic endeavours to a minimum and describe these then as 'kinder' to the patient. It is to be feared that such a treatment regimen leads to a shorter survival time and simultaneously to a decreased quality of life. Particularly in view of the person's advanced age, it would seem that we are obligated to treat them with the highest quality care so that the remaining time is not only extended, but is filled with life.

Aged↗
PubMed1997

[How can ethical training in a hospital be organized?].

BACKGROUND: Many everyday situations in hospitals that demand professional decisions also contain an ethical dimension. Unfortunately until today there are only a few physicians and nurses who have received a good medical-ethical knowledge during their professional education. DESCRIPTION: In this text the basic elements and structure of a model dealing with training in clinical ethics are illustrated. The program is dedicated to members of healing professions who work together. Aspects of great importance are the multiprofessional concept and the regard of the particularities of the hospital. CONCLUSION: Based on the project's experience, it is shown that the participants not only profit by discussing ethical issues of their professional practice, but there is also a positive effect on the cooperation among the employees.

Education, Medical, Graduate↗
PubMed1997

Bone health of adult hemodialysis patients is related to vitamin K status.

This investigation of 68 hemodialysis patients (ages 33 to 91) analyzed the association of biochemical indicators of vitamin K nutriture and bone metabolism, and related both to past bone fracture history and prospective bone fracture risk. Phylloquinone concentrations were significantly lower in the 23 patients with previous fractures compared to those without (0.93 vs. 1.50 nmol/liter, P < 0.003) and a smaller percentage of their serum osteocalcin was carboxylated (48.8 vs. 53.6%, P < 0.03). The 41 patients who never had fractures had nearly three times higher phylloquinone concentrations than the nine patients with fractures during a four-year follow-up period (1.59 vs. 0.55 nmol/liter, P < 0.002) and more carboxylated serum osteocalcin (55.2 vs. 42.0%, P < 0.01). None of the patients with phylloquinone concentrations over 2.2 nmol/liter had elevated intact parathyroid hormone (iPTH) concentrations, and only patients with less than 1 nmol/liter phylloquinone had severe hyperparathyroidism (iPTH > 300 ng/liter). Our data thus indicate that suboptimal vitamin K nutriture in hemodialysis patients is associated both with increased bone fracture risk and with a high prevalence of hyperparathyroidism.

Adult↗