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Biomedical subjects

T Nikolaus

Publications and source records attributed to T Nikolaus.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Research and education in geriatrics at German universities and colleges].

To assess the situation of geriatric research and education at German universities, a questionnaire was sent out to all medical faculties (n = 37). The response rate was 91.9% (n = 34). There are five universities with a geriatric chair (14.7%), one with a department of geriatric medicine within internal medicine, and two departments of geriatric psychiatry. At 15 universities geriatric research is established (44.1%), but only 12 universities report that geriatric contents are implemented in the teaching of medical students. The comparison of universities with and without geriatric chairs and departments showed big differences. Whereas all universities with geriatric chairs or departments conduct geriatric research and offer education in geriatric medicine, the others failed to do so. Only 26.9% (n = 7) have geriatric research and 15.4% (n = 4) offer medical teaching in geriatrics. There is a strong link between geriatric chairs, research, and pregraduate teaching. Geriatric medicine is established only at few universities. To improve the overall situation of geriatrics in Germany the implementation of further geriatric chairs and departments at universities seems to be necessary.

Aged↗
PubMed1998

Genes encoding putative effector proteins of the type III secretion system of Salmonella pathogenicity island 2 are required for bacterial virulence and proliferation in macrophages.

The type III secretion system of Salmonella pathogenicity island 2 (SPI-2) is required for systemic infection of this pathogen in mice. Cloning and sequencing of a central region of SPI-2 revealed the presence of genes encoding putative chaperones and effector proteins of the secretion system. The predicted products of the sseB, sseC and sseD genes display weak but significant similarity to amino acid sequences of EspA, EspD and EspB, which are secreted by the type III secretion system encoded by the locus of enterocyte effacement of enteropathogenic Escherichia coli. The transcriptional activity of an sseA::luc fusion gene was shown to be dependent on ssrA, which is required for the expression of genes encoding components of the secretion system apparatus. Strains carrying nonpolar mutations in sseA, sseB or sseC were severely attenuated in virulence, strains carrying mutations in sseF or sseG were weakly attenuated, and a strain with a mutation in sseE had no detectable virulence defect. These phenotypes were reflected in the ability of mutant strains to grow within a variety of macrophage cell types: strains carrying mutations in sseA, sseB or sseC failed to accumulate, whereas the growth rates of strains carrying mutations in sseE, sseF or sseG were only modestly reduced. These data suggest that, in vivo, one of the functions of the SPI-2 secretion system is to enable intracellular bacterial proliferation.

Acetyltransferases↗
PubMed1998

Mutations in Salmonella pathogenicity island 2 (SPI2) genes affecting transcription of SPI1 genes and resistance to antimicrobial agents.

The Salmonella typhimurium genome contains two pathogenicity islands (SPI) with genes encoding type III secretion systems for virulence proteins. SPI1 is required for the penetration of the epithelial layer of the intestine. SPI2 is important for the subsequent proliferation of bacteria in the spleens of infected hosts. Although most mutations in SPI2 lead to a strong reduction of virulence, they have different effects in vitro, with some mutants having significantly increased sensitivity to gentamicin and the antibacterial peptide polymyxin B. Previously we showed that certain mutations in SPI2 affect the ability of S. typhimurium to secrete SPI1 effector proteins and to invade cultured eukaryotic cells. In this study, we show that these SPI2 mutations affect the expression of the SPI1 invasion genes. Analysis of reporter fusions to various SPI1 genes reveals highly reduced expression of sipC, prgK, and hilA, the transcriptional activator of SPI1 genes. These observations indicate that the expression of one type III secretion system can be influenced dramatically by mutations in genes encoding a second type III secretion system in the same cell.

Animals↗
PubMed1997

[Assessment of chronic pain in elderly patients].

Pain is extremely common among older people but often inadequately treated. Chronic pain and its management have major implications for quality of life and quality of care, especially for terminal ill patients and residents of long-term-care facilities. Many physicians lack information about pain assessment and may have an inaccurate knowledge base about pharmacological agents and non-pharmacological approaches used in pain control. Although fundamental data on the pathophysiology and management of chronic pain is still lacking there is some information to provide a framework for rational nosology and therapeutic strategy. Some guidelines may help to improve pain assessment and management in elderly people and may help to enhance physicians' awareness about that problem.

Aged↗
PubMed1996

Elderly patients' problems with medication. An in-hospital and follow-up study.

OBJECTIVES: To examine medication problems during a stay in hospital and after discharge and to identify risk factors that contribute to poor compliance with medication a prospective observational study was carried out in an university-affiliated geriatric hospital and a patients' home. PATIENTS: One hundred and nineteen patients admitted from home to the geriatric hospital underwent a comprehensive geriatric assessment. They were also tested in opening and removing tablets from various common medicine containers. Drug prescriptions before, during and after the hospital stay were recorded. Medication use at home was observed by a member of a hospital-based home intervention team. The patients' reports of their drug therapy was compared with those by their family doctors. RESULTS: Of all tested patients 10.1% failed to open at least one container. This inability was associated with poor vision, impaired cognitive function and low manual dexterity. Compliance with prescribed medication was associated with cognitive function, ability to handle medication containers, number of prescribed drugs and recent changes in drug prescriptions. Of the patients only 39.5% had stable drug prescriptions during the 3-month study period. Doctor/patient agreement concerning drug therapy was low in all age groups. The agreement rate and patients' knowledge of their treatment was correlated with cognitive function and the number of prescribed drugs. CONCLUSION: Patients' ability to open and remove tablets from common commercial packages/containers should be tested routinely during a stay in hospital. Management of medication should be taught and supervised within the first few days after discharge from hospital.

Aged↗
PubMed1996

Prospective value of self-report and performance-based tests of functional status for 18-month outcomes in elderly patients.

To determine predictors of death, nursing home placement and hospital admission, a prospective study was carried out in a university-affiliated geriatric hospital and a general practice. One hundred and thirty-five patients consecutively admitted from home to the geriatric hospital and discharged home again (site 1), and 144 patients, aged 70 years and over, of a general practice (site 2) were recruited for a comprehensive geriatric assessment program. At baseline, none was completely dependent on others, or severely demented. At follow-up after 18 months, 46 subjects (17%) had died, 20 subjects (7%) had been institutionalized, and 79 had been admitted to hospital (28%) in the interim. Univariate analysis demonstrated a significant association between Barthel Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Balance and Gait Evaluation, Timed "Up and Go", Timed Test of Money Counting. Grip-Strength and Williams Board Test, and death as well as nursing home placement. Barthel-ADL were significantly correlated with hospital admission. In a logistic regression analysis, Barthel-ADL were independent predictors for death; Barthel-ADL, Timed "Up and Go", Timed Test of Money Counting, and Williams Board Test were independent predictors for nursing home placement. No independent predictor was found for hospital admission. It is concluded that self-report and performance-based measures of functional capabilities are useful instruments to identify patients at risk for nursing home placement and death. Factors contributing to hospital admissions are other than those measured by the applied tests.

Aged↗
PubMed1995

[The risk assessment of the need for help and care as well as the risk of mortality among older people. The results of an 18-month pilot study in a family practice].

OBJECTIVE: To investigate prospectively the prognostic power of various demographic and diagnostic parameters, as well as of medical history, for evaluating in elderly patients the probability of their requiring care and of their risk of dying soon. PATIENTS AND METHOD: All the elderly patients (> or = 70 years) of one general practitioner were included. Of 178 patients who fulfilled the inclusion criteria, 144 participated (93 women, 49 men; mean age 78.7 +/- 5.8 years). Demographic, basic diagnostic and medical history data of the kind that can be easily collected in general practice were recorded. The general practitioner was also asked to assess the probability of each patient requiring care and the likelihood of their dying soon. Several functional tests that record or measure daily activity were conducted. After 18 months all admissions to care, homes for the elderly or hospital and deaths were recorded. The different groups were compared. RESULTS: The probability of requiring care and of dying within the observation period were predicted more accurately by functional tests and questions than by conventional diagnostic methods. This was particularly so for functional investigations of basic daily activity, cognitive ability and manual skills. There were significant differences between the groups in the results of tests (P < 0.01). CONCLUSION: Functional tests can be rapidly performed and have high diagnostic and prognostic power. They are therefore recommended for use by general practitioners for assessing the probability of a given patient requiring care and for estimating the likelihood of early death.

Activities of Daily Living↗
PubMed1995

The Timed Test of Money Counting: a simple method of recognizing geriatric patients at risk for increased health care.

The purpose of this prospective study was to measure patients' ability to open a purse, take out money, and count it, in order to identify persons in need of increased health care. The study population consisted of 183 patients (mean age 78.9; range: 66-95) in two settings: 78 consecutively admitted geriatric hospital patients who could return home, and 105 community-dwelling patients aged 70 years or older. None was completely dependent on others, nor severely demented. Time for task performance was measured. Further assessment included the Mini-mental State Examination (MMSE), Barthel index of ADL, instrumental activities of daily living (IADL), socioeconomic status, grip strength, Williams board test, and medication profile. The Timed Test of Money Counting (TTMC) was reliable (interrater and intrarater), and showed construct and concurrent validity with other measures of physical function. There was a strong correlation (p < 0.001) between the time required to count money, and to open and close the panel doors of the Williams board. The other functional measures were also significantly correlated with the TTMC. After 18 months, 26 of the patients had died, and 5 were lost to follow-up. The remainder were divided into those who had stable needs (group I), and those with increasing care needs or nursing home placement (group II). Time required for money counting was significantly different (p < 0.001) between groups (30.9 +/- 17.5 seconds for group I, and 122.6 +/- 94.4 seconds for group II).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

The Timed Test of Money Counting: a short physical performance test for manual dexterity and cognitive capacity.

The competent handling of money is an essential basis for living independently. Seventy-eight consecutively admitted patients to a geriatric hospital underwent the Timed Test of Money Counting (TTMC) which measures patients' ability to open a purse, take out all the money and count it. Further assessment included Mini-Mental State Examination (MMSE), Barthel Index of ADL, Self-maintaining and Instrumental Activities of Daily Living (IADL), grip strength and Williams' Board Test. The TTMC was reliable (inter-rater and intra-rater) and showed construct and concurrent validity with other measures of physical function. Unlike many other physical performance tests the TTMC is quickly performed and requires no special equipment or training.

Activities of Daily Living↗
PubMed1995

Assessment of nutritional risk in the elderly.

To enhance physicians' awareness of nutritional problems in the elderly, a nutritional risk assessment scale was developed and validated. 126 patients (mean age 82.0 +/- 6.7, range 65-96 years) admitted from home to a geriatric hospital were enrolled in the study. After informed consent was obtained, they underwent a comprehensive geriatric assessment of physical, emotional, and cognitive functions, overall functional capacity, and social situation. The nutritional status was assessed by the nutritional risk assessment scale. This scale consists of items relating to gastrointestinal disorders, chronic diseases with pain, immobility, alterations in body weight, appetite, difficulties in eating, cognitive or emotional problems, medication, smoking and drinking habits, and social situation. The maximum score which indicates a high risk is 12. The scores from the nutritional risk assessment scale were compared with a physician's clinical judgement (patients being graded as "obese', "well-nourished', "undernourished') as the "gold standard' and with body mass index, other anthropometric findings, and serum albumin and prealbumin levels. The nutritional risk assessment scale was reliable (inter- and intrarater) and showed construct and concurrent validity. There was a significant correlation with clinical judgement (p < 0.01) and other parameters of nutritional status (p < 0.05). The scores of undernourished patients (n = 37; 5.35 +/- 1.60, range 3-8) were significantly different (p < 0.05) from those who were classified as well nourished (n = 63; 2.66 +/- 1.59, range 0-7) or obese (n = 26; 2.73 +/- 1.76, range 0-7). When implemented as part of a comprehensive geriatric assessment, this questionnaire can be completed within 5-10 min. The nutritional risk assessment scale is simple and reliable and helps in the identification of elderly patients at risk of poor nutrition.

Aged↗
PubMed1993

Actual versus prescribed timing of lovastatin doses assessed by electronic compliance monitoring.

The objective of the study was to compare compliance with and the hypocholesterolaemic effect of lovastatin given once daily as a morning or an evening dose. Twenty-four out-patients with familial hypercholesterolaemia were randomly assigned to receive placebo first, then lovastatin 20 mg, to be taken once daily for 4 weeks, either with the breakfast or evening meal, in a single-blind fashion. Drug compliance was assessed by pill counts and continuous electronic monitoring. Two compliance parameters were evaluated, consumption, defined as percentage of prescribed doses taken, and time compliance, the percentage of total dosing events recorded within defined intervals (6.00-10.00 h, and 17.00-21.00 h), for the morning and evening regimes. Both regimes satisfactorily reduced the total and LDL-cholesterol concentrations, and there was no significant difference in the extent of the reductions. Pill counts overestimated compliance, as revealed by the monitoring method. The times of actual consumption of doses by the patients often differed from that prescribed, predominantly in patients who were told to take the evening dose. Partial time compliance may have confounded the efficacy of the drugs. Electronic compliance monitoring appears to be particularly useful in chronopharmacological studies.

Adult↗
PubMed1992

[The early rehospitalization of elderly patients. Causes and prevention].

The causes of early rehospitalization (within 3 weeks) of very elderly patients, its possible avoidance and appropriate preventive measures were analysed retrospectively in patients of a geriatric hospital. Included were all those patients who had been admitted to the hospital from their home several (mean: five) times between 1987 and 1990 (48 women, 19 men; mean age 81.3 +/- 7.2 years--a total of 331 re-admissions). The most frequent diagnoses were heart failure (38.8%), acute cerebrovascular accident or its sequelae (31.3%), dementia (23.9%), fall or its sequelae (22.3%) and diabetes (20.9%). Of the 331 re-admissions 87 (26.3%) occurred during the first 3 weeks after discharge. The most important reasons of this early re-admissions were inadequate home care (41.4%), undesirable drug effects and non-compliance (25.3%), as well as rapid progression of the basic disease (14.9%). In the judgement of the hospital team more than 40% of the early re-admissions were avoidable, among those re-admitted because of inadequate home care and those in connection with drug intake even more than half. Early hospitalization is frequently avoidable, if individual geriatric assessment is undertaken and discharge carefully planned.

Acute Disease↗
PubMed1992

Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from hospital.

OBJECTIVE: A pilot study to assess patient compliance with medication by using a new measurement technique, continuous electronic monitoring. DESIGN: Survey. Compliance monitors were provided to eligible patients at discharge from the hospital to measure drug intake behavior prospectively for a period of 3 weeks. SETTING: Ambulant patient care after discharge from a geriatric hospital, Krankenhaus Bethanien, which is affiliated with the University Clinic, Heidelberg. PATIENTS: A consecutive convenience sample of 18 independently living elderly patients (median age 76 years) completed the study. The patients were on maintenance therapy with cardiac glycosides and/or potassium-sparing diuretics prescribed to be taken once daily. INTERVENTION: The monitoring method provides information about patients' real timing of drug use by continuously recording date and time of openings and closings of the medication containers (monitors). In addition to a standard measure, the percentage of prescribed doses taken, information about regularity of drug use is obtained. RESULTS: Compliance, percentage of prescribed doses taken, was remarkably variable; it ranged from 24% to 100%, 95% CI: 62%-84%. Mean compliance declined from the first to the third week after discharge, 85% vs 69%, 95% CI: 74%-95% and 56%-81%, respectively (P < 0.05). Omissions of doses, the predominant pattern of non-compliance, were observed in 17 of 18 patients. Regularity of dose timing, as defined by the number of interdose intervals within 24 h +/- 15%, varied from 10% to 100%, 95% CI: 46%-76%. CONCLUSIONS: Continuous electronic monitoring revealed highly variable compliance in patients prescribed maintenance therapy. Even with a once-daily regimen, persistent and high compliance cannot be assumed. The monitoring technique may be of great value to research and, possibly, to practical therapeutic management.

Aged↗
PubMed1991

Treatment of coronary heart disease with diet and exercise--problems of compliance.

The effects of low fat diet and intensive physical exercise were examined in a randomized prospective study in patients with angiographically documented coronary heart disease. In addition to supervised regular physical exercise, patients of the intervention group (n = 18) were subjected to intensive dietary counselling with the aim of a low fat, low cholesterol diet to be maintained for at least 12 months. The control group (n = 27) received relevant advise only and usual care by private physicians. In the intervention group there was significant lowering of plasma triglycerides (202 +/- 82/141 +/- 74 mg/dl) and body weight (78.2 +/- 9.5/73.7 +/- 10.4 kg) while total and LDL cholesterol did not change significantly. There was a tendency for a rise of HDL-cholesterol (35.6 +/- 9.0/40.4 +/- 14.8 mg/dl, p = 0.07). According to 24-hour diet protocols there was a significant lowering of energy intake (2.298 +/- 697/1.602 +/- 758 kcal/day), of fat intake (111.7 +/- 44.4/52.0 +/- 23.9 g/day) and of intake of dietary cholesterol (402.8 +/- 186/161.3 +/- 100.3 mg/day) as well as of saturated fatty acids (42.5 +/- 20.4/14.3 +/- 8.1 g/day). Fatty acid composition of adipose tissue was not correlated with the patients' 24-hour dietary protocols. In the control group there were no changes of plasma lipids, body weight or diet composition according to 24-hour protocols after 1 year compared to data at the beginning of the study. There was, however, a marked correlation of adipose tissue composition and dietary information given by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1986

[Combination therapy of obesity with a reducing diet and physical training. Cardiovascular and metabolic effects].

Twenty obese patients were either given a caloric restricted diet (300 kcal/d) over 4 weeks alone or underwent an additional ergometer exercise programme for up to 2 hours daily. Combination therapy resulted in an improvement of physical performance by 26% despite weight loss of 11 kg. Blood pressure could be reduced both at rest and on exercise. Blood pressure regulation and heart rate under orthostatic conditions remained unchanged for both therapeutical approaches. The effect on carbohydrate and lipid metabolism was also more favorable in patients on combination therapy than in those given a reduction diet alone. Combination of reduction diet and physical exercise is therefore superior to caloric restriction alone with regard to cardiovascular and metabolic considerations.

Adult↗