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A Wettstein

Publications and source records attributed to A Wettstein.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Attitude of seniors to rationing in health care--before and after a lecture series].

UNLABELLED: Prior to the first lecture in the public series of lectures entitled "Rationing of Health Care: Are Elderly the Victims?" and before a lecture given to a Senior Citizens Association on the same subject, all participants were polled. The polling was repeated at the end of the lecture series. The initial participation totalled 69 with two-thirds women, average age 64 years (50% were from the health care or social welfare sector), and 57 retired business people (50% women). At the end, there were 45 listeners (average age 65 years), with 30 taking part in both surveys. The majority believed that rationing is already taking place, only 1/6 rejected such measures in principle. When asked, nearly all those surveyed were in favor of quality of life after treatment and life expectancy as criteria for the right to medical services. Personal criteria, such as nationality, social role, self-related causes and calendar age were rejected by the majority, although less clearly by the business people than by the general participants. This rejection became more marked after the lecture series. Those surveyed gave various specific judgements on decisions about the complex allocation of resources and favored decision-making by patients themselves unless they were senile. A large minority were opposed to very elderly patients making decisions themselves, even if they were not senile. CONCLUSION: The elderly persons polled demand that all rationalization measures be exploited before rationing is implemented. Rationing criteria must be of a universal nature and borne by the general public.

Adult↗
PubMed2000

[Milieu therapy for patients with dementia. Appropriate, regular stimulation by pleasant experiences].

The target group includes caregivers of demented persons at home and in institutions. The aim is a synopsis of different ways to cope with behavioural disturbances by milieu-therapy for demented persons. Appeals are made to their remaining resources, thus getting them more joy and less frustration by less excessive demands. Less boring activities avoid to feel under-challenged. More activity during day-time provides better sleep at night.--Consequently there are less behavioural disturbances with less stress for caregivers thus enabling them to keep the patients longer at home, leading to lower health costs. Behavioural disturbances of demented persons should always be treated by milieu-therapy achieving a response rate of up to 60%. With application of adjuvant medication, e.g. geriatric neuroleptics, a rate of 70% is within reach. Milieu-therapy is optimal for the prevention of behavioural disturbances. The better the adaptation of milieu-therapy to the individual patient's deficits and lifestyle and to the lifestyle of his caregiver, the better the effect.

Aged↗
PubMed2000

Cholinesterase inhibitors and Gingko extracts--are they comparable in the treatment of dementia? Comparison of published placebo-controlled efficacy studies of at least six months' duration.

The efficacy of four cholinesterase inhibitors (tacrine, donepezil, rivastigmine, metrifonate) and Ginkgo special extract EGb 761 in Alzheimer's disease were compared. The differences in the effects of the active substance and placebo on cognition were measured on the ADAS-Cog scale, taking into account the different degrees of dementia in the various studies and the dropout rate due to adverse drug reactions. Efficacy, expressed as the delay in symptom progression or the difference in response rate between active substance and placebo, showed no major differences between the four cholinesterase inhibitors and the Ginkgo special extract. Only tacrine exhibited a high dropout rate due to adverse drug reactions. In view of this, the subject of new prescriptions should be critically reviewed. Second-generation cholinesterase inhibitors (donepezil, rivastigmine, metrifonate) and Ginkgo special extract EGb 761 should be considered equally effective in the treatment of mild to moderate Alzheimer's dementia.

Alzheimer Disease↗
PubMed1999

[The resources of the social network of single person households during acute illness. Basic data for home care planning in an influenza epidemic].

UNLABELLED: 230 single persons living in the city of Zurich, 60% aged 18-45, 10% 45-65 and 22% older than 64 years; 70% males were subject to an enquiry. The questioned persons mostly live in two-room-apartments, on average for 11 years, they are single for 8.5 years on average. Solely 5.4% have no living relatives but 32% see them only irregularly (same for all age groups) and 4% are not persistently in touch with friends or acquaintances. 36% were needing help in the past because of sickness or accident. They got it from neighbours (38%), friends, acquaintances (36%), family members (17%) and from home care organisations (9%). In case of a heavy wave of influenza only 14% would not help their neighbours, they would help an average of four neighbours but also they would surely not help four neighbours. The answering persons know 23 singles (= 10%) who presumably would not get any help and 20 (= 9%) who would decline help. 90% of the questioned persons believe, that they would get help by family members or friends, even if those live far away, but still 29% expect help from home care organisations, of the questioned over 64 years old even 52%. CONCLUSION: 10-30% of city singles need help in form of home care in case of an acute illness like heavy influenza.

Adolescent↗
PubMed1999

[Epidemiology of dementia and regional health care concepts for dementia patients and relatives].

The prevalence of dementia varies according to the definitions used but shows always an exponential increase with age, a doubling by every five years increase from 60-95 years. Due to the aging of the baby boom generation a doubling of dementia prevalence in the next 50 years is to be expected. Alzheimer's disease is the most frequent cause of dementia. Combinations with vascular, Lewybody, frontotemporal and other causes of dementia are much more frequent than first considered. They all give rise to severe dementia despite only mild Alzheimer changes in the brain. However, a therapeutic response may be expected from cholinergic therapy. Since this pharmacotherapy of dementia only leads to a limited delay of 6-10 months in the progression of dementia, combinations with psychosocial measures such as caregiver-education and care-planning are necessary. We therefore need centers of excellence, such as memory clinics or psychogeriatric counselling centers throughout Switzerland.

Aged↗
PubMed1999

Effect of immersion of biopsy forceps in formalin on tissue urease activity.

BACKGROUND AND AIMS: It is routine practice to wash biopsy forceps that have been immersed in formalin solution before taking gastric biopsies to test for urease activity as formalin is thought to inactivate the urease enzyme. The aim of this study was to assess the effect of pre-immersion of biopsy forceps in formalin solution on the ability to detect Helicobacter pylori urease activity in biopsies obtained with the same forceps. METHODS: Two hundred consecutive patients undergoing gastroscopy who had macroscopic evidence of possible H. pylori infection had an initial antral biopsy taken using sterile forceps for determining biopsy urease activity. The same forceps were then used to obtain an antral biopsy for histological examination. The forceps were then used, without washing off any adherent formalin solution, to obtain a further antral biopsy for urease testing. RESULTS: The concordance rate for urease tests, with or without formalin exposure, was 100% (95% confidence interval (CI) 98.2-100%). Fifty-six of 200 patients (28%) were found to have urease-positive biopsies. Of these, 52/56 (92.9%) had identifiable H. pylori on histopathology. One hundred and forty-four of 200 patients (72%) were found to have urease-negative biopsies. Of these, seven (4.9%) had identifiable H. pylori on histopathology. Six of seven (85.7%) had only a small number of organisms identified. The sensitivity and specificity for the urease test compared with the histopathology as a reference standard was 88.1% (95% CI 79.9-96.4%) and 97.2% (95% CI 94.4-99.9%), respectively. CONCLUSION: Immersion of biopsy forceps in formalin did not reduce the ability to detect urease activity in gastric biopsies taken subsequently.

Biopsy↗
PubMed1998

[Successful coping with declining objective life style by institutionalized long-term patients. Results of a follow-up analysis of quality of life in long-term care institutions with the Zurich Quality of Life Inventory].

Measurement of quality of life in institutionalized frail patients is difficult considering the high prevalence of dementia. The Zurich quality of life inventory was developed specifically for this purpose and applied to describe longitudinally 103 institutionalized long-term care patients 3-12 months after entry: 11 slow-stream-rehabilitation patients (SSR), 16 severely dependent patients (ASL), 61 moderately dependent patients (ALL), and 15 young severely dependent patients, all of whom were assessed at least twice. The objective conditions of life deteriorated in all 4 groups, significantly in the SSR and ASL, and with high significance in the whole population from 121 +/- 54 to 139 +/- 58 (P < 0.001). Well-being did not change significantly in any of the groups or overall (from 122 +/- 59 to 117 +/- 54, p = 0.90). Deteriorating life conditions were due to a decline in clinical dementia rating, (p < 0.01) and living space diameter (p < 0.001), whereas the remaining subscores of life condition, i.e., number of falls, days of sickness, life style rating, and all subscores of well-being, i.e., number of medicines, valuation of handicap and of suffering, visual self-rating of well-being and caregivers' stress did not change significantly.

Activities of Daily Living↗
PubMed1997

[The use of adenosine in the diagnosis and treatment of cardiac arrhythmias].

The authors investigated the effect of adenosine or ATP on narrow QRS tachycardia in 56 pts, 3 pts with wide QRS tachycardia 9 pts with suspected latent preexcitation and 10 pts with PVC suspected to be ventricular parasystole. After the bolus iv. administration of adenosine or ATP every SVT was stopped related to AV node (44 pts), but in the rest twelve related to atrial origin of SVT only one automatic atrial tachycardia could be stopped. From the 9 patient suspected to have concealed WPW 2 pts had delta wave during the effect of adenosine, and in four pts parasystole was demonstrated among the pts had varying coupling interval PVC. None of the pts who had wide QRS tachycardia was the tachycardia stopped, but in two cases the supraventricular origin--atrial flutter and tachycardia--was discovered. The authors emphasize the favourable effect of adenosine in narrow complex tachycardia and suggest that it can given safely in wide QRS tachycardia of unknown origin either. The diagnostic effect of adenosine can be used in sinus rhythm too if latent preexcitation or ventricular parasystole is suspected.

Adenosine Triphosphate↗
PubMed1997

[Headache as a symptom of angina].

The authors report two cases where headaches was the only manifestation of severe myocardial ischemia. They had high degree coronaria sclerosis which was demonstrated by angiocardiography in one patient and at autopsy in the second patient. These findings suggest that in the mechanism of headache angina rather the pain perception than generalized vasospasm plays an important role.

Adult↗
PubMed1997

[Medical evaluation of dementia].

A careful medical evaluation of each dementia patient from any age group is necessary. Dementia targeted questioning of the patients and their relatives should be accompanied by a quantitative dementia rating like the NOSGER-scale. The essential neuropsychological evaluation should be followed by a nosological differential diagnosis including a row of laboratory tests. Brain imaging is necessary only if one of the Dietch-criteria is met. Pharmaco-therapy should be considered for non-cognitive symptoms of dementia and a cholinergic therapy in cases of Alzheimer's disease. Considering the axiome of dementia: one dementia = two in need of help, the care-giver burden has to be eased by proposing sets of medico-social interventions, optimally at a family conference.

Aged↗
PubMed1997

[The Zurich prospective dementia study 1987-1993].

1987-1993 the Zurich prospective dementia study examined twice yearly 308 nursing-home patients: 192 with senile dementia of Alzheimer-type, 18 with Parkinsonism, 20 with Parkinson dementia and 78 controls, with the Zurich variant of the mini-mental state and rated their dementia state by CDR, activities of daily living with ADL and social behavior with an SVS-scale. At the end of the study or at death the average age was 86.2 years (range 63-103 and 159 autopsies were performed which confirmed the clinical diagnoses at least partly in 70%. Of the 62 cases with autopsies who had been studied more than two years 25 showed M.Alzheimer, 8 M, Parkinson, 7 vascular dementia and 13 a combination of those three diagnoses 40% of these Alzheimer patients exhibited no deterioration in the SVS for two years, 40% respectively 30% during one, resp. two years in the CDR, 20% resp. 40% in the ADL and 23% resp. 5% in the MMS. This demonstrates that good nursing-home care can stabilize behaviour and to a lesser extent even cognitive abilities of a large minority of patients with a pathologically confirmed progressive dementing illness.

Activities of Daily Living↗
PubMed1996

[Cost reduction in long-term nursing thanks to a memory clinic--results of a case control study].

Between 1991 and 1995, 334 persons from the city of Zurich have been investigated at the gerontologic counselling facility of the memory clinic of the nursing home Entlisberg near Zurich. 49 (14.7%) of these persons suffered from a treatable disease (16 from depression, 13 from chronic intoxication, 20 from other treatable diseases), 10 from other disturbances (debility or postapoplectic state), and 275 from dementia. In 45% of the cases dementia was moderate, in 47% moderate to severe, and in 8% severe. In most cases dementia was of Alzheimer's type (60.7%), others were of multi-infarct type (17.5%), of mixed type (13.1%), or other types (8.7%). Until march 1996, 64 (19.4%) of these 334 on the average 74-year-old persons treated in the memory clinic have been admitted to a city nursing home. They have compared to a random sample, including 312 demented persons of similar ages and similar date of admittance to the same institutions. The proportion of demented persons cared before admittance by a spouse was about 28% in both groups. On an average, the mini mental state (Zurich variant) at admittance to a nursing home was 10.95 points in patients from the memory clinic, compared to 13.43 points in the control group. Thus, patients that have formerly been advised and trained entered the nursing home in a state of dementia more advanced by 2.48 points. Based on an average yearly demelioration by about 2.4 points, this means admittance to a nursing home is delayed by 376 days. Patients for whom admittance to a nursing home could be avoided completely by the treatment proposed by the counselling were not considered in this calculation.

Aged↗
PubMed1995

T-cell-receptor repertoire in chronic plaque-stage psoriasis is restricted and lacks enrichment of superantigen-associated V beta regions.

Preferential usage of certain T-cell receptors by the lymphocytic infiltrate in psoriasis might indicate the involvement of an antigen in the pathogenesis of this disease. However, to date there are no data on the complete T-cell-receptor V alpha and V beta repertoire in psoriatic patients. We therefore compared the usage of T-cell-receptor variable regions in blood and skin of 10 patients with chronic plaque-stage psoriasis by means of semiquantitative polymerase chain reaction. Additionally, HLA class II alleles were analyzed by means of sequence-specific oligonucleotide typing. A considerable restriction of the T-cell-receptor repertoire was observed in the skin, where up to 20% of the variable regions present in the blood were not detectable. This was true for both alpha- and beta-chains. However, no interindividually constant pattern of T-cell-receptor restriction was deducible. Inconsistently, a certain preferential usage of some beta chains occurred within the cutaneous compartment. This report on the complete T-cell-receptor V alpha and V beta repertoire in psoriasis documents the restricted receptor repertoire of infiltrating T cells and a lack of enrichment of superantigen-associated V beta regions. Thus superantigens seem not to play a pathogenetically relevant role in chronic plaque-stage psoriasis.

Genetic Heterogeneity↗