Search PubMed⌕ Search

Biomedical subjects

D Schaeffer

Publications and source records attributed to D Schaeffer.

At least 19 recordsLinked to original sources
PubMed2006

[Managing chronic illness implications for the health care system].

Although chronic diseases build the main focus of health problems, the German health care system is not sufficiently prepared to deal with the new challenges. The reasons are diverse, but one of the most decisive is that the various consequences in dealing with chronic disease are scarcely noticed by the health service. These consequences are brought out by the following article by referring to the available literature and our own studies and are discussed in its implications for a needs-driven design of care. Special attention is paid to care, because it increasingly assumes a key role in the treatment of chronically ill, which still faces barriers in this country. These discussed are also.

Aged↗
PubMed2002

[Retinopathy of prematurity: 10-year retrospective study at the University Hospital of Strasbourg].

OBJECTIVES: This work was splitted in two parts: the first one was the study of retinopathy incidence in premature infants less than 33 weeks gestation, born between 1988 and 1997; the second one is the identification of severe retinopathy different risk factors. PATIENTS AND METHODS: Our study was retrospective over ten years. All premature infants less than 33 weeks gestation born between January 1, 1988 and December 31 1997, admitted to the Strasbourg neonatal intensive care unit with retinopathy, were included (164 children). First we studied the incidence evolution of retinopathy over these ten years; then by a statistical study (univaried and multivaried) we looked for a significant difference for several factors between the infants with mild retinopathy and the group with severe ocular disease. RESULTS: Retinopathy incidence decreased in ten years from 13.7 to 6.7% for the moderate forms (P < 0.001) and from 3.7 to 1.7% for severe stage (non significant). A significant difference was found for various factors after comparison between both groups. The birth weight (P = 5 x 10(-4)), the gestational age (P = 4 x 10(-6)), were weaker in the group with severe retinopathy. A maternofetal or nosocomial infection (P = 0.009; P = 0.002), hemodynamic shock (P = 10(-6)), patent ductus arteriosus (P = 10(-6)), bronchopulmonary dysplasia (P = 3 x 10(-6)), postnatal steroid treatment (P = 0.007), respiratory distress syndrome (P = 0.01), were all more frequent in the severe retinopathy sample. The number of days with oxygenotherapy (P = 10(-6)) and mechanical ventilation (P = 10(-6)) the number of blood transfusion (P = 10(-5)) were higher in this group than in the other. The logistic regression analysis showed that the hemodynamic parameters influence mostly on the risk of severe ocular disease, like an hemodynamic shock syndrome (OR = 16.94; CI = 2.12-135.77) or a patent ductus arteriosus (OR = 5.36; CI = 1.53-18.74). CONCLUSION: A decrease of the retinopathy incidence in premature infants was observed in ten years, probably due to better care in the neonatal period. An unstable hemodynamic state would be one prominent risk factor in the genesis of severe retinopathy of prematurity.

Blood Transfusion↗
PubMed2002

Can glutamine and growth hormone promote protein anabolism in children with cystic fibrosis?

To determine whether recombinant human growth hormone (rhGH), glutamine (GLN) or a combination of both agents can enhance protein synthesis in cystic fibrosis (CF) patients, six 9.6 +/- 0.5-year-old prepubertal children (4 M, 2 F) with CF and stable lung disease with undernutrition (weight/height <50th percentile) or delayed growth (height <5th percentile) received stable isotope infusions, in the postabsorptive state and on 4 separate study days: (a) at baseline, and after a 4-week treatment with either, (b) oral GLN (0.7 g/kg/day), (c) rhGH (0.3 mg/kg/week, SC), or (d) both GLN and rhGH. Four-hour infusions of (13)C-leucine were used to assess leucine appearance rate (Ra, an index of protein breakdown), oxidation (Ox), and non-oxidative leucine disposal (NOLD, an index of protein synthesis). Results are expressed as changes (%) from baseline:We conclude that in children with CF: (1) due to high inter-subject variability, oral glutamine does not significantly enhance protein gain; (2) rhGH has significant anabolic effects which are mediated by stimulation of protein synthesis, and (3) glutamine does not enhance the effect of rhGH.

Bicarbonates↗
PubMed2001

[Consumer perspective and quality development in ambulatory nursing care].

In the 1990s, the debate surrounding the issue of quality in outpatient nursing care was given a remarkable boost. Also the conviction steadily grew that quality assurance should be more adjusted to values and expectations of people in need of nursing care, the addressees of such services. But a critical analysis is required to determine to what extent the role of "customer" or "consumer", a role often ascribed to them in this context, can actually be reconciled with their possibilities, expectations and interests. Based on the results of empirical studies, the following article shows that the patient's view, his expectations and evaluations largely depend on some specific consequences of being in need of care and using outpatient nursing care. The article goes into the divergent perspectives that, on the one hand, are characteristic of patients and, on the other, of the nursing staff and other bodies concerned with quality of care.

Aged↗
PubMed2001

[Patient records: supporting interprofessional communication in hospital].

Complete and continuous documentation in patient records is an important condition for adequate communication with patients, between the professions concerned and to ensure the quality of the following working steps in care provision. Part of a German research project concerning the interprofessional communication in hospital was therefore to analyse the use of the documentation system. 54 users were asked about practical aspects of their documentation system and 450 patient records were evaluated. The analysis focused on the medical and nursing documentation of admission, process and discharge. Deficits that need to be improved appeared first of all in the practical aspects of the documentation system, the flow of information between the professions, in specific gaps of medical and nursing admission, documentation of process and discharge. Quality management is asked to improve and develop the documentation in collaboration with the users and to consider specific problems when introducing computer based records.

Documentation↗
PubMed2000

The normalization of AIDS in Western European countries.

The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Care management: scientific thoughts on a current topic].

The following article deals with one of the management concepts now undergoing extensive international debate--the care management concept favored in Great Britain--and discusses its importance in respect to the optimization of outpatient nursing care in the Federal Republic of Germany. After a presentation of the key elements comprising the concept, four central task complexes relating to care management are discussed: establishing demand--and need oriented nursing, assuring the integration and continuity of care, especially when chronic diseases are involved, helping family members to provide nursing care and promoting health as one of the nursing profession's tasks. It is shown that care management is a tool that can be used to tackle deficits in outpatient nursing care and find innovative solutions to them, thereby promoting the nascent professionalization of nursing in Germany, a trend that is long overdue in international terms.

Case Management↗
PubMed2000

[Pain management and nursing care--results of a review of the literature].

Especially for patients with chronic conditions, the ability to cope with the experience of illness in their daily lives is essential for the quality of life. An analysis of the international literature, of German nursing textbooks and journals was carried out to determine the dissemination of the state of the art of pain management. International research findings indicate a wide gap between the state of the art and pain management practice. Multidisciplinary role model programs where nurses play a major role as change agents have proved to be an effective strategy to change the institutional practice of pain management. In Germany, pain therapy as a medical discipline as well as academic courses in nursing were only institutionalized in the last decade. As a consequence pain research and therapy remained the domain of medicine and psychology up to now. Enhancing knowledge and educative skills of nurses will not only promote the quality of care. It is a key concept of professionalization in nursing.

Analgesics↗
PubMed2000

[Management and care of severely ill patients in ambulatory care nursing--results of an evaluation study].

The last few years have seen numerous attempts to expand outpatient nursing and adapt it to the changing health problems of the population. Even so, outpatient nursing care for severely ill patients and those with complex nursing needs still has its shortcomings. Today, it may well be the case that these patients, too, are being discharged far more quickly from the inpatient into the outpatient sector thanks to ever greater constraints on hospital care, but there they are running up against a wide variety of problems, ones that first became obvious with AIDS but can also be seen with other groups of patients suffering from serious illnesses. The paper goes into the question of what the care of severely ill patients and those requiring nursing attention looks like in the outpatient sector, what difficulties arise from the point of view of the nursing services involved, and what challenges will have to be met in the future to improve their situation.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Carotenoids and colon cancer.

BACKGROUND: Carotenoids have numerous biological properties that may underpin a role for them as chemopreventive agents. However, except for beta-carotene, little is known about how dietary carotenoids are associated with common cancers, including colon cancer. OBJECTIVE: The objective of this study was to evaluate associations between dietary alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin, and beta-cryptoxanthin and the risk of colon cancer. DESIGN: Data were collected from 1993 case subjects with first primary incident adenocarcinoma of the colon and from 2410 population-based control subjects. Dietary data were collected from a detailed diet-history questionnaire and nutrient values for dietary carotenoids were obtained from the US Department of Agriculture-Nutrition Coordinating Center carotenoid database (1998 updated version). RESULTS: Lutein was inversely associated with colon cancer in both men and women [odds ratio (OR) for upper quintile of intake relative to lowest quintile of intake: 0.83; 95% CI: 0.66, 1.04; P = 0.04 for linear trend]. The greatest inverse association was observed among subjects in whom colon cancer was diagnosed when they were young (OR: 0.66; 95% CI: 0.48, 0.92; P = 0.02 for linear trend) and among those with tumors located in the proximal segment of the colon (OR: 0.65; 95% CI: 0.51, 0.91; P < 0.01 for linear trend). The associations with other carotenoids were unremarkable. CONCLUSION: The major dietary sources of lutein in subjects with colon cancer and in control subjects were spinach, broccoli, lettuce, tomatoes, oranges and orange juice, carrots, celery, and greens. These data suggest that incorporating these foods into the diet may help reduce the risk of developing colon cancer.

Adenocarcinoma↗
PubMed1999

[State of development and challenges of federal German nursing science].

Nursing care in the Federal Republic of Germany has taken an unexpected, major developmental leap in recent years: numerous new study programs for nursing have been established over a very short period. Additionally we have also seen the advent of nursing science in our universities, and the development of nursing research is essential in making this field a true scientific discipline. This paper takes stock of what has been achieved so far, reviewing nursing as it is practised, study programs, and the development of the scientific discipline and nursing research. It will show that, in spite of the numerous achievements in the recent past, there are still many more tasks that need to be addressed. Just one of these is to fill the continuing vacuum by building up the science, pushing ahead with the development of nursing research, and creating appropriate conditions for promising researchers from the next generation.

Forecasting↗
PubMed1999

Caesarean section and other methods for assisted delivery: comparison of effects on mare mortality and complications.

Data from 116 mares that had caesarean section or vaginal delivery at 2 university hospitals were analysed in 5 groups, as follows: dystocia corrected by caesarean section, Group DCS (n = 48); elective caesarean section, Group ECS (n = 10); caesarean section concurrently with colic surgery, Group CCS (n = 8); assisted vaginal delivery, Group AVD (n = 22); and controlled vaginal delivery under general anaesthesia, Group CVD (n = 28). Survival rate in all mares that had caesarean section, excluding Group CCS, was 88% (51/58). All mares in Group ECS survived and Group CCS had the lowest survival rate (38%). In 98 mares with dystocia, Groups DCS (15%) and AVD (14%) had significantly lower (P<0.05) mortality rates than Group CVD (29%). There were no differences between groups for duration of dystocia. The placenta was retained in 75 (65%) of 116 mares, and for a longer period following elective caesarean section than following assisted vaginal delivery. Multiple complications (> or = 3) were recorded in 6 mares in Group CVD but not in the other groups. Of the 102 foals delivered from 98 mares with dystocia, 11 (11%) were alive at delivery and 5 (5%) survived to discharge. Survival rate for foals was 38% in Group CCS, and 90% in Group ECS. Under conditions similar to those in this study, it is calculated that caesarean section is preferable to CVD if dystocia is protracted and great difficulty and trauma is involved, even if CVD allows delivery of the foal.

Anesthesia, General↗
PubMed1997

Effect of intra-arterial environment on endothelialization and basement membrane organization in polytetrafluoroethylene grafts.

PURPOSE: To determine if a complete intra-arterial environment affects endothelialization rate and basement membrane organization in polytetrafluoroethylene (PTFE) grafts. METHOD: Thirty dogs underwent either infrarenal abdominal aorta PTFE interposition (12) or intraluminal stented (18) grafting. Grafts were explanted at 4 and 8 weeks and rate of endothelial ingrowth calculated. Endothelial cells were identified and basement membrane organization assessed using antibodies against endothelial cell-specific surface antigen CD31, type IV collagen, and laminin. RESULTS: Endothelialization rates, expressed as percent graft surface area coverage per week, were 3.7% +/- 0.62% (4-week control), 12.9% +/- 0.58% (4-week stented), 4.2% +/- 0.62% (8-week control), and 10.0% +/- 0.54% per week (8-week stented grafts). Endothelial repaving rates were constant for control and increased in all stented grafts (P <0.01). At 4 weeks, laminin was identified in all control (6 of 6) and no stented grafts. Staining was confined to the 20% of the hyperplastic intimal area immediately below the endothelium. At 4 weeks, type IV collagen was present throughout the entire hyperplastic intima in control specimens but was confined to a discrete subendothelial zone in stented grafts. By 8 weeks, type IV collagen became concentrated in the luminal one third of the intima in control grafts. CONCLUSION: Intra-arterial graft location is associated with early formation of an organized basement membrane and accelerated endothelialization in PTFE grafts.

Animals↗
PubMed1996

[Innovative processes in ambulatory care--AIDS as a pilot project].

Flexibility in nursing practice and the willingness to be innovative are discussed, using the care of patients with AIDS as an example. When this new infectious disorder made its first appearance many countries tried to provide a patient-centred, community based service, in spite of the severity of the illness and the fact that it was usually lethal. A number of innovations were required to achieve this. The top priority was the provision of a community nursing service. This contribution consists of the analysis of the structure of provisions for care of patients with AIDS in the German Federal Republic (BRD). It deals with the reaction of the nursing services and asks to what extent the objectives have been achieved. Three different ways to adapt to the situation in the BRD are described and analysed. Data are based on qualitative interviews with members of the nursing service. It is shown that AIDS has led, in the BRD, to numerous innovations in community nursing care, the relevance of which far transcends the treatment of AIDS. In spite of this success, the care of patients is unsatisfactory. Many promising attempts to change came to grief as a result of resistance and obstacles to implementation. Others proved to be insufficiently robust or inappropriate in view of the multiplicity of problems encountered in AIDS. Reasons are to be found in the defective structure of the service, in the fact that management difficulties concerned with implementation of innovations were underestimated and that there is a "crisis" in nursing in the BRD. There have been criticisms for a long time, pointing out that the basic qualification is insufficient, that it does not prepare nurses adequately to deal with new social and health problems. If no change is introduced to training, community nursing is unlikely to be able to cope innovatively and flexibly with new challenges in the future.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Prevention and health promotion in chronic patients as a responsibility of treatment institutions].

The tasks of prevention and health promotion involve more than lowering the probability that healthy people will fall ill. In view of the increase in chronic diseases, more must be done than presently customary to apply them not only to health assurance, including the preservation and augmentation of resources, but also to prevention of the probability that poor states of health will spread or grow worse. Implementation there of presupposes that curative institutions will cultivate preventive potentials. This article reflects on how that could be done: what prevention and health promotion in the case of chronic illness mean as tasks for curative institutions and how they can be conceptualized. To conclude with, the article shows what inhibitory conditions presently stand in the way of curative institutions attending to preventive and health-promotion tasks and what changes will be necessary to eradicate them.

Activities of Daily Living↗