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Biomedical subjects

G C Fischer

Publications and source records attributed to G C Fischer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Standardising health outcome measurements in general practice.

BACKGROUND: Outcome measures are gaining importance especially in areas such as divisions of general practice. The plethora of outcome measurements and the rhetoric surrounding this may make it difficult for doctors to decide the place of such measures in daily practice. An understanding of outcomes and their indicators is emerging as an essential requirement for good practice. OBJECTIVE: The aim of this paper is to propose a practical framework for describing health outcome measurements that may be applied to general practice. METHODS: This paper outlines the key features of outcomes measurements and proposes a model for understanding health outcome indicators using a set of indicators relevant to clinical practice. RESULTS: Pertinent to developing outcome terminology for use with patients in general practice are the four key features: a clear description of the indicator utility in practice comparability between practices endurance over time. CONCLUSION: To have reliability and validity and be able to deliver outcomes with practical and clinical significance, we need to be sure that the instruments we use are precisely defined. It is also important that the meaning is universally understood by all who might want to use the instruments. The product should also have cultural applicability beyond English. In clinical practice, the definition of the instrument aims not only to give the general practitioner a clear understanding of what is being measured but how it is used and the implications for its future use.

Family Practice↗
PubMed1998

[Diabetes mellitus and physical medicine].

In the treatment of diabetes, the importance of kinesitherapy increases steadily. In fact, a prospective study (1996) which was done on 897 Finnish middle-aged males over a period of 4 years, showed that the risk of diabetes can be reduced to 50% by moderate physical exercise of 40 minutes per week compared with less active persons of the same age. The amount of kinesitherapeutic measures depends on the physiological resilience of the diabetes patient and on the extent of existing diabetes-induced lesions. An endurance kinesitherapy activates the carbohydrate metabolism and affects the glucosensitive receptors situated in peripheral and central organs. A muscle activity of ten minutes can already multiply by fifteen the increase of glucose absorption from the blood. Another positive result by physical effort is to be seen in the preventine and therapeutic effect of an increased insuline action. The individually adapted kinesitherapeutic endurance stimulation should last from five to ten minutes each day and reach at least 50% of maximum capacity but not more than 70%. This maximum capacity can among other things be gauged from the heart rate as well as from the breathing rate.

Adolescent↗
PubMed1997

[Screening for rehabilitation needs of patients in care of family practitioners].

Family doctors play an important role in promoting the access of patients to rehabilitation. On the one hand they are very often the first professionals to be contacted if patients want to take part in rehabilitation procedures whereas on the other hand there are also many patients whose need for rehabilitation remains undisclosed. No detailed estimates are available on how many of such patients exist in German GP-practices although it should be an important task of family doctors to discuss the pros and cons of rehabilitation particularly with their patients who are in need of it. We performed a non-representative pilot study in three GP offices during ten working days. patients older than 29 years were screened for their "rehabilitation status" with an instrument frequently used in German rehabilitation clinics. The patients were also asked whether or not they would like to participate in a rehabilitation procedure and what was the reason for their decision. Not knowing the patients' answers their doctors rated whether or not it would be appropriate for their patients to take part in rehabilitation. Additionally the doctors stated what kind of rehabilitation should be performed and what could be ist aims. In a sample of 181 patients about one-third was found to be in a severe "rehabilitation status", about one third in a state with higher than normal values--although not severe--and also approx. another third had a normal status. Family doctors stated that for one-third of their patients rehabilitation would be undoubtedly suitable at the time of the screening. In about two thirds of the cases the results of the questionnaire and the doctors' ratings corresponded. Some patients felt completely healthy although the results of the questionnaire and the doctors' statements rated them as being in need of rehabilitation. Other patients in need of rehabilitation rejected it for other than health-related reasons. The results of our study give evidence to the family doctors' key role for patients' access to rehabilitation. A representative study with a larger sample should be performed in the future because it could yield more detailed figures on the rehabilitation needs of family doctors' patients. Possibilities of standardised screening for rehabilitation needs in primary medical are should also be studied. The results of our pilot study also indicate the need for studies concerning non-medical causes of underutilised rehabilitation facilities. Family doctors should discuss these problems with their patients.

Family Practice↗
PubMed1996

[A prevention program for health problems in the elderly. Ambulatory Geriatric Screening (AGES) for use in general practice].

Ambulatory Geriatric Screening (AGES) is a standardized interview and examination instrument, the purpose of which is to detect major health or psychosocial problems in the elderly ambulatory patient, and thus prevent secondary illnesses. It comprises a patient and doctor's assistant questionnaire and a doctor's examination sheet with brief instructions for use. In a study conducted between 1992 and 1995, AGES was employed in 67 randomly selected general practitioners' offices in the area around Leipzig and Hannover. An important result was that in an average of 10.2 health-related problems per patient, 4.8, that is almost a half, had been unknown to the care-providing physician. In the case of very old patients, however, the family doctor was usually better informed. The application of the AGES in the office is less time-consuming than might be feared. For the evaluation of the patient questionnaire and the scheduled small examinations, the doctor's assistant needs only 10 to 15 minutes. Thereafter, the family doctor can check the results at a glance and use them as a basis for further talks with the patient and his therapeutic approach.

Aged↗
PubMed1996

[Why do elderly couples use ambulatory nursing care?].

More than one million people in Germany are in need of home care and elderly caregiving wives and their caretaking husbands are an important group in the society. Demographical changes with a shift to more elderly people in relation to younger people will further increase the importance of this group. Home care service organisations play an important role in supporting these couples, but they are still rarely made use of. To optimize the support that can be rendered by home care services, information is needed on what influences the decision of elderly couples to use or not to use such services. A set of data from an earlier study about the situation of more than 300 couples aged 60 years or older is used to determine influencing factors in bivariate and multivariate analysis. The theoretical framework is a behavioural model of service use. The need for care measured by loss of function in activities of daily living turns out to be the most important factor influencing the use of home service organisations. Other variables such as e.g. disability of caregivers play a minor role. It seems that home care services are used as a kind of "last resort" if there is no other way to handle the situation. In trying to optimize home care services, the different values of factors influencing their use should be considered. It is important to take into consideration that those who solicit home care aid wish to retain their autonomy at the same time.

Activities of Daily Living↗
PubMed1995

[Effects of 2 reimbursement models on house calls by general practitioners].

This study compares the effects of the salary payment in the former GDR with the fee for service remuneration in Germany for outpatient service. The investigation focused on home visits 3 by family doctors in Magdeburg in the first two quarters of the years 1985 and 1992. The retrospective study based on existing documentations. Main questions were the modification of frequency resp. nature and matter of home visits. The frequency of home visits increased by about 134%. Distributed by age-groups, the home visits at patients up to the age of 55 showed only a small increase. However, the increase with patients between 60 and 79 years of age was 350%. In particular, diseases of the ICD Group VII (diseases of the vascular system) were affected by the increase. In contrast to this home visits of nurses were influenced to a lesser degree by the system changes. These are indications that the increase in the home visits is not due to an increased demand for them.

Adolescent↗
PubMed1995

[Management of elderly patients by the family physician].

The care for elderly patients is traditionally a task of the general practitioner and will be of increasing importance in the future. Medical considerations focus on the patient's functional abilities which should play a primary role. These should, however, not neglect the patient's resources for the development of social and mental competence. Medical interventions so far will also need social indications evaluating their importance in the every day life context of the individual patient. Based on scientific knowledge of geriatrics and gerontology there should be a wide-spread introduction of standardized instruments into geriatric diagnostics and evaluation. Geriatric screening may be one example. This will support the development of a special geriatric quality management in general practice. There is a need for further development of ambulatory rehabilitation for the elderly. The general practitioner in this field will have to control the teamwork with rehabilitation-professionals and professionals from the social support services.

Activities of Daily Living↗
PubMed1994

[Continued medical education from the viewpoint of the established physician].

From the point of view of the General Practitioner continuous medical training of today still is in many aspects insufficient. Mainly the choice of the topics is not oriented at the real training needs of the G.P. and has only poor relationships to every day practice. There are rather no possibilities of an active involvement of the G.P. and a lot of sessions are still carried out by speakers with a special clinical experience. It seems that the peer review groups will be one of the most successful forms of continuous training in the future. It leads to an active co-operative training among C.P.'s, totally realize to every days practice and leads to a more standardized and better care of the patient.

Curriculum↗
PubMed1984

The effect of high molecular weight kininogen on surface-adsorbed fibrinogen.

High molecular weight kininogen (HMWK) plays an important role in altering the association of plasma fibrinogen with surfaces. Plasma initially deposits fibrinogen onto most materials, but on hydrophilic surfaces within 10 min adsorbed plasma fibrinogen cannot be detected on the surface by anti-fibrinogen antisera. However, using HMWK-deficient plasma, fibrinogen remains immunologically identifiable. The interrelationship of adsorbed plasma fibrinogen with kininogen on hydrophilic surfaces is studied further using glass slides stained for protein with Coomassie Blue, and oxidized silicon crystal slices in an automated ellipsometer. On glass slides when plasma that is deficient in both low molecular weight kininogen (LMWK) and HMWK, is reconstituted with HMWK (0.04 Units/ml), fibrinogen is no longer detected on the surface. This finding is specific for HMWK, since, when the same plasma is reconstituted with LMWK (220 micrograms/ml), the amount of fibrinogen detected on the surface is unchanged. The alteration of surface-adsorbed fibrinogen by HMWK is not due to plasmin-induced fibrinolysis, since it occurs in plasminogen-free plasma. In the ellipsometer, surface adsorption of normal plasma is associated with a significantly less (p less than 0.0005) thick protein layer (1.99 +/- 0.08 degree change in azimuth) than plasmas deficient in HMWK (2.32 +/- 0.11). Using ellipsometry, HMWK in plasma is shown to shorten the time in which immunologically detectable surface-adsorbed fibrinogen was removed or altered. These studies in a whole plasma system present further evidence that HMWK specifically modifies the association of plasma fibrinogen with hydrophilic surfaces.

Adsorption↗
PubMed1980

Interaction of high molecular weight kininogen, factor XII, and fibrinogen in plasma at interfaces.

Using ellipsometry, anodized tantalum interference color, and Coomassie blue staining in conjunction with immunologic identification of proteins adsorbed at interfaces, we have previously found that fibrinogen is the main constituent deposited by plasma onto many man-made surfaces. However, the fibrinogen deposited from normal plasma onto glass and similar wettable materials is rapidly modified during contact activation until it can no longer be identified antigenically. In earlier publications, we have called this modification of the fibrinogen layer "conversion," to indicate a process of unknown nature. Conversion of adsorbed fibrinogen by the plasma was not accompanied by marked change in film thickness, so that we presumed that this fibrinogen was not covered but replaced by other protein. Conversion is now showen to be markedly delayed in plasma lacking high molecular weight kininogen, slightly delayed in plasma lacking factor XII, and normal in plasma that lack factor XI or prekallikrein. We conclude that intact plasma will quickly replace the fibrinogen it has deposited on glass-like surfaces by high molecular weight kininogen and, to a smaller extent, by factor XII. Platelets adhere preferentially to fibrinogen-coated surfaces; human platelets adhere to hydrophobic nonactivating surfaces, since on these, adsorbed firbinogen is not exchanged by the plasma. The adsorbed fibrinogen will be replaced on glass-like surfaces during surface activation of clotting, and platelets failing to find fibrinogen will not adhere.

Adsorption↗
PubMedDate not supplied

Convex-lens-on-slide: a simple system for the study of human plasma and blood in narrow spaces.

On clot-promoting surfaces, intact normal blood or plasma deposits fibrinogen and then supplants it with high molecular weight kininogen (HMWK). On glass, plasma layers of less than about 25 micron thick, while still containing enough fibrinogen to coat the surrounding surfaces, lack sufficient HMWK per surface area to remove this fibrinogen deposit. Thus normal intact citrated plasma allowed to enter the space between a glass slide and a convex lens resting belly-down on the slide will leave a disc of fibrinogen where the thickness of plasma layer was below this "critical height" H. The discs of fibrinogen left by plasma that lacks HMWK pathologically or by activation or dilution, are larger--the required H being greater. The present study shows that plasma dilution (final volume divided by original plasma volume) plotted against H yields a straight line. In preliminary series, the slope of this line increases with the atomic weight of five metals whose oxidized surfaces were used as substrates. In whole blood collected in either heparin or ACD, a circle of platelets adheres to oxidized silicon, anodized tantalum, or glass; this circle is similar in size to the one of fibrinogen left by plasma.

Blood Cells↗