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H Sandholzer

Publications and source records attributed to H Sandholzer.

At least 19 recordsLinked to original sources
PubMed2006

[Presenting problem: abdominal pain].

The Saxon Study for General Medicine (SESAM) investigated the reasons why patients consulted the general physician, what diagnoses were established, and how the patients were subsequently treated. In the majority of cases, the reason for the abdominal complaints was located in the gastrointestinal or urogenital tract, in the presence of infections or psychosomatic problems. Gynecological problems must also be considered, while diseases other than gastrointestinal are of no significance for the differential diagnosis of abdominal complaints in the general physician's office.

Abdominal Pain↗
PubMed2006

[Red, yellow, green: management of gastrointestinal complaints].

In a patient presenting with acute abdominal pain, initiation of symptomatic treatment must be preceded by the reliable exclusion of a potentially serious situation (acute abdomen = red light). Rapidly progressive or severe abdominal pain mandates an urgent diagnostic investigation on the part of the physician. No less important is the positive diagnosis of psychosomatic disorders (yellow light). If the family doctor fails to properly counsel the patient, too much diagnostic effort can lead to an iatrogenic somatic fixation. In the absence of all the above, the light shows green for causal therapy, an open mind on the diagnosis, symptomatic treatment and follow-up.

Abdomen, Acute↗
PubMed2006

[Diagnostic work-up of abdominal pain by the family doctor: an avertable potentially threatening situation must be excluded].

When patients attend the physician's office with acute abdominal pain, the doctor must first exclude a potentially dangerous condition (acute abdomen) before initiating symptomatic treatment (e. g. painkilling drugs). The need for this is based in the first instance on the presence of severe complaints in combination with the absence of a plausible explanation for the patient's distress, as well as, secondarily, the anxiety of the patient or the person accompanying him, or even the doctor's own anxiety about possibly overlooking a serious pathology.

Abdomen, Acute↗
PubMed2005

[Sports and leisure injuries in summer].

In the first days of summer, there is an increase in the number of summer-related accidents and injuries. Typical for the types of sports practiced in summer, such as ball games, cycling or skating are injuries to the wrist and ankle, knee, head and shoulder. The most frequent victims of swimming accidents are children under four years of age, and adolescents aged between 15 and 19 years. During grilling, burns often occur, most of which, however, are superficial and can be treated in the doctor's office. The incidence of dog bites also increases in summer. In such cases consideration must be given not only to tetanus boosters, but also to the possibility of an infection with rabies.

Animals↗
PubMed2005

[Insect stings and their sequelae].

In the summer months, insect stings are a common reason for seeking help from the general physician. In the majority of cases a local reaction is seen, but, far less often, an anaphylactic reaction may also occur. Such an acute situation requires calm but decisive action, and the initiation of an evaluation by an allergy specialist. The family doctor should regularly review the facilities for treating an anaphylactic reaction in his office, and, where necessary, optimize them.

Anaphylaxis↗
PubMed2004

[STEP--standardized assessment of elderly people in primary care].

BACKGROUND: There is a need for a standard preventive assessment scheme, which is effective, feasible and acceptable throughout European primary care. METHODS: A consensus based guideline including systematic reviews of the evidence was done by an expert panel of general practitioners (core group) and epidemiologists / geriatricians from seven European countries. RESULTS: The Step group identified 8 health domains to be considered in a preventive assessment; client's perspective and attitudes. physical state, functional state, significant symptoms, mental function, social circumstances, medication and primary preventive issues. To select the health areas with a proven preventive potential the strength of scientific evidence and the relevance to primary preventive care was assessed. The final recommendations graded as the preventive primary care impact factor as follows: A1=strongly recommended were hypertension, symptomatic heart failure, urinary incontinence, hearing impairment, vision impairment, falls, breathlessness, depression, dementia, medication review, functional status, activity and physical exercise. A2=recommended: Hypertension over the age of 80, history of myocardial infarction, symptomatic coronary heart disease, atrial fibrillation, history of TIA or stroke, peripheral vascular disease, diabetes, thyroid dysfunction, osteoporosis, lipids, faecal incontinence, weight status, foot problems, oral heath, osteoarthritis, sleeplessness, pain, social circumstances, tobacco and alcohol use, psychological support for patients with chronic disease and (national) immunization & cancer programs. CONCLUSIONS: The rising population of elderly people in Europe gives cause for health care professionals and policy makers to consider optimal ways to preserve health and function in old age. An Evidence based, proactive preventive geriatric assessment can help to promote heath and function in older people.

Age Factors↗
PubMed2000

[Psychotherapeutic and psychosocial therapy in general practice. Results of demonstration project on quality management in psychosocial primary care].

Since 1987, psychosocial primary care (PPC) provided by General Practitioners, are reimbursed by German health insurances. The aim of the psychosocial primary care is to improve recognition and treatment of mental disorders in the primary care sector. As a part of a eight-center national demonstration program on quality management in the outpatient services, General Practitioners (n = 191) from 5 regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial strain were documented. Differences between psychosocial strain, treatment and outcome were determined by analyses of variance. Men and patients beyond the age of 65 were underrepresented. Psychosocial treatments were offered more often to those patients, who had the highest level of anxiety and depression. Patients with physical illness, with pain and without psychological attribution to the illness belief were offered less psychosocial interventions and reached a worse outcome. The study outcome helps to improve training programs as to recognition and treatment of psychosocial problems in primary care. Male and generally elderly patients with somatic symptoms and lack of psychological attribution need a special psychosocial intervention to improve the outcome.

Adult↗
PubMed2000

[Primary psychosomatic management in general practice. Results of a German nationwide demonstration project of quality assurance].

In the frame of a national demonstration program, psychosocial care of patients with psychological and psychosomatic problems were assessed. General practitioners (n = 191) from six regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial symptoms were documented. Anxiety (62%), depression (51%) and marital/family conflicts (44%) were the most frequent symptoms. Somatic treatment and psychosocial intervention were offered equally. Patients with psychosocial treatment achieved better results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-orientated case conferences, consultation services and collaborative groups.

Combined Modality Therapy↗
PubMed1999

Gender differences in the recognition of depression in old age.

OBJECTIVE: The study should answer the question of whether identical symptom presentations of depression in male and female patients leads to similar recognition rates in primary care. METHOD: We performed a survey in primary care. Two written case vignettes were presented to 170 family physicians in a face-to-face interview which took place in their practices. The case vignettes described either a mildly depressed otherwise healthy old patient (case 1) or a severely depressed patient with somatic comorbidity (case 2). For each case different versions with regard to patients' gender were used: in case 1 only the gender of the patient varied; in case 2 both the gender and the anamnesis (stroke/hypothyroidism) varied. Afterwards the interviewers asked standardised open questions. The physicians were not aware of the mental health focus and the gender focus of the study. RESULTS: The study is representative with a response rate of 77.6%. For primary diagnosis, the female versions were given the diagnosis of depression more often. There was a non-significant trend that female physicians considered depression more often. CONCLUSION: The results show that gender-related experience and stereotypes on the physicians' side influence the diagnosis of (old age) depression in primary care. Further studies should elucidate the influence of the physicians' gender on the management of psychiatric disorders.

Aged↗
PubMed1999

[Early diagnosis and early treatment of cognitive disorders: a study of geriatric screening of an unselected patient population in general practice].

To investigate the feasibility of early assessment of preventable disabilities in primary care, we developed a geriatric preventive screening examination with various indicators of physical, emotional, and social functions as well as laboratory exams. Cognitive impairment was measured by the modified MMSE. Severe cases of dementia, who would deserve home visits were excluded. Results of the assessment procedure in 446 patients aged 70 and over (71.5% females) were compared to ratings of general practitioners (n = 67). In these patients we found 4250 medical, 374 psychiatric, and 528 social problems. 45.4% of medical, 61.8% of psychiatric, and 56.8% of social problems where hitherto unknown to the GPs. The prevalence of cognitive impairment was 4.6% according to GPs diagnosis and 21% according to the MMSE. The sensitivity of GPs diagnosis was 14%, the specificity 98%, and the overall agreement measured by kappa was 0.17. There were significant (p < 0.05) associations of cognitive impairment with poor health, vascular disease, syncope, weight loss, previous hospitalization, depression, and ADL and IADL-items. Hypertension, or pathological thyroid function, occurred more frequently in the cognitively impaired (p > 0.05). Only 19.5% of dementia cases had severe functional loss, which substantiates our hypothesis that mild dementia was studied. Of all cases with newly identified cognitive impairment (n = 83 of 446 patients), three (3.6%) had reversible disorder such as depression (n = 1), drug toxicity (n = 2) 3 (3.6%) received counseling, and 5 (6%) further diagnostic assessment or treatment. One (1.2%) patient did not accept any treatment. In the remainder of 71 patients (85.5%), the GPs adopted a wait and see strategy with no intervention. In conclusion, memory deficits seem to be underdiagnosed in general practice despite much treatable comorbidity or social problems, and some reversible conditions such as depression and drug adverse effects.

Activities of Daily Living↗
PubMed1999

Family physicians and the risk of suicide in the depressed elderly.

BACKGROUND: Depression is the most frequent psychiatric disorder in the elderly. It is the reason for most suicides in this age group. METHOD: We performed a representative survey in primary care. Two written case vignettes were presented to 170 family physicians in face-to-face interviews which took place in their practices. The case vignettes described either (Case 1) a mildly depressed otherwise healthy old patient or a severely depressed patient (Case 2) with somatic comorbidity. Afterwards the interviewers asked standardized open questions. The physicians were not let into the mental health focus of the study. RESULTS: The response rate was 77.6%. Depression was considered for primary or differential diagnosis by 91.2% of the physicians in Case 1 and by 70% in Case 2 (chi2-test; p < 0.01). For further anamnesis, only 2.4% of the physicians were interested in suicidal ideation of the patient. When directly asked at the end of the interview, 76.9% of the physicians said they would talk about suicide. Those who would not, thought that the patient would communicate suicidal intent himself/herself, or they feared to induce suicide by asking directly. CONCLUSION: Thinking of suicidality and its prevention is not uppermost in the physicians' mind. Therefore, and also with regard to the relatively high rate of depression recognition, we conclude that educational means should not only focus on the recognition and screening of depression, but also on the management--'how to talk about...'--of complex problems like suicide in the elderly, in order to change suicide rates.

Aged↗
PubMed1999

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

OBJECTIVE: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Adolescent↗
PubMed1999

[Gerontopsychiatric treatment in comparison between integrated management at a university and separated management at a district hospital. 1: Patient characteristics].

OBJECTIVE: We wanted to study differences between geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the University Psychiatric Hospital (PUK) compared to those in a separated (only according to age) care in the Psychiatric State Hospital (LKH), which together treat all psychiatric inpatients in Goettingen, Germany. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the PUK (n = 151) and the LKH (n = 145) in the years 1991 and 1992. RESULTS: The LKH patients were significantly older (74.8 +/- 8.7 y versus 70.3 +/- 8.3 y), more often living alone and/or without children. 31.9% of them were living in a nursing home compared to 6.5% of the PUK patients. Psychic disorders had not shown up before old age in 55.7% of all cases. 50.4% of the patients were in a psychiatric hospital for the first time. The majority of the patients (65.6%) had not been investigated by a psychiatrist before admission. CONCLUSIONS: More socially handicapped patients were treated in the LKH. For most cases, the hospital treatment had been the first psychiatric treatment at all.

Adult↗
PubMed1999

[Gerontopsychiatric treatment in comparison between integrated management at a university and separated management at a district hospital. 2: Diagnoses and treatment].

OBJECTIVE: We wanted to study differences between geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the University Psychiatric Hospital (PUK) compared to those in a separated (only according to age) care in the Psychiatric State Hospital (LKH), which together treat all psychiatric inpatients in Goettingen, Germany. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the PUK (n = 151) and the LKH (n = 145) in the years 1991 and 1992. RESULTS: Most patients of the LKH suffered from organic brain diseases/dementia (63.4%; PUK: 29.1%). In the PUK, depression was the most frequent diagnosis (57.6%; LKH: 21.1%). A part of about 25% of the patients showed neurological deficits. Specialised diagnostics were performed mostly in the PUK. Both institutions treated the wide majority of patients with CNS drugs. Antidementia drugs were given significantly more often in the LKH. About one third of the patients were released into changed living environments. CONCLUSIONS: Patients with further progressed dementias were treated mainly in the LKH. This has consequences for diagnostics, treatment duration and side effect rate.

Adult↗
PubMed1996

Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure.

OBJECTIVES: The aim of this study was to determine the impact of nasal nocturnal oxygen therapy on respiration, sleep, exercise capacity, cognitive function and daytime symptoms in patients with congestive heart failure and Cheyne-Stokes respiration. BACKGROUND: Cheyne-Stokes respiration is common in patients with congestive heart failure and is associated with significant nocturnal oxygen desaturation and sleep disruption with arousals. Oxygen desaturations and arousals cause an increase in pulmonary artery pressure and sympathoneural activity and therefore may reduce exercise capacity. Oxygen is an effective treatment of Cheyne-Stokes respiration and should improve exercise capacity in these patients. METHODS: The study was designed as a randomized crossover, double-blind, placebo-controlled trial: 22 patients were assigned to 1 week each of nocturnal oxygen and room air. After each week, polysomnography, maximal bicycle exercise with expiratory gas analysis and trail-making test were performed, and a health assessment chart was completed. RESULTS: Nocturnal oxygen significantly reduced the duration of Cheyne-Stokes respiration (162 +/- 142 vs. 88 +/- 105 min [mean +/- SD]; p < 0.005). Sleep improved as evidenced by less stage 1 sleep and fewer arousals (20 +/- 13 vs. 15 +/- 9/h total sleep time; p < 0.05) as well as more stage 2 and slow-wave sleep; nocturnal oxygen saturation also improved. Peak oxygen consumption during exercise testing increased after oxygen treatment (835 +/- 395 vs. 960 +/- 389 ml/min; p < 0.05). Cognitive function evaluated by the trail-making test improved, but daytime symptoms in the health assessment chart did not improve significantly. CONCLUSIONS: Successful treatment of Cheyne-Stokes respiration with nocturnal nasal oxygen improves not only sleep, but also exercise tolerance and cognitive function in patients with congestive heart failure.

Adult↗