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Biomedical subjects

J Hammerstein

Publications and source records attributed to J Hammerstein.

At least 19 recordsLinked to original sources
PubMed2000

[Effects of defensive medicine on costs].

Physicians who give priority to the reduction of their exposure to malpractice as compared to the health of their patients practise defensive medicine. Far-reaching yieldingness to unjustified requests of the patients in order to avoid unpleasant quarrels also falls into this category. Among other things, an increase in diagnostics, consultations and in-patient treatments as well as a decrease in risky medical measures are the consequences. Investigations performed mainly in the U.S.A. and to a minor degree also in Holland and the U.K.--but none in Germany--have clearly shown that global medical costs can considerably be forced up by defensive thinking and acting of the physicians. As an example, the increase in the rate of Caesarean sections based on defensive reasoning is discussed. The defensive way of acting in daily medicine is predominantly a response to stringent jurisdiction often obviously favouring the patient's claims. Thus, indirectly the respective judges also bear responsibility for the explosion of medical costs!

Cesarean Section↗
PubMed1999

Depression and anxiety symptoms in women at high risk for breast cancer: pilot study of a group intervention.

OBJECTIVE: The psycho-oncology literature to date contains only one outcome study based on a group model for high-risk relatives of breast cancer patients. The authors set out to study the effects of group intervention in high-risk relatives of breast cancer patients. METHOD: Thirty-three high-risk relatives of breast cancer patients participated in a six-session, 12-hour group intervention model that consisted of educational and psychosocial components. RESULTS: There was a significant reduction of depression symptoms as reported on the Center for Epidemiologic Studies Depression Scale. Similarly, there was a significant reduction of anxiety symptoms as reported on the State-Trait Anxiety Inventory state scale. CONCLUSIONS: In this pilot study, the investigators found the group intervention model effective at reducing symptoms of depression and reactive (not chronic) anxiety.

Adaptation, Psychological↗
PubMed1998

[Personal experiences of a physician with legal proceedings].

According to the author's experience with a judicial inquiry, the borderline between the right of the prosecutor to get an insight into the patients file and the right of the physician to refuse the disclosure of the patient's medical history is very much blurred. Even if the inquiry is directed just against an unknown person, a physician should be aware that the Department of Public Prosecution might take stiffening procedural steps to enforce its demand. At any rate, the physician's position to keep the patient's data secret is very weak in such a situation.

Adult↗
PubMed1995

[Legal liability in failed sterilization from the physician's viewpoint].

Recanalization of oviducts as well as spermatic ducts occur at a low promille rate after sterilization even if correctly performed. Therefore, pregnancies after unsuccessful sterilization cannot be taken as an immediate proof for a faulty surgical procedure. The surgeon is recommended to have the correctness of a sterilization confirmed in writing by competent witness of the operation (assistant doctor, nurse). Whenever possible, tissues of the occluded organs should be sent to the pathologist for histologic proof. In addition, special attention must be payed to a proper information of the patient on the failure rate in order to avoid the risk to become sued subsequently for incomplete information if the woman becomes pregnant. In the German jurisdiction, a child born after a faulty performed sterilization is classified as damage or cause of a damage according to the law of contract. Based on this judicial principle, a physicians may be sentenced to pay alimonies. This is felt by many physicians as an abasement of their professional engagement. It is also criticized, that suffering from an unwanted but otherwise normal pregnancy following faulty sterilization entitles a woman to financial compensations. Very recently, judicial differences in this respect have become known between the Federal Constitutional Court and the Federal Court. At present, it is still open which of the judicial points of view will finally predominate.

Attitude of Health Personnel↗
PubMed1994

Reproductive medicine--a field of contradictory legislation in Germany.

A brief survey is given on the German legislation concerning reproductive medicine which is contradictory both in juridical and ethical terms. Being under strong ideologic and/or populistic pressure, it favours negative family planning measures such as all kinds of birth control including induced abortion, and handicaps, on the other hand, the more sophisticated procedures of assisted fertilization to overcome infertility. Thus, legal restrictions in this country halt the scientific progress and set back the clinical standard in comparison to our neighbouring countries, all of which are more liberal in their respective legislation.

Ethics, Medical↗
PubMed1993

Pharmacokinetics and protein binding of 3-ketodesogestrel and gestodene in the serum of women during 6 cycles of treatment with two low dose oral contraceptives.

The serum concentrations of 3-ketodesogestrel (KDG) and gestodene have been measured in 30 and 31 women respectively who took low dose oral contraceptives containing 30 micrograms ethinylestradiol together with either 150 micrograms desogestrel or 75 micrograms gestodene for 6 months. On days 1, 10 and 21 of the first third and sixth treatment cycles blood samples were drawn at 0, 0.5, 1, 1.5, 2, 3, 4 and 24 h. KDG and gestodene levels were measured by radioimmunoassays and were evaluated for Cmax (peak serum concentration), tmax (time to Cmax), and AUC (area under the curve) to 4 and 24 h. The overall total gestodene concentrations were higher and the accumulation of the steroid throughout a cycle greater than that of KDG. For example, the AUC0-4 of gestodene increased in cycle 1 by a factor of 2.8 (day 10 vs. day 1) and 3.6 (day 21 vs. day 1) compared to 2.3 and 2.6 for KDG. The higher concentration of gestodene reflects a lower volume of distribution than KDG, and is consistent with gestodene binding to sex hormone binding globulin (SHBG) with a higher affinity than KDG. Concentrations of KDG and gestodene were higher on day 1 of cycles 3 and 6 than on day 1 of cycle 1. The serum concentrations of KDG and gestodene during multiple dosing cannot be predicted on the basis of single dose pharmacokinetics.

Adolescent↗
PubMed1993

Influence of gestodene and desogestrel as components of low-dose oral contraceptives on the pharmacokinetics of ethinyl estradiol (EE2), on serum CBG and on urinary cortisol and 6 beta-hydroxycortisol.

A randomized controlled clinical trial was undertaken over a 6-month treatment period with two low-dose combined oral contraceptives (OC) to investigate whether the metabolism and elimination of ethinyl estradiol (EE2) is differently influenced by the two progestational components gestodene (G) and desogestrel (D), an issue which has been very controversial recently. The two formulations contained 30 micrograms EE2 each, together with either 75 micrograms G or 150 micrograms D. Of the 40 young women recruited for each formulation, 31 of each group were available for statistical evaluation. The pharmacokinetics of serum EE2 were studied on day 1, 10 and 21 of cycle 1, 3 and 6. There were no significant differences between the two groups in any cycle with respect to parameters measured. This was true for the distinct intracyclical rise in the mean EE2 serum levels from day 1 to day 10 and the smaller further increase between day 10 and day 21, with no change in this respect between the cycles studied. Respective changes were seen with regard to the area under the EE2 serum concentration curve up to 4 and 24 hours (AUC0-4 and AUC0-24), cmax and tmax of serum EE2. The estrogen-dependent corticoid-binding globulin (CBG) increased similarly in the two groups intracyclically and slightly also intercyclically at all times tested. Except for the first treatment cycle, urinary excretion of cortisol and 6 beta-hydroxycortisol displayed a tendency to lower values intracyclically as well as intercyclically, again with no differences between the two groups. Also, the 6 beta-hydroxycortisol-to-cortisol ratio was not different between the groups, showing a slight tendency to rise from about 4 at the beginning of the medication to around 5.5 at the end of the 6th treatment cycle in both groups. It is concluded that G and D as components of low-dose OCs exert comparable effects on the metabolism and elimination of EE2.

Adult↗
PubMed1993

Sexual behavior, contraception and the risk of contracting HIV.

Recently, concern has been expressed on a possible association between the use of oral contraceptive pills (OCs) and an increased risk of contracting the HIV infection. As a consequence it has been postulated that a low prevalence of condom use due to widespread utilization of oral contraceptive pills would result in an acceleration of the spread of AIDS. The International Committee for Research in Reproduction (ICRR) a group of eleven experts in the field of gynecology, endocrinology and contraception, wishes to comment on the concerns raised about OC use and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male.

OBJECTIVE: To determine the influence of estrogens on male fertility. DESIGN: A 36-year-old eugonadal male was subjected to two different regimens of treatment with ethinyl estradiol (EE2). Sperm quality, immunoreactive luteinizing hormone (LH) and follicle-stimulating Hormone (FSH), testosterone (T), estrone (E1), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), prolactin (PRL) and sex hormone-binding globulin were determined at intervals of 2 weeks for 315 days. SETTING: A gender dysphoria clinic. PATIENT: A transsexual male nurse. MAIN OUTCOME MEASURES: It was hypothesized (and confirmed) that by comparing the effects of increasing and constant dose of EE2 on fertility parameters, differences in estrogen-sensitivity would show more clearly. Furthermore, this procedure served to find the minimal dose of EE2 for complete testicular suppression. RESULTS: Low doses of EE2 (20 micrograms/d) had no negative effect on sperm motility and density for a period of approximately 4 weeks, whereas high doses (60 micrograms/d) reduced motility already after a few days and led to a pronounced decrease in sperm density after 2 weeks. After discontinuation of therapy, motility normalized faster than sperm density. Under increasing doses of EE2 there was a constant decrease of FSH that occurred several weeks earlier than that of LH. Under constant dose of EE2 (60 micrograms/d) the decrease of LH was delayed (with respect to FSH) by only a few days. The decrease in T showed a stronger correlation with that of FSH than with that of LH. Volume and fructose content of the seminal fluid correlated with the decrease in T. Rebound effects were observed for FSH, LH, T, and fructose during the therapy-free interval. Ethinyl estradiol therapy had no influence on the serum concentrations of E1, E2, and PRL. Estrone was the dominant estrogen before and after therapy with EE2. Adrenal gland activity was markedly suppressed by EE2, as reflected by the decrease in DHEAS. CONCLUSION: The suppressive effect of EE2 on FSH and sperm motility was more pronounced and consistent than on LH and sperm density. The T decrease appears to be mainly caused by a direct effect of EE2 on the testes.

Adult↗