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Biomedical subjects

J Kruse

Publications and source records attributed to J Kruse.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effect of informed consent on anxiety in patients undergoing diagnostic electrophysiology studies.

The process of informed consent has been suspected to raise patient anxiety, but this supposition has not been well studied or validated. The aim of this study was to evaluate the effect of a detailed informed consent protocol on patient anxiety. Fifty patients (36 men, 14 women, mean age 55 +/- 18 years) undergoing diagnostic cardiac electrophysiologic studies were enrolled. Patients were randomly assigned to receive either a consent that did not detail specific risks regarding the procedure (consent A) or one that detailed the risks (consent B). The Spielberger State-Trait Anxiety Inventory was administered before obtaining consent (state 1), immediately after the consent protocol (state 2), and after the electrophysiologic testing procedure, when the results of the test were known to the patient (state 3). Midazolam was administered during the procedure by staff who were blinded to the state/trait anxiety scores and the type of consent the patient had received. Patients receiving consent A had a significant decrease in state 2 anxiety compared with those who received consent B (adjusted mean difference 3.3; 95% confidence intervals 0.2 to 6.4). In the consent A group, 74% of patients received midazolam as opposed to 96% in the consent B group (p <0.02). Patients without inducible ventricular arrhythmias had a significant decrease in state 3 anxiety compared with those with inducible ventricular arrhythmias (adjusted mean difference 8.9; 95% confidence intervals 2.3 to 15.5). Thus detailed informed consent is associated with increased anxiety relative to a consent that does not detail specific risks. However, the difference in anxiety is mild and its clinical impact requires further exploration.

Anti-Anxiety Agents↗
PubMed1997

End stage coronary disease treated with the transmyocardial CO2 laser revascularization: a chance for the 'inoperable' patient.

OBJECTIVE: The aim of this study is to evaluate the short and mid-term efficacy of the Transmyocardial High Power CO2 Laser Revascularisation (TMLR) as a last resource method for end-stage coronary disease patients. METHOD AND PATIENTS: The High Power CO2 Laser 800 W Heart Laser (PLC Medical Systems) was used since February 1994 to treat 268 patients. In 52% of the cases (140) the indication for TMLR treatment was virtual inoperability by the classical bypass revascularisation. In the other 128 patients (48%), where only an incomplete revascularisation was expected, the TMLR was combined with a feasible bypass revascularisation (CABG). Of all patients, 71% were operated on 1-5 times before and or treated by several percutaneous transluminal coronary angioplasty (PTCA). All patients were sufferers of angina pectoris and most were classified Canadian Cardiac Society (CCS) 3-4, despite the maximal medical treatment. The ejection fraction was normal in 13% of patients only, and in 47% of them it was below 40% (10-68%). RESULTS: The operation itself was generally well tolerated. We lost only one patient at the table. The hospital survival was 89.2%; 88.2% in the combined group and 90.3% in the TMLR only group. After the routine follow up screening 3, 6 and 12 months postoperatively (262 patients--131 TMLR and 131 TMRL/CABG), 40% of the TMLR patients upgraded into the functional class CCS 0-1; the combined group of patients scored up even in 84%. All considering their quality of life to be 'better than years ago'. The ergometry stress test, impossible for most of them before, became feasible and better in 80% of the patients. In the follow up period of the combined group, another 6 (4.7%), and in the TMLR only group, 12 (9.4%) patients died. CONCLUSION: The short and middle term results of this--until now the largest single institution series of TMLR treated patients--were that patients almost without exception were refused for any kind of surgery by several other centres; this shows an acceptable survival rate and a surprising level of pain relief, increased activity and better quality of life then ever expected. In our experience, TMLR is a suitable method for treatment of end stage coronary disease, if all standard measures, medical therapy, PTCA and redo coronary revascularisation possibilities are exhausted. The favourable results imply the question as to whether this method will become an alternative for a second bypass operation in the future. The TMLR as an alternative for heart transplant is already a reality for some of our patients.

Cohort Studies↗
PubMed1996

Slow-speed freezing of chemically unfixed biological tissues and long-term storage of frozen samples for cryoscanning electron microscopy.

We describe a procedure in which plant tissue as well as a yeast culture on agar are frozen with slow cooling rates for observation of surface structures in a cryoscanning electron microscope. A system is also presented for long-term storage of frozen specimens under liquid nitrogen, in which the material is maintained for direct observation. Some small tools are described, which are essential for making preparations using slow-speed freezing and for the storage of prepared samples. Three examples of preparations with different complications are given: the "sculptures" on the surface of a leaf of Allium schoenoprasum, an early stage of flower development of Allium cernuum, and a part of an agar-grown colony of Arxula adeninivorans. In our experience, it is possible to store fully hydrated samples under the described conditions for more than a year without damaging the fine structures.

Allium↗
PubMed1996

Accuracy of automated finger blood pressure devices.

BACKGROUND AND OBJECTIVES: Automated finger blood pressure devices are marketed to consumers as accurate devices to monitor blood pressure. Our study compared the accuracy of these devices to standard blood pressure cuffs. METHODS: Three models were purchased and tested against standard cuff measurement. With the patient relaxed and seated for at least 5 minutes, cuff measurement was performed. The blood pressure was then measured by the three finger devices in quick succession. RESULTS: No statistically significant correlation was shown between cuff measurement and the finger device measurements. CONCLUSIONS: Patients should be cautioned that these devices may not be able to perform as they are marketed.

Adolescent↗
PubMed1996

[What is supportive psychotherapy?].

Although supportive psychotherapy is of great importance in psychiatry and psychosomatic medicine, supportive treatment strategies have not been paid much attention so far in literature and training. Clinical indication criteria for supportive techniques are: lack of treatment motivation and introspection, impairment of object relations and impulse control, inadequate modulation of affect and difficulties in establishing a therapeutic working alliance. After reviewing the principles of supportive psychotherapy, special aspects of supportive treatment techniques are discussed.

Humans↗
PubMed1995

[Perceived emotional support of HIV-positive men in relation to the stage of the disease].

Perceived emotional support is considered important in buffering the adverse effects of life-threatening conditions, e.g. AIDS. The aim of the present study was to investigate (1) which aspects of perceived emotional support are associated with depression, anxiety and suicidality in patients with HIV-infection, and (2) whether perception of emotional support is influenced by the stage of disease. 40 male patients with HIV-infection, most of them homosexuals (no drug-addicts, no signs of neuropsychiatric impairment) were investigated. A Perceived Emotional Support Scale, Zung's Self-rating Depression Scale and Spielberger's State-Trait-Anxiety Inventory were administered. To assess suicidality, a clinical interview was carried out. Stage of disease was determined according to CDC-classification and CD4-cell count. The data indicate that (1) aspects of perceived emotional support concerning regulation of self-esteem in relation to a key figure are of greatest importance in predicting depression and state-anxiety and (2) emotional support is perceived significantly better in patients with low CD4-count, i.e. in those patients facing the greatest threat.

Adult↗
PubMed1995

Defibrination essential in the assay of ionized magnesium in mononuclear cells.

Intracellular free (ionized) magnesium concentration was measured in mononuclear cells isolated from healthy volunteers by use of dual wavelength fluorescence (indicator: mag-fura-2). We found a free Mg2+ concentration of 1.28 +/- 0.08 mmol/l in mononuclear cells isolated from heparinized blood. When we defibrinated blood samples prior to the isolation step we measured 0.78 +/- 0.05 mmol/l of free Mg2+ in these cells. We conclude that this difference is caused by the platelets present in the heparinized specimens.

Benzofurans↗
PubMed1995

Economic viability of a model rural family practice.

BACKGROUND AND OBJECTIVES: A model rural clinic was established by the Quincy Family Practice Residency Program with the financial support of sponsoring local hospitals. The purpose of the study was 1) to determine the financial viability of such a model practice and 2) to determine the practice's financial effect on the sponsoring hospitals. METHODS: The rural practice was established in a medically underserved area 30 miles from the sponsoring hospitals. A cost analysis of months 7-18 of operation was performed, including an analysis of charges generated at the sponsoring hospitals. Theoretical models of practice to enhance economic viability were explored. RESULTS: The 3,051 office visits fell short of expectations. These visits generated a net practice income of $18,596. Had the practice sought full payment for these visits instead of accepting Medicare assignments, the net income potential would have been $39,182. Growth of the practice until it reached the average size of a typical rural family practice (6,000 annual visits) would produce a net income of $67,113 with Medicare assignments and $103,578 if Medicare assignments were not accepted. Had the practice been a federally designated rural health clinic, a mid-level practitioner with physician supervision could have generated a net practice income of $53,640 for 3,051 visits or $138,863 for 6,000 visits. Referrals from the model clinic for laboratory work, radiology, and hospital admissions generated $9.17 in charges for the sponsoring hospitals for each dollar charged by the clinic. CONCLUSIONS: The financial viability of rural practices is adversely affected by the Medicare reimbursement system. Our model clinic had a positive economic effect on the sponsoring hospitals, suggesting that innovative collaborative sponsorship of such clinics may be mutually beneficial.

Costs and Cost Analysis↗
PubMed1995

[Trauma of illness--crises in self concept regulation by cancer patients].

Oncological diseases often represent a psychic trauma, which leads affected patients into a narcissistic crisis. Starting from the concept of narcissistic regulation system (Deneke, 1989), the origins of the destabilisation of the self are described, and parallels to persecution trauma will be drawn. The longing of the patients for symbiotic relationships are investigated in their double sense. On the one hand they serve the patient to stabilise his self, on the other hand they involve the danger of traumatisation within an object relation. The consequences for the process of mourning and integration will be discussed.

Adaptation, Psychological↗
PubMed1993

Cortisone image and emotional support by key figures in patients with bronchial asthma. An empirical study.

In a subgroup of patients with bronchial asthma, irrational fears of steroid medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone often underlies non-compliant illness behaviour. In the present study, cortisone image and the relationship with a key figure was investigated in 62 patients with bronchial asthma, all of whom had participated in a structured asthma treatment and teaching programme (ATTP). The data show that (1) perceiving cortisone as threatening predicts poor adherence to ATTP guidelines how to manage severe attacks, and (2) patients having a supportive relationship with their key figure are less likely to experience threatening aspects of cortisone.

Acute Disease↗
PubMed1993

[Cortisone level and emotional support by key figures in patients with bronchial asthma].

In a subgroup of patients with bronchial asthma, irrational fears of cortisone medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone, often underlies noncompliant illness behaviour. In the present study, cortisone image and subjectively experienced emotional support by a key figure was investigated in 62 patients, all of whom had participated in the Düsseldorf Asthma treatment and teaching programme (ATTP). The data show that patients having a supportive relationship with their key figures are less likely to experience threatening aspects of cortisone. The findings are discussed in light of psychoanalytic object relations theory.

Adaptation, Psychological↗
PubMed1993

The physiology of labor and management of prolonged labor.

Prolonged labor is a common occurrence, but proper diagnosis is difficult, and the management is controversial. Prolonged labor can be prevented by providing the laboring woman with proper emotional support and by encouraging ambulation and position changes. The indication for and proper use of oxytocin and other measures to correct prolonged labor are discussed.

Female↗