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Biomedical subjects

L Pientka

Publications and source records attributed to L Pientka.

At least 19 recordsLinked to original sources
PubMed2003

Comprehensive geriatric assessment in the elderly cancer patient.

The proportion of older cancer patients is increasing due to demographic and disease-specific reasons. However, this group of patients is severely underrepresented in research and clinical therapy. Limitation in physical and functional capacity with considerable interindividual heterogeneity remains one of the important problems in the treatment decision process. One approach to this problem is the use of a Comprehensive Geriatric Assessment (CGA) to describe and classify these deficits with high validity and reliability. The different domains of CGA are described with special respect to the instruments applied, as CGA has also a key role in the decision process.

Activities of Daily Living↗
PubMed2002

[Phytotherapy of benign prostatic hyperplasia. Current evidence-based evaluation].

Despite its popularity as a medication in various European countries or as a nutritional supplement in the United States, the role of plant extracts for the treatment of LUTS due to BPH remains controversial. Only a few randomized clinical trials that meet standard criteria of evidence-based medicine but with relatively short follow-up times and some meta-analyses mainly regarding Serenoa repens and Pygeum Africanum as well as more recent studies on pumpkin seeds have shown clinical effects and good tolerability. To better judge the therapeutic potential of these plant extracts, additional randomized placebo-controlled clinical trials with sufficient follow-up are needed.

Evidence-Based Medicine↗
PubMed2002

Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH often presents as lower urinary tract symptoms (LUTS) due to difficulties in voiding and irritability of the bladder. We conducted a retrospective cohort study within the Integrated Primary Care Information (IPCI) database, a general practitioners database in The Netherlands, to assess the incidence of LUTS suggestive of BPH (LUTS/BPH) in the general population. MATERIALS: Our study population comprised all males, 45 years or older who were registered for at least 6 months prior to start of follow-up. The study period lasted from 1 January 1995 to 31 December 2000. Cases of LUTS/BPH were defined as persons with a diagnosis of BPH, treatment or surgery for BPH, or urinary symptoms suggestive of BPH that could not be explained by other co-morbidity. RESULTS: The study cohort comprised 80,774 males who contributed 141,035 person-years of follow-up. We identified 2181 incident and 5605 prevalent LUTS/BPH cases. The overall incidence rate of LUTS/BPH was 15 per 1000 man-years (95% CI: 14.8-16.1). The incidence increased linearly (r(2) = 0.99) with age from three cases per 1000 man-years at the age of 45-49 years (95% CI: 2.4-3.6) to a maximum of 38 cases per 1000 man-years at the age of 75-79 years (95% CI: 34.1-42.9). After the age of 80 years, the incidence rate remained constant. For a symptom-free man of 46 years, the risk to develop LUTS/BPH over the coming 30 years, if he survives, is 45%. The overall prevalence of LUTS/BPH was 10.3% (95% CI: 10.2-10.5). The prevalence rate was lowest among males 45-49 years of age (2.7%) and increased with age until a maximum at the age of 80 years (24%). CONCLUSIONS: The incidence rate of LUTS/BPH increases linearly with age and reaches its maximum at the age of 79 years.

Age Distribution↗
PubMed2002

[Osteoporosis in elderly patients].

Osteoporosis is defined by an abnormal high loss of bone mineral. This loss leads to fractures of vertebral bodies as of the femoral neck with dramatic consequences. Therefore it is necessary to regard osteoporosis as a disease rather than normal aging process. Diagnosis of osteoporosis is based on clinical examination and measurement of bone-mineral density. Beyond life-style changing interventions pharmacological treatment in a stepwise approach is recommended. Supplementation with Vitamin D and calcium is the mainstay of therapy with individual addition of bisphosphonates or other substances. The specific ways for decision making are exemplified with special regard to their individual advantages and disadvantages.

Absorptiometry, Photon↗
PubMed2001

Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization.

BACKGROUND: Mortality predictions calculated using scoring scales are often not accurate in populations other than those in which the scales were developed because of differences in case-mix. The present study investigates the effect of first-level customization, using a logistic regression technique, on discrimination and calibration of the Acute Physiology and Chronic Health Evaluation (APACHE) II and III scales. METHOD: Probabilities of hospital death for patients were estimated by applying APACHE II and III and comparing these with observed outcomes. Using the split sample technique, a customized model to predict outcome was developed by logistic regression. The overall goodness-of-fit of the original and the customized models was assessed. RESULTS: Of 3383 consecutive intensive care unit (ICU) admissions over 3 years, 2795 patients could be analyzed, and were split randomly into development and validation samples. The discriminative powers of APACHE II and III were unchanged by customization (areas under the receiver operating characteristic [ROC] curve 0.82 and 0.85, respectively). Hosmer-Lemeshow goodness-of-fit tests showed good calibration for APACHE II, but insufficient calibration for APACHE III. Customization improved calibration for both models, with a good fit for APACHE III as well. However, fit was different for various subgroups. CONCLUSIONS: The overall goodness-of-fit of APACHE III mortality prediction was improved significantly by customization, but uniformity of fit in different subgroups was not achieved. Therefore, application of the customized model provides no advantage, because differences in case-mix still limit comparisons of quality of care.

APACHE↗
PubMed2001

[Health services research in geriatrics and geriatric rehabilitation from the national and international viewpoint].

In Germany, health services research geriatric problems is not of major scientific and political importance. Focusing on geriatrics, it is essential to produce good data concerning efficacy, effectiveness and costs of the interventions. Otherwise, the discussion about the allocation of resources in the German health care system will take place without good arguments for special geriatric interventions. Prerequisite for this goal is the definition of adequate endpoints targeting functional deficits and the operationalization of multi- and comorbidity. Another problem is research focused on the "black box" of specific geriatric interventions. A special German situation is the distinction between acute and rehabilitative geriatric settings where very similar patients are treated. For this reason, it is essential for the geriatrician in the German context to focus more on health services research to demonstrate with scientific evidence their important contribution for the care of the elderly.

Aged↗
PubMed2001

[AR-DRG effects on geriatrics in Germany].

The parties of the self-governing Health Service are at present preparing the introduction of a general case, flat rate compensation system for the hospital section on behalf of the legislature. The system is based on the performance definitions and case classifications of the Australian DRG System, Version 4.1. The relative evaluation of the individual DRG for the implementation into the system in Germany will be based on German cost and benefit data. For this purpose a calculation of case-specific treatment costs based on a representative selection of hospitals will be made. The geriatrics field will have to adapt itself to these regulations in the same way as all other medical disciplines. Difficulties are arising due to the inconsistent classification of cost and benefit data in connection with the classification. The geriatric field is under-represented in the calculation of relative evaluation and, therefore, the spectrum of benefit cannot be shown in the planned calculation system. Analogous to the calculation of German relative cost evaluation, the geriatric section will define in a project the actual costs for their treatment cases and determine the consecutive relative evaluation.

Aged↗
PubMed2001

[Knowledge for prolonging longevity without disability].

The relationship between quality of life and aging is difficult to describe with the usual epidemiological concepts like mortality. A functional approach is more important and meaningful for the analysis of the aging process. The ICIDH classification has the advantage of combining the diseases process itself and the consequences concerning functional limitations. Studies about the "active life expectancy" show that quality of life and life expectancy are two different dimensions of the aging process. For the purpose of prevention, it is important to demonstrate that preventive interventions could help reduce the number of years with functional limitations. Most of the epidemiological studies indicate that even lost functions could be restored. For these interventions, it is important to individualize the goals for preventive measures to balance physical and emotional needs of the elderly.

Aged↗
PubMed2001

[Applied evidence-based medicine].

The success of evidence-based medicine (EbM) will also depend whether its effectiveness is proven in empirical studies. The main question is how the information-seeking behaviour of physicians can be modified. A series of studies have shown that their information management is frequently not based on a rational model of knowledge acquisition. In particular, many studies concerning the implementation of guidelines as a practical application of EbM have demonstrated that, in addition to a general skepticism about guidelines, many practical obstacles are relevant. An optimal implementation strategy should consider these from the beginning.

Antirheumatic Agents↗
PubMed2001

Male lower urinary tract symptoms and related health care seeking in Germany.

OBJECTIVES: To investigate the prevalence of lower urinary tract symptoms (LUTS) and LUTS- related health care issues in the male population between the ages of 50 and 80 in Germany. METHODS: 8,973 randomly chosen men in the age group of interest received by mail a self-administered questionnaire addressing voiding symptoms and bother, common health status, and social demographic as well as health care resources related issues. RESULTS: Of 6,031 (67.2%) returned questionnaires, 5,404 (60.2%) were properly filled out and entered into the database. Of these, 5,004 (56%) completed all IPSS questions. 3,539 (70.7%) of the men presented with no or mild LUTS (IPSS 0--7), 1,465 (29,3%) with moderate to severe voiding symptoms (IPSS >7), respectively. From logistic regression analysis it appears that mainly bother from voiding symptoms as well as incomplete emptying and week stream induced a visit to the doctor. Of men with moderate symptoms (IPSS 8--19), 40% did not report any bother. CONCLUSION: LUTS is a common condition among German elderly males. In general, bother from LUTS seem to have more effects on health care seeking behavior than symptoms themselves or physical health status. Bother scores may discriminate between those individuals with moderate symptoms (IPSS 8--19), who may be followed through watchful waiting instead of active therapy.

Aged↗
PubMed2000

[Evidence-based medicine--problems and application to geriatrics].

The use of evidence-based medicine (EBM) in the field of geriatrics faces some specific problems. Deficits in representation of older people in medical trials and the attitude of the majority of patients and their physicians considering disease as normal aging counteract successful implementation. EBM is also feasible in older patients after some adjustments without dropping the principles of the method or the preferences of patients, thus, resulting in improvement in diagnostic and therapeutic decisions. The methods are exemplified in the use of prophylactic antibiotics in endoscopic gastrostomy, a relevant geriatric problem with practical consequences.

Aged↗