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L Pientka

Publications and source records attributed to L Pientka.

34 records · Page 2Linked to original sources
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↗
PubMed2000

Comparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit.

OBJECTIVE: To evaluate the ability of three scoring systems to predict hospital mortality in adult patients of an interdisciplinary intensive care unit in Germany. DESIGN: A prospective cohort study. SETTING: A mixed medical and surgical intensive care unit at a teaching hospital in Germany. PATIENTS: From a total of 3,108 patients, 2,795 patients (89.9%) for Acute Physiology and Chronic Health Evaluation (APACHE) II and 2,661 patients (85.6%) for APACHE III and Simplified Acute Physiology Score (SAPS) II could be enrolled to the study because of defined exclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Probabilities of hospital death for patients were estimated by applying APACHE II and III and SAPS II and compared with observed outcomes. The overall goodness-of-fit of the three models was assessed. Hospital death rates were equivalent to those predicted by APACHE II but higher than those predicted by APACHE III and SAPS II. Calibration was good for APACHE II. For the other systems, it was insufficient, but better for SAPS II than for APACHE III. The overall correct classification rate, applying a decision criterion of 50%, was 84% for APACHE II and 85% for APACHE III and SAPS II. The areas under the receiver operating characteristic curve were 0.832 for APACHE II and 0.846 for APACHE III and SAPS II. Risk estimates for surgical and medical admissions differed between the three systems. For all systems, risk predictions for diagnostic categories did not fit uniformly across the spectrum of disease categories. CONCLUSIONS: Our data more closely resemble those of the APACHE II database, demonstrating a higher degree of overall goodness-of-fit of APACHE II than APACHE III and SAPS II. Although discrimination was slightly better for the two new systems, calibration was good with a close fit for APACHE II only. Hospital mortality was higher than predicted for both new models but was underestimated to a greater degree by APACHE III. Both score systems demonstrated a considerable variation across the spectrum of diagnostic categories, which also differed between the two models.

APACHE↗
PubMed2000

[Osteoporosis: the epidemiologic and health economics perspective].

Epidemiology of osteoporosis reveals some specific properties with considerable consequences on economic and social aspects, which are discussed briefly. Large parts of an aging population are under risk of developing osteoporosis with consecutive morbidity and mortality. The epidemiological consequences and economic burden will increase during the next 20 years due to demographic changes. Proximal femoral fractures are most important causing relevant mortality and, if survived, regularly relevant functional loss. Due to the increasing importance of osteoporosis, efficient age-adapted strategies in diagnosis and therapy need to be developed.

Costs and Cost Analysis↗
PubMed1999

[Intensive care medicine for elderly patients: how applicable are the APACHE III and III score systems?].

OBJECTIVE: Scores like APACHE (Acute Physiology And Chronic Health Evaluation) were evaluated for unselected intensive care unit (ICU) admissions. Can they also be used for risk stratification and quality assurance in selected subgroups like elderly patients? METHODS: Over a 3-year period data of all admissions of a 12 bed interdisciplinary ICU were collected. APACHE II and III scores and probabilities of hospital deaths were compared with observed outcomes. The discriminatory power was evaluated by calculating the areas under the receiver operating characteristic (ROC) curves. Calibration was analyzed with standardized mortality ratios (SMR) and the Hosmer-Lemeshow goodness-of-fit statistic. RESULTS: Of 3382 admissions due to exclusion criteria, 2795 patients were analyzed, 1396 (49.9%) of these were > or = 65 years, mean age 75 (65-99) years. 62.5% were non-operative, 37.5% postoperative admissions, 35% after emergency operations. ICU mortality was 11.7%, hospital mortality 25.1%. The areas under the ROC curves were 0.77 for APACHE II and 0.79 for APACHE III (whole collective 0.83 and 0.85, respectively). The SMR was 1.17 for APACHE II and 1.23 for APACHE III compared with 1.06 and 1.22 for all patients, respectively. Calibration for elderly patients was insufficient for APACHE II (Hosmer-Lemeshow chi-square = 19, p < 0.025) as well as for APACHE III (chi-square = 41, p < 0.001), while it was good for all patients for APACHE II (chi-square = 12, p > 0.1) but not so for APACHE III (chi-square = 48, p < 0.001). CONCLUSIONS: APACHE II and III both show good discrimination for elderly patients although a little inferior than for all patients. Both scores can be used for risk stratification of elderly ICU patients. Mortality prognosis is not sufficient for geriatric patients although APACHE II calibrates well for all. Application of these scores for quality assurance in selected subgroups like elderly patients cannot be recommended based on these data.

APACHE↗
PubMed1999

[Geriatric assessment--description of functional deficits and follow-up assessment of elderly stroke patients].

The aim of the present study was to describe the course and outcome of rehabilitation using a national recommended assessment program (AGAST). In our study 162 patients with stroke were included. Nearly all patients had improvement of activities of daily living (Barthel Index) and mobility (Tinetti Gait and Balance Score, Frenchay Arm Test). A similar trend was observed in patients with cognitive impairment and depression on admission. Of the different tests, the Barthel Index and mobility scores were shown to be important predictors of length of hospital stay. Further evaluation of the assessment instruments is needed to assess different aspects of quality of life (self-rated well-being, satisfaction). To assess the efficiency of geriatric rehabilitation in patients with stroke, it will be important to measure resource consumption and to evaluate the long-term results.

Aged↗
PubMed1999

[The costs of hip-fracture in Germany: a prospective evaluation].

OBJECTIVE: To assess the direct and indirect costs of hip fracture in dependence of postoperative care setting. STUDY DESIGN: Prospective cohort study. METHODS: 227 consecutive patients in three hospitals (city, town, and small town) presenting with hip fracture. For 177 patients there was follow-up regarding post-operative care-setting. During follow-up the cost of the remaining patient at 1, 3, 6 month were recorded and afterwards adjusted to the distribution of the initial cohort. To obtain information on patient characteristics, assessment during hospital stay and follow up have been performed. RESULTS: There was a relevant difference in costs depending on the care setting after hip fracture. The nursing home - nursing home, community - community, and community - nursing home resulted in total costs at 6 month of 17,701 DM, 27,102 DM and 54, 503 DM, respectively (average: 24,508 DM). Nursing home costs contributed significantly to the differences between groups. Valid and predictive measures could not be established in first analysis of performed assessments. CONCLUSION: Due to the high incidence of hip fractures (100,000/y) indirect costs play a major role in the economic impact of this illness. The analysis of the effectiveness of interventions has to take into account these costs to achieve adequate conclusions.

Aged↗
PubMed1999

[The elderly stroke patient - observations 18 months after the event].

The further development of 162 stroke patients (average age 77 years), who were geriatrically assessed during hospitalization, was evaluated ca. 18 months after stroke. Questionnaires were mailed to patients. 53% of the patients (n = 86) returned the questionnaire duly filled in; 20% (n = 32) had died; in the remaining 27% of cases (n = 44) no information was obtained on further development. 80% of those patients who responded lived at home despite numerous medical problems. Family members assumed most of the care required. Follow-up treatment and pain therapy proved to be particularly problematic. The Barthel Index according to data collected was significantly lower compared to figures noted upon release from the hospital. Hardly anyone among those patients received follow-up treatment. 74% of patients complained of pain although the majority has regular contacts with the family doctor. For those patients who died in the 18 months interval, significantly lower values for the activities of daily living (ADL) has already been recorded upon hospitalization. They had a less favorable view of their state of health and were less satisfied with life in general.

Activities of Daily Living↗
PubMed1999

Management of the BPH syndrome in Germany: who is treated and how?

OBJECTIVES: To review the available data on contemporary management of symptomatic benign prostatic hyperplasia (BPH) within the German healthcare system. METHODS: Information was obtained from articles published in scientific journals retrieved through searches in Medline and Embase. In addition, preliminary data from the first representative German survey on lower urinary tract symptoms (LUTS) were obtained ('Herner LUTS-Study', a community-based survey in Herne, a city within the industrial complex called the Ruhr Area). Finally, the recently established German guidelines for the diagnosis and treatment of the BPH-Syndrom (BPS) were reviewed. RESULTS: Only few studies are published in the literature analysing the current concepts of management of BPH in Germany. These studies show that there is variation in the concepts of conservatory and surgical management of BPH. The German BPH guidelines suggest watchful waiting for patients with mild LUTS (total I-PSS < or = 7) and medical therapy or surgery for those with moderate to severe LUTS (I-PSS >7). There was no final consensus on the role of phytotherapy in the German treatment guidelines, due to the lack of clinical data. alpha(1)-Blockers and finasteride (for prostates >40 ml) are recommended medical treatment approaches. Transurethral resection of the prostate (TUR-P) is considered to be the standard surgical procedure. Preliminary data from the Herner LUTS-Study show, that approximately 30% of men aged 50-80 years have moderate to severe LUTS (i.e. total I-PSS score >7). About a third of these men currently seek healthcare. CONCLUSIONS: LUTS and BPS are a highly prevalent condition in Germany. With the estimate that the number of men over the age of 65 will almost double in Germany within the next 30 years, it will be a challenge in the next millennium to find the healthcare resources for the management of BPS. Copyrightz1999S. KargerAG,Basel

Germany↗
PubMed1997

[Functional disability in the elderly: epidemiologic aspects].

The improvements in life expectancy have resulted in an increasing number of people at older ages with specific medical problems. The "epidemiologic transition" from acute to chronic diseases makes it imperative to change the focus from the treatment of different acute diseases to a broader approach. As a greater proportion of the population survives to very old ages, the public health impact of the burden of disease and disability and related utilization of medical care and need for supportive and long-term care has become an important concern. This requires a specific approach emphasizing the functional well-being of older persons. Recent studies have shown that age and frailty are no synonyms and even a greater proportion of the oldest old have a potential for improving. Therefore, it is necessary to address this perspective in the medical care of elderly people.

Activities of Daily Living↗
PubMed1991

Comorbidities and perioperative complications among patients with surgically treated benign prostatic hyperplasia.

We address the question of whether or not age and comorbidity are related to intra- and postoperative complications after a transurethral resection. The data are derived from a retrospective, population-based study conducted in Hagen, Germany, which included all patients with an initial prostatectomy for benign prostatic hyperplasia (N = 621) during the five-year period 1984-1988. Seventy-seven percent of the patients had at least one of the following preoperative risk factors: heart disease, hypertension, smoking, chronic obstructive lung disease, and diabetes. There was no intraoperative death. The risk of intraoperative circulatory complications was found to be related to age only for patients without a history of heart diseases or hypertension. The incidence of major complications was 3.1 percent and was significantly higher in the oldest age group. Three patients (0.54%) died postoperatively in the hospital. Infections were the most frequent postoperative complications. The relationship of age and overall postoperative complications was not statistically significant either for patients with (p = 0.121) or without any comorbidity (p = 0.651). Based on this study it seems reasonable to conclude that age is not a clinically relevant risk factor for perioperative complications in patients who have a transurethral resection for benign prostatic hyperplasia.

Age Factors↗
PubMedDate not supplied

[The "Geriatric Assessment" Study Group (AGAST): recommendations for the use of assessment procedures].

This work presents preliminary recommendations for a three-step geriatric assessment approach developed by a newly created working group consisting of members from nine geriatric departments in Germany and Switzerland. The recommendations were based on a literature review, expert consultation, and a consensus meeting. As part of this effort, instruments and guidelines for selected geriatric assessment instruments were translated and will be tested in German language. Further research is planned for refining the recommended method. Currently, these recommendations might help to stimulate the spread of geriatric assessment method in German-speaking areas and facilitate joint research projects among geriatric institutions.

Activities of Daily Living↗
PubMedDate not supplied

[Identification of functional deficits in the acute hospital by geriatric assessment].

Functional deficits of elderly patients are often not recognized during routine treatment in acute hospital care. In Germany, there are only limited experiences with the use of standardized assessment-scales in this health care setting. In this study, 112 patients were recruited for a very broad geriatric assessment focused on methodological and practical questions. There were 38.8% with deficits in the ADL and 12.6% with depressive symptoms. Many patients showed low motivational factors such as energy, efficacy and will. Geriatric syndromes such as malnutrition were also very common. In general, many patients in acute care hospitals have functional deficits which are not recognized by the physicians. For many patients, short instruments are sufficient for screening purposes. The effectiveness of a complete geriatric assessment depends mostly on the use of good selection criteria.

Activities of Daily Living↗