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Biomedical subjects

M Berger

Publications and source records attributed to M Berger.

At least 19 recordsLinked to original sources
PubMed2007

[Cost predictors of depressive inpatient episodes in Germany. The health insurer's point of view].

BACKGROUND: Inpatient treatment is the most costly sector of treatment for depressive disorders in Germany. However, little is known about which patient and hospital characteristics contribute to costs of inpatient episodes. PATIENTS AND METHODS: To take part in this study, patients had to fullfill criteria for ICD-10 diagnosis of F31.3-F31.5, F32, F33, F34.1, F43.20, or F43.21. Episodes were recorded between September 9 2001 and March 3 2003 in ten hospitals in three German states. Inpatient records of 1,202 persons were analysed. Multiple regression analysis was performed to identify significant patient predictors of cost per inpatient episode, and the predictive function of hospital characteristics was analysed by applying hierarchical linear modeling. RESULTS: Patient characteristics at admission could not explain a substantial part of the variance in episode costs. Better prediction was possible including variables from the whole treatment process. Also, conditions for admission and patient-related factors did not well explain cost differences between hospitals, but characteristics of the whole treatment were. CONCLUSION: For predicting costs of inpatient depressive episodes, the complete course treatment has to be considered. As in the physiologic sector, therapeutic and diagnostic procedures have a great effect on cost prediction.

Adolescent↗
PubMed2006

[Rubeola].

Explore the source record for details and available documents.

Adult↗
PubMed2006

[A specific therapy for chronic depression. McCullough's Cognitive Behavioral Analysis System of Psychotherapy].

Chronic depression is a common disorder which causes significant impairment and enormous treatment costs. Traditional pharmacological and psychological treatment approaches have shown only modest success. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) by James McCullough is the only therapy developed specifically for chronic depression. It integrates behavioral, cognitive, and interpersonal strategies. The approach is supported empirically and shown to be effective. This article presents the state of the art regarding research in psychotherapeutic treatment for chronic depression. In addition, the development of the approach and therapeutic strategies and techniques of CBASP are described.

Antidepressive Agents↗
PubMed2005

[Driving and the elderly: aspects of aging and handicap].

Impairment of cognitive performance is associated with an excess risk of accidents. Adaptation of driving behavior in subjects with benign cognitive disorders reduces risk of automobile accidents. Cessation of driving or at least not driving alone limits the excess accident risk for drivers with dementia. Alterations in visual field and acuity increase risk of traffic accidents. Drugs affecting vigilance and neurological, cardiovascular and osteoarticular disorders increase accident risk. Screening for these disorders in the elderly is a necessary public safety measure.

Accidents, Traffic↗
PubMed2005

Magnetic resonance signal alterations in the acute onset of heterotopic ossification in patients with spinal cord injury.

The purpose of our study was to evaluate magnetic resonance (MR) signal characteristics of acutely forming heterotopic ossification (HO) in paralyzed patients. Fourteen patients with spinal cord injury (female n=2, male n=12, mean age 38.3 years) and acute onset of radiographically proven HO had contrast-enhanced 1.5-T MRI within 13.4+/-18.3 days of clinical onset of symptoms. MR signal alterations of affected muscles, fascia, subcutaneous tissue, skin and adjacent bone were evaluated. A diffuse T2-hyperintense signal of multiple muscle groups was seen in all patients (bilateral in 12) involving quadriceps (n=13, 93%), adductors (n=13, 93%) and iliopsoas (n=12, 86%) with contrast enhancement in n=11 (79%), n=8 (57%) and n=8 (57%) patients. All patients had nonenhancing areas (mean size 2 x 3.5 x 5.8 cm) within diffusely enhancing muscles. HO formation occurred around these nonenhancing areas in four patients with computed tomography follow-up. Other MR findings included fascial edema (n=14, 100%), fascial enhancement (n=13, 93%), subcutaneous edema (n=13, 93%), subcutaneous enhancement (n=12, 86%), bone marrow edema (n=5, 36%), and joint effusion (n=12, 86%). MRI reveals mostly bilateral edema and enhancement of muscles, fascia and subcutaneous tissue during acute onset of HO. HO develops in the periphery of well-defined areas of no enhancement.

Adolescent↗
PubMed2005

[Are bonus systems applicable to guideline-oriented depression treatment provided by general practitioners and neurologists?].

In the outpatient treatment of depression, the potential of diagnostic and therapeutic methods is seldom exhausted resulting in variable quality of treatment and partly insufficient cost effectiveness. Implementation of a guideline-oriented reimbursement system seems to be an option to improve quality of treatment. Corresponding incentive systems have been outlined and evaluated for the health care of somatic diseases such as diabetes. Acting on these experiences, an attempt was made to utilize them for the area of psychiatric disorders. Taking depression as an example, a model for a quality-oriented, guideline-based reimbursement system for general and specialist practice is presented.

Ambulatory Care↗
PubMed2005

[Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison].

Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity.

Adult↗
PubMed2005

[Data supporting quality circle management of inpatient depression treatment].

BACKGROUND: Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management. METHODS: In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment. RESULTS: According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious. CONCLUSIONS: Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.

Attitude of Health Personnel↗
PubMed2005

[Aneurysmal bone cyst of the second metacarpal: technique of conservation of the metacarpophalangeal joint and short-term result. A case report].

The authors report an aneurismal bone cyst in the second metacarpal of a 16-year-old patient. It was an aneurismal bone cyst of the agressive diffuse variety involving the proximal metaphyseal, diaphyseal and distal epiphyseal zones. Conservation of the MCP joint of the index was the priority. The authors report the technique used as well as the clinical and radiological results.

Adolescent↗
PubMed2005

Fluoxetine versus trimipramine in the treatment of depression in geriatric patients.

INTRODUCTION: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), and trimipramine, a tricyclic antidepressant (TCA), were compared in terms of efficacy and tolerability in a six-week, parallel group, double-blind pilot study in 41 geriatric patients with major depression (61 - 85 years old). METHOD: The Hamilton Rating Scale for Depression (HAMD-17), the Montgomery-Asberg Rating Scale (MADRS), the Adjective Mood Scale (Bf-S), the Clinical Global Impression (CGI), and the Patients Global Impression (PGI) were used to measure changes in depressive symptoms. RESULTS: Improvement with treatment was found on all scales. Efficacy and tolerability were similar in both groups. No statistically significant differences were found. CONCLUSION: These findings suggest that fluoxetine and trimipramine are comparable in terms of efficacy and tolerability in the treatment of major depression in geriatric patients.

Aged↗
PubMed2005

Observations of the periodontal ligament and cementum in cats with dental resorptive lesions.

The etiology of feline dental resorptive lesions is unknown, but some evidence suggests that interactions between components of the periodontium may be initiating factors in the development of these lesions. In the present study, 22 clinically normal teeth were harvested from 7 cats. The teeth and periodontium were radiographed and examined histologically. In addition, 14 of the 22 teeth were examined histometrically. Two teeth were histologically normal with an open apical foramen and two were normal with a closed apical foramen. Histological evidence of periodontal ligament degeneration without cementum resorption was observed in 8 teeth, and varying degrees of cementum resorption were observed in 10 teeth. Mandibular molar and premolar teeth had distal drift, and mandibular canine teeth had mesial drift. Alterations in the periodontal ligament may represent a preclinical stage of dental resorption.

Animals↗
PubMed2004

[Psychological stress and impaired quality of life in patients with tinnitus].

OBJECTIVES: The majority of patients with chronic decompensated forms of tinnitus have comorbid psychological disorders, possibly accompanied by restricted quality of life and participation in everyday activities. There is no standardized tool to measure these clinically relevant dimensions. SAMPLE AND METHOD: Both the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 (SF-36) were administered to a consecutive sample of patients ( n=110) who were recruited from the tinnitus outpatient service in the department of psychiatry and psychotherapy. Using the Tinnitus Questionnaire (TF), associations of the HADS and SF-36 scales with tinnitus grading were determined and the classification of patients (mild-medium-severe-very severe) was evaluated. RESULTS: A severe tinnitus grading is correlated to a high extent of anxiety and depression and a low quality of life. With the exception of the SF-36 subscale on physical functioning, all scales discriminated between the extreme groups (mild vs severe/very severe), but less between the two medium groups. CONCLUSIONS: Patients with severe decompensated tinnitus (grades III and IV) should be seen for diagnosis of psychiatric comorbidity and supportive psychotherapy/psychopharmacotherapy used when necessary.

Activities of Daily Living↗
PubMed2004

[Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg].

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.

Adjustment Disorders↗
PubMed2004

Parenteral nutrition practices in hospital pharmacies in Switzerland, France, and Belgium.

OBJECTIVE: Important changes in administering total parenteral nutrition (PN) admixtures have occurred over the past decade. This study describes hospital pharmacists' practices in France (F), Switzerland (CH), and Belgium (B). METHODS: From the responses received using a standardized questionnaire, (n = 378) we determined the origin, types of container used, and choice of PN formula (standard versus tailor-made) and the type of quality control and the existence of nutrition support teams. RESULTS: The mean response rates were 55.6% (CH), 30.5% (F), and 24.5% (B). Standard formulas were used mainly for adult patients (CH, 86%; F, 79%; B, 86%), whereas approximately 50% of tailor-made PN bags were used for children. Single-compartment or multicompartment bags or glass bottles contained standard formulas. Most standard formulas were provided by industry, apart from (B), where 50% of PN solutions were compounded by hospital pharmacies. Single-compartment bags contained generally tailor-made formulas produced exclusively by hospital pharmacies in (CH) and (B), whereas 33% were provided by industry in (F). Quality controls were mostly visual and occurred in 75% to 95% of hospitals. Nutrition support teams were present in 32% to 45% of hospitals. CONCLUSION: The choice, origin, and type of container used for PN formulas were highly variable among countries. However, the use of standard formulas in bags was predominant in (CH) and (B). The function of nutrition support teams was similar in (F), (CH), and (B).

Belgium↗
PubMed2004

Serum levels of substance P and response to antidepressant pharmacotherapy.

Substance P (SP) is possibly involved in the etiopathology of affective disorders. Here we investigated the relationship of SP serum levels and response to antidepressant drug therapy. SP serum levels were determined before and during a 9-week drug trial in 40 depressed patients treated with paroxetine in combination with either lamotrigine (n = 20) or placebo (n = 20). Responders (n = 18) and non-responders (n = 22) significantly differed in SP serum levels: responders started with higher SP levels that decreased during drug therapy, whereas non-responders had lower SP levels that increased at the beginning. There were no differences between patients with adjunct lamotrigine or placebo. These preliminary data indicate that SP serum levels might be related to response to antidepressant drug therapy. Further studies have to substantiate this finding.

Acute Disease↗
PubMed2004

ACTH and PRL sensitivity of highly differentiated cell lines obtained by adrenocortical targeted oncogenesis.

We established cell lines from adrenal tumors of transgenic mice harboring the large T-antigen of simian virus 40 under the control of the adrenocortical specific promoter of the scavenger aldose reductase-like akr1b7 gene. Mass spectrometry analyses of serum-supplemented or serum-free culture media showed that ATC1 line secreted only corticosterone. These cells, propagated over 25 passages, were characterized with regard to ACTH and PRL responsiveness, as measured by increased corticosterone production, induction of genes involved in the different steps of steroidogenesis (cholesterol delivery, steroid biosynthesis and detoxification of by-products) and expression of transcriptional regulators (SF-1 and DAX1). Corticosterone secretion (RIA) in serum-free medium was stimulated over 12-fold after 6 h treatment with either 10(-9)M ACTH or PRL and both hormones seemed equivalent in promoting this secretion (149 +/- 14 ng and 145 +/- 18 ng/10(6) cells/6 h, respectively). As expected, Northern blots indicate that ATC1 cells expressed mRNAs for the enzymes of corticosterone metabolism CYP11B1 and CYP21A, as well as those for the proteins SIK, SRB1, StAR, CYP11A1, and AKR1B7. Interestingly, these cells have maintained not only the expression of SF-1 but also that of DAX1. No expression of the zona glomeruloza-specific cyp11b2 gene was detected. With the exception of cyp21a and mc2r genes which were constitutively expressed, most of the genes above mentioned were induced in a time- and dose-dependent fashion in response to ACTH or PRL while DAX1 was repressed. Importantly, hormone-mediated repression of DAX1 gene expression was also observed in vivo in mice adrenals. Altogether these data demonstrate that ATC1 line provided an unique model of well differentiated zona fasciculata immortalized cells suitable for the dissection of molecular events leading to ACTH and PRL regulation of adrenal functions.

Adrenal Cortex Neoplasms↗
PubMed2004

The influence of microgravity on memorized arm movements.

To investigate sensory and motor functions in microgravity, goal-oriented arm movements were performed by 9 cosmonauts in weightlessness. The ability to reproduce predefined motor patterns was examined pre-, in-, and post-flight under two different paradigms: In a first test, the cosmonaut had to reproduce passively learned movements with eyes closed, while in the second test, the cosmonaut learned the pattern with eyes open. The different learning paradigms effected the metric parameters of the memorized stimulus pattern while the influence of the different gravity levels resulted in significant offsets and torsions of the reproduced figures. In comparing the inflight condition with preflight, intact proprioceptive afference seemed to play an important role for reproducing movements from motor short-time memory correctly.

Adaptation, Physiological↗