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P Oster

Publications and source records attributed to P Oster.

At least 19 recordsLinked to original sources
PubMed2006

Understanding the immune responses to the meningococcal strain-specific vaccine MeNZB measured in studies of infants.

Vaccine trials with infants enrolled between 6 and 10 weeks of age (young infants) and 6 and 8 months of age (older infants) provided an opportunity to evaluate immunoglobulin G (IgG) isotype distribution and avidity maturation as indicators of antibody function and immunologic memory. Following vaccination with a strain-specific outer membrane vaccine, MeNZB, pre- and postvaccination sera were used to determine IgG isotype responses and avidity indices (AI) in subsets of vaccinated subjects. Measurements of IgG isotypes involved 100 infants from each trial. AI were measured in 50 infants from the young infant trial who received a fourth vaccine dose and in 40 older infants from whom serum was collected 7 months after the primary vaccination course. IgG1 and IgG3 dominated the responses to the vaccine. A modest linear correlation (P < 0.001) occurred between serum bactericidal antibody (SBAb) titers and the total IgG or the IgG1 antibody units in older infants. The young infants showed a modest linear correlation between SBAb and total IgG (P = 0.005) and a weak linear correlation between SBAb and IgG1 (P = 0.003). Increased avidity with age was demonstrated in both groups. The AI in the young infants increased from 51.5% (95% confidence interval [CI], 47.7 to 54.7) postvaccination to 68.7% (95% CI, 65.5 to 71.9%) following the fourth dose of vaccine (P < 0.001). The mean avidity of the older infants increased significantly (P = 0.00012) from 42.4% (95% CI, 39.1 to 45.3%) postvaccination to 50.4% (95% CI, 47.2 to 53.6%) 4 months later. A fourth dose of MeNZB is now being given to young infants at 10 months of age.

Antibodies, Bacterial↗
PubMed2006

The VR2 epitope on the PorA P1.7-2,4 protein is the major target for the immune response elicited by the strain-specific group B meningococcal vaccine MeNZB.

A protracted epidemic of group B meningococcal disease in New Zealand led to the testing of a strain-specific tailor-made vaccine, MeNZB. Immunogenicity levels achieved during age group trials enabled New Zealand's regulatory authority to grant licensure to deliver MeNZB to all individuals under age 20. During the trials target strains for serum bactericidal antibody measurements included the vaccine target strain NZ98/254 and two comparator epidemic-type strains (NZ94/167 and NZ02/09). In this study, 12 other strains differing variously from the vaccine strain by their capsular group, PorB type, and PorA variable region specificities, or PorA expression, were used as target strains. The PorA specificity of the serum bactericidal antibody responses to the vaccine was determined for 40 vaccinees. Sets of 10 pre- and postvaccination sera were chosen randomly from the young infant, older infant, toddler, and school-age group trials. Antibody recognition of linearized PorA proteins was also determined using immunoblotting. Across all age groups vaccine-induced serum bactericidal antibodies specifically targeted the VR2 P1.4 epitope of the PorA P1.7-2,4 protein irrespective of the PorB type and/or capsular type of the target strain. Deletion of amino acids within the VR2 epitope or replacement of the epitope through genetic exchange allowed strains variously to resist antibody-directed complement-mediated lysis and negated PorA-specific antibody recognition in immunoblots. The demonstration that the immunodominant antibody response was specifically for the VR2 P1.4 epitope of the PorA protein supports the public health decision to use a strain-specific vaccine for the control of New Zealand's epidemic of meningococcal disease.

Amino Acid Sequence↗
PubMed2005

Safety and immunogenicity of New Zealand strain meningococcal serogroup B OMV vaccine in healthy adults: beginning of epidemic control.

As the first step towards control of a strain specific epidemic of meningococcal disease in New Zealand (NZ), this study, an observer-blind, randomised controlled trial in 75 healthy adults, evaluated safety and immunogenicity of two different dosages of a meningococcal group B vaccine administered in a three dose regime. The "tailor-made" outer membrane vesicle (OMV) vaccine (candidate vaccine) developed using a New Zealand meningococcal group B strain (B:4:P1.7b,4) was well tolerated with no vaccine related serious adverse events. Similar local and systemic reactions were observed in those receiving the New Zealand candidate vaccine and the control parent Norwegian vaccine (MenBvac). A four-fold rise in serum bactericidal antibodies (SBAb) against the vaccine strain 4-6 weeks after the third vaccination was achieved in 100% of New Zealand candidate vaccine 2,519 microg participants and in 87% of 50 microg participants. The safety and immunogenicity profile observed in this study of healthy adults enabled studies in children to be initiated using 25 microg dosage.

Adolescent↗
PubMed2005

Validation of the serum bactericidal assay for measurement of functional antibodies against group B meningococci associated with vaccine trials.

Provisional licensure of the trial vaccine, MeNZB, required demonstration of immune responses in vaccines, as measured by a validated Serum Bactericidal Assay (SBA). Reported are the investigations undertaken to define test parameters, lower limits of quantitation and measurement of SBA reproducibility. Results helped to formulate the operating procedure for the measurement of serum bactericidal antibodies during six age-group MeNZB vaccine trials. The lower limit of quantitation was determined as a titre of 4. A four-fold rise in antibody (sero-conversion) from a pre-vaccination titre of 2 (<4) required a minimum post-vaccination titre of 8, a more stringent measurement than has been used in other published studies.

Antibodies, Bacterial↗
PubMed2005

["FRAGILE"-Old people and surgery].

As life expectancy and modern surgical and intensive care techniques develop, the number of old patients in surgery is rising. Associated are problems with the indication for surgical intervention and rising incidence of "typical" peri- and postoperative complications such as postoperative delirium. Geriatric assessment serves to identify patients at risk of developing complications, to describe the postoperative course of functional and cognitive abilities, and to adjust therapeutic strategies to the individual needs of these patients. The most important instruments of geriatric assessment are described. Postoperative delirium, the most prevalent complication in surgical geriatric patients, is discussed in detail with regard to risk factors, prevalence, diagnosis, and therapeutic options.

Activities of Daily Living↗
PubMed2005

[Physical exercise in old age].

For the prevention of diseases and especially functional deficits in old age, physical activity is a simple, practicable and successful method. With increasing age and frailty or in rehabilitation training, these activities have to be more and more individualized and medically supervised. The paper defines from today's viewpoint suitable activities and the amount of training necessary. Finally, the need for research about physical training in geriatric medicine is pointed out.

Aged↗
PubMed2005

[Increasing importance of opioids in geriatrics].

BACKGROUND: During the previous 20 years the prescription of opioids for medical use has increased steadily. Patients and professionals have great reservations about the use of opioids in the elderly. The aim of this study was to describe the changes in analgesic therapy in a geriatric clinic during the previous 10 years. METHOD: The quality and quantity of prescriptions for opioids as well as the costs of the analgesic therapy in a large geriatric clinic between 1994 and 2003 were analyzed. RESULTS: The use of opioids increased steadily from 0.72 mg per day and patient in 1994 to 9.50 mg in 2003 (1320%). The introduction of sustained release tilidine/naloxone and tramadol led to a change of the prescribed forms but only to a slight increase in the total consumption of these drugs. In 1994 the average daily cost of analgesic therapy was 15 cents per patient compared with 46 cents in 2003. The percentage of analgesics in the pharmacological budget increased from 5.6 to 10.8%. CONCLUSION: Dealing with opioids should be a part of the training program for all members of the geriatric team. Analgesics have come to play an important role in the pharmacological budget at least in this geriatric clinic.

Aged↗
PubMed2004

[Satisfaction of geriatric patients with their pain therapy. Wish and reality].

AIM: The goal of this study was to determine the level of satisfaction of geriatric patients with their pain therapy, their wishes for improved treatment, and possible influencing factors. METHODS: From April to November 2002, all patients able to communicate ( n=1432) were included in the study if they had reported pain in the previous 7 days or were taking regular analgesic medication without specifying pain. RESULTS: Of the geriatric patients reporting from home, 36.4% were not satisfied with their pain therapy up to that time, and 25.4% of surgical patients were dissatisfied as were 28.5% of patients treated in other departments. A total of 93.3% desired better pain treatment. Independent predictors for dissatisfaction with their therapy or wish for improvement were increasing pain intensity, frequent concomitant complaints in addition to pain, and the objectively perceived everyday competence. CONCLUSION: This study supports the observation that competent pain therapy is necessary and that there is room for improvement in geriatric facilities. Measuring pain intensity, posing questions pertaining to satisfaction with pain therapy, and determining whether patients desire better pain treatment are all indispensable for optimal care. Pain therapy should equally address reduction of pain intensity and management of other complaints.

Aged↗
PubMed2003

[Case management and functional outcome in persons aged 65 years and over with hip fracture].

The goal of the investigation was to study case management and functional outcome in older patients with hip fracture. A prospective observational survey was performed, including all patients aged 65 years and over presenting with hip fracture in Heidelberg, from 1 July 1999 to 30 June 2000. All patients were reassessed by telephone calls 6 months post-fracture. A total of 331 patients were included (mean age 81.5 years, 81% female,23.8% nursing home residents). Hip fracture incidence per 1,000 was 7.8/year, and nursing home residents had a six times higher incidence rate than those living at home. Prior to the fracture, half of the patients were dependent in ambulation and a third needed support in basic activities. With substantial comorbidity (42% cognitive impairment), complications were common. Geriatric care was needed for 82% of the survivors. In-hospital treatment costs were about 10,000 Euro per fracture. Mortality at 6 months was 19.9%. The majority of survivors showed loss of competence and mobility. Functional outcome in older patients with hip fracture is disappointing. As the majority of the patients are frail, clinical treatment is complicated by "geriatric" problems. Thus, improved interdisciplinary care, with close cooperation between geriatricians and surgeons might result in a better functional outcome.

Age Factors↗
PubMed2003

[Causes for in-hospital treatment of nursing home residents].

The high rates of hospitalization in nursing home residents are as well known as the hazards of in-hospital treatment especially in this group of frail older people. Moreover, hospital admissions cause considerable costs. The objective of the study was to analyze why nursing home residents are admitted for in-hospital geriatric care, and to form hypotheses of how to prevent these admissions without loss of quality of care. Reason of admission, comorbidity, competence and length of in-hospital stay were assessed in all nursing home residents referred to the Geriatric Centre at the University Hospital of Heidelberg over 12 months. There were 245 admissions of 231 nursing home residents (83.1% female; age 84.2 +/- 7.10 years). Comorbidity was substantial (77% urinary incontinence, 69% dementia, 40% stool incontinence, 22% pressure ulcers), and 56% of residents needed assistance in using the toilet before admission. Mean length of in-hospital stay was 32.6 days (median 29 days). Out of a total amount of 7983 days of in-hospital care, 3627 (45%) were caused by falls and fractures, 2039 (26%) by cardiovascular events (mainly ischemic stroke), 835 (11%) by infections and 495 (6%) by problems concerning nutrition. Most of the leading causes of admission of nursing home residents to in-hospital geriatric care might be affected by improvements in nursing home care. Thus, data suggest that hospitalization rates might be substantially reduced by targeted prevention and therapy as well as by structural measures to improve case management in the nursing homes. Such interventions should be developed and proved in controlled studies.

Activities of Daily Living↗
PubMed2003

[Geriatrics-quo vadis? The system of geriatric care].

The authors describe the current and perspective structure of geriatric care in hospital and rehabilitation units. First the specific needs of elderly patients with various medical problems (multiple morbidity) are described. Furthermore the article analyses optimised structures of geriatric care. These visions are not limited to care in hospital and rehabilitation units but include prevention and long term care for elderly people as well.

Aged↗
PubMed2002

[Problems recognizing pain in geriatrics].

OBJECTIVE: Elderly people often present substantial problems in pain assessment. The aim of the study was to quantify and discuss the problem of recognizing pain in hospitalized geriatric patients. METHODS: 124 geriatric patients and their treating doctors were questioned about pain, pain intensity and influence of pain on daily living in a cross-sectional-study. The score of the Barthel index (activity of daily living, ADL) at admittance and discharge, the cognitive status (monumental status of Folstein, MMS), the use of analgetic drugs and the medical diagnoses were assessed. The answers of the question "Did you/your patient have pain in the past seven days?" from patients and doctors were used to make seven groups. RESULTS: 20 (16,1%) patients could not answer the question about pain. In comparison to the group of patients who were able to answer, they were restricted in ADL and MMS. However, the answers of doctors about pain did not differ. 25 (20,3%) answers of treating doctors were wrong compared to the answers of the patients. In these cases, intensity and influence of pain on daily living were estimated low by the patients. In 14 (11,3%) patients, doctors could not state about pain. These patients were least restricted in ADL at admission and discharge. Altogether, the pain of 13/46 (28,3%) patients was treated insufficiently at the day of the interview. CONCLUSIONS: In half of the geriatric patients, pain was not well or not at all recognized by the treating doctors. Pain of not communicative patients was assessed similarly by the doctor as that of patients who were able to give information. In this geriatric hospital, little support at admittance and a superior improvement in the activities of daily living during the in-hospital treatment lead to less attention to pain by the doctor. The importance of pain therapy in geriatrics is illustrated by the fact that almost every third patient with pain is treated insufficiently at the day of the interview.

Activities of Daily Living↗
PubMed2001

[Recognizing pain in geriatric patients by an interdisciplinary team. Reliability of judgment and factors of influence].

The prevalence of chronic pain increases with age. The awareness of pain in geriatric patients is more difficult than in younger people because of various reasons. The occupational groups of the geriatric team might be different in respect of discerning symptoms of pain. 126 geriatric patients were enrolled in this study. They were asked if they had pain today and in the last seven days. At the same time the members of the geriatric team (old people's nurses, nurses, physicians, physio-, occupational and speech therapists) were asked the same questions with respect of their patients. Items possible influencing the answers were recorded: patient's characteristics: age, cognition (Folstein's minimental state) and duration of hospital stay before this interview; employee's characteristics: age, days of care in the past 7 days, weekly working hours, occupational years and years working in this geriatric hospital. The judgement of the geriatric team varied widely. It was dependent on the profession, days of care, weekly working hours and professional experience. Changes of care in the last 7 days have an negative effect in all occupational groups. Other features will be discussed in details. The handing of the patient's pain should be improved within the occupational groups.

Aged↗
PubMed2001

[Geriatric care in Germany--results of an empirical study].

BACKGROUND: In Germany, the situation of geriatric medicine has improved significantly over the past few years. Until now, though, there was little information available on the structure of the clinical geriatric departments. Since this information is vital to assess whether these departments can provide high-quality services, the German Federal Association of Clinical Geriatric Departments conducted a survey among its members. The goal was to gain deeper insight into the structure of the geriatric acute hospitals and rehabilitation units. METHODS: In 1999, member institutions were mailed a standardized questionnaire and all institutions (100%) returned the questionnaire to the association's central office. To increase data quality, data were screened and reports were generated for each institution. These reports were returned to the institutions which were asked to verify them. RESULTS: This article shows that in 1998 acute geriatric hospitals (n = 89), rehabilitation units (n = 52), acute day clinics (n = 45) and rehabilitation day clinics (n = 26) had--on average--60/60/15.3/14 beds/places and 828.15/677.3/164.2/125.9 patients. Occupancy rates averaged out at 88.7%/84.3%/86.4%/63.7% and daily hospital rates at DM 401.4/322.4/293.8/243.2. Basically, all geriatric institutions included in this survey had a multi-professional geriatric team. Patient-to-staff ratios for psychologists, social workers, ergo-, physio- and speech therapists were better in day clinics than in in-patient clinics and better in rehabilitation units than in acute hospitals. Geriatric institutions mainly focused on the treatment of neurological deficits. Most patients were admitted from other hospitals and discharged to their private residence. CONCLUSIONS: The results of this survey indicate that especially the acute hospitals are often not sufficiently staffed. Moreover, further efforts are necessary to clarify the indications for and modalities of geriatric day clinic treatment and rehabilitation. The data also show that a categorical distinction between geriatric acute hospitals and rehabilitation units is not possible. However, further data collection and more detailed analyses are needed.

Aged↗
PubMed2001

Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls.

OBJECTIVE: To determine the safety and efficacy of an exercise protocol designed to improve strength, mobility, and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls. DESIGN: A randomized controlled 3-month intervention trial, with an additional 3-month follow-up. SETTING: Out-patient geriatric rehabilitation unit. PARTICIPANTS: Fifty-seven female geriatric patients (mean age 82 +/- 4.8 years; range 75-90) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times per week for 3 months. Patients of the control group attended a placebo group 3 times a week for 3 months. Both groups received an identical physiotherapeutic treatment 2 times a week, in which strengthening and balance training were excluded. MEASUREMENTS: Strength, functional ability, motor function, psychological parameters, and fall rates were assessed by standardized protocols at the beginning (T1) and the end (T2) of intervention. Patients were followed up for 3 months after the intervention (T3). RESULTS: No training-related medical problems occurred in the study group. Forty-five patients (79%) completed all assessments after the intervention and follow-up period. Adherence was excellent in both groups (intervention 85.4 +/- 27.8% vs control 84.2 +/- 29.3%). The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses. For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455-1.245). CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail, high-risk geriatric patients with a history of injurious falls.

Accidental Falls↗
PubMed2001

Safety of a new conjugate meningococcal C vaccine in infants.

BACKGROUND: Group C conjugate meningococcal vaccines (Men C) were introduced into the UK primary immunisation schedule in November 1999. There has been extensive professional and public interest in their efficacy and safety. AIM: To determine the occurrence of at least one uncommon adverse event in infants related to the administration of the Chiron Men C vaccine. METHODS: A total of 2796 infants aged approximately 2 months were recruited into the study from areas in and around Sheffield and from Scotland. They were vaccinated with the Chiron Men C vaccine at 2, 3, and 4 months along with routine immunisations. Data on adverse events occurring one month after each dose were collected actively and prospectively and reviewed for possible relation to the vaccine. RESULTS: There were no deaths. There were no serious adverse events considered definitely or probably caused by the vaccine. Four infants developed serious adverse events (hypotonia, screaming syndrome, maculopapular rash, and agitation, respectively) that were considered possibly related to the vaccine. All recovered completely. Adverse events were seen in 1804 children but were considered possibly related to the vaccine in only 49 (1.8%). On subsequent immunisation there were no recurrences of adverse events considered to be possibly related to the vaccine.

Female↗
PubMed2000

[Success and variability of success of inpatient rehabilitation of the elderly: an empirical study based on medical-psychiatric and psychosocial indicators].

This study considers findings of psychological gerontology as particularly important for geriatric rehabilitation research. Its concrete aim was to describe the course and outcome of geriatric rehabilitation based on a wide range of success criteria, to explore the influencing role of age, sex, and diagnosis as well as to describe the variability pattern of success. The data were gathered from a sample of 100 older adults who underwent treatment in a German inpatient rehabilitation unit. Participants were assessed across five measurement occasions by use of a state-of-the-art geriatric assessment and a psychological data collection part. The results underline, for one, that significant improvements of functional as well as psychological capacity were obtained. Second, age and sex played practically no role concerning the course of the success criteria, whereas diagnosis revealed some statistically meaningful effects. Third, it was found that the variability of success was characterized by a relatively homogeneous pattern of gain with regard to functional criteria; with respect to psychological variables, heterogeneity was more pronounced and some participants show loss as well, a chance for further improvement of the geriatric rehabilitation.

Adult↗