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Biomedical subjects

W Kaiser

Publications and source records attributed to W Kaiser.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Treatment prognosis and discharge 2 years later. III. Berlin Deinstitutionalization Study].

In a two-year follow-up we report on discharges in a cohort of 422 middle-term and long-term inpatients and prognoses of their psychiatrists and psychologists concerning time of discharge and location, after 50% long-term patients with a present stay of more than two years and 82% of middle-term patients (stay: 6-24 months) had been discharged. More than one-third of the long-term patients could be placed in sheltered accommodation, but 42% are still referred to nursing homes. All together 68% are still in institutional settings--either as inpatients or in nursing homes. Prognoses were not very reliable concerning the time of discharge but substantial with regard to placement in sheltered accommodation. This can be interpreted as a result of successful co-operation between inpatient and community-based services.

Activities of Daily Living↗
PubMed1998

[How does the quality of life of long-term hospitalized psychiatric patients change after their discharge into the community?].

In the Berlin deinstitutionalisation study, quality of life in 134 long-term hospitalised psychiatric patients was examined twice: Discharged patients were interviewed again one year after their return to the community, whereas patients who continued to be hospitalised were reinterviewed after 1(1/2)-2 years after the first interview. Quality of life was assessed by the Berlin Quality of Life Profile. Four groups were distinguished in the analysis: 1. patients who continued as inpatients in the same hospital, 2. patients who had been referred to other hospitals, 3. patients who had been discharged after less than one year of continuous inpatient care, and 4. patients discharged after more then one year of hospital care. The four groups differed significantly in several sociodemographic and illness-related variables. Regarding the objective quality of life data, the four groups differed significantly in respect of the spheres leisure, social contacts and safety at follow-up. Discharged patients had more leisure activities, more often a "good friend", and more frequent social contacts within the last week. They had been less often victim to a crime. In a cross-sectional analysis, the four groups showed significant differences regarding subjective quality of life in the spheres accommodation and safety. In a longitudinal analysis, no group showed any significant negative changes. Positive changes were found in the group of patients formerly hospitalised for more than a year most often: satisfaction with leisure activities, with the financial situation, and with accommodation improved significantly during the follow-up period. Results show a marked and significant improvement in the objective and subjective quality of life indicators in formerly long-term hospitalised patients after discharge.

Adult↗
PubMed1998

[Interviewer effects in assessing subjective quality of life and satisfaction with care in sheltered housing].

The impact of interviewer-effects on subjective evaluative criteria was examined in a randomized control group design (n = 26 x 2) of clients of sheltered living in Berlin-Spandau. The assessment of care and subjective quality of life showed that clients were more satisfied if they had been interviewed by their responsible caregivers compared to interviewers from other providers of the same region--unknown to the clients. Conductibility of interviews was independent of interview conditions. A systematic overestimation of satisfaction should be taken into account if responsible caregivers interview their own clients. Such data should not be used comparing different settings.

Adult↗
PubMed1997

Profiles of subjective quality of life in schizophrenic in- and out-patient samples.

For the use of subjective quality of life as an evaluation criterion, it should be known if measures are reliable, to what extent they are influenced by other variables and whether differences and similarities can be detected across treatment situations. Quality of life profiles (Berliner Lebensqualitatsprofil/Lancashire Quality of Life Profile) of 440 schizophrenic patients (from Berlin, Germany and from Wales, UK) were examined. Reliabilities differed between life domains and groups. The influence of other variables was moderate and varied between the groups. Several significant differences between subsamples could be shown between in-patients with a shorter present stay and out-patients. In addition, interesting similarities in profile patterns between in-patients with a longer stay (> or = 2 years) and out-patients can be found. Being admitted to a psychiatric hospital seems to have an influence on the level and structure of subjective quality of life for some time. Being in a psychiatric hospital for a longer time seems to coincide with a stabilization of level and structure of subjective quality of life. Future reports on subjective quality of life should include diagnostically homogeneous sampling and control the correlation with psychopathology. Further research is needed to clarify the impact of other variables (e.g. length of stay, cognitive variables, treatment features) on patients' satisfaction in different settings.

Adult↗
PubMed1997

Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile.

Quality of life (QOL) has become an important outcome measure for many disorders, including mental illness. The Lancashire Quality of Life Profile (LQOLP) was developed for use in operational contexts, and has been translated into several languages. It is in use in several European and North American community psychiatric services. The present paper addresses the questions: how easy is it to use?; how reliable is it?; do the results of the LQOLP vary by setting in a meaningful way?; how do the results co-vary with measures of clinical symptoms and social functioning?; how well does it measure change?; is it clinically useful? While most of the answers to these questions are favourable, there is a need for further research and development of the profile, in particular with reference to the consequences of the use of the profile as a routine monitoring instrument and the most appropriate form of statistical analysis in longitudinal data-sets.

Bias↗
PubMed1997

[Comparative stability evaluation of dynamic hip screw and gamma-nail osteosyntheses in unstable pertrochanteric femoral osteotomies].

In 24 human cadaver femora standardized instable pertrochanteric osteotomies were created. The right and left femur of each pair were alternately selected for osteosyntheses with the gamma nail and the dynamic hip screw. Afterwards an examination of stability was performed. Cyclical loads were increased in 500 N increments to the maximum loading capacity, while the deformation rate was continuously measured. Radiographs were taken to prove the results of loading. The mean deformation was much greater in the DHS group than for the gamma nail, the maximum load to failure was significantly lower. Femoral shaft fractures caused by the loading occurred five times as often in the gamma nail osteosyntheses than in the DHS.

Aged↗
PubMed1997

Early supported hospital discharge following acute stroke: pilot study results.

OBJECTIVE: To establish the feasibility and method of evaluation of an early supported hospital discharge policy for patients with acute stroke. DESIGN: A randomized controlled trial comparing an early supported discharge service to conventional care. SETTING: Three acute hospitals in Newcastle upon Tyne. SUBJECTS: Ninety-two eligible patients with acute stroke admitted between 1 February 1995 and 31 January 1996. MAIN OUTCOME MEASURES: Placement, length of stay, readmission rates, mortality, functional ability (Nottingham Extended Activities of Daily Living (ADL) Scale), handicap (Oxford Handicap Scale), global health status (Dartmouth Coop Function Charts) and carer stress (General Health Questionnaire 30 item). RESULTS: The median length of stay for patients randomized to early supported discharge was 13 days compared to 22 days in the conventional care group (p = 0.02). The median Barthel ADL index at seven days post stroke of patients randomized to early supported discharge was 15, and 13 for those randomized to conventional care (NS). At three months post stroke the median Nottingham EADL score of patients randomized to early supported discharge was 10 compared to 7 for those who received conventional care (NS). There were no statistically significant differences in the global health status of patients or carer stress. CONCLUSION: An early supported discharge service following acute stroke with individualized rehabilitation in the community is feasible and can be evaluated by a randomized controlled trial but a larger multicentre trial is needed before such a service is widely adopted.

Activities of Daily Living↗
PubMed1997

Incidence of acute oligoanuric renal failure in dextran 40 treated patients with acute ischemic stroke stage III or IV.

Two hundred eleven patients with acute ischemic stroke, stage III or IV, received daily intravenous infusion of 500-1000 mL low-molecular dextran (dextran 40) over a period of 4 days. In 10 cases (4.7%) acute renal failure, associated with dextran infusion, could be observed; oligoanuria occurred after a mean time of 4 (3-6) days. The incidence of dextran-induced acute renal failure was significantly higher in patients with a preexisting reduction of glomerular filtration rate below 30 mL/min/1.73 m2 (p < 0.005). Five of the patients (50%) with acute renal failure died within 4-12 days after the hemodilution therapy with dextran 40; this high lethality was due to nonrenal complications.

Acute Disease↗
PubMed1997

Recurrence of Hodgkin's disease after 10 or more years: late relapse or de-novo malignancy due to HLA-DPB1*0301-linked susceptibility?

Recurrences of Hodgkin's disease (HD) ten or more years after initial therapy are rare and heterogeneous concerning pathological, biological and clinical features. Though usually regarded as relapses of initial disease at least part of these late recurrences may represent de-novo HD due to an increased constitutional risk. Following recent reports genetic risk for HD may be linked to the HLA-DPB1*0301 allele. Therefore, we investigated DPB1 and other HLA class I and II gene loci in three patients with very late recurrences of HD presenting at our institution within the last two years. All patients carry the HD susceptibility allele HLA-DPB1*0301. The expected probability of three patients with HD displaying the HLA-DPB1*0301 phenotype by chance is only p = 0.022. As serologic investigations also revealed Epstein-Barr virus (EBV) activity in all three cases our results support a role of genetic susceptibility possibly leading to impaired immune responses to EBV in very late recurring HD. Additionally, HLA-DPB1*0301 may be valuable for identifying patients with HD who might be candidates for a long term follow-up.

Adolescent↗
PubMed1997

[Quality of life, needs and treatment evaluation of long-term hospitalized patients. Part II of the Berlin Deinstitutionalization Study].

OBJECTIVE: Objective living situation, subjective quality of life, need for care, and assessment of treatment of long-term hospitalised patients were investigated. METHODS: 237 patients from 6 hospitals were examined using standardised instruments. RESULTS: Patients' satisfaction was generally relatively high, but varied greatly in subgroups and individuals. Patients were most satisfied with personal safety in the hospital and least satisfied with the expectation to live in the hospital for a long time. Therapists assessed clearly more needs for care in the patients than the patients did themselves. Statistical analysis revealed significant correlations between the subjective quality of life in different domains, the number of needs stated and plausible determining factors. CONCLUSIONS: Findings reflecting patients' living situation in the hospital are very heterogeneous. In respect of subjective evaluation criteria, there is little space for improvement in the future.

Activities of Daily Living↗
PubMed1996

Autoimmune reactions in patients with silicone breast implants.

Silicone breast implants have been surgical routine for over 30 years. An association between silicone augmentation and immune related diseases has been reported in approximately 100 cases. In a retrospective single center study we investigated 36 non-selected women with silicone breast implants and 36 sex- and age-matched controls. Autoimmune reactions were evaluated by measuring antinuclear antibodies (ANA), rheumatoid factor (RF) and thyroid gland antibodies (TMS), along with angiotensin-converting enzyme (ACE), C-reactive protein (CRP) and other immunological and laboratory parameters. In the controls only 3 (8%) women had an elevated ANA titer and 1 demonstrated thyroid autoantibodies (microsomal), giving a total of 4 (11%) women with detectable autoantibodies. By contrast, 12 (33%) of the 36 women with silicone augmentation had raised ANA titers (> or = 1 : 80), a significantly higher percentage than in the control group (p < 0.02). Of the 12 women, 1 showed antismooth muscle antibodies (ASMA; titer 1 : 40) and 2 of the patients displayed antineutrophilic cytoplasm antibodies (ANCA; 1 : 320 and 1 : 40, respectively), one of the latter also being positive for rheumatoid factor. 2 further women demonstrated thyroid autoantibodies (microsomal), giving a total of 14 (39%) women in whom significant autoantibodies were detectable. Clinical symptoms (musculoskeletal) were present in 1 patient. Most of the observed autoantibodies were organ-unspecific, with a predominance of elevated ANA titers of the heterogeneous type and not related to a distinct clinical entity. However, none of the investigated women with silicone breast implants showed clinical symptoms or signs of connective tissue disease according to ARA criteria.

Acute-Phase Proteins↗
PubMed1996

A study of sleep in the European blackbird.

Sleep states in the blackbird, Turdus merula, were determined by recording the electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), and heart rate (HR), and from behavioral observations and responses to auditory stimulation by natural calls. The presence of changes in slow wave activity was determined from the power spectra of the EEG. Spectral power density in the 0.5-4.0 Hz band during slow wave sleep (SWS) attained highest values in the first part of the night, then declined. This trend in EEG spectra, which occurred across the night, probably reflects a homeostatic process strikingly similar to that observed in mammals. The reactivity to natural calls during SWS episodes also decreased across the night. Episodes of interhemispheric EEG asymmetry, which typically lasted from 2 to 4 s, occurred when birds displayed the front sleep posture and they constituted 140-200 s of each night. Unihemispheric sleep episodes probably result from unilateral activation of the visual system, and they could be considered as an evolutionary adaptation. HR was highest in wakefulness and lower in sleep but, due to large variability, reliable discrimination between sleep and wakefulness could not be made. Comparison of the blackbird's behavior during 4 different nights revealed a strong effect of the first night on sleeping behavior. A significant reduction in back sleep posture occurred during the baseline night, when lead wires were connected.

Animals↗
PubMed1996

Automatic learning of rules. A practical example of using artificial intelligence to improve computer-based detection of myocardial infarction and left ventricular hypertrophy in the 12-lead ECG.

The authors developed a computer program that detects myocardial infarction (MI) and left ventricular hypertrophy (LVH) in two steps: (1) by extracting parameter values from a 10-second, 12-lead electrocardiogram, and (2) by classifying the extracted parameter values with rule sets. Every disease has its dedicated set of rules. Hence, there are separate rule sets for anterior MI, inferior MI, and LVH. If at least one rule is satisfied, the disease is said to be detected. The computer program automatically develops these rule sets. A database (learning set) of healthy subjects and patients with MI, LVH, and mixed MI+LVH was used. After defining the rule type, initial limits, and expected quality of the rules (positive predictive value, minimum number of patients), the program creates a set of rules by varying the limits. The general rule type is defined as: disease = lim1l < p1 < or = lim1u and lim2l < p2 < or = lim2u and ... limnl < pn < or = limnu. When defining the rule types, only the parameters (p1 ... pn) that are known as clinical electrocardiographic criteria (amplitudes [mV] of Q, R, and T waves and ST-segment; duration [ms] of Q wave; frontal angle [degrees]) were used. This allowed for submitting the learned rule sets to an independent investigator for medical verification. It also allowed the creation of explanatory texts with the rules. These advantages are not offered by the neurons of a neural network. The learned rules were checked against a test set and the following results were obtained: MI: sensitivity 76.2%, positive predictive value 98.6%; LVH: sensitivity 72.3%, positive predictive value 90.9%. The specificity ratings for MI are better than 98%; for LVH, better than 90%.

Adolescent↗
PubMed1996

[Serum uric acid level in type 1 and type 2 diabetic patients].

In 50 type-1 and 50 type-2 diabetic patients serum uric acid levels were measured. Type-1 diabetics showed significantly lower serum uric acid levels in comparison to type-2 diabetics (p < 0.02). This significant difference has been observed in both women (p < 0.001) and men (p < 0.01). Serum uric acid level was lower in type-1 diabetics than in healthy controls but only in diabetic men the difference was statistically significant (p < 0.001). Male type-2 diabetic patients showed serum uric acid levels similar to the controls, but levels were higher in women with type-2 diabetes (p < 0.001). The results of this study show that in type-1 diabetic patients the serum uric acid levels are lower in normal (creatinine clearance > or = 80 ml/min) as well as in slightly decreased (creatinine clearance < 80 ml/min) glomerular filtration rate. But in type-2 diabetic patients the serum uric acid levels were significantly higher when glomerular filtration rate was below 80 ml/min in contrast to normal renal function (p < 0.05).

Adolescent↗
PubMed1996

[Clinical characteristics of long-term hospitalized patients. Part I of the Berlin Deinstitutionalization Study].

The Berlin Deinstitutionalization Study investigates effects of the planned reduction of psychiatric hospital beds in Berlin prospectively. In the beginning cross-sectional survey all adult psychiatric patients from two and a half districts, who had been hospitalized for more than 6 months, were examined. The total sample was 422 patients. Treatment situation and needs for nursing care are reported. The primary diagnosis according to ICD-10 was organic disorder (incl. Korsakov's syndrome) in 70 patients and mental retardation in 61. Psychopathology and social disabilities were examined in 237 of the remaining 291 patients. On average, psychopathology and disabilities were moderate. A cluster analysis classified three groups. When patients should be discharged, special protective measures might be necessary only for the two smaller groups (together 31%).

Adolescent↗
PubMed1996

[Subjective quality of life of patients with chronic schizophrenia].

The main results of quality of life research in sociology and social psychology and the findings of psychiatric studies on subjective quality of life are summarized. The present study examined subjective quality of life in patients with chronic schizophrenia in different treatment settings (n = 318/ICD 10:F20). The satisfaction scales of the instrument used (Berliner Lebensqualitätsprofil) are shown to have adequate consistency coefficients. Psychopathological variables accounted for more variance than demographic and illness-related characteristics and features of objective quality of life. Negative schizophrenic symptoms were not of particular concern, and anxiety/depression scores did not interact with satisfaction ratings in different settings. Two of nine domains (living situation and mental health) and the total scores showed significant differences between patients in different settings. The degree of contrast between in- and out-patients seemed to be influenced by the current length of stay of the in-patients. In addition to cross-sectional studies, there is a need for further examination of differences in subjective quality of life and in treatment effects in longitudinal studies, which should make use of panel designs.

Activities of Daily Living↗
PubMed1996

[Quality of life as a planning and evaluation criterion in psychiatric management].

In sociology and psychology, quality of life and subjective well-being have been being relevant constructs and subject of empirical research for several decades. Results of this research are reviewed, and findings of the more pragmatic specific studies on quality of life in the mentally ill are summarised. Although subjective quality of life may be influenced by various factors, it stands as an own important criterion. Finally, some open questions for empirical research, for theoretical studies and for public discussion are mentioned. These questions should be addressed before a decision can be made as to which extent quality of life is a useful criterion for the planning and evaluation of mental health care.

Forecasting↗