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Biomedical subjects

W Keitel

Publications and source records attributed to W Keitel.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Guideline for the joint swelling symptom--primary physician problem management and referral indications. German Society of Rheumatology "Quality Assurance" Committee].

The guideline "Joint Swelling" is addressed to primary care physicians--general practitioners, internists or orthopedists without special experience in rheumatology. It provides a framework for interviewing patients, as well as for physical, laboratory and imaging examinations and for selection of treatment appropriate to the level of primary care. Situations which call for urgent evaluation and criteria for referral to rheumatologists are described. The appendix contains comments on signs and symptoms to differentiate arthralgia from joint swelling and on the diagnostic value of a history of joint swelling without confirmation by the physician. Further recommendations for the evaluation of patient history and physical and technical examinations are given in a tabular form. The significance of laboratory and imaging procedures is discussed.

Arthritis, Rheumatoid↗
PubMed1999

[Fibromyalgia syndrome--out of control?].

On account of the very rapid increase in the number of cases and the resulting growing demands on medical resources, the fibromyalgia syndrome now poses a serious challenge to the health service. The diagnostic work-up of the clinical entity is fraught with problems and still leaves open a wide range of differential diagnostic possibilities,. Despite a wealth of pathological findings in the areas of pain physiology, the neuroendocrine system and sleep behaviour, the pathogenesis remains speculative. Accurate assessments of function in those affected are not possible, and evaluations of impaired performance only to a limited degree. The confusing multiplicity of therapeutic approaches, and the results of long-term studies of the natural history of the condition reflect the very limited efficacy of currently available treatment strategies.

Adult↗
PubMed1999

No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study.

OBJECTIVE: To investigate the effect of long-term antibiotic treatment in patients with reactive arthritis (ReA) and undifferentiated oligoarthritis. METHODS: One hundred twenty-six patients were treated with ciprofloxacin (500 mg twice a day) or placebo for 3 months, in a double-blind, randomized study. Of these patients, 104 (48 treated with ciprofloxacin and 56 treated with placebo) were valid for clinical evaluation: 55 were diagnosed as having ReA with a preceding symptomatic urogenic or enteric infection and 49 as having undifferentiated oligoarthritis. These 2 groups were randomized separately. The triggering bacterium was sought by serology and/or culture. The percentage of patients in remission after 3 months of treatment was chosen as the primary efficacy parameter. RESULTS: A triggering bacterium could be identified in 52 patients (50%): Chlamydia trachomatis in 13, Yersinia in 14, and Salmonella in 25. No patient was positive for Campylobacter jejuni or for Shigella. No difference in outcome was found between treatment with ciprofloxacin or placebo in the whole group or in subgroups of patients with ReA or undifferentiated oligoarthritis. No difference was seen in patients with a disease duration <3 months. Ciprofloxacin was not effective in Yersinia- or Salmonella-induced arthritis but seemed to be better than placebo in Chlamydia-induced arthritis. This difference was not significant, however, which might be due to the small sample size. CONCLUSION: Long-term treatment of ReA with ciprofloxacin is not effective; however, it might be useful in the subgroup of patients who have Chlamydia-induced arthritis. This has to be proven in a bigger study focusing on patients with Chlamydia-induced arthritis.

Adult↗
PubMed1999

[Quality assurance in rheumatology].

Coming from a collection of letters for quality assurance in rheumatology, a provisional program by the Commission for Quality Assurance of the German Society for Rheumatology is introduced. The completion and supplementation of the manual has been started already. The necessary continuation of this process shall be undertaken via internet. Contacts with other medical societies are planned to improve the consensus of the guidelines and to work on comprehensive topics of global interest. General practitioners and self-help groups for patients should be consulted to optimize this project. Specific controversially discussed procedures for diagnosis and therapy have to be clarified by prospective studies. Finally, the result of this project has to be reviewed by using the criteria for the assessment of guidelines developed by the Society of Physicians of Germany resulting in evidence based guidelines. The most important aspects of a comprehensive quality management in practices for rheumatology, rheuma- and rehabilitation hospitals are pointed out.

Germany↗
PubMed1999

[Occupational therapy in the diseases of the locomotor system].

The spectrum of occupational therapy (OT) services in rheumatology includes the restoration of disturbed muscle function, psychosocial aspects, instruction and training in joint protection and manufacturing of orthotic devices as well as advice and training with technical aids and adapting the home and workplace according to the patient's disability. OT is especially indicated in inflammatory rheumatic diseases with polyarticular involvement, but also in degenerative joint diseases, various forms of soft tissue rheumatism and spinal disorders. It should be prescribed by a physician and functional therapist together with regard to the specific location of functional derangement and is to be dosed individually according to the work-load applied. A wide range of techniques involving different materials--including textiles, leather, wood, clay--enable individual joints or functional entities to be exercised specifically. Integration and coordination of OT with the other elements of multidisciplinary therapy, e.g. pharmacological treatment, physiotherapy, orthopedic surgery is the important task of the rehabilitation team. The objective measurement of therapeutic effects serve the purposes of demonstrating the quality of the results and also of motivating the patient. The methods used will depend on the clinical picture, the structures damaged, and the time available for the therapist.

Humans↗
PubMed1998

[Quality recommendations of the German Society of Rheumatology. Basis for further responsibilities].

The manual "Qualitätssicherung in der Rheumatologie" is a consensus based thesaurus of diagnostic and therapeutic guidelines. The Committee for Quality Assurance in the German Society of Rheumatology proposes a plan for further activities in this field. The revision and updating of the manual was already begun, which will be continued and shall be Internet-based in the near future. Guidelines with topics of interdisciplinary interest (e.g. low back pain, ankylosing spondylitis) are to be unified. In order to achieve a broader consensus, practicing physicians and self-help organizations of patients should be asked to review the guidelines. Some controversies in clinical rheumatology are to be solved in prospective studies. Whereas the manual is kept as a body of reference for rheumatologists, a practice guideline "joint swelling" will be developed according to recommended criteria for appraisal of guidelines.

Germany↗