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W Koller

Publications and source records attributed to W Koller.

At least 55 records · Page 3Linked to original sources
PubMed1995

MONI: an intelligent database and monitoring system for surveillance of nosocomial infections.

Recording, recognition, and prevention of nosocomial infections are the primary responsibilities of the hospital infection control unit. To perform these tasks, this unit needs information from diverse sources--the patient's symptoms and signs, microbiological and virological test results, and information regarding antibiotics and treatment come from different levels of healthcare delivery. Because of the large amount of data (e.g., about 300 microbiological requests daily) a computer system is required to store this information and to provide a means for subsequent evaluation. MONI (Monitoring of nosocomial infections) is an intelligent database and monitoring system for surveillance and detection of nosocomial infections. Data can be entered into the system manually as well as transferred automatically from external information systems. The central feature of the system is the automatic detection of and calling attention to conditions that may be a detriment to patient recovery, such as possible hospital-acquired infections, risk factors, diseases to be reported, etc. By using this system, we seek to reduce the frequency of infection and the frequency of nosocomial deaths by improving the quality of patient treatment, shortening the length of stay in a hospital, and the use of fewer and/or cheaper antibiotics. MONI provides a means to access relevant medical data (names of infectious agents, antibiotics, department names, monitoring rules, etc.) from a library. This library can be updated or otherwise modified, even during use. An infection control team using this system can customize it to suit the demands of that particular unit. Automatic data transfer from external information systems is made possible by tables that translate between different code systems. The system also offers flexibility; the program can be configured to adapt it for use in other hospitals and institutions. The core element of MONI is the monitoring module, which is implemented as a layer between data input and the database. Upon data acquisition, the system checks the input against several monitoring tools and alerts the user to matches, which may indicate an infection risk. Processing of a rule may be deferred, depending on complexity of the rule and the actual and estimated workload of the system. Examples of the monitoring guidelines are: (1) suspicion of nosocomial infection; (2) infection at a normally sterile site; (3) infection due to bacteria with unusual antibiotic sensitivity patterns; (4) lab report indicates that patient is treated with ineffective antibiotic; (5) possible choice for less expensive antibiotic; (6) infection which is required to be reported to state and/or health authorities; (7) patients receiving prophylactic antibiotics longer than medically indicated; and (8) infections of two or more patients in different wards with the same bacteria (cf. Evans 85). The MONI system was developed at one of the largest hospitals in Europe, the Vienna General Hospital (2,200 beds). This facility serves as the teaching hospital of the University of Vienna Medical School. The size of the hospital and the large amount of data made it necessary to introduce such a system into clinical routine. MONI was programmed in C and C++ with a state-of-the-art graphical user interface (Presentation Manager, Workplace Shell) for OS/2. IBM Database 2 for OS/2 (dB 2/2) was used in constructing the database. The layer between the database and the monitoring application is driven by the multitasking and interprocess communication abilities of OS/2. A pen-based support system that assists in mobile data acquisition is currently under development.

Anti-Bacterial Agents↗
PubMed1994

Information transfer in high dependency environments: an ergonomic analysis.

We have studied the information flow in HDE (with special focus on the information transfer process) using data provided by a group of experienced health care professionals. A model of the information flow in HDE was built up. It postulates the existence of quanta of information (due to the artificial fragmentation of the information flow produced by the clinical working processes: organization in shifts, demand of simultaneous activities from different staff members, etc.). This fragmentation is described by using the so-called Clinical Information Process Units (CIPUs), which correspond to patient care activities going on in parallely and serially linked blocks, performed by the staff in the specific environments. Due to a transfer in responsibility over the patient the CIPUs are linked by information transfer events which are described using transfer modules (TraMs). We exemplified 32 CIPUs related to the clinical environments (PreOp, Surgery, Recovery Intensive Care, Ward, Diagnostics, Outpatient) and the health care professional groups (Anesthesiologist/Intensivist, Surgeon, Nurse, Physician, Diagnostic Physician, Physical Therapist). A matrix was established providing the transfer situations among the CIPUs enabling a systematic classification of the TraMs. The contents of the TraMs are built up of information link elements, which are assembled according to the specific settings of the transfer situation given by the emitter, receiver and purpose. In summary we modelled the process of information transfer in HDE through CIPUs, TraMs and information links in a way, which may be useful to design information technology applications or to reorganize the information management in HDE.

Anesthesiology↗
PubMed1994

[Resistance spectrum of staphylococci at the Vienna general hospital (July to December 1991)].

This study describes the antibiotic resistance of 1961 staphylococcal strains that were isolated at the University Hospital of Vienna from July to December 1991. Staphylococcus aureus (SA) represented 43.2%; coagulase-negative (CNS) staphylococci 56.8%, three quarters of which were Staphylococcus epidermidis. Excepting netilmicin, the proportion of resistant strains to all antibiotics was higher with CNS than SA. Methicillin resistance (M(r)) was found in 11.8% of SA and 30.3% of CNS. Borderline oxacillin resistance (BOR) was noted in 7.4% of SA and 32.5% of CNS. It is important to note that severe or generalized infections due to M(r) staphylococci should be treated with glycopeptide antibiotics such as vancomycin or teicoplanin from the very beginning, whereas chemotherapy of those with BOR strains may also be carried out with beta lactamase-stable beta lactam antibiotics. Comparing the results of this study with those of the first half of 1991, the respective proportion of M(r) staphylococci was significantly lower than 23.6% for SA and 47.6% for CNS recorded then. As compared with the foregoing period, however, these strains demonstrated increased resistance frequencies to gentamicin (from 81.3 to 90%), amikacin (from 35.4 to 69%), netilmicin (35.4 to 55%), and ciprofloxacin (56.2 to 64%). This is taken as an indication for the epidemic spread of a clone of resistant strains.

Anti-Bacterial Agents↗
PubMed1993

Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients.

In 56 patients with multiple trauma with ISSs > or = 33 we prospectively collected data of seven scoring systems (ISS, TS, TRISS, GCS, PTS, APACHE II, SSS) and sequentially determined blood lactate concentrations. These data were analyzed in relation to the patients later developing adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF). Twenty-two patients developed ARDS, and 18 developed MOF. Of the mentioned scoring systems only ISS, PTS, and SSS were predictive of subsequent ARDS, and only ISS and SSS were predictive of subsequent MOF. Lactate concentrations at days 2, 3, and 4 were significantly different between patients with and without subsequent ARDS, MOF, or both. Surprisingly, APACHE II scores did not correlate with subsequent ARDS or MOF, nor did they show any significant relation with lactate concentrations at any time. By stepwise regression analysis ISS, SSS, and lactate level at day 3 were the most significant variables toward the development of ARDS and MOF. It is concluded that scoring systems directly grading the severity of groups of trauma patients have predictive value for late and remote complications such as ARDS and MOF, whereas scoring systems that grade the physiologic response to trauma--although clearly related to mortality--have no such predictive value.

Adolescent↗
PubMed1993

Double-blind controlled study of methazolamide in the treatment of essential tremor.

We studied the effect of the carbonic anhydrase inhibitor methazolamide in 25 patients with essential tremor (ET) in a double-blind, placebo-controlled trial. Tremor assessment included patient self-reporting of functional disability, clinical rating of motor tasks and tremor severity, and accelerometric measurements. There was no significant difference between methazolamide and placebo in any of the assessments. Side effects, paresthesias, sedation, headaches, and gastrointestinal symptoms were common. Only two patients elected to remain on the drug after the study. Methazolamide has only limited efficacy in the treatment of essential tremor.

Analysis of Variance↗
PubMed1992

Test models for hygienic handrub and hygienic handwash: the effects of two different contamination and sampling techniques.

Two methods for artificial contamination of hands and two sampling techniques to recover the test organisms were compared for their effects on the results of two post-contamination hand treatments: a handrub with two portions of 3 ml of 2-propanol 60% v/v for 1 min, and a handwash with liquid soap 20% w/v for 1 min followed by a 15 s rinse. The two contamination methods involved a short immersion of the hands (up to the middle of the mid-hand) in a suspension of the test organism followed by either air-drying (3 min) or drying by rubbing the hands' vigorously against each other (3 min) in a standardized way. The two sampling techniques consisted of rubbing the fingertips in either 10 ml trypticase soy broth (TSB) against the bottom of a Petri dish; or 100 ml TSB against glass beads contained in a bowl. Sixteen volunteers were randomly allotted to four blocks of four. They carried out the four possible combinations of two treatments and two contamination methods in a series of four tests arranged in a Latin-square design. In addition, the two sampling techniques were compared with each other concurrently by sampling of the right and left hand each with a different one of the two techniques. The alcoholic handrub reduced the release of test organisms significantly (2P less than 0.005) more effectively, by 1.1-1.3 x log10, than did the handwash with liquid soap, regardless of the contamination or sampling method. Whereas the two recovery techniques yielded virtually identical results in corresponding situations, the method of artificial contamination affected the mean reduction factors, strongly.(ABSTRACT TRUNCATED AT 250 WORDS)

1-Propanol↗
PubMed1992

The effect of acetazolamide on essential tremor: an open-label trial.

We studied the effect of the carbonic anhydrase inhibitor acetazolamide on 24 patients with essential tremor by patient self-evaluation of functional disability, rating of motor task function, and clinical rating of tremor severity. Acetazolamide significantly reduced tremor severity, but there was no statistically significant change in patient self-assessment of function or motor task rating. Although side effects were common, over half the patients elected to remain on the drug.

Acetazolamide↗
PubMed1992

Essential tremor.

Explore the source record for details and available documents.

Data Collection↗
PubMed1992

Assessment of changes in lung microvascular permeability in posttraumatic acute lung failure after direct and indirect injuries to lungs.

We prospectively studied the variation in sequence of occurrence of lung microvascular permeability (LMVP) increase and clinical onset of posttraumatic acute lung failure (ALF) in the sequential failure of organ systems after direct and indirect lung injury. Acute lung failure developed in 52 of 255 trauma patients. Thirty-seven of these developed ALF after a direct injury to lung tissue and 11 after an indirect injury. Lung microvascular permeability was measured with a gamma camera simultaneously over both lungs using indium 113m-labeled transferrin and technetium 99m-labeled erythrocytes in 24 patients with ALF due to direct lung injury and in 4 with ALF due to indirect injury. A localized increased LMVP was observed initially only in the directly traumatized lung (traumatized/nontraumatized lung: 10.03 +/- 5.08/3.73 +/- 3.33 %/h), but involved the primarily nontraumatized lung within 4 days (traumatized/nontraumatized lung: 9.13 +/- 4.49/10.89 +/- 5.05 %/h). In contrast, in ALF due to indirect lung injury, an increased LMVP over both lungs was observed initially (right/left lung: 11.57 +/- 6.18/12.63 +/- 5.73 %/h) and 4 days later (right/left lung: 12.3 +/- 5.49/11.92 +/- 5.75 %/h). Acute lung failure due to direct lung injury occurred significantly earlier (less than 72 h) (P less than 0.01), whereas onset of indirectly induced ALF was later (greater than 72 h). Sepsis syndrome and multiple organ failure were the major complications once ALF occurred after a direct injury. In contrast, sepsis syndrome and multiple organ failure commonly preceded or paralleled the onset of ALF due to an indirect injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Educational programmes for infection control in Austria.

Educational aims and strategies (simply arousing awareness, sensitivity and understanding; and/or training in practical skills and knowledge; or the ability to teach infection control, and to convince those taught) depend on the target group. Infection control is part of the curriculum for students of medicine and other health care professions, and is included in course examinations. Postgraduate doctors may seek training on courses which are organized by the Hygiene Institute of the University of Vienna in co-operation with the Austrian Society of Hygiene, Microbiology and Preventive Medicine. Registered nurses may enroll in the Austrian Nurses' Association training scheme (6 weeks of theory with professional work for 2 years), leading to approval as Hygieneschwester/-pfleger. Postgraduate in-hospital education for all health-care professions occurs in many Austrian hospitals, with resources from Vienna and Linz. Hospital managements, health authorities and politicians are influenced via their own educational activities and via publications.

Austria↗
PubMed1991

The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants.

A prospective, randomized double-blind study with intra-individual comparison of the results was undertaken with 20 volunteers to assess the influence of cosmetic additives on the acceptability of a mixture of n-propanol (50% v/v) and isopropanol (30% v/v) for hand disinfection. Three to 5 ml of antiseptic was rubbed into the hands until dry 15 times a day, 5 days a week and for 2 weeks per preparation. For self-assessment the parameters 'appearance', 'intactness', 'turgor' and 'sensation' were evaluated weekly by visual analogue; for assessment by a dermatologist the same parameters except 'sensation' were used. Each score was compared before and after treatment. The antimicrobial efficacy of the alcoholic mixture was equivalent to or better than the standard (isopropanol 60% v/v, 1 min). The frequent application of these antiseptic preparations caused a slight but significant deterioration of the skin condition as judged by both self-assessment and dermatologist; however, this was significantly less when the antiseptic contained cosmetic additives. It is concluded that the addition of suitable emollients can significantly increase the acceptability of alcoholic disinfectants.

1-Propanol↗
PubMed1991

Improvement of septic syndrome after administration of recombinant human growth hormone (rhGH)?

Twenty patients with generalized sepsis were studied prospectively to evaluate the effects of recombinant human growth hormone (rhGH) administration. Five patients had developed sepsis after major abdominal surgery, 15 patients after multiple trauma with head injury (HTI-ISS 38 +/- 2 and Glasgow Coma Scale 4 +/- 1). The urea production rate (UPR) could be significantly reduced by the intramuscular administration of 1.5 IU of rhGH/kg bodyweight (BW) per day (UPR day: 5, 62 +/- 6.7 gm/d vs. UPR day: 10, 42.6 +/- 5.9 gm/d). The catabolic index of Bistrian (BI) was significantly lower after rhGH therapy on day 10 compared to day 5. IGF-1 increased significantly after the administration of rhGH. The nitrogen balance, however, did not become positive, despite the administration of rhGH. The changes in sepsis were estimated by the scoring system according to Elebute and Stoner on days 3, 5, 7, 10, and 13. In those patients who were available for post-treatment evaluation the parameters had returned to baseline values after the withdrawal of rhGH. Results indicate that this therapy might ameliorate the nitrogen intake, but has no influence on the course of sepsis. Compared to previously published results in nonseptic patients, the somatomedin inhibitors as well as the split-products of the complement system and the metabolites of arachidonic acid may have been responsible for this weak effect of rhGH and IGF-1 in septicemia.

Adult↗
PubMed1990

Autologous transplantation of adrenal medulla in Parkinson's disease. 18-month results.

Eighteen of 19 patients who underwent autologous adrenal medullary transplantation to the right caudate nucleus have been followed up for 18 months. During the course of this study, a statistically significant improvement was noted in percent "on" time, percent "on" time without dyskinesia, activity of daily living (ADL) scores during the "on" stages, and ADL, motor, and Schwab-England scores during the "off" stages. Benefits tended to be maximal at 6 months and to gradually lessen thereafter, although statistically significant improvement in comparison with baseline was still present at 18 months for ADL, motor, and Hoehn-Yahr scores during the "off" stages. Almost all parameters had deteriorated by 18 months compared with 12 months, including those remaining significantly improved in comparison with baseline. These patterns were similar for each of the three participating centers. Complications were largely restricted to the perioperative period.

Adrenal Medulla↗
PubMed1990

The secretion of human growth hormone stimulated by human growth hormone releasing factor following severe cranio-cerebral trauma.

Patients suffering from severe cranio-cerebral trauma show alterations of the secretory patterns of thyroid stimulating hormone (TSH) and human growth hormone (HGH) which may be of prognostic significance. We studied 10 patients following severe brain injury and prospectively compared a new synthetic human growth hormone releasing factor (HGHRF) test with the thyrotropin releasing hormone (TRH) test. On admission, all patients had a Glasgow Coma Scale score of 3 or 4. All patients had a low T3 syndrome. In the patients who died the TSH response after stimulation with TRH was also absent. In the patients who survived a significant TSH increase was observed (p less than 0.05). In comparison to the patients who died those who survived showed a significant (p less than 0.001) HGH increase after HGHRF stimulation. This test might be useful as an additional tool in establishing early prognosis in patients with severe brain injury.

Adult↗
PubMed1990

Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations.

The antimicrobial efficacy of three 'two-phase' surgical hand disinfection procedures was compared, in a volunteer study, to 60% n-propanol, applied for 5 min, which is the reference hand-disinfection procedure used in Austria and West Germany (FRG). The procedures involved sequential use of unmedicated soap or a disinfectant-detergent containing 4% chlorhexidine gluconate (CHX; 'Hibiscrub') followed by a handrub preparation containing 70% w/w isopropanol plus 0.5% CHX ('Hibisol'). The immediate and sustained effects (3 h) of washing with unmedicated soap (3 min) followed by rubbing on 'Hibisol' (4 min) were significantly smaller (log10 reductions of 1.72 and 1.12) than with each of the other procedures. Use of 'Hibiscrub' (3 min) and 'Hibisol' (4 min) produced log10 reductions of 2.50 and 1.71, equalling those of the reference procedure with n-propanol (2.49 and 1.78). When 'Hibisol' was used for 5 min rather than 4 min, a considerable, though not significant, increase in effect was achieved (log10 reductions of 2.90 and 2.07). Replacement of unmedicated soap by 'Hibiscrub' could significantly improve the effectiveness of the hand disinfection procedure commonly used by surgeons in German-speaking countries; namely to wash hands first with soap and then disinfect them with an alcoholic preparation. It may also be of additional advantage as this adds another 'layer' of CHX when 'Hibisol' rather than alcohol alone is used.

1-Propanol↗