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Biomedical subjects

W O Seiler

Publications and source records attributed to W O Seiler.

At least 19 recordsLinked to original sources
PubMed1992

[Cost-benefit analysis of a new treatment concept in patients with indwelling catheters].

An earlier and a new treatment concept for patients equipped with long-term indwelling bladder catheters were compared with regard to cost, expenditure of time, and equipment in a retrospective study involving 58 patients treated by the earlier concept and 60 treated by the new one. The new concept dispensed with the need for bladder irrigation and routine replacement of the indwelling catheters. Under the earlier concept, 18 indwelling catheter replacements and 53 bladder irrigations were required per patient and year during the years 1979/80. This compares with 6 indwelling catheter replacements and 0.05 bladder irrigations per patient and year for the years 1989/90 under the new concept. The use of analgesics and spasmolytics fell from 55 to 21 units per patient per year. Significantly fewer urinalyses were performed during 1989/90. The use of antibiotics remained unchanged. When compared with the earlier one, the new concept for the management of patients with indwelling catheters provides savings of 1265 minutes (21 hours) of nursing time and sFr. 405 for equipment per patient per year. Applied to our geriatric hospital (120 beds, 80 nursing staff), this translates into annual savings of one full nursing post and sFr. 34,000 for equipment.

Aged↗
PubMed1991

[Decubitus ulcers in geriatrics--pathogenesis, prevention and therapy].

Magnitude and duration of interface pressure are the crucial etiological factors in the decubitus ulcer formation. Small amounts of interface pressure that exceed the average capillary pressure (range: 2.7 to 6.3 kPa) may lead to compression of the skin microcirculation and resultant tissue necrosis when a critical duration of interface pressure of more than 2 h is reached. The principles of decubitus ulcer prevention are derived from the pathophysiology of ulcer formation as noted: reduction of interface pressure below 3 kPa by bedding each at-risk patient on a 'super-soft' mattress and shortening the duration of interface pressure below 2 h. by turning of patients from the supine position to the right and left 30 degrees oblique back position every two hours. Decubitus ulcers typically show impaired wound healing. Conditions most conspicuously protracting normal wound healing are: tissue hypoxia, fibrin deposits, necrotic tissue, local infection, defective migration of keratinocytes, impaired general condition, etc. Based on these pathophysiological mechanisms, five therapeutical principles are proposed: complete relief of interface pressure, débridement of necrotic tissue, treatment of infection using systemical antibiotics, wet and air-permeable wound dressing, improvement of patient's general condition.

Aged↗
PubMed1990

[Wound healing: from polypragmasy to rational therapy concepts--can growth factors contribute anything?].

Impaired wound healing as seen in diabetic, arterial, venous and decubital ulcers is still an unsolved problem. The lack of precise knowledges of wound pathophysiology renders efficient therapeutic approaches difficult. Many local and systemic factors are delaying wound repair, e.g., tissue ischemia, intra- and extravascular fibrin depositions, vasodilatation of the non-nutritive microcirculation, necrosis, infection, impaired migration of the epithelial cells of the ulcer edge and an inadequate cytokines pattern. With regard to these factors general therapeutic measures are proposed. We believe that in the near future cytokines may substantially improve our actual treatment methods of chronic ulcers.

Bandages↗
PubMed1990

[Bulk-forming agents as laxatives in geriatric patients].

Constipation in elderly long-care patients is an important problem. We compared the daily administration of three bulk-forming agents, semen psyllii (Effersyllium), wheat bran with karaya gum (Crusca di Fior) and bruised linseed, with the routine laxative therapy in our clinic based on lactulose (Duphalac) and a combination of paraffin oil and phenolphthalein (Agarol). To evaluate these two laxative regimens the following parameters were monitored: quantity and quality of the feces and of additional laxatives used for regular defecation; acceptance by the patient; costs per patient and day. The results of this study show that daily administration of a laxative is significantly more efficient than periodic administration, and that daily administration of a bulk-forming agent is, at the same level of effectiveness, less expensive (-35%) than therapy with lactulose alone.

Aged↗
PubMed1990

Beta-carotene in tube feeding.

The supplementation of an enteral feeding formula on soya-basis specially designed for geriatric patients with 1,5 mg to 2 mg beta-carotene per day increases its corresponding plasmatic concentration from 20 mcg/L to normal to optimal levels near 500 mcg/L. This intake is much lower than the proposed safe intake of 6-20 mg beta-carotene per day. A close incorporation of beta-carotene in the lipid moiety of the ready-to-use formula might increase its bioavailability. The other anti-oxidative vitamins A and E remain to their respective normal levels at a supplemental daily intake of 2500 IU vitamin A and 12,5 mg vitamin E. The new enteral feeding formula for geriatric patients seems to cover their global nutritional needs.

Adult↗
PubMed1989

Computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia. A prospective clinicopathologic study.

The accuracy of computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia was studied prospectively. Out of 50 demented patients, autopsy revealed 32 cases with either senile dementia of the Alzheimer's type (SDAT), multi-infarct dementia (MID), or a combination of both. Eighteen patients had dementia caused by other diseases. Based on a combination of computed tomography, electroencephalography, and clinical features, senile dementia of the Alzheimer's type was differentiated from all 50 patients, with a specificity of 83% and a sensitivity of 80%. Focusing on senile dementia of the Alzheimer's type, multi-infarct dementia, or a combination of both, specificity decreased to 65% and sensitivity to 47%. Comparing the different methods, multi-infarct processes were diagnosed with a higher sensitivity by the clinical features (73%) than by computed tomography (18%) or electroencephalography (18%). None of the methods validly differentiated multi-infarct dementia from a combination of multi-infarct dementia and senile dementia of the Alzheimer's type.

Aged↗
PubMed1989

Impaired migration of epidermal cells from decubitus ulcers in cell cultures. A cause of protracted wound healing?

Cultured epidermal cells of explants from decubitus ulcer edges showed significant (P less than 0.05) decreased maximal growth rate (range, 1.3-15.6%) and decreased area of outgrowth per explant (mean and SD, 1.6 +/- 1.7 mm2) when compared with explants obtained 4-5 cm distant from the ulcer edge (range, 46.7-68.8% and 4.6 +/- 2.7 mm2, respectively) and from healthy skin (range, 78.8-93.3% and 6.6 +/- 1.2 mm2, respectively). In contrast, epidermal cells in biopsies from the ulcer edge were significantly (P less than 0.05) more prevalent (range, 1.9-48.2%) as compared with biopsies of healthy skin (range, 3.1-5.1%). Therefore, the decreased growth rate and decreased area of outgrowth may be caused by a defective migration potential rather than an impaired mitotic activity. The latter seems to be normal, as demonstrated by the histomorphometry, which indicates the in vivo situation. Decreased migration potential of epidermal cells could explain the clinically observed protracted epithelialization of decubitus ulcers.

Adult↗
PubMed1989

[Bladder infection due to long-term indwelling catheters].

In the long-term catheterized elderly, damage do the epithelial wall is primarily responsible for bladder infections, due to the presence of the catheter as a foreign body and its frequent manipulations. The presence of bacteriuria, a classic sign of infection in the non-catheterized patient, is of little diagnostic importance in the long-term catheterized patient, since it is both permanent and inevitable. Routine preventive measures, as frequent catheter changes or prophylactic antibiotics, are of no value. Other measures are worth considering, since they will, if instituted, reduce the frequency of severe complications from long-term catheterization and improve quality of life.

Aged↗
PubMed1988

Practical management of catheter-associated UTIs.

In the long-term catheterized elderly, damage to the epithelial wall is primarily responsible for bladder infections, due to the presence of the catheter as a foreign body and its frequent manipulations. The presence of bacteriuria, a classic sign of infection in the non-catheterized patient, is of little diagnostic importance in the long-term catheterized patient, since it is both permanent and inevitable. Routine preventive measures--eg, frequent catheter changes, prophylactic antibiotics--are of no value. Other measures are worth considering and, if instituted, will reduce the frequency of severe complications from long-term catheterization and improve quality of life.

Aged↗
PubMed1987

Seventy-two hour polygraphic and behavioral recordings of wakefulness and sleep in a hospital geriatric unit: comparison between demented and nondemented patients.

Continuous 72-h polygraphic recordings were carried out in 30 hospitalized, mostly severely demented patients and 14 nondemented control patients. Mean age was greater than 80 years in both groups. In the dementia group, the diagnoses were senile dementia Alzheimer type (n = 16), multi-infarct dementia (n = 8), and mixed or undefined dementia (MIX) (n = 6). The nondemented controls suffered from various medical or psychiatric disorders or were recovering from previous accidents. Dementia patients had less stage 2 and REM sleep and thus less total sleep time than did control subjects. No statistically significant differences were noted between dementia subgroups. There were no differences between controls and demented patients in terms of NREM-REM cycle, and there was no association between the severity of the clinical condition and any of the sleep parameters in the demented patients. In contrast to healthy elderly and old persons, women and men patients with dementia showed no differences in their sleep patterns. In both patient groups, most sleep occurred at night, and wakefulness was predominant during the day. Only three of the dementia patients displayed somewhat more daytime than nighttime sleep. The main conclusions were that polygraphic sleep recordings did not contribute to a better differential diagnosis in patients with advanced dementia and that inversion of the sleep/wakefulness rhythm was uncommon in these separately roomed demented patients.

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PubMed1986

Influence of the 30 degrees laterally inclined position and the 'super-soft' 3-piece mattress on skin oxygen tension on areas of maximum pressure--implications for pressure sore prevention.

The measurement of the transcutaneous PO2 (tc PO2) demonstrates that localized pressure on skin sites under bony prominences (e.g., the sacral and trochanteric areas) decreases the tc PO2 at these skin positions to zero when subjects are lying motionless on a normal hospital mattress. This explains the high risk of pressure sore formation in elderly patients, who have a greatly reduced frequency of involuntary movements. Therefore, the first principle of pressure sore prevention is the elimination of localized pressure on both the trochanteric and sacral skin areas simultaneously. This can be achieved by bedding elderly patients who are at risk on a 'super-soft' mattress and by turning them regularly to the 30 degrees laterally inclined position. With healthy adults, placed in this position, both the skin areas over the trochanteric and sacral bony prominences remain almost free from pressure and thus normally oxygenated. In addition, the tc PO2 measurement allows an immediate assessment of the efficacy of a procedure for sore prevention.

Beds↗