[Pharmacist rounds on geriatric wards : Assessment of 1 year of pharmaceutical counseling]. / Pharmazeutische Visite auf geriatrischen Stationen : Auswertung der pharmazeutischen Empfehlungen eines Jahres.

BACKGROUND: Older patients suffer more often from drug-induced complications. OBJECTIVE: What are the precise recommendations pharmacists can give to geriatricians? MATERIAL AND METHODS: Two pharmacists conducted clinical rounds on 2 geriatric wards over a period of 54 weeks. Protocols of conspicuous medications for geriatric patients were analyzed and suggestions were made. RESULTS: Particularly frequent were the questionable medical indications for proton pump inhibitors, allopurinol, pregabalin and gabapentin. Adjustment of the dosage of heparin and its analogs to impaired renal function of patients was often lacking. This was also occasionally the case for metformin, some antibiotics and simvastatin. There were several interactions of drug combinations with a high risk for QT prolongation. The inhibition of resorption of bisphosphonates and L­thyroxin by the simultaneous intake of magnesium and calcium seemed to be probable. Furthermore, it was noticed that for some medications for patients treated by percutaneous endoscopic gastrostomy (PRG) administration by feeding tubes was not possible and combinations of different eye drops which should not be applied simultaneously but at delayed time intervals. CONCLUSION: An additional medication-related visit provides an interventional option for avoidance of medication errors.

[Dementia-friendly hospital wards : Expert recommendations for planning and design]. / Demenzsensible Krankenhausstationen : Expertenempfehlungen zu Planung und Gestaltung.

BACKGROUND: Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS: An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS: The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

[Diabetes mellitus and dementia]. / Diabetes mellitus und Demenz.

Diabetes mellitus, particularly type 2 diabetes, is a risk factor for dementia and this holds true for incident vascular dementia and Alzheimer's disease. Cerebrovascular complications of diabetes and chronic mild inflammation in insulin resistant states partly account for this increased risk. In addition, cellular resistance to the trophic effects of insulin on neurons and glial cells favor the accumulation of toxic metabolic products, such as amyloid and hyperphosphorylated tau protein (pTau). Weight loss frequently precedes overt cognitive symptoms of Alzheimer's disease. This results in an increased risk of hypoglycemic episodes in stable diabetic patients who are on suitably adjusted doses of oral insulin or insulinotropic antidiabetic drugs. In turn, hypoglycemic episodes may induce further damage in the vulnerable brains of type 2 diabetes patients. Patients with unexplained weight loss, hypoglycemic episodes and subjective memory complaints must be screened for dementia. Once dementia has been diagnosed the goals of diabetes management must be reevaluated as prevention of hypoglycemia becomes more important than tight metabolic control. As weight loss accelerates the rate of cognitive decline, nutritional goals must aim at stabilizing body weight. There is no available evidence on whether drug treatment of diabetes in middle-aged persons can help to prevent dementia; however, physical exercise, mental activity and higher education have preventive effects on the risk of dementia in later life. In addition, nutritional recommendations that are effective in preventing cardiovascular events have also been shown to reduce the risk of dementia.

[Depression in frail geriatric patients. Diagnostics and treatment]. / Depression beim gebrechlichen Alterspatienten. Diagnostik und Therapie.

Frailty is associated with an increased risk of depressive syndromes. This review aims to summarize data on coincidence, clinical presentation, and diagnostic and therapeutic work-up of depression in frail patients. Depressive syndromes in geriatric patients are characterized by increased frequency and intensity of somatic symptoms. There is considerable overlap with symptoms of frailty. Both syndromes indicate an increased risk for subsequent somatic morbidity, worsening depression functional deterioration, admission to a nursing home and mortality. Diagnosis of subthreshold depressive syndromes allows preventive measures to be initiated. Barrier-free access to preventive and therapeutic interventions is essential. Concomitant somatic symptoms in subthreshold depression increase risk of progression to major depression. They must be addressed in an interdisciplinary approach involving geriatric teams and geriatric psychiatry.

[Dementia: diagnosis and therapy]. / Demenz: Diagnostik und Therapie.

Dementia is a clinical syndrome characterized by progressive memory loss. Alzheimer's disease, a neurodegenerative disorder, accounts for the majority of clinical cases. The differential diagnosis comprises other neurodegenerative disease entities and vascular dementia, but also secondary and potentially reversible disturbances of cognitive function such as delirium or depression. Diagnostic work-up consists of standardized cognitive testing, neuroimaging, and a basic laboratory test battery. Pharmacological treatment of cognitive symptoms is accompanied by pharmacological and nonpharmacological treatment of psychiatric and behavioral symptoms, establishment of a supportive social network, as well as prevention and treatment of medical complications of dementia. This article summarizes current clinical knowledge on dementia and has a special interest in treatment and prophylaxis of complications in the field of internal medicine.

Cross-validation of theoretically quantified fiber continuum generation and absolute pulse measurement by MIIPS for a broadband coherently controlled optical source.

The predicted spectral phase of a fiber continuum pulsed source rigorously quantified by the scalar generalized nonlinear Schrödinger equation is found to be in excellent agreement with that measured by multiphoton intra-pulse interference phase scan (MIIPS) with background subtraction. This cross-validation confirms the absolute pulse measurement by MIIPS and the transform-limited compression of the fiber continuum pulses by the pulse shaper performing the MIIPS measurement, and permits the subsequent coherent control on the fiber continuum pulses by this pulse shaper. The combination of the fiber continuum source with the MIIPS-integrated pulse shaper produces compressed transform-limited 9.6 fs (FWHM) pulses or arbitrarily shaped pulses at a central wavelength of 1020 nm, an average power over 100 mW, and a repetition rate of 76 MHz. In comparison to the 229-fs pump laser pulses that generate the fiber continuum, the compressed pulses reflect a compression ratio of 24.

The differential effect of risperidone and olanzapine on insulin sensitivity after 3 weeks of treatment: a HOMA pilot study.

BACKGROUND AND METHODS: Patients with an acute psychotic episode underwent HOMA testing for insulin sensitivity (IS) prior to and after 3 weeks of treatment with olanzapine (n = 7) or risperidone (n = 7). RESULTS AND DISCUSSION: The HOMA-IS index was reduced in the olanzapine group, but significantly increased in patients treated with risperidone. There was a significant "time × medication" interaction (p = 0.03). The BMI significantly increased as a result of both treatments. IS can be acutely ameliorated by antipsychotic treatment with risperidone despite weight increase. CONCLUSIONS: Compared to risperidone, the IS is impaired after a 3-week treatment with olanzapine. Already short-term antipsychotic treatment may have eff ects on insulin sensitivity.

Insulin secretion and sensitivity after single-dose amisulpride, olanzapine or placebo in young male subjects: double blind, cross-over glucose clamp study.

INTRODUCTION: Increased risks of weight gain and diabetes mellitus have been reported for schizophrenic patients under long-term treatment with several atypical antipsychotic drugs including olanzapine. Among other antipsychotic drugs, treatment with the selective dopamine D2 and D3 receptor antagonist amisulpride has been implicated with a lower risk for metabolic complications. PATIENTS AND METHODS: In this study we compared the acute, non-adiposity related effects of a single dose of olanzapine, amisulpride and placebo on insulin sensitivity and secretion in 10 healthy subjects in a randomised, double blind cross-over design. Subjects underwent euglycemic-hyperinsulinemic and hyperglycemic clamp tests using an automated clamp device. C-peptide and pro-insulin levels were determined using highly specific immuno-assays. RESULTS: Insulin sensitivity was not significantly different between both verum medications and placebo. However, C-peptide secretion during hyperglycemic clamp was significantly higher after administration of amisulpride than after olanzapine or placebo. This was true both for the early phase and for the second phase of insulin secretion (C-peptide at 0, 5,10 and 30 min: amisulpride 1.49±0.49; 4.22±1.45; 3.19±1.22; 5.33±1.85; olanzapine 1.35±0.47; 3.84±1.37; 2.72±0.91; 4.28±1.96; placebo 1.72±0.82; 3.59±1.19; 2.71±1.02; 4.54±1.42 ng/mL, mean±SD; ANOVA p=0.043). Pro-insulin levels did not differ significantly between groups. DISCUSSION: A low dose of the D2/D3 antagonist amisulpride, but not olanzapine appears to acutely increase pancreatic insulin secretion in healthy controls. Stimulation of ß-cells could be a protective factor against the development of diabetes mellitus.

[Diabetes and dementia]. / Diabetes und Demenz.

Diabetes mellitus is a known risk factor for cognitive dysfunction and dementia. Chronic hyperglycemia, genetic predisposition, arterial hypertension, hyperlipoproteinemia, micro- and macrovascular diseases, and depression play a major role in the development of cognitive dysfunction. Both pathophysiology of diabetes and dementia and the specifics of diabetes therapy in patients with dementia are presented in this review.

[Acute illness and depression in the elderly and the influence of cognitive impairment : AIDE-cog trial]. / Komorbidität von Depression und Demenz bei geriatrischen Patienten mit akuter körperlicher Erkrankung: AIDE-cog-Studie.

Geriatric patients with acute somatic illness have a high comorbidity of depression and dementia. The following differential diagnoses have to be discerned: pseudodementia in acute depressive states, depression as a risk factor for dementia, and a depressive episode in the early stage of dementia. For both the symptoms and the trigger factors of these differential diagnoses the overlap and the particularities were qualitatively examined in the AIDE-cog (Acute Illness and Depression in Elderly cognition) trial. A second prospective randomized controlled part of the AIDE-cog trial quantitatively evaluated the influence of cognitive impairment in geriatric patients with an acute somatic illness and comorbid depression on the therapeutic effect of cognitive behavioral therapy. A preliminary analysis shows that already in early dementia the therapeutic effects are inferior. Other psychotherapeutic methods that address the remaining cognitive and emotional functions in dementia must be evaluated.

Does night-time cortisol excretion normalize in the long-term course of depression?

INTRODUCTION: While there is extensive literature on HPA system activity in acutely depressed patients, there is only limited information about the presence of hypercortisolemia during the interepisode interval of affective disorders. We hypothesized an increase in HPA system activity in depressed patients compared to controls, and proposed that night-time cortisol excretion during follow-up will depend on clinical outcome. METHODS: We measured night-time cortisol excretion in 27 patients during an acute episode of major depression as well as a 20-week follow-up. 40 healthy subjects served as control group. RESULTS: During the acute episode depressed patients showed increased levels of night-time cortisol excretion compared to healthy controls. Both, patients with full and sustained remission (n=8) as well as patients with incomplete remission or relapse (n=19) showed declining cortisol excretion in night-time urine during follow-up. At the end of follow-up cortisol excretion did not differ between patients with affective disorder and healthy controls. DISCUSSION: Irrespective of residual depressive symptoms, HPA system activity declines after the generally investigated acute depressive episode.

[Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany]. / Spezialisierte Stationen zur Behandlung von akut erkrankten geriatrischen Patienten mit zusätzlichen kognitiven Beeinträchtigungen in Deutschland.

During recent years, specialized wards have been established in geriatric hospital departments as a consequence of the growing need of special care for acutely ill older patients, who are also cognitively impaired. However, there are neither established standards nor any commonly agreed concept of care. A written survey among 12 specialized wards in Germany revealed some characteristics of these wards: extended geriatric assessment, special education of staff including validation and gerontopsychiatric issues, and particular equipment/architecture, such as hidden doors and group rooms, and in some cases loop tracks for walking, therapeutic facilities, and 'living rooms' on the wards. There is a wide variability with respect to the designation of these wards, the number of beds, length of stay, and admission criteria. It appears from this survey that there should be an exchange of empirical experience made on these wards, and there is a need of collaborative research on its usefulness.

Supercontinuum generation system for optical coherence tomography based on tapered photonic crystal fibre.

We report smooth and broad continuum generation using a compact femtosecond Ti:Sapphire laser as a pump source and a tapered photonic crystal fibre as a nonlinear element. Spectral output is optimized for use in optical coherence tomography, providing a maximum longitudinal resolution of 1.5 microm in free space at 809 nm centre wavelength without use of additional spectral filtering.

C-band waveguide amplifier produced by femtosecond laser writing.

An optical waveguide amplifier fabricated on erbium-ytterbium-doped phosphate glass by direct femtosecond laser writing is demonstrated. The waveguides are manufactured using 1040-nm radiation from a diode-pumped cavity-dumped Yb:KYW oscillator, operating at a 885 kHz repetition rate, with a 350 fs pulse duration. Peak internal gain of 9.2 dB is obtained at 1535 nm, with a minimum internal gain of 5.2 dB at 1565 nm. Relatively low insertion losses of 1.9 dB enable for the first time an appreciable net gain in the full C-band of optical communications.

Giant intrasellar carotid aneurysm - an unusual cause of panhypopituitarism.

Carotid artery aneurysms represent a very rare cause of pituitary failure. We describe the case of a female patient harbouring a giant aneurysm of the left carotid artery that subsequently led to panhypopituitarism. Interestingly, the late postoperative course was complicated by severe hyponatremia, whose origin may have been due to inappropriate ADH secretion. This case illustrates the problems of diagnosis and postoperative handling of panhypopituitarism due to an intrasellar aneurysm.

LDL size distribution in relation to insulin sensitivity and lipoprotein pattern in young and healthy subjects.

OBJECTIVE: Smaller LDL particles are associated with an increased risk for coronary artery disease and have been found predominantly in subjects with the insulin resistance syndrome. Although insulin resistance has been suggested to be a basic defect, little is known about the relation between this predisposing factor (and associated metabolic disturbances) and LDL size distribution in young and metabolically healthy subjects. In the present study, we investigated the relation between insulin sensitivity, lipoprotein distribution, and LDL patterns in young adults to increase the understanding of the development of metabolic risk factors in an early phase of the life span. RESEARCH DESIGN AND METHODS: Young, clinically healthy subjects (n = 50; age 21.1-30.6 years) were enrolled in the study. Glucose metabolism was characterized by peripheral insulin sensitivity assessed by a hyperinsulinemic-euglycemic clamp and by levels of fasting insulin, C-peptide, and glucose. Lipoproteins were measured, and LDL fractions were additionally characterized by the diameter of the major LDL peak, estimated by 2-16% polyacrylamide gradient gel electrophoresis. Cholesterol ester transfer was estimated with a fluorescent spectroscopic method that measures the transfer of fluorescent cholesteryl linoleate between exogenous donor and acceptor particles. In this assay system, cholesterylester transfer protein (CETP) activity was only influenced by the plasma CETP concentration therefore reflecting more likely the CETP mass. RESULTS: In the entire study group, 47 subjects had LDL phenotype A (LDL diameter > 25.75 nm) and 3 subjects had an intermediate phenotype (25.50-25.75 nm). An interrelation between LDL size and LDL triglyceride (LDL-TG) per apolipoprotein (apo) B (Spearman's rank correlation analysis; r = -0.78; P < 0.001) or LDL cholesterol ester (CE) per apoB (r = 0.58, P < 0.001) was found, and 39% of the plasma samples studied were characterized by a monodispersed LDL pattern. Furthermore, LDL diameters correlated negatively with total TGs (men: r = -0.52, P < 0.001; women: r = -0.61, P < 0.001) and positively with insulin sensitivity (total population: r = 0.54, P < 0.001). In addition, LDL size was inversely related to the [VLDL + LDL cholesterol (CH)]/HDL-CH ratio and positively to the HDL-CE/TG ratio, which were both related vice versa to CETP activity levels. A direct relation between CETP activity levels and LDL size or composition was not observed. In a linear regression analysis including parameters of lipoprotein metabolism (TG, HDL cholesterol, CETP activity level), glucose metabolism (insulin sensitivity, fasting insulin), and sex, only TGs predicted significantly for 62% of LDL size variability. If the total study population was evaluated according to quintiles of insulin sensitivity, increasing TGs (analysis of variance, Scheffé test; P < 0.05) and CETP activity levels (P < 0.05) were combined with decreasing LDL particle diameters (P < 0.05) and with a preponderance of a monodispersed LDL pattern (60%) in the most insulin-resistant group. CONCLUSIONS: Among parameters of the lipoprotein and glucose metabolism, total TG is the single most important factor affecting LDL size variability, even in young adults. If the study population is evaluated according to insulin sensitivity, lipoprotein pattern is altered in a more atherogenic manner in the most insulin-resistant subjects. In this group, increasing TG and CETP activity levels are associated with decreasing LDL particle diameters and preponderance of a monodispersed LDL pattern. Although increasing CETP levels are combined with this particular lipoprotein profile, a direct relation to LDL size and composition is not found.