Geriatric assessment in the inpatient sector : 20 years quality assurance of the Geriatrics in Bavaria Database.

BACKGROUND: Geriatric assessment is an integral part of geriatrics and leads to various improvements in the treatment of geriatric patients. MATERIAL AND METHODS: Analysis of assessment data and patient characteristics in a large inpatient geriatric patient population. Evaluation of data from the Geriatrics in Bavaria Database (GiB-DAT) over 20 years as well as a cross-sectional study from 2020. Presentation of data for patients in inpatient acute geriatrics as well as continuing geriatric rehabilitation. RESULTS: The number of patient records and participating hospitals has steadily increased for both inpatient care types to 821,913 (status 31 March 2021). The Barthel index and other assessment results show differentiated values between acute geriatrics and continuing geriatric rehabilitation. CONCLUSION: The results demonstrate the differences in patient outcomes between the two types of care as well as changes in the setting over time. The constancy of the applied assessment instruments contributes to the comparability of the different hospitals; however, it is necessary to introduce new and alternative assessment instruments and to further develop inpatient geriatrics.

[Effectiveness of geriatric rehabilitation in the oldest old: evaluation of South German observational data]. / Wirksamkeit geriatrischer Rehabilitation bei Hochbetagten : Eine Auswertung süddeutscher Versorgungsdaten.

BACKGROUND: Geriatric rehabilitation might be the only way for the very old to maintain their participation in social life, since in many cases self care, everyday skills and basic activities of daily living can only be recovered by an integrative treatment approach using a multiprofessional team setting. At the same time limited financial resources in health care have to be considered to make appropriate allocation decisions in geriatric rehabilitation. PURPOSE: The goal of this work was to determine whether chronological age is a limiting factor for functional outcome in geriatric rehabilitation. MATERIALS AND METHODS: Data from the state of Baden-Württemberg (KODAS data set) from the years 2005-2011 for nonagenarians and data for centenarians from the Geriatrics in Bavaria database (GiB-DAT) project from the years 2003-2011 were compared to the data of the younger seniors undergoing geriatric rehabilitation. For the KODAS data collection, 31 geriatric rehabilitation clinics in Baden-Württemberg were involved. The GiB-DAT project included 59 geriatric rehabilitation clinics in Bavaria. Both databases compare the results of the geriatric assessment at the beginning and at the end of geriatric rehabilitation. RESULTS: The analyzed data are presented with regard to the functional outcome in the very elderly and are discussed with respect to policy implications.

[Geriatrics for internists in primary care]. / Geriatrie in der ambulanten Versorgung durch hausärztlich tätige Internisten.

Internal medicine specialists involved in primary care will have a leading part in the treatment of geriatric patients with complex healthcare needs in the future. Approved models like specialized geriatric practices, ambulant or mobile geriatric rehabilitation and special geriatric services for nursing homes are available. Essential is a geriatric qualification that fits with the tasks of an internist in primary care. An incentive payment system has to be created for this purpose to improve the treatment of elderly patients.

[Economic consequences of complications in abdominal and thoracic surgery in the German DRG payment system]. / Betriebswirtschaftliche Bedeutung von Komplikationen in der Viszeral- und Thoraxchirurgie im DRG-System.

BACKGROUND: The Surgical Department of the University Hospital Grosshadern has been making a systematic record of complications since 2005. With respect to the ongoing problem of under-financing from DRG reimbursements, an analysis of the relationship between surgical cases with severe complications and insufficient reimbursement warranted a detailed analysis. MATERIAL AND METHODS: Out of 16 762 in-house patients during 2005-2007 we assigned 6707 cases into four divisions - hepato-pancreato-biliary, colorectal, minimal invasive and general abdominal surgery as well as 1469 cases of thoracic surgery, for costs and reimbursement. In all groups patients with mandatory treament of complications were compared to the remaining cases without complications. Within these, further subgroups were analysed: patients with a need for artificial ventilation (partition A of the G-DRG system), cases with excessive loss (underfunding above 10 000 Euro) and their intersections. RESULTS: With the exception of minimal invasive surgery, each division featured 10-15 % of serious complications. Losses for these cases ranged from 159 % (thoracic surgery) to 102 % (other abdominal surgery) of the overall loss in each division. Cases with excessive losses, representing 1.5 % of all patients, caused 80 % to 100 % of this deficit. Complicated cases alloted to DRGs for artificial ventilation still represented 50 % of the under-fund-ing. CONCLUSION: Cases with mandatory complication treatment can be discerned as separate economic entities. They are considerably overlapping cases with excessive underfunding, so further analysis might lead to an improved reimbursement policy. In addition, the connection between quality management and economic efficiency is highlighted.

[Geriatric rehabilitation. Inpatient, day patient and outpatient]. / Rehabilitation in der Geriatrie. Stationär, teilstationär und ambulant.

Geriatric rehabilitation is a cornerstone of every treatment plan in elderly persons in the inpatient, day clinic and outpatient settings. Geriatric patients tend to be more in need of care and to have a loss of domestic independence due to multimorbidities. The goal of geriatric rehabilitation is to preserve and/or restore the disease-related functional deficits in order to guarantee mobility and activities of daily living (ADL) in addition to curative treatment. Structural prerequisites in all geriatric units are the comprehensive geriatric assessment (CGA) and the existence of an interdisciplinary geriatric team. Geriatric rehabilitative treatment is based on functionality (ICF) and is therefore indicated in a wide spectrum of diseases. The demographic shift necessitates an increase in geriatric treatment structures with innovative concepts such as geronto-traumatological interdisciplinary units or geriatric outpatient office groups with a better networking of different care structures.

Molecular monitoring of inactivation efficiencies of bacteria during pulsed electric field treatment of clinical wastewater.

AIMS: The applicability of an alternative wastewater disinfection concept based on the pulsed electric field (PEF) treatment is tested with molecular biology techniques using clinical wastewaters. METHODS AND RESULTS: Hospital wastewater was treated with the PEF technology. The inactivation efficiencies of bacteria were successfully monitored with real-time polymerase chain reaction (PCR). As the differentiation between living and dead bacterial cells is important for the determination of the disinfection efficiency, propidium monoazide (PMA) was applied. PMA selectively penetrates cells with compromised membranes and intercalates into the DNA inhibiting a subsequent PCR amplification. The rates of reduction were examined for specific pathogens and wastewater populations using PCR-denaturing gradient gel electrophoresis. The results showed that the main part of the bacterial population could be inactivated efficiently with the PEF treatment. Moreover, it was demonstrated that naturally occurring nuclease activities were not affected by the PEF treatment in contrast to a thermal treatment. CONCLUSIONS: The results indicated that the PEF treatment is an appropriate alternative disinfection concept for the treatment of clinical wastewaters and surpass the disadvantages of other disinfection methods. SIGNIFICANCE AND IMPACT OF THE STUDY: With the use of propidium monoazide for live-dead distinction, a new concept could be developed for the evaluation of disinfection methods.

[Scintigraphic studies of skeletal abnormalities during childhood (author's transl)]. / Szintigraphische Studien bei Skeletterkrankungen in der Pädiatrie.

An extensive application of nuclear medical examination in the field of pediatric diagnostics was only made possible by introduction of short-lived radionuclides. On the one hand, they cause low radiation exposure, on the other they allow short-term check-ups. Analysis carried out on examination results of 47 children revealing various skeletal disorders showed a combination of radiologic-nuclear medical examination methods to produce maximal information suitable for both diagnostics and therapeutical planning. Specific questions such as termination of pathologic alteration process within the skeleton, can be answered only by the use of the scintigraphy. With reference to 4 cases the wide range of possibilities and limitations of skeletal scintigraphy in pediatrics are shown.

Putting the pieces together: using "off-the-shelf" software to safely transfer medical data.

We describe a new computer-based, network-driven system for administering, transferring, and evaluating reports of spontaneous adverse drug reactions and serious adverse events. The system consists of three regional centers, one coordinating center, and a central database at the national drug regulatory authority. In view of its high level of data security, reliability, easy expandability, and inexpensiveness due to the use of standard shareware products, the system can serve as a model for a clinical health information network.

[Application of capillary gas chromatography to androgen excretion - analysis as diagnostic tool in paediatric endocrinology (author's transl)]. / Kapillargaschromatographische Analyse des Androgenausscheidungsmusters als diagnostisches Hilfsmittel in der pädiatrischen Endokrinologie.

A gas-chromatographic method on glass capillary columns was developed mainly for the separation of androgens in order to diagnose endocrinopathies, especially various forms of intersexual anomalies. For this purpose the gas-chromatographic conditions were chosen in such a way as to gain a long distance (retention time interval) between the alkanes n-C24H50 and n-C28H58, because these two alkanes limit the area in which most of the androgens appear. Column: 50 m X 0.25 mm (ID), WCOT, OV 101. (Formula: see text). The steroids were analysed in 24-hour urine samples. Extraction was performed with ethyl acetate, followed by persililation to methoxim-trimethylsilyl derivatives. The application of the procedure was demonstrated in two clinical cases, whereby Hamilton's theory, according to which certain androgens as well as their metabolites reflect the psychological and physical status of a person, was evaluated. On the basis of the present results it can be stated that gas chromatography on capillary columns, as described in this paper, is a useful diagnostic tool. With this method it is easy to detect disorders in the synthesis and metabolism of steroid hormones.

[The familial incidence of various types of hyperlipoproteinaemia (author's transl)]. / Uber das familiäre Vorkommen verschiedenartiger Hyperlipidämien.

Serum lipid values were determined in the first degree relatives of 31 children within the framework of a screening programme for cardiovascular-disease risk factors in schoolchildren of either sex (11 to 12 years old). Familial hyperlipoproteinaemia was not present in 5 families. The investigations revealed 12 families with hypercholesterolaemia and 2 with hypertriglyceridaemia. 12 families showed that form of hyperlipoproteinaemia which has been described in the literature as "familial combined" or "multiple type" hyperlipoproteinaemia. Spontaneous variation in serum lipids was observed in 4 out of the 12 above-mentioned children when determinations were repeated. The variability in expression of hyperlipoproteinaemia in the individual case, as well as in families, is one of the reasons for the controversy over the classification of hyperlipoproteinaemias. It is well known that hyperlipoproteinaemia, especially of the familial type, represents a significant risk factor for cardiovascular disease. Thus, it is essential to treat persons with elevated serum cholesterol or triglyceride values and to examine their relatives for hyperlipoproteinaemia.

[Results of the exercise (ergometer) test as a diagnostic screening procedure in children with short stature]. / Erfahrungen mit dem sogenannten Ergometertest als Screeningverfahren bei Kleinwuchs im Kindesalter

The so-called Exercise Test of Lacey and coworkers (1973) is based on the fact that a functioning pituitary can be stimulated by physical exercise. The test was performed in 28 children of short stature as an out-patient screening test. The results were satisfactory since a growth-hormone deficiency could be excluded in 70% of the cases. The convenience of this test, which entails the investigation of only two blood samples, is stressed in respect to paediatric practice.

[Plasma 25-hydroxycholecalciferol after daily vitamin D administration in comparison with massive single-dose prophylaxis (author's transl)]. / Plasmaspiegel des 25-Hydroxycholecalciferols nach Tages- und "Stossprophylaxe" mit Vitamin D.

The effect of daily administration of 1200 IU vitamin D3 was compared with the response to a single oral dose of 200,000 IU in 21 young infants by determination of the plasma 25-OHCC levels. After about one week the mean value recorded in group 1 was 27 +/- 13 ng/ml; the corresponding value in group 2 was 127 +/- 78.4 ng/ml. At the second control examination about one month subsequently, the mean values were 61 +/- 26.2 ng/ml and 104 +/- 69.0 ng/ml respectively. The wide range of values found in the single-dose group clearly demonstrates the advantage of daily vitamin D administration for routine prophylaxis against rickets in infancy.

[Serum levels of 25-hydroxycholecalciferol (25-OH-D3) in children of different age groups (author's transl)]. / Serumspiegel des 25-Hydroxycholecalciferols (25-OH-D3) bei Kindern verschiedener Altersstufen.

Serum 25-OH-D3 levels were determined in 78 children aged 6 weeks to 15 years, in March 1977 and March 1978 in Vienna. The total number of probands was divided into age groups, each comprising a range of 3 years. The average value with 1 SD. found over the whole age range was 48.3 +/- 25.75 nmol/l (i.e. 19.4 +/- 10.34 ng/ml). Somewhat higher levels were found in the age groups 3 to 6 and 6 to 9 years, with a slight decrease in the later age groups, but no significant differences were detected. The obtained values seem to represent the "normal" 25-OH-D3 serum levels of our population in the above-mentioned age range.

A computer program for drawing structure formulas of the hormonal steroids used most frequently in endocrinology.

A BASIC program has been developed for plotting planar structure formulas of steroid hormones. The structure formulas can be designed either by selecting distinct root-molecule shapes for further figuration of the wanted formula, i.e. androstane, 4-androstene, estrogen, cholestane, pregnane or 4-pregnene structures, or by editing detailed information concerning the molecule to be designed, starting with the number of carbon atoms, etc. The position of hydroxy and/or keto groups, as well as some stereochemical details, are also freely selectable according to the systematic steroid name. Graphs are displayed on the screen and can be printed. The program is supported by most of the conventional BASIC versions running on personal computers with graphic abilities, since graphic symbols are predominantly used for drawing the structure formulas instead of lettering the symbols.

[Chronic hypophosphatemic osteopathy ("rachitis"). Clinico-osteological review]. / Die chronische hypophosphatämische Osteopathie ("Rachitis"). Klinisch-osteologische Ubersicht.

Chronic hypophosphatemia is the most common type of "resistant" rickets. Bone deformities, dwarfism and X-chromosomal dominant heredity, are regular findings in this "inborn error" of phosphate metabolism. Continumous administration of high dosage of vitamin D results in some improvement of the rickets-like bone lesions. Oral administration of phosphate seems to improve longitudinal growth. A summary of our experiences in 44 patients is presented.

The subcellular defects in the androgen insensitivity syndrome.

The androgen insensitivity syndrome (AIS) was studied with consideration of the complexity of mechanisms involved on the intracellular level: testosterone (T) and dihydrotestosterone (DHT) receptors and the androgen-5 alpha-reductase (A5R). Five children with "normal" female external genitalia (group A) and three patients with variable forms of ambiguity (group B), ages 1 to 18 years, were studied. Tissue specimens from genital skin were analysed for the Kd- and N max-values of the cytosolic and nuclear T- and DHT-receptors, as well as for the Km- and Vmax-data of the tissue specific A5R. The enzyme analyses were performed with a kinetic method. Results show that patients from group A mainly lack action of the nuclear DHT receptor, combined with reduces binding capacity in the cytosol. T binding was poor in both, cytosolic and nuclear fractions, respectively. Results of group B proved to be more inhomogeneous, ranging from total absence of a DHT receptor to normal binding capacities in the nuclear fractions, accompanied by decreased cytosolic N max values for that ligand. T binding was poor in all patients of group B in the cytosolic and nuclear fractions, respectively. A5R was qualitatively normal in all patients examined, except one, but decreased enzyme activities could be observed in a wide range. In summary, the study confirms the complex mechanisms, presenting as AIS clinically. Moreover a close relationship between abnormalities of androgen receptor function and changes in A5R activity could be evaluated, thus confirming the recent theories about intracellular androgen action.

Radio gas chromatography for evaluation of sub-cellular hormone synthesis in the androgen insensitivity syndrome.

This paper gives a description of a radio gas-liquid chromatographic method for the evaluation of androgen hormone synthesis patterns in the testicular tissue of a patient suffering from the androgen insensitivity syndrome (AIS). A modified dual-column gas chromatography system, equipped with column switching facilities and a radioactivity monitor run parallel to a flame ionisation detector, enables the monitoring of radioactive intermediates of testosterone anabolism and catabolism, generated from a labelled precursor. Tissue preparations were incubated with tritiated pregnenolone for 45 min at 37 degrees C. Steroid hormones were stripped from the aqueous phase by solvent extraction and analysed by gas chromatography as methoxitrimethylsilyl (MO-TMS) derivatives on a 15 m X 0.32 mm I.D. fused-silica capillary column coated with DB-5. The results reveal abnormal enzyme kinetics due to accelerated precursor utilisation. The findings reflect the pathophysiology of AIS at the sub-cellular level of the androgen hormone target organ.