[Pharmacotherapy of urinary incontinence in the elderly]. / Pharmakotherapie der Harninkontinenz im Alter.

The prevalence and the incidence of Urinary Incontinence is growing. Women suffer predominantly from stress and mixed urinary incontinence and men from urge incontinence. In elderly people, the pathophysiological and the physiological change in the lower urinary tract system must be considered as well as an underlying multimorbidity. Stress urinary incontinence is among others caused by an insufficient urethral closure mechanism and urge incontinence is followed by unhibited detrusor contractions. Medical treatment is beside other important conservative options only one part of the treatment strategy in incontinence. Duloxetine, a serotonine-norepinephrine reuptake inhibitore can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64 %. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, darifenacin, fesoterodin, oxybutynin, propiverine, solifenacin, tolterodine and trospium chloride are available to treat urge incontinence. The efficacy of these agents are almost comparable in the elderly with the exception of oxybutynin IR. However, tolerability is different and not well studied in the elderly population with the exception of fesoterodin. Side effects, especially dry mouth, dizziness and constipation often limit their use. None of the agents show ideal efficacy or tolerability in all patients. Last summer therefore a ß3-agonist mirabegron was also introduced in Germany but was withdrawn.

Self-perceived health status and mental health outcomes in young adults born with less than 1000 g.

AIM: To assess self-perceived health status and mental health outcomes of former extremely low-birth-weight (ELBW) infants at young adulthood compared with community norms and to analyse predictors of poor outcome. METHODS: Fifty-five ELBW adults, 18 men (33%), with median (range) gestational age of 28.7 (25.0-34.0) weeks and birth weight of 930 (680-990) grams, born in Switzerland, were included. They self-rated their health status and mental health at a mean (range) age of 23.3 (21.8-25.9) years. Health status was measured by the Medical Outcomes Study Short Form-36 questionnaire and mental health by the Brief Symptom Inventory. RESULTS: The mean scores for both outcome measures were in the normal range. However, the study group self-rated significantly higher physical health status and lower mental health status compared with the community norms, and scores for self-perceived mental health tended to be worse in the former. ELBW adults reported more problems in socio-emotional role functioning compared with the community norms. Female sex was associated with poorer and bronchopulmonary dysplasia with better mental health status. CONCLUSION: Health status and mental health of former ELBW adults were overall satisfying. However, the comparison with the community norms revealed differences, which may be important for parental and patient counselling and developing support strategies.

Improving the health care of geriatric patients: management of urinary incontinence: a position paper.

A multidisciplinary German expert group met in 2012 to discuss the current status and prospects of health care of geriatric patients with urinary incontinence in Germany. The purpose of this position paper is to raise awareness among health care providers for the challenges associated with adequate management of urinary incontinence in frail elderly. The experts agree that a multidisciplinary collaboration is essential for the successful treatment of urinary incontinence symptoms which are often associated with loss of autonomy and social isolation. For most geriatric patients, usually the general practitioner is the first contact when seeking help. Hence, the general practitioner plays a crucial role in the coordination of diagnosis and treatment. The involved health care providers should have adequate education and training in their respective disciplines and should be networked allowing quick turnaround times. Non-pharmacological treatments (e.g. behavioural interventions) should have been tried before any pharmacotherapy is initiated. If pharmacological treatment of urinary incontinence involves the use of anticholinergic agents, cognitive performance should be monitored regularly. If indicated, anticholinergic agents with a documented efficacy and safety profile, explicitly assessed in the elderly population, should be preferred.

[Management of geriatric patients with benign prostatic hyperplasia]. / Das Management geriatrischer Patienten mit benignem Prostatasyndrom.

Multimorbid older men are increasingly more common in daily practice and present a challenge because they are often affected by lower urinary tract symptoms (LUTS) and age-associated benign prostatic hyperplasia (BPH). In order to identify possible risks in diagnostics, therapy and counselling at an early stage, screening for functional deficits or risk factors with standardized procedures is helpful. An initial screening with subsequent assessment of everyday skills using the Barthel Index, Timed up & Go Test, and a cognitive test are recommended. If frailty syndrome is detected, it should be taken into account during the pre-, peri-, and postoperative management, as it may indicate increased morbidity and mortality. Noninvasive methods for reducing the prostate volume without anesthesia can be a therapy option in older multimorbid patients, and with individual planning and consideration of risk factors, up to 70% of individuals become symptom-free. However, there is currently no gold standard for this vulnerable patient group. Number of medications and concomitant diseases and higher need for help are per se risk factors for unsatisfactory results after transurethral resection of the prostate (TURP) or laser vaporization. With drug therapy, concomitant medications and their interactions, especially in the cytochrome system, an existing multimorbidity and adherence to therapy must be taken into account. Combination therapies may complement each other and may bridge the time until surgery. Minimally invasive methods that can be performed without general anesthesia are suitable for geriatric patients, especially those with recurrent retention. Studies with the Rezüm® system (NxThera Inc., Maple Grove, MN, USA) and UroLift® (NeoTract Inc., Pleasanton, CA, USA) show that about 70% of patients can be relieved from the permanent catheter.

[Delirium in geriatric urology patients]. / Das Delir bei geriatrischen Patienten in der Urologie.

BACKGROUND: Delirium is a common but often undiagnosed complication in geriatric patients following a major or minor operation. With 14-56% in patients over 70 years of age, it is one of the most frequent complications seen in hospitals. The link between the prescription of drugs with antimuscarinic effects and cognitive disturbance is also well known. METHODS: Recognizing the presence of delirium and the criteria to establish the diagnosis of delirium will improve a clinician's ability to detect this complication. Treating delirium with non-pharmacologic, reduces the incidence and side effects of postoperative delirium. The purpose of this article is to describe the diagnosis and treatment of postoperative delirium. RESULTS: A sudden rise following fluctuating symptoms with decreased attentiveness, awareness and thinking are typical symptoms of delirium. The organic origin is not focused and must be considered. Transurethral resection (TUR) of the prostate and the bladder can increase the risk of bleeding, delirium and TUR syndrome. As simple instruments to assess signs and symptoms, the Clinical Assessment Method (CAM) and the Nurses Delirium Screening Scale (Nu-DESC) in the clinical setting are well examined. CONCLUSIONS: Preoperatively screening and execution of a geriatric assessment to detect vulnerable elderly could be a first step in reduction of complication. Regularly screening for delirium reduces the pre-, post-, and perioperative complications in patients with delirium.

[Do benign prostatic hyperplasia drugs affect mood or cognition?] / Beeinflussen Medikamente gegen das benigne Prostatasyndrom Stimmung oder Kognition?

Based on new evidence, we discuss the risk of central nervous side effects, mainly reduced cognition/dementia and depressive symptoms during the use of drugs for the treatment of lower urinary symptoms suggestive of benign prostatic hyperplasia. Cognitive impairments during use of muscarinic antagonists are well documented and mechanistically well understood, but their occurrence differs quantitatively between members of this drug class. The occurrence of depressive symptoms while using 5α-reductase inhibitors only became known recently but has now been observed consistently in several studies and is mechanistically plausible; it appears to occur with similar incidence when using dutasteride and finasteride. A moderate increase in new diagnoses of dementia has recently been reported from a single study upon use of tamsulosin but not other α1-adrenoceptor antagonists. The plausibility of a mechanistic cause-effect relationship is only moderate, and the association could be explained based on selection bias. Overall, physicians should be alert for the occurrence of central nervous side effects during the treatment of lower urinary tract symptoms.

Molecular epidemiology of Giardia and Cryptosporidium infections in dairy calves originating from three sources in Western Australia.

A longitudinal study was undertaken to determine the spread of naturally acquired Giardia and Cryptosporidium in dairy cattle in Western Australia. Samples were collected weekly from birth to weaning, and only calves that were sampled four or more times were included in the analysis. It was found that calves rapidly acquire infections with Cryptosporidium parvum and Giardia, with Cryptosporidium being the first to appear within 1-3 weeks after birth whereas Giardia was most prevalent in calves 4-7 weeks of age. Cryptosporidium and Giardia were detected in 48 and 89% of sampled calves, respectively. No significant association was observed in the present study between parasite occurrence and season or management practices (housing), and calf-to-calf contact appears to be the most likely source of transmission. Molecular characterization of isolates of Giardia and C. parvum recovered from calves demonstrated that only the occurrence Cryptosporidium represents a public health risk in terms of the potential for zoonotic transmission.

[The effect of supervised rehabilitation on ankle joint function and the risk of recurrence after acute ankle distortion]. / Effekten af superviseret genoptraening på ankelledsfunktion og risiko for recidivskade efter akut ankeldistorsion.

INTRODUCTION: The effect of an early rehabilitation programme, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. METHODS: Ninety-two subjects, matched for age, sex, and level of sports activity, were randomised to a control or training group. All subjects received the same standard information about early ankle mobilisation. In addition, the training group participated in supervised physical therapy rehabilitation (one hour, twice weekly) with emphasis on balance training. Postural sway, position sense, and isometric ankle strength were measured six weeks and four months after the injury, and at 12 months data on re-injury were collected. RESULTS: In both the training group and the control group, there were a significant difference between the injured and the uninjured side for all variables except for position sense at six weeks. The side-to-side differences in per cent were similar for both groups for all variables (p > 0.05) at six weeks, and there were no such differences at four months. Re-injury occurred in 11/38 (29%) is the control group, but in only 2/29 (7%) in the training group (p < 0.05). CONCLUSION: These data showed that an ankle injury led to reduced ankle strength and postural control at six weeks, but that these variables had become normal at four months, irrespective of supervised rehabilitation. However, the findings also showed that supervised rehabilitation may reduce the number of re-injuries, and may therefore play a role in injury prevention.

Low power wireless acquisition module for wearable health monitoring systems.

This paper presents a low power wireless acquisition module for use within wearable health monitoring systems and Ambient Assisted Living applications. The acquisition module provides continuous monitoring of the user's electrocardiogram (ECG) and activity, as well as the local temperature at the module. The module is placed on the chest of the user, and its wearability is achieved due to its fabrication based on a flexible PCB, and by the complete absence of connecting wires, as a result of the integration of flexible and dry ECG monitoring electrodes on the acquisition module, which do not require preparation with electrolyte gel. The design of the acquisition module also aimed for the minimization of power consumption to enable long-term continuous monitoring, namely concerning the wireless link, for which a proprietary low power solution was adopted. A low power analog frontend was custom designed for single-lead ECG monitoring, achieving a current consumption of 220 εA. The wireless acquisition module has a current consumption down to 1.3 mA while processing the acquisition of sensor data, and 4 mA when the wireless transceiver is active.

Design and realization of a wireless sensor gateway for health monitoring.

This paper describes the design and realization of a wireless sensor gateway (WSG) within a wireless sensor network (WSN) for health monitoring. The WSN allows recording and wireless transmission of biosignals, namely the electrocardiogram, pulse wave and body weight, which are important parameters for cardiovascular monitoring. These can be displayed, analysed, and saved on the WSG through a user interface based on a touch screen. The proposed WSG has the distinctive feature of using two different radio transceivers, exploiting the advantages of each device. Currently, most personal computers and handhelds have standardized Bluetooth interfaces (IEEE 802.15.1) but not ZigBee interfaces (IEEE 802.15.4). Hence, the proposed gateway is designed to receive data from wireless sensors through its ZigBee interface and to forward them to a personal computer via its Bluetooth interface. This feature, combined with simple touch screen menu navigation will reach increased patient compliance and consequently increased benefit for patient in terms of healthcare and safety.

Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit.

Although morbidity and mortality of acute poisoning are increased in elderly compared to younger patients, little has been published on this topics in the last years (Medline search). To investigate the influence of age on the clinical course of acute poisoning with different toxic agents, a longitudinal retrospective study at the Toxicological Intensive Care Unit (ICU) of the 2nd Department of Internal Medicine (Klinikum Nürnberg, Germany) was performed.A total of 5883 patients treated at our toxicological ICU were enrolled into the study, including all patients of the years 1982, 1992, and 1997. These three years were selected to investigate possible time-dependent changes of intoxication characteristics and quality of therapy at our ICU over a time span of 15 years. For each patient the following data were obtained from a standardized toxicological record: age, gender, toxic agents responsible for acute poisoning, and length of stay at the toxicological ICU. For a subgroup of 3740 patients, the cause of acute poisoning and the clinical outcome was also recorded. As compared with younger patients, mean length of stay at the ICU, indicating a more serious course of acute poisoning, was prolonged in elderly and, i. e., in very old patients (p <0.001). However, this prolongation of time at the ICU was only observed in elderly patients poisoned with drugs or with mixed poisoning including drugs, while mean length of stay was not prolonged in elderly patients poisoned with alcohol, with illegal drugs, chemicals, animal/plant poison, or other toxic agents. Patients with the highest risk of dying in the ICU after acute poisoning were elderly patients attempting suicide with drugs. Mortality in 3740 patients with acute poisoning was 0.24%, while it was 2.17% in the 184 patients being 65 years old or older. Thus, mortality was 9-fold higher in the elderly. Mean length of stay at the ICU decreased significantly from 1982 to 1992 and to 1997 (p <0.001) indicating an improvement of the therapeutical ICU management of acute poisoning and/or less dangerous toxic agents (i. e. less barbiturates). The age-dependent increase of the length of stay at the ICU until very old age (> 80 years) was most pronounced in 1982 and also declined markedly until 1997.Age, suicide attempt, and ingestion of (multiple) drugs seem to be risk factors for a higher mortality and a prolonged stay in the ICU after acute poisoning. Although in general the clinical course after poisoning has more complications and an impaired prognosis in old age, each category of toxic agents (drugs, alcohol, chemicals, etc.) has its own special "risk profile" for elderly patients. However, due to advances in modern ICU medicine the general prognosis of acute poisoning is good in old and even in oldest old patients.

The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.

The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.