Catheter-free geriatric care. Routines and consequences for clinical infection, care and economy.

In a geriatric hospital the routines of one ward were modified with the intention of removing indwelling catheters from all patients admitted to the ward. A continence training programme had been designed during the preceding 6 months. A total of 124 patients were admitted with indwelling catheters during a period of 18 months. It was possible to remove the catheters in 117 of these. Patients and their relatives reacted favourably to catheter-free care. The attitude of ward staff also was positive. The overall nursing requirements did not increase. Antibiotic prescription was 90 per cent less than in the control wards. This difference was accounted for not only by a reduction in drugs used against urinary tract infections, but also by a lower consumption of agents mainly used in the treatment of septicaemia, bronchopneumonia and wound infection. The cost of laundry and of hygiene and storage articles, including catheters, absorbing pads and other incontinence aids was 46 per cent of that in the control wards. Four years later, 65 per cent and 72 per cent of the patients from the test and control wards respectively, had died. Of the surviving patients from the test ward 78 per cent were still catheter-free.

[Clinical use of a thermal method for measuring peripheral blood flow according to A.M. Baptista (author's transl)]. / Die klinische Anwendung der Thermalmethode für die Untersuchung des peripheren Blutkreislaufs von A.M. Baptista

Measurement of peripheral circulation according to Baptista is discussed and its applicability in clinical work demonstrated. Examples are given showing changes following peroral treatment with inositol niacinate and intra-arterial injection of carbon dioxide.

Effect of intra-arterial CO2 insuffflation on occlusive arterial disease in the lower leg.

Twenty patients with a mean age of 79 years were followed over a period of 6 months after intra-arterial insufflation of CO2 in the lower extremity. All patients had severe peripheral occlusive arterial disease caused by atherosclerosis and were scheduled for amputation. A significant increase of the distal perfusion pressure was obtained in the majority of the cases resulting in pain relief and healing of ulcers and gangrenes.

A virtual reality trauma simulator.

The authors have evaluated a trauma simulator based on virtual reality techniques. Ten surgeons and 15 medical students performed distal locking of a femoral nail (A). Furthermore, 10 medical students performed simulated osteosynthesis of a femoral neck fracture (B). Total surgery time (A) (mean value) was shorter for surgeons (108 s) compared with students (157 s) at the first (p = 0.033), second (102 respectively 138 s, p = 0.13) and third (96 respectively 160 s, p = 0.15) operation. Total fluoroscopy time (A) (mean value) was shorter for surgeons compared with students at the first (45 respectively 89 s, p = 0.001), second (48 respectively 83 s, p = 0.02) and third (50 respectively 107 s, p = 0.10) operation. The positioning of the hip nails (B) improved between the first and last trial. Total surgery and fluoroscopy time were reduced. All participants thought that this and similar simulators should be part of the programme and that this simulator would be helpful if they were about to learn the procedures.

Long term study of hypnotic medication in geriatric patients. A study of dixyrazine, nitrazepam and amylobarbitone.

The hypnotic effect of dixyrazine (a phenothiazine derivate), nitrazepam and amylobarbitone was studied during six months in 52 geriatric inpatients (17, 16 and 19 in each group, respectively) with a mean age of 78 years. The variables registered were the percentage of patients asleep at 10 pm and 6 am and the observed number of awakenings. Certain mental and somatic variables were rated according to a schedule for geriatric behaviour. The observations were made every two to three weeks. No systematic significant change with time was observed for any of the three drugs for the percentage of patients asleep at 10 pm or 6 am or for the number of awakenings. Nor was any difference found between the three drugs in respect of these variables. There was no significant change in somatic or mental variables according to the geriatric rating schedule. The results indicate that dixyrazine, nitrazepam and amylobarbitone retain their hypnotic effect in geriatric patients during continuous use for a six-month period. No side effects were observed that influenced the patient' behaviour. The results do not support the view that barbiturates, i.e. amylobarbitone are inappropriate as hypnotics in the elderly patient.