Priorities of elderly dizzy patients in general practice. Findings and psychometric properties of the"Dizziness Needs Assessment" (DiNA).

BACKGROUND: Dizziness as a geriatric syndrome needs to be assessed using a multi-dimensional, patient-centred approach in addition to a disease-orientated strategy. The aim of the study was to determine the priorities of elderly patients by a specific needs questionnaire, the"Dizziness Needs Assessment" (DiNA), and to evaluate its psychometric properties. METHODS: General practitioners (GPs) distributed questionnaires containing the DiNA as well as the Patients' Intentions Questionnaire (PIQ) to patients aged at least 65 years and suffering from dizziness. Items of both questionnaires were analysed by frequencies, means and rank correlations. Factor structure was explored by principal component analysis. RESULTS: A total of n=123 patients (mean age 76 years, 73% women) had suffered from dizziness on average for more than 3 years (57% chronic, i.e. >6 months). Knowing the cause of the dizziness was rated as very important by patients, and about half of them wished that their doctor would make more effort to investigate this. Among other differences, chronically dizzy patients ranked the risk of falling significantly higher than those with acute dizziness. Factor analysis revealed four subscales: "handicap and mobility" showed a very good reliability of 0.77 (Cronbach's α), indicating a "trait", whereas the other subscales rather indicated "state" characteristics. Validation coefficients showed that PIQ assesses general patient needs compared to the more specific dizziness-related needs revealed by the DiNA. CONCLUSION: The DiNA proved to be a valuable instrument to assess the specific priorities of elderly patients suffering from dizziness. Regarding the limited therapy options for dizziness in old age, a doctor-guided shift of patients' attention from causes to symptom-related implications could be a promising approach.

[Complication rate of out-patient removal of ear wax: systematic review of the literature]. / Komplikationshäufigkeit bei der ambulanten Zerumenentfernung : Systematische Literaturübersicht.

BACKGROUND: Cerumen impaction is known as a frequent problem both in general practice as well as in community based ENT surgeries. The aim of the present review was to describe the frequency and types of complications due to different methods of ear wax removal. METHODS: A systematic review of the literature was carried out (Pubmed, Cochrane, Scopus) and data from the arbitration board for medical liability were evaluated. RESULTS: Controlled studies addressing the complications of ear wax removal are lacking in the literature and absolute risks could not be reported. Perforation of the tympanic membrane was observed in up to 1% of the cases. Syringing seems to result in a greater number of complications than mechanical removal using a curette. CONCLUSIONS: Complication rates were found to be higher than previously assumed. However, none of the publications had initially been intended to detect adverse events. It can be concluded that syringing can be delegated to trained staff members only if pre-existing defects of the tympanic membrane have been excluded.

[Home visits in German general practice: findings from routinely collected computer data of 158,000 patients]. / Hausbesuche: Versorgungsforschung mit hausärztlichen Routinedaten von 158.000 Patienten.

INTRODUCTION: Home visits are an integral part of general practice. However, information on this subject is lacking in Germany. Therefore we aim to describe the quantity of home visits, the target population and the workload for general practitioners on the basis of computerised data routinely collected in general practices. METHODS: The routine care data originate from 136 practices of the areas of Göttingen and Freiburg. Electronic patient records provided billing codes for home visits and consultations, patients' anonymous identification number, age, gender and ICD codes. RESULTS: 84 practices with complete datasets of 158,383 patients were available for the cross-sectional analysis in 2002. 12% of all patients required at least one home visit - significantly more elderly and female patients. Half of all patients visited at home requested one visit, whereas nearly 5% needed at least fortnightly visits throughout the year. 2/3 of all visited patients received an emergency visit. The quantity and nature of diseases also influenced home visit status. The workload of an average practice contained 9 visits per 100 consultations. 15 practices provided datasets between 1997 and 2001. In this period the total number of home visits declined. Within the same period, the target group has increasingly been restricted to old patients. CONCLUSION: Old age, female gender, quantity and nature of diseases positively influence home visit status. Compared to general practices in other European countries, the workload caused by house calls seems high in this German sample. Over recent years the frequency of home visits has decreased. In view of the demographic changes, decisions will have to be made as to who will care for the growing numbers of old patients requiring home visits.

CD26 (dipeptidyl-peptidase IV)-dependent recruitment of T cells in a rat asthma model.

CD26 truncates several chemokines as well as neuropeptides and influences immune responses via modulation of cell adhesion and T cell activation, suggesting an involvement of CD26 in asthmatic and airway inflammation. Therefore, Fischer 344 (F344), Brown Norway (BN) and Lewis (LEW) rat strains, which differ in their CD26-like enzymatic activity, were compared using an asthma model. Additionally, two CD26-deficient mutant F344 rat substrains were included and compared to the wild-type F344 substrain. Immunization was performed twice with ovalbumin (OVA), and 2 weeks later the rats were challenged with OVA intratracheally Flow cytometry (FACS) analysis of different leucocyte subsets as well as enzyme-linked immunosorbent assay (ELISA) for IgE levels in the blood and bronchoalveolar lavage (BAL) were performed 24 h after challenge. LEW rats with the lowest CD26 activity among the rat strains investigated here displayed significantly reduced CD4+ T cell numbers in the BAL compared to wild-type F344 and BN rats. Moreover, in asthma, the ratio of CD26+ to CD26- T cell receptor (TCR)-positive cells increased significantly in F344 and LEW but not BN rats. Most intriguingly, in both CD26-deficient F344 rat substrains the number of CD4+ T lymphocytes was markedly reduced compared to wild-type F344. The decrease in T cell recruitment observed in the CD26-deficient rats was associated with significantly reduced OVA-specific IgE-titres. This is the first report to show a remarkably reduced T cell recruitment in rat strains that either lack or exhibit reduced CD26-like enzymatic activity, suggesting a role for CD26 in the pathogenesis of asthma via T cell-dependent processes such as antibody production.