A standardized assessment and intervention protocol for managing risk for falls on a geriatric rehabilitation unit.

This article describes the intervention protocols implemented at the Sisters of Charity Hospital of Ottawa, Canada on a 36-bed geriatric rehabilitation unit for managing the risk for falls in patients assessed to be at high, moderate, or low risk. The implementation of tailored protocols is of particular importance on rehabilitation units because staff must balance the treatment goal to increase patient mobility, activity level, and independence with the need to prevent falls. Thus, this article also describes the related standardized criteria and decisional guidelines used in determining patients' level of independence on the unit for each fall-risk category. This article concludes with an outline of practices designed to facilitate safe transfers and completion of activities of daily living among geriatric patients with functional impairments by teaching and promoting the use of behavioral compensatory strategies for disability-related deficits.

[Clinical aspects, diagnosis and pathology of non-aortic aneurysms]. / Klinik, Diagnostik und Pathologie nichtaortaler Aneurysmen.

On the basis of a large autoptic material (67,352 autopsies between 1948 and 1978), clinical symptoms, diagnosis and pathologic anatomy of 140 non-aortal aneurysms (except cerebral basal arterial aneurysms) are presented. There was an accumulation beyond the 5th decade of age, among the etiologic factors atherosclerosis was predominant. 65 percent of the cases were men, 35 percent were women. Diagnosis during life time was only achieved in 16 cases (11.5 percent): in 6 cases by palpation and/or auscultation, in 4 cases by angiography, in 3 cases by an incidental intraoperative finding, in 2 cases by the help of an X-ray survey and in one case by sonography. The main reason for this low percentage of intravitally diagnosed aneurysms has to be sought in the poverty or the complete lack of clinical symptoms. If there are clinical symptoms, these are most frequently caused by a thrombosis of the aneurysm with a consecutive disturbance of arterial perfusion, and less frequently by a rupture of the aneurysm with or without compression of adjacent organs. The prerequisite for a more frequent and earlier intravital diagnosis is the inclusion of an aneurysm into differential diagnostic thinking, especially in elderly patients and unclear clinical symptomatology.

Influence of an antiarrhythmic premedication on the development of premature ventricular contractions during fiberoptic gastroduodenoscopy.

Heart rate, blood pressure and ECG changes during fiberoptic gastroscopy were examined in 128 patients, 60 of whom had been orally premedicated with Mexiletine. 55% of the non-premedicated patients developed occasional, and 22% of this group developed accumulated or frequent, premature ventricular contractions. In the patient group with antiarrhythmic premedication, the respective figures were 25% and 8%, and in this group patients with a normal ECG developed premature ventricular contractions less frequently than patients with pathological changes in the ST segment. The antiarrhythmic premedication had no influence on pulse or blood pressure.

[Clinical evaluation of serum bile acids as a new liver function test (author's transl)]. / Die klinische Bewertung der Serumgallensäuren als neuer Leberfunktionstest.

In a randomized patient material, with various histologically verified hepatobiliary diseases, the serum levels of Cholyl glycine (CG) and Sulfolithocholyl glycine (SLCG) were compared with each other. SLCG levels are a more sensitive parameter and permit a more significant differentiation between fatty and normal livers and between cases with and without portal hypertension in liver cirrhosis. There were poor correlations between the hitherto routinely performed laboratory tests and the SLCG levels, but good correlations between SLCG and defined parenchymal liver diseases. the publication ends with the presentation of a newly developed SLCG-stimulation test, which provides a staging of parenchymal liver diseases without unnecessary requirements of time and material and with minimal stress to the patients.

[Diagnosis of aneurysms of the aorta and its large branches. A clinical pathoanatomical study (author's transl)]. / Diagnose des Aneurysmas der Aorta und ihrer grossen Aaste. Klinisch patho-anatomische Studie.

On the basis of 67,352 autopsies 516 aorta aneurysms and 112 aneurysms of large branches of the aorta are classified according to their etiology, frequency, size and sex distribution. Cardiological, abdominal and neurological symptoms are predominant clinically. Palpation, auscultation, and X-rays with angiography and echography are still sufficient to arrive at the correct diagnosis in the majority of cases. In addition to conservative therapy a surgical intervention should be considered as far as circumstances permit.

[Social profile and accompanying diseases in acute and chronic pancreatitis (author's transl)]. / Sozialprofil und Begleiterkrankungen der akuten and chronischen Pankreatitis.

200 patients with pancreatitis were examined for various concomitant and previous diseases, and socioeconomic factors, in a retrospective study. This pancreatitis group (PG) was compared with a control group (CG) of 250 patients. Most frequent amongst the etiological factors, were biliary diseases, especially a state after cholecystectomy. Second in rank, was chronic alcoholism. For women, the incidence was highest in the 7th decade; for men, there was a double peak in the 4th and 6th decade, respectively. The incidence was about equal for both sexes. The following factors were found to play no essential role in the PG: type of profession, cigarette consumption, gastric and/or duodenal ulcers, partial gastric resection, renal and cardiac insufficiency, viral hepatitis, liver cirrhosis of hypertriglyceridemia. There is a significant accumulation of mumps in the history of the PG, which had gone along without any clinically detectable affection of the pancreas in childhood, in practically all cases.

[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)]. / Uber den Einfluss einer beta-adrenolytischen Prämedikation auf Herz-Kreislaufparameter und freie Fettsäuren bei der Osophago-Gastro-Bulboskopie.

Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.