ABSTRACT
BACKGROUND: Dementia is of increasing medical and societal relevance. Hospitalization of dementia patients is mostly due to behavioral and psychological symptoms of dementia (BPSD). There is a need for sufficient qualified personnel in hospitals in order to be able to effectively treat these symptoms. OBJECTIVES: This study aims at identifying the personnel requirements for guideline-conform, evidence-based inpatient treatment concepts for patients with BPSD and to compare these with the resources defined by the German psychiatric personnel regulations (Psych-PV). Furthermore, it was the aim to identify how often patients with dementia received non-pharmacological therapy during inpatient treatment. METHODS: Based on the current scientific evidence for treatment of BPSD, a schedule for a multimodal non-pharmacological treatment was defined and based on this the corresponding personnel requirements were calculated. Using the treatment indicators in psychiatry and psychosomatics (VIPP) database as a reference, it was calculated on what proportion of treatment days patients were classified into G1 according to the German Psych-PV and at least once received more than two treatment units per week. RESULTS: For the implementation of a guideline-oriented and evidence-based treatment plan, a higher need for personnel resources than that provided by the Psych-PV was detected in all areas. Currently patients with dementia who received at least more than two treatment units per week during inpatient hospitalization, were classified into G1 according to German Psych-PV on 17.9 % of treatment days. CONCLUSION: Despite evidence for the efficacy of non-pharmacological treatment measures on BPSD, these forms of treatment cannot be sufficiently provided under the current conditions. The realization of a new quality controlled therapeutic concept is necessary to enable optimized treatment of patients with BPSD.
Subject(s)
Alzheimer Disease/therapy , Guideline Adherence , Mental Disorders/therapy , Patient Admission , Psychotherapy/methods , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Combined Modality Therapy , Cross-Sectional Studies , Evidence-Based Medicine/organization & administration , Female , Germany , Guideline Adherence/organization & administration , Health Services Accessibility/organization & administration , Health Services Needs and Demand/organization & administration , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , National Health Programs/organization & administration , Psychotherapy/organization & administrationABSTRACT
PURPOSE: Depressive symptoms often occur among women of reproductive age. In this article we perform an analysis of existing studies to examine a possible correlation between depression and the use of hormone-based contraceptives. METHODS: The computerized databases MEDLINE/PubMed were searched for studies examining the relation between depressive disorders and hormonal contraception of the years 1976-2010. RESULTS: Data on this topic are limited. At least two confounding variables influence the analysis of the available data and make it difficult to draw firm conclusions: the inconsistent use of the term "depression" and the large number of combined contraceptives which vary in their composition. The association between the use of oral contraceptives and depression is not clear. We found that depression is not a common side effect of hormone-based contraceptives. CONCLUSION: Individual, patient-based decisions with consideration of the individual history and predispositions are recommended when starting oral contraceptives. If depressive symptoms or mood changes occur, decisions regarding discontinuation or medication change need to be made on an individual basis.
Subject(s)
Contraceptives, Oral, Hormonal/adverse effects , Depressive Disorder/chemically induced , Affect/drug effects , Female , HumansABSTRACT
OBJECTIVES: Clinical trials in humans in Germany-as in many other countries-must be approved by local research ethics committees (RECs). The current study has been designed to document and evaluate decisions of chairpersons of RECs in the problematic field of non-therapeutic research with minors. The authors' purpose was to examine whether non-therapeutic research was acceptable for chairpersons at all, and whether there was certainty on how to decide in research trials involving more than minimal risk. DESIGN: In a questionnaire, REC chairpersons had to evaluate five different scenarios with (in parts) non-therapeutic research. The scenarios described realistic potential research projects with minors, involving increasing levels of risk for the research participants. The chairpersons had to decide whether the respective projects should be approved. METHODS: A total of 49 German REC chairpersons were sent questionnaires; 29 questionnaires were returned. The main measurements were approval or rejection of research scenarios. RESULTS: Chairpersons of German RECs generally tend to accept non-therapeutic research with minors if the apparent risk for the participating children is low. If the risk is clearly higher than "minimal", the chairpersons' decisions differ widely. CONCLUSION: The fact that there seem to be different attitudes of chairpersons to non-therapeutic research with minors is problematic from an ethical point of view. It suggests a general uncertainty about the standards of protection for minor research participants in Germany. Therefore, further ethical and legal regulation of non-therapeutic research with minors in Germany seems necessary.
Subject(s)
Attitude of Health Personnel , Decision Making , Ethics Committees, Research , Minors , Nontherapeutic Human Experimentation , Age Factors , Child , Committee Membership , Germany , Humans , Surveys and QuestionnairesSubject(s)
Tuberculosis, Pulmonary/diagnosis , Antibiotics, Antitubercular/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Humans , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Tuberculosis, Pulmonary/drug therapySubject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Lung Diseases/diagnosis , Respiratory Function Tests , Adult , Female , Humans , MaleABSTRACT
Ethambutol is said to be capable of elevating serum urate concentration. This statement was reconsidered in three investigations using strictly supervised administration of ethambutol in a single daily dose of 25 mg. per kg. of body weight: (1) In short term administration 10 healthy subjects received ethambutol for eight days. (2) In a pilot study 13 patients suffering from pulmonary tuberculosis were treated with a triple combination including thambutol for six months. (3) In a controlled trial 23 patients were randomly allocated to one of the following regiments: In the first group patients received ethambutol plus isoniazid plus rifampicin for six months. In the second group patients received streptomycin plus isoniazid plus PAS for three months and thereafter streptomycin plus isoniazid plus ethambutol for another three months. Serum urate concentrations and clearances of uric acid and of creatinine were determined periodically in all subjects. A slight increase in serum urate concentration occurring in long term therapy showed no relation to ethambutol administration, but was obviously dependant on parameters related to the course of the disease in form of increase in body weight and physical activity, or related to the well known syntropy of chronic alcoholism and tuberculosis.
Subject(s)
Ethambutol/pharmacology , Tuberculosis, Pulmonary/drug therapy , Uric Acid/blood , Alcoholism/metabolism , Body Weight , Creatinine/urine , Ethambutol/therapeutic use , Humans , Isoniazid/therapeutic use , Rifampin/therapeutic use , Streptomycin/therapeutic use , Uric Acid/urineSubject(s)
Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Aminosalicylic Acid/administration & dosage , Drug Evaluation , Drug Therapy, Combination , Ethambutol/administration & dosage , Humans , Isoniazid/administration & dosage , Recurrence , Rifampin/administration & dosage , Streptomycin/administration & dosage , Time FactorsABSTRACT
Cytogenetic analyses were carried out in lymphocytes of 37 persons before and during a primary chemoprophylaxis or a preventive chemotherapy with isoniazid as well as of 30 patients suffering from active pulmonary tuberculosis before and during a chemotherapy with isoniazid in combination with two other antimycobacterial drugs. The results of the four participating research groups consistently reveal no indication for a chromosome damaging activity of isoniazid, of its metabolites in the human organism and of the administered drug regimens.
Subject(s)
Chromosomes/drug effects , Isoniazid/pharmacology , Adolescent , Adult , Aged , Child , Child, Preschool , Chromosome Aberrations , Female , Humans , Isoniazid/therapeutic use , Karyotyping , Lymphocytes , Male , Middle Aged , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/prevention & controlABSTRACT
15 cases of histiocytosis X and 274 cases of histologically confirmed sarcoidosis were diagnosed during the investigation period from 1969 to 1975. Data of 12 adults with primary pulmonary histiocytosis X were evaluated in extenso. The necessary histological verification of diagnosis was only possible by open lung biopsy. Already in early stage small excavations were found by tomography in half of the cases. Eelvation of serum copper and of the index of leukocyte alkaline phosphatase was striking. In a single case antinuclear antibodies were proven. An intra patient comparison verifies corticosteroids suppressing the disease. On the occasion of a second lung biopsy in one case could be seen that after treatment no more histiocytosis-specific substrate was existing. Exacerbation and relapse during and after continuous long-term therapy were not observed. The features of histiocytosis X and sarcoidosis are set side by side in order to show differences and relations.
