Time filter

Source Type

Heppner H.J.,Klinikum Nuremberg | Heppner H.J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Heppner H.J.,Poison Information Center Nueremberg | Christ M.,Klinikum Nuremberg | And 6 more authors.
Zeitschrift fur Gerontologie und Geriatrie | Year: 2012

Introduction.Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions.Aim.This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy.Methods.From 2006-2009, all PICN inquiries involving individuals >70.years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning.Results.Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people >70.years; 156 (4.8%) of 3,272 T-ICU patients were >70.years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%.Conclusion.Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases. © Springer-Verlag 2012.

Heppner H.J.,Klinikum Nuremberg | Heppner H.J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Singler K.,Klinikum Nuremberg | Singler K.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 11 more authors.
Wiener Klinische Wochenschrift | Year: 2012

Aim Guidelines for the management of sepsis have been published but not validated for elderly patients, though a prompt work-up and initiation of appropriate therapy are crucial. This study assesses the impact of a sepsis protocol on timelines for therapy and mortality in standardized management. Methods Consecutive patients aged 70 years and older who were diagnosed with sepsis and admitted during the observation periods were included in this beforeand- after study at a medical intensive care unit (ICU). Age, sex, and process-of-care variables including timely administration of antibiotics, obtaining blood cultures before the start of antibiotics, documenting central venous pressure, evaluation of central venous blood oxygen saturation, fluid resuscitation, and patient outcome were recorded. Results A total of 122 patients were included. Sepsis was diagnosed in 22.9 % of patients prior to the introduction of the protocol and 57.4 % after introduction. Volume therapy was conducted in 63.9 % of the patients (11.5 % preprotocol). Blood culture samples were taken prior to the administration of antibiotics in 67.2 % of patients (4.9 % preprotocol), and antibiotics were applied early in 72.1 % of patients (32.8 % preprotocol). Lactate was set in 77.0 % of patients (11.5 % preprotocol). A central venous catheter was inserted in 88.5 % of patients (68.9 % preprotocol), and the target central venous pressure was achieved in 64.3 % of patients (47.2 % preprotocol). ICU mortality was reduced by 5.2 % and hospital mortality by 6.4 %. Conclusions The use of standardized order sets for the management of sepsis in elderly patients should be strongly recommended for better performance in treatment. Compliance with the protocol was associated with reduced length of stay, reduced mortality, and improved initial appropriate therapy. © Springer-Verlag Wien 2012.

Discover hidden collaborations