Tijdschrift voor gerontologie en geriatrie
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Tijdschr Gerontol Geriatr · Apr 1998
Review Comparative Study[The treatment of locally advanced (T3) prostatic carcinoma using radical prostatectomy or radiotherapy. A review].
In the Netherlands 16% of all newly diagnosed prostatic carcinomas are already locally advanced (TNM-system: T3), which means that the tumor spreads beyond the prostatic capsule, or grows into the seminal vesicles. The pre-operative clinical staging is not very reliable when local tumor extension is concerned: the sensitivity for detecting extracapsular extension is 67% for digital rectal examination and 58% for transrectal ultrasonography of the prostate. In 50% of clinically locally confined tumors spread outside the prostate is found; and in 18% of the T3 tumors the tumor is confined to the prostate. ⋯ There is, however, a subgroup of patients with undifferentiated carcinoma which shows high progression rates following radical prostatectomy; these patients need adjuvant hormonal treatment, or should be given a different therapy. The role of adjuvant radiotherapy following radical prostatectomy is still a matter of debate, as is the administration of neoadjuvant hormonal therapy. For the moment these therapies should only be given in clinical trials.
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Tijdschr Gerontol Geriatr · Aug 1995
Review[Informed consent and mental competence of the elderly in medical-scientific studies].
The decision whether a potential subject is competent or incompetent is a necessary and crucial part of conducting medical research in the elderly. The assessment of competency is required by the legal and ethical frameworks in which this research has to take place. The state of play in the national and international discussions of bills for legislation of this topic will be summarized. ⋯ Competency of consent is assessed by asking several questions about the essential elements of the study. The introduction of a try out of the study for a subject before asking consent ('experienced consent') is propagated as a method to optimize this consent of elderly subjects. Special conditions for giving the required information to elderly subjects, for the informed consent by proxy and for the inclusion of nursing-home residents, are discussed.
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Tijdschr Gerontol Geriatr · Apr 1995
Review[Delirium in the elderly and DSM IV: is there clarity about confusion?].
On the occasion of the recent presentation of DSM IV, this article offers survey of current insights concerning delirium, an important psychogeriatric disorder. Compared with DSM III and IIIR, diagnostic criteria in DSM IV have been enlarged and simplified. This has been done in order to improve clinical diagnosis, especially of mild manifestations of delirium. ⋯ This will facilitate future research into the etiological contribution of non-organic factors. Scientific research over the past decades strongly suggests that delirium in the elderly is far from a benign transient disorder. Besides adequate diagnosis and treatment, preventive measures are therefore of equal relevance.
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Tijdschr Gerontol Geriatr · Aug 1994
[Drug use on admission and discharge in a geriatric department of a psychiatric hospital].
Change in medication use was studied in patients admitted to a short-stay geriatric ward of a psychiatric hospital. One hundred ten patients were followed up until discharge from the short-stay ward, or, after transfer, until discharge from the medium-stay ward to home or to a nursing-home. Mean drug use on admission was 2.6 drugs; at discharge mean use was 2.1 drugs. ⋯ Prescription of laxatives and vitamins, especially folic acid and vitamin B12, increased. In comparison with studies on two other geriatric wards in general hospitals in The Netherlands the most marked difference was a reduction of 17% in this study of the number of patients using benzodiazepines on discharge in contrast to an increase of 18 and 3% in the two other studies. The number of patients using neuroleptics on discharge decreased in the present study with 26%; in the two other studies respectively a decrease of 7% and a constant prescription level was found.