Das Curriculum ?Rheumatologische Fachassistenz DGRh-BDRh�� als Weg der Professionalisierung medizinischer Assistenzberufe

Rheumatological care in Germany is influenced by limited resources and education and qualification of health professionals is a way to optimize utilization of these resources.The curriculum for rheumatology health professionals of the Academy of the German Association of Rheumatologists (DGRh) was developed to qualify clinical nursing specialists of rheumatology clinics as well as specialized rheumatology hospitals on a systematic basis.Since 2006 499 participants have each been trained over 4 weekends and certification was achieved by examinations. The topics cover the principles of anatomy and the pathology of diseases up to modern diagnostic methods and treatment, including practical skills. Additional specialized courses for nurses of rheumatology hospitals and refresher courses give the participants the opportunity to increase their depth of knowledge.After 8 of the basic courses questionnaires were sent to all participants for evaluation and 143 (51%) out of 277 participants responded. Of the responders 95% found that their knowledge of understanding rheumatic diseases improved considerably or very considerably, 90% found that their ability to determine urgent cases and 86% to correctly judge emergency situations had improved and 50% agreed with the statement that their field of work and their tasks had changed after the training courses. Increased responsibilities, documentations of patient history, involvement in clinical trials and infusions and information of the patients about their disease or the treatment were listed as new tasks of the participants. In conclusion the evaluation shows that the curriculum for rheumatology health professionals is an effective step towards qualification for clinical nursing specialists. We believe that this will support the work of medical doctors in rheumatology and will improve the quality of care for patients with rheumatic diseases.     

Das Pr?carcinom

Ohne ZusammenfassungMit 8 Textabbildungen.     

Das H?morrhoidalleiden

Suffering from hemorrhoids has been documented in the medical literature for centuries. Therefore many recommendations for conservative and operative treatment of this disease can be found. A specific treatment should be based on recent results of anatomical and pathophysiological research in this field and knowledge of the theoretical basis leads to an understanding of the disease and therapy. A wide spectrum of operative procedures is currently available which allows an individually adapted intervention corresponding to the individual situation.     

Das diabetische Fu?syndrom

Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. The pathophysiologies of diabetic foot ulceration with polyneuropathy and angiopathy as well as wound-healing impairment in patients with diabetes mellitus are important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the--compared with European data--noticeably higher rates of major amputations in Germany.     

?Diabetes-Excellence-Center��-Initiative

Approximately 25?C30% of patients in regular or maximum care German hospitals have diabetes mellitus but the secondary diagnosis of diabetes is only reported in 10% of these cases. This leads to an inadequate treatment of affected patients with a poorer prognosis, extended periods of hospitalization and lost revenue. For such patients structured in-patient diabetes management is necessary comprising, among others, specific education of doctors and nurses and algorithms for therapy in various situations. The aim of this project was the development of material for internal implementation in clinics with exemplary standard operating procedures, business case models and training curriculum for a professional management of the secondary diagnosis of diabetes mellitus in hospital. This article provides a specific catalogue of appropriate recommendations for business managers, medical controllers, diabetologists and nursing directors who are schooled in a daytime workshop by members of the diabetes excellence center expert group.     

Dronedarone: Das neue Antiarrhythmikum?

Dronedarone is recommended as the successor drug to amiodarone because a faster onset of effects and less side effects are to be expected. This review describes the pharmacological properties of this multi-channel blocker and summarizes the results from recent studies proving successful antiarrhythmic therapy using dronedarone in patients with atrial fibrillation.     

Einstellungen zum eigenen Altern: Eine Alters- oder eine Ressourcenfrage?

Recent studies have demonstrated that positive and negative stereotypes and attitudes toward age and aging may have substantial effects on the longterm development of cognitive and physical performance in old age. Relatively little is known to which degree attitudes toward one's own aging depend on (a) the current level of individual resources, (b) changes in the level of individual resources, or (c) the increasing age of older persons. The present study examined the relations between individual physical, mental, and cognitive resources and the attitudes toward one's own aging. The study was conducted with N=500 participants of the Interdisciplinary Longitudinal Study of Adult Development (ILSE) born between 1930 and 1932 (age: M=63.0, SD=0.9 at T1 and M=66.9, SD=0.9 at T2). The results indicate that the attitudes toward one's own aging (a) become more negative with increasing age, (b) most strongly depend on the available resources, (c) changes in level of resources contribute to the prediction of the attitudes toward one's own aging, and (d) age acts more as a reinforcing factor on the relation between resources and attitudes than as an independent factor on the attitudes toward one's own aging.     

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大动脉炎是继发性高血压的重要因素之一,为主动脉及其主要分支的慢性进行性非特异性炎变,可引起不同部位的狭窄或闭塞,少数病人因炎症破坏动脉壁的中层而致动脉扩张或动脉瘤。因病变部位不同,其临床表现各异,主要表现为受累部位的缺血症状。当大动脉炎累及胸腹主动脉和肾动脉时,可导致高血压。     

Aderlass und ?Rheuma��

Bloodletting was widely used in antiquity in the setting of a humoral-pathological concept as a general treatment for all ailments, as well as during the middle ages primarily as a remedy for the treatment of inflammatory and infectious diseases. The general population was convinced of the efficacy of this treatment for centuries, even requesting it on occasion on a prophylactic basis. Although questioned early in history, the number of sceptical voices increased in the 17th and 18th centuries. In 1835, P. Louis introduced statistics to medicine in Paris, thereby proving the inefficacy of bloodletting in inflammatory diseases. Today, bloodletting is used in scientific medicine in only a few rare disease.As long as rheumatic diseases remained undifferentiated, all cases were treated with bloodletting. After acute articular rheumatism 1591 was recognised as an independent disease entity, bloodletting remained the treatment of choice for most doctors right up to the end of the 19th century. Bloodletting was also the standard treatment for gout from antiquity up to the beginning of the 19th century. Following its differentiation in 1800, chronic articular rheumatism was no longer treated with venae sectio. Today, there is no indication for bloodletting therapy in rheumatology.     

Aktives Altern und Lebensqualität

Based on the Active Ageing Programme of the World Health Organization (WHO), a demonstration project was conducted in a city in North-Rhine Westphalia between October 2002 and December 2004. The aim of the study was to promote an active ageing process, to maintain autonomy and independence among older people, and thereby to promote health and quality of life. The target group included people aged 55 to 80 years. The aim was to include older persons in a critical period of life due to loss of partner within the last five years and people undergoing a status change due to retirement within the last two years. 344 participants were visited at home to assess their health and psychosocial situation and to identify opportunities for activities. Participants were supported in their efforts to realise the agreed-upon activities. In this article results of the external evaluation are presented. It is analysed whether quality of life according to the WHOQOL Bref improves among participants in the course of the project. Results of non-parametric tests show small differences in quality of life between the three waves of interviews (at the beginning of the project, after one year, at the end of the project). This holds true when only those participants are analysed who retired within the last two years. However, quality of life significantly improves among older persons who lost their partner within the last five years. In terms of implementation of the WHO Active Ageing Programme results suggest application of a risk group strategy.     

�� �� �� �� Ѫ ѹ

盐敏感性高血压是基因机制、离子转运机制、内皮功能障碍机制、肾脏机制、交感神经系统和中枢神经系统机制、肾素-血管紧张素-醛固酮机制、内分泌机制、胰岛素抵抗机制等等共同作用的结果。除了限盐治疗以外,其他针对盐敏感性高血压的降压措施包括补充钾离子和钙离子,降压药治疗,免疫疗法,基因疗法等等。降压药物包括利尿剂、钙离子拮抗剂、血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂都是治疗盐敏感性高血压的适用药物,改变我国高盐饮食习惯是盐敏感性高血压一级预防的关键性措施。     

Welche Informationsbed��rfnisse haben pflegebed��rftige ?ltere Menschen und pflegende Angeh?rige?

Background

The recent reform of the German Care Insurance Law (2008) was expanded to include independent consultancy for care issues. The goal of this study was to explore the informational needs of people in need of care and their informal caregivers.

Method

A semi-structured questionnaire was used to document 89?consultation conversations. The data were analyzed using qualitative content analysis.

Results

The findings identified that information was needed about (1) the German health care insurance system, (2) access to care, (3) local care services, and (4) situation and disease-specific concerns.

Conclusion

Consultancy services for people in need of care and informal caregivers require detailed knowledge about local care services and, therefore, should be integrated into the neighborhoods of the users.