Psychiatrische Kriterien zur Beurteilung der Einwilligungsfähigkeit

Every day each physician has to assess a patient’s capability to consent to medical treatment. This paper illustrates the legal term “capability to informed consent” and proposes psychopathological criteria to assess this capability. It is not possible to make this conditional to certain psychiatric diagnoses, but to some relevant symptoms. These symptoms are qualified to indicate the inability to understand, to process and to value the crucial information or the inability to determine or to express his personal will.     

Biochemical assessment of individual sports for improved performance

Biomechanists are able to offer a scientific service which aids the process of achieving improved sports performance. They are able to provide measurement tools to quantify key mechanical variables related to performance. Biomechanists use different methods to define these key variables, although there is no generally accepted approach on how this should be done. The process of intervention should be undertaken using information gained from a biomechanical assessment. This is often not conducted by the biomechanist and is usually left to other specialists. The success of this intervention is rarely evaluated so as to provide evidence to validate the earlier stages of the assessment. Biomechanists who have considerable experience and have conducted applied research programmes with specific sports seem to be able to demonstrate success. It is concluded that biomechanists need to support their claim to be able to influence performance outcome with more evidence based practice.     

Supplemental oxygen effects on ventilation in acclimatized subjects exercising at 5700 m altitude

INTRODUCTION: This study examines the effect of supplemental oxygen on acclimatized mountaineers at high altitude during rest and submaximal exercise. METHODS: Three healthy, acclimatized participants undertook nine periods of data collection lasting 10 min each over 2 consecutive days at 5700 m. These occurred at rest and exercise (40 and 80 W), breathing ambient air or supplemental oxygen (2 and 4 L m min') through an open-circuit breathing system. RESULTS: As minute ventilation increased during exercise, the fraction of inspired oxygen (FIO2) fell from 0.31 at rest to 0.23 with 2 L x min(-1) of oxygen and from 0.36 to 0.26 with 4 L x min(-1). Oxygen at both flow rates resulted in a significant increase in the arterial blood saturation of oxygen (SaO2) (Rest: 79% to 96% to 97%; 40 W: 80% to 95% to 97%; 80 W: 76% to 94% to 98%) and reduction in respiratory rate (RR) (Rest: 28 to 22 to 24; 40 W: 36 to 25 to 25; 80 W: 41 to 26 to 26). Tidal volume (VT, ml x s(-1)) was found to increase with the addition of oxygen (Rest: 959 to 844 to 969; 40 W: 1393 to 1834 to 1851; 80 W: 1558 to 2105 to 2215) and resulted in a non-significant reduction in minute ventilation (VE, L) (Rest: 25 to 17 to 21; 40 W: 46 to 45 to 43; 80 W: 61 to 51 to 53). No significant changes in heart rate were observed when oxygen was used (Rest: 78 to 62 to 71; 40 W: 90 to 91 to 96; 80 W: 105 to 102 to 101). CONCLUSION: An open-circuit breathing system may increase SaO2 and reduce RR in acclimatized mountaineers during rest and sub-maximal exercise at 5700 m, though further research is needed to confirm this.     

Radiation doses to patients and personnel involved in embolization of intracerebral arteriovenous malformations.

Radiation doses to patients and personnel were measured during 5 embolization procedures in 5 different patients. Thermoluminescent dosimeters were used to measure the absorbed doses in different points of the skin of patients as well as personnel. A transmission ionization chamber was used to determine the energy imparted in the patients. The effective dose equivalent HE during the procedures was estimated to be in the range of 6 to 43 mSv to the patients, 10 to 26 microSv to the radiologist in charge of the embolizations, 3 to 24 microSv to the assisting radiographer and 13 to 86 microSv to the nurse anesthetist. Radiation doses to the patients were considerable but the estimated risks from radiation were low compared to the risks of the arteriovenous malformation itself and the hazards of the embolization. The annual radiation doses to the personnel were well below established dose limits.     

Dental class 3 intercept clinic: a model for treating dental class 3 soldiers

OBJECTIVE: Dental Fitness Classification (DFC) 3 indicates that a soldier has a dental condition that, if not treated, is expected to result in a dental emergency within 12 months. Forty-two percent of Army recruits have DFC 3 conditions as reported by the 2000 Tri-Service Center Recruit Study. Initial entry training schools allow minimal time for dental care. The Fort Hood Class Three Intercept Clinic (CTIC) was created to treat DFC 3 conditions prior to soldiers being assigned to their units. The purpose of this study was to evaluate CTIC's ability to make soldiers dentally deployable before joining their new units at Fort Hood, Texas. MATERIALS AND METHODS: A retrospective review of the CTIC daily sign-in logs for the period of January 1999 to May 2001 was used to identify DFC 3 soldiers. The data were analyzed to determine frequency of DFC 3 by rank, DFC after CTIC visits, distribution of treatment type needed to establish dental readiness, and to identify soldiers whose DFC 3 conditions were not treated. Additionally, for the 6 months between November 2000 and April 2001, all soldiers who remained a DFC 3 when released to their units were followed to assess how long it took for them to attain a DFC 1 or 2 status. RESULTS: The retrospective review of the CTIC records identified 5,851 DFC 3 soldiers who in-processed to Fort Hood from January 1999 to May 2001. CTIC successfully converted 86.9% (N = 5,083) of the soldiers to DFC 1 or 2. Of a sample of 185 DFC 3 soldiers released to their units as a DFC 3, only 54% had converted to DFC 1 or 2, with 60.5 days being the mean days to convert. CONCLUSIONS: Trainees have large demands for dental care with minimal time to seek treatment during Initial Entry Training. A CTIC, or hybrid, can provide the necessary emergent dental care to remove soldiers from DFC 3 prior to their being assigned to their first permanent duty station.     

Gewahrsamstauglichkeit, Vernehmungsfähigkeit, Verhandlungsfähigkeit

Ability to undergo custody refers to the relatively short period of police custody, while ability to undergo detention refers to the ability to undergo pre-trial confinement or penal confinement. Ability to undergo custody indicates that the psychological and physical condition of the subject allows a relatively limited police confinement. Ability to undergo interrogation is considered to be the capacity to understand the sense of the questions posed during police investigations and at court, and to answer such questions meaningfully. In a civil court procedure, ability to undergo trial is the capacity to participate in legal proceedings. The capacity to undergo legal proceedings is bound to contractual capacity. Ability to undergo trial refers to the accused in criminal proceedings (principal proceedings). The German Federal High Court (BGH) defines ability to undergo trial as a state of mental clarity and freedom, so that it is possible to proceed against the accused according to criminal law. He must be in a position to represent his own interests reasonably, to maintain his rights, to conduct his defence in a reasoned and understandable manner and to deliver procedural declarations as well as to understand such. In addition, the carrying out of the principal proceedings may not endanger his life nor result in irreparable severe damage to his health.     

金黄色葡萄球菌感染的临床特征及耐药性分析

目的：调查金黄色葡萄球菌感染的临床特征及耐药情况，指导临床合理用药。方法：回顾分析成都军区总医院4年来临床各类标本中金黄色葡萄球菌的分离和耐药状况。结果：金黄色葡萄球菌主要引起皮肤和软组织感染和泌尿生殖道感染；医院感染50例，占总分离数的40．0％，其中38株为MRSA，占76．0％，社区感染75例，MRSA26株，占34．7％，体外药敏示MRSA仅对去甲万古霉素，氧氟沙星和凯福隆敏感，敏感率达100％，74．5％及73．4％，对其它抗生素基本表现为耐药，MSSA对去甲万古霉素，凯福隆，头孢唑啉，氧氟沙星，头孢拉啶和复达欣的敏感率分别为100％，88．5％，85．2％，82．0％，67．2％，和63．9％，对其它受试抗生素的敏感率均低于50％，结论：去甲万古霉素和氧氟沙星是金黄色葡萄球菌感染的首选药物，社区感染和医院感染的经验用药应区别对待。     

Evaluation of plasma clearance by synthesis of continuous infusion: principles and use

There is a technique of engineering analysis which can be described as "impulse synthesis" which uses the observational data of a system's response to a single sharp blow in order to predict its response to a steady force. This same technique has been applied to the calculation of in situ drug levels and for calculating plasma clearance values. The purpose of this paper is to elucidate the principles of this calculation technique and to critically assess its application to plasma clearance studies. We begin by tracing the history of the measurement of renal clearance of plasma. We then proceed to exposit the relevant principles of the synthesis technique. Finally, we report the results of our application of this technique to the analysis of simulated data in a manner intended to be of use to clinicians who might wish to consider employing the technique.     

Small-cell carcinoma of the lung: patterns of treatment failure in patients treated primarily by chemotherapy

Treatment failure patterns in 75 patients with small-cell carcinoma of the lung who were treated primarily by chemotherapy were reviewed. Of 10 patients with localized disease who underwent complete staging work-ups, six had metastases to the chest, four to the central nervous system, four to bone, and one to the lymph nodes. Of 32 patients with disease considered to be localized but who did not undergo complete staging work-ups, 23 had metastasis to the chest, 11 to the central nervous system, four to bone, and two to the lymph nodes. Of 33 patients with documented distant metastasis 23 had metastasis to the chest, 14 to the central nervous system, 15 to bone, and six to the lymph nodes. Median survival times of patients showing complete response to treatment was 17 months; for those showing partial response it was 7 months.     

The inter-relationships of physical activity, physical fitness, and body measurements

While several measures of physical activity have been used in research, it is not clear how these measures relate to each other or to measures of fitness and fatness. The purpose of this study was to examine the relationships of three commonly used indicators of physical activity to determine how they relate to each other as well as to measures of physical fitness and anthropometric measurements related to body fatness. Data from white adult men working for U.S. railroad companies in 1957 to 1960, who were free of pre-existing cardiovascular disease (N = 2,356), were used to study these relationships cross-sectionally. Total and intense leisure time activity and occupational activity were directly related to caloric intake. Total leisure time activity was inversely related to exercise test heart rate and directly related to body mass index, but not related to resting heart rate or skinfold thickness. Intense leisure time activity was significantly related to all fitness measures and not significantly related to fatness. Caloric intake was directly related to measures of fitness and inversely related to fatness. Occupational activity was directly related to measures of fitness and body mass index, and inversely related to skinfold thickness. These results provide a better understanding of methods appropriate to ascertaining physical activity in epidemiologic research as well as assisting in the comparison of results from studies which have used different physical activity indicators.     

Restrictive covenants in professional employment contracts

For a court to sustain a restrictive covenant with anticompetition as its major thrust does violence to our individual rights. There is no duty for a former employee not to compete as an incident of employment. Employers who seek to enforce restrictive covenants to protect their practice areas are asking the court to place on one side of the scales of justice the birthright of a newcomer to engage in the competitive marketplace and to place on the other side the right of the established group to have a public market area reserved exclusively for their benefit by prior claim. The court is being asked to take valuable legal rights to pursue competitive opportunities from one person or business and give them to the other person or business. In a legal sense, this is not easy to justify. Without something specific and private to protect other than public competitive opportunities, a restrictive covenant may violate public policy by casting a chilling effect on competition, may be abusive to constitutional equal protection, does violence to the concept of free enterprise, and tends to deny communities the services of highly trained professionals that may otherwise be hard to replace. The law of restrictive covenants varies from one state to another. Some jurisdictions have strayed from the traditional position detailed here and often are inclined to protect the employer's right to a service area for a specified term. The services of a local attorney should be obtained when it is necessary to deal with a contractual restrictive covenant.     

Patient expectations and perceived social support related to return to sport after anterior cruciate ligament reconstruction in adolescent athletes

ObjectiveExamine the relationship between pre-operative competitive status and return to sport expectations post-operatively among adolescents undergoing ACL reconstruction. Assess the association between perceived levels of social support and doubts in returning to sport after ACL reconstruction.DesignCross-sectional.SettingOutpatient sports medicine clinic at a single institution.Participants12–18 years old with an ACL tear who were planning to undergo ACL reconstruction.Main outcome measuresPsychovitality questionnaire responses and Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire scores.Results86% of participants expected to return to sports in six months or less after surgery; there was no significant difference in expected time to return to sport between competitive vs. recreational athletes. Competitive athletes were less likely to be content returning to a lower activity level after surgery compared to recreational athletes. There were no significant differences in MSPSS scores between those who did and did not report doubts in their ability to return to their previous sports.ConclusionMost of our adolescent athlete population expected to return to sport after ACL reconstruction within six months of surgery. Those with and without doubts in their ability to return to sports did not significantly differ in levels of perceived social support.     

Motion sickness questionnaire and field independence scores as predictors of success in naval aviation training.

The present report has shown that a motion sickness questionnaire can be used to predict susceptibility to motion sickness or flight training success, depending on the items scored. There is a discussion of the theory that motion sickness results from conflicting perceptual inputs. This theory is related to aircraft operating conditions. Scores on a personality test which appear to be related to similar perceptual phenomena are related to aviation success. One phenotype, field independence, seems to be promising in this regard. In addition to use of this finding in aviator selection, it is felt that studies of this trait, as it relates to an ability to reconcile conflict and to motion sickness insusceptibility, should be conducted.     

Using photoshop filters to create anatomic line-art medical images

There are multiple ways to obtain anatomic drawings suitable for publication or presentations. This article demonstrates how to use Photoshop to alter digital radiologic images to create line-art illustrations in a quick and easy way. We present two simple to use methods; however, not every image can adequately be transformed and personal preferences and specific changes need to be applied to each image to obtain the desired result. There are multiple ways to obtain anatomic drawings suitable for publication or to prepare presentations. Medical illustrators have always played a major role in the radiology and medical education process. Whether used to teach a complex surgical or radiologic procedure, to define typical or atypical patterns of the spread of disease, or to illustrate normal or aberrant anatomy, medical illustration significantly affects learning (). However, if you are not an accomplished illustrator, the alternatives can be expensive (contacting a professional medical illustrator or buying an already existing stock of digital images) or simply not necessarily applicable to what you are trying to communicate. The purpose of this article is to demonstrate how using Photoshop (Adobe Systems, San Jose, CA) to alter digital radiologic images we can create line-art illustrations in a quick, inexpensive, and easy way in preparation for electronic presentations and publication.     

Strategic planning in diagnostic imaging: meeting the challenge

PURPOSE: The 21st century has raised new and significant challenges to the practice of diagnostic imaging. Radiologists will have to navigate a difficult path as they face threats from disruptive technologies, adverse demographic changes, pressures to limit reimbursement both from the public and from the private sectors, increased domestic and crossborder competition, and many others. Success in these trying times will require greater attention to strategic planning if we are to thrive and survive in radiology. METHODS: Strategic planning and tactical implementation methodologies were reviewed, from Sun Tzu to the present day, for applicability to the needs of modern radiology groups. RESULTS: A framework for developing and implementing strategic plans was constructed to assist radiology leaders and groups in considering the spectrum of tasks, from gathering intelligence, to developing scenarios, to implementing and evaluating tactical plans. CONCLUSIONS: Strategy and tactics are too important to be ignored or left to others. They need to be core activities for all radiology leaders. Frameworks can be used to help in providing structure and rigour to strategic planning efforts at the department and group level.     

Prediction of susceptibility to acute mountain sickness by SaO2 values during short-term exposure to hypoxia

Prediction of the development of acute mountain sickness (AMS) in individuals going to high altitudes is still a matter of debate. Whereas some studies found that subjects with a blunted hypoxic ventilatory response (HVR) are predisposed to AMS, others did not. However, the HVR has often been determined under very acute (5 to 10 min) isocapnic hypoxia without consideration of the subsequent hypoxic ventilatory decline (HVD), and the assessment of AMS susceptibility was based on a single altitude exposure. Therefore, the aim of the present study was to evaluate the relationship between the individual arterial oxygen saturation (Sa(O2)) after a 20- to 30-min exposure to poikilocapnic hypoxia and the AMS susceptibility based on repeated observations. A total of 150 healthy male and female mountaineers (ages: 42 +/- 13 yr), 63 of whom had known susceptibility to AMS and 87 of whom never suffered from AMS, were exposed to various degrees of normobaric and hypobaric hypoxia. Sa(O2) values were taken by finger pulseoximetry after 20 to 30 min of hypoxic exposure. Sa(O2) values after 20 to 30 min of hypoxia were on average 4.9% lower in subjects susceptible to AMS than in those who were not. Logistic regression analysis revealed altitude-dependent Sa(O2) values to be predictive for AMS susceptibility. Based on the derived model, AMS susceptibility was correctly predicted in 86% of the selected individuals exposed to short-term hypoxia. In conclusion, Sa(O2) values after 20 to 30 min of exposure to normobaric or hypobaric hypoxia represent a useful tool to detect subjects highly susceptible to AMS.     

Fatal occupational injury related to helicopters in the United States 1980-1985.

This paper discusses characteristics of occupational traumatic deaths, caused by helicopters, during 1980-1985. Death certificate data are used to describe demographic characteristics and causes of death. Information from National Transportation Safety Board (NTSB) investigations is used to describe pilot experience and environmental circumstances surrounding the incident. During 1980-1985, 374 worker deaths involving helicopters were identified in the National Traumatic Occupational Fatality (NTOF) database. The majority of deaths resulted from trauma to body organs (including the brain). According to NTSB investigations, 59% of crashes in this study were attributed to pilot error, compared to 16.5% from mechanical failure of the helicopter. Thirty percent of deaths were related to military use of helicopters. While death due to occupational exposure to helicopters is not common, some workers (e.g., helicopter pilots) appear to be at especially high risk. This group should be studied further to develop better strategies for their protection.     

Adaptation to motion sickness from torso rotation affects symptoms from supine head nodding

INTRODUCTION: Space motion sickness affects more than 50% of astronauts. Adaptation to one kind of nauseogenic motion can affect the response to another. We hypothesized that repeated exposure to torso rotation (TR) would diminish motion sickness (MS) due to supine head nodding (HN), a ground-based analogue for space sickness. METHODS: During TR, standing subjects swept their gaze back and forth between two targets located 135 degrees to either side of straight ahead. For HN, the subject lay supine on a platform with his/her head and neck hanging over the edge. The head was pitched back and forth between the horizontal position and rotated back as far as possible. MS was quantified in 5 male and 20 female subjects using numerical estimates of discomfort and a more detailed questionnaire. Susceptibility to TR and HN was determined on three occasions for each stimulus. At least 1 mo separated any two tests. Subjects were exposed to TR once a day for 7 consecutive days 1 mo after the final control session. Within 24 h of the seventh session, and 1 mo later, susceptibility to HN was evaluated again. RESULTS: There was a significant decrease in MS susceptibility during repeated exposure to TR (time to stop 17.7 min on Day 1, 31.8 min on Day 7). In contrast, there was a significant increase in MS susceptibility to HN after repeated exposure to TR (mean time to stop 11.7 min before TR, 9.5 min after). Susceptibility to HN was back to normal (time to stop 11.4 min) 1 mo later. DISCUSSION: Subjects can adapt to TR by repeated exposure. At the same time, susceptibility to HN increases. Strategies for pre-adaptation to space motion sickness need to be chosen carefully as they could actually be counterproductive.