Vergleich der Jahresdaten zweier Schlaganfallstationen in neurologischen Kliniken an Akutkrankenh?usern

Das Stroke-unit-Konzept der Deutschen Gesellschaft für Neurologie unterscheidet sich von den Schlaganfallstationen skandinavischer und angloamerikanischer Pr?gung. Es zielt ab auf eine frühe Aufnahme von Schlaganfallpatienten, die Durchführung einer unmittelbaren Diagnostik und Therapie auf einer spezialisierten Station durch ein multiprofessionelles Team, ein kontinuierliches Monitoring in der akuten Phase und eine früh einsetzende Rehabilitation. Der Vergleich der Daten zweier Schlaganfallstationen an kommunalen Krankenh?usern zeigt eine hohe übereinstimmung bezüglich der behandelten Patientenzahl, der Diagnostik und Therapien sowie der aufgetretenen Komplikationen w?hrend des station?ren Aufenthaltes. Es zeigt sich bei den Patienten eine niedrige Krankenhausletalit?t. Der Datenvergleich dient einer Standortbestimmung und erm?glicht weitere Vergleiche mit ?hnlichen oder anderen Konzepten der Akutversorgung von Schlaganfallpatienten.     

Therapieadhärenz in der neurologischen Praxis

In light of increasing prevalence rates of chronic conditions and a growing elderly population, patients' nonadherence to medical regimes reflects a significant problem in modern health care. In the past, patients were primarily held responsible for problematic adherence. Over the past decades this attitude has changed dramatically, and it is now acknowledged that lack of adherence reflects a problem requiring different approaches and interventions on many different levels. Here we highlight central aspects and consequences of adherence problems in long-term therapy. Factors affecting treatment motivation in multiple sclerosis patients are summarized focusing on neurologic treatment issues, and specific intervention strategies for patients, doctors, and nurses are discussed.     

Arztbriefe neurologischer Kliniken in der Sicht niedergelassener Neurologen und Nervenärzte

Eight discharge reports involving five diagnoses (anterior territory ischemic stroke, epilepsy, Parkinson's syndrome, multiple sclerosis, polyneuropathy) from five neurological departments were peer-reviewed by five neurologists working in out-patient (private) practice. The review considered the diagnosis, case history, clinical status, laboratory investigation, differential diagnosis and treatment. Criticism mainly involved the quality of the clinical assessment, lack of clinical status at discharge, narrow or incomplete differential diagnosis and the quality of the neurophysiological investigations for epilepsy and polyneuropathy. Improvement potential was seen for the speed of reporting, better comprehensibility, omission of irrelevant information, greater participation of experienced neurologists in report writing, and standardization.     

Häufigkeit und Kostenschätzung der Erkrankungen des Nervensystems und der Psyche Eine Evaluierung an österreichischen Non-Profit-Krankenhäusern

There were 273,722 hospitalizations due to neurological disorders reported in Austria's nonprofit hospitals in 1997, including the related operated cases (14.12% of all 1.9 million hospitalizations). The individual disease groups, e.g., cerebrovascular disorders (59,269 admissions or 3.06%), multiple sclerosis (3,920 admissions or 0.2%) are detailed and the cost resulting from these diseases were estimated according to the Austrian Diagnosis Related Groups. The number of hospitalizations due to psychiatric disorders was 99,346 (5.13%). According to our results, we were able to estimate that 6,492 beds (at the moment 2,053 beds) were required for inpatient treatment in the area of neurology and psychiatry, which means one bed per 1,260 inhabitants.     

Die Bedeutung der Röntgenbefunde in der neurologischen Praxis

Ohne Zusammenfassung     

Häufigkeit und Ursachen der Selbstmordneigung in der Marine im Vergleich mit der Armee

Ohne Zusammenfassung     

Häufigkeit und Ursachen seelischer Erkrankungen in der deutschen Marine unter Vergleich mit der Statistik der Armee

Ohne Zusammenfassung     

Die Wertung der Spirochätenagglutinationsreaktion für die Diagnose luetischer Erkrankungen,gemessen an klinisch gesicherten neurologischen Fällen

Ohne Zusammenfassung     

Die Behandlung der Atemlähmung bei neurologischen Erkrankungen,Vergiftungen und Infektionen

Ohne ZusammenfassungMit 4 TextabbildungenHerrn Professor Dr. med. H. Pette zum 70. Geburtstag in Verehrung gewidmet.     

Eckpunkte für die Regelung der öffentlich-rechtlichen Unterbringung in psychiatrischen Krankenhäusern – mit Erläuterungen

While the provisions of the highest courts concerning the involuntary commitment and treatment in psychiatric hospitals of people unable to give their consent are being implemented, in many federal states corresponding adjustments to the rules governing involuntary commitment in accordance with the mental health laws and laws on involuntary commitment are still pending. In states where new regulations do exist, legal experts express doubts that they conform to the Constitution and the UN Convention on the Rights of Persons with Disabilities. The DGPPN has formulated key parameters for involuntary commitment from a clinical perspective, which should be taken into account in the new regulations of the individual federal states.     

Über die familiäre juvenile Form der Alzheimerschen Krankheit mit neurologischen Herderscheinungen

Ohne Zusammenfassung     

Begutachtung der Tagesschläfrigkeit bei neurologischen Erkrankungen und dem obstruktiven Schlafapnoesyndrom (OSAS)

Patients with increased daytime sleepiness are impaired in all areas of their social environment. Expert opinions are recommended for pension proceedings, regarding driving licenses as well as for restrictions at the workplace. All possibilities should be considered in the differential diagnosis of sleep disorders, which have to be treated before an expert opinion is submitted. Statutory regulations on evaluation of sleepiness are contained in the guidelines for assessing a patient's fitness to drive. The importance of daytime sleepiness in other occupations should be assessed according to the respective workplace. The patient should be informed of the appraisal with regard to career choice and workplace design. The expert thus has the responsible task of carrying out interdisciplinary differential diagnosis of pathological sleepiness and monitoring treatment success with appropriate test methods. In the present paper the legal guidelines in Germany and available test methods are presented.     

Zur Casuistik der multiplen Hirnnervenlähmung durch Geschwulstbildung an der Schädelbasis

Ohne Zusammenfassung     

Rückfallprognosen bei Sexualstraftätern — Vergleich der prädiktiven Validität von Prognoseinstrumenten

In order to evaluate risk assessment instruments for sex offenders in Germany, we compared the predictive validity of the Static-99, HCR-20, SVR-20, and PCL-R scales for 134 sex offenders. The mean follow-up time was 9 years (range 1-340 months), using the first entry into the National Register of Criminal Convictions as endpoint variable. For the estimate of predictive power, the area under the curve (AUC) of receiver operating characteristic (ROC) analysis was calculated. The AUC plots accurately identified violent or sexual recidivists and "false positives" at all scale levels. Comparing the predictive validity of these four instruments, the results favored Static-99. As for the limited sample size, differences between the assessment instruments were, however, not statistically significant. The ROC analysis for Static-99 showed that including treatment dropouts does not improve predictive accuracy (including dropouts: AUC 0.710; excluding dropouts: AUC 0.721). Kaplan-Meier survival analyses yielded highly a significant correlation to recidivism time point for two Static-99 and SVR-20 risk categories. Higher-risk categories were related to earlier recidivism. However, relying on the Static-99 and SVR-20 alone showed false positive results: for up to two out of three sex offenders, they predicted recidivism which did not occur.     

Anfälle in der Neugeborenenperiode

In the USA 1.5–3.0/1,000 neonates suffer an epileptic seizure in the postnatal period while the rate is even higher in preterm babies. In neonates and preterm babies it is often difficult to clinically recognize a seizure. Seizure semiology greatly differs from what is seen at a later age and the correlation between clinical seizures and electroencephalographic (EEG) patterns is weak. The introduction of amplitude-integrated EEGs as bedside monitoring in neonatal intensive care units has had a great impact on the recognition and treatment of seizures. The prognosis of children is determined primarily by the underlying disease, such as hypoxic ischemic encephalopathy (HIE), infarct/bleeding and central nervous system (CNS) infections. However, in recent papers it was demonstrated that a seizures can itself provoke morphological changes and inhibit brain development, which is even more pronounced in cases with preexisting CNS lesions (e.g. HIE). An increase of apoptotic necrosis of neuronal cells was found in neonatal rats after various antiepileptic (AE) drugs, e.g. phenobarbital (PB), valproate (VPA), phenytoin (PHT), carbamazepine (CBZ) and lamotrigine (LTG), but not after levetiracetam (LEV) or topiramate (TPM). The discussion that PB might hamper and inhibit brain development triggered the use of LEV and TPM in newborns. At least in some small cohorts the results are indicative for the efficacy of LEV in preterm and term babies to control seizures: therefore, LEV is used nowadays in some hospitals as the first drug in neonatal seizures.