Prevention is in! Surveillance is out!

There has been a major change in the basic approach taken to hospital hygiene practices, and indeed to infection control within the hospital on the whole. Whereas as recently as the 1990s lectures on the topic of hand disinfection at international congresses were confined to “the periphery of the congress”, today several keynote speakers address this issue with the full attention of the audience. This trend is also reflected in publications, and going beyond the domain of hand disinfection, has highlighted the important role of surface disinfection as well as of instrument disinfection in the prevention of nosocomial infections. The role of preventive as opposed to evidence-based hospital hygiene measures has for decades triggered lively discussions. The enormous rise in nosocomial infections due to antibiotic-resistant infections (MRSA, VRE, ESBL, etc.) will, no doubt, have made a significant contribution to bringing about a change in attitude. Even if of all the transmission channels implicated, the hands are the chief vehicles, there is in the meantime widespread evidence that contaminated instruments and surfaces can play a role in transmission. Surveillance is no doubt suitable for analyzing pathogenic transmission channels or shortcomings in infection control measures, but it is no substitute for the requisite preventive use of disinfection measures, since as a rule by the time the results of infectiology diagnostic measures are available, microbial spread will already have taken place. Prevention has had a long tradition in Germany and, in respect of infectious diseases, can be traced back to the 1880s (Robert Koch). It was therefore not surprising that it was Germany, where such efforts were initiated already in already in 1959, that began to formulate guidelines for efficacy testing of disinfection procedures. Since 1989 such guidelines have been compiled for the whole of Europe, thus assuring the preconditions for provision of high-quality disinfectants and, above all, for disinfection procedures whose efficacy has been verified. For the future it must be advocated that industry, on the one hand, will continue to develop more environmentally compatible disinfectants with broader spectra of action and that, on the other hand, the test methods for efficacy testing will be further improved in order to meet the requirements for efficacy testing of such agents.     

The consult is real,the visit is virtual

A web-based service was developed through which patients can obtain second opinions from physicians. Factors addressed included incorporating e-appointments into a medical practice, consolidating different approaches to second opinions, complying with disparate state licensing regulations, and communicating the program's features to providers and patients.     

挂号难:难在何处?

向在医院门前彻夜排队挂号的患者队伍中“加塞”的,除了看得到的“号贩子”,还有看不到的医疗资源分布不均的现实。     

If she is conscious,what is she?

What is consciousness? What is its importance and how is it to be described? The paper looks at some of the principal theories and their attempts to solve the “hard problem” of how consciousness is produced by nervous tissue, and attempts to close the “explanatory gap” between such (apparently) profoundly different things as subjective awareness and a physical brain. It ends with a tentative suggestion that, despite centuries of philosophical frustration, recent appeals to quantum physics may offer a glimmer of hope.