Verbesserung der diagnostischen Treffsicherheit bei Patienten mit vermuteter rheumatischer Erkrankung durch Vorselektion in der Früharthritissprechstunde

The diagnosis and treatment of inflammatory rheumatic diseases can be delayed by a long waiting period for an appointment with a rheumatologist. This study investigated whether preselection of patients in an early arthritis clinic is a suitable tool to improve this situation. In 2006 an early arthritis clinic was founded by the Collaborating Center of Rheumatology in Halle (Saale). General practitioners refer patients by using a special registration form that helps to identify patients with an early joint swelling or inflammatory back pain. Patients are then allocated to a pool of participating rheumatologists and are seen by one of them within 2 weeks. For our scientific evaluation the data of 248 patients from the early arthritis clinic and data of 187 regular patients were gathered by means of an additional questionnaire for rheumatologists and patients. In the early arthritis clinic 40.3?% of patients received the diagnosis of an inflammatory rheumatic disease compared with 19.3?% in the control group. In the latter group 51?% were diagnosed as having degenerative joint or spine disorders compared with 22?% in patients from the early arthritis clinic; however, 61?% of patients who were referred to the early arthritis clinic did not fulfill the criteria of the registration form. On the other hand, patients in this group fulfilling these criteria had an inflammatory rheumatic disease in 68.1?% of the cases. The mean duration of symptoms at the time of first rheumatological consultation was significantly shorter in the early arthritis clinic than in the control group (6 vs. 39 months). Our data demonstrate that the preselection of patients can serve as a useful instrument to guide the referral of patients to rheumatologists. The high percentage of patients who did not fulfil the criteria of the registration form indicates that a further improvement of this form is necessary and stresses the need for intensive communication between rheumatologists and general practitioners. Early arthritis clinics may be an alternative to the current efforts of the legislative authorities to improve specialist care by centralized distribution of specialist appointments.     

Rheumatologie – Integration in die studentische Ausbildung (RISA)

The German Society of Rheumatology and the Committee for Student Training investigated what effects the structures in university medicine have on student teaching. In February 2014 a questionnaire was sent to the teaching staff and Deans of each of the 37 medical faculties. Of the locations seven were classified as being independent rheumatological university hospitals and nine universities had a W2/W3/C3 grade professor as head of a department of clinical rheumatology but answerable to superiors. In the 37 faculties in Germany the proportion of lecture hours, the proportion of obligatory lecture hours, the number of hours for practical exercises and the number of hours for bedside teaching were distributed very differently and as a rule higher in universities with academic freedom. Not all medical faculties have obligatory teaching in the field of clinical rheumatology. On average medical students see five patients with rheumatological symptoms during their studies. In summary, over the past years it has not been possible to successfully utilize the great importance of rheumatology for society and the innovation potential of this discipline in order to improve the integration of clinical rheumatology into universities.     

Gunshot-related transport of micro-organisms from the skin of the entrance region into the bullet path

The skin defect of a gunshot entrance wound is caused by the retrograde and anterograde displacement of skin particles. In the present study, we investigated whether gunshots to bacterially contaminated skin are associated with the transport of micro-organisms into the bullet path. The shots were fired into composite models of pig skin and gelatin blocks. The outer surface of the skin was covered with a thin layer of a defined bacterial suspension [green fluorescent protein-labelled Escherichia coli in the preliminary test and Staphylococcus epidermidis, DSM 1798, in the main test series]. After the bacterially contaminated fluid had dried, test shots were fired from a distance of 5 and 10 m using calibre .38 Special cartridges with different bullet types (round nose, truncated cone, hollow point and flat nose). Subsequent bacteriological analyses showed that all the bullet tracks in the gelatin serving as tissue simulant contained displaced micro-organisms from the skin surface. The results are presented and discussed with reference to the transport of skin particles into the depth of the wound track.     

Gebrauchsnutzen moderner Hörsysteme

Background

In the face of the rapid development of hearing aid system technology it is helpful to regularly study the user benefit of the current generation.

Test persons and methods

To contribute to the question on how the user benefit of current hearing aids compares with the benefit of the previous generation of hearing aids, a multicentre study was carried out in cooperation with 79 hearing aid acoustics companies in Germany. The user benefit of modern hearing aids in everyday life was assessed by asking end users to participate in a survey by completing a questionnaire. The questionnaire consisted of 20 items, 10 of which were taken from validated international inventories (SSQ: Speech, Spatial and Qualities of Hearing scale, IOI-HA: International Outcome Inventory for Hearing Aids) and the other 10 were formulated particularly for this purpose.

Results

A total of 664 usable questionnaires were returned whereby 421 responders were first time users and 243 responders were previous hearing aid users. The results of the present study showed that modern hearing aid system technology provides significant extra benefits at the 5 % level relative to the previous generation of hearing aids for all variables tested in this study.

Conclusions

Even though the amount of gain in terms of user benefit may be overestimated due to well-known placebo effects, an obvious net effect was evident. Correlations between the level of hearing aid benefit and possible influencing factors, such as age, gender, subjects own hearing aid, duration of use or hearing loss, could not be identified.     

Säuglingsernährung und Ernährung der stillenden Mutter

Network

The network Healthy Start – Young Family Network is a project from IN FORM – German national initiative to promote healthy diets and physical activity. In this nationwide network medical and scientific societies, professional organizations, and professionally oriented institutions combined together to accompany and support parents through pregnancy and birth by providing information on nutrition and allergy prevention.

Recommendations

The recommendations of various relevant professional organizations and institutions were compiled, discussed among the members of scientific advisory board of the network and formulated into standardized key messages (recommendations for actions). These recommendations were distributed to young families in the form of application-oriented messages for everyday life and as an integral part of disseminator training in the form of background information. They include key messages on breastfeeding, infant formula, baby foods, drinks (complementary fluids intake), nutritional supplements, nutrition for breastfeeding mothers, stimulants while breastfeeding, medication and food supplements while breastfeeding as well as advice on non-nutrition and non-smoking related allergies in children.     

Y90-Radioembolization of Lung Metastases via the Bronchial Artery: A Report of 2 Cases

We report successful Y90-radioembolization of the lung applying Y90-resin microspheres via the bronchial artery in two patients with diffuse colorectal and renal cancer metastases, respectively. The deposition of radioactive Y90-resin-microspheres was technically feasible and resulted in a reasonable absorbed dose in the tumors. However, open questions remain regarding dosimetry and safe dose exposure to the lung. The technique warrants thorough investigation before clinical use. A Phase I trial to evaluate safety and preliminary efficacy is under preparation.     

Diagnosis of focal liver lesions suspected of metastases by diffusion-weighted imaging (DWI): systematic comparison favors free-breathing technique

Two echo planar imaging diffusion-weighted imaging (DWI) techniques [one breath hold (DWI_bh), repetition time/echo time (TR/TE) 2100/62 ms; one at free breathing (DWI_fb), TR/TE 2000/65 ms] were compared regarding diagnosis of focal liver lesions (FLLs) in 45 patients with suspected liver metastasis without prior treatment. Apparent diffusion coefficient values of 46 benign and 67 malignant FLLs were analyzed by receiver operating characteristics (ROC) analysis. DWI_fb detected more malignant lesions than DWI_bh (P=.002). Lesion size ≤10 mm was associated with FLLs missed by DWI_bh (P=.018). Area under the ROC curve of DWI_fb (0.801) was higher compared to that of DWI_bh (0.669, P<.0113), demonstrating the diagnostic superiority of DWI_fb.