Hamburg, Germany
Hamburg, Germany

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Hoffmeister U.,University of Ulm | Molz E.,University of Ulm | Bullinger M.,Universitatsklinikum Hamburg Eppendorf | Van Egmond-Frohlich A.,SMZ Ost Donauspital | And 7 more authors.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011

Aim: Different providers of obesity treatment in children and adolescents in Germany were compared using the following criteria: outpatient/inpatient; with/without AGA certification; good/less good quality. Methods: A total of 1,916 patients (8-16.9 years) from 48 study centers were examined before (t0), after (t1), and at least 1 year after therapy (t2/3). Body mass index (BMI), blood pressure, blood lipids, and psychosocial data were measured. Results: Patients from inpatient rehabilitation centers were older and more obese. Patients from AGA-certified centers were more obese, and the completeness of comorbidity screening was higher. There were no differences in short- or long-term BMI reduction. "Good" treatment centers (classified after the UKE study 2004) did not differ from those centers not rated as "good" in weight reduction. Patients treated in "good" centers were more obese, and screening for comorbidity was better. No differences in drop out and loss to follow-up were found. Conclusion: There were only small differences between the different groups. Pronounced differences were found between the individual treatment centers. In order to improve therapy processes and outcomes, benchmarking and quality management have to be extended. © 2011 Springer Medizin Verlag.


Hoffmeister U.,University of Ulm | Bullinger M.,Universitatsklinikum Hamburg Eppendorf | Van Egmond-Frohlich A.,SMZ Ost Donauspital | Goldapp C.,Bundeszentrale fur Gesundheitliche Aufklarung | And 6 more authors.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011

Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables. A total of 1,916 children aged 8-16 years from 48 (5 rehabilitation, 43 outpatient) institutions were examined. Data were collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1), and 1 year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was -0.27 and 1 year later at t2 was -0.23 (per protocol analysis; intention to treat: t1=-0.24; t2=-0.06). Psychological health and quality of life, which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations and in the weight reduction accomplished. © 2010 Springer Medizin Verlag.


Greunig D.,Stabstelle Organisation und Strategische Unternehmensentwicklung | Jurgens C.,Berufsgenossenschaftliches Unfallkrankenhaus Hamburg | Oppermann S.,Fakultat Life Science
Notfall und Rettungsmedizin | Year: 2013

Background. In case of a mass casualty event, emergency services bear the primary responsibility for decontaminating patients. Over the course of many emergencies, we have learned that not all patients stay at the site of a disaster. They try to reach the nearest known medical facility by themselves or with the help of others. Even in CBRN (chemical, biological, radiological, and nuclear) situations they might not wait for the arrival of the rescue services. All hospitals must, therefore, be prepared for such events. They must have facilities for decontaminating and treating patients after such events in order to protect their staff and the hospital itself. This article describes the equipment needed, knowledge necessary, and steps to be taken, considering cost pressures and decreases in personnel in German hospitals. Every hospital should be able to admit patients in the wake of a CBRN incident. The questions that need answering are the following: What kind of preparation is most expedient? Materials and methods. At an emergency hospital, a decontamination site was established and run using only standard hospital equipment and 9 members of the hospital staff without prior education on decontamination. Following registration with three different materials (identification wristband, hanging badge, felt-tip pen mark on the back of the hand), 25 persons were sprinkled with one invisible surrogate contaminant (fluorescine) and one visible surrogate contaminant (flour). Decontamination was performed using water, common hospital soap, and sponges. The decontamination performance was assessed using both normal light and black light. Subsequent to the exercise every staff member and every proband was asked, via questionnaire, to judge the decontamination process and its effects on personnel and probands. Results. The setup of the decontamination unit by untrained staff members revealed no problems; the unit was operative within 18 min. The decontamination of all probands took 90 min. Successful decontamination of the visible contaminant was observed on 61.5% of the probands, and of the invisible contaminant on 26.9% of the probands. The capacity of our decontamination unit determined by a standard formula was less than estimated, due to a bottleneck at the arrival facility. The strain on the staff members using NBC-protective suits was noncritical; however, the limited communication with team members and patients was criticized. Only the hanging badges for registration were suitable for sufficient decontamination and safe identification. Conclusions. No special knowledge is necessary to develop a predesigned hospital decontamination unit using normal hospital materials and gear and untrained personnel. Nine people are sufficient to run the unit. They need some special education to perform adequate decontamination. Improved communication technology is required. Prior to calculating a given hospital's capacity for treating the victims of contamination, an evaluation of the decontamination process and its specific limitations at that hospital is required. Only the hanging badges for registration allowed sufficient decontamination and safe identification. © Springer-Verlag 2013.


Ueberle F.,Fakultat Life science | Dettmann E.,Fakultat Life science | Eden C.,Fakultat Life science | Jayakumar J.,Fakultat Life science | And 6 more authors.
Biomedizinische Technik | Year: 2012

Magnetic Resonance Imaging (MRI) could be of high importance for imaging the foetal heart, especially to diagnose anomalies of the heart and the great vessels. While in the imaging of adult hearts MR triggering can be done through Electro-Cardiogram (ECG) or finger pulse oximetry (POX), these methods cannot apply because the foetus lies within the uterus. The aim of this project was to demonstrate the feasibility of non-invasive triggering of the MR by the foetal heart beat using Doppler Ultrasound. An artefact-free Doppler transducer was used to pick up the heart motion signals. An algorithm was developed which allowed triggering of the MR system. In an animal study, successful imaging of the foetal sheep heart was performed on 9 pregnant ewes at a 1.5T scanner. With dedicated software, MR cine sequences of the foetal heart beat and standard two- and four chamber images of the structures of the hearts of 124 days old foetuses could be recorded with a good resolution. © 2012 by Walter de Gruyter Berlin Boston.


Kording F.,University of Hamburg | Yamamura J.,University of Hamburg | Much C.,University of Hamburg | Adam G.,University of Hamburg | And 3 more authors.
Biomedizinische Technik | Year: 2013

The aim was to investigate the feasibility to perform cardiac magnetic resonance imaging (MRI) using a MR compatible Doppler-ultrasound (US) device as a new method to trigger the human heart cycle. MRI images were compared between ECG and Dopplerultrasound triggered examination in terms of image quality by an objective measure of acutance and functional assessment. © 2013 by Walter de Gruyter.


Hamm M.,Fakultat Life science | Konig D.,Medizinische Universitatsklinik Freiburg
Ernahrungs Umschau | Year: 2012

If sport is performed regularly, it is necessary to put a focus on dietary behaviour in order to maintain health and performance. The following points are particularly important. For optimal energy requirements in sports, at least 50 % of energy should be provided by carbohydrates. For endurance sport, 60-65 % carbohydrate may be needed. Particularly for endurance sport lasting more than an hour, carbohydrate intake during the competition is desirable. To optimise glycogen resynthesis, carbohydrates of intermediate to high glycaemic index should be taken immediately after the end of the exercise, for up to 4 hours. Fat intake should not be more than 35 % of the total calorie intake; fat is not a limiting factor for physical performance. For sports involving strength or endurance type of exercise, the recommended protein intake of 1.2-1.7 g/kg body weight/day provides enough protein for regeneration and reforming muscle. If endurance sport lasts for at least one hour, fluid should be taken every 15-20 min. 0.8 I fluid per hour is accepted in endurance sport. The drink should be weakly hypotonic to isotonic. Supplementation with high doses of antioxidative vitamins does not improve muscular performance. It can be assumed that balanced and fully adequate nutrition guarantees the intake of vitamin levels which are needed for optimisation of plasma concentrations.


Richter V.,University of Leipzig | Richter V.,Arbeitskreis Omega 3 E.V. | Hamm M.,Fakultat Life science | Hamm M.,Arbeitskreis Omega 3 E.V.
Perfusion (Germany) | Year: 2012

Inflammatory processes play a central role in the development of atherosclerosis. Various families of lipid mediators derived from long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosapentae-noic acid (DHA) were recently identified to function as pro-resolving mediators. These locally acting mediators include resolvins, protectins and marensins. They act via specific receptors activating pro-resolving programmes on several target cells. Because the progression of chronic inflammatory diseases could be connected with impaired resolution processes, pro-resolving lipid mediators, generated from EPA and DHA, may have beneficial roles in prevention of atherosclerosis. One of the possibilities of facilitating the biosynthesis of omega-3 fatty acid derived from pro-resolving lipid mediators is by supplementation with EPA and DHA. Therefore, intake of long-chain fatty acids is important for health both on population basis and in subjects with increased cardiovascular risk. © Verlag PERFUSION GmbH.


Ueberle F.,Fakultat Life science | Rad A.J.,Fakultat Life science
Biomedizinische Technik | Year: 2012

Ballistic pressure pulse sources are used for the treatment of soft tissue pain. The devices use a technical principle, which is known from air guns, i.e. a projectile is accelerated by pressurized air towards a metal plate (applicator). At the patient side, a fast (4.5μs), almost singular pressure pulse of 2..10 MPa is created, which is followed by an equally short rarefaction phase of about the same amplitude. In order to characterize the pressure pulse devices, a "dry" test bench was built mimicking the properties of the patient skin by a silicone layer. Comparison of measurements in water and with the silicone layer demonstrated, that the pressure pulses could be reproduced almost identical in both situations. At present, 4 different hand pieces were evaluated using the "dry" test bench. The behaviour of the hand pieces when the pulse repeat rate was changed from single pulse to maximum rate (20.21 per second) was assessed. It turned out, that the pulse amplitudes and intensities depend strongly on the type of hand piece, and on the driving pressure. A decrease of peak pressure down to 63% was found at a pulse rate of 20 Hz as compared to single pulse amplitude at the same driving pressure. Further measurements show, that a strongly damped, low amplitude inertial oscillation of ca. 10 ms period follows after each pressure pulse. © 2012 by Walter de Gruyter Berlin Boston.


Rad A.J.,Fakultat Life science | Ueberle F.,Fakultat Life science
Biomedizinische Technik | Year: 2012

Several approaches for simulating ultrasound are available. The main tools are Finite or Boundary element methods and the spatial impulse response methods. Finite and Boundary Element methods are the most flexible but also the most computationally expensive tools available. On the other hand the spatial impulse response is restricted only to linear acoustic problem, but with low computational demands and prime costs. While with diagnostic ultrasound it's mostly sufficient to confine the equations on linear acoustics, this simplification is not possible with therapeutic ultrasound. High pressure amplitudes of therapeutic ultrasound transducers create strong nonlinear effects in the medium, which cannot be simulated using linear acoustic theory. We compare two types of optical hydrophones developed for pressure pulse measurements, the fiber-optic-hydrophone and the light-spot-hydrophone. Both are based on reflection changes of a laser beam due to the medium density modulation by a sound wave at the sensitive end of the device. The aim of our work is to compare the measurement of a Panametrics NDT Transducer with simulations using ABAQUS FEM Software. © 2012 by Walter de Gruyter Berlin Boston.


Schutte M.,Fakultat Life science | Brune F.,Referat IV.1 Strategische Fuhrung und Leitung | Kalff D.,Referat IV.1 Strategische Fuhrung und Leitung | Jansch A.,Fakultat Life science
Notfall und Rettungsmedizin | Year: 2016

Background: Skills training for mass casualty incidents (MCI) shows a lack of reliable and valid assessment criteria; therefore, feedback about incident management is based either on expert judgment or self-reflection by participants. A questionnaire was developed as a means to support the tactical appraisal of MCI training and to close the methodological gap. Material and methods: In this study four groups of emergency medical response personnel (N = 86) carried out three MCI scenarios and rated the incident management by the use of Likert scale items. Scale construction relied on exploratory factor analysis (EFA). Multiple item (Likert) scales were tested with respect to reliability by internal consistency measures. The diagnostic potential of the scales was analyzed by exploratory mean (scale values) comparisons. Results: The EFA revealed a model with three factors labelled resource allocation, goal orientation and stress management. The multiple item (Likert) scales showed satisfactory reliability for group comparisons based on scale values. Subsequent exploratory analysis of differences between scenarios and tactical interventions demonstrated the diagnostic potential of the scales. Conclusion: The new questionnaire can be used in the context of training debriefing and research. The scales have convincing psychometric properties; however, research into the effectiveness of the tactical dimensions is still required. © 2015, Springer-Verlag Berlin Heidelberg.

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