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Wehmeier M.,Institute For Laboratoriumsmedizin
Klinikarzt | Year: 2012

Breath tests are valuable diagnostic tools. They base on breath gas analysis, are easy to perform, non- invasive und usually comfortable. In the diagnosis of Helicobacter pylori or lactose intolerance breath tests are clinically established and regulary used. In the last years new tests coming up with promising results. The application is for both in- patient and out- patient. This article presents the current breath tests with indication, options and limitations. Source

Hand disinfection with alcoholic solutions is pivotal for infection control. This method is well accepted, effective and frequently conducted. Burn injuries in conjunction with hand disinfection is rare and usually caused by negligence, vandalism or in conjuction with suicide attempts. We report a case of severe burns related to hand disinfection in a microbial laboratory in a hospital. The fire inquest showed correct performance of the technician. The cause of the accident was electrostatic sparking caused by an outdated air handling unit in combination with typical laboratory garment. This accident in a microbial laboratory illustrates the necessity of adequate humidification in air handling units in hospitals. Source

Diagnostic pathways in the field of laboratory medicine could contribute economically to integrate modern .,disease management" from the perspective of healthcare policy into a complex development with limited resources. The objective is to bridge the gap between medical and economic demand. Diagnostic pathways could be an innovative way to optimize processes in medicine with the objective of transparency of costs, results and performance, especially if technical prerequisites for web-based communication (i.e., order entry, digitized laboratory analyzed findings) are given. The precondition is that laboratory diagnostics must be appreciated as a core procedure of a hospital. Furthermore, diagnostic pathways provide the opportunity to define processes concerning disease severity and rate of resource usage. The pathways support the physician by finding the probable or medically worthwhile primary and secondary diagnosis for coding the DRG (Diagnoses Related Groups). This results in guaranteeing revenues and an increase in the quality of therapy. The very visualization of medical decisions by diagnostic pathways results in the reduction of ill-conceived activities and consequently in an improvement of health economics. © 2011 by Walter de Gruyter Berlin Boston. Source

Ambrosch A.,Institute For Laboratoriumsmedizin
Chirurg | Year: 2016

Mediastinitis occurs as a severe complication of thoracic and cardiac surgical interventions and is the result of traumatic esophageal perforation, conducted infections or as a result of lymphogenic and hematogenic spread of specific infective pathogens. Treatment must as a rule be accompanied by antibiotics, whereby knowledge of the spectrum of pathogens depending on the pathogenesis is indispensable for successful antibiotic therapy. Polymicrobial infections with a high proportion of anaerobes are found in conducted infections of the mediastinum and after esophageal perforation. After cardiac surgery Staphylococci are the dominant pathogens and a nasal colonization with Staphylococcus aureus seems to be a predisposing risk factor. Fungi are the predominant pathogens in immunocompromised patients with consumptive underlying illnesses and can cause acute or chronic forms with granulomatous inflammation. Resistant pathogens are increasingly being found in high-risk patient cohorts, which must be considered for a calculated therapy. For calculated antibiotic therapy the administration of broad spectrum antibiotics, mostly beta-lactams alone or combined with metronidazole is the therapy of choice for both Gram-positive and Gram-negative bacteria inclusive of anaerobes. For patients at risk, additional antibiotic classes with a spectrum against methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) can be administered. Increasing rates of multidrug-resistant Gram-negative bacteria (e.g. Enterobacteriaceae) and non-fermenting bacteria (e.g. Pseudomonas and Acinetobacter) in individual cases necessitates the use of polymyxins (e.g. colistin), new tetracyclines (e.g. glycylglycines) and newly developed combinations of beta-lactams and beta-lactam inhibitors. For treatment of fungal infections (e.g. Candida, Aspergillus and Histoplasma) established and novel azoles, amphotericin B and echinocandins seem to be successful; however, detection of Candida, particularly in mixed infections does not always necessitate treatment. Mediastinitis is still a severe infectious disease with a high mortality, which necessitates an early and broad spectrum antibiotic therapy; however, with respect to optimal duration of therapy and selection of antibiotics, data from good quality comparative studies are lacking. © 2016, Springer-Verlag Berlin Heidelberg. Source

Orth M.,Institute For Laboratoriumsmedizin
Clinical Chemistry and Laboratory Medicine | Year: 2015

Performance criteria should be a challenge for the laboratories to improve their quality. In countries with mandatory proficiency testing, the definition of performance criteria is a particular issue. If the definition of performance criteria is mandated from the regulatory bodies to medico-scientific institutions, scientific approaches (i.e., based on biological variation), the state-of-the-art approach (i.e., based on technical feasibility) as well as medical needs can be used to set up performance criteria such as the Richtlinie der Bundesärztekammer (RiliBÄK; Guideline of the German Medical Association on Quality Assurance in Medical Laboratory Examinations) in Germany. The experiences with RiliBÄK show that these performance criteria have to be revised on an ongoing basis. © 2015 by De Gruyter. Source

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