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Haeckel R.,Bremer Zentrum For Laboratoriumsmedizin | Wosniok W.,University of Bremen | Streichert T.,Universitatsklinik Cologne
Clinical Chemistry and Laboratory Medicine | Year: 2015

The organizers of the first EFLM Strategic Conference "Defining analytical performance goals" identified three models for defining analytical performance goals in laboratory medicine. Whereas the highest level of model 1 (outcome studies) is difficult to implement, the other levels are more or less based on subjective opinions of experts, with models 2 (based on biological variation) and 3 (defined by the state-of-the-art) being more objective. A working group of the German Society of Clinical Chemistry and Laboratory Medicine (DGKL) proposes a combination of models 2 and 3 to overcome some disadvantages inherent to both models. In the new model, the permissible imprecision is not defined as a constant proportion of biological variation but by a non-linear relationship between permissible analytical and biological variation. Furthermore, the permissible imprecision is referred to the target quantity value. The biological variation is derived from the reference interval, if appropriate, after logarithmic transformation of the reference limits. © 2015 by De Gruyter.


Luers J.-C.,Universitatsklinik Cologne | Huttenbrink K.-B.,Universitatsklinik Cologne
HNO | Year: 2013

A dehiscence of the superior semicircular canal is associated with many middle and inner ear symptoms of varying specificity. Concerning the pathophysiology, the way in which these symptoms are connected to a postulated missing bony layer of the superior semicircular canal remains to be completely clarified. In particular, it is unclear why a bony dehiscence might induce symptoms at all; as shown by recent experimental investigations, the natural in vivo coverage of the superior semicircular canal by dura, cerebrospinal fluid and brain prevents changes in inner ear impedance. Diagnosis of superior semicircular canal dehiscence is currently based on a combination of different tests. While cranial computed tomography (with its limited visual resolution) has proven to be largely unsuitable, ocular vestibular-evoked myogenic potentials (oVEMP) are considered an important component of diagnosis. In addition to symptomatic treatment, isolated cases also present the option of highly invasive surgical intervention. Although the majority of published case reports document positive clinical outcomes for operated patients, these procedures are associated with considerable perioperative risks. © 2013 Springer-Verlag Berlin Heidelberg.


Koch K.,Institute For Qualitat Und Wirtschaftlichkeit Im Gesundheitswesen | Miksch A.,Universitatsklinikum Heidelberg | Joos S.,Universitatsklinikum Heidelberg | Schurmann C.,Institute For Qualitat Und Wirtschaftlichkeit Im Gesundheitswesen | Sawicki P.T.,Universitatsklinik Cologne
Deutsches Arzteblatt | Year: 2011

Background: In 2009, the U.S. Commonwealth Fund conducted a survey of primary care physicians in a number of different countries to determine their views on aspects of their daily work and their perceptions of their countries' health care systems as a whole. A similar survey had been carried out in 2006. Methods: From February to July 2009, the survey was carried out by interview in representative samples of primary care physicians, general practitioners, internists providing primary care, and pediatricians in 11 countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the UK, and the USA. Results: A total of 10 320 interviews were conducted. Only in the Netherlands and Norway did most respondents (60% and 56%, respectively) consider their health care system to be functioning well. Everywhere else, many of the respondents - in particular, 82% of the respondents in Germany - saw a fundamental need for change. 73% of the German physicians stated that recent changes in the health care system had brought about a decline in the quality of care. In all countries but Germany, the percentage of respondents sharing this opinion was 41% at the highest. Nevertheless, most of the German physicians had a positive opinion of the patient care that they themselves delivered. Conclusion: The 2009 survey, like its predecessor in 2006, revealed major differences in physicians' perceptions of their health care systems from one country to another. The German respondents' dissatisfaction with, and negative evaluation of, their health care system as a whole contrast with their positive views of their own patient care.


Malter M.,Universitatsklinik Cologne | Fink G.R.,Universitatsklinik Cologne
Fortschritte der Neurologie Psychiatrie | Year: 2016

The identification of an antibody-associated autoimmune encephalitis underlying diverse syndromes, typically comprising epileptic seizures and neuropsychiatric symptoms, and their favorable prognosis, when treated with immunotherapies, is one of the success stories in neurology in recent years. Here we review current widely used therapy regimens in antibody-associated autoimmune encephalitis and the prognosis of the different antibody-associated sub-forms. The main therapeutic instruments encompass tumor therapy (if tumor is detected) and immunotherapies, though recommendations are mainly based on retrospective data analysis. The primary therapeutic goal is complete remission. The degree to which this can be accomplished depends upon the different sub-forms. © Georg Thieme Verlag KG Stuttgart, New York.


Aim: This review evaluates which conclusions can be drawn for the clinical daily routine in operative treatment of distal radius fractures, regarding the published biomechanical studies concerning implant systems within the last 10 years. Method: After identification of 21 articles about biomechanical studies of implant systems for the treatment of distal radius fractures from a literature search, these articles were analysed concerning the specimens, the fracture model as well as the implants used. The quintessence was reviewed with regard to their clinical relevance. Results: All tested palmar angular stable plate systems showed sufficient stiffness for holding the load transmission from the hand to the forearm also within active fist closure. There was no advantage of palmar angular stable plates concerning stiffness compared to dorsal angular stable plates. Angular stable plates are superior over non-angular stable plates in treatment of distal radius extension fractures. Locking screws should be preferred over locking pegs. Subchondrally placed screws have a higher stability than more proximal localised screws. When palmar plates with 2 rows of distal screw holes are used, the highest stability can be achieved by filling all screw holes. However using 2 screws in each row is sufficient. Conclusion: There were clinically relevant implications from the published biomechanical studies concerning implant systems for treatment of distal radius fractures in the last 10 years and their considerations provide a safer therapy of distal radius fractures. These are to be respected accordingly. © 2012 Georg Thieme Verlag KG Stuttgart New York.


Schroder W.,Universitatsklinik Cologne | Krones C.J.,Marienhospital Aachen
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2012

The radical economisation of the German healthcare system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex dailywork schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion. © Georg Thieme Verlag KG Stuttgart · New York.


The aim of this article is to present the most relevant musculoskeletal complications known to be associated with being overweight or obese in childhood and adolescence in order to help the clinicians and physiotherapists in the diagnostic and management of these patients. Various musculoskeletal problems like slipped capital femoral epiphysis and Blount disease are well-known complications. More recent studies describe the effects of overweight on musculoskeletal pain and controversial influences on fracture rates. Reduced physical activity is a contributing factor in obesity, but also effects bone mineral accrual. Reduced postural stability and increased falls may be the reason for increased fracture rates. Furthermore these data show relevant changes of locomotion studied by gait analysis. Longitudinal kinematic studies may be needed to understand the entire aspect of gait development in overweight children. Obesity is still a serious health problem and has a relevant impact on the development of a child's musculoskeletal system. Obesity affects the locomotor sytem both functionally and structurally. Future studies are necessary to help us better understand the pathophysiology and development of optimal therapeutic strategies. © 2013 Springer-Verlag Berlin Heidelberg.


Keller C.,Universitatsklinik Cologne | Meister I.G.,Universitatsklinik Cologne
Journal of Clinical Neuroscience | Year: 2014

Sigmund Exner postulated in 1881 that lesions of the base of the medial frontal gyrus could specifically produce writing impairments and attributed the writing centre to this area. We report two patients who suffered from strokes in this area. These patients suffered from writing disturbances comprising both omitted words within a sentence or badly written words, as well as aphasia. These patients, in line with prior reports, illustrate the crucial role of the Exner area at the base of the medial frontal gyrus for the cerebral writing network; we suggest that this region plays an important role for phoneme-grapheme conversions. © 2013 Elsevier Ltd. All rights reserved.


Muller H.,Universitatsklinik Cologne | Wiessmann T.,Universitatsklinik Cologne | Bechdolf A.,Universitatsklinik Cologne
Fortschritte der Neurologie · Psychiatrie | Year: 2012

Early and valid detection of the psychosis risk syndrome, and indicated prevention aim at preventing, delaying or ameliorating frank psychosis, improving current symptoms as well as emerging psychosocial disability. In a systematic literature search we identified seven completed randomised controlled trials of interventions for individuals at high risk of developing first episode psychosis. These studies evaluated antipsychotics, neuroprotective agents, cognitive behavioural and integrated treatment approaches. All trials reported advantages for specific interventions as compared to the respective control conditions (although not significant in each of the studies), which proved to be significant in the first meta-analysis of the studies. However, the current results do not allow recommendations for any specific treatment. Therefore, interventions should be thoroughly reviewed based on their risk/benefit ratio. The level of individual clinical risk, assumed benefits and side effects of interventions are critical determinants for these considerations. Future research is needed with sufficiently powered, methodologically sound replication studies, which are designed to explore differential efficacy of the interventions. © Georg Thieme Verlag KG Stuttgart.


Healthcare reforms and new legislations have a significant impact on patient care. New and more complex treatment designs and technologies are a great challenge for allied healthcare professionals. There is a growing demand for qualified allied healthcare professionals to increase productivity and to perform complex therapeutic regimens. Since recruitment of specialized healthcare workers is difficult, the University Hospital of Cologne arranges various training programs for allied healthcare staff. We provide more than 500 apprenticeship positions, 225 for nurses. Currently, 216 nursing students have been enrolled; thus, we have reached a 96 % capacity and could again improve last year's results. Some of our graduates continue their career in an academic course of study at university or a university of applied science. In this way nursing management loses qualified and dedicated employees at the bedside. In order to offer attractive alternatives to an academic course, it is important to complement basic education with advanced training and specialization. Traditional in-house education, basic as well as advanced training, is still the primary means to recruit qualified healthcare workers. Nursing management, therefore, still relies on this important strategic instrument for the recruitment and retention of staff. © 2013 Springer-Verlag Berlin Heidelberg.

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