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The choice of anesthesia procedure for surgical interventions in pregnancy is particularly important considering the responsibility for the unborn child and the patient. Uncertainties with the treatment of this patient group and lacking routine are common. Nevertheless, 0.5-2% of pregnant women require non-gynecological surgery. In this respect knowledge about the interrelationship between physiological changes and pharmacological effects with potentially negative impact for the embryo, fetus or neonate is of particular importance. In this article the physiology relevant for anesthesia during pregnancy is discussed and commonly used drugs are reviewed to enable anesthesiologists to formulate concepts to preclude adverse effects for the mother and child and to provide an adequate therapy. © 2010 Springer-Verlag.

Schwarz P.E.,Universitatsklinikum Carl Gustav Carus
Diabetologe | Year: 2013

The aims of diabetes prevention are reduction of visceral obesity at the physiological level, the implementation of prevention managers at the structural level and realization of measures for primary prevention of diabetes in the daily routine at the conceptual level. The IMAGE toolkit for diabetes prevention is one of the products of a European study group of the IMAGE project. It is based on IMAGE evidence-based guidelines and the IMAGE training curriculum for prevention managers. It includes practical examples and worksheets which substantially facilitate the implementation of a prevention program and can be directly transferred from the toolkit. After a European curriculum for prevention managers was developed within the framework of the IMAGE project, it could be implemented in Germany over the previous 2 years and intensively evaluated. Since the beginning of 2013 a German curriculum for the further training to prevention manager is available and can currently be appreciated in Dresden. Various healthcare insurances rely on this model and intend to increase the use of preventive measures by the linking of prevention and healthcare treatment. The check-up 35+ can be such a measure. This article reports on these and other elements of prevention. © 2013 Springer-Verlag Berlin Heidelberg.

Rollig C.,Universitatsklinikum Carl Gustav Carus
Urologe - Ausgabe A | Year: 2011

Current limitations in health services research (HRS) in Germany are caused by issues of research funding, interest-driven commissioning, and restricted research conditions due to the structural and organizational context of the German health system. Methodological challenges arise in the validation and generalizability of routine data. There are substantial risks of bias in non-controlled interventional studies. In order to overcome these limitations and to improve the standing and quality of HRS in Germany, political opinion leaders and stakeholders need to be provided with continuous information on the need and potential of HRS. Methodological standards are needed for the evaluation of routine data, and principles of evidence-based medicine must be applied in all research addressing the effectiveness of health care interventions. © 2011 Springer-Verlag.

The "medical nutrition therapy" in patients with type 2 diabetes mellitus is much more than providing energy and all essential nutrients. Considering the complex dysregulation of the glucose metabolism in patients with type 2 diabetes mellitus it rather is a valuable strategy to avoid uncontrolled blood glucose - besides the pharmacological treatment. Above all fiber intake may still be one of the most important approaches to smooth blood glucose curves and to delay gastric emptying. Additionally it is arguable, whether current recommendations on restricted fruit intake for patients with type 2 diabetes mellitus are still justified and whether this area may present a underutilised source for an increased intake of fibers, vitamins and phytochemicals. Micronutrient deficiencies are common in people with diabetes type 2 mellitus as well, which often is associated with the discussion about the benefits and risks of supplementation. Current studies related to the supplementation of chromium show how differentially the evaluation needs to be done in that case. © 2015, Georg Thieme Verlag. All rights reserved.

Zwipp H.,Universitatsklinikum Carl Gustav Carus
Trauma und Berufskrankheit | Year: 2010

Fractures of the talus, calcaneus and tarsal are associated with a significant reduction in earning capacity. Their diagnosis and therapy, therefore, are of particular importance. In order to avoid overlooking these injuries, well-lit and standardised X-rays in three defined planes are required; in the case of even slight doubt, thin-slice computer tomography in two planes is necessary. Talus fractures are anatomically set, central talus fractures are treated using stable screw fixation, while peripheral fractures are treated using mini-screw fixation. Calcaneus fractures are treated using anatomical and stable surgical internal fixation, while second and third degree open fractures can often only be covered using free flaps. Tarsal fractures of the Chopart and Lisfranc joints remain today the most frequently overlooked or insufficiently treated foot fractures. They usually require an open procedure with anatomic repositioning and fixation; in the case of multiple fractures, anatomic and angle-stable titanium implants are required. © Springer Medizin Verlag 2009.

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