Eberlein-Gonska M.,Universitatsklinikum Carl Gustav Carus Dresden
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011
Quality management has become more important due to the growing pressure for change within the healthcare sector. Responsible for this are driving forces that include not only competition and legislation, but also society. Therefore, quality management has developed especially in the direction of structural organization, process orientation, and professionalism. However, there is a lack of information concerning the scientific, evidence-based evaluation of activities, measures, and projects. Current studies and data are not able to answer questions concerning a strong correlation between quality management activities and treatment effects, and the influence on the whole system remains open. The reason for this is the complexity of the different dynamic factors influencing the benefit assessment. Single investigations can only indicate specific aspects of the multifaceted term quality analysis. There is a high demand for scientific and proven methods as well as for the understanding that scientifically established answers can only be given to well-defined and specific questions. © Springer-Verlag 2011.
Middeke J.M.,Universitatsklinikum Carl Gustav Carus Dresden
Leukemia | Year: 2015
In patients with relapsed or refractory (r/r) acute myeloid leukemia (AML), long-term disease control can only be achieved by allogeneic hematopoietic stem cell transplantation (HSCT). We studied the safety and efficacy of clofarabine-based salvage therapy. The study was designed as phase II, multicenter, intent-to-transplant (ITT) study. A total of 84 patients with r/r AML were enrolled. All patients received at least one cycle of CLARA (clofarabine 30 mg/m2 and cytarabine 1 g/m2, days 1–5). Chemo-responsive patients with a donor received HSCT in aplasia after first CLARA. Generally, HSCT was performed as soon as possible. The conditioning regimen consisted of clofarabine (4 × 30 mg/m2) and melphalan (140 mg/m2). The median patient age was 61 years (range 40–75). On day 15 after start of CLARA, 26% of patients were in a morphologically leukemia-free state and 79% exposed a reduction in bone marrow blasts. Overall, 67% of the patients received HSCT within the trial. The primary end point, defined as complete remission after HSCT, was achieved by 60% of the patients. According to the ITT, overall survival at 2 years was 43% (95% confidence interval (CI), 32–54%). The 2-year disease-free survival for transplanted patients was 52% (95% CI, 40–69%). Clofarabine-based salvage therapy combined with allogeneic HSCT in aplasia shows promising results in patients with r/r AML.Leukemia advance online publication, 11 September 2015; doi:10.1038/leu.2015.226. © 2015 Macmillan Publishers Limited
de With K.,Universitatsklinikum Carl Gustav Carus Dresden
Internist | Year: 2015
Because the development of resistance is steadily increasing, especially among Gram-negative pathogens and new developments in antibiotics are lacking, a rational antibiotic therapy is necessary now more than ever. A continuing uncritical and non-guideline-conform use of antibiotics leads to selection of multidrug-resistant pathogens, which can colonize patients and as instigators of infections make treatment more difficult. A prerequisite for targeted antibiotic therapy is a critical testing of the suspected infection diagnosis based on a guideline-conform microbiological preanalytical procedure. To promote a guideline-conform antibiotic therapy in hospitals with respect to choice of substance, dosage and duration, in December 2013 so-called antibiotic stewardship (ABS) measures were summarized in a so-called S3-guideline from the Association of the Scientific Medical Societies in Germany (AWMF) under the auspices of the German Society for Infectious Diseases (DGI). With a strategy of targeted antibiotic therapy and infection prevention it is possible to achieve optimum treatment results and to minimize the development of resistance. © 2015, Springer-Verlag Berlin Heidelberg.
Schellong J.,Universitatsklinikum Carl Gustav Carus Dresden
Public Health Forum | Year: 2015
In psychotraumatology, the terms "resilience" and "resources" have a predictive as well as a therapeutic meaning. Not everyone affected by a potentially traumatizing event develops a psychic post-traumatic stress disorder. Nature and extent of traumatization, as well as individual reactions and one's prior experiences, influence whether and how someone will be affected. Positive factors prevent the occurrence of a disorder. Personal and psychosocial resources improve coping possibilities even after onset of the condition. There is great prevention potential in the cooperation between the public and general health care system, and trauma specific counseling and treatment services. Interdisciplinary networking can remove the taboo, sensitize the public and break the affected person's isolation as well as give support when coping with mental impairments. © 2015 by De Gruyter.
Reichmann H.,Universitatsklinikum Carl Gustav Carus Dresden
Psychopharmakotherapie | Year: 2015
Safinamide offers an new option in the treatment of Parkinson's disease (PD). In contrast to other PD medication safinamide holds a dual mode of action, i.e., it has both a dopaminergic and an anti-glutamatergic effect. Safinamide is a selective and reversible MAO-B inhibitor and regulates use-dependently the glutamatergic system. In three international pivotal studies, which are discussed in this overview, safinamide has shown significant efficacy with respect to motor function and some signal to decrease dyskinesia, as well. The tolerability is extremely good. Solely, patients with major liver insufficiency should not receive safinamide. No specific monitoring is necessary. Safinamide should be applied once daily in the morning in a dose of 100 mg.
Venus H.,Universitatsklinikum Carl Gustav Carus Dresden
Quintessence international (Berlin, Germany : 1985) | Year: 2011
To compare the dimensional changes of two autopolymerising denture base resins using three different processing techniques. Sixty edentulous denture bases were made from the polymethylmethacrylates FuturaGen and PalaXpress. Ten bases were made from each resin using a manual injection technique (MI), a pneumatic injection technique (PI), and the fluid resin technique (F). Posterior palatal gap widths between casts and denture bases were measured. For an additional three-dimensional examination of occlusal changes, 10 maxillary dentures were made using FuturaGen/MI and 10 using PalaXpress/PI. Intermolar widths and changes in vertical dimension were determined. In all groups, measurements were taken after polymerization, after removal and repositioning, after polishing, and after storage in water for 1 and 3 weeks. Data were analyzed by using two-way ANOVA and Tukey test (P < .05). There were no differences in dimensional changes of FuturaGen and PalaXpress specimens. The pneumatic injection system produced significantly smaller posterior palatal gaps after storage in water for 3 weeks compared to the manual injection system (P < .0005) and the fluid resin technique (P = .003). The posterior gaps of dentures were 0.04 mm and below the recommended depth for carving a posterior palatal seal (0.4 to 3.0 mm). The processing technique rather than the choice of the two resins seems to be the dominate variable with respect to dimensional changes.
Kasten P.,Universitatsklinikum Carl Gustav Carus Dresden |
Lutzner J.,Universitatsklinikum Carl Gustav Carus Dresden
Deutsche Zeitschrift fur Sportmedizin | Year: 2010
Tendinopathies of the shoulder are a common complaint especially in overhead and throwing athletes. Risk factors are repetitive movements, dysbalances of the muscles, bony deformities of the acromion and instabilities of the shoulder. Tendinopathies are characterized by tendon degeneration with or without inflammation and later on by (partial-) tendon ruptures. Common sites of these changes are the areas close to the bony insertion sites because of their reduced blood perfusion. Stress shielding might play a role in the development of tendinopathy, as degenerative changes often occur in those areas with low strains. Clinical examination shows pain at the tendon insertion, mainly during isometric exercises, and pain projection to the humeral insertion of the deltoid muscle and to the dorsal capsule. A tendon rupture can be detected by loss of force. Magnetic resonance imaging helps identifying the pathology. Intraarticular application of contrast media increases the sensitivity and accuracy for the diagnosis of partial tendon ruptures. An intact tendon should be treated non-operatively with anti-inflammatory drugs and by treating the cause of the pathology, e.g. muscle dysbalances. For the treatment of an acromial impingement, besides functional training and training of proprioception, the humeral depressors (infraspinatus and subscapularis muscles) should be exercised, and for internal impingement, the shortened parts of the force couple have to be stretched. Symptomatic ruptures with failed conservative therapy should be treated surgically after exact evaluation of the type and extent of the rupture. Operative treatment is usually indicated for partial ruptures of more than 50%.
Trumm C.G.,Ludwig Maximilians University of Munich |
Stahl R.,Ludwig Maximilians University of Munich |
Clevert D.-A.,Ludwig Maximilians University of Munich |
Herzog P.,Klinikum Dachau |
And 6 more authors.
Investigative Radiology | Year: 2013
OBJECTIVES: The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. MATERIALS AND METHODS: This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. RESULTS: Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. CONCLUSIONS: With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials. Copyright © 2013 Lippincott Williams & Wilkins.
Dexel J.,Universitatsklinikum Carl Gustav Carus Dresden |
Kasten P.,Universitatsklinikum Carl Gustav Carus Dresden
Obere Extremitat | Year: 2013
Indications for elbow arthroscopy include diagnostic arthroscopy, removal of loose bodies and osteophytes, synovectomy, treatment of osteochondrosis dissecans and capsular release in case of contracture. In particular, the anatomic vicinity of the neurovascular structures to the portals requires a thorough knowledge of elbow anatomy and some experience with the procedure. The exact positioning of the patient, identification of the landmarks and knowledge of the correct portal placement are necessary to perform a safe and effective operation and to avoid complications. The overall complication rate is higher as compared to knee- or shoulder arthroscopy with minor complications predominating. Nerve lesions are transient most of the time; however, being permanent they cause substantial problems for the patient. Overall, elbow arthroscopy has become a safe and reliable procedure for the diagnosis and therapy of elbow disorders. © 2013 Springer-Verlag Berlin Heidelberg.
Kasten P.,Universitatsklinikum Carl Gustav Carus Dresden
Obere Extremitat | Year: 2011
Arthrocopic repair of rotator cuff ruptures has become a standard procedure in shoulder surgery. This review article compares the outcome of the arthroscopic technique to the (mini-) open technique. The reviewed papers do not show a clear superiority of one or the other technique: both allow for good to excellent outcomes depending on the preoperative tear size and muscle degeneration. Nevertheless, mastering the arthroscopic technique enables the surgeon to treat partial ruptures and other intraarticular lesions minimally invasively, which may have benefits over the open technique. © 2011 Springer.