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Halle (Saale), Germany

Achenbach S.,Universitatsklinikum Giessen und Marburg GmbH | Szardien S.,Kerckhoff Klinik | Gielen S.,Universitatsklinikum Halle | Hamm C.W.,Universitatsklinikum Giessen und Marburg GmbH
Kardiologe | Year: 2012

Non-ST-elevation acute coronary syndromes (NSTE-ACS) comprise a wide spectrum of disease severities and mortality risks. Next to establishing the diagnosis, clinical management therefore also requires risk stratification in order to adequately select the intensity and urgency of further work-up and treatment. In September 2011 updated recommendations for the management of patients with NSTE-ACS were published by the European Society of Cardiology. Major innovations included the use of highly sensitive troponin assays, including the resulting possibility of establishing a fast-track protocol, the routine recommendation of echocardiography in all patients and the introduction of coronary computed tomography (CT) angiography as a possibility to rule out coronary disease in selected individuals. The importance of risk stratification is emphasized throughout the document and routine use of the GRACE risk score as well as the CRUSADE bleeding risk score is encouraged. The recommendations reflect the availability of new antithrombotic agents and new timelines for invasive work-up are introduced. This comment in German summarizes the ESC guidelines and highlights relevant amendments as compared to the previous version. © Deutsche Gesellschaft für Kardiologie -Herz- und Kreislaufforschung e.V.Published by Springer-Verlag -all rights reserved 2012.

The shoulder joint and shoulder girdle are affected by numerous internal disorders. Heart diseases, but also pleurisy and diseases of the gall bladder and the biliary tract may manifest themselves by pain projected into the shoulder region. The shoulder joint is also affected by diseases that lead to an impairment of cartilage and bone metabolism, and also by disorders that come along with the deposition of pathological substances such as amyloid and hydroxy-apatite. The latter phenomena are characteristic for chronic kidney diseases. © Georg Thieme Verlag KG Stuttgart New York.

Simm A.,Universitatsklinikum Halle
Deutsche Medizinische Wochenschrift | Year: 2011

Geriatrics is in comparison to the other medical professions a relatively new discipline. The calendarical age is not suitable for the characterization of its patient population, the multimorbid old patients. The biofunctional age in terms of the ICF is a better choice. It is characterized in part by physical, psychical, and social context-factors, which can be analysed by geriatric assessments. A better cooperation between basic science orientated gerontological disciplines with the geriatrics will be, beside the implementation into the university medicine and the standardized uniform professional training, of essential importance for the further development of geriatric medicine. © Georg Thieme Verlag KG - Stuttgart - New York.

Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only. © 2010 Springer-Verlag.

The standardized training of practical competences in skills labs is relatively new among German Medical Faculties. The broad acceptance and outstanding evaluation results do not provide objective data on the efficiency and cost-efficiency of these trainings. This study aims on the quantification of the teaching effect of the surgical scrubbing technique EN1500 and its comparison with clinical references of OR personnel. Methods: 161 4(th) year medical students were randomized into intervention and control group. The intervention group received a 45 minute standardized peer-teaching training of practical competences necessary in the OR including the scrubbing according to EN1500. Fluorescence dye was mixed in the disinfectant solution. After hand disinfection, standardized fotographs and semi-automated digital processing resulted in quantification of the insufficiently covered hand area. These results were compared with the control group that received the training after the test. In order to provide information on the achieved clinical competence level, the results were compared with the two clinical reference groups. Results: The intervention group remained with 4,99% (SD 2,34) insufficiently covered hand area after the training compared to the control group 7,33% (SD 3,91), p<0,01. There was no significant difference between control group and reference groups: surgeons 9,32% (SD 4,97), scrub nurses 8,46% (SD 4,66). The student intervention group showed results that were significantly better than the clinical references. The methodic mistake remained negligible. In the sub-group analysis, the students with low or medium experience in surgical scrubbing and hand disinfection derived highest benefit from the training, whereas students with no or high experience did benefit less. All participants showed better results on hand palms compared to back of hand areas. Discussion: A single standardized peer-teaching of surgical scrubbing and hand disinfection according to EN1500 is sufficient to improve the measurable coverage of hand area and reduce the disinfection gap by 1/3. In absolute measures, the competence level of experienced surgeons and scrub nurses is achieved or even exceeded.

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