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Cough persisting beyond 8 weeks (ie, chronic cough) is one of the most common reasons for an outpatient visit. A protracted cough can negatively affect one's quality of life by causing anxiety, physical discomfort, social isolation, and personal embarrassment. Herein, the anatomy and physiology of the cough reflex are reviewed. Upper airway cough syndrome, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease account for most chronic cough after excluding smoking, angiotensin-converting enzyme inhibitor use, and chronic bronchitis. Many patients have more than one reason for chronic cough. Treating the underlying cause(s) resolves cough in most instances. There are some coughs that seem refractory despite an extensive work-up. The possibility of a hypersensitive cough reflex response has been proposed to explain these cases. Several clinical algorithms to evaluate chronic cough are presented.

Einleitung: Im Rahmen einer Beobachtungsstudie wurden Epidemiologie und notfallmedizinische Behandlung schwerer Verletzungen durch Brände untersucht. Methoden: (A) Differenzierte Auswertung der ausführlichen amtlichen Todesursachenstatistik [ref:1] (B) Tägliche Auswertung[for full text, please go to the a.m. URL], 31. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2013)

With competency based learning in a project driven environment, we are facing a different perspective of how students perceive mathematical modelling. In this chapter, a model is proposed where conventional education is seen as a process from mathematics to design, while competency driven approaches tend to have an inverted sequence. We assume there is a virtual barrier for on-demand learning with regards to the mathematical modelling layer under the layer of technical skills. Several successful attempts were done in the past to remove the technology skill from the chain in order to make the opportunities of modelling visible. After experiencing the modelling competency in such a setting, students can beneficially deploy it for technology. We evaluated this model based on a learning activity which was changed from traditional education into competency centred learning.

The long-term safety of patient-administered nebulized lidocaine for control of chronic cough has not been established.We performed a retrospective study of adults who received a prescription and nurse education for nebulized lidocaine for chronic cough between 2002 and 2007. A survey questionnaire inquiring about adverse reactions and the effectiveness of nebulized lidocaine was developed and administered to these individuals after the nebulized lidocaine trial. We conducted two mailings and a postmailing phone follow-up to nonresponders. When adverse events were reported in the questionnaire response, a structured phone interview was conducted to obtain additional details.Of 165 eligible patients, 99 (60%) responded to the survey. Responders were a median age of 62 years (range, 29-87 years); 77 (79%) were women, and 80 (82%) were white. The median duration of cough was 5 years before treatment with nebulized lidocaine. Of the patients who used nebulized lidocaine (93% of survey responders), 43% reported an adverse event. However, none of these events required an emergency visit, hospitalization, or antibiotic therapy for aspiration pneumonia. The mean (SD) of the pretreatment cough severity score was 8.4 (1.6) and posttreatment was 5.9 (3.4) (Plt; .001). Of the patients reporting improvement in cough symptoms (49%), 80% reported improvement within the first 2 weeks.Adults tolerated self-administration of nebulized lidocaine for difficult-to-control chronic cough. No serious adverse effects occurred while providing symptomatic control in 49% of patients.

To describe how the types of healthcare expenditures for patients with asthma have changed over the past decade.Cross-sectional comparison between individuals from 1996 to 1998 and 2004 to 2006.Expenditures among US individuals (aged 5 to 56 years) with asthma were compared using the 1996 to 1998 and the 2004 to 2006 Medical Expenditure Panel Surveys. Direct expenditures (medications, inpatient, outpatient, and emergency services) and changes in productivity (missed school and work days) were compared over this time frame. The adjusted analyses controlled for age, education level, race/ethnicity, gender, poverty, region, metropolitan statistical area, self-reported health, and Charlson Comorbidity Index.Mean annual per capita healthcare expenditures increased between 1996 to 1998 and 2004 to 2006 ($3802 vs $5322 inflated to 2010 US dollars, P.0001). Annual medication expenditures doubled from $974 to $2010 per person (P.0001) and outpatient visit expenditures increased from $861 to $1174 (P.0001) while hospitalization and emergency department (ED) visit expenditures were similar over the same time period. Missed school and work days decreased between the 2 periods (9.23 days in 1996-1998 vs 6.39 days in 2004-2006, P = .001).An increase in total direct expenditures in individuals with asthma was largely driven by an increase in spending on medications comparing 2004 to 2006 and 1996 to 1998 data. However, this increase was not offset by lower spending on hospitalization and ED visits.

This study tested the ability of an electronic prompt to promote an asthma assessment during primary care visits.We performed a prospective study of all eligible adult patients with previously diagnosed asthma in three geographically distinct ambulatory family medicine clinics within a 4-month period. The usual clinic visit process was performed at two geographically distinct control sites (n = 75 and n = 55 patients, respectively). The intervention group site (n = 64) had an electronic flag embedded in the Patient Check-in Locator field which prompted the distribution of a self-administered Asthma Management Questionnaire (AMQ) in the waiting room. The primary outcome measure was a documented asthma severity assessment.The front desk distributed the AMQ successfully in 100% of possible opportunities and the AMQ was completed by 84% of patients. Providers in the intervention group were significantly more likely than providers in the two non-intervention groups to document asthma severity in the medical record during a non-asthma ambulatory clinic visit (63.3% vs. 18.7% vs. 3.6%; p.001).The provision of standardized asthma information triggered by an electronic prompt at the time of check-in effectively initiates an asthma assessment during the primary care visits.

Fragestellung: Die Untersuchung der Relevanz eines Pancreastraumas beim schwerstverletzten Patienten wurde an einem grossen Kollektiv bisher nicht durchgeführt. Die hier dargestellte Untersuchung zeigt erstmalig die Prävalenz, den zurzeit durchgeführten Behandlungsstandard und das Out[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie; 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie

INSTRUCTIONS Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the instructions listed below: 1. Review the target audience, learning objectives and author disclosures. 2. Complete the pre-test online at www.jacionline.org (click on the Online CME heading). 3. Follow the online instructions to read the full version of the article, including the clinical vignette and review components. 4. Complete the post-test. At this time, you will have earned 1.00 AMA PRA Category 1 CME Credit . 5. Approximately 4 weeks later youwill receive an online assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive Part II MOC credit from the American Board of Allergy and Immunology.

Introduction: The quality of cold-stored livers slowly declines beyond approximately 8 hours of ischemia and the risk of primary dys- or non-function increases. Here provide in vivo evidence for the efficacy of the previously proposed end-ischemic gaseous oxygen persufflation to resuscitate large size[for full text, please go to the a.m. URL], 128. Kongress der Deutschen Gesellschaft für Chirurgie

Self-report is the most commonly used method for collecting information regarding asthma medication possession and adherence in clinical practice.To determine the agreement between self-report and pharmacy claims data for asthma medication possession.This is a retrospective study that examined pharmacy claims data 12 months before and after participants completed a structured asthma survey. This study was performed in a sample of health care workers and dependents17 years old in a large, self-insured Midwestern United States health care center. The main outcome measure was agreement (kappa calculation) between self-report and pharmacy claims data of asthma medication possession.Self-report of asthma medication use agreed moderately with pharmacy claims data for short-acting albuterol (κ=0.47 ± 0.03), salmeterol (κ=0.79 ± 0.04), and montelukast (κ=0.69 ± 0.03) but only slightly for inhaled corticosteroids (κ=0.18 ± 0.03) and prednisone (κ=0.10 ± 0.03) (n=1050 respondents). Both under self-reporting and over self-reporting were common with inhaled corticosteroids (14.4% and 23.1%, respectively) and varied significantly by specific drug type.Self-report moderately agrees with asthma medication possession for most adult asthma patients, though the agreement differs considerably between and within asthma medication classes.