Search

In 2013, the forum gesundheitsziele. de selected "reduction of alcohol consumption" and "patient safety" as new health targets. Besides the two selected targets, three other topics were considered: health at work, health during pregnancy and childbirth, and health and migration. This paper describes the selection process, which followed several criteria: mortality, morbidity, prevalence, burden of disease, economic impact, potential for improvement, equity in health, empowerment of and priorities of health problems in the population. The analysis particularly focused on the assessment of the feasibility and the readiness of stakeholders to participate in the development and implementation of health targets.

Die Wurzelspitzenresektion an Molaren ist eine etablierte Technik zur chirurgischen Zahnerhaltung, die gute Resultate erwarten lasst. In unserem Klientel (insgesamt 1314 Falle) beobachteten wir nach zwei Jahren bei 1019 Resektionen an Molaren eine Erfolgsquote von 85,5%. Indikation, Vorgehensweise, mogliche Komplikationen sowie alternative Verfahren werden diskutiert.

Die Laterodysgnathie ist eine Sonderform der skelettalen Dysgnathie, die sich durch eine Asymmetrie des Gesichtsschadels auszeichnet. Bei der chirurgischen Korrektur kommen die Verfahren der Umstellungsosteotomien zur Anwendung. Zusatzliche Masnahmen zur Verbesserung der auseren Kontur und der Okklusion sind moglich. Je nach Auspragung der Dysgnathie werden die Eingriffe in abgestufter Form durchgefuhrt. Insbesondere bei Defiziten im Weichgewebe konnen Restasymmetrien verbleiben. Vier klinische Falle werden hier vorgestellt.

Fragestellung. Die Klimatisierung der Narkosegase wird in erheblichem Mas vom Frischgasfluss beeinflusst und ist bei Durchfuhrung von Niedrigflussnarkosen besser als bei hohem Flow. Feuchte und Warme der Gase werden daruber hinaus aber auch von den Warmeverlusten und entsprechender Wasserkondensation in den Atemschlauchen beeinflusst, die ihrerseits vom technischen Design und den Materialeigenschaften der Atemschlauche abhangen. Mit dieser prospektiven Studie sollte untersucht werden, 1. inwiefern bei Durchfuhrung von Niedrigflussnarkosen die Klimatisierung der Narkosegase im klinischen Routinebterieb durch das technische Design der Schlauchsysteme beeinflusst wird. Des weiteren sollte 2. untersucht werden, ob bei Einsatz des Schlauchsystems, mit dem optimale Klimatisierungseffekte erreicht werden, diese sich auch bei Erhohung der Frischgasflows noch realisieren lassen. Methodik. Drei unterschiedliche Schlauchsysteme, das konventionelle Doppelschlauchsystem, ein koaxiales Schlauchsystem und ein Doppelschlauchsystem mit beheizten Schlauchen wurden bei der Durchfuhrung von Minimal-flow-Anasthesien mit einem Frischgasfluss von 0,5 l/min an einem Drager Cicero EM Narkosegerat eingesetzt. Die Atemgastemperatur und die absolute Feuchte im Inspirationsschenkel des jeweiligen Schlauchsystems wurden sowohl Atemsystem- als auch tubuskonnektornah gemessen. Die besten Klimatisierungseffekte wurden bei Einsatz der beheizten Schlauche erreicht. Mit diesem Schlauchsystem wurden deshalb weitere Messungen der inspiratorischen Atemgasfeuchte und -warme mit Frischgasflows von 1,0, 2,0 und 4,4 l/min durchgefuhrt. Die Messungen in allen Gruppen erfolgten wahrend der Durchfuhrung von Inhalationsnarkosen von zumindest 45 min Dauer an jeweils acht Arbeitstagen. Ergebnisse. Bei der Durchfuhrung von Minimal-flow-Narkosen wurden gleichermasen wahrend des Ablaufs der Arbeitstage mit allen Schlauchsystemen tubuskonnektornah Feuchtewerte zwischen 17 und 30 mgH2O/l erreicht. Nur wahrend der ersten Narkosen zu Beginn der Arbeitstage wurde eine kurze zeitliche Verzogerung von 15 bis 30 min bis zum Erreichen einer Feuchte von zumindest 17 mgH2O/l beobachtet. Bei Einsatz der beheizten Schlauchsysteme wurden gehauft auch Feuchtewerte uber 30 mgH2O/l gemessen. Die tubuskonnektornah gemessenen Atemgastemperaturen waren bei Einsatz des konventionellen und des koaxialen Schlauchsystems wahrend der Durchfuhrung von Minmal-flow-Narkosen mit Werten zwischen 23 und 30°C in einem akzeptablen Bereich. Bei Einsatz der beheizten Schlauche aber waren die inspiratorischen Atemgastemperaturen mit Werten zwischen 28 bis 32 °C deutlich hoher und nahezu optimal. Wahrend der Durchfuhrung von Minimal-flow-Narkosen waren somit bei Einsatz beheizter Schlauchsysteme die beste Klimatisierung der Atemgase zu erreichen. Mit diesem Atemsystem wurden deshalb weitere Messreihen mit zunehmenden Frischgasflows von 1,0, 2,0 und 4,4 l/min durchgefuhrt. Wahrend bei einem Frischgasfluss von 1,0 l/min die Atemgasklimatisierung weiterhin optimal ist, fallt bei weiterer Steigerung des Frischgasflows auf 2,0 l/min die Feuchte drastisch auf Werte unter 17 mgH2O/l, bei einem Flow von 4,4 l/min sogar auf Werte um nur 10 mgH2O/l ab. Dagegen erwiesen sich die Atemgastemperaturen bei Einsatz beheizter Schlauche als weitestgehend flowunabhangig und lagen immer, auch bei einem Flow von 4,4 l/min, um 28–32°C. Schlussfolgerungen. Mit konventionellen und koaxialen Schlauchsystemen wird bei der Durchfuhrung von Minimal-flow-Anasthesien eine zwar nicht optimale, aber ausreichende Atemgasklimatisierung erreicht. Der Einsatz koaxialer Systeme scheint im Vergleich zum konventionellen Doppelschlauchsystem nur bei langdauernden Narkosen zu einer weiteren Verbesserung der Klimatisierung zu fuhren. Wahrend des klinischen Routinebetriebs sind beide Systeme bezuglich der Klimatisierungseffekte als gleichwertig anzusehen. Bei Einsatz beheizter Schlauche ist unter den Bedingungen der Minimal-flow-Anasthesie die Klimatisierung der Atemgase deutlich besser als bei Einsatz konventioneller oder koaxialer Schlauchsysteme. Es werden nicht nur ausreichende, sondern gar optimale Feuchte- und Warmewerte erreicht. Diese optimale Klimatisierung wird aber nur bei Durchfuhrung von Niedrigflussverfahren realisiert, dann also, wenn der Frischgasflow nicht groser als 1 l/min ist. Bei hoheren Frischgasflows nimmt die Feuchte der Atemgase drastisch ab, wahrend die Atemgastemperaturen hoch bleiben. Es ist anzunehmen, dass die Beatmung mit warmem und trockenem Atemgas zu verstarkter Austrocknung des Atemwegsepithels der unteren Atemwege fuhrt. Beheizte Schlauche sollten deshalb nur bei Durchfuhrung von Niedrigflussnarkosen eingesetzt werden. Wahrend die Feuchte der Atemgase im wesentlichen von der Frischgasflussrate bestimmt wird, hangt die Atemgastemperatur im wesentlichen vom Warmeverlust am Inspirationsschenkel des Patientenschlauchsystems ab.

In 2013, the forum gesundheitsziele.de selected "reduction of alcohol consumption" and "patient safety" as new health targets. Besides the two selected targets, three other topics were considered: health at work, health during pregnancy and childbirth, and health and migration. This paper describes the selection process, which followed several criteria: mortality, morbidity, prevalence, burden of disease, economic impact, potential for improvement, equity in health, empowerment of and priorities of health problems in the population. The analysis particularly focused on the assessment of the feasibility and the readiness of stakeholders to participate in the development and implementation of health targets.

Measurement devices that support CO2 breath tests on an intensive care unit should a) monitor the δ13C release curve over time for reliable data interpretation b) provide results right after sampling and c) be small and easy to handle. NDIR technology could satisfy these requirements, but is sensitive to changes in the sample O2 and CO2 content, which might occur for intensive care patients. These interferences, due to pressure broadening in the hyperfine spectrum, were corrected by a calibration method, where measured δ13C values are expressed as basal value + slope x δ13C(sample), where basal value and slope were confined to depend on the O2 and CO2 interferences. These functions were determined by fitting measured δ13C values to the corresponding model pre-dictions, with sufficient agreement between both. The slope function turned out to be linear in the interferences and the basal value function nonlinear. The calibration samples, necessary for their characterization can be generated starting from a few, user provided samples, using a machine-built-in gas mixing system. Hence, the combined \(^{12}{\rm CO}_2\) and O2 impact can be corrected by an on-site calibration method and NDIR technology can be used for bed-side monitoring in an ICU. It paves the way for clinically and economically relevant 13C-breath tests like those for gastric emptying or drug/drug interactions.

During general anaesthesia gas climate significantly is improved by performance of low flow techniques. Gas climatisation, however, markedly also will be influenced by the temperature loss at, and corresponding water condensation within the hoses, factors which are related to the technical design and material of the patient hose system. The objective of this prospective study was to investigate 1. how anaesthetic gas climatisation during minimal flow anaesthesia is influenced by the technical design of different breathing hose systems in clinical practice. 2. to investigate, whether a sufficient gas climatisation also can be gained with higher fresh gas flows if that hose system is used, proven beforehand to optimally warming and humidifying the anaesthetic gases.Three different systems, a conventional two-limb hosing consisting of smooth silicone hoses, a coaxial hosing, and a hosing consisting of actively heated breathing hoses, attached to a Dräger Cicero EM anaesthesia machine, were used during minimal flow anaesthesia with a fresh gas flow of 0.5 l/min. Gas temperature and absolute humidity were measured at the tapered connection between the inspiratory limb and the breathing system as well as at its connection to the endotracheal tube. The best gas climatisation was observed if heated breathing hoses were used. Thus, using this hosing, additionally gas temperature and humidity in the inspiratory limb were taken at fresh gas flow rates of 1.0, 2.0 and 4.4 l/min respectively. Measurements were performed in all groups at all general anaesthesias lasting at least 45 minutes during the lists of eight different days each.In minimal flow anaesthesia, with all hose systems likewise, generally an absolute humidity between 17 to 30 mgH2O/l is reached at the endotracheal tube's connector during the course of the list. Only in the first cases of the day there was a short delay of 15 to 30 minutes before reaching a humidity of at least 17 mgH2O/l. Only with heated hoses, however, humidity frequently even exceeded 30 mgH2O/l. If conventional or coaxial hosings were used, during minimal flow anaesthesia gas temperatures in an acceptable range between 23 to 30 degrees C were measured at the tube connector. With heated hoses, however, warming of the gases was excellent with gas temperatures between 28 to 32 degrees C. In minimal flow anaesthesia climatisation of the anaesthetic gases proved to be best if heated hoses were used. Thus, using heated hose systems another three trials with increasing fresh gas flow rates of 1.0, 2.0 and 4.4 l/min respectively were performed. Whereas climatisation of the anaesthetic gases still was found to be optimal with a fresh gas flow of 1.0 l/min, the humidity dropped drastically to values lower than 17 mgH2O/l at 2.0 l/min and even down to 10 mgH2O/l at a flow rate of 4.4 l/min. Gas temperatures, however, turned out to be independent of the flow and remained at 28-32 degrees C, even at a flow as high as 4.4 l/min.Using conventional hose systems and coaxial hosings acceptable, but not optimal climatisation of the anaesthetic gases can be gained if minimal flow anaesthesia is performed. The use of a coaxial hose system seems to lead to improved climatisation in long lasting procedures only. In routine clinical practice, however, conventional and coaxial hose systems are similar in respect to the climatisation of breathing gases. Heated breathing hoses performed markedly better in terms of climatisation of the breathing gas than the coaxial and the conventional hose system. With this hosing not only sufficient but optimal moisture and temperature values are realized. Optimal climatisation, however, only can be gained if low flow anesthetic techniques with fresh gas flows equal or less than 1 l/min are performed. With higher fresh gas flow rates the humidity decreases markedly while high gas temperatures are maintained. (ABSTRACT TRUNCATED)

A multicentric, randomized, placebo-controlled double-blind study on ginkgo biloba special extract EGb 761 (Tebonin forte) in patients suffering from peripheral occlusive arterial disease (POAD) in Fontaine stage II b was carried out in order to prove its clinical efficacy in this indication according to guidelines of European Community authorities and the German Angiological Society and to confirm the results of former clinical studies with EGb 761.In total, 111 patients with angiographically proven POAD in Fontaine stage II b and intermittent claudication (pain-free walking distance150 m on the treadmill) were recruited in 5 centers and treated with either EGb 761 or placebo at a daily dose of 3 times 1 film-coated tablet over a duration of 24 weeks following a 2-week placebo run-in period. The primary response variable was the difference of the pain-free walking distance between the start of treatment and after 8, 16 and 24 weeks as measured on the treadmill (walking speed 3 km/h and slope of 12%) under standardized conditions.At the start of the treatment period, the mean pain-free walking distances were very similar with 108.5 m in the EGb 761 group and 105.2 m in the placebo group. At the end of the treatment period these values increased to 153.2 m and 126.6 m, respectively. The group differences were statistically significant at all three control visits with p = 0.017, p = 0.007, and p = 0.016. The differences for the maximum walking distance and the relative increases of the pain-free walking distance and the maximum distance were also significantly higher in the EGb 761 group with p-values0.05 each. In both groups Doppler indices remained nearly unchanged during therapy. The subjective assessment of the patients demonstrated an amelioration of complaints in both groups. Tolerability was very good with no adverse events under EGb 761 and one case of heartburn and gastric pain in the placebo group.It can be concluded from the results of this study that treatment with EGb 761 in POAD patients with Fontaine stage II b is very safe and causes a significant and therapeutically relevant prolongation of the patients' walking distance.

This monocenter, randomized, placebo-controlled double-blind study with parallel-group comparison was carried out in order to demonstrate the efficacy of Ginkgo biloba special extract EGb 761 on objective and subjective parameters of the walking performance in trained patients suffering from peripheral arterial occlusive disease in Fontaine stage IIb. In total 60 patients were recruited (42 men; aged 47-82 years) with angiographically proven peripheral arterial occlusive disease of the lower extremities and an intermittent claudication existing for at least 6 months. No improvement had been shown despite consistent walking training and a maximum pain-free walking distance on the treadmill of less than 150 m was recorded at the beginning of the study. The therapeutic groups were treated with either Ginkgo biloba special extract EGb 761 at a dose of 3 times 1 film-coated tablet of 40 mg per day by oral route or placebo over a duration of 24 weeks following a two-week placebo run-in phase. The main outcome measure was the difference of the walking distance between the start of treatment and after 8, 16 and 24 weeks of treatment as measured on the treadmill (walking speed 3 km/h and slope of 12%). As secondary parameters the corresponding differences for the maximum walking distance, the relative increase of the pain-free walking distance, the Doppler index and the subjective evaluation of the patients were analyzed. The absolute changes in the pain-free walking distance in treatment weeks 8, 16 and 24 as against the treatment beginning (median values with 95% confidence interval) led to the following values for the patients treated with Ginkgo biloba special extract EGb 761:19 m (14, 33), 34 m (18, 50) and 41 m (26, 64). The corresponding values in the placebo group were as follows: 7 m (-4, 12), 12 m (5, 22) and 8 m (-1, 21). The advantage of the EGb 761-treated group as compared to the placebo group could be verified statistically at the 3 time points with p0.0001, p = 0.0003 and p0.0001. The test for the presence of a clinically relevant difference of 20% between EGb 761 and placebo also produced a statistically significant result (p = 0.008). The Doppler index remained unchanged in both therapeutic groups: A corresponding statistically significant advantage for the EGb 761 group was observed on a descriptive level for the other parameters tested. The tolerance of the treatment was very good. The results of this placebo-controlled study show that treatment with Ginkgo biloba special extract EGb 761 produces a statistically highly significant and clinically relevant improvement of the walking performance in trained patients suffering from intermittent claudication with very good tolerance of the study preparation.

In der Norm „Grundbegriffe der Mestechnik“ [6] wird Messen als ein experimenteller Vorgang definiert. Bei diesem experimentellen Vorgang wird ein Wert einer meist physikalischen Grose ermittelt, und zwar als Vielfaches einer Einheit oder eines Bezugswerts. Zur Durchfuhrung einer Messung, zur Aufnahme eines Meswerts ist in aller Regel eine Meseinrichtung erforderlich, die sich als ein System, bestehend aus den folgenden Komponenten, darstellen last: — Meswertaufnehmer, — Auswertungseinheit, — Meswertausgabe.

The safe and reliable application of transcutaneous sensors requires their construction and fabrication to be embedded in a system of external regulation and internal rules.

Using a partially automatized form analysis of the electrocardiogramme a methodology of the quantitative determination of parameters of the ST-segment is described. The introduction of an index, the surface integral of the ST-segment referred of function shows a good correspondence with the decrease of the ST-segment under exercise. In subdivision into three possible norm regions the integral is used as a suitable additional parameter for the ascertainment and the coordination of the diagnosis latent ischaemic heart disease.

The integration of an ECG-electrode into a common transcutaneous sensor allows simple handling and leads to a reduction of the physiological stress of pre-term infants. Furthermore it may allow future replacement of an invasive method to measure the ECG under labour by a non-invasive one.