610 Medizin und Gesundheit
The nature and treatment of diseases of the ear / by William Kramer. Transl. from the German, with the latest improvements of the author since the last German ed. by James Risdon Bennett
Bezirks-Eintheilung der Mitglieder / Aerzte-Verein der Berliner Rettungs-Gesellschaft
Quality assessment of expert answers to lay questions about cystic fibrosis from various language zones in Europe: the ECORN-CF project
Kris De Boeck
Thomas Otto Friedrich Wagner
Helge Uwe Hebestreit
- Background: The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1. develop a detailed quality assessment tool to analyze quality of expert answers, 2. evaluate the intra- and inter-rater agreement of this tool, and 3. explore changes in the quality of expert answers over the time frame of the project.
Methods: The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer.
Results: A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232+/-0.036, p<0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105+/-0.024, p<0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time.
Conclusions: The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within ECORN-CF, the tool will help ensure that CF patients all over Europe have equal possibility of access to high quality expert advice on their illness.
Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively: a case control study
James D. Rawn
Prem S. Shekar
Tobias Michael Bingold
Holger K. Eltzschig
Stanton K Shernan
- Introduction: Acute kidney injury (AKI) after cardiac surgery increases length of hospital stay and in-hospital mortality. A significant number of patients undergoing cardiac surgical procedures require perioperative intra-aortic balloon pump (IABP) support. Use of an IABP has been linked to an increased incidence of perioperative renal dysfunction and death. This might be due to dislodgement of atherosclerotic material in the descending thoracic aorta (DTA). Therefore, we retrospectively studied the correlation between DTA atheroma, AKI and in-hospital mortality.
Methods: A total of 454 patients were retrospectively matched to one of four groups: -IABP/-DTA atheroma, +IABP/-DTA atheroma, -IABP/+DTA atheroma, +IABP/+DTA atheroma. Patients were then matched according to presence/absence of DTA atheroma, presence/absence of IABP, performed surgical procedure, age, gender and left ventricular ejection fraction (LVEF). DTA atheroma was assessed through standard transesophageal echocardiography (TEE) imaging studies of the descending thoracic aorta.
Results: Basic patient characteristics, except for age and gender, did not differ between groups. Perioperative AKI in patients with -DTA atheroma/+IABP was 5.1% versus 1.7% in patients with -DTA atheroma/-IABP. In patients with +DTA atheroma/+IABP the incidence of AKI was 12.6% versus 5.1% in patients with +DTA atheroma/-IABP. In-hospital mortality in patients with +DTA atheroma/-IABP was 3.4% versus 8.4% with +DTA atheroma/+IABP. In patients with +DTA atheroma/+IABP in hospital mortality was 20.2% versus 6.4% with +DTA atheroma/-IABP. Multivariate logistic regression identified DTA atheroma > 1 mm (P = *0.002, odds ratio (OR) = 4.13, confidence interval (CI) = 1.66 to 10.30), as well as IABP support (P = *0.015, OR = 3.04, CI = 1.24 to 7.45) as independent predictors of perioperative AKI and increased in-hospital mortality. DTA atheroma in conjunction with IABP significantly increased the risk of developing acute kidney injury (P = 0.0016) and in-hospital mortality (P = 0.0001) when compared to control subjects without IABP and without DTA atheroma.
Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma.
L'apport de la médecine à la littérature : les médecins-écrivains
Daniel Wilhelm Triller und seine "Wahrhaft hippokratischen" Freunde (Boerhaave, Hoffmann, Mead, Morgagni) : Mit Verwertung unveröffentlichter Briefe aus dem Triller-Nachlaß
The life and work of Andreas Vesalius
- In the year 1725 Boerhaave and Albinus edited their monumental edition in two volumes of the anatomical and surgical works of Vesalius. The title-page runs as follows :- Andreae Vesalii Invictissimi Caroli V Impcratoris Medici Opera Omnia Anatomica & Chirurgica cura Hermanni Boerhaave Medicinac, Botanices, Collegii Practici, & Chemiae in Academia Lugduno-Batava Professoris & Bernhardi Siegfried Albini Anatomes & Chirurgiae in eadem Academia Professoris Lugduni Batavorum lVlDCCXXV. The pages that follow offer an English version of the Latin Preface of the two editors. The Preface is in itself of importance for the history of medicine, and is famous as a succinct, lively, and reliable account of the founder of modern anatomy. It is offered here as a prelude to translations from the writings of Vesalius himself.
Medicinalstatistik, sociale Medicin und Hygiene
Notes upon the emotionality of a schizophrenic patient and its relation to problems of technique
Kurt R. Eissler
- It seems justifiable to inquire into the specific factors which make the emotionality of a schizophrenic patient different from that of other patients and to investigate to what extent this specificity of schizophrenic emotionality might require specific changes in the psychoanalytic technique. Although I do not think that this paper can really live up to the full requirements of such an ambitious undertaking, it nevertheless may contribute modestly to it. My speculations began during a phase of the treatment of a schizophrenic patient; long after her acute condition had subsided I thought I observed-within clinically pertinent areas-a specific relationship between the patient's ego structure and her emotions. It seems to me that this relationship might allow generalization in terms of a basic defect with which a schizophrenic patient has to struggle, although in various phases of the disease and of the treatment the phenomenology of schizophrenic emotionality differs unquestionably in significant aspects. However, before delving into the subject matter, a few general points must be raised in reference to the psychoanalytic theory of emotions....
Synaptic boutons sizes are tuned to best fit their physiological performances
Markus M. Knodel
- Poster presentation: Twenty Second Annual Computational Neuroscience Meeting: CNS*2013. Paris, France. 13-18 July 2013.
To truly appreciate the myriad of events which relate synaptic function and vesicle dynamics, simulations should be done in a spatially realistic environment. This holds true in particular in order to explain as well the rather astonishing motor patterns which we observed within in vivo recordings which underlie peristaltic contractionsas well as the shape of the EPSPs at different forms of long-term stimulation, presented both here, at a well characterized synapse, the neuromuscular junction (NMJ) of the Drosophila larva (c.f. Figure 1). To this end, we have employed a reductionist approach and generated three dimensional models of single presynaptic boutons at the Drosophila larval NMJ. Vesicle dynamics are described by diffusion-like partial differential equations which are solved numerically on unstructured grids using the uG platform. In our model we varied parameters such as bouton-size, vesicle output probability (Po), stimulation frequency and number of synapses, to observe how altering these parameters effected bouton function. Hence we demonstrate that the morphologic and physiologic specialization maybe a convergent evolutionary adaptation to regulate the trade off between sustained, low output, and short term, high output, synaptic signals. There seems to be a biologically meaningful explanation for the co-existence of the two different bouton types as previously observed at the NMJ (characterized especially by the relation between size and Po), the assigning of two different tasks with respect to short- and long-time behaviour could allow for an optimized interplay of different synapse types. We can present astonishing similar results of experimental and simulation data which could be gained in particular without any data fitting, however based only on biophysical values which could be taken from different experimental results. As a side product, we demonstrate how advanced methods from numerical mathematics could help in future to resolve also other difficult experimental neurobiological issues.