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At least 649 records · Page 36Linked to original sources
PubMed2005

[Structure of an interdisciplinary pituitary outpatient care unit at the University Hospital of Leipzig and results for treatment of prolactin and growth hormone secreting pituitary tumors].

BACKGROUND: Treatment of patients with pituitary adenomas is complex and involves several medical specialties. At the Medical Center of the University of Leipzig, Germany, an interdisciplinary pituitary outpatient care unit has been established for 6 years. METHODS: The interdisciplinary collaboration and the outcome of patients with growth hormone-(GH-) and prolactin-secreting pituitary adenomas are described. Moreover, therapeutic strategies for patients with hormonally active pituitary adenomas are presented and discussed. RESULTS: In patients suffering from GH-producing adenomas, a remission could be achieved in 80% (microadenomas) and 40% (macroadenomas) of the cases, respectively. This is comparable to major published studies. Furthermore, prolactinomas decreased in size during treatment in at least 75% of all cases depending on the initial size of the lesion which is also comparable to data from other groups. CONCLUSION: Taken together, an interdisciplinary approach improves outcome and quality of care of patients with hormonally active pituitary adenomas.

Acromegaly↗
PubMed2004

["Meet the AIX-PERTs." Emergency medical care at the beginning of the medical reform curriculum in Aachen].

BACKGROUND: Extensive knowledge and skills in the basics of emergency medical care are of paramount importance for every physician and should therefore be an integral part of medical education. METHODS: Regulations for medical licensure in Germany were revised by the administrative authorities in 2002 and as a consequence the Medical Faculty of the University of Aachen (Germany) decided to start the Medical Reform Curriculum Aachen. A multidisciplinary, problem-oriented and organ-related approach to medical education replaces the classical discrimination between basic and clinical sciences. RESULTS: With AIX-PERT (AIX-la-Chapelle Program for Emergency medical care and Resuscitation Training), a program consisting of problem-based learning sessions was developed for introduction to the first year students. Defined teaching objectives in emergency medicine are now incorporated in undergraduate medical education. CONCLUSION: The extremely positive evaluation of the new approach encouraged us to promote AIX-PERT further. In the future the effects of success of this approach will be assessed by longitudinal studies of skills and knowledge during the continuing curriculum.

Cardiopulmonary Resuscitation↗
PubMed2005

[HNORAD].

BACKGROUND: New media are gaining importance in undergraduate as well as postgraduate and continued medical education. We aimed to create an interactive educational program for imaging diseases of the ear, nose and throat (ENT). MATERIALS AND METHODS: Cases and images representing clinical routine were collected, arranged by content and graphically presented according to instructional criteria. Undergraduate students participating in the project used an authoring system to generate case studies, which were then published at http://www.HNORAD.de. RESULTS: HNORAD is an interdisciplinary teaching program offering more than 100 classical disease presentations. Three systematic indices offer a choice of instructional approach. Apart from typical images, the information presented includes patient history, clinical findings, imaging findings as described by a board-qualified radiologist, diagnosis, differential diagnosis and internet links. Elements of the radiologist's report are linked with the images in such a way that the structure or finding described can be interactively highlighted. An evaluation index allows proficiency testing in self study and as a part of taught courses. CONCLUSION: HNORAD is a valuable resource for students, ENT surgeons and radiologists at the undergraduate, postgraduate and CME level for self study as well as for course work.

Computer-Assisted Instruction↗
PubMed2006

[Further development of urology in the tension field of surgical and molecular medicine].

Methods based on molecular biology and molecular medicine now have important practical applications in many areas of theoretical and clinical medicine, and it is no longer possible to imagine life without them. This means that in a largely surgical discipline, such as urology, completely new challenges are coming to the fore, which urology, as an academic and clinical discipline, now has to face up to, and to a much greater degree than hitherto. However, there is less and less freedom of action in any university department of urology, as a result not only of intensified legal outline conditions in the healthcare sector and tight public budgets, but also of faculty- and hospital-specific blocks to innovation. There is an urgent need for the creation of appropriate outline conditions and innovative structures that will allow efficient surgical care and also an efficient way of working scientifically.

Academies and Institutes↗
PubMed2002

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers.

OBJECTIVE: The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested. DESIGN AND SETTING: Prospective clinical study in two level 1 trauma centers. METHODS AND MATERIALS: MQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle. After implementation in Munich (1st period, n=90; 2nd period, n=77) the validation took place in Essen (1st period, n=175; 2nd period, n=150). RESULTS: Improvements in diagnostics were shown by significant time savings in radiological diagnostics and before computed tomography in severe traumatic brain injury. In patients with hemorrhagic shock there was a reduction in time before transfusion (49 to 14 min in Munich; 31 to 22 min in Essen) and before emergency operation (74 to 43 min in Munich; 69 to 45 min in Essen). The time before craniotomy was reduced from 97 to 67 min in Munich. The incidence of delayed diagnosis of life-threatening lesions was diminished from 6% to 3% in Munich (not found in Essen). The TRISS technique showed a reduction in mortality in both hospitals in the second period (Munich: 15.4% TRISS vs. 9.1% observed mortality; Essen: 17.8% vs. 11.3%). CONCLUSIONS: MQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals

Germany↗
PubMed2003

A collaborative model for research on decisional capacity and informed consent in older patients with schizophrenia: bioethics unit of a geriatric psychiatry intervention research center.

RATIONALE: The numbers of older persons with psychiatric disorders are expected to rise rapidly in coming decades, yet most studies of the safety and efficacy of treatments for such disorders have focused on younger adults. A substantial expansion in research involving older patients is needed to meet the treatment needs of this fast growing group. A critical issue in intervention research is ensuring a patient's decision-making capacity. Considerable heterogeneity exists in this regard even within diagnostic groups. Cognitive changes as well as increased complexity of medication regimens in elderly patients may make it particularly difficult for some older persons to fully understand, appreciate, and/or reason about the risks and benefits of participating in any particular study. OBJECTIVES: Empirical research into assessing and possibly improving decisional capacity is warranted in older people with severe mental illness. Such research may be accomplished through collaborations among specialists from various related disciplines and, importantly, with active involvement of community partners. METHODS: We present one model of this type of collaboration, the Bioethics Unit of an Intervention Research Center, comprising a multi-disciplinary team along with a Community Advisory Board. RESULTS: Preliminary studies in our Center suggest that older individuals with psychotic disorders vary considerably in their decisional capacity, and many subjects appear to be fully capable for consenting to research projects. Furthermore, the patients' level of understanding of the consent material can be improved significantly through repetition and clarification of key elements in the consent form. CONCLUSIONS: The decisional capacity for a given research protocol is not necessarily an unmodifiable trait, but can be enhanced with improvements in consenting procedures, even in older persons with psychotic disorders.

Advisory Committees↗
PubMed2003

Pharmacotherapeutic interventions by a multi-specialty team: opinions of the general practitioners and nurses.

OBJECTIVES: The objective of this study was to assess the opinions of the general practitioners (GPs) and nurses towards a previous pharmacotherapeutic intervention and their opinions towards future alternative or complementary methods to improve nursing-home patients' drug treatments. METHODS: Sixty-six GPs and forty-five nursing-home nurses, working at nursing homes in southern Sweden, were sent a questionnaire to assess their opinions towards a pharmacotherapeutic intervention conducted by a multi-specialty team and their opinions on alternative or complementary future methods potentially improving patient treatment. RESULTS: The response rate was 62% for the GPs and 69% for the nurses. Both GPs and nurses were positive towards further co-operation regarding pharmacotherapeutic interventions. All nurses that were positive to further co-operation wished to do it in a multidisciplinary team, whereas some GPs wished to do this in a multi-specialty team. CONCLUSION: The opinions of GPs and nurses towards the pharmacotherapeutic intervention indicate that this or similar methods may successfully be used in clinical practice for improving drug therapy.

Attitude of Health Personnel↗
PubMed2006

Image-guided therapy and minimally invasive surgery in children: a merging future.

Minimally invasive image-guided therapy for children, also known as pediatric interventional radiology (PIR), is a new and exciting field of medicine. Two key elements that helped the rapid evolution and dissemination of this specialty were the creation of devices appropriate for the pediatric population and the development of more cost-effective and minimally invasive techniques. Despite its clear advantages to children, many questions are raised regarding who should be performing these procedures. Unfortunately, this is a gray zone with no clear answer. Surgeons fear that interventional radiologists will take over additional aspects of the surgical/procedural spectrum. Interventional radiologists, on the other hand, struggle to avoid becoming highly specialized technicians rather than physicians who are responsible for complete care of their patients. In this article, we briefly discuss some of the current aspects of minimally invasive image-guided therapy in children and innovations that are expected to be incorporated into clinical practice in the near future. Then, we approach the current interspecialty battles over the control of this field and suggest some solutions to these issues. Finally, we propose the development of a generation of physicians with both surgical and imaging skills.

Child↗
PubMed2005

Researchers' experiences, positive and negative, in integrative landscape projects.

Integrative (interdisciplinary and transdisciplinary) landscape research projects are becoming increasingly common. As a result, researchers are spending a larger proportion of their professional careers doing integrative work, participating in shifting interdisciplinary teams, and cooperating directly with non-academic participants. Despite the growing importance of integrative research, few studies have investigated researchers' experiences in these projects. How do researchers perceive the outcomes of integrative projects, or career effects? Do they view the projects generally as successes or failures? This study analyses researchers' experiences in integrative landscape studies and investigates what factors shape these experiences. The data stems from 19 semi-structured qualitative interviews and a Web-based survey among 207 participants in integrative landscape research projects. It finds that researchers experience participation in integrative projects as positive, in particular discussions among participants, networking, teamwork, and gaining new insights and skills. Furthermore, most researchers perceive the projects as successful and as having a positive effect on their careers. Less positive aspects of integration relate to publications and merit points. Factors found to contribute to positive experiences include reaching a high degree of integration amongst the involved disciplines, common definitions of integrative research concepts, and projects that include a large share of fundamental research as well as projects with many project outcomes. Based on these findings, we advise future projects to plan for integration, facilitate discussions, and reach agreement on integrative concepts. We suggest that aspects of fundamental research be included in integrative projects. We also suggest that planning be done at an early stage for peer-reviewed publications, to ensure that participants gain merit points from their participation in integrative research efforts.

Conservation of Natural Resources↗
PubMed2006

[Medical care in times of DMPs].

It is by DMPs that the legislator intervened in medical care processes in Germany for the first time. Targets of treatment, diagnostic definitions and treatments were determined by legal order. The best available evidence was defined by law. The medical profession has come into conflict with this situation, as with regard to diabetes the legally established evidence-based contents are not apt to consensus, as they deviate significantly not only from the German guideline for the care of diabetes but also from the relevant international guide lines. The patient's entitlement to an appropriate treatment according to the state of the art is not accommodated due to this inconsistency. The cooperation between ambulatory and stationary care units as well as the cooperation between family practitioner and medical specialist is determined by the DMPs in terms of interfaces. Regarding the graduation within the care system an improvement can be anticipated.

Diabetes Mellitus, Type 1↗
PubMed2006

[The importance of rehabilitation with cardiovascular diabetic patients after surgical interventions].

Patients with diabetes nowadays are not directly endangered by dysglycemia, but they suffer vascular complications. The diabetic patient with existing cardiovascular (CV) disease has a particularly high risk for further CV complications and, therefore, requires specific attention. These patients need an intense and multimodal therapeutic approach which includes a strong interdisciplinary cooperation between the cardiologist and the diabetologist. Cardiac rehabilitation can effectively improve prognosis of CV patients with numbers needed to treat (NNT) comparable to standard pharmacological treatment. In diabetics, after coronary surgery, metabolism frequently and markedly deteriorates, and this requires strict metabolic monitoring and close cooperation between the diabetes team and the other professionals (cardiologist, nurses, physiotherapists, psychologists . . .) to reduce complications arising from hyperglycemia and also hypoglycemia and to improve the CV risk factors by lifestyle changes. Frequently, diabetes is only diagnosed during the hospital stay for CV complication; therefore, in these patients, specific attention is required for teaching and inauguration of therapy. Due to the high risk of these patients and the need of qualified metabolic co-treatment, following CV surgery, diabetic patients should be treated preferentially in rehabilitation centres specialised in both cardiac and metabolic care. Recent studies indicate that a multimodal and aggressive approach in CV diabetic patients can markedly improve their prognosis.

Blood Glucose↗