[Ambulatory care of patients with somatically unexplained complaints : A comparative qualitative study]. / Die ambulante Betreuung von Patienten mit somatisch nicht erklärten Beschwerden : Eine vergleichende qualitative Studie.

BACKGROUND: The aim of this study was to compare the approach of general practitioners (GP) and outpatient specialists for psychiatry, neurology or psychosomatic medicine to patients with somatically unexplained complaints. METHODS: Qualitative interviews were conducted with general practitioners in Berlin and with outpatient specialists. Interviews were analyzed by qualitative content analysis. RESULTS: Both GPs and specialists rarely used structured diagnostic instruments. Guidelines are seen and used with reservation throughout the different specialties. Similar to the GPs, most of the specialists surveyed in this study had reservations against the necessity of a precise coding according to the International Classification of Diseases (ICD). CONCLUSION: In outpatient care the concern for the individual patient is the connecting element between different medical specialties. This results in a differential diagnostic and therapeutic approach that is not automatically in line with guidelines. The development of common concepts in ambulatory care might help to meet the demands of this complex group of patients with somatically unexplained complaints.

Establishing a nurse-based psychiatric CL service in the accident and emergency department of a general hospital in Germany.

INTRODUCTION: Patients with mental health problems in accident and emergency departments (A&E) are frequent users and often difficult to handle. Failure in managing these patients can cause adversities to both patients and A&E staff. It has been shown that nurse-based psychiatric consultation-liaison (CL) services work successfully and cost effectively in English-speaking countries, but they are hardly found in European countries. The aim of this study was to determine whether such a liaison service can be established in the A&E of a German general hospital. We describe structural and procedural elements of this service and present data of A&E patients who were referred to the newly established service during the first year of its existence, as well as an evaluation of this nurse-led service by non-psychiatric staff in the A&E and psychiatrists of the hospital's department of psychiatry. SUBJECTS AND METHODS: In 2008 a nurse-based psychiatric CL-service was introduced to the A&E of the Königin Elisabeth Herzberge (KEH) general hospital in the city of Berlin. Pathways for the nurse's tasks were developed and patient-data collected from May 2008 till May 2009. An evaluation by questionnaire of attitudes towards the service of A&E staff and psychiatrists of the hospital's psychiatric department was performed at the end of this period. RESULTS: Although limited by German law that many clinical decisions to be performed by physicians only, psychiatric CL-nurses can work successfully in an A&E if prepared by special training and supervised by a CL-psychiatrist. The evaluation of the service showed benefits with respect to satisfaction and skills of staff with regard to the management of psychiatrically ill patients. CONCLUSION: Nurse-based psychiatric CL-services in A&E departments of general hospitals, originally developed in English-speaking countries, can be adapted for and implemented in a European country like Germany. Open access: This article is published with open access at link.springer.com.

[Psychiatric and psychosomatic consulation-liaison. An overview]. / Konsiliar-Liaison Psychiatrie und Psychosomatik. Ein Überblick.

A high rate of psychiatric comorbidity is found in patients with somatic diseases in general hospitals. Reasons for psychiatric disorders in somatically ill patients are variable and can lead to or be a result of the physical illness or just occur coincidentally. Consultation-liaison services (C/L) assist the physician and the treatment team on internal surgical wards in general hospitals in paying attention to and caring for somatic psychiatric comorbidities with diagnostic, therapeutic and, if appropriate, secondary preventative methods. In this article an overview of the development of C/L psychiatry is given. Furthermore, the importance of particular psychiatric disorders seen by psychiatric C/L services and their treatment is described. Finally, specific aspects of service delivery with regard to collaborative care between general hospital physicians and private practitioners are discussed.

France in the era of Mendelism (1900-1930).

This paper describes and explains the reception of Mendelism among French biologists at the beginning of the 20th Century. Three dimensions of description must be taken into account: scholarly diffusion; transmission of the new science through teaching and textbooks; and effective research. These three axes of description do not provide the same picture: Mendelian research was widely reported among specialists; no significant teaching of Mendelism took place in the years 1900-1930; by 1930 only one biologist, Lucien Cuénot, had carried out significant genetic research, but he abandoned his Mendelian research in 1914. The resistance to Mendelism can be attributed to four categories of factors, none of which is sufficient. The first category includes a series of intellectual factors: a massively positivist conception of science, an approach to heredity that privileged a 'physiological' theory, and a poor development of cytology. The second set of factors stems from the failure of French academic biologists to establish a strong interaction with plant and animal breeding. The third factor is the relatively weak influence of the eugenic ideology in France. Finally, the particular organization of French universities, together with the deaths of numerous young scientists during World War I, amplified the effects of the previous factors.

On the internal dynamics of Mendelian genetics.

This paper offers a revisionist account of the development of Mendelian genetics, focusing on the 'problem of the gene', 1900-1930. I examine conflicting claims about the composition, location, and action of genes posed by Bateson, the Morgan group, and Goldschmidt. Their research programs focused on different phenotypes and were based on different assumptions about the nature of genes. The problem of the gene transcended such specific research programs, but their findings had to be taken into account to solve it. The need to resolve conflicting claims drove Mendelian geneticists to exploit the resources and invade the turf of other disciplines in their search for a sound characterization of the gene. The problem of reconciling conflicting views greatly influenced the development of genetics and provided the stimulus for many of the discoveries made by geneticists from 1900 to 1940.

Efficient inactivation of viruses and mycoplasma in animal sera using UVC irradiation.

Transmission of viruses by animal sera represents a considerable risk for humans and animals particularly when the serum is used for the production of pharmaceutical products such as vaccines. Procedures applicable for inactivating large numbers of different viruses, both enveloped and non-enveloped, are therefore mandatory. For this purpose we have developed and validated UVC irradiation as the virus-inactivation procedure of choice for serum to be used in an industrial setting. Spiking experiments in foetal calf serum (FCS) were performed by independent contract laboratories and revealed constantly high clearance rates for various viruses such as bovine parvovirus, parainfluenza type III virus, bovine diarrhoea virus, foot-and-mouth disease virus and different forms of mycoplasmas. UVC-treated sera maintained their growth-promoting activities for various cell types (MRC-5, Vero, CHO). Conventional growth curves generated in the presence of 10% and 1% UVC-treated FCS differed only slightly from controls, indicating the lack of significant damage during UVC exposure. Experiments using a sensitive photometric-based acid phosphatase assay (APA), which correlates well with the more tedious cell counting procedure, confirmed these findings even in the presence of minimal serum requirements. UVC treatment of animal sera appears advantageous compared to currently recommended inactivation procedures, such as Gamma irradiation, for at least three reasons: (i) it possesses a high inactivation capacity for parvoviruses, a pathogen that cannot be destroyed easily by conventional methods; (ii) it causes no noticeable impairment in cell growth and (iii) it can be performed in a controlled manner at the production site.

The French school of genetics: from physiological and population genetics to regulatory molecular genetics.

French genetics had unusual beginnings. There are clear indications that the French biological establishment resisted Mendelian genetics strenuously from about 1910 to 1940. From about 1930 to 1950 several unconventional research programs with a strongly physiological orientation paved the way for the full entrance of French biology into genetics after World War II. This review examines some salient features of this history to clarify the strengths, weaknesses, and distinctive features of French genetics until about 1965. We suggest that after that data French genetics slowly merged into the international mainstream as genetics has become a largely molecular discipline.

[Clinical and psychosocial characteristics of schizophrenia patients related to the duration of their hospitalization]. / Klinicheskie i psikhosotsial'ny kharakteristiki bol'nykh shizofreniei, sviazannye s dlitel'nost'iu gospitalizatsii.

Factors affecting the term of the hospital confinement of schizophrenic patients were evaluated using the Automated Rehabilitation Information System (ARIS). The formalized files on 682 patients treated in the V. M. Bekhterev Institute, Leningrad, USSR) and several hospitals in the GDR were analyzed. From the 725 signs studied 53 common factors were selected which reflected the clinical, personal and psychosocial characteristics of the patient as related to the hospital treatment duration. A computerized prognosis of the hospital treatment term using the image detection algorithms proved possible.