Development and validation of the German translation of the views on inpatient care (VOICE-DE) outcome measure to assess service users' perceptions of inpatient psychiatric care.

BACKGROUND: Service user satisfaction in inpatient psychiatric care is often measured with instruments that have been designed by professionals, without involving the perspective of service users. Views on Inpatient Care (VOICE), developed in England, is among the first service-user-generated outcome measures which included service users' perspectives in the process. AIMS: In this study, we aimed to validate a German version of VOICE. METHODS: The original questionnaire was translated into German and validated using data collected from 163 inpatients undergoing treatment in a psychiatric hospital. The instrument was tested for its psychometric properties, focusing on measurements of reliability and construct validity. Also, we assessed the impact of demographic variables. Finally, factorial analyses were carried out to compare the underlying factorial structure to the English version. RESULTS: The analyses revealed a high internal consistency (α = 0.90). No significant impact of demographic variables was observed. Factorial analyses indicated a one-factor structure which accounted for 40.39% of variance. CONCLUSIONS: Psychometrical evaluation of VOICE-DE indicated the questionnaire to be a suitable tool to assess service users' personal experience with treatment and satisfaction in German.

English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis.

Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy.

High spatial resolution and high contrast visualization of brain arteries and veins: impact of blood pool contrast agent and water-selective excitation imaging at 3T.

PURPOSE: To investigate a blood pool contrast agent and water-selective excitation imaging at 3 T for high spatial and high contrast imaging of brain vessels including the veins. METHODS AND RESULTS: 48 clinical patients (47 ± 18 years old) were included. Based on clinical findings, twenty-four patients received a single dose of standard extracellular Gadoterate-meglumine (Dotarem®) and 24 received the blood pool contrast agent Gadofosveset (Vasovist®). After finishing routine MR protocols, all patients were investigated with two high spatial resolution (0.15 mm (3) voxel size) gradient echo sequences in random order in the equilibrium phase (steady-state) as approved by the review board: A standard RF-spoiled gradient-echo sequence (HR-SS, TR/TE 5.1/2.3 msec, FA 30°) and a fat-suppressed gradient-echo sequence with water-selective excitation (HR-FS, 1331 binominal-pulse, TR/TE 8.8/3.8 msec, FA 30°). The images were subjectively assessed (image quality with vessel contrast, artifacts, depiction of lesions) by two investigators and contrast-to-noise ratios (CNR) were compared using the Student's t-test. The image quality and CNR in the HR-FS were significantly superior compared to the HR-SS for both contrast agents (p < 0.05). The CNR was also improved when using the blood pool agent but only to a minor extent while the subjective image quality was similar for both contrast agents. CONCLUSION: The utilized sequence with water-selective excitation improved image quality and CNR properties in high spatial resolution imaging of brain arteries and veins. The used blood pool contrast agent improved the CNR only to a minor extent over the extracellular contrast agent.

Bee-sting anaphylaxis: the use of medical antishock trousers.

There is a large population of unprotected individuals who are susceptible to Hymenoptera-induced anaphylaxis. Medical antishock trousers (the MAST suit) can play an important role in field treatment of anaphylactic shock. Upon application, both blood pressure and cerebral perfusion are preserved despite clinically profound vasodilation. The MAST suit mechanically increases peripheral resistance, analogous to the vasoconstrictive effects of adrenaline. In the two cases presented, the MAST suit reversed significant hypotension caused by Hymenoptera envenomation. Both patients recovered fully. Based on the suit's effectiveness in bee-sting anaphylaxis, it would seem that extended indications exist for using the MAST suit in other forms of low-resistance shock.