[Diagnosis and treatment of diving accidents. New German guidelines for diving accidents 2014-2017]. / Diagnostik und Behandlung von Tauchunfällen: Neue "Leitlinie Tauchun2014-2017".

In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.

Effects of chenodeoxy- and ursodeoxycholic acid on absorption, secretion and permeability in rat colon and small intestine.

The effect of equimolar concentrations of chenodeoxycholic (CDCA) and ursodeoxycholic acid (UDCA) on the colonic absorption of water, sodium and oxalate, and on the transmural potential difference was examined in the rat colon by an open perfusion technique. In addition, the ileal absorption of D-glucose, oxalate, water and sodium was measured in the presence and absence of CDCA and UDCA. CDCA reversed the absorption of water and sodium into secretion more effectively than UDCA Oxalate absorption and permeability of the colon measured by the disappearance of D-mannitol were enhanced by CDCA, but to a lesser extent by UDCA. The ileal absorption of water and sodium was nearly abolished by CDCA and inhibited to a lesser extent by UDCA in the presence of D-glucose in the perfusate. At equimolar concentrations, CDCA induced a more marked inhibitory effect on colonic function than UDCA. This quantitative difference may account for the less frequent side-effects of diarrhoea in cholelitholytic treatment with UDCA compared to CDCA.

[The significance of arthrography and arthroscopy in the diagnosis of meniscus injury--a comparative study (author's transl)]. / Die Bedeutung von Arthrographie und Arthroskopie in der Diagnostik der Meniskusverletzung. Eine vergleichende Untersuchung.

The article reports on 364 double-contrast arthrographics and 185 arthroscopies. The results obtained in 126 patients in whom both arthrography and arthroscopy had been conducted, were compared. It became evident that arthrography is of high informative value in the diagnosis of lesions of the meniscus, so that preference may well be given to this method in non-specific knee-joint complaints where meniscopathy is suspected. Arthroscopies are indicated in cases of clinico-arthrographic doubt. Trial arthrotomy for clarifying doubtful meniscus lesions without previous exploitation of all arthrographic/arthroscopic possibilities is no longer justified and should be abandoned. Arthroscopy is definitely superior to arthrography in the diagnosis of, in particular, cartilage structures, of the synovia and of the retropatellar space. It is here where arthrography has its narrow limitations--now and in the future--for methodical reasons.

A model to assess the usefulness of performance indicators.

This paper describes the Perception-Action-Impact (PAI) model used for testing the usefulness of health care organization performance indicators, and reports preliminary data in support of this model. Two hundred and ninety six hospitals contributed 500,000 obstetrical cases, and responded to surveys to assess various aspects of indicator usefulness. Domains of interest that were assessed include relevance of the measures, whether the measures identified opportunities for improvement, whether the health care organization took any action in response to the data, health care organizational structure for data use, and methods for dissemination of the indicator data. Findings from this study provide support for the PAI model. Consequently, perceptions regarding the indicators apparently have a significant impact on the usefulness of the data. When action was taken in response to the indicator data, a positive impact on patient care processes and outcomes was the typical result. Additional research is needed in the areas of data dissemination effectiveness, and the impact of attitude change on the use of performance measures.