[Reasons of changes in drug therapy after hospital discharge - a qualitative study of perception by general practitioners and patients]. / Gründe von Änderungen der medikamentösen Therapie nach Krankenhausentlassung - eine qualitative Studie aus Sichtweise von Hausärzten und Patienten.

BACKGROUND: After discharge from hospital there is often change of medication regimen. Usually, the main results of the inpatient stay and the subsequent treatment recommendations are summarised in a "discharge letter". Based on this, the general practitioner decides on how to proceed taking the individual aspects of his/her patient into consideration. The aim of the study is to trace changes of medication and suggested therapy in the discharge letter, from the GP through to the patient and the reasons/influencing factors for any changes in medication undertaken or retained. METHODS: A prospective qualitative study with successively selected patients, who were put on a new long-term medication, at discharge after a stay in a hospital internal medicine unit was undertaken. Semi-structured interviews were conducted with the patients 4-6 weeks after hospital discharge. Subsequently, interviews were conducted with the patient's GP on details of current medication. The interviews were recorded electronically, based on the consensus method and evaluated with respect to changes in medication and influencing factors. In order to detect discrepancies in drug therapy, discharge letters were included in the analysis. RESULTS: A total of 34 patients and their GPs were interviewed. Few changes of medication changes were registered; however, these were more frequent in the weeks after hospital discharge. Drug therapy recommendations were modified by GPs for different medical or non-medical reasons. Non-medical reasons identified included economic, health policy constraints, personal conviction or non-adhrence of the patient. Reasons for a change in medication by the patient included, questioning of the need for taking the drug, incompatibility, fears and a lack of knowledge about the medication. CONCLUSION: The data demonstrate that the transition from inpatient to outpatient care is a sensitive interface. The data do not allow quantitative estimation of the magnitude of this phenomenon. In this study, the reasons for the modification of the drug demonstrated that these findings could be the basis for further studies or the development of interventions for preventing unwanted medication changes.

[Systematic literature analysis on therapies applied in rehabilitation of hip and knee arthroplasty: methods, results and challenges]. / Systematische Literaturanalyse zu Therapien in der Rehabilitation nach Hüft- und Kniegelenks-Total-Endoprothesen: Methoden, Ergebnisse und Herausforderungen.

Evidence-based medicine is a central issue in medical practice. This also applies to rehabilitation services. The German Statutory Pension Insurance meets this need in its guideline programme. Amongst others a guideline for rehabilitation following hip or knee arthroplasty is currently being developed. In this context a hierarchic, systematic literature analysis was conducted summarising the current state of evidence with reference to the effects and the treatment requirements (frequency and duration) of different rehabilitative therapies following total hip or knee replacement. In the first step, a search for evidence-based guidelines, systematic reviews and health technology assessments was conducted. Secondly, search strategies for primary literature in the following databases were designed: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PsychINFO (01/1997-09/2007). Additionally, a handsearch of several German journals not listed in the databases was conducted. Randomized trials were preferred, however, non-randomized trials were included if the intervention and control groups were comparable with regard to the baseline parameters. Results can be classified into three categories: (1) therapies for which evidence for (positive) effects was found, (2) therapies for which evidence was found, however, their transferability onto rehabilitation in Germany should be discussed (e. g., studies on immediate post-surgery interventions), and (3) therapies for which no methodologically appropriate trials could be found. The literature reviewed does not allow for final conclusions as to frequency and duration of different therapeutic interventions within the rehabilitation time frame in Germany (usually the first three weeks post discharge from hospital). Overall, there is a need for further research.

[Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures]. / Leitlinienentwicklung in der Rehabilitation bei Rückenschmerzpatienten--Phase 2: Ergebnisse einer Analyse von KTL-Daten.

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

[The morphological aspects in a biomedical assessment of hydrobionts]. / Morfologicheskie aspekty v mediko-biologicheskoi otsenke gidrobiontov.

The morphological data are presented on the condition of internal organs in experimental animals during hygienic examination of a number of traditional fish species, as well as the results of the morphological study of the nature of pigment spots on the skin of perch. The problem has been considered on the importance of morphological investigations in the study of harmlessness of hydrobionts. A conclusion has been made on the necessity of conducting thorough morphological investigations of hydrobionts and those structural changes that can be induced by their usage.