[Evaluation and Utilization - Quality Management in a Paediatric University Outpatient Department]. / Evaluation und Inanspruchnahme - Qualitätssicherung in der pädiatrischen Ambulanz einer Universitätsklinik.

BACKGROUND: Based on an increasing number of outpatient treatments, an extensive demand planning is necessary to ensure the quality of medical care. University outpatient clinics are special parts of this sector and therefore it is necessary that a research demonstrates the nearly uninvestigated position of a paediatric outpatient clinic. PATIENTS: The research at the university hospital for children and adolescents in Leipzig started in 2009 to survey 2283 of in total 9391 patients and the physicians. METHODS: Sociodemographic data as well as economic and medical facts were determined by using questionnaires. In each case a questionnaire was answered by the children or their accompanying persons and a separate one was completed by the respective doctor. RESULTS: The results created a foundation, on the basis of patient volume per day and per daytime. Less than 20% of the children admitted to consult the clinic for their first time. The majority of patients visit them because of a letter of referral. Most of the patients (58%) were younger than 6 years old. Approximately 35% of patients did not come from the city region of Leipzig. CONCLUSION: The investigation evidenced the necessity of a day and night operating institution for children in the region of Leipzig as well as the high specialisation of the outpatient clinic. In need of further investigation is the cooperation between several physicians to find out if this lots of medical examination are necessary or if there took place overlapping.

Heavy-Metal Fractions in Solid and Liquid Separates of Swine Slurry Separated using Different Technologies.

Accumulation of metals is a concern with continuous application of swine slurry to agricultural soils. Solid-liquid separation is a promising approach for reducing phosphorus and total metal loadings with swine manure application to farmlands. However, very little work has been performed on the partitioning of different metal fractions in swine slurry to separated solids and liquids. This study examined the distribution of various metal fractions in raw manures (RM), their separated liquids (SL), and separated solids (SS). The three separation techniques used were centrifuge without flocculant (CNF), centrifuge with flocculant (CFL), and rotary press with flocculant (RFL). Concentrations of Cd, Cu, Zn, Ni, and Se in manure and separates were determined by a modified Sposito's sequential chemical fractionation scheme to extract water-soluble, exchangeable, organically bound, carbonate-precipitated, and residual fractions. The greatest concentrations of metals were recovered in the residual fraction, with the organically bound and carbonate-precipitated concentrations much greater than water-soluble and exchangeable fractions. Separation index () (i.e., percentage partitioned to SS) ranged from 13 to 66%, 9 to 87%, 16 to 93%, and 23 to 96% for water-soluble, exchangeable, organically bound, and carbonate-precipitated fractions, respectively. The values in general, were significantly ( < 0.05) greater for flocculant-based separation techniques than for CNF. For organically bound and carbonate-precipitated fractions, the greatest was obtained with the RFL for most metals. Our results suggest that applying the SL from RFL separation would minimize metal loading to farmlands compared with SL from CNF and CFL techniques. However, further validation is required using more sources of manure and different flocculants.

Phosphorus fractions in solid and liquid separates of Swine slurry separated using different technologies.

Solid-liquid separation is a manure management option whereby P-rich solid is separated from N-rich liquid, allowing the separated liquid to be used as a fertilizer without oversupplying P. Little information is available on how the different P fractions in manures are partitioned to solid and liquid during separation. We examined the distribution of various P fractions in liquid and solid separates of swine manure, separated using different techniques, to gain information useful for making choices regarding the optimum use of manure separates. Samples of raw manure (RM) and their separated solid (SS) and liquid (SL) were obtained using three different separation techniques: (i) centrifugation without flocculant (CNF), (ii) centrifugation with a flocculant (CFL), and (iii) rotary press with a flocculant (RFL). These were subsequently analyzed for P using a modified Hedley fractionation scheme. Only a small proportion of RM, ranging from 5 to 12%, was recovered in SS, an advantage if SS is to be transported off-site. Concentrations of molybdate-reactive P and total P in all P fractions were less in SL than in the corresponding RM on a fresh-weight basis. The separation index (percentage partitioned to SS) for total labile P (water-extractable + NaHCO-extractable P) was 63, 81, and 75% for CNF, CFL, and RFL, respectively. The proportion of total P in labile form was significantly lower in SL than in RM. Therefore, using SL as a fertilizer instead of RM may help to avoid excessive buildup of soil test P with manure applications.