[The Aut-idem Rule and the Importance of Patient-Individual Selection of Inhalers for the Therapy of Airway Diseases in Practices of Pneumologists and General Practitioners - Assessment and Implementation by Pneumologists and General Practitioners]. / Aut-idem-Regelung und Inhalatorauswahl bei inhalativer Therapie in pneumologischen und hausärztlichen Praxen unter Alltagsbedingungen ­ Einschätzung und Umsetzung durch Pneumologen und Hausärzte.

Drug therapy of obstructive airway diseases mainly relies on inhaled medication. The success of this therapy depends primarily on the selection of the appropriate inhaler considering patient's choice and the correct application. The aut-idem-rule, an active exclusion of the optional substitution by the pharmacist, allows prescribing physicians to ensure the delivery of a particular inhaler, which was selected for that patient, who was trained to use specifically that inhaler. This survey shows that pneumologists and, to a greater extent general practitioners, do not consistently make use of this option, although they unanimously agree on the importance of targeted inhaler selection. As a result, patients may receive different inhalers in the pharmacy, where the inhaler is chosen under consideration of market-driven aspects such as rebate contracts or stock. This causes that patients get confused by the exchange of their inhaler. Thus the exchange of the inhaler by the pharmacist leads to uncertainty and application problems in patients. Hence, the success of the comparatively complex inhaled therapy is endangered. This could be prevented, if prescribing physicians were informed and supported consistently regarding the use of aut-idem exclusion to ensure an optimal therapy for each individual patient.

Cost-efficiency aspects for fish passage restoration in the Ruhr River Basin.

The protection and sustainable management of the aquatic ecosystems is the central aim of the European Water Framework Directive. Due to the aspiration for good ecological status of the water bodies free fish passage will play an important part in river basin management. The Ruhr River has seen severe anthropogenic modifications due to urbanisation and industrialisation in the 19th and 20th centuries leading in the existence of approx. 1300 weirs within the Ruhr River Basin. The majority of the barriers are assessed as not passable or restricted passable. Against this background the Ruhrverband made a holistic approach towards restoring fish passage within the Ruhr catchment. Besides the scientific and technical aspects, such as the determination of potential (spawning) habitats and the development of measures in order to reach them, they also considered cost-benefit-ratio considerations for the Ruhr catchment as a whole as well as for site-specific designs of fish passage structures. Various benefits were evaluated taking into account different fields of economic interest. The model of financing all necessary measures should involve all responsible parties benefiting from the water utilizations. Such a mutual procedure delivers a fair cost distribution as well as an efficient implementation of measures.

Restoration of fish passage: development and results of a master plan established for the Ruhr River Basin.

According to the central aim of the European Water Framework Directive, the protection and sustained management of the aquatic ecological system, the ecological condition of a specific type of water, will be the primary parameter in future. Aiming at good ecological status in surface water bodies, population diversity and abundance of fish and macroinvertebrates is decisive. Free passage in river systems, to allow the natural migration of fish and all other aquatic organisms, is a prerequisite. To achieve this for the Ruhr River Basin a study has been commissioned in order to develop a master plan for river continuum restoration. Sustainable development aimed at promoting biodiversity in the surface water body system is a key objective. This project is complemented by investigations of the sediment--which is the nursery of the fish--in the rivers to identify river sections or tributaries which obviously provide a suitable habitat for the successful reproduction of big Salmonidae. The master plan illustrates the inherent problems of projects aimed at the restoration of fish passage in water bodies which are strongly affected by anthropogenic modifications. The results obtained may as well be transferred to other catchments with similar use patterns.

[Amalgam fillings in the deciduous and mixed dentition--a post-treatment evaluation of service life and quality]. / Amalgam-Füllungen im Milch- und Wechselgebiss--eine Nachuntersuchung zur Lebensdauer und Qualität.

295 amalgam fillings in deciduous teeth and 150 amalgam restorations in permanent first molars were examined in 112 child patients. The functional loss of restorations was corded and present fillings were assessed in view of marginal integrity, anatomy and surface condition. For primary molar amalgams the 4-year survival rates "estimate" ist ein Schätzwert--wenn der Autor es so gemeint hat, muss "estimate" stehenbleiben, andernfalls heisst es "iate" (= Quote) were 67% for Class 1 restorations and for 55% Class 2 fillings. After 4 years of placement 78% of the Class 1 restorations in permanent first molars were still intact.