[Vaccine Refrigerator and Vaccine Management in General Practices: A Representative, Web-Based Survey among General Practitioners (Keep Cool I)]. / Impfkühlschrank- und Impfstoffmanagement in Hausarztpraxen: Eine repräsentative, Web-basierte Umfrage unter Hausärzten (Keep Cool I).

Aim: The purpose of this study was to analyse vaccine refrigerator and vaccine management in primary care and to identify physician- and practice-related influencing factors. Background: Adequate cooling of vaccines in a temperature range of 2-8°C is essential to assure vaccine effectiveness. Studies from various countries have demonstrated cooling chain problems. We surveyed general practitioners about the quality of their vaccine refrigerator and vaccine management and aimed at identifying physician- and practice-related influencing factors. Methods: A cross-sectional, web-based questionnaire survey was performed among 3 physician populations in primary care: a 10% random sample of general practitioners (n=954), all teaching physicians of the Universities Duisburg-Essen (n=221) and Halle-Wittenberg (n=92). Surveyed were items on the following 6 aspects: (1) responsibilities within practice teams, (2) vaccine ordering and storing, (3) criteria for the vaccine pre-selection, (4) stocking system inside the refrigerator, (5) wrapping, and use of stocking boxes, (6) refrigerator and temperature control. The quality indicator "comprehensive refrigerator management" was defined to include 4 aspects: (1) separate refrigerator, (2) written temperature documentation (temperature-logbook), (3) regular storage control (wrapping, temperature and expiration date), and (4) storage in original wrappings. Results: A total of 278 physicians participated in the survey (22%). Of these, 80% had a separate refrigerator, 52% reported written temperature documentation, 93% documented regular storage control addressing vaccine wrappings, temperature and expiration dates, and 95% reported vaccine storage in original card box wrappings. A "comprehensive refrigerator management" was realised by 42% of the practices. This indicator was reached more frequently by practices with 3 or more physicians (p=0.01) and those with an additional qualification in travel medicine (p=0.036). Conclusion: Our survey showed good results for most aspects of the refrigerator and vaccine management but room for improvement with regard to temperature documentation.

[Diagnostic screening for cancer and coronary heart disease with radiological and nuclear imaging techniques: early diagnosis at any price?]. / Check-up mit radiologischen und nuklearmedizinischen Verfahren: Früherkennung "um jeden Preis"?

Recently nuclear and radiological imaging techniques such as Glucose-PET, whole body MRI, coronary CT and various laboratory tests are used to screen asymptomatic patients for cancer and coronary heart disease. This review, based on the current relevant publications, including recent Japanese prospective studies, discusses issues arising from this screening approach. Although cases of early cancer are detected using such an approach, this preventive strategy has not been shown to improve quality of life and/or decrease mortality, but leads to additional radiation exposure and a high number of false-positive results with subsequent emotional and medical stress. Epidemiologic considerations and scientific data are discussed in order to suggest to doctors appropriate strategies when counselling patients about imaging screening options.