Consumption of alcohol, cigarettes and illegal substances among physicians and medical students in Brandenburg and Saxony (Germany).

BACKGROUND: Patients regard health care professionals as role models for leading a healthy lifestyle. Health care professionals' own behaviour and attitudes concerning healthy lifestyle have an influence in counselling patients. The aim of this study was to assess consumption of alcohol, cigarettes and illegal substances among physicians and medical students in two German states: Brandenburg and Saxony. METHODS: Socio-demographic data and individual risk behaviour was collected by an anonymous self-administered questionnaire. Physicians were approached via mail and students were recruited during tutorials or lectures. RESULTS: 41.6% of physicians and 60.9% of medical students responded to the questionnaire; more than 50% of the respondents in both groups were females. The majority of respondents consumed alcohol at least once per week; median daily alcohol consumption ranged from 3.88 g/d (female medical students) to 12.6 g/d (male physicians). A significantly higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. A quarter of all participating physicians and one third of all students indicated unhealthy alcohol-drinking behaviour. The majority of physicians (85.7%) and medical students (78.5%) were non-smokers. Both groups contained significantly more female non-smokers (p < 0.05). Use of illegal substances was considerably lower in physicians (5.1%) than medical students (33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students. CONCLUSION: More than one third of the medical students and health care professionals showed problematic alcohol-drinking behaviour. Although the proportion of non-smokers in the investigated sample was higher than in the general population, when compared to the general population, medical students between 18-24 reported higher consumption of illegal substances.These results indicate that methods for educating and promoting healthy lifestyle, particularly with respect to excessive alcohol consumption, tobacco use and abuse of illegal drugs should be considered.

Home visits in primary care: contents and organisation in daily practice. Study protocol of a cross-sectional study.

INTRODUCTION: Medical care of homebound patients by home visits is an integral part of primary care in Germany and other industrialised countries. Owing to the sociodemography and changes in the health system, the need for home visits is projected to increase rather than decrease. Our study will provide information on content and organisation of home visits. This evidence is needed to assure sufficient medical care for homebound patients. Germany is one of the European nations with highest proportions of elderly age groups, so that our results will be indicative for other European countries with comparable organisation of primary care. METHODS AND ANALYSIS: This cross-sectional study is conducted over a period of 12 months. All home visits of each participating family practice are documented within a 1-week time period. The anonymous documentation of home visits is carried out by the family practitioner or medical assistant conducting the home visit. All Saxon Family practitioners received study information and were personally invited to participate in our study. Almost 303 (of 2677) family practitioners expressed their interest to participate to generate data on the content and organisational characteristics of home visits. Data analysis of more than 4000 home visits will take into account several patient-related and system-related parameters. Descriptive and multivariate analysis will be carried out by using non-parametric methods. Regarding expected cluster structure of the data, a multilevel analysis will be necessary. ETHICS AND DISSEMINATION: The study received ethical approval by the Ethical Commission of the TU Dresden and adheres to the Declaration of Helsinki. Considering that the results of our project will be indicative for ageing societies with comparable organisation of primary care, we will publish them in international open access journals concerned with healthcare and primary care research and disseminate them by a final symposium and at national/international scientific events.

Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial.

OBJECTIVES: Migraine is one of the most prevalent neurological disorders in Europe, severely affecting ability to work and quality of life. Medical therapies are considered to be the "gold standard" of treatment. This study addresses osteopathic treatment for acute therapy or prophylactic therapy as an alternative to traditional therapies. DESIGN: Forty-two (42) female patients with migraine were randomized into an intervention group (n = 21) and a control group (n = 21). Outcomes were evaluated with three questionnaires before the treatment (t1) and 6 months later (t2). INTERVENTIONS: The intervention group received five 50-minute osteopathic manipulative treatments (OMT) over a 10-week period. The control group did not receive OMT, sham treatment, or physical therapy. Patients of this group only filled the questionnaires. Both groups continued with previously prescribed medication. METHODS: The Migraine Disability Assessment (MIDAS) and Short Form-36 (SF-36) questionnaires as well as a German "pain questionnaire" were used to assess pain intensity, the impact of migraine on daily life and health-related quality of life (HRQoL), and the number of days subjects suffered from migraine. RESULTS: Three (3) of the eight HRQoL domains of the SF-36 form in the intervention group showed significant improvement (from t1 to t2), with a general betterment exhibited in the other domains. The total MIDAS score, pain intensity, and disturbance in occupation due to migraine as well as number of days of disablements were also significantly reduced. The control group showed insignificant differences in these areas. CONCLUSIONS: This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.

Video technology to advance safety in the operating room and perioperative environment.

Video is a powerful medium and is underused for patient safety in several areas: education, real-time consultation, process improvement, research, and workflow coordination. We illustrate this point through an overview of uses of video in health care by the authors and others in several institutions. These uses were in the context of team work training, operating room coordination, technical skills of invasive procedures, process improvement, telementoring, and multimedia video records. Also described are several key issues associated with the use of video, such as ethics and legal concerns. Technology advances and new methods will make video an important tool for improving patient safety.

Advanced visualization platform for surgical operating room coordination: distributed video board system.

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

Surgical necrotizing enterocolitis and intraventricular hemorrhage in premature infants below 1000 g.

BACKGROUND/PURPOSE: Infants with very low birth weight are at increased risk for both intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). IVH often progresses in severity after initial diagnosis and causes severe neurological morbidity and mortality. The authors examined the role of NEC in the progression of IVH in these infants. METHODS: The authors conducted a retrospective case-control study using data from the University of Maryland neonatal intensive care unit database between 1991 and 2003. From a cohort of 957 infants with very low birth weight, 53 pairs of infants labeled as IVH progression versus controls were selected and closely matched in respect to their gestational age and birth weight. Charts from these infants were reviewed to identify risk factors contributing to IVH progression. RESULTS: Infants with IVH progression were significantly more likely to suffer from NEC (odds ratio, 3.6), whereas infants with surgical NEC showed a greater association with IVH progression (odds ratio, 5.33). Association with thrombocytopenia was also seen (odds ratio, 3.33). Sepsis showed trend toward significance (odds ratio, 1.9; P = .095) for progression of IVH. CONCLUSION: Surgical NEC showed the greatest risk for IVH progression. NEC and thrombocytopenia also appear to be risk factors for IVH progression.

Gangrenous intestine in a hernia can be reduced.

A 3-month-old former 31-week premature triplet presented with a perforated terminal ileum 36 hours after complete reduction of an incarcerated inguinal hernia. Classic pediatric surgery teaching asserts that gangrenous bowel in an inguinal hernia will not reduce. In this case, gangrenous bowel was reduced and proceeded to perforate after reduction. Though extremely rare, it is possible to reduce gangrenous bowel, and disposition requires reliable observation at home or hospitalization, if circumstances warrant.