Chancen der Telemedizin für O&U

Telemedicine or eHealth today are important tools of everyday medical life. In all areas – from the preclinic, clinic to aftercare – significant improvements in communication structures have been noticed through various eHealth options, which have significant positive effects on the quality of patient care in orthopedics and trauma surgery. At the beginning, there were several isolated solutions and many small individual projects, but there was a lack of interdisciplinary and comprehensive systems in all health care fields. The German Trauma Society (DGU) took the lead together with AUC and paved the way for a modulated, comprehensive, interface-compatible teleradiology system. Nevertheless, there are still deficits across all sectors, which in the future will have to be optimized by eHealth methods and systems. Overall, there is an effort towards patient-centered solutions (mature patient)

Opportunities of telemedicine for orthopedics and trauma surgery

Today telemedicine, or eHealth, is an important tool in everyday medical life. In all areas, from the preclinical to aftercare, significant improvements in communication structures have been seen in various eHealth options, which have had significant, positive effects on the quality of patient care in orthopedics and trauma surgery. Initially, there were several isolated solutions and many small individual projects; however, there was a lack of interdisciplinary and comprehensive systems in all healthcare fields. The German Trauma Society (DGU) together with the AUC GmbH took the lead and paved the way for a modulated, comprehensive, interface-compatible teleradiology system. Nevertheless, there are still deficits across all sectors which, in the future, will need to be optimized by eHealth methods and systems. Overall, there is an effort towards patient-centered solutions (patient empowerment). In Germany, telemedicine has gradually gained acceptance in various sectors and is being used nationwide. Telemedicine has proven itself, especially in trauma networks

Sub-micrometre grained UO2 pellets consolidated from sol gel beads using spark plasma sintering (SPS)

UO2 beads from the sol supported precipitation method were calcined at a low temperature in order to obtain porous micro-beads, composed of nanometric particles. The sintering behaviour of the beads in spark plasma sintering was investigated. The powder had a good sinterability and the final grain size of the pellets could be tailored by varying the processing conditions, in order to resemble the microstructure of the traditionally fabricated UO2 pellets (i.e. grains of several µm size), or to achieve sub-micrometre size as observed in the high burnup structure. Dense UO2 pellets with a grain size as small as 300 nm were obtained by sintering at 835°C without dwell time, whereas 3 µm grained pellets were obtained at 1000°C and 5 min dwell time.JRC.E.4-Nuclear Fuel Safet

Investigation of fuel mechanical properties by micro-indentation

An innovative tool was developed to perform instrumented micro-indentation tests using a Vickers indenter, from the ambient temperature up to 1200°C. At present, a series of indentation experiments were carried out on stainless steel, fused silica and un-irradiated UO2, including experiments with either force or displacement control. Calculations were done to determine the Vickers Hardness and Young's modulus. In order to interpret in depth the experimental results, a finite element model was developed. The computational results are in a good agreement with the experimental load/displacement curves.JRC.E.3-Materials researc

Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

BackgroundOptimal care of multiple trauma patients has to be at a high level around the clock. Trauma care algorithms and guidelines are available, yet it remains unclear if the time of admission to the trauma room affects the quality of care and outcomes. Hence the present study intends to compare the quality of trauma room care of multiple severely injured patients at a level-1 trauma center depending on the time of admission.MethodsA total of 394 multiple trauma patients with an ISS???16 were included into this study (observation period: 52?months). Patients were grouped by the time and date of their admission to the trauma room [business hours (BH): weekdays from 8:00?a.m. to 4:00?p.m. vs. non-business hours (NBH): outside BH]. The study analysed differences in patient demographics, trauma room treatment and outcome.ResultsThe study sample was comparable in all basic characteristics [mean ISS: 32.3???14.3 (BH) vs. 32.6???14.4 (NBH), p?=?0.853; mean age: 40.8???21.0 (BH) vs. 37.7???20.2?years (NBH), p?=?0.278]. Similar values were found for the time needed for single interventions, like arterial access [4.8???3.9?min (BH) vs. 4.9???3.4?min (NBH), p?=?0.496] and quality-assessment parameters, like time until CT [28.5???18.7?min (BH), vs. 27.3???9.5) min (NBH), p?=?0.637]. There was no difference for the 24?h mortality and overall hospital mortality in BH and NBH, with 13.5% vs. 9.1% (p?=?0.206) and, 21.9% vs. 15.4% (p?=?0.144), respectively. The Glasgow Outcome Scale (GOS) comparison revealed no difference [3.7???1.6 (BH) vs. 3.9???1.5 (NBH), p?=?0.305]. In general, the observed demographic, injury severity, care quality and outcome parameters revealed no significant difference between the two time periods BH and NBH.ConclusionsThe study hospital provides multiple trauma patient care at comparable quality irrespective of time of admission to the trauma room. These results might be attributable to the standardization of the treatment process using established principles, algorithms and guidelines as well as to the resources available in a level-1 trauma center

Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee?

Evaluation of further improvement in treatment of patients with osteoarthritis of the knee requires measurement tools with a high discriminatory power. In this context, joint awareness in everyday life is seen as crucial criterion. Purpose of this study was to adapt and validate a German version of the "Forgotten Joint Score" (FJS) according to the COSMIN checklist. We evaluated a German translation of the FJS for reliability, validity and responsiveness according to the COSMIN checklist. Therefore, patients with an artificial knee joint completed the G-FJS questionnaire twice at intervals of at least 2 weeks. In addition, the Knee Society Score, the Oxford Knee Score, the Tegner Activity Scale, a Visual Analogue Scale, the EuroQol-5D (EQ 5-D), and a subjective assessment of the limitations were recorded. Between June and December 2014, one hundred and five patients (average age 65.2 years) completed both questionnaires and were available for data analysis. Test-retest reliability of the FJS was high with an ICC = 0.80 (95 % CI 0.69, 0.90) and with a Cronbach's alpha of 0.95 (95 % CI 0.92, 0.99). The German translation of the FJS is a viable tool for the postoperative monitoring after arthroplasty of the knee. This is the first study providing data on test-retest reliability of the FJS. The FJS is a reliable and valid measurement tool for evaluation of patient rated outcome in patients with an artificial knee joint. Validating cohort study, Level 1b

Characterization of aerosols from RDD surrogate compounds produced by fast thermal transients

Experimental tests have been performed to characterize the aerosols representative of radiological dispersion devices (RDDs, a.k.a. "dirty bombs") by applying to chosen surrogate compound rapid high temperature transients, vaporizing the sample and forming aerosols mainly by rapid cooling of the vapour. The materials, which were tested in their non-radioactive form, had been chosen from the radioactive sources widely used in industries and nuclear medicine applications, Co, CsCl, Ir and SrTiO3. Our analyses permitted the characterization of the inhalable fraction of the aerosols released, and the study of the influence of cladding materials on the aerosol release and on its characteristics.RST/Reactor Physics and Nuclear Material

RADES an experimental set-up for the characterization of aerosol release from nuclear and radioactive materials

A new experimental set-up for the characterization of aerosols has been developed, in order to support with experimental data a better understanding of the source term related to Radiological Dispersal Events (RDE's). We have developed this set-up with the aim of studying the separate eect of temperature, materials and dierent atmospheres on the characteristics of the produced aerosols, concentrating on the description of aerosol's size distribution and, their chemical and elemental composition. In the experiments we simulate RDE's by applying dierent thermal transients to the sample materials, employing a laser heating technique. Part of the sample is vaporized, and aerosols are generated by nucleation/condensation of the formed vapour in a controlled atmosphere. The laser heating technique has been chosen as it permits high exibility in regulating the thermal transient and the possibility of reaching extreme conditions, such as high temperature (up to 4500 K) with rapid transients (tenths of ms). Dierent collection systems have been developed (using inertia impaction phenomena or lters) and permit the collection of the aerosols on dierent substrates and the application of dierent post-analysis techniques for aerosols characterization (SEM/EDX, RAMAN, ICP-MS). The set-up has been tested for dierent materials, such as ceramic, salts and metals, and proved to be feasible for the production, collection and post-analyses of aerosols. In this paper will describe our original set-up, focusing on the instrumentation applied, on the post analysis techniques and on the experimental procedure. Finally we willalso give examples of the results obtained.JRC.E.3-Materials researc