Organisation der Notfallstation: Umfeld und Leistungsauftrag bestimmen das Organisationskonzept

Zusammenfassung: Untersuchungsziel: Organisationsformen von Notfallstationen wurden analysiert, um Gestaltungsgrundsätze abzuleiten. Methoden: Organisation und Leistungsauftrag der klinischen Notfallmedizin wurden anhand einer Literaturrecherche verglichen. Dabei wurden organisatorische Grundmuster in Abhängigkeit von der Anwesenheit von Spezialisten (Spezialisierung) und der Einbindung in die Spitalorganisation (Integration) entwickelt und aufgrund etablierter Effizienzkriterien vergleichend bewertet. Ergebnisse: Klinische Notfallstationen unterscheiden sich hinsichtlich Autonomiegrad, Leistungsbreite und Leistungstiefe. Vier Archetypen wurden abgegrenzt: Das Profit-Center als ertragsorientierte Wirtschaftseinheit, das Service-Center als auftragserfüllende Organisationseinheit, die funktionelle Organisation als fachlich abgegrenzte Einheit und die modulare Organisation, die sich durch eine zentrale Notfalleinheit und rasch mobilisierbare Spezialistenteams auszeichnet. Schlussfolgerungen: Es gibt keinen Königsweg. Jede organisatorische Lösung bietet in Abhängigkeit von Umfeldbedingungen und Leistungsauftrag Vor- und Nachteile. Die organisatorischen Grundmuster bieten eine Orientierungshilfe, wobei Leistungsvolumen und -spektrum wichtige Determinanten darstelle

A novel implantation technique for engineered osteo-chondral grafts

We present a novel method to support precise insertion of engineered osteochondral grafts by pulling from the bone layer, thereby minimizing iatrogenic damage associated with direct manipulation of the cartilage layer. Grafts were generated by culturing human expanded chondrocytes on Hyaff®-11 meshes, sutured to Tutobone® spongiosa cylinders. Through the bone layer, shaped to imitate the surface-contours of the talar dome, two sutures were applied: the first for anterograde implantation, to pull the graft into the defect, and the second for retrograde correction, in case of a too deep insertion. All grafts could be correctly positioned into osteochondral lesions created in cadaveric ankle joints with good fit to the surrounding cartilage. Implants withstood short-term dynamic stability tests applied to the ankle joint, without delamination or macroscopic damage. The developed technique, by allowing precise and stable positioning of osteochondral grafts without iatrogenic cartilage damage, is essential for the implantation of engineered tissues, where the cartilage layer is not fully mechanically developed, and could be considered also for conventional autologous osteochondral transplantatio

Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom

Pharmaceuticals are produced and used in increasingly large volumes every year. With this growth comes concern about the fate and effects of these compounds in the environment. The discovery of pharmaceuticals in the aquatic environment has stimulated research in the last decade. A wide range of pharmaceuticals has been found in fresh and marine waters, and it has recently been shown that even in small quantities, some of these compounds have the potential to cause harm to aquatic life. The primary pathway into the environment is the use and disposal of medicines; although much of the research in the area currently focuses on the removal of pharmaceuticals during sewage treatment processes, disposal via household waste might be a significant pathway requiring further research. To investigate the household disposal of unused and expired pharmaceuticals as a source of pharmaceutical compounds in the environment, we carried out a survey and interviewed members of 400 households, predominantly from southeastern England. We used the information on when and how they disposed of unfinished pharmaceuticals to construct a conceptual model to assess the pathways of human pharmaceuticals into the environment. The model demonstrated that disposal of unused pharmaceuticals, either by household waste or via the sink or toilet, may be a prominent route that requires greater attention

Journal of Geophysical Research: Earth Surface / The topography of a continental indenter : the interplay between crustal deformation, erosion, and base level changes in the eastern Southern Alps

The topography of the eastern Southern Alps (ESA) reflects indenter tectonics causing crustal shortening, surface uplift, and erosional response. Fluvial drainages were perturbed by Pleistocene glaciations that locally excavated alpine valleys. The Late Miocene desiccation of the Mediterranean Sea and the uplift of the northern Molasse Basin led to significant base level changes in the far field of the ESA and the Eastern Alps (EA), respectively. Among this multitude of mechanisms, the processes that dominate the current topographic evolution of the ESA and the ESA-EA drainage divide have not been identified. We demonstrate the expected topographic effects of each mechanism in a one-dimensional model and compare them with observed channel metrics. We find that the normalized steepness index increases with uplift rate and declines from the indenter tip in the northwest to the foreland basin in the southeast. The number and amplitude of knickpoints and the distortion in longitudinal channel profiles similarly decrease toward the east. Changes in slope of -transformed channel profiles coincide spatially with the Valsugana-Fella fault linking crustal stacking and uplift induced by indenter tectonics with topographic evolution. Gradients in across the ESA-EA drainage divide imply an ongoing, north directed shift of the Danube-ESA watershed that is most likely driven by a base level rise in the northern Molasse basin. We conclude that the regional uplift pattern controls the geometry of ESA-EA channels, while base level changes in the far field control the overall architecture of the orogen by drainage divide migration.(VLID)222030

Diffusive Evolution of Stable and Metastable Phases II: Theory of Non-Equilibrium Behaviour in Colloid-Polymer Mixtures

By analytically solving some simple models of phase-ordering kinetics, we suggest a mechanism for the onset of non-equilibrium behaviour in colloid-polymer mixtures. These mixtures can function as models of atomic systems; their physics therefore impinges on many areas of thermodynamics and phase-ordering. An exact solution is found for the motion of a single, planar interface separating a growing phase of uniform high density from a supersaturated low density phase, whose diffusive depletion drives the interfacial motion. In addition, an approximate solution is found for the one-dimensional evolution of two interfaces, separated by a slab of a metastable phase at intermediate density. The theory predicts a critical supersaturation of the low-density phase, above which the two interfaces become unbound and the metastable phase grows ad infinitum. The growth of the stable phase is suppressed in this regime.Comment: 27 pages, Latex, eps

Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse

BACKGROUND: Cocaine use seems to be increasing in some urban areas worldwide, but it is not straightforward to determine the real extent of this phenomenon. Trends in drug abuse are currently estimated indirectly, mainly by large-scale social, medical, and crime statistics that may be biased or too generic. We thus tested a more direct approach based on 'field' evidence of cocaine use by the general population. METHODS: Cocaine and its main urinary metabolite (benzoylecgonine, BE) were measured by mass spectrometry in water samples collected from the River Po and urban waste water treatment plants of medium-size Italian cities. Drug concentration, water flow rate, and population at each site were used to estimate local cocaine consumption. RESULTS: We showed that cocaine and BE are present, and measurable, in surface waters of populated areas. The largest Italian river, the Po, with a five-million people catchment basin, steadily carried the equivalent of about 4 kg cocaine per day. This would imply an average daily use of at least 27 ± 5 doses (100 mg each) for every 1000 young adults, an estimate that greatly exceeds official national figures. Data from waste water treatment plants serving medium-size Italian cities were consistent with this figure. CONCLUSION: This paper shows for the first time that an illicit drug, cocaine, is present in the aquatic environment, namely untreated urban waste water and a major river. We used environmental cocaine levels for estimating collective consumption of the drug, an approach with the unique potential ability to monitor local drug abuse trends in real time, while preserving the anonymity of individuals. The method tested here – in principle extendable to other drugs of abuse – might be further refined to become a standardized, objective tool for monitoring drug abuse

Uptake, Translocation, and Accumulation of Pharmaceutical and Hormone Contaminants in Vegetables

A team led by Wei Zheng, senior research scientist at ISTC, investigated whether our food is at risk of accumulating PPCPs when irrigated with wastewater from concentrated animal feedlot operations (CAFOs) and wastewater treatment plants (WWTPs). The results appeared in Zheng, Wei et al (2014). "Uptake, Translocation, and Accumulation of Pharmaceutical and Hormone Contaminants in Vegetables." in Kyung Myung, Norbert M. Satchivi, and Colleen K. Kingston, eds. Retention, Uptake, and Translocation of Agrochemicals in Plants. Washington, DC : American Chemical Society, 167-181. DOI: 10.1021/bk-2014-1171.ch009.Ope

Boerhaave syndrome as a complication of colonoscopy preparation: a case report

<p>Abstract</p> <p>Introduction</p> <p>Colonoscopy is one of the most frequently performed elective and invasive diagnostic interventions. For every colonoscopy, complete colon preparation is mandatory to provide the best possible endoluminal visibility; for example, the patient has to drink a great volume of a non-resorbable solution to flush out all feces. Despite the known possible nauseating side effects of colonoscopy preparation and despite the knowledge that excessive vomiting can cause rupture of the distal esophagus (Boerhaave syndrome), which is a rare but severe complication with high morbidity and mortality, it is not yet a standard procedure to provide a patient with an anti-emetic medication during a colon preparation process. This is the first report of Boerhaave syndrome induced by colonoscopy preparation, and this case strongly suggests that the prospect of being at risk of a severe complication connected with an elective colonoscopy justifies a non-invasive, inexpensive yet effective precaution such as an anti-emetic co-medication during the colonoscopy preparation process.</p> <p>Case presentation</p> <p>A 73-year-old Caucasian woman was scheduled to undergo elective colonoscopy. For the colonoscopy preparation at home she received commercially available bags containing soluble polyethylene glycol powder. No anti-emetic medication was prescribed. After drinking the prepared solution she had to vomit excessively and experienced a sudden and intense pain in her back. An immediate computed tomography (CT) scan revealed a rupture of the distal esophagus (Boerhaave syndrome). After initial conservative treatment by endoluminal sponge vacuum therapy, she was taken to the operating theatre and the longitudinal esophageal rupture was closed by direct suture and gastric fundoplication (Nissen procedure). She recovered completely and was discharged three weeks after the initial event.</p> <p>Conclusions</p> <p>To the best of our knowledge, this is the first report of a case of Boerhaave syndrome as a complication of excessive vomiting caused by colonoscopy preparation. The case suggests that patients who are prepared for a colonoscopy by drinking large volumes of fluid should routinely receive an anti-emetic medication during the preparation process, especially when they have a tendency to nausea and vomiting.</p

Analysis of pharmaceuticals in wastewater and removal using a membrane bioreactor

Much attention has recently been devoted to the life and behaviour of pharmaceuticals in the water cycle. In this study the behaviour of several pharmaceutical products in different therapeutic categories (analgesics and anti-inflammatory drugs, lipid regulators, antibiotics, etc.) was monitored during treatment of wastewater in a laboratory-scale membrane bioreactor (MBR). The results were compared with removal in a conventional activated-sludge (CAS) process in a wastewater-treatment facility. The performance of an MBR was monitored for approximately two months to investigate the long-term operational stability of the system and possible effects of solids retention time on the efficiency of removal of target compounds. Pharmaceuticals were, in general, removed to a greater extent by the MBR integrated system than during the CAS process. For most of the compounds investigated the performance of MBR treatment was better (removal rates >80%) and effluent concentrations of, e.g., diclofenac, ketoprofen, ranitidine, gemfibrozil, bezafibrate, pravastatin, and ofloxacin were steadier than for the conventional system. Occasionally removal efficiency was very similar, and high, for both treatments (e.g. for ibuprofen, naproxen, acetaminophen, paroxetine, and hydrochlorothiazide). The antiepileptic drug carbamazepine was the most persistent pharmaceutical and it passed through both the MBR and CAS systems untransformed. Because there was no washout of biomass from the reactor, high-quality effluent in terms of chemical oxygen demand (COD), ammonium content (N-NH(4)), total suspended solids (TSS), and total organic carbon (TOC) was obtained

Effect of Bio-Oss® Collagen and Collagen Matrix on Bone Formation

Objective: to compare the amount of new bone produced by Bio-Oss ® Collagen to that produced by collagen matrix in vivo. Method: eighteen bone defects, 5mm by 10mm were created in the parietal bone of 9 New Zealand White rabbits. 6 defects were grafted with Bio-Oss ® Collagen. 6 defects were grafted with collagen matrix alone (positive control) and 6 were left empty (negative control). Animals were killed on day 14 and the defects were dissected and prepared for histological assessment. Quantitative analysis of new bone formation was made on 100 sections (50 sections for each group) using image analysis. Results: A total of 339% more new bone was present in defects grafted with Bio-Oss ® Collagen than those grafted with collagen matrix (positive control). No bone was formed in the negative control group. Conclusion: Bio-Oss ® Collagen has the effect of stimulating new bone formation locally compared with collagen matrix in vivo. Bio-Oss ® Collagen may be utilized as a bone graft material. © Wong and Rabie; Licensee Bentham Open.published_or_final_versio