[Professionalization of Legal Dental Experts in Germany: Results of Studies on Structured Focus Groups]. / Ergebnisse strukturierter Fokusgruppenarbeit zur Professionalisierung des zahnärztlichen Gutachterwesens in Deutschland.

BACKGROUND: Legal expert opinions are a crucial instrument of professional self-control in medicine. To give impulses for further development, focus groups were initiated to reflect upon the perspective of legal dental experts. METHODS: 5 focus group discussions on the topic "Professionalization of legal dental experts" were conducted. A total of 32 experienced legal dental experts participated in the discussions. The results were evaluated by qualitative content analysis. RESULTS: A catalogue of 68 ideas was generated for improvement and divided into 15 categories. Among these were periodic quality circles, interprofessional exchange, supervision of novices and periodic feedback for legal dental experts and dentists. CONCLUSION: Self-reflection can be included as an instrument for quality improvement of legal dental expert opinions.

[Periodontal diseases--a review on the association between maternal periodontitis and adverse pregnancy outcome]. / Parodontale Erkrankungen--Eine Übersicht über die Beziehung mütterlicher Parodontitis und negativer Schwangerschaftsergebnisse.

Several prospective clinical trials have indicated an association between maternal periodontal status and adverse pregnancy outcome, e.g., low birth weight, pre-term birth and pre-eclampsia. However, the translation of these findings into clinical care and decision making is still a matter of debate. Gynecologists and obstetricians are usually not very familiar with periodontal diseases and do not always consider this pathology in routine preconception counselling. This article outlines the clinical pictures of the most common periodontal diseases and thus helps the gynecologists to identify patients with periodontal diseases.

[The glandular odontogenic cyst--a rare entity]. / Glanduläre odontogene Zyste - eine seltene Entität.

In this short communication, the very rare glandular odontogenic cyst (GOC) is presented as an independent entity. The GOC is a jawbone cyst of the maxilla and mandible. The typical radiological and histopathological characteristics of the GOC are described. Furthermore, differential diagnoses, current treatment options and the recurrence rates of this of entity are discussed.

[Pain management of cognitively impaired patients]. / Schmerzmedizinische Versorgung von Patienten mit kognitiven Beeinträchtigungen.

Pain is a significant problem in clinical practice and its control is one of the most important challenging aspects as pain has a major impact on patients' quality of life and health care costs. Particularly vulnerable persons, like cognitively impaired patients are challenging for pain management and underline its increasing relevance.National and international studies showed significant differences concerning pain therapy between cognitively impaired and cognitively intact patients. A possible cause of this may be that patients who are cognitively impaired are only in a restricted way able to express their pain. Furthermore, knowledge gaps and reservations concerning the effect and dosage of analgesics among cognitively impaired patients could be identified on the involved professions.Further investigations in Germany are needed as deficient treatment remains a persistent problem and evidence-based data are missing. These investigations should describe the status quo of pain management for cognitively impaired patients and provide information which processes have to be adapted to the needs of these vulnerable patients.

[An update: keratocystic odontogenic tumor--a cyst to a tumor]. / Update: Keratozystischer odontogener Tumor (KZOT)--Von der Zyste zum Tumor.

According to the 2005 WHO classification of head neck tumors the parakeratinized form of the odontogenic keratocyst (primordial cyst) is listed as benign odontogenic tumor and is classified as keratocystic odontogenic tumor (KCOT). In this short communication the surgical regimen as well as KCOT as an entity are discussed.

Radiographic assessment of a keratocystic odontogenic tumour using cone-beam computed tomography.

BACKGROUND: The keratocystic odontogenic tumour (KCOT), formerly known as the odontogenic keratocyst, is a benign intra-osseous odontogenic tumour. The KCOT is characterised by a potential for locally destructive behaviour and a relatively high recurrence rate. Most KCOT are incidentally discovered as well-defined unilocular or multilocular radiolucencies on routine panoramic radiographs. CASE REPORT: A 15-year-old boy was referred to dental care with a non-syndromic KCOT in the right angle of the mandible. Using cone-beam computed tomography (CBCT) as a diagnostic instrument for precise assessment of the KCOT, the exact location of the lesion was determined. TREATMENT: The cystic formation was enucleated without peripheral ostectomy. FOLLOW-UP: At post-operative follow-up after 3 and 6 months, the boy reported no pain and there was no residual swelling or fracture. Imaging was planned after 1 year to decide whether further surgical treatment is indicated. CONCLUSION: The CBCT is considered beneficial in cases of cystic formations to determine the localisation and borders of the lesion in all three dimensions.

[How dentists experience legal disputes with their patients - a qualitative approach]. / Wie erleben Zahnärzte eine gerichtliche Auseinandersetzung mit Patienten? Eine qualitative Untersuchung.

BACKGROUND: A well-established doctor-patient relationship is essential for dental care. Once ­there is a legal dispute between the dentist and the patient this doctor-patient relationship has failed. Here we show for the first time how dentists experience these lawsuits. We characterise the dentist's perspectives and investigate their influence on the doctor-patient relationship. METHODS: The experience of dentists who were involved in a legal dispute due to a failed dental treatment is pictured in a pilot study on the basis of narrative and problem-oriented interviews. The narrative part of the interview was analysed with the technique of narration analysis. The problem-oriented part of the interview was evaluated content-analytically. From these data a model describing the failure of a doctor-patient relationship was developed. RESULTS: Communicated burdens and stress were: expenditure of time, duration of the proceedings, financial burdens, limited support and the feeling of being treated unfairly. Consequences taken from the legal dispute were a more detailed documentation and an improvement in patient information. The conflict in the doctor-patient relationship is transformed to a different platform when the legal profession is involved. This contradictory constellation leads to a break in the doctor-patient relationship. Advice for other affected colleagues is: remain calm, aim at an out of court settlement, seek advice from other colleagues and request legal advice, be proactive, avoid court litigation and in the end draw conclusions from the dispute. There is a need for a higher quality of legal dental experts. A contact platform provided by the dental profession is required for interactive collegial communication. CONCLUSION: Lawsuits in cases of a conflict between the doctor and the patient are very stressful and need an active coping management but also are a chance for the development of the individual dentist and the profession.

[Attitudes of dental legal expert witnesses on their present status in Germany and approaches to the development of the profession]. / Ist-Zustand und Ansätze zur Professionalisierung des zahnärztlichen Gutachterwesens in Deutschland aus der Selbstsicht der Gutachter.

BACKGROUND: Dental litigation has a key role for the autonomy of the dental profession. We conducted a study among legal dental expert witnesses in order to reflect the present situation and reveal the potential for professional development. METHODS: A questionnaire was distributed among 161 participants of the Karlsruhe training for legal dental experts between 2004 and 2009. They were asked to describe and to reflect on the present situation of dental litigation in Germany. RESULTS: 83 questionnaires were returned (51.6%). The main reason to become a legal dental expert was to "support the profession". 68 participants (85.0%) think that civil action resulting from dental treatment will become more frequent. The quality of dental expert opinions is considered to be in need of improvement. Strategies to optimise dental expert opinions and to deal with the potential growing number of claims are developed. CONCLUSION: Basic and advanced training for dental expert witnesses assures the quality of dental expert opinions and also provides a chance for the further development of the dental profession.

Case report: non-syndromic multiple supernumerary teeth localized by cone beam computed tomography.

BACKGROUND: Supernumerary teeth are an infrequent developmental alteration that can appear in any area of the dental arches and which are often associated with several syndromes such as cleidocranial dysplasia or Gardner syndrome. Multiple supernumerary teeth in individuals with no other associated diseases or syndromes are very uncommon. CASE REPORT: A 14-year-old male patient presented with 13 unerupted supernumerary teeth distributed in all four quadrants. TREATMENT: After taking a cone beam computed tomograph (CBCT), surgical extraction was performed under general anaesthesia in two steps in order to minimize the risk of airway-constriction by haematoma. FOLLOW-UP: Follow-up examination was uneventful. Further orthodontic treatment is planned which will secure the orthodontic alignment and correct occlusion. CONCLUSION: Cone beam computed tomography is crucial for exact localization, for treatment planning, and for the surgical approach in cases of multiple supernumerary teeth.

Development of a brief screen for violence risk (V-RISK-10) in acute and general psychiatry: An introduction with emphasis on findings from a naturalistic test of interrater reliability.

Most violence risk assessment scales were originally developed for use in forensic settings at the time of discharge or release of patients into the community after long-term treatment. However, there is a considerable need for specialized, brief and structured risk assessment tools to inform risk decisions in short-term psychiatric treatment. The present study reports on research findings from the development and implementation of the violence risk screening-10 (V-RISK-10) in two acute psychiatric settings in Norway. The 10-item screen is easy to use, time-saving and may be used for screening of violence risk during hospital stay and after discharge into the community. Prospective validation studies of the screen concerning inpatient and post-release community violence have been conducted. Although data analyses are not yet complete, preliminary findings indicate that the screen has good predictive validity. This suggests that the screen is a promising tool in short-term acute psychiatric settings. However, the importance of reliability in mental health data and tests is well recognized, and a screen with good predictive validity is not worth much if clinicians are unable to agree on the scoring of one and the same patient. In this article we report results from a naturalistic interrater reliability investigation that involved 25 mental health professionals and 73 acute psychiatric patients. V-RISK-10 scoring was accomplished by two raters for each patient. The interrater reliability value for total scores was acceptable. Variations pertaining to the individual V-RISK-10 item, patient characteristics and rater characteristics are discussed.

[Subtainable health promotion via organisational development--a model project for teachers in professional training schools]. / Nachhaltige Gesundheitsförderung durch Organisationsentwicklung -- Ein Modellprojekt für Berufsschullehrkräfte.

The goal of this project is the development, implementation and evaluation of a concept designed for sustainable health promotion among occupational and trade school teachers. We assume that for sustainable health promotion -- along with a behavioral prevention program -- a change is necessary in the structure, as well as, the working and communication processes within schools. The realization of early teacher participation and self regulated cooperative groups initiates comprehensive and goal-oriented developmental processes in the project schools. The organizational development process was accomplished in the following way: At the beginning we conducted a diagnosis of school-specific and individual health risks and the resources available to the project schools. The results were reported for both the individual and for the teacher group. This was intended to clarify the potential for improvement and, thus, strengthen the teachers' motivation toward processes of change. Following the diagnosis, the teachers chose areas of stress-related strain and then worked in groups to develop and implement behaviour and working condition-oriented intervention strategies for health promotion. The diagnosis results confirm the necessity of school-specific health promotion: the schools demonstrate very different demand and resource profiles. Furthermore, is has become evident that the central success factor for health promotion in schools is the teachers' willingness for change. The individual and group reports of the diagnosis results seem to have made clear how essential individual and organisational changes are.

[Celecoxib in the symptomatic treatment of active osteo- or rheumatoid arthritis. Results of a post-marketing surveillance]. / Celecoxib in der symptomatischen Therapie bei aktivierter Osteoarthrose oder rheumatoider Arthritis. Ergebnisse einer Anwendungsbeobachtung.

BACKGROUND AND OBJECTIVE: The introduction of cyclooxygenase (COX)-2 selective drugs now offers physicians the possibility of a adequate analgesic and anti-inflammatory therapy. Drug induced side effects typically associated with NSAIDs are reduced. Using a post-marketing surveillance study (PSS) efficacy and tolerability of the COX-2-selective drug Celecoxib was evaluated. Patients were not restricted in the use of other medication. PATIENTS AND METHODS: By means of a prospective, non-intervening PSS patients mainly suffering from musculoskeletal conditions such as osteoarthritis (70.5 %) or rheumatoid arthritis (19.6 %) were examined by about 12,000 physicians. The median observation period was almost 5 weeks. RESULTS: In total 70236 patients (42 % males, 58 % females, mean age 60.3 years) were assessed. About 87 % of the patients were adequately treated with a daily dose of 200 mg. The tolerability of the treatment was judged to be "good" to "very good" by the physicians in 97 % and by the patients in 96 % of the cases. The overall incidence of undesirable events (UE) with or without potential causal relationship with the study medication was 2.8 % (1,955 patients), severe UEs manifesting in 0.3 % (223) of all patients. CONCLUSIONS: Overall, the PSS confirms the evident subjective efficacy and tolerability by both the physician's and the patient's overall assessment.

Ligand-dependent autophosphorylation of the insulin receptor is positively regulated by Gi-proteins.

Previously, we have shown that the human insulin receptor (IR) interacts with G(i)2, independent of tyrosine kinase activity and stimulates NADPH oxidase via the Galpha subunit of G(i)2. We have now investigated the regulatory role of G(i)2-proteins in IR function. For the experiments, isolated IRs from plasma membranes of human fat cells were used. The activation of IR autophosphorylation by insulin was blocked by G-protein inactivation through GDPbetaS (guanosine 5'-[beta-thio]disphosphate). Consistently, activation of G-proteins by micromolar concentrations of GTPgammaS (guanosine 5'-[gamma-thio]triphosphate) induced receptor autophosphorylation 5-fold over baseline and increased insulin-induced autophosphorylation by 3-fold. In the presence of 10 microM GTPgammaS, insulin was active at picomolar concentrations, indicating that insulin acted via its cognate receptor. Pretreatment of the plasma membranes with pertussis toxin prevented insulin- and GTPgammaS-induced autophosphorylation, but did not disrupt the IR-G(i)2 complex. The functional nature of the IR-G(i)2 complex was made evident by insulin's ability to increase association of G(i)2 with the IR. This leads to an augmentation of maximal receptor autophosphorylation induced by insulin and GTPgammaS. The specificity of this mechanism was further demonstrated by the use of isolated preactivated G-proteins. Addition of G(i)2alpha and Gbetagamma mimicked maximal response of insulin, whereas Galphas or Galphao had no stimulatory effect. These results define a novel mechanism by which insulin signalling mediates tyrosine kinase activity and autophosphorylation of the IR through recruitment of G(i)-proteins.

Platelet-derived growth factor activates production of reactive oxygen species by NAD(P)H oxidase in smooth muscle cells through Gi1,2.

Recent findings indicate that platelet-derived growth factor (PDGF) plays a role in the generation of reactive oxygen species (ROS) as second messengers in smooth muscle cells (SMC). To identify the source and signal transduction pathway of ROS formation in SMC, we investigated PDGF-induced ROS formation. Stimulation of SMC with PDGF resulted in a rapid increase of ROS production. Using an inactivating antibody, we identified the increase to be dependent on p22phox, a NAD(P)H-oxidase subunit. ROS release was completely inhibited by the Gi protein inhibitor PTX as well as an antibody against Galphai1,2, however, not by antibodies against Galphai3/0, Gas, and Gbeta1beta2. The effect of PDGF on ROS production in SMC membranes could likewise be mimicked by the use of a recombinant Galphai2 subunit but not by Galphai3, Galphai0, Gas, and Gbetagamma subunits. Immunoaffinity chromatography demonstrated coupling of Galphai1,2 to the PDGF a-receptor, which, after preincubation of the SMC membranes with PDGF, was increased in the absence of GTPgammaS but decreased in the presence of GTPgammaS and prevented by PTX treatment. These data define a novel G protein-dependent mechanism by which PDGF signaling is transduced through direct coupling of the Gai1,2 subunit of the trimeric G proteins to the PDGF tyrosine kinase receptor.

A novel approach to temporary stenting: degradable cardiovascular stents produced from corrodible metal-results 6-18 months after implantation into New Zealand white rabbits.

OBJECTIVE: To determine whether corrodible materials may be safely used as biodegradable cardiovascular implants. DESIGN: Corrodible iron stents (> 99.8% iron) were produced from pure iron and laser cut with a stent design similar to a commercially available permanent stent (PUVA-AS16). A total of 16 NOR-I stents were implanted into the native descending aorta of 16 New Zealand white rabbits (mean luminal diameter at the implantation site 3.4 mm, balloon diameter to vessel diameter ratio 1.13). RESULTS: No thromboembolic complications and no adverse events occurred during the follow up of 6-18 months. All stents were patent at repeat angiography after 6 (n = 9), 12 (n = 5), and 18 months (n = 2) with no significant neointimal proliferation, no pronounced inflammatory response, and no systemic toxicity. CONCLUSIONS: This initial in vivo experience suggests that degradable iron stents can be safely implanted without significant obstruction of the stented vessel caused by inflammation, neointimal proliferation, or thrombotic events.

[Compliance with hand hygiene in intensive care units]. / Compliance der Händedesinfektion auf Intensivstationen.

INTRODUCTION: Nosocomial infections are an important problem in modern hospitals. The prevalence in German intensive care units is 15.3%. Hand washing or hand disinfection is believed to be the most important means of preventing nosocomial infections. We wished to answer the following questions: 1. How good is the compliance of hand hygiene on intensive care units? 2. Is compliance associated with the patient/nurse-ratio? METHOD: In a study of 8 intensive care units the compliance of hand hygiene was observed on two occasions, once in May 1996 and again in November 1997. The prime necessity for hand disinfection occurred when handling ventilation devices, intravascular catheters, urinary catheters and dressings. In addition the patient/nurse-ratio was calculated. RESULTS: A total of 1,879 infection-relevant handlings were observed. The compliance of hand hygiene ranged from 25.7 to 83.2% (mean 55.2%). The most commonly observed handlings were the manipulation of venous catheters (52.7%), the highest compliance was observed with the manipulation of ventilation equipment (91.8%). With a better patient nurse ratio the compliance did not improve but remained the same or was even reduced. DISCUSSION: The compliance of hand disinfection is similar to other study results, but on some intensive care units there was considerable room for improvement. In this study the compliance of hand hygiene is more of a constant factor in individual intensive care units than associated with the patient/nurse-ratio.

[Metallic biomaterials for coronary stents]. / Metallische Biowerkstoffe für koronare Stents.

The introduction of coronary stents is a milestone in interventional cardiology. Two landmark studies have shown that stainless steel stents significantly decrease the restenosis rate as compared to balloon angioplasty. This fact led to a marked increase of stent implantation since the first stent implantation by Jacques Puel in 1986. Although the concept of coronary stenting significantly improved the interventional therapy of coronary artery disease, restenosis remains a major unsolved drawback of this technique. In addition to procedure and disease related factors like implantation pressure and plaque burden, data suggest that the stent as a medical implant plays a crucial role in the process of neointima formation. Since its introduction in cardiology, more than 50 different stents of different configuration and material have been developed. Although recent publications report of promising results using biodegradable materials, almost all coronary stents commercially available at the moment are made of metallic alloys. Whereas first generation stents were made exclusively from stainless steel and only minor interest was focussed on the stent material in the manufacture of coronary stents, recent studies strongly suggest that the metallic alloy used has a direct impact on the extent of neointima formation. Thus, metallic alloys differ not only with respect to mechanical features, but also by their biocompatible properties. These two factors are of major importance in the induction of vessel wall injury, inflammatory processes and cell proliferation. In the first part, the present paper reviews the metallurgic characteristics of metallic materials, which are currently used or under investigation in the production of coronary stents. In the second part, clinical and experimental results are summarized with respect to their biocompatibility and impact on the process of restenosis formation.

Surveillance of nosocomial infections in ICUs: is postdischarge surveillance indispensable?

OBJECTIVE: To determine how many infections are missed if the postdischarge surveillance (PDS) follow-up of intensive care unit (ICU) patients that is required by the National Nosocomial Infection Surveillance System method is not done. DESIGN: ICU patients were followed up and surveillance results with PDS (gold standard) and without PDS were compared. SETTING: Surgical or interdisciplinary ICUs in eight German acute-care hospitals. PATIENTS: All 1,857 patients within a 6-month period in the participating ICUs (a total of 9,129 ICU-patient-days). RESULTS: Without PDS, 45 urinary tract infections (UTIs) were diagnosed, compared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischarge follow-up was performed. Three nosocomial pneumonias (4%) and one bloodstream infection (8%) also were missed if surveillance was carried out without PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated NIs were missed if no follow-up was done. CONCLUSIONS: Since it is very time-consuming to follow patients after their transfer from the ICU, we do not perform a postdischarge follow-up of patients in the course of routine surveillance.