[Life-saving air supported avalanche mission at night in high alpine terrain]. / Lebensrettender luftgestützter lawineneinsatz bei nacht im hochalpinen gelände.

This is a case report about a helicopter emergency medical service (HEMS) operation during the night in response to an avalanche accident with two completely buried victims. One of the victims was rescued alive after 9.2 h presenting with a patent airway and an air pocket and was successfully rewarmed with forced air from 23°C core temperature without any neurological deficits. After the rescue the patient developed lung edema which resolved spontaneously within 2 days. The second victim was found dead presenting with an air pocket but solid frozen thorax. The special circumstances of the rescue operation and treatment are presented and discussed. The impact of a frozen chest on resuscitation decisions is presented and discussed with an emphasis on the triage of multiple victims.

Public reporting in Germany: the content of physician rating websites.

BACKGROUND: Physician rating websites (PRWs) are gaining in popularity among patients seeking quality information about physicians. However, little knowledge is available about the quantity and type of information provided on the websites. OBJECTIVE: To determine and structure the quantity and type of information about physicians in the outpatient sector provided on German-language physician rating websites. METHODS: In a first step, we identified PRWs through a systematic internet search using German keywords from a patient´s perspective in the two search engines Google and Yahoo. Afterwards, information about physicians available on the websites was collected and categorised according to Donabedian´s structure/process/outcome model. Furthermore, we investigated whether the information was related to the physician himself/ herself or to the practice as a whole. RESULTS: In total, eight PRWs were detected. Our analysis turned up 139 different information items on eight websites; 67 are related to the structural quality, 4 to process quality, 5 to outcomes, and 63 to patient satisfaction/experience. In total, 37% of all items focus specifically on the physician and 63% on the physician's practice. In terms of the total amount of information provided on the PRWs, results range from 61 down to 13.5 items. CONCLUSIONS: A broad range of information is available on German PRWs. While structural information can give a detailed overview of the financial, technical and human resources of a practice, other outcome measures have to be interpreted with caution. Specifically, patient satisfaction results are not risk-adjusted, and thus, are not appropriate to represent a provider's quality of care. Consequently, neither patients nor physicians should yet use the information provided to make their final decision for or against an individual physician.

Procalcitonin: inflammatory biomarker for assessing the severity of community-acquired pneumonia--a clinical observation in geriatric patients.

Community-acquired pneumonia is a common disease of the elderly and involves a high mortality risk. Demographic developments are creating new challenges for acute medical treatment strategies in geriatric patients with their underlying multimorbidity. In addition to the diagnostic parameters recorded on hospital admission, such as white cell count and C-reactive protein, procalcitonin, more than the risk scores CRB- and CURB-65 evaluated to date, appears to be a promising parameter for assessing the severity of pneumonia in elderly patients to allow early detection of severe courses and initiation of suitable treatment. The decisive factor is the dynamic course of the procalcitonin values over 3 consecutive days, as demonstrated in this case series.

[Age-dependent prioritisation of health-care spending--perspectives for the German health-care system]. / Altersabhängige Priorisierung von Gesundheitsleistungen--Perspektiven für das deutsche Gesundheitswesen.

Expenditure on health care has been rising for years. Also, the ageing population is a matter of fact. Generally, ageing goes along with higher expenditure for health care. Debates about the financial situation and solution for this situation are common. This article examines the impact of all aspects of ageism with regard to the expenditure in health care. Besides, for the practical effects of rationing, a multidimensional approach is illustrated. The article discusses the concept of age-dependent prioritisation of health-care spending.

[Drug administration and dosage forms in geriatric patients]. / Arzneimittelformen und Arzneimittelverabreichung in der Geriatrie.

The demographic shift demands more and more customized medical supplies and management structures for geriatric patients. The elderly patient with age-related functional restrictions and multi-morbidity is at special risk for an ill-adapted pharmacotherapy. In addition the frail elderly person is dependent on general-practitioner assistance. The prescription of a suitable drug and a safe and workable (galenic) application form is key to therapeutic success. Age-based intake regulations, repeated education, and intake training are crucial tasks for the general-practitioner when caring for a fast growing elderly patient population.

[Fever in the elderly patient]. / Alter Mensch fiebert-- wann wird's riskant?

The multimorbid geriatric patient with age-related functional deficits is at particular risk from fever. Although the underlying cause is usually an infection, collagenosis, malignomas or drug-associated side effects all play an increasingly important role in patients of advanced age. In this segment of the population, the question of the reasonableness of a diagnostic work-up weighed against the expected improvement in quality of life is of particular relevance. The most common complication is dehydration, which may be followed by marked confusion. Account being taken of the requirements and the social situation of the individual concerned, any critical development should prompt early hospitalization, ideally in a geriatric hospital.

Consultations with adolescents: the gap between their expectations and their experiences.

AIM: To study the expectations and experiences of adolescents when in consultation with doctors, particularly with regard to issues of confidentiality. METHODS: In a cross-sectional study, 613 seventh- and ninth-grade students (347 students aged 13 y and 266 students aged 15 y) completed a 40-item questionnaire specifically developed for this study. Students anonymously completed the self-administered questionnaire at school. RESULTS: Of these adolescents, 89% aged 13 y and 57% aged 15 y were accompanied by one of their parents to appointments with private practitioners. Of the respondents, 33%/52% (13-y-olds/15-y-olds) said that seeing the doctor alone for some time was important but only 18%/20% were given the opportunity to do so. Although 79%/90% of respondents stated that it was important for the doctor to keep information confidential, on request, only 37%/40% of private practitioners had spoken about confidentiality; 64%/78% of adolescents said that doctors should give assurance of confidentiality even with regard to their parents. However, only 26%/27% of private practitioners explicitly assured confidentiality with regard to parents. Acceptance of conditional confidentiality was high in all subpopulations. Short waiting times and the opportunity to talk about topics such as nutrition, drugs and sexuality were rated as important. CONCLUSION: Physicians should adapt their consultation style to the needs of adolescents by seeing the adolescent patient alone for some time and by assuring them of conditional confidentiality. Furthermore, they should provide opportunities to talk specifically about issues of potential concern to adolescents such as nutrition, drugs and sexuality. To accomplish these tasks, educational curricula in adolescent healthcare are required for physicians.