[The Primary Health Care Situation in Saxony-Anhalt. Perception, Description and Evaluation of Local Health Care Problems by Mayors]. / Die hausärztliche Versorgungssituation in Sachsen-Anhalt. Wahrnehmung, Beschreibung und Bewertung lokaler Versorgungsprobleme durch die Bürgermeister.

Background: The combination of ageing general practitioners and a shortage of young doctors is having a negative effect on primary health care in almost all municipalities in the German state of Saxony-Anhalt. The communities are finding it progressively more difficult to safeguard the provision of primary health care. To solve these problems, they have neither the appropriate skills nor sufficient funding. The aim of this study was to ask mayors in Saxony-Anhalt to describe and evaluate local primary health-care systems from their perspective. Method: In June of 2013, all 124 full-time mayors in Saxony-Anhalt were asked by e-mail to participate in a web-based survey. The questionnaire was broken down into the categories: "socio-demographics", "health-care system in the communities", "causes and measures taken to deal with health-care problems", "development of the primary health-care system" and "cooperation". The data were descriptively analysed using IBM Statistics SPSS. Results: The response rate was 51.6% (n=64). For 87.5% of the respondents the primary health-care system is an important location factor in their community. 45.3% consider it their duty to ensure the provision of local health care. However, 42.6% of the polled mayors believe the infrastructure in their community to be too unattractive to convince young general practitioners to settle down there. In the next 10 years, 75.0% of the respondents expect the provision of primary health care to deteriorate further. Conclusions: In view of local deficits, the polled municipalities are very interested in safeguarding the continued existence of primary health care. As local experts, communities should get more involved in planning and decision-making processes.

[Situation and perspectives of public health in Germany--research and teaching. Position paper of the German Public Health Association]. / Situation und Perspektiven von Public Health in Deutschland--Forschung und Lehre. Positionspapier der Deutschen Gesellschaft für Public Health e. V.

This position paper of the German Public Health Association describes current situation and perspectives of public health in Germany with emphasis on research and teaching. It outlines those measures necessary for strengthening of public health research in Germany.

A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery.

Pain, swelling and inflammation are expected during the recovery from total knee arthroplasty (TKA) surgery. The severity of these factors and how a patient copes with them may determine the ultimate outcome of a TKA. Cryotherapy and compression are frequently used modalities to mitigate these commonly experienced sequelae. However, their effect on range of motion, functional testing, and narcotic consumption has not been well-studied. A prospective, multi-center, randomised trial was conducted to evaluate the effect of a cryopneumatic device on post-operative TKA recovery. Patients were randomised to treatment with a cryopneumatic device or ice with static compression. A total of 280 patients were enrolled at 11 international sites. Both treatments were initiated within three hours post-operation and used at least four times per day for two weeks. The cryopneumatic device was titrated for cooling and pressure by the patient to their comfort level. Patients were evaluated by physical therapists blinded to the treatment arm. Range of motion (ROM), knee girth, six minute walk test (6MWT) and timed up and go test (TUG) were measured pre-operatively, two- and six-weeks post-operatively. A visual analog pain score and narcotic consumption was also measured post-operatively. At two weeks post-operatively, both the treatment and control groups had diminished ROM and function compared to pre-operatively. Both groups had increased knee girth compared to pre- operatively. There was no significant difference in ROM, 6MWT, TUG, or knee girth between the 2 groups. We did find a significantly lower amount of narcotic consumption (509 mg morphine equivalents) in the treatment group compared with the control group (680 mg morphine equivalents) at up to two weeks postop, when the cryopneumatic device was being used (p < 0.05). Between two and six weeks, there was no difference in the total amount of narcotics consumed between the two groups. At six weeks, there was a trend toward a greater distance walked in the 6MWT in the treatment group (29.4 meters versus 7.9 meters, p = 0.13). There was a significant difference in the satisfaction scores of patients with their cooling regimen, with greater satisfaction in the treatment group (p < 0.0001). There was no difference in ROM, TUG, VAS, or knee girth at six weeks. There was no difference in adverse events or compliance between the two groups. A cryopneumatic device used after TKA appeared to decrease the need for narcotic medication from hospital discharge to 2 weeks post-operatively. There was also a trend toward a greater distance walked in the 6MWT. Patient satisfaction with the cryopneumatic cooling regimen was significantly higher than with the control treatment.

[Diagnostic procedures and frequency of dementia. A prospective study in the daily routine of a geriatric hospital (PAOLA study)]. / Zur Diagnostik und Häufigkeit von demenziellen Erkrankungen. Eine prospektive Untersuchung im Alltag einer geriatrischen Klinik (PAOLA-Studie).

All 1019 patients admitted to the department of geriatric medicine of a general hospital were screened during an 11-month period prospectively and consecutively for dementia. This investigation is part of a study for investigation of informal caregivers and their willingness for home caregiving of dementia patients (PAOLA study). In about half of the 1019 patients, there was a suspicion of dementia by a median age of 83 years. In 28.2% (n=287) of all cases, dementia was clinically diagnosed and in 60.9% (n=621) it could be clinically ruled out at the time of investigation. Underlying diseases which initially misled to dementia suspicion were in 26.8% (n=30) of these cases depression disorders, 13.4% (n=15) intracranial lesions including tumor and hemorrhage, 8.9% (n=10) other psychiatric diseases including substance abuse as well as disabilities in seeing and hearing. These differential diagnoses might be treatable in individual cases. This study could not clarify in 10.9% (n=111) of all cases whether dementia was present in a patient at the time studied. It was mainly limited due to multiple concomitant morbidities and reduced patient communication skills.We recommend that structured diagnostic procedures and treatments should be performed at specialized centers in order to avoid missing any treatable underlying diseases. In addition, the patients should be followed up at regular intervals.

Combined UK/US field hospital management of a major incident arising from a Chinook helicopter crash in Afghanistan, 28 Jan 2002.

On Monday, 28 January 2002, a US Army Chinook helicopter crashed on landing in Afghanistan. Sixteen casualties were airlifted from the scene for treatment at the US Army 274th Forward Surgical Team and the British 34 Field Hospital Troop at Bagram airfield before aeromedical evacuation out of Afghanistan. This was the largest mass casualty incident to be dealt with in a combined fashion by the British and American medical services in Afghanistan during the initial months of Operation ENDURING FREEDOM. It illustrated how multinational surgical teams can successfully manage such incidents by following common and agreed protocols. The lessons learned are relevant to any combined operations in the near future.

Functional outcomes of instrumented posterior lumbar interbody fusion in active-duty US servicemen: a comparison with nonoperative management.

BACKGROUND CONTEXT: The existing literature lacks a functional outcome study addressing instrumented posterior lumbar fusion surgery in physically active patients. Furthermore, results of operative versus nonoperative treatment in these patients are not clear. PURPOSE: To evaluate patient-assessed function, pain, and satisfaction and military job performance between servicemen treated operatively and nonoperatively. STUDY DESIGN/SETTING: This is a nonrandomized analysis of consecutive active-duty military servicemen treated either operatively or nonoperatively for chronic back pain and single-level lumbar disc degeneration with emphasis on functional outcomes. PATIENT SAMPLE: Active-duty US servicemen with chronic low back pain. OUTCOME MEASURES/METHODS: Twenty-nine consecutive active-duty US servicemen were treated for chronic back pain and single-level lumbar disc degeneration by the same surgeon at a military spine facility. Fifteen were treated with instrumented posterior lumbar interbody fusion (PLIF), and 14 refused surgery and chose to be treated nonoperatively with spinal extensor muscle-strengthening exercise, medications, and restricted duty. The average follow-up time was 14 months (range, 6 to 24 months). All servicemen completed a functional outcome questionnaire American Academy of Orthopedic Surgeons/Scoliosis Research Society (AAOS/SRS) with emphasis on pre- and posttreatment function, pain, and satisfaction. The two groups were also compared using military job performance parameters. RESULTS: Four of 14 (28%) of the servicemen treated nonoperatively ultimately received a disability discharge from the military for back pain, another 5 of 14 (36%) remained on permanent duty-restriction profiles, and only 5 of 14 (36%) returned to full, unrestricted military duty. In the PLIF group, 12 of 15 soldiers (80%) were able to return to full duty, only 3 of 15 (20%) remained on permanent restrictive duty-limitation profiles, and 0 of 15 (0%) received a disability discharge from the military for back pain. Twelve of 15 (80%) of the PLIF group and 8 of 14 (57%) of the group treated nonoperatively were physically able to complete the posttreatment physical fitness test. No difference was observed between premorbid and posttreatment physical training (PT) test scores in either group. However, scores for patient-assessed posttreatment pain, function, and satisfaction were significantly higher in the PLIF group. Soldiers who were able to return to full military duty did so at an average of 2 months for the group treated nonoperatively (n = 5) and 4 months for the PLIF group (n = 12). Complications in the PLIF group included dural tear (n = 2), unilateral transient lower extremity paresthesia (n = 1), and wound seroma requiring reoperation (n = 1). CONCLUSIONS: In this nonrandomized study of 29 active-duty US servicemen with chronic low back pain and single-level lumbar disc degeneration, instrumented PLIF surgery was associated with a high rate of return to full military duty. Servicemen treated with this technique were less likely to receive a back pain disability discharge or a permanent physical limitation profile when compared with servicemen who chose to be treated nonoperatively. Outcomes with respect to postreatment pain, function, and satisfaction were higher in patients treated with instrumented PLIF and were excellent in servicemen who were able to return to full duty regardless of treatment.

Jefferson fracture resulting in Collet-Sicard syndrome.

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To increase awareness of and add to the spectrum of injury that can result from Jefferson fractures, to suggest a possible mechanism of injury, and to give a brief review of pertinent facts regarding C1 burst fractures and the Collet-Sicard Syndrome. SUMMARY OF BACKGROUND DATA: To the author's knowledge, this is the first reported case of a Jefferson fracture resulting in Collet-Sicard Syndrome. It represents only the second reported case of cranial nerve palsy caused by Jefferson fracture. METHODS: A 56-year-old man sustained a C1 burst fracture in a rollover motor vehicle accident. Repeated neurologic examinations over the ensuing days revealed lesions of cranial nerves IX, X, XI, and XII on the left side. RESULTS: Two weeks of traction, 10 weeks in a halo vest, and 2 weeks in a cervical collar resulted in adequate fracture healing and almost complete resolution of the patient's neurologic symptoms. CONCLUSION: Although this is the first reported case of Collet-Sicard Syndrome caused by Jefferson fracture, the authors' review of the literature suggests that cranial nerve injuries may go unrecognized in some patients with C1 burst fractures. The importance of a thorough neurologic examination, including examination of the cranial nerves, in all cases of cervical spine injury cannot be overemphasized.

Methicillin-resistant Staphylococcus aureus in a finger felon.

Methicillin-resistant Staphylococcus aureus is an increasingly prevalent nosocomial pathogen that presents therapeutic challenges. We report an incidence of methicillin-resistant S aureus in a felon. The biochemical and clinical characteristics of methicillin-resistant S aureus are reviewed. The alarming increase of this organism in various types of infections demands the attention of all surgeons and emphasizes the importance of early surgical drainage and culture of pus in all cases of infection. (J Hand Surg 2000; 25A:173-175.

A 26-year-old man with shoulder pain.

This case report included roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. The medical history, physical findings, and results of roentgenographic examinations precede clinical and roentgenographic differential diagnoses.