[Reasons of changes in drug therapy after hospital discharge - a qualitative study of perception by general practitioners and patients]. / Gründe von Änderungen der medikamentösen Therapie nach Krankenhausentlassung - eine qualitative Studie aus Sichtweise von Hausärzten und Patienten.

BACKGROUND: After discharge from hospital there is often change of medication regimen. Usually, the main results of the inpatient stay and the subsequent treatment recommendations are summarised in a "discharge letter". Based on this, the general practitioner decides on how to proceed taking the individual aspects of his/her patient into consideration. The aim of the study is to trace changes of medication and suggested therapy in the discharge letter, from the GP through to the patient and the reasons/influencing factors for any changes in medication undertaken or retained. METHODS: A prospective qualitative study with successively selected patients, who were put on a new long-term medication, at discharge after a stay in a hospital internal medicine unit was undertaken. Semi-structured interviews were conducted with the patients 4-6 weeks after hospital discharge. Subsequently, interviews were conducted with the patient's GP on details of current medication. The interviews were recorded electronically, based on the consensus method and evaluated with respect to changes in medication and influencing factors. In order to detect discrepancies in drug therapy, discharge letters were included in the analysis. RESULTS: A total of 34 patients and their GPs were interviewed. Few changes of medication changes were registered; however, these were more frequent in the weeks after hospital discharge. Drug therapy recommendations were modified by GPs for different medical or non-medical reasons. Non-medical reasons identified included economic, health policy constraints, personal conviction or non-adhrence of the patient. Reasons for a change in medication by the patient included, questioning of the need for taking the drug, incompatibility, fears and a lack of knowledge about the medication. CONCLUSION: The data demonstrate that the transition from inpatient to outpatient care is a sensitive interface. The data do not allow quantitative estimation of the magnitude of this phenomenon. In this study, the reasons for the modification of the drug demonstrated that these findings could be the basis for further studies or the development of interventions for preventing unwanted medication changes.

[Influence of package inserts on adherence to medication in primary care patients]. / Der Einfluss des Beipackzettels auf die medikamentöse Adhärenz bei hausärztlichen Patienten.

BACKGROUND: German legislation requires a package insert (PI) to be attached to any drug that informs patients about the use, indications, dosage and possible side effects. This PI is often blamed for deliberate deviations from the patient's prescribed medication regimen. It is unknown to what extent patients use the opportunity to inform themselves by the PI and potential consequences for medication adherence. METHODS: In semi-structured interviews patients were asked about their use of package inserts, their opinion about PI and potential consequences of PI. Patients with newly prescribed drugs were included in the study. Data analysis was carried according to the qualitative content analysis by Mayring. RESULTS: 71 interviews were analyzed. PIs are used in very different ways and intensity. PIs are predominantly associated with negative connotations. Reading of PI seems to have hardly any immediate impact on medication adherence. Patients expressed that they feel confidence in the pharmaceutical industry and especially rely on the expertise of theirs general practitioner. CONCLUSION: These results point out that the use of PIs may have less impact than often assumed. Reading the package insert in these patients did hardly affect medication adherence.

[Structures and practice of psychology departments in orthopaedic and cardiac rehabilitation: a comparison of outpatient and inpatient clinics in Germany]. / Strukturen und Praxis der Psychologischen Abteilungen in der orthopädischen und kardiologischen Rehabilitation: Vergleich zwischen ambulanten und stationären Einrichtungen in Deutschland.

We aimed at comparing the present structural quality and practice of psychological services in ambulatory (outpatient) and inpatient rehabilitation in Germany.A nationwide survey of psychological services in orthopaedic and cardiac outpatient rehab centres was carried out. Results were compared to those of an identical study of inpatient services that was conducted simultaneously.Data were obtained from 81 ambulatory centres (return rate: 44%). Structures and practice (e. g., diagnostic procedures, psychological interventions) in ambulatory and inpatient rehabilitation only differed marginally. Differences concern the staff/patient ratio which is slightly better in ambulatory centres and some aspects of working conditions (e. g., less assisting staff or supervision).From its beginning, ambulatory rehabilitation in Germany has followed the standards of the inpatient model as far as structural quality and processes are concerned. Psychological practice in the ambulatory setting reflects that too. It is discussed whether the uniformity of ambulatory and inpatient rehabilitation services really is appropriate, or whether a more flexible model (e. g., regarding treatment duration) is needed in the German rehabilitation system.

[The methodological quality of rehabilitation guidelines]. / Methodische Qualität von Leitlinien in der Rehabilitation.

INTRODUCTION: The concepts of clinical guidelines contribute to the decision-making and improvement in the quality of medical supply. This paper provides a literature research on rehabilitation guidelines and their evaluation by the "German Instrument for Methodological Guideline Appraisal (DELBI)". METHODS: The clinical guideline research was conducted with the help of an online database as well as expert surveys conducted between August and October 2007. The literature research was updated in October 2008. Only those guidelines that satisfied specific criteria were included in the evaluation. RESULTS: Although the research yielded 124 guidelines, only 28 were included in the evaluation after applying the criteria. In total, the evaluation was heterogeneous. With regard to each domain, the mean degree of fulfillment reached between 2.1% and 58.3%. DISCUSSION: Due to an extensive and detailed literature research and expert survey, all relevant clinical guidelines for rehabilitation, which are valid in Germany, could be gathered. A first examination of the guidelines seems to reveal several deficiencies. Possible reasons are discussed. CONCLUSION: This paper reveals a detailed survey of the clinical guidelines for rehabilitation. Compared to acute-care medicine, the number of available guidelines is distinctly smaller. With regard to the DELBI criteria, an enormous development in the quality of guidelines for rehabilitation is still necessary. Some of these might be due to inaccurate documentation, which will have to be considered in a further update.

[Analysis of therapeutic procedures in 5,838 rehab patients following total hip or total knee replacement]. / Ergebnisse einer Analyse der therapeutischen Leistungsdaten (KTL-Daten) von 5,838 Rehabilitandinnen und Rehabilitanden nach Hüft- bzw. Knieendoprothesenimplantation.

In the framework of the Practice Guidelines programme of the German Federal Pension Insurance (DRV Bund) evidence-based standards for rehabilitation following total hip or knee replacement are to be developed. The results of a quantitative analysis of present health-care on the basis of documented treatments (KTL) from 5 838 rehab patients are reported here. Based on a systematic review of international trials, treatment modules were specified and analyzed as to frequency and duration of current treatment. Furthermore, separate analyses were conducted for gender, age, and different clinics. No differences were found among rehab facilities as to exercise therapy, physiotherapy, or health education. However, psychological treatment and specific trainings differed considerably between centres.

[Systematic literature analysis on therapies applied in rehabilitation of hip and knee arthroplasty: methods, results and challenges]. / Systematische Literaturanalyse zu Therapien in der Rehabilitation nach Hüft- und Kniegelenks-Total-Endoprothesen: Methoden, Ergebnisse und Herausforderungen.

Evidence-based medicine is a central issue in medical practice. This also applies to rehabilitation services. The German Statutory Pension Insurance meets this need in its guideline programme. Amongst others a guideline for rehabilitation following hip or knee arthroplasty is currently being developed. In this context a hierarchic, systematic literature analysis was conducted summarising the current state of evidence with reference to the effects and the treatment requirements (frequency and duration) of different rehabilitative therapies following total hip or knee replacement. In the first step, a search for evidence-based guidelines, systematic reviews and health technology assessments was conducted. Secondly, search strategies for primary literature in the following databases were designed: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PsychINFO (01/1997-09/2007). Additionally, a handsearch of several German journals not listed in the databases was conducted. Randomized trials were preferred, however, non-randomized trials were included if the intervention and control groups were comparable with regard to the baseline parameters. Results can be classified into three categories: (1) therapies for which evidence for (positive) effects was found, (2) therapies for which evidence was found, however, their transferability onto rehabilitation in Germany should be discussed (e. g., studies on immediate post-surgery interventions), and (3) therapies for which no methodologically appropriate trials could be found. The literature reviewed does not allow for final conclusions as to frequency and duration of different therapeutic interventions within the rehabilitation time frame in Germany (usually the first three weeks post discharge from hospital). Overall, there is a need for further research.

[Changes of teaching in the interdisciplinary subject "rehabilitation, physical medicine, naturopathic treatment" in the German medical faculties 2004 to 2006/07]. / Entwicklung der Lehre im Querschnittsbereich "Rehabilitation, Physikalische Medizin, Naturheilverfahren" an den medizinischen Fakultäten 2004-2006/07.

BACKGROUND: Rehabilitation, Physical Medicine, Naturopathic Treatment (Querschnittsbereich Q-12) was introduced as a compulsory interdisciplinary subject in the revised Federal Medical Licensing Regulations (Approbationsordnung für Arzte) in October 2003. This offered the opportunity to increase the students' interest in rehabilitation-related issues and to integrate current evidence of rehabilitation research. The implementation of the Q-12 in the German medical faculties was investigated by yearly questionnaires during a three-year-period. METHODS: In 2004, 2005, and 2006/07 anonymous postal questionnaires concerning the teaching in Q-12 were sent to the 36 medical faculties in Germany. Non-responders were reminded at least once by a repeat postal questionnaire. RESULTS: The response rates were 67% in 2004, 72% in 2005, 50% in 2006/07, respectively. Of the 36 faculties 34 responded at least once. Ten faculties responded to all questionnaires. In a considerable number of faculties, Q-12 is being coordinated by university institutions which are not denominated as one of the subjects designated in the Q-12 title. Major differences regarding the implementation of Q-12 were found between the faculties. Further development of Q-12 faces several limitations of resources. Almost all faculties provide curricula for teaching Q 12, some of which are still incomplete. During all three examinations lecturer-centered teaching methods (lectures, seminars, other presentations) were used most frequently. POL-cases and other structured patient oriented teaching were also reported less frequently. E-learning was very rarely offered to the students. Musculoskeletal and neurological disorders were the most frequent specific indications for practice-related integration of Q-12 issues. Compulsory election subjects (Wahlpflichtfächer) related to Q-12 issues before and during the final year of the medical students, are not being offered by all faculties. The vast majority of the faculties advocate an exchange of materials for teaching and examinations. CONCLUSIONS: During the three examinations, major differences concerning the implementation of Q-12 were found between the faculties. Therefore, it is recommended that all faculties verify whether they adequately cover the joint educational objectives recommended for Q-12 by two German scientific societies. Furthermore, the more frequent application of up-to-date practice-oriented teaching and examination methods, an intensified implementation of Q-12-related issues in teaching specific indications, the completion of curricula, enhanced offer of compulsory election subjects related to Q-12 issues, continued scientific investigations and symposia/workshops concerning the promotion of Q-12-related teaching as well as the generation and exchange of teaching and examination materials are recommended.

[Problem oriented learning (POL) in rehabilitation on the example of a patient with ankylosing spondylitis]. / Problemorientiertes Lernen (POL) in der Rehabilitation am Beispiel eines Patienten mit Spondylitis ankylosans.

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported.

[Current teaching, learning and examination methods in medical education and potential applications in rehabilitative issues]. / Aktuelle Lehr-, Lern- und Prüfungsmethoden in der medizinischen Ausbildung und ihre Anwendungsmöglichkeiten für die Rehabilitation.

With introduction of the new Federal Medical Licensing Regulations (Approbationsordnung) in Germany, integrated teaching in "Rehabilitation, Physical Medicine, Naturopathic Treatment" (Querschnittsbereich Q12) has become obligatory for the first time. Furthermore, the new Regulations require the medical faculties in Germany to realize an innovative didactic orientation in teaching. This paper provides an overview of recent applications of teaching techniques and examination methods in medical education with special consideration of the new integrated course Q12 and further teaching methods related to rehabilitative issues. Problem-oriented learning (POL), problem-based learning (PBL), bedside teaching, eLearning, and the examination methods Objective Structured Clinical Examination (OSCE) and Triple Jump are in the focus. This overview is intended as the basis for subsequent publications of the Commission for Undergraduate and Postgraduate Training of the German Society of Rehabilitation Science (DGRW), which will present examples of innovative teaching material.

[Comparison of three outpatient therapy forms for treatment of chronic low back pain-- findings of a multicentre, cluster randomized study]. / Vergleich dreier ambulanter Therapieformen zur Behandlung chronischer Rückenschmerzen-- Ergebnisse einer multizentrischen, clusterrandomisierten Studie.

The AOK Baden-Württemberg health insurance fund initiated a study on the outpatient rehabilitation of patients with chronic low back pain, aimed at improving the treatment concept for its insurees with chronic low back pain (START). This model project was scientifically guided by the Hochrhein-Institute in Bad Säckingen. The paper compares the effectiveness of Enhanced Outpatient Physiotherapy (Erweiterte Ambulante Physiotherapie, EAP), Outpatient Rehabilitation (Ambulante Rehabilitation, AR) and Medical Training Therapy (Medizinische Trainingstherapie, MTT) in patients with low back pain. In seven regions in Baden-Württemberg, one of these three intervention forms was provided to the patients. A total of 1,274 patients were included in the study. The AOK Baden-Württemberg patients receiving treatment in one of the three intervention forms were seriously restricted in both the physical dimension of their health status and in their physical mobility in everyday life and at the workplace. Besides, they frequently reported considerable psychosocial strain. The three interventions led to significant and relevant decreases in pain intensity and to an improved health-related quality of life. There were no significant differences between the various treatments in terms of effectiveness. The patients shared an equally high satisfaction with the treatment received. In MTT, the total therapy length of 15 weeks was by far longer than in AR and EAP (about 5 and 8 weeks). Unlike AR and, in parts, EAP, patients may continue to work while participating in MTT. Therefore an immediate therapy start within a week was more likely possible in MTT (59 %) than in AR (10 %) or EAP (23 %). In evaluating the results a number of restrictions have to be considered. Nevertheless, based on our research findings, the following can be concluded: MTT is a suitable therapy concept in patients with low back pain characterized by a rapid start and-- compared to the other two concepts-- by lower therapy costs. MTT might represent a meaningful therapy element also in new forms of provision such as integrated services. Patients showing severe psychosocial strain should be assigned to an interdisciplinary therapy as it is provided by inpatient and outpatient rehabilitation facilities. For effective differential assignment to the various programmes, realization of a standardized rehab assessment is an important precondition.

[Educational objectives in the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Techniques" under the 9th Revision of the Licensing Regulations for Doctors--consensus recommendations of the German Society for Rehabilitative Sciences and the German Society for Physical Medicine and Rehabilitation]. / Lernziele im Querschnittsbereich Rehabilitation, Physikalische Medizin und Naturheilverfahren nach der 9. Revision der Approbationsordnung für Arzte--Gemeinsame Empfehlung der Deutschen Gesellschaft für Rehabilitationswissenschaften und der Deutschen Gesellschaft für Physikalische Medizin und Rehabilitation.

In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.

[Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures]. / Leitlinienentwicklung in der Rehabilitation bei Rückenschmerzpatienten--Phase 2: Ergebnisse einer Analyse von KTL-Daten.

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

[The DEGAM guidelines "Dysuria" by the German Society of General Practice and Family Medicine (DEGAM)--possible consequences of the implementation in general practice]. / Die DEGAM-Leitlinie "Brennen beim Wasserlassen"--mögliche Konsequenzen der Umsetzung in der allgemeinärztlichen Praxis.

INTRODUCTION: In Germany, there are hardly any reliable data on patient care in the primary care setting which warrant the development and implementation of clinical guidelines. In this paper, data generated by a prospective observational study of patients with urinary tract symptoms are compared to the recommendations of an evidence-based clinical guideline. PATIENTS AND METHODOLOGY: Over a period of 6 months all patients consulting one of 6 General Practitioners in southern Germany with symptoms of dysuria have been documented on a standardised patient record. Data were compared to the recommendations of the guideline "Dysuria" by the German Society of General Practice and Family Medicine (DEGAM) to assess the relevance and feasibility of the guideline. In a scenario, compliance with the guideline is extrapolated to the realm of primary care. RESULTS: Basic demographic and epidemiological data agree with basic assumptions of the guideline. As far as diagnostic and therapeutic strategies are concerned there are significant discrepancies between the recommendations and the realm of primary care. Microbiologic cultures are ordered far less then recommended, second line drugs are prescribed far more often then recommended, macroscopic urinoscopy is performed widely but not covered by the guideline at all. If GPs complied completely with the guideline, many more diagnostic procedures would be performed and a different palette of antimicrobial drugs would be prescribed. CONCLUSION AND OUTLOOK: The "Dysuria-Guideline" of DEGAM was developed for a prevalent and relevant topic in primary care in Germany. There are significant discrepancies between the recommendations and the realm of primary care. Post-hoc-analysis is an informative and feasible tool to identify potential obstacles against implementation of guidelines.

[The walking-counting test. A simple test for assessing the risk of falling]. / Der Geh-und-Zähl-Test. Ein einfacher Test zur Abschätzung des Sturzrisikos.

BACKGROUND AND OBJECTIVE: Falls and fractures caused by falls are common in the elderly. Interventions to prevent such falls and/or fractures are available. But there are no appropriate tests in general practice for the targeted use of preventative measures. This prospective study was undertaken to validate a simple "walking and counting" test for assessing the risk of falling. PATIENTS AND METHODS: 92 patients of a general practice, aged between 70 and 96 years (64 women, 28 men) were included in the study. All patients were given the "walking and counting" test in which they would walk as quickly as possible along a stretch of 4 m, repeated immediately in a 3-step sequence while counting backwards from 100. The walking speed without counting was measured initially (vo), as was the speed during distraction by counting (vD). The difference between the two values, delta v%, measured the percentage change under distraction. In 80 patients it was possible to record the number of falls over the entire subsequent period of 12 months. All data were assessed by relative operating characteristics (ROC) and Bayesian analysis. RESULTS: 40 patients had falls in the follow-up period of 12 months, falls being more frequent the higher the age and if there had been previous falls. While all patients were able to do the test, individual values differed considerably. There was a statistical correlation between the calculated change in walking speed and the risk of falling. Using a threshold value of 20% slowing of the walking speed, the test sensitivity was 95% (0.51-0.81: 95% confidence interval) and the specificity 0.85 (0.71-0.93), with a positive predictive value of 0.77 (0.59-0.84). CONCLUSION: The walking and counting test is a simple and informative test, more reliable than other parameters, to predict for an individual patient with danger of falling over a 12-months period. It provides the general practitioner with a tool for demanding appropriately targeted preventative measures.

[Patients' views on ambulatory orthopedic/traumatologic rehabilitation]. / Die Patientensichtweise in der ambulanten orthopädisch/traumatologischen Rehabilitation.

Although patients' perspectives play an important role in most area of the health care system, little is known so far about patients' views regarding outpatient rehabilitation. As part of an evaluation study on new model of rehabilitation, we therefore also investigated the patients' views, giving special attention to the commonly suggested advantages of outpatient rehabilitation. In the study, 1013 patients were given a questionnaire, in which patients could evaluate their satisfaction with outpatient rehabilitation and could mark preferences for either inpatient or outpatient rehabilitation. The results confirmed to a large extent the advantages of outpatient rehabilitation. This form of rehabilitation offers the patients a complex therapy close to their residence and can facilitate an early occupational reintegration. Outpatient rehabilitation also offers the possibility to take care of the family and to spend free time with the family. This fact is perceived as one important advantage leading to preference for outpatient rehabilitation. In general, patients were most satisfied with the care given by their therapists or physician, as well as with the treatment. They were less satisfied with the subsequent treatment after rehabilitation. A majority of patients felt left alone after treatment. One of the advantages of outpatient rehabilitation is the possibility of including relatives and the family doctor in the outpatient treatment. However, only few patients agreed, that the family doctor or relatives were sufficiently included in the treatment. Most younger patients prefer the outpatient rehabilitation. One of the reasons given was the possibility of taking care of important jobs at home. The results of our study give evidence for a high demand of patients for outpatient rehabilitation.

Improving diagnostic accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein (CRP)

BACKGROUND: Sore throat or pharyngitis is an extremely prevalent condition in primary care. There is a diagnostic dilemma in differentiating bacterial and non-bacterial infections for adequate use of antibiotics. Standard diagnostic procedures take too long for an immediate decision. AIM: To evaluate, if near patient C-reactive protein measurement in the general practice surgery improves diagnostic accuracy. METHOD: One hundred and seventy-nine consecutive patients with sore throat, from 15 general practitioners (GPs) in southern Germany (phase 1) and 161 consecutive patients from 14 GPs (phase 2), were examined physically and a throat-swab was taken and white blood-cell count (WBC) and CRP-measurement were performed. In phase 1, CRP was measured centrally to assess the method's diagnostic value and the adequate threshold. In the second phase, near patient CRP was measured and CRP values were used to make a diagnosis. RESULTS: Using relative operating characteristics (ROC) analysis, the diagnostic value of CRP measurement was much better than WBC count (area under curve = 0.85 versus 0.68). All diagnostic parameters improved when using the near patient CRP measurement. Sensitivity went up from 0.61 (95% confidence interval = 0.45-0.75) to 0.78 (0.61-0.90), specificity went up from 0.73 (0.65-0.81) to 0.82 (0.73-0.88). Positive and negative predictive value improved significantly as well. Diagnostic accuracy went up from 70.1% to 81.0%. Out of 1000 theoretical patients with sore throat, 109 more will be treated correctly when using CRP measurement as a diagnostic tool. CONCLUSIONS: Use of near patient CRP measurement can improve diagnostic accuracy in the differentiation of bacterial and non-bacterial pharyngitis in primary care, and potentially results in a more adequate use of antibiotics.

[The possible carcinogenic action of a protein concentrate from Saccharomyces yeasts grown on molasses]. / Izuchenie vozmozhnogo kantserogennogo deistviia belkovogo kontsentrata iz drozhzhei-sakharomitsetov, vyrashchennykh na melasse.

A testing was done in a chronic experiment on 300 rats and 360 mice of both sexes for carcinogenic potential of a new protein product from Saccharomyces yeast grown in melasse. The production procedures and techniques of the above product have been worked out at the Ukrainian Research Institute of Spirits and Biotechnology of Food Stuffs of Gospishcheprom (State Food Industry) of Ukraine. The studies made showed the new protein product has no carcinogenic effect.

[The possible hypolipidemic action of the dietary fiber from barley meal]. / Izuchenie vozmozhnogo gipolipidemicheskogo deistviia pishchevykh volokon iz muchki iachmenia.

A possible hypocholesteremic property was studied of food fibers from barley in a subchronic experiment on 60 white nondescript male rats under developing hypercholesterolemia of alimentary genesis. An aggravated dose of the above fibers has been shown to reduce deviations from the reference level brought about by administration of exogenous cholesterin. On completing the clinical trials, the studied product may be used in nourishment of those individuals presenting with disordered lipid metabolism.

[The surface status of the gastric mucosa in retinol deficiency]. / Sostoianie poverkhnosti slizistoi obolochki zheludka v usloviiakh defitsita retinola.

Changes of the stomach mucosa in retinol deficiency of the organism were studied by methods of scanning and transmission electron microscopy. Observation of stomach mucosa state of the animals was performed in dynamics (in proportion with increase of the vitamin deficiency). The disturbance of integrity of the apical part of the external cell membrane of the superficial epithelium and development of apical erosions in cells were established. Disturbance of integrity of the external membrane apical part in epitheliocytes provides erosions and ulcers development in retinol deficiency.