[Commonwealth Fund Survey 2012: Survey of Primary Care Doctors in 11 Countries: Use of Health Information Technology and Important Aspects of Care]. / Commonwealth Fund Survey 2012: Befragung von Primärärzten in 11 Ländern zur Nutzung von Informationstechnologie und zu wichtigen Versorgungsaspekten.

BACKGROUND: In 2006 and 2009 the US-American Commonwealth Fund (CMWF) already conducted international surveys with primary care physicians regarding their daily work and important aspects of care. In 2012 a third survey took place in 11 countries, with an emphasis on use of information technology. METHODS: There was a written survey and a telephone survey of primary care physicians conducted in eleven industrial countries. In Germany, a random sample of 4 500 primary care physicians out of all 16 federal states were contacted by mail between April and July 2012. The data acquisition in Germany was conducted by the BQS Institute for Quality and Patient Safety and funded by the Federal Ministry of Health. The results were weighted by age, sex, region and medical specialty of the participating doctors. RESULTS: 9 776 primary care physicians participated; 909 of them in Germany. The response rate in Germany was 20%. 80% of the primary care physicians in Germany are using electronic patient records. But special IT functions, with the exception of electronic prescriptions and ordering of laboratory tests, are little used compared to other countries. Even in countries with a wide use of special IT functions within the practices, the possibility of communicating with colleagues and patients electronically is often lacking. 35% of the German primary care physicians think the quality of care has declined since the last survey in 2009. Only in France do more primary care physicians share that feeling (37%). In 2012 a lot more German primary care physicians stated to have problems with long waiting times for specialist consults (2009: 10%; 2012: 68%).

[Inpatient Preventative and Rehabilitative Treatment for Informal Caregivers - An Explorative Investigation of Specific Offers in Germany]. / Stationäre Rehabilitation und Vorsorge für pflegende Angehörige - eine Sondierung der Angebote in Deutschland.

INTRODUCTION: In line with a new law in 2012 (Pflege-Neuausrichtungs-Gesetz) a special regard to informal care givers in inpatient rehabilitation and prevention facilities was established. Thus possibilities were created to facilitate care for people requiring nursing within the rehabilitation hospital while the informal caregiver is treated. On behalf of the German Ministry of Health the BQS Institute of Quality and Patient Safety analysed what specific offers for this target group are available in the rehabilitation setting and to what extent the requirements of the new law are already implemented. METHODS: To identify those specific offers for informal caregivers, a nationwide e-mail survey was conducted in 1,167 rehabilitation hospitals in Germany which was complemented with an internet research. Additionally semi-standardised interviews with 28 experts in different specialty fields as well as a literature research were conducted. RESULTS: 31 rehabilitation hospitals were identified, which provide specific measures for informal caregivers and 53 hospitals which provide care for the dependent person, too (overlaps are possible). By providing those offers, the providers are in unchartered waters in regard to concepts. Usually providers are relating to already existing measures in their indication areas and extend those through specific measures. To date, a targeted allocation of informal caregivers to appropriate facilities is not established.

[Patient-centredness and Quality of Care in Germany in International Comparison - Results of a Telephone Survey of Patients in 11 Countries]. / Patientenzentrierung und Qualität der Versorgung in Deutschland im internationalen Vergleich - Ergebnisse eines Telefon-Surveys von Patienten in 11 Ländern.

OBJECTIVES: The study was conducted to compare the results of the perceived quality of care in 11 industrialised countries from a patient perspective. This paper reports the German results and puts them in an international perspective. METHODS: In a nationwide poll a random sample of high utilising patients was surveyed between March and June 2011. 59,984 random phone numbers were generated for this purpose. Topics were access and coordination of care, patient safety and patient-centredness. RESULTS were weighted according to age, sex, education, place of birth of parents, income and size of dwelling place and further sociodemographic variables. RESULTS: 1,200 patients of 2,048 contacted patients fulfilled the enrollment criteria. Approximately one third felt that overall the health-care system works well while 22% said that the system needs to be completely rebuild. Regarding access to care 22% reported financial barriers while 59% reported to be able to get an appointment the same or next day to see a doctor. With respect to patient safety patients reported increased numbers of nosocomial infections compared to 2005. Patient satisfaction with general practitioners (GPs) is exceptionally high in -Germany. CONCLUSION: Compared to 10 other industrialised nations the picture is heterogeneous. In some areas Germany ranks among the top (satisfaction with GPs) while approximately every fifth surveyed patient feels the system needs to be rebuilt completely. It remains a matter of debate whether this rating regarding the reform needs of the system applies to the financing and structures of the system or the quality of care.

Glibenclamide reduces secondary brain damage after experimental traumatic brain injury.

Following traumatic brain injury (TBI) SUR1-regulated NCCa-ATP (SUR1/TRPM4) channels are transcriptionally up-regulated in ischemic astrocytes, neurons, and capillaries. ATP depletion results in depolarization and opening of the channel leading to cytotoxic edema. Glibenclamide is an inhibitor of SUR-1 and, thus, might prevent cytotoxic edema and secondary brain damage following TBI. Anesthetized adult Sprague-Dawley rats underwent parietal craniotomy and were subjected to controlled cortical impact injury (CCI). Glibenclamide was administered as a bolus injection 15min after CCI injury and continuously via osmotic pumps throughout 7days. In an acute trial (180min) mean arterial blood pressure, heart rate, intracranial pressure, encephalographic activity, and cerebral metabolism were monitored. Brain water content was assessed gravimetrically 24h after CCI injury and contusion volumes were measured by MRI scanning technique at 8h, 24h, 72h, and 7d post injury. Throughout the entire time of observation neurological function was quantified using the "beam-walking" test. Glibenclamide-treated animals showed a significant reduction in the development of brain tissue water content(80.47%±0.37% (glibenclamide) vs. 80.83%±0.44% (control); p<0.05; n=14). Contusion sizes increased continuously within 72h following CCI injury, but glibenclamide-treated animals had significantly smaller volumes at any time-points, like 172.53±38.74mm(3) (glibenclamide) vs. 299.20±64.02mm(3) (control) (p<0.01; n=10; 24h) or 211.10±41.03mm(3) (glibenclamide) vs. 309.76±19.45mm(3) (control) (p<0.05; n=10; 72h), respectively. An effect on acute parameters, however, could not be detected, most likely because of the up-regulation of the channel within 3-6h after injury. Furthermore, there was no significant effect on motor function assessed by the beam-walking test throughout 7days. In accordance to these results and the available literature, glibenclamide seems to have promising potency in the treatment of TBI.

Depression of neuronal activity by sedatives is associated with adverse effects after brain injury.

Analgesics and sedatives are frequently used in the treatment of acute brain injury and subsequent brain swelling. Most agents act on specific receptors to modulate neuronal activity, which is normally involved in feedback loops that direct system building and maintenance. We investigated the neurodegenerative effects of midazolam and isoflurane in a rat model of controlled cortical impact injury (CCII). Two hours prior to CCII, four experimental groups were treated with different agents including a minimum alveolar concentration (MAC 1.0) of isoflurane. For additional sedation, isoflurane MAC 1.67, midazolam alone, or midazolam in combination with flumazenil was used. Blood pressure and blood gas analysis were monitored to investigate systemic side effects. Two days after treatment, relative apoptotic cell counts were determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) method. With isoflurane and midazolam, electroencephalographic (EEG) recordings revealed a decrease in amplitude size and altered frequency distribution. Treatment using deep sedation with isoflurane MAC 1.67 or midazolam increased relative apoptotic cell count by 14.8% (95% CI 3.6 to 26.1, p<0.01) and 18.0% (95% CI 6.8 to 29.3, p<0.01), respectively. Co-treatment with flumazenil reversed the neurodegenerative effect of midazolam by -13.2% (95% CI -24.5 to -2.0, p<0.05). Functional neurological outcome was worse after isoflurane MAC 1.67 (18.8 score points; p<0.01) and midazolam (21.4 score points, p<0.001). Flumazenil antagonized the neurodegenerative effects of midazolam. In conclusion, neuronal survival and functional recovery are reduced by sedative use in a rat model of acute brain injury.

Cerebral microdialysis in acutely brain-injured patients with spreading depolarizations.

Multimodal cerebral monitoring was utilized to examine the relationship between pathological changes in microdialysis parameters and the occurrence of spreading depolarizations (SD) in brain-injured patients. SD are a relatively newly discovered phenomenon in man found to be linked to secondary insults and infarct growth and they can be detected via electrocorticography (ECoG). A total of 24 brain-injured patients (mean age: 52±11 years) requiring craniotomy took part in this prospective observational study. Each patient was monitored with a linear strip electrode for ECoG data and a cerebral microdialysis probe. SD were detected in 13 of the 24 patients. Pathological concentrations of glucose and lactate in brain parenchyma were significantly correlated with various time points prior to and/or immediately following the SD. Severe systemic hyperglycemia and systemic hypoglycemia were also found to be correlated with the occurrence of SD. The present study shows a clear relationship between SD and pathological changes in cerebral metabolism; further studies are needed to elucidate these complex interactions with the ultimate goal of developing therapeutic strategies for improving outcome in brain-injured patients.

Distribution of inositol-1,4,5-trisphosphate receptor isotypes and ryanodine receptor isotypes during maturation of the rat hippocampus.

Activation of inositol-1,4,5-trisphosphate receptors (InsP(3)Rs) and ryanodine receptors (RyRs) can lead to the release of Ca(2+) from intracellular stores and propagating Ca(2+) waves. Previous studies of these proteins in neurons have focused on their distribution in adult tissue, whereas, recent functional studies have examined neural tissue extracted from prenatal and young postnatal animals. In this study we examined the distribution of InsP(3)R isotypes 1-3 and RyR isotypes 1-3 in rat hippocampus during postnatal maturation, with a focus on InsP(3)R1 because it is most prominent in the hippocampus. InsP(3)R1 was observed in pyramidal cells and granule cells, InsP(3)R2 immunoreactivity was observed in perivascular astrocytes and endothelial cells, and InsP(3)R3 immunoreactivity was detected in axon terminals located in stratum pyramidale of CA1 and microvessels in stratum radiatum. RyR1 immunolabeling was enriched in CA1, RyR2 was most intense in CA3 and the dentate gyrus, and RyR3 immunolabeling was detected in all subfields of the hippocampus, but was most intense in stratum lacunosum-moleculare. During maturation from 2 to 10 weeks of age there was a shift in InsP(3)R1 immunoreactivity from a high density in the proximal apical dendrites to a uniform distribution along the dendrites. Independent of age, InsP(3)R1 immunoreactivity was observed to form clusters within the primary apical dendrite and at dendritic bifurcations of pyramidal neurons. As CA1 pyramidal neurons matured, InsP(3)R1 was often co-localized with the Ca(2+) binding protein calbindin D-28k. In contrast, InsP(3)R1 immunolabel was never co-localized with calbindin D-28k immunopositive interneurons located outside of stratum pyramidale or with parvalbumin, typically found in hippocampal basket cells, suggesting that InsP(3)R1s do not play a role in internal Ca(2+) release in these interneurons. These findings should help to interpret past functional studies and inform future studies examining the characteristics and consequences of InsP(3)R-mediated internal Ca(2+) release and Ca(2+) waves in hippocampal neurons.