[Structure quality assurance in in-patient medical rehabilitation of children and adolescents]. / Sicherung der Strukturqualität in der stationären medizinischen Rehabilitation von Kindern und Jugendlichen.

BACKGROUND: So far, the routine programmes of the statutory pension and health insurance institutes for quality assurance in medical rehabilitation have not included facilities for children and adolescents. Thus, a conjoint project of the statutory pension and health insurance institutes to assess and to describe the structure quality of in-patient medical rehabilitation clinics for children and adolescents was initiated. The aim of the project was a survey and an analysis of the currently existing clinic structures and the development of criteria for an evaluation of the structure quality. The Institute of Medical Psychology, University of Hamburg and the Department of Quality Management and Social Medicine, University of Freiburg were engaged to conduct the project. METHOD: A questionnaire was developed in a multi-stage process with expert involvement which covers general information, characteristics of structure quality as well as structure affiliated process characteristics of clinics. The survey was planned as a cross-sectional study. Data collection was accomplished from 1.12.2004 - 15.3.2005. RESULTS: A total of n = 177 facility addresses were available. The return rate was 83.3 %. Eventually, n = 79 facilities were included in the analysis. In sum, the results underline the heterogeneity of services in the field of child and adolescent rehabilitation. CONCLUSIONS: The results allow an analysis of the current clinic structures as well as a first comparison of clinics on the basis of the assessed structure characteristics.

Antiviral treatment and prophylaxis of influenza in primary care: German recommendations.

Antiviral drugs are a valuable supplementation to vaccines for the control and prevention of influenza. In Germany, for treating influenza amantadine, oseltamivir and zanamivir are approved. Amantadine and oseltamivir are also licensed for prophylactic use. On behalf of the Paul-Ehrlich-Society of Germany and the German Association for the Control of Virus Diseases, as two independent scientific societies, the first consensus Conference on the Antiviral Treatment and Prophylaxis of Influenza was held in June 2002. Based on the available data of clinical studies an expert group developed the following recommendations for the appropriate clinical use of the antiviral drugs: (1) since oseltamivir (orally administered) and zanamivir (administered by inhalation) have apparently similar clinical efficacy both drugs can be used alternatively for treatment. (2) Amantadine is not an alternative to the neuraminidase (NA) inhibitors because it is not effective against influenza B viruses, it frequently selects resistant virus mutants and it can cause adverse events. (3) When influenza is prevalent in the community patients with the clinical diagnosis of influenza should be treated with neuraminidase inhibitors if the symptoms are lasting not longer than 48 h. (4) Immunocompetent patients with a non-febrile illness and patients with a symptom history of more than 2 days should not be treated with antiviral drugs. (5) Although there are no data from clinical trials immunocompromised patients should also be treated when influenza has been diagnosed. (6) The prophylactic use of antiviral drugs can be recommended for persons with close contact to acutely ill persons and no recent vaccination against influenza. (7) The use of anti-influenza drugs have to be considered for prophylaxis in pandemics. A precondition for the adequate use of anti-influenza drugs in the primary medical care is the timely information on the local influenza situation delivered by surveillance systems.