Telemedicine versus on-site treatment at a surgical university clinic: Study of 225 consecutive patients.

INTRODUCTION: Recently, telemedical services are increasingly used. It remains unclear, if outpatients in general surgery can be treated via telemedicine (e.g. telework). We aimed to evaluate, if diagnosis and therapies of outpatients in general surgery can be found using a mobile healthcare communication app instead of personal contact. MATERIAL AND METHODS: In a prospective, double blind, anonymized clinical study we included consecutive outpatients at a general surgery department at a university hospital. For the telemedical "treatment" the on-site doctors uploaded variables (e.g. anamnesis, radiograph, etc.) for each patient. The telemedical doctor received the information only via app and did not see the patient physically. Both, the doctor on-site and the virtual telemedical-doctor then uploaded the diagnosis and their suggested therapy - blinded to each other. The outpatient received the on-site treatment only. The virtual treatment was solely for scientific purposes and had no therapeutic impact. RESULTS: 225 consecutive surgical outpatients (53 % female and 47 % male) were included. Mean age was 61 years. In 84 % of cases the telemedical diagnosis matched the on-site diagnosis. The telemedical treatment was not inferior as compared to the on-site treatment in 94 % of all cases and the same therapy was proposed in 76 %. In 6% of all cases the telemedical therapeutic regimen could possibly harm or lead to an over- or under treatment of the patient. CONCLUSION: Telemedical consultation seems to work in the field of general surgery. Telemedicine in general surgery potentially could decrease waiting time for an appointment and patient frequency. However, the potential harm of a wrong therapy remains due to the lack of a clinical observation.

Utilization rates of knee-arthroplasty in OECD countries.

BACKGROUND: The number of knee arthroplasties and the prevalence of obesity are increasing exponentially. To date there have been no published reviews on utilization rates of knee arthroplasty in OECD countries. METHODS: We analysed economic, medical and population data relating to knee arthroplasty surgeries performed in OECD countries. Gross domestic product (GDP), health expenditures, obesity prevalence, knee arthroplasty utilization rates and growth in knee arthroplasty rates per 100,000 population were assessed for total population, for patients aged 65 years and over, and patients aged 64 years and younger. RESULTS: Obesity prevalence and utilization of knee arthroplasty have increased significantly in the past. The mean utilization rate of knee arthroplasty was 150 (22-235) cases per 100,000 total population in 2011. The strongest annual increase (7%) occurred in patients 64 years and under. Differences between individual countries can be explained by economic and medical patterns, with countries with higher medical expenditures and obesity prevalence having significantly higher utilization rates. Countries with lower utilization rates have significantly higher growth in utilization rates. The future demand for knee prostheses will increase x-fold by 2030, with exact rates dependant upon economic, social and medical factors. CONCLUSION: We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030.

The effect of homeopathically prepared thyroxine on highland frogs: influence of electromagnetic fields.

BACKGROUND: Previous experiments show that amphibian larvae are responsive to homeopathically prepared thyroxine. METHODS: We studied the effect of a highly diluted and agitated thyroxine solution exposed to various electromagnetic fields on metamorphosis in highland Rana temporaria. The devices tested were: microwave oven, mobile phone, airport X-ray, and a red light barcode scanner. Animals were treated either with homeopathically prepared thyroxine (10(-30) parts by weight, 10(-35) in the water in which the animals were kept), or analogously prepared blank solution, or analogously prepared thyroxine exposed to the electromagnetic field of one of the devices tested. Solutions were administered at 48h intervals according to a standardized protocol. RESULTS: Animals treated with the standard test solution thyroxine 10(-30) metamorphosed more slowly than the control animals, ie the effect of the homeopathically prepared thyroxine was opposed to the usual physiological effect of molecular thyroxine. The cumulative number of test animals that had reached the four-legged stage at defined points in time was smaller in the group treated with homeopathically prepared thyroxine at most of the points in time. This was found independently by all three research teams involved. In contrast, this effect did not occur when the thyroxine solution had been exposed to the field of the early model microwave oven, or mobile phone. There was no difference between aqueous or alcoholic solutions were used, and there was, if any, only a small protective effect from aluminum foil. Airport X-ray and red light barcode scanning did not diminish the effect of the homeopathic solution.

Growth, zinc and copper nutritional status of male premature infants with different zinc intake.

Zinc is an essential nutrient for growth and low intake can result in growth retardation. However, high zinc intake can affect copper metabolism. Therefore, data from a study of 10 male premature infants fed a cow's milk-based formula nonfortified with zinc (mean +/- SD = 1.4 +/- 0.1 mg X l-1) were compared with data of 10 similar infants fed the same formula fortified with zinc (4.1 +/- 0.3 mg X l-1). Growth, food intake, zinc and copper nutritional status were studied from 6 through 122 days of age. No differences in gain of weight, length and head circumference and in food intake were found. Serum zinc concentration was significantly (p less than 0.05) and hair zinc concentration was slightly higher in the infants fed the zinc-fortified formula at 122 days of age. Copper and ceruloplasmin concentrations in serum and hair copper concentration were similar in both groups at 122 days of age. The results suggest that feeding a formula nonfortified with zinc did not affect growth of male premature infants. Feeding a zinc-fortified formula on the other hand had no influence on copper nutritional status.

[Regional analysis of infant nutrition during the 1st 3 months of life]. / Regionale Analyse der Säuglingsernährung während der ersten drei Lebensmonate.

A feeding survey was conducted amongst 100 infants during the first three months of life, from December 1980 to August 1981. If breast milk was not available, infants were fed with adapted nutrition. Recommended nutrition was changed in 62 infants, 30% within the first four weeks and 70% between six and ten weeks. Partially adapted nutrition was used by mothers most frequently, while breast milk and mixed milk feeding decreased to 42%. The different findings and causes of changes in the nutrition are discussed.

[Function and resorption of the region of the small intestine with reference to an extensive resection]. / Funktion und Resorption im Bereich des Dünndarmes im Hinblick auf ausgedehnte Resektionen

The function of the small intestine before and after extensive resection is dealt with on the basis of infant metabolism under normal and pathological conditions. As a result of the changed absorption conditions in such children, application of parenteral feeding, stepwise establishment of oral feeding using the building-up and cure diets which are available and compensation of long-term losses are necessary. The feasibility of testing the changed absorption conditions is mentioned.