Video Counselling in Rehabilitation Management. / Teleberatung im Reha-Management.

BACKGROUND: Telemedicine can provide great benefits for patients, their physicians and other professionals in the health care system. We have asked ourselves whether a similar service could make a sensible contribution to the rehabilitation management of Germany's statutory accident insurance? PATIENTS/MATERIALS AND METHODS: In the present study, consultations of insured persons with their physicians and rehabilitation managers were transmitted via video conference. Patient satisfaction was determined by survey and potential benefits were analysed. RESULTS: The participants of the study were generally very satisfied with the telecounselling. In particular, 96% of their questions to the rehabilitation manager could be cleared up during the sessions. However, roughly a third of those surveyed prefer personal contact with the rehabilitation manager. CONCLUSION: Telecounselling is well received by the insured in the rehabilitation management of occupational insurance associations and offers a useful alternative when, due to lack of resources - such as lack of time or great distance - the rehabilitation plan cannot be prepared locally together with the insured patient. Under the special circumstances of the coronavirus pandemic, it can also contribute to protecting the health of all involved.

The management of needlestick injuries.

BACKGROUND: An estimated 1 million needlestick injuries (NSIs) occur in Europe each year. The Council Directive 2010/32/EU on the prevention of NSIs describes minimum requirements for prevention and calls for the implementation of local, national and Europe-wide reporting systems. The Directive is to be implemented by all EU member states by 11 May 2013. The purpose of this study was to assess (and improve) the procedures for the reporting and treatment of needlestick injuries in a German tertiary-care hospital. METHODS: We carried out a prospective observational study of the NSI reporting system in the hospital over a period of 18 months and determined the incidence of NSIs, the prevalence of blood-borne pathogens among index patients, the rate of initiation of post-exposure prophylaxis, and the rate of serological testing of the affected health care personnel. RESULTS: 519 instances of NSI were reported to the accident insurance doctor over the period of the study, which consisted of 547 working days. 86.5% of the index patients underwent serological study for hepatitis B and C (HBV and HCV) and for the human immune deficiency virus (HIV); this resulted in two initial diagnoses (one each of active hepatitis B and hepatitis C) in the index patient. 92 of 449 index patients, or one in five, was infected with at least one blood-borne pathogen. HIV post-exposure prophylaxis was initiated in 41 health care workers. One case of hepatitis C virus transmission arose and was successfully treated. Other than that, no infection was transmitted. CONCLUSION: Complete reporting of NSIs is a prerequisite for the identification of risky procedures and to ensure optimal treatment of the affected health care personnel. The accident insurance doctor must possess a high degree of interdisciplinary competence in order to treat NSI effectively.

Primary pulmonary hypertension may be a heterogeneous disease with a second locus on chromosome 2q31.

OBJECTIVES: The aim of our study was to identify genetic causes of primary pulmonary hypertension (PPH), to estimate the proportion of families with mutations in the BMPR2 (bone morphogenetic protein receptor type 2) gene, and to examine whether genetic heterogeneity might play a role. BACKGROUND: The BMPR2 mutations have been identified in a substantial portion of patients with familial or sporadic PPH. However, the genetic cause of PPH remains unclear in at least 45% of families. METHODS: We investigated 130 members of 10 families with at least 1 PPH patient, recruited without selection for familial disease. Manifest PPH was documented in 21 individuals. An increase in pulmonary artery systolic pressure (PASP) above 40 mm Hg during supine bicycle exercise was found in 46 healthy individuals. Their PASP increased from 21.0 +/- 4.6 mm Hg at rest to 54.0 +/- 9.8 mm Hg during exercise. In 51 relatives, PASP values were normal at rest and during exercise, and 12 members were classified as status unknown. RESULTS: Two families showed a mutation in the BMPR2 gene. Three families with no BMBR2 mutation showed evidence for linkage to a more proximal location on chromosome 2q31 (odds ratio [OR] for linkage 1.1.10(6):1). This locus, designated PPH2, maps in-between the markers D2S335 and D2S2314. We obtained significant support for heterogeneity in PPH with an OR of 2.8.10(11). CONCLUSIONS: We conclude that PPH may be a genetically heterogeneous disorder with at least two-and possibly more-causative genes.