[Vaccine Refrigerator and Vaccine Management in General Practices: A Representative, Web-Based Survey among General Practitioners (Keep Cool I)]. / Impfkühlschrank- und Impfstoffmanagement in Hausarztpraxen: Eine repräsentative, Web-basierte Umfrage unter Hausärzten (Keep Cool I).

Aim: The purpose of this study was to analyse vaccine refrigerator and vaccine management in primary care and to identify physician- and practice-related influencing factors. Background: Adequate cooling of vaccines in a temperature range of 2-8°C is essential to assure vaccine effectiveness. Studies from various countries have demonstrated cooling chain problems. We surveyed general practitioners about the quality of their vaccine refrigerator and vaccine management and aimed at identifying physician- and practice-related influencing factors. Methods: A cross-sectional, web-based questionnaire survey was performed among 3 physician populations in primary care: a 10% random sample of general practitioners (n=954), all teaching physicians of the Universities Duisburg-Essen (n=221) and Halle-Wittenberg (n=92). Surveyed were items on the following 6 aspects: (1) responsibilities within practice teams, (2) vaccine ordering and storing, (3) criteria for the vaccine pre-selection, (4) stocking system inside the refrigerator, (5) wrapping, and use of stocking boxes, (6) refrigerator and temperature control. The quality indicator "comprehensive refrigerator management" was defined to include 4 aspects: (1) separate refrigerator, (2) written temperature documentation (temperature-logbook), (3) regular storage control (wrapping, temperature and expiration date), and (4) storage in original wrappings. Results: A total of 278 physicians participated in the survey (22%). Of these, 80% had a separate refrigerator, 52% reported written temperature documentation, 93% documented regular storage control addressing vaccine wrappings, temperature and expiration dates, and 95% reported vaccine storage in original card box wrappings. A "comprehensive refrigerator management" was realised by 42% of the practices. This indicator was reached more frequently by practices with 3 or more physicians (p=0.01) and those with an additional qualification in travel medicine (p=0.036). Conclusion: Our survey showed good results for most aspects of the refrigerator and vaccine management but room for improvement with regard to temperature documentation.

[How do you explain vaccine effects to patients? A representative, web-based survey among primary care physicians from North-Rhine Westphalia]. / Wie erklären Sie Ihren Patienten die Impfwirkung?

BACKGROUND: This study investigates how frequent general practitioners (GP) explain the immunological vaccine response to patients and which stylistic means they use. METHOD: Data from a cross-sectional, web-based survey were analyzed. The study population included a representative random sample of 10 % of GPs from North Rhine-Westphalia and all teaching physicians from two universities. The data was evaluated using a multi-method approach with a statistical analysis and a content analysis according to Mayring. RESULTS: The analysis included 187 GPs (69 % males, 56 % ≤50 years). 18.3 % of GPs routinely informed about the vaccine response. In a clinical vignette, 48.7 % used a layperson-oriented language, supported by figures of speech in 11.8 %. The key content categories were: protection against disease (63.6 %), antibody formation (64.2 %), vaccine concept (47.6 %), and potential adverse reactions (4.3 %). CONCLUSION: To improve patients' health literacy, physicians are asked to routinely explain the immunological effects of vaccines.

Lack of claudin-7 is a strong predictor of regional recurrence in oral and oropharyngeal squamous cell carcinoma.

OBJECTIVES: Adequate treatment of oral and oropharyngeal squamous cell carcinoma (OSCC) is dependent on correctly predicting the presence of lymph node metastases. Current methods to diagnose nodal metastases partly result in overtreatment with associated morbidity and undertreatment with decreased disease-free survival. E-cadherin has been studied extensively as potential marker for lymph node metastases. EpCAM and claudin-7 have a functional relationship with E-cadherin, forming a complex that promotes tumourigenicity in vitro. We hypothesize that the co-expression patterns of these related molecules is a better prognostic marker for nodal status and regional recurrences. MATERIALS AND METHODS: We constructed separate tissue microarrays of tumour centre and tumour invasive front of 227 OSCC with complete clinicopathological and follow-up data, including HPV status, and performed immunohistochemistry for these molecules. RESULTS: Lack of E-cadherin and presence of cytoplasmic EpCAM expression in the tumour front were predictive for nodal metastasis, but no co-expression pattern was found clinically relevant. Lack of claudin-7 in the tumour centre was highly and independently predictive for shorter regional disease-free survival (HR=0.19; 95%CI: 0.06-0.62) and disease-specific survival (HR=0.43; 95%CI: 0.21-0.87). High-risk HPV was not associated with any marker. CONCLUSIONS: The expression of E-cadherin and EpCAM, depending on the specific tumour sublocalization, is predictive for nodal status. However, co-expression did not improve the prediction of nodal status, indicating that the proposed in vitro complex is not functional in clinical samples. Additionally, lack of claudin-7 expression in the tumour centre may be used to identify patients with increased risk for regional recurrence.

External trial deep brain stimulation device for the application of desynchronizing stimulation techniques.

In the past decade deep brain stimulation (DBS)-the application of electrical stimulation to specific target structures via implanted depth electrodes-has become the standard treatment for medically refractory Parkinson's disease and essential tremor. These diseases are characterized by pathological synchronized neuronal activity in particular brain areas. We present an external trial DBS device capable of administering effectively desynchronizing stimulation techniques developed with methods from nonlinear dynamics and statistical physics according to a model-based approach. These techniques exploit either stochastic phase resetting principles or complex delayed-feedback mechanisms. We explain how these methods are implemented into a safe and user-friendly device.

D3 lymph node dissection in gastric cancer: evaluation of postoperative mortality and complications.

Since November 1995 we have been performing a D3 lymph node dissection in patients undergoing an operation for gastric cancer with a curative intent. The aim of the present study was to evaluate whether this procedure results in an increased postoperative mortality or complication rate in a Western population. Between November 1995 and August 1997 the postoperative courses of 76 patients were retrospectively assessed (45.3 lymph nodes per patient, lymph node ratio: 0.16). The patient outcome was compared with data from a historic control group of patients (n = 383) in whom the newly established D2 dissection was studied in our department. Regarding the demographic, clinical, and tumor-pathologic data, and the choice of resection and reconstructive procedures, the two groups differed only slightly. The postoperative mortality of 1% was lower (vs 6.8%) while the overall complication rate of 34% (vs 32.1%) was identical. In particular, no anastomotic leakage (vs 9.4%) and fewer nonsurgical complications (17.1% vs 27.9%) occurred. The reoperation rate was 1% vs 9.7%. However, in 6% of the patients drainage tubes had to be inserted under computed tomographic guidance. The average hospital stay remained unchanged (21.9 vs 20.7 days). A D3 dissection was shown to be feasible while demonstrating no disadvantages in the patients when compared with the D2 procedure.

Dispersive white-light interferometry for absolute distance measurement with dielectric multilayer systems on the target.

We have extended the use of a dispersive white-light interferometer for absolute distance measurement to include effects of dielectric multilayer systems on the target. The phase of the ref lected wave changes as a function of wavelength and layer thickness and causes errors in the interferometric distance measurement. With dispersive white-light interferometry these effects can be measured in situ, and the correct mechanical distance can be determined. The effects of thin films deposited upon the target have been investigated for one and two layers (photoresist and SiO(2) upon Si). Experimental results show that the thicknesses of these layers can also be determined with an accuracy of the order of 10 nm.

Comparison of coherent anti-Stokes Raman-scattering thermometry with thermocouple measurements and model predictions in both natural-gas and coal-dust flames.

Mobile coherent anti-Stokes Raman-scattering equipment was applied for single-shot temperature measurements in a pilot-scale furnace with a thermal power of 300 kW, fueled with either natural gas or coal dust. Average temperatures deduced from N(2) coherent anti-Stokes Raman-scattering spectra were compared with thermocouple readings for identical flame conditions. There were evident differences between the results of both techniques, mainly in the case of the natural-gas flame. For the coal-dust flame, a strong influence of an incoherent and a coherent background, which led to remarkable changes in the spectral shape of the N(2)Q-branch spectra, was observed. Therefore an algorithm had to be developed to correct the coal-dust flame spectra before evaluation. The measured temperature profiles at two different planes in the furnace were compared with model calculations.