[The effects of setting a standard in the acute pain therapy on a ward : Parameters for patient and provider satisfaction and cost structure (STANDAKU)]. / Auswirkung einer stationsweiten Standardisierung der Akutschmerztherapie : Parameter zur Patienten- und Providerzufriedenheit und Kostenstruktur (STANDAKU).

BACKGROUND: There is neither a "gold standard" nor commonly approved therapy goals in postoperative pain therapy. In a multi-center study, more than 80% of all patients treated stated that they suffered from postoperative pain. Moreover, patients evaluated the pain therapy as significantly worse than other medical or nursing practices. Therefore, there is a need for optimization in therapy for acute pain. OBJECTIVES: The goal of our project was to figure out if the introduction of a "pain treatment standard" would increase the satisfaction of patients, physicians, and nurses, and reduce the costs of pain-related medicine. MATERIALS AND METHODS: Overall, 2769 patients and 285 providers (202 nurses and 83 physicians) were polled. The medication costs in ten areas of the ward were evaluated and compared. The providers were offered a training course on the "pain standard" and it was officially introduced onto the wards. After some time, the satisfaction of patients and providers and the use of medicine were recorded again. RESULTS AND DISCUSSION: The maximum pain values declared by the patients significantly decreased after the introduction of the "pain standard." The satisfaction with pain therapy significantly increased for the patients and for the providers. The reported minimum pain values of the patients did not change significantly. The costs of pain medicine slightly increased. In general, there was a positive effect of introducing a "pain standard" for patients and providers.

Room temperature strong coupling in a semiconductor microcavity with embedded AlGaAs quantum wells designed for polariton lasing.

We report a systematic study of the temperature and excitation density behavior of an AlAs/AlGaAs, vertically emitting microcavity with embedded ternary Al0.20Ga0.80As/AlAs quantum wells in the strong coupling regime. Temperature-dependent photoluminescence measurements of the bare quantum wells indicate a crossover from the type-II indirect to the type-I direct transition. The resulting mixing of quantum well and barrier ground states in the conduction band leads to an estimated exciton binding energy systematically exceeding 25 meV. The formation of exciton-polaritons is evidenced in our quantum well microcavity via reflection measurements with Rabi splittings ranging from (13.93 ± 0.15) meV at low temperature (30 K) to (8.58 ± 0.40) meV at room temperature (300 K). Furthermore, the feasibility of polariton laser operation is demonstrated under non-resonant optical excitation conditions at 20 K and emission around 1.835 eV.

A new fully integrated X-ray irradiator system for dosimetric research.

A fully housed X-ray irradiator was developed for use within lexsyg or Magnettech desktop equipment. The importance of hardening of the low energy photon radiation is discussed, its performance and feasibility is empirically shown and sustained by basic numerical simulations. Results of the latter for various materials are given for different X-ray source settings in order to provide estimates on the required setup for the irradiation of different geometries and materials. A Si-photodiode provides real-time monitoring of the X-ray-irradiator designed for use in dosimetric dating and other dosimetric application where irradiation of small samples or dosemeters is required.

[Comparison of gold-plated silver- and silver oxide-impregnated silastic tympanostomy tubes: a randomized, prospective clinical trial]. / Vergleichende Untersuchung von Paukendrainage-Röhrchen: Eine randomisiert-prospektive Studie zur Verträglichkeit von Silberoxid-beschichteten Silikon- und Gold-beschichteten Silberröhrchen.

UNLABELLED: The insertion of tympanostomy tubes is the most common surgical procedure in the world. A major complication of chronic intubation is infectious otorrhea. The present study compares the rate of infectious otorrhea and survival rate of gold-plated silver tubes (GPR) vs. Silver Oxide-Impregnated Silastic Tubes (SPR). STUDY DESIGN: The prospective, randomized clincial trial was conducted with 116 children (59 female, 57 male) aged between 16 and 127 months (median: 51 months). Bilateral insertion of ventilation tubes was performed with SPR on one side and GPR on the other side in all children. The resulting data were compared using 2-tailed Wilcoxon-test. RESULTS: Out of 116 children, 11 left the study, 26 children finished the study by extrusion of both tubes, 32 children lost one tube and 47 children lost no tube. Total follow-up of GPR and SPR amounted to 703 and 949 months, respectively. Mean survival rate of SPR and GPR was 9.9 +/- 4.6 and 7.0 +/- 3.4 months, respectively (p < 0.001). During the first postoperative week, 13% of children suffered from otorrhea; after the first postoperative week until extrusion of the tubes, otorrhea was observed in 55% of children. The ratio otorrhea/months amounted to 0.046 and 0.05 in SPR and GPR, respectively (p: n. s.). CONCLUSIONS: Survival rate of SPR is significantly longer than compared to GPR. No differences in the otorrhea rate of SPR vs. GPR are detectable. The longer survival rate of SPR seems to be independent of the rate of infectious otorrhea but depends probably on other effects of biocompatibility.

[Triterpenoid sapogenins in the genus Grindelia]. / Triterpenoidsapogenine in der Gattung Grindelia.

A saponin fraction has been isolated from the ethanolic extract of Grindeliae herba. The saponin fraction showed strong haemolytic activity. The saponins were detected after separation on TLC by their color reactions and Rf values as well as by their haemolytic activity on blood agar. After hydrolysis, the chemical reactions and Rf values of the sapogenins were described. The main sapogenin was isolated by preparative chromatography and its structure was elucidated by mass, 1H-NMR, 13C-NMR, IR, and UV spectra. The compound is a new natural triterpenoid sapogenin lactone and is named grindeliasapogenin D. Spectral evidence is presented to establish its structure as 2 beta,3 beta,16 alpha,23-tetrahydroxyoleanan-28,13 beta-olide. Two further sapogenins present in small amounts were identified chromatographically as oleanolic acid and bayogenin using authentic reference substances. The aerial parts of Grindelia robusta Nutt, and G. lanceolata Nutt. (Asteraceae) (as well as two commercial extracts) were also investigated with respect to their saponin fraction. The 3 sapogenins mentioned above were detected in all samples. The antibiotic potency of the crude drug is not associated with the saponin fraction but is at least partially due to the resin fraction.

Attitudes of at-risk and affected individuals regarding presymptomatic testing for autosomal dominant polycystic kidney disease.

One hundred forty-one individuals with autosomal dominant polycystic kidney disease (ADPKD) and 137 at-risk individuals from 107 kindreds answered a questionnaire to determine knowledge and attitudes about ADPKD and the use of gene linkage analysis for prenatal and postnatal presymptomatic diagnosis. Both groups of individuals displayed a high level of knowledge about the disease. Although 87% of affected individuals considered the recurrence risk of ADPKD high, only 11% of ADPKD did not have children for this reason after diagnosis. Ninety-seven percent of at-risk individuals would utilize gene testing for themselves. Eight-eight percent of ADPKD and 89% of at-risk individuals would test offspring (not significant, NS) and 65% of ADPKD and 50% of at-risk individuals between the ages of 18 and 40 would use prenatal testing (NS). Only 4% of ADPKD and 8% of at-risk individuals between the ages of 18 and 40 would terminate a pregnancy for ADPKD. A greater percentage would terminate a pregnancy for a serious medical problem. The factors influencing presymptomatic testing were analyzed. The data suggest that presymptomatic testing will not substantially modify incidence of ADPKD since it may only occasionally alter reproductive plans.