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  • 1
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    STUTTGART: THIEME
    Call number: W5:1/1
    Keywords: Medizin
    Notes: FORTS. S.: MEDIZINISCHE GRUNDLAGENFORSCHUNG. BD II.
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  • 2
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    German Medical Science; Düsseldorf, Köln
    In:  Hypertonie 2005; 29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga; 20051123-20051125; Berlin; DOC05hochP153 /20060808/
    Publication Date: 2006-08-09
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 3
    Publication Date: 2010-10-09
    Description: Critical care medicine frequently involves decisions and measures that may result in significant consequences for patients. In particular, mistakes may directly or indirectly derive from daily routine processes. In addition, consequences may result from the broader pharmaceutical and technological treatment options, which frequently involve multidimensional aspects. The increasing complexity of pharmaceutical and technological properties must be monitored and taken into account. Besides the presence of various disciplines involved, the provision of 24-hour care requires multiple handovers of significant information each day. Immediate expert action that is well coordinated is just as important as a professional handling of medicine's limitations.Intensivists are increasingly facing professional quality management within the ICU (Intensive Care Unit). This article depicts a practical and effective approach to this complex topic and describes external evaluation of critical care according to peer reviewing processes, which have been successfully implemented in Germany and are likely to gain in significance.
    Description: Alle intensivmedizinischen Maßnahmen haben in der Regel tief greifende Konsequenzen für den Patienten, auch Fehler, die sich direkt oder indirekt aus den täglichen Prozessen ergeben. Aus immer breiteren medikamentösen und apparativen Therapiemöglichkeiten ergeben sich zunehmend mehrdimensionale Sichten, die nicht selten weitere Konsequenzen nach sich ziehen. Fortwährend komplexere Medikamentenwirkungen und technische Funktionen müssen stets kontrolliert und bedacht werden. Die 24-stündige Versorgung der Patienten macht die tägliche Präsenz von unterschiedlichen Kollegen erforderlich, große Mengen von Informationen müssen mehrmals täglich übertragen werden. Schnelles, koordiniertes Handeln durch Experten ist ebenso notwendig wie der professionelle Umgang mit den Grenzbereichen der Medizin.Ein professionelles Qualitätsmanagement in der Intensivmedizin rückt zunehmend in den Fokus der Intensivmediziner. Dieser Artikel bietet einen praxisnahen und effektiven Ansatz, das komplexe Thema des Qualitätsmanagement in der Intensivmedizin unkompliziert und effizient anzugehen. Die externe Evaluation in Form von intensivmedizinischen Peer Reviews wird hierbei näher beschrieben, als ein Verfahren, welches in Deutschland bereits sehr erfolgreich umgesetzt wird und zukünftig weiter an Bedeutung gewinnen wird.
    Keywords: peer review ; quality management ; intensive care medicine ; evidence based medicine ; effectiveness ; Peer Review ; Qualitätsmanagement ; Intensivmedizin ; evidenzbasierte Medizin ; Effektivität ; ddc: 610
    Language: English
    Type: article
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  • 4
    Publication Date: 2009-11-18
    Description: There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants 〈35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually i〈TextGroup〉 ntr 〈/TextGroup〉oduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.
    Description: Eine besondere Herausforderung bei der Durchführung parenteraler Ernährung (PE) bei pädiatrischen Patienten ergibt sich aus der großen Spannbreite zwischen den Patienten, die von extrem unreifen Frühgeborenen bis hin zu Jugendlichen mit einem Körpergewicht von mehr als 100 kg reicht, und ihrem unterschiedlichen Substratbedarf. Dabei sind alters- und reifeabhängige Veränderungen des Stoffwechsels sowie des Flüssigkeits- und Nährstoffbedarfs zu berücksichtigen sowie auch die klinische Situation, in der eine PE eingesetzt wird. Das Vorgehen unterscheidet sich deshalb ganz erheblich von der PE-Praxis bei erwachsenen Patienten, z.B. ist der Flüssigkeits-, Nährstoff- und Energiebedarf von Früh- und Neugeborenen pro kg Körpergewicht höher als bei älteren pädiatrischen und bei erwachsenen Patienten. In der Regel benötigen alle Frühgeborenen 〈35. SSW und alle kranken Reifgeborenen während der Phase des allmählichen Aufbaus der enteralen Nahrungszufuhr eine vollständige oder partielle PE. Die Zufuhrmengen der PE bei Neonaten müssen berechnet (nicht geschätzt) werden. Der Anteil der PE sollte zur Minimierung von Nebenwirkungen sobald wie möglich durch Einführung einer enteralen Ernährung vermindert (teilparenterale Ernährung) und schließlich komplett durch enterale Ernährung abgelöst werden. Eine unangemessene Substratzufuhr im frühen Säuglingsalter kann langfristig nachteilige Auswirkungen im Sinne einer metabolischen Programmierung des Krankheitsrisikos im späteren Lebensalter haben. Wenn bei älteren Kindern und Jugendlichen dagegen der Energie- und Nährstoffbedarf eines Patienten im Vorschul- oder Schulalter durch eine enterale Nährstoffzufuhr nicht gedeckt werden kann, ist abhängig von Ernährungszustand und klinischen Umständen spätestens innerhalb von 7 Tagen eine partielle oder totale PE zu erwägen.
    Keywords: premature infant ; low birth weight infant ; newborn infant ; monitoring ; childhood ; Frühgeborenes ; Low birth weight infant ; Neugeborenes ; Monitoring ; Kindheit ; ddc: 610
    Language: English
    Type: article
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  • 5
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS); 20160612-20160615; Frankfurt am Main; DOCP 086 /20160608/
    Publication Date: 2016-06-17
    Keywords: Non-SAH ; Aneurysm ; Clipping ; ddc: 610
    Language: English
    Type: conferenceObject
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  • 6
    Keywords: EXPRESSION ; ANTIGENS ; IMMUNE-RESPONSES ; tumor-infiltrating lymphocytes ; PATHOGENESIS ; MUTATIONS ; CARCINOMAS ; EPITOPES ; SELF-TOLERANCE ; CEA
    Abstract: High-level microsatellite-unstable (MSI-H) colorectal carcinomas (CRC) represent a distinct subtype of tumors commonly characterized by dense infiltration with cytotoxic T cells, most likely due to expression of MSI-H-related frameshift peptides (FSP). The contribution of FSP and classical antigens like MUC1 and CEA to the cellular immune response against MSI-H CRC had not been analyzed so far. We analyzed tumor-infiltrating and peripheral T cells from MSI-H (n = 4 and n = 14, respectively) and microsatellite-stable (MSS) tumor patients (n = 26 and n = 17) using interferon gamma ELISpot assays. Responses against 4 FSP antigens and peptides derived from MUC1 to CEA were compared with and without depletion of regulatory T cells, and the results were related to the presence of the respective antigens in tumor tissue. Preexisting FSP-specific T cell responses were detected in all (4 out of 4) tumor-infiltrating and in the majority (10 out of 14) of peripheral T cell samples from MSI-H CRC patients, but rarely observed in MSS CRC patients. Preexisting T cell responses in MSI-H CRC patients were significantly more frequently directed against FSP tested in the present study than against peptides derived from classical antigens MUC1 or CEA (p = 0.049). Depletion of regulatory T cells increased the frequency of effector T cell responses specific for MUC1/CEA-derived peptides and, to a lesser extent, T cell responses specific for FSP. Our data suggest that the analyzed FSP may represent an immunologically relevant pool of antigens capable of eliciting antitumoral effector T cell responses.
    Type of Publication: Journal article published
    PubMed ID: 22729559
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  • 7
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW; VOL: 6; DOC12 /20170810/
    Publication Date: 2017-08-10
    Description: We report a case of recurrent gastritis with pyloric stenosis and cholangitis due to a rare variation in bile duct anatomy. A 72-year-old female patient showed recurrent gastral ulcers and biliary colic with cholangitis caused by gallstones in the main bile duct with an ectopic orifice in the prepyloric region and concurrent inflammatory pyloric stenosis. After temporarily successful endoscopic treatment with stenting and pyloric dilatation, the patient suffered from recurrent cholangitis. Finally, the abnormal biliary anatomy required surgical treatment with biliodigestive anastomosis.
    Description: Wir berichten über eine 72-jährige Patientin, die sich mit rezidivierenden Magenulcera, Gallenkoliken und einer Pylorusstenose bei uns vorstellte. Als Ursache wurde eine ektopische Mündung des Gallengangs in den präpylorischen Magen diagnostiziert. Zusätzlich bestanden eine Pylorusstenose und rezidivierende Cholangitiden mit Leberabszessen. Nach vorübergehender Besserung der Symptome durch eine endoskopische Stenteinlage war letztlich die operative Anlage einer biliodigestiven Anastomose notwendig.
    Keywords: ectopic orifice of the bile duct ; ektopische Mündung des Gallengangs in den Magen ; ddc: 610
    Language: English
    Type: article
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  • 8
    Publication Date: 2010-09-28
    Description: In order to improve quality (of therapy), one has to know, evaluate and make transparent, one's own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state.Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches.Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs).
    Description: Um die (Behandlungs-)Qualität zu verbessern, muss man die eigenen Alltagsprozesse kennen und evaluieren, Transparenz erzeugen. Die Reflexion kann durch die Präsentation von Kennzahlen oder Indikatoren unterstützt werden, in denen der tatsächliche IST-Zustand dargestellt wird. Um dieses IST aufzuzeigen werden Qualitätsindikatoren benötigt. Qualitätsindikatoren zeigen den Erreichungsgrad einer spezifischen Qualität hin. Stellt sich ein Indikator als nicht mehr relevant heraus oder wird ein Erreichungsgrad von 100% erzielt, ist die weitere Erfassung eines solchen Indikators überflüssig.Für die Intensivmedizin gibt es in unterschiedlichen Ländern Untersuchungen von Qualitätsindikatoren. In standardisierten Verfahren wurden jeweils verschiede Indikatoren detektiert, die eine Relevanz besitzen in Hinblick auf die medizinische Behandlungsqualität und damit auf das Outcome von Intensivpatienten. In enger Abstimmung haben in Deutschland die intensivmedizinischen Fachgesellschaften 10 Kern-Qualitätsindikatoren für die Intensivmedizin verabschiedet, die mit einer Gültigkeit von 2 Jahren für deutsche Intensivstationen empfohlen werden.
    Keywords: quality indicators ; quality management ; intensive care medicine ; quality of therapy ; outcome ; Qualitätsindikator ; Qualitätsmanagement ; Intensivmedizin ; Behandlungsqualität ; Outcome ; ddc: 610
    Language: English
    Type: article
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  • 9
    Keywords: MECHANISM ; prognosis ; antibodies ; metastases ; LYMPHOCYTES ; INSTABILITY ; CARCINOMAS ; DR EXPRESSION ; TUMOR-SPECIFIC ANTIGENS ; ESTABLISHED MELANOMA
    Abstract: Besides being expressed on professional antigen-presenting cells, HLA class II antigens are expressed on various tumors of non-lymphoid origin, including a subset of colorectal cancers (CRC). Information about the regulation of HLA class II antigen expression is important for a better understanding of their role in the interactions between tumor and immune cells. Whether lack of HLA class II antigen expression in tumors reflects the selective immune destruction of HLA class II antigen-expressing tumor cells is unknown. To address this question, we tested whether lack of HLA class II antigen expression in CRC was associated with immune cell infiltration. We selected microsatellite-unstable (MSI-H) CRC, because they show pronounced tumor antigen-specific immune responses and, in a subset of tumors, lack of HLA class II antigen expression due to mutations inactivating HLA class II-regulatory genes. We examined HLA class II antigen expression, mutations in regulatory genes, and CD4-positive T cell infiltration in 69 MSI-H CRC lesions. Mutations in RFX5, CIITA, and RFXAP were found in 13 (28.9 %), 3 (6.7 %), and 1 (2.2 %) out of 45 HLA class II antigen-negative tumors. CD4-positive tumor-infiltrating lymphocyte counts were significantly higher in HLA class II antigen-negative tumors harboring mutations in HLA class II-regulatory genes (107.4 T cells per 0.25 mm(2)) compared to tumors without mutations (55.5 T cells per 0.25 mm(2), p = 0.008). Our results suggest that the outgrowth of tumor cells lacking HLA class II antigen expression due to mutations of regulatory genes is favored in an environment of dense CD4-positive T cell infiltration.
    Type of Publication: Journal article published
    PubMed ID: 25445815
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  • 10
    Abstract: Regulatory T cells (Treg cells) perform two distinct functions: they maintain self-tolerance, and they support organ homeostasis by differentiating into specialized tissue Treg cells. We found that epigenetic modifications defined the molecular characteristics of tissue Treg cells. Tagmentation-based whole-genome bisulfite sequencing revealed more than 11,000 regions that were methylated differentially in pairwise comparisons of tissue Treg cell populations and lymphoid T cells. Similarities in the epigenetic landscape led to the identification of a common tissue Treg cell population that was present in many organs and was characterized by gain and loss of DNA methylation that included many gene sites associated with the TH2 subset of helper T cells, such as the gene encoding cytokine IL-33 receptor ST2, as well as the production of tissue-regenerative factors. Furthermore, the ST2-expressing population was dependent on the transcriptional regulator BATF and could be expanded by IL-33. Thus, tissue Treg cells integrate multiple waves of epigenetic reprogramming that define their tissue-restricted specialization.
    Type of Publication: Journal article published
    PubMed ID: 28783152
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