[The distally based adipofascial sural artery flap for the reconstruction of distal lower extremity defects]

OBJECTIVE

Problematic tissue defects in the distal one-third of the lower leg represent a special challenge for the operative therapy. The distally based adipofascial sural artery flap is a safe and effective modification of the classical fasciocutaneous sural artery flap technique and makes the reconstruction in this problematic area more feasible. The surgical aim is soft tissue reconstruction with local tissue avoiding free tissue transfer.

INDICATIONS

Complex or chronic wounds (maximum width of 8 cm) of the distal lower leg with exposed bone, joints, tendons, and/or neurovascular structures, especially in cases of missing skin perforators.

CONTRAINDICATIONS

Arterial vascular disease (stage III-IV), especially peroneal artery occlusion. Postthrombotic syndrome with occlusion of the small saphenous vein. Chronic lymphedema.

SURGICAL TECHNIQUE

Preparation of the vascular pedicle of the distally based flap (including small saphenous vein, sural artery and nerve), the adjacent crural fascia and the subcutaneous fat without a skin island. The pivot point is about 6 cm cranial to the malleolus lateralis. The flap can be raised proximally up to the heads of the gastrocnemius muscle. After harvesting the flap there will be a change in blood flow direction in the small saphenous vein. The donor site can be closed primarily. The flap is covered with meshed split skin graft at the end of surgery.

POSTOPERATIVE MANAGEMENT

Strict elevation of the extremity for 5 days, then flap conditioning.

RESULTS

Between 1997 and 2012, this technique was used in 104 consecutive patients with soft tissue defects in the distal one-third of the lower leg. Flap survival was achieved 91 patients. In 2 patients amputation of the lower leg was necessary at the mid tibia level. In 3 cases flap necrosis occurred, requiring free tissue transfer.

Experimental study of fusion neutron and proton yields produced by petawatt-laser-irradiated D₂-³He or CD₄-³He clustering gases

We report on experiments in which the Texas Petawatt laser irradiated a mixture of deuterium or deuterated methane clusters and helium-3 gas, generating three types of nuclear fusion reactions: D(d,^{3}He)n, D(d,t)p, and ^{3}He(d,p)^{4}He. We measured the yields of fusion neutrons and protons from these reactions and found them to agree with yields based on a simple cylindrical plasma model using known cross sections and measured plasma parameters. Within our measurement errors, the fusion products were isotropically distributed. Plasma temperatures, important for the cross sections, were determined by two independent methods: (1) deuterium ion time of flight and (2) utilizing the ratio of neutron yield to proton yield from D(d,^{3}He)n and ^{3}He(d,p)^{4}He reactions, respectively. This experiment produced the highest ion temperature ever achieved with laser-irradiated deuterium clusters.

Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co-administration

OBJECTIVES

The renal elimination of tenofovir (TFV) may be subject to renal drug-drug interactions that may increase the risk of kidney injury. Case reports indicated that diclofenac might increase TFV-associated nephrotoxicity via a drug-drug interaction, leading to an increased intracellular TFV concentration in proximal tubular cells.

METHODS

A retrospective analysis of data for all patients from the Frankfurt HIV Cohort (FHC) who had diclofenac prescriptions between January 2008 and June 2012 was carried out.

RESULTS

Among 89 patients with diclofenac use, 61 patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28 patients (31.5%) were treated with TDF-sparing combination antiretroviral therapy (cART). Thirteen patients (14.6%) developed acute kidney injury (AKI) shortly after initiating diclofenac treatment. AKI occurred exclusively in TDF-treated patients, although all had previously stable renal function. All cases were accompanied by new onset of at least two parameters indicating proximal tubular damage, such as normoglycaemic-glucosuria and hypophosphataemia. TFV-associated nephrotoxicity was demonstrated by renal biopsy in four cases. Additionally, 11.5% of patients on TDF treatment developed new-onset proximal tubular damage, while having a preserved glomerular filtration rate. In contrast, diclofenac did not affect renal function in patients with TDF-sparing cART, as only one case of isolated hypophataemia was observed in these patients. In univariate analysis, risk factors for AKI were TDF-containing cART (P = 0.0076) and pre-existing hypophosphataemia (P = 0.0086).

CONCLUSIONS

Drug-drug interaction caused by diclofenac could exacerbate TFV-associated nephrotoxicity. Diclofenac should be used with caution in patients on TDF therapy, especially in those with hypophosphataemia. Our findings need to be confirmed in larger studies.

Measurement of the plasma astrophysical S factor for the 3He(d,p)4He reaction in exploding molecular clusters

The plasma astrophysical S factor for the 3He(d,p)4He fusion reaction was measured for the first time at temperatures of few keV, using the interaction of intense ultrafast laser pulses with molecular deuterium clusters mixed with 3He atoms. Different proportions of D2 and 3He or CD4 and 3He were mixed in the gas target in order to allow the measurement of the cross section for the 3He(d,p)4He reaction. The yield of 14.7 MeV protons from the 3He(d,p)4He reaction was measured in order to extract the astrophysical S factor at low energies. Our result is in agreement with other S factor parametrizations found in the literature.

Temperature measurements of fusion plasmas produced by Petawatt-Laser-Irradiated D2 - (3)He or CD4 - (3)He clustering gases

Two different methods have been employed to determine the plasma temperature in a laser-cluster fusion experiment on the Texas Petawatt laser. In the first, the temperature was derived from time-of-flight data of deuterium ions ejected from exploding D(2) or CD(4) clusters. In the second, the temperature was measured from the ratio of the rates of two different nuclear fusion reactions occurring in the plasma at the same time: D(d,(3)He)n and (3)He(d,p)(4)He. The temperatures determined by these two methods agree well, which indicates that (i) the ion energy distribution is not significantly distorted when ions travel in the disassembling plasma; (ii) the kinetic energy of deuterium ions, especially the "hottest part" responsible for nuclear fusion, is well described by a near-Maxwellian distribution.

[Hyperspectral imaging in head & neck oncology]

Hyperspectral Imaging has long been established in other scientific disciplines than medicine (e. g. earth science) as a means for objective classification of image data information. Some 10 years ago it was first introduced into medicine. Due to its immanent advantages - non-destructive specimen, compatibility with established optical tools (microscope, endoscope), objectivity, and user-independence - several attempts have been made in order to use its potential for the treatment of cancer patients. This publication reviews which methods have been developed for analogue issues in disciplines other than medicine, how these can be transferred into medicine, and what the perspectives are for the traditional innovative field of head-and-neck-oncology.

[Generation Y in ENT: leading a young generation of doctors]

BACKGROUND

The shortage of qualified doctors and nurses has led to a competition between hospitals. Analyzing the circumstances of the competition, nurses and doctors of so-called generation Y are important. These employees are mainly female and have different requirements compared to previous generations. Therefore, knowledge of these requirements will become a critical success factor for hospitals in the future.

METHOD

We interviewed medical students in Kiel and Hannover from 2005 to 2011 about the clinical department chosen, the criteria for choosing a specific clinic, and the importance of MD and PhD programs. In addition, we conducted an internet and Medline search for scientific studies on labor shortage, generation Y, and demographics. The data were sorted by main categories and relevance for hospitals. Statistical analyses were performed using descriptive measures.

RESULTS

We received 1,097 answers which represents approx. 75% of all students. Sixty-seven percent of the students were female, 33% male. Preferences for departments revealed internal medicine, pediatrics, and anesthesiology as the top three. ENT followed at rank 10. The main criteria for choosing a clinic were working climate, structure and broadness of education, family friendliness, and respect. MD programs were rated 2.6, while PhD programs were rated 3.6. Staff members of Generation Y "live while working" and disagree with hierarchies. Internet and computers are part of their daily routine.

CONCLUSION

Employees of Generation Y challenge leadership in hospitals by increasing demands. However, Generation Y can increase professionalization and competitiveness for hospitals significantly.

Polycarboxylates – Essential and Multifunctional

Starting from a variety of monomers as building blocks, a whole range of synthetic homopolymers and random copolymers can be easily synthesized in the laboratory and many of these polymers are commercially available. Acrylic acid in particular is a convenient and versatile starting point leading to a huge range of different polymer structures generally known as polycarboxylates. A great deal of work has been published on the effects polycarboxylates provide in laundry detergents. They have a pronounced dispersing capacity for particulate soil and sparingly soluble salts such as calcium carbonate and thus they are able to counteract incrustation and redeposition of soil onto fabrics. The incorporation of side chains of different lengths and chemistry opened the field of highly efficient rheology modifiers. This synthetic development has been aided by an increased understanding of the mode of action on a molecular level. Knowledge about the interaction of water-soluble polymers with nonionic and ionic surfactants and with particles has grown significantly and is still an area of great interest. Further, recent studies have shed more light on the dynamics of crystal growth of calcium carbonate in various environments and the role of polycarboxylates and other polymers in this process.

Public health and vector-borne diseases - a new concept for risk governance

Public Health is defined as an interdisciplinary multilevel approach that deals with questions of preventing diseases at the population level. In this context, this paper focuses on vector-borne diseases as an important threat with an increasing impact on human and animal health. Emphasis is laid on an integrated health approach ('One-Health' initiative) as it recognizes the interrelated nature of both human and animal health. The importance of vector-borne diseases to new and emerging diseases in Europe was demonstrated, for example, by the recent outbreak of West Nile virus infections in Greece, Northern Italy and Hungary; the spread of Crimean-Congo haemorrhagic fever virus across Turkey, south-western countries of the former USSR and the Balkans; the dramatic increase in hantavirus infections in Germany in 2012; and the dengue virus outbreak in Portugal in the same year. This paper provides a systematic approach for the analysis, assessment and governance of emerging health risks attributed to vector-borne diseases by using a holistic approach developed by the International Risk Governance Council (IRGC), called the 'IRGC Risk Governance Framework'. It can be used by decision-makers and general Public Health authorities in order to evaluate the situation regarding any specific pathogen or Public Health risk and to decide if additional measures should be implemented.

DiI labeling of human adipose-derived stem cells: evaluation of DNA damage, toxicity and functional impairment

INTRODUCTION

Adipose tissue-derived stem cells (ASCs) have become the primary focus of tissue engineering research. To understand their functions and behavior in in vitro and in vivo models, it is mandatory to track the implanted cells and distinguish them from the resident or host cells. A common labeling method is the use of fluorescent dyes, e.g. the lipophilic carbocyanine dye, DiI. This study aimed to analyze potential DNA damage, toxicity and impairment of the functional properties of human ASCs after labeling with DiI.

METHODS

Cytotoxicity was measured using the MTT assay and DNA damage was determined by means of the comet assay. Potential apoptotic effects were determined using the annexin V-propidium iodide test. Differentiation potential was evaluated by trilineage differentiation procedures in labeled and unlabeled ASCs. Proliferation as well as migration capability was analyzed, and the duration and stability of DiI labeling in ASCs during in vitro expansion was observed over a period of 35 days.

RESULTS

DiI labeling did not cause genotoxic effects 15, or 30 min or 24 h after the labeling procedure, and there were no cytotoxic effects until 72 h afterwards. No impairment of proliferation or migration capability or differentiation potential could be determined. However, after 35 days, only 37% of labeled cells could be detected using the fluorescence microscope, which indicates a decrease in staining stability during in vitro expansion.

CONCLUSION

DiI is a convenient method for ASCs labeling which causes no toxic effects and does not impair the proliferation, migration or differentiation potential of ASCs after the labeling procedure.

Validity of the six-minute walk test in cancer patients

The present study evaluated the validity of the six-minute walk test (6MWT) in cancer patients. 50 subjects (36 f, 14 m; 57.4±10.2 years; during (56%) or off (44%) cancer treatment) performed a 6MWT and a spiroergometry on a cycle ergo-meter (0+25 W, 3 min) to evaluate maximum exercise capacity (VO2peak). A subsample (n=30) completed a retest of the 6MWT within 2-7 days. Patients covered a distance of 594±81 m during 6MWT at an average intensity of 86.3±9.6% of HRmax and achieved a VO2peak of 21.2±4.86 ml · kg - 1 · min - 1 during cycle ergometry. The distance walked correlated significantly (p<0.001) with VO2peak (r=0.67) and perceived physical function (EORTC QLQ-C30 physical function subscale) (r=0.55). Concerning reliability the intraclass correlation coefficient was r=0.93 (95%CI: +0.86;+0.97; p<0.001) and the coefficient of variation 3%. During retest participants walked 3.1% (95%CI: +1.1; +5.2) farther and achieved a higher RPE (+1.0; 95%CI: +0.3;+1.8). Limits of agreement were between - 43.1 and 76.4 m. In cancer patients the 6MWT seems to be as valid and reliable as in healthy elderly, cardiac and pulmonary patients. Thus, it can be recommended for use in cancer patients.

Hepatitis B virus cell culture assays for antiviral activity

Hepatitis B Virus (HBV) is a causative agent of both acute and chronic hepatitis, a major etiologic factor of primary hepatocellular carcinoma, and a serious global health problem, with over 240 million estimated chronically infected individuals. Although there are several promising antiviral agents currently in clinical trials, alpha interferon remains the only licensed drug for the treatment of chronic HBV infection. Several cell lines and cell culture assays have been developed to identify potential therapeutics against chronic HBV infection. One of these cell lines, 2.2.15 (1), has been developed into a standardized assay, by the authors' laboratory, that has been repeatedly shown to be an accurate model of chronic cellular HBV replication and a predictive model of antiviral response for chronic hepadnaviral infection in vivo (2-5). This assay system, described here, is currently that used by the National Institutes of Health-National Institute of Allergy and Infectious Diseases (NIH-NIAID) (contract NO1-AI-45195) as an in vitro screen for antiviral agents against HBV replication.

Intensity of smiling and attractiveness as facial signals of trustworthiness in women

Facial attractiveness is associated with a variety of positive social characteristics including trustworthiness. Variations in smiling, such as the appearance of the Duchenne marker and increased intensity of expression, have likewise been linked with positive judgments of trustworthiness. The study investigated the interaction of the effects of models' attractiveness and their smiling intensity on impressions of perceived trustworthiness. Participants rated the attractiveness and expressivity of neutral, low intensity, and high intensity smiling images of 45 women models. These images were also presented to a second group of participants who rated trustworthiness. Repeated measures analysis of covariance of the effects of attractiveness and manipulated smile intensity on trustworthiness indicated a main effect for smile intensity: increased smile intensity was associated with greater trustworthiness. Attractiveness also contributed to rated trustworthiness independently of smiling intensity. Results suggested there is an additional contribution of facial expression in creating social impressions of trustworthiness.

Exercise effects on HRV in cancer patients

The present study evaluated the effects of physical exercise on heart rate variability (HRV) in cancer patients. 3 matched groups of each 15 tumour patients (60.4±8.9 years, 27 male, 18 female) were recruited: Physical exercise group 1 (acute treatment), Physical exercise group 2 (post treatment) and non-intervention group (acute treatment, no exercise). Exercise group patients received counselling for exercise and participated in a Nordic-Walking program. Short-term HRV-recordings, assessments of fatigue and quality of life (QoL) were performed prior to and 16 weeks after the exercise program initiation. MANCOVA revealed group × time differences in total power frequency domain of HRV and QoL (p<0.05). TP follow-up scores [logms(2)] differed significantly between non-intervention and intervention post treatment (2.0±0.5 vs. 2.6±0.5), but not between non-intervention and intervention during acute treatment. QoL follow-up scores differed significantly between non-intervention and intervention during acute treatment (47±15 vs. 64±18) and post treatment (47±15 vs. 69±19). Exercise enhances cardiac autonomic regulation of tumour patients during and after acute treatment. Because of the association of higher HRV-parameters and prolonged survival in cancer patients, improvement in autonomic control may be an important goal of exercise.

[The shortage of qualified staff in Germany: a survey on head physicians' expectations of young doctors]

BACKGROUND

The shortage of medical specialists in Germany has led to increased competition between hospitals, particularly in the recruitment of young skilled doctors. The quality of training appears to be the critical factor in a clinic's recruiting process. At the same time, the suitability of candidates is decreasing. There is currently no data on the suitability of candidates for otorhinolaryngology, nor are there any forecasts about the labor shortage in this speciality.

METHODS

We compiled a questionnaire according to accepted guidelines, which was then sent to 160 ENT departments by email. We asked about the size and location of the department and the number of applicants that were suitable or unsuitable. Finally, we asked about the current availability of staff as well as the requirements set by the head physician.

RESULTS

The response rate was 34% (54 questionnaires). Departments received an average of 20 applications per year, of which 36% were unsuitable. Departments received more applications in the new German states than in the old; however, no difference in the quality of candidates was seen. University hospitals receive almost three times more applications than other hospitals. The size of the department correlates with the number of applications and quality of the candidates. Almost 60% of chief physicians expected the lack of qualified staff to worsen in the future. However, 40% of chief physicians of large departments (> 50 beds) expected the situation to improve or remain unchanged. Chief physicians' main expectations of candidates included commitment, independent learning and team spirit.

CONCLUSIONS

A broad and structured residency program for new employees is the most important factor in the recruitment of new physicians. Large departments and university hospitals have advantages here. The expectations of head physicians differ from those of young staff in terms of commitment and autonomous learning.

Mobile stroke unit for diagnosis-based triage of persons with suspected stroke

BACKGROUND

In this feasibility study, we tested whether prehospital diagnostic stroke workup enables rational decision-making regarding treatment and the target hospital in persons with suspected stroke.

METHODS

A mobile stroke unit that delivers imaging (including multimodal brain imaging with CT angiography and CT perfusion), point-of-care-laboratory analysis, and neurologic expertise directly at the emergency site was analyzed for its use in prehospital diagnosis-based triage of suspected stroke patients.

RESULTS

We present 4 complementary cases with suspected stroke who underwent prehospital diagnostic workup that enabled direct diagnosis-based treatment decisions and reliable triage regarding the most appropriate medical facility for that individual, e.g., a primary hospital vs specialized centers of a tertiary hospital.

CONCLUSIONS

This preliminary report demonstrates the feasibility of prehospital diagnostic stroke workup for immediate etiology-specific decision-making regarding the necessary time-sensitive stroke treatment and the most appropriate target hospital.

Visual cortex combines a stimulus and an error-like signal with a proportion that is dependent on time, space, and stimulus contrast

Even though the visual cortex is one of the most studied brain areas, the neuronal code in this area is still not fully understood. In the literature, two codes are commonly hypothesized, namely stimulus and predictive (error) codes. Here, we examined whether and how these two codes can coexist in a neuron. To this end, we assumed that neurons could predict a constant stimulus across time or space, since this is the most fundamental type of prediction. Prediction was examined in time using electrophysiology and voltage-sensitive dye imaging in the supragranular layers in area 18 of the anesthetized cat, and in space using a computer model. The distinction into stimulus and error code was made by means of the orientation tuning of the recorded unit. The stimulus was constructed as such that a maximum response to the non-preferred orientation indicated an error signal, and the maximum response to the preferred orientation indicated a stimulus signal. We demonstrate that a single neuron combines stimulus and error-like coding. In addition, we observed that the duration of the error coding varies as a function of stimulus contrast. For low contrast the error-like coding was prolonged by around 60-100%. Finally, the combination of stimulus and error leads to a suboptimal free energy in a recent predictive coding model. We therefore suggest a straightforward modification that can be applied to the free energy model and other predictive coding models. Combining stimulus and error might be advantageous because the stimulus code enables a direct stimulus recognition that is free of assumptions whereas the error code enables an experience dependent inference of ambiguous and non-salient stimuli.

Laboratory tests of low density astrophysical nuclear equations of state

Clustering in low density nuclear matter has been investigated using the NIMROD multidetector at Texas A&M University. Thermal coalescence modes were employed to extract densities, ρ, and temperatures, T, for evolving systems formed in collisions of 47A MeV (40)Ar+(112)Sn, (124)Sn and (64)Zn+(112)Sn, (124)Sn. The yields of d, t, (3)He, and (4)He have been determined at ρ=0.002 to 0.03 nucleons/fm(3) and T=5 to 11 MeV. The experimentally derived equilibrium constants for α particle production are compared with those predicted by a number of astrophysical equations of state. The data provide important new constraints on the model calculations.

Tensile strength of flexor tendon repair using barbed suture material in a dynamic ex vivo model

The purpose of this study was to compare two sutures; a knotted polydioxane with a knotless barbed in a 4-strand Kirchmayr-Kessler suture technique. Human flexor digitorum tendons were separated into four groups. Group 1 - polydioxane; Group 2 - barbed suture; Group 3 and 4 - same as group 1 and 2 with an additional peripheral running suture. In each group the repaired tendons were subjected to linear and cyclical loads. No difference in maximum tensile strength after linear and cyclical force could be detected between the knotted polydioxane suture and the knotless barbed suture. On linear force tests an additional circumferential repair increased the maximum tensile strength of both sutures. Cyclical force loading did not lead to a reduction of maximum strength. Following linear and cyclical loading the 4-strand barbed suture achieved maximum tensile strengths comparable to the 4-strand repair using the polydioxane suture. Barbed suture repair may offer the advantage of knotless suture techniques.

Novel genital alphapapillomaviruses in baboons (Papio hamadryas anubis) with cervical dysplasia

Genital Alphapapillomavirus (αPV) infections are one of the most common sexually transmitted human infections worldwide. Women infected with the highly oncogenic genital human papillomavirus (HPV) types 16 and 18 are at high risk for development of cervical cancer. Related oncogenic αPVs exist in rhesus and cynomolgus macaques. Here the authors identified 3 novel genital αPV types (PhPV1, PhPV2, PhPV3) by PCR in cervical samples from 6 of 15 (40%) wild-caught female Kenyan olive baboons (Papio hamadryas anubis). Eleven baboons had koilocytes in the cervix and vagina. Three baboons had dysplastic proliferative changes consistent with cervical squamous intraepithelial neoplasia (CIN). In 2 baboons with PCR-confirmed PhPV1, 1 had moderate (CIN2, n = 1) and 1 had low-grade (CIN1, n = 1) dysplasia. In 2 baboons with PCR-confirmed PhPV2, 1 had low-grade (CIN1, n = 1) dysplasia and the other had only koilocytes. Two baboons with PCR-confirmed PhPV3 had koilocytes only. PhPV1 and PhPV2 were closely related to oncogenic macaque and human αPVs. These findings suggest that αPV-infected baboons may be useful animal models for the pathogenesis, treatment, and prophylaxis of genital αPV neoplasia. Additionally, this discovery suggests that genital αPVs with oncogenic potential may infect a wider spectrum of non-human primate species than previously thought.

Reconstruction of the thumb tip using palmar neurovascular flaps

OBJECTIVE

Reconstruction of the tip of the thumb using a neurovascular flap.

INDICATIONS

Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm) with exposure of bone and/or tendons.

CONTRAINDICATIONS

Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative).

SURGICAL TECHNIQUE

Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty.

POSTOPERATIVE MANAGEMENT

Plaster cast (finger slightly flexed) for 2 weeks.

RESULTS

Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.

Experimental determination of in-medium cluster binding energies and Mott points in nuclear matter

In-medium binding energies and Mott points for d, t, 3He and α clusters in low-density nuclear matter have been determined at specific combinations of temperature and density in low-density nuclear matter produced in collisions of 47A MeV 40Ar and 64Zn projectiles with 112Sn and 124Sn target nuclei. The experimentally derived values of the in-medium modified binding energies are in good agreement with recent theoretical predictions based upon the implementation of Pauli blocking effects in a quantum statistical approach.

[From personnel administration to human resource management : demographic risk management in hospitals]

BACKGROUND

The healthcare market is facing a serious shortage of qualified personnel in 2020. Aging of staff members is one important driver of this human resource deficit but current planning periods of 1-2 years cannot compensate the demographic effects on staff portfolio early enough. Therefore, prospective human resource planning is important to avoid loss of competence.

METHODS

The long range development (10 years) of human resources in the hospitals of the City of Cologne was analyzed. The basis for the analysis was a simulation model that included fluctuation of staff, retirement, maternity leave, status of employee illness, partial retirement and fresh engagements per department and profession. The model was matched with the staff requirements for each department. The results showed a capacity analysis which was used to convey strategic measures for staff recruitment and retention.

RESULTS

The greatest risk for shortage of qualified staff was found in the fluctuation of doctors and in the aging work force. Without strategic human resource management the hospitals would face a 50% reduction of the work force within 10 years and after 2 years there would be a 25% deficit of anesthesiologists with impact on the function of operation rooms (OR) and intensive care units. Qualification and continuous training of staff members as well as process optimization are the most important spheres of activity for human resource management in order to recruit and retain qualified staff members.

CONCLUSION

Prospective human resource planning for the OR and intensive care units can help to detect shortage of staff and loss of competence early enough to apply effective personnel development measures. A growing number of companies have started to plan ahead of the current demand of human resources. Hospitals should follow this example because the competition for qualified staff members is increasing rapidly.

[Dietary efficacy of a micronutrient combination in patients with recurrent upper respiratory tract infections. Results of a placebo-controlled double-blind study]

BACKGROUND AND OBJECTIVES

An optimal vitamin and mineral supply may contribute to the enhancement of immune defenses and thus favorably influence the course and intensity of recurrent upper respiratory tract infections (URIs). ln the present study the dietary efficacy and benefits of a micronutrient combination in patients with recurrent URls was evaluated.

METHODS

192 patients with recurrent URIs were enrolled in this randomized, placebo-controlled, double-blind multicenter trial for a study duration of 16 weeks. Efficacy variables were number, intensity and course of URIs (as assessed using a total common cold score [CCS]) and the alterations in micronutrient supply (vitamins C and D3, folic acid and selenium) during the study.

RESULTS

In subjects who initially had at least two common cold symptoms (N = 107) the symptoms improved in the active group (AG) significantly more than in the placebo group (PG; ACCS: AG -6.9 +/- 4.8; PG -5.4 +/- 4.5; p = 0.034). In patients with initially severe common cold (CC) episodes the symptoms improved in the AG to a statistically significant extent (ACCS: AG -93.8%, PG -91.2%, p = 0.043). In the age group below 45 years significantly fewer AG than PG patients were absent from their job during the second or third CC episode (AG: 14.3%, PG: 47.8%, p = 0.038). Patients with vitamin-D deficiency and/or insufficient vitamin-C supply reported significantly fewer CC episodes in AG than in PG. In the course of the trial, in AG vs. PG the serum vitamin C, folic acid and selenium levels increased (p < or = 0.001). The concentration of 25(OH)D3 decreased in both groups, but less so in the AG (AG -8.8%; PG-14%; p = 0.001).

CONCLUSION

Study results show the efficacy of a nutritional medical treatment with a special micronutrient combination in patients susceptible to infections and suffering from recurrent respiratory tract infections.