[Knee joint pain with signs of arthrosis]

Chronic pain in the knee joint is most commonly caused by osteoarthritis, especially in elderly patients but can be due to other causes, such as rheumatoid arthritis. The diagnostics include an exact patient medical history and a clinical examination, which often already provide clear indications of the cause of the knee pain. Subsequently, further diagnostics can then be considered, such as radiological procedures and laboratory diagnostics. The treatment is determined by the cause and the individual patient and aims to reduce pain and to preserve the mobility of the joint. Generally, therapy consists of pain management and physiotherapy as well as alternative therapeutic procedures, mostly in combination. Proximal tibial opening wedge osteotomy can be useful; however, partial or total knee arthroplasty should only be considered when conservative treatment options have been exhausted.

[Needs and wishes of healthy patients - how should physicians deal with them?]

BACKGROUND

It is hardly known how physicians feel and act if patients complain about social damage, familial tragedies or problems at work instead of illnesses or diseases.

METHODS

Seven general practitioners discussed this subject in a focus-group setting. Within two hours, the three female and four male practitioners described some typical needs and wishes of their healthy patients. They were also encouraged to relate their feelings, reactions and behaviour as doctors. We interpreted the transcript of the recorded discussion according to the rules of a content-analysis.

RESULTS

Certificates, (non-medical) advice and information, general care and reducing expenses are the main reasons for healthy patients to see them, the doctors quoted. The doctor's feelings depend on the personality of the patient and the reported problems. As a result, the physician's acceptance of needs and wishes of healthy patients varies over a broad spectrum and the decisions differ and seem arbitrary, although reporting on similar situations. Her/his personal attributes and mood mainly determine their decision about the patient's wishes.

DISCUSSION

The question of whether to refuse or to respect healthy patients' wishes was arbitrary in this focus-group setting. Because no specific medical curriculum exists, rules for doctors' reactions and decisions on social, familial or working problems of their patients could be helpful. In particular, specific problems should be dealt with by social workers and related professions.

Application of the "-Omic-" technologies in phytomedicine

The proof of efficacy of phytopreparations and the determination of their mode of action are permanent challenges for an evidence-based phytotherapy. The technology platform of genomics, proteomics and metabolomics ("-omic-" technologies) are high-throughput technologies. They increase substantially the number of proteins/genes that can be detected simultaneously and have the potential to relate complex mixtures to complex effects in the form of gene/protein expression profiles. Provided that phytopreparation-specific signatures in the form of gene/protein expression profiles can be developed, these technologies will be useful for the chemical and pharmacological standardization and the proof of the toxicological potential of a plant extract. Over a long-term perspective they may economize the proof of efficacy, the determination of the mode of action of phytomedicines and allow to investigate herbal extracts without prominent active principle(s). The application of this genomics revealed already that gene expression profiles induced by single drugs and the ones induced by the combination of the same drugs can be entirely different. These results make the information of the mode of action of isolated "active principles/lead substances" of phytopreparations questionable. The application of the "-omic-" technologies may lead to a change of paradigms towards the application of complex mixtures in medicine and open the new field of phytogenomics, -proteomics and -metabolomics.

[Quality aspects of the use of complementary medicine--experiences from the work of a quality circle]

OBJECTIVES

This article reports the results of a quality circle work, carried out by physicians using complementary medicine. It illustrates the problems occurring in this subject and summarizes characteristics of the daily work in relation to quality aspects. Patient characteristics were investigated; examples of mistakes in daily care are reported.

METHODS

The report is based on the two moderators' subjective impressions, on analysis of attendance lists, case reports, protocols, and surveys.

RESULTS

The quality circle was started in October 1994 and consists of a group of about 16 physicians, mainly general practitioners. Several objectives mentioned in official guidelines for quality circles could not be achieved, for example, the evaluation of results, analysis and assessment of the own performance according to established criteria, the degree to which published guidelines were followed, the development and implementation of problem-solving strategies. The quality circle was mainly a platform for exchange and continuing medical education. It also was the basis for an empirical study.

CONCLUSION

The continuing interest of patients in complementary medicine should motivate physicians to systematically evaluate these therapies. Participants of quality circles should prepare themselves extensively for the meetings. They should take measures to keep up-to-date with the current medical knowledge. Elements and objectives aiming at a higher quality standard can be examined and implemented in routine practice work. Research results should be integrated into the daily practice. Furthermore, academic or other independent institutions should carry out experimental research into traditional complementary therapies.

[Residues of disinfectants in hospital sewage]

All of 67 samples of sewage, taken at different points from the sewers of the Bonn University hospitals, contained phenolic substances in concentrations ranging from 0.09 mg/l to 5.05 mg/l. About 0.15 mg/l might be caused by human excretion of phenolics. Six samples contained free formaldehyde (2.72-28.38 mg/l), five samples chlorine (0.1 to 1 mg/l). In the main sewer of the hospitals the substances were diluted, but a measurable concentration reached the communities sewage lines. There were no characteristic diurnal changes of the concentrations. Measurements of biological oxygen demand (BOD) in native and artificially prepared sewages using o Sapromat showed, that pure phenol, o-phenylphenol, chlorine and formaldehyde in concentrations as found do not reduce the biologic decomposition. With the exception of chlorine, the substances seem to be integrated into the aerobic microbial decomposition. 3,4 chlorcresol, instead, is able to retard the begin and reduce the amount of decomposition in concentrations, which were found as maximal concentrations for phenolic substances in the sewage samples. Two of 67 samples with the highest concentrations of disinfectants revealed measurable toxity in form of a BOD reduction. The other samples, instead, showed a faster microbiological decomposition than comparable artificial sewage.