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The handling of moving boundaries of immersed particles requires special attention in thermal lattice Boltzmann simulations of particle-laden flows. The following three issues are of special importance: First, the thermal boundary conditions (Dirichlet or Neumann) have to be fulfilled on the particle surface. Second, reasonable values have to be found for temperature distributions in grid nodes that are uncovered by moving particles. Third, the heat transfer between particulate and fluid phase has to be evaluated efficiently. In this work, we present new numerical schemes for all of these three key aspects. They rely to a great degree on existing schemes for the hydrodynamic lattice Boltzmann method. In four benchmark cases we assess which of them are the most favourable ones and we also show to what extent schemes based on the same principles behave similarly or differently in the flow and heat transfer simulation. Unlabelled Image • New interpolated bounce-back and refilling schemes for the thermal LB method. • New efficient evaluation method for the heat transfer between particles and fluid. • Performance comparison of the proposed techniques with hydrodynamic LB techniques. • Identification of the best framework for particle-fluid flows with heat transfer. [ABSTRACT FROM AUTHOR]

Abstract In the present work a thermal Lattice-Boltzmann method (TLBM) is applied to study convection-diffusion problems and to determine averaged Nusselt numbers for particles being part of differently dense random packings. For the carried out numerical investigations a 3D TLBM framework is derived. Therein the hydrodynamic side is solved with a D3Q19 multiple-relaxation-time (MRT) collision operator and interpolated bounce back schemes. For the thermal side two different collision operators namely Bhatnagar-Gross-Krook (BGK) and MRT are applied and compared against each other. Furthermore, the impact of the LBM mesh structure is examined by comparing a D3Q7 and a D3Q19 model for the thermal side. Thermal diffusion and convection-diffusion problems for plane and curved boundaries are then studied and the results are validated against analytical solutions, when available or compared to established closure correlations. Furthermore, the best collision operator and boundary conditions - regarding numerical accuracy and stability - are selected to investigate convective-diffusive interphase heat transfer inside different static, random particle/fluid systems for varying porosities, Reynolds and Prandtl numbers. Obtained results are compared against published correlations. In addition a new closure correlation for drag forces and particle averaged Nusselt numbers in random particle packings in the range of ε = 0.6 − 1, Re p = 20 − 500 and Pr = 0.5 − 1.5 is proposed. Graphical abstract Unlabelled Image Highlights • DNS of fluid flow and heat transfer at single particle and in packings is performed. • A DDF-LBM MRT scheme relying on interpolated bounce back is utilized. • Effect of thermal collision operators and thermal boundary conditions is examined. • Drag force and Nusselt number correlations are derived which can be used in CFD/DEM. [ABSTRACT FROM AUTHOR]

Most patients with diabetes are treated in primary care (PC). We performed a systematic review to assess the effect of single and combined interventions on cardiovascular risk factors (CVRFs) and glycated haemoglobin (HbA1c) levels in patients with diabetes in PC settings. We searched the MEDLINE database from January 1990 to October 2008. According to the Cochrane Effective Practice and Organization of Care Group (EPOC) criteria, (cluster-)randomized control studies and controlled before-and-after studies were selected and reviewed. Identified interventions were classified according to a modified EPOC intervention taxonomy. We included 68 studies. Forty-five studies evaluated the effect of any intervention on HbA1c. Seventeen studies presented a significant improvement in HbA1c. Nine out of 27 studies evaluating CVRFs [cholesterol, blood pressure (BP)] and HbA1c showed a significant improvement in at least two of these factors. Audit and feedback on performance, clinical decision support systems, multi-professional teams and patient education seemed to be successful strategies. The increasing evidence regarding the treatment of persons with chronic illnesses, summarized in the Chronic Care Model (CCM), is not reflected in most recent studies about diabetes treatment in PC. Most interventions still seem only partly adapted to the CCM. The methodological quality of many studies is still poor and often the pivotal outcomes, CVRFs and HbA1c, are not appropriately addressed. As a consequence, the potential of PC in the care of patients with diabetes may still be underestimated. [ABSTRACT FROM AUTHOR]

Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs is slightly higher and they also have some antiphlogistic effect, but their use has to be strictly limited to a short period of time. They should mainly be used in the therapy of the acute and painful phase of osteoarthritis. Among the NSAIDs, Diclofenac is the medication of first choice. In patients with an increased risk of gastrointestinal complications, a protonpumpinhibitor should be added. Patients with cardiovascular risk factors should receive NSAIDs only in case of no appropriate alternative treatments. Opioids have their place in osteoarthritis treatment and should be part of an individualized pain regime, which should also contain a pain diary and proactive monitoring. It is important to emphasize the positive effects of physical activity on the function of the joints as well as the negative effect of overweight and immobility. [ABSTRACT FROM AUTHOR]

The Chronic Care Model (CCM) is an organizational approach to caring for people with chronic disease in a primary care setting. The system creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team. The CCM identifies essential elements of a health care system that encourage high-quality chronic disease care: the community; the health system; self-management support; delivery system design; decision support, and clinical information systems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: With the introduction of diabetes disease management programs (DMPs) in Germany, there is a necessity to evaluate whether patients receive care that is congruent to the Chronic Care Model (CCM) and evidence-based behavioral counseling. We examined differences as perceived and experienced by patients with type 2 diabetes between those enrolled in a DMP compared with patients receiving usual care in two federal states of Germany. RESEARCH DESIGN AND METHODS: A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund, including the German version of the Patient Assessment of Chonic Illness Care (PACIC) instrument, which had additional items for behavioral advice (5A). Two weeks later, a general reminder was sent out. RESULTS: A total of 1,532 questionnaires were returned (response rate 42.2%), and valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years, of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86) (P < 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales, similar differences were found for all five subscales plus the sum score (P < 0.001; mean for DMP = 3.08, mean for non-DMP = 2.78). CONCLUSIONS: DMPs, as currently established in primary care in Germany, may impact provided care significantly. The changes in daily practice that have been induced by the DMPs are recognized by patients as care that is more structured and that to a larger extent reflects the core elements of the CCM and evidence-based counseling compared with usual care. [ABSTRACT FROM AUTHOR]

BACKGROUND: A well established 'midlevel' of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia. In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement. METHODS: We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti. RESULTS: Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge. CONCLUSION: Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach which currently only marginally exists in the German health care system. Better medical education of practice nurses is indispensable, but GPs also have to accept that they cannot fulfil the requirement of future care alone. [ABSTRACT FROM AUTHOR]

BACKGROUND: Medical and technological progress has led to increased numbers of diagnostic tests, some of them inducing high financial costs. In Germany, high-cost diagnostic imaging is performed by a medical specialist after referral by a general practitioner (GP) or specialist in primary care. The aim of this study was to evaluate the physicians' perceived usefulness of high-cost diagnostic imaging in patients with different clinical conditions. METHODS: Thirty-four GPs, one neurologist and one orthopaedic specialist in ambulatory care from a Medical Quality Network documented 234 referrals concerning 97 MRIs, 96 CTs-scan and 41 intracardiac catheters in a three month period. After having received the test results, they indicated if these were useful for diagnosis and treatment of the patient. RESULTS: The physicians' perceived usefulness of tests was lowest in suspected cerebral disease (40% of test results were seen as useful), cervical spine problems (64%) and unexplained abdominal complaints (67%). The perceived usefulness was highest in musculoskeletal symptoms (94%) and second best in cardiological diseases (82%). CONCLUSION: The perceived usefulness of high-cost diagnostic imaging was lower in unexplained complaints than in specific diseases. Interventions to improve the effectiveness and efficiency of test ordering should focus on clinical decision making in conditions where GPs perceived low usefulness. [ABSTRACT FROM AUTHOR]

Fractionation through Deterministic Lateral Displacement (DLD) is a promising microfluidic method, able to address several particle characteristics. The influence of particle density on the fractionation however appears to be negligible at low Stokes numbers. In the present study, we investigate the trajectories of neutrally and negatively buoyant particles in standard DLD channels at different Reynolds numbers through coupled DEM-LBM simulations. The results show that the influence of particle density increases with Reynolds number, which enables fractionation by size and density. To facilitate the further use of our study, the results are combined in a correlation describing the influence of row shift fraction, Reynolds number and particle density on the critical diameter. Additionally, we investigate the influence of the Reynolds number on periods of neutrally buoyant particles and show that they can be predicted by simple fluid simulations through the introduced concept of fluidic periodicity. [Display omitted] • Resolved simulation of Deterministic Lateral Displacement. • Lattice Boltzmann Method coupled with Discrete Element Method. • Investigation of elevated Reynolds numbers and negatively buoyant particles. • D crit of DLD depends on particle density only at Re > > 1. • New correlation to predict D crit as a function of Re and ρ Part. [ABSTRACT FROM AUTHOR]

Microchannels have become important processing devices in particle technology. Particles typically processed in them are often highly non-spherical. Still the majority of studies investigating their behavior focus on spherical particles. The few studies investigating non-spherical particles tend to focus on straight channels. Therefore, studies on the behavior of non-spherical particles in other frequently used channel geometries such as the serpentine microchannel are needed. To fill this gap, we numerically study the behavior of oblate and spherocylindric particles of different aspect ratios in a square wave serpentine microchannel at various Reynolds numbers. Investigated are forming equilibrium streaks as well as particle rotation, both over one whole periodic element of the channel structure. The results show that non-spherical particles behave similar to spherical particles of the same volume but tend to defocus earlier with rising Reynolds numbers. Particles show recurring rotational behavior above certain Reynolds numbers, which are however lost with defocusing. [Display omitted] • Investigation of oblates and rods in a square wave serpentine microchannel. • Analysis of focusing positions and orientations over channel geometry. • Analysis of different particle volumes and aspect ratios. • Given identical particle density, particle volume is dominant for focusing behavior. • Particles can show distinct rotational behavior. [ABSTRACT FROM AUTHOR]

We investigated the association between skinfold thickness and race performance in male and female Ironman triathletes. Skinfold thicknesses at 8 sites and percent body fat were correlated to total race time including the split times for the 3 sub disciplines, for 27 male and 16 female Ironman athletes. In the males, percent body fat (r = 0.76; p < 0.0001), the sum ofupper body skinfolds (r = 0.75; p < 0.0001) and the sum of all 8 skinfolds (r = 0.71; p < 0.0001) were related to total race time. Percent body fat (r = ? 0.67; p < 0.001), the sum of upper body skinfolds (r = ? 0.63, p = 0.0004) and the sum of all 8 skinfolds (r = ? 0.59; p < 0.001) were also associated with speed in cycling during the race. In the females, none of the skinfold thicknesses showed an association with total race time, average weekly training volume or speed in the sub disciplines in the race. The results of this study indicate that low skinfold thicknesses of the upper body are related to race performance inmale Ironman triathletes, but not in females. [ABSTRACT FROM AUTHOR]

A 35 year old man with coldness, paleness, numbness, and pain at Dig. IV of the left hand comes to the consultation. The Allen-test is pathological, the angiography shows an occlussion at the length of 4 cm of the Arteria ulnaris beginning at the Hamulus ossis hamati. After therapy with prostaglandin El, aspirin 100 mg for 10 days and a smoking stop, the symptom disappeared at the re-consultation after 10 days. [ABSTRACT FROM AUTHOR]

We investigated the relationship between variables of anthropometry and training volume on race performance in 29 male non-professional ultra-triathletes. Anthropometric variables were determined in order to calculate body mass index, sum of skin-folds and percent body fat. Participants kept a comprehensive training diary recording their training volume in hours and kilometres in the 3 months before the race. The relationship of anthropometry and average weekly training volume with race performance was investigated with linear regression analysis. The sum of 8 skin-fold thicknesses was associated with total race time (r2=0.33, p<0.001), whereas the average weekly training volume was not (r2=0.00, p>0.05). The training volume showed no association with the sum of 8 skin-folds (r2=0.00, p>0.05). The sum of 8 skin-folds was neither associated with speed in the swim (r2=0.10, p>0.05) nor in the bike split (r2=0.10, p>0.05) but showed a significant association with speed in the run split (r2=0.38, p<0.0001). We concluded that anthropometry was of more importance than training volume in male Triple Iron triathletes and that these athletes were close to runners regarding the relationship of anthropometry with race performance. [ABSTRACT FROM AUTHOR]

In order to obtain a proper knowledge base in primary care, a form of electronic patient record is needed that takes into account the specific characteristics of the doctor-patient encounter, the patient population, the presentation of diseases and the associated prevalences. However, in real life this has not happened for several reasons. For the most part, existing patient records are determined by invoicing requirements rather than by endeavours to meet the intrinsic needs of primary care. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious scientific project in Germany to establish a system for adequate record keeping and analysis in primary care. Based on a classification system designed for the special situation of primary care, a scientific network is being established consisting of participating surgeries, general practitioners, computer scientists and statisticians. The project is supported by the German Federal Ministry of Education and Research. The aims are strictly scientific and the underlying hypothesis is that the knowledge-gaining process can be accelerated by combining the experience of many, especially with respect to complex interactions of factors and the analysis of rare events. Aside from maintaining a morbidity registry, within the CONTENT framework various prospective and retrospective studies on particular epidemiological and health economic research topics will be conducted. [ABSTRACT FROM AUTHOR]

[Display omitted] • A comparison of non-resolved DEM/CFD and PR-DNS is performed for fixed particle ensembles. • The PR-DNS is based on a thermal lattice Lattice-Boltzmann method (TLBM). • Three different types of particles are investigated: spheres, cylinders and cubes. • Drag force, lift force and heat transfer correlations are evaluated as part of the DEM/CFD. • DEM/CFD related issues are revealed helpful for future closure derivations. Particle-unresolved Eulerian/Lagrangian simulations (DEM/CFD) of static homogenous particle ensembles are compared to direct numerical simulations (DNS) performed with the Lattice-Boltzmann method (LBM). Eliminating particles' motion, the accuracy of the CFD can be examined in a targeted way. Local quantities at the particle scale such as drag, lift and Nusselt numbers are thus evaluated in detail. In particular, the influence of particles' shape on numerical accuracy of the non-resolved DEM/CFD utilizing different correlations is studied. As particle shapes spheres, cylinders and cubes are examined applying the widely used multi-sphere method (MSM) for particle approximation. The simulations are conducted for two different exemplary voidages of ε = 0.6 and ε = 0.8 in the Reynolds number range of Re p = 10 - 300 and the Prandtl number Pr = 1. The study reveals issues related to non-resolved DEM/CFD simulations especially in the case of non-spherical particles and provides important details for general DEM/CFD applications as well as for future closure derivations. [ABSTRACT FROM AUTHOR]

Classical fractionation principles are often not suited for microparticles. Therefore methods specifically designed to fractionate in those size ranges are being developed. One approach is the fractionation in serpentine microchannels: It has so far been mainly used for size fractionation but seems to be suited for density fractionation as well. In order to optimally design the systems to fractionate for particle size and density, detailed information on their combined influence on the forming equilibrium streaks is needed. As this information is currently lacking, we study those effects using a coupled DEM-LBM simulation approach. We include a detailed analysis of equilibria over the periodic elements of the channel structure, which is important for optimal placement of the channel outlet. The results confirm the capability of serpentine channels for density fractionation and demonstrate that density dependency is greatest at elevated Reynolds numbers and in channel sections orthogonal to the main channel orientation. [Display omitted] • The DEM-LBM is able to reproduce experimental results of equilibrium streaks. • Kernel density estimation is suited to determine equilibrium streaks from DEM-data. • At lower Reynolds numbers, streaks are almost independent of particle density. • At elevated Reynolds numbers, there is a clear influence of density on streaks. • A fractionation for size and density in one step is possible and demonstrated. [ABSTRACT FROM AUTHOR]

Background General practitioners ( GPs) play crucial roles in early detection of skin cancer. A pilot-study found a positive short-term effect of a 1-day dermatologic education programme on GPs' diagnostic competence. Objective To determine effects of a multifaceted intervention, including technical equipment and continuing feedback by a dermatologist, on GPs' diagnostic skills regarding skin cancer. Methods Randomized controlled trial with 78 GPs of the Canton of Zurich, Switzerland. Intervention: GPs in intervention group received a 1-day training, a Lumio© (magnifying glass with polarized light, 3Gen), a Nikon digital camera and - during 1 year - feedback on skin lesion pictures sent to the dermatologist. GPs in control group only received the 1-day training. Main outcome and measures: Primary outcome: structured assessment of GP's diagnostic skills in correctly diagnosing images of skin lesions regarding skin cancer. At baseline prior to intervention (T0), after the full-day training course in both groups (T1), and after 1 year of continuing feedback (T2) to the intervention group. Measures: Non-parametric unpaired (Wilcoxon-Mann-Whitney) tests were used to compare numbers of correctly classified skin lesions between both groups at T2 and for the change between T1 and T2. Results At T0, both groups classified a median of 23 skin lesions of the 36 images correctly. This value rose to 28 for both groups at T1 and fell to 24 for both groups at T2. No difference between control and intervention group at T2. Furthermore, we compared differences in the sum scores per GP between T1 and T2 for each group. Also in this comparison, no difference between control and intervention group was found. Conclusion and relevance No long-term effect of the multifaceted intervention was found on the competence to diagnose skin cancer by GPs. The positive short-term effect of the 1-day dermatologic education programme did not persist over 12 months. [ABSTRACT FROM AUTHOR]

Background: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. Objective: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). Methods: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. Results: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. Conclusions: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We examined the gender difference in performance of open-water ultra-swimmers crossing the English Channel between 1875 and 2011. A total of 1606 swimmers (1120 males and 486 females) crossed the English Channel within a mean time of 809.6 ± 175.6 min. The overall female swim time of 796.3 ± 188.7 min was not different compared with the overall male swim time of 815.4 ± 169.4 min ( P > 0.05). The fastest male swim time ever of 417 min was 6.7% faster than the fastest female swim time ever with 445 min. The gender difference in performance of the top three times ever was 8.9 ± 2.3%. Over the last 36 years, the performance of the annual top three swimmers showed no changes for both females and males. The top three males (564.3 ± 63.8 min) were significantly faster than the top three females (602.1 ± 58.7 min; P < 0.01). The gender difference remained unchanged at 12.5 ± 9.6% over the years. To summarize, the top three male swimmers in the English Channel were ∼12% faster than the females in the last 36 years. It seems unlikely that female open-water ultra-swimmers will overtop males in the near future in the English Channel. [ABSTRACT FROM AUTHOR]

Background: Due to technological progress and improvements in medical care and health policy the average age of patients in primary care is continuously growing. In equal measure, an increasing proportion of mostly elderly primary care patients presents with multiple coexisting medical conditions. To properly assess the current situation of co- and multimorbidity, valid scientific data based on an appropriate data structure are indispensable. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious project in Germany to establish a system for adequate record keeping and analysis in primary care based on episodes of care. An episode is defined as health problem from its first presentation by a patient to a doctor until the completion of the last encounter for it. The study aims to describe co- and multimorbidity as well as health care utilization based on episodes of care for the study population of the first participating general practices.Methods: The analyses were based on a total of 39,699 patients in a yearly contact group (YCG) out of 17 general practices in Germany for which data entry based on episodes of care using the International Classification of Primary Care (ICPC) was performed between 1.1.2006 and 31.12.2006. In order to model the relationship between the explanatory variables (age, gender, number of chronic conditions) and the response variables of interest (number of different prescriptions, number of referrals, number of encounters) that were applied to measure health care utilization, we used multiple linear regression.Results: In comparison to gender, patients' age had a manifestly stronger impact on the number of different prescriptions, the number of referrals and number of encounters. In comparison to age (beta = 0.043, p < 0.0001), multimorbidity measured by the number of patients' chronic conditions (beta = 0.51, p < 0.0001) had a manifestly stronger impact the number of encounters for the observation period. Moreover, we could observe that the number of patients' chronic conditions had a significant impact on the number of different prescriptions (beta = 0.226, p < 0.0001) as well as on the number of referrals (beta = 0.3, p < 0.0001).Conclusion: Documentation in primary care on the basis of episodes of care facilitates an insight to concurrently existing health problems and related medical procedures. Therefore, the resulting data provide a basis to obtain co- and multimorbidity patterns and corresponding health care utilization issues in order to understand the particular complex needs caused by multimorbidity. [ABSTRACT FROM AUTHOR]

Minimally invasive treatments of varicosis are increasingly establishing. Short and intermediate-term outcomes of endovenous treatments are satisfying: success rates are comparable with conventional surgery, whereas recovery is faster and complication rates are lower. Success rates are highest for endovenous laser ablation (EVLA). However, endovenous radiofrequency ablation (RFA) has advanced. Its short term outcomes are now comparable to EVLA, but with less side-effects. Ultrasound guided foam sclerotherapy (UGFS) replaced other forms of liquid sclerotherapy. In principle, this treatment can be combined with every other treatment for varicosis, but it loses its position as a monotherapy, due to poorer intermediate-term outcomes compared with EVLA and RFA. More prospective randomized con- trolled trials are needed in order to state an evidence based hierarchy of treatments for varicosis.With theminimally invasive treatments it is possible to treat patients on an outpatient basis. It will have to be assessed whether this will lead to higher cost-effectiveness. [ABSTRACT FROM AUTHOR]

In order to sustain the continuity and quality of treatment in diabetic primary care patients, it is necessary to introduce structured and regularly performed monitoring system into the practice team. The monitoring aims at early and valid recognition of potential complications resulting from a chronic disease. Ideally the practice nurse is in charge of the case management. The central element of the case management is a colour coded instrument, the diabetes traffic light scheme, by which means the most important clinical parameters and patient adherence can be screened in regular intervals. Additionally, the instrument regulates in-practice communication by means of stratified action plans and enables ideal treatment continuity also in larger teams. The experiences resulting from the development of this diabetes-specific traffic light scheme can be beneficial for the future development of similar instruments in other chronic diseases. [ABSTRACT FROM AUTHOR]

Two hundred and fifty seven male Caucasian ultraendurance athletes were recruited, pre-race, before different swimming, cycling, running and triathlon races. Fat mass and skeletal muscle mass were estimated using bioelectrical impedance analysis (BIA) and anthropometric methods in order to investigate whether the use of BIA or anthropometry would be useful under field conditions. Total body fat estimated using BIA was significantly high (P < 0.001) compared with anthropometry. When the results between BIA and anthropometry were compared, moderate to low levels of agreement were found. These results were in accordance with the differences found in the Bland-Altman analysis, indicating that the anthropometric equation of Ball et al. had the highest level of agreement (Bias = -3.0 ± 5.8 kg) with BIA, using Stewart et al. (Bias = -6.4 ± 6.3 kg), Faulkner (Bias = -4.7 ± 5.8 kg) and Wilmore-Siri (Bias = -4.8 ± 6.2 kg). The estimation of skeletal muscle mass using BIA was significantly (P < 0.001) above compared with anthropometry. The results of the ICC and Bland-Altman method showed that the anthropometric equation from Lee et al. (Bias = -5.4 ± 5.3 kg) produced the highest level of agreement. The combined method of Janssen et al. between anthropometry and BIA showed a lower level of agreement (Bias = -12.5 ± 5.7 kg). There was a statistically significant difference between the results derived from the equation of Lee et al. and Janssen et al. (P < 0.001). To summarise, the determination of body composition in ultra-endurance athletes using BIA reported significantly high values of fat and skeletal muscle mass when compared with anthropometric equations. [ABSTRACT FROM AUTHOR]

The Chronic Care Model provides evidence-based recommendations to improve the care for patients with chronic conditions. The Patient Assessment of Chronic Illness Care questionnaire (PACIC) is an instrument to evaluate the patient's perspective on receipt of care delivered in the five domains patient activation, delivery system, goal setting, problem solving, and follow-up. The aim of this study was to assess the psychometric characteristics of the PACIC in 442 primary care patients with major depression. The psychometric properties were good. We found possible ceiling effects in the two subscales 'patient activation' (12.9%) and 'problem solving/contextual' (8.9%), as well as floor effects in 'goal setting/tailoring' (4.6%). The Cronbach's α coefficient for the total scale was excellent (0.91). We found two major factors, which we labeled according to the PACIC domains as composite factors 'patient activation and problem solving' as well as 'goal setting and coordination'. The perspective of patients with mental disorders, such as depression, on primary chronic illness care can be assessed adequately by the PACIC. [ABSTRACT FROM AUTHOR]

Exercise-associated hyponatremia (EAH) is a well know electrolyte disorder in endurance athletes. Although fluid overload is the most like etiology, recent studies, however, argued whether EAH is a disorder of vasopressin secretion. The aims of the present study were to investigate (i) the prevalence of EAH in male ultra-marathoners and (ii) whether fluid intake, aldosterone or vasopressin, as measured by copeptin, were associated with post-race serum sodium concentration ([Na+]). In 50 male ultra-marathoners in a 100 km ultra-marathon, serum [Na+], aldosterone, copeptin, serum and urine osmolality, and body mass were measured pre- and post-race. Fluid intake, renal function parameters and urine excretion were measured. No athlete developed EAH. Copeptin and aldosterone increased; a significant correlation was found between the change in copeptin and the change in serum [Na+], no correlation was found between aldosterone and serum [Na+]. Serum [Na+] increased by 1.6 %; body mass decreased by 1.9 kg. The change in serum [Na+] and body mass correlated significantly and negatively. The fluid intake of ~0.58 l/h was positively related to the change in body mass and negatively to both post-race serum [Na+] and the change in serum [Na+]. We conclude that serum [Na+] was maintained by both the mechanisms of fluid intake and the hormonal regulation of vasopressin. [ABSTRACT FROM AUTHOR]

We investigated in 11 female ultra-runners during a 100 km ultra-run, the association between fluid intake and prevalence of exercise-associated hyponatremia in a cross-sectional study. Athletes drank ad libitum and recorded their fluid intake. They competed at 8.0 (1.0) km/h and finished within 762 (91) min. Fluid intake was 4.1 (1.3) L during the race, equal to 0.3 (0.1) L/h. Body mass decreased by 1.5 kg (p< 0.01); pre race body mass was related to speed in the race (r = -0.78, p< 0.05); and change (Delta) in body mass was not associated with speed in the race. Change in body mass was positively (r = 0.70; p< 0.05), and Delta urinary specific gravity negatively (r = -0.67; p< 0.05), correlated to Delta percent total body water. Changes in body mass were not related to fluid intake during the race. Fluid intake was not correlated to running speed and showed no association with either Delta percent total body water nor Delta [Na] in plasma. Fluid intake showed no relationship with both Delta haematocrit and Delta plasma volume. No exercise-associated hyponatremia occurred. Female ultra- runners consuming fluids ad libitum during the race experienced no fluid overload, and ad libitum drinking protects against exercise-associated hyponatremia. The reported higher incidence of exercise-associated hyponatremia in women is not really a gender effect but due to women being more prone to overdrink. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess health related characteristics and reasons for participation on the "check-up-cruise", second, to compare these variables with a representative Swiss Health Survey (SHS). Characteristics of the participants were collected cross-sectionally and afterwards compared with results of the SHS. Response rate was 74.6% (n = 206). Compared to the SHS population smoking rate and alcohol consumption were significantly lower and a doctor's visit within the last 12 months more frequent. Considerable differences in health related characteristics exist between our study and the SHS suggesting a self-selection of healthy people. Thus a potential health gain by this kind of medical prevention program is at least questionable. [ABSTRACT FROM AUTHOR]

Background: Case management by health care assistants in small primary care practices provides unclear benefit for improving depression symptoms.Objective: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving depression symptoms and process of care for patients with major depression.Design: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned.Setting: 74 small primary care practices in Germany from April 2005 to September 2007.Patients: 626 patients age 18 to 80 years with major depression.Intervention: Structured telephone interview to monitor depression symptoms and support for adherence to medication, with feedback to the family physician.Measurements: Depression symptoms at 12 months, as measured by the Patient Health Questionnaire-9 (PHQ-9); secondary outcomes were patient assessment of chronic illness care, adherence to medication, and quality of life.Results: A total of 310 patients were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control patients were assessed; 555 patients were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control patients). Compared with control patients, intervention recipients had lower mean PHQ-9 values in depression symptoms (-1.41 [95% CI, -2.49 to -0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups.Limitation: Patients, health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of patients was incomplete.Conclusion: Case management provided by primary care practice-based health care assistants may reduce depression symptoms and improve process of care for patients with major depression more than usual care.Primary Funding Source: German Ministry of Education and Research. [ABSTRACT FROM AUTHOR]

Ultra-endurance races lead to an enormous energy deficit, and a decrease in body mass in the form of fat mass as well as skeletal muscle mass can be found. The decrease in skeletal muscle mass has been demonstrated in ultra-runners. We investigated therefore, in an ultra-cycling race, whether ultra-cyclists also suffered a decrease in body mass and whether we could find changes in skeletal muscle mass and/or fat mass. The anthropometric method was used to determine body mass, skeletal muscle mass and fat mass in 28 male Caucasian, non-professional, ultra-cyclists before and after a 600 km ultra-cycling race. In order to quantify hydration status, we measured total body water, haematocrit, plasma sodium and urinary specific gravity. In addition, plasma urea was determined as a marker of protein catabolism. Body mass as well as fat mass decreased highly significantly (p<0.01) whereas skeletal muscle mass did not change (p>0.05). The post race minus pre race difference (Δ) in body mass was associated with Δ fat mass (p<0.05). Urea increased highly significantly (p<0.01); however Δ urea was not associated with Δ skeletal muscle mass. We concluded that ultra-cycling in contrast to ultra-running leads to no reduction in skeletal muscle mass. [ABSTRACT FROM AUTHOR]

Background: Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care.Methods: Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate). Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC), evaluations of general practice (Europep), enablement (PEI), and individual characteristics.Results: The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p < 0.004), but the effect of patient enablement on the PACIC score was negative (b = -1.13, p < 0.000).Conclusion: A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended. [ABSTRACT FROM AUTHOR]

Background: There has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. In Germany, apart from 'Heilpraktiker' (= state-licensed, non-medical CAM practitioners), some general practitioners (GPs) provide CAM in their practices. This paper aims to explore the attitudes of GPs about the role of CAM in Germany, in relation to the healthcare system, quality of care, medical education and research. Furthermore, experiences of GPs integrating CAM in their daily practice were explored.Methods: Using a qualitative methodological approach 3 focus groups with a convenience sample of 17 GPs were conducted. The discussions were transcribed verbatim and analysed using qualitative content analysis.Results: The majority of the participating GPs had integrated one or more CAM therapies into their every-day practice. Four key themes were identified based on the topics covered in the focus groups: the role of CAM within the German healthcare system, quality of care, education and research. Within the theme 'role of CAM within the healthcare system' there were five categories: integration of CAM, CAM in the Statutory Health Insurance, modernisation of the Statutory Health Insurance Act, individual healthcare services and 'Heilpraktiker'. Regarding quality of care there were two broad groups of GPs: those who thought patients would benefit from standardizing CAM and those who feared that quality control would interfere with the individual approach of CAM. The main issues identified relating to research and education were the need for the development of alternative research strategies and the low quality of existing CAM education respectively.Conclusion: The majority of the participating GPs considered CAM as a reasonable complementary approach within primary care. The study increased our understanding of GPs attitudes about the role of CAM within the German healthcare system and the use of 'Heilpraktiker' as a competing CAM-provider. It seems to be a need for increased funding for research, better education and remuneration by the Statutory Health Insurance in order to improve access to 'Integrative medicine' in Germany. [ABSTRACT FROM AUTHOR]