Search

Background: Constructional barriers often prevent persons who are only partially able, for example those requiring a wheel chair for pre-ambulation, from entering buildings where doctors practise. Even though many international and national resolutions have long been demanding free access to the environment for the partially able, this has not been specially prescribed in Germany. Hence, no one knows anything about outpatient health care facilities in this regard. The present study aimed at analysing accessibility to orthopaedic and neurological practices and surgeries for wheelchair patients., Method: We chose Essen, the sixth largest town in Germany, as an example of an urban area, where orthopaedists and neurologists are frequently accessed by wheelchair patients. We performed on-site investigations of the exterior and interior zones of all orthopaedic and neurological surgery buildings in Essen (each n = 29). Criteria for our descriptive analysis were parking lots for the handicapped, shunting areas, entrances at-grade, steps/stories, banisters, ramps, bells and openers of front, elevator and surgery doors, their opening and width. Following the criteria of the DIN 18 024 standard part 2 ("accessibility") the surgeries were divided into four groups 1) fully accessible; 2) slight barriers; 3) considerable barriers; 4) massive barriers., Results: None of the 58 investigated surgeries was fully accessible, 21 of the 29 surgeries of each medical specialty had massive barriers, so that wheelchair patients could access these surgeries only with the help of at least two (strong) persons. Six of the 29 orthopaedic and three of the 29 neurological surgeries had slight barriers, whereas two orthopaedic and five neurological surgeries had distinct barriers. Main barriers were steps in the entrance area; front, elevator or surgery doors too narrow (width less than 80 cm), and elevators too small., Discussion: For wheelchair patients in Germany, free choice of doctors seems to be massively reduced. Since 80 % of orthopaedic and 90 % of neurological surgeries in Essen do not fulfil the quality feature "constructional accessibility", measures that have been taken in the past to help partially able persons to participate in this respective aspect of social life have not been effective. New measures to improve the present situation should be agreed upon by all the institutions involved (politics, local authorities/construction supervision, sickness funds, doctors and associations of sickness fund physicians, and concerned persons). If voluntary measures do not lead to free choice of doctors for wheelchair patients, further legal regulations appear to be mandatory.

Background: Restless legs syndrome (RLS) is a movement and sleep disorder with leg dysesthesias with a high prevalence (9-18% in Austria)., Aim of the Study: Determination of frequency, diagnosis and therapy of RLS in general practitioner and specialist offices., Methods: Telephone survey of a random sample of 120 general practitioners, 100 neurologists and 80 specialists in internal medicine., Results: 69% of the whole sample of doctors reported seeing 1 to 10 RLS patients, but in proportion to the prevalence of these two conditions fewer cases of RLS than of Parkinson's disease are treated. In all three groups of doctors, 84% consider the 4 key symptoms (urge to move the legs accompanied or caused by dysesthesia; worsening of symptoms at rest or inactivity; relief by activity; worsening of symptoms in the evening/at night) the most important diagnostic criteria for RLS, followed by a complaint of disturbed sleep (75%), daytime tiredness (43%) and dopaminergic responsiveness in a therapeutic trial (29%). 83% of general practitioners and 86% of medical specialists refer their RLS patients to a neurologist, 19% to a polysomnographic examination. 75% of doctors decide for pharmacological treatment of RLS, 18% for psychotherapy, 15% for household remedies. 54% of all doctors (70% of the neurologists, 68% of the GPs, 48% of the medical specialists) prescribe dopamine agonists. L-Dopa is used by 49% (61% of the neurologists, 42% of the GPs, 44% of the medical specialists). 17% prescribe GABAergic drugs, 6% opiates. 51% would be highly interested in obtaining a drug specifically registered for the treatment of RLS., Conclusion: RLS is not as well known as Parkinson's disease. Thus providing doctors with relevant information and further education programs on this subject seems desirable. In Austrian doctors' offices the diagnosis of RLS is usually obtained clinically on the basis of the 4 key symptoms. Patients suffering from insomnia of multifactorial pathogenesis should be referred to an outpatient clinic for sleep disorders with an associated sleep laboratory. Especially neurologists and GPs consider dopamine agonists the treatment of first choice, closely followed by L-Dopa.

Nosocomial infections are usually considered to be a problem of hospitals. However, outpatient care is also not without risks to the patient or to the healthcare workers. Cases of iatrogenic infections following invasive acts such as intramuscular injections in medical offices have occurred repeatedly and have resulted in malpractice charges against the physicians involved. This illustrates a need for physicians in private practice to establish a concept for the prevention of nosocomial infections in their office. This concept should include patients as well as healthcare workers and must be adapted to the particular setting of the practice. After implementation of such a concept, it will be possible to provide care to all patients--the routine patient, the routine patient undergoing an invasive procedure, the patient who is colonized with a resistant microorganism, as well as the patient who presents himself with an infectious disease--under conditions that minimize the risk of nosocomial infection to the patient as well as to the healthcare workers. The essential elements of such a concept include written guidelines for disinfection, sterilization and personnel protection. Depending on the type of practice, additional guidelines, i.e. guidelines for reprocessing of endoscopes in a gastroenterology practice, will be needed.