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Purpose: High-tech operations performed in cardiac surgery are associated with an increased risk of surgical site infections. In this study, we investigated if surgical site infections following cardiac surgery influence revision surgeries and patients' length of stay, and compared the results to German hospital infection surveillance data. Methods: Over a period of 3 years, 2,621 patients of a cardiac surgery unit were enrolled following cardiac artery bypass graft surgery. Patients were examined for the incidence of surgical site infections, revision surgeries, and length of stay. The results were compared to the National Reference Center (NRC) data retrospectively. Results: Of the observed population, 4.5 % suffer from surgical site infections, and in 7.7 % of the patients, revision surgery had to be performed. The length of stay was exceeded significantly for the patients with surgical site infections (average stay 14.5 vs. 42.2 days, p < 0.001). Compared to the NRC data, severe surgical site infections were not increased significantly. Conclusion: Surgical site infections resulted in revision surgeries with a significantly increased inpatient stay. However, this increase did not differ significantly from comparable German university hospitals. [ABSTRACT FROM AUTHOR]

Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.

Introduction: The aim of the study was to examine adolescence-specific treatment models throughout Germany, to describe the implementation process of transition psychiatric care and to identify relevant health care problem areas for adolescents with mental disorders., Methodology: A questionnaire-based cross-sectional survey (N = 26) of hospital-based adolescent psychiatric treatment models was conducted. Service structures, treatment groups and interventions were investigated by the 28-item questionnaire., Results: There is an increase in adolescence-specific hospital-based services in Germany. These are characterized by multi-professional team work in diagnosis and adolescence-specific therapy approaches. Most of the treatment available is for young adults only (>18 years). Some of the services are organized in interdisciplinary cooperation models. Structural deficits in acute and crisis treatment, cross-sectoral cooperation and systematic transition are reported. Conclusions There is growing interest throughout Germany in the development of adolescent psychiatric treatment. Close interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry is necessary to overcome interface problems with the aim of a successful transition, but has not yet been implemented. Structural problems should be reduced in order to facilitate further development in transition psychiatry., Competing Interests: P. Abzieher: Es bestehen keine Interessenskonflikte für diese PublikationM. Lipp: Es bestehen keine Interessenskonflikte für diese Publikation T. Banaschewski war innerhalb der letzten drei Jahre als Berater für die Firmen Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg-GmbH, Shire und Infectopharm tätig und hat Vortragshonorare von den Firmen Lilly, Medice und Shire erhalten. Die vorliegende Publikation steht damit nicht im Zusammenhang.M. Driessen: Berater/Gutachtertätigkeit: KBO München 2016, Beratung zur Suchttherapie. FNK Düsseldorf 2017, BerufungskomiteeIndirekte Interessen:Mitgliedschaft/Funktion in Interessensverbänden: DGPPN, BDK, DeGT, APK, Zeitraum durchgehendSchwerpunkte wissenschaftlicher Tätigkeiten, Publikationen: Auch traumaassoziierte Themen, Zeitraum durchgehendSchwerpunkte klinischer Tätigkeiten: Gesamtgebiet psychiatrischer Störungen, Zeitraum durchgehendH. Staats: Es bestehen keine Interessenskonflikte für diese PublikationA. Karow has been consultant and/or advisor to or has received honoraria from: AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The investigation of clinical characteristics of patients in adolescence psychiatry relevant for transition medicine., Methodology: Sociodemographic and clinical data (SCID I/II, SIPS/SOPS, SPI-A, GAF, CGI) were consecutively taken from the interdisciplinary inpatient treatment centre for adolescents and young adults with mental disorders (N = 229, aged 16 - 25)., Results: Average age was 19 years (38 % male, 23 % migration background). A high proportion of early mental illnesses and comorbidities (66 %), psychosis risk syndromes (20 %) and suicidality (54 %), treatment discontinuation (33 %) with daily-life, social and family stress factors (52 % positive family history, 34 % trauma) were observed and a persistently high level of support and treatment was needed despite a significant clinical improvement (p < 0.001)., Conclusion: The results support the need for an interdisciplinary collaboration for the joint development of care structures in transition medicine., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The objective of this research was to clarify whether external factors (e.g. ward capacity, level of nursing intensity) had an influence on nursing staff compliance with hand hygiene guidelines. The study was conducted at a German hospital (450 beds). Quantitative data were collected prospectively in six trial phases (E1-E6) starting in June 2007 and ending in May 2008. Included in the study were ten hospital departments: four surgical wards, four internal medicine departments, and two interdisciplinary intensive care units. In six participant observation trials, nursing staff were monitored for the disinfection of hands. Narrative interviews were conducted immediately after the observation with those who did not disinfect their hands in accordance with national guidelines. Observations and interviews were unannounced, taking place at different times. The collected data was analysed on subsequent categorization after summarizing the core statements (content analysis). The statistical relevance of staff compliance to the rate of used ward capacity could be proved using a multifactorial regression model (P=0.011). Workload factors (e.g. maximum ward capacity, severity of patient cases) have an impact on staff compliance with hand hygiene guidelines, even where non-compliance contradicts the personal level of professional training.

Constructed wetlands have been promoted in recent literature for use in rural communities in developed as well as in developing countries as an appropriate technology to be handled with low operational maintenance costs. Within a joint project supported by BMBF (Project No O2WA0107 and No 02WA0108) research was done concerning the sanitation effect of constructed wetlands on wastewater effluents. This article will focus on the detection and the removal of cysts of Cryptosporidium parvum and Giarda lamblia, those being the most frequently identified pathogenic protozoan parasites worldwide with increasing medical and economical consequences. Two plants, one installed in 2000 as a pilot plant at Langenreichenbach near Leipzig (Saxony, Germany), the other one in routine operation since 1993 in a training center at the town of Belzig (Brandenburg, Germany) were tested for three years. Detection methods from the US EPA (ICR Protozoan Method for Detecting Giardia Cysts and Cryptosporidium Oocysts in Water by a Fluorescent Antibody Procedure (EPA/814-B-95-003;US EPA 1995) were employed in order to assess protozoal and bacterial reduction in the wastewater passing through different combinations of filter beds and fillings. Removal of cysts of Cryptosporidium and Giardia spp. turned out to be a 2 log reduction in all plants. The most effective structural element was a two-stage combination of filter beds leading to the highest removal efficiency both for the protozoan and the bacterial indicator organisms. Also, washed sand (0-2mm grain size) in the filter bed proved to be most effective filter material; the planted reed (phragmites spp.) or willow (salix spp.), however, turned out to be of minor importance for the filtering activity., (Copyright 2009 Elsevier GmbH. All rights reserved.)

Background: We report on two endemic outbreaks of VRE (vancomycin-resistant enterococci, vanA type Enterococcus faecium) on a hematological oncology ward in a university hospital and a new strategic concept to fight against spread of VRE., Patients and Methods: During management of the outbreak, a total of 1,124 patients and 1,700 specimens were investigated from June 1999 to December 2001. Protective measures were instituted. Intensive prophylactic infection control was practiced until December 2003., Results: Of the 1,124 patients, 44 were VRE-positive. From 1,700 environment specimens, 110 VRE isolates were obtained from the inanimate environment, 5 from the living environment. Molecular biological typing identified 5 different clones which had spread on the ward in different locations., Conclusion: The study shows the need for prophylactic microbiological screening investigations in the risk group of hematological oncology patients and consistent implementation of protective hygiene measures to prevent the spread of multiresistant infectious pathogens on risk wards. It is also shown that intervention can to control such an endemic outbreak.

Hospital information systems may contribute in different ways to quality management activities such as monitoring of quality indicators. Most existing quality management activities in hospitals are adjusted to a special medical field or particular disease. These activities often run simultaneously with other procedures and the documentation of patient care. To determine an interdisciplinary integrated quality management procedure, a pilot study was carried out at the Neurosurgery Department and Neonatology Division of the Medical Center of the University of Heidelberg. Predefined generic indicators that may be integrated in an existing information system and used in hospital routine were the basis of this project. The aim of the study was to support the quality management with periodic reports of these indicators. The pilot study showed that there were barriers along the path to an integrated generic quality management. To meet the requirements of routine monitoring, using predefined generic indicators of hospital care, much integration effort, directed at organizational aspects of information processing and information systems architecture, is still needed.

Local anesthetics are frequently administered in dentistry and thus can be expected to be a major source of drug-related complications in the dental office. Additionally, the dentist will more often be confronted with the treatment of risk patients; thus, the incidence of side effects can be expected to rise. In this study, 2731 patients receiving dental anesthesia were evaluated by questionnaire for risk factors, type and dosage of local anesthetic applied, type and duration of treatment, and complications associated with the administration of the local anesthetic. Of all patients, 45.9% had at least one risk factor in their medical histories, with cardiovascular diseases and allergies being the most frequent. The overall incidence of complications was 4.5%. It was significantly higher in risk patients (5.7%) than in nonrisk patients (3.5%). The most frequently observed complications (dizziness, tachycardia, agitation, nausea, tremor) were transient in nature and did not require treatment. Severe complications (seizure, bronchospasm) occurred in only two cases (0.07%). Articaine was found to be administered in over 90% of all dental anesthesias in Germany despite the great variety of local anesthetics available. Articaine 1:100,000 caused more sympathomimetic side effects than did articaine 1:200,000. Additionally, doses of local anesthetics proved not to be strictly determined according to body weight, especially for patients weighing less than 50 kg. In summary, it can be stated that dental local anesthesia can be considered safe. Nevertheless, the incidence of complications due to dental anesthesia can be expected to be further reduced if (a) patients are routinely evaluated for risk factors with an adequate medical history prior to dental treatment, (b) doses of local anesthetics are strictly determined according to body weight, (c) anesthetics with low concentrations of epinephrine are used, and (d) the concept of a differentiated dental anesthesia is applied.