Search

Background: The main goals of glaucoma treatment are to preserve the visual function and maintain as high a quality of life as possible at a cost acceptable to society. Therefore, it is crucial to carefully observe each individual patient in order to determine an individual and personalized treatment approach., Material and Methods: This article summarizes the advantages and disadvantages of medicinal glaucoma treatment as well as traditional methods of glaucoma surgery, based on the current state of knowledge. The article explains the various mechanisms of action of new minimally invasive procedures, introduces the methods mostly commonly used in Germany and gives recommendations for preoperative care and postoperative follow-up., Results/conclusion: In addition to the plethora of medicinal glaucoma treatments and classical surgical procedures, new minimally invasive treatment alternatives have become available in the past few years. The latter are an option for an earlier surgical intervention, especially in naïve or previously treated patients who appear to be unsuitable for medicinal treatment.

Karl-Peter Hadeler is a first-generation pioneer in mathematical biology. His work inspired the contributions to this special issue. In this preface we give a brief biographical sketch of K.P. Hadelers scientific life and highlight his impact to the field.

Background: Due to demographic change and societal transformation the number of elderly persons living in retirement homes is growing in Germany. Access to health care is more complicated in the setting of nursing homes. Different regional studies suggest unmet ophthalmological health care needs in institutionalized elderly people. This study assessed the current ophthalmological health care structure and supply status in nursing homes in Germany., Methods: This prospective, multicenter cross-sectional study was conducted by 14 study centers in Germany. Elderly people living in 32 nursing homes were included after approval by the local institutional review boards. A standardized examination was performed which included a detailed medical and ocular history, refraction, visual acuity testing, tonometry, biomicroscopy and dilated funduscopy. Unmet ophthalmological health care needs were documented and the data were analyzed descriptively and via logistic regression modelling., Results: A total of 600 participants (434 women and 166 men) aged 50-104 years were examined of which 368 (61%) had ophthalmological conditions requiring treatment. The most prevalent findings were cataracts (315; 53%), disorders of the eyelids (127; 21%), dry eye disease (57; 10%) and posterior capsule opacification (43; 7%). In 63 (11%) of the participants glaucoma was suspected and 55 (9%) of the examined population had a known diagnosis of glaucoma, of whom one third was not on any or on insufficient anti-glaucomatous therapy. 236 (39%) showed signs of age-related macular degeneration (AMD). Only 52% of the examined cohort had been examined by an ophthalmologist within the last 5 years and 39% stated that they would currently not be able to consult an ophthalmologist. Reported barriers were mainly transport and lack of support., Conclusion: This study demonstrates considerable unmet ophthalmological health care needs of the institutionalized elderly in Germany. Novel and reformed models of specialist care provision have to be developed.

Background: The term "glaucoma" covers a heterogeneous group of progressive optic neuropathies that are accompanied by characteristic visual-field defects. Primary open-angle glaucoma, the most common type, progresses insidiously and causes blindness if untreated. All current forms of treatment aim at lowering the intraocular pressure (IOP) in patients whose IOP is elevated. The implantation of anti-glaucoma drainage systems is one of the available options for surgical treatment., Methods: This review is based on pertinent literature retrieved by a selective search, including glaucoma treatment guidelines from Germany and abroad., Results: A paradigm shift is currently underway regarding the indications for the implantation of anti-glaucoma drainage systems. Trabeculectomy (a "fistulating" operation in which the aqueous humor is led out of the eye under the conjunctiva) is still considered the surgical gold standard, but drainage systems have been implanted with increasing frequency in recent years. Studies have shown that these systems are more likely to be beneficial the earlier they are implanted in the course of the patient's disease. Five-year follow-up data from the randomized, multicenter Tube Versus Trabeculectomy (TVT) study have now revealed that anti-glaucoma drainage systems are equivalent to trabeculectomy with respect to long-term IOP reduction, complication rates, and absolute and relative clinical success rates., Conclusion: Glaucoma is a major clinical and socio-economic problem whose surgical treatment increasingly involves the implantation of anti-glaucoma drainage systems.

Objective: To investigate validity and reliability of the Functional Gait Assessment (FGA) (German version) as a measure for balance abilities during walking in subacute stroke patients., Design: Cohort study., Setting: Inpatient rehabilitation center., Participants: Ambulatory subjects (N=28) at a maximum of 6 months after stroke participated in this study. One direct observer and 2 video observers rated the FGA., Interventions: Not applicable., Main Outcome Measures: Performance of the FGA was video recorded and directly rated. For testing concurrent validity of the FGA, subjects also completed testing in the Berg Balance Scale, fast walking speed, the Functional Ambulatory Category, the Rivermead Mobility Index, and the Barthel Index. Intrarater reliability, interrater reliability, and concurrent validity of the FGA were analyzed., Results: Intrarater (intraclass correlation coefficient=.97) and interrater reliability (intraclass correlation coefficient=.94) were almost perfect for total scores. Reliability of single items varied between substantial and almost perfect values. Analysis revealed significant correlations between the FGA and other measures of gait and balance functions between Spearman rho values of .71 and .93. The FGA differs significantly between levels of gait ability (Functional Ambulatory Category) (P< or =.01)., Conclusions: Almost perfect intrarater and interrater reliability for total FGA scores and good concurrent validity were shown in this study. Therefore, the FGA (German version) can be used as a reliable and valid tool to assess functional gait performance of patients in subacute stages after stroke.

Radiologists from seven independent practices in Germany (average number of cases 3,500 in 2001) combined to form a mammography quality control group. Documentation and follow up were standardised for all cases that resulted in a referral for open biopsy. A quantitative analysis of the data would be expected to clarify the quality achieved in ambulatory care and to show further possibilities for quality assurance measures. The first overall analysis of 2,500 referrals for biopsy from 1998 to 2001 shows differences between practices as regards the frequency of referral for biopsy and the proportion of referrals for suspected malignancy, which are based on practice-specific conditions (referral behaviour, age structure of patients) and individual case management. Practices are very close in relation to positive predictive value (ppv) and detection rate. The biopsy rate in 2001 slightly exceeded 3%, the overall detection rate was 1.7%, and ppv 81%. For asymptomatic women detection rate and ppv were 0.5% and 70%, respectively. Quality parameters for all mammography referrals in total exceed those of screening programmes. When restricted to asymptomatic women, results have been achieved that are comparable to those of established screening programmes. Naturally the patients involved here are those in whom mammography was indicated. Nonetheless, these results demonstrate a high quality of detection on the part of those performing mammography in routine ambulatory care, and can be used as a reference for other types of care. With consistent quality assurance in relation to technical considerations and personnel, a performance quality can be achieved in independent practices which to date has not been surpassed by specialist mammography centres.

Little is known about the organic component of Lower and Middle Palaeolithic technologies, particular with respect to wooden tools. Here I describe some wooden throwing spears about 400,000 years old that were discovered in 1995 at the Pleistocene site at Schöningen, Germany. They are thought to be the oldest complete hunting weapons so far discovered to have been used by humans. Found in association with stone tools and the butchered remains of more than ten horses, the spears strongly suggest that systematic hunting, involving foresight, planning and the use of appropriate technology, was part of the behavioural repertoire of pre-modern hominids. The use of sophisticated spears as early as the Middle Pleistocene may mean that many current theories on early human behaviour and culture must be revised.