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Background: Health care for persons with depressive disorders is not networked to an optimal degree in Germany. In order to improve outpatient care, an integrated care model for patients with depressive disorders was initiated in Freiburg in December 2008. The model aims at implementation of central recommendations of the "Conceptual Framework Integrated Care: Depression" of the German Association for Psychiatry and Psychotherapy., Methods: Usage of health services and effects of the model were analyzed by means of patient and physician data as part of a continuous project evaluation., Results: Since the launch of the project in December 2008, 40 physicians have been participating, and have included a total of 234 patients. Unipolar depressions constitute by far the most frequent disorders (91%). Most patients showed moderate (58%) or severe (36%) depressive symptoms. Most disorders were recurrent (61%). About three quarters of patients (75%) are treated exclusively by general practitioners. According to the physicians' ratings, 58% of the patients were remitted or showed subsyndromal symptoms in the eighth treatment week following their inclusion in the Freiburg model. After 16 weeks this number rose to 70% of patients. According to the information provided by the patients, in the PHQ-D, 59% of the patients were remitted or showed minimal symptoms., Conclusions: In the Freiburg model the "Conceptual Framework Integrated Care: Depression" could be implemented under current routine conditions. The first evaluation results indicate the success of this model. The results are indicative of a high quality of health care of the Freiburg model., (Copyright © 2012. Published by Elsevier GmbH.)

Objective: Important changes in administering total parenteral nutrition (PN) admixtures have occurred over the past decade. This study describes hospital pharmacists' practices in France (F), Switzerland (CH), and Belgium (B)., Methods: From the responses received using a standardized questionnaire, (n = 378) we determined the origin, types of container used, and choice of PN formula (standard versus tailor-made) and the type of quality control and the existence of nutrition support teams., Results: The mean response rates were 55.6% (CH), 30.5% (F), and 24.5% (B). Standard formulas were used mainly for adult patients (CH, 86%; F, 79%; B, 86%), whereas approximately 50% of tailor-made PN bags were used for children. Single-compartment or multicompartment bags or glass bottles contained standard formulas. Most standard formulas were provided by industry, apart from (B), where 50% of PN solutions were compounded by hospital pharmacies. Single-compartment bags contained generally tailor-made formulas produced exclusively by hospital pharmacies in (CH) and (B), whereas 33% were provided by industry in (F). Quality controls were mostly visual and occurred in 75% to 95% of hospitals. Nutrition support teams were present in 32% to 45% of hospitals., Conclusion: The choice, origin, and type of container used for PN formulas were highly variable among countries. However, the use of standard formulas in bags was predominant in (CH) and (B). The function of nutrition support teams was similar in (F), (CH), and (B).

The teeth of five adult captive brown bears (Ursus arctos ssp.) were examined and radiographed for occlusion, loss of teeth, dental plaque and calculus, and attrition under general anesthesia. Deposits of dental calculus were found in various locations with an overall prevalence of 8% to 15% of all tooth surfaces. In all five animals, severe enamel and dentinal attrition defects were observed in canine teeth with exposed pulp. Cage-chewing behavior is probably the main cause for the dental attrition. The composition of the food and feeding management are most likely responsible for the lack of natural cleaning and the resulting plaque and calculus formation. All affected canine teeth were treated with endodontic procedures using several materials and techniques, and evaluated one- to two-and-a-half years later by clinical examination, radiography, and scanning electron microscopy of silicone casts of the treated teeth. All coronal fillings were tight. The apices were not completely sealed in two teeth. We conclude that the use of adequate and specialized instrumentation and techniques for the treatment of these long, curved, large diameter root canals is more important than the particular endodontic and restorative materials used. The dental health status of zoo animals is an indicator of their general well-being. Preventive measures should be taken in their environment and management to minimize the risk of dental conditions.

Indications and modalities of quality control in infrainguinal bypass surgery are reviewed and discussed. A concept and an armamentarium for its practical use are presented. The majority of graft occlusions occur during the first postoperative year. Most failures in the first month are due to technical errors. Many of these can be detected by intraoperative completion control, and immediately repaired. This contributes to improved graft patency rates. In the further course, myo-intimal hyperplasia accounts for most graft stenoses and occlusions. If stenoses are detected and dilated before occlusion occurs, long-term patency is but little impaired. Conversely, patency rates are clearly inferior in grafts following thrombectomy or thrombolysis. Therefore, identification of failing grafts and avoidance of failure are the objectives of surveillance. We have followed routinely a surveillance program since 1991. During surgery, grafts were controlled by completion angiography. Arterial pressures were measured and the ankle-brachial index calculated postoperatively and 1, 3, 6 and 12 months after surgery. In addition, a number of grafts were followed by duplex sonography. Data were stored in an electronic data base featuring several interactive functions. E.g., ankle-brachial and duplex-sonography indices were calculated and rated automatically according to current criteria. Secondary patency after 18 months was 86 per cent in suprageniculate femoro-popliteal bypass grafts, 84 per cent in infrageniculate and 65 per cent in crural (n = 19/23/27).