315 research outputs found
Sexualität - (k)ein Thema in der Hochschulausbildung?: Entwicklung einer hochschuldidaktischen Ausbildungskonzeption für Sexualpädagogik
No full textWrede B, Hunfeld M. Sexualität - (k)ein Thema in der Hochschulausbildung?: Entwicklung einer hochschuldidaktischen Ausbildungskonzeption für Sexualpädagogik. Wissenschaftliche Reihe ; 61. Bielefeld: Kleine; 1997
Effects of anesthetic agents on seizure-induction with intra-cortical injection of convulsants
No full textAvailable online 26 January 2013RationaleStudies of partial or generalized seizure pathophysiology often require the use of intact animals. Additionally, anesthesia may be required for ethical reasons or paralysis if instrumental measures require immobilization. We examined three commonly used injected anesthetic for their impact on seizures induced by three convulsant agents.MethodsWe prepared rats, under pentobarbitone anesthesia (65 mg/kg) with a catheter, electrodes and a dural window, for later non-noxious experimentation. Three to seven days later, kainic acid (1.25 μg), picrotoxin (225 ng) or fluorocitrate (0.8 nmol) were injected intra-cortically in animals paralysed with succinylcholine, or anesthetised with pentobarbitone, urethane or fentanyl plus droperidol. We recorded EEG activity, the latencies to seizure discharges, the occurrence of spreading depressions and the presence of movements in response to the convulsants.ResultsFentanyl plus droperidol was the only anesthetic agent permissive for seizure-discharges and spreading depressions. No significant differences in the time for seizure onset for fentanyl plus droperidol compared to paralyzed unanesthetised rats were seen for any of the convulsants (Student's t-test p>0.20). Movements during seizures as well as other drug-induced behaviors continued to be expressed during anesthesia.ConclusionFentanyl plus droperidol has useful properties as an anesthetic agent in studies of seizure induction with different convulsants.M. Hunfeld, K.J. Pope, S.P. Fitzgibbon, J.O. Willoughby, M. Brober
Bakteriologische Infektionsserologie: Veraltet oder doch noch wichtig?
No full textThe discovery of the Gruber-Widal reaction is essential for the diagnosis of infections. Despite significant advances in modern molecular biological assays, the detection of pathogen-specific antibodies using immunological methods is still essential for the diagnosis of pathogens from blood and cerebrospinal fluid. The advantage of indirect diagnosis of bacterial pathogens by serological tests is that an immune reaction can also be detected against microorganisms that are difficult-to-cultivate or slow-growing, and can hardly be detected by conventional culture or molecular methods. However, the difficulty of assessment lies in the fact that no clear conclusions about the need for treatment or the success of the therapy can be derived from serological results alone. The limitations of these methods, however, also cannot be fully remedied by molecular biological methods, and therefore there is currently no perfect alternative to the use of infectious immunological detection methods. Ongoing problems with the quality of serological tests and the still inadequate regulatory efforts of the supervisory authorities make it absolutely necessary to carry out external quality control measures such as round robin tests.Die Entdeckung der Gruber-Widal-Reaktion gilt als grundlegend für die Infektionsdiagnostik. Der Nachweis erregerspezifischer Antikörper durch immunologische Methoden ist, trotz bedeutender Fortschritte moderner molekularbiologischer Assays, als indirekter Erregernachweis weiterhin maßgeblich für die Diagnose von Krankheitserregern aus Blut und Liquor. Der Vorteil einer indirekten Diagnose bakterieller Krankheitserreger durch serologische Tests liegt darin, dass eine Immunreaktion auch gegen Mikroorganismen nachgewiesen werden kann, die schwer zu kultivieren oder langsam wachsend sind und mit kultur- oder molekularbiologischen Methoden kaum nachgewiesen werden können. Die Schwierigkeit der Beurteilung besteht allerdings darin, dass allein aus serologischen Ergebnisse nicht immer eindeutige Aussagen über die Behandlungsnotwendigkeit oder den Erfolg der Therapie abgeleitet werden können. Die Einschränkungen, die diese Verfahren liefern, sind aber auch durch molekularbiologische Ansätze nicht immer zu verbessern. Daher gibt es derzeit für den Einsatz infektionsimmunologischer Nachweismethoden keine echte Alternative. Derzeit fortbestehende Qualitätsdefizite der serologischen Diagnostik und die bislang unzureichenden Regulierungsbemühungen der Aufsichtsbehörden machen die Durchführung von externen Qualitätskontrollmaßnahmen wie z.B. Ringversuchen unbedingt notwendig
Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany : a retrospective model analysis
No full textBackground: Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany.
Materials and Methods: We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied.
Results: In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used.
Conclusion: Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management
Results of the 2009 INSTAND proficiency testing trials for bacteriologic infection serology: a summary report
No full textCurrently external quality assessment schemes (EQUAS) achieved to be an independent instrument of external quality control and monitoring in laboratory medicine. This work outlines the results of the 2009 EQUAS for bacteriologic infection serology performed by INSTAND, Germany. Results mainly confirm the results obtained in previous years for most of the analyzed parameters. Problems remain however concerning the comparability of the various assay methods and the standardisation of serological tests for rare pathogens.Ringversuche erlangten gerade in den letzten Jahren als unabhängiges Mittel der externen Qualitätsüberprüfung und Überwachung zunehmende Bedeutung in der Laboratoriumsmedizin. Die vorliegende Arbeit stellt die Ergebnisse der bakteriologisch-infektionsserologischen INSTAND-Ringversuche aus dem Jahr 2009 zusammen. Die meisten Ergebnisse waren mit den publizierten Ergebnissen der Vorjahre vergleichbar. Weiterhin unbefriedigend stellt sich die Situation beim serologischen Nachweis seltener Infektionserreger dar
Towards sustainability for medical devices and consumables:: The radical and incremental challenges in the technology ecosystem
No full textGreen Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Policy AnalysisDesign for Sustainabilit
Zur Qualität bakteriologisch-infektionsserologischer Verfahren in Deutschland: Auswertung der infektionsserologischen Ringversuche 2016
No full textSerological testing that detects pathogen-specific antibodies and antigens remains the diagnostic gold standard in infection serology. Therefore, it is crucial to have standardized and accurate assays. Serological tests can also help to improve the quality of treatment and patient care. This paper summarizes and discusses the results of the proficiency testing trials for bacteriological infection serology that were conducted in Germany in 2016.Serologische Tests zum Nachweis von erregerspezifischen Antikörpern und Antigenen sind nach wie vor ein diagnostischer Goldstandard in der Infektionsserologie. Daher sind standardisierte und genaue Testverfahren äußerst wichtig. Sie können auch dazu beitragen, die Qualität der Behandlung und Patientenversorgung zu verbessern. In der vorliegenden Arbeit werden die Ergebnisse der bakteriologischen Infektionsserologie in Ringversuchen für das Jahr 2016 in Deutschland zusammengefasst und diskutiert
Reducing the Environmental Impact of Syringes at the Intensive Care Unit
No full textThis research project, part of the Green Intensive Care Unit (ICU) initiative at the Erasmus University Medical Center (EMC), is focused on reducing the environmental impact of syringes at the ICU by designing solutions based on circular economy principles. Based on a Material Flow Analysis of the EMC ICU, syringes and their packaging have been identified as one of the main environmental impact hotspots. Therefore, this project aimed to redesign the syringes, their packaging, and their use, according to circular design strategies suitable for medical products to decrease their environmental impact, while remaining convenient and safe in use for the healthcare staff and patients. Research was executed to understand the context from multiple perspectives. The outcomes demonstrated that decreasing the impact of syringes is not only related to the design of the syringe itself. Manufacturing, preparation, use and disposal, all contribute to the environmental impact of the syringe. Various possible interventions were derived to reduce its impact: 1.Adapting the infection prevention protocol and behaviour of the staff;2.Separating infectious waste from general hospital waste;3.Redesigning the syringe itself;4.Optimising the filling process of syringes. The final design is an optimised filling process for prefilled sterilised syringes (PFSs), based on circular strategies such as reduce, reuse, rethink and repurpose. Interventions include: eliminating a redundant sterilisation phase, reducing residual medication and changing from steam to gamma sterilisation. This resulted in decreasing the amount of waste, material, energy and water consumption, while offering similar convenience and safety for the staff and patients of the ICU.</p
Towards Circular ICUs:Circular Intubations as a Catalyser for Systemic Change
No full textThis project aims to reduce the environmental impact of the Intensive Care Unit (ICU) of the Erasmus Medical Center (EMC). Systemic design research was executed to map the current waste flow created by the ICU. Literature review, interviews and observations were performed to gather information about the healthcare protocols, hospital procurement process, intubation practices and used devices and consumables. This resulted in a set of challenges which were used to ideate from different perspectives to improve the sustainability of the ICU. A set of opportunities to introduce circularity within the ICU were defined. These opportunities ranged from waste separation to the reduction of the disposal of unused products. The selected circular opportunity was intubation, needed when patients cannot breathe by themselves. For this, a video laryngoscope, which is composed of various plastics, a video camera, and a led light, is used for only a few minutes and disposed of (and incinerated) directly afterwards. The aim of the second part of this research project was: Can we design a circular intubation procedure as a catalyzer for systemic change towards circular ICUs? One of the proposed circular strategies for the video laryngoscope is the reprocessing of intubation devices used at the ICU itself. A transition model toward reprocessing using UV-C radiation technique was further developed. Compared to current reprocessing procedures, UV-C disinfection consumes no water and less electricity and offers the possibility of decentralized reprocessing within the ICU department itself. This project aims to provoke conversations between the hospital, manufacturers and other stakeholders about how the healthcare sector could start reprocessing valuable medical devices towards a circular ICU.</p
Towards a Circular ICU: How to implement reusable video laryngoscopes at the ICU
No full textThe healthcare sector uses a lot of on single use medical products, causing large amounts of CO₂ emissions and excessive amounts of waste. This project contributes to a circular Intensive Care Unit (ICU) by investigating the barriers and possible solutions for a transition from single use video laryngoscopes (VL) to (partly) reusable ones, in order to develop guidelines and best practice for the transition of other single use medical products to reusables.To produce single-use products, raw materials are extracted, products are manufactured, used, and disposed of after using the product just one time. This is known as the linear economy or the ‘take-make-waste’ system, having a devastating effect on the environment. However, reusing medical products comes with organisational challenges. Concerns with patient safety, liability, the costs, and complexity of developing and maintaining in-house reprocessing infrastructure and logistics have left hospitals with a complex organisational challenge.The research question for this project is: How can the ICU become more sustainable through overcoming organisational challenges hindering the implementation of reusable video laryngoscopes? With the sub-questions: 1. What are the barriers and enablers for implementing the reuse of video laryngoscopes in the ICU? 2. How can the reuse of video laryngoscopes be implemented at the Erasmus MC? 3. What could be the next step in transitioning similar products (to the video laryngoscope) from single use to reusable?This design project was structured through three phases: Exploration, Analysis and Conceptualisation phase. Three product journeys were analysed: a single use VL, semi-reusable VL and a completely reusable VL. This project concludes, contrary to the original hypothesis, that barriers to for the implementation of reusable VL’s are minimal. The semi-reusable VL seems to require the least change from the organisation, but the fully reusable VL contributes better to the end goal of a fully circular ICU in 2030, notwithstanding its higher up-front cost.For the implementation of the reusable VL it is essential to spark the actual implementation of the reusable VL and communicate with and facilitate stakeholders. The implementation processes need to be kickstarted through the set-up of a tender, followed by a pilot, pilot evaluation and expansion of the pilot in order to ensure proper implementation. After implementing the VL three other medical devices were identified to follow in the footsteps of the reusable VL: Laryngoscope blades, bronchoscopes, and scissors. Laryngoscope blades and bronchoscopes can be collected in the same place since the use-case of them is very similar to the VL. Scissors will require further research but follow a similar journey to and from the CSD. This report brings value to the ICU of the Erasmus MC through identifying that the Erasmus MC has the resources and capabilities to implement the reusable VL’s, as well as presenting recommendations for the implementation process. Strategic Product Desig
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