What diabetics need to look out for when rehabing

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Doctors newspaper online, 30.09.2019

    

        
        
        

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Overview

For workers who have type 2 diabetes, a medical rehab may be advisable. But which of the payers is responsible – and what happens during the rehab?

By Thomas Hommel

A medical rehab usually lasts three weeks.

© Robert Kneschke / stock.adobe.com (Iconic image with photo model)

BERLIN. Approximately seven million people in Germany are currently suffering from diabetes mellitus – the majority of them, about 90 percent, of type 2 diabetes. However, many do not know that these patients have the option of resorting to knowledgeable support in the form of a rehabilitation measure.

This has now been pointed out by the German Diabetes Association (DDG) and an overview of important questions and answers relating to the medical rehabilitation of type 2 diabetes and the corresponding application has been published. The instructions are interesting for patients as well as for treating GPs and specialists.

When a rehab is displayed

In the treatment of diabetes, the focus is on "help for self-help", emphasizes the DDG. Sufferers should be empowered to manage their condition so that their quality of life is not compromised. "However, if the metabolic control is inadequate in the long term, the earning capacity and independence of the patient are at risk", warns Privatdozent Dr. med. Erhard Siegel of the DDG. At the latest, a rehabilitation measure should be considered.

According to experts, poor metabolic settings with elevated HbA1c levels, frequent hypoglycaemia in the past and workplace-related problems in dealing with the disease are among the three "hard" criteria that justify urgent rehabilitation needs.

" If there are already accompanying or consequential diseases of the cardiovascular system or diabetes-related damage to the eyes, nerves or kidneys, the demand is all the higher", says Stephan Ohlf from the board of the Federal Association of Clinical Diabetes Facilities (BVKD). There are also other criteria that include lifestyle factors in addition to obesity, hypertension or depression.

Who is responsible for what?

In addition, after an acute treatment in the hospital there is the possibility of an accelerated application procedure in the context of a so-called follow-up treatment (AHB). "In this case, the application must be made by the acute hospital," explains Ohlf.

The Head of Administration of the Eleonoren Clinic of the German Pension Insurance Hesse adds: "Any acute care hospital treatment that is required by the diabetes disease is in itself an AHB indication." As a rule, the measure begins within 14 days after discharge of the Patients from inpatient treatment.

When applying for a rehabilitation measure, the attending physician is usually the first point of contact for the patient. "The doctor compiles a report that, among other things, justifies the needs and prospects of rehab," explains DDG expert Siegel. The doctor can then forward the application to the responsible payers.

For employed persons the pension insurance is responsible, for pensioners it is the statutory health insurance. According to the German Pension Insurance Association (Bund Deutscher Rentenversicherung), just over 10,000 medical rehabilitations were carried out last year alone for employees suffering from type 2 diabetes.

The aim of the rehabilitation benefits granted by the pension insurance is to "significantly improve or restore the significantly impaired or already impaired ability to work of their insured, or at least avert a deterioration," as a brochure of the German pension insurance association Bund

The statutory health insurance (GKV), in turn, finances medical rehabilitation benefits if it can "avert, eliminate, mitigate, mitigate or prevent an aggravation."

Since 2014, the expenditures of the health insurance funds for medical care and rehabilitation have largely remained at the same level – with a slight upward trend. Last year, they were around 3.55 billion euros, as can be seen from a fact sheet of the GKV-Spitzenverband.

Supply in the team

A medical rehab lasts at least three weeks. It can be done both inpatient and outpatient. In the choice of clinic for inpatient and outpatient rehab patients could also "bring their personal wishes," explains DDG expert Siegel.

A special feature of medical rehabilitation is the interdisciplinary approach to therapy, Siegel emphasizes: this is how the treatment takes place in a multidisciplinary team. In concrete terms, this means that doctors, nursing staff, psychologists, physiotherapists, diabetes counselors, dieticians and social workers work closely together here. "Many clinics can also treat other health problems such as those of the spine, hips or knees," says Siegel.

Enough time for training

Another special feature of rehab is the intensity of the treatment. "A rehabilitation program gives enough time to train patients in detail even with difficult problems, to familiarize them with new medications, techniques or lifestyle changes," says diabetes expert Siegel. Whether switching to pump therapy, exercise therapy, rapid weight loss, psychological support or clarification of diabetes-related professional problems – all these aspects could be sustainably treated with qualified professionals.

Rehabilitation: Involved in the Costs

Medical rehabilitation services are available on an inpatient as well as full-time outpatient basis. They usually last three weeks and can be shortened or extended as needed.

Costs for travel, accommodation, meals, care, therapeutic services and medical applications are borne by the competent pension insurance institution, provided that the employee makes the rehab application. The reimbursement costs of patients have to be included in a rehabilitation clinic if they are accommodated on site – at a maximum of ten euros a day for a maximum of 42 days a year. If patients have already claimed rehabilitation benefits in one year – also from the health insurance – all additional days will be taken into account. The additional payment also depends on the income situation.

Employees are entitled to salary continuation for the period of rehab. In general, this is six weeks. If the claim is wholly or partially consumed because of similar previous illness, those affected by the pension insurance can receive transitional allowance for the duration of the medical rehabilitation. ( eb )

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Exchanging Adrenaline Auto-Injectors Endangers Patients

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Doctors newspaper online, 28.09.2019

    

        
        
        

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Allergists Warn

HANNOVER . Severe allergic reactions are increasing in all age groups. Studies indicate that the number of hospital admissions for serious allergic reactions has increased sevenfold, especially among children, in the last ten years, as allergists have pointed out in a press release for the 14th German Allergy Congress in Hannover.

"Anaphylaxis is clearly underestimated. One in every 100 people experiences an allergic shock at least once in their lives. The risk is much higher than most people are aware of, "says Professor Christian Vogelberg, CEO of the Society for Pediatric Allergology and Environmental Medicine e. Cited (GPA).

In children, anaphylactic reactions are reported to be predominantly food-related. First and foremost are peanuts, hazelnuts and milk protein. In adults, it is wasp and bee venom, legumes, animal protein and analgesics.

Critically, the allergists turn against the replacement of prescribed adrenaline auto-injectors (AAI) in the pharmacy. By the beginning of July closed "framework agreement on the supply of medicines" between the German Pharmacist Association and the Central Association of statutory health insurance, namely pharmacists are now obliged to deliver instead of the prescribed AAI one of the four least expensive AAI to the patient. "This has significantly worsened the care of patients at risk of anaphylaxis," says Professor Dr. Ludger Klimek, President of the Association of German Allergists (AEDA) in the Communication.

The background is that the patients and caregivers make elaborate training programs, such as the Anaphylaxis Training and Education team (AGATE, www.anaphylaxieschulung.de ), so that they can quickly and correctly use the syringe in an emergency to be able to deal with. If the patient receives an AAI that works differently from the trained model, this could endanger the emergency treatment, warn the allergists. (eb)

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First mosquito-borne West Nile virus infection in Germany

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Doctors newspaper online, 28.09.2019

    

        
        
        

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Fall in Saxony

BERLIN. For the first time, an infection and disease transmitted by mosquitoes in Germany has become known with the West Nile Virus (WNV): The person from Saxony was suffering from encephalitis, reports the Robert Koch Institute (RKI). She had recovered in the meantime.

The National Reference Center for Tropical Infectious Diseases at the Bernhard Nocht Institute for Tropical Medicine (BNITM) detected an infection with WNV. "The risk of further cases is decreasing as the number of mosquitoes declines in the autumn. In the coming summers, however, we must reckon with further West Nile virus infections, "RKI President Professor Lothar H. Wieler is quoted in the statement. "Fortunately, most of the cases are mild."

West Nile viruses are originally from Africa. The pathogens are transmitted by mosquitoes between birds, but also mammals (especially horses) and humans can be infected by mosquito bites, recalls the RKI. Transfers are also possible through blood transfusions. Human infections are about 80 percent without symptoms, almost 20 percent with mostly mild and nonspecific symptoms such as fever or rash.

Only less than 1 percent of those affected – usually older people with pre-existing conditions – experience meningitis or, more rarely, encephalitis. There are no vaccines or specific therapy for humans yet. Infections can be prevented by personal mosquito repellent.

Due to migratory birds and mosquitoes, the virus has migrated to more northern regions and can be spread there during the mosquito season. In recent years, there have been recurrent outbreaks in southern and central Europe and the Black Sea riparian states. In 2018 and 2019, scientists from the Friedrich-Loeffler-Institut (FLI) and the BNITM found more than 70 wild and zoo birds that died of WNV infections in Germany, especially in eastern Germany.

WNV is transmitted by native mosquitoes of the genus Culex. "Obviously, the unusually warm summer of the last two years caused by climate change has contributed to WNV establishing itself north of the Alps," says Professor Jonas Schmidt-Chanasit, Head of Virus Diagnostics at BNITM.

Infections with the West Nile virus are notifiable. Since 2018, the RKI has recommended physicians in the affected regions to have patients with encephalitis of unclear origin screened for West Nile viruses. Even with increased occurrence of fever with and without skin rashes, the virus must be considered as a trigger. The laboratory diagnostics should as far as possible take over a special laboratory. (eb)

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Anticoagulation can be continued with "cold" polypectomy

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Doctors newspaper online, 27.09.2019

    

        
        
        

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Japanese study

When small intestinal polyps are ablated with the cold snare, it does not seem necessary to discontinue anticoagulation. The risk of bleeding is rather lower than with heparin bridging and the use of cutting current.

By Beate Schumacher

Polypectomy: The authors of a Japanese study considered cold-loop erosion with continued anticoagulation as the standard procedure for removing polyps 1 cm.

© Albertinen KH / endoscopy images

OSAKA. In order to reduce the risk of bleeding in a colonoscopy with polypectomy, the German guideline recommends temporarily suspending an existing anticoagulation (discontinuation: Phenprocoumon 7 days, NMH and NOAK 1 day before the procedure, reuptake: NMH 6-12, phenprocoumon , NOAK 12-24 hours afterwards). In patients with oral anticoagulation, who have a high risk of thromboembolic risk, this time should be bridged with heparin.

What are exceptions?

An exception to this is the guideline polyps with a diameter of up to 5 mm: They can be removed under anticoagulation with vitamin K antagonists and with endoscopic bleeding prophylaxis if the INR does not exceed the therapeutic range.

A study from Japan suggests that this strategy can be extended to colon polyps that are less than 1 cm in diameter unless current is used for polypectomy ( Ann Intern Med 2019, online August 20 ). In the randomized controlled trial, the combination of continuous anticoagulation (CA) and cold snare (CSP) for bleeding was at least as safe as heparin bridging (HB) in combination with the hot snare (HSP).

Greater bleeding associated with the intervention occurred in 4.7 percent of CA / CSP patients and 12.0 percent of HB / HSP patients. In all cases these were post-polypectomy bleedings, which had to be breastfed in another endoscopic procedure. With the difference of 7.3 percent, the predefined minimum difference of 5 percent was proven to demonstrate the non-inferiority of the CA / CSP strategy.

Study participants were 168 patients who received oral anticoagulants mostly for atrial fibrillation and had at least one (non-pedunculated) colon polyp <1 cm removed. In total, around 600 lesions were treated. Haemostasis clips were used prophylactically more frequently in the HB / HSP group. For the CA / CSP patients, doctors needed less time per lesion and the hospital stay was shorter.

    

        4.7% of patients with polyps under anticoagulation with a cold
        Sling were eroded, suffered major bleeding. In patients under
        Heparin bridging and erosion with a hot snare accounted for 12 percent.

Based on the results, the study authors consider cold-loop erosion with continued anticoagulation as the standard procedure for removing polyps <1 cm, especially for those patients in whom discontinuation of anticoagulation is associated with a high thromboembolic risk.

A disadvantage of the study besides the lack of blinding is the simultaneous testing of two influencing factors. The effects of suspending oral anticoagulation without heparin bridging in patients with low thromboembolic risk have not been studied.

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Geriatrics: Guideline to Incontinence Updated

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Doctors newspaper online, 26.09.2019

    

        
        
        

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geriatrics

Geriatrists have updated the guideline on urinary incontinence with recommendations for diagnostics and therapy especially in geriatric patients.

COLOGNE. Urinary incontinence mainly affects the elderly. It is estimated that about 40 percent of over-70s are incontinent in Germany. The Working Group on Incontinence of the German Society for Geriatrics (DGG) has now taken this situation into account and developed recommendations specifically for geriatric patients. The WG has reviewed around 500 trials and evaluated them for use on older patients, the DGG reports. The results have now been published in an updated S2e guideline on urinary incontinence.

"After several months of work in the interdisciplinary working group, we have now developed a guideline that gives the treating physicians very clear recommendations for action," says Professor Andreas Wiedemann, head of the DGG working group and chief physician of the Urological Clinic at the Protestant Hospital Witten. As an example he mentions the long-term urinary bladder drainage: "For the first time it is firmly established that a bladder catheter for incontinence treatment is only allowed if all other therapies are not applicable or desired. So far, catheters have been rashly laid, "says Wiedemann. It is the only German-language guideline on this topic so far, according to the DGG.

These break a breach through the study jungle. "Many study authors define older patients by age 65+ alone. But that's not enough, "explains Wiedemann. "A geriatric patient is characterized by vulnerability, multi-morbidity – he has several diseases – and he is much older, over 75 years. There are also clear differences between men and women. We have therefore examined all study results as to whether they are even relevant for geriatric patients. "For example, surgical high-end methods such as sacral neuromodulation, so-called" bladder pacemakers ", are not suitable for geriatric patients. In contrast, toilet training is especially important. Even frail elderly people with cognitive or physical limitations respond well to this form of behavioral training, said the DGG. (eb)

The guideline is available on: www.awmf.org/leitlinien/detail/ll/084-001.html

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Expert dispute over the right way to more organ donation

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Doctors newspaper online, 24.09.2019

    

        
        
        

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Hearing on Health Committee on Wednesday

Contradiction or decision-making solution? In the near future, the Bundestag wants to determine to what extent the organ donation needs to be redefined. Associations and experts will be heard first this Wednesday.

By Thomas Hommel

The majority of citizens are in favor of organ donation, many do not have a donor card.

© Petra Steuer / JOKER / picture alliance

BERLIN. It is an unsolved problem of the sad kind: Around 10,000 people in Germany are waiting for a donor organ. About every third person dies because the right organ is missing. Now the legislature wants to take countermeasures and regulate organ donation.

There are three drafts to discuss. Everyone is in agreement to increase the number of organ donations. But the way is described differently: So sets a group of deputies to Green Party leader Annalena Baerbock on a strengthening of the willingness to decide to donate organs. For this purpose, citizens should be given the opportunity via an online register to document the decision, to change it at any time and to withdraw it.

The submission of an organ donation statement should also be possible in identity cards. Family doctors should advise patients and encourage them to register. The effort is to be reimbursed to physicians extra budgetary.

Decision or Opposition?

A second group around Minister of Health Jens Spahn (CDU) and the SPD health expert Professor Karl Lauterbach, on the other hand, strives for the double contradiction solution: every citizen is therefore considered as organ or tissue donor, as long as he has not contradicted during his lifetime. If the next of kin is not aware of any conflicting will, organ harvesting is considered permissible.

In the course of the new regulation, this group also wants to have a register created in which citizens enter their declaration. Both drafts also envisage education and information campaigns in the population.

A third motion by the AfD faction finally suggests a solution of trust. An increase in donor numbers requires confidence in the system created for this.

BÄK for Double Opposition Solution

The arguments for and against the drafts are also reflected in the opinions of the associations and experts, which will be heard in the health committee on Wednesday. The German Medical Association, which pleads for the double resolution solution, emphasizes that could be expected of almost every citizen after the legally regulated education by the health insurance, "to deal with questions of organ and tissue donation and binding for or to decide against a donation ".

The contradiction solution violates neither against the human dignity nor against the freedom of belief or world view, so the BÄK. The right to decide for themselves remains "essentially untouched". No one is forced to disclose the reasons for his decision.

The representatives of the big churches see that differently. The contradiction solution is afflicted with "considerable legal and ethical concerns," emphasize the Council of the Evangelical Church of Germany and the Commissariat of German Bishops. The organ donation decision must remain voluntary.

Church representatives plead for voluntariness

There are good reasons for the organ donation, the church representatives said. Nevertheless: "There is no moral obligation to donate his organs posthumously." For this reason, a legal duty could "certainly not".

In order to increase the number of organ donations "sustainably", organizational aspects in the transplantation procedure should be improved. The transplantation law passed in the spring sets "exactly here" and should therefore be consistently implemented.

The central cause of the low organ donation rate is a recognition or reporting deficit of potential organ donors in hospitals.

Professor Ulrich Kunzendorf, Director of the Department of Internal Medicine IV, University Hospital Schleswig-Holstein Campus Kiel

Similarly argued the board of the German Foundation for Patient Protection, Eugen Brysch. Silence is not an agreement. The right of self-determination is so severely restricted by the draft contradictory as would otherwise be "inconceivable" in data and consumer protection or in medical law.

When do patients feel compelled to donate?

People may feel compelled to donate organs or worry that a contradiction will not be found, even if there is a register for it. Thus, the confidence crisis, in which the donation of organs in Germany, "further aggravated," warns Brysch.

The association "Leben Donate!" Emphasizes that a paradigm shift in the regulation of organ donation is long overdue. The contradiction solves this. In all countries in which this rule applies, the organ donation figures are much better than in Germany, according to the statement of the association, the well-known supporters such as the President of the German Society of Surgery, Professor Matthias Anthuber, or former Federal Labor Minister Norbert Blüm (CDU).

The decision-making solution should be rejected because it is not clear at all that this could lead to improvements in organ donation. Addressing the citizen every ten years when applying for the identity card only postpones the problem rather than remedying it.

Relatives do not decide!

Peter Dabrock, professor of systematic theology at the University of Erlangen, accuses the representatives of the double contradiction solution against label fraud. One should only speak of a double contradiction rule "if, beyond the consent of the potential organ donor during his lifetime, the relatives would be given the opportunity to make independent decisions". Only then terminologically give the adjective "double" meaning.

This option is denied, however. On the other hand, Dabrock categorizes the draft decision-making solution as a "factually meaningful reform initiative sensitive to fundamental rights and the establishment of its practical concordance". You also put the "lever in the right places" on. These included, for example, the low-threshold provision of decision-making options with authorities, a register or the financial improvement of necessary conversations with the doctor.

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"The Earth is Broken Than the Hips of Your Granny"

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Doctors newspaper online, 21.09.2019

    

        
        
        

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Doctors protest

"The climate crisis is a medical emergency": Thousands of doctors and nurses take to the streets for more climate protection.

By Thomas Hommel

Doctors, therapists and carers contra global warming – here in front of the Charité in Berlin-Mitte. The former Charité boss Professor Detlev Ganten (center in the white coat) and the new president of the Charité Professor Hayo Kroemer (right next to the banner).

© Thomas Hommel

BERLIN. The medical students in white coats proudly hold their self-made posters in the air. "Short-haul flights are for insects only", is written on one. "The Earth is Broken Than Your Grandma's Hips," reads another.

An estimated 1000 physicians, continuing education, therapists, nurses and students followed the call of the German Climate Change and Health Alliance (KLUG) on Friday noon. They gathered in front of the Charité bedstead in Berlin-Mitte for the climate strike as part of the worldwide campaign "Health for Future". Above them hovers a large inflatable globe.

It applies to the use of the assembled doctors and nurses. Because the earth has a fever. "42 degrees are uncomfortable and also dangerous", calls the physician and cabaret dr. Eckart von Hirschhausen to the demonstrators. Almost everyone nods, because he also had to sweat a lot this summer and suspects: This is no longer normal, that is a consequence of climate change.

And it is putting more and more emphasis on the planet. "We are in the process of destroying all our progress," says Hirschhausen. He admonishes not to idly watch the planet's demise, but to do something. "Let us bring in our strength."

After all, five million people are employed in the health sector, according to Hirschhausen. The sincere trust in the people. That's a strong pound in the fight for a healthy planet. "If we want something together, then we also have a chance."

Doctors in duty: no tablets help against climate change

The doctors had been silent for far too long and believed that climate protection was the sole responsibility of politics, says dr. Peter Bobbert, head of the Marburger Bund Berlin / Brandenburg. "But that's over with today. We doctors stand for climate protection. "

Doctors commonly prescribe pills, says the former chief executive of the Charité, Professor Detlev Ganten. "But no help against climate change pills." Because only help civil disobedience. Ganten recalls in this context the "great tradition" of the university hospital when it comes to protesting against health risks due to political failure.

Rudolf Virchow had already pointed out to the German Kaiser that the health misery of the population is "a social and not a medical problem", Ganten notes.

Professor Heyo Kroemer, recently appointed Charité Chief has also intermarried with the demonstrators. Europe's largest university hospital wants to do more for climate protection and reduce CO2 emissions.

Doctors want to set signs

This Friday, when hundreds of thousands take to the streets for climate protection not only in Berlin but in many German cities, the earth can not even be saved, says a young doctor. But it could set a strong signal that could no longer ignore the policy.

Another doctor calls for the lobbyists of large industrial groups from the Chancellery and ministries to be kicked out. "Instead, bring in the scientists who have been pointing to climate change for years." As long as politicians remain idle, it's time for civil disobedience, she says too.

Cabaret artist Hirschhausen still has a very specific suggestion: Anyone who is going to buy a kilo of meat in the supermarket soon should get a bucket of liquid manure. He then had to dispose of it himself. Some might then start thinking about more climate protection. "Otherwise, I say: have fun grilling!"

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Bowel movement in babies: what is normal?

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Beware of striking colors or blood in the stool

The diaper content can be very different in color and shape. Parents should not be surprised if it turns black after the baby gets an iron supplement. "That is harmless," Dr. med. Axel Enninger, Medical Director of the Center for Pediatric and Adolescent Medicine at the Klinikum Stuttgart – Olga Hospital. However, if the stool turns black without giving iron, blood from the gastrointestinal tract may be the reason: Therefore, go to the doctor.

Also, if lighter blood is in the stool, a pediatrician should assess the situation. "In older children – but occasionally also in babies – the use of beetroot may be the reason for stool discoloration," says Enninger.

Parents should also watch out for discolored, whitish stools. "A white stool may indicate that something is wrong with bile excretion," says the pediatrician. Small white lines in otherwise normal colored stools can be worms – or simply undigested rice grains.

Pain in Constipation

"It does not matter how often the baby has a bowel movement, but whether it is painful in the meantime," explains the pediatrician. Parents need to watch their child as a whole: What does it look like? Does it hurt when defecating? A sign of constipation may be when the chair changes from day to day, from small dumplings to bulky chairs. The hardened stool occasionally causes small mucosal tears on the anus when constipation occurs, causing blood to be found in the stool. Then drugs that soften the stool can help. The rectum is less overstretched and the mucosal tears may heal again.

Does my baby have lactose intolerance?

"Congenital lactose intolerance is extremely rare in the first three to four years of life in Germany," says the specialist in pediatric gastroenterology. In this form of lactose intolerance babies do not tolerate breast milk because they lack a specific enzyme. You can react with abdominal cramps, flatulence and severe diarrhea. Congenital lactose intolerance is dangerous: it can lead to failure to thrive and development if not treated in time.

"In contrast to lactose intolerance, true cow's milk allergy in the first year of life is not uncommon," says Enninger. Some infants temporarily do not tolerate milk protein. Again, abdominal pain, bloating, constipation or diarrhea may occur. Some suffer from vomiting, sometimes accompanied by rash. Now and then respiratory problems, circulatory problems, and even anaphylactic shock can be the result. Many of these children then tolerate cow's milk protein after infancy.

        

IGeL-CT – Association confirms BfS findings

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Doctors newspaper online, 18.09.2019

    

        
        
        

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Prevention

After the Federal Office for Radiation Protection reported on illegal offers of X-ray-based early detection, a complaint to the Wettbewerbszentrale has been received for the first time.

By Raimund Schmid

BERLIN / BAD HOMBURG. Several radiological practices, MVZ and clinics offer radiographic screening for private individuals and self-payers. What according to the Federal Office for Radiation Protection (BfS) not only "unlawful", but therefore and in view of the officially evaluated application "also misleading" . A finding that the German Roentgen Society (DRG) can not and does not want to contradict.

A statement from the "Ärzte Zeitung" states that radiological procedures could "play an important role in the early detection of cancer". However, quality standards for technical and medical implementation are just as essential as "embedding in a comprehensive prevention concept and the establishment of strict criteria for further clarification and treatment in the case of suspected diagnosis".

Offers "outside the legal requirements" to which the Federal Office has now pointed out are "in fact unlawful, misleading and do not stand for a quality-assured, scientifically sound application of imaging techniques," confirms the association.

Also on the part of the professional association of radiologists (BDR) there is "nothing to gloss over", explains its CEO Markus Henkel. The legal situation was "clear", they had repeatedly informed the members that early detection CT without approval Regulation of the Ministry of the Environment are inadmissible and therefore should not be advertised.

In a review article for the BDR on drug advertising law, the Heidelberg medical lawyer Beate Bahner recently dealt with the legal risks of the early detection CT. Without the Ministerial Admission Regulation, this would be a "not medically diagnosed diagnostic measure", which may not be provided for radiation protection.

Here ends the therapy freedom of the radiologist. Violations could possibly even be prosecuted as bodily harm and then also have professional consequences.

Meanwhile, the Center for Combating Unfair Competition received a complaint against a provider of early detection CT immediately after the BfS communication. One can not give any information about how valid this input is, so executive committee member Peter Breun-Goerke. So far, there has been no complaint in this case, this is actually the first. (cw)

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Patient Day on the topic of olfaction and taste disorders

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Doctors newspaper online, 17.09.2019

    

        
        
        

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At the University of Dresden

BERLIN / BONN. The Olfactory and Gustology Working Group of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) is organizing a patient day on September 29 in Dresden on the topic of olfactory and taste disorders. Among other things, it is about causes of such disorders and treatment options.

According to the DGHNO-KHC, about 50,000 people are affected by olfactory or taste disorders in Germany every year.

Almost everyone knows about harmless colds: The nose is blocked, you do not smell anything anymore, the food tastes bland. However, such an olfactory loss (anosmia) is clinically relevant only if it persists even after the infection subsides. "This can happen, for example, after a true virus flu, if the viruses have damaged the olfactory mucosa," says Professor Thomas Hummel, head of the olfactory and taste center at the ENT clinic of the Dresden University Hospital, quoted in the message of the professional society.

In these cases, the sense of smell often returns completely, even if it may take months or years. Even with a loss of smell, which goes back to a chronic sinus inflammation, the sensory function often recovers when the inflammation is suppressed by medication or the mechanical blockade is eliminated by a polyp operation.

However, olfactory disturbances can also be a symptom of more profound damage – for example after traumatic brain injury or in neurodegenerative diseases such as Parkinson's disease. Complete recovery of the olfactory function is then very rare.

"Chemical sensory impressions are highly subjective," recalls Hummel in the DGHNO-KHC communication. How strong an odor loss is is therefore not easy to measure. An objective measure offers the EEG.

For some years now, therapy has been attempting to take advantage of the plasticity of the chemical senses; Here, some patients seem to benefit from a regular morning and evening olfactory training, reports the professional society in its communication.

In a patient brochure, the AG olfactology and gustology of the DGHNO-KHC also explains the function of the chemical senses and their disorders. There are also tips on how sufferers can compensate for everyday impairments and what precautions they should take.

Those affected should install smoke detectors and possibly gas detectors, note the purchase or opening date of food and dispose of questionable food in case of doubt. Also with the hygiene missing patients with olfaction loss, an important feedback. Here, Hummel recommends adhering to fixed schedules for personal hygiene, changing clothes and, for example, cleaning the toilet. "Even such seemingly trivial things contribute significantly to maintaining the safety in social interaction and thus the quality of life," said Hummel in the message. (eb)

Patient Day: 29.09.2019; 9: 00-16: 00; University Hospital, lecture hall in the house No. 19; Deadline: 25th September 2019; Contact: thummel@mail.zih.tu-dresden.de

Retrieve Patient Brochure about: https://olfaktologie.hno.org/patienten.html

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Humboldt – and his enormous influence on medicine

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Doctors newspaper online, 14.09.2019

    

        
        
        

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Interview with Expert

Alexander von Humboldt is famous as a widely traveled naturalist. It is less well known that he also obtained an honorary doctorate. About Humboldt's relationship to medicine.

By Angela Misslbeck

Alexander von Humboldt against the background of the volcanoes Chimborazo and Cargueirazo in the Andes. The picture was painted in 1859 by Julius Schrader.

© akg-images / picture alliance

Ärzte Zeitung: Professor Hesse, what was Humboldt's achievement that earned him an honorary doctorate in medicine?

Prof. Volker Hesse: Humboldt has been awarded three honorary doctorates three times: in Dorpat in 1827, in Bonn in 1828 and in Prague in 1848. The doctoral certificate of the University of Bonn was found here in Berlin. It expressly recognizes Humboldt for his achievements in the field of physiology and pathology and their importance to the public.

The honorary doctorate, however, was eventually followed by a whole conglomeration of observations, researches and developments of various kinds, including his emergency respirator for miners. Physiology revolved around the question of what constitutes life in Humboldt's time.

Some researchers assumed a specific life force. Humboldt initially also took the teaching of Vis vitalis, but later refrained from it and decided neither for nor against this hypothesis.

What were his physiological accomplishments?

Hesse: His achievements in the testing of "animal electricity" were above all the use of different electrode compositions and the examination of the influence of various substances (including morphine) on the conductivity of the animal muscle.

Humboldt has discovered exciting things, especially in electrophysiology. He has made about 4000 experiments with 3000 animals for galvanism. Among other things, he has observed the principle of resuscitation by power surges on a resting animal heart and thus practically described the defibrillation. He also applied his electrophysiological experience to healing, for example in his work: "On the Application of Galvanic Stimulants to Practical Healing."

Humboldt is known as a naturalist, geologist and geographer. What points of contact did he have with medicine?

Hesse: The most formative contact was certainly that of Jena anatomist Justus Christian Loder. With him he has – together with his brother Wilhelm – dissecting. But Humboldt had close contacts to doctors throughout his life. This began with botany training at Ernst Ludwig Heim, and continued with a scientific exchange on electrophysiology with Marcus Hertz, all the way to a friendly family relationship with Carl Ludwig Willdenow.

Also on his research trips Humboldt was almost always accompanied by doctors. He made his first journey in 1790 with the naturalist and physician Georg Forster. Aimé Bonpland, who accompanied Humboldt to Latin America, and Christian Gottfried Ehrenberg, his companion on the trip to Russia, were also physicians.

How did these influences affect the research trips?

Hesse: Wherever Humboldt was, he also had a focus on questions of physiology, anatomy and anthropology. For example, he measured skeletons and mummies during the Orinoco expedition and made skull scans on them. He also measured living people and compared their anatomy. His thirst for research led him to sections of monkeys, birds, crocodiles and shaking eels.

At the same time Humboldt was a very close observer of physiological processes. The infectious diseases malaria, yellow fever, smallpox, typhus and cholera, for example, he saw in their great ecological and social context. He noticed that yellow fever occurs less frequently at higher altitudes. He noted that smallpox vaccination is urgently needed in Latin America, and noted in his work in Cuba the "sinister link between poverty and disease."

Did Humboldt bring with him knowledge from his travels that enriched the medicine of his time?

Hesse: Humboldt was the first to describe altitude sickness with its physiological effects after climbing the Chimborazo. In addition, he brought from his travels with some drugs from the drug treasure of the Indians, including the Chinarinde against fever and the tonic Angosturarinde.

In the self-experiment with the Indian arrow poison Curare, he found that it works without contact with the blood as a stomach remedy. He described other plants as psycho drugs. For Guano he documented the use as a means for envelopes in joint and skin diseases in Indian medicine. There is also a variety of bioclimatological observations.

Modern medicine rarely or never refers to Humboldt – is he unjustly ignored today in this area?

Hesse: Alexander von Humboldt did not make any original first discovery in the field of medicine. But today he is of great importance because as a universalist he sees all areas of nature linked.

He elaborated the complex relationships in nature very precisely and at the same time demanded the dignified treatment of nature and all human beings alike. That makes him very modern.

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