Drei große Bereiche der Medizin erschließen sich der klinischen Immunintervention: die Tumorerkrankungen, die entzündlichen Erkrankungen inklusive der Autoimmunkrankheiten und die Transplantationsmedizin. Für das Paul-Martini-Symposium 2012 konnten herausragende Mediziner und Wissenschaftler in jedem dieser Bereiche gewonnen werden, die eine Bestandsaufnahme über neue immunstimulierende wie suppressive Therapien aus diesen 3 Fachgebieten vornehmen.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Seit 1. 1. 1993 ist auf den Erhebungsbogen der Pflege-Personalregelung des Gesundheitsstrukturgesetzes die Angabe des ICD-Schlussels (ICD = »international classification of diseases«) der Hauptdiagnose gesetzlich vorgeschrieben. Um die Fehlerquote bei dieser Verschlusselung und deren Ursachen zu analysieren, wurden fur das 1. Halbjahr 1993 die Daten der Pflege-Personalregelung erfast und die ICD-Schlussel mit den korrespondierenden Eintragen des Diagnosenarchivs abgeglichen. Bei 671 der 2308 uberpruften Erhebungsbogen (29 %) wurden Fehler bei der Verschlusselung festgestellt. Besonders hoch war die Fehlerquote in den Bereichen Kardiologie (39 %), Angiologie (37 %), Nephrologie (36 %) und Neurologie (35 %). Allerdings stammten die falschen Diagnosen in der Kardiologie und Nephrologie zu einem hohen Prozentsatz aus demselben Diagnosenteilbereich. - Im Sinne der Qualitatssicherung mussen die an der Verschlusselung beteiligten Arzte uber die negativen Folgen fur die Personalausstattung umfassend informiert werden; die Verschlusselung mus von erfahrenen Kollegen durchgefuhrt, klinikintern uberpruft und, falls technisch moglich, mit dem Diagnosenarchiv abgeglichen werden. Die Erfassung nur einer Hauptdiagnose ist bei multimorbiden Patienten nicht sinnvoll.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Since 1 January, 1993, it has been a legal requirement to enter, for identification of the main diagnosis, the appropriate code from the International Classification of Diseases (ICD) on the documentation forms of the Nursing Personnel Regulation as prescribed under the (German Federal Government's) Health Organization Law. This study was undertaken to analyse the frequency of errors in this coding and the reasons for it. The data of the Nursing Personnel Regulations during the first 6 months of 1993 were compared with the corresponding entries in the diagnostic archives. In 671 of 2308 analysed forms (29%) coding errors were discovered. The rate of errors was especially high in the areas of cardiology (39%), angiology (37%), nephrology (36%) and neurology (35%). However, a high percentage of the wrong codings for cardiological and nephrological diseases were still within the same diagnostic field.--These findings indicate that, to ensure quality, those doctors who do the coding should be fully informed about the potential consequences regarding staffing of such errors. All coding must be done by experienced doctors, be locally checked and, if technically possible, compared with the diagnostic archive entries. Also, the registration of only one main diagnosis is not sensible in the case of patients with multi-organ disease.

We have studied the relationship between insulin activation of insulin-receptor kinase and insulin stimulation of glucose uptake in isolated rat adipocytes. Glucose uptake was half-maximally or maximally stimulated, respectively, when only 4% or 14% of the maximal kinase activity had been reached. To investigate this relationship also under conditions where the insulin effect on activation of receptor kinase was decreased, the adipocytes were exposed to 10 microM-isoprenaline alone or with 5 micrograms of adenosine deaminase/ml. An approx. 30% (isoprenaline) or approx. 50% (isoprenaline + adenosine deaminase) decrease in the insulin effect on receptor kinase activity was found at insulin concentrations between 0.4 and 20 ng/ml, and this could not be explained by decreased insulin binding. The decreased insulin-effect on kinase activity was closely correlated with a loss of insulin-sensitivity of glucose uptake. Moreover, our data indicate that the relation between receptor kinase activity and glucose uptake (expressed as percentage of maximal uptake) remained unchanged. The following conclusions were drawn. (1) If activation of receptor kinase stimulates glucose uptake, only 14% of the maximal kinase activity is sufficient for maximal stimulation. (2) Isoprenaline decreases the coupling efficiency between insulin binding and receptor-kinase activation, this being accompanied by a corresponding decrease in sensitivity of glucose uptake. (3) Our data indicate that the signalling for glucose uptake is closely related to receptor-kinase activity, even when the coupling efficiency between insulin binding and kinase activation is altered. They thus support the hypothesis that receptor-kinase activity reflects the signal which originates from the receptor and which is transduced to the glucose-transport system.

Objective We developed a wallet-sized learning memory decision support system that helps patients with insulin-dependent diabetes mellitus adjust their insulin dosages. Research Design and Methods To determine the efficacy of the support system, we designed a randomized clinical trial with patients participating in a program in a diabetes education center. Patients were assigned to two groups of 21 patients each. All patients performed self-monitoring of blood glucose (SMBG) and were treated with multiple daily injections of insulin. Each of the patients was examined over a 32-day period. The basic educational program, i.e., practical advice in SMBG, diet, and exercise under homelike conditions, was identical in both groups. The only difference was that the first group used the computer for adjusting the insulin dose, whereas the second group received recommendations from the education team. Results The baseline HbA1 levels (9.8 ± 1.6 vs. 9.9 ± 1.6%) of both groups did not differ significantly. Mean blood glucose over the last 2 wk of the study was higher (P < 0.01) in the second group (8.4 ± 1.4 vs. 9.2 ± 2.0 mM); the frequencies of hypoglycemic episodes were not different (1.7 vs. 2.3%). Conclusions Metabolic control and safety were comparable in both groups. Thus, patients may benefit from such a system at home where no support by diabetes educators is available.