Hospital In Berlin Research Articles

Looking back: sectio in mortua and the role of the midwife

Operative vaginal delivery and, in particular, rotational forceps delivery require extensive training, specific skills, and dexterity. Performed correctly, it can reduce the need for difficult late second-stage cesarean delivery and its associated complications. When rotation to occiput anterior position is achieved, pelvic trauma and anal sphincter injury commonly associated with direct delivery from occiput posterior positions may be avoided.We report the original and novel use of real-time intrapartum ultrasound simultaneously during Kielland’s rotational forceps delivery to monitor correct execution and increase maternal safety.This is a prospective observational study performed at the Charité University Hospital in Berlin between 2013 and 2018. Simultaneous, real-time, intrapartum suprapubic ultrasound during Kielland’s rotational forceps deliveries were performed in a series of laboring women with normal fetuses and arrest of labor in the late second stage and with a fetal head malposition, requiring operative vaginal delivery. In addition to vaginal palpation for head station, rotation, and asynclitism, intrapartum ultrasound was also used to objectively determine head station, head direction, and midline angle. The operator was not blinded to the ultrasound findings.The delivering obstetrician examined the woman and performed the delivery. An assistant, trained in intrapartum ultrasound, placed a curved-array transducer transversely in the midline just above the pubic bone to display the forceps blades being applied and the rotation of the fetal head in occiput anterior position.In all 32 laboring women included in the study, the blades were applied correctly and the fetal heads successfully rotated to an occiput anterior position with direct ultrasound confirmation, and vaginal delivery was achieved. There were no cases of difficult application, repeat application, slippage of the blades, or rotation of the fetal head in the wrong direction. Maternal outcomes showed no vaginal tears, cervical tears, or postpartum hemorrhage >500 mL. There was 1 case of third-degree perineal tear (3a). Neonatal outcomes included mild hyperbilirubinemia (n=1), small cephalohematoma conservatively managed (n=1), and early-onset group B streptococcus sepsis secondary to maternal colonization (n=1). There were no neonatal deaths.Ultrasound guidance during Kielland’s rotational forceps delivery is an original and novel approach. We describe the use of intrapartum ultrasound in assessing fetal head station and position and also to simultaneously and objectively monitor performance of rotational forceps delivery. Intrapartum ultrasound enhances operator confidence and, possibly, patient safety. It is a valuable adjunct to obstetrical training and can improve learning efficiency. Real-time ultrasound guidance of fetal head rotation to occiput anterior position with Kielland’s forceps may also protect the perineum and reduce anal sphincter injury. This novel approach can lead to a renaissance in the safe use of Kielland’s forceps.

Decision Support for the Physician Scheduling Process at a German Hospital

The process of manually constructing monthly working schedules for physicians in medium-sized and large departments at hospitals is a very time-consuming and error-prone task. The scheduler, typically a senior physician, is an expensive resource and oftentimes almost irreplaceable because of his acquired expertise in the scheduling process. We develop a mathematical model that formalizes every rule and regulation necessary to generate lawful schedules in the anesthesiology department of a 626-bed hospital in Berlin, Germany. We embed our detailed and complex mixed-integer programming formulation, which generates schedules superior to the ones currently in use, in an Excel environment to ensure ease of use, maximum flexibility with respect to changing all relevant inputs, and a visual output representation for practitioners. The presented approach reduces the workload for the scheduler dramatically, thereby increasing his availability for medical services. Our generated schedules outperform manually created schedules by significantly reducing the number of rule and regulation violations, while also improving key performance measures such as assigned overtime, granted employee-preferred shifts, and fairness considerations. Our approach also highlights important aspects in modeling the physician scheduling problem for practical implementation that have been widely ignored in the existing literature.

Does multimorbidity in older psychiatric patients lead to higher transfer rates between psychiatric and somatic departments?

Multimorbidity is an increasing challenge in geriatric medicine, also in psychiatric patients. The question arises where an adequate treatment should be carried out. This exploratory study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an investigation of all admissions of older inpatients (>65years) to apsychiatric hospital within 3years. A total of 1266 admissions to a hospital in Berlin could be analyzed. Of the patients primarily admitted to the psychiatric department, 17.4% had to be transferred to asomatic department with apreponderance of patients with higher multimorbidity (11.7 ± 3.7 vs. 9.9 ± 3.8 somatic diagnoses, U‑test p < 0.001). Of the patients 19.7% were transferred from somatic departments to the psychiatric department mainly due to delirium. They were also often multimorbid (mean number of somatic diagnoses: 11.7 + 3.7 vs. 10.3 + 3.8, U‑test p < 0.001). Multimorbidity results in more frequent transfer of older patients in hospital.

Psychosocial Long-Term Impact of Donation on Kidney Living Donors - A Comparative Study of Two Major European Transplant Centres

Background Kidney living donation appears to be a safe procedure that does not affect the health of the kidney living donors (KLDs). Although the medical outcomes are being widely studied information regarding the long-term psychological outcome of these healthy individuals is missing. In our study we assessed the postoperative psychosocial status of KLDs in two major European transplantation centres, in the Hospital Clinic of Barcelona and the Charité-University Hospital in Berlin. Methods All kidney living donors who underwent nephrectomy between 1998-2014 were contacted. Data from 767 donors were collected. The donors completed a battery of psychometric questionnaires (HADS, PHQ, SOC, SF-36, ACSA, life events, questions from the ELSA), as well as questions regarding satisfaction, decision to donate and the donor-recipient relationship in a total of 274 questions. In this preliminary study HAD, SOC, SF-36 were evaluated and the results of the two centers were statistically compared. Results Results regarding the long-term psychosocial wellbeing up to 16 years after kidney donor nephrectomy are presented and compared to the general population of the two countries. The results show the KLDs in the studied centers are healthy adults with a QoL comparable to that of the general population for both countries. Anxiety and depression levels are low with a notable number of outliers explained. Group comparisons regarding age, gender, donor-recipient relationship, personality characteristics and recipient variables are made and multivariate analysis is performed to explain low psychosocial donor outcome. Conclusion The results and the differences between the two centers are critically discussed allowing conclusions regarding the donor evaluation practices and their postoperative care, as well as organizational and cultural differences.

Perinatal Outcome in Women with a Vietnamese Migration Background – Retrospective Comparative Data Analysis of 3000 Deliveries

Introduction Perinatal data of women with a Vietnamese migration background have not been systematically studied in Germany to date. Numerous details of important maternal and child outcomes were compared and analysed. The studyʼs primary parameters were the frequency of and indication for c-section. Methodology The perinatal data from a Berlin hospital were analysed retrospectively. The women (Vietnamese migration background vs. autochthonous) were grouped using name analysis. Datasets of 3002 women giving birth, including 999 women with a Vietnamese migration background, were included. The associations between primary or secondary cesarean delivery and different child outcomes depending on the migration background (exposure) were studied using logistical regression analysis. Results Women with a Vietnamese migration background have a lower c-section rate of 8.0% for primary and 12.6% for secondary c-section than women without a migration background (11.1% primary and 16.4% secondary c-section respectively). Regression analysis shows that the odds that women with a Vietnamese migration background will have a primary (OR 0.75; p = 0.0884) or secondary c-section (OR 0.82; p = 0.1137) are not significantly lower. A Vietnamese migration background was associated with higher odds for an episiotomy but not for a grade 3 – 4 perineal tear. A Vietnamese migration background does not have a significant influence on poor 5-min Apgar scores ≤ 7 and low umbilical cord arterial pH values ≤ 7.10. Newborns of mothers with a Vietnamese migration background have higher odds of a relatively higher birth weight (> 3110 g). Summary There was no evidence that women with a Vietnamese migration background are delivered more often by caesarean section. There were also no differences as regards important child outcome data from women in the comparator group. Overall, the results do not provide any evidence for poorer quality of care of women with a Vietnamese migration background in Berlin despite the cultural and communication barriers in the reality of care provision.

Robust allocation of operating rooms: A cutting plane approach to handle lognormal case durations

The problem of allocating operating rooms (OR) to surgical cases is a challenging task, involving both combinatorial aspects and uncertainty handling. We formulate this problem as a parallel machines scheduling problem, in which job durations follow a lognormal distribution, and a fixed assignment of jobs to machines must be computed. We propose a cutting-plane approach to solve the robust counterpart of this optimization problem. To this end, we develop an algorithm based on fixed-point iterations that identifies worst-case scenarios and generates cut inequalities. The main result of this article uses Hilbert’s projective geometry to prove the convergence of this procedure under mild conditions. We also propose two exact solution methods for a similar problem, but with a polyhedral uncertainty set, for which only approximation approaches were known. Our model can be extended to balance the load over several planning periods in a rolling horizon. We present extensive numerical experiments for instances based on real data from a major hospital in Berlin. In particular, we find that: (i) our approach performs well compared to a previous model that ignored the distribution of case durations; (ii) compared to an alternative stochastic programming approach, robust optimization yields solutions that are more robust against uncertainty, at a small price in terms of average cost; (iii) the longest expected processing time first (LEPT) heuristic performs well and efficiently protects against extreme scenarios, but only if a good prediction model for the durations is available. Finally, we draw a number of managerial implications from these observations.

Weather conditions influence the number of psychiatric emergency room patients.

The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p < 0.001). Three PCs explained 76.8% percent of the variance with PC1 loading mostly on temperature, PC2 on cloudiness and low pressure, and PC3 on windiness. PC1 and PC2 showed strong association with number of patients in the emergency room (p < 0.010) indicating higher patient numbers on warmer and on cloudy days. Further, PC1, PC2, and PC3 predicted the number of patients presenting in the emergency room for up to 7days (p < 0.050). A secondary analysis revealed that the effect of temperature on number of patients was mostly due to lower patient numbers on cold days. Although replication of our findings is required, our results suggest that weather influences the number of psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

The Windmill technique avoids manual removal of the retained placenta—A new solution for an old problem

ObjectiveThe primary objective is to assess the reduction in manual removal of placenta with the Windmill technique of placenta delivery in patients with retained placenta. DesignThe Windmill technique involves the application of continuous 360° umbilical cord traction and rotation in such a manner as to be perpendicular to the direction of the birth canal at the level of the introitus. This rotation through 360° is repeated slowly with movement akin to the motion of the blades of a windmill.We performed a 3-year retrospective case-control study at the Charité University Hospital in Berlin. Patients with a retained placenta more than 30min following failed traditional interventions were consented and offered the Windmill technique of placenta delivery. Study cases were compared to controls where an operative manual removal of placenta was performed. Patients with suspected placenta implantation problems, uterine atony, bleeding due to vaginal tract injury and coagulation disturbances were excluded. ResultsOver the study period 14 patients were recruited to the study arm and 17 patients were in the control group. With the Windmill technique for retained placenta, 86% (12/14, p<0.001) of patients avoided invasive operative manual removal of the placenta in theatre.There was a statistically significant reduction in mean blood loss (429ml vs 724ml, p=0.001) and mean postoperative fall in hemoglobin values (1.3g/dl vs 2.5g/dl, p=0.04). There was a reduction in the time to delivery of the placenta, antibiotic prophylaxis and use of general anesthesia. ConclusionThe Windmill technique for the delivery of the retained placenta is a simple, safe, effective and easy to teach technique that reduces invasive operative manual removal of the placenta, postpartum blood loss and delay in the placenta delivery. This innovative technique can also be a lifesaving intervention especially in areas with limited or no access to operative facilities.

Differences in the Frequency of Use of Epidural Analgesia between Immigrant Women of Turkish Origin and Non-Immigrant Women in Germany - Explanatory Approaches and Conclusions of a Qualitative Study.

Introduction: The starting point of this study was the considerably lower rate of epidural analgesia use among women of Turkish origin in Germany compared to non-immigrant women in the German Research Foundation (DFG)-funded study entitled "Perinatal Health and Migration Berlin". The study aimed to identify possible differences in the women's attitudes towards epidural analgesia. Methods: Exploratory study with semi-structured interviews, interviews lasting 17 minutes on average were conducted with 19 women of Turkish origin and 11 non-immigrant women at a Berlin hospital. The interviews were subjected to a qualitative content analysis. Results: Immigrant women of Turkish origin in Germany more frequently ascribe meaning to the pain associated with vaginal delivery. They more frequently categorically reject the use of epidural analgesia, 1) for fear of long-term complications such as paralysis and back pain and 2) based on the view that vaginal delivery with epidural analgesia is not natural. Information on epidural analgesia is frequently obtained from a variety of sources from their social setting, in particular, by word of mouth. The women in both groups stated that they would take the decision to use epidural analgesia independent of their partner's opinion. Discussion: The differences in epidural analgesia use rates observed correspond to the women's attitudes. For the immigrant women of Turkish origin in Germany, the attitude towards using epidural analgesia is based in part on misinformation. In order to enable the women to make an informed decision, epidural analgesia could receive a stronger focus during childbirth courses.

Incidence of constipation in patients with outpatient opioid therapy

Constipation is a common complication in patients with opioid therapy. Additionally, patient-related risk factors also contribute to the development of constipation and these factors have to be integrated into an individualized treatment plan. The aim of this study was to assess the incidence of constipation in patients with opioid therapy in an outpatient setting and to analyze the risk factors that contribute to the development of constipation. This retrospective cohort study was conducted in two university affiliated outpatient departments at the Charité hospital in Berlin. The trial included all consecutively treated patients with opioid therapy of at least 4 weeks duration. The study was conducted from January 2013 to August 2013. Constipation was defined according to the Rome III criteria. Out of 1166 screened patients, altogether 171 patients were included with a median duration of opioid therapy of 5 years. The most common diagnoses were back pain, musculoskeletal pain and neuropathic pain. In 14% of the treated patients symptoms of constipation were detected and another 35% needed laxatives for symptom control resulting in an overall incidence of constipation of 49%. The remaining 51% of the patients did not use any laxatives and did not experience symptoms of constipation. Age and dosing of opioid therapy significantly increased the risk of consipation but duration of opioid therapy was not related to the incidence of constipation. The incidence of constipation in this population remains high although a relevant number of patients were intermittently free of symptoms without using laxatives. An individualized therapy plan and patient education seem to be important elements to control opioid-associated constipation.

Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study.

Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor. The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients. A prospective, clinical observational study. This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia. at least 60 years of age; noncardiac surgery with general anaesthesia. impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language. None. Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression. Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed. A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor). The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery. ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/

Vertigo Ergo Sum: Kant, his Jewish “Students” and the Origins of Romanticism

For the early German Romantics in the 1790s, no thinker arguably had a greater influence on the genesis of their thought than Immanuel Kant. The work Kant produced between 1781 (the publication of The Critique of Pure Reason) and 1790 (the publication of The Critique of Judgment) underlies the basic Romantic understanding of cognition, ethics and aesthetics in Germany. An overlooked aspect of the development in Kant's thought, as well as a surreptitious influence on the origins of early German Romanticism, is Kant's fraught relationship with his Jewish students and acquaintances throughout the 1780s. This is made most explicit in his relationship to Markus Herz – a close confidant to Kant throughout the 1770s, the official respondent to Kant's inaugural dissertation as well as the director of the Jewish hospital in Berlin. Herz publishes in 1787 Versuch über den Schwindel [On Vertigo], a book that Herz openly dedicates to Kant and claims is directly influenced by Kant's teaching. Although Kant dismissed the book at the time, Herz's book on vertigo not only critiques Kant's conflation of reason and feeling, but introduces the possibility of individual psychology undermining the subject's orientation in thought.

100th anniversary of the Oskar-Helene-Heim - an obituary

The Oskar-Helene-Heim is one of the birthplaces of German orthopaedic clinics. The clinic was demolished in winter 2013/2014. Almost all of the historic buildings of the traditional specialist hospital in south-west Berlin were torn down in in the preparation for a housing project. The history of this facility is briefly described in this article.

Early administration of levosimendan is associated with improved kidney function after cardiac surgery - a retrospective analysis.

BackgroundSeveral animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration.MethodsRetrospective, single centre, observational analysis at a university hospital in Berlin, Germany. All adult patients without preoperative renal dysfunction that underwent coronary artery bypass grafting and/or valve reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered for analyses.ResultsOut of 1.095 included patients, 46 patients were treated with levosimendan due to a severely reduced left ventricular systolic function preoperatively (LVEF < 35%) and/or clinical signs of a low cardiac output syndrome. Sixty-one percent received the drug whilst in the OR, 39% after postoperative intensive care unit admission. When levosimendan was given immediately after anaesthesia induction, creatinine plasma levels (p = 0.009 for nonparametric analysis of longitudinal data in a two-factorial design) and incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p = 0.033) were significantly reduced in contrast to a later start of treatment. In addition, duration of renal replacement therapy was significantly shorter (79 [35;332] vs. 272 [132;703] minutes; p = 0.046) in that group.ConclusionsPostoperative kidney dysfunction is a common condition in patients under going cardiac surgery. Patients with severely reduced left ventricular function and/or clinical signs of a low cardiac output syndrome who preoperatively presented with a normal kidney function may benefit from an early start of levosimendan administration, i.e. immediately after anaesthesia.Trial registrationClinicaltrials.gov-ID: NCT01918618.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0167-8) contains supplementary material, which is available to authorized users.

The history of biliary surgery

From the ancient times biliary surgery attracted a great attention of the doctors and other specialists all over the world. In medieval times, main efforts of medical workers were targeted to the liver and biliary anatomy research. Until the XV century doctors were not aware of the cholelithiasis, first steps in diagnosing and treating this disease were related to obstructive jaundice and biliary abscesses. Surgical treatment in XVIII-XIX centuries included intra-abdominal abscess drainage, pus and bile drainage, gall bladder lithotomy. If biliary colic was associated with local skin hyperemia in right hypochondrium, a surgeon would make an incision in this area, leading to biliary fistula formation and further recovery in some patients. In the middle of XIX century, surgeons started to perform cholecystostomy, removing the stones out of the gall bladder and performing the cholecystopexy to the laparotomy wound. Only in 1882 27-year old Langhenbuch, who was appointed as a head doctor in a hospital in Berlin, was the first one in the world to perform a cholecystectomy in 43-year old patient, who suffered from biliary colics for 16 years. Langhenbuch started to do surgeries on biliary system after many years of training on dead bodies. The peculiar progress in biliary surgery was observed during the last century. Minimally invasive and endoscopic technologies along with general anesthesia and antiseptics made this specialty safe for most of the patients, with cholecystectomy becoming one of the world’s most common surgeries. During the last decades laparoscopic cholecystectomy became the surgery of choice in treating cholelithiasis, and endoscopic papillosphincterotomy and choledocholithotomy - in treating choledocholithiasis.

Editorial introductions

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Joachim SieperJoachim SieperProfessor Joachim Sieper is Head of Rheumatology at the Campus Benjamin Franklin of the Charitè University Hospital in Berlin, Germany. He has a longstanding interest in the pathogenesis, epidemiology, diagnosis and treatment of spondyloarthritides with a focus on ankylosing spondylitis over the recent years. He was involved in several of the pivotal clinical studies showing the dramatic efficacy of TNF-blocking agents in the treatment of ankylosing spondylitis. He is recipient of the Carol-Nachman-Award for Rheumatology (2000) and of the EULAR-Award (2003). Robert D. InmanRobert D. InmanDr Robert D. Inman completed his undergraduate degree at Yale University, USA, and his medical degree at McMaster University, Canada. He did his training in internal medicine at Vanderbilt University, USA, and his fellowship in rheumatology at Cornell University, based at Hospital for Special Surgery, USA. He worked as a research fellow at the Hammersmith Hospital in London, UK, then was appointed Assistant Professor of Medicine at Cornell University. He moved to the University of Toronto, Canada, where he was appointed Professor in the Departments of Medicine and Immunology. He was Director of Rheumatology at the University of Toronto and at University Health Network, Canada, from 1991 to 2002. He is currently Director of the Arthritis Center of Excellence at the University Health Network, Director of the Spondylitis Program at Toronto Western Hospital, and Deputy Physician in Chief, Research at University Health Network. He has held many national and international leadership positions including the member of the Board of Directors of the American College of Rheumatology, Chair of the Medical and Scientific Board of the Spondylitis Association of America. He is currently a member of the Executive Committees of the Assessment of Spondyloarthritis International Society (ASAS) and the Spondyloarthritis Research and Treatment Network (SPARTAN), and is past-President of the Spondyloarthritis Research Consortium of Canada (SPARCC). Kenneth G. SaagKenneth G. SaagKenneth G. Saag, Jane Knight Lowe Professor of Medicine, Division of Clinical Immunology/Rheumatology at the University of Alabama at Birmingham (UAB), USA, and Professor of Epidemiology, at UAB School of Public Health. He is the founding Director of the Deep South Musculoskeletal (DSM) Center for Education and Research on Therapeutics (CERTs) and Director of the AHRQ-supported UAB T32 in Health Services Research. Dr Saag is also Director of the UAB Center for Outcomes and Effectiveness Research (COERE), Director of the UAB Center of Research Translation (NIAMS P50) in Gout and Hyperuricemia, and Co-Director of the Multidisciplinary Clinical Research Center (NIAMS P60). Dr Saag's current research focuses on epidemiology and outcomes of osteoporosis and gout. He studies methods to translate evidence into practice and to design large practical trials for both arthritis and osteoporosis. Dr Saag is on the American College of Rheumatology (ACR) Board of Directors, has been a leader in development of the 2008 and 2011 ACR Recommendations on the Treatment of Rheumatoid Arthritis, and is a member of the ACR Council on Healthcare Economics (CHEC). He received the ACR Rheumatology Research Foundation Excellence in Investigative Mentoring Award in 2013. Dr Saag also serves as Vice President on the Board of Trustees of the National Osteoporosis Foundation (NOF), the Board of Directors of the Gout and Uric Acid Society, and is a member of the National Committee for Quality Assurance (NCQA) Expert Panel, Osteoporosis Advisory Working Group.

Wilhelm Uhthoff (1853–1927)

Wilhelm Uhthoff (Fig. 1) was a German ophthalmologist, especially interested in neurology. He was born on June 31, 1853, in Klein-Warin in Grand Duchy of Mecklenburg-Schwerin (now Mecklenburg-Vorpommern). He was raised in the countryside, as one of nine siblings. Because of the poor financial situation of his family he could not expect any financial means to support his education. Thus, working 7 days a week was required later on to pay off the loans obtained to cover education-linked expenses [1]. Fig. 1 Wilhelm Uhthoff (1853–1927) He studied medicine in Tubingen, Gottingen, Rostock and Berlin. He defended his doctoral dissertation in 1877 in Berlin. These years marked the initiation of collaboration with Rudolph Virchow (1821–1902), co-researcher, but also colleague at Breslau University thereafter. In 1878, Uhthoff began ophthalmology residency and became a research assistant at Heinrich Leopold Schoeler’s (1844–1918) clinic in Berlin [2]. Meanwhile, at Helmholtz Physics Institute, he carried out work on light luminance and visual acuity [3]. His interest in neuro-ophthalmology was expressed by establishing consultations at Carl Westphal neurology clinic of Charite Hospital in Berlin [3]. Among his co-workers Adolf Wallenberg (1862–1949), Hermann Oppenheim (1858–1919), Carl Moehli (1849–1919) and Ernst Siemerling (1857–1931) can be listed [2]. Uhthoff shared a bacteriological research interest with his eldest student, Theodor Axenfeld (1867–1930). In 1885, he obtained senior doctor lecturer title and 5 years later was appointed Ordinary Professor to the Chair of Ophthalmology in Marburg. In 1896, he accepted the position of the Head of the University Eye Clinic and moved to Breslau. Advancing his academic career, he was nominated for rector of Friedrich Wilhelm Silesian University (Schlesische Friedrich-Wilhelms-Universitat zu Breslau) and, subsequently, University of Breslau in 1908. Uhthoff was a devoted researcher and lecturer—many case reports of his authorship established the basis of modern neuro-ophthalmology. His research covered multiple fields, including eye anatomy and pathology, relation between light luminance and visual acuity, alcohol-induced loss of vision, color perception, visual acuity, sclera anatomy, cornea and conjunctiva pathology as well as difference in ophthalmologists’ and neurologists’ perception [4]. In 1890, he observed and described a novel symptom of reversible blurriness of vision after a strenuous physical exercise among multiple sclerosis patients. This symptom is known today as Uhthoff’s phenomenon (known also as Uhthoff sign or syndrome). In 1915, he described ophthalmological signs and symptoms of brain tumors, improving the picture of Foster-Kennedy syndrome [5]. During the 1st World War, while examining soldiers with head injuries, in cooperation with Sir Gordon Morgan Holmes (1876–1965), he worked on cortical representation of retinal areas [6]. He also described retinal detachment management, ophthalmological manifestations of intoxications and was an advocate for blind patients [4]. Uhthoff retired in 1923, however, he did not cease his scientific activity, but continued working on publications on acquired research material. He died suddenly of a heart attack as a complication of influenza on March 21, 1927, in Breslau [3].

Human Fragments: Plastic Surgery and Bare Life in Joseph Roth’s Feuilletons

This article examines three of Joseph Roth’s feuilletons in the context of the intersecting discourses of anthropology, medicine, and ethics in post-World War I Europe. Specifically, the article connects Roth’s description of the reconstructive surgery ward at the Charité hospital in Berlin, founded by pioneering surgeon Jacques Joseph, to the political-philosophical notion of “bare life,” in order to show how Roth thereby points to a new concept of human being beyond the prevailing anthropological categories of the time.

Paediatric or pediatric dentistry?

Paediatrics (or pediatrics) is the branch of medicine that deals with the medical care of children. A medical practitioner who specialises in this branch of medicine is known as a paediatrician (or pediatrician), and similarly in dentistry a dental practitioner who specialises in the dental treatment of children is known as a paediatric (or pediatric) dentist or alternatively as a paedodontist (or pedodontist). However, there is much confusion as to which of the two spellings is correct and many are unaware of the etymology (origin) of the word. Many students, general practitioners and indeed specialists have frequently asked “is it paediatric or pediatric dentistry that is the correct spelling?” Further confusion is caused by some podiatry words beginning with “pedo” (relating to feet). In ancient times physicians like Hippocrates understood the differences in growing and developing children and that this necessitated different treatment and management. Byzantine physicians made significant contributions to child care and built baby shelters (children’s hospitals). Later, a Persian physician (Al-Razi, 865–925 CE) published a short treatise on diseases among children and the first printed book on paediatrics (or pediatrics) was in Italian (Bagellardo 1472). Paediatrics (or pediatrics) as a specialised field of medicine developed in the mid-19th century, with the German Abraham Jacobi (1830–1919), who later worked in New York, USA, regarded as the father of paediatrics (or pediatrics). The first paediatric (or pediatric) hospital was the Hopital des Enfants Malades (Hospital for Sick Children), which opened in Paris in 1802 and accepted patients up to the age of 15 years. Following this a separate Paediatric (or Pediatric) Pavillion was created at the Charite Hospital in Berlin in 1830 and later in St. Petersburg (1834), Vienna (1837) and Wroclaw (1837). Great Ormond Street Hospital for Sick Children in London was formed in 1852 and in the USA the first children’s hospitals were the Children’s Hospital of Philadelphia (1855) and then Boston Children’s Hospital (1869). Academically the first University Chair of Paediatrics (or Pediatrics) in the UK was founded in Scotland in 1924 with the appointment of Professor Leonard Findlay. The first Chair of Paediatrics (or Pediatrics) in the USA was established earlier, in 1888, with the appointment of Professor Thomas Morgan Rotch at Harvard. In dentistry the first European Professor of Paediatric (or Pediatric) Dentistry was Gottorm Toverud at the University of Oslo, Norway. Scholarly journals for paediatrics (or pediatrics) were founded from 1884 (Archives of Pediatrics) and the first for paediatric (or pediatric) dentistry was in 1933 (Journal of Dentistry for Children). The American Academy of Pediatric Dentistry was founded in 1947, with its journal Pediatric Dentistry first published in 1978. By comparison, the European Academy of Paediatric Dentistry was founded in 1990 and our own journal was first published in 2000, originally as the European Journal of Paediatric Dentistry and since 2006 as the European Archives of Paediatric Dentistry. The question still remains: “is paediatric or pediatric the correct spelling?” The word paediatric (or pediatric) originates from two Greek words: παiς (pais or paedion = child) and ατρός (iatros = doctor or healer). The Ancient Greek diphthongs\αι[ and\οι[ were transliterated into Latin as \ae[ and \oe[. Therefore, the original spelling in English was “paediatric”. Noah Webster (1758–1843), an American lexicographer and English spelling reformer, K. J. Toumba (&) Department of Paediatric Dentistry, Leeds Dental Institute, Clarendon Way, Leeds LS2 9LU, UK e-mail: k.j.toumba@leeds.ac.uk

Information Based on Knowledge-Orientation Alone Has Minimal Effects in the Long Term

In their article, Stamm-Balderjahn et al show how information delivered by doctors had a primary preventive effect. Students from schools and vocational colleges aged 12–21 were able to participate in the study (the mean age was 16). A relatively high proportion of non-smoking students had never smoked (80%). The prevention program “Schuler in der Klinik [students in hospital]” aimed at educating young people about health-related, personal, and social aspects of tobacco consumption. The information was delivered by doctors in form of a two-hour interactive event in the pulmonary department of a hospital in Berlin. Pediatric psychology research shows that information based primarily on knowledge has limited long-term effects (1), and a multitude of risk factors need to be considered in the prevention of addition (2). Early abnormalities in the regulation of emotions (at nursery-school age) have an equally important role, i.e. a positive attitude towards smoking (2) or a strong need for independence or not having to conform to social norms. Especially socioemotional aspects of childhood development need to be considered in order to prevent addition effectively and in a sustained way. Socioemotional competence relates primarily to the following aspects: the ability to establish positive relationships with peers, self-control, cooperative behavior, positive self-assertion, and appropriate self-confidence. Successful prevention programs take up a lot of time (about 25 sessions) and, in many cases, they are offered to a child/school student repeatedly during the course of their development (start of school, primary school, onset of puberty). In order to stabilize the effect prevention measures need to be provided in an age-appropriate manner suitable to children’s developmental stages. Information provided by doctors for two hours in a lung hospital can be an important string point, but afterwards, socioemotional consequences (relating to the topic of addiction) have to be addressed in school and will have to be practiced repeatedly.