Interdisciplinary expert consensus document on management of type B aortic dissection

An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B aortic dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B aortic dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed aortic repair ("complicated chronic aortic dissections"). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B aortic dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.

Language, Thought, Relativism, Nationalism: An Interdisciplinary Study

Ms. Neumer and her team began their project with a critical analysis of the various theories of the relationship between language and thought. Their aim was to develop a theoretical position concerning the issue of universalism versus relativism. This issue is closely bound up with one of the main questions of the history of East and Central Europe, namely, the question of the nation, and the possibility of mutual understanding between national cultures. The team attempted to avoid falling into an all-too-common trap, that of allowing a political perspective to obscure the central theoretical issues. In a project whose outcome totalled over 1000 pages of manuscript in German, English and Hungarian, they touched on cognitive psychological, linguistic, semiotic, socio-semiotic, and other such themes. Their experience has convinced them of the fruitful heuristic possibilities of the interaction of scientific and philosophical approaches in this area of research. A preliminary analysis of the history of philosophy and inquiries into conceptual fields revealed that, in order to reach strong relativist conclusions concerning the unity of thought and language, it is required to take as a point of departure the widest possible sense of these concepts. But in fact, such an option ends up refuting itself: pursuing the premises to their final conclusion one arrives at the restriction of relativism. The team outlined a theory of the understanding of the Other which, borrowing from analytical as well as continental-hermeneutic trends, does not underestimate, on the one hand, the difficulties of understanding between various forms of life, cultures, and languages, but, on the other hand, can provide an alternative solution to the theory of incommensurabiltiy. Within the boundary of this problematic the team studied the problems of translatability, the acquisition of the mother and foreign languages, and natural or cultural determinacy of kind terms. The team regards its most original contribution to be the association of the problem of relativism-universalism and the language-thought relation with contemporary investigations into the question of orality, literacy, and secondary orality. Their conclusion was that, although certain connections can be revealed both between forms of communication and the thesis of the unity of language and thought, and between periods in the history of communication and the predominance of relativistic or universalistic tendencies, forms of communication do not unequivocally determine the answers to these questions.

[The model project "newborn auditory screening" in the Upper Palatinate: high process and result quality of an interdisciplinary concept]

BACKGROUND: In May 2003, a newborn auditory screening program was initiated in the Upper Palatinate. METHODS: Sequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening. RESULTS: A total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center. CONCLUSION: The effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.

Meeting the nutritional requirements of hospitalized patients: an interdisciplinary approach to hospital catering

The study served to assure the quality of our catering, to locate problems, and to define further optimization measures at the Bern University Hospital. The main objective was to investigate whether the macronutrient and energy content of the hospital food complies with the nutritional value calculated from recipes as well as with the recommendations issued by the German Nutrition Society (DGE).