One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.

The prognosis of poisoning with that mushroom is poor. The amount of ingested poison is crucial. Monitoring of kidney function is mandatory when poisoning is suspected. Therapy is directed to symptoms. Usually dialysis has to be commenced. To rule out other causes for kidney damage, a kidney biopsy is required.

Glucocorticoids are irreplaceable for the treatment of connective tissue diseases due to their strong and rapid anti-inflammatory and immuno-modulatory effects. Its use and their dosage depend on the activity of the disease and organ manifestations. There is no alternative to high doses, often even as intravenous pulse therapy, in life-threatening situations with imminent organ failure. Despite an additional immuno- suppressive medication, glucocorticosteroids are mandatory for long-term treatment in most cases. In special situations like high age, gravity or comorbidities like renal failure or hepatosis, glucocorticosteroids are the option with the least possible potential for complications. In the future, new corticosteroids and steroid sparing immuno-suppressants like biologics will be able to reduce the spectrum and the severity of corticoid-induced side effects. Modern state-of-the-art therapeutic regimens for patients with connective tissue diseases should not only be able to sufficiently control the disease activity but also include the prophylaxis of associated comorbidities like arteriosclerosis, osteoporosis or infections.

ZusammenfassungUnter den Bedingungen zunehmender Arbeitsverdichtung ist der ärztliche Stellenschlüssel in deutschen Krankenhäusern immer wieder Ausgangspunkt für Konflikte zwischen leitenden Ärzten und Verwaltung bzw. Träger. Bisher gab es keine publizierten Grundlagen für die Bemessung ärztlicher Vollzeitkräfte (VK) für internistische Normalstationen. Anhand der erfassten Arbeitsaufgaben im zeitlichen Kontext konnte in der vorliegenden Arbeit errechnet werden, dass zur Erfüllung des Versorgungsauftrages für einen internistischen Patienten auf einer rheumatologisch-nephrologischen Normalstation ein Assistenzarzt/Facharzt für 7 Betten und ein Oberarzt für 24 Betten geplant werden müssen. Gesprächs- und Recherche- Leistungen, Ausbildung und Supervision, die Teilnahme am Dienstsystem, Dokumentationsaufwand und Fortbildungsverpflichtungen bilden sich nicht adäquat im derzeitig gültigen DRG- System ab.

ZusammenfassungDie Gicht ist die häufigste metabolische Arthropathie. Obwohl Ätiologie und Pathogenese des Krankheitsbildes gut untersucht sind, bereitet die Diagnosesicherung mittels des Nachweises von Natriumuratkristallen aus einem Gelenkpunktat oder anderen betroffenen Geweben mitunter große Schwierigkeiten. Wir berichten von einem außergewöhnlich schweren Fall einer generalisierten Gichtarthropathie mit atypischer Manifestation und kompliziertem Verlauf. Dabei sollen wichtige Differenzialdiagnosen ausgedehnter ossärer Destruktionen beleuchtet werden.