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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 329 (1971), S. 348-348 
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über die Behandlungsergebnisse von 252 Coloncarcinomen aboral der linken Flexur und 60 Rectumresektionen mit zum Teil abdominellen, zum Teil sacralen Anastomosen berichtet, die zwischen 1955 und 1967 an der Chirurgischen Universitäts-Klinik Tübingen stationär aufgenommen wurden. Von 168 radikal möglichen Kontinuitätsresektionen wurden 139 dreizeitig nach Schloffer, 29 einzeitig vorgenommen. Nach 139 dreizeitigen Resektionen verstarb 1 Patient (= 0,7% prim. Op.-Letalität), nach 29 prim. Resektionen kamen 3 Kranke ad exitum (=10% Letalität). Aus Vergleichen mit entsprechenden Literaturangaben ergibt sich, daß die umständliche Schloffersche Methode maximale Sicherheit bietet bei einer hohen Gesamtresektionsquote (72,5%). Die Spätergebnisse wurden in Abhängigkeit vom Tumorstadium (nach der TNM-Klassifikation) anhand der 5-Jahresüberlebenskurven dargestellt: 73% der in Stadium I und II operierten Patienten überlebten die 5-Jahresgrenze, aber nur 40% der in Stadium III und 16% der in Stadium IV behandelten Fälle. 55% aller radikal Resezierten erreichten die 5-Jahresgrenze.
    Notes: Summary The results of treatment in 252 carcinomas of the colon, aboral of the left flexure and 60 resections of the rectum, some with abdominal and some with sacral anastomoses, are reported. All the patients had been admitted for treatment to the Surgical University Clinic, Tilbingen, between 1955 and 1967. Of 168 cases where radical resection was possible, 139 were operated according to Schloffer's 3-stage method, and 29 had one-stage operations. Of 139 patients who underwent 3-stage operations, one died (=0.7% prim. op. mortality) and of the 29 primary resections, 3 patients died (=10% mortality). On comparing this with the corresponding literature, it is shown that the laborious Schloffer method gives maximum safety, while the total number of resections performed is kept high (72.5%). Long-term results are given, related to the stage of the tumour (according to the TNM classification) and based on 5-year survival curves. 73% of the patients operated on in Stages I and II survived the 5-year survival line, but only 40% of the patients treated in Stage III and 16% of those treated in Stage IV survived the 5 years. 55% of all the patients who underwent radical resection reached the 5-year limit.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    s.l. : American Chemical Society
    The @journal of organic chemistry 29 (1964), S. 3723-3725 
    ISSN: 1520-6904
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1420-908X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1420-908X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Inflammation research 6 (1976), S. 147-153 
    ISSN: 1420-908X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Plasma kininogen levels in the peripheral venous blood of untreated patients with active rheumatoid disease was found to be more than twice the levels measured in healthy normal individuals or in convalescing uncomplicated fracture patients. Treatment with oral indomethacin or aspirin lowered the kininogen levels nearly to normal. Sequential studies showed that the fall in kiniogen was very rapid, occurring within 1–2 hours of ingestion of drug, and was parallelled by reduction in the clinical indices of inflammation. Control studies showed that the kininogen changes were not due to changes in plasma volume or non-specific changes in plasma protein concentration. Indomethacin treatment had no effect on plasma kininogen levels in healthy volunteers. The significance of this finding will be discussed.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Cellular and molecular life sciences 45 (1989), S. 337-339 
    ISSN: 1420-9071
    Keywords: Heart muscle ; opioids ; morphine ; ethylketocyclazocine ; cardiac function ; presynaptic modification
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Summary The opioid agonists morphine (selective for μ-receptors) and ethylketocyclazocine (selective for kappa-receptors), at concentrations evoking strong effects in neuronal structures, did not significantly affect the configuration of the intracellularly recorded action potential and the force of contraction in ventricular heart muscle isolated from guinea pigs, rabbits and man. These results suggest that any changes of heart functions in vivo in response to opioid-like drugs are probably not mediated postsynaptically at the myocardial cell membrane but rather presynaptically, influencing the release of noradrenaline and/or acetylcholine from the nerve terminals.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Kardiopulmonale Reanimation: Defibrillation – Halbautomatische Defibrillatoren –Überlebensrate – Neurologische Langzeitprognose – Rettungssystem: Behandlungsqualität – Logistische Strukturen ; Key words: Cardiopulmonary resuscitation: defibrillation – Semi-automatic defibrillators – Survival – Neurology – Emergency medical services systems: quality – Logistic structures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? Methods. The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation (VF) as first ECG rhythm. Prior to the onset of the study, all EMTs of the participating EMS systems were retrained in basic life support (BLS) measures. In each center, randomly assessed EMT-Ds (EMTs trained in Defibrillation) were trained to use semiautomatic defibrillators. With the help of one-line tape recording, the time intervals during resuscitation and treatment steps were evaluated. Successfully resuscitated patients were followed up with the help of the Glascow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories. Results. From 1 February 1991 until 28 June 1992, 159 patients with VF were randomized. In 121 cases, collapse was witnessed. 25% (14/57) of the patients receiving defibrillation by EMT-Ds (study group=S) were discharged from the hospital alive. In the control group, 52 patients were defibrillated by emergency physicians, following BLS by EMTs [control group 1=C1; discharged: 29% (15/52)]. Fifty patients received BLS and advanced cardiac life support (ACLS) by the emergency physicians crews [control group 2=C2; discharged 18% (9/50)]. In the study group, the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min, 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier (P〈0.05) in the control groups, as compared to the study group [S: 13 min, C1: 11 min; C2: 10.3 min]. Sixty-seven percent (30/45) of the study patients and 46% (36/76) of the control patients were defibrillated within 12 min. Study patients were defibrillated earlier (P〈0.05) (S: 9.9 min; C1: 12.2 min; C2: 12.75 min); return of spontaneous circulation (ROSC) was achieved earlier (P〈0.05) in the study group [S: 14 min; C1: 19 min; C2: 18.2 min] and the number of patients in the study group requiring no epinephrine during resuscitation was higher (P〈0.01) than in the control groups [S: 35.3% (12/34); C1: 10% (4/40); C2: 10.5% (4/38)]. Furthermore, the total amount of epinephrine [mean (±standard error)] administered in the study group [S: 2.35 (±0.49) mg; C1: 6.71 (±0.98) mg; C2: 7.71 (±1.31) mg] was significantly lower (P〈0.05). No significant differences in neurological long-term prognosis were found for the groups investigated. Conclusion. Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibrillators; (c) the consistent implementation of a tiered EMS.
    Notes: Zusammenfassung. In einer prospektiven Multicenterstudie wurde der Einfluß der Defibrillation durch Rettungsassistenten im Vergleich zum bisher praktizierten Verfahren (Basismaßnahmen der kardiopulmonalen Reanimation durch Rettungsassistenten und Defibrillation ausschließlich durch den Notarzt) auf die Überlebensrate und die neurologische Langzeitprognose bei 159 Patienten mit außerklinisch aufgetretenem Kammerflimmern untersucht. Alle Zeitintervalle des Reanimationsablaufs und die Behandlungsqualität wurden mittels Diktaphon erfaßt und nachvollzogen. Es bestanden keine signifikanten Unterschiede in der primären Überlebensrate, der Entlassungsrate und der neurologischen Langzeitprognose zwischen den untersuchten Gruppen. Aufgrund deutlicher Unterschiede zugunsten der Studiengruppe (Defibrillation durch Rettungsassistenten) in indirekten Parametern (kürzerer Zeitraum bis zur Wiederherstellung spontaner Kreislaufverhältnisse und größere Anzahl an Patienten, die kein Adrenalin benötigten) und der Tatsache, daß in den untersuchten Zentren der Zeitpunkt bis zur ersten Defibrillation signifikant nach vorne verlagert werden konnte, empfehlen wir die Defibrillation durch Rettungsassistenten: a) wenn sie den Patienten vor dem Notarzt erreichen, b) nach straffem Ausbildungsprogramm und unter kontinuierlicher ärztlicher Kontrolle. Um die Defibrillationsmaßnahme durch Rettungsassistenten effektiver werden zu lassen, müssen tiefgreifende Veränderungen im Rettungssystem vorausgehen: Verkürzung des Zeitintervalls bis zum Beginn von Basismaßnahmen sowie konsequente Durchführung eines gestaffelten Rettungssystems.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 43 (1994), S. 187-193 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter:Ärztlicher Notfalldienst – Leitstelle – Notarzt – Notrufnummer – Rettungsdienst ; Key words: Dispatching centers – Emergency calls – Emergency medical service – Emergency physicians – General practitioners service
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. There is no doubt that a single emergency phone number is desirable, but in contrast to other countries, in Germany different emergency phone numbers and dispatching centers exist for the fire brigade (FB), the emergency medical service system (EMS), and the general practitioners' emergency service (GPS). Due to this fact, valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another. The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number, fraction of emergency calls, and specificity. Further, the total number of calls potentially referring to a hypothetic single dispatching center with a general emergency phone number (112) was calculated. During a 4-month period, all telephone calls were registered and related to day, time, and origin of the call (city or county) and classified as non-urgent or emergency calls, calls appropriate to the dispatching center dialed, emergency calls to be transferred, or unspecific calls. A total of 80 987 calls were received (city area 84.3%, county area 15.7%), most of them directed to the FB of Mainz (33 086). The EMS dispatching center received 31 286 calls, the five GPS-centers 15 256 calls; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS. During weekdays the EMS and FB received the most calls, with a reduced frequency on Saturdays and Sundays (Table 2). Nevertheless, the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS. The FB had the highest specificity of calls; more than 50% of the calls to the GPS were unspecific (Fig. 1). Of all calls, 4.37% were classified as emergency calls; two-thirds of these came from the area of Mainz during the daytime. During off-duty hours of the GPS in the city, 51% of the emergency calls reached the EMS directly; 49% had to be connected by the police or FB. During duty hours of the GPS, the fraction of calls directed to the EMS decreased significantly to 35%. During duty hours of the GPS centers in the county area, only 14% of the urgent emergency calls reached the EMS dispatcher directly (Fig. 2). Compared to the multiple-center mode, a hypothetic single dispatching center for all systems would probably be followed by a slight increase in total number of calls due to the fact that the GPS numbers would be answered 24 h a day, but there would be only minimal differences in the total number received on most days; only on Sundays would a decrease be expected. The EMS area of Mainz, with a total of 13 different telephone numbers for 7 dispatching centers, can be regarded as typical of the German situation. The high number of emergency calls to be transferred (up to 86% under special circumstances) demonstrated that this weak point in the German EMS system must be eliminated by introducing a single emergency number. This should occur when a Europe-wide three-digit number "112" will be instituted, probably in 1995. Additionally, the continued existence of 5- or 10-digit telephone numbers for non-urgent calls may be useful for allowing non-verbal differentiation of calls. In any case, all telephone numbers, including the latter calls, have to enter one dispatching center. The main advantage of a single dispatching center would be avoidance of the time-consuming transfer of emergency calls from one dispatching center to the other.
    Notes: Zusammenfassung. In Deutschland existieren unterschiedliche Notrufnummern, über die sowohl nicht dringliche Hilfeersuchen als auch Notrufe an die jeweiligen Einsatzzentralen gerichtet werden. Durch Weitervermittlung wird häufig wertvolle Zeit uneinholbar verloren. Mit einer viermonatigen, repräsentativen Analyse wurde daher das gesamte Anrufvolumen, der Anteil von Notrufen, der Anteil von Notrufweiterleitungen analysiert sowie das potentielle Anrufvolumen einer hypothetischen einheitlichen Notrufnummer errechnet. Insgesamt wurden 80 987 Anrufe, die zu 84,3% aus der Stadt Mainz stammten, registriert. Die meisten Anrufe gingen bei der Berufsfeuerwehr Mainz ein (33 086), gefolgt von der Rettungsleitstelle Mainz (31 286) und den Ärztlichen Notfalldienstzentralen (15 256). In dem Gesamtanrufaufkommen waren 3542 Notrufe enthalten (4,37%). 67% dieser Notrufe stammten aus dem Stadtgebiet. Im Stadtgebiet Mainz wurden außerhalb der Dienstzeiten des ärztlichen Notfalldienstes 51% der Notrufe primär an die Rettungsleitstelle gerichtet (Abb. 2). Während der Dienstzeiten der Ärztlichen Notfalldienstzentrale Mainz verringerte sich dieser Anteil auf 35%. Im Kreisgebiet erreichten während der Dienstzeiten der Ärztlichen Notfalldienstzentralen nur 14% der Notrufe primär die Rettungsleitstelle. Bei Hilfeersuchen an nur eine einheitliche Notrufzentrale wäre eine gleichmäßigere Auslastung der Leitstelle zu erwarten. Der Rettungsdienstbereich Mainz-Bingen mit insgesamt 13 verschiedenen Notrufnummern ist durchaus als typisch für die deutsche "Notrufvielfalt" anzusehen. Der hohe Anteil von Notrufen, die weitervermittelt werden mußten (bis zu 86%) zeigt, daß diese Schwachstelle des Rettungssystems nur mit einer einheitlichen Notrufzentrale und einer generellen Notrufnummer 112 beseitigt werden kann.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 47 (1998), S. 957-967 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Evidence Based Emergency Medicine ; Studiendesign ; Ethik ; CAD ; Metaanalyse ; Key words Evidence Based Emergency Medicine ; Study design ; Ethics ; CAD ; Metaanalysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Evidence Based (Emergency) Medicine (EB(E)M is a term referring to the application into daily clinical practice of only those methods, procedures, medications etc. which are based on scientific evidence.Where diagnostic and therapeutic principles have not been validated on a prospective, controlled randomised basis, this should be tried out at a later time, if at all possible. This concept may allow to bridge the gap between research and clinical practice, and represents the major goal of EB(E)M. Protagonists of EBEM are at times confronted with criticism that EBEM does not constitute the only but one out of several possible approaches to quality controlled medical care. The fact that more than 50% of all emergency procedures are not evidence based give rise to the question as to whether the performance of randomised controlled studies is ethically justifiable, if control groups are included whose treatment leaves out generally recommended and recognised (though not evidence based) therapeutic and/or diagnostic principles. The following examples may enumerate some of the procedures, methods or medications, respectively, without proven scientific evidence: ·*Medication for resuscitation of cardiac arrest victims ·*Medication for acute asthmatic attacks ·*Initial treatment of uncontrolled haemorrhagic shock ·*Endotracheal intubation in VF/VT ·*The principle need for initial ventilation and the volumes of ventilation in cardiac arrest patients ·*Effectivenes of ACD- and VEST-CPR. A few typical examples are presented to illustrate the requirements of current study designs which have to be met before results of an evaluation are accepted by the EBEM scientists to obtain approval for application of a procedure, method or medication in clinical practice (large patient numbers, power calculations, ethical issues) as well as their benefits and drawbacks.
    Notes: Zusammenfassung „Evidence Based Emergency Medicine” (EBEM) ist ein Begriff, der im Zusammenhang mit Qualitätsmanagement immer häufiger verwendet wird. Er soll letztlich zum Ausdruck bringen, daß Effektivität und Effizienz von Methoden, Verfahren, Medikationen etc. – wo immer möglich – durch wissenschaftliche Beweise (erhoben in kontrollierten Studien oder abgeleitet aus Metaanalysen, aber auch beruhend auf „State of the Art Reviews”) belegt werden müssen, bevor sie in die ärztliche Praxis umgesetzt werden.Wo dies nicht oder nicht mehr möglich ist, muß versucht werden, die zugrundeliegenden diagnostischen und therapeutischen Prinzipien im Nachhinein zu validieren. Nur so kann die Lücke zwischen Forschung einerseits und klinischer Praxis andererseits überbrückt und zugleich überwunden werden. Den Befürwortern einer strikten EB(E)M stehen Skeptiker gegenüber,die EB(E)M nur als eines von mehreren möglichen Konzepten verstanden wissen möchten. Angesichts der Tatsache, daß vermutlich mehr als die Hälfte notfall- und intensivmedizinischer Methoden nicht „evidence based” angewendet wird, stellt sich auch die Frage, ob randomisierte Studien mit Kontrollgruppen, die das Auslassen etablierter – wenn auch wissenschaftlich nicht bewiesener klinischer – Prinzipen beinhalten, ethisch vertretbar sind. Markante Beispiele solcher Verfahren, für die in jüngster Zeit ein wissenschaftlicher Beweis angemahnt wird, sind u.a.: ·*die medikamentöse Behandlung des Herzkreislaufstillstands, ·*die Notfallmedikation beim Asthmaanfall, ·*die initiale Schocktherapie bei unkontrollierbaren traumatischen Blutungen, ·*die endotracheale Intubation beim Patienten mit Kammerflimmern, ·*die Notwendigkeit und ggf. das Ausmaß der initialen Beatmung bei Patienten mit Herzkreislaufstillstand, ·*die ACD- bzw. Vest-Reanimation Anhand einzelner typischer Beispiele, aber auch anhand der Anforderungen an Designs moderner Studien (Patientenzahlen, Powerkalkulation, Realisierbarkeit etc.) werden bei Würdigung der Forderungen nach EBEM deren Probleme und Gefahren (Verweigerung der Kostenübernahme nicht EBEM basierter Verfahren durch die Kostenträger und Administratoren etc.) verdeutlicht.
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  • 10
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Klinische Studien ; Klassifikation ; Notfallmedizin ; Planung ; Durchführung ; Key words Clinical trials ; Classification ; Emergency medicine ; Design ; Conduct
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Clinical studies are usually conceived of as controlled randomized trials, as retrospective patient statistics or as single case reports. However, such a classification is too narrow and overlooks many other forms of study designs. This review, therefore, offers a more encompassing and practical classification of clinical studies for the field of emergency medicine. Randomized controlled trials fulfill scientific criteria at the highest level (gold standard): comparison, repeatability, objective measurement. At the same time, randomized trials also have to comply with demanding ethical criteria and must be justifiable in the individual patient. Therefore, comparable uncertainty with regard to the superiority of the treatment options under investigation is a sine qua non. In addition to randomized trials, six other groups of clinical trials have the potential to solve scientific questions in emergency medicine: observational studies, decision analysis, meta analysis, public health care studies, case reports and descriptive summary statistics and studies on ethical problems. This variability in trial designs calls for a clinically oriented methodologist; the concept and institutionalization of theoretical surgery has been a response to this demand. All study types in this review are illustrated by examples in emergency medicine. Literature for advanced reading in particular trial methodologies can be found in the reference list. A checklist summarizes all elements for designing and conducting randomized trials in emergency medicine. All clinical trials striving for a high standard of quality – whether randomized or not – depend on the following prerequisites: professional organization, time effort, a supportive social environment and a scientific culture.
    Notes: Zusammenfassung Bei klinischen Studien wird in erster Linie an kontrollierte randomisierte Studien, an retrospektive Serienberichte und an Einzelfallberichte gedacht. Diese Klassifikation ist aber viel zu eng und übersieht die vielen Möglichkeiten und Notwendigkeiten von andersartigen Studienplänen und -durchführungen. Prospektive kontrollierte randomisierte Studien sind experimentelle Studien an Patienten mit dem höchsten Anspruch an Wissenschaftlichkeit (Goldstandard), aber nur unter strengsten ethischen Prämissen: therapeutische Vertretbarkeit im Hinblick auf den jeweiligen Patienten und deshalb vergleichbare Ungewißheit für die Überlegenheit eines Verfahrens am einzelnen Patienten. Daneben gibt es sechs weitere Gruppen von Studienarten, die für die Lösung notfallmedizinischer Probleme benötigt werden, und diese Gruppen haben eine Serie von speziellen Ausprägungen. Dies macht den anwendungsorientierten klinischen Methodiker so notwendig, die Entwicklung der Theoretischen Chirurgie findet darin ihre Erklärung. Für jede Studienart werden in dieser Übersicht Beipiele aus der Notfallmedizin und Literaturstellen angegeben, wo das methodische Rüstzeug für die speziellen Studienausprägungen zu finden ist. Eine Checkliste für die Planung einer randomisierten kontrollierten Studie schließt die Arbeit ab, zusammen mit dem Beispiel der Mainz-Marburg Studie zum perioperativen Risiko. Alle klinischen Studien mit Qualität, nicht nur die kontrollierten randomisierten Studien, verlangen eine professionelle Organisation, Zeit sowie ein soziales Umfeld und eine Studienkultur, die solche wissenschaftlichen Leistungen gedeihen lassen.
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