GMS Krankenhaushygiene interdisziplinar最新文献

{"title":"Decontamination of room air and adjoining wall surfaces by nebulizing hydrogen peroxide.","authors":"Torsten Koburger,&nbsp;Harald Below,&nbsp;Tina Dornquast,&nbsp;Axel Kramer","doi":"10.3205/dgkh000166","DOIUrl":"https://doi.org/10.3205/dgkh000166","url":null,"abstract":"<p><strong>Aim: </strong>In 2010, the ASP GLOSAIR(TM) 400 was introduced in Germany for nebulizing hydrogen peroxide (H(2)O(2)). Since there were no results of practical experience, the new method was to be checked under practical conditions for its effectiveness in decontaminating air in rooms, infested with mold after water damage and, at the same time, under experimentally controlled conditions, test surfaces, contaminated with Aspergillus brasiliensis.</p><p><strong>Method: </strong>After the nebulizer was used in two rooms with a massive mold infestation, the air colony count was determined (MAS-100(®) Zinsser Analytik) and, at the same time, the mold infestation in samples of wall plaster.As part of this controlled study, test surfaces contaminated with Aspergillus brasiliensis were positioned vertically and horizontally in a test room. The effectiveness of the nebulization (5-6% H(2)O(2) for 2 hours) was tested on these surfaces according to EN 13697.</p><p><strong>Results: </strong>In a massive mold infestation resulting from water damage (worst case), an approximately 9-fold decrease in the mold content and an approximately 13-fold decrease in the number of colony-forming units (sum of the bacteria + fungi) could be detected in the room air immediately after the nebulizing was finished. Even in samples of wall and joint plaster, the molds were reduced, although to a distinctly lesser extent. By indoor nebulization of 5-6% H(2)O(2), A. brasiliensis was reduced >4 log on vertical and horizontal surfaces.</p><p><strong>Discussion: </strong>In rooms with a massive mold infestation, the ASP GLOSAIR(TM) 400 system is suitable for attaining a clear reduction in the fungal and bacterial room air load, lasting for a week. On vertical and horizontal surfaces, contaminated experimentally with A. brasiliensis, a reduction of >4 lg is achieved. As a load of 10(4) to 10(5) fungal spores is unlikely to occur on pre-cleaned surfaces, the GLOSAIR(TM) 400 can be considered a suitable complementary process for the substantial reduction of fungal contamination.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc09"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical results of the application of a hemoglobin spray to promote healing of chronic wounds.","authors":"Peter Arenberger,&nbsp;Peter Engels,&nbsp;Monika Arenbergerova,&nbsp;Spyridon Gkalpakiotis,&nbsp;Francisco Javier García Luna Martínez,&nbsp;Americo Villarreal Anaya,&nbsp;Laura Jimenez Fernandez","doi":"10.3205/dgkh000162","DOIUrl":"https://doi.org/10.3205/dgkh000162","url":null,"abstract":"<p><p>A new technological approach for supplying hypoxic chronic wounds with oxygen is a moist wound treatment with aqueous solutions containing tissue compatible oxygen binders. This facilitates diffusion of oxygen, necessary for the healing process, from the surroundings (room air through an open-porous wound padding) into the ulcerous tissue. A product that is still in development is a spray which contains hemoglobin obtained from domestic pigs. Clinical investigations (a clinical trial, treatment observations and single patient uses) are presented, which were performed to create clinical data regarding efficiency and safety of this product. All data have shown that the application of the hemoglobin spray promoted wound healing in all analyzed cases.Data from a clinical study in Mexico and subsequent therapy observations revealed that in 39 out of 42 patients (93%) the treated wounds were healed. 9 patients from a series of therapy observations in Monterrey (Mexico) showed similar observations. All treated wounds were closed. Single patient uses carried out in Witten (Germany; 6 wounds from 8 (75%)) and Prague (Czech Republic; 5 wounds from 5 (100%) were healed) further support these results: The application of hemoglobin spray can promote healing of chronic wounds. Within the framework of the clinical investigation, the treatment observations, and the individual healing experiments the hemoglobin spray was applied more than 2,000 times onto chronic wounds of 82 patients. In all cases, the spray was well tolerated and there were no adverse event that might have been an adverse reaction to the hemoglobin spray.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc05"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual infections: Femoral abscess due to Nocardia abscessus in a patient suffering from metastatic peripheral bronchial carcinoma and hygienic consequences.","authors":"Georg Daeschlein,&nbsp;Atteyet-Alla Fetouh Yassin,&nbsp;Andreas Franke,&nbsp;Axel Kramer,&nbsp;Klaus-Peter Schaal","doi":"10.3205/dgkh000160","DOIUrl":"https://doi.org/10.3205/dgkh000160","url":null,"abstract":"<p><p>During the course of a peripheral bronchial carcinoma with pulmonary and cerebral metastases a femoral abscess developed in a 49 year-old patient after radio- and chemotherapy. A bacterial strain, which was isolated four times from a deep wound of the left thigh was tentatively identified as a member of the genus Nocardia on the basis of selected phenotypic and chemotaxonomic characteristics. The isolate was confirmed to belong to Nocardia abscessus by 16S rRNA gene sequencing. This species had previously been described as the causative agent of soft tissue infections. Although rare, nocardia soft tissue infections as complication of systemic nocardiosis are typical air born infections of immuncompromised patients and need specific attention. Infection prevention can be realized by restriction of soil and aerosol (builder's dust) together with antibiotic intervention (oral administration of trimethoprim/sulfamethoxazole).</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uniform documentation of measures in cases of MRSA - an important step towards improving the quality of treatment.","authors":"Vicki Strübing,&nbsp;Thomas Dittberner,&nbsp;Claudia Metelmann,&nbsp;Nils-Olaf Hübner","doi":"10.3205/dgkh000178","DOIUrl":"https://doi.org/10.3205/dgkh000178","url":null,"abstract":"<p><p>The basis for the management and documentation of multiresistant organisms (MRO) in medical facilities in Germany are the Infection Protection Act (IPA) and the recommendations given by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO).With the Infection Protection Amendment Act an accounting capability for the treatment of patients with MRO will be established in the outpatient care sector. At the same time an electronic documentation is required. In order to comply with the law demanding that the transfer of data concerning the carrier status of a patient should be done without any delays or errors and with minimal effort. Therefore, the documentation should be done according to standards across all sectors and institutions.The documentation of services by multiple providers is to plan with all stakeholders in order to meet the requirements for a proper and professional documentation.The sheet developed in the framework of the HICARE project allows documenting the decolonisation process across sector and service providers. Additionally, it is approved by the MDK MV for documenting the additional efforts to claim the OPS 8-987.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc21"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The project HICARE: cross-sectoral action alliance against multi-resistant pathogens.","authors":"Roland Linder,&nbsp;Isabell Thoms,&nbsp;Ingo Pfenning,&nbsp;Rolando Schadowski,&nbsp;Volker Möws","doi":"10.3205/dgkh000182","DOIUrl":"https://doi.org/10.3205/dgkh000182","url":null,"abstract":"<p><p>Multi-resistant pathogens are a serious problem on a considerable scale for the health sector. Patients with infections induced by multi-resistant bacteria cause enormous additional treatment costs of around 20,500 € per insured. Due to the recently used billing and documentation system there is a significant shortage of information transparency. The guidelines for hospital hygiene and infection prevention published by the Robert Koch Institute (RKI) include a presumption provision, which means that subject to compliance with these guidelines the observance of the current state of medical science is suspected. In case of a derogation, a scientific justification is necessary, which is used e.g. in connection with liability questions. Within the framework of legal reforms in 2011, the legislator aspires a nationwide improvement of hygiene quality in medical institutions and information transparency. Many specific issues about the general reporting obligation of infections with multi-resistant pathogens or about the standardized exchange of infection documentations between medical institution and health authority remain unresolved.Regional, cross-sectoral networks create the base to tackle targeted measures collectively and may develop sustainable and tailored solutions for their region. With these considerations in mind, the project HICARE was founded in Mecklenburg-Vorpommern. The project pursues the aim to develop an intervention strategy against the spread of multi-resistant pathogens. Health insurances make an important contribution to quality of medical treatment by participation.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc25"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistently elevated IgA antibodies to Mycoplasma pneumoniae in patients with internal carotid artery stenosis.","authors":"Florian Daxböck,&nbsp;Afshin Assadian,&nbsp;Thomas Watkins-Riedel,&nbsp;Ojan Assadian","doi":"10.3205/dgkh000161","DOIUrl":"https://doi.org/10.3205/dgkh000161","url":null,"abstract":"<p><strong>Background: </strong>It has been suggested that Mycoplasma pneumoniae may play a role in the development of atherosclerosis, but to date this association is still a matter of debate due to conflicting findings.</p><p><strong>Methods: </strong>We have investigated the levels of specific IgA antibodies to M. pneumoniae in 91 patients with internal carotid artery (ICA) stenosis using a commercial kit (SeroMP™ IgA; Savyon Diagnostics, Israel; cut-off value: 20 binding units; BU). All patients underwent surgery for ICA stenosis. From each patient, the first serum sample (S1) was taken before surgery, and the second after an interval of 6 month (S2).</p><p><strong>Results: </strong>The S1 seroprevalence was 18.7% (17/91). Thirteen of the 17 patients with positive S1 levels also remained positive after six month, whereby no decrease of IgA level was seen (median S1 level: 34 BU, range: 22-65 BU; median S2 level: 37 BU, range: 22-58 BU). Specifically, six of the patients showed an increased level after 6 months, and six a decrease, with the level remaining constant in one patient. In contrast, only 3 of the 74 S1 negative patients became positive for anti-M. pneumoniae IgA between the taking of the first and the second serum specimen (p<0.01). None of the assessed demographic factors or risk factors for atherosclerosis was associated with IgA seropositivity, neither were the degree CAVK or the degree of stenosis.</p><p><strong>Conclusion: </strong>These findings cannot be explained throughout by the general seroprevalence, or by past respiratory tract infections with the pathogen, and therefore may suggest a role for M. pneumoniae in the development of atherosclerosis, since a chronic infection must be assumed.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc04"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the Hazard Assessment and Critical Control Points (HACCP) system be used to design process-based hygiene concepts?","authors":"N-O Hübner,&nbsp;S Fleßa,&nbsp;J Haak,&nbsp;F Wilke,&nbsp;C Hübner,&nbsp;C Dahms,&nbsp;W Hoffmann,&nbsp;A Kramer","doi":"10.3205/dgkh000181","DOIUrl":"https://doi.org/10.3205/dgkh000181","url":null,"abstract":"<p><p>Recently, the HACCP (Hazard Analysis and Critical Control Points) concept was proposed as possible way to implement process-based hygiene concepts in clinical practice, but the extent to which this food safety concept can be transferred into the health care setting is unclear. We therefore discuss possible ways for a translation of the principles of the HACCP for health care settings. While a direct implementation of food processing concepts into health care is not very likely to be feasible and will probably not readily yield the intended results, the underlying principles of process-orientation, in-process safety control and hazard analysis based counter measures are transferable to clinical settings. In model projects the proposed concepts should be implemented, monitored, and evaluated under real world conditions.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc24"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of multi-resistant organisms - challenges to a regional data management system.","authors":"Miriam G Gerlich,&nbsp;Andreas Möller,&nbsp;Christian Schäfer,&nbsp;Anne-Kathrin Strohbach,&nbsp;Janina Krafczyk-Korth,&nbsp;Wolfgang Hoffmann","doi":"10.3205/dgkh000183","DOIUrl":"https://doi.org/10.3205/dgkh000183","url":null,"abstract":"<p><p>The health care region Baltic Coast is within the framework of the joint project HICARE (Health, Innovative Care & Regional Economy) to be developed from January 2011 to December 2014 into a model region to combat the spread of multi-resistant organisms (MRO). The concept of the project area \"IT & Epidemiology\" will be introduced here. An IT system is to be developed and implemented consisting of two interconnected elements, a central data management and a web-based support system for information and decision. Particular challenges are the consolidation of data decentrally collected from numerous and heterogeneous data sources, compliance with the data privacy protection laws and the complex management of patients' informed consent. The information collected by the central data management will be the basis of epidemiological evaluations. Prevalence and incidence of MRO in patients and staff of medical facilities, single risk factors as well as risk profiles, the range and extent of treatments including their effectiveness and sustainability will be investigated. Furthermore, cost and cost-utility analyses will be performed.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc26"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30383465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological safety and cost-effectiveness of weekly breathing circuit changes in combination with heat moisture exchange filters: a prospective longitudinal clinical survey.","authors":"Nils-Olaf Hübner,&nbsp;Georg Daeschlein,&nbsp;Christian Lehmann,&nbsp;Sergei Musatkin,&nbsp;Ute Kohlheim,&nbsp;Andreas Gibb,&nbsp;Ojan Assadian,&nbsp;Hiroyoshi Kobayashi","doi":"10.3205/dgkh000172","DOIUrl":"https://doi.org/10.3205/dgkh000172","url":null,"abstract":"<p><strong>Aim: </strong>To assess the safety and cost effectiveness of a usage for seven days of breathing circuit systems (BCSs) in combination with heat moisture exchanger filters (HMEF) in operation room anesthesia.</p><p><strong>Method: </strong>In a prospective longitudinal clinical study, the contamination on high-risk surfaces (HMEF together with inner and outer surface of BCS) was monitored over 1, 2, 5, and 7 days. RESULTS of endogenous respiratory patient flora and contamination flora of BCS, HMEF and bag were compared. Costs of prolonged use of BCS together with HMEF up to 7 days were calculated.</p><p><strong>Results: </strong>Neither physiological respiratory flora nor colonizing pathogens of the oropharynx of the ventilated patients were transmitted through the filters at any time. None of the included patients developed a postoperative pneumonia. Using the BCS for 24 hours provides a cost savings of up to 40% versus single use. Extending the change interval from 24 hours to 48 hours saved over 50% compared to change after each patient, and an additional 19% compared to change after 24 hours. In combination with a HMEF BCS can be used up to 7 days without clinical risk on multiple patients in operation room settings.</p><p><strong>Conclusion: </strong>Expanding the usage of berating in combination with usage of moist exchange filters is feasible, microbiologically safe and cost effective, as 41% of material costs per ventilation may be saved. Further research is needed to confirm these results.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc15"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30385000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care German hospitals - results from a pilot study of the German Society for Hospital Hygiene (Deutsche Gesellschaft für Krankenhaushygiene, DGKH).","authors":"Axel Kramer,&nbsp;Sylvia Ryll,&nbsp;Christian Wegner,&nbsp;Lutz Jatzwauk,&nbsp;Walter Popp,&nbsp;Nils-Olaf Hübner","doi":"10.3205/dgkh000177","DOIUrl":"https://doi.org/10.3205/dgkh000177","url":null,"abstract":"<p><strong>Objective: </strong>Data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (ESBL) Gram negative organisms, multiresistant Pseudomonas and Acinetobacter species or toxin-building Clostridium difficile in German hospitals are sparse. To provide data for different regions in Germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of February 2010.</p><p><strong>Method: </strong>For participating hospitals, the level of care (primary/secondary/tertiary), staffing with infection prevention personnel, availability of a MRSA-screening, microbiological support and the prevalence of five emerging bacterial pathogens in intensive care, surgical and medical wards was assessed by questionnaire.</p><p><strong>Results: </strong>Overall, 3411 patients were included. In tertiary hospitals, the following prevalences were given: MRSA 1.8%, ESBL E. coli 0.45%, ESBL Klebsiella spp. 0.41%, multiresistant Pseudomonas 0.53%, multiresistant Acinetobacter species 0.15%, VRE 0.49% und Clostridium difficile 1.01%. In secondary hospitals, as prevalences resulted for MRSA 3.48%, ESBL E. coli 0.4%, ESBL Klebsiella spp. 0.4%, multiresistant Pseudomonas 0%, multiresistant Acinetobacter species 0%, VRE 0.13% und Clostridium difficile 1.34%.</p><p><strong>Discussion: </strong>The prevalence of MRSA found is comparable to other prevalence studies published in the last years, but remarkably higher than reported by the German National Surveillance System (KISS). As no prevalence data for other pathogens as MRSA could be found, only data from the ITS-KISS are available for comparison. Again, the prevalences found in the present study are much higher than reported by the KISS. Whether this is by chance or indicates a systematic underreporting in the KISS remains unclear.</p><p><strong>Conclusion: </strong>The results from this one day point prevalence study show that prevalences of emerging bacterial pathogens differ markedly between regions, departments and hospitals. This can be explained by regional, methodical and other difference associated with the level of care provided by these hospitals. Still, the prevalences found fit well to other prevalence studies from the last years but are remarkably higher than to be expected by the KISS. As questionnaire-based one-day prevalence studies have been shown to be inexpensive and feasible, such studies, using a fixed day and protocol, should be extendedly used in the future to collect representative data for Germany. By such initiatives, scientific societies as the DGKH can take part in collecting valuable epidemiological data of emerging bacterial pathogens.</p>","PeriodicalId":88496,"journal":{"name":"GMS Krankenhaushygiene interdisziplinar","volume":"6 1","pages":"Doc20"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/dgkh000177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30385005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}