This description of the burden on care management resulting from acute and subacute changes in clinical and functional status of chronic patients emphasizes the continuing and unpredictable nature of medical attention required in a nursing home or chronic care facility. ACEs occur far more frequently among the elderly than is generally recognized. Thus a high level of medical and nursing skill is necessary in chronic care facilities.
In accordance with the protocol of the European Malignant Hyperpyrexia Group, an account is given of the experience regarding establishment of the "in vitro contracture test" for diagnosis and exclusion of malignant hyperpyrexia disposition at the University Clinic of Leipzig. Since its commencement in 1986 these diagnostic possibilities are being increasingly utilized, and--basing on 76 MH manifestations and suspected cases--324 persons have been examined until now. Besides the representation of the methodical features (e.g. performance of biopsy in tranquanalgesia in children), emphasis was on the safety of executing this test (attaining higher specificity, total absence of MH manifestations). The epidemiological study of the results shows the varying knowledge of physicians and the interference by insufficient investigation alternatives in individual areas. On the basis of the results, the use of the in vitro contracture test is recommended in all MH suspected cases by the authorized and qualified regional centres.
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