Klinische Studien außerhalb von Universitätskliniken

The demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006.The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article.     

Universitätskliniken im Spannungsfeld des Krankenhausmarktes

Zusammenfassung In den letzten Jahren manifestierte sich im deutschen Gesundheitssystem ein Trend zu stärkerer Ökonomisierung. Damit ist eine Intensivierung des Wettbewerbs zwischen den Krankenhäusern verbunden. Die Folge ist, dass Krankenhäuser ihre Position am Markt erkämpfen und behaupten müssen. Bei den Universitätskliniken kommt erschwerend hinzu, dass sie als Forschungs- und Lehreinrichtungen in diesem Wettbewerb mit ungünstigen Kostenstrukturen arbeiten müssen. Zusätzlich wird dieser Wettbewerbsnachteil durch die gesetzlich vorgegebene Verpflichtung zur Sicherung der Maximalversorgung der Bevölkerung verschärft. Diese Verpflichtung bringt eine ungünstige Erlössituation mit sich. Vor dem Hintergrund knapper Finanzmittel werden daher in jüngster Zeit auch Universitätskliniken zur Privatisierung ausgeschrieben.Eine Alternative zur Privatisierung von Kliniken ist die Änderung der Rechtsform zur Kapitalgesellschaft oder zur Stiftung öffentlichen Rechts nach amerikanischem Vorbild. Darüber hinaus bieten public private partnerships (PPPs) eine Alternative, um externes Kapital an die Klinik zu führen, ohne auf Mitspracherechte zu verzichten. Schließlich können Universitätskliniken auch eine strategische Neuausrichtung durchführen und vergleichbar zu privaten Trägern Rationalisierungspotenziale durch Restrukturierungen, z. B. in den Segmenten medizinische Versorgung, Forschung und Personal, realisieren. Entscheidend ist jedoch, dass Universitätskliniken eigene Initiativen und Entwicklungen starten. Dafür werden in diesem Beitrag mehrere Handlungsoptionen aufgezeigt.     

Universitätskliniken und das neue Preissystem

Ohne Zusammenfassung     

Publikationsleistungen der Universitätskliniken für Anästhesiologie

Aim

This study assessed the publication performance of university departments of anesthesiology in Austria, Germany and Switzerland. The number of publications, original articles, impact factors and citations were evaluated.

Material and methods

A search was performed in PubMed to identify publications related to anesthesiology from 2001 to 2010. All articles from anesthesiology journals listed in the fields of anesthesia/pain therapy, critical care and emergency medicine by the “journal citation report 2013” in Thomson Reuters ISI web of knowledge were included. Articles from non-anaesthesiology journals, where the stem of the word anesthesia (anes*, anaes*, anäst*, anast*) appears in the affiliation field of PubMed, were included as well. The time periods 2001–2005 and 2006–2010 were compared. Articles were allocated to university departments in Austria, Germany and Switzerland via the affiliation field.

Results

A total of 45 university departments in Austria, Germany and Switzerland and 125,979 publications from 2,863 journals (65 anesthesiology journals, 2,798 non-anesthesiology journals) were analyzed. Of the publications 23?% could not be allocated to a given university department of anesthesiology. In the observation period the university department of anesthesiology in Berlin achieved most publications (n?=?479) and impact points (1,384), whereas Vienna accumulated most original articles (n?=?156). Austria had the most publications per million inhabitants in 2006-2010 (n=50) followed by Switzerland (n=49) and Germany (n=35). The number of publications during the observation period decreased in Germany (0.5?%), Austria (7?%) and Switzerland (8?%). Tables 2 and 4–8 of this article are available at Springer Link under Supplemental.

Conclusions

The research performance varied among the university departments of anesthesiology in Germany, Austria and Switzerland whereby larger university departments, such as Berlin or Vienna published most. Publication output in Germany, Austria and Switzerland has decreased. Data processing in PubMed should be improved.     

Etablierung von Patientensicherheit – national und international

Aim

This article focuses on the establishment of patient safety in Germany from a political perspective.

Background

Publication of the US report “To err is human” by the Institute of Medicine in 1999 was the starting point for the broad and open discussion about errors in the medical world, including the causes and prevention of these errors.

Strategy to improve patient safety

This report introduced a new paradigm: instead of only to “blame and shame” individual doctors and nurses, a system-based approach was the focus. The report emphasizes the relevance of failures caused by the organization of health care itself (e.g., coordination, communication). In Germany, the foundation of the network German Coalition for Patient Safety in 2005 was fundamental to establish a strategy which guarantees that all health professionals could work together to prevent errors in medicine.     

Universitäres Benchmarking

Lump sum reimbursement and the resulting concentration of medical treatment in maximum care clinics have led to substantial increase in economic pressure on university hospitals. Nearly all hospitals have introduced business ratios to economically judge each department. In order to evaluate the validity and comparability the business ratios of seven university traumatology departments were evaluated. Structural data as well as cost calculation results in different cost groups were evaluated. Major differences could be identified despite the fact that the cost calculations were all based on the same method (InEK method). In particular the costs for distribution to other medical specialties such as radiology or anesthesiology differed widely. Costs for infrastructure also showed a great variation. Differences in efficiency cannot be the only cause for these discrepancies and lacking standardization of cost calculation methodology is also another major cause. All the business ratios analyzed must be looked at critically and unless a thoroughly standardized methodology of cost calculation is implemented, cost ratios will have a limited potential for hospital benchmarking.     

Bericht über die chirurgischen Universitätsklinik in Bern von Ostern 1865 bis Ostern 1872

Ohne Zusammenfassung (Hierzu Tafel VI.) (Fortsetzung von Band II. Seite 199.)     

Internes Qualitätsmanagement: Patientenbefragung in einer urologischen Universitätsklinik

INTRODUCTION AND OBJECTIVE: In order to support the introduction of quality management, a systematic patient questionnaire was used in the Urology Clinic of the University Hospital of Münster and in another comparable clinic. The aim was to distinguish between well established areas and areas needing improvement. METHODS: A multidimensional questionnaire with emphasis on items involving patient satisfaction was developed and handed out to the patients before they left the clinic. The questionnaire could be sent back with an enclosed envelop free of charge. RESULTS: Hospital hygiene was rated as most important factor by the patients, followed by professionalism of the physicians and nurses. Patients were dissatisfied with hospital hygiene, making this an issue for improvement. Physicians and nurses were rated positively in both clinics. Furthermore, a high proportion of patients (82%) said that they had no pain after surgery. Overall, patients were very satisfied with their hospital stay in both clinics. CONCLUSIONS: After analyzing the questionnaires, we could identify areas in need of improvement and areas of high performance. In particular, hospital hygiene needs to be improved. In order to reach more patients, the inquiries need to be performed in all departments of the University Hospital of Münster.     

Wissenschaftliche Aktivität der Urologischen Klinik in Budapest in der Nachkriegszeit (1946–1956)

The authors studied the publications written by the staff of the University Department of Urology in Budapest, Hungary between 1946 and 1956. The collection was contributed on the occasion of Professor Babics’s 10-year-long chairmanship. Over a period of 10 years, 214 papers were published by 15 urologists, including 3 books and 3 PhD theses; 16 papers were published in German, 22 in English, 2 in French, and 1 in Italian. The most frequent topic of the papers (26) was basic science (e.g., ureter motility, lymph circulation, intrarenal pressure condition). Other papers dealt with nephrology, artificial kidneys, TURP, and nephron-sparing renal surgery. Some articles examined various types of malignant tumors and benign prostatic hyperplasia, while 17 publications focused on the topic of andrology. Tuberculosis was also discussed by the authors. Despite political isolation, the communist dictatorship, poverty, the lack of health equipment, physicians educated before WWII with their work morality and hard work managed to perform contemporary clinical and basic scientific research.     

Analyse und Möglichkeiten der Optimierung von Prämedikationsgesprächen an einem Universitätsklinikum

Die Anaesthesiologie - Das Prämedikationsgespräch als Risikoevaluation vor einem operativen Eingriff ist ein wichtiges Element der perioperativen Betreuung. Bisher liegen wenige Arbeiten...     

Etablierung von interdisziplin?ren Prostatakrebszentren nach den Empfehlungen der DKG

The introduction of prostate cancer treatment centers according to the criteria of the German Cancer Society ("Deutsche Krebsgesellschaft", DKG) aims at improving the quality of care for patients with prostate cancer. Systematic analyses of the effects and costs are lacking as yet. Three years after certification of the Interdisciplinary Prostate Cancer Center at the Charité Hospital Berlin we observed a decrease in the rate of positive surgical margins (tumor stage pT2), but other parameters of treatment quality including patient satisfaction remained unchanged. A survey among urologists of the region showed a high acceptance of prostate cancer centers in general. The majority of participating urologists appreciated the work of the Charité center, in particular the treatment recommendations given by the center were mostly followed and the majority of urologists regularly use educational activities of the center. However, only 30% of the participating urologists confirmed short-term improvements in the quality of patient care. Yearly additional costs for the Charité prostate cancer center are estimated at 205,000 euro (precertification phase and certification) and 138,000 euro (monitoring phase), despite the initial drop in mean treatment costs per case (radical prostatectomy). The introduction of prostate cancer treatment centers certified by the DKG is cost intensive, increases in treatment efficiency notwithstanding. Short-term improvements in quality of care cannot be unequivocally demonstrated. Prostate cancer centers serve an important role in counseling and medical education and may thus help disseminate evidence-based treatment strategies.     

H��ftgelenkinfektionen �C Ergebnisse einer Umfrage unter 28 orthop?dischen Universit?tskliniken

Background

Despite numerous prophylactic measures infections still remain a hazardous complication in orthopedic surgery.

Material and methods

A questionnaire about hip joint infections was sent to all university orthopedic departments in Germany and Austria. The questionnaire included 33 questions with respect to demographic data, causative organisms, diagnostic measures, treatment options for early and late infections, antibiotic therapy and prosthesis reimplantation.

Results

The participation rate was 70%. The most frequent primary surgical indication was primary total hip replacement and Staphylococcus aureus and S. epidermidis were the most common pathogens identified. All departments performed a joint aspiration for diagnosis confirmation but for other diagnostic measures a great discrepancy could be observed. In the treatment of early infections removable components were always exchanged, whereas a local antibiotic therapy was not always employed. With regard to late infections a two-stage protocol was more frequently used than a one-stage treatment, whereby the implantation of a cement spacer was more commonly performed than a resection arthroplasty. The time between stages varied between 6 and 12?weeks and systemic antibiotics were administered for a mean time of 6 weeks. For prosthesis reimplantion cementless components were mostly used but no clear tendency could be determined for systemic antibiotic therapy.

Conclusion

Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner.     

Erhebung der Qualifikationen von Lehrkräften in der Ausbildung von Notfallsanitätern und Notfallsanitäterinnen

Notfall + Rettungsmedizin -