Behandlungspfade für Weichteilsarkome

Background

Soft tissue sarcomas represent only approximately 1% of malignant tumor diseases in adults with an incidence of 1.8–5.5/100,000 per year. Together with the heterogeneity and nonspecific clinical symptoms, this rarity often leads to delayed diagnosis and inconsistent therapy; however, a standardized diagnostic and therapeutic procedure is necessary for the best possible outcome.

Diagnostics

Patients typically present with a painless swelling. Depending on the exact location, there may be movement restriction and sometimes neurological symptoms. Due to its good contrast and reproducibility, the gold standard for local imaging is magnetic resonance imaging (MRI) with contrast medium. After completion of the local imaging, the histological tumor verification is performed with a core needle biopsy or open biopsy. Excisional biopsy should only be considered in exceptional cases. If malignancy is confirmed, a staging of the patient and search for metastases is mandatory before initiation of therapy. This is usually done by computed tomography (CT) of the thorax and abdomen or, in special cases, by positron emission tomography CT (PET-CT).

Therapeutic algorithm

The therapeutic approach is determined by an interdisciplinary tumor board. For local easily resectable tumors without metastases an R0 resection is indicated. This is followed by adjuvant radiotherapy in the case of high-grade sarcomas. For locally advanced tumors or metastases, neoadjuvant or adjuvant chemotherapy as well as surgical resection of metastases are used.

Follow-up

The tumor follow-up includes regular clinical and radiological control of the former tumor region as well as the search for metastasis. This should be performed as far as possible at the primarily treating tumor center.

     

Ausbildungsinitiative der Deutschen Gesellschaft für Urologie für innovative Forschung

The tasks of the Working Group on Urological Research (AuF) of the German Society of Urology (DGU) are to support communication and initiation of joint ventures in German urology and to cooperate with associated subjects and neighboring countries. The annual “wet lab workshops” needs a space between annual and “wet lab workshops” on the topics of tumor cell culture, gene silencing, proteomics, and tissue engineering and the use instead of annual topic-related symposium“urological research,” organized and carried out by the AuF as of 2009, serve to achieve a close change to closer integration of praxis and theory. This should contribute to a lasting quality improvement of the scientific work in urology. Accomplishing these objectives seems urgently necessary to preserve the interests of urologists, because more than ever research has become indispensable in an increasingly difficult environment of health care policy.     

Controllinginstrumente für OP-Manager

Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractivity, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the “balanced score card” system of Kaplan and Norton.     

McPeek-Punktesystem für Polytraumapatienten

Purpose

For outcome analysis of trauma patients, outcome measurements such as commonly used trauma scores could be improved for difficult scientific and epidemiological purposes. The current study investigated if the McPeek score, which is established in scheduled abdominal surgery, could be modified for multiple trauma patients and whether it could become an additional helpful tool.

Methods

A systematic review of adult trauma patients admitted to the emergency department of the University Hospital of Berne, Switzerland, from 2002 to 2004 was performed. Common trauma scores were used to calculate a modified McPeek score. Correlation, regression and graphical analyses were performed.

Results

A total of 565 multiple trauma patients were included in the study and the observed McPeek score was allocated to each patient based on the total poulation. Subsequently, the predicted McPeek score was calculated by using common trauma scores (ordinal regression, p?<?0.0001, pseudo-R²?=?0.532) and a residual (observed – predicted) McPeek score could then be calculated. With this modified McPeek scoring system, the influence of age, head injury and blood glucose (as examples of known factors influencing outcome) on outcome could be exactly quantified.

Conclusion

The modified McPeek scoring system is a helpful outcome analysis tool in multiple trauma patients. It may complement common trauma scores and may optimize comparative outcome measurements in therapy and research following prospective validation.     

Voraussetzungen für Propofolsedierung

Ohne Zusammenfassung     

Transportextensionsschiene für Oberschenkelbrüche

Ohne Zusammenfassung     

G-DRG-System für die Urologie

BACKGROUND: The German diagnosis-related group (G-DRG) system is based on the belief that there is only one specific coding for each case. The aim of this study was to compare coding results of identical cases coded by different coding specialists. MATERIAL AND METHODS: Charts of six anonymous cases -- except final letter and coding -- were sent to 20 German departments of urology. They were asked to let their coding specialists do a DRG coding of these cases. The response rate was 90%. RESULTS: Each case was coded in a different way by each coding specialist. The DRG refunding varied by 6-23%. The coding differences were caused by different interpretations of definitions in the DRG system and also by inaccurate chart analysis. CONCLUSION: The present DRG system allows a wide range of interpretation, leading to aggravation of the ongoing disputes between hospitals and insurance companies.     

Lappensimulator für lokale Defektdeckungen

The Hannover Medical School (Germany) developed the"Flap Lab I" flap simulator, a practical improvement to surgeon training. It provides realistic conditions for understanding and following the principles for planning and performing local flaps for coverage of skin defects. The Flap Lab I has proved to be a very good training model in several training courses. This article introduces among others the Z-flap, reverse Z-flap (so-called hanging man), and Limberg flap.     

Technische Voraussetzungen für DALE-UV

Before a service provider can take part in DALE UV it is essential for the standard texts used in legally required accident insurance to be integrated in the software used in the practice/hospital providing the services and for electronic signatures and coding of the business events to be communicated to be possible. Other requirements are: a chipcard reader and a smartcard, access package of a provider for secure internet access, installation of the afore mentioned components, and training/tutoring in the DALE UV procedures. The necessary forms for applications to take part in the DALE UV procedure can be obtained from the appropriate associations in each land or downloaded from http://www.dale-uv.de/download. Until 31.12.2005 a grant, payable on one occasion only, is available for new equipment needed specifically for this purpose. In addition, transmission fees are reimbursed at a rate of 0,35 EUR. The way emergency doctors on call work with the accounts clearing houses will not be affected by DALE UV.     

Rahmenbedingungen für ein Kinderherztransplantationsprogramm

Background

Heart transplantations in the pediatric population pose specific technical and organizational challenges to the clinical team.

Material and methods

At the University Heart Center Freiburg-Bad Krozingen fixed organizational schemes, time management tracks and specific technical aspects of surgery were implemented. Between 1997 and 2016 a total of 46 patients under 18 years old underwent a heart transplantation at the center.

Results

Survival after 10 years was approximately 90%. The quality of life and physical activity were very satisfactory for the majority of children and adolescents.

Conclusion

Implementation of clinical planning schemes and time tracks for transplantation based on primary disease, type and number of previous surgeries, can help to achieve very satisfactory outcomes after heart transplantation in the pediatric population.

     

Differenzialindikationen für verschiedene Harnableitungsformen

When urinary diversion is indicated, patient information concerning the advantages and disadvantages of different types of urinary diversion and their choices is of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent anal urinary diversion, continent cutaneous urinary diversion and urethral bladder substitution). In the individual case, the choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease and indication for cystectomy. Medical criteria which possibly limit choices of type of urinary diversion are kidney function/upper urinary tract status and limitations concerning the gastrointestinal tract, concerning urethra/sphincter as well as the ability and motivation to perform intermittent self-catheterization. Preoperative information may use simulation of certain postoperative scenarios (urethral self-catheterization, fixation of water-filled conduit bags, holding test for anal liquids) to allow the individual patient to choose the optimal type of urinary diversion for his/her given situation from the mosaic of choices and possible individual limitations.     

Freiburger Index für Patientenzufriedenheit

Background

The recently introduced Freiburg index of patient satisfaction (FIPS) is a new questionnaire to assess treatment-related patient satisfaction after surgery and interventional procedures. The questionnaire had first been tested psychometrically in a mixed population of urology patients. The current study describes the results of an interdisciplinary validation. In addition, an English version is presented.

Methods

The questionnaire was used in two cohorts of cardiology (n?=?120) and surgical (n?=?127) patients. The evaluation included a comprehensive methodological and statistical evaluation including validation in comparison to the ZUF-8 questionnaire.

Results

The psychometric evaluation showed good results. The analyzed samples showed no missing values or ceiling effects. Furthermore, a high reliability (Cronbach’s alpha 0.82), unidimensionality, sufficient distribution of values and validity (high correlation to the ZUF-8, r?=?0.65, p?<?0.001) of the questionnaire could be confirmed.

Conclusions

The FIPS constitutes an interdisciplinary validated questionnaire to evaluate treatment-related patient satisfaction which can be used to objectify and compare results from clinical studies and quality in patient care. Colleagues of English-speaking countries are invited to participate in the validation of the hereby presented English version.     

CT-basierten Klassifikationshilfe für Acetabulumfrakturen

Background

The basis for the classification of acetabular fractures depends on accurate radiological diagnostics. The use of conventional X-rays alone implicates a low intrapersonal reproducibility and interpersonal reliability. By applying computed tomography (CT) at an early stage in the emergency room, the typical diagonal X-rays of ala and obturator, on which the classification is based, are no longer recommended. The aim of this study was to develop a new reliable classification system based on standardized CT slices according to the system of Judet and Letournel without using diagonal X-rays.

Materials and methods

In this study 12 select cases with acetabular fractures were peer reviewed. In each case eight characteristic CT slices (five axial, two coronal and one sagittal) were selected as well as the conventional anteroposterior X-ray of the pelvis. All cases were peer reviewed by 14 members of the “AG Becken” (working group pelvis). The classification of the acetabular fractures was based on Judet and Letournel and the results were compared with the reference classification. The results were scaled according to differences to the original classification and the relevance to the approach as well as the medical qualification of the member.

Results

A total of 167 out of 168 possible classifications were conducted, 90 cases (54?%) were in accordance with the reference classification. In 69 cases (41?%) the outcome was different, which would have had no influence on the choice of the surgical approach. A wrong classification was present eight times (5?%). According to the medical qualification status the senior physicians were right in 54%, the residents in 53?%. Within the group of senior physicians 7.5?% of the classifications were completely wrong and 93?% of the participating members would have preferred to have more CT slices.

Conclusion

The CT-based classification developed represents an adaption to the current standard of diagnostics of acetabular fractures and represents a step towards simplification of the classification. It is suitable to estimate the correct surgical approach and the behavior of the fracture. For an accurate classification and the association to one of the fracture types in the system of Judet and Letournel more slices and 3D reconstructions (MPR) are necessary.     

Werberecht für Ärzte

Background

The advertising rights for physicians are being increasingly liberalized.

Objectives

Which new forms of advertising open opportunities for doctors and what are the limits of the advertising rights?

Methods

Evaluation of the administration of justice and consulting practices.

Results

Only advertisements which are contrary to professional standards are inadmissible. As long as the preferred advertising can be sustained in the scope of the individual occupational rules and regulations of countries, the therapeutic goods advertising act (HWG) and the unfair competition act (UWG) then it is permitted.

Conclusion

Advertising for physicians will experience new ways and possibilities in the future. The individual chambers and courts, however, have not yet developed a standard line so that when in doubt professional help is recommended.     

Leben für die Medizin

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie -