Patientenaufklärung/präoperative Aufklärung

Every medical intervention constitutes a physical injury and therefore requires the consent of the patient to avoid liability. In order that the patient can effectively consent to the intervention by ensuring autonomy of decision, the patient must be fully informed of the risks involved in medical interventions. The patient must be informed of the essential benchmark data however, it must be borne in mind that each individual case is always decisive for deciding whether clarification has been correctly carried out. In these instances individual factors, such as the personal background of the patient, play a role. Documentation of the clarification serves as proof that it has been carried out and to what extent.     

Patientenaufklärung — Fakt und Fiktion

One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.     

Videoassistierte anästhesiologische Patientenaufklärung

Background

Video-assisted patient education (VaPE) has in the past been a subject of many studies. Compared to conventional methods, most authors reported a better transfer of information, some found increased patient satisfaction and a time-sparing effect. There was no increase in anxiety caused by VaPE. Some authors even found a reduction of anxiety levels before anesthesia. All publications to date have focused on the patient’s point of view. There have been no reports on how anesthetists as users assess VaPE.

Methods

In this study 22 anesthesia departments using VaPE were contacted. A total of 122 anesthetists were sent questionnaires of which 81 (66%) were completed and returned. The anesthetists were first questioned about the characteristics of the workplace, the frequency of preanesthesia patient contacts, the content of the videos, the technique of video presentation and their own professional experience. After this the anesthetists were asked to assess five statements concerning: usefulness of VaPE, economy of time, transfer of knowledge, induction of anxiety and influence on the quality of the consent interview. In each category there were 4 choices: fully agree, partly agree, partly disagree and fully disagree. The first two choices were evaluated as positive and the second two as negative answers. The anesthetists were also asked to state the most valued characteristics of VaPE. Out of eight given options they were to select the most favored three. A final question was whether in their opinion VaPE could be recommended to non-users.

Results

Of the anesthetists 97.5% stated that disclosure interviews predominantly took place in the preoperative anesthetic clinic and 73% performed 15 or more patient interviews per day. Videos about general anesthesia were applied by 70%, about non-obstetric regional anesthesia by 56% and about obstetric epidural anesthesia by 59%. The videos were presented to groups of patients via large screens by 27%, individually with CD players or tablet computers by 51% or with both methods (22%). Of the anesthetists 69% had 5 years or more professional experience, 97.5% found VaPE useful for patients education, 92.5% observed a time-saving effect for the following interview and 96% stated that after watching the video patients were better informed. An increase of anxiety caused by VaPE was noted by 46% whereas 54% found no such effect. As to the quality of interview 50% reported an advantage in focusing on the patient’s individual risk profile and the other 50% reported no advantage. The ranking of the main advantages was 1) better patient information, 2) time-saving effect, 3) helpful for patient education, followed by 4) increased patient satisfaction, 5) better understanding of anesthesiology, 6) individualization of the interview and 7) helpful in questions of legal liability. The answer option “no advantage” was not chosen at all. Of the participants 82.5% would recommend VaPE unconditionally (fully agree), 17.5% would give a conditional recommendation to colleagues and no one would not recommend VaPE.

Conclusion

This survey among anesthetists confirmed most results obtained from patient-based studies: medical users attributed to VaPE a better information transfer and a time-sparing effect. Furthermore, users regarded VaPE as helpful for the preanesthesia interview. As compared to the patient-based results, however, many anesthetists seem to overrate the anxiety, caused by disclosure videos. From the users’ point of view, VaPE is a highly appreciated method for patient education which can be recommended to colleagues.

     

Videoassistierte Patientenaufklärung in der Anästhesiologie

In video-assisted patient education (ViPa), patients watch an educational video about the process and the risks of anaesthesia in addition to the preanaesthetic interview with the anaesthesiologist. Used as a supplement to the preanaesthetic visit, the videos can increase patients' knowledge and satisfaction without having any negative effect on perioperative anxiety. Because the video graphically depicts the basic information, the preanaesthetic visit can then focus on specific aspects of the individual patient, i.e. high anxiety or specific questions. The redundant and monotonous explanations about the procedures and risks of anaesthesia by the interviewing anaesthesiologist are partly replaced by the video, but for medico-legal reasons the ViPa cannot totally replace the preanesthetic interview. It can be used in pediatric anaesthesia and reduces parental anxiety. Because of the lack of studies, the effects of the ViPa on perioperative patient compliance, especially for outpatient surgery, and on the economics of anaesthesia clinics are unclear.     

Patientenaufklärung über die Risiken von Erythrozytenkonzentraten

In Germany approximately 4–5 million erythrocyte concentrates are administered annually. Every transfusion fulfills the criteria for an organ transplantation and represents a measure that includes risks which must be clarified with informed consent. This article describes the legal requirements for informed consent, the content, form and the exceptions. Finally, the consequences of errors in informed consent are presented.     

Die Patientenaufklärung zur Prostatakarzinomfrüherkennung ist unzureichend*

Men that undergo an early detection investigation should be informed of the advantages and disadvantages as well as of the therapeutic consequences. In this study the quality of information was checked using the state of scientific knowledge of the patients. An informative consultation was carried out before the early detection investigation using a clarification brochure and an examination by a urologist. A questionnaire was also filled out after the investigation. A total of 1,536 men were questioned. Although 47% of the men had previously undertaken a PSA at least once, only 55% knew their own test result. Subjectively 82% of men felt well informed. In contrast one-third did not know the significance of an increased PSA level. In the field of patient clarification for the early detection for prostate cancer there are considerable deficits but the information received was considered adequate by the participants. However, more than one-third did not understand the significance of the PSA level.     

Texturst?rung

The term ??degeneration?? is misleading, particularly in histopathologic diagnosis, and should only be used in relation to cellular pathology. To characterize soft tissue pathology precisely, the term ??texture alteration?? is proposed, since it reflects the major component ?C tissue matrix ?C of soft and connective tissues.     

Botulinumtoxin bei neurogener Blasenfunktionsst?rung

Botulinum neurotoxin (BoNT) has become increasingly established in the treatment of neurogenic bladder dysfunctions over the last 12 years. Today it represents an alternative to conservative medical therapy and reduces the indications for broader surgical measures. Since September 2011, BoNT/A is approved for the use in neurogenic bladder disorders. This article therefore summarises the main findings once more, particularly with regard to practical application.The by far most commonly used BoNT subtype is botulinum neurotoxin A (BoNT/A), which has shown the most convincing effects after detrusor injections in the urological field. It unfolds its full effect after about 7 days. Subjective parameters, such as urination frequency, incontinence and quality of life are improved most substantially, which is objectively reflected by the increase in bladder capacity and the reduction of maximum detrusor pressure. Significantly decreasing effectiveness and necessity for repeated injections must be expected after about 9 months. Repeated applications have proven to be effective. Systematic side effects are rare and do not reach dramatic extents. The major urologic side effect, which is not uncommon, is the increase in residual urine, which can lead to urinary retention in patients with spontaneous voiding.     

Diagnostik der neurogenen Blasenfunktionsst?rung

Patients with congenital and acquired neurogenic bladder dysfunction due to central and peripheral nervous lesions are significantly limited in their daily lives. The neurogenic dysfunction of the bladder and lower urinary tract are often misinterpreted and later fed to a diagnosis. Without therapy severe complications, including renal damage, could be the consequence in the follow up. Therefore, dedicated diagnostics have to be done to recognize the different disorders and to determine the specific therapy. For these patients a lifelong bladder monitoring and neuro-urological management is necessary. This article describes techniques of neuro-urological testings and the interpretation in case of neurogenic disorders.     

Selbstverletzungen bei Menschen mit Borderline-Pers?nlichkeitsst?rung

One symptom of Borderline personality disorder is self inflicting behavior, especially cuts and thermal injuries in the upper extremity. Due to the complex underlying psychiatric disease, surgical treatment of these injuries can be tedious and frustrating; therefore it is sometimes necessary to differ from classical plastic surgery principals and to favorite a more conservative approach. In every case, close cooperation with psychiatrist is inalienable.     

Abklärung einer progredienten Okklusionsstörung

A 61-year-old male patient presented with a progressive malocclusion and neuropathic pain mimicking trigeminal neuralgia which had been unsuccessfully treated with carbamazepin over a long period. Magnetic resonance imaging revealed a tumor mass in the lower compartment of the left temporomandibular joint. Total excision of the disk was carried out and histological examination revealed a synovial sarcoma. This case shows the urgent need for using imaging techniques of every non-traumatic progressive malocclusion.     

Hom?opathische Prophylaxe von Harnweginfekten bei Patienten mit neurogener Blasenfunktionsst?rung

Recurrent urinary tract infections (UTI) in patients with spinal cord injury are a frequent clinical problem. Often, preventive measures are not successful. We present the case reports of five patients with recurrent UTI who received additional homeopathic treatment. Of these patients, three remained free of UTI, whereas UTI frequency was reduced in two patients. Our initial experience with homeopathic prevention of UTI is encouraging. For an evidence-based evaluation of this concept, prospective studies are required.     

Posttraumatische Belastungsstörung

Die Unfallchirurgie - Die posttraumatische Belastungsstörung ist gekennzeichnet durch die Symptomebenen Nachhallerinnerung, Vermeidung und Übererregung als Reaktion auf ein...     

Posttraumatische Belastungsstörung

Objective

Posttraumatic stress disorder (PTSD) is a psychological sequelae of having experienced violence. Its prevalence is higher in rescuers than among the general population. The aim of this article is to introduce this disorder to emergency physicians and to familiarize them with the symptoms. A short review of the neurbiological backgrund shall help to destigmatize people with psychiatric disorders.

Methods

Presentation and analysis of current reviews and respective sections of diagnostic manuals.

Results and conclusions

Life-time prevalence of PTSD lies between 4 and 10?%, which is higher in certain risk populations (rescuers, soldiers) and victims of personal violence. PTSD has a psychophysiological and biological basis in neurocircuits concerning fear. Trauma-focused cognitive–behavioral therapies and EMDR (eye movement desensitization and reprocessing) have proven effective in clinical studies, although the drop-out rate is high and about a third of patients do not benefit from treatment. These therapies can also be used as an early intervention with fewer sessions. Selective serotonin reuptake inhibitors (SSRI) can reduce symptoms.