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.     

Erfolgsfaktoren für die Rehabilitation

Trauma und Berufskrankheit - Im Rahmen einer prospektiven Fall-Kontroll-Studie wurde ein assessmentgestütztes System zur Optimierung der BGSW-Effekte (berufsgenossenschaftliche stationäre...     

DRG für die Nierentransplantation

Renal transplantation is a cost-effective form of renal replacement therapy which prolongs life and improves the quality of life. The representation in the German DRG system is, however, not cost-covering in all cases. Cost-effectiveness must also be considered in view of long-term transplant survival which relates to overall costs to the health care system and goes beyond hospital costs.     

Erfolgsfaktoren für die Rehabilitation

The aim of the current study is to develop and to evaluate an assessment-driven quality management system for optimising effects of inpatient rehabilitation of the BGSW. Of 768 patients admitted to the inpatient rehabilitation by the largest regional statutory accident insurance (VBG), 493 (64.2%) suffered from a major trauma of the lower extremities. SF-36, WOMAC and EQ-5D were administered to this sample on admission (T 1), at discharge (T 2) from the inpatient rehabilitation, at the end of a scheduled prolongation (T 2a) and at the 6-month follow-up (T 3). The treatment and management concept was optimised in three subsequent steps. We compared the effect sizes between cohorts treated during the subsequent optimising steps. The assessment-driven quality management system was practicable in patients suffering from a major trauma of the lower extremities undergoing inpatient rehabilitation programmes of the statutory accident insurance (BGSW). The results support the hypothesised possibility and necessity for permanent assessment-driven optimising of rehabilitation processes.     

Notfallmedizin – Medizin für eine alternde Gesellschaft

Due to fundamental demographic as well as social changes, the emergency medical services (EMS) have to respond to an increasing number of geriatric emergencies. By means of some typical case histories the practical problems arising in preclinical emergency medical intervention and the central role of context factors like social isolation, reduced mental capabilities and the resulting need for help are demonstrated. It is discussed how emergency medical services (EMS) can contribute to the problems of an ageing society beyond the scope of a system which is dedicated only to the individual. One possibility is the epidemiological analysis of geriatric emergencies, the accompanying context factors and the development of an adequate infrastructure which is adapted to the needs of the elderly. The EU project EMERGE is an example of how emergency medical expertise is utilized in an interdisciplinary cooperation. An automatically working system based on ambient sensor technology is developed for early detection and prevention of emergency situations in the home environment. Supportive technology ("assisted living") should enable the elderly to live a safe and self-determined life as long as possible. Integration of this additional information into the processes of Emergency Medical Services (EMS) is the logistic prerequisite to establish a social medical assistance tailored to the needs of an ageing society.     

A-Mode-Ultraschall-Pointer für die navigierte Beckenchirurgie

Surgical navigation has proven to be a minimally invasive procedure that enables precise surgical interventions with reduced exposure to irradiation for patient and personnel. Fluoroscopy-based modules have prevailed on the market. For certain operations of the pelvis computed tomography is necessary with its high imaging quality and considerably larger scan volume. To enable navigation in these cases, matching of the CT data set and the patient's real pelvic bone is essential. The common pair point-matching algorithm is complemented by the surface-matching algorithm to achieve an even higher overall precision of the system. For conventional surface matching with a solid pointer, the bone has to be exposed from soft tissue quite extensively, using a solid pointer. This conflicts with the claim of computer-assisted surgery to be minimally invasive. We integrated an A-mode ultrasonic pointer with the intention to perform extended surface matching on the pelvic bone noninvasively. Related to the conventional method, comparable and to some extent even improved precision conditions could be established.     

Fit für die Rettung?

Aim

Prospective examination of cardiovascular (CV) risk factors and cardiorespiratory fitness in firefighters (FFs) in Germany and comparison with the international literature.

Methods

A total of 97 North Rhine–Westphalian FFs working in emergency service participated in the study (time period 1/2014–9/2014). Participation was voluntary and data were anonymized. Anthropometric parameters, CV risk factors and cardiorespiratory fitness were examined. In order to estimate the 10-year CV risk, the Framingham Risk Score was utilized. The metabolic syndrome was diagnosed using the definition of the International Diabetes Federation.

Results

The examined FFs demonstrated a significant tendency towards obesity which was shown by the BMI and by abdominal waist circumference. In 32?% of FFs, an increased abdominal waist circumference was measured. Systolic resting blood pressure was elevated in 17.5?% of FFs; diastolic resting blood pressure was increased in 40.2?%. The relative maximal oxygen uptake (rel. VO_2max; 37.3 ± 6.3 ml ? kg^?1min^?1) was comparable with the average citizen. In international comparison, the 10-year CV risk can be seen as equivalent or less (according to the Framingham Risk Score). In 14?% of the examined FFs, a metabolic syndrome was detected. When regarding the metabolic syndrome, the international comparison revealed that the prevalence of the German FFs was among the lowest.

Conclusion

The results showed frequent CV risks factors in the examined FFs. Especially in a job which requires physical fitness, the results lead to a need for action in order to minimize the CV risk factors and to improve their fitness. Due to the particular labor conditions FFs have to be educated (empowerment). The setting has to be changed (internal training programs and leisure time activities toward more physical fitness) to decrease CV risk factors and to improve cardiorespiratory fitness. Therefore, an implementation of health-promoting concepts should be taken into consideration.

     

Paracetamol für die perioperative Analgesie

Since paracetamol was first synthesized in 1878 it has become one of the most popular and widely used drugs for the first-line treatment of fever and pain. The reasons for this popularity are a wide variety of formulations, an assumed positive safety record and the wide availability as an over-the-counter drug. However, recently several studies questioned the positive risk-benefit ratio of paracetamol for postoperative pain by observing several possible adverse effects and limitations. The aim of the present review is to give an update of the recent literature on the efficacy of paracetamol for postoperative pain and on the value of the clinical relevance of different adverse effects of paracetamol. Finally, based on the current findings the authors try to assess the role of paracetamol for the treatment of postoperative pain.     

Biomaterialien für die autologe Knorpelzelltransplantation

Autologous chondrocyte transplantation (ACT) is a cell-based biological cartilage repair procedure for the regeneration of injured articular cartilage. The further modification of classical ACT to matrix-associated autologous chondrocyte transplantation (MACT) includes the use of biomaterials as cell carriers and has biological and surgical advantages. The use of biomaterials as cell carriers for chondrocytes requires the analysis of cell culture conditions, cell-cell and cell-matrix interactions and also the determination of chondrocytic differentiation. The biomaterials used preserve the specific cellular architecture of chondrocytes and the combination of cultivated cells with biomaterials leads to the formation of cartilage-specific extracellular matrix components.     

Ursachen von Attraktivität und ihre Bedeutung für die ästhetische Medizin

As part of analysis in the field of research into attractiveness, a morphing software is able to generate a prototype of the attractive female face. The face is the result of a consensus on particular features of attractiveness such as darker skin tone, slim face, long eyelashes, high cheek-bones, narrow nose, full lips, etc., which work together harmoniously. Those female faces evaluated as particularly attractive correspond to the scheme of childlike characteristics. This phenomenon can be explained by the evolutionary history of man: youthful and healthy women have always been preferred by men as more suitable partners for reproduction. For thousands of years, therefore, women have attempted to emphasise the characteristics of youth: be it by colouring hair, lengthening eyelashes, emphasising eyes, plucking eyebrows or removing body hair. For some time now, aesthetic surgery has been offering new opportunities in this direction, and is increasingly used and accepted. A change in norms and values is under way that will lead in the future to aesthetic surgery being seen as a matter of course, the use of which will be associated with greater social prestige.     

Der artifizielle Sphinkter für die Inkontinenztherapie

The artificial urinary sphincter (AUS) has been successfully implanted in the last 40 years. Continuous improvement of the AUS and increasing experience with the device has led to its widespread acceptance. The major indication is still post-prostatectomy incontinence. In this collective patient satisfaction was reported in over 90%. In a number of patients with neurogenic bladder dysfunction and congenital or acquired anatomical disorders of the urethra, an AUS can be an alternative to urinary diversion. Nonetheless, complications such as infections and erosions are still a problem, leading to revisions and secondary procedures in up to 20% of the cases. Therefore, operative expertise and precise execution of aseptic rules are basic prerequisites.     

Der Notfalldatensatz für die elektronische Gesundheitskarte

Notfall + Rettungsmedizin - Um den Zugang zu Informationen zur Patientenvorgeschichte in Notfallsituationen zu verbessern, sollen zukünftig auf Wunsch der Versicherten Notfalldaten auf der...