Fehlermanagement: Kulturwandel für mehr Patientensicherheit

From the investigations by Mr. Scheidegger (nestor of medical error management for over 20 years) it is known that in the past patient safety has not received sufficient attention during a treatment process even though it had been known for many years that more than 10% of patients will suffer an adverse event during hospitalization. If one realizes how many patients receive inpatient and outpatient treatment in Germany alone it becomes evident how relevant this problem is and what enormous costs (extended hospital stay, continued morbidity, reduced productivity, liability etc.) result for the healthcare system and for society. The critical incident reporting system (CIRS) would enable physicians to reduce the error rate and in particular the sometimes tragic consequences for patients.     

Eine neue Methode für kineplastische Operationen

Ohne Zusammenfassung Mit 9 Abbildungen im Text.     

Epigenetik: für Kliniker mehr interessant als relevant?

Die Anaesthesiologie -     

Eine neue Repositionstechnik für die verhakte hintere Schulterluxation

The case of a 61-year-old male with posterior dislocation of the right shoulder joint is presented and a new technique for closed reduction of posterior locked shoulder dislocation is described. The technique involves four steps: in step 1 a constant traction is applied on the injured arm, in step 2 the arm is internally rotated and in steps 3 and 4 the second arm of the physician is used as a lever arm to lateralize and ventralize the shoulder. Lateralization and ventralization of the humeral head are essential to engage the humeral head and to pass it around the glenoid during reduction. Steps 3 and 4 are performed simultaneously. In the presented case the patient suffered a traumatic shoulder dislocation with a rim fracture of the glenoid. After reduction the shoulder was stable and conservative treatment was performed. A 2 year follow-up examination revealed a pain-free and stable shoulder with free range of motion and an Oxford instability score of 48 points. The described reduction technique for posterior locked shoulder dislocation is a simple and gentle technique, which can be performed easily by one person.Presentation of a reduction technique for locked posterior shoulder dislocation. Constant traction and internal rotation is performed for engaging the locked humeral head. After disengaging the humeral head the reduction is performed by using the arm of the physician as a lever arm.     

Eine neue Kraftquelle für bewegliche Hände

Ohne Zusammenfassung Mit 9 Abbildungen im Text.     

Modernes Implantatdesign für Osteosynthesen bei vorbestehender Osteoporose

Osteoporosis is characterized by a reduction of bone mass and changes in bone micro-architecture. The resulting reduction in bone strength leads to the well recognized increase in the risk of fracture, particularly at the radius, hip, and spine. The treatment of osteoporotic fractures is challenged by the reduced mechanical capacity of osteoporotic bone, reflected in reduced holding power and increased fragility. The aim of successful fracture treatment in individuals with osteoporosis is early fixation of the fracture with immediate and almost unrestricted weight-bearing capacity. The key factor for effective fracture treatment is strict adherence to the basic principles of stable fracture fixation: reposition, compression, long, wide supports, as well as additive techniques such as angular stability and bone augmentation. Modern osteosynthesis implants effectively support the application of these principles. Modifications in implant design and techniques enable the surgeon to apply and combine the essential components of the basic principles for the treatment of mechanically impaired bone. The key components employed in modern implants include integrated compression techniques, multidirectional angular stability, expandable support surfaces, as well as multiple augmentation options. However, despite modern implant technology, osteoporotic bone fractures remain a significant challenge for the orthopaedic surgeon and require meticulous planning and implementation of the basic principles.     

Anästhesie für Herzkatheteruntersuchungen bei Kindern

Cardiac catheterization in children with congenital heart disease or in adults with completely or partially corrected cardiac defects, is a growing field of activity for anaesthesiologists. This requires not only the willingness for interdisciplinary co-operation, but also detailed knowledge about the pathophysiology of congenital heart diseases. In interventional paediatric cardiology significant innovations have occurred during recent years including stenting of a patent ductus arteriosus and of peripheral pulmonary artery stenosis. Furthermore, radiofrequency catheter ablation for recurrent tachyarrhythmia, or resynchronisation therapy with biventricular pacing in the setting of congestive heart failure, or implantation of cardioverter defibrillators are increasingly being employed which require anaesthesia support.     

Sicherungen für den Spender bei der Bluttransfusion

Zusammenfassung Auf Grund ausgedehnter Erfahrungen mit der Bluttransfusion wird empfohlen, die unmittelbare Aneinanderlagerung von Spender und Empf?nger strenger zu vermeiden als bisher, jedenfalls aber in allen F?llen, in denen auch nur die entfernteste M?glichkeit einer Sch?digung des Spenders durch übertragung von Seiten des Empf?ngers vorliegt. Die bei uns übliche Handhabung der Methode nachOehlecker wird beschrieben. Es folgen einige Ratschl?ge betreffend die Versorgung der zur Freilegung der Venen bei Spender und Empf?nger angelegten Wunden.     

Eine neue Operationsmethode für doppelseitige,mit rüsselartig vorragendem Zwischenkiefer komplizierte Hasenscharte

Ohne Zusammenfassung (Mit 10 Abbildungen.)     

Fragebögen für Patienten mit Rückenschmerzen

Self-assessment questionnaires are becoming increasingly important in the evaluation and outcome-assessment of low back pain patients, both in the research environment and in everyday clinical practice. Questionnaires allow a standardised, patient-orientated examination of the symptoms and effects of the disease as well as the assessment of change following treatment. The aim of the current review was to provide a summary of the questionnaires that are currently available in the German language for the assessment of patients with low back pain; the review focuses on those that have been shown to be reliable and valid and widely-used on an international basis. The following topics are considered: (1) current pain experience and pain history, (2) disability due to low back pain, (3) coping with pain and psychological disturbance, (4) general health status and (5) outcome. Depending on the aim of the study, the evaluation of outcome may involve disease-specific symptoms (pain and disability), general health status, the ability to work, and the utilisation of health care resources (medical consultations, treatment, use of medication). For the analysis of treatment effects, prospective assessment of the relevant characteristics is recommended - that is, assessments should be made before the treatment and again with identical questionnaires at follow-up. Especially within the context of scientific studies, instruments should be chosen that enable an international comparison of the data generated. In everyday clinical routine, a short standardised documentation of the most important dimensions is recommended.     

Neue Röntgenverfahren für die Skeletdiagnostik

Ohne Zusammenfassung a. E.