Evaluation der Ergebnisqualität des besonderen Heilverfahrens der Gesetzlichen Unfallversicherung

The German statutory accident insurance organization is supporting a research project to evaluate the outcome quality of medical treatment procedures associated with this insurance, with the aim of setting examples of particular kinds of injuries and injury patterns as the basis for a results-oriented evaluation of medical treatment measures. A first step was to select injury patterns that should be included. A two-step Delphi survey was carried out. A total number of 160 respondents could choose from a list of injury patterns, both suitable and unsuitable, to include. They could also suggest and evaluate further injury patterns. In both surveys, the number of participants was 60%. Injury patterns rated as particularly suitable included fractures of the distal radius (75.9%), ankle joint fractures (61.1%), and anterior cruciate ligament rupture (43.3%), whereas vertebral body fractures (9.3%), hand injuries (3.7%), and pelvic fractures (1.9%) were rated as less suitable. The Delphi survey proved to be a suitable instrument for the selection of injury patterns.     

Severe road traffic injuries in Kenya, quality of care and access

Background

Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services.

Objective

Determine access and quality of care for RTI casualties in Kenya.

Design

Cross-sectional survey

Setting

53 large and medium size private, faith-based and public hospitals.

Participants

In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken.

Results

Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured was 15–49 years. First aid was availed to 16.0% of casualties. Unknown persons transported 76.5% of the injured. Police and ambulance vehicles transported 6.1% and 1.4%, respectively. 51.9% reached health facilities within 30 minutes of crash and medical care provided to 66.2% within one hour. 40.8% of recipient facilities were adequately prepared for RTI emergencies.

Conclusions

Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient.     

Arbeitsplatzorientierte muskuloskelettale Rehabilitation (ABMR)

As of May 3^rd, 2011, workplace-related muscular skeletal rehabilitation has been a rehabilitation module within the German Statutory Accident Insurance (DGUV). Essential components of the procedure include compiling and documenting detailed standardized functional workplace profiles. A comparison of these profiles enables existing physical deficits to be identified and adequate deficit-orientated therapy to be planned. The effectiveness of workplace-related musculoskeletal rehabilitation was measured by means of a prospective monitoring study. Commercial and industrial employees (both male and female) aged between 20 and 65 years at the time of their accident were included in the study. Numerous rehabilitation process parameters, the results of re-entry to work as well as residual reductions in work capacity were evaluated. Immediately following workplace-related musculoskeletal rehabilitation, work capacity for the last job performed could be achieved. The number of cases of a reduction in work capacity was low. Workplace-related musculoskeletal rehabilitation proved to be a highly successful specific therapy, supporting re-entry to work within a minimum period of time. Further, possibly randomized studies for sustainable evidence of efficiency are desirable.     

Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review

Aims. This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions. Background. Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy. Design. Systematic review. Methods. MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched. Results. Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially‐available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort. Conclusions. There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy‐related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended. Relevance to clinical practice. This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence‐based advice to their patients.     

Factors associated with health status of older Americans.

BACKGROUND: health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood. OBJECTIVES: to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans. METHODS: we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses. RESULTS: age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not. CONCLUSION: these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree.     

Direct demonstration that autologous bone marrow transplantation for solid tumors can return a multiplicity of tumorigenic cells

Patients with solid tumors are increasingly being treated by autologous bone marrow transplantation (BMT). Although response rates appear to be increased, disease recurrence is the commonest cause of treatment failure. Whether relapse is entirely due to residual disease in the patient or arises also from infiltrating malignant cells contained in the autologous marrow transplant has not been resolved. If the latter explanation is correct, then purging would be required as part of the transplantation procedure. We used retrovirally mediated transfer of the neomycin-resistance gene to mark BM harvested from eight patients with neuroblastoma in clinical remission. The marked marrow cells were subsequently reinfused as part of an autologous BMT. At relapse, we sought the marker gene in malignant cell populations. Three patients have relapsed, and in each the marker gene was detected by phenotypic and genetic analyses of resurgent malignant cells at medullary and extramedullary sites. Analysis of neuroblast DNA for discrete marker gene integration sites suggested that at least 200 malignant cells, each capable of tumor formation, were introduced with the autologous marrow transplant and contributed to relapse. Thus, autologous BMTs administered to patients with this solid tumor may contain a multiplicity of malignant cells that subsequently contribute to relapse. The marker-gene technique we describe should permit evaluation of the mechanisms of relapse and the efficacy of purging in patients receiving autologous marrow transplantation for other solid tumors that infiltrate the marrow.