[Expert assessment of work disability--do we realize the effects?]. / AU-Begutachtung--Wissen wir eigentlich, was wir bewirken?

Three inquiries on the results of medical expertises concerning incapacitation for work in cases where employers had doubted this fact, seem to establish that the Medical Service of the Social Health Insurance (MDK) is quite capable of keeping improper use of the epithet "unfit for work" in check. If the design of the studies is critically analysed, it becomes evident that most problems are still unsolved. More clarity regarding the sense or nonsense of this work-intensive topic may result from a carefully and completely planned randomised trial. Such a study appears mandatory, the more so since the economic benefit of the expertises does not seem to be very bright, taking several hypotheses into consideration.

[Recycling of disposable medical devices (medical device products)]. / Wiederaufbereitung von Einmalartikeln (MD-Produkten).

Modern medicine uses large amounts of one-way-devices. This includes mass articles as well as technically sophisticated ones, all of them in accordance with GMP (Good-manufacturing-practice) guidelines. Recycling of selected one-way devices in technically possible and economically useful. Prerequisite for recycling is the inclusion of legal, economic and ecologic points of view. In addition the validation of processes and agreement on installation of continuous quality control is necessary to minimise risks. We suggest admission of recycling and reuse of one-way devices and suggest to proceed stepwise: 1. Principal decision to permit recycling 2. Appointment of an interdisciplinary Federal Board "Medical Devices" for coordination and channelling of activities 3. Selection of products for recycling 4. Principal decision for the systematics of the process together with: process control, product control during a pre-testing stage, random tests in prospective, multi-centre studies for the control of production and use. 5. Introduction of internal quality control systems to allow internal and external control of routine work.

[Short-term occupational disability]. / Die Kurzzeitarbeitsunfähigkeit.

The present political discussion about absenteeism in industry and introduction of days of absence in case of sickness emphasises the amount of short-term sickness cases. More or less openly the misuse of continued salary payment via "unauthorized" working inability is discussed: this is often connected with the increased absenteeism on Mondays and Fridays. From the point of view of the Legal Health Insurances this thesis of misuse is investigated in an analysis of cases of short-term work disability.

[Possibilities of quality assurance in ambulatory rehabilitation]. / Möglichkeiten einer Qualitätssicherung bei ambulanter Rehabilitation.

Formal, structurally determined quality requirements (for medical and non-medical staff, space and equipment, respectively) are supplemented by guidelines that are able to inform about the actual course of rehabilitation. Not only externally controlled medical reports on the treatment are suited for this, but also inquiries of patients comparisons between sickness insurances (for example on duration of inability to work, need for hospital measures of rehabilitation) and the comparison with patients who did not take part in ambulant rehabilitation. A report system has to be built up that pictures the clientele of the "reha"-institution, measures changes and documents results a long-term basis. The proposed periodical tests and final test serve not only for the control of patient progress in each single case with information for the practitioner, but also give financial committees hints on the efficiency of the work of the institutions for rehabilitation. Continuous attendance is proposed with a report system and scientific evaluation, whose results are sent concisely but anonymous by to the contract partners on a quarterly basis. A committee for quality assurance discusses new developments and improves ambulant rehabilitation.