Subject(s)
Chronic Pain , Physicians , Chronic Pain/diagnosis , Chronic Pain/etiology , Expert Testimony , Humans , Physician-Patient RelationsABSTRACT
The student accident insurance has been part of the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) for 50 years. In order to assess the reduction in working capacity (Minderung der Erwerbsfähigkeit, MdE) in the event of permanent consequences of accidents and injuries, the recommendation to treat the affected child or adolescent "as an average adult" is currently still valid. The present work deals with the everyday practice of the MdE assessment in children and adolescents and their weaknesses through the transfer of the principles from adulthood. In addition, proposals for the adaptation of the assessment principles for the growth age are drawn up.
Subject(s)
Fractures, Bone , Insurance, Accident , Accidents , Adolescent , Adult , Child , HumansABSTRACT
Prior to a medical intervention (and also when omitted) it is important to implement the prerequisites for medical treatment as formulated by the legislation during the last decades. Essential points are the timely and comprehensive clarification and informed consent of the patient on diagnosis, therapy, complications and aftercare. The case described here substantiates the essential points which must be considered with respect to operative activities in the interests of the patient as well as the treating physicians. This problematic and the legal assessment based on expert testimony can be paradigmatically demonstrated by a verdict of the Higher Regional Court (Oberlandesgericht, OLG) Munich in association with a case of spondylosis and show why the essential points of this verdict should be discussed.
Subject(s)
Informed Consent/legislation & jurisprudence , Patient Education as Topic/legislation & jurisprudence , Postoperative Complications/etiology , Spinal Fusion/adverse effects , Spinal Fusion/legislation & jurisprudence , Spondylosis/surgery , Germany , Humans , Liability, LegalABSTRACT
INTRODUCTION: Early pain relief in patients with acute nontraumatic abdominal pain in emergency departments has been discussed for years. Some randomized trials have addressed this issue but conclusive data are lacking. In this study, we assessed the current treatment practice in German hospitals in order to evaluate the necessity of a further clinical trial. METHODS: An online survey containing 27 questions was sent to general and visceral surgeons at attending level using a mailing list provided by the Professional Board of German Surgeons (BDC) using a standard interview software. The questionnaire collected demographic data, current treatment policies about frequency of early analgesia, types of pain medication, and opinions about their use and effects. RESULTS: Four hundred ninety-five completed questionnaires were returned. Many surgeons were cautious about early analgesia in the emergency department. Forty-five percent of the surgeons would provide analgesia prior to diagnosis to the majority of patients. Within the departments, differing opinions existed regarding the analgesic treatment (41 %). Thirty-two percent of all the respondents knew about a false diagnosis after early analgesia. There was heterogeneity in the estimation of the impact of pain medication on masking of clinical symptoms. A randomized controlled trial would be supported by the majority of respondents. As influencing factors for withdrawing early analgesia, we found the examiner being over 40 years of age (p < 0.05), low experience with the clinical picture of acute abdominal pain (p < 0.05), high estimation of the masking of clinical findings (p < 0.001), and knowing about a false diagnosis after early analgesia (p < 0.001) to be significant. CONCLUSION: Discordance in the analgesic treatment regimens in patients with acute abdominal pain still exists in German hospitals. The topic remains subject of frequent discussions. More high quality data are needed before a clear guideline can be given for implementation in clinical routine management.
Subject(s)
Abdominal Pain/drug therapy , Analgesics/administration & dosage , Early Medical Intervention , General Surgery , Practice Patterns, Physicians' , Abdominal Pain/diagnosis , Adult , Aged , Attitude of Health Personnel , Data Collection , Diagnostic Errors , Emergency Service, Hospital , Female , Germany , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
German statutory accident insurance covers employees and trainees against occupational accidents, employers bear the inherent charges. Expert opinion is obtained, in particular, for discussing causality questions and for rating accidental health disorders. Causality has to be estimated based on the "theory of essential condition", health disorders have to be substantiated without any reasonable doubt. Reduction in earning capacity due to an accident may not consider the individual kind of occupation and has to be rated by an abstract approach.
Subject(s)
Accidents, Occupational/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Insurance, Accident/legislation & jurisprudence , Causality , Disability Evaluation , Germany , Health , Humans , Insurance, LiabilityABSTRACT
The principle of informed consent to invasive diagnostic or therapeutic procedures is not applicable in most patients suffering from consciousness disorders. As in other medical situations, German law assigns priority to the patient's autonomy and employs the concept of presumed will inferred from third-party (e.g. relatives) communications or deduced from a living will. While discussion concerning the validity of such advance directives is ongoing, their applicability needs to be checked carefully in every case. When the patient's attitude or wish however remains unclear or not discernible, in an emergency situation medical activities must be directed without loss of time towards damage reduction and life preservation under all circumstances ("guaranteed provision of medical attention"). In clinical practice, efforts to deduce the patient's will must relate to the urgency and invasiveness of the intended medical procedures. This paper describes the framework of current legal rules and important case decisions involved in the process of decision-making for patients unable to give informed consent. Any such decisions must be documented comprehensively in hospital records.
Subject(s)
Advance Directive Adherence/ethics , Advance Directive Adherence/legislation & jurisprudence , Advance Directives/ethics , Advance Directives/legislation & jurisprudence , Informed Consent/ethics , Informed Consent/legislation & jurisprudence , Unconsciousness/therapy , Emergency Medical Services/ethics , Emergency Medical Services/legislation & jurisprudence , Germany , HumansABSTRACT
BACKGROUND: Methods for error analysis are suitable to increase patients' safety as well as staff satisfaction and may avoid, in a sense of process control, financial damage to the hospital. The aim of the presented pilot study was to establish and evaluate an incident reporting system as a first step towards a new safety culture. METHODS: In June 2003 an incident reporting system was introduced in the central surgical suite, in which the surgical and anaesthesiologic departments took part as well medical and nursing staff. Besides conceiving a report form, a "board of confidence" was elected, kick-off meetings were held and a baseline study on the basis of industrial psychological knowledge was initialised. RESULTS: The process of creating confidence is arduous and depends elementarily on sincere cooperation of management staff, especially of the heads of the departments. The exclusive participation of only two medical departments led to conflicts. Therefore, after finishing the pilot study, the system was expanded to the whole surgical suite including all operating departments. In order to increase the motivation for the strictly voluntarily participation, the frequency of regular echoes to the staff was optimised. To achieve high acceptance in the whole staff, the board of confidence needs a clearly defined position within the system of quality management. CONCLUSIONS: For the first time in Germany an incident reporting system under participation of several medical departments has been installed. After finishing the pilot project, in future we will be able to evaluate changes caused by this system. Simultaneously an electronic database for reported adverse events and strategies to avoid them are being developed based on similar systems in aviation industry. In near future, the system will be of increasing importance likewise for inpatient units and non-operative departments.
Subject(s)
Operating Rooms , Quality Assurance, Health Care , Risk Management , Germany , Humans , Pilot Projects , Safety Management , Time FactorsABSTRACT
In legal and private accident insurance you can find a distinction between "accident" and "results of an accident". In the system of the AUB (general terms of accident insurance) the insurant's injury is a notional part of the accident, which has been criticized by some medical experts. In fact, this distinction could entail different meanings and interpretations of the term "results of an accident", especially in section 10.1 AUB. In the author's point of view, section 10.1 AUB is applicable whenever different factors due and not due to the accident combine to produce the injury or the further damage (e.g. death, disablement).
