[From Science to Law: Findings of Reha XI Project on Ascertaining the Need for Rehabilitation in Medical Service Assessments]. / Aus der Forschung ins Pflegestärkungsgesetz II: Das Projekt Reha XI zur Feststellung des Rehabilitationsbedarfs in der MDK-Pflegebegutachtung.

Introduction: In the broad-based consortium project "Reha XI - Identifying rehabilitative requirements in medical service assessments: evaluation and implementation", a comprehensive analysis of the corresponding procedures was carried out by the medical services of the German Health Insurance Funds (MDK). On the basis of this analysis, a Good Practice Standard (GPS) for assessments was drawn up and scientifically evaluated. This article discusses the findings and applicability of the GPS as the basis for a nationwide standardized procedure in Germany as required by the Second Act to Strengthen Long-Term Care (PSG II) under Vol. XI Para. 18 (6) of the German Social Welfare Code. Method: The consortium project comprised four project phases: 1. Qualitative and quantitative situation analysis of the procedures for ascertaining rehabilitative needs in care assessments carried out by the MDK; 2. Development of a Good Practice Standard (GPS) in a structured, consensus-based procedure; 3. Scientific evaluation of the validity, reliability and practicability of the assessment procedure according to the GPS in the MDK's operational practice; 4. Survey of long-term care insurance funds with respect to the appropriateness of the rehabilitation recommendations drawn up by care assessors in line with the GPS for providing a qualified recommendation for the applicant. The evaluation carried out in the third project phase was subject to methodological limitations that may have given rise to distortions in the findings. Findings: On the basis of the situation analysis, 7 major thematic areas were identified in which improvements were implemented by applying the GPS. For the evaluation of the GPS, a total of 3 247 applicants were assessed in line with the GPS; in 6.3% of the applicants, an indication for medical rehabilitation was determined. The GPS procedure showed a high degree of reliability and practicability, but the values for the validity of the assessment procedure were highly unsatisfactory. The degree of acceptance by the long-term care insurance funds with respect to the recommendations for rehabilitation following the GPS procedure was high. Conclusion: The application of a general standard across all MDKs shows marked improvements in the quality of the assessment procedure and leads more frequently to the ascertainment of an indication for medical rehabilitation. The methodological problems and the unsatisfactory findings with respect to the validity of the assessors' decisions require further scientific scrutiny.

[Not Available]. / Vergleichende Untersuchungen mit der oralen und intravenösen Glucosebelastung zur Erfassung einer verminderten Kohlenhydrattoleranz.

Oral (o.GTT) and intravenous glucose tolerance tests (i.v. GTT) were carried out on 492 patients of both sexes, aged from 5 to 78 years. Three hundred and fifty-nine non-diabetics in all were suspected clinically of reduced carbohydrate tolerance leaving 133 patients for comparison (controls). In 102 obesity was noted, 221 had a family history of diabetes and 36 had experienced complications with previous pregnancies. Patients were divided into two groups: i.e. below and above 40 years of age and subdivided again according to normal weight or obesity. At the oral test 100 g glucose was given and the blood sugar determined every 30 min for 180 min. The intravenous test was performed according toCONARD's method(5). Age did not affect the glucose tolerance test in the healthy patient (controls), and following oral or intravenous tests no appreciable difference was noted between the younger and older groups, apart from the 60 min oral estimation; the average age of the older group, however, being relatively low at 54 years. Both groups together showed a general upper biological limit (mean value + 2s D ). The oral tests in patients below 40 years of age with accompanying slight obesity, in patients with a family history of diabetes and in patients of normal weight with complications in previous pregnancies, showed no appreciable difference from those of the corresponding age groups of normal weight; yet the intravenous test was significantly different in all groups concerned. In the case of patients of the same age but with gross obesity (more than + 30% according to Broca), in patients with a family history of diabetes with accompanying obesity and in obese patients with complications in previous pregnancies, significantly abnormal curves were found with the oral as well as i.v. test. In the same groups, above the age of 40 years, in comparison with controls of normal weight and corresponding age, the curves of the oral as well as intravenous tests were significantly different and became more so when gross obesity was present or other symptoms were combined with obesity. In patients clinically suspected of impaired glucose tolerance the carbohydrate tolerance became poorer with increasing age and obesity. According to our observations it would appear simpler to elicit a reduced glucose tolerance with the i.v. method than with the oral test.