ABSTRACT
Owing to the changes in the laws governing the health care system, medical rehabilitation for patients treated as in-patients is becoming increasingly a subject of discussion, especially for chronic illnesses. Using multiple sclerosis (encephalomyelitis disseminata) as an example, a special database is used to examine the courses, contents, improvements or deteriorations seen in in-patient rehabilitation as experienced by 901 patients who were in rehabilitation clinic in the years 1995-1998. This period was selected to allow the ascertainment of possible effects of far-reaching changes in the law taking effect from autumn 1996 onward. The EDSS (Expanded Disability Status Scale) was applied, and patients financed by statutory health insurances were compared with those financed by pension insurance funds for length of stay, outcome and therapeutic content. In the case of 256 patients being financed by pension funds it was possible to use the classification of therapeutic services as a basic tool and the connection with degree of disability was recognizable: different degrees of severity of the illness led to different treatment programmes. Health insurance patients were always more severely ill than those financed by pension insurance. Interestingly, the legal changes had no effect on the treatment outcomes of the patients. The data retrieved confirm the efficacy of the rehabilitation programmes.
Subject(s)
Multiple Sclerosis/rehabilitation , National Health Programs/legislation & jurisprudence , Patient Admission/legislation & jurisprudence , Adult , Combined Modality Therapy , Disability Evaluation , Eligibility Determination/legislation & jurisprudence , Female , Follow-Up Studies , Germany , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Social Security/legislation & jurisprudenceABSTRACT
1. The humoral immunosystem is impaired in those cases of catabolic metabolism in which quantitative and qualitative insufficient alimentation is expected after operation. 2. We showed that after cardiac surgery with extracorporal circulation as well as after other operations a reasonably balanced parenteral nutrition composed of carbohydrates and amino acids could considerably inhibit the changes in the humoral immunity, which is a valuable contribution to the prevention of infection. 3. In our experiments on transformation of lymphocytes after mitogenic stimulation, the depressive effects of operation on the cellular immunity were found to be etiologically more complex than was previously assumed in publications.
Subject(s)
Heart Diseases/surgery , Immunity, Cellular , Postoperative Complications/prevention & control , Surgical Wound Infection/prevention & control , Bronchoscopy , Cholecystectomy , Extracorporeal Circulation , Herniorrhaphy , Humans , Hydrocortisone/blood , Immunoglobulin G/analysis , Immunoglobulins/analysis , Lymphocyte Activation , Parenteral NutritionABSTRACT
1. The humoral immunosystem is impaired in those cases of catabolic metabolism in which quantitative and qualitative insufficient alimentation is expected after operation. 2. After cholecystectomies as well as after cardiac surgery with extracorporal circulation a reasonably balanced parenteral nutrition composed of carbohydrates and amino acids would considerably inhibit the changes in the humoral immunity, which is a valuable contribution to the prevention of infection. 3. In our experiments on transformation of lymphocytes after mitogenic stimulation, the depressive effects of operation of the cellular immunity were found to be etiologically more complex than was previously assumed in publications.
