[Determination of training costs associated with surgical procedures during specialization as an orthopaedic and trauma surgeon]. / Ermittlung der operationsbezogenen Ausbildungskosten zum Facharzt für Orthopädie und Unfallchirurgie.

BACKGROUND: Trauma surgery is a discipline in which the training phase for specialization requires a technical and time-intensive learning curve, including the repetitive training of manual skills. This results in prolonged operation times and thus elevated costs. OBJECTIVES: The present study retrospectively examines operations in trauma surgery and orthopaedics at a Munich university hospital according to the required curriculum for further specialist training. The duration of procedures at the various training levels and the resulting costs were compared. MATERIAL AND METHODS: Based on digital surgical records, more than 2,000 surgical interventions were analysed and checked that they fulfilled the practical requirements. Patients with multiple injuries and polytrauma, in addition to irregularly complex cases, were removed from the calculation to ensure high comparability of the individual cases. This yielded more than 1,000+ cases for evaluation. The per-minute cost was calculated to allow for the translation of operating time into costs. RESULTS: The study shows a prolonged duration of operating time of 19.75 % when the procedure was conducted by residents. This prolongation can be split into 37 subgroups according to body region and type of procedure. The prolongation of operation time could be quantified as a specific prolongation per cluster, in addition to cumulative prolongation. By including the operating costs, the operation-dependent training costs are shown as an exact sum of Euros. CONCLUSION: Surgical training of residents costs hospitals the appropriate amounts of time and money and reduces the overall number of procedures performed, justifying special consideration of the financing of training hospitals.

[Epidemiological research on primary hyperparathyroidism. A prospective multicenter study]. / Epidemiologische Untersuchungen zum primären Hyperparathyreoidismus. Eine prospektive Multizenterstudie.

Serum calcium determination of 11,588 hospitalized patients during a twelve-month period revealed hypercalcaemia in 74 (0.64%). Further clinical and biochemical investigation established primary hyperparathyroidism in 20 of them (27%), and in 15 (20%) a malignant tumour (with bone metastases in six) as the cause of the hypercalcaemia. Rarer causes were found in 11 patients (15%): diuretic medication (5), lithium treatment (3), immobilization (2) or hyperthyroidism (1). In the remaining 28 patients (38%) no cause of the hypercalcaemia could be established with certainty. In at least six patients, however, there were clinical pointers towards hyperparathyroidism in the absence of unequivocal biochemical findings. Leaving out of account borderline cases, one must reckon on a prevalence of hyperparathyroidism in 0.17% of an unselected group of hospitalized patients. Parathyroid hyperfunction must always be considered in the differential diagnosis because of its manifold clinical presentation.

Postoperative astigmatism induced by intraocular lens tilt.

We report a case of intraocular lens implantation with an unexpected postoperative increase in spectacle astigmatism but no change in corneal astigmatism. The Nd:YAG laser was used to release a fibrous capsular band that was tilting the posterior chamber implant and causing four diopters of astigmatism.

Validating professional judgment in a home care agency.

In the absence of validate assessment techniques, health care practitioners often make professional judgments regarding their clients' needs for services. This article explores the validity and reliability of those judgments in a home care agency and discusses the implications for decision-making in long-term care.