[Patient education: quality criteria in its implementation]. / Patientenschulung: Qualitätskriterien der Schulungsumsetzung.

Patient education has become increasingly important in medical rehabilitation in recent years. While educational programmes are often conducted under ideal circumstances during the developmental process, basic conditions may be less favourable in routine application on a daily basis. Therefore, quality requirements of patient education are needed. We have previously defined quality requirements regarding the conception of educational programmes and now propose quality criteria concerning the execution of patient education, with particular attention to inpatient medical rehabilitation of adult patients. In this report, both the procedure and the results of the process of criteria development are described. We obtained patient education experts' opinions regarding both dimensions and criteria of educational quality using the Delphi technique, which included a consensus group discussion. Final agreement was reached for eleven dimensions assessed with 59 criteria, covering the following domains: basic conditions of patient education; necessary qualifications of instructors; integration of patient education into the rehabilitation process; and quality management. The quality criteria proposed aim to increase the awareness of quality requirements and to provide a tool for improving the quality of patient education in medical rehabilitation.

[Patient education as a constituent of a patient-oriented approach in rehabilitation]. / Patientenschulung als Element der Patientenorientierung in der Rehabilitation.

Patient education is a central component of patient-oriented medical rehabilitation. The aim of patient education is to provide patients with the fundamentals of acting as competent partners in the rehabilitation process. Thus, the goals of educational group programmes are compliance, self-management, and empowerment, which are aspired by means of providing information, training skills, and modifying attitudes. According to expert opinions, such programmes should comply with certain minimum criteria regarding aims, methods, and frameworks, which can then be complemented by additional quality criteria. Furthermore, educational programmes should meet all the substantial requirements and standards of the respective medical area and exhibit proven effectiveness. A nationwide survey of rehabilitation institutions has shown that the implementation of patient education does not meet the quality requirements in all cases, particularly regarding patient-oriented didactics, standardisation, manual-use and evaluation. An additional quality feature is marked by the skills and qualifications of the educators. Instructors should be competent in leading and moderating groups and using various methods and media in order to fulfill the standards of modern educational concepts. As ample evidence has shown, patient participation and improved self-efficacy are indispensable when trying to promote healthy lifestyles in patients. Additional opportunities for enhancing patient orientation and optimizing patient education are provided by measures of behavioural planning and after-care as attempts to convey the behavioural changes in the patients' everyday lives.

Estrategia de detección de retinopatía diabética en un centro de salud primario / Strategy for detection of diabetic retinopathy in a primary health care center

Objetivo: Realizar un estudio de prevalencia de retinopatía diabética (RD) en pacientes registrados y controlados en un centro de atención primaria de salud, para su derivación a médico oftalmólogo del Hospital Base, de forma más selectiva, para disminuir la sobrecarga de atención en el nivel secundario de salud. Métodos: El estudio se realizó en una población de 105 pacientes (210 ojos), procedentes del registro del Programa Crónicos de Diabetes, del consultorio Urbano de San Felipe, Servicio de Salud Aconcagua. Los datos valorados en este estudio fueron: edad del paciente, tiempo de evolución de diabetes mellitus, tratamiento utilizado, parámetros de control metabólico (glicemia ayunas últimos 6 meses, colesterol total de plasmático, Índice de Masa Corporal (ICM), creatininemia) hábitos deletéreos (tabaquismo, beber problema) presencia de complicaciones micro o macrovasculares asociadas (nefropatía, neuropatía diabética o pie diabético) y fondo de ojo, realizado por médico no especialista, entrenado para este efecto en el Hospital Base de San Felipe. Resultados: Se obtuvo una prevalencia del 23,5 por ciento de RD en el total del grupo de diabéticos tipo 2 estudiados. Los factores de riesgo que presentan esta complicación son: tiempo de evolución (el porcentaje es definitivamente mayor en los diabéticos tipo 2 con más de 15 años de evolución) y la presencia de otras complicaciones crónicas. La ceguera bilateral es 0 por ciento y el estado de ojo único es de 2,8 por ciento. Conclusiones: La prevalencia de RD en una población diabética registrada en Atención Primaria es de 23,5 por ciento. Los factores de riesgo son el tiempo de evolución desde el diagnóstico de diabetes mellitus y la asociación de otras complicaciones micro o macrovasculares. En el 78 por ciento de los casos, independiente del tiempo de evolución, los pacientes no tenían registro de fondo de ojo previo.

[Fractures of the mandibular collum in childhood--a long-term follow-up with orthopantomography]. / Kiefergelenkfortsatzfrakturen im Kindesalter--eine Langzeitstudie im Orthopantomogramm.

The study including fifty children younger than 10-years-old with dislocated unilateral collum fractures concerns the chronological development of morphological alterations in the orthopantomogramm. Regardless of fracture type, the radiographs indicate, that a very good restitution can be attained with an exclusive functional therapy using an activator in all analyzed patients. A realignment can not be found.

[Outcome of wisdom tooth germ transplantation]. / Zur Frage des Erfolges bei Weisheitszahnkeimtransplantationen.

In 68 patients, 79 tooth germs of the third molar were transplanted. Out of this group, 43 patients with 50 transplantations under-went a follow-up examination. All surgery was performed by one surgeon. Retrospectively, we tried to establish whether the success of postoperative healing depends on the donor and receiver regions. Crossing the jaw border clearly worsens the prognosis for transplantation. Altogether 9 transplantations turned out to be failures, 7 of which had been transplanted from the upper to the lower jaw. The results of this investigation showed incomplete root development in 34%, the necessity of endodontic treatment in 6% and enlarged periodontal pockets in 8%. Ankylosed teeth were found in 10%; we did not see any root resorptions.

[Long-term outcome of functional treatment for high double-sided condylar fractures]. / Spätfolgen einer funktionell behandelten, doppelseitigen hohen Kollumfraktur.

The conservative procedures widely used to treat fractures of the condylar neck seem to provide positive short-term benefits, but on long-term observation the results sometimes are not consistent with the early prognosis. We observed a patient (adult female) from the time of the accident for a period of 7 years. The patient suffered from a high double-sided fracture of the condylar neck combined with a multiple fracture in the frontal region of the mandible. The treatment plan was: 1. primary osteosynthesis of the fracture in the frontal-region, 2. intermaxillary fixation for 14 days, 3. functional post-operative treatment using monoblock. Up to the first month it looked like a normal recovery. However, after three months the expected recovery became questionable. After 7 years it was obvious that the recovery had reached its peak between 3 months and 1 year after the operation. The patient experienced chronic pain and progressive loss of function. Such results are unsatisfactory and new operative procedures using osteosynthesis have to be developed.