[Classification of floater patients : Evaluation of a study database on the relationship between characteristics and impairment]. / Typisierung von Floaterpatienten : Auswertung einer Studiendatenbank zum Zusammenhang von Merkmalen und Beeinträchtigung.

Subjective impairment of floater patients can only be partially quantified using ophthalmological test methods. In order to classify floater patients, patient-related characteristics associated with higher level of impairment should be identified. A data set of a prospective, multicenter single-arm primary study of 64 floater patients who underwent vitrectomy includes patient-related characteristics and information on subjective preoperative and postoperative (3 months after vitrectomy) impairment. Data on impairment were collected with a floater-specific questionnaire and condensed into self-rated impairment indices (SRI). Medians of the SRI were calculated for the manifestation of sociodemographic and ophthalmological parameters as well as for the classification of floaters on the study and second eye and tested for significance. Higher preoperative SRI were associated with professional activity, young age, reduced preoperative visual acuity, retinal alterations and higher refractive errors as well as floaters on the second eye. Higher postoperative SRI were found in combination with cataract and younger age. The SRI differences were only occasionally significant. Classification of floaters as documented by the surgeon and by SRI were significantly correlated only for patients without other visual comorbidities besides floaters. The primary study reported high preoperative subjective impairment and a significant decrease in SRI after vitrectomy for almost all patients. The current study showed that some individual patient-related characteristics tended to be associated with greater preoperative impairment and greater benefit from vitrectomy.

[Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. / Indikation, Prozedere und Outcome der präklinischen Notfallthorakotomie ­ eine systematische Literaturrecherche.

BACKGROUND: Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD: A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS: A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION: The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.

[Evaluation of methodological quality in published RCTs on cataract surgery : Pilot study on the degree of adherence to CONSORT statement requirements and their qualitative validity]. / Bewertung der methodischen Qualität publizierter RCTs in der Kataraktchirurgie : Pilotstudie zur quantitativen Zielerfüllung bestehender Anforderungen laut CONSORT-Statement und deren qualitative Validierung.

BACKGROUND: The CONSORT statement can be considered as a guideline to ensure transparency in the reporting of randomized clinical trials (RCT), in addition to specific author instructions and requirements of journals. It provides a total of 25 criteria and 12 additional subcriteria on methodological and regulatorical determinants of clinical trials. The availability of the CONSORT recommendations, however, does not necessarily imply adherence to their obligations and correct realisation of the latter from a methodological perspective, so that even in ophthalmology a lack of transparency in trial reporting cannot be excluded. OBJECTIVE: The question was whether a consistent consideration of the CONSORT checklist criteria by authors actually implied transparent reporting of underlying study results. MATERIALS AND METHODS: This pilot study was based on a random sample of six published RCTs on cataract surgery extracted from an existing trial publication register. Compliance with each of the 25 CONSORT criteria and its 12 subcriteria and the content accuracy of the latter were independently assessed by two parallel raters for the six trial publications. RESULTS: The median compliance with the 37 CONSORT criteria and subcriteria was 62% [min-max 48-81%]; the median fraction of their correct implementation was 47% [min-max 34-69%]. CONCLUSIONS: Promotion of transparent reporting by means of the CONSORT statement appears to be problematic in implementation. There is a discrepancy between information as required by CONSORT and the content accuracy of its actual presentation. Thus, in particular, reviewers of clinical trial publications should not only check for the presence of data to be provided according to CONSORT, but also verify the meaningfulness in the respective context, at least on a random basis.

Clinical outcome and cost effectiveness of inpatient rehabilitation after total hip and knee arthroplasty. A multi-centre cohort benchmarking study between nine rehabilitation departments in Rhineland-Palatinate (Western Germany).

BACKGROUND: Rehabilitation after hip and knee replacement surgery is effective, but cost intensive. To ensure consistent cost-effectiveness across different providers prospective cohort studies on its clinical and economic outcome are recommended. Comparisons alongside suitable outcome quality indicators enable to contrast different providers and--in case of clinically or economically relevant differences--reveal constructive approaches to quality improvement. AIM: Therefore an external benchmarking for posthospital curative treatment after hip and knee arthroplasty between nine inpatient rehabilitation departments in the German Federal Land Rhineland-Palatinate was implemented based on data acquired between 01/2007 and 12/2009. DESIGN: Multi-centre retrospective cohort benchmarking study. SETTING: Inpatient rehabilitation in nine rehabilitation departments POPULATION: A total of 8672 patients after unilateral hip arthroplasty (THA) and 8180 patients after unilateral knee replacement (TKA) surgery were investigated. The median age of the patients after hip arthroplasty varied between 71 and 75 years, after knee arthroplasty between 72 and 75 years. The department-wise proportions of female patients ranged from 62% to 77% (THA) and from 70% to 81% (TKA). METHODS: Data on clinical outcome of inpatient rehabilitation after THA and TKA were documented using the EVAReha® software. As primary indicator of clinical outcome quality the intra-individual pre-post change in the total Staffelstein Index was determined [%], as primary economic indicator the cost-normalized effect estimate (CNEE) was estimated [%/€] relating the individual Staffelstein Index change to a patient's respective direct costs [€] paid by the statutory health insurance. RESULTS: In the nine departments the median Staffelstein index increase after THA ranged between 18% to 31% corresponding to median CNEEs ranging from 9% to 15% Staffelstein increase per €1000 investment of the statutory health (Kruskal/Wallis P<0.001). After TKA the median Staffelstein index increase ranged between 19% to 34% corresponding to median CNEEs ranging from 9% to 16% Staffelstein increase per 1,000 € investment of the statutory health (Kruskal / Wallis P<0.001). CONCLUSION: Inpatient follow-up treatment after hip and after knee replacement surgery demonstrated a statistically significant and both clinically and economically relevant heterogeneity between the departments. Additional exploratory analyses by means of adjustment with further predictors could not resolve these heterogeneities. CLINICAL REHABILITATION IMPACT: Benchmark information on cost effectiveness would enable departments to learn from the "best" and to implement corresponding peer cooperation, to then identify own shortcomings and potentials, and thereby to analyze and optimize local processes.

[Clinical and economical outcome evaluation of dental care services received by German patients in countries outside the EU]. / Klinische und ökonomische Evaluation der Inanspruchnahme zahnärztlicher Leistungen im Ausland.

PURPOSE: During the past decade German patients developed an increasing tendency to dental health tourism in countries outside the European Union. The present investigation aimed at evaluating both clinical and economic outcome of dental care in these countries with regard to German directive standards. METHODS: Based on physical examinations performed by the Medizinische Dienst der Krankenversicherung Rheinland-Pfalz in the context of reimbursement or regress requests after dental care in countries outside the European Union, an individual treatment concept was designed and its direct costs from the patient's perspective were estimated according to German standards. Furthermore, the clinical outcome was evaluated and treatment concepts for the correction of clinically relevant findings were simulated; the corresponding costs were estimated. A descriptive cost-cost analysis has been performed from the patient's perspective and a secondary one from the health service's perspective. RESULTS: A total of 60 examinations (january 2001 to october 2002) were analysed. 29 of these 60 patients showed clinically relevant findings affording post treatment correction, among which 23 treatment concepts significantly disagreed with German directive standards. From the 60 patients' perspective median costs of 942 euro; for treatment outside the EU versus hypothetical costs of 750 euro; for treatment in Germany were observed. In addition, the 29 patients with clinically relevant findings affording corrective treatment implied median costs of 1,383 euro;. From the health service perspective, median costs of 761 euro; could be avoided due to treatments outside the EU, whereas median costs of 1,220 euro; were simulated due to necessary corrective treatments. CONCLUSION: From the patients' perspective dental care outside the EU has to be reconsidered both from a clinical and an economic point of view.