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1.
Unfallchirurg ; 113(3): 247-8, 2010 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-20165827

RESUMO

Quality management is only complete and sound when it comprehensively takes all comments from patients or staff into consideration, especially negative comments. In this manner, complaints, surveys and registered risks can be seen in a synoptic way. Every comment must be evaluated in relation to isolated cases as well as in the sense of pattern recognition.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Anamnese/métodos , Pacientes , Relações Médico-Paciente , Alemanha , Humanos
2.
Ther Umsch ; 62(3): 179-83, 2005 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-15801662

RESUMO

"Learning from ones mistakes" is an essential part of clinical quality improvement. But focusing on a retrospective analysis of mishaps from the past is not sufficient for quality enhancements, nor is the restriction to mistakes in the solely legal sense. Analysis has to include anonymous data aggregated over dissatisfying results from multiple sources. Recognizing patterns of underlying causes for errors is the key to effective error prevention. In many cases the true cause might be predominantly organizational.


Assuntos
Notificação de Abuso , Erros Médicos/prevenção & controle , Padrões de Prática Médica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão de Riscos/organização & administração , Gestão da Segurança/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Gestão de Riscos/métodos , Análise de Sistemas
4.
Orthopade ; 33(9): 1051-60, 2004 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-15278276

RESUMO

BACKGROUND: Little is known about the incidence of adverse effects after chiropractic manipulation. Over representation of severe and under representation of less severe complications has to be assumed. MATERIAL AND METHODS: A total of 57 expert opinions from the malpractice advisory board of the North Rhine General Medical Council (Nordrheinische Arztekammer), as well as judgments from German courts since 1949, were analyzed. RESULTS AND CONCLUSIONS: A total of 16 of 57 cases of chiropractic manipulation (since 1975) were attested as malpractice by expert opinion, seven of which had significant negative consequences. In nine cases, the judgments of German courts refer to manual therapy. Of these, five deal with informed consent. Observance of the "Bingen Declaration" would have avoided all cases of malpractice found by the advisory board over 29 years.


Assuntos
Quiroprática/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Manipulação Quiroprática/efeitos adversos , Adulto , Prova Pericial , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade
5.
Orthopade ; 33(4): 412-5, 2004 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-15141666

RESUMO

The basis of evidence for hygiene rules implemented in hospitals is traditionally small. This is not only because there is little theoretical knowledge on the reciprocal influence between a single hygienic mistake/a single microbial input and the manifestation of a nosocomial infection. There are also not enough clinical studies, especially on complex hygiene questions, to determine whether special measures (e.g., septic rooms)can compensate for deficits in hygiene practice. Furthermore, it would be necessary to designate security buffers distinctly. In-house traditions are able to stabilize hygienic behavior in an excellent manner. They should be fostered and not disparaged as myths. Discussions of experts should not be conducted in public; that is disastrous for the everyday work of physicians in hospitals.


Assuntos
Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Higiene/normas , Controle de Infecções/métodos , Controle de Infecções/normas , Medicina Tradicional , Salas Cirúrgicas/normas , Padrões de Prática Médica/normas , Guias de Prática Clínica como Assunto
6.
Chirurg ; 75(2): 120-5, 2004 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-14991173

RESUMO

Surgery in outpatients and surgery under hospital conditions should provide the patient with the same high level of quality and the same low risk level. The one-person surgery practice is able to offer the patient a classic "one client-one customer" relation. Thus, the continuity of treatment is optimal. On the other hand, intervening systemic complications are more easily managed by the multidisciplinary staff of a hospital with its equipment. The weaknesses of both principles can be counteracted by employing special precautions in organization. The future of surgery is to be seen in combined forms, for example, in-sourcing of a surgeon from private practice into a hospital.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Programas Nacionais de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Alemanha , Humanos , Tempo de Internação , Equipe de Assistência ao Paciente/normas , Gestão de Riscos/normas , Centro Cirúrgico Hospitalar/estatística & dados numéricos
8.
Zentralbl Chir ; 128(4): 348-54, 2003 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-12700996

RESUMO

Medical malpractice is assumed for surgical procedures much more often than for conservative treatment. In a nut shell there can be identified three general problem areas--treatment of patient in inappropriate facilities, inadequate information of patient and lack of documentation. Several examples are given. For the assessment of assumed medical malpractice the expert opinion and consented guidelines are crucial; they both benchmark "good medical practice". Thus these two tools have to be handled and developed carefully.


Assuntos
Prova Pericial/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Benchmarking , Documentação/normas , Alemanha , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Procedimentos Cirúrgicos Operatórios/normas
9.
Zentralbl Chir ; 128(4): 355-8, 2003 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-12700997

RESUMO

The aims of risk management concerning medical malpractice are (1) the quick, correct and fair assessment of assumed medical failures, (2) to prevent the expansion of medical complications after an assumed medical failure and (3) the identification of patterns of risks. The latter has to be done locally and national-wide; it has to be done focussed to the respective medical subject and in a general matter as well.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Imperícia/legislação & jurisprudência , Complicações Pós-Operatórias/prevenção & controle , Gestão de Riscos/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Alemanha , Humanos , Equipe de Assistência ao Paciente/legislação & jurisprudência , Encaminhamento e Consulta/legislação & jurisprudência
10.
Onkologie ; 26(6): 535-8, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14709926

RESUMO

In oncology, as in all other medical disciplines, medical malpractice is assumed when the physician has not taken sufficient care in his treatment, and when he has not met the required standards of medical care. The physician is liable for damages when distinct harm has arisen from this. In oncology, accusations of malpractice arise especially when suspicion of a malignancy is not based on unequivocal substantive diagnostic criteria (for example, the appropriate appraisal of routine x-rays or screening scans), or in terms of organizational mistakes. Stringent safeguards in oncological diagnostics and therapy are usually based on approved and generally recognized guidelines. From the time that the malignancy is suspected, there is therefore little concrete danger that malpractice will be attested provided these guidelines are complied with. The tolerance accorded by experts in respect of intraoperative complications in oncological operations appears to be great amongst medical expert witnesses. If a malpractice is attested, the distinct damage resulting from this can only be appraised approximately, e.g. by comparing the statistical probability of survival in various tumor stages.


Assuntos
Imperícia/legislação & jurisprudência , Oncologia/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Alemanha , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Responsabilidade Legal , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência
11.
Zentralbl Chir ; 127(12): 1083-5, 2002 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-12529825

RESUMO

A social health insurance needs opinions on diagnostic and therapeutic procedures - for the single question regarding the individual patient and as general assessments (health technology assessments) as well. The Medical advisory services of social health insurance (their federal branches and their central board) have to do more than 9 Mio individual expert opinions and more than 100 general assessments or HTA-reports a year. Several examples are to be shown.


Assuntos
Consultores/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Alemanha , Humanos , Cobertura do Seguro/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Avaliação da Tecnologia Biomédica/legislação & jurisprudência
13.
Arch Orthop Trauma Surg ; 121(6): 338-42, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11482467

RESUMO

Radiographic changes in the early stages of osteomyelitis may be subtle and, especially after plate osteosynthesis, frequently missed. A previously described experimental model of local bacterial infection was used in an attempt to determine the reliability of specific changes on conventional radiographs for the diagnosis of osteitis after metal-plate implantation and subsequent inoculation of Staphylococcus aureus in rabbit tibiae. Roentgenograms of the treated limbs were evaluated, and seven radiographic parameters, to which numerical scores were assigned, were determined for each bone. Our results substantiate the conclusion that a radiographically verified periosteal reaction is a constant and early skeletal feature of acute osteomyelitis and has the strongest association to the microbiological results (P < 0.05), emphasising its high predictive value. Plate implantation does not notably impede the diagnosis of osteomyelitis. An association between the amount of inoculated bacteria and the extent of radiographic changes could be found. The results of this present study closely resemble those described in man and suggest that this model may be useful for future experimental investigations in determining a score judging the severity of osseous involvement in local bacterial infection after plate osteosynthesis.


Assuntos
Osteíte/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Animais , Modelos Animais de Doenças , Osteíte/microbiologia , Prognóstico , Coelhos , Radiografia , Sensibilidade e Especificidade
14.
Z Arztl Fortbild Qualitatssich ; 95(6): 425-8, 2001 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-11503562

RESUMO

New techniques in medicine in an enormous variety and limited financial resources make it necessary to define step by step the "national medical how to do". This is to be done by the four boards of health care self-government--especially by the "Koordinierungsausschuss". Thus the clinically active physicians are enabled to implement their own new ideas and their own innovations--especially via high quality guidelines, consented within the scientific societies. This new closed circle, a kind of "government free zone" should be used intensively by all active colleagues.


Assuntos
Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde , Pesquisa/normas , Guias como Assunto , Humanos , Pesquisa/tendências , Sociedades Científicas
16.
Unfallchirurg ; 104(3): 257-60, 2001 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-11284357

RESUMO

Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.


Assuntos
Luxações Articulares , Manúbrio , Esterno , Adulto , Seguimentos , Humanos , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Manúbrio/diagnóstico por imagem , Dispositivos de Fixação Ortopédica , Radiografia Torácica , Fatores de Risco , Esterno/diagnóstico por imagem , Fatores de Tempo
17.
Z Arztl Fortbild Qualitatssich ; 95(2): 113-9, 2001 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-11268876

RESUMO

In Germany, the increasing relevance of Evidence-based medicine (EbM) is not only a consequence of growing economic limitations in the health care system but of a changed jurisdiction, too: liability of the statutory health insurances (SHI) to pay for medical care depends on the proof of its effectiveness. This is of special importance for the Medical Services in their role as an advisor of the SHI. The article depicts the basic assignments of the Medical Services of the Statutory Health Insurance, their legal frame and the role of EbM in sociomedical expertising. The way of fundamental sociomedical expertising, its internal and external effects, the personnel and technical/logistic requirements are described as well as potential of improvement.


Assuntos
Atenção à Saúde/normas , Medicina Baseada em Evidências , Programas Nacionais de Saúde/normas , Alemanha , Humanos , Programas Nacionais de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde
18.
Z Arztl Fortbild Qualitatssich ; 95(2): 121-4, 2001 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-11268877

RESUMO

Generally available national guidelines are the only way to guarantee that the clinically active doctor will consider the same rules as the doctor as an expert within a malpractice procedure. Especially the following question has to be ruled out by national guidelines: From what time on is an innovation to be considered as "normal"--as "standard"? The same is true for continued expert discussions and for the "medical-economic balance". Without national guidelines recognized as well-known rules, the doctor accused in a malpractice procedure will find himself in an unacceptable position of legal uncertainity.


Assuntos
Imperícia , Médicos , Alemanha , Guias como Assunto , Humanos , Imperícia/legislação & jurisprudência
20.
Intensive Care Med ; 26(10): 1566-70, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11126274

RESUMO

OBJECTIVE: To evaluate the effect of adjunctive C1-esterase inhibitor substitution therapy on clinical characteristics and outcome of patients with streptococcal toxic shock syndrome (TSS). DESIGN: Observational. SETTING: Medizinische Poliklinik, University of Bonn, Germany. PATIENTS: Seven patients with direct or indirect evidence of streptococcal TSS. INTERVENTION: In addition to conventional and supportive therapy, all patients received 2-3 single doses of C1-esterase inhibitor totaling 6,000-10,000 U within the first 24 h after admission. MEASUREMENTS AND RESULTS: All patients developed fulminant septic shock, multiorgan failure and/or capillary leak syndrome and necrotizing fasciitis within 10-72 h following the onset of first symptoms. Between 1 and 4 days following administration of C1-esterase inhibitor, a marked shift of fluid from extravascular to intravascular compartments took place in all but one patient, accompanied by a transient intra-alveolar lung edema and rapidly decreasing need for adrenergic agents. Six of seven patients survived. CONCLUSIONS: These clinical observations in a small series of patients and the favorable outcome point towards a positive effect of early and high-dose administration of C1-esterase inhibitor as adjunctive therapy in streptococcal TSS. The possible mechanism involved may be the attenuation of capillary leak syndrome (CLS) via early inactivation of complement and contact systems. Controlled studies are needed to establish an improvement of the survival rates of patients with streptococcal TSS following administration of C1-esterase inhibitor.


Assuntos
Proteínas Inativadoras do Complemento 1/uso terapêutico , Choque Séptico/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Adulto , Idoso , Síndrome de Vazamento Capilar/microbiologia , Terapia Combinada , Proteínas Inativadoras do Complemento 1/farmacologia , Cuidados Críticos/métodos , Feminino , Deslocamentos de Líquidos Corporais , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Choque Séptico/metabolismo , Choque Séptico/mortalidade , Choque Séptico/fisiopatologia , Infecções Estreptocócicas/metabolismo , Infecções Estreptocócicas/mortalidade , Infecções Estreptocócicas/fisiopatologia , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
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