[PDCA cyclus and morbidity and mortality conference as a basic tool for reduction of wound infection in colorectal surgery]. / PDCA-Zyklus und Morbiditäts- und Mortalitätskonferenz als Basis der Wundinfektionsreduktion in der Kolorektalchirurgie.

BACKGROUND: Morbidity and mortality conferences (M + M) are used for the discussion of errors and thereby further education in surgery. However, it is not clear whether this kind of quality assurance has any influence on the results of surgery. MATERIAL AND METHODS: We investigated whether M + M as part of PDCA-cylce (plan, do, check, act) with prospectively collected quality data, fixing future goals using benchmarking data and defining a strategy to reach these goals can lead to an increase in quality. RESULTS: Using surveillance data n = 673 colorectal resections were analysed. Between 2003 and 2008 we found a wound infection rate of 5.6 %. Comparing 2003-2005 (period of strategy development using M + M) and 2006-2008 (period of strategy conversion) the frequency decreased from 7.8 % to 3.5 % (p = 0.012). Thereby the risk factors for wound infection (ASA, wound classification, duration of surgery and wound infection score) were not different. CONCLUSIONS: M + M as part of this PDCA cycle resulted in a clear increase in surgical quality.

The dermatologist in military operations.

The military dermatologist has a specific and significant role in military operations--in time of war as well as in peace. Many dermatologists are unfamiliar with the impact that our specialty and cutaneous disease has upon the ability of the military to fulfill the missions, duties, and responsibilities assigned by our government. This article highlights a few of the recent or ongoing types of military operations in which our specialty plays a prominent part.

Recollections of parent-child relationships in OCD out-patients compared to depressed out-patients and healthy controls.

The present study examined the relationship between parental bonding in 26 psychiatric out-patients with obsessive-compulsive disorder (OCD) compared to 34 out-patients with major depressive disorder (MDD) and 41 healthy controls. The results indicated significantly lower levels of parental care and higher levels of maternal overprotection for the patients with a current principal diagnosis of depression, compared to healthy controls. In multiple regression analyses, the presence of depressive disorder was related to all Parental Bonding Inventory (PBI) subscales. When the presence of current depressive disorder was controlled for statistically, the diagnosis of OCD was not associated with abnormal patterns of parental bonding on the PBI.

Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study.

To determine and compare short- and long-term effects of aerobic exercise (AE), stress management treatment (SMT), and treatment-as-usual (TAU) in fibromyalgia, 60 patients were randomized to 14 weeks of treatment by either AE, SMT or TAU. Outcome measures at baseline, midway through treatment, at treatment completion, and at 4 year follow up included a patient made drawing of pain distribution, dolorimetry of tender points, ergometer cycle test, global subjective improvement, and VAS registrations of: pain, disturbed sleep, lack of energy, and depression. Both AE and SMT showed positive short-term effects. AE was the overall most effective treatment, despite being subject to the most sceptical patient attitude prior to the study. At follow up, there were no obvious group differences in symptom severity, which for AE seemed to be due to a considerable compliance problem.