Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Feb 2013
Review[Pathophysiology and therapy of castration-resistant prostate cancer].
Advanced prostate cancer that progresses under androgen deprivation therapy has long been thought to be refractory to further hormonal treatment. The identification of the mechanism of cancer cells has revolutionized this understanding. ⋯ Due to the heterogeneity of tumors with cells in varying states of differentiation, the treatment of CRPC with androgen deprivation therapy remains a cornerstone of disease management. To what extent the experimental findings and the recommendations in the guidelines are put into practice was the subject of a survey among urologists analyzing their treatment strategies with CRPC patients.
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Der Urologe. Ausg. A · Dec 2012
[Irreversible electroporation: the new generation of local ablation techniques for renal cell carcinoma].
Local ablation techniques are a major focus of current developments in oncology. The primary aim is to retain organs and preserve organ functions without compromising the oncological outcome. ⋯ First published in 2005 IRE is currently undergoing preclinical and clinical trials in several areas of oncology and the initial results have been promising. The IRE technique could be a significant development in ablation treatment for renal cell carcinoma (RCC) but decisive proof of its effectiveness for local RCC has not yet been provided. This study presents the results of preclinical and initial clinical trials which are discussed and compared with those of other ablation techniques in order to demonstrate the current value of IRE.
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Studies have shown for many years that the cause of errors or patient injury is in a high proportion of cases to be found under human factors. Human factors include all those factors which determine the safety and capabilities of humans especially in complex situations or systems. Up to now this topic has barely been systematically dealt with in training and there is a large deficit. ⋯ Professional performance at the highest level can only be expected from teams which regularly participate in team training for critical situations. In addition to simulation training with human factors, other aspects of patient safety are also essential. The concept of high reliability organizations (HRO) could make an important contribution in the sense of a safe hospital concept and includes the collection and analysis of critical incidents (critical incident reporting system CIRS) as well as the focus on the system of patient safety instead of individual persons and errors.
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Der Urologe. Ausg. A · Nov 2012
[Possibilities and perspectives of quality management in radiation oncology].
The medical discipline radiation oncology and radiation therapy (treatment with ionizing radiation) has developed rapidly in the last decade due to new technologies (imaging, computer technology, software, organization) and is one of the most important pillars of tumor therapy. Structure and process quality play a decisive role in the quality of outcome results (therapy success, tumor response, avoidance of side effects) in this field. Since 2007 all institutions in the health and social system are committed to introduce and continuously develop a quality management (QM) system. ⋯ The Radiation Center Hamburg (SZHH) has functioned as a medical care center under medical leadership and management since 2009. The total QM and organization system implemented for the Radiation Center Hamburg was prepared in 2008 and 2009 and certified in June 2010 by the accreditation body (TÜV-Süd) for DIN EN ISO 9001:2008. The main function of the QM system of the SZHH is to make the basic principles understandable for insiders and outsiders, to have clear structures, to integrate management principles into the routine and therefore to organize the learning processes more effectively both for interior and exterior aspects.
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Der Urologe. Ausg. A · Nov 2012
[Learning from errors: applying aviation safety concepts to medicine].
Health care safety levels range below other complex industries. Civil aviation has throughout its history developed methods and concepts that have made the airplane into one of the safest means of mass transport. ⋯ This applies particularly to including the topic of safety into relevant curricula. Physicians are obliged by the oath"primum nil nocere" to act, but economic as well as political pressure will eventually confine professional freedom if initiative is not taken soon.