Der Unfallchirurg
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Accident insurance consultants (D-physicians) are qualified specialists with particular expertise in occupational medicine. Within the medical treatment procedure of the German Statutory Accident Insurance (DGUV), D‑physicians must make a report on the medical care after occupational accidents. This nationwide evaluation aimed to systematically measure the quality of documentation of these medical reports. Peer review is a common method to ensure process quality. ⋯ The first nationwide peer review of the DGUV proved to be a practical and valid quality assurance procedure to evaluate the medical reports of D‑physicians. The quality of the reports was in general good. The DGUV plans to repeat the peer review process taking further groups of D‑physicians into consideration.
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In addition to highly specialized medicine, the initial treatment of wounds and minor surgical interventions are generally necessary basic services of emergency care in hospitals. The reimbursement of outpatient emergency services for persons with statutory insurance is currently based on the uniform assessment standard (EBM), where the recording of business expenses in the private practice sector serves as the basis for the calculation. Hospitals have considerably higher maintenance costs than medical practices. ⋯ It could be shown that even without consideration of the relevant holding costs, cost coverage cannot be achieved in any case. The previous reimbursement of outpatient wound care on the basis of the EBM appears to be inadequate. In the future, an adjustment or supplementary remuneration seems to be necessary in order to ensure sufficient quality of care.
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Cognitive and psychoemotional impairment after traumatic brain injury is often underrated, especially after mild injury. Even subtle problems can considerably interfere with routine functioning. They require precise psychotherapeutic diagnostics and adequate neuropsychological treatment. Early detection and documentation of the initial symptoms and initiation of further steps are mandatory, also and particularly during first-line surgical management.
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An evidence-based psychotraumatological expert assessment should include a thorough clarification of the diagnoses on different levels of findings and an inclusion of modern methods to clarify the authenticity. The surgical examiner is of great importance in the cooperation since he mostly undertakes the initial documentation, including psychological damage, and ultimately evaluates the overall damage after an assessment. A good interdisciplinary understanding and appreciation are therefore the prerequisite for a comprehensible expert assessment.
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The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation. ⋯ A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.