Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Does rationing of intensive care beds lead to premature ward return with preventable complications?].
Readmission to the surgical intensive care unit was necessary in 105 of 2269 patients (4.6%) who were discharged between 1991 and 1995. Mortality was 20% Cardiopulmonary reasons during the first 72 h after initial discharge were rare [33 patients (1.4%)].
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Algorithms represent a graphical display of decision-making by giving clearly defined and formalized guidelines. The systematic order of decisions and consequent actions is guided by medical priority and regulates the time frame and sequence of each single step in a logical manner. With the help of clinical algorithms highly complex processes such as the management of the severely injured patient can be translated into a clearly structured, logical pathway. ⋯ The use of algorithms allows a systematic search for errors in the process of quality management. In emergency situations they suggest a structured way of problem-solving to the less experienced user. Algorithms are useful instruments in teaching medical decision-making.
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Hospital standards for the care of multiple traumatized patients include certain clinical capabilities, special logistics (appraisal of structure), and--even more important--algorithms for simultaneous activities in diagnosis and therapy (assessment of process). The main goal in the trauma system should be definitive, specialized care for the injured in the shortest possible time. Economically there is no way of creating a tight network of highly developed trauma centers close to every patient. ⋯ Trauma registers are necessary to plan for the future. Quality improvement programs (education, system evaluation) should be installed, especially for smaller hospitals bound into the trauma system. Financial support is essential for hospitals designated for care of multiple traumatized patients in rural areas.
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Necrotizing fasciitis has changed considerably over time. The disease used to be due to group A streptococci and affected otherwise quite healthy or traumatized subjects. Today we see multibacterial infections in polymorbid or immunocompromised patients. ⋯ Sometimes frozen-section biopsy proves helpful. Septic immune response and organ failure develop rapidly in these patients. After vigorous staged necrosectomy, extensive plastic reconstruction is mostly required.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Changes in postgraduate education (health policy prerequisites, work schedule regulation)].
Postgraduate training is an integral part of becoming a doctor. Postgraduate training in Germany is learning by doing, while working as a doctor. ⋯ There is a clear disproportion between the demand for postgraduate-training posts and the corresponding supply. By flexibilisation of the regulations for postgraduate training and by complementing methods for training and learning, the downward movement of the capacities for postgraduate training will be taken care of.