Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Verifying routine preoperative diagnosis between private practice and the surgical university clinic].
In an attempt to shorten the preoperative in-patient period and to avoid unnecessary investigations, a cooperative patient management model was established for a number of surgical operations at the University Department of Surgery, Anaesthesiology and their referring Specialist and General Practitioners. The latter were requested to carry out the previously defined preoperative routine investigations, which allowed for a marked reduction in hospital diagnostics. Ambulatory preoperative patient management and a new admission routine resulted in a 57% decrease of the average preoperative in-patient stay for the observed procedures.
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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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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study["Score systems as a measure for quality assurance in polytrauma?"].
Score systems in trauma try to aggregate the severity of injury in a single number of formula. They give a common basis to standardize logistics and outcome in trauma management. This holds true only if the score is valid, reliable, and based on a meticulous documentation of data. As errors cannot be excluded, individual decisions in trauma management can never rely on scores alone.
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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.