Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Dec 2000
["Medical decision making in the tension field between medical possibilities, cost pressure and humanity."].
The progress in medicine has contributed to the fact that for 50 years life expectancy in Germany has increased by three to four years per decade. The number of older people has considerably increased and at the same time there has been a decline in the birthrate with the effect that the portion of the people over 60 years, now a quarter of the population, will rise to a third of the population in 2040. The dual relationship between patient and physician has changed due to the extension of the statutory health insurance to more than 90% of the population. ⋯ Thus the financial, organizational and structural deficits in the health care system that are resulting from the social legislation are shifted by means of the liability law to the individual physician or to other service providers. Even treatment guidelines cannot protect them from this because the "standard patient" does not exist. What we really need are appropriate reforms including adjustments of the insurance structures which offer the insured alternatives: Expansion of the financial elements of the statutory health insurance Adjustments of the health care structures with integration between the outpatient and inpatient sector Restriction of the legislator to the definition of framework provisions and service limits Orientation of the health care necessities to the health care needs of the patients Economy must not dominate over humanity Adjustment of the social legislation and the liability law Settlement of the details by the joint self-administration of physicians and health insurance funds.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Genuine medical accreditation systems in the USA according to standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--reflections on the transferability of the procedures to Germany].
In a number of anglophone countries in parallel to the industrial trend accreditation systems have been developed for health care organizations and specially for hospitals. These systems were introduced and instituted as a part of the health care system in the countries. Central elements and central procedures of these genuine-medical accreditation systems for hospitals in the United States, in Australia, Canada, France and in Great Britain are mostly identical. ⋯ Core of the systems is a catalogue with standards, which in a systematic and comprehensive way gives ideas of good professional performance in hospitals. The catalogues can be used internally to develop and improve quality and quality management in a hospital. Primarily, however, the accreditation systems are designed to provide most objective measures for external evaluation of quality and quality management.
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During the last phase of progressive cancer numerous problems may arise. Additionally to pain and other symptoms, psycho-social and spiritual considerations supervene. In such cases palliative medicine offers positive options. ⋯ The statistics of the home care service Bonn shows that in 1999 73 per cent of patients could be treated at home until the end of live. In 43 per cent physicians made the initial contact with this service organisation. This proves the necessity and acceptance of new structures in palliative out-patient care.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Treatment of nausea nad vomiting in palliative medicine].
Nausea and vomiting are the most distressing gastrointestinal symptoms in patients with far advanced malignant diseases. A complex pathophysiology exists between gastrointestinal tract and brainstem. Neurotransmitters play an important role. ⋯ Dependent on the cause the antiemetic, which blocks receptors peripherally or centrally, will be chosen. Main antiemetic groups are prokinetics, 5HT3-antagonists, dopaminantagonists, antihistaminics and phenothiazines. Symptom relief can be reached in 90% of the patients with a differentiated approach.