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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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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Confrontation with aversive trauma symptoms is a key element in the treatment of stress-associated disorders, especially posttraumatic stress disorder. It is aimed at working through and reattributing aversive memories and situations. Various techniques enable confrontation in sensu (i.e. imagined) and in vivo (in reality). Confrontation techniques are highly effective; however, since there is a risk of temporarily enhanced, possibly previously suppressed traumatic memories, confrontation must be carefully prepared and revised.
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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.