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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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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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.