Das Gesundheitswesen
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Das Gesundheitswesen · Jan 2002
[The "Barthel Index": alternative to expertising in compulsory care insurance?].
Measuring the level of care needed is difficult and since the introduction of nursing care insurance in Germany in 1995 the assessment method applied by the MDK (Medizinischer Dienst der Krankenversicherung) has repeatedly been criticised. The method is very costly and not broadly tested for its validity and reliability. ⋯ In this article the authors show - based on a preliminary study in 1999 - that by using the Barthel Index a discriminance analysis will show identical results in 80 % of all cases. The authors regard this identical measurement of care needs, which is reached by scoring only ten items (BI) versus thirty (MDK's assessment method) and with a presumingly higher reliability, as a major progress and reason enough for further discussion and studies of the use of the Barthel Index for care needs assessment.
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Das Gesundheitswesen · Nov 2001
[Towards a new line in public school health service; the medical profession in the fields of social pediatrics, occupational health and multiprofessional health promotion].
The circumstances of life and the health status of children and adolescents in Germany have undergone fundamental changes. Public institutions, such as schools or kindergartens more often are not only support but a substitute for family structures. Individual medical care being guaranteed, seeking for prevention and treatment and health status differ widely according to sociological patterns. ⋯ School health services will have to engage in occupational health and will have to be present mostly in the school buildings proper. School health services will have to report and publish epidemiological data for use by school, community and medical professionals. In case of continued compulsory medical examination of schoolbeginners wide use should be made of qualified assistant personnel, so that physicians can focus on true medical problems in school and moreover will be enabled to deliver medical expertise and treatment within the community to people and population groups in need.
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With the increase of treatable chronic diseases and of the number of elderly persons in society, rehabilitation and social services to compensate disabilities are getting increasingly important. At the same time, social security systems today are hard pressed to control health care costs and to justify their services. ⋯ For this reason knowledge and use of this Classification are now being taught to experts of the MDK (German medical service of health insurances). The way how this is done in the MDK Berlin-Brandenburg and first results are reported.
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Although microorganisms are the main cause of nosocomial infections, they are by no means their only determinants. Patient-associated factors play a major role (especially immune status), the therapeutic conditions (personnel behaviour, 'devices') and the patient's environment. The hospital infection control team is responsible for implementing and operating an efficient and cost-effective infection control and prevention system. ⋯ The increase in methicillin (oxacillin) resistant S. aureus (MRSA) is particularly worrying. Building up an effective surveillance system for nosocomial infections, as demanded by the new German infection control act has far-reaching implications and entails recording risk-adjusted infection rates (KISS project = Hospital Infection Surveillance System of the National Reference Center for Hospital Hygiene in cooperation with the Robert Koch-institute). Proper collaboration between hospital staff in implementing infection control measures, and especially hand hygiene is of paramount importance.
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Das Gesundheitswesen · Jun 2001
Comparative Study[Tobacco smoking attributable mortality in Germany].
The goal of the study is the estimation of mortality rates attributable to tobacco smoking (TAM) for the Federal States of Germany. ⋯ The data reveal for Germany that tobacco smoking is the most preventable health risk.