Das Gesundheitswesen
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Das Gesundheitswesen · Mar 1999
[The guideline clearing programme of the self-governmental bodies in the German health care system--a project to promote quality assurance in medicine].
Within the German health system guidelines are increasing considered as a meaningful and necessary aid to decision making. In this context the effectiveness of guidelines essentially depends on their methodical quality. Because of the fact that most of the German-language guidelines introduced within the past years show obvious methodological defects, the Agency for Quality in Medicine developed within the last two years the following programme for quality-assurance and promotion of guidelines: 1. ⋯ Establishment of quality demands for guidelines 3. Methods and instruments for quality promotion of guideline programmes 4. Measures to promote and check the quality of guidelines ("German Guidelines Clearinghouse") The following article reports on background, aims, instruments, method development and acceptance of the programme.
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The topic suggests a conflict between ethics and economy in medical care. It is often argued that today's welfare state in affluent societies with their social insurance systems makes it easier for the doctor to translate ethical demands into reality without being hampered by economic restrictions. Both doctors and patients took advantage of this system of medical care by mingling social guarantees for health with the doctor's income. ⋯ The same is true for ethics versus economy. Doctors as "free entrepreneurs" must learn that markets will not guarantee reimbursement of costs but react to supply and demand. Hence, regulation of medical care by economic instruments creates better chances even for ethics in medical care against economy.
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Das Gesundheitswesen · Oct 1998
[Maternal protection law and exposure of personnel in the recovery room and surgical intensive care unit by inhalation anesthetics].
According to Section 4 of the German maternity law (MuSchG), pregnant and nursing women are not allowed to work in places where they may be exposed to hazardous gases. Due to MuSchG these women are often effered work in the recovery room (RR) and the surgical intensive-care unit (ICU). The present study examined the occupational exposure in the RR and the ICU to nitrous oxide, isoflurane and the new volatile agents desflurane and sevoflurane in accordance with the German work place safety and maternity laws. ⋯ To reduce the working-place concentrations below the legal threshold it is necessary to use local scavenging devices in addition to appropriate ventilation systems. According to our data, pregnant and nursing women should not be allowed to work in the RR or to nurse mechanically ventilated patients after surgery in the ICU.
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Das Gesundheitswesen · Aug 1998
[Contribution to the discussion: development and prospects of public health service in Bavaria--example: environmental medicine].
Some aspects of development in modern public health services are described by the example of their function in the fields of environmental and social medicine and hygiene. New public management and quality management are important factors in this development. For some parts of the public health services a renewed structure in organisation seems to be necessary. To give quality assured and evidence based advice to policy, public health services need cooperation with scientific institutes and other partners in the field of public health, nowadays just because of reduced resources.