Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study[Surgical research and publications in Germany--an analysis of 1984-1994].
The present study analyses a selection of German and American surgical and cancer research journals from the years 1984 and 1994. The aim of the study was to evaluate the amount of publications by German surgeons in these journals. ⋯ In parallel, German surgeons are still the major contributors to German language journals, but increasingly publish in the American ones as well. The impact factor is one of the major selection criteria on to which journal a paper shall be submitted.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[The trauma register of the 'Polytrauma' Committee of the German Society of Trauma Surgery as the basis for quality management in the management of severely injured patients].
The data of 1037 severely injured patients (mean ISS = 20) from 15 clinics were centrally and prospectively collected in the Trauma Registry of the German Society of Trauma Surgery and analyzed anonymously. Significant differences in respect to the treatment criteria (i.e., duration of basic diagnostics in severe trauma) and quality of outcome (TRISS method and Z statistic) were revealed for some clinics. The feedback of their data offers the associated clinics the possibility of identification of treatment phases that are worth being optimized.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Minimal invasive bypass operations on the beating heart and using mechanical stabilization of the heart surface].
Different minimally invasive techniques are currently being controversially discussed among cardiac surgeons. For revascularization of anterior myocardial vessels, off-bypass procedures were performed in 64 cases through an anterolateral submammary minithoracotomy using the left internal mammary artery. Application of mechanical epicardial stabilization facilitated adequate exposure of the anastomosis and resulted in good patency rates and a low number of complications.
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Hospital standards for the care of multiple traumatized patients include certain clinical capabilities, special logistics (appraisal of structure), and--even more important--algorithms for simultaneous activities in diagnosis and therapy (assessment of process). The main goal in the trauma system should be definitive, specialized care for the injured in the shortest possible time. Economically there is no way of creating a tight network of highly developed trauma centers close to every patient. ⋯ Trauma registers are necessary to plan for the future. Quality improvement programs (education, system evaluation) should be installed, especially for smaller hospitals bound into the trauma system. Financial support is essential for hospitals designated for care of multiple traumatized patients in rural areas.
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Algorithms represent a graphical display of decision-making by giving clearly defined and formalized guidelines. The systematic order of decisions and consequent actions is guided by medical priority and regulates the time frame and sequence of each single step in a logical manner. With the help of clinical algorithms highly complex processes such as the management of the severely injured patient can be translated into a clearly structured, logical pathway. ⋯ The use of algorithms allows a systematic search for errors in the process of quality management. In emergency situations they suggest a structured way of problem-solving to the less experienced user. Algorithms are useful instruments in teaching medical decision-making.