Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Changes in the spectrum of the health provision contract and their effects on education, graduate education, research, quality of treatment and continuing development of surgery].
The legal "contract for patient care" issued by the Federal Government for all hospitals interferes with graduate medical education (approbation order), postgraduate surgical training, the KMK paper for new structures and financing of university medicine, health politics of the Physicians Parliament and the Legal Health System, guidelines for surgical practice, internal and external quality measurement, and, last but not least, with clinical research in surgery. The different effects are outlined in detail.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Emergency care and treatment costs of polytrauma patients].
Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days on ICU, the total costs were DM 106924.36 (about 70,000 US $). DM 39,635.88 (= 37%) were the costs for physicians and nurses; DM 67,289.08 (= 63%) were needed for materials, X-rays, laboratory investigations, drugs and blood components. ⋯ In Germany, a new way of compensation by a diagnosis-related group was introduced in 1996. These data suggest that treatment of severe multiple trauma is very expensive and trauma care could be economically harmful for smaller hospitals. We conclude that treatment of multiply injured patients (ISS > 16 p) should be compensated for by a special daily amount of about DM 5000 (about 3500 US $) for selected trauma centres.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Technical aspects of segment I resection of the liver].
Due to posterior location and the close relationship to vascular and biliary structures, resection of tumors within the caudate lobe of the liver may be a surgical challenge as well as an oncological hazard. Various approaches and techniques of isolated tumorectomy and combined liver resections are available and must be tailored to the individual situation. Prerequisite for a low operative risk is control of bleeding which can be achieved by sequential inflow and outflow occlusion of the liver.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Economic considerations in critically ill intensive care patients].
Since 1992 the data for all patients referred to our ICU have been entered on computer and analyzed for parameters relevant to therapeutic effectiveness on the one hand and cost-containment on the other. The analysis of data for 5424 patients concerning APACHE II-score, age, number of ICU days, time of mechanical ventilation and/or hemodialysis, cardio-respiratory complications and insufficiency, ICU discharge date and hospital discharge date demonstrates a profile or our intensive care services using all resources efficiently. The data revealed no ethically acceptable parameter or necessity to include economic considerations in medical decisions which had to be taken for individual patients and situations.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Skin cultivation in treatment of severely burned patients].
In severe burns a total body surface area (TBSA) of more than 60% restricts possible donor areas for autologous STS coverage. Additional wound surfaces may further harm the patient. ⋯ Long culture times from 14 (KFGS) up to 28 days (CEA), infection of the culture and the woundbed, mechanical instability in the first period after grafting, restoring the dermal equivalent in full thickness burns and high costs are the problems of this new means of burn wound covering. Technical details of cultivation and coverage procedures using CEA and KFGS are discussed.