Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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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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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Does rationing of intensive care beds lead to premature ward return with preventable complications?].
Readmission to the surgical intensive care unit was necessary in 105 of 2269 patients (4.6%) who were discharged between 1991 and 1995. Mortality was 20% Cardiopulmonary reasons during the first 72 h after initial discharge were rare [33 patients (1.4%)].
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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.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Verifying routine preoperative diagnosis between private practice and the surgical university clinic].
In an attempt to shorten the preoperative in-patient period and to avoid unnecessary investigations, a cooperative patient management model was established for a number of surgical operations at the University Department of Surgery, Anaesthesiology and their referring Specialist and General Practitioners. The latter were requested to carry out the previously defined preoperative routine investigations, which allowed for a marked reduction in hospital diagnostics. Ambulatory preoperative patient management and a new admission routine resulted in a 57% decrease of the average preoperative in-patient stay for the observed procedures.