Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].
The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. ⋯ National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Genuine medical accreditation systems in the USA according to standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--reflections on the transferability of the procedures to Germany].
In a number of anglophone countries in parallel to the industrial trend accreditation systems have been developed for health care organizations and specially for hospitals. These systems were introduced and instituted as a part of the health care system in the countries. Central elements and central procedures of these genuine-medical accreditation systems for hospitals in the United States, in Australia, Canada, France and in Great Britain are mostly identical. ⋯ Core of the systems is a catalogue with standards, which in a systematic and comprehensive way gives ideas of good professional performance in hospitals. The catalogues can be used internally to develop and improve quality and quality management in a hospital. Primarily, however, the accreditation systems are designed to provide most objective measures for external evaluation of quality and quality management.
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During the last phase of progressive cancer numerous problems may arise. Additionally to pain and other symptoms, psycho-social and spiritual considerations supervene. In such cases palliative medicine offers positive options. ⋯ The statistics of the home care service Bonn shows that in 1999 73 per cent of patients could be treated at home until the end of live. In 43 per cent physicians made the initial contact with this service organisation. This proves the necessity and acceptance of new structures in palliative out-patient care.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Treatment of nausea nad vomiting in palliative medicine].
Nausea and vomiting are the most distressing gastrointestinal symptoms in patients with far advanced malignant diseases. A complex pathophysiology exists between gastrointestinal tract and brainstem. Neurotransmitters play an important role. ⋯ Dependent on the cause the antiemetic, which blocks receptors peripherally or centrally, will be chosen. Main antiemetic groups are prokinetics, 5HT3-antagonists, dopaminantagonists, antihistaminics and phenothiazines. Symptom relief can be reached in 90% of the patients with a differentiated approach.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Consideration, assessment and treatment of difficulty in breathing in palliative medicine].
Next to pain, the most frequent fear of dying patients, their relatives and doctors in attendance is to suffocate, even if there is no significant dyspnoea. During their progress of disease, around half (40-60%) of all tumour patients suffer from difficulty in breathing. This is due to many reasons, which include the entire differential diagnosis of dyspnoea as well as psychological and social aspects. ⋯ Besides application of demand drugs as morphine and lorazepam the most important therapy against asphyxia is the individual treatment of symptoms. All people involved should be educated in general treatment, nursing and psychological care to reduce the dying patient's fear of suffocation. This will result in the reduction of the patients states of panic and therefore allow them to die in a more peaceful way.