Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Accreditation of hospitals in the USA according to the standards of the Joint Commission of Healthcare Organizations (JCAHO)--reflections on the transferability of these procedures to Germany].
The Accreditation-Process of the Joint Commission on Accreditations of Healthcare Organisations (JCAHO), specially the new international arm of the Joint Commission International Accreditation (JCIA) is also in Germany already in use. Some decades of experiences with the accreditation of healthcare institutions in the USA, generally recognized standards as well as a transparent process of survey are best conditions for an international transfer. The current legal requirements will be fulfilled by the system. Finally the JC-Process defeats the philosophy of a continuous quality improvement.
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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.