Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Sympathetic reflex dystrophy and phantom pain. Diagnosis, therapy and prognosis].
The incidence of phantom limb pain has been significantly underestimated for many years. However, studies published during the recent decade indicate that the real incidence of phantom limb pain may be between 60% and 90%. Reflex sympathetic dystrophy (RSD) occurs with an incidence of about 15.000 new cases every year in Germany. ⋯ None of the patients treated with a combination of local anaesthetics and low dose morphine developed phantom limb pain. Therapy of choice for RSD is the sympathetic blockade. The most suitable method is intravenous regional sympathetic blockade (IVRSB) with guanethidine (2).
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Back pain is a common disease causing tremendous costs for treatment, rehabilitation, pension payments and work-loss. The reasons of back pain vary considerably and often remain doubtful. The effectiveness of current treatment concepts has not yet been proven significantly. In accordance with the literature, in chronic pain only multimodal concepts of treatment seem to be successful as far as they take care about somatic, psycho-social, and sport physiological aspects.
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Indications and limits of nerve block techniques].
Repetitive nerve blocks as a monotherapeutic treatment are loosing importance in the therapy of chronic pain. Such invasive methods for pain reduction are just one strategy in the interdisciplinary and multimodal planning of pain therapy. ⋯ Furthermore, it is necessary for the physician to know the typical complications of the invasive treatment and to be able to manage them. It is recommended to document the pain course.
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Z Arztl Fortbild Qualitatssich · Sep 1997
Practice Guideline Guideline[Practice guideline--tumor pain. Drug Committee of the German Medical Society].
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Z Arztl Fortbild Qualitatssich · Aug 1997
[Quality assurance measures in surgical gynecology. Program development and routine introduction in Hessia].
Frequently, quality assurance measures fail during application in routine practice despite showing very promising results in the developmental stage. Using the project 'Quality assurance in gynecological surgery' as an example which has made the leap into routine practice, we describe the development of a successful quality assurance measure. We name some of the elements which have proved to be crucial for the assumption of a new quality assurance measure. ⋯ All current professional and legal demands on medical quality assurance were included as were methodological knowledge for the optimal formation of such a measure. The evaluation of the measure on approximately 50,000 gynecological surgical procedures showed that the new quality assurance measure is suitable in gynecological surgery as an instrument both for making transparent the quality of health care delivery as well as for supporting comprehensive internal and external assessments of performance, outcomes, and processes of care and comparisons with the "best" care provider ("benchmarking"). Secondly, a favorable point in time--here the introduction of a diagnosis related payment system--and the early and close cooperation on the part of the program developers with political decision-makers helped to ensure that the newly developed quality assurance measure in gynecological surgery was accepted for routine practice.