Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Oct 2003
[Suspected diagnosis of bronchial asthma--development of an algorithm for diagnosis of asthma in general practice].
In 2003, the German Ministry of Health will publish a legal document that will allow for the implementation of disease management programmes for asthma and COPD. Examination of German asthma guidelines reveals that they do not include recommendations for a stepwise diagnostic work-up of patients with relevant symptoms in general practice. Therefore an algorithm was developed for the diagnosis of asthma in general practice, based on both national and the most important foreign guidelines providing specific advice on diagnostic procedures.
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Z Arztl Fortbild Qualitatssich · Jul 2003
[Evidence-based medicine as a model of decision making in clinical practice].
The way how we apply the principles of evidence-based medicine in the real clinical world is based on a number of implicitly assumed theoretical models. The aim of the present article is to identify these theories and use their impact to explain their importance for the application of evidence-based medicine. ⋯ In the context of these theories, there are three archetypal models of clinical decision making. These include the intuitive, the hypothesis-based and the evidence-based approach. In this sense, evidence-based medicine is a hermeneutic model for making clinical decisions. The mean impact of evidence-based medicine is the introduction of the best external evidence as a basis of the hermeneutic clinical casework. In the model of the "best external evidence", the clinician experiences a great change in clinical decision making. This change is generated by crossing the border from applying scientific clinical hypotheses to systematically identified and reviewed results of high-quality research work. In this sense, hermeneutic casework demonstrates that there is a contradictory unity between evidence-based clinical data and the clinician's understanding of a clinical case--a contradiction that may only be solved by the clinician's internal evidence.
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Z Arztl Fortbild Qualitatssich · Feb 2003
[What kind of information do German health information pamphlets provide on mammography screening?].
To make an informed decision on participation in mammography screening, women have to be educated about all the risks and benefits of the procedure in a manner that is detailed and understandable. But an analysis of 27 German health pamphlets on mammography screening shows that many relevant pieces of information about the benefits, the risks, and especially the meaning of screening results are only insufficiently communicated. ⋯ Depending on content, 17 to 62% of the quantifiable statements were actually given as numerical data. To provide comprehensive information and to avoid misunderstandings, it is necessary to supplement the currently available health pamphlets and make the information on mammography screening more precise.
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Z Arztl Fortbild Qualitatssich · Jan 2003
[The European Regional Cooperative Centers for rheumatic diseases: a nation-wide network of interdisciplinary rheumatic care]].
The organisation of regional co-operative centres for rheumatic diseases was supported by a grant from the German Ministry of Health from 1992 to 1998, which aimed to improve the management of patients with chronic rheumatic diseases. After establishing the centres formal structures the major task was to improve quality of care by co-ordination and co-operation of all the institutions and health care providers involved in the management of rheumatic patients. For all these activities to be continued the regional co-operative centres for rheumatic diseases were integrated in the German Society of Rheumatology as one of its working groups in 1996. ⋯ Quality management is further supported and intensified by annual scientific workshops. In addition, the regional co-operative centres for rheumatic diseases are engaged in research and an important partner of the German Competence Network Rheumatic Diseases. Based on the established structures the horizontal and vertical network should be further involved in general medical care and should intensify the interaction with clinical and basic research.
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Z Arztl Fortbild Qualitatssich · Aug 2002
Comparative Study[The DRG law--planning gone wrong? The conversion from the physician's point of view].
With the Health Care Reform Act of 2000 the German government initiated the introduction of a new hospital funding system based on an internationally used Diagnosis Related Group (DRG) system. In June 2000, the medical self-governing bodies (consisting of representatives of the German Hospital Federation, the German Statutory Health Insurance Funds and the Association of Private Health Insurances) commissioned for the execution of this project decided to use the Australian Refined DRG system, version 4.1 (AR DRG) as the basis for the future German (Refined) DRG system (G-DRG). ⋯ The new reimbursement system is not only intended to cover acute hospital care but also parts of early rehabilitation, palliative and sub-acute care. Due to its economic incentives the effects of introducing the DRG system in Germany will not only affect the hospital sector but ambulatory care, nursing and rehabilitation as well.