Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Aug 2002
[Introduction of the DRG system in Germany: objectives, problems and perspectives on the basis of a lump sum payment from the perspective of the Federal Ministry of Health].
On March 1, 2002 both chambers of the German Parliament passed a law to regulate the framework for the introduction of the new DRG-based case fee system in Germany (Fallpauschalengesetz). Its essential aim is to implement an efficiency-orientated reimbursement system promoting efficiency, transparency and quality in the hospital sector. ⋯ Largely extended quality assurance measures can help to reduce potential risks. Also, the self-governing bodies are liable to conduct accompanying research.
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Z Arztl Fortbild Qualitatssich · Aug 2002
[The National Program for disease management--guidelines under the auspices of the German Medical Association--a method report].
In March 2002, the German Medical Association established a National Programme for Disease Management Guidelines (DMG). This programme focuses on the development and implementation of consented key recommendations of German guidelines and evidence-based treatment recommendations for specific prioritized problems of health care issued by various organisations. Among other things, the aim is to ensure (1) that guidelines within a framework of structured care should not assume the character of directives; (2) that the evidence-based principles for structured care programmes be both scientifically accounted for and practicable and consider guidelines that have already proved to work; (3) that a consensus be obtained between the institutions of the medical self-governing bodies, the Association of the Scientific Medical Societies in Germany (AWMF) and the relevant medical societies concerning the identification, updating and implementation of the key topics of structured care programmes: (4) that the outcomes of the German Guideline Clearinghouse be taken into consideration. The methodological foundations of this programme for disease management guidelines are outlined in the following method report.
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Z Arztl Fortbild Qualitatssich · Jul 2002
[Is preimplantation diagnosis legal?--on the need for harmonizing legislation].
Whether PGD is already legally permitted in Germany today is a moot point. A guidelines draft of the Germany's Federal General Medical Council, the Bundesärztekammer, on pre-implantation genetic diagnostics that--like the earlier findings of the ethics commission of the German federal state of the Rhineland-Palatinate--assumed that the method is admissible, if certain clearly-defined indications are present and a rigorous testing procedure has been established, has given the discussion a new impetus. The discussion is in full swing, with calls by politicians for the legislator to pass a regulation mounting. ⋯ The new regulations should determine under which conditions PGD is permissible. As is already the case for other norms that apply to reproductive medicine, but also for the practice of abortion, these regulations should contain an analogous right of refusal for the professionals involved. The laws relating to the healing professions, to the professional chambers, as well as the regulations of the various German federal states (which together constitute the Federal Republic of Germany) that apply to the professions should be amended accordingly.
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Z Arztl Fortbild Qualitatssich · Jun 2002
[Tobacco dependence--evidence-based treatment strategies].
One third of German smokers try to stop smoking at least once a year. As smoking is an important risk factor for the development of numerous diseases and a number of smoking-cessation strategies have proved to be effective every smoker should be encouraged to give up smoking and be informed of these methods. A more widespread use of evidence-based smoking-cessation methods should therefore be promoted more vigorously. ⋯ More complex interventions should be supplemented by behaviour therapy aimed at changing behaviour patterns. Medical support in the form of nicotine replacement (NRT) or bupropion treatment should be offered. Moreover international guidelines (not only German ones but also American, and European ones in general) all recommend as the most effective strategy the combining of smoking-cessation methods based on behavioural treatment with nicotine replacement therapy or bupropion treatment.
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Z Arztl Fortbild Qualitatssich · Nov 2001
Review[Diagnosis and differential diagnosis of bronchial asthma].
Asthma and COPD (chronic obstructive pulmonary disease) are the most important obstructive pulmonary diseases. Patient's history and physical evaluation give major hints of the underlying disease. Further diagnostic measures comprise lung function analysis including spirometry, plethysmography and--in severe cases--blood gas analysis. ⋯ Thus, allergy tests--particularly skin prick tests--have to be carried out. To further define an underlying allergy, in some cases even specific inhalative provocation tests have to be performed. X-ray of the thorax and other imaging techniques, detailed blood analysis, further diagnosis of the upper respiratory tract and the cardiac system may have to be carried out a) to quantify the effects of a severe form of asthma or COPD on other organs, and b) for differential diagnostic examinations.