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At least 631 records · Page 35Linked to original sources
PubMed1990

[Results of interlocking nailing of distal tibial fractures].

Between 1982 and 1989, 117 fractures of the distal part of the lower leg were surgically treated in the Trauma Clinic belonging to the employers' liability insurance company in Frankfurt/Main. A follow-up examination of 85 of these patients, based on X-ray series, clinical reports, and insurance files, shows the functional results. Because of the high proportion of good to excellent results (95.4%), we consider fracture of the distal tibia a good indication for interlocking nailing, even from the aspect of the borderline indication of fracture in the fifth sixth. In open fractures of the distal part of the lower leg we consider the change of method from primary stabilization with external fixation to secondary interlocking nailing an appropriate procedure. The methods presented for internal fixation of fractures of the distal tibia by interlocking nailing allow early partial and full weight-bearing with the stability needed for exercising.

Adult↗
PubMed1990

Obstetric care among family physicians in Pennsylvania. Trends, association with residency training, and policy implications.

A study was designed to investigate the status of obstetric practice by Pennsylvania family physicians and its relationship to family practice residency training. A 50% probability sample of all family and general physicians and of all graduates of Pennsylvania family practice residency programs was surveyed by mail. Ten percent of Pennsylvania family physicians and general practitioners reported currently practicing obstetrics, 44% of whom said they planned to stop within 3 years. Telephone survey information from nonresponders suggests that even fewer (5%) of the state's family physicians may actually be practicing obstetrics. Family practice residency training, postresidency obstetric training, and small community size were the best predictors of current obstetric practice. Family physicians in the smallest communities, however, were also those most likely to be planning to stop, and graduates of residency programs were increasingly choosing not to practice obstetrics. Cost of liability insurance and fear of lawsuits were primary reasons cited for stopping obstetrics. Family physicians have been major providers of obstetric care in the nation's rural areas. Now, increasingly firm evidence that fewer family physicians are practicing obstetrics signals increasing shortages in obstetric care for women in rural communities. Changes in the practice climate and obstetric training programs for family physicians seem essential to help reverse these trends.

Adult↗
PubMed1989

Pilot study report: obstetrical care by Texas family physicians.

Fewer family physicians are including obstetrics in their practices. This has caused concern about access to obstetrical care and has fueled the debate about the need for obstetrics curriculum in family practice residencies. Reasons frequently cited by previous research for this change in practice pattern include the rapidly escalating cost of liability insurance and the threat of lawsuit for obstetrical malpractice. The decrease in the availability of obstetrical care from family physicians has hampered access to obstetrical care, especially for rural Texans. Texas family physicians have not been surveyed previously about their obstetrical practices. For this pilot study I surveyed 205 of Texas' 4,700 family physicians and general practitioners (4%) about their past and present obstetric practices. The sample was randomly selected, and included both MDs and DOs. Of the 64.9% who responded, 28% were practicing obstetrics, 11% had never included obstetrics in their practices, and 61% had practiced obstetrics in the past. Forty percent of those who had discontinued obstetric practice did so after 1983. High malpractice premiums and fear of lawsuits were the most frequently chosen reasons for discontinuing the obstetric component of practice. Documenting this trend of decreasing availability of obstetrical care from family physicians, and sharing the data with policymakers, may help to prevent the disappearance of the family physician who delivers babies.

Female↗
PubMed1989

A review of 50 malpractice claims.

A study of 50 malpractice claims reveals that, although claims against optometrists have increased in number over the past two decades, the relative cost of professional liability insurance coverage has remained stable. The most common cause of claims is misdiagnosis of intraocular disease, principally retinal detachment, open-angle glaucoma, and tumors. Corneal disease and complications of contact lens wear also contribute to errors of diagnosis. The great majority of claims alleging misdiagnosis involve optometrists who have failed to use diagnostic drugs for dilation of the pupil; few claims are due to adverse responses to ophthalmic drugs. Failure to prescribe polycarbonate plastic as the spectacle lens material for patients at risk for ocular injury constitutes another cause of claims. A small number of claims allege failure to offer binocular vision therapy to amblyopic children.

Amblyopia↗
PubMed1987

[Carcinogenic industrial substances--a review of the present information].

The potential carcinogenic risks of chemical substances at the workplace show increasing importance in occupational and environmental medicine, but the problems are also discussed controversially. Based on national and international literature estimations according the portions of occupational cancer are given. In accordance with former estimations from our institute, it is concluded, that 1-2% of all cancer deaths are caused by work and profession. A review of data from newer literature shows, that the numbers of chemicals with carcinogenic potency vary considerably. This is mainly due to the largely unknown mechanism of carcinogenesis, aspects of syncarcinogenesis and cocarcinogenesis as well as the different evaluation of mutagenicity-, short-term- and animal-tests on the one hand and of epidemiologic as well as casuistic studies on the other hands regarding carcinogenicity of chemicals for humans. In this context, the importance of epidemiologic studies for detecting unknown cancerogenic risks for humans is emphasized. In the field of occupational medicine it is relevant to differ between compensation and prevention. According to this aspects, for compensation of a malignant tumor as an occupational disease, more strict criterias must be fulfilled to objectify the carcinogenicity of a substance for humans than for preventive measures. On the basis of the monographs as well as reviews of the International Agency for Research on Cancer (IARC) the single substances, mixture of substances and industrial processes with proven or probably carcinogenicity for humans are given. In comparison to the monograph of Hueper from 1963 it is concluded, that until now no critical increase of carcinogenic substances at the workplace has occurred. For preventive efforts at the workplace, the medical examinations are important. These are based on various regulations by law or by German Employers Liability Insurance. In conclusion, recommendations and demands are given regarding prevention, evaluation and compensation of malignant diseases as well as detection of unknown carcinogenic risks for humans at the workplace.

Carcinogens↗
PubMed1987

Cutting the nation's health care costs.

In 1984 health care expenditures totaled $387.4 billion, and may reach $757.9 billion by 1990. The following factors and their annual cost overrun price tags are the prime forces behind this rapidly growing expense: professional liability insurance, litigations, and defensive medicine, $30 billion; hospital administrative management and employee excess, $6.3 billion; community hospital profits, $8.3 billion; oversupply and duplication of drugs and drug sundries, $22.5 billion; the oversupply of physician specialists, at least $10 to $15 billion; unsolicited physician interpretation of routine, unsophisticated tests, $13.2 billion; and, finally, an American lifestyle adversely affected by illicit drugs ($60 billion), alcohol ($117 billion), and automobile accidents ($43.3 billion), for a total cost of $220 billion yearly.The intent of this article is to educate the public in an open and responsible fashion, and to demonstrate that the health care industry in the United States can save approximately $334.0 billion yearly.

Cost Control↗
PubMed1979

[Standard requirements for electric wheelchairs (author's transl)].

Electric Wheelchairs are driven on public roads. Neither an operating license, liability insurance nor special driving license is necessary according to Road Traffic and Road Licensing Regulations. Statutory regulations prescribe that these wheelchairs must be fitted with two independent brakes and adequate lighting equipment. Safety can be increased by: Totmann brake system - battery servicing - improved battery chargers and technical safety tests. Maintenance of the wheelchair prolongs its life. Social security agencies should allow a large number of the most severely handicapped people to benefit from medically prescribed wheelchairs.

Electricity↗