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At least 19 recordsLinked to original sources
PubMed2005

[Dehydration. Ethical standards finding in the social controversy].

Three case histories are presented, in which terminal hydration was omitted. Two patients were in the terminal phase of a menigiosis carcinomatosa and Creutzfeldt-Jacob disease, the third was completely aphasic and hemiplegic after ischemic stroke. All three died peacefully without signs of suffering or thirst. The psychological aspects of therapeutic-palliative change and the archetypical horror of death are considered. The moral justification is discussed in relation to the "Principles for Physicians Accompanying the Dying" of the German chamber of physicians. The respect of the patient's will is the guiding principle. These ethical controversies should be discussed sincerely and frankly so that the society is enabled to follow.

Aged↗
PubMed1995

[The general practice course catalog--an attempt at quality assurance in graduate general practice education].

Additionally to the training in the hospital and in the practice, the rules for continuing education for general practise, established at the meeting of medical German physicians in 1992 demand the participation in theoretical seminars. The content and duration of these seminars is content and duration of these seminars is laid down in recommendations of the chamber of the physicians of Germany to ensure the quality of the courses. According to this, the first recommendations consists of the Course Book for General Medical Practise regarding a course of 240 hours duration. This is a nation-wide standardized curriculum which was accepted from all German chambers of physicians as the basis of the further education in family medicine. The standardization and the structuring of the content, goals, and methods of teaching and learning as well as the organization of the seminars, the working materials for the teachers, regular training for the presenters and teachers, methods for a nation-wide evaluation of the seminars, and independence from commercial interests are the features to ensure the quality of the courses.

Education, Medical, Continuing↗
PubMed1997

[The success of medical continuing education. Methods of evaluation--possibilities, limits and future developments].

The question, whether evaluation of continuing medical education (CME) is necessary, is discussed in Germany for several years. It is frequently criticized that the effects of continuing education on the medical practice and the quality of the patient care are hardly concrete. Evaluation is too often understood as a tool of external control rather than an instrument of self control and feedback for the teachers and organizers of CME events. The evaluation methods in use have many methodological shortcomings, i.e., lack of objectivity, reproducibility, feed back to the students, nearness to practice, and are therefore reason for the missing acceptance of the evaluation by physicians. Evaluation methods make sense if they contribute to efficient learning. They are supposed to aid in correctly assessing both the need and success of learning. These demands are currently most completely fulfilled by the Canadian "Maintenance of Competence Program" (MOCOMP), the applicability of MOCOMP in Germany is now proofed by the German chamber of physicians.

Adult↗
PubMed2006

[The German program for disease management guidelines. Background, methods, and development process].

The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the German DM-CPG Program is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health-care provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year, DM-CPGs have been published for asthma, chronic obstructive pulmonary disease, type 2 diabetes, and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.

Disease Management↗
PubMed1991

[Diagnosis of brain death: limitations of angiography after osteoclastic trepanation].

A 50-year-old man sustained severe skull-brain trauma with intracerebral bleeding, cortical contusion foci and fracture of the petrosal bone. He went into coma a few hours after the accident. Three days after surgical removal of an intracerebral bleeding via a frontoparietal osteoclastic trepanation (removal of a 4 x 5 cm piece of bone) there occurred complete brainstem areflexia, respiratory arrest and drop in temperature; the encephalogram was isoelectric. There was thus no clinical-neurological doubt of brain death. But cranial digital subtraction angiography, generally considered to give the most reliable evidence of irreversible loss of cerebral functions, showed contrast medium in the branches of the left cerebral artery. The diagnostic criteria of brain death, as proposed by the Federal German Chamber of Physicians (Bundesärztekammer), were thus not exactly met, and despite the clinically obvious brain death a contemplated removal of organs for transplantation was therefore not undertaken. The patient died 6 hours after the angiography. This case shows that the value of angiography for the diagnosis of brain death may sometimes be limited, at least in those cases in which osteoclastic trepanation has been performed or there are other causes for a skull defect, because they can prevent the rise of intracranial pressure which brings about the cerebral circulatory arrest.

Angiography, Digital Subtraction↗
PubMed1992

[Diagnosis of brain death].

From the medical, the juridical as well as the theological point of view brain death represents the death of an individual. According to the German Chamber of Physicians, acute brain damage with coma, absence of all brainstem reflexes and apnoe allows the diagnosis of cerebral death, if repetition of the physical examination after distinct time intervals documents the irreversibility of this state. Additional investigations such as EEG, evoked potentials (BAEP), transcranial doppler sonography, brain scintigraphy or cerebral angiography allow to shorten this period if electrocortical silence, absence of waves 3-5 of BAEP or the cessation of cerebral perfusion has been proven. Strict observation of these criteria is mandatory for the diagnosis of brain death.

Brain Death↗
PubMed2000

[The new German resuscitation guidelines in the context of international recommendations].

The German Guidelines for Cardiopulmonary Resuscitation were adapted to match the revised International Guidelines. The revised German edition was based both on the guidelines issued by the American Heart Association (AHA) in 1992 and on those of the European Resuscitation Council (ERC) of 1998, as well as on those released by the International Liaison Committee on Resuscitation (ILCOR) in 1997. Due to the diverging instructions for action the emergency physicians felt considerably unsafe as to what they should really do to achieve maximum results. Only 10.3 per cent of the german emergency physicians followed the recommendations given by the German Federal Chamber of Physicians. Innovations in respect of the basic checkup concern the time for controlling the respiration and circulation (ten seconds). Contrary to the international recommendations the "diagnostic block" is performed in Germany without interspersing basic reanimation. In artificial respiration the tidal volume has been reduced to 600 ml in accordance to the ERC and ILCOR guidelines. The search for the pressure point for cardiac pressure massage has also been adapted to the international recommendations. Also in accordance with the international recommendations defibrillation in case of ventricular fibrillation is now being performed only thrice in series without interspersed basic reanimation. There is some uncertainty with regard to choosing the requisite energy: 16.6% of the emergency physicians opt for less than 200 joule in primary defibrillation whereas 13% are in favour of more than 200 joule. Contrary to the international recommendations which prescribe peripheral venous access as application site for reanimation by drugs, the german guidelines favour the endobronchial path, which is already being practised by 57.4% of the emergency physicians. Hence, emergency medication can be effected in Germany 4 minutes earlier than in other countries. After three unsuccessful applications of 1 mg each of adrenalin the dosage is increased to 5 mg, and in agreement with the AHA guidelines escalating doses are also possible. Sodium bicarbonate is recommended only after more than 20 minutes of reanimation and if so, only in a reduced dose of 0.5 mval/kg body weight. In accordance with the international recommendations there is now a universal algorithm that decides on application only between ventricular fibrillation and nonfibrillation. The new german recommendations have adapted the reanimation procedure in agreement with ERC to national usage without abandoning any principles of the international guidelines.

Cardiopulmonary Resuscitation↗
PubMed1998

Potential pitfalls in apnea testing.

To determine the influence of baseline paCO2 on the results of apnea testing in the diagnosis of brain death, we performed an open prospective study on 36 patients fulfilling all other criteria for the diagnosis of brain death according to the criteria proposed by the Advisory Board of the German Federal Chamber of Physicians. For testing of apnea, patients underwent hypoventilation with 100% oxygen supply until a baseline paCO2 of 40 torr (5.3 kPa, n = 24, group 1) or 60 torr (8.0 kPa, n = 12, group 2) was reached. Then, patients were disconnected from the ventilator and apneic oxygenation with insufflation of 61 O2/min into the tracheal cannula was performed for five minutes. Arterial blood gas samples were obtained every minute during the testing period. In parallel, patients were observed for signs of spontaneous breathing. All patients remained apneic during the five minute test period. No relevant hypoxia (paO2 < 80 torr [10.6 kPa]) was observed in either group. In group 1, a mean baseline paCO2 of 45 torr (6.0 kPa) was registered, mean end-paCO2 was 75 torr (10.0 kPa). In group 2, paCO2 values were 66 torr (8.8 kPa) and 90 torr (12 kPa), respectively. Baseline pH in group 1 (7.32) decreased to 7.18 at the end of testing and from 7.23 to 7.13 in group 2. Patients in group 2 were in possible danger of developing a CO2-induced narcosis mimicking apnea. Secondary organ damage due to severe respiratory acidosis could not be excluded in the patients of group 2. As no complications were observed in group 1 and apnea was evident in all these patients, we consider a baseline paCO2 of 40 torr (5.3 kPa) sufficient to establish apnea after five minutes of apneic oxygenation if an increase of baseline paCO2 of at least 20 mmHg is documented by arterial blood gas sampling. A higher baseline paCO2 may endanger patients without yielding more specific testing results.

Apnea↗
PubMedDate not supplied

[Cost analysis of a bone bank].

The costs of a bone-bank working in accordance with the guidelines of the german federal chamber of physicians are described. Establishing a bone-bank storing deep-frozen bone is not very expensive. The main costs are due to laboratory costs for excluding HIV, hepatitis, syphilis and bacterial contamination of bone grafts. In our experience with 206 bone grafts about 20% of them are to be discharged because of positive laboratory tests. The costs of each bone graft are DM 327. A second HIV-Test of the donor 3 months after explantation of a bone graft will cause rising of costs up to 47%. About 20-30% of bone graft donors will probably not carry out this test. In this case discharging of the bone graft is necessary.

Bacteria↗
PubMed2002

Transcutaneous and intra-arterial blood gas monitoring--a comparison during apnoea testing for the determination of brain death.

Intra-arterial (i.a.) and transcutaneous (t.c.) blood gas monitoring were compared with in vitro blood gas analysis (abg) during apnoea testing for the determination of brain death in a prospective observational study. All three methods were used simultaneously in 19 patients in whom brain death was suspected. Brain death was confirmed in each case adhering to the recommendations of the Scientific Advisory Board of the German Federal Chamber of Physicians which demand a PCO2 of at least 60 mmHg. In vitro parameters ranged from 23.2 to 80.4 mmHg (PCO2), 52.7 to 509.9 mmHg (PO2), and 7.072 to 7.591 (pH). The intra-individual correlations between both monitoring methods (rPCO2=0.958, rPO2=0.859) and between each of them and abg (r>0.960) were high. Absolute deviations from abg for the corrected as well as uncorrected measurements were similar for both methods, except with regard to group bias where an advantage for the i.a. values emerged. Since many of the i.a. measurements failed and the disposable i.a. probes cost much more than the t.c. electrodes, the i.a. technique at present holds no advantage over t.c. measurements in testing for apnoea in suspected brain death except where simultaneous monitoring of pH and temperature are desired.

Adolescent↗
PubMed1993

[The omitted x-ray examination--benefit and risk--a comparison].

Today the risk of omission of an x-ray examination is often underestimated compared with the assumed stochastic - i.e. random - risk of radiation exposure associated with the x-ray examination. The benefit of the x-ray examination can be estimated by considering how it influences the diagnostic decision and the therapy. Three degrees of justification (indication) supply proof of different degrees of the proportion of benefit gained. It is evident that some of the x-ray examinations that are being performed, are unnecessary, whereas on the other hand even so-called routine x-ray examinations can yield a therapeutically relevant finding in some patients. A comparison of benefit and risk shows that the estimated benefit exceeds the assumed irradiation risk by several orders of magnitude. This is exemplified by examinations of the thorax and lumbar vertebral column. The guidelines issued by the German Federal Chamber of Physicians on quality assurance in x-ray diagnostics and CT result in a considerable reduction of patient doses. Advantage must be taken of the benefit of x-ray examinations performed with an extremely critical eye on the relevant indication and with minimised irradiation exposure. Omitting an indicated examination may endanger the patient to such an extent that major neglect of the irradiation risk is warranted.

Humans↗
PubMed2004

[A hundred years of physicians' professional organization: an overview].

The impressive advances of the natural sciences in the 19th century was in Germany accompanied by the formation of a medical profession that clearly separated itself from other healthcare providers and increasingly claimed autonomy from governmental agencies. But due to the opposition of the state governments who felt their jurisdiction over the healthcare system was threatened, the plan to create a legally supported Reich Physicians' Chamber (Reichsärztekammer) failed at the end of the 19th century. It remained the responsibility of teh German Physicians' Congress (Deutscher Arztetag) to establish consistent standards for medical professional activities in the form of a legally non-binding Code of Professional Conduct. During the Weimar Republic physicians' politics -- within a socio-political context that many felt was hostile towards the medial profession -- was characterized by the pursuit of the medical profession. By establishing the Reich Physicians' Ordinance (Reichsärzteordnung) in 1935 the Nazi state fulfilled a long-cherished desire of the German medical profession. After 1945 regional physicians' chambers and panel fund physicians' unions (Kassenärztliche Vereinigungen) in the form of corporate bodies under public law could rapidly be set up in the western zones of occupied Germany, while emerging structures of medical self-government in the Soviet occupied zone were readily smashed.

Germany↗
PubMed1995

[Does quality assurance modify clinical research, medical progress and medical graduate education in surgery?].

For years, external safeguard of quality has been continuously practised in the field of surgery by several local medical societies. Beside its original task of comparing and reviewing given standards of all surgical departments, other clinically or scientifically relevant questions can be answered on the basis of the enormous numerical data, too. The patient data, available to the chamber of physicians of Westphalia-Lippe, German, are showing that the experiences of clinical research rapidly and almost ubiquitously find their expression in the daily routine work of surgeons. Examples like the introduction of routine thrombosis prophylactics of changes in the surgical techniques for inguinal rupture and gallstone show how progress in medicine by postgraduate medical education is realized in the daily clinical workday routine.

Cholelithiasis↗