Time filter

Source Type

Aim: This review evaluates which conclusions can be drawn for the clinical daily routine in operative treatment of distal radius fractures, regarding the published biomechanical studies concerning implant systems within the last 10 years. Method: After identification of 21 articles about biomechanical studies of implant systems for the treatment of distal radius fractures from a literature search, these articles were analysed concerning the specimens, the fracture model as well as the implants used. The quintessence was reviewed with regard to their clinical relevance. Results: All tested palmar angular stable plate systems showed sufficient stiffness for holding the load transmission from the hand to the forearm also within active fist closure. There was no advantage of palmar angular stable plates concerning stiffness compared to dorsal angular stable plates. Angular stable plates are superior over non-angular stable plates in treatment of distal radius extension fractures. Locking screws should be preferred over locking pegs. Subchondrally placed screws have a higher stability than more proximal localised screws. When palmar plates with 2 rows of distal screw holes are used, the highest stability can be achieved by filling all screw holes. However using 2 screws in each row is sufficient. Conclusion: There were clinically relevant implications from the published biomechanical studies concerning implant systems for treatment of distal radius fractures in the last 10 years and their considerations provide a safer therapy of distal radius fractures. These are to be respected accordingly. © 2012 Georg Thieme Verlag KG Stuttgart New York. Source

Schroder W.,Universitatsklinik Cologne | Krones C.J.,Marienhospital Aachen
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie

The radical economisation of the German healthcare system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex dailywork schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion. © Georg Thieme Verlag KG Stuttgart · New York. Source

Koch K.,Institute For Qualitat Und Wirtschaftlichkeit Im Gesundheitswesen | Miksch A.,Universitatsklinikum Heidelberg | Joos S.,Universitatsklinikum Heidelberg | Schurmann C.,Institute For Qualitat Und Wirtschaftlichkeit Im Gesundheitswesen | Sawicki P.T.,Universitatsklinik Cologne
Deutsches Arzteblatt

Background: In 2009, the U.S. Commonwealth Fund conducted a survey of primary care physicians in a number of different countries to determine their views on aspects of their daily work and their perceptions of their countries' health care systems as a whole. A similar survey had been carried out in 2006. Methods: From February to July 2009, the survey was carried out by interview in representative samples of primary care physicians, general practitioners, internists providing primary care, and pediatricians in 11 countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the UK, and the USA. Results: A total of 10 320 interviews were conducted. Only in the Netherlands and Norway did most respondents (60% and 56%, respectively) consider their health care system to be functioning well. Everywhere else, many of the respondents - in particular, 82% of the respondents in Germany - saw a fundamental need for change. 73% of the German physicians stated that recent changes in the health care system had brought about a decline in the quality of care. In all countries but Germany, the percentage of respondents sharing this opinion was 41% at the highest. Nevertheless, most of the German physicians had a positive opinion of the patient care that they themselves delivered. Conclusion: The 2009 survey, like its predecessor in 2006, revealed major differences in physicians' perceptions of their health care systems from one country to another. The German respondents' dissatisfaction with, and negative evaluation of, their health care system as a whole contrast with their positive views of their own patient care. Source

The aim of this article is to present the most relevant musculoskeletal complications known to be associated with being overweight or obese in childhood and adolescence in order to help the clinicians and physiotherapists in the diagnostic and management of these patients. Various musculoskeletal problems like slipped capital femoral epiphysis and Blount disease are well-known complications. More recent studies describe the effects of overweight on musculoskeletal pain and controversial influences on fracture rates. Reduced physical activity is a contributing factor in obesity, but also effects bone mineral accrual. Reduced postural stability and increased falls may be the reason for increased fracture rates. Furthermore these data show relevant changes of locomotion studied by gait analysis. Longitudinal kinematic studies may be needed to understand the entire aspect of gait development in overweight children. Obesity is still a serious health problem and has a relevant impact on the development of a child's musculoskeletal system. Obesity affects the locomotor sytem both functionally and structurally. Future studies are necessary to help us better understand the pathophysiology and development of optimal therapeutic strategies. © 2013 Springer-Verlag Berlin Heidelberg. Source

Haeckel R.,Bremer Zentrum For Laboratoriumsmedizin | Wosniok W.,University of Bremen | Streichert T.,Universitatsklinik Cologne
Clinical Chemistry and Laboratory Medicine

The organizers of the first EFLM Strategic Conference "Defining analytical performance goals" identified three models for defining analytical performance goals in laboratory medicine. Whereas the highest level of model 1 (outcome studies) is difficult to implement, the other levels are more or less based on subjective opinions of experts, with models 2 (based on biological variation) and 3 (defined by the state-of-the-art) being more objective. A working group of the German Society of Clinical Chemistry and Laboratory Medicine (DGKL) proposes a combination of models 2 and 3 to overcome some disadvantages inherent to both models. In the new model, the permissible imprecision is not defined as a constant proportion of biological variation but by a non-linear relationship between permissible analytical and biological variation. Furthermore, the permissible imprecision is referred to the target quantity value. The biological variation is derived from the reference interval, if appropriate, after logarithmic transformation of the reference limits. © 2015 by De Gruyter. Source

Discover hidden collaborations