RESUMEN
BACKGROUND: In recent years, there has been an ongoing improvement in the treatment and structural aspects of acute trauma care. Because of the definition of rehabilitation as a post-acute part of the treatment of traumatic injuries, especially in multiple injured patients, there is need to improve the interaction and cooperation between acute care hospitals and rehabilitation clinics. This article gives a survey of the current state of rehabilitation in Germany. MATERIALS AND METHODS: Based on a directory of rehabilitation clinics and an internet search, all rehabilitation clinics were identified and included in the analysis for clinic location, structural and equipment attributes. RESULTS: In total 551 rehabilitation clinics with expertise in the treatment of traumatic and orthopedic injuries were identified. In detail, broad differences between the federal states could be observed. The number of rehabilitation clinics per state ranged from 1 to 136 and the number of beds from 70 to 18040. The average catchment area covered by a rehabilitation clinic is 648 km(2) (range 149-2106 km(2)) with an average of 1584 patients per clinic per year. Of the clinics 68% can treat patients with methicillin-resistant Staphylococcus aureus (MRSA) infections and 62.1% are able to deal with patients who need renal dialyses. Almost all clinics provide an x-ray facility (96.4%) while computed tomography (CT) and magnetic resonance imaging (MRI) are available in 52.6% and 50.3%, respectively. CONCLUSION: The number of rehabilitation clinics available seems to be adequate for all patients with traumatic injuries but there are enormous differences between the federal states. Because rehabilitation is important for the outcome of multiple injured patients, a further improvement of the quality and integration into the regional trauma network seem to be necessary.
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Áreas de Influencia de Salud/estadística & datos numéricos , Diagnóstico por Imagen/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/rehabilitación , Centros de Rehabilitación/estadística & datos numéricos , Diagnóstico por Imagen/instrumentación , Alemania/epidemiología , Humanos , Rehabilitación/instrumentación , Rehabilitación/estadística & datos numéricos , Centros TraumatológicosRESUMEN
INTRODUCTION: Whilst initial closed reduction followed by definitive open fixation is widely applied in the treatment of distal radial fractures, the effect of the closed reduction on the reconstruction of the articular surface remains unclear. Our research questions were: METHODS: Palmar tilt and radiocarpal inclination of 425 patients were measured at admission, following initial closed reduction and after surgical reconstruction. RESULTS: Closed reduction increased palmar tilt by 12.1° and radial inclination by 2.7°. Open surgical reduction further corrected palmar tilt by 17.88° and radial inclination by 3.5°. Whilst there was no association between postoperative palmar tilt and initially achieved closed reduction, a significant association between radial inclination following closed reduction and surgical fixation was found. CONCLUSION: Our retrospective study challenges the existence of a relationship between the initial closed reduction and the reconstruction of the anatomic joint line in surgically treated distal radial fractures.
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Placas Óseas , Fijación Interna de Fracturas , Radiografía , Fracturas del Radio/cirugía , Fenómenos Biomecánicos , Femenino , Fijación Interna de Fracturas/métodos , Curación de Fractura , Alemania , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatologíaRESUMEN
BACKGROUND: During the treatment of severely injured patients, rehabilitation takes an important role. In this study we examined the present structures in acute care hospitals, which influence the process of rehabiliation. MATERIALS AND METHODS: The data was captured in a questionnaire. The questions deal with the personal and structural situation of acute care hospitals in Germany. The questionnaires were sent to all clinics, which are registered in the TraumaNetwork DGU. RESULTS: 424 hospitals answered the questionnaire. This is a response rate of 57.3% regarding 740 acitve clinics in the TraumaNetwork DGU. 58% have no opportunity for rehabilitation. The majority of the hospitals have a physiotherapy, (98.6%) or an occupational therapy (71.0%); 33.3% have a case management. Only 17.0% of the hospitals have rehabilitation teams which take care during the hospital stay. These teams consist mainly of internal rehabilitation physicians and physical therapists. Supraregional Trauma Center have better organized structures, as hospitals with lower level of care. Only 56.6% of all hospitals reported that they were familiar with the cooperating rehabilitation hospitals. There are special cooperations with rehabilitation hospitals in 34.4% of all cases. CONCLUSION: The early mobilisation of severely injured patients is an integral part of the postoperative course in German hospitals. While on the one hand a large number of hospitals have good structural conditions on the other hand these structures are little integrated in the daily treamtment. There are major gaps and uncertainties in the cooperation between acute care clincs and rehabilitation hospitals. The integration of rehabilitation hospitals in the TraumaNetwork DGU could be a good chance to improve this collaboration.
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Manejo de Caso/estadística & datos numéricos , Redes Comunitarias/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Traumatología/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/rehabilitación , Enfermedad Aguda , Adulto , Anciano , Cuidados Críticos/estadística & datos numéricos , Femenino , Alemania/epidemiología , Encuestas de Atención de la Salud , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Transferencia de Pacientes/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
The quality of medical education is an ongoing challenge due to the continuing changes of the health-care politics and general social conditions. At many German university hospitals the dominating picture is overfilled courses, lack of hands-on practice, reduced patient contact and the dull provision of theoretical, abstract knowledge. The reformed surgical curriculum at the University of Marburg university hospital is used to demonstrate that, in spite of large student numbers, a practice-oriented, small-group training at a high didactic level is possible. The surgical training courses are organized in detail and coordinated. Course contents and structure are media available in print and online versions for both students and teachers and thus fulfill not only transparency needs but also contemporary requirements. The strategy of a practice- and patient-oriented, small-group training is followed strictly in the surgical curriculum. In addition, accompanying tutorial possibilities for individual study in an up-to-date learning center are offered. Here the students have the opportunity to intensify knowledge acquired in previous or future courses with numerous attractive education means. Continuous evaluation of the individual training courses at the end of each semester not only document motivation of the students but also serve to continuously improve the training concepts.
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Selección de Profesión , Competencia Clínica/legislación & jurisprudencia , Educación de Postgrado en Medicina , Cirugía General/educación , Simulación por Computador , Curriculum , Docentes Médicos , Alemania , Hospitales Universitarios , Humanos , Internado y Residencia/legislación & jurisprudencia , Modelos AnatómicosRESUMEN
BACKGROUND: The effectiveness of e-learning for reporting of x-ray-findings in a prospective, randomized trial was tested. MATERIAL AND METHODS: Twenty advanced medical students were randomized into two groups. The test group practiced 4-6 hours with the newly developed software, the control group used conventional learning material. Afterwards, a test was carried out including 30 pathologic x-ray films that were randomly spread through 200 non-pathologic images. The required time, the number of correctly appraised images and the frequency of falsely suspected pathologies were recorded. In addition, we asked for an assessment of the own capabilities in evaluating x-ray films and of passing the radiology training. RESULTS: The test group showed a markedly improved efficiency in comparison to the control group in all parameters. The required time was 57.4% shorter than in the control group (p < 0.05), 18.3% more cases were evaluated correctly (p < 0.05). The frequency of falsely suspected pathologies decreased by 61% (p < 0.05). There was no significant correlation of the objective abilities of a student with his/her self-assessment or of passing the radiology course. CONCLUSION: This study shows that an effective standardized training of practical skills by means of e-learning is feasible and reasonable.