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  • 1
    Electronic Resource
    Electronic Resource
    Infektionsraten in der Unfallchirurgie Eine Übersicht anhand der neueren deutschsprachigen Literatur (1997)
    Springer
    Der Unfallchirurg 100 (1997), S. 457-464 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Postoperative Wundinfektion ; Infektionsrate ; Osteomyelitis ; Key words Postoperative wound infection ; Infection rates ; Osteomyelitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Infection rates are important markers for clinical quality assurance. For internal control, they may only be used under the condition of homogeneous data collection and evaluation according to identical standard operating procedures during the entire investigation period. For inter-hospital comparison, they may only be used if additionally the observed patient groups are well defined and comparable. A survey of the infection rates published during the last 6 years in the German traumatological literature (n = 71) indeed shows (concerning series later than 1985) similar infection rates for procedures in less and in more problematic anatomical regions and in clean and contaminated situations of about 2 – 3%, after open injuries sporadically max. 10%. Finally, it is demonstrated that conclusions concerning a general ``risk of infection'' based on infection rates for specific surgical procedures are not possible and vice versa. We strongly recommend the future application of a standardized definition of wound infection. The differentiation between deep and superficial infection should be abandoned. For all mentioned ``infection rates'' it should be indicated whether it is with reference to the risk of infection of a specific procedure or only a general statement.
    Notes: Infektionsraten sind wichtige Marker für die klinische Qualitätssicherung. Sie können für den internen Gebrauch jedoch nur dienen, wenn sie in standardisierter und langjährig gleicher Weise ermittelt werden. Für den interhospitalen Vergleich taugen sie nur dann, wenn darüber hinaus die zugrundeliegenden Kollektive bekannt und vergleichbar sind. Eine Zusammenstellung von Infektionsraten, welche in den vergangenen 6 Jahren im deutschsprachigen traumatologischen Schrifttum (n = 71) mitgeteilt wurden, zeigt für Eingriffe in anatomisch problematischen und unproblematischen Regionen sowie für Eingriffe im kontaminierten wie im nicht kontaminierten Gebiet (bezogen auf Kollektivgruppen der letzten 10 Jahre) überwiegend gleichermaßen Infektionsraten von maximal 2 – 3%, für offene Frakturen bei einzelnen Autoren bis 10%. Vor allem der Unterschied zwischen offenen und geschlossenen Verletzungen scheint – adäquate Operationstechnik vorausgesetzt – zunehmend nachrangig zu werden. – Außerdem kann gezeigt werden, daß ein Rückschluß von Infektionsraten einzelner Operationen auf die allgemeine Gefährdung nicht möglich ist und vice versa. – Es wird empfohlen, weiterhin eine einheitliche Definition der postoperativen Wundinfektion zu verwenden, auf die Unterscheidung zwischen oberflächlicher und tiefer Infektion zu verzichten und bei allen Angaben zur Infektionsrate stets klar zu deklarieren, ob es sich um die Infektionsgefährdung in Bezug auf einen spezifischen Eingriff oder um eine allgemeine Angabe handelt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050142
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  • 2
    Electronic Resource
    Electronic Resource
    Vorgeworfene Behandlungsfehler nach postoperativen Infekten am Bewegungsapparat Analyse von 261 gutachtlichen Bescheiden (1998)
    Springer
    Der Chirurg 69 (1998), S. 1263-1269 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Malpractice ; Wound infection ; Locomotor system ; Surgical expert opinion. ; Schlüsselwörter: Behandlungsfehler ; Wundinfektion ; Bewegungsapparat ; chirurgische Begutachtung.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Postoperative Infekte am Bewegungsapparat können zum Vorwurf eines ärztlichen Behandlungsfehlers führen. Untersuchungsziel war, Anerkennungsrate und Art gutachtlich bestätigter Fehler festzustellen, um Vermeidungsstrategien anzubieten. 261 Bescheide zu vermuteten Behandlungsfehlern bei postoperativen Infekten am Bewegungsapparat wurden retrospektiv ausgewertet. Die Anerkennungsrate betrug 43,7 %. Häufigster Fehler war die verspätete Diagnose (34,2 %), gefolgt von inkonsequenter Therapie (27,2 %) und insuffizienter operativer Revision (5,3 %). In 33,3 % lagen Fehlerkombinationen vor. Die meisten Fehler wurden bei Infektionen nach Eingriffen an der Hand und Osteosynthesen großer Knochen vermutet. Die Anerkennungsrate war nach Gelenkpunktionen am höchsten (69,2 %). In 15,3 % wurden Dokumentationsmängel attestiert. Die Mehrzahl der Fehler resultierte aus diagnostischer und therapeutischer Unsicherheit, die z. B. durch eine klare Infektdefinition, Einholen einer zweiten Meinung, „Second-look-Operation“, unverzögerte und radikale Revisionseingriffe, sorgfältige Nachkontrolle und disziplinierte Dokumentation vermeidbar wären.
    Notes: Summary. Postoperative infection in the locomotor system may lead to malpractice suits. The aim of the study was to determine the success rate of these claims and the type of expert-confirmed medical negligence so that strategies for avoiding such negligence can be offered. A total of 261 decrees concerning suspected malpractice after postoperative infection in the locomotor system were retrospectively evaluated. Of these, 43.7 % claims were successful. The most frequent type of negligence was late diagnosis (34.2 %), followed by inconsistant treatment (27.2 %) and insufficient surgical revision (5.3 %). In 33.3 %, combined types of negligence were found. Most frequently, negligence was suspected after infection following hand surgery and internal fixation of long bones. The highest success rate of claims was seen after puncture of joints (69.2 %). Insufficient documentation was confirmed in 15.3 %. The majority of negligence resulted from diagnostic and therapeutic doubts, which could be avoided, e. g., by a clear definition of infection, consultation of a second opinion, a 2nd-look operation, undelayed and radical surgical revision, painstaking follow-up and disciplined documentation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050566
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  • 3
    Electronic Resource
    Electronic Resource
    Susceptibility to local infection in biological internal fixation (1999)
    Springer
    Archives of orthopaedic and trauma surgery 119 (1999), S. 82-85 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Resistance to local infection after fracture fixation with plate osteosynthesis may be influenced by the implantation technique. It is known that the extent of the surgical approach to the bone can compromise the local defence capacity. We have investigated susceptibility to infection after a local bacterial challenge in rabbit tibiae using either the open surgical approach for ‘biological’ internal fixation of standard 2.0 dynamic compression plates or the method of minimally invasive plate osteosynthesis (MIPO), a percutaneous, tunnelling insertion technique preserving the integrity of the overlying soft tissue. After the wounds had been closed, various concentrations of Staphylococcus aureus were injected in the direct vicinity of the implants. The infection rate for the open surgical technique was 38.5% and that for the MIPO technique, 25%. This difference is not statistically significant (P 〉 0.05) suggesting that resistance to local infection associated with the MIPO method is at least equivalent to the open approach for plate osteosynthesis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004020050361
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  • 4
    Electronic Resource
    Electronic Resource
    Precepts, approaches and strategies (1991)
    Springer
    Landscape ecology 6 (1991), S. 7-13 
    Details
    ISSN: 1572-9761
    Keywords: Climate change ; sand dunes ; coastal dynamics ; coastal defence ; dune management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00157740
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  • 5
    Electronic Resource
    Electronic Resource
    The use of a GIS in assessing the impacts of sea level rise on nature conservation along the Dutch coast: 1990–2090 (1991)
    Springer
    Landscape ecology 6 (1991), S. 105-113 
    Details
    ISSN: 1572-9761
    Keywords: Coastal dune management ; Netherlands ; sea level rise ; GIS ; ecological effect assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract The Dutch coastline is expected to change considerably during the next 100 years. Erosion will prevail, although accretion will occur locally. To establish a new policy for coastal defence management an integrated policy analysis study was performed. Major dune functions (nature conservation, recreation, public drinking water supply, housing and industry) have been inventarized by using a Geographic Information System. This study reports on the part of the analysis which takes nature conservation interests into account. Evaluation of nature interests has been based on the criteria: rarity and diversity of plant species c.q. vegetation types, succession stage, and completeness. This results in a classification of nature into five classes, based on abiotic as well as biotic characteristics of the landscape. Losses of nature interests were studied due to: loss of land because of shoreline retreat, to remodelling of the foredune ridge, and to changes of the dune groundwater level. An evaluation is given of the methods used to assess ecological impacts. Ideas are presented for further research on the prediction of ecological impacts and on coastline management which combines traditional coastal defence with nature conservation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00157750
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