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Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints. In addition to the legal principles of the medico-legal assessment with a focus on statutory accident insurance, this overview article discusses the principles of expert assessment and presents landmarks for the expert opinion of the most frequent neurological and psychiatric symptoms occurring in the context of post-COVID syndrome. [ABSTRACT FROM AUTHOR]

This article deals with the general recommendations on vaccination and postexposure prophylaxis, which can be utilized for cuts and needlestick injuries. Cuts and needlestick injuries among surgeons are common occupational accidents. These should be interpreted as acute or emergency situations, especially if there was contact with infectious index patients or the danger of infection cannot be excluded. This results in high economic costs but also in the individual confrontation with an infectious disease that is definitely incurable. The aim of this review is to highlight the general and occupational vaccine recommendations for surgeons. In addition, background information and legal principles are presented. There is a duty to provide and to obtain information about effective protective measures against infectious diseases from cuts and needlestick injuries even for surgeons. In addition, primary prophylaxis, vaccination recommendations, and postexposure prophylaxis after cuts and needlestick injuries as well as the TOP principle are presented. The TOP principle comprises technical, organizational and person-related protective measures. [ABSTRACT FROM AUTHOR]

In 2012 there was profound criticism from the German Social Jurisdiction Conference of the reduction in earning capacity (MdE) table values of orthopedic and trauma surgery for the sequelae of occupational accidents. As a result a group of experts was convened to reform the MdE under the patronage of the German statutory accident insurance in an interdisciplinary approach. The goal was to evaluate the published MdE values under the premises laid down by the German Statutory Accident Insurance Act (Social Security Statutes, SGB VII). The expert group tried to scientifically and methodically calculate MdE values due to injury-related health deficits in individuals and the resulting limitations in pursuing a profession. The expert group defined a prototype patient with a lower limb amputation and concomitant disabilities. This patient was then processed through the various databases of the German Employment Agency to evaluate professions that were no longer suitable for this test person. All job market research and databases were not able to deliver reliable and proven information to deduce MdE values from this survey. This path to scientifically evaluate MdE values leads to no result even with all the resources of the German Employment Agency. Nevertheless, reacting to some major points of the ongoing criticism of the MdE values, the expert group aimed for a harmonization of the divergent values and initiated an interdisciplinary, interprofessional and internal society dialogue to form a consensus on basic MdE values. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hintergrund: Die Deutsche Gesetzliche Unfallversicherung (DGUV) hat ein neues Qualitätssicherungsverfahren für Erstberichte zur „besonderen Heilbehandlung“ nach einem Arbeitsunfall oder einem Wegunfall entwickelt und bundesweit eingesetzt. Diese Berichte werden bezüglich der Dokumentationsqualität (Schlüssigkeit und Vollständigkeit) durch den Einsatz eines Peer-Review-Verfahrens geprüft. Mit diesem Verfahren wird die - für die Steuerung des Heilverfahrens notwendige - Dokumentation überprüft und nicht die Behandlungsqualität.Material und Methoden: Ausgewählte ärztliche Peers nahmen die Beurteilung von ca. 33.000 Durchgangs(D)-Arzt-Berichten EDV-gestützt vor. Die Beurteilung erfolgte anhand einer Checkliste, die in einem vorgelagerten Forschungsprojekt entwickelt und evaluiert worden war.Ergebnis und Schlussfolgerung: Die webbasierte Plattform zur Übermittlung von anonymisierten D‑Arzt-Berichten und deren Bewertung hat sich für den bundesweiten Einsatz mit umfangreicher Stichprobengröße bewährt. Es wurde ein vollständig papierloses Qualitätssicherungs(QS)-Verfahren realisiert, um den D‑Arzt-Bericht als ein zentrales Dokument für die Heilverfahrenssteuerung zu evaluieren. Jeder einzelne der am Projekt teilnehmenden D‑Ärzte wird im Herbst 2018 eine individuelle Rückmeldung erhalten, die auch Informationen über die Ergebnisse der Vergleichsgruppe beinhält. Diese Angaben dienen dem Qualitätsmanagement des D‑Arztes bzw. der D‑Arzt-Praxis. [ABSTRACT FROM AUTHOR]

Die Expertengruppe zur Reform der Minderung der Erwerbsfähigkeit (MdE) unter der Schirmherrschaft der Deutschen Gesetzlichen Unfallversicherung (DGUV) hat die v. a. aus dem Deutschen Sozialgerichtstag 2012 hervorgegangene Kritik an den gegenwärtigen MdE-Tabellenwerten für orthopädisch/unfallchirurgische Arbeitsunfallfolgen aufgenommen und in einem interdisziplinären methodischen Ansatz überprüft. Es sollte der Bezug dieser Werte zum aktuellen deutschen Arbeitsmarkt analysiert und auf Aktualität wissenschaftlich überprüft werden. Der Prozess wird hier im Einzelnen dargestellt. Auch unter Zuhilfenahme der Arbeitsmarktforscher in den verschiedenen wissenschaftlichen Instituten der Agentur für Arbeit war es nicht möglich, das von der Expertengruppe für einen prothetisch gut versorgten unterschenkelamputierten Verletzten definierte Teilhabedefizit in der konkreten Beschäftigungsmöglichkeit so abzubilden, dass dabei verlässliche Arbeitsmarktdaten zu verschlossenen Beschäftigungsmöglichkeiten und daraus ableitbaren verwehrten Anteilen am gesamten Arbeitsmarkt abschätzbar waren. Der schon von anderen Arbeitsgruppen immer wieder versuchte Weg muss damit als nicht zielführend angesehen werden. Wissenschaftlich begründbare Daten für einen MdE-Wert im Sinne des Wortlautes des SGB VII lassen sich nicht erheben. Dennoch ist unter den verschiedenen kritischen Punkten, denen sich die MdE-Tabellenwerte ausgesetzt sehen, ein interprofessioneller, interdisziplinärer und innergesellschaftlicher Konsensusprozess zur Vereinheitlichung der MdE-Werte erforderlich und von der Expertengruppe in Gang gesetzt worden. [ABSTRACT FROM AUTHOR]

Die zum 01.01.2013 verabschiedete Neuordnung der stationären Heilverfahren in der gesetzlichen Unfallversicherung in Form eines neuen stationären Durchgangsarztverfahrens (DAV), eines modifizierten Verletzungsartenverfahrens (VAV) und eines ebenfalls neuen Schwerstverletzungsartenverfahrens (SAV) befindet sich kurz vor Ablauf der 5‑jährigen Übergangsfrist. Zwischenzeitlich sind in Bayern und Sachsen über zwei Drittel der an der Versorgung von Verletzten nach Arbeitsunfällen teilnehmenden Kliniken auf Basis der neuen Anforderungen geprüft. Dabei hat sich in 3 von 4 Fällen die bisherige Einstufung der Kliniken bestätigt. Der Blick auf die Landkarte zeigt eine weitgehend homogene Verteilung der stationären Einrichtungen in den Verfahrensarten. Auch im Schwerstverletzungsartenverfahren steht mit aktuell 23 teilnehmenden Kliniken ein weitgehend flächendeckendes Netz zur Verfügung. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Specialized pain medicine is a well-established component of the service portfolio of all accident hospitals of the statutory accident insurance ( Unfallversicherungsträger) for the diagnostics and therapy of chronic pain following injuries or occupational diseases. The diagnostic clarification of possible causes is an essential part of the service and selection of the optimal therapy for relief of pain also involves avoidance of secondary impairment caused by analgesics. For staff personnel and rehabilitation managers of statutory accident insurance clinics the most frequent indications to undertake specialized pain diagnostics and therapy are when patients suffer from extraordinary, subjective pain-related impairments, prolongation of work-related rehabilitation or when a distinction between preexisting or unrelated factors to the pain and causes must be made. In this respect, interdisciplinary assessment options with mutually elaborated therapy recommendations are available, which allow optimal rehabilitation management. This overview presents the core competencies of pain clinics in this setting and indications for the utilization of pain clinics within the rehabilitation process. [ABSTRACT FROM AUTHOR]

The German Social Accident Insurance (DGUV) has the statutory mandate to eliminate the consequences of accidents and to prevent an aggravation by all appropriate means. For this purpose, special methods have been developed in recent decades, such as occupational insurance inpatient further treatment ( Berufsgenossenschaftliche Stationäre Weiterbehandlung, BGSW) and extended outpatient physiotherapy ( Erweiterte Ambulante Physiotherapie, EAP). In 2012 workplace-related musculoskeletal rehabilitation ( Arbeitsplatz-bezogene muskuloskeletale Rehabilitation, ABMR) was added to these complex treatments but for complex injuries and delayed healing processes these procedures reach their limits. The trauma centers of the Association of Statutory Insurance Clinics ( Klinikverbund der gesetzlichen Unfallversicherung, KUV) provide a number of specialized rehabilitation measures in order to ensure an optimal seamless rehabilitation of the severely injured. As part of the complex inpatient rehabilitation ( Komplexe Stationäre Rehabilitation, KSR) procedure, extensive diagnostic investigations and nursing services are also provided besides an extensive therapy, which exceeds the therapy volume of the BGSW. The rehabilitation team can use the infrastructure of BG clinics and maintains close contact with the rehabilitation management of the accident insurance companies. In addition to KSR, integrated special rehabilitation methods are provided, such as neurorehabilitation of severe traumatic brain injuries and treatment after spinal cord injury. Such diagnoses and particularly severe injuries require advanced rehabilitation possibilities 'under one roof'. Further special rehabilitation methods, such as activity-oriented rehabilitation ( Tätigkeitsorientierte Rehabilitation, TOR) and pain rehabilitation, ensure that the German Society of Trauma Surgery (DGU) phase model of trauma rehabilitation will be implemented. This provides an early start in the context of acute treatment as so-called early rehabilitation. After a specialized post-acute rehabilitation, additional therapeutic measures are often required to alleviate the consequences of major accidents. [ABSTRACT FROM AUTHOR]

Background: In the case of occupational accidents requiring ambulatory care, patients are treated by qualified accident insurance consultants who are specialists with particular expertise in occupational medicine. No formal system for quality assurance has yet been implemented for this sector of the German healthcare system. Objectives: The aim of the present study was to develop and test two instruments to assess patient satisfaction with care and the quality of routine reports prepared by accident insurance consultants. Material and methods: After an extensive review of existing instruments and qualitative interviews with patients, a standardized written patient satisfaction questionnaire was developed and psychometrically tested. In close collaboration with an expert panel, an online checklist to assess completeness and plausibility of relevant items in routine reports by accident insurance consultants was also developed. This peer review instrument was tested in several steps for feasibility and accuracy. Results: The final patient satisfaction questionnaire consisted of 38 items on various aspects of patient satisfaction. Statistical analyses indicated that relevant psychometric criteria were met. The peer review process was successfully implemented as a web application. Problems in reporting important details about accidents and the medical treatment could be identified with sufficient accuracy using the online checklist. Conclusion: The patient questionnaire and the peer review process developed and tested in this study are feasible and reliable measures for quality assurance in ambulatory care provided by accident insurance consultants. Results generated by both instruments can be included as summary reports in quality assurance reviews or for individual feedback to accident insurance consultants. [ABSTRACT FROM AUTHOR]

The assessment of injuries to the tendons of the knee in the statutory accident insurance is carried in two mental steps. In the first step of scientific testing, the focus is on the external event that has led to rupture of the tendons. The second step is an analysis of the history of the findings, clinical aspects, imaging results, intraoperative macroscopic findings and the histology. The classification and evaluation of the individual findings are made on the basis of the current scientific knowledge on the mechanisms of injuries of quadriceps and patellar tendons and the causes of diseases of the knee extensor apparatus. By weighing up the facts of the findings an evaluation result can always be achieved. [ABSTRACT FROM AUTHOR]

Background: Severely injured persons are supported by the statutory accident insurance through rehabilitation management. Objectives: Expectations and experiences with regard to rehabilitation management Methods: Review the development of rehabilitation management, compare expectations and experiences and identify room for improvement. Results: The expectations with regard to rehabilitation management were largely fulfilled. In some cases there is still room for improvement, which has to be addressed in a dynamic process. Conclusion: Rehabilitation management is worthwhile for everyone involved. The procedure results in a more effective and efficient supervision of treatment and participation. It hence allows customer satisfaction to be improved, total costs to be reduced and the reputation of the statutory accident insurance to be strengthened. [ABSTRACT FROM AUTHOR]

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of the current study is to develop and to evaluate an assessment-driven quality management system for optimising effects of inpatient rehabilitation of the BGSW. Of 768 patients admitted to the inpatient rehabilitation by the largest regional statutory accident insurance (VBG), 493 (64.2%) suffered from a major trauma of the lower extremities. SF-36, WOMAC and EQ-5D were administered to this sample on admission (T 1), at discharge (T 2) from the inpatient rehabilitation, at the end of a scheduled prolongation (T 2a) and at the 6-month follow-up (T 3). The treatment and management concept was optimised in three subsequent steps. We compared the effect sizes between cohorts treated during the subsequent optimising steps. The assessment-driven quality management system was practicable in patients suffering from a major trauma of the lower extremities undergoing inpatient rehabilitation programmes of the statutory accident insurance (BGSW). The results support the hypothesised possibility and necessity for permanent assessment-driven optimising of rehabilitation processes. [ABSTRACT FROM AUTHOR]

Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the mid-1920s Porter and others developed a reform approach for existing health care systems, aiming at a patient-focused, value-based orientation. Improving patient outcomes by attaining, preserving and restoring good health is inherently less costly than dealing with poor health. The authors of the present article will outline that the German statutory accident insurance system, which was already introduced in1884 and is of an evolving nature, reflects key elements of Porter's efficient value-based health care system. The German accident insurance system with its statutory mandate limited to the prevention and rehabilitation of work-related damage to one's health can also serve as a model for other larger health care insurance systems. Prevention and rehabilitation is pursued using all appropriate means to achieve the set goals of protecting and restoring individual health. In line with these objectives, the statutory health insurance controls the process in terms of the required care quality. The components of a complex health care system, usually managed by a variety of different institutions, are consolidated. Thus it can be ensured that in both prevention and rehabilitation all services that are necessary to keep focussing the value "individual health" rather than indemnities are applied., (Copyright © 2018. Published by Elsevier GmbH.)

Occupational accidents can involve high subsequent costs, especially in cases when early retirement is necessary. Early implementation of effective treatment is therefore of decisive importance. To ensure uniform care it would be a good idea to set up a traumatology network with external departments of the employers' liability insurance companies' hospitals in trauma surgery hospitals with good reputations. A network of this kind would fill the gap between hospitals working to SGB V and the specialised and individual care provided for in SGB VII in the employers' liability insurance companies' own institutions. [ABSTRACT FROM AUTHOR]