[5-Year-Follow-up of the MEmbeR Multicenter Study on Medical-Occupational Rehabilitation]. / 5-Jahres-Follow-Up der multizentrischen Evaluationsstudie zur medizinisch-beruflichen Rehabilitation (MEmbeR).

In Germany, medical-occupational rehabilitation represents an essential link between rehabilitation programs focusing either on medical or occupational rehabilitation. Its main objective is return to work. The current study presents the vocational integration 5 years after medical-occupational rehabilitation and determines possible prognostic factors for long-term occupational integration. To evaluate the effectiveness of medical-occupational rehabilitation, a 5-year-follow-up interview was conducted with participants (n=105) of the multicenter study on medical-occupational rehabilitation (MEmbeR). As a main result, 76% of the participants were still employed 5 years after medical-occupational rehabilitation and the return to work rate was 57%. Prognostic factors for long-term occupational integration could not be identified. However, a low degree of disability, an unrestricted capacity for teamwork as well as an unrestricted ability to judge might be beneficial factors for a successful reintegration. The high amount of participants who returned to work 5 years after medical-occupational rehabilitation, supports the concept of medical-occupational rehabilitation. However, more studies are needed to identify further factors influencing the outcome.

[The MEmbeR Multicenter Study on medical-occupational rehabilitation]. / Multizentrische Evaluationsstudie zur medizinisch-beruflichen Rehabilitation (MEmbeR).

INTRODUCTION: MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Germany. METHODS: 196 neurological, psychiatric, orthopaedic, and internal medicine patients from 21 rehabilitation centres all across Germany have been enrolled and followed-up for 2 years after discharge. Primary outcome parameter was defined as return to work. Further, the SF-12 and a Mini-ICF-Rating have been used. RESULTS: Mean age was 34.1 (9.9) years, length of stay 150.0 (223.5) days. Prior to occupational rehabilitation, 69.9% were unable to work, 2 years after discharge only 5.6%. Rate of participants seeking a job was reduced from 19.7% to 3.1%. In summary, 78.1% returned to work. Employed participants were younger (32.8 [9.7] vs. 38.5 [9.4] years, p=0.001) and less disabled (Degree of Disablement [GdB]: 20.0 [31.2] vs. 36.1 [33.7], p<0.05). CONCLUSION: The multicenter cohort study MEmbeR provides further knowledge about the outcome of medical-occupational rehabilitation in Germany.

[Multicomponent therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Multimodale Therapie des Fibromyalgiesyndroms. Systematische Übersicht, Metaanalyse und Leitlinie.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: The use of a multicomponent therapy (the combination of aerobic exercise with at least one psychological therapy) for a minimum of 24 h is strongly recommended for patients with severe FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").

[Simple and valid ICD9-/10- and IKPM coding using an electronic data-assisted coding system "do it"--experiences after one years use]. / Einfache und valide ICD9-/-10- und IKPM-Kodierung mit Hilfe des EDV-gestützten Verschlüsselungssystems "do it"--Erfahrungen nach einjähriger Anwendung.

UNLABELLED: Question by introducing "Fallpauschalen" and "Sonderentgelte" in German health system the coding of diagnoses and therapies gains a new momentum. Therefore, a new computer based coding-system for ICD- and ICPM- digits is presented. The physician gets enabled for simple and valid classification within his documentation routine. METHODS: Development of a hierarchic menue system, whose first part represents the anatomic region. The second part is reserved for the most common diagnosis rsp. therapies within its special anatomic region. By further sub-menues all other ICD numbers in the orthopedic and traumatologic field may be coded (selection related by frequency). This coding-system has been in clinical use since jan. 1st. 1995. RESULTS: Control of the efficiency of this coding-systems by 1316 patients with 1551 operations within one year. By using ICD-10, the representation of orthopedic-traumatologic diagnosis inhanced by factor 1.8 versus ICD-9. According to ICPM, 3560 therapies were coded, making it 2-3 actions per operation. "Fallpauschalen" were found in 21.9%, in 27.7% there were "Sonderentgelte". Within one year the coding error rate was reduced from 25% to 5%. CONCLUSIONS: Because of its easy handling the coding system "do it" represents a good alternative to conventional coding rsp. clear text analysis.

[Endoprosthetic joint replacement in Morquio-Brailsford syndrome]. / Endoprothetischer Gelenkersatz beim Morquio-Brailsford-Syndrom.

Morquio-Brailsford's disease belongs to the mucopolysaccharidoses, it shows growth-retarding with dysproportional dwarfism. Due to bone deformations and joint dysplasias very early severe arthritic changes arise with serious functional disabilities, especially in the loaded lower extremities; this may lead to early alloplastic joint replacement surgery. By means of two patients with respective bilateral THR and singular total knee replacement intraoperative complications and postoperative follow up (up to 12 years) are represented casuistically. Unfavourable anatomic properties (dysplasia, size of joints) were the main technical surgery problem; the use of individually manufactured implants might be recommended in some of these cases. The achieved subjective and objective functional results of our cases were-compared to the preoperative situation-altogether quite satisfactory.

[Synovectomy of the knee joint in rheumatoid arthritis. Follow-up studies]. / Synovektomie des Kniegelenks bei rheumatoider Arthritis. Verlaufsbeobachtungen.

A total of 156 synovectomies were performed to treat recurrent swelling of the knee joints in 148 patients with rheumatic diseases. The late results observed in 112 patients (72%) re-examined after an average follow-up period of 6.2 years are discussed. The subjective and objective findings in patients undergoing early surgery proved to be superior to those seen after late synovectomy. Also in comparison with a group of patients submitted to synoviorthosis, surgical synovectomy, in particular when carried out at an early stage, showed more favorable results. For this reason, should conservative treatment fail, and recurrent swelling of the knee joints persist, early surgical intervention ist recommended.

[Computer-assisted classification of ICD-9/10 and IKPM in compliance with the new federal health care regulation--practice-oriented solution for trauma surgery and orthopedics]. / Rechnergestützte Verschlüsselung der ICD-9/-10 und IKPM gemäss der neuen Bundespflegesatzverordnung--praxisorientierte Lösung für Unfallchirurgie und Orthopädie.

From the beginning of 1995, the German law on the health system structure prescribes that in all clinics the four-digit ICD code be supplied for each diagnosis and the ICPM code for each operation. This makes on-line access to diagnosis and therapy codes embedded in a clinic documentation system advisable. Since 1 February 1995, in one department of traumatologic surgery the ICD diagnosis and ICPM therapy coding is managed on-line by the doctors in the outpatient clinic and operation theatre, using the "do it" coding system in combination with the KAUZ system for clinic documentation. The user guidance supplied by a frequency-oriented menu and specialist traumatological terms makes it possible to determine the ICD and ICPM codes without any great expenditure of effort. Furthermore, the appropriate flat rates per case and special charges are displayed. Comparison of manual and computer-assisted coding of operations during 1 month (160 patients, 173 operations) showed that manual coding could be corrected or improved by the computerized system in 35% of cases. The ICD-10 system has already been integrated: it improves the recording of diagnoses and will simplify the change over to the coming new revision.

[Mesomelic dysplasia: presentation of a case and literature of Werner's syndrome]. / Mesomele Dysplasie: Falldarstellung und Literatur zum Werner-Syndrom.

The extremely rare Werner syndrome (tibial hemimelia, foot polydactyly, triphalangeal thumbs) is represented by an own case: a 21 year old female has been treated since her birth in the orthopedic department of Homburg/Saar university clinic. First, during several operative sessions, there was the correction of the bilateral completely webbed fingers and the resection of the supernumerary toes. Because of tibial hypoplasia there was need of bilateral operative club-foot-correction, too. Presentation of the course over 20 years with clinical and roentgenological late results. In several publications we find different classifications of the collective name, tibial hemimelia'; the symptom-triade congenital tibia-defect/foot-polydactyly/triphalangeal thumb was of special interest.

[Metabolic diseases of bones. Catamnestic study of the incidence and kind of problems in surgical treatment]. / Stoffwechselerkrankungen des Knochenskeletts. Katamnestische Studie über Häufigkeit und Art der Probleme bei operativer Behandlung.

By a catamnestic study at Orthopedic Department of Homburg/Saar University Clinic 156 courses of variant constitutional diseases of bone (1965-1986) were recorded. The frequencies of primary spontaneous fractures, fracture healing-disturbances, refractures and pseudarthroses after operative management of bone lesions or correction-osteotomies were of special interest. While there was no increased rate of traumatic or spontaneous lesions or prolongated healing-rate in case of Rickets and M. Ollier, those complications with need of osteosynthetic measures were more often due to M. Paget and M. Jaffé-Lichtenstein. As expected, osteogenesis imperfecta represented the highest rate of osseous lesions; an uneven situation was found among multiple/generalized epi- and metaphyseal dysplasias.