[Prevalence, comorbidity and interdisciplinary treatment of rheumatoid arthritis - Insurance data on outpatient and inpatient care in Baden-Württemberg]. / Prävalenz, Komorbidität und interdisziplinäre Versorgung der Rheumatoiden Arthritis ­ Versicherungsdaten zur ambulanten und stationären Versorgung in Baden-Württemberg.

BACKGROUND: Rheumatoid arthritis (RA) has an increased number of comorbidities compared with the general population. OBJECTIVE: Study aim was to collect epidemiological data on prevalence, incidence and comorbidities of RA as well as utilization of outpatient and inpatient care services. MATERIAL AND METHODS: In an age and gender-adjusted case control study, a total of 3.4 million patients insured by the AOK Baden-Württemberg were analysed with respect to visits to physicians, prevalence, incidence and comorbidities of RA. The study was based on out- and inpatient diagnoses from 2013. RESULTS: The RA prevalence was 0.64% (n = 26,919), the incidence was 0.04%. Patients with RA have significant more comorbidities in almost all diagnosis groups, especially in musculoskeletal and cardiovascular diseases, compared to a control group (n = 181,209). 22.8% of RA patients had not contacted an internist rheumatologist, orthopedist or orthopedic surgeon. Biological disease-modifying anti-rheumatic drugs (DMARDs) were almost exclusively prescribed by internist rheumatologists, while conventional DMARDs were equally prescribed by general practitioners and rheumatologists. Of the RA patients 32.6% were hospitalized at least once a year and were nearly twice as frequently inpatient as the control group. CONCLUSION: RA patients need more in- and outpatient healthcare services and suffer significantly more often from comorbidities. The general practitioner is the most frequently visited physician. Other consulted physicians are rheumatologists, ophthalmologists, orthopedists/orthopedic surgeons and internists not specialized in rheumatology. The study highlights the need to create consensus treatment algorithms and maintain a close interdisciplinary and intersectoral cooperation and communication.

[Incidence of knee injuries : Numbers for outpatient and inpatient care in Germany]. / Inzidenz von Kniegelenkverletzungen : Zahlen für die ambulante und stationäre Versorgung in Deutschland.

BACKGROUND: Musculoskeletal illnesses and injuries are among the most common ailments in the Federal Republic of Germany. In 2008 they generated costs of nearly 29 billion euros. Figures about their incidence and prevalence are necessary for a demand-oriented planning of future patient-centred care. METHOD: Pseudonymised data of 3.8 million people insured by AOK Baden-Württemberg between 2008 and 2013 were evaluated. The diagnoses were assigned to nine injury groups. For outpatient care confirmed diagnoses were considered, and for inpatient care both primary and secondary diagnoses were considered. For all patients with structural knee injuries, it was evaluated whether they made use of one of five eligible treatment paradigms either in the quarter in which they were injured or in the following quarter. RESULTS: 418,257 patients were treated in 2013 for at least one new-onset injury (10.9 % of all insurees); 86,783 insurees (2.3 % of all insurees) had a newly occurring knee injury. The vast majority of the patients were treated by specialist doctors. While magnetic resonance imaging clearly increased during the observation period, the incidence of surgical therapy did not change. Striking are the different age distributions regarding the types of injuries, with a high injury incidence amongst young men and a significant increase in injuries between 2008 and 2013, especially amongst women. CONCLUSION: For the first time, the data quantify the knee injury incidences of a large cohort in Germany. They show which inpatient and outpatient health care services have been claimed and that an age- and gender-adapted prevention and an increased awareness are needed.

[Medical informatics in obstetrics and gynecology - the actual challenge?]. / Was sind die aktuellen Aufgaben? - Medizinische Informatik in der Frauenheilkunde.

There is common agreement about the importance of information management systems in obstetrics and gynecology. Those systems are necessary tools for medical quality management and are essential for the actual preparation for the age of the "diagnosis related groups" that will be introduced in Germany next year. Nevertheless there are only small scientifically activities to improve information management systems and to evaluate their performance. Great efforts are necessary to develop new features and not to loose the conflict between the needs of the physicians and their patients and the needs and demands of hospital administrative authorities.

[Principles and advanced techniques for better internetpresentations in obstetrics and gynecology]. / Prinzipien und aktuelle Techniken der Internetpräsentation in der Frauenheilkunde.

Internet presentations are common tools for better medical communication and better scientific work. Meanwhile a great number of gynecological and obstetrical institutions present data via the world wide web within a wide range of quality and performance. Specific HTML editors offer quick and easy presentations, but only advanced internet techniques enable interesting multimedia presentations. N-tier applications are the future standard and we must integrate them in general informatical systems. New Concepts, actual tools and general problems will be discussed and new principles similar to actual E commerce techniques are able to solve our special medical demands.

[Integrated gynecology: new medical treatments due to psychosomatic methods of evaluation]. / Integrative Frauenheilkunde: neue Behandlungsstrategien dank psychosomatischer Evaluationsmethoden.

OBJECTIVE: Women with gynecologic cancer are confronted with difficult decisions regarding the therapeutic options. The objective of the present paper is to demonstrate the relationship between surgical procedures and the outcome on quality of life and to discuss the implications for patient management. METHODS: Gynecologic patients were assessed in a prospective study with preoperative semistructured interviews and objective assessments (T1), interviews were repeated 4 and 12 months postoperatively (T2, T3). RESULTS: Women planned for hysterectomy with severe complaints indicate a better postoperative quality of life. Cancer patients, however, tend to feel more distressed about the surgical procedure if they could not be treated organ preserving or by reconstructive techniques. Medical interaction is dependent on the patient's anxiety level and mostly important for their quality of life before and after surgery. CONCLUSION: Psychosomatic research is not only necessary to understand the patient's needs before and after surgery but may also serve as an evaluation method of therapeutical options. By this methods we are able to anticipate the medical and psychological consequences of the therapeutic decisions. Future studies will systematically explore the alternating effect of surgical procedures on the patient's well-being.

[Body image in gynecologic patients before and after radical surgery]. / Das Körpererleben gynäkologischer Patientinnen vor und nach radikaler Chirurgie.

After radical gynecologic surgery women are faced with therapy-induced changes of their body. Since 1995, the body images of women who undergo pelvic exenteration, Wertheim-Meigs-operation or hysterectomy are assessed preoperatively and four and twelve months postoperatively. The aim of this multidimensional prospective study is to get basic information for effective counselling and support. One year after hysterectomy women state to have a normal body image. Cancer patients feel less attractive, less self-confident and more discontented in sexuality depending on therapy-induced changes of their bodies. These women could profit from problem-related preoperative counselling. Postoperative counselling offers will be helpful to support women in the process of acceptance of bodily changes and in the reorganisation of their sexual life.

[Anxiety and coping behavior before and after radical gynecological surgery]. / Angst und Krankheitsbewältigung vor und nach radikaler gynäkologischer Chirurgie.

Pretreatment phase-interactions between patient, family and medical staff around the time of diagnosis may have profound and long-term effects on quality of life. These interactions do not only influence the ability of the patient to come to terms with the diagnosis, but often set the tone for all future dealings with medical community. The imperatives for the medical staff in this process are to provide both: information and hope. In this context, anxiety and defense mechanisms--as protection of ego against anxiety--are psychoanalytic based constructs. The investigation of the interference between these constructs and information reflects the extraordinary background for an effective and continuing communication. These considerations require the care team to individualize their approach to each patient.

Pelvic exenteration: effects of surgery on quality of life and body image--a prospective longitudinal study.

OBJECTIVES: The goal of this study was to evaluate the impact of reconstructive and nonreconstructive surgical procedures on quality of life and body image for women who undergo pelvic exenteration. METHODS: Twenty-eight patients were assessed in a prospective study with a preoperative semistructured interview and an objective assessment (T1). Interviews and questionnaires were repeated 4 (T2) and 12 (T3) months postoperatively. The women were divided into groups with two, one, or no ostomies. A separate comparison was made of women with and without vaginal capacity. Quality of life was defined in terms of five categories according to the definition of health proposed by the World Health Organization: physical and psychosocial health; marital and sexual status; medical interactions. RESULTS: At all points in time, the patients' quality of life was affected most significantly by worries about the progression of the tumor. Twelve months postoperatively, patients with two ostomies reported a significantly lower quality of life (P = 0.008) and poorer body image (P = 0.002) than patients with no ostomy. At T3, patients with vaginal capacity reported fewer problems in all categories related to quality of life and significantly (P = 0.015) fewer sexual problems. CONCLUSION: An evaluation of quality of life and body image demonstrates the benefits of newer techniques for organ reconstruction. Thus, organ reconstruction should be performed whenever possible in patients with pelvic exenteration.

[Pelvic exenteration: effects of surgical method on quality of life]. / Die pelvine Exenteration: Auswirkungen des Operationsmodus auf die Lebensqualität.

This prospective longitudinal study explores the quality of life of patients who underwent pelvic exenteration (n = 21) with or without reconstructive procedures by standardized questionnaires and semistructured interviews. Quality of life is defined in following categories: physical status, psychosocial issues, medical interaction, marital and sexual problems. At three points in time (preoperatively, 4 and 12 months postoperatively) the quality of life was mostly affected by worries about tumor-progress and not being able to care for oneself. Patients who received reconstructive or preserving procedures felt less restrained in all categories than those without reconstructive surgery although the preoperative situation was not different.