[Quality Assurance in Sociomedical Evaluation by Peer Review: A Pilot Project of the German Statutory Pension Insurance]. / Qualitätssicherung in der Sozialmedizinischen Begutachtung durch Peer Review - ein Pilotprojekt der Deutschen Rentenversicherung.

BACKGROUND: The sociomedical evaluation by the German Pension Insurance serves the purpose of determining entitlement to disability pensions. A quality assurance concept for the sociomedical evaluation was developed, which is based on a peer Review process. Peer review is an established process of external quality assurance in health care. The review is based on a hierarchically constructed manual that was evaluated in this pilot project. METHODS: The database consists of 260 medical reports for disability pension of 12 pension insurance agencies. 771 reviews from 19 peers were included in the evaluation of the inter-rater reliability. Kendall's coefficient of concordance W for more than 2 raters is used as primary measure of inter-rater reliability. RESULTS: Reliability appeared to be heterogeneous. Kendalls W varies for the particular criteria from 0.09 to 0.88 and reached for primary criterion reproducibility a value of 0.37. CONCLUSION: The reliability of the manual seemed acceptable in the context of existing research data and is in line with existing peer review research outcomes. Nevertheless, the concordance is limited and requires optimisation. Starting points for improvement can be seen in a systematic training and regular user meetings of the peers involved.

[Psychosocial patient education groups focusing on work-related issues - results of a survey of German medical rehabilitation centers]. / Patientenschulungen mit arbeits- und berufsbezogener Thematik - Ergebnisse einer bundesweiten Befragung deutscher Reha-Einrichtungen.

INTRODUCTION: Psychosocial patient education programs focusing on work-related issues are a core element in the German statutory pension insurance's profile of requirements (POR) regarding inpatient vocationally oriented medical rehabilitation (VOMR). AIM: This study aims at analyzing the prevalence of patient education programs focusing on work-related issues in German rehabilitation centers with regard to their content and quality.Data were collected in a national survey on the current state of patient education within medical rehabilitation programs in Germany in 1473 inpatient and outpatient medical rehabilitation centers. METHOD: Data were analyzed both quantitatively and qualitatively, with free text responses being assigned to categories, drawing upon criteria developed by the German Center of Patient Education and the pension insurance's POR. RESULTS: 283 of the 908 institutions participating in the survey provided information on 454 psychosocial patient education programs focusing on work-related issues. "Unemployment and job training", "work hardening", "stress"/"relaxation" were named most frequently. The criteria derived from the POR regarding group content and from the Center of Patient Education regarding group size and education methods were largely fulfilled. CONCLUSIONS: There is a need for existing group programs in VOMR to be further manualized, evaluated and published. More patient education programs focusing on work-related issues should be developed specifically for relevant indications.

[Vocational orientation in medical rehabilitation: development of a practice handbook and a homepage as user-oriented media for rehabilitative practice]. / Entwicklung eines Praxishandbuchs und einer Homepage zur arbeits- und berufsbezogenen Orientierung in der medizinischen Rehabilitation als nutzerorientierte Medien für die rehabilitative Versorgungspraxis.

Vocational orientation in medical rehabilitation has become an important issue in rehabilitation science and practice in Germany. Although a variety of vocationally oriented interventions has been developed in recent years, there is still a lack of consensus with regard to the definition of specific types of interventions as well as relevant criteria (e. g., methods; instruments; duration/frequency; patient groups). Building on preliminary definitions, basic types of vocationally oriented measures/interventions were conceptually modified and refined in the context of a consensual process. 39 experts of various professions were contacted during a 2-stage Delphi survey to evaluate existing definitions of vocationally oriented interventions using key questions. Standardized descriptions of 5 vocationally oriented basic interventions were specified in cooperation with an interdisciplinary panel of experts. Descriptions were published in a workbook and a homepage for researchers and clinicians, which also contain information on the implementation of measures into rehabilitative care as well as good practice examples. The media developed in this project may contribute to the transfer of research results on vocationally oriented rehabilitation into health care practice.

Pump geometry for resonant and quasi-resonant optical excitation of microcavity lasers.

A simple new pump geometry for optical excitation of microcavities and vertical-cavity surface-emitting lasers is presented. The technique circumvents the high reflectivity of the cavity stop band by excitation through the substrate at a large angle of incidence. Under these conditions, the reflectivity of the bottom Bragg reflector is small, and optical pumping at any desired photon energy becomes possible. Experimental results for optical excitation with this new geometry are compared with resonant optical pumping through the cavity mode.

Misleading changes of the signal intensity on opposed-phase MRI after injection of contrast medium.

OBJECTIVE: The effect of opposed-phase imaging on the interpretation of MR contrast studies is highlighted. MATERIALS AND METHODS: A model calculation is performed. It demonstrates the change of signal intensity of an average tumor before and after application of Gd-DTPA on an in-phase and an opposed-phase image, depending on the percentage of fat within the voxels. The effect is then demonstrated, using a small cotton stick soaked with water or a solution of contrast agent representing a tumor before and after i.v. application of Gd-DTPA. RESULTS: If an average enhancing tumor, which is surrounded by fat, occupies less than 50-60% of the slice thickness, it becomes undetectable on opposed-phase images. The reason is that due to signal cancellation on the opposed image, no signal change or even signal decrease results, while signal increase is visible on the in-phase image. CONCLUSION: In those areas of the body where significant partial volume of a tumor with fat may occur (such as for breast tumors growing along ducts, which are surrounded by fat), severe errors can result. Therefore we explicitly warn from using opposed-image sequences for MR contrast studies.

[Spatial urethral rest pressure and stress pressure profile in women with stress incontinence. Doppler microtransducer studies]. / Das räumliche Urethraruhedruck- und -stressdruckprofil bei stressinkontinenten Frauen. Doppelmikrotransduceruntersuchungen.

The functional urethral length (FUL), the maximum urethral closure pressure (MUCP), and the urethro vesical quotient (u/v) have been measured in 32 women suffering from urinary stress incontinence. The pressure was registrated in four different sectors of the urethra (left, posterior, right, anterior). We found statistical significant differences (t-Test, Wilcoxon-Test). The average FUL at the anterior urethral wall was 27.5 mm, at the posterior wall 30.2 mm. Concerning the UVDR and the u/v-quotient we found higher values at the ventral wall than at the posterior and lateral sides (9.79 kPa and 6.87 kPa and 1.63 and 1.14 resp.). Because of spatial different results of pressure distribution along the urethra walls the microtransducer had to be marked to enable the investigator to localize the direction of the pressure chip during registration. The pressure profile should be registrated only at the dorsal or dorsolateral parts of the urethra. Measurements at the anterior walls of the urethra showed no correlation between history, clinical tests, and urodynamic measurements. By reason of the submitted results we developed a new 5-channel microtransducer for simultane measurements of the urethra pressure profile at rest and at stress in four directions and we proved it in patients with and without urinary stress incontinence. New aspects are visible concerning the functional and morphological states of the urethra by use of the spatial urethral pressure profile.