[Psychotherapeutic treatment of traumatic stress with the EMDR (Eye Movement Desensitization and Reprocessing) method]. / Traumatherapie mit der Fingerspitze. Die überraschenden Erfolge der EMDR-Methode.

EMDR (Eye Movement Desensitization and Reprocessing) is a method, developed at the end of the nineteen-eighties, for the treatment of the post-traumatic stress disorder (PTSD). The patient is asked to concentrate on certain aspect of the traumatic memory while keeping his eyes fixed on the movements of the therapist's finger. Apparently, this triggers information processing that results in appreciable relief for the patient. The method has proven to be equally as effective as behavioral-therapeutic techniques, and, has in the meantime, been included in national and international guidelines for the treatment of PTSD. The indications for EMDR treatment include not only PTSD, but, increasingly, also other, sometimes more severely chronic, it trauma sequelae. Within the framework of basic care, EMDR must be embedded within a treatment plan and should, where applicable, be combined with other methods.

[Psychological trauma in trauma medicine--the current status of psychological management of trauma victims in Germany]. / Psychotraumatologie in der Unfallmedizin--Zum Stand der psychischen Versorgung von Unfallopfern in Deutschland.

A clinically significant amount of accident victims display psychological disorders as a reaction to the trauma. Outcome studies on multiple trauma emphasize that life quality following severe accidental injury is influenced by early diagnosis and treatment of psychic co-morbidity. In a nationwide survey concerning the state of the art in in-patient treatment of injury patients conducted in Germany, every surgical ward was contacted and physicians were asked about their standard procedures of detecting and treating psychotraumatic complications. The results of the survey indicate that surgeons pay close attention to signs of psychological comorbidity and have good basic knowledge of psychotraumatic disorders. Nevertheless, there are structural deficiencies caused by the fact that only a few wards have staff specially trained in psychotraumatological care. Only a minority of patients is treated for psychotraumatic symptoms. In view of the high prevalence rates for psychotraumatic disorders in the aftermath of severe accidental injuries, the article discusses the need for psychic diagnosis and support as well as the necessary cooperative structures required in the model of Integrative Posttraumatic Acute Care.

[Diagnostic spectrum and treatment requirements of general practice clients. Results of the ADT Panel of the Central Institute of National Health Insurance Management]. / Diagnosespektrum und Behandlungsaufwand des allgemeinärztlichen Patientenklientels. Ergebnisse des ADT-Panels des Zentralinstituts für die kassenärztliche Versorgung.

Results of the ADT-Panel of the Central Research Institute of ambulatory health care in Germany. The ADT-Panel of the Central Research Institute contains the remuneration data that are quarterly collected by office-based physicians and transmitted in anonymous form. These data can be classified according to the status of the insured patient, the diagnoses made or the treatment provided. The Patient Panel does therefore represent an important instrument which allows a rapid scientific analysis (3 to 4 weeks after the end of a quarter) about how patients are treated by different specialists. It might also be used to forecast trends. The Patient Panel does as well allow the demonstration of specialty-related statistics on diagnoses and disease-related treatment provision. The complete publication and some exemplary tables can be found in the DGN Internet (www.dgn.de; Deutsches Gesundheitsnetz). A short summary is available on the home page of the Central Research Institute (www/zi-koeln.de).

[Growth in the number of physicians and the structure of medical practice. Has the quality of ambulatory care changed?]. / Die Entwicklung von Arztzahlen und Praxisstrukturen. Andert sich die Qualität der ambulanten Versorgung?

In order to realize a good health policy that, over the long term, combines humanity, effectiveness and efficiency, corrections in the evolution of the number of physicians, changes in the structure of practices, and the preservation of quality in ambulatory care are urgent tasks for the remaining decade of this century. In this connection, the development of medical orientational data and the so-called priority health aims, will be of use. In particular, the system of "health-insurance" doctors is threatened by external influences outside the control and authority of the administrative organs concerned. Here, the influence on the overcapacity of doctors arises in the present constitutional provision which states that all those physicians who wish to work within the health-insurance system, must be allowed to do so. Owing to the increasing "financial bottlenecks" that health-insurance doctors will encounter, the future practicing physician will increasingly become a "businessman", since rising costs and decreasing turnover will exercise a powerful effect on the doctor's practice. In such a situation new practice structures might have a positive effect. In view of all these factors that threaten the independence of the practicing physician, the difficulty arises of preserving the quality of medical care. Already, attempts are being made, on an "outside the medical profession" basis, to ensure quality control, and the proposals made by the expert councils are an indication that this discussion must be intensified among the medical profession itself.