[Matched-pair analysis comparing laparoscopic (LA) vs. single-port appendectomy (SP) for initial assessment of a new surgical approach during its inauguration]. / "Matched-Pair"-Analyse der laparoskopischen (LA) vs. Single-Port-Appendektomie (SP) zur initialen Evaluation im Rahmen der Etablierung einer neuen Operationsmethode.

INTRODUCTION: By minimising the invasiveness of a surgical intervention, a reduction of operative trauma can be achieved. AIM AND METHODS: The aim of this study was based on a theoretical approach to investigate (i) the feasibility of the SP approach and its overall costs, and, furthermore, (ii) the patients' outcome based on simple perioperative parameters available in daily clinical practice. Therefore, single-port (SP) and laparoscopic appendectomies (LA) were compared using a matched-pair analysis. As a prediction, an absolute match between the criteria histology, sex and ASA stage was required. RESULTS: From 01/01/2009 to 12/31/2010, 196 (60 % were females) consecutive patients underwent appendectomy. Out of them, in 23 patients with either SP or LA appendectomy the predictions for matched-pair analysis (congruence in histopathological finding, sex and ASA criteria) were fulfilled. The operating time was the target criterion for the feasibility of the new surgical method (SP), which could be shortened as seen by comparing SP No. 1-10 with 11-23 (54.6 ± 19.8 min vs. 28.5 ± 18.9 min) expressing the typical effect of a learning curve. The times were similar to those for LA. The postoperative hospital stay and complication rate used to appropriately assess patient outcome did not show a significant difference if comparing SP and LA. Based on the use of single ports, which can be re-used (which has been also a further target) in SP (34.8 %) at the end of the investigation period, SP and LA can be considered comparable surgical techniques with regard to operating times, middle-term outcome and general costs. CONCLUSION: SP is (in case of well-developed laparoscopic expertise) a surgical method that can be easily inaugurated and considered as a feasible approach in daily surgical practice; it is comparable to LA with regard to outcome and general costs. Based on this, SP can be gradually added to the spectrum of surgical procedures in clinical practice and can be performed in suitable cases. A further systematic institutional or even country-wide case register appears to be recommendable to recruit a larger case number and, thus, to achieve a better knowledge on the perioperative management as well as the especially interesting long-term outcome for an appropriate assessment of treatment quality.

[Diagnoses as the subject of health service research to analyse the morbidity of outpatients]. / Diagnosen als Gegenstand der Versorgungsforschung zur Analyse der Morbidität ambulanter Patienten.

Health service research needs coded diagnoses of outpatients. The morbidity treated by physicians in ambulatory care is analysed every quarter on the basis of the diagnoses of about 1,2 Mio. patients by a randomised panel. Patient data combined with diagnoses, encounters and procedures demonstrate the variety of medical care provided. Relevant research questions are for instance the influence of co-payment on the structure of diagnoses or the prevalence of heart diseases in the offices of general practitioners. The comparison of prescribing patterns and diagnoses demonstrates the predominantly probatory therapy with proton pump-inhibitors in the case of gastroesophegal reflux disease. The plausibility and validity of disease documentation are permanently observed by regular checks.

[Outpatient treatment of patients with cardiovascular diseases]. / Behandlung von Patienten mit Kreislauferkrankungen in der Arztpraxis.

In Germany, cardiovascular disturbances belong to the diseases most frequently treated in the offices of general practitioners and internal specialists. With comprehensive monitoring and the taking of adequate therapeutic measures, the average mortality age of the majority of the 18 million patients suffering from circulatory diseases lies at 79.4 years. In the age group of over 70 years, 70 to 80% of the patients receive treatment against cardiovascular disturbances, most of them against hypertension. One of the most important goals of monitoring and intervention in the outpatient sector is the treatment of hypertension, especially in connection with measures taken against disturbances in lipometabolism in order to prevent secondary diseases. The success of treatment is shown by the decreasing age standardized rate of cardiac infarctions, especially among men, and the decreasing mortality rate of patients below 65. The increasing treatment in the outpatient sector is accompanied by additional interventions, especially by bypass surgery in the hospital sector. The concerted actions in both the outpatient and the inpatient sector result in a higher service provision to come to a higher quality of life in the patients and to prevent early death.

[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).

[The massive migration out of the Soviet Occupied Zone and the German Democratic Republic]. / Die Massen-Migration aus der SBZ und der DDR

PIP: This article is a review of research on mass migration from the Soviet Occupied Zone and the German Democratic Republic to the Federal Republic of Germany during the 1950s. The various official sources of migration statistics are first described, and the extent of politically motivated migration is assessed. The sociological consequences of this migration are then examined, and individual migration motives are briefly considered.^ieng

[Flight and exit from the German Democratic Republic: a comment on a familiar topic]. / Flucht und Ausreise aus der DDR: ein Beitrag zum "Wohlbekannten".

PIP: The author discusses population movement out of the German Democratic Republic since 1945 and critically evaluates the sources of migration statistics. These include the official population statistics of the German Democratic Republic, official migration statistics from the Federal Republic of Germany, West German data acquired through the processing of refugees, and migration data from the West German population censuses of 1961 and 1970. Reasons for migrating, political motivation and implications, and the socioeconomic aspects of East-West migration are discussed.^ieng

The instructional media: an overview.

PIP: The advantages of using audiovisual instructional techniques in training programs for nurses were noted and administrative strategies for encouraging the effective use of educational technology were provided. Audiovisual instructional techniques can enhance classroom learning, create opportunity for individualized learning programs, and can serve as an effective tool for monitoring and supervising clinical training. In the classroom situation, audiovisual techniques should be incorporated as a basic instructional tool and not simply used to occasionally supplement traditional learning techniques. The use of these tools can free the teacher for more personalized teaching tasks. Educational technology permits instructors to develop individualized learning programs for their students. Students can progress at their own pace and students can learn to manage their own learning process. Audiovisual tools can be used to monitor student-patient interactions. Supervisors can monitor the work of a larger number of students with these devices. These devices also permit students to reexamine and to judge their own performance. Administrations should not view educational technology as a way to reduce costs. Costs will not decline and may, at least initially, increase. Administrators should purchase equipment to fit the needs of the faculty and the students instead of expecting the faculty to develop programs suited to particular types of equipment. The faculty should be provided with assistance to learn how to operate the new equipment.^ieng