[Trust and reliability in surgery]. / Vertrauen und Verlässlichkeit in der Chirurgie.

Social interactions are hardly possible without trust. Medical and in particular surgical actions can change the lives of people directly and indirectly existentially. Thus, the relationship between doctor and patient is a special form of social interaction, and will be hard to find anywhere else. The nature of the doctor-patient relationship also determines the success of a treatment. The core and the importance of trust, as a central part of this relationship, will be reconstructed in the present paper. The increasing possibilities of information acquisition in modern societies, and the ever-present need for transparency, impact more and more on the doctor-patient relationship. At first glance, concepts of trust seem to be of secondary importance. The current developments regarding the remuneration of services in the medical system likewise bear the risk to increasingly determine the importance of trust in the doctor-patient relationship. However, it is necessary to delineate reliability from trust. Due to the conditions which are constitutive for the operational disciplines, a climate of trust, even in a modern information society, is more necessary than ever.

[The validity of routine data on quality assurance: A qualitative systematic review]. / Die Validität von Routinedaten zur Qualitätssicherung : Eine qualitative systematische Übersichtsarbeit.

BACKGROUND: The assessment of the quality of medical practice is a legitimate requirement by society. Reliable methods for measurement of the quality of performance are sought worldwide. Quality is often quantified by using administrative data and in Germany this method has been implemented by the health insurance company AOK. OBJECTIVES: (1) How is the AOK quality system rated by senior consultant surgeons? (2) How valid are quality statements derived from administrative data? METHODS: This article was compiled following the PRISMA (i.e. preferred reporting items for systematic reviews and meta-analyses) statement for qualitative systematic reviews. In order to answer the first question the Professional Association of German Surgeons (Berufsverband der Deutschen Chirurgen) initiated two surveys and to answer the second question a structured literature search following the PICO (i.e. patient problem or population, intervention, comparison control or comparator and outcomes) format was initiated. In addition numerous websites were contacted. RESULTS: Of the responding senior consultant surgeons 95% considered that the AOK method of quality measurement by administrative data is not objective. One third was definitely wrongly classified. The literature search revealed that no validation data exist for the AOK indicators, including the Elixhauser comorbidity risk score. Altogether, the sensitivity of indicators is poor when good sensitivity is defined by the Institute for Applied Quality Improvement and Research in Health Care (AQUA Institute) as ≥ 80 < 90%. CONCLUSIONS: Quality statements resulting from administrative data alone are unreliable.

[MR tomography and computer tomography of alcohol-induced brain tissue changes]. / MR-Tomographie und Computertomographie von alkoholtoxischen Hirngewebsveränderungen.

Results of MRI in five alcoholics suffering from acute neurologic disorders such as ataxia, ophthalmoplegia and confusion are presented. The detection of focal cerebral lesions of high signal intensity in T2-weighted Spin-Echo- and Gradient-Echo-images in periventricular white matter, thalamus and pons combined with patients history and clinical presentation led to the diagnosis of Wernicke-Encephalopathia and Pontine Myelinolysis. MRI was far more sensitive compared with CT.

Postprandial hyperoxaluria and intestinal oxalate absorption in idiopathic renal stone disease.

Calcium and oxalate were studied in daily, fasting and postprandial urine specimens from healthy subjects and patients with idiopathic renal calcium stones in response to a test meal free of oxalate, and supplemented with calcium and 14carbon-oxalic acid. The data showed that the amount of oxalate in fasting urine of patients with stones did not differ from that in controls. Generally, patients with stones had considerable postprandial hyperoxaluria in terms of excretion and concentration, associated with a significantly higher degree of supersaturation with regard to calcium oxalate compared to controls. These findings were paralleled by decreased intestinal absorption of 14carbon-oxalate and by unchanged 24-hour urinary oxalate. Although the source of increased postprandial oxalate in patients with stones is not clear the possibility of enhanced de novo synthesis from oxalate precursors is discussed. In patients with different types of calciuria the 2 main risk factors (hyperoxaluria and hypercalciuria) for the process of stone formation are recognizable more readily in the postprandial urine specimens than in fasting or daily urine specimens.