[Quality in acute inpatient rheumatology 2021 : Current aspects of the KOBRA quality label of the Association of Rheumatological Acute Care Clinics]. / Qualität in der akutstationären Rheumatologie 2021 : Aktuelle Aspekte zum KOBRA-Qualitätslabel des Verbandes Rheumatologischer Akutkliniken (VRA e.V.).

A comprehensive health policy quality campaign launched in 2021 aims to improve the quality and transparency of hospital care for people with diseases in Germany. Legal requirements for minimum volumes and the expansion of quality contracts between cost units and hospitals as well as the use of quality indicators relevant to planning for demand-oriented and quality-oriented further development of inpatient care will increase competition in the quality of care between hospitals. The topic of development and definition of quality in medicine was also comprehensively addressed by the Association of Rheumatological Acute Care Clinics (VRA) shortly after its foundation in 1998. At the center of acute inpatient quality management are binding structural criteria linked to the continuous outcome benchmarking in acute rheumatology care (KOBRA) project launched in 2003 in rheumatology (and continuously implemented to date) measuring process and outcome quality. Based on this framework (fulfillment of the structural quality and participation in the KOBRA project) successfully participating rheumatology units can acquire the KOBRA seal of approval for 2 years at a time, which is awarded by the project management, the aQua Institute. The outstanding position of the project is exemplified by data evaluation on treatment change in active rheumatoid arthritis, diagnosis confirmation of connective tissue diseases and vasculitis during the inpatient stay as well as on participatory decision-making processes concerning rheumatoid arthritis (referring to the results of the data collection period 2018). By anchoring projects for structural, process and outcome quality acute inpatient rheumatology is well prepared for the paradigm shift demanded by health policies. Additionally, the KOBRA project is a good prerequisite to meet the requirements concerning quality management fixed in the Federal Joint Committee (G-BA) guidelines for recognition as a rheumatology center.

A continuous-wave optical parametric oscillator around 5-µm wavelength for high-resolution spectroscopy.

We present a continuous-wave optical parametric oscillator (OPO) capable of high resolution spectroscopy at wavelengths between 4.8 µm and 5.4 µm. It is based on periodically poled lithium niobate (PPLN) and is singly resonant for the signal radiation around 1.35 µm. Because of the strong absorption of PPLN at wavelengths longer than 4.5 µm, the OPO threshold rises to the scale of several watts, while it produces idler powers of more than 1 mW and offers continuous tuning over 15 GHz. A supersonic jet spectrometer is used in combination with the OPO to perform measurements of the transient linear molecule Si(2)C(3) at 1968.2 cm(-1). Fifty rovibrational transition frequencies of the ν(3) antisymmetric stretching mode have been determined with an accuracy on the order of 10(-4) cm(-1), and molecular parameters for the ground and the v(3) = 1 state have been determined most precisely.

[Rehabilitation and Diagnosis Related Groups (REDIA Study): impact of DRG introduction in the acute sector on medical rehabilitation in Germany]. / Rehabilitation und Diagnosis Related Groups (REDIA-Studie): Auswirkungen der DRG-Einführung im Akutbereich auf die medizinische Rehabilitation.

As experiences from other countries show, introduction and use of Diagnosis Related Groups (DRG), as of January 2004 now also mandatory in Germany, may have a significant impact on associated rehabilitation. The Institute of Hospital Management (IKM) in a multi-centre study promoted by Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Westfalen is conducting a study regarding potential diversion of healthcare expenditures from acute care towards rehabilitation as a result of DRG introduction in Germany. For documentation of potential short-term changes in patient populations and patient streams, extensive data have been collected in the first two phases in 2003/04 and 2005/06 for a total of 1342 cardiologic and orthopaedic patients. Indication-specific comparison of the two phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in an intake of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversion of treatment efforts from the acute to the rehabilitative sector, regarding increased nursing effort and potential changes in the therapeutic and medical treatment to be provided, has not been proven as yet. The increase in wound problems expected by practitioners was confirmed in the orthopaedic area by an increasing number of wound healing disturbances and haematomas; in bypass-patients, an increasing number of pericardium and pleura bruises was found. The analyses performed on the data collected revealed no limitations in the patients' ability to participate in rehabilitative measures when the first and the second phase of the study are compared. To be able to depict the further course and interdependencies of changes, continuous systematic observation of developments would be desirable. To ascertain a lasting impact of DRG implementation at least a third study-phase will be necessary, which should be placed at the end of 2008, at the time when the DRG convergence phase will end.

[Surgical treatment of bronchial carcinoid]. / Zur chirurgischen Therapie der Bronchuskarzinoide.

84 patients with bronchial carcinoid tumors were analysed on during of 28 years. 26 of them were detected by radiography and 58 by symptoms. The bronchoscopy with biopsy is the most important diagnostic procedure. The preoperative histological or cytological diagnosis was correct in 25 cases. The suspicion was given only in 39 patients. The surgical therapy was carried out in all cases with conventional resection of lung as well as parenchyma preserving methods. We used atypical or typical segmental lung resections, bronchotomy with direct suture, sleeve or wedge resection of the bronchus and fenestration of bronchus with closure of the window with free skin graft. The prognosis after surgical treatment is very good. The 5-year-survival was 89%.

[Endoscopic management of bronchial stump fistulas with fibrin glue]. / Endoskopische Versorgung von Bronchusstumpffisteln mit Fibrinkleber.

Dehiscence of bronchial trunk after lung resection is a severe complication. Beside early re-thoracotomy, in certain cases endoscopic (bronchoscopic) treatment of the bronchial fistula may be applied. In a series of patients, we used this method successfully with the help of a fibrin glue of domestic production. The method is most appropriate for fistulas of small and medium size.