[Which medical errors do general practitioners make? Data from the Expert Arbitration and Advisory Board of the Baden-Württemberg State Medical Association]. / Welche Fehler machen Hausärzte? Daten der Gutachter-Kommission der Landesärztekammer Baden-Württemberg.

BACKGROUND: In Germany, medical error reporting systems are well established. They collect information reported principally by physicians. Systematic data collection concerning medical errors is also performed by expert arbitration and advisory boards of the German State Medical Associations. METHODS: Data base MERS (Medical Error Reporting System); cases from the Expert Arbitration and Advisory Board of the State Baden-Württemberg from the years 2004-2011 (8,042 cases) were evaluated as follows: extraction of the cases from general practitioners (n=307, 4%); categorisation of the type of error and degree of severity; classification according to ICD-10 (International Classification of Diseases); overview of confirmed cases including commentaries of the above board; logistic regression analysis of factors potentially associated with confirmed cases. RESULTS: In 26% (n=80) the board confirmed medical errors. 55% of the errors were assigned to the category "diagnosis" (n=44), 21% to "general therapy" (n=17), 8% to "operative therapy" ("minor surgical operations") (n=6) and 10% to "injections" (n=8). 29% of cases (n=23) were associated with permanent damage or death. The majority of cases could be assigned to ICD-10 categories "I" (cardiovascular system, n=20) and "S-T" or "V-Y" (consequences of external causes or external causes of morbidity and mortality, n=34). No significant associations were found by logistic regression analysis. CONCLUSION: The rate of confirmed cases corresponds with the rate of all medical disciplines. The presented overview is illustrative and may be of help to avoid errors by using it for continuing medical education.

Analgesic drug use associated with statin prescription--a cross-sectional study in primary care settings.

BACKGROUND: To investigate whether features of muscular complaints (MC) differ between receivers of a statin prescription and non-receivers. To analyze the relationship between analgesics prescription, statin prescription and/or musculoskeletal disorders. METHODS: Cross-sectional study. Consecutive patients in offices of family practitioners were interviewed using a standardized questionnaire. Target variables: Rates of features of MC in patients with or without a statin prescription and rates of analgesic drug prescription in patients with or without statin prescription and/or musculoskeletal disorders. Odds ratios (adjusted for age, sex, and socio-economic status) were calculated using logistic regression analysis. RESULTS: 1135 patients in 26 general practitioners' offices were asked to participate, and 1031 patients agreed. Features of MC did not differ between the two groups of patients. Analgesic prescription was found to be associated with statin prescription in patients without musculoskeletal disorders (OR 2.2, CI 1.1-4.7 without statin, OR 2.5, CI 0.9-6.9 with statin) and particularly in those with musculoskeletal disorders (OR 5.2, CI 2.9-9.3 without statin, OR 9.3, CI 4.5-19.1 with statin). CONCLUSIONS: Analgesic prescriptions are probably positively associated with statin prescription. Assuming that analgesics attenuate MC, an even stronger association between MC and statin use seems likely. The results generate the hypothesis that statin use contributes to analgesic use in primary care patients.

[Nephropathia epidemica caused by Puumala hantavirus infection: a case report from the outpatient sector]. / Nephropathia epidemica durch Hantavirus-Infektion vom Puumala-Typ: Ein Fallbericht aus dem ambulanten Sektor.

HISTORY AND ADMISSION FINDINGS: A 42-year-old man without pre-existing health problems presented to his family practitioner in Baden-Württemberg with fever (up to 39˚ C for two days), headache, abdominal pain, back pain and aching limbs. Ten days before, he had done heavy gardening work. He felt diffuse pain on abdominal palpation. The physical examination of the skin, lymph nodes, the heart, the lungs and the oral mucosa was unremarkable. INVESTIGATIONS AND DIAGNOSIS: Erythrocytes, leukocytes and sporadic bacteria were found in the urine. Urine test strip analysis gave a threefold positive result for protein. The blood test revealed in an elevated C-reactive protein, leukocytosis, elevated creatinine and thrombocytopenia. Enlarged kidneys and an enlarged spleen were found on ultra sound examination. IgG and IgM tested for Hantavirus infection were detected by IFA (Immunofluorescence antibody assay) and by ELISA (enzyme-linked immunosorbent assay). TREATMENT AND COURSE: The blood tests had returned to normal by 15 days after onset of the fever which had persisted for 7 days. Oliguria and/or anuria did not occur. After three weeks of illness, the blood pressure was found to be at hypertensive levels and the patient was treated with antihypertensive drugs. CONCLUSION: A history of gardening work (exposure to rodents) and nonspecific symptoms (like headache and fever), in combination with elevated serum creatinine and thrombocytopenia, should raise the suspicion of nephropathia epidemica (hemorrhagic fever with renal syndrome) caused by hantavirus infection. As sequelae of hantavirus infection may persist, patients should subsequently be followed for clinical and laboratory evidence of renal disease. Hospitalization is not generally warranted.

[GP (general practitioners)-centered care - international data and recent development in Germany with focus on Baden-Württember]. / Hausarztzentrierte Versorgung - internationale Daten und aktuelle Entwicklungen in Deutschland mit Fokus auf Baden-Württemberg.

BACKGROUND: Since the health-care reform in 1993, there are ambitious efforts of introducing gatekeeping in Germanys' primary health-care system. Gatekeeping is said to reduce costs and improve health-care quality. The aim of this article is to summarise the actual literature and the newest progression of gatekeeping for the example of Baden-Württemberg. METHODS: By means of a selective literature search, national and international data on gatekeeping are summarised. RESULTS: Most available data on gatekeeping are from US-American studies whereas data from Germany are rare so far. The effects of gatekeeping are defined by means of various outcome measures (e.g., physician-patient relationship, health-care quality, visits, referrals, costs, prescribing behaviour). The observed effects in terms of these outcome measures are not uniform and are contradictory to a great extent. Newest data from GP (general practitioners)-centred care model regions in Germany indicate a high satisfaction among these patients. Furthermore, an increase of consultations at specialists with referrals from the gatekeepers could be observed whilst the overall number of referrals to specialists remained equal so far. Baden-Württemberg's first generation contracts for GP-centred care were based on different legal paragraphs resulting in partially considerable differences in terms of the conditions for physicians and patients. DISCUSSION: On the basis of the available data, the effects of gatekeeping cannot conclusively be determined. In Germany, scientific evaluation of the different gatekeeping models and publication of their results are absolutely necessary to assess the expected cost saving and quality improving effects of gatekeeping.

[Prediction of premature pension after stationary rehabilitation due to adipositas--a prognostic model based on routinely collected data of the State Insurance Institution of Baden-Württemberg]. / Vorhersage vorzeitiger Berentung nach stationärer Rehabilitation wegen Adipositas -- ein Prognosemodell basierend auf Routinedaten der Landesversicherungsanstalt Baden-Württemberg.

Up to 60 % of the German population can be marked as obese. Due is to its frequency and its associated diseases like cardiovascular disorders and disorders of the musculoskeletal system adipositas is a severe burden on the German health care system. This burden is caused by costs of the disease and costs due to premature pensioning. In this study logistic regression modelling has been performed by means of routinely collected data of patients of the regional statutory pension insurance institute Landesversicherungsanstalt Baden-Württemberg (LVA-BW) rehabilitated due to adipositas (n = 599). The aim was to detect influential variables for the prognosis of premature pensioning (n = 135). The data of the patients were obtained from a research database of the "RehaNet" project which includes data of the standardized discharge report of the Federation of German Pension Insurance Institutes and quality assurance questionnaires of the LVA-BW. Three variables remain in the model after a step-down procedure for modelling by logistic regression. The selected variables are age (in years), the physician's statement about the patients limitations of movement after rehabilitation (yes/no) and about the patients ability to work in future (more/less than half-day). After internal validation of the model by bootstrap methods the model achieves a sensitivity of 73 %, a specificity of 87 %, a positive and a negative predictive value of 57 and 93 % respectively. The area under the curve (AUC) of the ROC analysis is 0.87, so the model achieves a good prognostic value. Thus, this model is a valuable test for the exclusion of possible premature pension while or after rehabilitation due to adipositas. It was found that the situation of "no premature pensioning" of patients rehabilitated due to adipositas can be predicted quite accurately with little information (three variables). This reveals a perspective for further research in the possibility of an early, risk-adapted and individualised intervention after stationary rehabilitation for adipositas to keep employment.

Statistical probability mapping reveals high-frequency magnetoencephalographic activity in supplementary motor area during self-paced finger movements.

Investigations of both haemodynamic and electroencephalographic measures of brain activity have demonstrated supplementary motor area (SMA) involvement in self-paced finger movements. In contrast, analysis of magnetoencephalographic (MEG) signals in the time domain has usually failed to detect SMA activity in healthy individuals. We investigated oscillatory MEG activity in 12 normal adults during (a) a self-paced, complex sequence of finger movements and (b) a simple finger opposition task paced externally by tactile stimuli presented to the contralateral thumb. Statistical probability mapping revealed enhanced non-phase-locked spectral amplitudes in the 22-28 Hz range over bilateral frontal cortex during self-paced as compared to externally cued finger movements. This activity may reflect recruitment of cell assemblies in SMA during self-paced, complex movements.