[KTQ--a project on hospital accreditation]. / KTQ--Projekt zur Zertifizierung von Akutkrankenhäusern.

"KTQ--Cooperation for transparence and quality in hospitals" is a joint project of the German Hospital Federation (DKG), of the Substitute Sickness Funds Associations (VdAK/AEV) and of the German Medical Association (BAK). Further partners are the German Nursing Care Council (DPR) and pro-Cum Cert--an organization of charity hospital owners. Since September 1998 the project is financially supported by the Federal Ministry of Health (BMG). The project is still on an experimental status. The participation will be voluntary for hospitals. The KTQ--Accreditation process consists of a self assessment followed by an external assessment--both on the basis of an identical criteria-catalogue. The accreditation process has to be repeated regularly. Accredited hospitals have to publish their results through a quality-report. Since May 2000 the project is tested by 25 hospitals. It is evaluated under the guidance of a scientific institute (IMI, Tübingen). The KTQ--project will be applicable in routine in 2001.

[Guidelines and evidence-based medicine in Germany]. / Leitlinien und Evidenz-basierte Medizin in Deutschland.

Clinical Practice Guidelines (CPGs) are increasingly common in the German health care system. The German physicians' self-governmental body's position regarding CPGs as a tool of Evidence-based medicine (EBM) was described in a joint policy paper concerning quality in health care in late 1998. The German Medical Association (GMA) and the National Association for Statutory Health Insurance Physicians (NASHIP) stated that "the principles of EBM should be implemented into the German Health Care System" by the following means: to assess systematically and appraise critically the evidence in health care to develop evidence-based consensus CPGs for priority problems in health care to implement CPGs using graduate, post-graduate, and continuing medical education, as well as audits and CPG-based information management to evaluate quality in health care against the background of CPGs. The following paper will discuss the aims and scopes and the limits of this concept.

[The guideline clearing programme of the self-governmental bodies in the German health care system--a project to promote quality assurance in medicine]. / Das Leitlinien-Clearingprogramm der Selbstverwaltungskörperschaften im Gesundheitswesen--Ein Projekt zur Qualitätsförderung in der Medizin.

Within the German health system guidelines are increasing considered as a meaningful and necessary aid to decision making. In this context the effectiveness of guidelines essentially depends on their methodical quality. Because of the fact that most of the German-language guidelines introduced within the past years show obvious methodological defects, the Agency for Quality in Medicine developed within the last two years the following programme for quality-assurance and promotion of guidelines: 1. Definition of quality policies for clinical practice guidelines in Germany 2. Establishment of quality demands for guidelines 3. Methods and instruments for quality promotion of guideline programmes 4. Measures to promote and check the quality of guidelines ("German Guidelines Clearinghouse") The following article reports on background, aims, instruments, method development and acceptance of the programme.

[Medical guidelines in Germany--current status and future developments]. / Arztliche Leitlinien in Deutschland--aktueller Stand und zukünftige Entwicklungen.

Medical guidelines are considered more and more as a meaningful and necessary tool ensuring a high quality of medical care. However, some doubts were recently mentioned concerning the quality of German guidelines. In 1997, the Society of Physicians of Germany and the Association of Panel Physicians have therefore initiated a program for the promotion of the quality of guidelines in Germany. Tools have been developed with the purpose to report and assess the quality of guidelines. Additionally, a "clearing-procedure for guidelines" and recommendations for the development of evidence-based guidelines were introduced. Background and content of these evaluation tools are reported in this article.

[Necroses in the granular cell layer of the cerebellum due to methylchloride intoxication in guinea pigs (author's transl)]. / Uber Körnerzellnekrosen bei der experimentellen Methylchloridvergiftung des Meerschweinchens

QUESTION: Neurotoxic action of methylchloride was reported by various authors. As this solvent is widely used in chemical industry the morphological changes in the CNS of guinea pigs due to methylchloride intoxication were comparatively studied by light- and electron-microscopy. MATERIAL AND METHODS: 19 guinea pigs of both sexes (body weight 300-600 g) were individually exposed to inhalation of methylchloride mixed to normal breathed air in a 2 Vol.-% amount in a pressurised vessel of 20,000 cm3 volume (details on the experimental arrangement see VOLK 1973) for each 10 min 6 times a week. 3 control animals were fed like the experimental animals and exposed to normal breathing air for the same time in the pressurised vessel. The experimental period varied between 7 and 70 days, the number of inhalations was between 6 and 61. At the end of the experiment the animals were sacrificed by perfusion with 3% buffered glutaraldehyde under Thiogenal anesthesia. For light microscopy paraffin sections were prepared from tissue samples of the cerebrum, cerebellum, brain stem, mesencephalon, spinal medulla and spinal ganglia (stainings: HE; Turnbull's blue; Nissl; Klüver-Barrera; Mallory; Bodian and Kossa). For electron microscopy tissue blocks of the cortex, corpus callosum, striatum, mesencephalon and cerebellum as well as of spinal medulla and spinal ganglia were postfixed in 1% OsO4 and embedded in Araldit in the common way. RESULTS: Clinical observations--9 animals showed normal behaviour after 32 inhalations in 37 days.--6 animals displayed staggering, atactic moving of the head, retardation in spontaneous reactions and mobility. Ataxia and paresis of the hind legs occurred earliest after 17 inhalations. 4 animals showed all these symptoms only after 25 days. Morphological findings: Macroscopy: Occurrence of necroses in the cerebellar cortex was mainly observed in the lower part of the vermis; pressings of tissue in the occipital foramen, tissue swellings around the aqueduct and consecutive enlargement of the lateral ventricles occurred. Light microscopy: Changes in the Stratum granulosum in the lower part of the vermis as pyknosis of the cell nuclei and hydropic swelling of the cytoplasm (fig. 1a) were seen after 10 days. Focal necroses of the granular layer as well as "Status spongiosus" and edema occurred after 21 days (fig. 1b). In later phases these alterations were also present in other regions of the vermis and of the cerebellum, too. Furthermore, edema of the Lamina dissecans, hydropic swelling of the Bergmann's glia and marked edematous transformation of the molecular layer were observed. In this phase the hitherto intact Purkinje cells responded to the intoxication by homogenization of the cytoplasm and cell necroses. Electron microscopy: Initially an increase in density of the nuclear chromatin of the granular cells was observed associated with formation of homogeneous electron dense chromatin fragments which were finally released to the perikaryon (figs. 2a, 2b)...