[Influence of the injection technique on the false negative rate of SLNE in multifocal breast cancer]. / Einfluss der Injektionstechnik auf die Falsch-negativ-Rate bei der SLNE des mehrherdigen Mammakarzinoms.

AIM: We investigated the influence of the injection technique on the false negative rate in identifying the sentinel lymph node in multifocal breast cancer. PATIENTS, METHODS: 958 consecutive patients were divided into unifocal and multifocal breast cancer patients. The scintigrafic and intraoperative detection rate as well as the false negatives were calculated in relation to peritumoral or subareolar injection. RESULTS: In all patients the scintigrafic and intraoperative detection rate exceeded 99%, except in patients with multifocal cancer, who were injected peritumorally. In this group the intraoperative detection rate declined to 96%. In patients with unifocal breast cancer the false negative rate was below 5%, independent of the injection technique. Multifocal breast cancer patients showed a significant dependence on the injection technique. The false negative rate was 26.3% in patients with peritumoral injection and 5.6% in those with subareolar injection. CONCLUSION: The results clearly demonstrate that in multifocal breast cancer a reliable detection of a SLN is impossible with the peritumoral injection technique. Subareolar injection seems to be a way to operate on multifocal breast cancer with SLNE, but the number of investigated patients is too low for statistic approval. So, prospective studies should be performed to validate these preliminary results before SLNE becomes routine in multifocal breast cancer.

[Determinants of patient satisfaction in a university clinic of dermatology as a parameter for patient orientation in quality management]. / Determinanten der Patientenzufriedenheit in einer dermatologischen Universitätsklinik als Parameter zur Patientenorientierung im Rahmen des Qualitätsmanagements.

BACKGROUND: Acquisition of patient's quality perception is an essential element for quality management in a clinic. Determinants important for patient satisfaction at a dermatological university clinic were investigated. PATIENTS AND METHODS: 650 in-patients of a dermatological university clinic were approached in written form at discharge. The questionnaire contained questions to importance and satisfaction, to structures and processes of the clinic orientated at the requirements of KTQ (Cooperation for transparency and quality in the hospital). RESULTS: The response rate was 51 %. 98 % of the patients stated that they would like to be treated in the clinic again. High satisfaction was shown to important items for patients as medical and nursing care and the healing process. In general patient's needs differ little to those derived from other patient questionnaires but they show specialty specific features. Important suggestions can be derived from the attached free text answer. CONCLUSIONS: From the results a lot of steps to improve patient's care could be derived and implemented. Since the results of patient questionnaires are subjected to multiple partially subjective factors, the comparison with other hospitals/disciplines (benchmarking) or the exact scientific acquisition is only restrictedly possible. Repetitive investigations in combination with further steps are a valuable instrument on the way to a continuous improvement process.

[Networking as an opportunity to profile a clinic? Strategy options after the evaluation of resource allocation]. / Vernetzung als Chance zur Profilierung einer Klinik? Strategieoptionen nach Evaluation der Zuweiser.

BACKGROUND AND OBJECTIVES: Diagnosis-related groups of medical services has recently been introduced for reimbursing hospital services. The aim has been to optimize bed capacity, decrease the duration of inpatient stay and provide good follow-up medical care. This confronts hospitals with the need for closely cooperating with the referring general practitioners or specialists. METHOD: A specially structured questionnaire was sent to all those general practitioners and specialists (n=890) who had referred patients to a university department of dermatology. The response rate was 23%. The completed questionnaires were analysed with respect to criteria judged to be important in determining referral for inpatient care and the quality of medical and related service provisions. RESULTS: Especially important to the referring doctors were optimal competence of patient care, the degree of cooperation and prompt, detailed information after the patients have been discharged. CONCLUSION: This type of analysis can serve to optimize the course of diagnosis/treatment and to utilize fully the available hospital resources. Also considered are various ways in which a hospital department can, by networking with general practitioners and specialists, become a centre for providing optimal services.

[Evaluating the pregnant cervix uteri by ultrasound with computer-assisted texture analysis]. / Zur Beurteilung der graviden Cervix uteri im Sonogramm mittels computergestützter Texturanalyse.

BACKGROUND: Cervical ripening during pregnancy is associated with ultrastructural alterations, presumably correlated with structural changes of the ultrasonographic image. Analysing these changes might allow conclusions on cervical consistence without necessarily performing manual examination. PATIENTS AND METHODS: Ultrasound findings of 112 patients with normal pregnancy (14th to 41st week of pregnancy) have been compared to those of 57 patients admitted because of cervical insufficiency (20th to 35th week). A representative region of interest was analysed using a computer based texture analysing system ("Ultra" written in "Interactive Data Language"). 125 parameters derive from various texture algorithms: 1st order gray scale statistics, row, slit and area statistics, gradient statistics, cooccurrence statistics. By means of factor and multiple regression analysis those parameters could be determined, which contribute significantly to the clinical assessment of cervical consistence. Weighting these parameters a so called texture score (TS) and--implementing the other parameters of the Bishop-Score (BS)--a texture based cervical score (TBCS) could be established. RESULTS: Manual assessment of cervical consistence could be reproduced excellently by noninvasive texture analysis. TBCS was highly correlated to BS, correlation to remaining duration of pregnancy (RDOP) was highly significant for TBCS but insignificant for BS. CONCLUSIONS: Manual assessment of cervical consistence may be replaced by noninvasive texture analysis. Using RDOP as target parameter TS and TBCS turn out to be superior to manual assessment and BS respectively. DISCUSSION: Computer aided texture analysis of cervical ultrasound imaging provides a useful information, which can be obtained easily and might help to reduce palpatory controls and increase the accuracy of prediction of pregnancy prolongation.