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Biomedical subjects

H K Selbmann

Publications and source records attributed to H K Selbmann.

At least 19 recordsLinked to original sources
PubMed1992

[Quality assurance in ambulatory care. Viewpoint of the forensic expert for concentrated action in public health].

FUNDAMENTALS: Assuring the quality of medical care is a self-imposed obligation on the part of the profession and, at the same time, a legal obligation. MAIN TOPICS: On the way to implementing this requirement, the following points must be taken into account: the measurability of the quality of medical care, establishment of the quality of structure, treatment and results, aids for the determination and documentation, remuneration, and the motivation for implementing quality control. CONCLUSIONS: A further development of present day approaches to quality assurance resulting in returning to the physician more responsibility while putting on him the onus of proof, would be desirable.

Expert Testimony↗
PubMed1991

[Clinic interns, individual performance appraisal and obstetric quality assurance].

Obstetrical management and fetal outcome were individually analysed annually from 1987 to 1990, using computerised equipment. The individual results were discussed anonymously with all colleagues, but every colleague knew his own results. Clinical methods and obstetrical management had not been changed during the investigation period. The number of high-risk pregnancies increased significantly, whereby the incidence of risk-related surgical interventions decreased at the same rate. The number of FBA and EDA increased significantly (p less than 0.001). The mean umbilical artery pH increased during the last four years from 7.27 to 7.30 (p less than 0.05), i.e. that each colleague achieved an improvement. The incidence of acidotic values in the umbilical artery decreased significantly (pH less than 7.20 from 13.2% to 7.1%, pH less than 7.10 from 3.6% to 1.2% p less than 0.01). The rate of caesarean section increased (p less than 0.05) and the number of vaginal operative deliveries did not change significantly. As early as one year after the introduction of the individual efficiency control, a significant improvement in obstetrical results could be demonstrated.

Clinical Competence↗
PubMed1990

[Age structure and incidence of cancer. An epidemiologic observation in West Germany].

Cancer is the second most common cause of death in West Germany. With increasing age, however, its significance decreases--in men and women to differing extents. The incidence and mortality of cancer increase exponentially with age; every second woman with fatal cancer was older than 75, the median age in men being 71. Since 1970, the age-corrected cancer mortality rate in men has remained unchanged, while in women it has decreased by about 9%. On the basis of the changing age structure in the general population, by the year 2005, an increase in deaths from cancer of almost one-third is expected, with 27,000 more deaths among men than among women. In view of all the possible influencing factors, the present data do not suffice to permit a causal interpretation of the statistical relationship between age and malignant tumor development.

Adult↗
PubMed1990

Hospital information systems and quality assurance.

Hospital information systems may contribute in different ways to quality assurance activities such as assessing the quality of primary care, monitoring quality indicators, supporting clinical care evaluation studies, and auditing concurrently the ongoing process of care using reminders or decision support techniques. Examples of effective contributions are given. However, to meet all requests of quality assurance in real-world settings many efforts developing new technologies will still be necessary.

Decision Support Systems, Management↗
PubMed1990

[Clinical types of immunologic transplant reactions following perforating keratoplasty].

The incidence of allograft rejection was determined for 740 penetrating keratoplasties performed between 1980 and 1987. All 740 cases were followed up for at least 1 year. The reaction forms of allograft rejection were grouped according to biomicroscopic appearance. The incidence and progression of symptoms are described. Rejection types are subdivided into patients with favorable versus poor prognosis. Of the patients 37.9% demonstrated an immune response (including discrete forms). Clear reaction patterns within the two groups of patients became apparent when reaction variations were carefully differentiated. Epithelial immune reaction was found in 5.2%/10.5% and subepithelial infiltration in 1.7%/4.8% of the patients with favorable/poor prognosis. The largest disparity in frequency occurred in progressive endothelial reaction; 3.8% in patients with favorable versus 36.7% in patients with poor prognosis. Focal endothelial reactions occurred in both groups with comparable frequencies (14.1%/13.3%). The large percentage of immunological reactions, including late manifestations (approximately 12% after 1 year) and some with irreversible progression, warrants continuing efforts to treat and prevent this complication.

Cornea↗
PubMed1989

[Data from the Bavarian perinatal survey on the problem of the incidence of cesarean section].

Data are presented on caesarean section rates during the first five-year period of the Bavarian Perinatal Study (BPE 1982-1986), comprising 450,000 births. In order to identify long-term trends, statistical studies from the Munich Perinatal Study (MPS) dating back to 1975 were continued in the same Munich hospitals through to 1982-1984. The results may be broken down as follows: 1. The overall rate of caesarean sections has been increasing, steadily, reaching 15% in the 1986 BPE. No clear levelling-off is evident yet. 2. The highest rates of caesarean sections and vaginal operative deliveries were found in university hospitals. Spontaneous deliveries occurred least often in university hospitals (about 70%), and most frequently in the larger country and private hospitals (77-79%). Smaller externally staffed private hospitals had about the same rate of vaginal-operative deliveries as university hospitals. 3. Following caesarean section, postoperative complications prompted a three- to sixfold higher rate of maternal transfer to other hospitals over that following spontaneous delivery. 4. As maternal age increases, so does the rate of caesarean section for primiparae. Nevertheless, recent years have witnessed a levelling-off for women over 34 years of age. No trend toward further increase is evident for this age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis.

In a randomized clinical trial the prophylactic effects of locally administered antimicrobials on quantitative colonization and respiratory infections were studied in intubated patients with an expected period of mechanical ventilation of greater than 6 days. Nineteen patients received 50 mg of polymyxin B and 80 mg of gentamicin distributed among nose, oropharynx and stomach at 6-h intervals, as well as 300 mg of amphotericin B in the oropharynx. Twenty untreated patients served as controls. In the control group colonization by respiratory pathogens was more common (oropharynx 19 vs 6 patients (p less than 0.001); trachea 19 vs 11 (p less than 0.01)), and the number as well as the count of the colonizing species was usually higher. Fourteen patients of the control group developed respiratory infections, including nine cases of pneumonia, as compared to four patients with prophylaxis, including one case of pneumonia (p less than 0.01). Pneumonia-associated deaths were prevented with prophylaxis; however, the overall mortality remained unchanged. Respiratory infections in the prophylaxis group were associated with organisms resistant to the agents used, but the overall occurrence of resistance was not increased, as compared to the control group. We conclude that unrestrained upper airway colonization by respiratory pathogens and respiratory tract infection were causally related. Local antimicrobial prophylaxis proved to be a highly effective strategy for the prevention of potentially life-threatening pneumonias in critically ill patients, but in the present study the host setting appeared to be the major determinant of outcome.

Administration, Intranasal↗
PubMed1978

Nephroblastoma and neuroblastoma--histology and prognosis.

Statistically evaluating the influence of a histological grading, respectively of morphological differences on prognosis of nephroblastomas and neuroblastomas, better chances for survival become evident not only for earlier clinical stages, but also for nephroblastomas with high differentiation, or neuroblastomas with signs for differentiation. Only for neuroblastomas a relevant predeliction of tumors with signs of differentiation for the early clinical stage I is present. Combined subclassification according to clinical stages and histological grades results in 3 risk groups with different chances for survival. These 3 groups may play a role for specific therapeutic considerations.

Child, Preschool↗
PubMed1978

[Reflections on quality control in perinatalogy exemplified by the Munich Perinatal Study (author's transl)].

Quality control has four component parts: standardized observation, a procedure to measure the quality of individual production, a technique for aggregating and comparing measurements, and a means by which the behaviour of the subjects can be influenced by these comparisons. The greatest problems, which often remain unsolved, can be traced to the definition and measurement of the quality of medical care. Some problems and the feasibility of quality control are demonstrated using perinatalogy and the Munich Perinatal Study as models. This trial of self control shows that voluntary participation of the hospitals, assured anonymity, self-responsibility, and a statistical evaluation that can be used for educational purposes play an important part.

Female↗