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Biomedical subjects

R N Braun

Publications and source records attributed to R N Braun.

At least 19 recordsLinked to original sources
PubMed1992

[Unconscious self control of diagnostic performance].

Assessment of quality of general practitioners' performances and assessment of maintaining quality requires appropriate parameters. Such are the specific protocols developed by general practice basic research. They are guiding the doctor in more than 80 difficult first consultations. When assessing the quality of a colleagues performance, we cannot give him a good mark, if he does not utilize these new tools. His eventual contendedness with a mere consulting by experience and intuition does not count. If a general practitioner on the other hand conscientiously and broadly makes use of the protocols, we can attest him: As far as possible he is offering medical care with a minimal risk of overlook rare, hidden avoidably dangerous outcomes. That is a symptom of good general practice.

Clinical Competence↗
PubMed1989

[From the reason for consultation to the result of consultation in (pediatric) surgery].

For the first time in the literature we have tried to open up the region of applied surgery to research. We noticed that there are many unsolved problems awaiting clarification. The aim of our study was to find out how often we could come to an exact diagnosis by our consultation. With the help of imaging diagnostic facilities, the chemical pathology laboratory, and histological examination in connection with operation we were usually able to come to an exact diagnosis. However, patients with unclear abdominal pain where it is essential--amongst other diagnoses--to exclude acute appendicitis (as the most common condition with a potentially dangerous, but avoidable outcome) still present a lot of diagnostic problems. There are for example, no appropriate concepts as basis for the nomenclature of such unresolved cases.

Austria↗
PubMed1989

[Classification of reasons for consultation and results of consultation in a selected sample from specialized pulmonary outpatient care].

According to Braun's theory of applied medicine terminology 4 results of medical consultation can be defined: A) classification of symptoms, B) classification of groups of symptoms, C) classification of the clinical picture, and D) exact diagnosis. In general practice only about 10% of the results of medical consultation are exact diagnoses. We wondered if the categories A-D also pertain to the patients of a specialized pulmonary diseases outpatient department. 20 consecutive new patients were studied who had been referred by other outpatient departments, consultant specialists, or general practitioners. The group consisted of 13 men and 7 women, mean age 40 years, range 18 to 65 years. In 9 patients consultation resulted in an increase in differentiation by one or two stages in comparison with the reason for referral. The result of consultation was not an exact diagnosis, in 10 cases, even in a specialized outpatient department. Thus, Braun's terminology of applied medicine with respect to the reason for, and the result of a medical consultation is generally valid, as shown by application to a specialist outpatient department.

Adolescent↗
PubMed1989

[Theoretical occupational studies in ambulatory care at a university eye clinic].

In the present publication we report our attempts to analyze the diagnostic actions of an ophthalmologist working in the out-patient department of a major eye clinic according to the theories that have been established in applied medicine in other fields. To the best of our knowledge such a study has never been undertaken before. Using our experience from work in the field of applied general medicine it was possible to analyze both the diagnostic approach taken and the average time spent per patient that enabled the doctor to start specific treatment of the presenting symptoms. We observed that the consultation time per patient was comparatively short and that a precise diagnosis, as previously defined by us, is only rarely established. In most of the cases treatment was initiated with a "presumptive diagnosis" and the patient was subsequently followed up as long as necessary. There is no doubt as to the importance of further studies in this field for future application in general ophthalmology.

Adult↗
PubMed1989

[Occupational theoretical considerations on the function of the physician in imaging procedures].

The work of a radiologist was analyzed from the viewpoint of the theory of applied medicine. It was possible to do so on the basis of the results of research work done in general practice. Our pilot study embraced 120 investigations in cases referred intramurally. In 62% of them we were asked to exclude named diseases. The other patients presented symptoms or signs. Which required elucidation and we were asked to find or exclude pathology. True diagnoses were made in 8 cases only. Clinical picture was the classification in 15, mere symptoms in another 32 cases. In the remaining 73 cases no pathology was found.

Diagnosis, Differential↗
PubMed1989

[Strategies in general practice].

The strategies necessary for general practice are developed unconsciously. It is possible to taperecord and optimize them. This way protocols for general practice were created. These specific tools can be used as parameters to evaluate intuitive consulting on the medical front-line. Investigating the basic problems showed that the concept diagnosis and the regularities of cases distribution keep a central position in that new region of medical research. In the future highest priority should be given to the task to develop a defined nomenclature applicable in the innumerable cases in which by generalists an exact diagnosis can not be made.

Curriculum↗
PubMed1989

[Demarcation of diseases].

Feinstein's opinion that diseases overlap does not stand up to professional criticism. Different diseases can certainly present very similarly, but they cannot overlap, in the same way as specialties cannot overlap. The specialties are separated from each other according to their different connections with the diseases. Diseases are separated from each other by their relations to the symptoms and clinical signs on the one hand and the results of medical consultation on the other hand. These considerations emphasize the fact that doctors should not make a diagnosis too hastily if a typical symptomatology is present. That, however, has nothing to do with overlapping of diseases, but with the temptation in the presence of a typical clinical picture to jump to a diagnosis without first having scrupulously clarified the possibility that the classical symptomatology was not, in fact, really due to the atypical manifestations of a totally different disease.

Appendicitis↗
PubMed1988

[What is the contribution of intuitive diagnosis in cardiac pain?].

This study reports on a new type of experiment developed by the author for general practice and tested over a period of 1 1/2 years. In the course of the test period all patients presenting with uncharacteristic precordial pain were once again solely counselled according to the dictate of experience. Previously the author had based his diagnosis on intuitive assessment over 25 years, followed by a further period of 10 years in which he had acted according to a programmed schedule as far as possible. The consulations were recorded on tape during the period and this recording was subsequently tested against the parameter supplied by the specific diagnostic programme. The outcome of the test was even less favourable than had been anticipated. The young doctor can work appreciably more efficiently without any further investment, than previously. It follows that it would appear essential to proceed in general practice according to the outlined programme given for 86 problematic situations.

Angina Pectoris↗