PubMed · 11624433
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G Theves. 2000. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11624433/
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Since the mid-1990s, the lack of proper development in health services research in the healthcare system of the Federal Republic of Germany has been repeatedly criticised by healthcare policy-makers and experts alike, whilst also being the subject of a number of reform initiatives. Rehabilitation sciences, which were established in Germany as an autonomous scientific discipline in the early 1990s, could benefit in terms of conception, methodology and organisation from these activities and the new interest bestowed on healthcare sector research. At the same time, the converse also holds true since from the very beginning health services research has played a particular role in the development of rehabilitation sciences-unlike the role it has played in the overall healthcare system. The complex nature of the areas of research covered by rehabilitation, together with the theoretical plurality and methodological diversity associated with it, may be ascribed to the fact that (up to the present) this sector has lacked a broader framework connecting together health research concerns and issues. This article presents a comprehensive overview of current concerns and issues as evidenced in publications of the past 15 years that make an explicit contribution to health services research. It highlights the rehabilitation system research undertaken in the past decade as a central plank of health services research. Furthermore, it also investigates the backdrop to health services research in rehabilitation in terms of its development, its research concerns, its methodology, its organisation and its infrastructural embeddedness.
Patients with end-stage renal disease awaiting kidney transplantation require regular urological evaluation. The urologist's main task is early diagnosis and treatment of genitourinary malignancies and evaluation of the lower urinary tract. Furthermore, urologists are often confronted with the question of whether or not to perform pretransplant urological surgery, i.e., native nephrectomy for polycystic kidney disease. Urological care after kidney transplantation involves diagnosis and treatment of ureteral complications, malignancies, lower urinary tract symptoms, and last but not least erectile dysfunction, which has a prevalence of 20-50% among kidney transplant recipients. For the evaluation and follow-up of the living kidney donor, international guidelines have been developed in recent years to also help the urologist to perform a correct evaluation and follow-up of the kidney donor.
Late graft outcome depends on an intensive post-transplant care program. Direct post-transplant inpatient rehabilitation in a specialized hospital as well as outpatient services, along with an inpatient check-up every 2-3 years are important for maintaining an excellent long-term graft function. In our experience recognizing and treating risk factors after organ transplantation such as arterial hypertension, vasculopathy, hyperlipidemia, metabolic syndrome including PTDM, osteoporosis, recurrent diseases and also the recipient's education (compliance) are most important landmarks in a post-transplant care program. This inpatient as well as outpatient post-transplant care program with the aim of long-term graft function for organ recipients, performed in a network, represents a modern health service including effective and economical aspects, which health insurance in Germany is obliged to pay for.