Zeitschrift fur arztliche Fortbildung最新文献

Regarding the liability of the expert witness, is has to be differentiated between the responsibility according to the civil law and the criminal law. Responsibility in the criminal law means the punishableness for the guilty and illegal fulfillment of a criminal offense in the legal sense, while responsibility in the civil law means compensation towards another citizen. Criminal prosecution occurs ex officio. Prerequisite for prosecution in the civil law is an action of the victim.

The expert testimony in the common law countries is fundamentally different from the one in the continental European countries. According to the anglo-american law, both parties present the evidence to the court. Witnesses are examined and cross-examined. Most important, the expert is not appointed by the court or a helper of the court, but the expert is an expert witness. He is presented by one of the parties, examined and cross examined. Because some of the expert witnesses may be biased, there can be a war of experts.

Diseases and their effects are characteristics of legal evidence in a number of claims regarding social welfare. The courts frequently use medical expert assessment to clarify the important facts of the case. The medical assessment has to be formulated thoroughly and clearly as well as understandable for the layman as it is of decisive importance for the lawsuit.

The European Society of Cardiology has dealt in detail with concepts of cardiological rehabilitation in 1992 and has published guidelines. According to the opinion of this society, the organization of cardiological rehabilitation can differ among the European countries considering the socio-economic structures, legal and insurance regulations as well as national traditions. Guidelines for the standards of cardiological rehabilitation have to be flexible and adaptable to the organization of each European country. According to the opinion of Müller-Fahrnow, the beginning of modern medical rehabilitation in the Federal Republic of Germany is clearly linked to the development of concepts for cardiological rehabilitation at the end of the sixties and beginning of the seventies with a holistic approach under consideration of a kinetotherapeutic and psychosocial focus. A countrywide introduction of the concept of the following curative treatment at the end of the seventies by the insurances contributed to a significant stabilization of the new qualities of rehabilitation and, again the cardiological rehabilitation played an important role (Müller-Fahrnow W., 1994). This paper demonstrates basic elements and structures of the cardiological rehabilitation in an orientating manner and contains conclusions about the future development.

Physician's patients are often faced with a conflict of interests between the benefit and other interests (society, institutions). This problem has emerged in medical history since the 18th century when the traditional loyalty towards the individual patient was challenged by a social orientations in the physician's ethos. Current bioethical theories regarding this professional conflict of interest are discussed and applied to allocation problems in HMO-health plans. It is argued that the conflict of interests can only be solved if doctors set their professional priority on the healing relationship towards the individual patient.

Rehabilitation of incontinent patients is an interdisciplinary challenge. Many therapeutical options in gynecological urology reveal an optimal rehabilitation of these patients. In the last years, a great scientific progress in the area of neurourology offers patients with severe dysfunction of the lower urinary tract (e.g. spinal cord injury) new concepts to improve their urological problems.

This article is intended to provide a comprehensive overview regarding motives, implications, aims, history, underlying principles, and methods as well as criticism and potential impact of "Evidence Based Medicine" (EBM). The term was defined and the movement initiated by British and Canadian clinicians-epidemiologists. So far, a translation and national adaptation remain to be established. It seems that EBM is suited to compensate for many irrationalities within our clinical practice and health care system. Not only should the underlying principles, aims, methods, and techniques of EBM be considered in clinical practice and primary care in Germany. They should also be emphasized during medical training and postgraduate education and in the needs-oriented distribution of scarcening resources.

Physical and rehabilitation medicine is an independent medical subspecialty and is not derived from "physics" but from "physis-nature". Beside the elements of specific movements, it does use physical components such as heat, cold, light, water, and electricity for therapeutic purposes. Physical medicine and rehabilitation has always been a discipline with own methods, issues, and own areas of research and theory. The treatment techniques of this specialty are summarized under the term "physiotherapy". Its methods, which also contain balneology and medical climatology, are using physical and physiological principles of order in the organism. The application of this therapy happens for the training of impaired functions, influence of pathogenetic processes causing pain, and for the activation of the body's regeneration capacities. Physiotherapy is not limited to certain diseases or stages of illness but may prevent, abolish, or weaken malregulation of functional units, especially when used in repetitions. A particular focus of the rehabilitation is to address the still remaining functional reserves of an injured organism in a way that a compensation can be reached as close a possible to the etiological point of the pathogenetic chain of causes. Declared goal of the physiotherapy is the induction and optimization of healing processes. Due to this interdisciplinary approach, physical and rehabilitation medicine is an essential part for almost every medical subspecialty. Because of the increasing importance of this discipline, the specialist for physicial and rehabilitation medicine was introduced in Germany in 1992.