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Auswirkungen des DRG-Systems auf Anschluss- und Rehabilitationsbehandlung in Sydney, New South Wales, Australien 驻德国人在悉尼,新南威尔士
Pub Date : 2002-02-01 DOI: 10.1055/s-2002-19957
F. Köhler
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引用次数: 6
Lässt sich die Zugehörigkeit zur neurologischen Rehabilitation in den Phasen B, C und D durch FIM™-Werte bestimmen? 拔都、神经康复阶段B、C和D通过FIM™-Werte决定?
Pub Date : 2002-02-01 DOI: 10.1055/s-2002-19949
M. Nosper
The classification of patients for phase B, C and D of neurological rehabilitation follows the suggestions of the Bundesarbeitsgemeinschaft fur Rehabilitation (BAR) based on defined clinical criteria and on neurological rehabilitation assessment. The focus of this study is to define the intervals of the complete FIM(tm)-index, intervals covered empirically as well as by evaluations of physicians, that permit utmost accuracy in assigning patients to phase B, C and D of neurological rehabilitation. Therefore, data records of 3686 patients from 4 neurological rehabilitation centres were evaluated. The patients' functional autonomy was classified by FIM(tm) on admission, in intervals of 14 days and at discharge, at the same time all patients in addition were assigned to phases B, C or D by the rehabilitation centre physicians. Statistical analysis of a total of 11,247 links of the phase classifications and FIM-indexes at 6 measurement points showed that correct correlation to phase B, C and D could be obtained on average in 79 to 89 % of the cases, based on the assumption that 18 - 36 points of the FIM-index assign to phase B, 37 - 90 points to phase C and 91 - 126 points to phase D. Discrimination between phases B and C could be obtained accurately in an average of 84 %, discrimination between phases C and D in an average of 89 %. Conformance of the FIM-intervals with TAR-based groups of care efforts compared to the evaluation by physicians indicate that the FIM(tm) represents the need for care with greater validity. If assignment to phases B, C and D would have been done on the basis of the FIM-index instead of evaluation by a physician, 8,9 % fewer patients would on admission have been classified for phase C but, instead, 4,5 % more patients for phase B and 4,4 % for phase D. In case of using the FIM-intervals for classification, 12,1 % more phase B patients could have changed to phases C or D. Of the phase C cases, 17,7 % could have been transferred to phase D before discharge. The number of phase D patients would have remained unchanged comparing admission and discharge. FIM-orientated classification for the phases of neurological rehabilitation offers considerable advantages: operationalized criteria, possibility of statistical evaluation, objectiveness, reliability, validity, reproducibility of the decisions, sensitivity to change, prognostic sensitivity, and suitability as an instrument for internal and external quality assurance.
神经康复B、C、D期患者的分类遵循德国康复协会(BAR)的建议,以明确的临床标准和神经康复评估为基础。本研究的重点是定义完整的FIM(tm)-指数的间隔,这些间隔涵盖了经验和医生的评估,以便最大限度地准确地将患者分配到神经康复的B、C和D阶段。因此,我们评估了来自4个神经康复中心的3686例患者的数据记录。采用FIM(tm)对患者在入院时、14天间隔和出院时的功能自主进行分类,同时由康复中心医师将所有患者分为B、C或D阶段。统计分析的11247链接阶段分类和FIM-indexes测量6点显示正确关联阶段B, C和D可以获得79年的平均89%的情况下,基于这样的假设——18 - 36分的FIM-index分配阶段B, 37 - 90分阶段C和D . 91 - 126分阶段阶段B和C之间的歧视可以准确地获得平均为84%,C阶段和D阶段的歧视平均为89%。与医生评估相比,FIM-间隔与基于tar的护理努力组的一致性表明,FIM(tm)代表了更高效度的护理需求。如果作业阶段B, C和D将已经完成的基础上FIM-index代替医生的评估,8日减少9%患者入院时已经分类阶段C,但相反,4,5%以上患者B阶段和4,4% D阶段使用FIM-intervals分类,12日1%的B阶段患者可以改变阶段C或D C阶段的情况下,17岁,7%放电之前可能已经转移到D阶段。D期患者的数量在入院和出院时保持不变。面向fim的神经康复阶段分类具有相当大的优势:可操作的标准,统计评估的可能性,客观性,可靠性,有效性,决策的可重复性,对变化的敏感性,预后敏感性以及作为内部和外部质量保证工具的适用性。
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引用次数: 2
Schnittstellenproblematik - Reha-Ökonomie
Pub Date : 2002-02-01 DOI: 10.1055/S-2002-19953
B. Birkner
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引用次数: 1
Onkologische Rehabilitation:Evaluation der Effektivität stationärer onkologischer Rehabilitationsmaßnahmen 肿瘤康复:评估静止肿瘤康复措施的效果
Pub Date : 2002-02-01 DOI: 10.1055/s-2002-19952
J. Teichmann
Hintergrund: Methodik: I Re S Ergebnisse: Schlussfolgerungen: Background: Methods: I Re S Results: Conclusions:
研究:方法:I Re S Ergebnisse: Schlussfolgerungen;背景:方法:I Re S结果:结论:
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引用次数: 27
Phasenspezifische Hilfsmittelverordnungen in der neurologischen Rehabilitation 药物从神经性康复中控制
Pub Date : 2001-12-01 DOI: 10.1055/s-2001-18970
A. Bestmann, M. Lingnau, M. Staats, S. Hesse
Zielsetzung: Methode Ergebnisse Schlussfolgerung Objective: Design: Results: Conclusion:
目测结果
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引用次数: 6
Qualitätsmanagement in Rehabilitationseinrichtungen in der Bundesrepublik Deutschland - Eine stratifizierte repräsentative Studie zum Stand der Umsetzung 德国康复中心管理——一项针对实施情况的具有针对性的具有代表性的研究
Pub Date : 2001-12-01 DOI: 10.1055/s-2001-18971
H. Eckert
Hintergrund: Fragestellung: Methodik: Ergebnisse: Diskussion: Schlussfolgerungen: Background: Objective: Methods: Results: Discussion: Conclusions:
背景:方法:结果:推理:推理:逻辑:结果:推理:
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引用次数: 6
Chronische Pankreatitis: Gewichtsverlust und Leistungsschwäche - Erfahrungen aus einer spezialisierten Rehabilitationsklinik 后遗症:体重恶化加上成绩不足?从专业康复诊所得到的经验
Pub Date : 2001-12-01 DOI: 10.1055/s-2001-18966
U. Armbrecht
: There are various potential explanations for weight-loss and poor physical performance in patients with chronic pancreatitis: In severe chronic pancreatitis the decline in enzyme secretion is an important cause for the malassimilation syndrome frequently seen in these patients. Occasionally, difficulties may arise in establishing this decline and in quantifying the secretory capacity of the gland. Many patients limit their food intake because of the pain caused by eating. In untreated patients with diabetes, glucosuria may contribute to their malnutrition. Insufficient funds for food due to alcoholism and anorexia may also be of some significance. Concomitant gastrointestinal diseases and malabsorption following gastrointestinal surgery are frequently found in patients with chronic pancreatitis. Neurological complications and traumatic lesions after accidents - often in connection to the underlying alcoholism - are joined by physical inactivity and thus contribute to the development of muscular atrophy and decreased physical performance. Consequently, rehabilitation of patients with chronic pancreatitis is challenging: They not only need expert medical treatment of both the symptoms of chronic pancreatitis and the concomitant disorders. Therapy must also include dietary support, careful physical training, and - in cases caused by alcoholism - psycho-social support. So far, the multi-professional competence required for these purposes can only be expected in a specialized rehabilitation centre.
慢性胰腺炎患者体重减轻和体能差的可能原因有多种:在重症慢性胰腺炎中,酶分泌减少是导致这些患者常见的同化不良综合征的重要原因。有时,在确定这种下降和量化腺体的分泌能力时可能会出现困难。许多病人因为吃东西引起疼痛而限制食物的摄入量。在未经治疗的糖尿病患者中,血糖升高可能导致营养不良。由于酗酒和厌食症导致的食物资金不足也可能有一定的意义。慢性胰腺炎患者常在胃肠手术后并发胃肠道疾病和吸收不良。事故后的神经并发症和创伤性损伤——通常与潜在的酒精中毒有关——加上缺乏身体活动,从而导致肌肉萎缩和身体机能下降。因此,慢性胰腺炎患者的康复是具有挑战性的:他们不仅需要对慢性胰腺炎的症状和伴随疾病进行专业的医学治疗。治疗还必须包括饮食支持、仔细的体育训练,以及——在酗酒引起的情况下——心理社会支持。到目前为止,这些目的所需的多专业能力只能在专门的康复中心才能得到。
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引用次数: 13
Aktiver Morbus Bechterew: Symptomatik, Einschränkung der Lebensqualität, Therapiebeurteilung und Therapieerwartung aus Sicht des Patienten 主动默症检查:症状、生活质量不足、从病人的角度进行判断和期待
Pub Date : 2001-10-01 DOI: 10.1055/s-2001-17413
A. Falkenbach, B. Curda
Es besteht Unsicherheit, wie im Falle des Morbus Bechterew die Aktivitat der Erkrankung zu definieren und zu messen ist. Therapeutische und rehabilitative Interventionen sollten sich jedoch immer nach der aktuellen Krankheitssituation richten. Ein anerkanntes Assessmentverfahren zur Erfassung der Krankheitsaktivitat erscheint also sehr wunschenswert. In der vorliegenden Studie soll allein die primare Beurteilung der aktiven Krankheitsphase durch den Patienten selbst erfasst werden. Was bedeutet fur den Patienten ein aktiver Morbus Bechterew? In einem standardisierten Interview wurden 100 Patienten mit Morbus Bechterew befragt, was aus ihrer eigenen Erfahrung ein aktiver Morbus Bechterew ist, was sie dann „am meisten stort”, welche Therapiemasnahmen dann sinnvoll sind und was sie von einer optimalen Behandlung in der aktiven Krankheitsphase erwarten. Fur die Patienten bedeutet ein aktiver Morbus Bechterew insbesondere Schmerzen (99 Nennungen), Bewegungseinschrankung (19), Muskelverspannung (10), nicht liegen konnen (6), Einengung im Brustbereich (5) und Atemnot (5). Die Mudigkeit wurde von 2 Patienten genannt. Den Patienten selbst „storen” in der aktiven Krankheitsphase dann in erster Linie die Schmerzen (77), die Bewegungseinschrankung (55), die sozialen (20) und beruflichen Folgen (18) sowie die Schlafstorungen (17) und die erschwerte Atmung (16). Medikamente (84) und Bewegung (42) wurden als sinnvolle Masnahmen wahrend eines aktiven Morbus Bechterew erachtet. Die grose Bedeutung von Schmerzen und Bewegungseinschrankung fur die Patienten ist nicht uberraschend. Auffallig ist die relativ haufige Nennung von Atembeschwerden, wahrend die Mudigkeit bei spontaner Beurteilung aus der Sicht des Patienten offensichtlich nur eine geringe Rolle spielt. Die Rheumatologie schenkte in den vergangenen Jahren somit moglicherweise den Atembeschwerden zu wenig und der Mudigkeit zu viel Aufmerksamkeit. In ankylosing spondylitis uncertainty prevails among rheumatologists on how to define and measure activity. In the present study the patient's view of activity was evaluated. What does active ankylosing spondylitis mean for the patient? In a standardized interview the patient was asked to describe, from his own experience, what active ankylosing spondylitis means, what bothers him most, what helps most, and what he expects from therapy. For the patient, active ankylosing spondylitis means pain (99 responses), mobility restriction (19), muscle tension (10), inability to stay supine (6), restriction in chest mobility (5) and dyspnea (5). Fatigue was mentioned by two patients. In active states patients are mainly bothered by pain (77), mobility restriction (55), consequences for social life (20) and work (18), disturbed sleep (17) and difficult breathing (16). Drugs (84) and physical activity (42) were judged the best treatments during active ankylosing spondylitis. It was no surprise that pain and mobility restriction were cited most often by the patients. Breathing
但如何定义并测量毛病的动向,在吗啡强力法中都存在相当大的不确定性。然而,治疗和改造的干预应确保以现有疾病状况为原则。因此,人们希望的方法是名声审核型侦测核武的方法。本项研究的目的是评估病人自己的小学活期评估。但这对病人意味着什么在一个标准化的访谈中,100个病人都使用吗啡进行观察。他们从自己的经验中学习积极吗啡是什么,哪些是他们“停留最多”的,哪些是有效的治疗手段,以及他们期望在症状期取得最佳治疗成效的方法。对患者来说,活地颤抖特别意味着疼痛(对于他们来说叫上动作麻痹)、肌肉紧绷(19)、肌肉紧绷(10)、胸腔紧绷(6)和呼吸困难(5)。两名病人称这种活症(5)。在发病期,病人主要是饱受痛苦(77)、行动不便(55)、社会影响(20)、工作影响(18)、失眠(17)、紧张的呼吸(16)。在实验死亡的情况下,药物(84)和活动(42)都被认为是明智的处理方式。疼痛对于病人来说最大的意义和运动敏感度并没有让他们感到惊讶。最突出的现象是呼吸困难方面比较常见,患者认为主动评估的勇气通常不大。令人意外的是,近几年,风湿病很少引起呼吸困难,人们的胆量也很少引起。蓄意潜逃的海绵宝宝在急救让病人产生实验结果患者怎么了?在一篇关于病人的标准采访中讨论了来自﹙阿方舟制片室﹚对病人来说,积极对照患者州病人因不能照料(77岁)、家具限制(55岁)、社会生活约束(20岁)和工作约束(18岁)、disturd卧床(17岁)和弥留(16年)。毒品组(84年)和物理行动组(42年)是裁判我不知道该恨我我要限制病人一切《诽谤》最受欢迎的是《迷信》结果表明现代风湿病原因可能混淆了视线和混淆了事实
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引用次数: 9
Multiperspektivische Einschätzungen zur Wahrscheinlichkeit der Wiedereingliederung von Patienten ins Erwerbsleben nach orthopädischer Rehabilitation - Ergebnisse und prognostische Relevanz 关于病人在矫形康复后重返工作队伍的可能性的多种观点评估——结果和预测相关性
Pub Date : 2001-08-01 DOI: 10.1055/s-2001-15992
W. Bürger, S. Dietsche, M. Morfeld, U. Koch
: This article analyses various methods of predicting whether patients in orthopaedic rehabilitation will return to work. In this regard, items of patients, physicians in charge of rehabilitation and general practitioners have been collected and compared to working time lost due to illness. In total, 72 % of patients had successfully returned to work after one year. The patients whose reintegration could not be achieved could be identified best by asking if they believed that they would be in a position to work until the statutory retirement age (96 % identified) on the one hand and on the other hand by the physicians' estimate as to the degree the last gainful activity might be resumed (90 % identified). In this context, the criteria have to be laid down very restrictively in order to sufficiently filter out patients not likely to return to work. The patients likely to return to work are identified best by means of the following characteristics: lack of intention to retire early (96 % identified), planning to return to work directly after rehabilitation (88 % identified), and little working time lost due to illness prior to rehab (86 % identified). In general, a major percentage of patients not likely to return to work can be identified by these statements of patients and physicians. The statements of general practitioners are clearly less valuable for prediction and show only weak correlation with the respective statements of the physicians in charge of rehabilitation.
本文分析了预测骨科康复患者能否重返工作岗位的各种方法。在这方面,收集了病人、负责康复的医生和全科医生的项目,并与因病损失的工作时间进行了比较。总共有72%的患者在一年后成功重返工作岗位。对于无法重新融入社会的患者,可以通过询问他们是否认为自己能够工作到法定退休年龄(96%确定),以及另一方面根据医生对最后一次有酬活动可能恢复的程度的估计(90%确定)来确定。在这种情况下,必须制定非常严格的标准,以便充分过滤掉不太可能重返工作岗位的患者。有可能重返工作岗位的患者可以通过以下特征来确定:缺乏提前退休的意图(96%确定),计划在康复后直接重返工作岗位(88%确定),以及康复前因疾病损失的工作时间很少(86%确定)。一般来说,很大比例的患者不太可能重返工作岗位,可以通过患者和医生的这些陈述来确定。全科医生的陈述显然对预测的价值较低,并且与负责康复的医生的各自陈述只有微弱的相关性。
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引用次数: 47
Prädiktoren der beruflichen Wiedereingliederung nach stationärer kardiologischer Rehabilitation im Rahmen der Arbeiterrentenversicherung (德国一家出版社
Pub Date : 2001-08-01 DOI: 10.1055/s-2001-15988
H. Budde, M. Keck
: Vocational reintegration is one of the major goals of cardiac rehabilitation. 70 % of blue-collar workers under 50 years of age resume their job after in-patient cardiac rehabilitation. 10 % are hindered to do so by cardiac problems. Specific measures exist that may facilitate work resumption. As these measures should be started as soon as possible there is a need for predictors of return to work which can be obtained easily and at an early stage. Subjects of this prospective study were 650 patients (10 % female) under 50 years of age who participated in an in-patient cardiac rehabilitation programme under the workers' pension insurance scheme. At the beginning of programme participation, problems in work resumption as expected by the patient and by his physician were obtained, as well as depression and anxiety scores (HADS-D). Physicians' and patients' expectations concerning problems in resuming work turn out to be significant predictors of the vocational situation of the male patients six months following medical rehabilitation. The depression score obtained at the outset of the programme is the only predictor of return to work in female patients.
职业重返社会是心脏康复的主要目标之一。70%的50岁以下蓝领工人在住院心脏康复后恢复工作。10%的人因心脏问题而无法做到这一点。有具体措施促进复工。由于这些措施应尽快开始,因此需要能够在早期阶段轻易获得的返回工作的预测指标。这项前瞻性研究的对象是650名50岁以下的患者(10%为女性),他们参加了工人养老保险计划下的住院心脏康复计划。在参与方案开始时,获得了患者及其医生预期的恢复工作的问题,以及抑郁和焦虑评分(HADS-D)。医生和患者对复工问题的期望是男性患者医学康复后6个月职业状况的重要预测因子。在项目开始时获得的抑郁评分是女性患者重返工作岗位的唯一预测指标。
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引用次数: 17
期刊
Rehabilitation Die
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