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Wienke A, Sailer R. Cave! Haftung wegen mangelnder Sicherungsaufklärung bei Entlassung aus der stationären Versorgung entgegen ärztlichem Rat. Laryngorhinootologie 2014; 93:260-1. [DOI: 10.1055/s-0033-1354396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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77
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Wienke A, Sailer R. [Is the physician the insurance broker for his patients?]. Laryngorhinootologie 2013; 92:834-5. [PMID: 24285207 DOI: 10.1055/s-0033-1354397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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78
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Wienke A. [Adoption of the new patient rights law: more paperwork hassles in the clinic and general practice]. Laryngorhinootologie 2013; 92:675-8. [PMID: 24105039 DOI: 10.1055/s-0033-1341448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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79
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Schlitt A, Lutze A, Wienke A, Seifert T, Dudaklieva T, Gawe R, Schulz S, Hofmann B, Schaller HG, Werdan K. High degree of severe periodontitis in patients with coronary heart disease from Eastern Germany, but no relation to cardiovascular outcome, the PARO-CHD study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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80
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Wienke A. Medizinische Leitlinien sind wettbewerbsrechtlich nicht justiziabel. Laryngorhinootologie 2013; 92:543-4. [DOI: 10.1055/s-0032-1331752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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81
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Wienke A, Stenger A. BGH: Keine Strafbarkeit von niedergelassenen Vertragsärzten wegen Bestechlichkeit. Laryngorhinootologie 2013; 92:411-2. [DOI: 10.1055/s-0032-1321840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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82
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Wienke A. [Briefing and accusation of medical malpractice--the second victim]. Laryngorhinootologie 2013; 92 Suppl 1:S1-22. [PMID: 23625708 DOI: 10.1055/s-0032-1333252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 [1]. Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decisions are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession and the actual requirements of the realities in the healthcare field. But also the technical and scientific progress bear new risks beside the therapeutic successes, further especially bigger hospitals require high efforts regarding organisation favouring errors in cases of deficiencies. Even the increasing juridification of the medicine that is expected to achieve a provisional highlight with the planned law of patients' rights leads to an important focus on the quality of medical care [2]. The explicit legal regulation of patients' rights, which have never been out of question up to now, confirms the impression of patients who have to be protected from their doctors. This development favours a natural mistrust in the quality of the treatment and the desire of legal verification in cases of treatment failures. A totally perfect and error-free treatment, however, will never occur. Already this fact leads to the obligation to do everything possible to reduce the risk to an absolute minimum. The risks that might arise from a relation of treatment are manifold. Not only may the patient undergo risks that arise in particular from lacking or insufficient briefing, complications, or medical malpractice. Also the doctor has to fear legal consequences if he does not stick clearly to the increasing requirements that jurisdiction and legislation impose - not least by the planned law of patients' rights. In the following, the basic principles and particularities will be described that apply for the patients' briefing. Further the different types of medical malpractice will be explained in relation to the resulting procedural consequences. Finally some current problematic fields will be described with regard to other possible liabilities or responsibilities of physicians in hospitals or doctor's offices.
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Wienke A, Sailer R. Alter Wein in neuen Schläuchen. AKTUELLE DERMATOLOGIE 2013. [DOI: 10.1055/s-0032-1326629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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84
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Wienke A. [Injury of the internal carotid artery in adenectomy]. Laryngorhinootologie 2013; 92:258-9. [PMID: 23568558 DOI: 10.1055/s-0032-1331772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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85
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Wienke A, Stenger A. Dauerbrenner „Honorarärzte“ und andere Kooperationen Status quo und Ausblick. Laryngorhinootologie 2013; 92:117-8. [DOI: 10.1055/s-0032-1316327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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86
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Wienke A, Stenger A. [Compensation claims for skull base injuries related to paranasal sinus operation]. Laryngorhinootologie 2012. [PMID: 23188697 DOI: 10.1055/s-0032-1312649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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87
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Wienke A. [BSG (federal social court) prohibits external collaborations in ambulatory surgeries]. Laryngorhinootologie 2012; 91:646-7. [PMID: 23011666 DOI: 10.1055/s-0032-1328950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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88
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Behrens A, Kainzinger F, Nölling T, Wienke A, Pech O, Ell C. S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“: Was kostet die neue Leitlinie im stationären Alltag? Ein Rechenmodell und eine Analyse der Umsetzung 2011 unter den Mitgliedern der ALGK. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2012; 50:1002-7. [DOI: 10.1055/s-0032-1313080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Surov A, Holzhausen HJ, Wienke A, Schmidt J, Thomssen C, Arnold D, Ruschke K, Spielmann RP. Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features. Br J Radiol 2012; 85:e195-205. [PMID: 22665932 DOI: 10.1259/bjr/78413721] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence, clinical signs and radiological features of breast lymphoma. METHODS This is a retrospective review of 36 patients with breast lymphoma (22 primary and 14 secondary). 35 patients were female and 1 was male; their median age was 65 years (range 24-88 years). In all patients, the diagnosis was confirmed histopathologically. RESULTS The prevalence of breast lymphoma was 1.6% of all identified cases with non-Hodgkin lymphoma and 0.5% of cases with breast cancer. B-cell lymphoma was found in 94% and T-cell lymphoma in 6%. 96 lesions were identified (2.7 per patient). The mean size was 15.8 ± 8.3 mm. The number of intramammary lesions was higher in secondary than in primary lymphoma. The size of the identified intramammary lesions was larger in primary than in secondary lymphoma. Clinically, 86% of the patients presented with solitary or multiple breast lumps. In 14%, breast involvement was diagnosed incidentally during staging examinations. CONCLUSION On mammography, intramammary masses were the most commonly seen (27 patients, 82%). Architectural distortion occurred in three patients (9%). In three patients (9%), no abnormalities were found on mammography. On ultrasound, the identified lesions were homogeneously hypoechoic or heterogeneously mixed hypo- to hyperechoic. On MRI, the morphology of the lesions was variable. After intravenous administration of contrast medium, a marked inhomogeneous contrast enhancement was seen in most cases. On CT, most lesions presented as circumscribed round or oval masses with moderate or high enhancement.
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Wienke A, Stenger A. [No liability when the patient does not understand the medical patient information]. Laryngorhinootologie 2012; 91:508-9. [PMID: 22826201 DOI: 10.1055/s-0031-1301358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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91
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Cristofolini M, Worlitzsch D, Wienke A, Silber RE, Borneff-Lipp M. Surgical site infections after coronary artery bypass graft surgery: incidence, perioperative hospital stay, readmissions, and revision surgeries. Infection 2012; 40:397-404. [DOI: 10.1007/s15010-012-0275-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 05/25/2012] [Indexed: 11/30/2022]
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92
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Wienke A, Stenger A. [2012 Health Care Structural Regulation - what is really changing?]. Laryngorhinootologie 2012; 91:386-90. [PMID: 22628129 DOI: 10.1055/s-0031-1286330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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93
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Scheller C, Vogel AS, Simmermacher S, Rachinger JC, Prell J, Strauss C, Reinsch M, Kunter U, Wienke A, Neumann J, Scheller K. Prophylactic intravenous nimodipine treatment in skull base surgery: pharmacokinetic aspects. J Neurol Surg A Cent Eur Neurosurg 2012; 73:153-9. [PMID: 22241592 DOI: 10.1055/s-0032-1313724] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Nimodipine is primarily used in subarachnoid hemorrhage (SAH). Clinical trials revealed also a beneficial effect of prophylactic nimodipine treatment on cranial nerve functions following vestibular schwannoma surgery. OBJECTIVE The unknown pharmacokinetics of prophylactically administered nimodipine were investigated. METHODS Samples were taken from 27 patients with skull base lesions. Prophylactic intravenous nimodipine infusion was started 5.8-25.8 h (mean 17.9 h) before surgery. Nimodipine concentrations were determined in serum (intra- and postoperatively), cerebrospinal fluid (CSF) (intraoperatively), and tissue samples. RESULTS Wide interindividual differences were observed. Mean concentrations for nimodipine were 46.9 ng/ml (SD: 6.4; min. 4.1 and max. 92.7 ng/ml) in intraoperative serum, 73.2 ng/ml (SD: 16.7; min. 6.6 and max. 253 ng/ml) in postoperative serum and 8.3 ng/ml (SD: 1.5; min. 1.0 und max. 29.7 ng/ml) in intraoperative CSF. The correlation between intra- and postoperative serum (p=0.004, r=0.560) and between intra-operative serum and CSF concentration (p=0.003, r=0.567) were statistically significant. Furthermore the correlation between intraoperative serum concentration and concentrations collected from vestibular nerves was high (r=0.711), but not statistically significant (p=0.178). CONCLUSIONS Interindividually, continously administered intravenous nimodipine produces considerably variable serum levels. Controls of nimodipine serum concentrations may be useful to optimize nimodipine medication in skull base surgery and in the management of SAH. The serum nimodipine level is a useful marker for CSF and intracranial nerve tissue concentrations of nimodipine.
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Wienke A, Stenger A, Sailer R. Alles neu, macht der Mai. Laryngorhinootologie 2012; 91:251-3. [DOI: 10.1055/s-0031-1286332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wienke A. Hochschulambulanzen können ihr Leistungsspektrum ausweiten. Laryngorhinootologie 2012; 91:119-20. [DOI: 10.1055/s-0031-1286331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sadat F, Wienke A, Dunst J, Kuhnt T. Survival of patients with head and neck cancer. Impact of physical status and comorbidities. Strahlenther Onkol 2011; 188:62-70. [PMID: 22189439 DOI: 10.1007/s00066-011-0009-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/15/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Prognostic factors (e.g., gender, tumor stage, and hypoxia) have an impact on survival in patients with head and neck cancer. Thus, the impact of physical status and comorbidities on treatment decision and survival were evaluated. PATIENTS AND METHODS A total of 169 primary, inoperable patients with squamous cell cancer of the head and neck were retrospectively investigated. Patients were treated with hyperfractionated accelerated radio(chemo)therapy (HARcT) or hypofractionated radio(chemo)therapy (HypoRcT). Depending on the individual patient's situation (Karnofsky Performance Index, KPI), treatment for patients with a KPI of 80-100% was generally radiochemotherapy and for patients with a KPI ≤ 70% treatment was radiotherapy alone. In addition, all comorbidities were evaluated. Uni- and multivariate proportional hazards model were used, and overall survival (OS) was estimated by the Kaplan-Meier method. RESULTS Treatment consisted of HARcT for 76 patients (45%), HART for 28 patients (17%), HypoRcT for 14 patients(8%), and HypoRT for 51 patients (30%). Of the patients, 107 patients (63%) presented with a KPI of 80-100%. OS (20%) was significantly better for patients with a KPI of 80-100%, while the OS for patients with a KPI ≤ 70% was 8% (p < 0.001). Good KPI, total irradiation dose (> 70 Gy), and chemotherapy were significant prognostic factors for better OS. CONCLUSION Our retrospective analysis shows that performance status with dependency on comorbidities was an independent risk factor for OS.
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Wienke A. [Post-hospitalization after care in accordance with paragraph 15 a SGB V. When does the responsibility of the hospital physician begin and when does it end? ]. Laryngorhinootologie 2011; 90:764. [PMID: 22161633 DOI: 10.1055/s-0031-1286329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Wienke A, Stenger A, Sailer R. [New requirements : on the amendment of the physicians' Model Professional Code of Conduct 2011]. HNO 2011; 59:1230-2. [PMID: 21909768 DOI: 10.1007/s00106-011-2401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wienke A. [Poststationary treatment in the hospital after § 115a SGB V. When does the responsibility of the hospital physician begin and end?]. HNO 2011; 59:1135-8. [PMID: 21909769 DOI: 10.1007/s00106-011-2400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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