Search

Die Behandlungskosten der systemischen Therapie des Bronchialkarzinoms steigen derzeit aufgrund neuer zielgerichteter Substanzen rapide an. Therapiebedingte Erhohungen der Uberlebensdauer durch eine vermehrt individualisierte Therapie werden diese Entwicklung weiter verstarken. Dies erklart die hohe und exemplarische gesundheitsokonomische Relevanz der Behandlung des Bronchialkarzinoms, die mit Hilfe verschiedener okonomischer Methoden und Instrumente analysiert werden kann. Aus epidemiologischer und wirtschaftlicher Sicht sollte der Pravention hochste Prioritat gegeben werden, die gesundheitspolitische und gesellschaftliche Meinungsbildung hierzu ist jedoch noch nicht abgeschlossen. Belastungsfahige Aussagen zum Stellenwert der Fruherkennung sind in den nachsten Jahren zu erwarten. Als Losungsmoglichkeiten dieser okonomischen Problematik werden gesetzliche, institutionelle und kooperative Ansatze im Gesundheitswesen diskutiert.

Background: We designed a dose- and time-intensified high-dose sequential chemotherapy regimen for patients with relapsed and refractory Hodgkin lymphoma (HD). Patients and methods: Eligibility criteria included age 18 – 65 years, histologically proven primary progressive (PD) or relapsed HD. Treatment consisted of two cycles DHAP (dexamethasone, highdose cytarabine, cisplatinum); patients with chemosensitive disease received cyclophosphamide followed by peripheral blood stem cell harvest; methotrexate plus vincristine, etoposide and BEAM plus peripheral blood stem cell transplantation (PBSCT). Results: A total of 102 patients (median age 34 years, range 18– 64) were enrolled. The response rate was 80% (72% complete response, 8% partial response). With a median follow-up of 30 months (range 3 – 61 months), freedom from second failure (FF2F) and overall survival (OS) were 59% and 78% for all patients, respectively. FF2F and OS for patients with early relapse were 62% and 81%, for late relapse 65% and 81%; for PD 41% and 48%, and for multiple relapse 39% and 48%, respectively. In multivariate analysis response after DHAP (P

Patients receiving chemotherapy for Hodgkin's disease can potentially be treated in the out-patient department. In spite of this the proportion of patients receiving the chemotherapy on in-patient departments is 54% per chemotherapy cycle in average in the HD6 trial for advanced Hodgkin's disease of the German Hodgkin Study Group (GHSG). The aim of this retrospective analysis is to identify the set of parameters which influence the decision of in- or out-patient treatment for the patients in the HD6 trial. Parameters tested in the univariate analysis are the patient characteristics, the type of chemotherapy, toxicity and the type of treatment institution. The significant parameters are included in a logistic regression model. From this multivariate analysis the type of treatment institution turned out to be the most important factor in the decision of treatment setting. Restricting the analysis to university clinics, the treatment setting of the first two cycles is more influencial than patient dependent parameters.

Little attention has yet been payed on establishing modern and competitive organizational structures in German hospitals. In this paper, we attempt to apply elements of lean management to the work of physicians working in an inpatient setting. Traditional ways of communication and their disadvantages are discussed. These include loss of motivation, bureaucratic structures and a lack of interdisciplinary cooperation. Using Maslow's theory of motivation, possible improvements are discussed, such as the reduction of restrictive job characteristics, an increase of physicians' spheres of competence and the use of their innovative potentials. These suggestions are explained using practical examples. The aim of the study is to contribute to quality management in hospitals by increasing personal responsibilities according to lean management.