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On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all terminally ill patients. Politics and health care providers must establish prerequisites for adequate pain diagnosis, pain therapy and palliative medicine.

Mit dem Auftrag des EBOM soll der aktuelle Informationsstand uber die Entwicklung der osteopathischen Medizin wie auch der Osteopathie im europaischen Raum gegenuber Gesundheitsberufen, Patienten und Patientenorganisationen, Kostentragern und den politisch Verantwortlichen kommuniziert werden. Weiter verfolgt das EBOM mit diesem Auftrag die Etablierung einer universitaren Ausbildung in osteopathischer Medizin und letztlich deren Integration in ein Gesamtkonzept der neuromuskuloskeletalen Medizin in Europa.

Zunehmende Bedeutung gewinnen aber auch zivil- und strafrechtliche Aspekte der Schmerztherapie. So fuhrt der gewachsene Anspruch der Patienten an eine effektive und sorgfaltige Therapie immer haufiger zu Schadensersatzanspruchen an die behandelnden Arzte. Insbesondere der Sorgfalt bei der Aufklarung des Patienten, als auch der Dokumentation der durchgefuhrten Therapie mus hierbei das besondere Augenmerk des klinisch tatigen Schmerztherapeuten und des arztlichen Sachverstandigen gelten.

die Vorstellung eines Indikationskataloges zu den verschiedenen osteopathischen Techniken; Vorschlage zur gebuhrenzifferbezogenen Abrechnung osteopathischer Leistungen; aktuelle Themen.

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all terminally ill patients. Politics and health care providers must establish prerequisites for adequate pain diagnosis, pain therapy and palliative medicine.

On the basis of the current anti-doping requirements for the World Cup, major processes and regulations are explained. Over and beyond the area of football, they are highly relevant for physicians responsible for the care and treatment of professional athletes. Apart from a knowledge of the respective current anti-doping list of banned substances, the administrative guidelines for the application to use notifiable substances must be complied with. In order to avoid errors resulting in serious consequences for athletes, the care-providing physician in professional sport must have immediate access to the necessary information on anti-doping regulations, and be familiar with the contact addresses of the respective anti-doping authorities.

Repeated impacts by heading might lead to significant head injuries in soccer players comparable to those of patients with accidental minor traumatic brain injury (TBI). The neuroprotein S-100B released into the circulation is suggested to be a reliable marker indicating brain damage. The objective was to evaluate the neuroprotein S-100B serum levels in young amateur soccer players early after controlled heading compared to early measurements after normal exercise as well as in other patients after minor TBI.Sixty-one male amateur soccer players (median age 15.3 years) performed controlled heading aimed at the forehead for 55 minutes. Data were compared to 58 male amateur soccer players (15.9 years) performing 61 minutes of normal exercise training without head contact and 81 young male patients early after TBI who underwent computed tomography (CCT) for detection of intracranial lesions. First venous blood samples were drawn before the training sessions, second and third samples 60 and 360 minutes after heading or 64 and 355 minutes after exercise, respectively, 65 and 366 minutes after TBI.Median S-100B serum levels of the heading group only slightly increased from 0.15 ng/ml to 0.18 ng/ml 60 minutes after end of training. Within 360 minutes S-100B values decreased again to 0.15 ng/ml reaching the initial values. S-100B serum values of the exercise group showed a similar transient increase exhibiting significant lower levels before exercise (0.10 ng/ml) as well as 64 minutes (0.11 ng/ml) and 355 minutes after exercise (0.09 ng/ml) compared to the heading group. According to age stratification in the heading group, starting median S-100B levels were significantly higher in subjects with 12-13 years (0.22 ng/ml) and 14-15 years (0.17 ng/ml) compared to those with 16-17 years of age (0.06 ng/ml). None of the subcollectives did reach median S-100B levels of the CCT+ group (n = 20) at admission (0.62 ng/ml) or 366 minutes later (0.32 ng/ml), which were significantly elevated compared to those of the CCT group (n = 61) at admission (0.10 ng/ml) or 370 minutes later (0.08 ng/ml).Controlled repetitive heading in young amateur soccer players leads to a transient increase between 60 to 360 min after training, but does not appear to evoke a longer lasting S-100B release into serum indicating cellular brain damage. After heading S-100B levels are significantly elevated compared to normal exercise. Although soccer players with 12-13 years and 14-15 years revealed significantly higher S-100B values than with 16-17 years of age, the transient increase is independent of the age-related starting values. However, since brain damage due to abrupt heading a ball of high speed or accidental trauma during regular soccer games cannot be excluded, S-100B measurements in soccer players are initiated during video-controlled soccer games.

Das therapeutische Angebot fur bewegungsgestorte Kinder befindet sich zwischen andauernder Behandlungsnotwendigkeit einerseits und den zunehmend begrenzten finanziellen Ressourcen im Gesundheitswesen andererseits. Entscheidungen unter nicht optimalen Bedingungen treffen zu mussen, ist die zentrale ethische Frage in der Medizin (Graf-Baumann u. Reiter-Theil 1991).

Review of the literature shows that information concerning risk factors for football injuries is incomplete and partly contradictory. The aim of this study was to analyze the influence of medical history, physical findings, football skills, and football performance, as well as psychosocial characteristics on the occurrence and severity of football injuries. The prospective outline of the study was as follows: after a baseline examination was performed to ascertain possible predictors of injury, all players were followed up weekly for 1 year to register subsequent injuries and complaints. Two hundred sixty-four of 398 players (67%) had complete weekly follow-ups over 1 year. A majority of the players (N = 216; 82%) were injured during the observation period. In comparing injured and uninjured players, several differences were observed. To create a multidimensional predictor score for football injuries, 17 risk factors were selected. These risk factors covered a wide spectrum, such as previous injuries, acute complaints, inadequate rehabilitation, poor health awareness, high life-event stress, playing characteristics, poor reaction time, poor endurance, and insufficient preparation for games. By summing up the individual risk factors, a predictive sum was calculated for each player. The more risk factors present at the baseline examination, the higher the probability of that player incurring an injury in the ensuing year. Using two risk factors as the cut-off score, more than 80% of the players were correctly classified as to whether they went on to incur an injury. Based on these findings, knowledge from the literature, and practical experience, possibilities for a prevention program are suggested.

Der arztliche Sachverstandige (Gutachter) ist entweder Berater der Trager der gesetzlichen Sozialversicherungen und der privaten Versicherungen oder unparteiischer Sachverstandiger im Auftrage eines Gerichts

Wenn wir uns im Rahmen dieses Symposiums, das ubrigens das erste zum Thema der HWS-Beschleunigungsverletzungen ist, das von der manualmedizinischen Seite durchgefuhrt wird, auch mit den Prinzipien der Begutachtung auseinandersetzen, so geschieht dies nicht zuletzt aufgrund jahrelanger Erfahrungen in den oft sehr unsachlich gefuhrten Auseinandersetzungen zwischen Gutachtern mit rein traumatologischem oder orthopadischem Hintergrund und erfahrenen Manualmedizinern.

In den letzten 30 Jahren sind die Klagen gegen Arzte — insbesondere gegen Geburts-helfer undPlastische Chirurgen — auf Schadensersatz und Schmerzensgeldforderungen einerseits, sowie Ermittlungsverfahren wegen fahrlassiger Totung oder Korperverletzung andererseits lawinenartig angestiegen.

Von Beginn des Lebens an bestimmen Herkunft, religiose Erziehung, familiare und kulturelle Traditionen und soziale Beziehungen in unserem privaten und beruflichen Umfeld unser Menschen- und Wertebild. Von den Angehorigen der Berufe im Gesundheitswesen wird im besonderen Mase eine personliche, laufende Auseinandersetzung mit dem Werte- und Menschenbild gefordert.

Bei der Vorbereitung des zweiten Workshops zur Entwicklung der Arzthaftung war die fur die Programmgestaltung zustandige Arbeitsgruppe zunachst davon ausgegangen, eine vergleichende Betrachtung einiger Gesundheitssysteme in Europa, z.B. Deutschland, Osterreich, Schweiz, Skandinavien, im Hinblick auf die fur die Arzt-haftung relevanten Kriterien voranzustellen.

So verdienstvoll und spannend es sein mag, 2 so gegensatzliche Begriffe wie Lebensqualitat und Gesundheitsokonomie zu verknupfen, so schwierig scheint es, gesundheitsokonomische Folgerungen aus der Diskussion und Definition von Lebensqualitat abzuleiten. Die Gesundheitsokonomie ist in der Bundesrepublik Deutschland noch ein sehr junges und bei weitem nicht entwickeltes Gebiet. Die Diskussion um die Lebensqualitat hingegen existiert seit Jahrzehnten. Wenig berucksichtigt wurden dabei allerdings okonometrisch relevante Kriterien. Dies beschrankte sich in der Vergangenheit leider vorwiegend auf die Relation zwischen Lebensqualitat und der sog. Spitzenmedizin.

Seit 1987 fuhren die VITA und die Sportschule Zurich in enger Zusammenarbeit mit den Arzten und Physiotherapeuten der Schulthess-Klinik in Zurich sowie weiteren Arzten und Physiotherapeuten in anderen Stadten der Schweiz regelmassig Ruckenschul-Kurse durch. Von Anfang an wurden die Teilnehmer uber Grunde und Motivation zur Teilnahme an diesen Kursen befragt. Die Antworten sind um so mehr von sozio-okonomischer Bedeutung, als sie Auskunft uber jene Ruckenschmerz-Betroffenen geben, welche aus eigener Initiative und unter Leistung eines personlichen finanziellen Beitrages den Schritt zur Teilnahme an einem Ruckenschul-Kurs unternommen haben. In diesem Sinne ist dies ein Novum verglichen mit den wissenschaftlichen Studien, die seit der Entstehung der Ruckenschulen veroffentlicht worden sind.

Mit diesem Kurs konnen Sie herausfinden, wo Ihre Schwachen und Probleme bezuglich Ihrer Haltung und Bewegung liegen. Das Buch soll Ihnen helfen, indem es logische Zusammenhange darstellt und Verstandnis und Motivation weckt. So konnen Sie sich nicht nur im Alltag bewuster bewegen, sondern auch ein Ubungsprogramm erarbeiten mit dem Sie Ihren Problemkreis selbstandig positiv beeinflussen.

Ich will den Versuch machen, die Wertung der Institution Psychosomatik von Prof. Meyer aus einer ganz anderen, sicher ungewohnlichen und vielleicht frechen Perspektive, namlich der des Managements, des Marketings zu beleuchten. Spatestens seit der Einfuhrung des neuen einheitlichen Bewertungs-masstabes(EBM) fur arztliche Leistungen ist in vielen Bereichen der kassenarztlichen Versorgung ein Existenzkampf um die alleinige Zustandigkeit fur bestimmte Versorgungsbereiche ausgebrochen.