Restructuring the German Outpatient Health Care System: An Economic and IT Perspective

Among other proposals to reform the German outpatient health care system the establishment of networks of cooperating physicians (doctors’ networks) has found high and controversial consideration in recent years. In this paper we analyze doctors’ networks both from an economic perspective, particularly with a view on network strategies, and the perspective of supporting information technologies. Our main conclusions are that the viability of doctors’ networks critically depends on trust-building mechanisms like the restriction of the network in size and complexity and the application of fair profit allocation rules. Concerning information technology the implementation and use of highly integrated interorganizational systems appears most promising. We propose an architecture of such systems. It integrates information technology along the medical, the business and the communication systems dimension and serves as a vehicle for efficient use of shared patient data and other network resources, knowledge creation, fair profit allocation, improved business control and a high level of integrity vis-a-vis the patient

Adenomyoma of the small intestine a rare pathological lead point for intussusception in an infant

INTRODUCTION: Intussusception is a typical abdominal emergency in early childhood. CASE DESCRIPTION: We report a case of an infant in the typically affected age group with an intussusception triggered by a rare benign intramural intestinal adenomyoma as a pathological lead point. The infant had the typical symptoms of a recurrent idiopathic ileocolic intussusception. DISCUSSION AND EVALUATION: Idiopathic intussusception is frequent in the infant age group. Contrary to that, reports on pathological lead points for intussusceptions are sparse in the toddler age. CONCLUSIONS: That case illustrates that even in intussusceptions in the typically affected age group, it is important to be aware of pathological lead points, especially if the intussusceptions are recurrent

Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns

AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel atresia

Prenatal Detection of Congenital Duodenal Obstruction—Impact on Postnatal Care

Background: Duodenal obstruction is a rare cause of congenital bowel obstruction. Prenatal ultrasound could be suggestive of duodenal atresia if polyhydramnios and the double bubble sign are visible. Prenatal diagnosis should prompt respective prenatal care, including surgery. The aim of this study was to investigate the rate and importance of prenatally diagnosed duodenal obstruction, comparing incomplete and complete duodenal obstruction. Methods: A retrospective, single-center study was performed using data from patients operated on for duodenal obstruction between 2004 and 2019. Prenatal ultrasound findings were obtained from maternal logbooks and directly from the investigating obstetricians. Postnatal data were obtained from electronic charts, including imaging, operative notes and follow-up. Results: A total of 33/64 parents of respective patients agreed to provide information on prenatal diagnostics. In total, 11/15 patients with complete duodenal obstruction and 0/18 patients with incomplete duodenal obstruction showed typical prenatal features. Prenatal diagnosis prompted immediate surgical treatment after birth. Conclusion: Prenatal diagnosis of congenital duodenal obstruction is only achievable in cases of complete congenital duodenal obstruction by sonographic detection of the pathognomonic double bubble sign. Patients with incomplete duodenal obstruction showed no sign of duodenal obstruction on prenatal scans and thus were diagnosed and treated later