CLINIC AND O U TPATIE NT CLINIC

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Dulcie Gregory
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1 CLINIC AND O U TPATIE NT CLINIC FO R NE U R O LO GY

FACTS AND FIGURES Clinic and outpatie nt clinic for ne urology Fe rdinand- Saue rbruch - Straße 17475 Gre ifs w ald Te le ph one : 03834-866815 Te le fax: 03834-866806 E- m ail: Ke s s le r@ uni- gre

2 FACTS AND FIGURES Clinic and outpatie nt clinic for ne urology Fe rdinand- Saue rbruch - Straße Gre ifs w ald Te le ph one : Te le fax: E- m ail: Ke s s le r@ uni- gre is w ald.de H om e page : w w w.m e dizin.uni- gre ifs w ald.de /ne urolog/ H e ad of de partm e nt: Se nior ph ys icians : H e ad of nurs ing s taff: QM re pre s e ntative : Univ.- Prof. D r. m e d. C. Ke s s le r Prof. D r. m e d. U. Runge OA D r. m e d. A. D re s s e l OA D r. m e d. D. Roßbe rg OA D r. m e d. A. Kh aw OÄ D r. m e d. B. Gaida- H om m e rnick OA D r. m e d. M. Sabole k Frau I. Bie ble r OA D r. m e d. M. Sabole k Spe cialis ts Univ.- Prof. D r. m e d. C. Ke s s le r Ne urologis t Ce rtificate D opple r and D uple x s onograph y w ith auth orization to train s taff Prof. D r. m e d. U. Runge Ne urologis t, ps ych iatris t H e ad of inte rdis ciplinary e pile ps y ce ntre of th e Unive rs ity Clinic Gre ifs w ald Ce rtificate for e pile ptology Ce rtificate for pre ope rative e pile ps y diagnos tics Ce rtificate for EEG w ith auth orization to train s taff QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

3 Ce rtificate for EM G and e vok e d pote ntial OA D r. m e d. A. D re s s e l Ne urologis t Spe cialis t for s pe cialne urologic inte ns ive m e dicine H e ad of ne uroim m unologic outpatie nt de partm e nt H e ad of inte rdis ciplinary liq uor laboratory of th e Unive rs ity Clinic Gre ifs w ald Ce rtificate for EM G OA D r. m e d. D Roßbe rg Ne urologis t, ps ych iatris t Ce rtificate for EM G and e vok e d pote ntial H e ad of auth orize d outpatie nt de partm e nts for EM G and botulinum toxin OA D r. m e d. A. Kh aw Ne urologis t Ce rtificate for EM G w ith auth orization to train s taff Ce rtificate for EEG w ith auth orization to train s taff H e ad of ne urovas cular outpatie nt de partm e nt H e ad of s trok e unit OÄ D r. m e d. B. Gaida- H om m e rnick Ne urologis t H e ad of ne urologic e m e rge ncy unit Re s pons ible for vagus cons ultations OA D r. m e d. M. Sabole k Ne urologis t Re s pons ible for m ove m e nt dis orde r cons ultations Th e clinic and outpatie nt clinic for ne urology h as 54 be ds available. In th e ye ar of th e re port patie nts re ce ive d inpatie nt tre atm e nt and patie nts re ce ive d outpatie nt tre atm e nt. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

4 T M ED ICAL CARE SERVICES h e clinic and outpatie nt clinic for ne urology tre ats patie nts w ith dis e as e s affe cting th e brain, th e s pinalcord, pe riph e ralne rve s or m us cle s. As th e only ne urology clinic in Gre ifs w ald th e clinic provide s bas ic tre atm e nt for th e local population. As a unive rs ity clinic and a m axim um care h os pitalth e clinic offe rs its patie nts up- to- date te ch nologie s for diagnos is and tre atm e nt. Th e clinic and outpatie nt clinic is part of th e ne urology ce ntre of th e unive rs ity clinic Gre ifs w ald, w h ich builds on th e clos e co- ope ration of th e clinics for ne urology, ne uros urge ry and ne uroradiology. Up- to- date te ch nicale q uipm e nt for ultras ound e xam inations, e le ctroph ys iological diagnos tics and th e laboratory for th e e xam ination of ne rve liq uid h as be e n purch as e d as th e clinic m ove d to its ne w building com ple x in Saue rbruch s tras s e. Be s ide s tw o be dde d w ards and an e m e rge ncy and functionalw ard th e clinic h as als o a s trok e unit and an inte rm e diate care unit for patie nts w ith s e ve re dis e as e s. Th e s e units are clos e to th e inte ns ive care unit of th e anae s th e tic de partm e nt, w h ich e nable s us to tre at patie nts w h o re q uire artificialre s piration in clos e co- ope ration. An additionalvide o s urve i lance unit is us e d to diagnos e and tre at s e ve re convuls ive dis orde rs. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

5 SPECIAL AREAS OF M ED ICAL CARE Tre atm e nt of s trok e patie nts and vas cular ris k patie nts Patie nts w ith acute s trok e s are tre ate d on th e ce rtificate d, s uprare gionals trok e unit. Th e s trok e unit of th e ne urologicalde partm e nt of th e unive rs ity clinic Gre ifs w ald is th e only ce rtificate d, s uprare gionals trok e unit in W e s te rn Pom e rania. Th rough clos e co- ope rations w ith th e clinics for ne uros urge ry and inte rnalm e dicine and th e ins titute s of diagnos tic radiology and ne uroradiology a ldiagnos tic and th e rape utic proce dure s are available 24 h ours a day on 356 days a ye ar. Be s ide s ys te m ic lys is, w h ich e nable s th e ope ning of a clotte d blood ve s s e lw ith in th e firs t th re e h ours afte r a s trok e, s ince 2006 w e als o offe r intra- arte riallys is as routine tre atm e nt. Th is w ide ns th e tim e fram e w ith in w h ich a clotte d ve s s e lcan be ope ne d to 6 h ours. Lys is : dis s olution ofa vas cular th rom bus th rough th e us e of drugs A furth e r are a of m e dicalcare com pris e s th e afte r care tre atm e nt and th e prim ary and s e condary pre ve ntion of s trok e and vas cular ris k patie nts, w h ich is offe re d by th e ne urovas cular outpatie nt de partm e nt and include s ultras ound e xam inations of th e arte rie s s upplying th e brain, e xte ns ive inform ation and cons ultation talk s and advice on th e rapie s. M ore ove r, patie nts w ith ce rtain m e dicalpre - re q uis ite s can re ce ive s urge ry to tre at s e ve re clottings of th e ce rvicalarte ry. Th e s e proce dure s are conducte d in co- ope ration w ith ne uroradiologicalde partm e nt of th e ins titute for radiology and th e de partm e nt for vas cular s urge ry. Ne urovas cular: conce rning ve s s e ls s upplying th e brain Th e clinic for ne urology tak e s part in nationw ide m e as ure s for q uality as s urance. Th e ne urovas cular laboratory can be us e d for th e e xam ination of inpatie nts affe cte d by s trok e s and for vas cular ris k outpatie nts. As a ce ntre for th e tre atm e nt of s trok e s th e clinic offe rs training m e as ure s for m e m be rs of re s cue te am s (doctors and param e dics ) and th e ge ne ralpopulation. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

6 D iagnos is and tre atm e nt of patie nts affe cte d by convuls ive dis e as e s Patie nts s uffe ring from convuls ive dis e as e s are care d for during s pe cialis e d outpatie nt cons ultations or during a s tay in h os pital. For patie nts s uffe ring from s e izure s, w h ich are h ard to clas s ify, th e re is a vide o- EEG- s urve i lance unit for cons tant m onitoring available. Th is s urve i lance unit is als o us e d for pre - ope rative e pile ps y diagnos is. In a lot of cas e s an ope ration to re m ove th e brain tis s ue re s pons ible for e pile ptic s e izure s im prove s th e patie nt s condition. 75% of th e patie nts are pe rm ane ntly fre e of s e izure s. Th is ope rative th e rapy be com e s ne ce s s ary for e pile ps ie s w ith focalfunctionalbrain dis orde rs, w h ich could not be tre ate d s ufficie ntly w ith drugs. Surgicalproce dure s to tre at e pile ps y are pe rform e d in co- ope ration w ith th e ne uros urgicalde partm e nt. Epile ps y patie nts w h o do not re s pond to m e dication and w h o cannot re ce ive s urge ry ge t a vagus - s tim ulator im plante d, w h ich re s ults in a pe rm ane nt re duction of s e izure s in 35% of th e patie nts. D ue to clos e co- ope ration be tw e e n ne urologis ts /e pile ptologis ts, ne uropae diatricans, ne uros urge ons, anae s th e s iologis ts, s pe cialis ts for nucle ar m e dicine, ne urops ych ologis ts, ps ych iatris ts, ph arm acologis ts and ne uropath ologis ts th e Gre ifs w ald e pile ps y ce ntre is one of th e nationa ly and inte rnationa ly acclaim e d ce ntre s. D iagnos is and tre atm e nt of patie nts affe cte d by m ultiple s cle ros is (M S) and oth e r inflam m atory dis e as e s affe cting th e brain and th e s pinalcord Th e tre atm e nt and ons ulatation of patie nts w ith m ultiple s cle ros is is anoth e r focus of our m e dicalcare s e rvice s. Th e initialdiagnos is is m ade during a s tay in h os pitaland als o acute proble m s are tre ate d in th is w ay, w h e re as ne ce s s ary cons ultations and fo low - ups are m ainly pe rform e d as outpatie nt tre atm e nt w ith in th e cons ultation h ours s pe cialis e d on ne uroim m unology. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

7 Th is cons ultation is ce rtificate d th rough th e "Kas s e närztlich e Ve re inigung" of M e ck le nburg- W e s te rn Pom e rania. Th e liq uor laboratory of th e ne urology clinic can be us e d for e xam inations of ne rve liq uid. Th e laboratory is ce rtificate d by th e Ge rm an As s ociation of Liq uor D iagnos is (D e uts ch e Ge s e ls ch aft für Liq uor D iagnos tik ). Furth e r s e rvice s of th e de partm e nt Th e ne urology clinic tak e s part in th e m us cle ce ntre of M e ck le nburg- W e s te rn Pom e rania. M ore ove r, th e re e xis ts a clos e co- ope ration w ith th e clinic for h ae m atology and oncology to tre at patie nts w ith brain tum ours. At th e e nd of 2006 w e e s tablis h e d outpatie nt cons ultations s pe cialis e d on Park ins on s dis e as e and oth e r m ove m e nt dis orde rs. Furth e r, w e offe r s pe cialis e d cons ultations for patie nts w ith h e adach e and outpatie nt botulinum toxin tre atm e nt. Clinicaland bas ic s cie ntific re s e arch proje cts, focus s ing e s pe cia ly on th e s pe cialfie lds of th e clinic, are conducte d in th e clinic and outpatie nt clinic for ne urology. Th e doctors and th e s e nior ph ys icians are active m e m be rs of various as s ociations and h e ad a large num be r of s cie ntific proje cts. A s m a ls e le ction of proje cts, w h ich w i l be ne fit th e patie nts, can be found in th is re port unde r th e h e ading Quality m anage m e nt proje cts. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

8 M EASURES OF INTERNAL QUALITY M ANAGEM ENT Evide nce -bas e d: s cie ntifica ly prove n I n 2006 w e e s tablis h e d a w e e k ly inte rdis ciplinary tum our confe re nce. Th is m e e ting is an e s s e ntialpart of th e q uality m anage m e nt for th e guide d and e vide nce - bas e d th e rapy of intrace re braland intras pinaltum our dis e as e s. Toge th e r w ith co le ague s of th e oncology, ne uros urge ry, radioth e rapy and pos s ible oth e r dis cipline s involve d patie nts w ith th e above m e ntione d tum ours are dis cus s e d and a binding plan of tre atm e nt is agre e d. A lne w ly diagnos e d m alignant tum our dis e as e s are re porte d to th e tum our ce ntre Gre ifs w ald for e pide m iologicale valuation. Se ve re com plications occurring w h ile th e patie nt is tre ate d in h os pitalare analys e d and dis cus s e d during th e inte rdis ciplinary m orbidity and m ortality confe re nce, w h ich tak e s place on a re gular bas is. Since 2006 th e re is a w e e k ly clinic- inte rnals e m inar s uitable for furth e r training, during w h ich inte re s ting and im portant clinicalas pe cts, as w e las th e ne w e s t re s e arch re s ults from th e fie lds of diffe re ntialdiagnos is, diagnos tics and th e th e rapy of ne urologicaldis e as e s are pre s e nte d. Th is s e m inar h e lps to continuous ly train our s taff and to im prove th e m e dicalcare. Tw ice a w e e k th e re is a m e e ting w ith th e ne uroradiology and once a w e e k an additionalm e e ting w ith ne uros urge ry tak e s place. H e re, cas e s w h ich are inte re s ting for s e ve ralde partm e nts or w h ich are difficult to tre at, are pre s e nte d and furth e r diagnos tic or th e rape utic proce dure s are dis cus s e d. Th e m e e ting contribute s to th e q uality as s urance of th e m e dicalcare and to th e furth e r training of our as s is tant ph ys icians. UPD RS: Unifie d Park ins on's D is e as e Rating Scale Since 2006 th e s e ve rity of Park ins on s dis e as e is as s e s s e d for in- and outpatie nts us ing th e UPD RS (Unifie d Park ins on s D is e as e Rating Scale ). Th is is a unifie d and e s tablis h e d rating s cale us e d to as s e s s th e patie nt s m otoric capability and th e patie nt s ability to pe rform e ve ryday life - activitie s. Th is is e s pe cia ly im portant, as it e nable s doctors to obje ctive ly e valuate th e cours e of th e dis e as e and th e s ucce s s of QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

9 th e applie d th e rapie s. A lm ultiple s cle ros is patie nts, re ce iving in- or outpatie nt tre atm e nt, are te s te d us ing th e fo low ing s core s : ED SS, M ultiple Scle ros is FunctionalCom pos ite Inde x (M SFC), BD I (Be ck s D e pre s s ion Inve ntory), FSS (Fatigue Scale according to Krupp), as w e l as M ultiple Scle ros is FSS (M SFSS). Th e s e are s tandardis e d and e s tablis h e d rating s cale s us e d to as s e s s th e patie nts m otoric and m e ntalcapabilitie s and pos s ible accom panying m e ntals ym ptom s. Th e s e s core s are e s pe cia ly im portant, as th e y e nable doctors to obje ctive ly e valuate th e cours e of th e dis e as e and th e s ucce s s of th e s ym ptom atic th e rapie s. In 2006 th e clinic- inte rnals tandards for th e s trok e unit h ave be e n com ple te ly re vis e d. Th e s tandards can be s e e n as e s tablis h e d guide line s for diagnos is and th e rapy and th e y h e lp to guarante e e vide nce - bas e d h igh q uality e m e rge ncy tre atm e nt at any tim e, als o in e m e rge ncy s ituations or during th e nigh t duty. Eve ry s taff m e m be r in our de partm e nt can acce s s th e s e s tandards via th e inte rne t at any tim e. Th e nurs ing s taff of th e s trok e and th e inte ns ive care units re ce ive s re gular furth e r training on topics, w h ich are re le vant for inte ns ive m e dicine and re late to ne urological dis e as e s. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

10 Clinicals tudie s and re s e arch proje cts Ne urops ych ologicalte s ting and docum e ntation of e ve nt corre lating s ignals w ith in re s e arch proje cts w ith m ultiple s cle ros is patie nts : In th is proje ct it is te s te d h ow m ultiple s cle ros is patie nts and h e alth y pe rs ons re cognize e m otionalfaciale xpre s s ion. Es tablis h e d pape r- bas e d te s ting s ys te m s are us e d, as w e las EEG and ce re bral m agne tic re s onance tom ograph y (cm RT). Inte rre lations be tw e e n frontaland te m porolim baldys functions in s ch izoph re nic patie nts and patie nts w ith s ligh tly im pairm e nts of te m porolim bals tructure s (junior re s e arch e rs te am ): In th is proje ct th e de partm e nt w ork s in clos e co- ope ration w ith th e ne urops ycologicalw ork ing group and th e Ins titute of Radiology/Ne uroradiology of th e unive rs ity clinic Gre ifs w ald. Th e junior re s e arch e rs te am e xam ine s h ow frontaland te m porolim baldys functions are conne cte d, w h ich is e xe m plifie d on patie nts w ith attack s of m ultiple s cle ros is. D ata conce rning affe ct dis crim ination of a group of h e alth y pe rs ons are curre ntly com pare d w ith data of m ultiple s cle ros is and s ch izoph re nic patie nts. Spons or: Ge rm an M inis try for Education and Re s e arch. Body re s pons ible for proje ct: Ge rm an Ce ntre for Ae ronautics and As tronautics. D IAS: Clinicals tudy on th e tre atm e nt of acute apople xy w ith s ys te m ic lys is th e rapy w ith in 6 h ours. PERFORM : Clinicals tudy on th e s e condary proph ylaxis of apople xy. BENEFIT and BENEFIT fo low - up s tudy: D ouble blind random ize d m ultice ntre d ph as e III s tudy on e arly tre atm e nt of m ultiple s cle ros is w ith inte rfe ron- ß1b (Be tafe ron ). Spons or Sch e ring. Th e firs t double blind ph as e w ith a duration of 2 ye ars h as be e n com ple te d and patie nts are now in th e ope n labe lfo low - up ph as e of th e s tudy. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

BEYOND and BEYOND fo low - up s tudy: D ouble blind random ize d m ultice ntre d ph as e III s tudy on im m une m odulation of patie nts w ith m ultiple s cle ros is. Spons or Sch e ring.

11 BEYOND and BEYOND fo low - up s tudy: D ouble blind random ize d m ultice ntre d ph as e III s tudy on im m une m odulation of patie nts w ith m ultiple s cle ros is. Spons or Sch e ring. In th is s tudy, cons is ting of th re e parts, it is e xam ine d h ow patie nts w ith e pis ode s of m ultiple s cle ros is re act, w h e n th e untilnow pe rm is s ible dos e of 250 g inte rfe ron- ß1b (IFNß- 1b; Be tafe ron ) applie d a ltw o days is e xch ange d w ith a h igh e r dos e of 500 g IFNß- 1b. Im m une re s pons e fo low ing apople xy: W ith in th is proje ct, w h ich is s pons ore d as part of th e NBL3 program m e, bas ic agre e m e nts w e re m ade conce rning th e participation in th e graduate program m e GRK840 (s e e be low ). Graduate program m e GRK840 s pons ore d by th e Ge rm an Re s e arch As s ociation (D FG): Im m une s uppre s s ion fo low ing apople xy as pre dis pos ing factor for infe ctions : Exam ination of th e im m une re s pons e of patie nts w ith acute apople ctic s trok e s and in anim alm ode l. It w as s h ow n th at s trok e patie nts de ve lop an im m e diate and s e ve re lym ph ocytope nia, w h ich probably is th e pre dis pos ing factor for infe ctions in s trok e patie nts. Curre ntly th e re is furth e r re s e arch conce rning th e m e ch anis m s caus ing th is proce s s. UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

12 M ain diagnos e s according to OPS in 2006 RANKING ICD NAM E CASES 1 I63 Ce re bralinfarction G40 Epile ps y G45 Trans ie nt ce re bralis ch ae m ic attack s and re late d s yndrom e s G35 M ultiple s cle ros is I61 Intrace re bralh ae m orrh age 56 6 F45 Som atoform dis orde rs 52 7 R55 Syncope and co laps e G62 Oth e r polyne uropath ie s G44 Oth e r h e adach e s yndrom e s G41 Status e pile pticus 34 Com pe te ncy diagnos e s according to OPS in 2006 ICD G20 C71 NAM E Park ins on's dis e as e M alignant ne oplas m of brain G45.9 Trans ie nt ce re bralis ch ae m ic attack, uns pe cifie d G71 G00 Prim ary dis orde rs ofm us cle s Bacte rialm e ningitis, not e ls e w h e re clas s ifie d G05.1 Ence ph alitis, m ye litis and e nce ph alom ye litis in viraldis e as e s clas s ifie d e ls e w h e re Inform ation s tate d h e re are additionalcom pe te nce s for th e m ain com pe te ncie s m e ntione d above (inde pe nde nt of th e cas e s tre ate d in th e re port ye ar 2006). QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

13 M ain proce dure s according to OPS in 2006* RANKING OPS NAM E CASES Com pute rize d tom ograph y (CT) w ith outus e ofcontras tage nt One - dim e ns ionald opple r ultra s ound ofce re bralblood ve s s e ls Colour D opple r ultra s ound of ce rvicalve s s e ls One - dim e ns ionald opple r ultra s ound ofce rvicalve s s e ls M e as uring ofbrain w ave s - EEG Nucle ar m agne tic re s onance tom ograph y (M RT) ofs k u lw ith out us e of contras tage nt M e as uring ofde libe rate ly s tim ulate d brain w ave s (e vok e d pote ntials ) Exam ination ofliq uor s ys te m Inte rdis ciplinary ne urologicaltre atm e nt of acute apople ctic s trok e s Nucle ar m agne tic re s onance tom ograph y (M RT) ofs k u lus ing a contras t age nt Trans oe s oph age ale ch ocardiograph y Com pute rize d tom ograph y of pe riph e ralve s s e ls us ing a contras tage nt Exam ination ofne rve conduction - ENG Colour D opple r ultra s ound of ce re bralblood ve s s e ls 218 * Th e s urve i lance of vitals igns during ope rations and anae s th e s ia/s e dations, anae s th e s ia on its ow n and blood trans fus ions during th e proce dure s are not s tate d s e parate ly. Com pe te ncy proce dure s according to OPS in 2006 OPS NAM E Exam ination ofliq uor s ys te m : lum bar puncture Inte rdis ciplinary tre atm e ntofs e ve re convuls ive dis orde rs (e pile ps y) Non-invas ive m e as ure m e nt of brain w ave s (EEG) unde r vide o s urve i lance be fore s urge ry in cas e s of convuls ive dis orde rs (e pile ps y) Tre atm e nt of a ve s s e ls via a cath e te r: s e le ctive th rom bolys is Tre atm e nt to re - ope n a ne w ly aris ing th rom bus via inje ction D iagnos ing of typicals ym ptom s ofdifficult convuls ive dis orde rs (e pile ps ie s ) Inform ation s tate d h e re are additionalcom pe te nce s for th e m ain com pe te ncie s m e ntione d above (inde pe nde nt of th e cas e s tre ate d in th e re port ye ar 2006). UNIVERSITY CLINIC GREIFSW ALD QUALITY REPORT FOR PATIENTS 2006

14 RESEARCH In our re s e arch data bas e you can alw ays find curre nt re s e arch re ports of our clinic: h ttp://fodb.uni- gre ifs w ald.de /inde x.ph p. QUALITY REPORT FOR PATIENTS 2006 UNIVERSITY CLINIC GREIFSW ALD

INS TITU TE O F CLINICAL CH E M IS TR Y AND LABO R ATO R Y

INS TITU TE O F CLINICAL CH E M IS TR Y AND LABO R ATO R Y M E D ICINE FACTS AND FIGURES Ins titute of ClinicalCh e m is try and Laboratory M e dicine Fe rdinand- Saue rbruch - Straße 17475 Gre ifs w ald