Biomedical subjects

C Heuer

Publications and source records attributed to C Heuer.

At least 19 recordsLinked to original sources

PubMed2007

Subclinical and clinical mastitis in heifers following the use of a teat sealant precalving.

This study investigated the effect in heifers of infusion of a bismuth subnitrate teat-canal sealant and bacterial intramammary infection (IMI) precalving on prevalence of postcalving IMI and incidence of clinical mastitis in the first 2 wk postcalving. Glands (n = 1,020) from heifers (n = 255) in 5 seasonally calving, pasture-fed dairy herds were randomly assigned within heifer to 1 of 4 treatment groups (no treatment; mammary gland secretion collection; infusion of a teat sealant; or sample collection with infusion of teat sealant). Heifers within a herd were enrolled on one calendar day, 31 d on average before the planned start of the seasonal calving period. Duplicate milk samples were collected from each gland within 4 d after calving for bacterial culture. Herd owners collected duplicate milk samples, before treatment, for bacterial culture from glands they defined as having clinical mastitis. The gland prevalence of IMI precalving was 15.5% and did not differ between herds. Bacteria isolated precalving included coagulase-negative staphylococci (76.9% of all bacteriologically positive samples), Streptococcus uberis (14.1%), Staphylococcus aureus (5.1%), Corynebacterium spp. (3.8%), and others (0.1%). The presence of an IMI precalving increased the risk of an IMI postcalving 3.6-fold and the risk of clinical mastitis 4-fold, relative to no IMI precalving. Infusion of the teat sealant reduced the risk of postcalving IMI due to Strep. uberis by 84%, and of clinical mastitis by 68%. Sampling the glands precalving had no effect on postcalving IMI or on clinical mastitis incidence. Use of an internal teat canal sealant in heifers precalving may be a useful tool for reducing the risk of subclinical and clinical mastitis in heifers.

Administration, Topical↗

PubMed2006

Farm management practices associated with macrocyclic lactone resistance on sheep farms in New Zealand.

AIM: To identify farm practices associated with the presence of resistance to a macrocyclic lactone (ML) anthelmintic on sheep farms in New Zealand. METHODS: A cross-sectional study was conducted to test for associations between the presence of resistance to an ML anthelmintic (ivermectin) and management practices on sheep farms in New Zealand. Selection of farms was both random (n=80) and purposive (n=32; being farms with a history of suspected ML resistance). Resistance was inferred from faecal nematode egg count (FEC) reduction (FECR) tests (FECRTs) when there was <95% reduction in FEC 7-10 days after treatment with a half dose of ivermectin (0.1 mg/kg). A logistic regression model was built to identify farm-level factors that were associated with the presence or absence of ML resistance. RESULTS: Of the 112 flock managers that were approached for interview, 103 (92%) returned useable questionnaires. The odds of ML resistance were increased: on farms that had used long-acting ML products in ewes as a pre-lambing treatment for > or =3 of the previous 5 years (odds ratio (OR) = 7.2; 95% confidence interval (CI) = 1.7-30.3); on farms where <70% of the total stock units mid-winter were from sheep (OR=6.5; 95% CI=1.6-25.6); on farms which over the year purchased >10% of the number of sheep present mid-winter (OR=7.1; 95% CI=1.5-34.7); and on farms where the average wool diameter of the main flock was <37 (OR=4.1; 95% CI=1.1-14.7) microns. The model provided a good fit to the data (pseudo R2=0.64; Hosmer-Lemeshow statistic = 0.38). CONCLUSIONS: Explanatory factors identified as associated with the presence of ML (ivermectin) resistance on farms included the use of long-acting anthelmintic formulations in ewes pre-lambing, sources of refugia of unselected parasites on the farm, breed of sheep and their requirements for anthelmintic treatments, and the importing of resistant parasites with purchased stock. The study provides support for controls that aim to provide refugia of susceptible worms and that minimise the risk of introduction of resistance through effective quarantine drenching.

Animal Husbandry↗

PubMed2005

Reproductive performance of beef cow herds in New Zealand.

AIM: To describe the reproductive performance of beef cow herds in New Zealand and to develop reference ranges for assessing the reproductive performance of individual herds from in-calf rates, that take into account variation in the length of mating periods. METHODS: Veterinary practices throughout New Zealand involved in beef cattle work were asked to collect reproductive data from seasonally calving beef cow herds mated in the spring of 2001 through to the end of summer of 2002. An estimate of conception rate (termed calculated conception rate: CCR) was determined for each herd, assuming that the conception rate was constant for each 21-day interval of the mating period. The algebraic relationship between CCR and in-calf rate at pregnancy testing was defined for mating periods of different durations and, therefore, given the in-calf rate and the duration of the mating period, a CCR could be determined for each herd. Expected pregnancy rates were recalculated from CCR data for a range of mating period durations to produce a look-up table for assessing herd reproductive performance. Reproductive data describing regional differences in in-calf rates and CCRs, bull:cow ratios, breed characteristics, start dates of mating and durations of mating periods were summarised. The effect of study variables in explaining CCRs was examined using a general linear model (GLM). RESULTS: Data were collected from 1,005 beef cow herds distributed throughout New Zealand. The median in-calf rate for all herds was 91%, the lower quartile was < or =88% and the upper quartile > or =94%. The mean CCR for herds with complete reproductive data (862) was 55% (SD 11), the lower quartile was < or =48% and upper quartile > or =61%. Median in-calf rates for 2-year-old heifers (mated at approximately 15 months of age), 3-year-old heifers (mated at approximately 27 months of age), and mixed-age cows were 90%, 91% and 92%, respectively. The study variables that accounted for significant variation in breeding group CCR in a multivariate GLM were 'region' (p<0.01) and 'date mating commenced' (<0.01). The adjusted R2 for the model was 0.055. CONCLUSIONS: The reproductive reference range produced provides veterinarians and herd managers with a quantitative method for assessing reproductive performance of beef cow herds compared with industry averages, from in-calf rates at the time of pregnancy testing and durations of mating periods.

Animal Husbandry↗

PubMed2005

Investigation of bovine venereal campyloacteriosis in beef cow herds in New Zealand.

AIMS: To determine regional prevalences of beef cow herds in New Zealand positive for Campylobacter fetus subsp venerealis antibodies in samples of vaginal mucus tested using an immunoglobulin (Ig) A enzyme-linked immunosorbent assay (ELISA), and to examine the suitability of the IgA ELISA for detecting infection with C. fetus subsp venerealis under field conditions in New Zealand. METHODS: Vaginal mucus samples (n=1,230) collected from beef cow herds (n=125) throughout New Zealand (approximately 10 samples/herd) were tested for antibodies to C. fetus subsp venerealis using an IgA ELISA. Test results were compared between herds classified as having low, medium and high fertility based on pregnancy test results interpreted in relation to the duration of the mating period used. In addition, a small number of samples were collected from dairy cows that were mated using artificial insemination (AI) and had no contact with breeding bulls. The influence of putative risk factors for the spread of venereal disease and the effect of sample quality on the status of herds according to test results was assessed using multivariate logistical regression. Preputial washings from 54 bulls from nine herds classified as low fertility in which mucus samples from > or =3 cows were IgA antibody-positive were cultured for the presence of Campylobacter spp, and isolates of C. fetus subspecies were characterised using a polymerase chain reaction (PCR) test. RESULTS: One or more mucus samples was positive to the IgA ELISA in 70% of all herds tested. The prevalence of IgA antibody- positive individuals was >20% in most regions of New Zealand and did not differ significantly for cows from herds classified as high, medium or low fertility (28%, 26% and 23%, respectively; p=0.39). No relationship was found between mucus antibody status and age of breeding group, herd size, herd fertility, number of herds that female replacements or breeding bulls were sourced from, whether a serving ability test (SAT) was used to assess bulls, or the quality of samples submitted to the laboratory. Campylobacter fetus subsp venerealis was not cultured from any of the 54 bulls sampled. Four other species of Campylobacter and related organisms were cultured, viz Arcobacter cryaerophilus, Campylobacter jejuni, Campylobacter fetus subsp fetus and Helicobacter cinaedi. CONCLUSIONS: The specificity of the IgA ELISA as a diagnostic test for C. fetus subsp venerealis was found to be unsatisfactory under New Zealand conditions. It is possible that an immunological response by cows to Campylobacter species other than C. fetus subsp venerealis caused cross-reactivity in the IgA ELISA. The results do not support the hypothesis that C. fetus subsp venerealis is widespread in New Zealand.

Animal Husbandry↗

PubMed2004

Attitudes of New Zealand farmers to methods used to control wild rabbits.

Four years after the release of Rabbit haemorrhagic disease virus (RHDV) in New Zealand, we conducted a mail survey of farmers to ascertain their attitudes and practices about rabbit control. A multistage sampling frame (stratified by rabbit-proneness and farm type) was used to select 828 farms in eight geographical regions. The useable response proportion of the survey was 69.3%, and 21% of respondents considered rabbits to be a problem on their farms. Although practices for rabbit control had changed from 1995 to 2001, shooting (practised by 85% of respondents) remained the predominant method used (albeit less frequently than in 1995). Ten percent of farmers used RHDV baiting; of those, 90% released the virus relatively infrequently. Farmers perceived shooting to be the most-humane and environmentally safe method, while RHDV was perceived to be the most effective. Perception of the level of competition for grazing between rabbits and livestock was the factor most-strongly associated with the use of shooting and RHDV. Most (60%) respondents considered the introduction of RHDV to have been beneficial.

Animal Husbandry↗

PubMed2004

Incidence of abortion and association with putative causes in dairy herds in New Zealand.

AIM: To estimate the distribution and causes of abortion in dairy herds across New Zealand during the 2001/2002 breeding season. METHODS: A questionnaire survey was sent to all veterinary practices that employed members of the New Zealand Veterinary Association. Veterinarians were requested to record the numbers of dairy herds serviced by their practice in which the rate of aborting cows was zero (0%), low (1-5%) and high (6-10% and >10%), and all laboratory submissions, specimens, tests and results related to their investigation of abortions in these herds, for each category. RESULTS: Forty-two large animal practices serving 1,431 dairy clients from all except one region in New Zealand responded. The within-herd incidence of abortion was zero in 497 herds (34.7%), low in 876 herds (61.2%), and high in 58 herds (4.1%) in the season 2001/2002. Within the high category, 0.6% herds reported abortions at a frequency as high as may be expected in epidemic abortions (>10%). Compared to other regions, the abortion incidences tended to be relatively high in Northland, Auckland and the Bay of Plenty, and low in Hawke Bay, Waikato and Nelson (p<0.001). Cases were submitted for laboratory investigation from 51/934 (5.5%) herds. Even though submission rates increased with the level of abortion, most submissions originated from herds with a low abortion rate. The main agents identified among submissions as the cause of abortion were Neospora caninum (Nc) (35%) and bovine viral diarrhoea virus (BVDV) (16%). Among 39 submissions from low abortion herds, 33% were suspected due to Nc and 15% to BVDV, and this was not statistically different (p>0.10) from the distribution in 13 submissions from high abortion herds (46% Nc, 23% BVDV). While cases associated with Nc were submitted in April, May and June, submissions for suspected BVDV spread evenly over the months of March to July. CONCLUSION: In the 2001/2002 season, approximately 4% of dairy herds in New Zealand recorded a relatively high incidence of abortion (>5%) and 0.6% herds experienced an incidence of >10%. BVDV and Nc were the most frequently diagnosed agents associated with abortion, regardless of whether the seasonal incidence of abortion within a herd was low or high.

Journal Article↗

PubMed2004

Validation of a bulk tank milk antibody ELISA to detect dairy herds likely infected with bovine viral diarrhoea virus in New Zealand.

AIMS: To assess the sensitivity and specificity of a bulk tank milk (BTM) antibody enzyme-linked immunosorbent assay (ELISA) to detect likely infection of a dairy herd with bovine viral diarrhoea virus (BVDV). The ELISA was subsequently used to estimate the prevalence of likely infected herds in parts of the North Island of New Zealand. METHODS: BTM samples from 724 randomly selected dairy herds in the Waikato, Bay of Plenty and Northland regions of New Zealand were tested for BVDV antibodies. From this group, 20 herds were again randomly selected from each of the quartiles of the ELISA percentage inhibition (%INH) result. From each participant herd, serum from 15 randomly selected calves aged 6-18 months and 15 cows was collected and tested using an indirect blocking ELISA for BVDV antibodies. RESULTS: Among serum results from calves from 50 herds available for analysis, 34 (68%) herds were classified as likely non-infected (0-3 seropositive among 15 calves) and 16 (32%) as likely infected (5-15 seropositive among 15 calves). Receiver-operator characteristic (ROC) analysis identified an optimal cut-off for BTM of 80%INH associated with 81% sensitivity and 91% specificity for likely herd infection. The prevalence of BVDV antibodies in cows within herds and %INH for BVDV in bulk milk were positively correlated (p<0.01). The association between bulk milk %INH and the prevalence of BVDV antibodies in calves was stronger than the same association in cows. Based on the threshold of 80%INH, the 95% confidence interval (CI) for prevalence of likely infection in the 724 herds in the Waikato, Bay of Plenty and Northland regions of New Zealand was 12-17%. Vaccination against BVDV was not significantly associated with the likely infection status of the herd based on prevalence of BVDV antibodies among calves. CONCLUSION: An ELISA test result for BVDV antibodies in BTM >/=80%INH can be used as a threshold to indicate the presence of likely infection with BVDV in dairy herds in New Zealand, with 81% sensitivity and 91% specificity.

Journal Article↗

PubMed2004

The use of test day information to predict energy intake of dairy cows in early lactation.

This study aimed to validate a previously developed model for the estimation of energy balance in high producing dairy cows from test day information during the first 12 wk of lactation. Monensin (an ionophor) increases the energy status of dairy cows. Gold standard for the validation was a higher energy status, indicated by lower blood ketone body concentrations, lower percent milk fat, and higher milk-yield of monensin-supplemented than control cows in 8 randomized block design feeding trials. Estimated energy intake (eE(intake)) was calculated as estimated energy balance (eEB) plus energy in actual milk produced (in units of MJ(nel)) plus a constant or variable amount of energy required for maintenance. The variable amount was based on BW, while the constant was the average BW in each parity group (1, 2, 3, 4+). Both eEB and eE(intake) were compared between groups of cows with and without monensin supplementation (n = 600 lactations). The trials started with a presupplement period during lactation wk 2 to 5 followed by a supplementation period during lactation wk 6 to 12. During the presupplement period, both eEB and eE(intake) were similar for all cows. At 2, 3, and 8 wk after starting the monensin supplementation, the eEB of the supplemented cows was significantly higher, while eE(intake) was significantly higher throughout the supplementation period. The results were similar for the 2 methods of calculating energy for maintenance, variable or constant. The feed conversion efficiency, calculated as kg of fat-protein corrected milk per MJ(nel) of eE(intake), was highest in first calving cows compared with cows having more lactations, and correlated with standard milk production at trial group level. It was concluded that eE(intake) was a valid measure of net energy absorption.

Animal Nutritional Physiological Phenomena↗

PubMed2004

Endemic stability for Theileria parva infections in Ankole calves of the Ankole ranching scheme, Uganda.

A population-based study was carried out on the Ankole ranching scheme in south-west Uganda with the aim of determining the endemic status of Theileria parva infections. For this purpose, the age-related sero-prevalence of T. parva and the specific calf mortality associated with the parasite were assessed. Blood samples were collected from 931 Ankole calves of up to 12 months of age from 81 randomly selected herds. The relationship between rainfall pattern and whole-body Rhipicephalus appendiculatus counts was determined. The influence of tick control practices on East Coast fever-related calf mortality, and sero-positivity were also determined. A significant (r2 = 0.76, P = 0.000) association between R. appendiculatus counts and rainfall was observed. There was no significant (P > 0.05) association between theileriosis-related calf mortality, sero-positivity and the different tick control practices. Antibody prevalence based on the PIM ELISA was above 70% among calves of 6 months of age in 96% in all the herds. Theileria parva-related calf mortality determined by repeated herd visits and farm records ranged between 0 % and 5.4 %. It was concluded that endemic stability for theileriosis, caused by T. parva, existed in the study area, and that the risk of the occurrence of economically important outbreaks of East Coast fever in indigenous cattle was regarded as minimal under the prevailing conditions.

Animals↗

PubMed2001

Variability of acetone in milk in a large low-production dairy herd: a longitudinal case study.

The objective of this study was to relate acetone in milk with cow and management factors in one low producing dairy herd (5260 kg milk per 305-day lactation). Milk acetone was measured in regular monthly milk samples one to three times within 100 days of lactation in 4433 lactations (2639 cows, 7800 measurements) from one herd over a period of 32 months (1988-91). Associations between milk acetone and cow factors and surrogate measures of management were evaluated by variance components of multiple fixed effect models. Lactation stage, calendar month of study, production groups and milk yield were strong, and percentage milk fat and parity were weak predictors of milk acetone. There was a trend of increasing body weight loss from the first to the second month of lactation with increasing milk acetone level. A substantial increase in milk production in 1991 was accompanied by an almost twofold rise in milk acetone. It was concluded that environmental parameters had strong relationships with milk acetone even in this low-producing herd.

Acetone↗

PubMed2001

Critical reading of epidemiological papers. A guide.

Many clinicians, medical practitioners and decision makers have no formal training in epidemiology but need to understand and sometimes evaluate results in epidemiologic studies. This paper attempts to give guidance to non-epidemiologists on how to read and evaluate the quality of epidemiologic studies and their results critically. Different methodological issues for evaluating whether the results of a study are causal or by bias, chance or confounding are given. This includes criteria for the choice of an appropriate study design followed by problems of the definition of the study population and the sample selection. We will also point to potential sources of bias in the data collection procedure and list some principles for statistical analysis. Finally, we include comments on how the results should be presented and issues which are related to public health and ethical questions. Although it is not usually possible to perform a perfect study and the correct approach to study design and analysis is often highly dependent on specific features of the population and the surroundings, our paper should help to distinguish between weak and strong investigations and papers.

Bias↗

PubMed2001

Prediction of energy balance in high yielding dairy cows with test-day information.

This study used a previously developed model to predict herd mean energy balance of the first 12 wk of lactation from test-day information. The predictions were compared with calculated energy balance based on feed analysis and to changes in body weight. Seven independent feeding trials including 43 diets (519 lactations, 254 cows; 1987 to 1996) were used. Conventional diets were discriminated from nonconventional diets by significant differences between mean calculated energy balance of subtrial diets versus control diets. The total difference between group means of predicted minus calculated energy balance was positive throughout the observed lactation period. It was lowest (5 to 9 MJ of net energy for lactation) during negative energy balance of the conventional diets in wk 2 to 7 when 18 to 50% of the total difference was due to random variation. Because of this difference, both predicted and calculated energy balances were compared to body weight change as a reference for true energy balance. Body weight change was adjusted for rumen fill. While calculated energy balance tended to be negative at times when cows gained weight, predicted energy balance was positive. Cows fed nonconventional diets gained weight, while calculated energy balance was extremely negative, whereas predicted energy balance based on test-day information was positive. We concluded that the prediction difference was relatively small when standard rations were used, and that nonconventional rations biased predicted energy balance to a lesser extent than calculated energy balance. Estimating energy balance based on test-day information appears feasible.

Animal Feed↗

PubMed2001

Determination of acetone in cow milk by Fourier transform infrared spectroscopy for the detection of subclinical ketosis.

Fourier transform infrared analysis (FTIR) was used in combination with partial least squares regression (PLS) to predict the concentration of acetone in milk. FTIR spectra were compared with results of a gas-chromatographic head space method. Principal component analysis of whole spectra (3000 to 1000 cm(-1)) suggested to reduce the spectrum of analysis for acetone to 1450 to 1200 cm(-1). A second derivative was applied to the spectra to remove baseline effects and further enhance the spectral features. Full cross-validation was used to compare the reference with predicted acetone concentrations of samples not included in model development. PLS applied to the full spectral range resulted in a complex 19-factor model with a cross-validation error of 0.22 mM. After reducing the spectrum and taking the second derivative, we obtained a model with seven factors that yielded a cross-validation error of 0.21 mM. This compares favorably with a previously reported model with 20 factors and an error of 0.25 mM. Using PLS predictions to identify cows with subclinical ketosis resulted in 95 to 100% sensitivity and 96 to 100% specificity when the threshold for subclinical ketosis was 0.4 to 1.0 mM. The corresponding positive predictive values were > or = 76% and the negative predictive values > 98% throughout an assumed range of subclinical ketosis prevalence of 10 to 30%.

Acetone↗

PubMed2001

Effect of monensin on blood ketone bodies, incidence and recurrence of disease and fertility in dairy cows.

Twelve trials designed to test the effect of monensin on milk production were carried out at eight different research farms. Data from these studies were evaluated for effects of monensin on health and reproduction. Monensin was added to the concentrate starting either 2 wk before (293 cows) or 5 wk after calving (601 cows) for periods ranging 16 to 37 wk. Applied after calving, the incidence of clinical mastitis was reduced in the monensin-treated animals. Monensin decreased the rate of intramammary infection (approximated by a change from below to above 250,000 somatic cells in milk) in first lactation heifers by 13%. Indicated by an adjusted incidence rate ratio of 0.58 (P = 0.03), the case incidence of noninfectious lameness decreased from 31% in control cows to 18% in cows receiving monensin before calving. The time from calving to first service was shorter for cows fed monensin before calving. Monensin reduced calving to conception intervals in cows with endometritis during the pretreatment period. No significant effects of monensin were observed for the duration of intra mammory infection (somatic cells in milk above 250,000), infectious lameness, endometritis, cystic ovarian disease, a summary category of 'other diseases,' times from calving to first observed estrus, and from first service to conception.

Animals↗

PubMed2000

Purification of an ascomycin derivative with simulated moving bed chromatography. A case study.

A purification process was developed for the separation of a semi-synthetic ascomycin derivative from its by-products. The process consists of a silica gel filtration and crystallization step prior to two simulated moving bed (SMB) separations, where in the first part the polar by-products and in the second part the apolar by-products were removed. The desired purity was achieved in a final crystallization step. Key elements of the whole process were the design of the first crystallization to obtain a product feasible for SMB chromatography and the specification of operating parameters for the two corresponding SMB steps. Starting from a crude product with an assay of only 44.9% an overall yield for the whole process of 81.0% was achieved with a final purity of >98%.

Chromatography, Gel↗

PubMed2000

The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery.

Neuronavigation, today a routine method in neurosurgery, has not yet been systematically assessed in direct comparison with conventional microsurgical techniques. The aim of the present study was the direct comparison of the impact of neuronavigation on glioblastoma surgery regarding time consumption, extent of tumor removal and survival. For each of 52 patients operated for primary glioblastoma with neuronavigation, a patient operated on without navigation was matched. Completeness of tumor resection, including volumetric analysis, was examined by early post-operative MRI. Operating and survival times were obtained for all patients. At a rate of 86.5%, surgeons' opinions about neuronavigation were positive. Operating times were identical in the two groups, while preparation times were 30.4 min longer with navigation. Radiological radicality was achieved in 31% of navigation cases vs. 19% in conventional operations. The absolute and relative residual tumor volumes were significantly lower with neuronavigation. Radical tumor resection was associated with a highly significant prolongation in survival (median 18.3 vs. 10.3 months, p < 0.0001). Survival was longer in patients operated on using neuronavigation (median 13.4 vs. 11.1 months). Neuronavigation increases radicality in glioblastoma resection without prolonging operating time. Regarding the problem of brain shift, neuronavigation should be optimized by intraoperative real-time imaging.

Adult↗

PubMed2000

Measurement error correction using validation data: a review of methods and their applicability in case-control studies.

Measurement error is a serious problem in the analysis of epidemiological data. In the past 20 years, a large number of methods for the correction of measurement error have been developed. While at the beginning mostly methods for cohort studies were considered, recently more attention has been paid to case-control studies. Although a variety of methods have been proposed, they are very rarely used in practice. To stimulate their use and further development, this article provides a comprehensive overview on methods developed for multivariable regression analysis of epidemiologic studies with validation data sets. The methods are systematically classified with respect to the underlying theory. An assessment of prerequisites, assumptions and performance of the available methods is given. Particular attention is paid to applicability to case-control studies and need for further research and development is pointed out.

Bias↗

PubMed1999

Integration of generic indicators for quality management in hospital information systems.

Hospital information systems may contribute in different ways to quality management activities such as monitoring of quality indicators. Most existing quality management activities in hospitals are adjusted to a special medical field or particular disease. These activities often run simultaneously with other procedures and the documentation of patient care. To determine an interdisciplinary integrated quality management procedure, a pilot study was carried out at the Neurosurgery Department and Neonatology Division of the Medical Center of the University of Heidelberg. Predefined generic indicators that may be integrated in an existing information system and used in hospital routine were the basis of this project. The aim of the study was to support the quality management with periodic reports of these indicators. The pilot study showed that there were barriers along the path to an integrated generic quality management. To meet the requirements of routine monitoring, using predefined generic indicators of hospital care, much integration effort, directed at organizational aspects of information processing and information systems architecture, is still needed.

Germany↗