Search PubMed⌕ Search

Biomedical subjects

H K Selbmann

Publications and source records attributed to H K Selbmann.

At least 37 records · Page 2Linked to original sources
PubMed1999

Compliance of German pediatric patients with oral antibiotic therapy: results of a nationwide survey.

BACKGROUND: Noncompliance with a prescribed therapy is a common problem in ambulatory pediatrics. OBJECTIVE: To establish a nationwide status quo of compliance of German ambulatory pediatric patients with oral antibiotics prescribed for various bacterial infections. PATIENTS AND METHODS: In this study, organized and financed by the German Society for Pediatric Infectious Diseases, 42 pediatricians in private practice who were selected to represent the 3 main regions of Germany and residence in large cities or small towns, respectively, enrolled consecutive patients who had bacterial infections that required therapy with oral antibiotics. Choice of agent and duration of treatment were left to the study physicians. Compliance was measured by a standardized telephone interview on the penultimate day and a urine bioassay for antibacterial activity on the last day of the planned treatment period. Parents did not know the true purpose of the study. RESULTS: Five hundred eight-four patients were fully evaluable. The most frequent diagnoses included tonsillopharyngitis (n = 231), otitis media (n = 170) and lower respiratory tract infections (n = 114). Most frequently prescribed antibiotics included amoxicillin (n = 102), potassium penicillin V (n = 81) and clarithromycin (n = 67). Overall compliance (positive urine test) on the last day of therapy was 69.5% (406 of 584 patients). Compliance was not significantly influenced by the region of residence or the underlying bacterial infection. It was significantly associated with the antibiotic used (macrolides, 89.0%; penicillins, 62.2%; cephalosporins, 66.4%; P = 0.0001 for macrolides vs. the others). Best compliance was found with clarithromycin (94.0%) and erythromycin estolate (89.8%). Compliance was also significantly better in patients > or =6 years old (77.7%; P = 0.016); with a treatment duration of < or =7 days (77.6%; P = 0.014); when the drug package contained a dose-taking reminder (79.7%; P = 0.003); and when the pediatrician's behavior toward the patient was assessed by the parents as "very sympathetic" or "sympathetic" (72.6%; P = 0.017). Subjecting all variables to logistic regression analysis, we found 3 variables to be significant predictors of treatment compliance: choice of antibiotic (P = 0.0001); patient age (P = 0.0008); and residence in town or city (P = 0.03). CONCLUSIONS: A noncompliance rate of >30% is unsatisfactory. Whereas some variables significantly associated with compliance cannot be influenced (patient age; place of residence in town or city), others are amenable to modifications. These include the physician-patient interaction and the choice of antibiotic. Agents should be preferred that are well-accepted by patients, that enable short-term therapy with few daily doses and with a package that contains a dose-taking reminder.

Administration, Oral↗
PubMed1999

Mortality in blind subjects. A population-based study on social security files from Baden-Württemberg.

BACKGROUND: Previous studies indicated that mortality is increased in blind subjects. However, no detailed analysis with respect to causes of blindness and the effect of additional diseases has been performed. The present study was undertaken to examine these questions. MATERIALS AND METHODS: The investigation is based on social security files from the Württemberg-Hohenzollern region (population 5.5 millions) in Germany. In total, 571 files of blind subjects whose blindness benefits terminated (mostly due to death) in 1994 were included. Medical opinions on ophthalmological status and general health were extracted from the files. Standardised mortality ratios (SMRs) on the basis of life tables of former West Germany were calculated using maximum likelihood methods taking into account censoring. RESULTS: Most subjects in our study had one or more additional diseases at onset of blindness (74%). The SMR in all blind is 1.41 [95% CI (confidence interval) = 1.28-1.54; n= 571]. Mortality of blind subjects is increased if subjects suffer from multiple disease at onset of blindness: the SMR in blind with multiple diseases is 1.76 (95% CI = 1.58-1.94; n = 421) versus 0.85 (CI = 0.70-1.0; n = 150) in otherwise healthy blind subjects. In cases where specifically ocular diseases were responsible for the visual loss, the symbol [M] indicates that the blind subject suffered from multiple disease at onset of blindness and [E] denotes that this was not the case. The SMRs for main causes of blindness are: macular degeneration [M] 1.5 (CI = 1.3-1.8; n = 123), [E] 1.1 (CI = 0.8-1.5; n = 43); glaucoma [M] 1.6 (CI = 1.3-2.1; n = 65), [E] 1.0 (CI = 0.6-1.5; n = 26); high myopia [M] 1.2 (CI = 0.8-1.7; n = 32), [E] 0.8 (CI = 0.5-1.2; n = 21); optic atrophy [M] 1.1 (CI = 0. 6-1.8; n = 19), [E] 1.4 (CI = 0.4-3.2; n = 4), and tapetoretinal degeneration [M] 2.3 (CI = 1.1- 4.2; n = 10), [E] 0.9 (CI = 0.4-1.8; n = 12). The SMR of cases of blindness in conjunction with other diseases was fairly high for diabetic retinopathy: 5.5 (CI = 4.4-6. 8; n = 81). Central-nervous-system-triggered blindness led to an SMR of 1.5 (CI = 1.0-2.2; n = 37). DISCUSSION: According to the results of the present study mortality is significantly increased in blind subjects. However, increased mortality in cases of blindness due to specifically ocular disease (e.g. macular degeneration) is associated with the presence of multiple (extra-ocular) diseases at onset of blindness.

Adolescent↗
PubMed1999

Blindness incidence in Germany. A population-based study from Württemberg-Hohenzollern.

UNLABELLED: Few data on the incidence of blindness in Germany are available. We analysed causes of legal blindness for the region Württemberg-Hohenzollern (population 5.5 million) in order to help fill in this gap. MATERIAL AND METHODS: Population-based investigation on the incidence of legal blindness (visual acuity <1/50) based on materials from the social services. Age-dependent blindness incidences were modelled via logistic regression models. RESULTS: 647 blind persons were newly registered in 1994 (blindness incidence 11.6/100,000). The blindness incidence is moderate in infants (4.5/100,000) and decreases further during childhood. At the age of 20 years, the incidence again rises to the former level and remains relatively constant. After the age of 60 years, the incidence increases sharply: 5-year odds ratios are 1.76 (CI: 1.68-1. 85) in women and 1.72 (CI: 1.60-1.84) in men. The blindness incidence is higher in women, 15.6/100,000, compared to 12.2/100,000 in men. The major causes of blindness are: macular degeneration, 3. 92/100,000; diabetic retinopathy, 2.01/100,000; glaucoma, 1.6/100, 000; high myopia, 0.77/100,000; optic atrophy, 0.68/100,000; central nervous system-triggered blindness; 0.56/100,000, and tapetoretinal degenerations, 0.52/100,000. DISCUSSION: Due to monetary incentives for the blind persons, social service files offer accurate and complete data. Besides macular degeneration, glaucoma and diabetic retinopathy are major causes of blindness. Thus, this study suggests further blindness prevention activities for diabetic retinopathy and glaucoma.

Adolescent↗
PubMed1998

[Checklist for methodological quality of guidelines. A contribution to quality promotion of medical guidelines].

The society of physicians of Germany and the society of panel physicians laid down in the "assessment criteria for guidelines in medical care" what kind of demands the medical selfadministration makes on guidelines. This measure also had the goal to support and strengthen the efforts of the AWMF for guidelines of high value. On the basis of these assessment criteria, a tool was compiled for the systematic registration and documentation of quality criteria for good guidelines for the first time in areas of German language. This check list is guided by the structure and content of the "Criteria for Appraisal for National Guidelines" by the Scottish Intercollegiate Guidelines Network.

Germany↗
PubMed1997

[New blindness incidents in Württemberg-Hohenzollern].

UNLABELLED: Blindness causes human suffering and high social costs. Preventive measures are necessary. Virtually all blind people are registered with the social services. Data from these institutions may help in (long-term) planning for blindness prevention. MATERIAL AND METHODS: The present investigation analysed data from the social services of the region Württemberg-Hohenzollern. The files contained information on ocular status, year of birth, district, and sex of newly blind subjects of the year 1994. RESULTS: Two thirds (66.8%) of newly blind subjects are women. About half (47.8%) of all subjects are over 80 years of age. The most frequent causes of blindness are: macular degeneration, 33.7%; diabetic retinopathy, 17.3%; glaucoma, 13.8%; and high myopia, 6.6%. CONCLUSIONS: Blindness is increasingly a problem of high age. Diabetic retinopathy and glaucoma are still major causes of blindness. For these diseases blindness prevention is conceivable. Thus co-ordinated blindness prevention activities should focus on diabetic retinopathy and glaucoma.

Adolescent↗
PubMed1997

[Low molecular weight heparin, reviparin, after PTCA: results of a randomized double-blind, standard heparin and placebo controlled multicenter study (REDUCE Study].

BACKGROUND: Unfractionated heparin and its low molecular fragments possess antiproliferative effects and have been shown to reduce neointimal smooth muscle cell migration and proliferation in response to vascular injury in experimental studies. OBJECTIVES: The specific objective of the REDUCE trial was to evaluate the effect of a low molecular weight heparin on the incidence and occurrence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty. METHODS: The REDUCE trial is an international prospective, randomized, double-blind, multicenter study. Twenty-six centers in Europe and Canada enrolled 625 patients with single lesion coronary artery obstructions suitable for PTCA. Three hundred and six patients received reviparin as a 7000 U bolus before PTCA followed by 10,500 U as an infusion over 24 hours and then twice a day 3500 U s.c. application for 28 days. The 306 patients in the control group received a bolus of 10,000 U unfractionated heparin followed by an infusion of 24,000 U over 24 hours. These patients then received 28 days of s.c. placebo injections. The primary endpoints were efficacy (defined as a reduction in the incidence of major adverse events, i.e., death, myocardial infarction, need for reintervention or bypass surgery), absolute loss of minimal luminal diameter, and incidence of restenosis during the observation period of 30 weeks after PTCA. RESULTS: Using the intention-to-treat analysis for all patients, 102 patients (33.3%) of the reviparin group and 98 patients (32%) of the control group have reached a primary clinical endpoint (relative risk = 0.98; 95% confidence limit, 0.88-1.09; p = 0.707). Likewise, no difference in late loss of minimal luminal diameter was evident for either group. Acute events within 24 hrs occurred in 3.9% of the reviparin group and in 8.2% of the control group (relative risk = 0.49; 95% confidence limit, 0.26-0.92; p = 0.027) during or immediately after the initial procedure. In the control group, 8 major bleedings occurred, and in the reviparin group, 7 major bleeding complications were observed within 35 days after PTCA. CONCLUSIONS: Reviparin use during and after coronary angioplasty did not reduce the occurrence of major clinical events or the incidence of angiographic restenosis over 30 weeks.

Adult↗
PubMed1997

Internal and external measures of quality assurance in gynecological surgery.

In the light of exploding costs in health care and increasing demands for public accountability, gynecological surgeons are forced to improve the effectiveness and efficiency of their care in order to increase the satisfaction of their 'clients'. To do so, the implementation of a structured quality management system in gynecological care units is strongly encouraged. Basic requirements for an efficient quality management system comprise developing appropriate structures for the system, training staff in management techniques and using tools to monitor the quality of care. An important part of a quality management system is structured data collection permitting regional benchmarking between hospitals. The study 'Quality assurance in gynecological surgery' of the German Society of Gynecology and Obstetrics is mentioned as an example of such an external measure. Profiles help gynecological care units to recognize problem areas of their care. A list of further structural characteristics of a quality-oriented gynecological care unit, such as second opinion techniques or the application of clinical practice guidelines, is given to enable the evaluation or certification of quality management systems in gynecological departments.

Accreditation↗
PubMed1997

[Experiences with external quality assurance in gynecologic surgery].

A project, 'Quality Management in Gynecological Surgery', was developed as an external means of quality management in gynecological surgery and tested in 44 clinics in 1994. The external comparison of clinics generally demonstrated the high quality of the services, but certain aspects of these services exhibited an extremely high variability, for instance as far as thrombosis prevention and the choice of the routes of access for defined interventions are concerned. The positive effects of the project were that the clinics used the comparative data provided by the project as a basis to modify the management processes and thus improved the quality of their services. On the other hand, the external comparisons uncovered the need for guidelines for the management of patients. It will now be the responsibility of the gynecological societies to establish such guidelines and communicate them to their members via the appropriate channels.

Female↗
PubMed1997

[Effects of quality assurance measures on surgical gynecology treatment].

Basing on the example of the project "Quality assurance in gynaecological surgery", we show which effects due to participation in an externally supported quality assurance measure can be reached short-term. 44 gynaecological clinics documented 42,433 operative procedures within the project in 1994. In 1995, seven participants continued the documentation (9,430 operations). We measured the quality of care over time, using 20 quality indicators that were formulated in the project. Quality improvements were achieved in the two-year study period particularly for indicators which focused on less complex processes of care (i.e. thromboprophylaxis with heparin). However, more complex processes of care, such as the indication for an operation, have not yet changed. Nevertheless, according to the results of structured interviews, we expect long-term quality improvements: due to the participation in the project, 26 clinics reported increasing attention to the quality of care, 12 clinics changed their organisation of the quality assurance system and 11 clinics began internal quality improvement projects on the basis of the study benchmarks.

Female↗
PubMed1997

[Modern techniques for quality control and quality management in gynecological health care].

Information technologies may contribute in many effective ways to total quality management. Their supporting capacity concerns areas such as clinical documentation and quality control as well as problem analysis, quality assurance and improvement and knowledge management. Here however, a great deficit of the available departmental information systems must be stated.

Documentation↗
PubMed1997

[Quality and innovation management in surgery for the patient's benefit].

While the objective of management of innovations is to move the achievable quality in the direction of maximum quality, the purpose of quality management is to achieve the achievable quality everywhere. Other than in pharmaceutical and medicinal products and in out-patient care, there is no systematic technology assessment for hospital care in Germany. Before broadly implementing innovations in health care, they have to be embedded in good clinical practice guidelines to assure their appropriate indication and performance. Since health insurance funds are the greatest profiteers, they should fill the financial gap for the research of transferring innovations into daily medical practice.

Diffusion of Innovation↗
PubMed1996

Low molecular weight heparin (reviparin) in percutaneous transluminal coronary angioplasty. Results of a randomized, double-blind, unfractionated heparin and placebo-controlled, multicenter trial (REDUCE trial). Reduction of Restenosis After PTCA, Early Administration of Reviparin in a Double-Blind Unfractionated Heparin and Placebo-Controlled Evaluation.

OBJECTIVES: The specific objective of the REDUCE trial was to evaluate the effect of low molecular weight heparin on the incidence and occurrence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). BACKGROUND: Unfractionated heparin and its low molecular weight fragments possess antiproliferative effects and have been shown to reduce neointimal smooth muscle cell migration and proliferation in response to vascular injury in experimental studies. METHODS: The REDUCE trial is an international prospective, randomized, double-blind, multicenter study. Twenty-six centers in Europe and Canada enrolled 625 patients with single-lesion coronary artery obstructions suitable for PTCA. Three hundred six patients received reviparin as a 7,000-U bolus before PTCA, followed by 10,500 U as an infusion over 24 h and then twice-daily 3,500-U subcutaneous application for 28 days. The 306 patients in the control group received a bolus of 10,000 U of unfractionated heparin followed by an infusion of 24,000 U over 24 h. These patients then underwent 28 days of subcutaneous placebo injections. The primary end points were efficacy (defined as a reduction in the incidence of major adverse events [i.e., death, myocardial infarction, need for reintervention or bypass surgery]), absolute loss of minimal lumen diameter and incidence of restenosis during the observation period of 30 weeks after PTCA. RESULTS: Using the intention to treat analysis for all patients, 102 (33.3%) in the reviparin group and 98 (32%) in the control group have reached a primary clinical end point (relative risk [RR] 1.04, 95% confidence interval [CI] 0.83 to 1.31, p = 0.707). Likewise, no difference in late loss of minimal lumen diameter was evident for both groups. Acute events within 24 h occurred in 12 patients (3.9%) in the reviparin group and 25 (8.2%) in the control group (RR 0.49, 95% CI 0.26 to 0.92, p = 0.027) during or immediately after the initial procedure. In the control group, eight major bleeding complications occurred, and in the reviparin group, seven were observed within 35 days after PTCA. CONCLUSIONS: Reviparin use during and after coronary angioplasty did not reduce the occurrence of major clinical events or the incidence of angiographic restenosis over 30 weeks.

Angioplasty, Balloon, Coronary↗
PubMed1996

[Noise field screening. Results of a television field study for detection of visual field defects].

White noise field campimetry is able to transform usually negative scotomas immediately into perceivable visual field defects. As this method needs a monitor, the obvious solution was to evaluate the suitability of the noise field stimulus broadcasted to home TV sets. Therefore, in cooperation with the "Süddeutscher Rundfunk" (SDR) as well as several health insurance companies ("AOK Baden-Württemberg" and other "RVO-Kassen"), approximately 300,000 viewers were invited to take this test after receiving brief information and instruction. There were 531 calls for questionnaires to document the subjects' findings and the results of a subsequent ophthalmological examination. In most cases this clarified the perceived noise field defect. Out of 127 evaluable questionnaires, 78 cases did not show any relevant ophthalmological pathology; this held true especially for lesions of the visual pathway. However, in 49 persons the ophthalmologists detected pathological findings; in 20 of these, the scotomas were previously unknown to the physicians. Glaucomatous optic neuropathy and macular degeneration were most frequently diagnosed as causing the white noise field defects. Finally, some preliminary estimates of the costs and benefit of this study are presented.

Adolescent↗
PubMed1996

[Basic principles of quality management in public health service].

Philosophy, objectives and tools of Total Quality Management are applicable in Public Health services as in every other business. However, they need special adaptation. In Public Health offices requirements of an effective Total Quality Management are the commitment of the top management, an appropriate structure of the quality management system, customer orientation and quality awareness of the personnel, quality indicators and the existence of procedures for problem recognition, good command of the tools of quality management, and the knowledge of the effectiveness of implemented traditional quality assurance measures. Certification procedures following the European Quality Award seem to be appropriate for a global evaluation of quality and quality management of a Public Health office.

Forecasting↗