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Biomedical subjects

H Stalder

Publications and source records attributed to H Stalder.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Procedures and technical aptitude of primary care physicians: which practice?].

PROBLEM: There is little knowledge of the practices of private physicians in Switzerland. However, this knowledge is a prerequisite for definition of the learning objectives in post-graduate and continuous education. OBJECTIVE: To ascertain the procedural skills of family physicians and general internists and compare them with variables such as education and the location of practice. METHOD: Questionnaire containing 68 procedural skills sent to all family physicians and general internists in the Cantons of Valais (VS) and Geneva (GE). RESULTS: 142/204 questionnaires (69%) were analyzed. A mean of 28.7 skills are practiced by the physicians. The internists use fewer procedures than the generalists. There is no difference between generalists practising in VS and GE, nor between location of the practice (urban or rural). The internists in GE and/or those practising in urban settings use fewer procedures than those practising in VS and in rural locations. Internists practising in rural setting use the same number of procedures than the generalists. Fifteen procedures are used by > or = 75% of physicians, 6 of these concern X-ray procedures. 60% of the procedures are used more frequently by the generalists, in particular surgical, ENT and gynecological procedures. There is no difference between generalists and internists as far emergency procedures or procedures in the cardiological and pneumological domain are concerned. CONCLUSIONS: The number of procedures depends nor only on the speciality of the private physician (generalist or general internist), but also and mainly on the location of the practice, the density of physicians and emergency practice. These findings can be used in defining the learning objectives of the primary care curriculum.

Clinical Competence↗
PubMed1997

[Procedures and technical aptitude of primary care physicians: which education?].

OBJECTIVE: To ascertain the educational goals of internal medicine teachers in the domain of clinical skills, the realization of these objectives and their pertinence for the practice of primary care physicians. METHODS: Questionnaire containing 44 clinical skills sent to the chiefs of the services of internal medicine of public hospitals in French-speaking Switzerland and the 5 Swiss university hospitals. Comparison of these results with an earlier study concerning the practice of clinical skills of the primary care physicians. RESULTS: The participation was 82%. The educational goals were identical for all the chiefs of internal medicine independently of whether they were university-dependent or not, or in a large or small hospital. 22 of the proposed clinical skills were considered as teaching goals for > or = 70% of the heads of medicine. However, they thought that only 8 of these 22 skills were acquired by the majority of their residents. 8 of these 22 skills were considered to be indispensable for proper functioning of the service. There was a good correlation between the acquired skills and those considered to be indispensable for proper functioning of the service. The medical chiefs considered most of the skills practiced by the primary care physicians were also educational objectives. However, they thought that only 23% of these skills were acquired by their residents. Only half of the skills considered as acquired were practiced by a majority of the primary care physicians. CONCLUSIONS: Many clinical skills are considered as educational goals by the medical chiefs of hospital services in internal medicine. However, they consider only a third of these goals as acquired by their residents at the end of their residency. There was a good correlation between the skills thought to be acquired and those considered to be indispensable for proper functioning of their service, and a poor correlation between the skills considered as acquired and those practiced by primary care physicians.

Clinical Competence↗
PubMed1996

Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions.

BACKGROUND: Upper-respiratory-tract infection is one of the main causes of overuse of antibiotics. We have found previously that bacteria such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae can be isolated from the nasopharyngeal secretions of a substantial proportion of adults with upper-respiratory-tract infections. We have assessed the efficacy of co-amoxiclav in patients with common colds but no clinical signs of sinusitis or other indications for antibiotics. METHODS: Between January, 1992 and March, 1994, 314 patients who presented to our outpatient clinic with common colds were enrolled in the double-blind, placebo-controlled study. They were randomly assigned 5 days' treatment with co-amoxiclav (375 mg three times daily) or identical placebo. Clinical examinations were done at enrolment and on day 5-7 to assess outcome (cured, persistent symptoms, worse symptoms). Seven patients were excluded after randomisation, seven did not have nasopharyngeal aspiration, and 12 did not return for followup assessment. FINDINGS: Of 300 patients with nasopharyngeal aspirates, 72 had negative bacterial cultures, 167 had cultures positive only for bacteria unrelated to respiratory infections, and 61 had cultures positive for H influenzae, M catarrhalis, or S pneumoniae. At 5-day follow-up of these culture-positive patients, the distribution of outcome was significantly better among co-amoxiclav-treated (n=30) than placebo-treated (n=28) patients (cured 27 vs 4%; persistent symptoms 70 vs 60%; worse symptoms 3 vs 36%; p=0.001). Patients on co-amoxiclav also scored their symptoms significantly lower than patients on placebo (p=0.008). Among culture-negative patients (n=230), the outcome distribution did not differ between the treatment groups (p=0.392). INTERPRETATION: The majority of patients with upper-respiratory-tract infection do not benefit from antibiotics and side-effects are frequent. However, for the subgroup whose nasopharyngeal secretions contain H influenzae, M catarrhalis, or S pneumoniae, antibiotics are clinically beneficial.

Adult↗
PubMed1996

[Patient satisfaction in the ambulatory setting: validation of a scale and identification of associated factors].

BACKGROUND: Patient satisfaction is increasingly used to evaluate the performance of health services. Validated French-language instruments to measure satisfaction are currently lacking. This study was designed to validate a questionnaire of this kind and to identify factors associated with patient satisfaction. METHODS: Mail survey of 1027 patients who consulted at 4 different ambulatory health care settings in Geneva, Switzerland. The participation rate was 81%. The questionnaire measured 7 dimensions of satisfaction using 16 items adapted from other sources. RESULTS: The questionnaire was easy to respond to (scores were available for 95 to 99% of respondents, depending on the scale). The internal consistency of the scales was satisfactory (Cronbach alpha between 0.65 and 0.82) for 5 of 6 multi-item scales; it was lower for the scale which measures satisfaction with access to care. Factor analysis identified two principal components corresponding roughly to the "process" and to the "organization" of care. Open comments also confirmed the validity of the multi-item scales. Several patient or visit characteristics were independently associated with the level of satisfaction: older patients, those who were born in Switzerland, who had a visit appointment, who consulted a specialist, and those who saw the same physician as at their previous visit were more satisfied than other patients. CONCLUSIONS: The brief satisfaction questionnaire described in this paper is easy to use, and its reliability and validity are good. Its use can be recommended in ambulatory health care settings. Several variables associated with the level of satisfaction were identified; they should be measured in satisfaction surveys to allow correct appraisal of the results.

Adolescent↗
PubMed1996

Acute bilateral carpal tunnel syndrome associated with human parvovirus B19 infection.

Human parvovirus B19 has been described as a causative agent of erythema infectiosum (a disease common in children), aplastic crisis in patients with hemolytic disorders, and arthralgias and arthritis. Joint involvement may be a prominent clinical feature of parvovirus B19 infection and may last for several weeks. We describe three cases of acute bilateral carpal tunnel syndrome associated with parvovirus B19 infection as evidenced by serological data and, in one case, by detection of parvovirus B19 DNA in blood with use of PCR.

Acute Disease↗
PubMed1996

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland.

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.

Adolescent↗
PubMed1995

Genetic heterogeneity within the coding regions of E2 and NS3 in strains of bovine viral diarrhea virus.

We have amplified and sequenced parts of the genomes of eleven laboratory strains of bovine viral diarrhea (BVD) virus originating from North America, New Zealand and Europe. The cumulative nucleotide (nt) sequence heterogeneity of the amplified fragments located in the analysed region of the gene encoding the nonstructural protein NS3 (P80) was 24% as compared to 47% for E2 (Gp53). The nt substitutions in the E2 region resulted in replacements in 42% of amino acid (aa) positions, while the deduced aa sequence of all BVD virus strains remained identical in NS3 and differed from the corresponding region of classical swine fever viruses. This makes possible the differentiation of bovine and porcine pestiviruses. It is suggested that genetic heterogeneity results from passage in transiently infected animals.

Amino Acid Sequence↗
PubMed1995

Bone mass at lumbar spine and tibia in young males--impact of physical fitness, exercise, and anthropometric parameters: a prospective study in a cohort of military recruits.

Bone mineral density (BMD) and bone mineral content (BMC) were measured using DXA at lumbar spine and tibial diaphyses at the beginning and at the end of a 15-week training period in 151 military recruits of the Swiss army belonging to 5 different troop categories (infantry grenadiers, tank drivers, tank gunners, signalmen, and privates) who each were exposed to physical training of various intensity. At baseline, height, body mass index, and degree of physical fitness independently correlated with vertebral and tibial BMD. Over the 15 weeks of physical training BMD at tibial diaphyses increased by 2.2 +/- 0.3% at the left leg (p = 0.0001) and by 1.1% at the right leg (p = 0.002) with differences between troop categories. At lumbar spine, BMD decreased significantly in tank drivers (-1.2 +/- 0.4%, p = 0.001) and particularly in infantry grenadiers (-2.1 +/- 0.4%) who had the most strenuous weight-bearing training, but not in other troop categories. This decrease was twice as large at the center of the vertebra than for the whole vertebra. These BMD changes were associated with increments in serum levels of osteocalcin and alkaline phosphatase activity. From the initial cohort, 48 subjects volunteered for a third investigation carried out 2 years after the end of the military training period. At this time, lumbar BMD and BMC had risen back to baseline, whereas at tibial diaphyses bone width and BMC but not BMD increased by 5.8 +/- 1.1% and 6.2 +/- 0.9%, respectively, vs. baseline (p = 0.0001 for both).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

[Enterocolitis due to a saponin-containing drug. Apropos of a case].

The case of a 60-year-old female patient with watery diarrhea is reported. The history was characterized by prolonged diagnostic vagaries, due in part to histological features of ileal, rectal and duodenal biopsies which were suggestive of celiac disease. This was clinically excluded. After halting the intake of a compound drug containing saponins, administered for venous insufficiency, the diarrhea ceased immediately but could be provoked by rechallenge with the same drug. The patient thus had drug induced chronic diarrhea mimicking celiac disease, a condition which is less rare than is thought and easily diagnosed by a thorough enquiry on drug intake.

Biopsy↗
PubMed1994

Valgus tibial osteotomy in a patient with benign dominant osteopetrosis (Albers-Schoenberg disease). A case report.

Operation in osteopetrosis, or Albers-Schoenberg disease, needs careful technique because of the brittleness of the bone. We report a patient with autosomal-dominant osteopetrosis (MIM 166600)18 and unicompartmental osteoarthritis of the knee which was treated by a valgus tibial osteotomy. Our experience, and a review of the literature, shows that external fixation is a valuable form of treatment because it is noninvasive and ensures perfect interfragmentary compression.

Aged↗
PubMed1994

Do physicians take into account patients' expectations?

To determine whether patient expectations are fulfilled when they are expressed to physicians, self-administrated questionnaires were given to 360 consecutive ambulatory patients. Information was randomly given or not given to physicians. Diagnosis (94%), information about prognosis (82%) and prevention (76%), and continuing care (80%) were important expectations. There was no agreement between global or individual patient expectation and physician response (kappa < or = 0.3). The physicians prescribed more medications than expected, and almost never discussed prevention or prognosis. Finally, the characteristics of care were not different between the physicians who knew and those who did not know patient expectations. The authors conclude that ambulatory patients visit physicians to receive a diagnosis, continuing care, and information about prognosis and prevention. In this study, physician knowledge of those expectations did not increase their fulfillment.

Adult↗