[Shared decision making: need or current trend?].
Explore the source record for details and available documents.
Decision Making↗
Biomedical subjects
J Schilling
Publications and source records attributed to J Schilling.
Immunoglobulin isotype profile of tissue transglutaminase autoantibodies is correlated with the clinical presentation of coeliac disease.
Coeliac disease (CD) is characterized by the appearance of autoantibodies against tissue transglutaminase (tTG-Ab). Immunoglobulin A (IgA) tTG-Ab have been described as excellent diagnostic markers, but the Ig subclass distribution and the importance of isotype tTG-Ab have not yet been established. In this study, using newly developed isotype- and subclass-specific radioligand assays, we examined anti-tTG IgA1, IgA2, IgG1, IgG4 and IgE antibodies in 30 symptomatic, untreated patients with CD and 22 subjects suspected to suffer from silent CD (sCD). Among 30 patients with CD, 27 (90.0%) were positive for IgA1 tTG-Ab, whereas only 12 (40.0%) had autoantibodies of the IgA2 subclass (P <0.001). IgG1, IgG4 and IgE tTG-Ab were detected in 17 (56.6%), 0 and 3 (10.0%) individuals, respectively. IgA1 was also the predominant anti-tTG subclass in patients with sCD (n=20, 90.1%), followed by IgA2 antibodies (n=7, 31.8%), IgG1 antibodies (n=4, 18.2%), IgG4 antibodies (n=1, 4.5%) and IgE antibodies (n=1, 4.5%). The comparison between both groups revealed a significantly higher prevalence of IgG1 antibodies in patients with symptomatic CD (P <0.01). In 10 of 11 subjects undergoing an intestinal biopsy, the diagnosis of an sCD was confirmed. In this subgroup, there was a positive association between the presence of IgA2 and IgG1 tTG-Ab and severe (Marsh 2-3) mucosal abnormalities. In conclusion, patients with symptomatic and sCD predominantly have IgA1 tTG-Ab. IgG1 tTG-Ab are associated with symptomatic disease and, when present in patients with sCD, are correlated with a severe mucosal destruction. These data suggest that tTG-Ab subclasses could reflect inflammatory events associated with epithelial destruction.
Adolescent↗
Polymer nanotubes by wetting of ordered porous templates.
Explore the source record for details and available documents.
Journal Article↗
ATOP dyes. optimization of a multifunctional merocyanine chromophore for high refractive index modulation in photorefractive materials.
This paper reports synthesis, characterization and structural optimization of amino-thienyl-dioxocyano-pyridine (ATOP) chromophores toward a multifunctional amorphous material with unprecedented photorefractive performance. The structural (dynamic NMR, XRD) and electronic (UV/vis, electrooptical absorption, Kerr effect measurements) characterization of the ATOP chromophore revealed a cyanine-type pi-conjugated system with an intense and narrow absorption band (epsilon(max) = 140 000 L mol(-)(1) cm(-)(1)), high polarizability anisotropy (deltaalpha(0) = 55 x 10(-)(40) C V(-)(1) m(2)), and a large dipole moment (13 D). This combination of molecular electronic properties is a prerequisite for strong electrooptical response in photorefractive materials with low glass-transition temperature (T(g)). Other important materials-related properties such as compatibility with the photoconducting poly(N-vinylcarbazole) (PVK) host matrix, low melting point, low T(g), and film-forming capabilities were optimized by variation of four different alkyl substituents attached to the ATOP core. A morphologically stable PVK-based composite containing 40 wt % of ATOP-3 showed an excellent photorefractive response characterized by a refractive index modulation of Deltan approximately 0.007 and a gain coefficient of Gamma approximately 180 cm(-)(1) at a moderate electrical field strength of E = 35 V microm(-)(1). Even larger effects were observed with thin amorphous films consisting of the pure glass-forming dye ATOP-4 (T(g) = 16 degrees C) and 1 wt % of the photosensitizer 2,4,7-trinitro-9-fluorenylidene-malononitrile (TNFM). This material showed complete internal diffraction at a field strength of only E = 10 V microm(-)(1) and Deltan reached 0.01 at only E = 22 V microm(-)(1) without addition of any specific photoconductor.
Journal Article↗
Glial tumor cell adhesion is mediated by binding of the FNIII domain of receptor protein tyrosine phosphatase beta (RPTPbeta) to tenascin C.
The extracellular domain of receptor protein tyrosine phosphatase beta (RPTPbeta) is composed of several domains which mediate its interactions with distinct ligands present on the surface of either neurons or glial cells. Here, we demonstrate that the fibronectin type III domain (FNIII) of RPTPbeta binds to glial tumor-derived cell lines and primary astrocytes. We used affinity purification to isolate several proteins that specifically bind to the FNIII domain of RPTPbeta. One of these, a 240 kDa protein that was purified from U118MG glioblastoma cell, was identified as tenascin C based on the amino acid sequence of several tryptic peptides. The interaction of RPTPbeta with tenascin C was found to mediate cell adhesion. Adhesion and spreading of SF763T astrocytoma cells expressing RPTPbeta on tenascin C was specifically abolished by the addition of a soluble fragment containing the FNIII domain of the receptor. RPTPbeta-dependent cell adhesion was mediated by binding to the alternatively spliced FNIII repeats A1,2,4 (TnfnA1,2,4) of tenascin C. Furthermore, COS cells expressing RPTPbeta adhere to TnfnA1,2,4, while the parental cells did not. These results demonstrate that the FNIII domain of RPTPbeta binds to tenascin C and suggest that RPTPbeta present on glial tumor cells is a primary adhesion receptor system to the extracellular matrix.
Animals↗
Methods of the National Check Bus Project.
OBJECTIVES: Prevention at the worksite is considered increasingly important. This paper describes the methods used in a nationwide prevention campaign performed at a large Swiss bank and a Swiss industrial company. The aim of this project was to encourage general health awareness among company employees. We also aimed to provide the companies with general health analyses of their staff as a basis for future health promotion. Furthermore, new screening methods were evaluated in the field of research. METHODS: Participation in the programme was voluntary and free of charge. The programme targeted all 25,243 employees of the two companies in all regions of Switzerland. A mobile unit was available on site. The programme included a written health questionnaire and medical examinations (e.g., blood pressure, blood tests, ultrasound of the common carotid artery, osteodensitometry, examinations of the eye, etc). Analysis of individual test results, information brochures, and a telephone information service were also provided. Based on the data of the individuals, the "health status" of the employees of the two companies was analysed. The companies did not have access to the data of the individuals. The programme ran from August 1996 to August 1998. RESULTS: With a total of 10,321 persons taking part in the project, the participation rate was 41%. For the different examinations offered, patterns of participation were identifiable that varied with age, hierarchical status within the concern, body mass index, and number of physical complaints of the employee. Some of the variables showed the same trend for different tests, while others showed opposite trends. CONCLUSIONS: Participation in worksite health promotion programmes is dependent on a complex system of individual and structural variables that need to be considered when planning worksite health promotion programmes. Consideration of specific target population characteristics, including motivations and incentives as well as structural constraints is likely to improve participation rates in worksite health promotion programmes among employees.
Adolescent↗
Health technology assessment of three screening methods in Switzerland.
OBJECTIVE: To describe the level of health technology assessments for three screening methods in Switzerland. METHODS: Analysis of documents and expert opinions on mammography screening, ultrasound examinations during normal pregnancy, and screening for prostate-specific antigen (PSA) with a focus on services provided, recommendations, formal regulations, national papers, projects, and formal assessments. RESULTS: Preventive services are explicitly recommended by the Swiss federal law on health insurance. Two routine ultrasound examinations during normal pregnancy as well as PSA analysis for men over 40 years of age on medical indication are covered by basic health insurance. Mammography screening every 2 years has been covered since 1997 for women over 50 years. A systematic screening program for mammography exists in the western part of Switzerland, and a nationwide program is planned. However, a national program may not come into being until a quality assurance program for evaluation is established, and a nationwide fee for reimbursement-to include all costs of such a program-is accepted by providers and insurers. CONCLUSION: According to the Swiss health insurance law, the effectiveness of mammography screening and ultrasound examinations during normal pregnancy have to be proven. Systematic evaluation of these screening methods is in preparation. PSA is not part of current evaluation. It can be concluded that health technology assessment in Switzerland is now required by law for several medical services. However, limited financial and personnel resources as well as the lack of disease registers may hamper progress in the near future.
Adult↗
Quality programmes, accreditation and certification in Switzerland.
PURPOSE: To report on current quality initiatives in health care in the context of accreditation and certification in Switzerland. SOURCE OF INFORMATION: A review from the Swiss Accreditation Service, the Swiss Medical Association and the University of Zurich. SETTING: In Switzerland, health care providers and health insurers are obliged by law to sign contracts on quality of care. The law texts and related ordinances do not state explicitly the content and format of quality contracts between providers and costs payers. Finding adequate practical solutions is the responsibility of the partners involved. Six different possibilities of quality initiatives are studied and discussed in this report. These include initiatives to create independent certification or inspection bodies for health care organizations accredited by the national accreditation body. FINDINGS: So far, there is only one established standardized system with clear requirements. This accreditation and certification model is an adaptation of the International Standards Organization but so far it has not been used often in the public domain. Each of the other five approaches are more frequently applied but none of them lead to full external peer review certification including medical outcome yet. CONCLUSIONS: A lot of harmonization work still has to be done and clear branch specific requirements need to be agreed upon. Practicability and validity of external peer review schemes may also need further evaluation and improvement to reach the goals of health care systems in the future.
Accreditation↗
[Quality of dispensation of prescription medication from the patients' point of view].
A cross-sectional survey investigated quality relevant aspects of the most common distribution channels (pharmacies, self-dispensing physicians) for prescription drugs in Switzerland. A self-administered questionnaire focusing on consumers' behaviour, perception and priorities regarding the process of dispensation of prescriptive medication was mailed to a random sample of 3000 patients, aged 18 years or older, with regular intake of prescriptive medication. Chi-square analysis was performed on 1058 responses. 60% of the respondents received their medication mainly or exclusively from pharmacies and 40% from self-dispensing physicians. In German-speaking Switzerland 53% of participants received their prescription drugs exclusively or mainly from self-dispensing physicians, compared to only 10% in the French-speaking area (p = 0.00). This distribution confirms the existing differences in regulation of self-dispensation in these regions. Most of the patients took 2-4 prescriptive drugs a day. The French Swiss received slightly more prescriptive medication than the German Swiss (p = 0.05). 45% of the participants, especially women and people using a pharmacy, reported additional, usually occasional over-the-counter medication. Provision of technical information (41%), friendliness (19%), and the availability of drugs (19%) were valued most important when receiving prescription drugs and 96% of the participants were satisfied with the service. In consequence, the participants were strongly bound to their source of drug supply. Some 80% received instructions for use there. However, only half were informed about the purpose of the medication, drugs' side effects, or possible drug interactions. Physicians provided such information more often than pharmacy staff. This observation may be attributable to the double role played by the self-dispensers, who provide medical care and at the same time hand out the drug. In conclusion, patients' satisfaction is achieved equally by both medication channels. However, there is a need to improve counselling to ensure excellence in the supply of drugs.
Adult↗
The Swiss database on quality projects in medical institutions.
Since the early 1990s it is important for every medical institution to report on activities in the field of quality improvement and quality assessment because there is a certain pressure from the market and from health insurance laws in various countries. Nevertheless, researchers as well as clinicians or administrators are rarely informed on ongoing projects. To register projects in quality research, an Internet-based information system was established to register projects on quality of medical institutions. Among others, hospitals, private doctors' offices, medical specialty societies and cost-payers are regarded as institutions in this effort. An interactive database provides information on the institution performing a project and on what is being/has been performed in a certain place during a certain period of time. At present medical institutions are invited to report on their projects, but this initiative can only succeed if it provides information from as many different institutions as possible: for data skills and help your colleagues! Place your knowledge, activities and information at disposal to the public and profit from your colleagues.
Databases as Topic↗
Health technology assessment in Switzerland.
Switzerland has a mixed public and private healthcare system. All citizens are enrolled in compulsory basic health insurance. A 1996 law allows people to choose among different sickness funds and managed care plans. The federal government is empowered to act on important health issues, but the 26 cantons have prime responsibility in health care and social welfare. They have their own laws on health care, hygiene, hospitals, and social welfare. These laws are not harmonized. The system is complex, with a mix of public (mainly hospitals) and private (mainly doctors' offices) providers. The health services are decentralized. Ambulatory care was traditionally provided in doctors' offices, but the last decade has seen the development of centers for day surgery, group practices, and managed care plans. Decisions on placement, location, and extension of services are decentralized. The payment system is very complex. Current trends include global budgets, cost analyses, and prices related to patient categories. However, coverage policy is developed centrally and includes both traditionally established services and new technologies. New technologies are added to the list only after evaluation by the Federal Coverage Committee. The coverage process integrates health technology assessment (HTA). Coverage can be granted in stages, including limited coverage and temporary coverage. Technologies and coverage can be reevaluated on the basis of registries or assessment information. The structure of the Swiss healthcare system does not lend itself to the establishment of a national HTA program. However, recent moves include the development of a coordinating mechanism for HTA in Switzerland.
Delivery of Health Care↗
Appropriateness and necessity research on the Internet: using a "second opinion system".
Appropriateness and necessity research of various procedures in medicine may be the most complex field of innovation in healthcare and technology assessment. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal quality components of structures, processes and outcomes become irrelevant without a proper indication. The first part of our appropriateness initiative in interventional cardiology and gynecology was to formulate guidelines. To define the appropriateness for coronary angiography, coronary revascularization and hysterectomy, literature-based consensus methods were used. The second part was to disseminate the guidelines in a user-friendly manner via the Internet. Therefore, we relied on a system-driven query facility for propositional (experts) rules. The next part of the appropriateness initiative may be a user-friendly Internet-based data collection system to validate the national accepted guidelines. Most important may be that only data that is needed can be collected using a refined database technology. The described Second Opinion System can be found under: http:sos.inf.ethz.ch. Research on indications with data on clinical outcome may open new opportunities to validate indication guidelines using Internet/database technology for data analysis and browsing of decision graphs concerning clinical decision-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes.
Aged↗
[Possible future of the project for quality assurance of indications and outcome in interventional cardiology and gynecology].
In the last few years the basis for national guidelines for the indications of coronary angiography, coronary revascularisation and hysterectomy has been established. The guidelines have been published and are accessible to medical doctors and patients on the Internet using a database system called "Second Opinion System": http:/(/)sos.inf.ethz.ch Dissemination, implementation and validation of the guidelines will be of major importance in the near future. With reference to validation, the question remains whether the established guidelines are correct for the everyday treatment of patients. A suitable method of answering this important question is comparison between the appropriateness and necessity rates of the various indication groups, combined with outcome measurements. The Internet-based second opinion system (SOS) may be used for data collection in order to verify hypotheses. Because of the database architecture, only relevant information about the patients is collected via Internet, independent of time and place. In addition, the system allows users to evaluate their individual data, and special attention is given to data protection. The discussion about priorities in health care (rationing) will be increasingly important in the near future. The present project may offer a way of maintaining adequate access to health care services for patients. Therefore, the participation of as many institutions as possible in the project "quality assurance of indication and outcome in interventional cardiology and in gynaecology" is of great importance.
Cardiology↗
Patient throughput times for orthopedic outpatients in a department of radiology: results of an interdisciplinary quality management program.
The purpose of this project was to employ quality management methods in order to decrease throughput times for orthopedic outpatients sent to the department of radiology. The following intervals were measured at the onset of the study and after 6 and 12 months: (a) between arrivals at outpatient clinic and radiology counter; (b) between arrival at radiology counter and time of last radiograph; and (c) between time of last radiograph and radiology report printing time. After the initial measurement, numerous changes were initiated both in radiology and in orthopedic surgery. The mean interval between arrival at the outpatient clinic and in radiology decreased by one third from 60 min during the first measurement to 40 (p < 0.001) and 41 min during the second and third measurement. The proportion of patients with total radiology times of more than 30 min decreased from 41 to 29 % between the first and third measurements (p < 0.001). The corresponding results for radiology times of more than 45 min were 17 and 11 % (p = 0.03). A standard type of quality management program can be employed successfully in order to reduce radiology throughput times for orthopedic outpatients.
Ambulatory Care↗
Swiss consensus guidelines for hysterectomy. Swiss Society of Gynecology and Obstetrics, Switzerland.
OBJECTIVE: The quality of the indication for hysterectomy is widely discussed at present. In early 1996, the committee for quality assurance of the Swiss Society of Gynecology and Obstetrics decided to set up nationally accepted guidelines for the indication of hysterectomy. METHODS: A modified Delphi approach was used. In a first step, general guidelines and actions prior to hysterectomy were defined. An expert panel of 17 Swiss gynecologists rated 74 frequent indications, twice for appropriateness (more benefits than risks for the patient), once for necessity (n = 34; procedure has to be offered or discussed with the patient), and outlined suggestions to be performed prior to hysterectomy. RESULTS: In a home rating round before the first panel met, there was an agreement rate of 48%. In 45% we observed neither agreement nor disagreement; in 7% we found disagreement. After the panel discussion 89% of experts agreed, 11% were indeterminate, and there was no disagreement. The necessity ratings showed agreement in 68% while 32% were indeterminate. The average median rating on a 1-9 point scale (1 = extremely inappropriate, 9 = extremely appropriate or necessary) was 5.4 over all single indications for appropriateness and 7.8 in single indications for necessity. After a second panel for consensus all panelists agreed on both appropriateness and necessity. CONCLUSION: The results of the appropriateness and necessity consensus presented in this paper reflect the findings of a 17 member Swiss panel. This joint effort by a medical society may be a step towards the direction of a peer controlled healthcare system.
Congresses as Topic↗
Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients.
OBJECTIVE: To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN: Randomized, prospective, double-blind, placebo-controlled study. SETTING: Two university-affiliated hospitals in Switzerland. PATIENTS: Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS: Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS: Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.
Abdomen↗
Dynamic changes in the immunoreactivity of neuropeptide systems of the suprachiasmatic nuclei in golden hamsters during the sleep-wake cycle.
The sleep-wake cycle is virtually the most prominent circadian rhythm in mammals. In the timing system of sleep and wakefulness, the intrinsic neuropeptide systems of the suprachiasmatic nuclei (SCN) may play an important role. To elucidate this possible influence in the golden hamster, the immunoreactivity patterns of the suprachiasmatic gastrin-releasing peptide (GRP), vasoactive intestinal polypeptide (VIP), and arginine-vasopressin (AVP) systems were investigated in relation to the day-night and sleep-wake cycle by use of immunocytochemistry combined with semiquantitative planimetric analysis. For the GRP system, the highest level of immunoreactivity (expressed as area density) was observed in sleeping hamsters. Intermediate levels were found in awake, motorically active evening animals, whereas the lowest levels of immunoreactivity were detected in awake, motorically inactive hamsters studied in the morning. The immunoreactivity of the VIP system showed a completely opposite pattern, indicating highest area density in awake morning, intermediate area density in awake evening and lowest area density in sleeping golden hamsters. The immunoreactivity pattern of the AVP system, displaying highest levels in sleeping individuals, was virtually identical to that of the GRP system. Together with the related signs of neuronal activity, the present results favor an important role of these neuropeptide systems for the integration of central nervous information related to the sleep-wake cycle with photic information of the retinal input.
Animals↗
Quality assessment in gynecology and obstetrics. Projects and experience in Switzerland.
The first steps in quality assessment of results of performance in gynecology and obstetrics were taken by the Swiss Association of the OB/GYN Clinics of the Swiss Society of Obstetrics and Gynecology in the 1980's. Currently, medical data of more than 800,000 patients are available, allowing a good comparison of the quality of results. Concerned that purchasing coverage for health services was made exclusively on the basis of cost, resulting in lower public health quality, the Swiss Society of OB/GYN set up a Board of Quality Assessment in 1995. Not only the quality of results, but also the quality of indications, structures and processes are considered by using a modified Donabedian model. Moreover, standardized patient information forms have been worked out for 15 gynecological and five obstetrical operations. Since hysterectomy is the most common major gynecological operation in Switzerland, the evaluation of the quality of the indications is of substantial interest. Guided by the RAND Appropriateness Method, criteria for quality assessment with respect to appropriateness and necessity of hysterectomy have been drawn up. Swiss guidelines and 125 different clinical scenarios are defined by a panel of 22 OB/GYN experts. The aim of this project is to offer an interactive second opinion system, called "Swiss Guidelines for Hysterectomy", and anonymous self-assessment of quality. Appropriateness and necessity of medical procedures have to be defined by medical professionals providing a proper balance between the patient's desires and financial demands.
Female↗