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J Steurer

Publications and source records attributed to J Steurer.

At least 19 recordsLinked to original sources
PubMed2006

[Research interest by general practitioners: a survey].

BACKGROUND: For doing research on topics in primary care medicine participation of primary care physicians is necessary. Research in this field of medicine is only marginally established in Switzerland. OBJECTIVE: In a postal survey we evaluate the general attitudes of physicians towards research in the field of primary care. In particular we were interested in their willingness to participate in research projects and the facilitating and impeding factors to take part in such projects. METHODS: A purpose designed questionnaire was sent by post to 3044 primary care physicians in the central and eastern parts of Switzerland. RESULTS: The return rate was 52%. A majority of 94% of the responding physicians revealed interest in primary care research and 60% of all responders are willing to participate actively in such projects. They are prepared to spend about 15 min a day for data acquisition. Their willingness to participate depends on the conditions that, first, the research topic is relevant for daily practice and, second, boards odder Continuous Medical Education credits for time spent for research. Time constraints, additional administrative work and lack of relevance of research topics to daily practice are the main barriers. CONCLUSION: This survey demonstrates the general interest of primary care physicians to participate in relevant research projects. Therefore the structure to set up such research should be established.

Attitude of Health Personnel↗
PubMed2006

[Cardiovascular prediction rules: problems for application in practice results of a workshop].

Guidelines for primary prevention of cardiovascular disease recommend a management based on global cardiovascular risk calculated with prediction rules. While cardiovascular prediction rules are applied as a tool to estimate risk, Guidelines describe which consequences to be drawn based on this risk information. We performed a workshop to discuss open questions for application of prediction rules in primary care. Technical aspects may not be a problem, however, additional barriers for application in daily routine exist. First, accuracy of risk estimation is unclear for some of the prediction rules. Second, risk factors, which are intuitively relevant (like obesity), are lacking in most of the prediction rules. Third, differences between guidelines and prediction rules are sometimes not clear for the general physician. In this article we want to answer the most important questions, which have been discussed during the workshop.

Coronary Disease↗
PubMed2006

Patient education in asthma: a survey of physicians' knowledge of the principles and implementation of self management in practice.

BACKGROUND: Therapeutic patient education, particularly when including written instructions in self-management, improves outcomes in asthma. The education of patients in self-management requires specific knowledge and skills, which are not generally taught in under- or postgraduate training programmes. PURPOSE: To investigate physicians' knowledge of the principles and implementation of self-management in asthma care. METHOD: A 14-item questionnaire was developed, piloted and subsequently sent to 1039 general physicians (general practitioners and internists) and pulmonologists registered as members of the Medical Society of Zurich. RESULTS: 368 (35%) of the physicians returned the questionnaire. 352 (96%) stated that they care for patients with asthma, 312 (87%) provided asthma education, 264 (75%) gave information about the mechanisms of illness, 272 (77%) provided instructions on how to use inhalers although only 212 (60%) checked inhaler technique. 170 (48%) instructed patients in home measurement of peak flow recordings (PEFR). 21% of general physicians and 52% of pulmonologists provided written action plans outlining what actions to take if PEFR or symptoms deteriorated. The majority of physicians were aware of positive benefits of patient education and over 80% stated that all asthmatic patients should be offered education. Only 32% felt that they should personally be educating the patients whilst two-thirds expressed a preference for the education to be provided by a specialist centre. 66% of the physicians expressed a desire to undertake further training in effective patient education. CONCLUSION: Whilst most physicians in this study state to be aware of the benefits of patient education in asthma, only 24% actually provide their patients with asthma self-management plans. With a low response rate, our study is likely to be biased towards those physicians with a greater interest in asthma; hence actual use of self-management plans is likely be lower than in our sample.

Asthma↗
PubMed2006

[Check-up: general aspects].

A Check-up is characterized as a medical examination and a counselling of asymptomatic persons. The aim of such a Check-up is the identification of modifiable risk factors for different illnesses and/or the detection of a treatable, latent disease. The value and the cost-effectiveness of regular Check-up examinations can be assessed in scientific enquiries. However, the question whether regular Check-up examinations are or are not of value from an individual or societal point of view cannot be answered by the results of evaluative studies alone. This question should be discussed between an individual person and a physician or, in general, on a societal level. In addition, in this paper we discuss various tests recommended for a patient who requires a Check-up examination.

Adult↗
PubMed2006

Are mutans streptococci detected in preschool children a reliable predictive factor for dental caries risk? A systematic review.

Research suggests that mutans streptococci play an important role in cariogenesis in children but the usefulness of bacterial testing in risk assessment is unknown. Our objective was to summarize the literature assessing the association of mutans streptococci and dental caries in preschool children, (Pre)Medline (1966-2003), Embase (1980-2003), the Cochrane Register of Controlled Trials (2003, issue 3), and reference lists of included studies were searched. All abstracts found by the electronic searches (n = 981) were independently scrutinized by 2 reviewers. Minimal requirements for inclusion were assessment of preschool children without caries at baseline, reporting of mutans streptococci present in saliva or plaque at baseline and assessment of caries presence after a minimum of 6 months of follow-up. Participants' details, test methods, methodological characteristics and findings were extracted by one reviewer and cross-checked by another. Homogeneity was tested using chi2 tests. Results of plaque and saliva testing were pooled separately using a fixed effects model. Methodological quality of reports was low. Out of 9 studies included, data from 3 reports on plaque test assessment alone (n = 300) and from 4 reports on saliva test assessment alone (n = 451) were available for pooled analysis. The pooled risk ratio (95% CI) was 3.85 (2.48-5.96) in studies using plaque tests and 2.11 (1.47-3.02) in those using saliva testing. Presence of mutans streptococci, both in plaque or saliva of young caries-free children, appears to be associated with a considerable increase in caries risk. Lack of adjustment for potential confounders in the original studies, however, limits the extent to which interpretations for practice can be made.

Child, Preschool↗
PubMed2004

[Medical decision making: some aspects].

Three main aspects of medical decision making will be shortly described in this article. Comprehensible information is required to make decisions. The question is, how much information is needed to make decisions, and a third aspect in this article concerns the decision maker. Research in the field of information transfer has shown that medical information, as presented in most journals, is difficult to understand. According to the classic decision theory, decisions are taken after collecting all available information. More recent research in decision making proves the hypothesis that human beings are able to decide correctly with much less information than presumed earlier. In medicine the patient is the decision maker, and the primary task of physicians is to inform the patient about his health status and enable him to reach a conclusion.

Decision Making↗
PubMed2004

What is the impact of the ACE gene insertion/deletion (I/D) polymorphism on the clinical effectiveness and adverse events of ACE inhibitors?--Protocol of a systematic review.

BACKGROUND: The Angiotensin Converting Enzyme (ACE) insertion/deletion (I/D) polymorphism has received much attention in pharmacogenetic research because observed variations in response to ACE inhibitors might be associated with this polymorphism. Pharmacogenetic testing raises the hope to individualise ACE inhibitor therapy in order to optimise its effectiveness and to reduce adverse effects for genetically different subgroups. However, the extent of its effect modification in patients treated with ACE inhibitors remains inconclusive. Therefore our objective is to quantify the effect modification of the insertion/deletion polymorphism of the angiotensin converting enzyme gene on any surrogate and clinically relevant parameters in patients with cardiovascular diseases, diabetes, renal transplantation and/or renal failure. METHODS: Systematic Review. We will perform literature searches in six electronic databases to identify randomised controlled trials comparing the effectiveness and occurrence of adverse events of ACE inhibitor therapy against placebo or any active treatment stratified by the I/D gene polymorphism. In addition, authors of trials, experts in pharmacogenetics and pharmaceutical companies will be contacted for further published or unpublished data. Hand searching will be accomplished by reviewing the reference lists of all included studies. The methodological quality of included papers will be assessed. Data analyses will be performed in clinically and methodologically cogent subgroups. The results of the quantitative assessment will be pooled statistically where appropriate to produce an estimate of the differences in the effect of ACE inhibitors observed between the three ACE genotypes. DISCUSSION: This protocol describes a strategy to quantify the effect modification of the ACE polymorphism on ACE inhibitors in relevant clinical domains using meta-epidemiological research methods. The results may provide evidence for the usefulness of pharmacogenetic testing for individualised ACE inhibitor therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

[Where are the boundaries of science in medicine?].

Medicine in general can be described as science and praxis. A central aspect of every science is the formation of theories and the testing of these theories and hypotheses with methods accepted by the scientific community as the adequate way to do it. Modern medicine defined as science is based on knowledge from natural sciences as well as the humanities. Medicine, defined as practice or in some instances as art, is not science. Medical practice can be described as the application and integration of scientific knowledge in the process of medical decision making and thereby the care of patients and the prevention of illnesses. The main problem in modern medicine is the lack of a "theory of medicine", elucidating the relation between science and practice.

Critical Pathways↗
PubMed2004

[Pharmacogenetics. Tailored therapy in medicine -- opportunities and challenges].

This article provides a general introduction into the field of pharmacogenetics and discusses its opportunities and limits. Pharmacogenetic research explores genetic variability between patients to explain observed differences in effectiveness of a drug therapy or adverse event profiles. Sometimes drug therapy is unfavourable: Patients may respond only partially to a drug therapy, do not respond at all, or suffer from serious adverse events. The reasons for the varying effectiveness of a drug therapy are due to factors like absorption; metabolism, elimination and target interaction. Recent research has led to a better understanding of the molecular genetic mechanisms behind those factors. Numerous new polymorphisms have been described, for example for the beta 2-adrenergic receptor or the cytochrome which can either improve or reduce the response to drug therapy. Two polymorphisms for the tumour necrosis factor alpha have shown to be associated with an increased risk of serious adverse events (hypersensibility: fever, rash, gastrointestinal symptoms) if treated with abacavir (HIV-treatment). Pharmacogenetic tests provide information about certain polymorphisms and raise the hope for an individualized pharmacotherapy. Yet, not only genetic but also environmental factors influence the effectiveness of a therapy. Even though results from research implies that pharmacogenetics has a great potential to maximize the effectiveness of pharmacotherapy and to reduce the incidence of drug-related adverse events, extensive clinical research both on effectiveness and costs is required to assess the true benefits of these exciting new technologies.

Anti-HIV Agents↗
PubMed2004

[Preserving vision in the elderly: a survey to start a quality development program in general practice].

The study examined the rate of patients, who do not follow recommendations for routine screening, do not visit physicians for eye-symptoms and when suffering from diabetes or glaucoma do not adhere to follow-up. To what extent can primary care physicians impact on these deficits of ophthalmologic care? 4918 consecutive, > or = 40 old patients of 107 primary care physicians of 9 networks participated. Of these patients 15% had never, 43% not within the last 3 years, consulted an ophthalmologist. 16% were diabetics, 7% had glaucoma and 46% had observed subjective eye symptoms. A quarter of these patients turn to their primary care physician, when having eye problems. Primary care physicians do not frequently suggest routine ophthalmologic controls nor do they use diagnostic tools like the Amsler-grid or the Swinging-Flash-Light Test.

Adult↗
PubMed2003

[Manipulation of blood pressure self-monitoring protocol values: a randomized controlled study].

Treatment monitoring of hypertensive patients can be achieved using data from blood pressure measurements obtained in follow-up visits, from sporadic 24 hours ambulatory blood pressure monitoring (ABPM) and from patients' self-measurements. Blood pressure self-measurement values seem to be the easiest to obtain. A disadvantage is the uncertainty about the accuracy with which patients report these values. In this randomised clinical trial with 48 hypertensive outpatients we compared reported self-measurements with the stored values in the devices. One group was unaware of the storing capacity of the device. All patients measured their blood pressure twice in the morning and twice in the evening over a period of 14 days. Endpoints of our analysis were the comparison of the number of measurements performed and the missing and manipulated values between the two groups. The non-informed group measured blood-pressure more frequently than the informed group (76.1 vs. 58.8 measurements; p = 0.0005). Compared to the informed group, the number of agreements between stored and reported values was smaller in the non-informed group (95.7% vs. 87.5%; p = 0.026) whereas reporting of fictional data only occurred in the non-informed group (0 vs. 55; p = 0.002). Our data show, that use of blood-pressure devices with a memory function increases the accuracy of reported self-measured values and can lead to better treatment monitoring.

Adult↗
PubMed2003

[Anticoagulatin in atrial fibrillation--status of therapy in a network of physicians].

Despite of sound evidence, that oral anticoagulation reduces substantially the incidence of stroke-events in patients with atrial fibrillation and concomitant risk factors, in daily practice only a part of these patients is in fact treated with anticoagulation. The aim of this cross-sectional study was to evaluate to which extent existing guidelines for the treatment of patients with atrial fibrillation are transformed in the "real world" context of a Swiss urban network of primary care providers. The greatest part (88.4%) of the included patients with atrial fibrillation had a high risk for thromboembolism and herewith the indication for anticoagulation was given. For a primary care collective the amount of patients with anticoagulation was high: 74.1% did receive this kind of preventive therapy. 89% had robust International normalized ratio (INR) values within the recommended range (INR 2.5-3.5). The most common reasons not to prescribe oral anticoagulation were: old age (17.5%; mostly in combination with other reasons), risk of falls (16.5%), medical indication not given (16.5%). Thus the recommendations of the guidelines have been transformed into practice for a bigger part of the included patients. Given these results a broadly implemented quality-improvement-project to bring up the anticoagulation rate even higher hardly seems to be efficacious and is presently not of top priority in this network of primary care providers.

Adult↗
PubMed2003

[Pulmonary rehabilitation of COPD in Switzerland--an assessment of current status].

The aim of this survey was to characterize respiratory rehabilitation programmes for patients with COPD in Switzerland. Rate of return of questionnaires was 94%. In 2001, 2238 patients with COPD followed an inpatient (1790) or outpatient (448) respiratory rehabilitation programme. This corresponds to 1% of all patients with COPD in Switzerland. Physical exercise is estimated to be significantly more important compared to breathing exercises, patient education and psychosocial support although this prioritization is not as pronounced as in the current literature. Disease-specific instruments to measure health related quality of life that represents the most important outcome measure for patients with COPD should be implemented in practice. Thereby both the components of rehabilitation programmes and predictive factors for a successful rehabilitation could be evaluated.

Adult↗
PubMed2003

Observational studies on ultrasound screening for developmental dysplasia of the hip in newborns - a systematic review.

AIM: To assess whether observational studies provide evidence to support general ultrasound screening for developmental dysplasia of the hip (DDH). METHOD: Systematic Review. Following a predefined study protocol, observational studies on ultrasound screening in unselected newborns were identified by search through 23 electronic databases and by hand search. Two reviewers selected the studies independently of each other and extracted the data. RESULTS: 49 observational studies were included. The prevalence of DDH ranged from 0.5 % to 30 % depending largely on the various possible definitions of DDH. Less than 0.1 % of patients with DDH were missed by ultrasound regardless of the technique employed (Graf or Terjesen). About 90 % of newborns with Graf type IIa hips requiring ultrasound control did not develop DDH. Only six studies with 23 108 newborns reported on complications, and there was only one infant with an avascular necrosis of the femoral head. The effectiveness of a general ultrasound screening cannot be evaluated reliably for several reasons: reports were often incomplete, follow-up of newborns with normal findings at the time of screening was often not carried out, clinically meaningful data about outcome as well as control groups were missing. CONCLUSION: General ultrasound screening for developmental dysplasia of the hip cannot be sufficiently assessed by the observational studies available. The lack of evidence does not mean that ultrasound screening is ineffective, but randomized controlled trials comparing the effectiveness of different screening regimens are needed.

Costs and Cost Analysis↗
PubMed2002

[Continuing education and quality assurance].

The goal of Continuous medical education is to increase knowledge and skills of medical doctors to guarantee a high standard of medical care. According to the published literature on the effect of Continuous medical education interactive didactic methods seems to be more effective to reach the mentioned goal compared to lectures. These results are in accordance with the constructivist learning theory. The assessment of the learning needs, one of the fundamental elements of this theory, is a complex issue. A potential method to evaluate the needs is presented in the following paper.

Curriculum↗
PubMed2002

[Clinical decision aids].

Clinical prediction rules should help the medical doctors to increase the accuracy of diagnostic and prognostic assessments in situations where decision making is complex. A decision rule is a clinical tool that quantifies the contributions that various components of the history, physical examination, laboratory results and imaging techniques make toward the diagnosis or prognosis in an individual patient. Before decision rules are broadly used in a clinical situation they have to be validated. This can be done by using part of the original data to perform a validation. To answer the question about the generalizability of the rules they have to be tested in an additional, prospectively collected data set.

Decision Support Systems, Clinical↗