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J Steurer

Publications and source records attributed to J Steurer.

At least 37 records · Page 2Linked to original sources
PubMed2002

[The learning curve in surgery: possibilities and limits of this method].

The learning curve is a graphic representation of the relationship between the experience of a surgeon and one or more performance indicators. The operation time alone is an insufficient indicator to assess the performance of a surgeon. The procedure time has to be set in relation to the complication rate and in laparoscopic surgery to the conversion rate. Techniques to visualize the changes over time are the moving average method for the operation time and the Cusum method for dichotomous outcomes, like the conversion and the complication rates. At the time when the learning curve reaches the plateau phase this representation can be used to assess the quality of a surgeon or a team in one hospital. As far as there is no validated complexity scale for laparoscopic procedures available it is difficult to compare patient populations between different hospitals. Out of this reason the learning curve is no legitimate instrument to rank surgeons or different hospitals.

Clinical Competence↗
PubMed2001

[Clinical evidence].

Explore the source record for details and available documents.

Evidence-Based Medicine↗
PubMed2001

Use of the Internet by medical doctors in Switzerland.

QUESTIONS UNDER STUDY: To investigate the utilisation of the Internet by primary care physicians for medical purposes during their daily practice, and to clarify the reasons for use or non-use of this technology. METHODS: Cross-sectional postal survey in German-speaking Switzerland employing a purpose-designed pre-validated 69-item questionnaire. A random sample of 2009 primary care physicians participated in the investigation. MAIN OUTCOME MEASURES: Number of primary care physicians with access to the Internet; reasons for using the Internet during consultations; sources of information in solving medical problems arising from concurrent patient care. RESULTS: 55% of the physicians returned the completed questionnaire. 75% of respondents reported access to the Internet. Only 7% use the Internet during patient consultations. The main reasons for not using the Internet were time pressure and concerns about potential negative interaction with physician-patient communication. To solve patient-specific problems arising during daily practice, 59% of the practitioners consult text-books or colleagues. Only 14% of respondents report regularly finding useful information on the Internet. Internet users assess information quality by checking on authorship, institution, publishing company, or whether the information is sponsored by a third party with a potential conflict of interest. CONCLUSIONS: Access to the Internet is widespread amongst German-speaking Swiss primary care physicians. Only a small minority use the Internet for information retrieval during consultation hours. Electronic information systems need to be tailored to the needs of primary care physicians.

Communication↗
PubMed2001

[Tests and criteria in diagnosis of chronic hypotension--a systematic review].

The diagnosis of hypotensive circulatory disorders is based on a variety of criteria and classifications. This paper aims to provide a systematic review of published definitions and diagnostic criteria for hypotensive disorders. Searches for relevant papers were undertaken in Medline, Winspirs version (January 1966 to December 1999) and in textbooks of internal medicine. References of all identified articles were also searched. Publications in English, French, German and Italian were included. In 47 articles, 56 different reference were made to definitions and diagnostic criteria for hypotension. At present there is no uniform definition of hypotension and there are no clear, standardized criteria on which to base a diagnosis. Basically, one distinguishes between two schools of thought. The Anglo-American literature describes hypotensive disorders in terms of orthostatic dysregulation in the presence of an underlying primary condition, whereas the German-speaking countries use mixed approaches. On the one hand, the questionable pathological value of essential/primary hypotension is discussed; on the other hand, tests for orthostatic circulatory function, like the Schellong test, appear to have become established. Neither resting blood pressure limits nor a drop in blood pressure during orthostatic challenge can be used to diagnose hypotension. The orthostatic test is a better diagnostic tool than resting blood pressure. Hypotension is probably difficult to classify in simple terms because it is usually a symptom of numerous disorders hallmarked by a variety of pathophysiological mechanisms. Hypotension should indeed be understood as a secondary symptom of a primary disease. Accordingly, the primary aim of diagnostic efforts should be to uncover the underlying condition. The studies included were of insufficient methodological quality. Moreover, the heterogeneity among the individual studies made pooled analysis impossible. This systematic review revealed a marked lack of studies with valid results.

Blood Pressure↗
PubMed2001

Standardizing nerve crushes with a non-serrated clamp.

Standardized experimental nerve crush attempts should include the number, duration, and intensity (amount of pressure) of crushes. The authors have developed a new crushing device, a clamp with which predetermined forces can be applied to nerves. This allows the exertion of different, standardized forces to crush a nerve within a scale that produces second-degree injuries. The main advantages of the clamp are that it is small, although very robust, is purely mechanical, and is easy to handle. The jaws of the clamp are not serrated, so that pressure on the nerve is uniformly transmitted. To avoid unintended nerve damage, the edges of the jaws are smoothly rounded off. The closure of the clamp is mechanized by a spring. As the spring is exchangeable, any number of different preloads are available. The force can be varied, according to different requirements, and is applicable to variantly thick nerves in any experimental animal, thus enhancing standardization, and making cross-over comparisons of experimental study results possible.

Action Potentials↗
PubMed2001

[Critical appraisal of medical literature:pragmatic approach].

Due to the enormous amount of medical information in journals and the Internet, keeping doctors up to date has become increasingly difficult. A pragmatic approach to reduce the amount of information is to select on the basis of the topic, the title, and the abstract. After this selection, reading should not be limited to the abstract alone. Abstracts go short on essential information about the applicability of the information in clinical practice. To read the whole article might be time-consuming, but the validity of the data has to be evaluated prior to application to patients.

Abstracting and Indexing↗
PubMed2001

[Description of Internet-based models for continuing medical education. First results and experiences with asthma patients].

The Pilot study "Quality Development through the Internet" by the Horten Center is an integral part of a concept on dissemination of medical knowledge. It offers participants the possibility to compare interactively their own and their peers' performance with their competence and with accepted guidelines within a web-based Audit-Cycle. The participants can discuss the evidence-based recommendations which are offered. In addition, changes in behavior and care can be documented objectively.

Asthma↗
PubMed2000

[Evaluation of an internet site on evidence-based medicine].

The present study evaluated a Swiss internet provider of Evidence-based Medicine (EBM) with regard to its utilization and function for medical practitioners. The internet provider under study (www.evimed.ch) primarily provides abstracts of original articles relevant to medical practice that are presented according to the criteria of EBM and includes information about EBM itself. In March 1999 a survey was conducted to better appraise the benefits gained from the information provided from the website visitors' point of view. Around 400 persons who had entered their names in the homepage guest book were informed about the survey by e-mail. A total of 167 questionnaires were filled in online, which is equivalent to the reply rate of close to 42%. The majority of the replies (63.5%) were from private-practice physicians, 22.2% from hospital-based physicians. The average age ranged between 40 and 49 years. 67.7% of the 167 respondents had internet access at their workplace, 72.5% had private internet access. For their own practical work, 61.1% of the respondents rated the information provided by www.evimed.ch as generally useful. The clinical relevance of the studies presented in the Journal Club was rated as good by 55.7% and as very good by 26.9%. The reliability of the information provided was rated as good by 56.3% and as very good by 35.3%. The majority regarded the following homepage sites as personally important: Journal Club (55.7%), articles about EBM (46.1%), MEDLINE access (37.7%) and article citations/links (41.3%). The homepage was visited at an average frequency of 1-3 times a month. 50.3% preferred electronic media (40.1% using various internet providers, 10.2% www.evimed.ch) and 44.3% preferred print media to search for specialist information on a specific medical subject. With regard to new medical findings, 44.9% of the respondents stated that they used print media, 17.4% the www.evimed.ch homepage and 28.7% other internet sources as their primary information medium. Based on this survey, the majority of the respondents gave a positive rating of the www.evimed.ch homepage. Information about EBM and critically appraised studies were evaluated as particularly useful.

Adult↗
PubMed2000

[Cholesterol determination in ambulatory general practice within the scope of the Brugg/AG quality circle].

Findings of studies designated by the acronyms 45, WOSCOP, LIPID and CARE have provided data that led physicians to rethink their "cholesterol testing behavior." Twelve physicians participated in a study conducted in cooperation with the quality circle of the Brugg region in Aargau. Each doctor collected data from the files of 100 patients and filled in a questionnaire. Cardiovascular risk factors and arteriosclerotic secondary illnesses were compiled along with demographic data. Moreover, information was gathered on whether the patient's cholesterol levels had been checked within the last five years. In total, 1183 questionnaires were evaluated, comprising 691 women and 492 men with an average age of 48.6 years. Cholesterol levels had been determined within the last five years in 61.2%. The individual testing behavior of the physicians varied. One-third tested all three blood lipid values (total cholesterol, HDL and triglyzerides) with an equivalent frequency. By contrast, one-third primarily only determined total cholesterol. The last one-third mostly tested total cholesterol and triglyzeride levels. The frequency of serum lipid tests increased proportionally to the number of risk factors. Cholesterol levels were tested less frequently (approx. 55%) in smokers and patients who never practiced sports than in patients with other risk factors (approx. 85%). The testing rate increased proportionally to the increasing number of arteriosclerotic secondary illnesses, but did not reach the one-hundred percent mark until 3 secondary illnesses were involved. Dietary counseling was the primary therapeutic intervention; medication was prescribed with a much rarer frequency. Although 75% of the patients with arteriosclerotic secondary illnesses had measurably higher cholesterol levels (> 5.2 mm/l), approx. one-third of the patients with coronary heart disease received therapy with cholesterol-lowering drugs as compared to only 16% of the patients with peripheral occlusive arterial disease. The conclusions that we can draw from these results for clinical practice are: if cholesterol levels are to be determined in order to evaluate a patient's cardiovascular risk, HDL cholesterol levels should also be tested since the ratio of these two values is a good predictor. To date, triglyzeride levels have not been identified as relevant risk factors for vascular events. Physicians evaluated the other risk factors variably, in particular with regard to obesity. For clinical practice, the potential risk factor of lack of exercise should be defined more accurately. In patients with clinically manifest arteriosclerotic secondary illnesses, serum lipids should be tested routinely and appropriate therapy induced when required.

Adult↗
PubMed2000

[Value of the Valsalva maneuver for evaluating systole heart function].

Many tests and examinations are used for diagnosing heart failure. Their accuracy tends to vary, echocardiography representing the gold standard. The Valsalva maneuver involves an easy-to-perform test for assessing the cardiac ejection fraction. The present study investigated the power of the Valsalva test in patients who received an echocardiography for various indications. A total of 153 patients were examined, some recruited from private practices, some from different hospitals. An echocardiographically measured left-ventricular ejection fraction of 45% was set as the limit value. 30 patients had an ejection fraction of less than 45%, signaling a relevant systolic dysfunction. The sensitivity of the Valsalva test for detecting impaired function was 70% and its specificity 72%. The positive predictive value was 39% and the negative predictive value 90%. This means that when the Valsalva test produces a normal result and the EKG is also normal, the likelihood that the patient has no relevant systolic dysfunction is very great. The Valsalva test is cost-effective, quick and easy to perform and useful for evaluating left-ventricular pump function.

Adolescent↗
PubMed2000

[Effects of written intervention on the number of laboratory studies per patient].

In the context of economic measures in health care we followed over a period of nine months the consequences of a written intervention on the attitude of house staff to prescribe laboratory tests. Since it is well known that these tests have a major impact on health costs several studies have been conducted to test whether costs can be reduced without sacrifice of treatment quality. The study was undertaken in 1997. It had three phases of three months duration each: one for observation, one with the intervention and a follow-up phase. The laboratory tests requested by eleven physicians for their patients during the first month after the initial visit were analyzed. During the intervention--phase six physicians chosen at random were informed about their own average as well as that of the entire group (mean of the entire observation period of all physicians). Unexpectedly the hypothesis that the number of laboratory tests requested per patient would drop only in the group of informed physicians and should stay the same for the physicians without this intervention did not materialize. The number of performed tests dropped in both groups.

Attitude of Health Personnel↗
PubMed2000

[Do physicians interpret therapy outcome differently than students?].

Results are presented in the most varied ways in medical publications and advertising material. The reader should be able to interpret the results of such studies accurately. In the present investigation our interest focused on whether a physician learns to analyse results correctly in medical school or in his subsequent clinical career. We also investigated whether the interpretation of therapeutic data differs as between students in the 4th year of medical school, students of the 6th year and physicians. In a questionnaire, one result from the Helsinki Heart Study was presented in for different ways: (a) absolute risk reduction, (b) relative risk reduction, (c) NNT (number needed to treat) and (d) percentage of patients without a cardiovascular event during the monitoring period. To each group we assigned a different drug. We interviewed students in the 4th and 6th years of medical school, physicians during a continuing education course and physicians before and after an evidence-based medicine (EBM) course. They replied by stating which drug they would select for therapy. Evaluation of the questionnaire showed that the majority regarded the drug for relative risk reduction as the most effective. Physicians taking part in the EBM course analysed the statistical data better than the other groups interviewed, and their answers even improved significantly after the EBM course. There was no difference in the interpretation of therapeutic results between students and physicians who had not taken part in an EBM course. The study also found that in all the groups interviewed the presentation of the results of scientific studies has a marked influence on their interpretation. We conclude that interpretation of medical studies should form part of every student's and physicians's training, either in medical school or continuing education courses. On the other hand, the results of studies should be uniformly expressed in absolute figures, to make it easier to compare different results.

Angina Pectoris↗
PubMed2000

[Prevalence of diagnoses in ambulatory and hospitalized patients].

Prevalence and distribution of different clinical presentations were analyzed in 6000 hospitalized and ambulatory patients. One medical University clinic and three further hospital units, two university outpatient clinics and four practitioners participated. 6000 main diagnoses and 2560 additional diagnoses had been recorded. The mean age was 64 for the hospitalized patients, 50 years for the outpatient clinic and 47 years at the doctors' office. Cardiovascular diseases were most common. This group of diagnoses was twice as common in hospitalized patients (40.9%) than in the ambulatory group: 19.5% (outpatient clinic) and 15.2% (private practice). In contrast, psychiatric diagnoses were 5 times more frequent in the practice than in the hospital (11.6% vs. 2.4%) and musculoskeletal diseases were even 7 times more common in the practice (13.3% vs. 1.9). 93% of the hospitalized patients had one of the 25 most prevalent diagnoses. This percentage was substantially lower in patients of the outpatient clinic (73%) and of private practice (64%). An additional diagnosis was posed for every other patient in the hospital or at the outpatient clinic, in the practitioners office only for every fourth patient. The analysis shows that hospitalized patients often have a different set of diagnoses than ambulatory ones. To guarantee a broad internistic training outpatient clinics are of great importance. A part of internistic education, however, can also be obtained by cooperation with practitioners.

Adult↗
PubMed2000

The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review.

The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified. A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data. Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976-1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) 1.37-1.77), number-needed-to-treat 5.8 (95% CI 4.5-8.1). There was no evidence of any effect of study period (12-24 weeks) or cumulative dose of NAC on efficacy. In five trials, 286 of 466 (61.4%) patients receiving NAC reported improvement of their symptoms compared with 160 of 462 (34.6%) patients receiving placebo (relative benefit 1.78 (95% CI 1.54-2.05), number-needed-to-treat 3.7 (95% CI 3.0-4.9)). With NAC, 68 of 666 (10.2%) patients reported gastrointestinal adverse effects compared with 73 of 671 (10.9%) taking placebo. With NAC, 79 of 1,207 (6.5%) patients withdrew from the study due to adverse effects, compared with 87 of 1,234 (7.1%) receiving placebo. In conclusion, with treatment periods of approximately 12-24 weeks, oral N-acetylcysteine reduces the risk of exacerbations and improves symptoms in patients with chronic bronchitis compared with placebo, without increasing the risk of adverse effects. Whether this benefit is sufficient to justify the routine and long-term use of N-acetylcysteine in all patients with chronic bronchitis should be addressed in further studies and cost-effectiveness analyses.

Acetylcysteine↗
PubMed2000

Conception of an XML-based ontology for a Web-based medical information service.

In order to be useful for practice, medical information on the World Wide Web must be relevant, reliable, well designed, and easy accessible. Approaches towards improving these requirements include evidence-based medical information services such as EVIMED. This research paper considers the question of how a user can be supported in accessing requested information from EVIMED and how further, semantically related information can easily be retrieved. The presented method of resolution is based on Schmid's concept of media and on Gruber's concept of the ontology. The use of the emerging Web standard eXtensible Markup Language (XML) in order to implement it, allows for the design of a component-based solution supporting an easy adaptation of the representational vocabulary in accordance with the conceptualization of the user, i.e., the practitioner.

Decision Support Systems, Clinical↗