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N Biller-Andorno

Publications and source records attributed to N Biller-Andorno.

8 recordsLinked to original sources
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↗
PubMed2005

[Ethics and diagnosis related groups].

At the turn of the year 2003/2004 a change took place in the in-patient sector of the German public health care system from the former daily-rate-based reimbursement of medical services to a reimbursement in accordance with diagnosis related groups (DRGs). At the same time, there are indications for a paradigm change in the allocation of medical services: away from the even provision of medical care across all country's municipalities towards a concentration in specialized medical centres - with uncertain ethical implications. On one hand, one hopes to cut costs in the in-patient area. On the other hand, it is questionable, whether cutting costs still allows an adequate treatment of multimorbid, chronically ill patients. The new system likely favours the active, autonomously deciding patient, who is capable of using additional information from the planned quality reports to obtain the best possible medical services. But the new system could create a disadvantage for the less informed patient groups, especially those who don't have easy access to such information. It is not our intention to idealise the German health care system before the invention of diagnosis related groups. Based on a survey of studies from the U.S., the article assesses consequences of such a system and relates them to ethical considerations.

Diagnosis-Related Groups↗
PubMed2004

Ethics, EBM, and hospital management.

Matters of hospital management do not figure prominently on the medical ethics agenda. However, management decisions that have to be taken in the area of hospital care are in fact riddled with ethical questions and do have significant impact on patients, staff members, and the community being served. In this decision making process evidence based medicine (EBM) plays an increasingly important role as a tool for rationalising as well as rationing health care resources. In this article, ethical issues of hospital management and the role of EBM will be explored, with particular reference to disease management programs, diagnosis related groups, and clinical pathways as recent developments in the German health care system.

Critical Pathways↗
PubMed2001

Who shall be allowed to give? Living organ donors and the concept of autonomy.

UNLABELLED: Free and informed consent is generally acknowledged as the legal and ethical basis for living organ donation, but assessments of living donors are not always an easy matter. Sometimes it is necessary to involve psychosomatics or ethics consultation to evaluate a prospective donor to make certain that the requirements for a voluntary and autonomous decision are met. The paper focuses on the conceptual questions underlying this evaluation process. In order to illustrate how different views of autonomy influence the decision if a donor's offer is ethically acceptable, three cases are presented--from Germany, the United States, and India. Each case features a person with questionable decision-making capacity who offered to donate a kidney for a sibling with severe renal insufficiency. Although the normative framework is similar in the three countries, different or sometimes even contrary arguments for and against accepting the offer were brought forward. The subsequent analysis offers two explanations for the differences in argumentation and outcome in spite of the shared reference to autonomy as the guiding principle: (1) Decisions on the acceptability of a living donor cannot simply be deducted from the principle of autonomy but need to integrate contextual information; (2) understandings of the way autonomy should be contextualized have an important influence on the evaluation of individual cases. CONCLUSION: Analyzing the conceptual assumptions about autonomy and its relationship to contextual factors can help in working towards more transparent and better justified decisions in the assessment of living organ donors.

Adult↗
PubMed2001

It's only love? Some pitfalls in emotionally related organ donation.

Transplanting organs from emotionally related donors has become a fairly routine procedure in many countries. However, donors have to be chosen carefully in order to avoid not just medically, but also morally, questionable outcomes. This paper draws attention to vulnerabilities that may affect the voluntariness of the donor's decision. Suggestions are made as to how to approach the evaluation and selection of potential donors.

Adult↗