Search PubMed⌕ Search

Biomedical subjects

S Hölzer

Publications and source records attributed to S Hölzer.

13 recordsLinked to original sources
PubMed2001

[Selection, problems and perspective of quality indicators].

The advances in information technology offer new possibilities to gather and analyse health-related information in order to get an inside view into the quality of medical care. Applied medical interventions and the related outcome for the patient can be evaluated if information of a certain degree of complexity is available. Performance measures are based on collection and aggregation of data. They try to abstract medical performances in order to get objective and comparable variables. These variables are useful in evaluating and monitoring the different dimensions of patient care. Performance measurement can inform people about the outcomes they can expect from certain treatments. Beside formal criteria such as validity and reliability, the specific objectives determine the selection of a relevant performance measure. This article describes actual problems and solutions in the data collection and the analysis of performance measures for the domain of oncology. This way, we want to encourage the meaningful, but critical use of performance measures in medicine. The provision of such information can build the basis for the process of medical decision making by physicians, the selection of a suitable medical institution by patients, and the allocation of resources by providers.

Humans↗
PubMed2001

[Current approaches for the implementation of guidelines by means of information technologies].

Clinical practice guidelines (CPGs) play an increasingly important role in the harmonisation process of health care delivery and disease management. It is known that nationally or internationally produced guidelines that have no consistent implementation strategy, have limited impact in changing physicians' behaviour and patterns of care. The literature provides evidence for the effectiveness of computerisation of CPGs for increasing compliance and improving patient outcomes. The integration of knowledge-based functions for decision support or monitoring in clinical information systems is one effective way. Another approach relies on the original, mostly text-based, guidelines. By structuring these resources with the eXtensible Markup Language (XML) we are able to improve the availability of clinically relevant knowledge at the point of care. XML allows for in-context searching and the customized presentation of guideline content. We are confident that this new approach will improve the acceptance and the benefits of the increasing number of guidelines in medicine.

Biomedical Technology↗
PubMed2000

Patterns of care for patients with primary differentiated carcinoma of the thyroid gland treated in Germany during 1996. U.S. and German Thyroid Cancer Group.

BACKGROUND: To determine current patterns of care and disease characteristics for patients with thyroid carcinoma, a Patient Care Evaluation Study was initiated in 1996 in the U.S. and Germany. This project addresses ongoing concerns with respect to the diagnostic evaluation and treatment of patients diagnosed with thyroid carcinoma and raises questions concerning how physicians are interpreting current standards and acting on the basis of these recommendations. METHODS: Patients with primary thyroid carcinoma were entered into a prospective multicenter observational study with free choice of treatment (no control group) between January 1, 1996 and December 31, 1996 in Germany. This resulted in a total of 2537 cases under observation and analysis; 1685 patients had papillary carcinoma (66.4%), 691 had follicular carcinoma (27.2%), 70 had medullary carcinoma (2.8%), and 91 had anaplastic carcinoma (3.6%). The 2376 patients with carcinoma of either papillary or follicular histology were included in the current analysis. RESULTS: The major symptoms reported for patients with papillary and follicular thyroid carcinoma was neck mass (reported in 76% and 79%, respectively) followed by dysphagia (reported in 25% and 27%, respectively), stridor (reported in 9% and 14%, respectively), and neck pain (reported in 7% and 8%, respectively). Greater than 50% of the patients with papillary thyroid carcinoma were reported to have American Joint Committee on Cancer/International Union Against Cancer Stage I disease. Between 37-39% of the follicular carcinoma patients had Stage I and Stage II disease. Only slight differences in the diagnostic approach to patients with papillary or follicular carcinoma were noted. The majority of patients underwent an ultrasound of the thyroid region (78.1%), which was suggestive of carcinoma in only 39% of the cases. A thyroid scan was performed on 76.6% of patients, and the results were suggestive of carcinoma in 44.8% of the individuals. In contrast, fine-needle aspiration biopsy of the thyroid is highly recommended in the current Clinical Practice Guidelines (CPG) but results were obtained in only 27.4% of the patients. Total thyroidectomy without lymph node dissection was the most commonly used surgical procedure in the treatment of patients with papillary and follicular thyroid carcinoma. Only approximately 2% of patients at low risk in the group with Stage I disease were treated with a lobectomy. In 80% of the patients with Stage I papillary thyroid carcinoma and approximately 90% of those patients diagnosed with Stage II, III, and IV disease treating physicians chose to utilize radioiodine as adjuvant treatment after disease-directed surgery. External beam radiation was added to the treatment regimen for many patients diagnosed with Stage III and IV disease (30% in patients with papillary thyroid carcinoma and 33% in patients with follicular thyroid carcinoma). CONCLUSIONS: To the authors' knowledge no single effective diagnostic test for thyroid carcinoma currently is available and in the majority of cases a combination of ultrasound, thyroid scan, or fine-needle aspiration biopsy together with the clinical findings (e.g., thyroid mass) led to a diagnosis of carcinoma. The authors suspect that the high prevalence of concomitant pathologic findings such as goiter, even in the healthy population in Germany, reduces the accuracy of all diagnostic test methods and may account for the frequent use of imaging techniques. The majority of patients underwent a total or near-total thyroidectomy. Total thyroidectomy with radical lymph node dissection was used very frequently in those patients with papillary thyroid carcinoma (22%). German physicians tend to surgically treat early stage thyroid carcinoma somewhat more radically than recommended in the CPG. With respect to other treatment options employed as part of the first course of treatment, radioiodine appears to play the most important role. [See commentary o

Adenocarcinoma, Follicular↗
PubMed2000

Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study.

BACKGROUND: The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS: Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS: Of the 5584 cases of thyroid carcinoma, 81% were papillary, 10% follicular, 3.6% Hürthle cell, 0.5% familial medullary, 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS: In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes.

Adenocarcinoma, Follicular↗
PubMed2000

[Patient care evaluation studies--a comprehensive concept for evaluation of oncologic patient management].

As part of the oncological patient care, tumor documentation has been attributed growing importance as a means of quality assurance. The extended organ specific tumor documentation can serve to answer some specific clinical questions. The rational of the so called Patient Care Evaluation Studies (PCES) carried out by the Commission on Cancer of the American College of Surgeons in the US will be shown in this article and the objectives of an initial study being carried out in the Federal Republic of Germany simultaneously with the US-study will be demonstrated. PCES are a way to compare actual patient care with idealized recommendations of Clinical Practice Guidelines. Thus, the application of Practice Guidelines in the clinical routine as one aspect of evidence based medicine can be analyzed.

Aged↗
PubMed2000

[Patient-oriented, treatment-accompanying documentation as a basis for evaluation with medical oncology as an example].

The documentation of patient characteristics, procedures of care and follow-up of the disease plays an important role in monitoring quality of care and support of clinical research. In order to evaluate the use of Clinical Practice Guidelines and their positive implications towards quality of care (especially patient's outcome), some closer reflections are needed to meet the special requirements. Our intention is to optimise content and extent of the collected information to characterise the different dimensions of the quality of medical care best possible. During the past two decades a comprehensive infrastructure concerning tumour documentation has evolved in Germany. To ensure the possibility to compare and evaluate diagnostic and therapeutic approaches in different medical institutions or health care systems, the systematic, patient-oriented treatment accompanying tumour documentation is a compelling requirement. It is a difficult task to describe pattern of care and measure both performance and outcome objectively. The paradigm of a patient-oriented treatment accompanying documentation includes the collection of clinical relevant process and outcome data in order to reflect the intention and way of thinking of the treating physicians and to get an impression of the "real world effectiveness" of the applied interventions.

Delivery of Health Care↗
PubMed2000

Structured clinical documentation for the assessment of medical care.

The developing infrastructure for tumour documentation in Germany offers the unique opportunity to provide the physicians with useful clinical information, to evaluate standards of care, and get an impression about the "real-world-effectiveness" of cancer care. In order to compare and evaluate diagnostic and therapeutic approaches in different medical institutions or health care systems, the systematic, patient-oriented, treatment accompanying tumour documentation is a compelling requirement. Our intention is to optimise content and extent of the collected information to characterise the different dimensions of the quality of medical care the best possible. We found that most of the problems are deriving from the contextually and timely correct documentation of medical procedures which includes diagnostic as well as therapeutic interventions. The content of the documentation together with standards of care, such as Clinical Practice Guidelines, should be parallel developed in interdisciplinary co-operation. This way, the fundamental domains of performance, such as appropriateness, availability, continuity, safety, effectiveness, and timeliness of medical care can described and evaluated objectively.

Documentation↗
PubMed2000

XML structured clinical information: a practical example.

At Giessen university, a drug formulary comprising drug data and treatment guidelines is supplied to clinical users who can access the drug information by an index of drug substances and drug substance groups. The guideline itself is a textual description with related information such as drug substances and drug brand names. Since clinical users also want to access the information by drug names, we had to extract this information from the textual descriptions. The extraction however caused some effort. In order to not repeat this effort in the future, we used the eXtensible Markup Language (XML) to restructure the information sources. This paper describes our experiences with this kind of legacy to XML conversion and outlines a possible migration path towards the XML technology.

Drug Information Services↗
PubMed1999

Integrated knowledge-based functions in a hospital cancer registry--specific requirements for routine applicability.

The background of the presented work is the design, realization, and routine use of integrated knowledge-based functions in the context of a hospital cancer registry. The first field of application was supporting registrars to detect data inconsistencies and incompleteness timely during the documentation process. Especially, we focused on the acceptance of the administrator of the underlying information system and on the phenomenon of duplicate and outdated messages. These aspects are specific for integrated knowledge based functions and a precondition for obtaining a routine applicability and acceptance.

Artificial Intelligence↗
PubMed1999

Data warehousing as a tool for quality management in oncology.

At present, physicians are constrained by their limited skills to integrate and understand the growing amount of electronic medical information. To handle, extract, integrate, analyse and take advantage of the gathered information regarding the quality of patient care, the concept of a data warehouse seems to be especially interesting in medicine. Medical data warehousing allows the physicians to take advantage of all the operational data they have been collecting over the years. Our purpose is to build a data warehouse in order to use all available information about cancer patients. We think that with the sensible use of this tool, there are economic benefits for the Society and an improvement of quality of medical care for patients.

Ambulatory Care↗
PubMed1998

Plug and play--fiction or reality?

This paper discusses some experiences with the integration of a tumor documentation system into a distributed healthcare environment using a new European middleware technology. Although the middleware already offers a considerable support to the software engineer, further facilities have been suggested and partially implemented in order to accelerate integration scenarios.

Computer Communication Networks↗
PubMed1997

Survey among physicians by means of dynamic access to an Internet information server database.

Current database management systems, client-server architecture and the internet infrastructure are simplifying the exchange of information. Large and widespread electronic medical record systems are accessible via platform-independent browsing applications. The following brief summary shows one of the manifold conceivable applications of these technologies in medicine. It describes a survey among physicians with the scope of quality assurance in medicine. The dynamic, platform-independent, world-wide access to databases offers interesting aspects in medical informatics.

Computer Communication Networks↗