Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    ISSN: 0044-281X
    Keywords: Schlüsselwörter Leitlinien –¶Evidenz-basierte Medizin –¶Qualität im Gesundheitswesen –¶Gesundheitspolitik – Deutschland ; Key words Clinical practice guidelines – Evidence-based Medicine – quality in health care –¶health politics – Germany
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Clinical Practice Guidelines (CPGs) are increasingly common in the German health care system. The German physicians‘ self-governmental body‘s position regarding CPGs as a tool of Evidence-based medicine (EBM) was described in a joint policy paper concerning quality in health care in late 1998. The German Medical Association (GMA) and the National Association for Statutory Health Insurance Physicians (NASHIP) stated that “the principles of EBM should be implemented into the German Health Care System” by the following means: • to assess systematically and appraise critically the evidence in health care • to develop evidence-based consensus CPGs for priority problems in health care • to implement CPGs using graduate, post-graduate, and continuing medical education, as well as audits and CPG-based information management • to evaluate quality in health care against the background of CPGs. The following paper will discuss the aims and scopes and the limits of this concept.
    Notes: Zusammenfassung Auf die Bedeutung von Leitlinien als Instrumentarium der Evidenz-basierten Medizin ist von Bundesärztekammer und Kassenärztliche Bundesvereinigung Ende 1998 in der gemeinsamen Stellungnahme zur Qualitätssicherung hingewiesen worden: So sollen die Prinzipien der Evidenz-basierten Medizin in der Gesundheitsversorgung dadurch Berücksichtigung finden, dass die aktuellen wissenschaftlichen Erkenntnisse an den praktizierenden Arzt künftig systematischer als bisher herangetragen werden, und zwar mittels eines mehrstufigen Vorgehens: • Systematische Recherche und Bewertung der Evidenz; • Aufbereitung der bewerteten Evidenz und Erstellung evidenz-basierter Konsensus-Leitlinien für prioritäre Versorgungsbereiche; • Implementierung von Leitlinien mittels Aus-, Weiter-, Fortbildung, Qualitätszirkelarbeit, leitliniengestützter Dokumentationssysteme u.ä.; • Evaluation der ärztlichen Tätigkeit auf der Grundlage evidenz-gestützter Leitlinien. Hintergründe, Grenzen und Möglichkeiten dieses Konzeptes werden im folgenden diskutiert.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 1752-7325
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives: Dental fluorosis prevalence has increased in the United States, Canada, and other nations due to the widespread availability of fluoride in many forms, with fluoride ingestion during the first three years of life appearing most critical in fluorosis etiology. With few contemporary studies of fluoride ingestion in this age group, the purpose of this paper is to describe patterns of estimated fluoride ingestion from birth to 36 months of age from water, dentifrice, and dietary fluoride supplements and combined. Methods: Repeated responses to separate series of questions about water intake, use of fluoride dentifrice, and use of fluoride supplements were collected by questionnaire as part of the longitudinal Iowa Fluoride Study and used to estimate fluoride intake. Estimated intake is reported by source and combined at different ages. Effects of subject age and other covariates on fluoride intake were assessed using regression methods appropriate for the analysis of correlated data. Results: For most children, water fluoride intake was the predominant source, especially through age 12 months. Combined daily fluoride intake increased through 9 months, was lower at 12 and 16 months, and increased again thereafter. Mean intake per unit body weight (bw) was about 0.075 mg F/kg bw through 3 months of age, 0.06 mg F/kg bw at 6 and 9 months, 0.035 mg F/kg bw at 12 and 16 months, and 0.043 mg F/kg bw from 20–36 months. Depending on the threshold chosen (e.g., 0.05 or 0.07 mg F/kg bw), variable percentages of the children exceeded the levels, with percentages greatest during the first 9 months. Regression analyses showed fluoride intake (mg F/kg bw) from 1.5–9 months to decrease with increasing child's age, mother's age, and mother's education, with a complex three-way interaction among these factors. From 12–20 months, fluoride intake increased with increasing child age and decreased with increasing mother's age. No statistically significant relation-ships were found for fluoride intake from 24–36 months. Conclusions: There is considerable variation in fluoride intake across ages and among individuals. Longitudinal studies may be necessary to fully understand the relationships between fluoride ingestion over time and development of fluorosis.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    ISSN: 1752-7325
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectivety investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. Methods: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one-month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at-risk tooth was retained. Results: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. Conclusions: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Compensation for acute blood loss requires cardiovascular integrity. In older people, asymptomatic cardiovascular impairment is common. In these subjects, even moderate blood loss is often treated by external volume replacement although its benefits are not clear. We investigated the effect of 450 ml of blood loss on the microcirculation and compensatory mechanisms in healthy older blood donors. Red blood cell count, plasma viscosity and protein concentration were measured. Plasma volume replacement was calculated using haematocrit. We measured microcirculation tissue perfusion by laser Doppler fluxmetry prior to, during and after blood donation. Blood loss was immediately accompanied by a median rapid water shift of 208 ml (interquartile range 134–298 ml). Haemodilution led to a decrease in haematocrit, protein and plasma viscosity. We observed no changes in cutaneous microcirculation. Moderate blood loss is tolerated in older cardiovascularly asymptomatic patients without having an impact on microcirculation. This may reduce the need for external volume replacement.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...