[Qualitative and economc impact of implementing GP guidelines in a medical practitioners' network]. / Qualitative und öko- nomische Auswirkungen der Implementierung hausärztlicher Leitlinien in ein Arztenetz.

The aims of the study were to determine whether the participants of a practitioners' network changed their prescribing behaviour according to the guidelines discussed and to assess the implications for drug costs. Guidelines concerning the prescription of lipid-lowering drugs, antidiabetics and cardiovascular drugs were introduced in quality circles with about 90 participants in a practitioners' network. All statutory health care insurance physicians of Hesse served as comparison group. The analysis of the prescription data demonstrates that the network physicians attained their pre-determined quality goals but differed with respect to the cost implications for the drug target classes. Higher prescribing rates for recommended though more expensive drugs do not necessarily raise the drug costs of the indication group, which is partly due to the substitution of other drugs. The implications on treatment costs by implementing a guideline should be assessed for all sectors of the healthcare system. This kind of data was not available for this study. It is becoming increasingly relevant to know the cost implications of a guideline recommendation since (suspected) higher costs appear to be a barrier for guideline adherence.

Origins of highly mosaic mycobacteriophage genomes.

Bacteriophages are the most abundant organisms in the biosphere and play major roles in the ecological balance of microbial life. The genomic sequences of ten newly isolated mycobacteriophages suggest that the bacteriophage population as a whole is amazingly diverse and may represent the largest unexplored reservoir of sequence information in the biosphere. Genomic comparison of these mycobacteriophages contributes to our understanding of the mechanisms of viral evolution and provides compelling evidence for the role of illegitimate recombination in horizontal genetic exchange. The promiscuity of these recombination events results in the inclusion of many unexpected genes including those implicated in mycobacterial latency, the cellular and immune responses to mycobacterial infections, and autoimmune diseases such as human lupus. While the role of phages as vehicles of toxin genes is well established, these observations suggest a much broader involvement of phages in bacterial virulence and the host response to bacterial infections.