[Preserving vision in the elderly: a survey to start a quality development program in general practice]. / Erhaltung des Sehvermögens im Alter: Eine Patienten- und Hausarztbefragung zur Einleitung eines Qualitätsentwicklungsprojektes in der Hausarztpraxis.

The study examined the rate of patients, who do not follow recommendations for routine screening, do not visit physicians for eye-symptoms and when suffering from diabetes or glaucoma do not adhere to follow-up. To what extent can primary care physicians impact on these deficits of ophthalmologic care? 4918 consecutive, > or = 40 old patients of 107 primary care physicians of 9 networks participated. Of these patients 15% had never, 43% not within the last 3 years, consulted an ophthalmologist. 16% were diabetics, 7% had glaucoma and 46% had observed subjective eye symptoms. A quarter of these patients turn to their primary care physician, when having eye problems. Primary care physicians do not frequently suggest routine ophthalmologic controls nor do they use diagnostic tools like the Amsler-grid or the Swinging-Flash-Light Test.

[Anticoagulatin in atrial fibrillation--status of therapy in a network of physicians]. / Antikoagulation bei Vorhofflimmern--Stand der Therapie in einem Arztenetzwerk.

Despite of sound evidence, that oral anticoagulation reduces substantially the incidence of stroke-events in patients with atrial fibrillation and concomitant risk factors, in daily practice only a part of these patients is in fact treated with anticoagulation. The aim of this cross-sectional study was to evaluate to which extent existing guidelines for the treatment of patients with atrial fibrillation are transformed in the "real world" context of a Swiss urban network of primary care providers. The greatest part (88.4%) of the included patients with atrial fibrillation had a high risk for thromboembolism and herewith the indication for anticoagulation was given. For a primary care collective the amount of patients with anticoagulation was high: 74.1% did receive this kind of preventive therapy. 89% had robust International normalized ratio (INR) values within the recommended range (INR 2.5-3.5). The most common reasons not to prescribe oral anticoagulation were: old age (17.5%; mostly in combination with other reasons), risk of falls (16.5%), medical indication not given (16.5%). Thus the recommendations of the guidelines have been transformed into practice for a bigger part of the included patients. Given these results a broadly implemented quality-improvement-project to bring up the anticoagulation rate even higher hardly seems to be efficacious and is presently not of top priority in this network of primary care providers.

[Value of the Valsalva maneuver for evaluating systole heart function]. / Aussagekraft des Valsalvamanövers für die Beurteilung der systolischen Herzfunktion.

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.

Early results after mitral valvuloplasty for pure mitral regurgitation.

In this study we present the results of 105 consecutive patients with pure mitral regurgitation who underwent surgical treatment. In all patients mitral regurgitation was associated with mitral valve prolapse: 54 patients underwent mitral valvuloplasty and 51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-up criteria at one year after surgery. After mitral valvuloplasty, NYHA decreased from 2.7 +/- 0.8 to 1.1 +/- 0.7 (P less than 0.01) and workload capacity increased from 65 +/- 28% to 96 +/- 25% (P less than 0.001); left endsystolic atrial dimension and enddiastolic dimension decreased from 6.2 +/- 0.8 to 4.8 +/- 1.2 cm (P less than 0.001) and from 7.2 +/- 1.3 to 5.9 +/- 0.8 cm (P less than 0.01); ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographic improvement was significant but less remarkable than after valvuloplasty; ventricular contraction fraction fell from 39 +/- 7% to 29 +/- 8% in contrast to patients undergoing mitral valvuloplasty in whom no significant change occurred. Complications were rare in both groups though only a minority of patients undergoing mitral valvuloplasty received anticoagulants. We conclude that mitral valvuloplasty in patients with pure mitral regurgitation when compared with the patients after mitral valve replacement.

[Early results of percutaneous transluminal coronary vessel dilatation in single vessel disease. Comparison with drug treated or surgically treated patients, retrospective for dilatation suited patients]. / Frühresultate der perkutanen transluminalen Koronargefässdilatation bei Ein-Gefäss-Erkrankung. Vergleich mit medikamentös oder chirurgisch behandelten, retrospektiv für Dilatation geeigneten Patienten.

The shortterm results (mean follow-up 0.9 years) in 61 patients with single vessel disease (1-VD) who had undergone percutaneous transluminal coronary angioplasty (PTCA) were compared with those in 33 patients with 1-VD treated medically and in 36 patients with 1-VD treated by bypass surgery. All medically and surgically treated patients had coronary artery stenoses which were classified in a retrospective analysis as suitable for PTCA. Initially there were no significant differences between the three groups with respect to functional impairment (NYHA class), incidence of prior myocardial infarction, left ventricular ejection fraction and localization of the coronary stenoses. Comparison of follow-up results at the end of the first year showed (1) that the NYHA class was reduced to a similar extent both in patients treated surgically and in those treated by PTCA, (2) that the NYHA class in the medically treated group was significantly greater than in the other two groups, and (3), that there was no difference among the three groups with respect to infarct and mortality rate.