ABSTRACT
BACKGROUND: Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available. OBJECTIVES: Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference. MATERIALS AND METHODS: Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks. RESULTS: For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators. CONCLUSIONS: The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.
Subject(s)
Leg Ulcer/diagnosis , Varicose Ulcer/diagnosis , Clinical Competence/standards , Consensus , Diagnosis, Differential , Germany , Health Plan Implementation/organization & administration , Humans , Leg Ulcer/classification , Leg Ulcer/therapy , National Health Programs/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Quality Assurance, Health Care/organization & administration , Varicose Ulcer/classification , Varicose Ulcer/therapyABSTRACT
Medullary carcinoma of the breast has a relatively favorable prognosis despite its malignant histopathological appearance, providing a challenge for the pathologically based diagnosis of breast cancer. Macroscopic and microscopic findings combined provide diagnostic criteria. The importance of the immunophenotype of medullary carcinoma is not well defined. Because the reproducibility of morphological criteria is limited, we conducted an immunohistochemical study in search of markers that could facilitate histopathological classification. We examined 32 medullary carcinomas in comparison with 30 high grade ductal invasive carcinomas with similar morphology using 23 different immunohistochemical markers. The results showed an overlap with the so called basal like subtype of invasive breast cancer (negativity for steroid hormone receptor, positivity for basal cytokeratins). None of the immunohistochemical markers enabled a specific discrimination between the two groups. Medullary carcinomas overexpress EGF-R more frequently (P<0.004). In combining the characteristic morphological criteria and the immunohistochemical detection of the basal like phenotype and EGFR, a higher diagnostic accuracy can be achieved. The immunophenotype alone does not allow a definite classification of medullary carcinoma.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Medullary/pathology , Carcinoma, Ductal/pathology , Female , Humans , Immunohistochemistry , Immunophenotyping , Neoplasm InvasivenessABSTRACT
Differential display technology applied to rabbit blastocysts identified an mRNA that encodes a motif similar to that of the proteolipid protein PLP2/A4 of man, mouse and sheep. The open reading frame (456bp) has 88% amino acid identity to human PLP2/A4. The gene is maximally expressed at the beginning of gastrulation: in situ hybridizations exhibited a sickle-shaped area of labelling at the posterior pole of day 7 post-coitum embryos, which appeared at day 6.5 and decreased in size up to day 8. Weaker labelling was found in the extraembryonic mesoderm, in the anterior part of the primitive streak and in the trophoblast. Time and site of gene expression coincide with emerging morphogenetic activities at the posterior pole of the embryo at the beginning of gastrulation.
Subject(s)
Gastrula/metabolism , Gene Expression Regulation, Developmental , Amino Acid Sequence , Animals , Blastocyst/metabolism , In Situ Hybridization , MARVEL Domain-Containing Proteins , Membrane Proteins , Mesoderm/metabolism , Molecular Sequence Data , Myelin Proteolipid Protein/chemistry , Myelin Proteolipid Protein/genetics , Myelin Proteolipid Protein/metabolism , Proteolipids , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rabbits , Sequence Homology, Amino Acid , Trophoblasts/metabolismABSTRACT
In 194 healthy children of all ages, sonographic measurements of the liver and spleen were performed on standardized section planes and normal values established. These measurement values showed an approximately linear increase in the course of development and correlated best with the body length. For a rapid orientational evaluation of the liver size, sonographic nomograms of the individual measurements were developed. The spleen size was determined by volume calculation. On the basis of an index of liver size, which was calculated from the individual measurements, a diagram for simultaneous determination of liver and spleen size could be developed. These nomograms permit objective morphometry of size changes in the two organs.
