Sistema de indicadores para evaluar la calidad de los servicios generales de la Clínica Central Cira García / System of indicators to evaluate the quality of general services of Cira García Central Clinic

Introducción: En Cuba el sistema nacional de salud con acceso universal y cuidado de los individuos, la familia y la comunidad es una fortaleza reconocida internacionalmente. La Clínica Central Cira García es un centro de atención médica especializada de referencia internacional en la atención a pacientes extranjeros. Su calidad ha sido certificada por distintas organizaciones, no obstante, trabaja intencionadamente por elevar los estándares alcanzados. Objetivo: Proponer un sistema de indicadores para evaluar la calidad del subproceso servicios generales de la Clínica Central Cira García. Métodos: Se aplicaron métodos teóricos y empíricos, a través del análisis y la síntesis, el método sistémico-estructural-funcional y el análisis de contenido, se analizó la documentación existente relativa a la gestión de la calidad de la institución y en particular de servicios generales, se sistematizaron los resultados y se propuso el sistema de indicadores de calidad a evaluar. Se utilizaron la observación y la entrevista en la caracterización del funcionamiento de las distintas esferas de trabajo que comprende el subproceso servicios generales con lo que se obtuvieron criterios del público interno. Se aplicó una encuesta de satisfacción a pacientes no hispanohablantes de países desarrollados. Se trianguló la información y se detectaron las brechas de mejora. Resultados: Se propuso un sistema de cuatro dimensiones, 14 variables y 54 criterios para evaluar la gestión de calidad del subproceso servicios generales el cual prácticamente no era tomado en cuenta en los indicadores de calidad utilizados hasta el momento. En las encuestas de satisfacción la mayoría de los criterios establecidos recibieron niveles satisfactorios por al menos el 90 por ciento de los encuestados. El tiempo de espera para recibir la habitación y el dominio de idiomas fueron los criterios que mostraron mayor insatisfacción. Conclusiones: Para garantizar un turismo de salud competitivo que cumpla con las expectativas de pacientes que seleccionen con este fin el destino Cuba, se necesita contar con un sistema de indicadores para evaluar la calidad de los procesos no clínicos que apoyan el desarrollo de los procesos clave que puedan generalizarse a las instituciones que desarrollan turismo de salud(AU)

Introduction: In Cuba, the national health system with universal access and care for individuals, the family and the community is an internationally recognized strength. Cira García Central Clinic is a specialized medical care center of international reference in the care of foreign patients. Its quality has been certified by different organizations, however, it intentionally works to raise the standards achieved. Objective: Propose a system of indicators to evaluate the quality of the sub-process called general services in Cira García Central Clinic. Methods: Theoretical and empirical methods were applied, through analysis and synthesis, the systemic-structural-functional method and content analysis, the existing documentation related to the quality management of the institution and in particular of general services was analyzed, the results were systematized and the system of quality indicators to be evaluated was proposed. Observation and interview were used in the characterization of the functioning of the different areas of work comprising sub-process called General Services, thus obtaining criteria from the internal public. A satisfaction survey was applied to non-Spanish-speaking patients from developed countries. Information was triangulated and improvement gaps were detected. Results: A system of four dimensions, 14 variables and 54 criteria was proposed to evaluate the quality management of the sub-process general services which was practically not taken into account in the quality indicators used so far. In the satisfaction surveys, most of the established criteria received satisfactory levels by at least 90percent of the respondents. The waiting time to receive the room and the mastery of languages were the criteria that showed the biggest dissatisfaction. Conclusions: To guarantee a competitive health tourism that meets the expectations of patients who select Cuba destination for this purpose, it is necessary to have a system of indicators to evaluate the quality of non-clinical processes that support the development of key processes that can be generalized to the institutions that develop health tourism(AU)

Development and Evaluation of Vaginal Suppository Containing Althaea officinalis L. Polysaccharide Extract

Abstract Intrauterine adhesions cause several gynecological problems. Althaea officinalis L. roots known as marshmallows contain polysaccharides (M.P.) which possess anti-inflammatory and anti-ulcerogenic activities also can form a bio-adhesive layer on damaged epithelial membranes prompting healing processes. Vaginal formulations of herbal origin are commonly applied to relieve cervico-uterine inflammation. Herein, we aim to develop and evaluate vaginal suppositories containing polysaccharides isolated from the A. officinalis root. Six formulations (four P.E.G.-based and two lipid-based suppositories containing 25% and 50% M.P.) met standard requirements, which were then subjected to qualitative and quantitative evaluation. All suppositories exhibited acceptable weights, hardness, content uniformity, melting point, and disintegration time, which fall within the acceptable recommended limits. Higher concentrations of M.P. in PEG-bases moderately increased the hardness (p<0.05). PEG-formulations showed content uniformity>90% of the average content while it was 75-83% for suppocire formulations. All formulations disintegrated in<30minutes. In-vitro release test revealed that M.P. release from 25%-MP formulations was higher than that of 50%-M.P. suppositories. Overall, results revealed the feasibility of preparing P.E.G.-or lipid-based suppositories containing M.P., which met the B.P. quality requirement

Quality control and drug-drug interactions between commercially available Metoprolol and Glimepiride tablets

Abstract Quality is paramount and needs to be maintained throughout the shelf life of pharmaceuticals. The current study aimed to evaluate the quality, potency, and drug-drug interaction in an in vivo animal model by using two drugs, namely, metoprolol and glimepiride. Tablets were selected for their physical characteristics, such as shape, size, and color. Quality control tests, such as weight variation, hardness, friability, and disintegration tests, and invitro drug release studies were performed as per USP. Drug-drug interaction and in vivo studies were carried out according to the standard protocol of the animal ethics committee. Quality control tests of both the tablets were within the specified range. The cumulative release percentages of the drugs were 81.12% and 85.36% for Metoprolol Tartrate and Glimepiride, respectively, in a physiological buffer solution within 1 h. The combination of metoprolol and Glimepiride also significantly decreased the blood glucose level in diabetic animals. However, the blood glucose level increased in the group receiving metoprolol only, but the difference was not significant. The result suggested that the formulations are safe. However, the chronic use of this combination requires frequent monitoring of blood glucose level to improve its efficacy and for the patient's safety.

Formação em educação física no contexto de saúde pública nos melhores cursos do Brasil / The formation of physical education in public health in the best courses in Brazil

RESUMO O objetivo do estudo foi revisar projetos pedagógicos (PP) para identificar a formação do profissional de Educação Física (PEF) (Bacharelado) no contexto de Saúde Pública nos melhores cursos do Brasil. Foram selecionados os 10 melhores cursos de graduação em EF ranqueados em dois sistemas de avaliações nacionais (Exame Nacional de Desempenho na Educação e Ranking Universitário Folha) e as 10 melhores Universidades num ranking internacional (QS World University Rankings). Mediante revisão rápida foram extraídas informações dos PPs de 18 cursos que atenderam aos critérios de inclusão. Trinta e seis disciplinas no contexto de Saúde Pública foram localizadas nas grades curriculares. Em relação a carga horária média menos de 1% da grade eletiva dos cursos era dedicada a disciplinas sobre Saúde Pública. O estudo revelou um cenário de formação de Bacharéis em EF distante do crescimento que a área demonstrou no campo da Saúde Pública nos últimos anos. É importante que os cursos de graduação em EF considerem uma formação específica no contexto da Saúde Pública, de modo a favorecer a consolidação da atuação do PEF e a qualidade do seu serviço na Atenção Primária à Saúde.

ABSTRACT The purpose of the study was to review pedagogical projects (PP) to identify the formation of the Physical Education professionals (PEF) in the context of Public Health in the best courses in Brazil. Methods: The 10 best PE undergraduate courses ranked in two national assessment systems were selected (National Education Performance Examination and Folha University Ranking) and the 10 best Universities in an international ranking (QS World University Rankings). Through a quick review, information was extracted from the PPs of 18 courses that met the inclusion criteria. Thirty-six subjects in the context of public health were located in the curricula. Regarding the average workload, less than 1% of the elective course schedule was dedicated to subjects on Public Health. The study revealed a scenario for the formation of Bachelors in PE far from the growth that the area has shown in the field of Public Health in recent years. It is important that PE undergraduate courses consider specific training in the context of Public Health, in order to favor the consolidation of the PEF's performance and the quality of its service in Primary Health Care.

Analysis and Evaluation of Reviews on Lean and Six Sigma in Health Care.

BACKGROUND AND OBJECTIVES: Health care is a complex industry in which professionals are facing the challenge of balancing lower costs with better health and quality of care. To remain competitive, health care organizations have promoted the use of Lean and Six Sigma in various settings. More than 300 refereed English-language articles about Lean and/or Six Sigma in health care are found in the literature, and many reviews have been published on this subject. METHODS: This article characterizes the literature by evaluating and classifying 22 reviews, based on year of publication, country, taxonomy, health care setting, outcome, tools, and enabling factors, in order to identify gaps in the literature and set new directions for research. RESULTS: Findings indicate that 90% of reviews are characterized by restrictive inclusion criteria that result in the inclusion of only 3% to 66% of the literature at the corresponding time. Furthermore, there is no full comprehensive literature review available on Lean and Six Sigma in health care. Other gaps in the literature include more studies with better research design, broader applications in various health care settings and various countries, sustainability assessment and long-term effects, and evidence of failed Lean and Six Sigma implementations. CONCLUSION: This study provides an updated starting point for future research to researchers and practitioners in the field.

Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare.

Healthcare is a unique service industry and it deals with complex tasks. To overcome complex tasks, healthcare organizations need to implement DMAIC (Define, Measure, Analyze, Improve, Control) approach of Lean Six Sigma (LSS) to improve quality performance. Application of DMAIC in a healthcare organization provides guidelines on how to handle a quality service system toward patient satisfaction. This approach also helps healthcare service providers to reduce waste, variation and work imbalance in the service processes. This chapter discusses five phases of DMAIC approach and its integration with the theory of constraints (TOC) for continuous improvements in healthcare performance. The integration of TOC and DMAIC approach would enhance healthcare performance by reducing medical costs, medical errors, administration errors and defects. Moreover, this integration can improve performance in healthcare service processes where it is not possible to reduce bottlenecks.

The fishery performance indicators for global tuna fisheries.

We characterize the ecological, economic, and community performance of 21 major tuna fisheries, accounting for at least 77% of global tuna production, using the Fishery Performance Indicators. Our analysis reveals that the biggest variations in performance among tuna fisheries are driven by the final markets that they target: international sashimi market tuna fisheries considerably outperform a comparison set of 62 non-tuna fisheries in the Fishery Performance Indicator database, international canned tuna market fisheries perform similarly to the comparison set, and tuna fisheries supplying local markets in coastal states considerably underperform the comparison set. Differences among regional fishery management organizations primarily reflect regional species composition and market access, despite stark variation in governance, management, and other enabling conditions. With a legacy of open access, tuna's harvest sector performance is similar across all fisheries, reflecting only a normal return on the capital and skill invested: industrial vessels slightly outperform semi-industrial and artisanal vessels. Differences emerge in the post-harvest sector however, as value chains able to preserve quality and transport fish to high value markets outperform others.

[Analysis of Different Quality Management Systems in Medical Practices in Saxony]. / Analyse verschiedener Qualitätsmanagementsysteme in Arztpraxen für Sachsen.

INTRODUCTION: Since 1 January 2004, all physicians, psychotherapists and medical care centres on contracts with statutory healthcare in Germany are obliged according to § 135a section 2, no. 2 of the Fifth Social Security Statute Book to introduce and develop an intra-institutional quality management system. Thus, physicians are faced with the question of which quality management system is best suited to their own practice. METHODS: A total of 24 medical practices were chosen by random sampling. The sample was collected in Saxony because the Health Insurance Physicians Unification Saxony provided the necessary information. First, 2 primary units were determined from the basic population. In the following step, a sample was taken for each primary unit using 3 quality management systems. The analysis was carried out with the help of three specially developed questionnaires (physician, employee and patient). The individual questions were developed independently of a quality management system. The basis was formed by the guidelines of the Federal Joint Committee, which describes the concrete contents of the quality categories. A total of 26 quality categories with different questions were available in the 3 survey groups. For the analysis of the data, the arithmetic mean was formed in the individual question complexes. Subsequently, a variance analysis was used to test whether the systems differed statistically significantly on average. Taking into account the costs of the individual quality management systems and their introduction, the effect size was finally analyzed according to η2 and Cohen's d. Finally, a cost-benefit analysis was carried out by researching the direct/indirect costs of the various quality management systems through a literature study. RESULTS: Based on model documents and process support, the "Quality and Development in Practices" had the highest score. Due to a specific family practitioner specialty, "Quality management systems in Saxony medical practices" had the next best scores. The individual quality categories such as the 'range of services' or 'treatment pathways and guidelines' indicate significant differences and sustained effect sizes between quality management systems. CONCLUSION: The assessment of quality management systems shows significant differences. The specific differences between the systems can be explained by the differences in process tools.

Statistical Process Control: No Hits, No Runs, No Errors?

A novel intervention or new clinical program must achieve and sustain its operational and clinical goals. To demonstrate successfully optimizing health care value, providers and other stakeholders must longitudinally measure and report these tracked relevant associated outcomes. This includes clinicians and perioperative health services researchers who chose to participate in these process improvement and quality improvement efforts ("play in this space"). Statistical process control is a branch of statistics that combines rigorous sequential, time-based analysis methods with graphical presentation of performance and quality data. Statistical process control and its primary tool-the control chart-provide researchers and practitioners with a method of better understanding and communicating data from health care performance and quality improvement efforts. Statistical process control presents performance and quality data in a format that is typically more understandable to practicing clinicians, administrators, and health care decision makers and often more readily generates actionable insights and conclusions. Health care quality improvement is predicated on statistical process control. Undertaking, achieving, and reporting continuous quality improvement in anesthesiology, critical care, perioperative medicine, and acute and chronic pain management all fundamentally rely on applying statistical process control methods and tools. Thus, the present basic statistical tutorial focuses on the germane topic of statistical process control, including random (common) causes of variation versus assignable (special) causes of variation: Six Sigma versus Lean versus Lean Six Sigma, levels of quality management, run chart, control charts, selecting the applicable type of control chart, and analyzing a control chart. Specific attention is focused on quasi-experimental study designs, which are particularly applicable to process improvement and quality improvement efforts.

A Six Sigma Approach to Analyze Time-to-Assembly Variance of Surgical Trays in a Sterile Services Department.

INTRODUCTION: We analyze the assembly of surgical trays in a hospital's sterile services department. The department assembles 520 different tray setups. However, tray assembly times are unknown, imposing a challenge to production planners. To respond to demand, workers from other departments are often called, leading to higher operational costs and more frequent quality problems due to workers' poor training and inconsistency. METHODS: Conducting traditional time-motion studies is infeasible in such a high variety production setting. Thus, we used design of experiments to optimize the data acquisition. Assembly times of 36 trays were sampled using a 2-factor nested factorial design. Through regression analysis, we built a model to estimate completion times of trays not sampled in the experiment. RESULTS: A prediction model with 90.8% accuracy was obtained from the experimental data. The model was validated with assembly times from several trays not included in the experiment. Predicted assembly times had an absolute error of 7.83% on average compared with observed assembly times. CONCLUSIONS: Design of experiments and regression analysis combined were able to optimize time data acquisition using a small sample of trays, resulting in a model that predicted assembly times within an acceptable margin of error.

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

OBJECTIVE: Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. DESIGN: Before-and-after cohort study. SETTING: Multidisciplinary intensive care unit (ICU) in an academic medical center. PATIENTS: Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). METHODS: We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. RESULTS: Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). CONCLUSION: We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Using Lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions.

BACKGROUND: An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. METHODS: The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record. Data on lead time (time between receiving a request and sending the completed request to the Health Information Management department) and process time (amount of time the staff worked on the request) were collected via manual pre- and post-time studies. RESULTS: Following implementation of interventions, the median lead time for processing durable medical equipment and supply requests decreased from 50 days to 3 days (p < 0.0001). Median processing time decreased from 14min to 9min (p < 0.0001). The decrease in processing time realized annual cost savings of approximately $11,000. CONCLUSIONS: Collaborative leadership and multidisciplinary training in Lean methods allowed the CCC staff to incorporate common sense, standardize practices, and adapt their work environment to improve the timely and reliable provision of equipment and supplies that are essential for their patients. IMPLICATIONS: The application of Lean methodologies to processing requests for DME and supplies could also result in a natural spread to other paperwork and requests, thus avoiding delays and potential risk for clinical instability or deterioration.

Continuous improvement projects: an authorship bibliometric analysis.

Purpose The purpose of this paper is to describe the current research on hospital continuous improvement projects (CIPs) from an author characteristics' perspective. This work addresses the following questions: who are the predominant research authors in hospital CIPs? To what extent are the research communities collaborating in distinct research groups? How internationalized has hospital CIPs research become with respect to author location? Design/methodology/approach A systematic literature review was conducted, identifying 302 academic publications related to hospital CIPs. Publications were analyzed using: author, quantity, diversity, collaboration, and impact. Findings Hospital CIPs are increasingly attracting new scholars each year. Based on the authors' analysis, authors publishing in this area can be described as a relatively new international community given the countries represented. Originality/value This paper describes the current hospital CIP research by assessing author characteristics. Future work should examine additional attributes to characterize maturity such as how new knowledge is being created and to what extent new knowledge is being disseminated to practitioners.

[The way the quality of health services is perceived and treated by the managerial personnel of public hospitals]. / Postrzeganie jakosci szpitalnych swiadczen zdrowotnych przez kadre zarzadcza szpitali publicznych.

BACKGROUND: Managerial knowledge and skills as well as profound understanding of goals and objectives of management determine the effectiveness and efficiency in all areas of managerial activities. In particular, this applies to the quality of healthcare services, perceived as a compliance between the effects (of medical treatment) and the assumed relevant objectives (defined/desired health condition). The aim of the research was to distinguish and define the way the health service quality is perceived by the hospital managerial personnel. MATERIAL AND METHODS: The questionnaire was mailed to 836 members of the managerial personnel of public hospitals in the Lódz province. Of this number 122 questionnaires were returned. RESULTS: Only 22 (18.49%) of respondents presented the definition of quality. Attempts to meet patients' expectations and to satisfy them were found to be the prevailing perception of the healthcare quality and 96.64% of respondents considered competences of medical staff contributory. Almost 64% of respondents disagree with the opinion that the number of medical staff does not affect the service quality. According to the respondents, a 46% increase in financial resources on average could significantly improve the quality of healthcare services. More than half (66.76%) of respondents claim that healthcare services that are available cover 82% of patients' needs. Almost 57% (56.52%) of respondents consider that the subordinate- superior relationship influences their work involvement. According to 42.61% of respondents, the offered incentives encourage actions for the quality improvement. CONCLUSIONS: The results of the research indicate the need to develop a clear cut definition of the health service quality by the managerial personnel of public hospitals and to change their understanding, perception and treatment of the discussed issue, which provides a basis for the effective and efficient hospital management. Med Pr 2016;67(3):365-373.

Systematic Review of the Application of Lean and Six Sigma Quality Improvement Methodologies in Radiology.

PURPOSE: Preventable yet clinically significant rates of medical error remain systemic, while health care spending is at a historic high. Industry-based quality improvement (QI) methodologies show potential for utility in health care and radiology because they use an empirical approach to reduce variability and improve workflow. The aim of this review was to systematically assess the literature with regard to the use and efficacy of Lean and Six Sigma (the most popular of the industrial QI methodologies) within radiology. METHODS: MEDLINE, the Allied & Complementary Medicine Database, Embase Classic + Embase, Health and Psychosocial Instruments, and the Ovid HealthStar database, alongside the Cochrane Library databases, were searched on June 2015. Empirical studies in peer-reviewed journals were included if they assessed the use of Lean, Six Sigma, or Lean Six Sigma with regard to their ability to improve a variety of quality metrics in a radiology-centered clinical setting. RESULTS: Of the 278 articles returned, 23 studies were suitable for inclusion. Of these, 10 assessed Six Sigma, 7 assessed Lean, and 6 assessed Lean Six Sigma. The diverse range of measured outcomes can be organized into 7 common aims: cost savings, reducing appointment wait time, reducing in-department wait time, increasing patient volume, reducing cycle time, reducing defects, and increasing staff and patient safety and satisfaction. All of the included studies demonstrated improvements across a variety of outcomes. However, there were high rates of systematic bias and imprecision as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. CONCLUSIONS: Lean and Six Sigma QI methodologies have the potential to reduce error and costs and improve quality within radiology. However, there is a pressing need to conduct high-quality studies in order to realize the true potential of these QI methodologies in health care and radiology. Recommendations on how to improve the quality of the literature are proposed.

South African clinical practice guidelines quality measured with complex and rapid appraisal instruments.

BACKGROUND: Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning recommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments' common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded. RESULTS: Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument. CONCLUSIONS: Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.

[Evaluation and Utilization - Quality Management in a Paediatric University Outpatient Department]. / Evaluation und Inanspruchnahme - Qualitätssicherung in der pädiatrischen Ambulanz einer Universitätsklinik.

BACKGROUND: Based on an increasing number of outpatient treatments, an extensive demand planning is necessary to ensure the quality of medical care. University outpatient clinics are special parts of this sector and therefore it is necessary that a research demonstrates the nearly uninvestigated position of a paediatric outpatient clinic. PATIENTS: The research at the university hospital for children and adolescents in Leipzig started in 2009 to survey 2283 of in total 9391 patients and the physicians. METHODS: Sociodemographic data as well as economic and medical facts were determined by using questionnaires. In each case a questionnaire was answered by the children or their accompanying persons and a separate one was completed by the respective doctor. RESULTS: The results created a foundation, on the basis of patient volume per day and per daytime. Less than 20% of the children admitted to consult the clinic for their first time. The majority of patients visit them because of a letter of referral. Most of the patients (58%) were younger than 6 years old. Approximately 35% of patients did not come from the city region of Leipzig. CONCLUSION: The investigation evidenced the necessity of a day and night operating institution for children in the region of Leipzig as well as the high specialisation of the outpatient clinic. In need of further investigation is the cooperation between several physicians to find out if this lots of medical examination are necessary or if there took place overlapping.

[Evaluation of a Self-Help Supported Counseling Concept for Children and Adolescents with Disproportional Short Stature]. / Evaluation eines selbsthilfegestützten psychosozialen Interventionsangebotes für Kinder und Jugendliche mit disproportionalem Kleinwuchs.

BACKGROUND: Disproportionate short stature may impair the quality of life (QoL) of patients and their families. This study aimed to evaluate a self-help supported counseling concept to increase the QoL of the participants. METHODS: QoL data from 58 children/adolescents (8-17 years) with a diagnosis of achondroplasia was collected at 2 measurement points during one year using the the QoLISSY questionnaire (self-/parental report). Differences before and after participation vs. non-participation in the intervention were evaluated using a linear mixed model. RESULTS: The longitudinal results show a greater increase of QoL in the active intervention group compared to a passive control group (p=0,005). The increase in the self-reported QoL of affected patients was significantly higher than for the parent-report (p=0,048). CONCLUSIONS: The study shows that patients with achondroplasia benefit from a self-help supported counseling concept. However, this should be tested in a randomized trial.