Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

BACKGROUND: Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. METHODS: Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. RESULTS: Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. CONCLUSION: Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration.

[Evaluation of the impact of the mammography screening program on breast cancer mortality: feasibility study on linking several data sources in North Rhine-Westphalia]. / Evaluation der Auswirkungen des Mammographie-Screening-Programms auf die Brustkrebsmortalität : Machbarkeitsstudie zur Verknüpfung verschiedener Datenquellen in Nordrhein-Westfalen.

BACKGROUND: In the German Mammography Screening Program (MSP), women aged 50-69 years are offered X-ray-based mammography for the early detection of breast cancer (BC) every 2nd year. To maintain the licensing of the MSP, evidence of a positive benefit-risk assessment of the radiation-related health risk has to be provided. Therefore, long-term effects of the program have to be shown by evaluating the BC mortality reduction based on the MSP. A current feasibility study attempts to develop different data flow models to evaluate whether, based on current legislations on data confidentiality, secondary data routinely available in the German health system can be linked in such a way that they can be used for epidemiological evaluation studies. We present the"NRW model," which builds on procedures developed and evaluated in the Epidemiological Cancer Registry of North Rhine-Westphalia (EKR-NRW). METHODS: Data of the Association of Statutory Health Physicians in Westfalen-Lippe (KVWL) are used to enumerate the cohort of women in WL who are entitled to MSP participation and their use of curative mammography outside of the MSP. The EKR-NRW provides epidemiological and medical data on all BC cases in WL, on cohort mortality, and on causes of death. The central MSP database MaSc offers the screening history of all MSP participants. The established uniform encryption methods employed in the EKR-NRW are used for linking records from the three data sources in one data-merging center (DZS). To this end, data are first captured in standardized formats, variably aggregated and transferred in an encrypted format, checked for anonymity and diversity level in an encrypted form, and eventually stored in a factually anonymized manner in the evaluation center (ES). Researchers can obtain data sets with plain text epidemiological-medical data from the ES for analyses.

[Visual function and quality of life in patients with age-related maculopathy: results of the Münster Age and Retina Study (MARS)]. / Visuelle Funktion und Lebensqualität bei Patienten mit altersabhängiger Makulopathie: Ergebnisse der Münsteraner Altern- und Retina-Studie (MARS).

BACKGROUND: The aim of this study was to examine the association between increasing severity of age-related maculopathy (ARM) stages, visual function and quality of life. METHODS: Using the 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ) in the Münster age and retina study (MARS), 974 patients (normal fundus: n = 208; early ARM: n = 466; late ARM: n = 300) with bilateral gradable fundus photographs were asked about their visual function and quality of life. The NEI VFQ scales with regard to general health, general vision, near vision, distance vision and peripheral vision were assessed. According to the ARM stages, age- and gender-adjusted mean scores were calculated and tested for statistically significant differences. RESULTS: The perception of general health, general vision, near vision, distance vision and peripheral vision was getting worse with increasing severity of ARM stages. Comparing the maculopathy groups, significant differences in age- and gender-adjusted mean scores were found between patients with late ARM and healthy subjects and patients with late and early ARM. Furthermore, we observed for the dimension general vision a significant difference of the mean score between early ARM and healthy control group [mean score; early ARM: 68.7 (0.7) vs. control group: 72.2 (1.1); p = 0.005]. CONCLUSIONS: The results of the NEI VFQ reflect the clinical expectation of an inverse relation between increasing severity of ARM stages and visual function and quality of life.

[Association between classic cardiovascular risk factors and age-related maculopathy (ARM). Results of the baseline examination of the Münster Aging and Retina Study (MARS)]. / Assoziation zwischen klassischen kardiovaskulären Risikofaktoren und altersabhängiger Makulopathie (ARM). Ergebnisse der Basisuntersuchung der Münsteraner Altern- und Retina-Studie (MARS).

BACKGROUND: Epidemiological studies have reported inconsistent associations between cardiovascular risk factors and the occurrence of age-related maculopathy (ARM). METHODS: In the baseline examination of the Muenster Aging and Retina Study (MARS), we assessed this potential relationship in 1060 subjects who underwent clinical and ophthalmologic examinations. The ARM status was graded according to international standardized classifications. RESULTS: There were 974 eye pairs available for analysis. Smoking, hypertension, hypercholesterolemia, and a history of myocardial infarction or stroke were found significantly more often in patients with ARM. There were no statistically significant multivariate associations between overweight, diabetes, or a history of myocardial infarction or stroke. CONCLUSIONS: Our results confirm previous epidemiological studies pointing to a potential role of atherosclerotic processes in the development of ARM.

[Parameters of maternal oxygen transport in risk pregnancies]. / Maternale Sauerstofftransportparameter bei Risikoschwangerschaften.

Fetal oxygen supply depends on the one hand on placental perfusion and on the other on maternal and fetal oxygen transport parameters. In the study reported here the maternal oxygen transport parameters, such as the O2 half-saturation pressure P50 (mmHg) and the factors influencing it (2, 3-DPG, ATP, pH) were studied in high-risk pregnancies in comparison with a control group of normal pregnancies. A total of 112 patients at the Department of Gynecology and Obstetrics of the Rhine-Westphalian Technical University in Aachen were examined. All calculations were done with the BMDP static analysis system. Using the Mann-Whitney test, no location differences in the various parameters were detected at the level alpha = 0,05 between to group of patients with EPH gestosis and the control group. The same results were obtained when patients with placental insufficiency were compared with the control group. In contrast, a significant shift in location in oxygen transport was detectable in patients in whom there was an imminent danger of premature birth. In such cases it must be assumed that the fetus is at risk. After at least two days' intravenous administration of Fenoterol the possibility of a transient deficiency of fetal oxygen supply due to the change in the maternal oxygen transport parameters must be considered, since it cannot be assumed that there will be a compensatory increase in placental perfusion under Fenoterol. With peroral tokolysis the oxygen supply to the fetus is not impaired as far as maternal oxygen transport parameters are concerned.