The development of quality circles/peer review groups as a method of quality improvement in Europe. Results of a survey in 26 European countries.

BACKGROUND: Peer review groups (PRGs) and quality circles (QCs) commenced in The Netherlands and have grown to become an important method of quality improvement in primary care in several other European countries. OBJECTIVE: Our aim was to provide an overview of QC/PRG activities and exemplary programmes in European countries. METHODS: A survey was performed in three consecutive steps by EQuiP (European Working Party on Quality in Family Practice), which is a representative association of experts from 26 European countries. The national representatives initially completed a structured questionnaire documenting the number and objectives of QCs/PRGs, sources of support and special programmes in their countries (step 1). In step 2, these sources were used to extend and validate the expert statements. Step 3 studied paradigmatic initiatives in depth. RESULTS: Step 1 took place in 2000; the response rate was 100% (26 countries). QCs/PRGs were very active in 10 countries; 16 countries showed little or no activity. Participation ranged from <2 to 86% of all GPs. Step 2 concentrated upon the countries with a high level of activity. Development appeared to be associated with establishment in private practice and the portion of GPs with vocational training. Eight programmes from six countries describing the establishment and the targeting of QC/PRG work are presented as case reports (step 3). CONCLUSION: In the last 10 years, substantial development of QCs/PRGs has taken place in The Netherlands, the UK, Denmark, Belgium, Ireland, Sweden, Norway, Germany, Switzerland and Austria. Further evaluation is needed to clarify the impact on quality of care.

Surgery planning tools for the osseous grafting treatment.

This paper presents a method for computer assisted selection of optimal donor sites for autologous grafts in the craniofacial surgery planning. The method consists of two stages. The non-automatic graft design step is followed by a fully automatic procedure to find the best harvesting site in the predefined donor region. The main idea of the proposed method is based on the registration paradigm. The optimal donor site is identified by performing an optimization of the surface based similarity measure between the donor region and the designed graft template. An efficient optimization method based on the Levenberg-Marquardt algorithm has been implemented. It enables, once the preprocessing step has been performed, selection of the optimal donor site in time less than one minute.

[Evaluation of the urinary tract in children with renal agenesis]. / Ocena stanu ukladu moczowego u dzieci z agenezja nerki.

The condition of urinary tract in 24 children with kidney agenesia was estimated. 14 out of 24 children had additionally renal abnormalities or different renal diseases. It was detected that more than 50% of patients developed chronic failure of this single kidney, but renal function of normal single kidney remains many years correct.

[The analysis of plasma beta 2-microglobulin concentration in patients with chronic renal failure treated by hemodialysis]. / Stezenie beta 2-mikroglobuliny w surowicy krwi pacjentów z przewlekla niewydolnoscia nerek leczonych powtarzanymi hemodializami.

Plasma beta 2-microglobulin concentrations increase in long-term dialyzed patients. This rise correlates with impairment of excretion and degradation by inefficient kidneys and also with increased synthesis of this protein during standard hemodialysis. In extreme cases, in particular in patients treated by hemodialysis for a long time, when their plasma beta 2-concentration rises significantly, the protein can be deposited in tissues. This study reports the results of determining serum beta 2-microglobulin levels in 14 patients with chronic renal failure treated by hemodialysis. The average age of patients at the beginning of the study was 16 years. All patients were hemodialyzed with cuprophane membranes. Determinations of beta 2-microglobulin levels were repeated after 6, 12 and 24 months. The results show that serum beta 2-microglobulin levels rose during this period of hemodialysis therapy.

[Concentration of selected trace elements in serum and erythrocytes of children with chronic renal failure and am attempt at deficiency correction with animal blood preparation]. / Stezenie wybranych pierwiastków sladowych w surowicy krwi i krwinkach czerwonych u dzieci z przewlekla niewydolnoscia nerek oraz próba korygowania niedoborów preparatem krwi zwierzecej "Livex".

The results are presented of studies in 32 children with chronic renal failure treated conservatively in whom the value was evaluated of serum Mg, Zn, and Se concentration, and erythrocyte Mg, and Zn concentration. Among the patients a group of 15 children was isolated whose diet was enriched with the animal blood preparation brown Livex containing among others the studied trace elements. Significant Zn and Mg deficiency was demonstrated in the serum and Mg deficiency in the erythrocytes of the ill children which were effectively corrected after three months of supplementation with the preparation Livex.

[Serum gastrin in patients with acute kidney failure]. / Serumgastrin bei Patienten mit akutem Nierenversagen.

In 18 patients with acute renal failure and 11 patients with chronic renal insufficiency serum gastrin levels were estimated before and after a test meal. The results were compared with those obtained in a group of 52 healthy subjects. It was stated that patients with acute as well as chronic renal failure display a "physiological" increase of serum gastrin after stimulation by a test meal. In contrast to healthy subjects the post-test meal gastrin curves in patients with chronic and acute renal insufficiency during the anuric/oliguric phase started from significantly higher fasting values. From the results obtained it seems that diminished renal clearance of gastrin by the insufficient kidneys is only partially responsible for the elevated fasting values found in anuric/oliguric patients with acute renal failure or patients with chronic renal insufficiency.