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Biomedical subjects

A Frei

Publications and source records attributed to A Frei.

At least 37 records · Page 2Linked to original sources
PubMed1997

[A new model for economic studies of therapies exemplified by postoperative parenteral nutrition].

In this economic evaluation we compared the costs of a new therapeutic system (two-chamber bag) in total parenteral nutrition (TPN) with the comparative standard therapeutic systems (multiple-bottle system in intensive care patients followed by a combination solution (glass bottles) on the ward). In the model, standard treatment algorithms of a 10-day course TPN for patients after major gastric surgery were specified for both application systems, the two-chamber bag and the comparative system. Based on the standard treatment pattern, the resource utilisation (manpower services, medical needs, material) was assessed. In a base case analysis the types and amounts of resources were valued using salaries, prices and tariffs to assess the costs. The costs per day and per case of the therapeutic systems were compared. Sensitivity analyses were carried out to validate the cost-estimates. The total costs per patient of the two-chamber bag amounted to DM 2324.41, which was substantially less than the DM 2728.99 cost of the comparative system. The average daily costs for the two-chamber bag system were 12% to 23% lower than for the comparative system. The results were shown to be valid for the whole range of tested parameters. This model makes it possible to obtain an economic evaluation of various therapeutic modalities without undertaking a prospective randomized study with the attendant high time and cost requirements.

Cost-Benefit Analysis↗
PubMed1996

[Helicopter use in the Swiss air rescue service for children. Inland transport in 1992].

In 1992, the Swiss helicopter rescue service (REGA) transported 515 injured and 141 sick children (total n = 656). More than 60% of the children were boys; the age group from 10 to 16 years dominated. Primary care was provided in 415 of the flights, whereas the remaining cases were interhospital transfers to institutions with pediatric intensive care units. The main reason for primary interventions was sports accidents, followed by medical disease and traffic accidents. The majority of the sick children (70%) were severely ill with life-threatening diseases according to National Advisory Committee for Aeronautics (NACA) indices IV to VII. On the other hand, only 47% of the injured children had NACA indices of IV to VII. Most of these children had minor injuries suffered during sports activities; they were rescued mainly because of the site of the accident and not the severity of the injury. The remaining trauma victims had had traffic or home accidents and were usually severely injured. Head injuries were the most common reason for intervention due to accidents, and central nervous disorders and respiratory problems were the main reason for interventions in children suffering from serious illnesses. For primary REGA rescue interventions, the mean time from accident to arrival at the hospital was 64 minutes: 18 minutes from injury to alarm, 17 minutes from alarm to arrival at the scene, and 29 minutes for scene time and flight to the hospital. Costs for helicopter rescue are twice as high as for ground-based rescue (ambulance). However, considering the relatively high percentage of severely injured or life-threatened sick children involved, air rescue and its higher costs appear to be justified.

Adolescent↗
PubMed1996

[Second opinion in Switzerland. Design of program and evaluation study].

From 1994 till 1996, the sickness funds represented in the Forum schweizerischer Krankenversicherer are carrying-out a Second Opinion Pilot Program. This program is subject to a scientific evaluation. The objectives and the organisation of the program are presented, and material and methods of the study are described.

Cohort Studies↗
PubMed1995

[Disulfiram in the treatment of alcoholic patients].

In a retrospective investigation we report our experience with alcohol-dependent patients who were hospitalized between 1987 and 1990. There were 58 patients, 29% of them were hospitalized several times. In the middle of 1991 and 1992 we interviewed the family doctors and the social workers who cared for the patients. In 48% of the patients there was improvement, in 24% there was a stabilization, and in 28% we noted a deterioration. There was no difference in patients treated by the family doctor alone or in patients treated by the social workers. Comparing patients taking Disulfiram with patients taking no drug, there was no difference in improvement (48% versus 50%). But the good results in patients not taking disulfiram were nearly exclusively noted for those who had been hospitalized in a special clinic for alcohol-dependent persons. Patients who were hospitalized several times for alcohol withdrawal had a worse chance to improve their situation (-20%). The therapy with disulfiram in alcohol-dependent patients is helpful to cure chronic alcoholics. Programs in a specialized clinic improve also the chance to be cured of the addiction.

Adult↗
PubMed1994

[Socioeconomic assessment of therapies--report of a methodological procedure].

In most cases, evaluations of treatments are restricted mainly to their clinical efficacy. With health resources becoming scarcer, cost-benefit-analyses assume greater significance in the assessment of therapies. The following article introduces a methodological concept for the assessment of costs and benefits in the treatment of mental deterioration. In this concept, data on clinical effectiveness were derived from an existing clinical long term trial. In addition, according to the characteristics of the patients included in the clinical trial, a new sample of similar patients was examined. A cross-sectional analysis was performed in order to measure resource utilization. The clinical trial and the cross-sectional analysis were then combined to assess the cost effectiveness of the treatment. For this purpose, the patients of both the clinical trial and the cross-sectional analysis were classified into groups according to severity of symptoms. The proportions of medically- and placebo-treated patients in the different severity groups were followed up during the long term trial. The costs of resource utilization of each severity group were calculated. Consequently, depending on the course of the illness, direct treatment costs for medical- and placebo-treated patients could be compared. The results show clear differences. Rehabilitation measures and emotional care are provided mainly for patients with moderate symptoms, whereas the services for patients with more severe symptoms concentrate on basic care, such as dressing and undressing, washing, feeding, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1990

[Catamnesis of psychiatrically evaluated automobile drivers].

The present catamnestic study covers 100 petitioners, who either applied for the first time for a driving licence or for readmission to traffic after confiscation of their license by the police. 99 of them were former inpatients or still inpatients at the time of judgement. For all of them, the decision of the police depended upon our expertise. For the judgement we considered our psychiatric investigation, the clinical report and the police traffic record. Normally, our mode of admission was quite generous. The duration of catamnesis lasted at least two years. Our of the 100 petitioners, 88 were considered to be fit for driving; 67 unconditionally and 21 under the condition of regular survey or treatment. Subsequently seven of the petitioners showed a poor probation, i.e. their licenses were taken away by the police, one due to a severe and two due to minor accidents. Nobody was injured. In comparison to the experience of other authors about probation in traffic of former psychiatric inpatients, we think we can report a favourable result. A rather generous mode of admission to traffic seems to be justified in these patients.

Accidents, Traffic↗
PubMed1987

Bolus injection of cimetidine and hypotension in patients in the intensive care unit. Incidence and mechanisms.

Incidence and mechanisms of cimetidine-induced hypotension were investigated during the first intravenous injection of cimetidine (200 mg over three minutes) in 68 consecutive patients in the intensive care unit. Systolic pressure decreased more than 5 mm Hg (average, 14 mm Hg) in 50 patients, exceeding 30 mm Hg in nine (13%), while heart rate and pulmonary artery pressure (seven patients) did not change. Blood pressure decreased significantly more in patients requiring vasoconstrictor drug support. The arterial vasodilator properties of cimetidine were demonstrated in 12 normal volunteers in whom brachial artery cimetidine infusions caused a significant decrease of forearm vascular resistance. This effect was more pronounced when forearm vessels were preconstricted with dopamine hydrochloride (n = 6) or norepinephrine (n = 6), pointing toward an interference of cimetidine with sympathetically mediated vasoconstriction. Thus, intravenous injection of cimetidine in critically ill patients, presumably through arterial vasodilatation, is frequently associated with decreases of blood pressure, particularly in patients requiring vasoconstrictor drug support.

Adolescent↗
PubMed1986

Diffuse peritonitis and chronic ascites due to infection with Chlamydia trachomatis in patients without liver disease: new presentation of the Fitz-Hugh-Curtis syndrome.

Two women were admitted for increasing abdominal pain, vaginal discharge, and severe or moderate chronic ascites. Diffuse peritonitis without evidence of liver disease was found in both cases, and in one the ascites and vaginal discharge contained Chlamydia trachomatis. Both patients responded to doxycycline, and this and the laboratory findings pointed strongly to C trachomatis as the aetiological agent. C trachomatis may cause severe peritoneal infections with chronic ascites formation in the absence of liver disease in women with the Fitz-Hugh-Curtis syndrome. Prompt diagnosis and antibiotics lead to rapid cure.

Adult↗
PubMed1986

Cerebral blood flow and antihypertensive treatment with enalapril.

The intravenous 133Xenon method was used to measure regional cerebral blood flow (rCBF) in 20 patients with moderate hypertension. Regional cerebral blood flow under pretreatment, in the placebo period and after 8 weeks of enalapril treatment were compared. The rCBF values [(F1), and initial slope, (IS)] showed no statistical difference during the three periods in spite of significantly higher blood pressure values in the placebo period. It is concluded, that with enalapril good blood pressure control is achieved without any adverse effect on rCBF.

Adrenergic beta-Antagonists↗