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Biomedical subjects

B Aust

Publications and source records attributed to B Aust.

6 recordsLinked to original sources
PubMed2000

Stress prevention in bus drivers: evaluation of 13 natural experiments.

The research aim was to select, compare, and analyze interventions and preventive actions from international bus companies to decrease bus drivers' occupational stress and sickness absenteeism. Through networking, international surveys, and literature study, 13 "natural experiments" were identified with an acceptable research design rating. Interventions were both work and person directed. Principles of worker participation were often followed. The variety in intervention programs, outcome measures, case evaluations, and methodological flaws makes it difficult to present a general picture of program effectiveness. However, analyses on more objective and more subjective outcomes do point at positive effects. This study suggests that stress prevention that combines adequate interventions and proper implementation may be beneficial to both the employee and the company.

Cross-Cultural Comparison↗
PubMed2000

[Previous experiences with the evaluation of guidelines. Disillusionment after an enthusiastic start].

The evaluation of medical guidelines shows that the development and implementation of medical guidelines have failed to meet the high expectations raised both in Germany and internationally. Especially, the quality of German guidelines has been strongly criticized. Since then, several 'guidelines for guidelines' were published, and a variety of other measures were taken to define quality standards for the development and implementation of guidelines. It is expected that the application of these new standards will improve the quality of medical guidelines and therefore increase the chances for a more successful implementation. Only guidelines with high quality and wide acceptance, which are actually applied, will have positive effects on the process and outcome of medical care. But guidelines are only one way to improve the quality of medical care. The decision about the development and use of new guidelines should be based on the careful consideration of possible improvements and disadvantages.

Germany↗
PubMed2000

[Previous experiences with evaluation of practice guidelines].

Numerous expectations are associated with the development of guidelines. Referring to the experiences so far it can be stated that despite the large amount of guidelines that have been developed, little attention has been given to dissemination, implementation and evaluation of guidelines. The developed guidelines often do not follow international accepted quality criteria, for example many are not based on scientific evidence or they lack the involvement of all relevant parties. The main problems occur in the process from development to implementation of a guideline. Results from evaluation studies nevertheless show that guidelines can have positive effects on the process and outcome of medical care. More scientifically sound evaluation studies are needed to assess the effects of guidelines. Especially in Germany a lot more needs to be done to improve the quality of guidelines and the amount of evaluation studies.

Evidence-Based Medicine↗
PubMed1999

[Formal decision aids in surgery--results of a survey].

Even though many decision-aids have been developed in the past, the application of these systems in clinical practice is still rare. There are many reasons for this, including the reservations of potential users. A survey in three university surgery clinics was conducted to assess the experience and attitudes towards decision-aids among physicians. Seventy-two of the 102 physicians approached (71%) filled out and returned the short questionnaire that was sent to them. More than half of the 72 survey participants already use decision-aids. Among them, guidelines are used most often (46%), whereas other instruments (algorithms, scores, decision trees) are used less frequently (10-17%). Computer-based decision-aids are hardly used at all (7%). These results are in contrast to the strong request for more decision-aids, especially for computer-based systems (40%). Physicians who already use decision-aids are more interested in additional systems. More than 70% of all participants are interested in more information about the topic. The standardized question about attitudes towards computer-based decision-aids reveals more positive than negative appraisal, whereas the answers to open questions focus more on objections. The substantial differences between the three survey locations in parts of the survey results show that attitudes towards decision-aids are influenced by the way the instruments are introduced and the way the users are informed and involved in the process of implementation. A successful implementation of decision-aids in clinical practice should therefore try to integrate the future users as much as possible.

Academic Medical Centers↗
PubMed1994

Metabolism of dichloromethane (methylene chloride) to formaldehyde in human erythrocytes: influence of polymorphism of glutathione transferase theta (GST T1-1).

Human hemolysate was incubated in vitro with different concentrations of dichloromethane (methylene chloride). The resulting enzymatically mediated production of formaldehyde was determined by two independent analytical methods (Nash-reaction/colorimetry or HPLC). The formation of formaldehyde from dichloromethane is influenced by the polymorphism of glutathione-S-transferase (GST) Theta, in the same way as the metabolism of methyl bromide, methyl chloride, methyl iodide and ethylene oxide. Three quarters of the population ("conjugators") possess, whereas one quarter ("non-conjugators") lack this enzyme activity in human erythrocytes. The metabolism of dichloromethane in hemolysate in vitro can be described by Michaelis-Menten kinetics; for an individual with high GST T1-1 enzyme activity, the maximum velocity of formaldehyde production was calculated to be approximately 180 pmol/min per mg Hb, the kM being approximately 60 mM dichloromethane. Carcinogenicity of dichloromethane in long-term inhalation exposure of rodents has been attributed to metabolism of the compound via the GST-dependent pathway. Extrapolation of the results to humans for risk assessment should consider the newly discovered polymorphic enzyme activity of GST Theta. Furthermore, the possible existence of a "high-risk" population among humans should be considered in epidemiological research.

Erythrocytes↗