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Biomedical subjects

G Brenner

Publications and source records attributed to G Brenner.

At least 19 recordsLinked to original sources
PubMed2005

Relativistic electron correlation, quantum electrodynamics, and the lifetime of the 1s(2)2s(2)2p2p0(3/2) level in boronlike argon.

The lifetime of the Ar13+ 1s(2)2s(2)2p2p0(3/2) metastable level was determined at the Heidelberg Electron Beam Ion Trap to be 9.573(4)(5). The accuracy level of one per thousand makes this measurement sensitive to quantum electrodynamic effects like the electron anomalous magnetic moment (EAMM) and to relativistic electron-electron correlation effects like the frequency-dependent Breit interaction. Theoretical predictions, adjusted for the EAMM, cluster about a lifetime that is approximately shorter than our experimental result.

Journal Article↗
PubMed2005

State-selective quantum interference observed in the recombination of highly charged Hg 75+...78+ mercury ions in an electron beam ion trap.

We present experimental data on the state-selective quantum interference between different pathways of photorecombination, namely, radiative and dielectronic recombination, in the KLL resonances of highly charged mercury ions. The interference, observed for well resolved electronic states in the Heidelberg electron beam ion trap, manifests itself in the asymmetry of line shapes, characterized by "Fano factors," which have been determined with unprecedented precision, as well as their excitation energies, for several strong dielectronic resonances.

Journal Article↗
PubMed2003

[Glaucoma in practices of ophthalmologists].

The aim of this study is to describe the prevalence of glaucoma among patients of office-based ophthalmologists on the basis of accounting data. The data can be taken from the so-called Patient-physician-panel for morbidity analysis (ADT panel) that has been developed by the Central Research Institute of Ambulatory Health Care in Germany. In this panel, the treatment data of patients treated by selected office-based physicians in North Rhine and Brandenburg are included. In both regions, 30 ophthalmologists were involved in the survey. The two random samples that have been performed, include the treatment data of nearly 55,000 patients from North-Rhine and of 58,000 patients from Brandenburg. The treatment prevalence of glaucoma with established diagnosis amounts to about 12% of the ophthalmologic patients in North Rhine and to about 13% in Brandenburg. If these figures are secondarily related to the total number of persons older than 39 years who are insured via social health insurance funds in these regions, the rates are 2.8 or 2.9% respectively. The majority of patients suffering from glaucoma (including suspected cases and exclusion diagnoses) underwent tonometry and it can be assumed that most of the patients received medical treatment. With the help of the morbidity panel, glaucoma patients with established diagnosis can be distinguished from those patients for whom this diagnosis has only been excluded and from cases where the suspicion remained unconfirmed. The standardised treatment prevalence of glaucoma almost amounts to the same rate in both regions. Ophthalmologists should use the additional specifications of the ICD-10 code more often (especially for cases of suspicion and exclusion). This would also lead to a higher significance of the ICD-10 terms indicated.

Adult↗
PubMed2001

[Special applications in health telematics: electronic prescription/electronic patient file/digital archiving].

Our challenge for the upcoming years is the development and the implementation of telematic applications that allow the exchange of data between different sectors of the health care system by a network system. Although most of the techniques already exist today, our highly administrated health care system makes further developments difficult. The communication process is subject to conventional procedures that have to be agreed upon between the contracting parties. The aim is to implement a common electronic communication platform for the health care system which can be accessed by all users. For this purpose, the implementation of electronic prescriptions (digital transmission of data that are up to now communicated from the physicians' office to the pharmacy in paper form) and of electronic patient files (structured documentations of findings according to standards agreed upon between the contracting parties) are of fundamental importance.

Drug Prescriptions↗
PubMed2000

[Outpatient treatment of patients with cardiovascular diseases].

In Germany, cardiovascular disturbances belong to the diseases most frequently treated in the offices of general practitioners and internal specialists. With comprehensive monitoring and the taking of adequate therapeutic measures, the average mortality age of the majority of the 18 million patients suffering from circulatory diseases lies at 79.4 years. In the age group of over 70 years, 70 to 80% of the patients receive treatment against cardiovascular disturbances, most of them against hypertension. One of the most important goals of monitoring and intervention in the outpatient sector is the treatment of hypertension, especially in connection with measures taken against disturbances in lipometabolism in order to prevent secondary diseases. The success of treatment is shown by the decreasing age standardized rate of cardiac infarctions, especially among men, and the decreasing mortality rate of patients below 65. The increasing treatment in the outpatient sector is accompanied by additional interventions, especially by bypass surgery in the hospital sector. The concerted actions in both the outpatient and the inpatient sector result in a higher service provision to come to a higher quality of life in the patients and to prevent early death.

Adult↗
PubMed2000

The cost of prescription medicines to patients.

The study compares the cost-sharing (co-payment) arrangements for prescribed medicines in a sample of EU countries. Through a set of typical prescription scenarios, the cost burden to individual patients of prescriptions are examined, in the context of drug price, and from the perspective of therapeutic need. The cost to patients of medicines is consistently lower in some, and higher in other, countries, regardless of the type of prescription charge system. Fixed charge systems, as opposed to graduated co-payment systems, are obviously more likely to lead to similar charges for the treatment of comparable clinical conditions, but depending on the level of the charge, can result in the patient paying a higher charge than the price of the drug to the health organisation. Exemption from charges for prescription medicines, commonly relate to clinical condition and level of income. Some systems also have age-related criteria and apply ceilings to the total prescription cost burden borne by the patient. The impact on patient costs of specific policy formulations is discussed and a proposal is made for cost convergence for comparable therapies. The method used in this study may also provide a route for investigating model systems prior to implementation.

Cost Sharing↗
PubMed2000

Importing budget systems from other countries: what can we learn from the German drug budget and the British GP fundholding?

The rising costs of pharmaceutical expenditures are a common problem for policy makers in most European countries. In two countries, budget systems for pharmaceutical spending exist(ed). In Great Britain, between 1991 and 1999 GP fundholders were responsible for prescribing costs, and in Germany an overall expenditure cap for pharmaceutical prescribing has been used since 1993. These two examples are analysed in order to identify the conditions that are needed for successfully implementing budget systems for prescribing costs in other countries. It is argued, that a good budget system balances the provision of enough information for budget holders to monitor their expenditures on the one hand, against an explosive increase of transaction costs on the other hand. Apart from that, it makes doctors responsible only for expenditures that they themselves can actually control, and does not provide them with an incentive to use that discretionary power by shifting expenditures to other health care sectors. A good information infrastructure is needed for the implementation of budget systems in general. For the introduction of fundholding, a number of additional criteria need to be met, such as having gate-keeping GPs with personal lists and having a single-payer system.

Budgets↗
PubMed2000

[Diagnostic spectrum and treatment requirements of general practice clients. Results of the ADT Panel of the Central Institute of National Health Insurance Management].

Results of the ADT-Panel of the Central Research Institute of ambulatory health care in Germany. The ADT-Panel of the Central Research Institute contains the remuneration data that are quarterly collected by office-based physicians and transmitted in anonymous form. These data can be classified according to the status of the insured patient, the diagnoses made or the treatment provided. The Patient Panel does therefore represent an important instrument which allows a rapid scientific analysis (3 to 4 weeks after the end of a quarter) about how patients are treated by different specialists. It might also be used to forecast trends. The Patient Panel does as well allow the demonstration of specialty-related statistics on diagnoses and disease-related treatment provision. The complete publication and some exemplary tables can be found in the DGN Internet (www.dgn.de; Deutsches Gesundheitsnetz). A short summary is available on the home page of the Central Research Institute (www/zi-koeln.de).

Ambulatory Care↗
PubMed1999

Prevalence of risk factors of coronary heart disease in Turks living in Germany: The Giessen Study.

Turkish people represent the majority of immigrants in Germany. Even though a high proportion of Turks has been living in Germany since about 20 years, little is known about risk factors of coronary heart disease (CHD) in this population. In this study a sample of 325 male and 155 female Turks are investigated, who voluntarily underwent a health check-up in Germany. Data about the presence of CHD, risk factors and blood parameters were collected. Mean residence time was 21 and 17 years (males/females). A low percentage of female participants was observed compared to the general Turkish population in Germany. Age adjusted prevalence of CHD reached 9.5% in males and 6.7% in females, respectively. Dyslipoproteinemia (DLP) showed the highest prevalence of all risk factors investigated in both genders. Total cholesterol (TC) levels were comparable to those of other western countries and remarkably higher than reported for the population in Turkey. Besides this, low high density lipoprotein-cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) levels could be found in the majority of the sample. The highest odds ratios for CHD were estimated for stress and hypertension in males and obesity in females. It is concluded that Turkish immigrants in Germany showed an assimilation of lipid pattern to western populations. However, reasons for low HDL-C levels remain unclear. Changes in the lipid metabolism chiefly seem to contribute to the risk factor pattern of Turkish immigrants in Germany.

Adolescent↗
PubMed1999

German adaptations of ICD-10.

The introduction of the ICD-10, published by WHO 1992-94 in English and by DIMDI 1994/95 in German, is a very slow process. Some states introduced ICD-10 for the preparation of statistics of mortality, but only few use it for morbidity. ICD-9 is in Germany only in hospitals still in use. Much effort was put into the improvement of the official ICD-10 and the development of additional aids for more simple and better encoding of diagnoses. Thus a revision especially for ambulatory health care (ICD-10-SGBV with the incorporated ICD-10-Basisschlüssel) and a collection of German terms and expressions of diagnoses that are not at all part of the official ICD-10 (ICD-10-Diagnosenthesaurus) were published. Three years ago a conversion table ICD-9/-10 was developed which can now be harmonised with WHO's Translator. The experiences with all these instruments are satisfying. The development of methods for automatic encoding of free-text phrases of diagnoses has now been started.

Disease↗
PubMed1998

[Structured documentation for quality management in patients with diabetes mellitus].

The medical services rendered by office-based physicians have to be assessed on the basis of valid, practicable, and reliable indicators. The necessity to implement such indicators follows from the fact that quality and economic efficiency have been combined. The indicators can be derived from already existing guidelines. The target is to define medical services according to their type, extent, frequency and their point of intervention with regard to the medical problems and the treatment goals. The aim is to implement measures that permit the qualitative and economic evaluation of medical services. On the basis of these indicators the Central Institute of Panel Physicians develops together with scientific groups data sets that are able to show if, and to which degree, physicians act guideline-conform. The data sets can be used as documentation modules for transmission purposes and will therefore be integrated into the standard interface for basic clinical data profiles of already existing practice computer systems. While the Centre of German Physicians for Quality Assurance in Medicine is responsible for guideline-development, the conversion of the guidelines into appropriate data set structures is accomplished by the Central Institute of Panel Physician. This close co-operation represents a useful division of the work to be done in connection with the implementation of quality management in physician offices.

Cost-Benefit Analysis↗
PubMed1997

Physician and other ambulatory care services in Germany.

The Germany multipayer universal health insurance plan in 1992 consumed 8.7% of its nation's total expenditures. Nevertheless, its macromanaged approach has allowed until recently for pluralism, decentralization, and self-regulation among providers and sickness funds (not-for-profit, third party payers). With 34.8% more physicians per 1,000 persons, German doctors provided twice as many patient contacts per capita than in the United States. Due to economic constraints and increases in payroll taxes, the Federal Republic of Germany's parliament, with its 1993 health reform plan, virtually froze all payments to providers for a 3-year period. Among other contentious provisions were the following: (1) limiting the entry of new physicians into municipalities that are considered by government health manpower planning experts to be oversupplied in that specialty; (2) requiring community-based physicians to participate in controlling pharmaceutical costs; and (3) eliminating some of the German traditional barriers between their in- and out-of-hospital physicians. This article focuses on how the Germans now micromanage their physician and other ambulatory care services within a macromanaged system that, in terms of patient access, benefits, quality, and cost, should be the envy of the Americans.

Ambulatory Care↗
PubMed1995

[Ambulatory surgery in Germany between demand and competition].

The Health Care Structure Act has provided incentives for outpatient surgery; 50% is now being performed outside the hospital. Additional incentives are to be provided for outpatient nursing care. An outpatient surgery is only economically efficient in cooperative practices.

Ambulatory Surgical Procedures↗
PubMed1994

A chip card for patients with diabetes.

DIABCARD provides the specification for the core of a Chip Card Based Medical Information System (CCMIS) for the treatment of patients with chronic diseases. It will provide an instrument for assessing health care services, improve the links between health care providers and set up communication between the different levels of health care. It will therefore improve the quality of care and thus the life of patients with chronic diseases. DIABCARD concentrates on diabetes at the moment, the concept of the diabetes chip card will, however, be extendable to other chronic diseases.

Chronic Disease↗