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Biomedical subjects

H K Selbmann

Publications and source records attributed to H K Selbmann.

At least 55 records · Page 3Linked to original sources
PubMed1995

Bilateral spastic cerebral palsy--a collaborative study between southwest Germany and western Sweden. III: Aetiology.

In this third report from the collaborative study of children with bilateral spastic cerebral palsy born between 1975 and 1986, aetiology was analysed. Evidence for a prenatal aetiology increased with gestational age, whereas evidence for a peri-/neonatal aetiology decreased. The largest subgroup, the leg-dominated subtype, showed the same distribution of aetiology as the total group. A prenatal aetiology was found mainly among term and moderately preterm children with a four-limb-dominated subtype; a peri-/neonatal aetiology among very preterm children with a three- or four-limb-dominated subtype or among term children with a dyskinetic-spastic subtype. The findings support the hypothesis generated from the authors' epidemiological results of a peri-/neonatal aetiology being predominant among preterm, and a prenatal aetiology among term, children with bilateral spastic cerebral palsy.

Cerebral Palsy↗
PubMed1995

Application of neural networks to the ranking of perinatal variables influencing birthweight.

In this paper we compare Multi-Layer Perceptrons (a neural network type) with Multivariate Linear Regression in predicting birthweight from nine perinatal variables which are thought to be related. Results show, that seven of the nine variables, i.e., gestational age, mother's body-mass index (BMI), sex of the baby, mother's height, smoking, parity and gravidity, are related to birthweight. We found no significant relationship between birthweight and each of the two variables, i.e., maternal age and social class.

Age Factors↗
PubMed1995

[Quality management, possibilities and chances in ophthalmology].

German legislation introduced in 1988 called for obligatory quality assurance (QA) practice to be initiated by health care providers. In 1992 the scope of the legislation was extended. Opportunities for introducing quality assurance practice in ophthalmology are demonstrated through examples. A necessary preliminary step to QA is to identify priority areas requiring action. A second necessary action entails the definition of quality indicators. Through their monitoring, these quality indicators allow identification of problem areas as reflected in the collected data. The final important phase of QA practice involves development of strategies to counteract identified problems. This process implies one or more cycles of: problem analysis, establishment of rectifying targets, actual intervention and finally evaluation of interventions made. Compulsory inter-hospital comparison of QA data calls for agreed standards within health care fields. In conclusions, QA practices in ophthalmology (with special reference to the pilot project on QA in cataract surgery) suggest that QA measures are well accepted by health care providers in this field.

Cataract Extraction↗
PubMed1995

[What is "quality management"?].

According to the EN DIN ISO norms measures of quality planning, quality control, quality assurance and quality improvement define a comprehensive quality management. These international norms may solve the recent confusion of terms in Germany. The trend in quality assuring measures clearly shows in the direction of quality audits, but we believe that too much control is contra-productive. Benefits may be expected by the implementation of comprehensive quality management systems, appropriate techniques of benchmarking, practical guidelines and certifications of surgical departments with good quality management systems.

Forecasting↗
PubMed1995

[Sensitivity and specificity of masked field campimetry].

Patients with circumscribed visual field defects are able to perceive the scotomata immediately while looking at randomly distributed black and white squares (12' x 12') flickering on a VDU with a high frequency (approximately 30 Hz), resulting in a stimulus field comparable to the white-noise field on a TV screen without reception. In 368 eyes of 368 patients with varying lesions of the visual pathway the results of white-noise field campimetry were compared with those of conventional threshold-related, slightly suprathreshold automated grid perimetry. Rate of detection (sensitivity) was 84.2% in conventional perimetry and 80.7% in white-noise field campimetry, respectively. The results are not significantly different (p > 0.1; McNemar test). Examinations in 198 eyes of 198 persons without any indication of a visual pathway defect allowed a definition of the normal range of white-noise field campimetry to be made. The specificity of this new method was 82.3%. The outcome of this most extensive study on sensitivity and specificity of noise field campimetry is compared with other publications. The results presented emphasize the capabilities of this new method as a screening test. They encourage the initiation of a field study using the noise field stimulus broadcasted to home TV sets.

Adolescent↗
PubMed1994

Bilateral spastic cerebral palsy--a comparative study between southwest Germany and western Sweden. II: Epidemiology.

Epidemiological data of a collaborative study on children with bilateral spastic cerebral palsy (BSCP) between south-west Germany and western Sweden are reported. The study period covered the birth years 1975 to 1986. Overall, the rate of BSCP increased during the birth year periods 1975-77 and 1978-80, but decreased thereafter. The rise was due to an increase of BSCP in low-birthweight (LBW) children, especially very LBW (VLBW) children. Mortality rates in LBW, and particularly VLBW, children decreased significantly during the whole study period in both countries. The BSCP rate, after the initial increase, showed a decrease during the second half of the study period in LBW children. Results are interpreted in favour of a predominantly prenatal aetiology in normal-birthweight and of a predominantly peri- and neonatal aetiology in LBW children.

Cerebral Palsy↗
PubMed1994

[Quality management between science and competition].

The call for an increase in quality assurance becomes louder and louder. However, it is almost always understood as a more intensive monitoring of quality. The ideas of total quality management described in the ISO norms 9000-9004 gain ground only slowly. By defining quality indicators and developing practical guidelines or appropriate methods of quality management, science could provide the basis. Information processing can make essential contributions such as the profiles of the German perinatal surveys or the Swiss gynecological-obstetrical quality statistics developed by Hochuli et al., but the only way to a widely applied total quality management is quality-assuring activities and quality becoming factors of competition themselves.

Competitive Medical Plans↗
PubMed1993

Bilateral spastic cerebral palsy--a comparative study between south-west Germany and western Sweden. I: Clinical patterns and disabilities.

The results of a collaborative study of bilateral spastic cerebral palsy (BSCP) between south-west Germany and western Sweden are reported, comprising 249 children in south-west Germany and 264 children in western Sweden. A severe gross motor disability was present in 65 per cent of the German and 62 per cent of the Swedish children; learning difficulties or mental retardation in 73 and 76 per cent; active epilepsy in 28 and 26 per cent; and severe visual disability in 20 and 19 per cent, respectively. Severe disabilities were especially pronounced in children with normal birthweights, in whom the most severe subtypes of BSCP were also found. Leg-dominated BSCP was the predominant subtype among low-birthweight children, but also occurred in more than half of the normal-birthweight children. The authors conclude that the two series were comparable, and that reliable results between countries can be obtained if clear-cut classifications and definitions are used.

Adolescent↗
PubMed1992

[Quality assurance in ambulatory care. Viewpoint of the forensic expert for concentrated action in public health].

FUNDAMENTALS: Assuring the quality of medical care is a self-imposed obligation on the part of the profession and, at the same time, a legal obligation. MAIN TOPICS: On the way to implementing this requirement, the following points must be taken into account: the measurability of the quality of medical care, establishment of the quality of structure, treatment and results, aids for the determination and documentation, remuneration, and the motivation for implementing quality control. CONCLUSIONS: A further development of present day approaches to quality assurance resulting in returning to the physician more responsibility while putting on him the onus of proof, would be desirable.

Expert Testimony↗
PubMed1991

[Clinic interns, individual performance appraisal and obstetric quality assurance].

Obstetrical management and fetal outcome were individually analysed annually from 1987 to 1990, using computerised equipment. The individual results were discussed anonymously with all colleagues, but every colleague knew his own results. Clinical methods and obstetrical management had not been changed during the investigation period. The number of high-risk pregnancies increased significantly, whereby the incidence of risk-related surgical interventions decreased at the same rate. The number of FBA and EDA increased significantly (p less than 0.001). The mean umbilical artery pH increased during the last four years from 7.27 to 7.30 (p less than 0.05), i.e. that each colleague achieved an improvement. The incidence of acidotic values in the umbilical artery decreased significantly (pH less than 7.20 from 13.2% to 7.1%, pH less than 7.10 from 3.6% to 1.2% p less than 0.01). The rate of caesarean section increased (p less than 0.05) and the number of vaginal operative deliveries did not change significantly. As early as one year after the introduction of the individual efficiency control, a significant improvement in obstetrical results could be demonstrated.

Clinical Competence↗
PubMed1991

Quality assurance and medical information processing.

Quality assurance of medical care is a process designed to improve quality of health care delivery by eliminating deficiencies. Since every quality assurance process starts with the assessment of quality and the recognition of deficiencies, quality assurance is in the first place a problem of information: if one does not know the inadequacy of the own care, one has no idea that it should be improved. Therefore, appropriate quality indicators differentiating between good and bad medical care and functioning information systems with or without computers are basic prerequisites for the assurance of quality. Additionally, external comparisons of the hospital's own data with the data of other hospitals stimulate the efforts of quality assurance committees. Computer based hospital information systems may be valuable tools to support quality assurance processes. However, further research and development of quality monitoring systems, practicable medical and economical quality indicators, and decision supporting techniques will be necessary to meet all requests of the quality assurance professionals.

Health Services Research↗