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Hans-Konrad Selbmann

Publications and source records attributed to Hans-Konrad Selbmann.

12 recordsLinked to original sources
PubMed2006

[The German program for disease management guidelines. Background, methods, and development process].

The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the German DM-CPG Program is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health-care provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year, DM-CPGs have been published for asthma, chronic obstructive pulmonary disease, type 2 diabetes, and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.

Disease Management↗
PubMed2006

[Correlation of NK cell activity against autologous tumour cells and K562 cells with the clinical outcome during therapy with mistletoe extracts].

BACKGROUND: Suppression of NK cell activity is considered to be an unfavourable prognostic factor for tumour progression. There is proof that mistletoe extracts may increase NK cell activity. However, the inverse relation between an increase of NK cell activity and clinical progress of cancer has not been investigated. AIM AND DESIGN: The relation of NK cell activity and progress of cancer in patients under therapy with mistletoe extracts was examined in a prospective, monocentric, cohort study. At the same time the in vitro killing of K562 cells and autologous tumour cells was compared. PATIENTS AND METHODS: 40 patients with operable cancer of the breast or colon were included. The patients did not receive any immunologically relevant therapies except for mistletoe extracts. The absolute NK cell count in peripheral blood as well as the in vitro NK cell activity were monitored for up to 2 years and compared with clinical outcome as well as quality of life. RESULTS: The absolute NK cell count in peripheral blood increased within the observation period. Patients without progression had a significantly higher mean activity of NK cells against K562 cells than patients with progression. In the latter group, only stage IV patients showed reduced NK cell activity. The killing activity against autologous tumour cells was <5% in about 77.5% of the patients and could not be evaluated further. The NK cell activity against K562 cells was not related to the number of NK cells. CONCLUSIONS: We found a relation between NK cell activity and the progression of malignant disease. In further studies the causality of this relation has to be clarified. The establishment of NK cell activity against autologous tumour cells as a suitable parameter during follow-up was not successful.

Aged↗
PubMed2006

[Quality and quality development in medical practices--epidemiological results of the accompanying evaluation of the new KBV quality management system].

The motivation for quality management has now reached medical and psychotherapeutic practices. This is partly due to exogenous factors, including regulatory requirements such as Sect. 135a SGB V (German Book of Social Code) demanding the implementation and further development of internal quality management from both out-patient and in-patient healthcare providers. The National Association of SHI-Accredited Physicians in Germany (KBV), along with several regional associations, responded to these internal demands and external requirements by developing the quality management system "Quality and Development in Practices (QEP)". Assisted by an independent institute, 61 selected practices participated in the pilot study. The pilot phase included five interview rounds held between April and November 2004 with 60 practices taking part. The results describe practitioners' expectations for the current state of and the demand for internal quality management. Only one in five practices expects improvements from the implementation of quality management in the area of healthcare processes and management. The improvement of organizational processes, patients' safety and patient outcomes are considered more important. In a self-assessment procedure which included 73 targets with 236 verifications from the quality target catalogue a distinct potential for quality improvement has been revealed. The greatest need for improvement has been identified in cases where quality management defines specific requirements for the practices. These include: treatment pathways, patient information, risk management, case discussions and instruction, quality improvement, regulations and quality measurement. Even practices with advanced quality development activities were able to detect some potential for improvement with the application of the QEP catalogue. In order to attain 15 selected quality targets with 45 verifications, the practices were provided with tools like sample documents and suggestions for internal regulations to be used for quality improvement and requiring relatively small efforts. The effectiveness of implementing a quality management system cannot be adequately demonstrated by an accompanying evaluation. However, established instruments (such as the quality target catalogue and verifications), complemented with suitable outcome indicators, allow the effects of the implementation of internal quality management to be measured in a comparative, or, ideally in a randomized study.

Epidemiology↗
PubMed2006

[Is reaching consensus on the development of guidelines nonsense?].

Cultural background influences the development of guidelines. In Germany, classifications exist from S1 (low level of evidence, no structured process of consensus finding) up to S3 (high level of evidence, consensus finding by a representative body). Consensus is indispensable in the guideline development process because every step is influenced by preferences and values, from the choice of output and outcome criteria to the role of pathophysiological models in the assessment of new therapies. A structured process of consensus finding increases transparency. Different models of consensus finding are discussed.

Consensus↗
PubMed2006

[Health services research and guidelines--from the Association of the Scientific Medical Societies' (AWMF) perspective].

The Association of the Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) is an umbrella organization. It currently represents 151 scientific societies and thus the majority of medical researchers in Germany. Through the coordination and support of the scientific medical societies, the AWMF significantly contributes to health services research by establishing guidelines that ensure a high quality of healthcare. To this purpose, AWMF founded a guideline committee in 1995, whose objective is to assist AWMF member societies in the establishment of guidelines, the organization of training sessions for AWMF guideline representatives, the hosting of regular guideline conferences and the close cooperation with the German Medical Association (Bundesärztekammer, BAK) and the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) in the development of national disease management guidelines (Nationale Versorgungs Leitlinien, NVL). Together with the Agency for Quality in Medicine [AQuMed; Arztliches Zentrum für Qualität in der Medizin (AZQ)], AWMF published a 'German Instrument for Methodological Guideline Appraisal' ('Deutsches Instrument zur methodischen Leitlinien-Bewertung', DELBI) in order to assure the quality of the guideline development process. A close cooperation has also developed between AWMF and the German Medical Association within the scope of their program for promoting health services research and with the Board of the German Network for Health Services Research (Deutsches Netzwerk for Versorgungsforschung, DNVF). Furthermore, AMWF has acknowledged a special need for improving the financial and conceptual promotion of a systematic evaluation of guideline development and the implementation and application of guidelines in everyday clinical practice.

Biomedical Research↗
PubMed2005

[Evaluation of the pilot project for the gradual area-wide outpatient medical care of patients with diabetes mellitus in Southern Wuerttemberg].

The aim of the diabetes pilot project of the AOK Baden-Wuerttemberg and the KV Southern Wuerttemberg was to prevent diabetes-related complications or to delay their progress by attaining predefined, short-term therapy goals (e.g., stabilization of HbA1c and blood pressure levels). Besides the observation of the short-term therapy aims, the scientific monitoring also included the development of the healthcare structure and the changes of the healthcare processes. Measured against the HbA1c value of the 13.902 patients suffering from type-2 diabetes included in the first 6 months of the year 2000, an improvement of the outcome quality (HbA1c < or = 7.5%) could be observed with an increased goal attaihment degree of 66.6% (IV/2002) compared to the initial value of 60.3% (p < 0.001). The predefined blood pressure levels (< or = 140/90 mmHg) were achieved by 55.8% of the patients at the beginning and by 64.6% at the end of the evaluation period (p < 0.001). In terms of healthcare processes, an intensification of the medicinal therapy is remarkable.

Ambulatory Care↗
PubMed2004

Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease.

OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy in detecting high-grade coronary stenoses in patients with known coronary artery disease (CAD) using multidetector computed tomography (MDCT). BACKGROUND: The MDCT systems with electrocardiographic (ECG)-gating permit visualization of the coronary arteries. However, severe calcifications and higher heart rates are known to degrade image quality and limit correct diagnosis. METHODS: Sixty-six patients with proven CAD as assessed by conventional coronary angiography (CCA) were studied by MDCT (mean time 24 months postangiography). Total calcium score and all coronary arteries, including distal segments and side branches, were assessed with respect to evaluability, presence of high-grade coronary artery stenoses (>70%), and correct diagnosis. Results were compared to CCA. RESULTS: A total of 105 lesions were detected by CCA. The MDCT correctly detected 39 lesions (sensitivity 37%, specificity 99%). The correct clinical diagnosis could be obtained in 24 patients (36%). Artifacts due to elevated heart rates or severe coronary artery calcification were the main cause of degraded image quality inhibiting correct diagnosis. In 21/66 patients (32%) all four major coronary vessel segments could be visualized. A threshold for maximum heart rate and a maximum calcification level were established (65 beats/min and an Agatston Score Equivalent of 335, respectively). A second analysis was made using these thresholds. Of all patients studied, 10/11 (91%) were correctly diagnosed when adhering to these thresholds. CONCLUSIONS: When using MDCT as a noninvasive diagnostic modality to assess advanced CAD, it appears to be mandatory to preselect patients in order to achieve reliable results.

Adult↗
PubMed2003

Critical appraisal of clinical performance measures in Germany.

BACKGROUND: One of the tasks of the Federal Co-ordinating Committee, as part of the self-governing health care system in Germany, is to develop clinical performance measures (CPMs). As these measures generally exert a strong impact on health care delivery, their methodological quality should meet the highest standards. OBJECTIVE: To develop, for use in the German health care system, methodological quality requirements for CPMs and performance assessment programs. MATERIALS AND METHODS: We assembled and reviewed internationally available materials on CPMs. From these we prepared lists of requirements for appraising the methodological quality of CPMs and CPM programs. PRODUCTS: Lists of criteria for use in appraising the appropriateness of the development, content, format and application of CPMs and their value to the health care system for performance measurement; a checklist for assessing the methodological quality of CPMs/CPM programs. CONCLUSION: The methods applied and the products from this project offer a useful framework for prospective CPM/CPM program developers and set a high threshold for the development of methodologically rigorous clinical performance measurement.

Delivery of Health Care↗
PubMed2003

[Quality of hygiene in endoscope reprocessing--the fundamentals of indicator-assisted quality management in gastroenterology].

High level disinfection and infection control in reprocessing gastrointestinal endoscopes is a critical security factor for patients in gastrointestinal health care. National and international guidelines for an adequate high quality disinfection of gastrointestinal endoscopes have been developed aiming to obtain infection control. The German Medical Association has recently published recommendations on quality assurance in gastrointestinal endoscopy including standardised procedures for disinfection and infection control. A prospective study was carried out in a large urban area in both private practices and hospitals to identify and characterise flaws and limitations in disinfection of gastrointestinal endoscopes by measuring a set of indicators of the quality of structures, processes and outcomes. Moreover, the influence of information and continuous medical education on the quality of disinfection and infection control were to be evaluated. The bacterial contamination of endoscopes after reprocessing was measured as a relevant outcome quality indicator. The results revealed substantial flaws in cleaning and disinfection procedures in gastrointestinal endoscopy under routine clinical conditions. Overall, 49 and 39 percent of all (pre- and post-interventionally, resp.) checked endoscopes were contaminated by one or more bacteria. More often failures were discovered in the optic rinse system than in the cleaning/disinfection and the final rinse and drying process. A substantial failure rate was detected in gastrointestinal endoscope reprocessing under routine conditions according to the reprocessing procedure. Compared to manual and semi-automatic cleaning and disinfection, the full automatic cleaning and disinfection machines (RDG-E) showed the best results. Though their cleaning process remains improveable, it seems advisable to prefer RDG-E-machines for disinfection and infection control in gastrointestinal endoscopy. Continuous quality control of disinfection should be obtained by introducing regular microbiological examinations of the reprocessed endoscopes. Negative microbiological controls of the contamination of endoscopes are suitable quality indicators of a quality management system aiming to improve the quality of structures, processes and outcomes in gastroenterological health care.

Disinfection↗
PubMed2002

[Assessment of methodological quality of clinical performance measures].

One of the tasks of the federal "Coordinating Committee" within Germany's self-governing health care system is to develop clinical performance measures. Since these performance measures usually exert an enormous influence on health care delivery their methodological quality should meet highest standards. The aim of our study was to develop quality requirements for clinical performance measures to be used in Germany; we did this mainly by compiling internationally published criteria. We present lists of quality requirements for clinical performance measures and performance assessment programs as well as a checklist for documenting and assessing comprehensively the methodological quality of these measures. Developing clinical performance measures by using these criteria could improve their methodological quality and promote the objectivity of performance assessment in medical care.

Delivery of Health Care↗