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Michael T Koller

Publications and source records attributed to Michael T Koller.

5 recordsLinked to original sources
PubMed2005

Views of patients and physicians on follow-up visits: results from a cross-sectional study in Swiss primary care.

PRINCIPLES: Decision making on follow-up visits is of great importance to patient-physician interaction and healthcare economy. However, followup visits are a somewhat neglected topic in primary-care research, and patients' views are widely unknown. The aim was to assess the relation between the views of patients and those of physicians on follow-up visits. METHODS: We performed a cross-sectional study in six general practices in a rural area of Berne, Switzerland. Separately recorded paired data from patients and physicians on the need for and timing of revisits were analysed for differences and agreement. The revisit ultimately scheduled by the patient and the physician at the end of the consultation after sharing views on revisits was compared with the initial statements. RESULTS: A total of 250 patient-physician consultations were observed. More patients (25%) than physicians (11%) (difference 14%; 95% CI 7% to 20%) deemed a revisit unnecessary or proposed need-based revisits. Observed patient-physician overall agreement on the need or no-need of further visits was 81% (95% CI 76% to 86%). If both patients and physicians (n = 164) agreed on the need for a revisit, patients preferred slightly longer revisit intervals than did their physicians (5.9 days; 95% CI -2.6 to 14.4). The revisit interval recorded in the appointment calendar at the end of the consultation nearly always matched the patient's preferences. CONCLUSION: In one fifth of all consultations, patients' views on revisits differ from those of their physicians, with patients choosing a more liberal involvement in follow-up visits. Actively involving patients in the process of revisit handling might have an influence on revisit frequencies. The impact of the shared revisit handling on patientrelevant outcome measures and healthcare economy needs further consideration..

Adolescent↗
PubMed2003

Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review.

OBJECTIVE: To summarise the evidence on accuracy of the Ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid-foot. DESIGN: Systematic review. DATA SOURCES: Electronic databases, reference lists of included studies, and experts. REVIEW METHODS: Data were extracted on the study population, the type of Ottawa ankle rules used, and methods. Sensitivities, but not specificities, were pooled using the bootstrap after inspection of the receiver operating characteristics plot. Negative likelihood ratios were pooled for several subgroups, correcting for four main methodological threats to validity. RESULTS: 32 studies met the inclusion criteria and 27 studies reporting on 15 581 patients were used for meta-analysis. The pooled negative likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence interval 0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative likelihood ratio for both regions in children was 0.07 (0.03 to 0.18). Applying these ratios to a 15% prevalence of fracture gave a less than 1.4% probability of actual fracture in these subgroups. CONCLUSIONS: Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.

Ankle Injuries↗
PubMed2003

Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results.

PURPOSE: The number of operations to reach a plateau phase in colorectal laparoscopic surgery is still under debate. There are few publications reporting on multidimensional assessment of the learning curve, including operation time and complication and conversion rates. The purpose of this study was to define a multidimensional learning curve for sigmoid resection performed by two surgeons with experience in laparoscopic surgery. METHODS: Between 1993 and 2001 from a total of 715 laparoscopic colorectal procedures, two surgeons performed self-educated 338 sigmoid resections. Demographic data, indications for surgery, procedure performed, operation time, frequency and kind of complications, conversion rate, and days to discharge were recorded. The moving average method was used to demonstrate the change of the operation time. The cumulative sum technique was used to chart the changes in the conversion and complication rates. RESULTS: Surgeon A performed 199 and Surgeon B 139 sigmoid resections. The operation time decreased from 225 minutes to 169 minutes after approximately 90 operations for Surgeon A and from 270 minutes to 223 minutes after 110 operations for Surgeon B. Based on a decline in intraoperative complications and conversion rate, the steady state was reached after approximately 70 to 80 interventions for both surgeons. CONCLUSIONS: The assessment of a learning curve should not be limited to measurement of a decrease in operation time but should also include the conversion and complication rates. The cumulative sum technique and moving average method as proposed in this study seem appropriate to evaluate the learning curve in this clinical domain. Our findings might be especially useful for those planning training programs in laparoscopic surgery.

Adult↗