Evaluation de la filière coordonnée de prise en charge des patients diabétiques «Diabaide» : période 2004-2006

La filière coordonnée "diabaide" a été mise en place à fin 2004 dans l'objectif d'améliorer la prise en charge des patients diabétiques par une organisation des soins fondée sur la collaboration, le partage de l'information et la coordination des prestations, afin de renforcer l'autonomie des patients (éducation et auto-prise en charge), d'améliorer la qualité des soins (recommandations thérapeutiques et protocoles de soins) et de maîtriser les coûts. La filière, à ses débuts, était constituée principalement de la cellule multidisciplinaire "diabaide", qui offrait des consultations ambulatoires et hospitalières par des professionnels spécialisés. Cette évaluation, intermédiaire, avait pour objectif d'estimer si le programme avait atteint ses objectifs après deux années d'activités. [....] Le développement de programmes de prise en charge des maladies chroniques est encore à ses débuts en Suisse et "diabaide" fait image de pionnier dans ce domaine. Après cette évaluation, le programme a été modifié en 2007 et ne correspond plus à la description fournie dans ce document. De nouveaux programmes ont également été mis en place en Suisse depuis 2007 (par exemple makora Diabetes-Disease Management Programm à Zürich). Dans le canton de Vaud, le département de la santé de l'action sociale a créé en 2010 un programme cantonal visant à réduire l'impact du diabète sur la population en agissant sur la prévention et sur l'amélioration de la prise en charge des personnes diabétiques. Le programme cantonal a pour objectif notamment de développer une prise en charge globale, inspirée en partie du programme "diabaide", qui sera stratifiée en fonction de la sévérité de la maladie et des besoins des patients, intégrera l'auto-gestion (self-management), sera organisée en filières interdisciplinaires, et sera fondée sur les preuves. [Auteurs, p. 5]]]> Diabetes Mellitus/therapy ; Disease Management ; Evaluation Studies ; Switzerland ; Vaud fre https://serval.unil.ch/resource/serval:BIB_3183D750B875.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_3183D750B8757 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_3183D750B8757 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_3184 2022-10-01T01:16:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_3184 Paul Strand: An American Modernist. Halter, P info:eu-repo/semantics/bookPart incollection 1997 Aspects of Modernism: Studies in Honour of Max Naenny, pp. 253-274 Fischer A, (ed.) Häusser, M (ed.) Hermann, T (ed.) oai:serval.unil.ch:BIB_31843 2022-10-01T01:16:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_31843 Uttaramimamsa. Bronkhorst, J info:eu-repo/semantics/bookPart incollection 2004 2nd International Conference on Indian Studies : proceedings, vol. 4-5, pp. 113-120 Czekalska, R (ed.) Marlewicz, H (ed.) oai:serval.unil.ch:BIB_31849 2022-10-01T01:16:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_31849 Filling-in in schizophrenia: a high-density electrical mapping and source-analysis investigation of illusory contour processing. Foxe, JJ Murray, MM Javitt, DC info:eu-repo/semantics/article article 2004 Cerebral Cortex oai:serval.unil.ch:BIB_3184B3C52440 2022-10-01T01:16:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_3184B3C52440 Increased efflux of amyloid-β peptides through the blood-brain barrier by muscarinic acetylcholine receptor inhibition reduces pathological phenotypes in mouse models of brain amyloidosis. info:doi:10.3233/JAD-131091 info:eu-repo/semantics/altIdentifier/doi/10.3233/JAD-131091 info:eu-repo/semantics/altIdentifier/pmid/24072071 Paganetti, P. Antoniello, K. Devraj, K. Toni, N. Kieran, D. Madani, R. Pihlgren, M. Adolfsson, O. Froestl, W. Schrattenholz, A. Liebner, S. Havas, D. Windisch, M. Cirrito, J.R. Pfeifer, A. Muhs, A. info:eu-repo/semantics/article article 2014 Journal of Alzheimer's Disease, vol. 38, no. 4, pp. 767-786 info:eu-repo/semantics/altIdentifier/eissn/1875-8908 urn:issn:1387-2877 <![CDATA[The formation and accumulation of toxic amyloid-β peptides (Aβ) in the brain may drive the pathogenesis of Alzheimer's disease. Accordingly, disease-modifying therapies for Alzheimer's disease and related disorders could result from treatments regulating Aβ homeostasis. Examples are the inhibition of production, misfolding, and accumulation of Aβ or the enhancement of its clearance. Here we show that oral treatment with ACI-91 (Pirenzepine) dose-dependently reduced brain Aβ burden in AβPPPS1, hAβPPSL, and AβPP/PS1 transgenic mice. A possible mechanism of action of ACI-91 may occur through selective inhibition of muscarinic acetylcholine receptors (AChR) on endothelial cells of brain microvessels and enhanced Aβ peptide clearance across the blood-brain barrier. One month treatment with ACI-91 increased the clearance of intrathecally-injected Aβ in plaque-bearing mice. ACI-91 also accelerated the clearance of brain-injected Aβ in blood and peripheral tissues by favoring its urinal excretion. A single oral dose of ACI-91 reduced the half-life of interstitial Aβ peptide in pre-plaque mhAβPP/PS1d mice. By extending our studies to an in vitro model, we showed that muscarinic AChR inhibition by ACI-91 and Darifenacin augmented the capacity of differentiated endothelial monolayers for active transport of Aβ peptide. Finally, ACI-91 was found to consistently affect, in vitro and in vivo, the expression of endothelial cell genes involved in Aβ transport across the Blood Brain Brain (BBB). Thus increased Aβ clearance through the BBB may contribute to reduced Aβ burden and associated phenotypes. Inhibition of muscarinic AChR restricted to the periphery may present a therapeutic advantage as it avoids adverse central cholinergic effects

Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey

Objective: To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. <br><br> Methods: We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (≥2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). <br><br> Results: We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. <br><br> Conclusions: In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project

BACKGROUND: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. OBJECTIVE: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. METHODS: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. RESULTS: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, editorial independence). 95% of appraisers found the instrument useful for assessing guidelines. Reliability was acceptable for most domains (Cronbach's alpha 0.64-0.88). Guidelines produced as part of an established guideline programme had significantly higher scores on editorial independence and, after the publication of a national policy, had significantly higher quality scores on rigour of development (p&lt;0.005). Guidelines with technical documentation had higher scores on that domain (p&lt;0.0001). CONCLUSIONS: This is the first time an appraisal instrument for clinical practice guidelines has been developed and tested internationally. The instrument is sensitive to differences in important aspects of guidelines and can be used consistently and easily by a wide range of professionals from different backgrounds. The adoption of common standards should improve the consistency and quality of the reporting of guideline development worldwide and provide a framework to encourage international comparison of clinical practice guidelines. [authors]]]> oai:serval.unil.ch:BIB_4919CAD59633 2022-05-07T01:17:13Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_4919CAD59633 Neuronal death during development in the isthmo-optic nucleus of the chick: sustaining role of afferents from the tectum. info:doi:10.1002/cne.902340307 info:eu-repo/semantics/altIdentifier/doi/10.1002/cne.902340307 info:eu-repo/semantics/altIdentifier/pmid/3988990 Clarke, P.G.H. info:eu-repo/semantics/article article 1985 Journal of Comparative Neurology, vol. 234, no. 3, pp. 365-379 info:eu-repo/semantics/altIdentifier/pissn/0021-9967[print], 0021-9967[linking] <![CDATA[Neurons have been counted in the isthmo-optic nucleus following lesions of the optic tectum, its main source of afferents. Late lesions, made at 10.8-12.2 days of incubation, were employed as they cause the fewest non-specific side effects. The lesions spared the isthmo-optic tract, and although they caused many retinal ganglion cells to die, the degeneration did not spread to the inner nuclear layer, which contains the target cells of the isthmo-optic fibers. Hence the effects on the isthmo-optic nucleus were due to its being deprived of afferents. Even in unoperated embryos, 60% of the isthmo-optic neurons are known to die between embryonic days 12 and 17. The tectal lesions greatly increased the cell loss ipsilaterally; this was due to cell death, since other explanations such as migration away or differential cellular shrinkage have been ruled out. The fact that additional neuronal death occurred mainly during the latter half of the period of natural cell death implies that the tectal afferents are important for the survival of the isthmo-optic neurons during this latter half, but not before

Analyse économique du traitement de l'ostéoporose post-ménopausique par hormonothérapie substitutive chez la femme

[Table des matières] 1.1. Présente étude. 1.2. Littérature relative aux études économiques d'une hormonothérapie de substitution (HTS). 1.3. Etat des connaissances relatives aux effets cliniques d'une HTS. 2. Méthode. 2.1. Représentation de l'arbre de décision. 2.2. Réalisation du modèle. 3. Matériel. 3. 1. Incidences des événements considérés : fractures du fémur proximal, cancers du sein et de l'endomètre, infarctus du myocarde. 3.2. Survie/mortalité suite aux événements considérés : fractures de la hanche, cancers du sein, cancers de l'endomètre, infarctus du myocarde, autres. 3.3. Valeurs des risques relatifs des événements considérés lors de l'application d'une HTS : fracture du fémur proximal, cancer du sein et de l'endomètre, accident cardiovasculaire. 3.4. Observance à une HTS. 3.5. Prévalence des hystérectomies à 50 ans. 3.6. Coûts : programme de prévention, HTS, du suivi, liés à l'hospitalisation primaire pour infarctus du myocarde et cancer du sein. 3.7. Hypothèses de base. 4. Résultats. 4.1. Sous les hypothèses de base : nombre et pourcentage d'événements prévenus et induits par rapport à une situation sans HTS, coûts de l'HTS et de la surveillance médicale, coûts nets des événements, coûts totaux, coûts par fracture de la hanche évitée. 4.2. Analyse de sensibilité : taux d'escompte, HTS et surveillance médicale, taux d'incidence et de survie, modulation de l'efficacité du traitement hormonal sur la prévention des infarctus du myocarde, induction plus élevée de cas de cancers du sein, observance, traitement sélectif de la population à risque de fractures. 5. Importance de l'étude considérée

Maîtrise de la qualité dans les hôpitaux universitaires: satisfaction des patients

[Table des matières] Introduction et présentation des projets / B. Burnand, JP. Vader, F. Paccaud. - La satisfaction du patient hospitalisé : un petit guide / M. Lorenzini, Y. Eggli. - "Satisfaction du patient hospitalisé": enquête exploratoire par entretien / M. Lorenzini. - Patientenzufriedenheit, Studie Kardiologie Bern/Basel: Schlussbericht / M. Langenegger. - Notfallstation und Spitalaufenthalt aus der Sicht des Patienten : eine kundenorientierte, repräsentative Erhebung / W. Langewitz, H. Weber, M. Zierath. - Satisfaction des patients hospitalisés pour cardiopathie ischémique aiguë / B. Burnand, K. Dupriez, T. Pernegger, MD. Schaller, JM. Gaspoz. - Commentaires et recommandations / B. Burnand, JP. Vader, F. Paccaud. Annexes: Questionnaire "Appréciation critique de votre séjour hospitalier". - Questionnaire de satisfaction du Service des hospices cantonaux "Votre séjour à l'hôpital - votre point de vue"; etc

Le patient du futur : volet suisse d'un projet européen

Les systèmes de santé du monde occidental poursuivent leur mutation en termes d'organisation et de fourniture de prestations. Les progrès - biotechnologies et nouvelles techniques de l'information - ouvrent de nouvelles perspectives de prévention, de traitements des maladies et d'accès à l'information, tant du point de vue des patients que de celui des divers acteurs qui décident de la future évolution du système sanitaire. Ces progrès techniques vont de pair avec de profondes modifications culturelles et sociales. Le temps est révolu où les patients se soumettaient passivement aux prestations médicales et où information et savoir étaient réservés aux médecins. Dans ce contexte, un certain nombre de questions apparaissent comme fondamentales pour l'avenir : o Qu'attendent les patients et les citoyens du système de santé ? o Les patients à venir seront-ils différents de ceux d'aujourd'hui ? o En quoi consistera la demande de prestations des futurs patients ? o De quelle façon les futurs patients obtiendront-ils l'information, les conseils et l'assistance dont ils ont besoin ? o Qui répondra aux différents besoins et attentes des futurs patients ? o Comment les politiciens et les prestataires de soins devraient-ils réagir face à la demande d'une plus grande autonomie de la part des patients ? [Avant-propos]]]> Patient Participation ; Patient Satisfaction ; Patient Advocacy ; Attitude to Health ; Professional-Patient Relations ; Delivery of Health Care ; Switzerland fre https://serval.unil.ch/resource/serval:BIB_9159660A5914.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_9159660A59141 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_9159660A59141 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_915A1D2BD4DE 2022-05-07T01:22:50Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_915A1D2BD4DE Results at Up to 30 Years After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis. info:doi:10.1097/MIB.0000000000001061 info:eu-repo/semantics/altIdentifier/doi/10.1097/MIB.0000000000001061 info:eu-repo/semantics/altIdentifier/pmid/28301429 Lightner, A.L. Mathis, K.L. Dozois, E.J. Hahnsloser, D. Loftus, E.V. Raffals, L.E. Pemberton, J.H. info:eu-repo/semantics/article article 2017-05 Inflammatory bowel diseases, vol. 23, no. 5, pp. 781-790 info:eu-repo/semantics/altIdentifier/eissn/1536-4844 urn:issn:1078-0998 <![CDATA[Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with chronic ulcerative colitis. No study to date has examined functional and quality-of-life outcomes 30 years after pouch construction. Using data from a prospectively maintained database with annually distributed questionnaires, functional outcomes, pouch complications, and quality of life after IPAA were determined. Overall, 93.3% of patients had a functioning pouch at 30 years. Stool frequency during the day increased slightly from a mean of 5.7 (SD, 2.3) at 1 year to 6.2 (SD, 2.9) at 30 years (P &lt; 0.001); nighttime frequency also increased slightly from 1.5 (SD, 1.2) to 2.1 (SD, 1.2) (P &lt; 0.001). Pouch outcomes and stool frequency were significantly associated with diagnosis, being worse in patients with Crohn's disease, but were minimally associated with age greater than 65 years. After IPAA, the 30-year cumulative probability of pouchitis, stricture, obstruction, and fistula were 80.2%, 56.7%, 44.0%, and 15.8%, respectively. Quality of life scores remained stable over the 30 years. IPAA is a durable operation for patients requiring proctocolectomy for chronic ulcerative colitis and indeterminate colitis. The functional outcomes and quality of life remained relatively unchanged over the 30 years after IPAA underscoring the longevity of pouches