FREE ORAL COMMUNICATIONS 2: ALCOHOL AND LIVER—CLINICAL RESEARCHO2.1RAPID DECLINE OF LIVER STIFFNESS WITH ALCOHOL WITHDRAWAL IN HEAVY DRINKERS

Background and aims. Measurement of liver stiffness using real-time elastography appears as a promising tool to evaluate the severity of chronic liver diseases. Previous studies in patients with alcoholic liver disease have suggested that fibrosis was the only histological parameter to influence liver stiffness. To challenge this hypothesis, we have prospectively tested the short-term impact of alcohol withdrawal on liver stiffness value. Methods. All patients hospitalized for alcohol withdrawal in our Liver Unit between September 2008 and December 2010 had a liver stiffness determination (using a FibroScan® device) at entry (D0) and 7 days after alcohol withdrawal (D7). Stiffness values were compared using non-parametric test for paired-values. We compared (i) the 10 measures performed at D0 and at D7 for each patient; (ii) the variation of the median result of all patients (using Wilcoxon test in both cases). Results. A total of 138 patients were included in the study [median alcohol consumption: 150g/day (range: 40-400); hepatitis C: n=22 (15.9%); cirrhosis: n=29 (21.0%)]. From D0 to D7, the liver stiffness decreased significantly in 61 patients (44.2%) and increased significantly in 18 (13.0%). Considering all patients, median liver stiffness value decreased from 7.25 to kPa (P<0.001). The stage of fibrosis indicated by liver stiffness changed in 47 patients between D0 and D7 (decrease in 33 and increase in 14). Conclusion. Liver stiffness decreases significantly in nearly half of alcoholic patients after only 7 days of abstinence. This result strongly suggests that non-fibrotic lesions (such as inflammatory ones) may influence liver stiffness. From a practical point of view, it also shows that variation in alcohol consumption must be taken into account for the interpretation of liver stiffness valu

Questionnaire of chronic illness care in primary care-psychometric properties and test-retest reliability

<p>Abstract</p> <p>Background</p> <p>The Chronic Care Model (CCM) is an evidence-based approach to improving the structure of care for chronically ill patients with multimorbidity. The Assessment of Chronic Illness Care (ACIC), an instrument commonly used in international research, includes all aspects of the CCM, but cannot be easily extended to the German context. A new instrument called the "Questionnaire of Chronic Illness Care in Primary Care" (QCPC) was developed for use in Germany for this reason. Here, we present the results of the psychometric properties and test-retest reliability of QCPC.</p> <p>Methods</p> <p>A total of 109 family doctors from different German states participated in the validation study. Participating physicians completed the QCPC, which includes items concerning the CCM and practice structure, at baseline (T0) and 3 weeks later (T1). Internal consistency reliability and test-retest reliability were evaluated using Cronbach's alpha and Pearson's r, respectively.</p> <p>Results</p> <p>The QCPC contains five elements of the CCM (decision support, delivery system design, self-management support, clinical information systems, and community linkages). All subscales demonstrated moderate internal consistency and moderate test-retest reliability over a three-week interval.</p> <p>Conclusions</p> <p>The QCPC is an appropriate instrument to assess the structure of chronic illness care. Unlike the ACIC, the QCPC can be used by health care providers without CCM training. The QCPC can detect the actual state of care as well as areas for improvement of care according to the CCM.</p

Comparison of Collegial Individual and Group Reviews of General Practice Multiple Choice Questions

Aims: In most German medical faculties, credits in general practice can be earned via exams using multiple-choice questions (MCQ). Measures such as peer-reviews may help assure the quality of these exams. In order to use time and personnel intensive peer reviews effectively and efficiently, the procedures used are key. Therefore, we wanted to find out whether there are differences between group and individual reviews regarding defined parameters.Methods: We conducted a controlled cross-over study with three GP reviewers from four different German universities. Each reviewed 80 MCQs, 40 individually and 40 within a group, including external assessments by a panel of experts. Furthermore all reviewers were asked to evaluate the review process and the time spent carrying out these reviews.Outcomes: We found no significant differences between the reliability and the validity of individual reviews versus group reviews. On average slightly more time was spent on group reviews compared with the individual reviews. The subjective assessments of the study participants regarding their satisfaction with the process and the efficiency and effectiveness of the reviews suggest a preference for group reviews.Conclusions: Based on this study, there are no definite recommendations for or against either approach. When choosing between the two, the specific work structures and organisation at the local faculty should be taken into account.Zielsetzung: Im Fach Allgemeinmedizin werden die obligat zu benotenden Leistungsnachweise an vielen Hochschulstandorten über Klausuren mit Multiple-Choice-Fragen (MCF) erbracht. Zur Qualitätssicherung bietet sich u.a. ein Peer-Review-Verfahren der eingesetzten MCF an. Für die optimale Effektivität und Effizienz solcher zeit- und personalintensiven Peer-Reviews ist nicht zuletzt die Verfahrensweise von Bedeutung. Ziel der Studie war es zu untersuchen, ob sich Einzel- von Gruppen-Reviews hinsichtlich definierter Parameter unterscheiden. Methodik: In einer kontrollierten Studie mit cross-over Design, durchgeführt mit je drei allgemeinmedizinischen Reviewern vier verschiedener deutscher Hochschulstandorte, wurden die Beurteilungen der Reviewer von 80 MCF (für jeden Teilnehmer jeweils 40 im Einzel-, 40 im Gruppen-Review) mit externen Beurteilungen durch ein Expertengremium und untereinander verglichen. Daneben wurden über Fragebögen subjektive Einschätzungen der Studienteilnehmer zum Review und der Zeitaufwand erfasst.Ergebnisse: Statistisch signifikante Unterschiede in der Validität und Reliabilität fanden sich zwischen Einzel- und Gruppen-Review nicht. Der Zeitaufwand für die Gruppen-Reviews lag im Mittel etwas höher als für die Einzel-Reviews. Die subjektiven Einschätzungen der Studienteilnehmer zur Zufriedenheit mit dem Review-Prozess, der Effektivität und Wichtigkeit der Reviews lassen auf eine Präferenz für den Gruppen-Review schließen.Schlussfolgerungen: Eindeutige Empfehlungen für oder gegen die Durchführung eines der beiden Review-Verfahren lassen sich aufgrund der Studienergebnisse nicht abgeben. Die spezifische Arbeitsstruktur und -organisation sowie die Präferenzen der Mitarbeiter an den einzelnen Hochschulstandorten sollten bei der Wahl des Verfahrens berücksichtigt werden