The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

Background: Previous studies in the literature have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of non-medical factors (i.e. embodied in health care system design) as possible contributors to variations in colonoscopy performance. Methods: We used patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers across 11 western countries. Variability was captured through two performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables using a multilevel two-equation system. Results: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and higher withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and higher withdrawal times. Conclusions: Our results suggest that gate-keeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight that longer withdrawal times do not necessarily mean higher quality in teaching-centers.Medical Practice Variation (MPV), performance, non-medical factors, panel two-equation linear-probit model, colonoscopy

Gastroenterologists overestimate the appropriateness of colonoscopies they perform: an international observational study

BACKGROUND AND STUDY AIM: Little is known about how gastroenterologists perceive the appropriateness of colonoscopies they perform. The objective of this study was to compare the appropriateness and necessity of colonoscopies as assessed by an expert panel and by the gastroenterologists performing the colonoscopies. METHODS: This observational study included 21 centers in 11 countries. Patients referred for colonoscopy were consecutively included. Appropriateness and necessity of colonoscopies were independently rated on a 9-point scale by the gastroenterologists performing them and by an expert panel using a validated method (RAND). The differences between the ratings from the two groups were examined. Results: 6004 patients were included in the study. Comparisons of ratings were possible for 5381 (89.6 %) patients. The gastroenterologists' mean appropriateness rating was 7.2 +/- 1.7, and the panel's mean appropriateness rating was 5.4 +/- 2.3 ( P &lt; 0.001). The percentages of indications rated inappropriate, uncertain, appropriate, and necessary were 4.1 %, 23.8 %, 14.2 %, and 58.0 % for the gastroenterologists and 27.2 %, 26.7 %, 25.0 %, and 21.1 % for the panel, respectively. Agreement between the two groups' ratings was poor (28.8 %, kappa = 0.11). Differences between the two groups' ratings decreased with increasing patient age, decreasing health status, and decreasing expertise level of the referring physician. However, the gastroenterologists produced consistently higher ratings. CONCLUSIONS: Compared with an expert panel, gastroenterologists tend to overestimate the appropriateness of colonoscopies they perform. Except for well-delineated reasons, participating gastroenterologists weighed patient characteristics differently from the panel when judging appropriateness. Ways to increase the prospective use of appropriateness criteria in order to improve appropriateness and reduce overuse of colonoscopies should be examined further. [Authors]]]> Colonoscopy ; Gastroenterology oai:serval.unil.ch:BIB_6852 2022-05-07T01:19:36Z <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_6852 Prospective randomized comparison of imipenem-cilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis. Jaccard, C Troillet, N Harbarth, S Zanetti, G Aymon, D Schneider, R Chioléro, R Ricou, B Romand, J Huber, O Ambrosetti, P Praz, G Lew, D Bille, J Glauser, MP Cometta, A info:eu-repo/semantics/article article 1998 Antimicrob Agents Chemother, vol. 42, pp. 2966-72 oai:serval.unil.ch:BIB_6852615BE8BB 2022-05-07T01:19:36Z <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_6852615BE8BB Smoked cannabis and doping control: looking for the wrong target analyte? Brenneisen, R. Meyer, P. Chtioui, H. Saugy, M. Schweizer, C. Kamber, M. info:eu-repo/semantics/conferenceObject inproceedings 2009-08 Annales de toxicologie analytique, vol. 21, pp. S25 Goullé, Jean-Pierre (ed.) info:eu-repo/semantics/altIdentifier/isbn/0768-598X <![CDATA[Introduction: Since 2004, cannabis is prohibited by the World Anti-Doping Agency (WADA) for all sports in competition. In the years since then, about half of all positive doping cases in Switzerland have been related to cannabis consumption. In most cases, the athletes plausibly claim to have consumed cannabis several days or even weeks before competition and only for recreational purposes not related to competition. In doping analysis, the target analyte in urine samples is 11-nor-delta-9-tetrahydrocannabinol- 9-carboxylic acid (THC-COOH), the reporting threshold for laboratories is 15 ng/mL. However, the wide detection window of this long-term THC metabolite in urine does not allow a conclusion concerning the time of consumption or the impact on the physical performance. Aim: The purpose of the present pharmacokinetic study on volunteers was to evaluate target analytes with shorter urinary excretion time. Subsequently, urines from athletes tested positive for cannabis should be reanalyzed including these analytes. Methods: In an one-session clinical trial (approved by IRB, Swissmedic, and Federal Office of Public Health), 12 healthy, male volunteers (age 26 ± 3 yrs, BMI 24 ± 2 kg/m2) with cannabis experience (&gt; once/month) smoked a Cannabis cigarette standardized to 70 mg THC/cigarette (Bedrobinol® 7%, Dutch Office for Medicinal Cannabis) following a paced-puffing procedure. Plasma and urine was collected up to 8 h and 11 days, respectively. Total THC, 11-hydroxy-THC (THC-OH), and THC-COOH were determined after enzymatic hydrolyzation followed by SPE and GC/MS-SIM. The limit of quantitation (LOQ) for all analytes was 0.1 ng/mL. Visual analog scales (VAS) and vital functions were used for monitoring psychological and somatic side-effects at every timepoint of specimen collection (up to 480 min). Results: Eight puffs delivered a mean THC dose of 45 mg. Mean plasma levels of total THC, THC-OH and THC-COOH were measured in the range of 0.1-20.9, 0.1-1.8, and 1.8-7.5 ng/mL, respectively. Peak concentrations were observed at 5, 10, and 90 min. Mean urine levels were measured in the range of 0.1-0.7, 0.10-6.2, and 0.1-13.4 ng/mL, respectively. The detection windows were 2-8, 2-96, and 2-120 h. No or only mild effects were observed, such as dry mouth, sedation, and tachycardia. Besides high to very high THC-COOH levels (0-978 ng/mL), THC (0.1-24 ng/mL) and THC-OH (1-234 ng/mL) were found in 90 and 96% of the cannabis-positive urines from athletes. Conclusion: Instead of or in addition to THC-COOH, the pharmacologically active THC and THC-OH should be the target analytes for doping urine analysis. This would allow the estimation of more recent Cannabis consumption, probably influencing performance during competition. Keywords: cannabis, doping, clinical trial, plasma and urine levels, athlete's sample

Appropriateness of colorectal cancer screening: appraisal of evidence by experts

Objectives. To evaluate how the level of evidence perceived by an international panel of experts was concordant with the level of evidence found in the literature, to compare experts perceived level of evidence to their appropriateness scores, and to compare appropriateness criteria for colonoscopy between experts and an evidence-based approach. Design. Comparison of expert panel opinions and systematic literature review regarding the level of evidence and appropriateness of colonoscopy indications. Participants. European Panel on the Appropriateness of Gastrointestinal Endoscopy multidisciplinary experts from 14 European countries. Main outcome measures. Concordance and weighted kappa coefficient between level of evidence as perceived by the experts' and that found in the literature, and between panel- and literature-based appropriateness categories. Results. Experts overestimated the level of published evidence of 57 indications. Concordance between the level of evidence perceived by the experts and the actual level of evidence found in the literature was 36% (weighted kappa 0.18). Indications for colonoscopy were reported to be appropriate, uncertain, and inappropriate by the experts in 54, 19, and 27% of the cases, and by the literature in 37, 46, and 17% of the cases. A 46% agreement (weighted kappa 0.29) was found between literature-based and experts' appropriateness criteria. Conclusions. Experts often overestimated the level of evidence on which they based their decisions. However, rarely did the experts' judgement completely disagree with the literature, although concordance between panel- and literature-based appropriateness was only fair. A more explicit discussion of existing evidence should be undertaken with the experts before they evaluate appropriateness criteri

Current sedation and monitoring practice for colonoscopy: an international observational study (EPAGE)

BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (&lt;/= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. CONCLUSIONS: Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring. [Authors]]]> Colonoscopy ; Conscious Sedation ; Hypnotics and Sedatives ; Monitoring, Physiologic ; Physician's Practice Patterns oai:serval.unil.ch:BIB_254F2604090A 2022-05-07T01:13:03Z <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_254F2604090A Simulating fully-integrated hydrological dynamics in complex Alpine headwaters info:doi:10.31223/X5RG7Q info:eu-repo/semantics/altIdentifier/doi/10.31223/X5RG7Q https://doi.org/10.31223/X5RG7Q James, Thornton René, Therrien Grégoire, Mariéthoz Niklas, Linde Philip, Brunner info:eu-repo/semantics/other misc 2021-02-26 eng oai:serval.unil.ch:BIB_255 2022-05-07T01:13:03Z <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_255 High Pressure Techniques in Chemistry and Physics: Spectroscopic Measurements: NMR. Helm, L Powell, D.H. Merbach, A.E. info:eu-repo/semantics/bookPart incollection 1997 Practical Approach Series, pp. 187-216 oai:serval.unil.ch:BIB_2549 2022-05-07T01:13:03Z <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_2549 Paul Tillich et l'histoire de l'art. Reymond, B info:eu-repo/semantics/article article 1997 RThPh, pp. 67-74 oai:serval.unil.ch:BIB_25490 2022-05-07T01:13:03Z <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_25490 Actualité de la Convention européenne des droits de l'homme, mai 2002 - octobre 2002. Flauss, JF info:eu-repo/semantics/article article 2002 Actualité juridique de droit administratif, vol. 20, pp. 1277-1286 oai:serval.unil.ch:BIB_25491 2022-05-07T01:13:03Z <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_25491 Le statut pénal du Président de la République et la Convention européenne des droits de l'homme. Flauss, JF info:eu-repo/semantics/article article 2002 Les Petites Affiches, vol. 261, pp. 4-10 oai:serval.unil.ch:BIB_25492 2022-05-07T01:13:03Z <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_25492 Du droit international comparé de droits de l'homme dans la jurisprudence de la Cour européenne des droits de l'homme. Flauss, JF info:eu-repo/semantics/bookPart incollection 2002 Le rôle du droit comparé dans l'avènement du droit européen, vol. 43, pp. 159-182 Widmer, P. (ed.) oai:serval.unil.ch:BIB_25493 2022-05-07T01:13:03Z <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_25493 Dualisme juridictionnel et Convention européenne des droits de l'homme. Flauss, JF info:eu-repo/semantics/bookPart incollection 2002 Liber amicorum J. Waline, Gouverner, administrer, juger, pp. 523-546 oai:serval.unil.ch:BIB_25494 2022-05-07T01:13:03Z <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_25494 Pathologies infectieuses en réanimation Charbonneau, P Praz, G Glauser, M.P info:eu-repo/semantics/book book 2002 oai:serval.unil.ch:BIB_25495 2022-05-07T01:13:03Z <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_25495 La primauté des droits de l'homme : licéité ou illicéité de l'intervention humanitaire. Flauss, JF info:eu-repo/semantics/bookPart incollection 2002 Le Kosovo et la Communauté internationale - L'histoire, l'actualité et l'avenir. Kosovo and the International Community, pp. 87-102 Tomuschat, C (ed.) oai:serval.unil.ch:BIB_254951546C6B 2022-05-07T01:13:03Z <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_254951546C6B MR gated subtraction angiography: evaluation of lower extremities info:eu-repo/semantics/altIdentifier/pmid/3961174 Meuli, R. A. Wedeen, V. J. Geller, S. C. Edelman, R. R. Frank, L. R. Brady, T. J. Rosen, B. R. info:eu-repo/semantics/article article 1986-05 Radiology, vol. 159, no. 2, pp. 411-8 info:eu-repo/semantics/altIdentifier/pissn/0033-8419 <![CDATA[We report the first clinical experience with a new method for projective imaging of blood vessels (angiography) using magnetic resonance. Vascular contrast is produced noninvasively by the phase response of moving protons. Diastolic and systolic gated images produce, respectively, flow signal and flow void; the difference image is a map of the pulsatile flow: an arteriogram. Preliminary studies are presented of the lower extremities of one healthy volunteer and four patients (one each with occlusive disease, soft-tissue tumor, arteriovenous malformation, and venous femoral-popliteal graft). Patient data are compared with accompanying conventional arteriograms, and the new method is discussed

Appropriateness of Upper Gastrointestinal Endoscopy: Comparison of American and Swiss Criteria

Objective: Examine the reproducibility of the RAND method for developing criteria for the appropriateness of medical procedures. Design: Comparison of two sets of explicit criteria for appropriateness of upper gastrointestinal (UGI) endoscopy, developed by separate expert panels from two countries.Setting: United States, Switzerland. Study participants: National experts from different medical specialties involved in the referral or application of UGI endoscopy.Interventions: Each panel was presented with about 500clinical scenarios (indications)that were rated on a nine-point scale as to the appropriateness of performing UGI endoscopy for a patient with that clinical presentation. Main outcome measurer: (1) distribution of appropriateness ratings and intrapanel agreement categories between the two panels, (2)between-panel agreement of assigning appropriateness for comparable indications and, (3) percentage of indications with major between-panel differences. Results: Ratings for 2/3 of indications could be compared. The Swiss panel showed higher intrapanel agreement (54.6% versus 46.2% p=0.002). Seventy-eight percent of comparable Indications were assigned to indentical categories of appropriateness by both panels (kappa=0.76,P <0.001). For 93% of the 376 comparable indications, there were no major interpanel differences. Conclusion: Separate expert panels in different countries, using a standardized methodology, produce criteria for appropriatenesof medical procedures that are similar. Given the resources being invested throught the world in devilping criteria and guidelines, international collaboration in seeking optimal use of limited health care resources should be intensifled. © 1997 Elsevier Science Ltd. All rights reserve

The appropriateness of colonoscopy: a multi-center, international, observational study

OBJECTIVE: To examine the appropriateness and necessity of colonoscopy across Europe. DESIGN: Prospective observational study. SETTING: A total of 21 gastrointestinal centers from 11 countries. PARTICIPANTS: Consecutive patients referred for colonoscopy at each center. INTERVENTION: Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy. MAIN OUTCOMME MEASURE: Appropriateness of colonoscopy. RESULTS: A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45-54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79-48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74-4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49-0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40-0.75] were less likely to have an appropriate or necessary indication. CONCLUSIONS: This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms

Appropriateness of colorectal cancer screening: appraisal of evidence by experts

OBJECTIVE: . To evaluate how the level of evidence perceived by an international panel of experts was concordant with the level of evidence found in the literature, to compare experts perceived level of evidence to their appropriateness scores, and to compare appropriateness criteria for colonoscopy between experts and an evidence-based approach. DESIGN: /B&gt;. Comparison of expert panel opinions and systematic literature review regarding the level of evidence and appropriateness of colonoscopy indications. PARTICIPANTS: /B&gt;. European Panel on the Appropriateness of Gastrointestinal Endoscopy multidisciplinary experts from 14 European countries. MAIN OUTCOME MEASURES: /B&gt;. Concordance and weighted kappa coefficient between level of evidence as perceived by the experts' and that found in the literature, and between panel- and literature-based appropriateness categories. RESULTS: /B&gt;. Experts overestimated the level of published evidence of 57 indications. Concordance between the level of evidence perceived by the experts and the actual level of evidence found in the literature was 36% (weighted kappa 0.18). Indications for colonoscopy were reported to be appropriate, uncertain, and inappropriate by the experts in 54, 19, and 27% of the cases, and by the literature in 37, 46, and 17% of the cases. A 46% agreement (weighted kappa 0.29) was found between literature-based and experts' appropriateness criteria. CONCLUSIONS: /B&gt;. Experts often overestimated the level of evidence on which they based their decisions. However, rarely did the experts' judgement completely disagree with the literature, although concordance between panel- and literature-based appropriateness was only fair. A more explicit discussion of existing evidence should be undertaken with the experts before they evaluate appropriateness criteria. [Authors]]]> https://serval.unil.ch/resource/serval:BIB_887FC68E8E60.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_887FC68E8E602 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_887FC68E8E602 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_8881F677BE0F 2022-05-07T01:22:09Z <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_8881F677BE0F Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication. info:eu-repo/semantics/altIdentifier/pmid/19369804 Ahmed, Sara Gogovor, Amédé Berman, Erica Miloff, Minda Burnand, Bernard Krelenbaum, Marilyn Montague, Terrence info:eu-repo/semantics/article article 2009 Healthcare quarterly (Toronto, Ont.), vol. 12, no. 2, pp. e1-e13 info:eu-repo/semantics/altIdentifier/pissn/1710-2774 <![CDATA[Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population =65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components

Maintenance of medically induced remission of Crohn's disease

The natural history of Crohn's disease is characterized by recurring flares alternating with periods of inactive disease and remission. This implies that most patients need to take medication for a large period of their life, mostly for maintenance of remission and, intermittently, additional therapy during a flare. Low-dose systemic corticosteroids are not effective in maintaining remission and should not be used for this indication. There is a trend towards a prolonged time to relapse in patients in remission who are treated with budenoside, a corticosteroid with high topical anti-inflammatory activity and low systemic activity. Azathioprine and 6-mercaptopurine are effective in maintaining remission. Maintenance benefits remain significant for patients who continued with the therapy for up to 5 years. Methotrexate has also been found to be effective in maintaining remission in Crohn's disease in patients who have responded acutely to methotrexate. Cyclosporine has not been found to be an effective maintenance agent. Only a few studies in small numbers of patients have been published on the use of tacrolimus. There is a lack of convincing evidence of efficacy of mycophenolate mofetil. The use of anti-TNF agents may change the future approach to maintenance therapy for Crohn's disease. Patients who responded clinically to infliximab, adalimumab and certolizumab have maintained their clinical response when receiving repeat infusions or subcutaneous injections, respectively. In patients refractory to other therapies, infliximab may be effective in maintaining remission. [Ed.]]]> eng oai:serval.unil.ch:BIB_A88D71A3D46E 2022-05-07T01:24:35Z <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_A88D71A3D46E Sul contatto linguistico nella Romània medievale: le lettere di Bartolo de Cavalli alias Bartol de Cavalls. Parte II Tomasin, Lorenzo info:eu-repo/semantics/article article 2020 «Estudis Romànics», vol. 42, pp. 33-54 ita oai:serval.unil.ch:BIB_A88DF5599EF5 2022-05-07T01:24:35Z <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_A88DF5599EF5 Organisation de la prise en charge des accidents vasculaires cérébraux en Suisse romande info:eu-repo/semantics/altIdentifier/pmid/28727353 Carrera, E. Hirt, L. Sztajzel, R. Michel, P. Kleinschmidt, A. Du Pasquier, R. info:eu-repo/semantics/article article 2017-04-26 Revue medicale suisse, vol. 13, no. 560, pp. 883-884 info:eu-repo/semantics/altIdentifier/pissn/1660-9379 urn:issn:1660-9379 fre oai:serval.unil.ch:BIB_A88DF9D15917 2022-05-07T01:24:35Z openaire documents urnserval <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_A88DF9D15917 Clinical assessment of fluorescence cytoscopy during transurethral bladder resection in superficial bladder cancer. info:doi:10.1007/BF00942040 info:eu-repo/semantics/altIdentifier/doi/10.1007/BF00942040 info:eu-repo/semantics/altIdentifier/pmid/9079749 Jichlinski, P. Wagnières, G. Forrer, M. Mizeret, J. Guillou, L. Oswald, M. Schmidlin, F. Graber, P. Van den Bergh, H. Leisinger, H.J. info:eu-repo/semantics/article article 1997 Urological research, vol. 25 Suppl 1, pp. S3-6 info:eu-repo/semantics/altIdentifier/pissn/0300-5623 <![CDATA[The prognosis of superficial bladder cancer in terms of recurrence and disease progression is related to bladder tumor multiplicity and the presence of concomitant "plane" tumors such as high-grade dysplasia and carcinoma in situ. This study in 33 patients aimed to demonstrate the role of fluorescence cystoscopy in transurethral resection of superficial bladder cancer. The method is based on the detection of protoporphyrin-IX-induced fluorescence in urothelial cancer cells by topical administration of 5-aminolevulinic acid. The sensitivity and the specificity of this procedure on apparently normal mucosa in superficial bladder cancer are estimated to be 82.9% and 81.3%, respectively. Thus, fluorescence cytoscopy is a simple and reliable method for mapping the bladder mucosa, especially in the case of multifocal bladder disease, and it facilitates the screening of occult dysplasia

Pregnancy and breastfeeding in patients with Crohn's disease

Crohn's disease commonly affects women of childbearing age. Available data on Crohn's disease and pregnancy show that women with Crohn's disease can expect to conceive successfully, carry to term and deliver a healthy baby. Control of disease activity before conception and during pregnancy is critical, to optimize both maternal and fetal health. Generally speaking, pharmacological therapy for Crohn's disease during pregnancy is similar to pharmacological therapy for nonpregnant patients. Patients maintained in remission by way of pharmacological therapy should continue it throughout their pregnancy. Sulfasalazine, mesalazine and corticosteroids are safe, azathioprine and 6-mercaptopurine are reasonably safe with few discordant data, infliximab seems safe as well, whereas methotrexate is contraindicated during pregnancy. During breastfeeding, mesalazine and prednisone are considered safe, azathioprine/6-mercaptopurine, budesonide and infliximab probably safe and methotrexate is contraindicated. [Ed.]]]> Anti-Infective Agents; Anti-Infective Agents/therapeutic use; Anti-Inflammatory Agents, Non-Steroidal; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use; Breast Feeding; Crohn Disease; Crohn Disease/drug therapy; Drug Therapy, Combination; Female; Glucocorticoids; Glucocorticoids/therapeutic use; Humans; Immunologic Factors/therapeutic use; Mesalamine; Pregnancy; Pregnancy Complications; Pregnancy Complications/drug therapy; Pregnancy Outcome; Safety eng oai:serval.unil.ch:BIB_3A1A65CACAE1 2022-05-07T01:15:44Z <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_3A1A65CACAE1 La construction de l'hypothèse de crise Despland, Jean-Nicolas Durigon, Daniel Valloton Zulauff, Sandrine info:eu-repo/semantics/bookPart incollection 2010 Intervention psychodynamique brève : un modèle de consultation thérapeutique chez l'adulte, pp. 59-75 Despland, Jean-Nicolas (ed.) Michel, Luc (ed.) De Roten, Yves (ed.) info:eu-repo/semantics/altIdentifier/isbn/9782294706882 fre oai:serval.unil.ch:BIB_3A1A6DE514EE 2022-05-07T01:15:44Z <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_3A1A6DE514EE Angio-scanner post-mortem : mise en place d'un protocole standard optimisé Grabherr, S. Doenz, F. Bruguier, C. Steger, B. Dominguez, A. Rizzo, E. Meuli, R. Mangin, P. info:eu-repo/semantics/conferenceObject inproceedings 2010 JFR 2010, 58e Journées Françaises de Radiologie, vol. 91, pp. 1418 info:eu-repo/semantics/altIdentifier/isbn/0221-0363 fre oai:serval.unil.ch:BIB_3A0D5A7ED75A 2022-05-07T01:15:44Z <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_3A0D5A7ED75A 1945 bis Gegenwart. Spanien, Portugal https://www.metzlerverlag.de/ Kunz, Marco info:eu-repo/semantics/bookPart incollection 2013 Phantastik. Ein interdisziplinäres Handbuch, pp. 181-183 Brittnacher, H.R. (ed.) May, M. (ed.) info:eu-repo/semantics/altIdentifier/isbn/9783476023414 ger oai:serval.unil.ch:BIB_3A0D7B66C923 2022-05-07T01:15:44Z openaire documents urnserval <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_3A0D7B66C923 L'avènement de la didactique des langues étrangères: entre humanisme et néo-libéralisme info:doi:10.4000/edl info:eu-repo/semantics/altIdentifier/doi/10.4000/edl urn:isbn:978-2-940331-73-4 info:eu-repo/semantics/altIdentifier/isbn/978-2-940331-73-4 info:eu-repo/semantics/altIdentifier/pissn/0014-2026 info:eu-repo/semantics/altIdentifier/pissn/2296-5084 Zeiter, Anne-Christel Jeanneret, Thérèse info:eu-repo/semantics/other misc <![CDATA[Depuis les années 1950, l’enseignement des langues se construit en regard de l’idéal de la construction européenne de l’après-guerre, période où une Europe unie, pacifiée et surtout durablement en paix vient se poser en réaction aux atrocités de la Seconde Guerre mondiale. Cette idée évolue peu à peu jusqu’aux années 1970, où le Parlement européen se penche sur la faisabilité d’un système commun d’apprentissage des langues, en différentes étapes qui iront du Niveau-seuil (1976) à l’élaboration, dès 1991, du Cadre Européen Commun de Référence pour les Langues (CECR, 2001). Les années quatre-vingt marquent alors un changement important en ce qui concerne tant la manière que les raisons d’apprendre une nouvelle langue: l’enseignement doit permettre aux élèves de rencontrer non plus seulement des textes et œuvres, mais des personnes, avec qui il va être important d’échanger