Patient experience in primary care: association with patient, physician and practice characteristics in a fee-for-service system.

Nowadays we typically use patient experience as a quality of care indicator, although this has some limitations. The aim of this study was to investigate to what extent patient, physician and practice characteristics were associated with patient-reported experience of care in the major dimensions in family medicine in a fee-for-service system. The data came from the Swiss part of the Quality and Costs of Primary Care (QUALICOPC) study, an international cross-sectional survey. A random sample of 194 Swiss family physicians and 1540 of their patients were included in this analysis. We assessed patient experience using three scores characterising access, communication and continuity-coordination. Multilevel statistical methods were used to analyse these scores based on patient-level, physician-level and practice-level factors. Poor experience of access was associated with poor health (incidence rate ratio [IRR] 1.91, 95% confidence interval [CI] 1.54-2.55) but was lower among older patients (IRR 0.75, 95% CI 0.63-0.88). Experience of access was also reported as poorer in urban areas and in practices including other paramedical professionals (besides medical assistants) (IRR 1.27, 95% CI 1.06-1.51). Communication was reported as poorer in practices where physicians achieve greater daily face-to-face consultations (IRR 1.16, 95% CI 1.08-1.25) and in patients reporting higher incomes (IRR 1.24, 95% CI 1.01-1.52). Additionally, younger patients reported poorer continuity-coordination experience. In the continuity-coordination domain, patient experience appeared better in group practices (including other family physicians) and in those of physicians with a greater weekly workload in terms of hours. Finally, we found experience of communication and continuity better in the French-speaking area than German-speaking area of Switzerland. In this study, we found that patient experience in family medicine in Switzerland was very good for all domains studied; access, family physician-patient communication and continuity-coordination of care. Most often, predictive factors of care experience relate to the patient's characteristics, such as age and health status. However, several practice characteristics such as size, composition and functioning (in particular, time spent with the patient) represent potential levers for improving patient-reported experience. The variations observed between the three linguistic areas in Switzerland are also interesting, since they raise the issue of the role of sociocultural factors in this field

Identifikation von Einflussfaktoren auf die persönliche Beanspruchungsbilanz im Rahmen einer Kampagnenbeurteilung zum Thema Rückengesundheit

Die vorliegende Studie untersucht analog zu den salutogenetischen Erklärungsansätzen für Gesundheit, welchen Einfluss rückenspezifische Fitness-Parameter sowie das Ausmaß an sportlicher Aktivität auf die persönliche Beanspruchungsbilanz bei unterschiedlichen Belastungen am Arbeitsplatz nehmen. Darüber hinaus wird die der Untersuchung zugrundeliegende informationsbasierte Aufklärungskampagne zum Thema Rückengesundheit hinsichtlich ihrer Wirksamkeit überprüft

Radiation dose optimization in pediatric temporal bone computed tomography: influence of tube tension on image contrast and image quality

Introduction: The purpose of this experimental study was to investigate the effect of tube tension reduction on image contrast and image quality in pediatric temporal bone computed tomography (CT). Methods: Seven lamb heads with infant-equivalent sizes were scanned repeatedly, using four tube tensions from 140 to 80kV while the CT-Dose Index (CTDI) was held constant. Scanning was repeated with four CTDI values from 30 to 3mGy. Image contrast was calculated for the middle ear as the Hounsfield unit (HU) difference between bone and air and for the inner ear as the HU difference between bone and fluid. The influence of tube tension on high-contrast detail delineation was evaluated using a phantom. The subjective image quality of eight middle and inner ear structures was assessed using a 4-point scale (scores 1-2 = insufficient; scores 3-4 = sufficient). Results: Middle and inner ear contrast showed a near linear increase with tube tension reduction (r = −0.94/−0.88) and was highest at 80kV. Tube tension had no influence on spatial resolution. Subjective image quality analysis showed significantly better scoring at lower tube tensions, with highest image quality at 80kV. However, image quality improvement was most relevant for low-dose scans. Conclusions: Image contrast in the temporal bone is significantly higher at low tube tensions, leading to a better subjective image quality. Highest contrast and best quality were found at 80kV. This image quality improvement might be utilized to further reduce the radiation dose in pediatric low-dose CT protocol

Speciation leads to divergent methylmercury accumulation in sympatric whitefish

Central European lake whitefish (Coregonus spp.) colonized Swiss lakes following the last glacial retreat and have undergone rapid speciation and adaptive radiation. Up to six species have been shown to coexist in some lakes, and individual species occupy specific ecological niches and have distinct feeding and reproductive ecologies. We studied methylmercury (MeHg) accumulation in sympatric whitefish species from seven Swiss lakes to determine if ecological divergence has led to different rates of MeHg bioaccumulation. In four of seven lakes, sympatric species had distinctly different MeHg levels, which varied by up to a factor of two between species. Generally, species with greater MeHg levels were smaller in body size and planktivorous, and species with lower MeHg were larger and benthivorous. While modest disparities in trophic position between species might be expected a priori to explain the divergence in MeHg, δ15N of bulk tissue did not correlate with fish MeHg in five of seven lakes. Results of a nested ANCOVA analysis across all lakes indicated that only two factors (species, lake) explained substantial portions of the variance, with species accounting for more variance (52%) than inter-lake differences (32%). We suggest that differences in MeHg accumulation were likely caused by diverging metabolic traits between species, such as differences in energy partitioning between anabolism and catabolism, potentially interacting with species-specific prey resource utilization. These results indicate substantial variability in MeHg accumulation between closely related fish species, illustrating that ecological speciation in fish can lead to divergent MeHg accumulation pattern

A two-microphone noise reduction system for cochlear implant users with nearby microphones. Part II: Performance Evaluation

Users of cochlear implants (auditory aids, which stimulate the auditory nerve electrically at the inner ear) often suffer from poor speech understanding in noise. We evaluate a small (intermicrophone distance 7 mm) and computationally inexpensive adaptive noise reduction system suitable for behind-the-ear cochlear implant speech processors. The system is evaluated in simulated and real, anechoic and reverberant environments. Results from simulations show improvements of 3.4 to 9.3 dB in signal to noise ratio for rooms with realistic reverberation and more than 18 dB under anechoic conditions. Speech understanding in noise is measured in 6 adult cochlear implant users in a reverberant room, showing average improvements of 7.9–9.6 dB, when compared to a single omnidirectional microphone or 1.3–5.6 dB, when compared to a simple directional two-microphone device. Subjective evaluation in a cafeteria at lunchtime shows a preference of the cochlear implant users for the evaluated device in terms of speech understanding and sound quality

LIF promotes neurogenesis and maintains neural precursors in cell populations derived from spiral ganglion stem cells

<p>Abstract</p> <p>Background</p> <p>Stem cells with the ability to form clonal floating colonies (spheres) were recently isolated from the neonatal murine spiral ganglion. To further examine the features of inner ear-derived neural stem cells and their derivatives, we investigated the effects of leukemia inhibitory factor (LIF), a neurokine that has been shown to promote self-renewal of other neural stem cells and to affect neural and glial cell differentiation.</p> <p>Results</p> <p>LIF-treatment led to a dose-dependent increase of the number of neurons and glial cells in cultures of sphere-derived cells. Based on the detection of developmental and progenitor cell markers that are maintained in LIF-treated cultures and the increase of cycling nestin-positive progenitors, we propose that LIF maintains a pool of neural progenitor cells. We further provide evidence that LIF increases the number of nestin-positive progenitor cells directly in a cell cycle-independent fashion, which we interpret as an acceleration of neurogenesis in sphere-derived progenitors. This effect is further enhanced by an anti-apoptotic action of LIF. Finally, LIF and the neurotrophins BDNF and NT3 additively promote survival of stem cell-derived neurons.</p> <p>Conclusion</p> <p>Our results implicate LIF as a powerful tool to control neural differentiation and maintenance of stem cell-derived murine spiral ganglion neuron precursors. This finding could be relevant in cell replacement studies with animal models featuring spiral ganglion neuron degeneration. The additive effect of the combination of LIF and BDNF/NT3 on stem cell-derived neuronal survival is similar to their effect on primary spiral ganglion neurons, which puts forward spiral ganglion-derived neurospheres as an <it>in vitro </it>model system to study aspects of auditory neuron development.</p

Coping better with health problems after a visit to the family physician: associations with patients and physicians characteristics.

Good patient experience is recognized as an important component of a strong primary care system. Among the dimensions related to experience in family medicine, the ability to cope better with health problems is considered to be a measure of the quality of a consultation with a family physician (FP). The objective is to identify factors related to patients, physicians and practice, associated with patients' ability to cope better with their health problems after a family medicine consultation. The data stemmed from the Swiss part of the Quality and Costs of Primary Care (QUALICOPC) study, an international cross sectional survey aiming to compare quality, cost and equity in primary care. In Switzerland, a random sample of 199 FPs and 1791 patients participated. The negative answer to the question: "After this visit, I feel I can cope better with my health problems" was modeled using multilevel logistic regressions. Difficulty to cope better with health problems was positively associated with the following: younger age (OR: 1.58, 95% CI [1.03-2.41]), cultural aspects related to the Swiss area of language (French speaking people declared higher inability than German and Italian ones), presence of chronic disease (OR: 1.54 95% CI [1.00-2.39]). Conversely an intermediate number (1-4) of visits during the last 6 months (OR: 0.37 95% CI [0.23-0.62]) and the satisfaction with the physician (OR: 0.18 95% CI [0.08-0.44]) are negative predictors of the patient inability to cope better with his health problems. A self-reported effort-reward imbalance at work (OR: 0.64 95% CI [0.41-1.00]) was the only predictive FP characteristic (negatively associated). Although the design of the study does not allow causal inference, this study showed that the predictors of patient difficulties to cope better with health problem are mainly centered on the patients' characteristics. The patient-physician relationship both in terms of quality and frequency of visits is probably also important. Organizational practice characteristics do not seem to play a major role but stress at work among physicians should be further investigated

WNT Activation and TGFβ-Smad Inhibition Potentiate Stemness of Mammalian Auditory Neuroprogenitors for High-Throughput Generation of Functional Auditory Neurons In Vitro.

Hearing loss affects over 460 million people worldwide and is a major socioeconomic burden. Both genetic and environmental factors (i.e., noise overexposure, ototoxic drug treatment and ageing), promote the irreversible degeneration of cochlear hair cells and associated auditory neurons, leading to sensorineural hearing loss. In contrast to birds, fish and amphibians, the mammalian inner ear is virtually unable to regenerate due to the limited stemness of auditory progenitors, and no causal treatment is able to prevent or reverse hearing loss. As of today, a main limitation for the development of otoprotective or otoregenerative therapies is the lack of efficient preclinical models compatible with high-throughput screening of drug candidates. Currently, the research field mainly relies on primary organotypic inner ear cultures, resulting in high variability, low throughput, high associated costs and ethical concerns. We previously identified and characterized the phoenix auditory neuroprogenitors (ANPGs) as highly proliferative progenitor cells isolated from the A/J mouse cochlea. In the present study, we aim at identifying the signaling pathways responsible for the intrinsic high stemness of phoenix ANPGs. A transcriptomic comparison of traditionally low-stemness ANPGs, isolated from C57Bl/6 and A/J mice at early passages, and high-stemness phoenix ANPGs was performed, allowing the identification of several differentially expressed pathways. Based on differentially regulated pathways, we developed a reprogramming protocol to induce high stemness in presenescent ANPGs (i.e., from C57Bl6 mouse). The pharmacological combination of the WNT agonist (CHIR99021) and TGFβ/Smad inhibitors (LDN193189 and SB431542) resulted in a dramatic increase in presenescent neurosphere growth, and the possibility to expand ANPGs is virtually limitless. As with the phoenix ANPGs, stemness-induced ANPGs could be frozen and thawed, enabling distribution to other laboratories. Importantly, even after 20 passages, stemness-induced ANPGs retained their ability to differentiate into electrophysiologically mature type I auditory neurons. Both stemness-induced and phoenix ANPGs resolve a main bottleneck in the field, allowing efficient, high-throughput, low-cost and 3R-compatible in vitro screening of otoprotective and otoregenerative drug candidates. This study may also add new perspectives to the field of inner ear regeneration

Charge order at the frontier between the molecular and solid states in Ba3NaRu2O9

We show that the valence electrons of Ba3NaRu2O9, which has a quasi-molecular structure, completely crystallize below 210 K. Using an extended Hubbard model, we show that the charge ordering instability results from long-range Coulomb interactions. However, orbital ordering, metal-metal bonding and formation of a partial spin gap enforce the magnitude of the charge separation. The striped charge order and frustrated hcp lattice of Ru2O9 dimers lead to competition with a quasi-degenerate charge-melted phase under photo-excitation at low temperature. Our results establish a broad class of simple metal oxides as models for emergent phenomena at the border between the molecular and solid states.Comment: Minor changes, with supporting information. To appear in Phys. Rev. Let

Spiral Ganglion Neuron Explant Culture and Electrophysiology on Multi Electrode Arrays

Spiral ganglion neurons (SGNs) participate in the physiological process of hearing by relaying signals from sensory hair cells to the cochlear nucleus in the brain stem. Loss of hair cells is a major cause of sensory hearing loss. Prosthetic devices such as cochlear implants function by bypassing lost hair cells and directly stimulating SGNs electrically, allowing for restoration of hearing in deaf patients. The performance of these devices depends on the functionality of SGNs, the implantation procedure and on the distance between the electrodes and the auditory neurons. We hypothesized, that reducing the distance between the SGNs and the electrode array of the implant would allow for improved stimulation and frequency resolution, with the best results in a gapless position. Currently we lack in vitro culture systems to study, modify and optimize the interaction between auditory neurons and electrode arrays and characterize their electrophysiological response. To address these issues, we developed an in vitro bioassay using SGN cultures on a planar multi electrode array (MEA). With this method we were able to perform extracellular recording of the basal and electrically induced activity of a population of spiral ganglion neurons. We were also able to optimize stimulation protocols and analyze the response to electrical stimuli as a function of the electrode distance. This platform could also be used to optimize electrode features such as surface coatings