以医院评审为契机 持续改进医疗服务质量——我国及国际医院评审概况探靛

通过回顾我国医院评审的进程和国际上几个国家的医院评审概况,总结和探讨国际先进经验,从而为我国医院评审评价体系的建设提供参考。     

3D-based full-guided ridge expansion osteotomy – A case report about a new method with successive use of different surgical guides,transfer of splitting vector and simultaneous implant insertion

For horizontal bone deficiency alveolar ridge osteotomy is considered an option for augmentation. Major advantages are the option for a one-stage approach and the absence of donor site morbidity. However, the conventional technique is associated with complications such as perforations and fractures of the cortical bone.A case using a 3D based modified, full-guided alveolar ridge expansion is described to explain the technique step by step. Main features of modified technique: successive application of surgical guides for ridge osteotomy and expansion – implementation of virtually determined splitting vector, which allows guided bone splitting along a guide surface of template in an ideal direction - osteotomy as deep as implant length. The example shows that the 3D based modified alveolar ridge osteotomy is a suitable alternative to the conventional technique as it has several advantages such as fewer fractures and perforations of the cortical vestibular bone.The individualized preoperative planning helps to minimize complications. However, long-term outcomes and a study, conducted on a study group, is needed to evaluate the benefits of our presented treatment protocol.     

Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: An alternative concept to autologous transplantation and flap mobilization

Three-dimensional augmentation in severely atrophic bone and after cancer resection is a challenging clinical indication that is mostly solved using autologous bone transplantation. The development of the digital technique along with the additive manufacturing and three-dimensional (3D) printing opened new avenues for reconstructive oral and maxillofacial surgery. Therefore, patient-specific titanium mesh is a novel means of stabilizing the augmentation region using particulate bone substitute materials (BSMs) combined with autologous bone as a minimally invasive concept. However, dehiscence is a frequently reported complication in this field. Therefore, the aim of the present case series was to introduce a biomaterial-based regenerative concept in terms of exposed open healing to overcome the dehiscence related to 3D-titanium meshes. Additionally, this case series presents a novel protocol using a combination of xenogeneic BSMs with an autologous blood concentrate system (platelet-rich fibrin [PRF]) and collagen matrices without any autologous transplantation. Seven patients with alveolar ridge atrophy with different etiologies (cancer resection, severe atrophy after tooth loss, aplasia, trauma, implant infections) were treated using the open-healing concept. Therefore, after 3D augmentation using the described biomaterials, the flap margins were approximated, and the gap between the flap margins was bridged using a collagen matrix loaded with liquid PRF that was then covered by either a PTFE-based membrane or sterile latex. No periosteum splitting was performed at any time point. After a healing period of 4–8 months, all patients received dental implants as virtually planned. Bone biopsies were performed during dental insertion for histological evaluation. The augmentation area displayed a vital and well-vascularized newly formed bone that incorporated the BSM granules to build a hybrid bone. Additionally, open healing resulted in newly formed soft tissue without any signs of scar formation or fibrosis. The regenerated soft tissue was used to build a new flap during implant insertion and showed good functional and aesthetic results after implant insertion. The open-healing concept of the regeneration of the soft tissue along with bone tissue to regenerate a harmonic implantation bed is a minimally invasive intervention without periosteum splitting or large flap mobilization. However, further controlled clinical studies are needed to evaluate this concept in a larger patient cohort to outline the potential clinical benefit.     

Cost-effectiveness of childhood rotavirus vaccination in Germany

Background

Rotavirus (RV) causes a highly contagious gastroenteritis especially in children under five years of age. Since 2006 two RV-vaccines are available in Europe (Rotarix^® and RotaTeq^®). To support informed decision-making within the German Standing Committee on Vaccination (STIKO) the cost-effectiveness of these two vaccines was evaluated for the German healthcare setting.

Methods

A Markov model was developed to evaluate the cost-effectiveness from the statutory health insurance (SHI) and from the societal perspective. RV-cases prevented, RV-associated hospitalizations avoided, and quality-adjusted life years (QALY) gained were considered as health outcomes. RV-incidences were calculated based on data from the national mandatory disease reporting system. RV-vaccine efficacy was determined as pooled estimates based on data from randomized controlled trials. Vaccine list prices and price catalogues were used for cost-assessment. Effects and costs were discounted with an annual discount rate of 3%.

Results

The base-case analysis (SHI-perspective) resulted in an incremental cost-effectiveness and cost-utility ratio for Rotarix^® of € 184 per RV-case prevented, € 2457 per RV-associated hospitalization avoided, and € 116,973 per QALY gained. For RotaTeq^®, the results were € 234 per RV-case prevented, € 2622 per RV-associated hospitalization avoided, and € 142,732 per QALY gained. Variation of various parameters in sensitivity analyses showed effects on the ICERs without changing the overall trend of base-case results. When applying base-case results to the 2012 birthcohort in Germany with 80% vaccination coverage, an estimated 206,000–242,000 RV-cases and 18,000 RV-associated hospitalizations can be prevented in this birthcohort over five years for an incremental cost of 44.5–48.2 million €.

Conclusion

Our analyses demonstrate that routine RV-vaccination could prevent a substantial number of RV-cases and hospitalizations in the German healthcare system, but the saved treatment costs are counteracted by costs for vaccination. However, with vaccine prices reduced by ∼62–66%, RV-vaccination could even become a cost-saving preventive measure.     

German national drug information service: user satisfaction and potential positive patient outcomes

Objective The pharmacist-run national German drug information service (DIS) has operated since 1988. Answering a steadily increasing demand over the past decade, our centre has, in total, provided information in more than 14,000 cases, mainly for community pharmacists. Information on user’s satisfaction and on possible direct or indirect benefits for patients is as yet scarce. Our objectives were to assess user’s satisfaction with the DIS and to identify any patient-related benefits based on the user’s judgment. Setting Independent national drug information centre at ABDA headquarters. Method A questionnaire was developed, pre-tested, optimized, and used in daily practice over a period of one year (09/2003–08/2004). The questionnaire comprised seven items, aimed only at inquiries which pertained to a patient-related issue. Results During the study period, a total of 1,639 inquiries were answered. Of these, 1,017 (62%) were eligible. The response rate was 45% (455/1,017). Ratings (1 = poor to 5 = very good, mean ± SD) showed positive evaluations for professional quality of advice␣(4.7 ± 0.5), clarity/understandability of advice (4.7 ± 0.5), timeliness of response (4.6 ± 0.7), and helpfulness regarding counselling patients and/or physicians (4.6 ± 0.6). Potential patient benefits could be identified in 42% of the cases that were available to follow-up (190/455). Conclusion This evaluation showed high satisfaction among users of a nationwide DIS, based on quality, understandability, timeliness, and helpfulness regarding counselling. According to its users, DIS was also able to provide positive patient outcomes. Presented in part at the 2nd International Joint Congress of Clinical Pharmacy of the American College of Clinical Pharmacy (ACCP) and the European Society of Clinical Pharmacy (ESCP), Paris, France, April 28–30, 2004, and at the Joint Meeting of the German (DPhG), Austrian (?PhG), and Czech Pharmaceutical Societies, Regensburg, Germany, October 6–9, 2004.