European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication.

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Quality assurance in endoscopy in colorectal cancer screening and diagnosis.

Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on quality assurance in endoscopy includes 50 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of endoscopy and other elements in the screening process, including multidisciplinary diagnosis and management of the disease.

[Mortality of foreign and indigenous population in the German Federal Republic]. / Mortalität der ausländischen und der einheimischen Bevölkerung in der Bundesrepublik Deutschland.

Comparative mortality studies with respect to nationality have not yet been published in a comprehensive way for the Federal Republic of Germany. A recent special analysis of causes of death for German mortality statistics of the year 1986 indicates a lower mortality risk among the migrant compared to the indigenous population. Apart from potential biases, such as underreporting of nationality of death cases or overestimation of the size of the non-indigenous population in Germany, from the perspective of socio-epidemiology the possibility arises that selection processes lastingly affect the mortality risk of migrants. The dependence of the length of stay from the quality of the state of health or rather a plausible increased likelihood of remigration in case of chronic disease may constitute important influences, which could explain the differences in mortality between indigenous and migrant population.

[Structured documentation for quality management in patients with diabetes mellitus]. / Strukturierte Dokumentation für das Qualitätsmanagement bei Patienten mit Diabetes mellitus.

The medical services rendered by office-based physicians have to be assessed on the basis of valid, practicable, and reliable indicators. The necessity to implement such indicators follows from the fact that quality and economic efficiency have been combined. The indicators can be derived from already existing guidelines. The target is to define medical services according to their type, extent, frequency and their point of intervention with regard to the medical problems and the treatment goals. The aim is to implement measures that permit the qualitative and economic evaluation of medical services. On the basis of these indicators the Central Institute of Panel Physicians develops together with scientific groups data sets that are able to show if, and to which degree, physicians act guideline-conform. The data sets can be used as documentation modules for transmission purposes and will therefore be integrated into the standard interface for basic clinical data profiles of already existing practice computer systems. While the Centre of German Physicians for Quality Assurance in Medicine is responsible for guideline-development, the conversion of the guidelines into appropriate data set structures is accomplished by the Central Institute of Panel Physician. This close co-operation represents a useful division of the work to be done in connection with the implementation of quality management in physician offices.

[Hip ultrasound screening in Germany. Results and comparison with other screening procedures]. / Sonographisches Hüftscreening in Deutschland. Ergebnisse und Vergleich mit anderen Screeningverfahren.

General ultrasound screening programmes to determine DDH are still a matter of discussion due to a lack of evidence. To facilitate further discussions this review gives an overview of the international data and literature concerning the different screening policies taking into account the results of the German evaluation study from 1997 to 2002. General ultrasound screening programmes are established in Germany and Austria. The analysis of the German screening showed 535 cases of DDH with first operative procedure (age 10 weeks to 5 years) that were treated as inpatients: 66% underwent a closed reduction, 11% an open reduction and 23% an osteotomy of the acetabulum/femur. The number of children who had no ultrasound of the hip before diagnosis decreased from 22% in the first year to 8% in the last. The first ultrasound examination was without pathological findings in 12% of the cases. Capture-recapture estimates suggested that 52% of cases were reported, so that the incidence for first operation due to DDH was 0.26 per 1,000 live births in 1997. This is much lower than in other countries and 4/5 less than the time before screening with ultrasound in Germany. At most 42% of the cases might be preventable by an improvement of the screening programme, but at least 51% would not be prevented. The German ultrasound screening programme has proved to be effective. Improvement of economic efficiency is still possible. Therefore, the German programme with different screening times can be recommended.

[Hip ultrasound screening within the scope of U3--initial experiences]. / Hüftsonographie-Screening im Rahmen der U3--Erste Erfahrungen.

OBJECTIVE: After introduction of hip sonographic screening in Germany in the year 1996 we are interested in its organisational features and the results on a national level. It has to be scrutinized in how far the medical consequences are oriented and in accordance with the national guideline of hip sonographic screening. METHODS: Our study includes all 191.000 documentation sheets of hip sonographic screening in the year of 1996 in Germany. RESULTS: In the year 1996 pediatricians were responsible of 70% of all hip sonographic screening which were performed on the 36. day (median). About 80% of the examined infants showed alpha-angles > 56 Grad, about 1.7% only reached < 51 Grad. 27% of all cases were recommended a second sonographic examination and 7.7% should get a therapy. For 73% of all examined infants the consequences were compatible with the national guidelines for hip sonography screening. Orthopaedists more often showed deviations than other professional groups. CONSEQUENCES: There is the case for a more binding consensus regarding the adequate consequences in the cases of sonographic alpha-ankles between 51 to 56 degrees. In the light of an unexpected high proportion of infants with therapy recommendations there is to establish an informational feedback which covers results from the monitoring of the hip sonographic screening as well as results from the national outcome study.

[Outpatient treatment of patients with cardiovascular diseases]. / Behandlung von Patienten mit Kreislauferkrankungen in der Arztpraxis.

In Germany, cardiovascular disturbances belong to the diseases most frequently treated in the offices of general practitioners and internal specialists. With comprehensive monitoring and the taking of adequate therapeutic measures, the average mortality age of the majority of the 18 million patients suffering from circulatory diseases lies at 79.4 years. In the age group of over 70 years, 70 to 80% of the patients receive treatment against cardiovascular disturbances, most of them against hypertension. One of the most important goals of monitoring and intervention in the outpatient sector is the treatment of hypertension, especially in connection with measures taken against disturbances in lipometabolism in order to prevent secondary diseases. The success of treatment is shown by the decreasing age standardized rate of cardiac infarctions, especially among men, and the decreasing mortality rate of patients below 65. The increasing treatment in the outpatient sector is accompanied by additional interventions, especially by bypass surgery in the hospital sector. The concerted actions in both the outpatient and the inpatient sector result in a higher service provision to come to a higher quality of life in the patients and to prevent early death.

[Initial results of the evaluation study of ultrasound hip screening in Germany]. / Erste Ergebnisse aus der Evaluationsstudie des sonographischen Hüftscreenings in der Bundesrepublik Deutschland.

AIM OF STUDY: To assess the effectiveness of a universal sonographic screening of developmental dysplasia of the hip (DDH) established in Germany since 1996. METHODS: Currently a national survey is being performed in Germany to identify infants and young children who receive inpatient treatment for DDH. Between May, 1997 and October, 1997 monthly questionnaires were sent to all pediatric orthopaedic surgeons (active surveillance) and they were asked to report all inpatient cases between 10 weeks of age and 5 years with current closed or open reduction and/or osteotomies due to DDH. Information on time and results of previous ultrasound screening as well as treatment modalities was obtained in reported cases. RESULTS: 129 children (mean age at hospital admission 15.9 months, range 1.1 to 57.1 months) underwent closed reduction (n = 51), open reduction (n = 40) and osteotomies of the hip (n = 38) in the 6-month study period. Ultrasound screening has been performed too late and not at all in 45 children (35.1%). While in 18 cases (13.7%) no information could be obtained on screening results, the majority of children (n = 66, 51.2%) had completed DDH screening prior to the sixth week of life as recommended. Preliminary calculation of the unadjusted incidence of inpatient treatment for DDH in Germany was 0.33 per 1000 livebirths. CONCLUSION: DDH cases are still identified after introduction of an universal ultrasound hip screening in Germany. Continued evaluation must show, whether the incidence will decrease throughout the next few years.

[Model project of hearing screening in new-born in Hanover (preliminary results)]. / Modellprojekt Neugeborenen-Hörscreening in Hannover (Zwischenergebnisse).

In Germany, congenital hearing disorders are usually detected too late resulting in insufficient therapy of the disorder. To investigate these problems, the Federal Ministry of Health and the principal associations of statutory health insurance commissioned a pre-operative study. The study's aim is to verify whether introduction of a universal new-born hearing screening results in earlier diagnosis of hearing disorders and thus improves medical care for children with impaired hearing. Feasibility, effectiveness and economic tenability of this hearing screening programme will be investigated. The study is realised in the Hanover region and aims at carrying out a hearing test in all new-born during the first days of life. The tests will be performed in all 10 birth clinics and 2 paediatric clinics in the relevant region and in 24 otolaryngological practices. Hearing ability is controlled via an automated screening device measuring otoacoustic emissions. Sensitivity and specificity of the test is more than 95%. Economical feasibility is investigated by cost-effectiveness analyses. During a 6-month period the screening has been implemented in all clinics in every day routine. The mean coverage rate in the clinics has been stabilised to 97% of the total number. 4.7% of the children were presumed to suffer from unilateral hearing disorders and 2.3% from bilateral. In 13 cases the diagnosis of hearing disorder was confirmed. The mean age of diagnosis in these children was 3.7 months. The average age of therapy onset was 4.4 months. According to the present experience, area-wide implementation of hearing screening seems feasible in existing health care structures. The intention to advance the time of diagnosis and the therapy onset can be achieved by this method. Systematic training, introduction and quality assurance measures of screening are mandatory. Tracking of suspicious cases is necessary, even if it challenges data privacy regulations.