Productivity of medical research in Switzerland.

BACKGROUND: Little evidence exists about what contributes to successful medical research, an increasingly important issue in an era of limited research budgets. This study examined predictors of productivity of Swiss medical research. METHODS: Principal investigators of clinical research projects funded by the Swiss National Science Foundation between 1990 and 1994 were surveyed by mail. They provided information about the research question, whether changes were made to the protocol and why, their assessment of the importance of results for science and for public health, and additional funding of the project. The amount of the grant and the project priority score were obtained from the Foundation. Indicators of scientific productivity were the number of peer-reviewed articles and the summed impact factor per grant. RESULTS: The size of the grant predicted scientific output (number of articles and summed impact factor), but the marginal return decreased with the total sum awarded. The award of a continuation grant by the same agency and additional funding from other sources were also positively linked with productivity. In addition, the initial priority rating of the project by the funding agency's scientific committee and the assessment of scientific importance of the results by the principal investigator were also independently associated with productivity. Finally, modifications of the initial research plan in response to new scientific opportunities were linked with greater productivity, whereas modifications induced by technical or other difficulties were associated with lower productivity. CONCLUSIONS: Productivity in medical research, measured by peer-reviewed articles produced, requires adequate resources and ability to respond to new scientific challenges, and it can be anticipated by peer-review.

[Four models for external quality assessment in the health sector]. / Quatre modèles de reconnaissance externe de la qualité dans le secteur de la santé.

European hospitals have adopted four different models for external assessment of their quality systems: Accreditation along the JCAHO criteria Certification along the ISO 9000 criteria Assessment according to the EFQM model Visitatie (in Netherlands). The characteristic of the first three models are exposed, and their differences and similarities discussed. The perspectives for the future in Switzerland are briefly presented.

COOP Charts in French: translation and preliminary data on instrument properties.

This paper describes the procedure used to translate the COOP Charts into French and provides preliminary information on the instrument's acceptability, reliability and validity. The charts were translated in several steps: seven initial translations were combined into a first pilot version, which was then tested for acceptability, clarity and alternative wordings in two convenience samples taken from the general population (n = 53). The modified version was then reviewed by a lay panel and another translator and submitted by mail to 209 congress participants to test several construct validity hypotheses through known-groups comparisons. A panel of public health professionals discussed the content validity of the charts. Finally, test-retest reliability and concurrent validity with SF-36 Health Survey scores were examined among 65 patients with end-stage renal disease. The translation process identified a wide variability in translation options for several items. The acceptability of the charts was excellent. The test-retest correlations ranged from 0.60 to 0.87. Content validity appeared to be appropriate, except for the chart on 'social support', which combines the questions of need and availability of social support. The utility of illustrations was questioned by some respondents: many claimed not to have used the illustrations in selecting their response, while others found them to be not expressive enough. Most preliminary tests of construct validity were consistent with theory. This French translation of the COOP Charts appears to be ready for more extensive testing in the intended target population of ambulatory patients.

[Quality of care: from theory to practice]. / Qualité des soins: de la théorie à la pratique.

Quality of care is growing concern among health care professionals and managers. As a multidimensional concept, it cannot be reduced to simple customer satisfaction. Taking into account the views of the three major players in the health care system-patients, providers and payers-quality can be defined as the capacity to satisfy patients' needs according to professional knowledge and within available resources. Efficacy, efficiency, appropriateness, acceptability, legitimacy and equity are dimensions of health care quality. Contrary to popular belief, quality is neither maximum performance, nor satisfaction at all costs, nor punishment or elimination of "bad apples". In ambulatory medicine, quality implies first of all the ability to master the processes occurring during an office visit. However, although history taking and physical examination are the cornerstones of medical practice, they have not been well studied. Improving quality of care in the ambulatory sector will require better knowledge about medical decision-making processes, in particular identification of the most relevant information required for a decision and the optimal way of obtaining it in any specific clinical situation.

Changes in the vascular reactivity of the isolated tail arteries of spontaneous and renovascular hypertensive rats to endogenous and exogenous noradrenaline.

We have investigated the changes in the responses to noradrenaline of isolated tail arteries of spontaneously hypertensive (SHR) and renovascular hypertensive rats (Wistar-Kyoto: two-kidney, one-clip model, WKY:2K1C) compared with normotensive (Wistar-Kyoto, WKY) rats. Renovascular hypertension was induced by 4 weeks' unilateral renal artery clipping. Arteries were vasoconstricted with exogenous noradrenaline, electrical field stimulation or high potassium. The effects of the latter two stimuli were abolished by reserpine and so were presumably dependent on the presence of endogenous noradrenaline. In the SHR the maximal vasoconstriction produced by all three stimuli was greater than in WKY. Dose-response curves were steeper and there was no change in threshold. Vascular mass was greater. We interpret these results as showing an increase in vascular reactivity in the SHR caused by structural adaptation. The WKY:2K1C responses to noradrenaline could also be explained in terms of structural adaptation but there was no increase in vascular mass. Sensitivity to potassium and electrical stimulation was decreased, suggesting a defect in vascular neurotransmission. This was supported by the observations of a decreased arterial noradrenaline content and of decreased sensitivity to cocaine.

Noradrenaline inhibits vasoconstriction induced by electrical stimulation.

Exposure of the isolated rat tail artery to exogenous noradrenaline inhibited vasoconstriction induced by electrical field stimulation. Phenylephrine produced brief inhibition; guanfacine potentiated electrical stimulation. Sympathetic neurotransmission may be blunted by brief increases in circulating noradrenaline levels.