ABSTRACT
Increasing medical complexity, centrifugal forces of medical subspecialization and growing economic constraints are the key reasons for the introduction of quality management into routine care processes such as dialysis. Adequate quality assurance and improvement must be implemented in order to supply medical staff, care providers, and patients with the necessary information on critical issues of clinical management of dialysis patients. QiN (Quality in Nephrology), the quality management program of the largest German dialysis provider, is outlined here as a practicable example. The first of 2 parts provides information on the structure, implementation of QiN and achieved clinical improvement in routine care. The second part (quotation) analyzes longitudinal data in order to differentiate whether observed improvements during more than 5 years of QiN can be ascribed to the intervention (application of QiN) or whether they are due to other factors such as generally improved medical knowledge.
Subject(s)
Kidney Failure, Chronic/therapy , Quality Assurance, Health Care/standards , Renal Dialysis/standards , Evidence-Based Medicine , Germany , Humans , Practice Guidelines as Topic , Risk AdjustmentSubject(s)
Cardiovascular Diseases/etiology , Renal Dialysis , Troponin I/blood , Troponin T/blood , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Adult , Aged , Aged, 80 and over , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Middle Aged , PrognosisSubject(s)
Autoimmune Diseases/diagnosis , Giant Cells , Hepatitis/diagnosis , Liver Diseases/diagnosis , Acute Disease , Adult , Autoimmune Diseases/immunology , Biopsy , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis, Differential , Hepatitis/pathology , Humans , Liver Diseases/immunology , Liver Diseases/pathology , Male , Time FactorsSubject(s)
Antibodies, Antineutrophil Cytoplasmic/analysis , Spondylitis, Ankylosing/immunology , Adult , Female , Humans , Male , Middle AgedABSTRACT
It was our purpose to determine the immunodiagnostic value of ANCA directed against BPI in diseases known to be associated with ANCA, such as ANCA-associated vasculitides, inflammatory bowel disease (IBD) and the associated condition primary sclerosing cholangitis. The immunoreactivity of recombinant PBI (rBPI) was established in order to develop an ELISA specific for rBPI. By means of this assay, BPI-ANCA were assessed in sera of 178 patients with IBD or the associated disorder primary sclerosing cholangitis, 112 patients with ANCA-associated vasculitides, and in sera of 182 disease and 140 health controls. BPI-ANCA were found to be closely associated with IBD and primary sclerosing cholangitis (34% and 44% of ANCA-positive sera, respectively). By contrast, BPI-ANCA positivity was low (<10%) in the double-negative sera of patients with ANCA-associated vasculitides and in disease and health controls. BPI-ANCA appear to constitute an important marker for IBD and primary sclerosing cholangitis, but not for the ANCA-associated vasculitides.