RÉSUMÉ
Androgen deprivation therapy is an integral part of the treatment of advanced and progressive prostate cancer. Various prospective randomised trials have investigated whether or not temporary suspension of androgen deprivation might delay the emergence of castration resistant prostate cancer and concomitantly improve quality of life. Until now, no phase III trial has been able to prove that intermittent androgen deprivation might delay the development of castration resistant tumours. Data from previous trials, except for one study, did at least not show adverse effects on survival. Data on quality of life are inconsistent, showing a trend towards improved quality of life with IAD. German as well as European guidelines reflect IAD as an established constituent of day-to-day medical practice. This review is intended to provide a code of practice for an individualised treatment as based on recently published studies.
Sujet(s)
Antagonistes des androgènes/administration et posologie , Tumeurs de la prostate/traitement médicamenteux , Évolution de la maladie , Calendrier d'administration des médicaments , Allemagne , Humains , Mâle , Guides de bonnes pratiques cliniques comme sujet , Études prospectives , Tumeurs de la prostate/mortalité , Tumeurs de la prostate/anatomopathologie , Tumeurs prostatiques résistantes à la castration/prévention et contrôle , Qualité de vie , Essais contrôlés randomisés comme sujet , Analyse de survieRÉSUMÉ
The regulation for the scale of remuneration for physicians (GÖA) is a Federal act which must be approved by the Federal Council. The structure and specification of the services in the current scales are out of date. The current performance ratings should be replaced by a strict economic analysis calculation model. This is the only way the Medical Council (BÄK) can foresee that higher performance ratings for services can be enforced against the health insurance companies.
Sujet(s)
Remboursement par l'assurance maladie/économie , Remboursement par l'assurance maladie/législation et jurisprudence , Modèles économiques , Programmes nationaux de santé/économie , Programmes nationaux de santé/législation et jurisprudence , Médecins/économie , Rémunération , Allemagne , Médecins/législation et jurisprudenceSujet(s)
Hyperplasie de la prostate/diagnostic , Diagnostic différentiel , Évolution de la maladie , Médecine factuelle , Humains , Mâle , Prostatectomie/méthodes , Hyperplasie de la prostate/chirurgie , Résultat thérapeutique , Échographie , Obstruction du col de la vessie/diagnostic , Obstruction du col de la vessie/étiologie , Obstruction du col de la vessie/thérapie , Urodynamique/physiologieRÉSUMÉ
A financial adjustment of the scale of medical fees (GoA) has not been undertaken for 27 years so that in 2007 the medical profession must work and run the practice with charge rates from 1982. The Medical Council considers an increase in the proceeds of the GoA catalogue of services with adjustment according to the development of costs and income to be indispensible.
Sujet(s)
Honoraires médicaux/tendances , Prévision , Coûts des soins de santé/tendances , Urologie/économie , Urologie/tendances , AllemagneSujet(s)
Prestations des soins de santé/organisation et administration , Relations interprofessionnelles , Médecine/organisation et administration , Pratique professionnelle privée/organisation et administration , Orientation vers un spécialiste/organisation et administration , Programmes médicaux régionaux/organisation et administration , Spécialisation , Service hospitalier d'urologie/organisation et administration , Urologie/organisation et administration , Comportement coopératif , Allemagne , Relations interinstitutionnellesSujet(s)
Réseaux communautaires/économie , Programmes nationaux de santé/économie , Assurance de la qualité des soins de santé/économie , Urologie/économie , Réseaux communautaires/législation et jurisprudence , Analyse coût-bénéfice/législation et jurisprudence , Allemagne , Humains , Programmes nationaux de santé/législation et jurisprudence , Assurance de la qualité des soins de santé/législation et jurisprudence , Urologie/législation et jurisprudenceRÉSUMÉ
In Germany, discussions on the fees for statutory sickness insurance for ambulatory surgery has, in the last few years, become almost a symbol of dispute for the German health services. Outpatient surgeons complain about the fact that the fees do not cover their services. They see innovation severely threatened by bureaucracy, profitability by planned economy, rights by reasons of State, aggravated by the 'reform' attempts of the Greens and Socialist coalition Federal Government. On the other hand their opponents complain about the money mindedness of the doctors. Intentional panic or real disaster? The fundamental consideration to clarify this question is based on a comparison of the German statutory medical insurance fees and private fees with our neighbours. In Europe an economic area with similar prices for goods, services and wages, even 'outpatient operations' services with comparable cost rates should be paid for at a corresponding level. Any discrepancies would give cause to look for an explanation by analysing the historic development of fees and the question of a fair comparison between operations and the non-operative services.
RÉSUMÉ
The conversion of [1,2,6,7-3H]testosterone to [3H]dihydrotestosterone has been assessed in ground sp¿ongiosa of normal and osteoporotic bone. The tissue was obtained from 23 patients, 18 women, 3 men and 2 children who were undergoing orthopedic surgery. The formation of dihydrotestosterone was demonstrated in all samples examined. The half maximum rate of dihydrotestosterone formation occurred at a substrate concentration of 0.3 microM a value similar to that reported for dihydrotestosterone formation in other androgen target organs. Under the standardized conditions utilized in this study the rate of dihydrotestosterone formation did not differ significantly in normal as compared to osteoporotic bone. Furthermore, the conversion of testosterone to androstenedione was also similar in osteoporotic and normal bone. Based on these studies it seems reasonable to conclude that dihydrotestosterone rather than testosterone is the active intracellular androgen in human bone since in other androgen target tissue androgen action is mediated by dihydrotestosterone if 5 alpha-reductase is present.
