Prevalence and characteristics of tracheal cobblestoning in children.

Background: Tracheal follicular pattern or so-called tracheal cobblestoning is a poorly described entity in the literature and is depicted as a nodular or lumpy appearance of the tracheal wall mucosa suggesting tracheal irritation from factors like gastro-esophageal reflux (GERD) or pulmonary infection. The aim of the present study was to investigate the prevalence and characteristics of tracheal cobblestones in a large pediatric population.

Methods: A large database of rigid tracheoscopies recorded in children (0-6 years of age) undergoing general anesthesia with planned tracheal intubation for elective surgical procedures was retrospectively analyzed.

The prevalence of tracheal bronchus in pediatric patients undergoing rigid bronchoscopy.

Background: Tracheal bronchus (TB) is defined as an abnormal bronchus that originates directly from the lateral wall of the trachea above the carina and goes towards the upper lobe territory of the lung. We analyzed rigid endoscopies of the trachea in children to determine the incidence and characteristics of TB.

Methods: In total, 1021 rigid endoscopies of the trachea recorded from children aged 0 to 6 years were analyzed.

Pediatric tracheotomy: a 30-year experience.

Background/purpose: The aim of this study was to investigate changes of pediatric tracheotomy practice over time.

Methods: A retrospective analysis of all tracheotomies at the University Children's Hospital Zurich from January 1990 to December 2009 was performed. Data analyzed included the indication for tracheotomy, patient comorbidities, age, duration of cannulation, and complications.

Controlled rapid sequence induction and intubation - an analysis of 1001 children.

Background: Classic rapid sequence induction puts pediatric patients at risk of cardiorespiratory deterioration and traumatic intubation due to their reduced apnea tolerance and related shortened intubation time. A 'controlled' rapid sequence induction and intubation technique (cRSII) with gentle facemask ventilation prior to intubation may be a safer and more appropriate approach in pediatric patients. The aim of this study was to analyze the benefits and complications of cRSII in a large cohort.

Endoscopic airway findings in children with or without prior endotracheal intubation.

Background: Airway alterations found after endotracheal intubation are usually associated with mechanical trauma from the tube. However, no studies are available concerning alterations in airways that have never been intubated before. It was the aim of the study to compare endoscopic findings in the larynx and trachea of children who had undergone prior endotracheal intubation with findings in children who had not been intubated before.

Using the analytic hierarchy process to elicit patient preferences: prioritizing multiple outcome measures of antidepressant drug treatment.

Background And Objective: In health technology assessment, the evidence obtained from clinical trials regarding multiple clinical outcomes is used to support reimbursement claims. At present, the relevance of these outcome measures for patients is, however, not systematically assessed, and judgments on their relevance may differ among patients and healthcare professionals. The analytic hierarchy process (AHP) is a technique for multi-criteria decision analysis that can be used for preference elicitation.

Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany.

Objective: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas.

Cost effectiveness of rituximab for non-Hodgkin's lymphoma: a systematic review.

Background: The monoclonal antibody rituximab has shown clinical effectiveness in combination with chemotherapy for the treatment of non-Hodgkin's lymphoma (NHL) in several randomized controlled studies. Rituximab maintenance therapy is associated with significant improvement in progression-free and overall survival in patients with NHL. However, treatment with rituximab causes considerable costs for healthcare systems.

[Safe use of cuffed tracheal tubes in children].

In the last 5 years the use of cuffed tracheal tubes in infants and children has become popular worldwide and is accepted by major medical authorities. The advantages of cuffed tracheal tubes in smaller children - in particular the almost 100% chance to insert the right sized tracheal tube at the first attempt and their reliable sealing characteristics within the trachea - makes tracheal intubation and ventilation considerable easier and safer. This certainly compensates for the higher cost of cuffed compared to uncuffed tracheal tubes.

[Navigating in evidence-poor waters - how much hydration is needed at the end of life? The recommendations of a Swiss expert group (Bigorio group)].

The dehydration, a physiological disturbance due to fluid depletion of the organism, is a common condition in the elderly and most common in the agonal state if not corrected with medical means. Alas, there is little evidence and a paucity of literature as well if one looks for firm data. Do we generally influence the course and duration of the dying process by hydrating or withholding fluids respectively and in what respect? We don't know.

Integrating patients' views into health technology assessment: Analytic hierarchy process (AHP) as a method to elicit patient preferences.

Background: Patient involvement is widely acknowledged to be a valuable component in health technology assessment (HTA) and healthcare decision making. However, quantitative approaches to ascertain patients' preferences for treatment endpoints are not yet established. The objective of this study is to introduce the analytic hierarchy process (AHP) as a preference elicitation method in HTA.

Electronic medical record use in pediatric primary care.

Objectives: To characterize patterns of electronic medical record (EMR) use at pediatric primary care acute visits.

Design: Direct observational study of 529 acute visits with 27 experienced pediatric clinician users.

Measurements: For each 20 s interval and at each stage of the visit according to the Davis Observation Code, we recorded whether the physician was communicating with the family only, using the computer while communicating, or using the computer without communication.

German diabetes management programs improve quality of care and curb costs.

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management.

Primary care pediatricians' perceptions of vaccine refusal in europe.

An electronic survey assessing primary care pediatricians' estimations and practices regarding parents' vaccination refusal was sent to 395 members of the European Academy of Pediatrics Research in Ambulatory Setting network, with a response rate of 87%. Of respondents who vaccinate in the clinic, 93% estimated the total vaccine refusal rate as <1%. Of all respondents, 69% prefer a shared decision-making approach to handle refusing parents.

Information on ethical issues in health technology assessment: how and where to find them.

Background: Comprehensive health technology assessments (HTAs) include thorough reflections on ethical issues associated with health technologies, their use, and value-based decisions in the assessment process. As methods of information retrieval for effectiveness assessments are not applicable to information retrieval on ethical issues, a specific methodological approach is necessary.

Objectives: In the absence of existing adapted methods, our objective was to develop a methodological approach for the systematic retrieval of information on ethical issues related to health technologies.

Enhanced light trapping in thin-film solar cells by a directionally selective filter.

A directionally selective multilayer filter is applied to a hydrogenated amorphous silicon solar cell to improve the light trapping. The filter prevents non-absorbed long-wavelength photons from leaving the cell under oblique angles leading to an enhancement of the total optical path length for weakly absorbed light within the device by a factor of kappa(r) = 3.5.

Comparison of awake spinal with awake caudal anesthesia in preterm and ex-preterm infants for herniotomy.

Background: Spinal anesthesia (SA) is widely used for awake regional anesthesia in ex-preterm infants scheduled for herniotomy. Awake caudal anesthesia (CA) is suggested as an alternative approach for these patients and type of surgery. The aim of this study was to compare efficacy and complications of the two different techniques.

Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre.

Introduction: Parents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified.

Materials And Methods: In cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs.

Financial incentives in the German Statutory Health Insurance: new findings, new questions.

Objectives: This paper presents findings of a mandatory three-year evaluation of a prevention bonus scheme offered in the German Statutory Health Insurance (SHI). Its objective is to describe the rationale behind the programs, analyze their financial impact and discuss their implications on potentially conflicting goals on solidarity and competition.

Methods: The analysis included 70,429 insured enrolled in a prevention bonus program in a cohort study.

Substitution of theophylline slow-release formulations according to the rebate contracts in the German statutory health insurance.

On the basis of the rebate contracts between individual statutory health insurance funds and pharmaceutical enterprises, the generic substitution of prescribed medications is economically attractive and is advocated for statutory health insurees in Germany. In addition to the drugs whose substitution can be considered to be uncritical, rebate contracts also include controversial substances such as the bronchodilator theophylline (CAS 58-55-9), which has a narrow therapeutic range and should only be substituted under certain conditions. The objective of this article was to check the safety of the substitution of theophylline by means of a comparative evaluation of bioequivalence studies carried out on theophylline slow-release preparations.

The German Coronary Artery Disease Risk Screening Model: development, validation, and application of a decision-analytic model for coronary artery disease prevention with statins.

Background: Coronary artery disease (CAD) is a major cause of death in industrial countries, leading to high health-related costs and decreased quality of life.

Objective: To develop and validate a decision-analytic model for CAD risk screening in Germany (German Coronary Artery Disease Screening Model).

Design: Markov model.