The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project.

Background And Aims: The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting.

Methods And Results: 27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women).

Appropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica.

Study Design: Prospective, controlled, observational outcome study using clinical, radiographic, and patient/physician-based questionnaire data, with patient outcomes at 12 months follow-up.

Objective: To validate appropriateness criteria for low back surgery.

Summary Of Background Data: Most surgical treatment failures are attributed to poor patient selection, but no widely accepted consensus exists on detailed indications for appropriate surgery.

The effect of nonmedical factors on variations in the performance of colonoscopy among different health care settings.

Background: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance.

Methods: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used.

Use of the Cognitive Performance Scale (CPS) to detect cognitive impairment in the acute care setting: concurrent and predictive validity.

The Cognitive Performance Scale (CPS) was initially designed to assess cognition in long term care residents. Subsequently, the CPS has also been used among in-home, post-acute, and acute care populations even though CPS' clinimetric performance has not been studied in these settings. This study aimed to determine CPS agreement with the Mini Mental Status Exam (MMSE) and its predictive validity for institutionalization and death in a cohort (N=401) of elderly medical inpatients aged 75 years and over.

Surrogate markers for atherosclerosis in overweight subjects with atherogenic dyslipidemia: the GEMS project.

Metabolic syndrome is a constellation of major risk factors for cardiovascular disease. In affected individuals with this syndrome, the independent contribution of low high-density lipoprotein-cholesterol and increased triglyceride levels to the development of atherosclerosis remains to be clarified. We assessed the relationship between these 2 parameters and several surrogate markers for atherosclerosis.

A European view of diagnostic yield and appropriateness of colonoscopy.

Background/aims: This study's purpose was to examine the relationship between appropriateness criteria and diagnostic yield of colonoscopy.

Methodology: This observational study prospectively included consecutive patients referred for colonoscopy from 21 centers in 11 countries. Patient, center, and colonoscopy characteristics were collected.

Factors associated with the technical performance of colonoscopy: An EPAGE Study.

Background: Variations in colonoscopy practice exist, which may be related to healthcare quality.

Aims: To determine factors associated with three performance indicators of colonoscopy: complete colonoscopy, adenomatous polyp diagnosis, and duration.

Patients: Consecutive patients referred for colonoscopy from 21 centres in 11 countries.

The appropriateness of colonoscopy: a multi-center, international, observational study.

Objective: To examine the appropriateness and necessity of colonoscopy across Europe.

Design: Prospective observational study.

Setting: A total of 21 gastrointestinal centers from 11 countries.

Variations in colonoscopy practice in Europe: a multicentre descriptive study (EPAGE).

Objective: The volume of colonoscopies performed is increasing and differences in colonoscopy practice over time and between centres have been reported. Examination of current practice is important for bench-marking quality. The objective of this study was to examine variations in colonoscopy practice in endoscopy centres internationally.

High prevalence of major cardiovascular risk factors in first-degree relatives of individuals with familial premature coronary artery disease--the GENECARD project.

Background: Hypertension, hypercholesterolemia, obesity and smoking are highly prevalent among patients with familial premature coronary artery disease (FP-CAD). Whether these risk factors equally affect other family members remains unknown.

Methods: We examined 222 FP-CAD patients, 158 unaffected sibs, 197 offspring and 94 spouses in 108 FP-CAD families (> or = 2 sibs having survived CAD diagnosed before age 51 (M)/56 (F)), and compared them to population controls.

Appropriate treatment for Crohn's disease: methodology and summary results of a multidisciplinary international expert panel approach--EPACT.

Background/aims: For many therapeutic decisions in Crohn's disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel.

Methods: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method.

Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center.

Objectives: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall.

Design: Prospective cohort study with 6-month follow-up.

Setting: Swiss academic medical center.

Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE).

Background And Study Aims: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally.

Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE).

Background: Screening for colorectal cancer (CRC) has been shown to decrease mortality.

Objective: To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.

Design: Prospective observational study.

Clustering of risk behaviors with cigarette consumption: A population-based survey.

Objective: This study assessed clustering of multiple risk behaviors (i.e., low leisure-time physical activity, low fruits/vegetables intake, and high alcohol consumption) with level of cigarette consumption.

Gastroenterologists overestimate the appropriateness of colonoscopies they perform: an international observational study.

Background And Study Aim: Little is known about how gastroenterologists perceive the appropriateness of colonoscopies they perform. The objective of this study was to compare the appropriateness and necessity of colonoscopies as assessed by an expert panel and by the gastroenterologists performing the colonoscopies.

Methods: This observational study included 21 centers in 11 countries.

Prognosis or "curabo effect?": physician prediction and patient outcome of surgery for low back pain and sciatica.

Study Design: Prospective study with patient and physician questionnaires, clinical records, and imaging.

Objective: To compare physician expectations of surgery for sciatica and patient outcome.

Summary Of Background Data: Physician accuracy in identifying individual patient prognosis is important for therapeutic decisions.

Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis.

Background: Numerous trials of the efficacy of brief alcohol intervention have been conducted in various settings among individuals with a wide range of alcohol disorders. Nevertheless, the efficacy of the intervention is likely to be influenced by the context. We evaluated the evidence of efficacy of brief alcohol interventions aimed at reducing long-term alcohol use and related harm in individuals attending primary care facilities but not seeking help for alcohol-related problems.

The EPAGE internet guideline as a decision support tool for determining the appropriateness of colonoscopy.

Background: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians' acceptance ofan Internet-based guideline on the appropriateness of colonoscopy.

Methods: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy.

Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.

Background: The quality of colon cleansing is a major determinant of quality of colonoscopy. To our knowledge, the impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study. Therefore, this study assessed the factors that determine colon-cleansing quality and the impact of cleansing quality on the technical performance and diagnostic yield of colonoscopy.

Cognitive impairment in elderly medical inpatients: detection and associated six-month outcomes.

Objective: The authors examined the relationship of cognitive impairment at hospital admission to 6-month outcome (hospital readmission, nursing home admission, and death) in a cohort of elderly medical inpatients.

Methods: A group of 401 medical inpatients age 75 and older underwent a comprehensive geriatric assessment at hospital admission and were followed up for 6 months. Cognitive impairment was defined as a score <24 on the Mini-Mental State Exam.

Patient use of the Internet for health care information in Switzerland.

Study Aims: The aim of this study was to examine for the first time the frequency of Internet use for medical purposes by patients in Switzerland.

Methods: In 2001 over a period of one month, 1604 patients at 8 medical practices in Switzerland completed a self-administered questionnaire on their access to the Internet and any search for medical information using this media. The attending physician supplied the patient's diagnosis and information on the severity of the disorder motivating the visit using a separate questionnaire.

Success of referral for alcohol dependent patients from a general hospital: predictive value of patient and process characteristics.

To assess the effectiveness of a multidisciplinary evaluation and referral process in a prospective cohort of general hospital patients with alcohol dependence. Alcohol-dependent patients were identified in the wards of the general hospital and its primary care center. They were evaluated and then referred to treatment by a multidisciplinary team; those patients who accepted to participate in this cohort study were consecutively included and followed for 6 months.

Seroepidemiology of Herpes Simplex virus type 1 and 2 in Western and Southern Switzerland in adults aged 25-74 in 1992-93: a population-based study.

Background: Genital herpes is one of the most prevalent sexually-transmitted diseases, and accounts for a substantial morbidity. Genital herpes puts newborns at risk for very severe disease and also increases the risk of horizontal HIV transmission. It thus stands as an important public health problem.

Influence of clinical and economical factors on the expert rating of appropriateness of preoperative use of recombinant erythropoietin in elective orthopedic surgery patients.

To evaluate the relative impact of clinical factors and health care environment resources on the expert ratings of appropriateness of preoperative erythropoietin in elective orthopedic surgery, the authors analyzed 6905 individual votes on 496 clinical scenarios from 14 experts, applying a multivariate logistic model. Sixty-six percent of the indications were appropriate when resource constraints (RC) were not considered and 53% when they were, resulting in a drop in the median vote of 2 points on a 9-point scale (P < 0.05).