Richard Maier

Endurance Exercise Training in Orthostatic Intolerance A Randomized, Controlled Trial

Orthostatic intolerance is a syndrome characterized by chronic orthostatic symptoms of light-headedness, fatigue, nausea, orthostatic tachycardia, and aggravated norepinephrine levels while standing. The aim of this study was to assess the protective effect of exercise endurance training on orthostatic symptoms and to examine its usefulness in the treatment of orthostatic intolerance. 2768 military recruits were screened for orthostatic intolerance by questionnaire. Tilt-table testing identified 36 cases of orthostatic intolerance out of the 2768 soldiers. Subsequently, 31 of these subjects with orthostatic intolerance entered a randomized, controlled trial. The patients were allocated randomly to either a “training” (3 months jogging) or a “control” group. The influence of exercise training on orthostatic intolerance was assessed by determination of questionnaire scores and tilt-table testing before and after intervention. After training, only 6 individuals of 16 still had orthostatic intolerance compared with 10 of 11 in the control group. The Fisher exact test showed a highly significant difference in diagnosis between the 2 groups (P=0.008) at the end of the study. Analysis of the questionnaire-score showed significant interaction between time and group (P=0.001). The trained subjects showed an improvement in the average symptom score from 1.79±0.4 to 1.04±0.4, whereas the control subjects showed no significant change in average symptom score (2.09±0.6 and 2.14±0.5, respectively). Our data demonstrate that endurance exercise training leads to an improvement of symptoms in the majority of patients with orthostatic intolerance. Therefore, we suggest that endurance training should be considered in the treatment of orthostatic intolerance patients.

Mitochondrial DNA haplogroup T is associated with coronary artery disease and diabetic retinopathy: a case control study

BackgroundThere is strong and consistent evidence that oxidative stress is crucially involved in the development of atherosclerotic vascular disease. Overproduction of reactive oxygen species (ROS) in mitochondria is an unifying mechanism that underlies micro- and macrovascular atherosclerotic disease. Given the central role of mitochondria in energy and ROS production, mitochondrial DNA (mtDNA) is an obvious candidate for genetic susceptibility studies on atherosclerotic processes. We therefore examined the association between mtDNA haplogroups and coronary artery disease (CAD) as well as diabetic retinopathy.MethodsThis study of Middle European Caucasians included patients with angiographically documented CAD (n = 487), subjects with type 2 diabetes mellitus with (n = 149) or without (n = 78) diabetic retinopathy and control subjects without clinical manifestations of atherosclerotic disease (n = 1527). MtDNA haplotyping was performed using multiplex PCR and subsequent multiplex primer extension analysis for determination of the major European haplogroups. Haplogroup frequencies of patients were compared to those of control subjects without clinical manifestations of atherosclerotic disease.ResultsHaplogroup T was significantly more prevalent among patients with CAD than among control subjects (14.8% vs 8.3%; p = 0.002). In patients with type 2 diabetes, the presence of diabetic retinopathy was also significantly associated with a higher prevalence of haplogroup T (12.1% vs 5.1%; p = 0.046).ConclusionOur data indicate that the mtDNA haplogroup T is associated with CAD and diabetic retinopathy in Middle European Caucasian populations.

The Mitochondrial T16189C Polymorphism Is Associated with Coronary Artery Disease in Middle European Populations

Background The pivotal role of mitochondria in energy production and free radical generation suggests that the mitochondrial genome could have an important influence on the expression of multifactorial age related diseases. Substitution of T to C at nucleotide position 16189 in the hypervariable D-loop of the control region (CR) of mitochondrial DNA (mtDNA) has attracted research interest because of its suspected association with various multifactorial diseases. The aim of the present study was to compare the frequency of this polymorphism in the CR of mtDNA in patients with coronary artery disease (CAD, nu200a=u200a482) and type 2 diabetes mellitus (T2DM, nu200a=u200a505) from two study centers, with healthy individuals (nu200a=u200a1481) of Middle European descent in Austria. Methodology and Principal Findings CR polymorphisms and the nine major European haplogroups were identified by DNA sequencing and primer extension analysis, respectively. Frequencies and Odds Ratios for the association between cases and controls were calculated. Compared to healthy controls, the prevalence of T16189C was significantly higher in patients with CAD (11.8% vs 21.6%), as well as in patients with T2DM (11.8% vs 19.4%). The association of CAD, but not the one of T2DM, with T16189C remained highly significant after correction for age, sex and body mass index (BMI) and was independent of the two study centers. Conclusions and Significance Our results show for the first time a significant association of T16189C with CAD in a Middle European population. As reported in other studies, in patients with T2DM an association with T16189C in individuals of European decent remains questionable.

Chlamydia pneumoniae seropositivity and the risk of nonarteritic ischemic optic neuropathy

OBJECTIVEnTo determine whether IgG antibodies to Chlamydia pneumoniae are associated with nonarteritic ischemic optic neuropathy (NAION).nnnDESIGNnRetrospective case-control study.nnnPARTICIPANTSnThe study cohort consisted of 71 consecutive patients with NAION and 71 controls matched for age and gender.nnnMAIN OUTCOME MEASURESnSerum immunoglobulin G (IgG) antibody titers to Chlamydia pneumoniae.nnnRESULTSnPatients with NAION had significantly higher IgG antibody titers to C. pneumoniae compared with control subjects (IgG titer > or =1:128: 29 patients versus 15 controls, P = 0.017). The odds ratio for patients with an IgG titer > or =1:128 was 2.56 (95% confidence interval [CI], 1.2-5.5). Adjustment for arterial hypertension, diabetes mellitus, and myocardial infarction resulted in an odds ratio of 3.48 (95% CI, 1.3-9.6).nnnCONCLUSIONSnOur results suggest that elevated titers of IgG antibodies to C. pneumoniae are associated with NAION.

Role of Inflammation-Related Gene Polymorphisms in Patients with Central Retinal Vein Occlusion

OBJECTIVEnCentral retinal vein occlusion (CRVO) is a vision-threatening disease, primarily occurring among patients aged more than 60 years. Several risk factors, including arterial hypertension and diabetes mellitus, have been identified. Compression of the central retinal vein by an atherosclerotic retinal artery at the lamina cribrosa also has been implicated in the pathogenesis of the disease. Functional gene polymorphisms of cytokines or chemokines previously shown to affect atherogenesis or hemostasis are potential risk factors for CRVO. The present study investigates a hypothesized association between inflammation-related gene polymorphisms and the presence of CRVO in a relatively large cohort of patients.nnnDESIGNnCase-control study.nnnPARTICIPANTSnThe study group consisted of 315 patients with CRVO and 335 control subjects.nnnMETHODSnDetermination of genotypes was done by 5 exonuclease assay (TaqMan).nnnMAIN OUTCOME MEASURESnGenotypes of interleukin (IL)1β -511C>T, IL1 receptor antagonist (IL1RN) 1018T>C, IL4 -584C>T, IL6 -174G>C, IL10 -592C>A, IL18 183A>G, tumor necrosis factor (TNF)-α -308G>A, monocyte chemoattractant protein (MCP)-1/CCL2 -2518A>G, IL8 -251A>T, and RANTES (CCL5) -403G>A polymorphisms.nnnRESULTSnGenotype distributions and allele frequencies of the investigated gene polymorphisms did not significantly differ between both groups (P>0.05). Arterial hypertension, diabetes mellitus, and cigarette smoking were significantly more frequent in patients with CRVO than among control subjects (arterial hypertension: 67.0% vs. 52.2%, P<0.001; diabetes mellitus: 16.8% vs. 6.3%, P<0.001, cigarette smoking: 32.1% vs. 23.6%, P = 0.02). In a logistic regression analysis, the presence of arterial hypertension was associated with an odds ratio (OR) of 1.75 (95% confidence interval [CI], 1.26-2.44) in those with CRVO, whereas an OR of 2.52 (95% CI, 1.46-4.35) was found in those with diabetes mellitus. A history of cigarette smoking was associated with an OR of 1.57 (95% CI, 1.09 - 2.25) for CRVO.nnnCONCLUSIONSnOur data suggest that the investigated inflammation-related gene polymorphisms are unlikely major risk factors for CRVO.nnnFINANCIAL DISCLOSURE(S)nThe author(s) have no proprietary or commercial interest in any materials discussed in this article.

Profound tumor-specific Th2 bias in patients with malignant glioma

BackgroundVaccination against tumor-associated antigens is one promising approach to immunotherapy against malignant gliomas. While previous vaccine efforts have focused exclusively on HLA class I-restricted peptides, class II-restricted peptides are necessary to induce CD4+ helper T cells and sustain effective anti-tumor immunity. In this report we investigated the ability of five candidate peptide epitopes derived from glioma-associated antigens MAGE and IL-13 receptor α2 to detect and characterize CD4+ helper T cell responses in the peripheral blood of patients with malignant gliomas.MethodsPrimary T cell responses were determined by stimulating freshly isolated PBMCs from patients with primary glioblastoma (GBM) (nu2009=u20098), recurrent GBM (nu2009=u20095), meningioma (nu2009=u20097), and healthy controls (nu2009=u20096) with each candidate peptide, as well as anti-CD3 monoclonal antibody (mAb) and an immunodominant peptide epitope derived from myelin basic protein (MBP) serving as positive and negative controls, respectively. ELISA was used to measure IFN-γ and IL-5 levels, and the ratio of IFN-γ/IL-5 was used to determine whether the response had a predominant Th1 or Th2 bias.ResultsWe demonstrate that novel HLA Class-II restricted MAGE-A3 and IL-13Rα2 peptides can detect T cell responses in patients with GBMs as well as in healthy subjects. Stimulation with a variety of peptide antigens over-expressed by gliomas is associated with a profound reduction in the IFN-γ/IL-5 ratio in GBM patients relative to healthy subjects. This bias is more pronounced in patients with recurrent GBMs.ConclusionsTherapeutic vaccine strategies to shift tumor antigen-specific T cell response to a more immunostimulatory Th1 bias may be needed for immunotherapeutic trials to be more successful clinically.

Erfolgreiche Umsetzung des EFQM-Management-Modells an der Universitätsaugenklinik Graz

BACKGROUND AND OBJECTIVEnIn the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3 years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely Committed to Excellence (C2E). The project work towards achieving this C2E-award is described below.nnnSTUDY DESIGN AND METHODSnEFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology.nnnRESULTSnThese areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria.nnnDISCUSSIONnThe EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.ZusammenfassungHintergrund und FragestellungVor dem Hintergrund von gesetzlichen Vorgaben und knapper werdenden Ressourcen kann die Einführung eines Qualitätsmanagement (QM)-Systems einen Wettbewerbsvorteil bzw. eine Standortgarantie für eine Krankenanstalt bringen. Die Universitätsaugenklinik Graz beschäftigt sich seit 3xa0Jahren mit dem EFQM-Modell und hat nun den ersten Qualitätspreis, Committed to Excellence (C2E), erreicht. Die Projektarbeit wird in der folgenden Arbeit beschrieben.Studiendesign und UntersuchungsmethodenEFQM steht für European Foundation for Quality Management, eine Organisation, die 1989 von der EU zusammen mit 14 führenden Wirtschaftsunternehmen gegründet wurde. Der Reifegrad einer Organisation in Hinblick auf Qualität wird in diesem Modell anhand verschiedener Qualitätspreise bestimmt, wobei Committed to Excellence (C2E) die erste Stufe darstellt. Am Beginn unserer Arbeit für den C2E-Level stand eine Selbstbewertung mittels Fragebogens, in dem die Stärken und Verbesserungspotenziale der Universitätsaugenklinik erhoben wurden. Die größten Verbesserungspotenziale nach Auswertung des Fragebogens waren: 1. die stationäre Aufnahme eines Kataraktpatienten, 2. der mangelnde Informationsfluss zwischen den verschiedenen Berufsgruppen, 3. die Unkenntnis der Ziele und Strategie der Universitätsaugenklinik bei den Mitarbeitern.ErgebnisseDiese Problembereiche wurden in einer 6-monatigen, von der EFQM strukturierten Projektarbeit bearbeitet. Die gesamte Projektarbeit, die ermittelten Ergebnisse (Kennzahlen) sowie deren schriftliche Dokumentation wurden in einem 1-tägigen Assessment (Bewertung/Prüfung) durch einen Assessor der Quality Austria positiv beurteilt.DiskussionDas EFQM-Modell ist ein anspruchsvolles Qualitätsmanagementmodell. Nach entsprechender Schulung der Projektmitglieder bzw. bei externer Betreuung durch erfahrene Qualitätsmanager kann es an einer Universitätsklinik mit den Bereichen PatientInnenversorgung, Lehre und Forschung erfolgreich angewendet werden.AbstractBackground and objectiveIn the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3xa0years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely “Committed to Excellence (C2E)”. The project work towards achieving this C2E-award is described below.Study design and methodsEFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology.ResultsThese areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria.DiscussionThe EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.

Aufbau eines umfassenden Qualitätsmanagement (QM) Systems nach EFQM (European Foundation for Quality Management) an der Univ.-Augenklinik Graz - Die Pilotphase

SummaryPURPOSE: The EFQM business model was primary introduced into industry as a management tool to improve quality and is now going to be adapted in health care issues at our Department of Ophthalmology. METHOD: As a first step an initial self-assessment within the EFQM model was made by physicians, nurses and medical technicians by means of an adapted questionaire in November 2006. 9 main criterias were defined (5 enabler criterias i.g. leadership, partnership, resources and processes and 4 results criteria respectively e.g. people, customer and society results) and additional 20 subcriterias added (as adapted in our hospital). The PDCA cycle and the RADAR logic with quantification between 0 and 100 were applied. RESULTS: The results of the first EFQM self assessment showed a high degree of variation (e.g. in terms of peoples satisfaction and need for improvement (between 25–75 scores). According to our initial self assessment improvement measures have been made and are going to be introduced. In January 2006 we defined 15 initiatives with improvement measures in the EFQM criteria people, partnership & resources, processes and key results. SUMMARY: Our first self assessment showed a high degree of variation. Reasons for the variation of the answers of our initial self assessment were the inhomogenity of the staff and questions that refer to general issues (leadership in general, politics, resources). According to our initial self assessment measures have to be introduced in due time.ZusammenfassungHINTERGRUND/AUSGANGSSITUATION: Neben dem bekannten ISO System existiert nun im Gesundheitswesen für die Durchführung von Qualitäts Management (QM) das Europäische Foundation for Quality Management (EFQM)Modell. Die Univ.-Augenklinik ist seit 2006 eine von 4 EFQM Modellkliniken des LKH-Universitäts Klinikums Graz. In dieser Arbeit werden unsere ersten Erfahrungen mit dem EFQM Modell beschrieben. MATERIAL UND METHODE: Zur Erhebung der Ausgangssituation wurde im Dezember 2006 eine schriftliche EFQM-Selbstbewertung mittels standardisierten Fragebogens von einem Kernteam (bestehend aus Mitgliedern verschiedener Berufsgruppen der Univ.-Augenklinik) durchgeführt. 15 Projekte bzw. Initiativen mit Verbesserungspotentialen aus den EFQM – Kriterien MitarbeiterInnen, Partnerschaft & Ressourcen, Prozesse und Schlüsselleistungen wurden definiert. Als Managementinstrument bei der Umsetzung der Maßnahmen im täglichen Alltag dient v.a. der Plan Do Check Act (PDCA) Cyclus, bei der prozentuellen Bewertung der Assessments die Results-Approach-Deployment-Assessment-Review (RADAR) Logik. ERGEBNISSE: Die Ergebnisse der ersten Selbstbewertung weisen eine hohe Variabilität der Antworten innerhalb der verschiedenen Berufsgruppen auf. Kriterien mit Verbesserungspotenzialen waren u.a. Ziel und Strategie, Prozesse sowie die berufsgruppenübergreifende Kommunikation und Information. Von 15 Projekten/Initiativen wird dzt ein neues Projekt geplant (Plan), 6 werden umgesetzt (DO), 2 sind in der Phase der Überprüfung (Check) und 6 sind in die Routine umgesetzt (ACT). ZUSAMMENFASSUNG: Das EFQM Business Model scheint ein geeignetes Instrument, um Probleme im klinischen Alltag zu definieren, nach Formulierung von Projekten Maßnahmen zu ergreifen und die Umsetzung an Hand des PDCA Cyclus und der RADAR® Logik zu evaluieren. Die daraus abgeleiteten Maßnahmen sind wiederum Grundvoraussetzung für die Erreichung des Commited toExcellence (C2E) Zertifikats.

EFQM Projekt der Univ. Augenklinik im Rahmen der C2E Rezertifizierung: Management ambulanter PatientInnen ohne Termin

SummaryBACKGROUND: Core function of an outpatient clinic is the management of patients scheduled after surgery, patients in subspecialities and those suffering from emergencies. MATERIAL AND METHODS: The Department of Ophthalmology aims at the reduction of ambulatory patients without an appointment, an ambitious goal supported by the management of the hospital, too. This EFQM project was designed to renew the C2E award after the first C2E certificate could be accomplished in 2008. The trigger for the project was the result of an employee survey which ruled out a deterioration of the labors conditions and lack of transparency in the outpatient process. In 2009 an survey yielded 350 patients without an appointment per month in the outpatient clinic. RESULTS: Different measures had been implemented to improve the current process like the implementation of a new triage process to differentiate between acute patients with emergencies, patients to be dealt by an external ophthalmologist and patients to be scheduled for a subspeciality team. An information package about this initiative was developed for physicians, referring hospitals and patients (articles in newspapers, letters, personal communication). CONCLUSION: This project which was awarded with the Committed to Excellence certificate in 2010 succeeded in reducing the number of patients without an appointment by 30 % within a period of 8 months.ZusammenfassungHINTERGRUND: Kernaufgaben der Ambulanz einer Univ. Augenklinik sind die Behandlung von planmäßig bestellten PatientInnen (nach Operationen oder aufgrund von Spezialuntersuchungen, zugewiesen durch den praktizierenden Facharzt/die Fachärztin) sowie die Untersuchung und Behandlung von Notfällen. Die Reduktion von ambulanten PatientInnen ohne Termin wird nicht nur von der Univ. Augenklinik angestrebt, sondern ist auch ein strategisches Ziel der Anstaltsleitung. Diese Arbeit beschreibt die EFQM Projektarbeit der Univ. Augenklinik, dieses Ziel in einem Zeitraum von 8 Monaten zu erreichen. MATERIAL UND METHODE: Auslösend für das Projekt waren neben der Zielvorgabe der Anstaltsleitung die Ergebnisse einer MitarbeiterInnenbefragung, bei der ein Verbesserungspotential der Arbeitsplatzbedingungen und eine mangelnde Transparenz der ambulanten Prozesse auffallend waren. Eine Isterhebung im Oktober 2009 ergab, dass 350 PatientInnen ohne Termin pro Monat in der Augenklinik behandelt wurden (davon 55 % mit Zuweisung , 45 % ohne Zuweisung). Zu Beginn des Projektes wurde das Vorgehen bei der Selektion der PatientInnen ohne Termin in einem Istprozess schriftlich festgehalten. Nach Elimination einiger Problemfelder (v. a. im Bereich der Triage) konnte der Sollprozess im Laufe der Projektarbeit erstellt werden, womit die Basis für eine Reduktion der ambulanten PatientInnen geschaffen wurde. RESULTATE: Zentrales Element in beiden Prozessen ist das Triagegespräch, bei dem zwischen akuten Patienten, Patienten geeignet für den Facharzt und Patienten bestimmt für die Spezialambulanz unterschieden wird. Die Ergebnisse des Triagegespräches werden im Sollprozess dokumentiert und sind jederzeit nachvollziehbar. Die Maßnahmen zur Erlangung des Sollprozesses werden mittels verschiedener Medien (lokale Zeitungen, Poster bei Kongressen, Rundschreiben) an die Bevölkerung, die PatientInnen und zuweisende KollegInnen kommuniziert. SCHLUSSFOLGERUNG: Durch eine konsequente Unterscheidung von PatientInnen, die lt. Krankenanstaltengesetz von einer Univ. Augenklinik behandelt werden müssen (Notfälle, PatientInnen einer Spezialambulanz , ausgesuchte postoperative Kontrollen) und solchen, die primär in das Tätigkeitsprofil eines praktizierenden Augenarztes gehören (Brillenanpassung, Erstuntersuchungen, Kontrolluntersuchungen, etc.) konnte die Anzahl der PatientInnen ohne Termin an der Univ. Augenklinik um 30 % reduziert werden.

EFQM Modell Univ.-Augenklinik Graz: Optimierung der ambulanten Prozesse im Arbeitsschwerpunkt "Augentumoren"

SummaryBACKGROUND: An increasing number of Austrian patients and patients from abroad leads to an increasing long time of waiting for an appointment at our ocular oncology service. Aim of this project is to optimize processes and shorten the stay of a patient in our outpatient clinic, without an increase of staff. Further aims of our activity are a definition of time for each diagnostic procedure, a shortening of the time of waiting and a realistic planning of the personal. METHOD: In November 2007 a first self assessment with a standardised EFQM questionaire by means of the workshop method was performed at the Department of Ophthalmology. Strengths and areas for improvement were defined, optimisation measures suggested and implemented. IMPROVEMENT MEASURES: A maximum number of new and control patients each day was defined as well as a minimum number of junior residents to examine the patients and senior residents to supervise the diagnostic and therapeutic decisions. Referring ophthalmologists were asked to send their patients reports in advance to prioritisize patients according to their disease. As an example a retinoblastoma patient will be treated as an emergency patient, uveal melanomas will be diagnosed within one week and treated within 3 weeks. Processes were documented by means of the Adonis® software procedures checked by the PDCA (Plan Do Act Check ) cycle according to Deming. SOPs (Standard operating procedures) were designed to optimize treatment procedures and guidelines were implemented. We try to fullfil requirements in residents education according to ICO guidelines. RESULTS: The time of waiting of each patient could be shortened, patients and physicians satisfaction improved. Appointments were organised according to the dignity of the tumor. A second day in the outpatient service had to be implemented in order to maintain a high quality of our patients service. SUMMARY AND PERSPECTIVE: The EFQM business model provided our ocular oncology service with management tools like process formation and introduction of SOPs to improve the patients flow. Next we intend to implement objectives (key figures) to monitor our process of improvement.ZusammenfassungAUSGANGSSITUATION: Auf Grund einer zunehmenden Anzahl von Tumor PatientInnen aus Österreich und dem Ausland kommt es in der Bestellambulanz zu langen Wartezeiten. Bei primär gleichbleibenden Personal-, Zeit- und Raumressourcen wurden Optimierungen der Abläufe (Prozesse) im ambulanten Alltag notwendig. ZIELE: Ziele sind eine Optimierung der Prozesse in der ambulanten Versorgung eines(r) Tumorpatienten(in) sowie eine Verkürzung der Wartezeiten in der Ambulanz auf eine Untersuchung. Weitere Ziele sind eine Neudefinition der benötigten Zeitressourcen in den jeweiligen Behandlungsschritten, die Einhaltung der festgelegten Termine sowie eine realistische Planung der vorhandenen Personalressourcen. METHODEN: Am Beginn erfolgte eine Selbstbewertung (Self Assessment) mittels standardisiertem EFQM Fragebogen im Rahmen von Workshops gemeinsam mit den Führungskräften aller Berufsgruppen. In der Folge wird in Qualitätszirkelsitzungen der IST-Zustand weiter analysiert, Stärken und Verbesserungspotentiale aufgezeigt, entsprechende Optimierungs-Maßnahmen vorgeschlagen und anschließend implementiert. VERBESSERUNGSMAßNAHMEN: Pro Ambulanztag wird eine Mindestanzahl an PatientInnen und ÄrztInnen festgelegt, sowie ein Mindestausmaß an Diagnostik bestimmt. Die Fachärzte werden gebeten, ihre erhobenen Befunde im Vorfeld zu faxen (mailen), damit die Terminvergabe nach Priorität der Erkrankung erfolgen kann. Um Personal nach den vorhandenen Ressourcen einzusetzen, erfolgt eine genaue Einteilung in Zeit- und Untersuchungseinheiten. Prozesse werden erstellt und graphisch festgehalten (Prozessdarstellung mittels Adonis Software®) und in der täglichen Routine mittels Plan Do Check Act Zyklus (PDCA) kontrolliert und angepasst. Standard Operating Procedures (SOPs) werden neu erstellt bzw. adaptiert und an internationale Standards angeglichen. Leitlinien werden entweder erstmalig erstellt oder von Fachgesellschaften übernommen und implementiert. Ebenso werden Fort- und Weiterbildungen bedarfs- und zielorientiert geplant, durchgeführt und evaluiert. ERGEBNISSE: Beim Prozess der ambulanten Untersuchung der PatientInnen konnte durch die eingeleiteten Verbesserungsmaßnahmen die Verkürzung der Wartezeit der PatientInnen erreicht und Termine nach Priorität der Erkrankung vergeben werden, womit die Zufriedenheit der PatientInnen und zuweisenden Fachärzte steigt. Durch eine Einteilung nach vorhandenen Personalressourcen wurde bei den MitarbeiterInnen die Zufriedenheit erhöht. ZUSAMMENFASSUNG UND PERSPEKTIVE: In einer Spezialambulanz mit vorgegebenen Rahmenbedingungen können durch Initiativen unter Anwendung des EFQM Modells Verbesserungsinitiativen formuliert und mit konkreten Maßnahmen Verbesserungen erzielt werden. Die Ergebnisse müssen in weiterer Folge mittels regelmäßiger PatientInnen- und MitarbeiterInnen-Befragungen sowie definierter Kennzahlen objektiviert werden.