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DOI: 10.1055/s-0028-1109323
© Georg Thieme Verlag KG Stuttgart · New York
Evidenzbasierte und interdisziplinär konsentierte Versorgungspfade für Patientinnen und Patienten mit Morbus Crohn oder Colitis ulcerosa
Evidence-Based and Consented Pathways for Patients with Inflammatory Bowel Diseases (IBD)Publikationsverlauf
Manuskript eingetroffen: 12.11.2008
Manuskript akzeptiert: 16.2.2009
Publikationsdatum:
16. Juni 2009 (online)

Zusammenfassung
Morbus Crohn und Colitis ulcerosa sind charakterisiert durch rezidivierende Schübe, ein frühes Manifestationsalter und Einschränkungen in Aktivitäten und Teilhabe. Sie erfordern eine wohnortnahe, krankheitsbegleitende und problemorientierte Versorgung. Die entwickelten Versorgungspfade sollen die Wege für kooperatives Handeln zwischen den verschiedenen Versorgungssektoren, ärztlichen und nicht-ärztlichen Berufsgruppen, Einrichtungen und Kostenträgern ebnen.
Grundlage sind die S3-Leitlinien der beiden Krankheitsbilder, klinische Überlegungen, Interviews mit Fachleuten, systematisch gesuchte Evidenz und Ergebnisse einer Betroffenenbefragung.
Die Probleme der Erkrankten wurden erfasst, abgegrenzt und operationalisiert. Allen relevanten Problemsituationen wurden medizinische und nicht-medizinische Leistungen und Leistungserbringer zugeordnet. Abhängig von der Schwere des Krankheitsverlaufs wurde die Koordination der Versorgungsaufgaben den verschiedenen medizinischen Versorgungsebenen und -sektoren zugeteilt. Ein regelmäßiges umfassendes Assessment im Rahmen der medizinischen Betreuung soll erforderliche individuelle Interventionen feststellen. Weitere Säulen sind die leitliniengerechte medizinische Versorgung, eine bedarfsgerechte Information und Schulung der Kranken mit dem Ziel einer Befähigung zu partizipativer Entscheidungsfindung und Selbstmanagement sowie die Anregung zu Forschung und Entwicklung.
Die Versorgungspfade sind evidenzbasiert und interdisziplinär konsentiert (S3). Ihre Anwendbarkeit soll im Rahmen einer Implementierung evaluiert werden.
Abstract
Crohn’s disease and ulcerative colitis are diseases characterized by remission and relapse, an early age of onset and restrictions on activities and participation. IBD patients need a comprehensive, easily accessible and problem-oriented health care. This requires the integration and coordination of different health care sectors, medical and non-medical professionals, social and health care facilities and funding agencies.
The pathways to guide patients through integrated health care were based on clinical considerations, interviews with patients and specialists, systematically searched evidence and results of a questionnaire survey. Within a systematic assessment-assignment approach relevant problems were identified and subsequently related to different medical and non-medical professionals, health care services and medical sectors.
The pathways further imply (1) medical care according to evidence-based guideline recommendations, (2) patient education programs to foster shared decision making and self-management and (3) suggestions for further research.
The pathways were consented in a consensus conference using nominal group process methods. Their feasibility and effect will be evaluated within a regional implementation project.
Schlüsselwörter
chronisch-entzündliche Darmerkrankungen - Morbus Crohn - Colitis ulcerosa - evidenzbasierte Versorgung - Leitlinien
Key words
inflammatory bowel diseases - Crohn’s disease - ulcerative colitis - evidence based care - guidelines
Literatur
- 1
Roy M A.
Inflammatory bowel disease.
Surgical Clinics of North America.
1997;
77 (6)
1419-1431
Reference Ris Wihthout Link
- 2
Sandler R S, Golden A L.
Epidemiology of Crohn’s disease.
J Clin Gastroenterol.
1986;
8 (2)
160-165
Reference Ris Wihthout Link
- 3
Shivananda S, Lennard-Jones J, Logan R. et al .
Incidence of inflammatory bowel disease across Europe: is there a difference between
north and south? Results of the European collaboration study on inflammatory bowel
disease (EC-IBD).
Gut.
1996;
39
690-697
Reference Ris Wihthout Link
- 4
Irvine E J.
A critical Review of epidemiological studies in inflammatory bowel disease.
Scan J Gatroenterol.
2001;
36 (1)
2-15
Reference Ris Wihthout Link
- 5
Drossman D A, Patrick D L, Mitchell C M. et al .
Health-related quality of life in inflammatory bowel disease – functional status and
patients worries and concerns.
Dig Dis Sci.
1989;
34 (9)
1379-1386
Reference Ris Wihthout Link
- 6
Berklev T, Jahnsen J, Schulz T. et al .
Course of disease, drug treatment and health-related quality of life in patients with
inflammatory bowel disease 5 years after initial diagnosis.
Eur J Gastroenterol Hepatol.
2005;
17
1037-1045
Reference Ris Wihthout Link
- 7
Raspe H, Lühmann D.
Klinische und Versorgungsleitlinien.
Z ärztl Fortbilb Qual sich.
2002;
96
212
Reference Ris Wihthout Link
- 8
Stange E F, Schreiber S, Fölsch U. et al .
Diagnostik und Therapie des Morbus Crohn.
Z Gastroenterol.
2003;
41
19-68 (Sonderdruck)
Reference Ris Wihthout Link
- 9
Hoffmann J C, Zeitz M, Bischoff S C. et al .
Diagnostik und Therapie der Colitis Ulcerosa: Ergebnisse einer evidenzbasierten Konsensuskonferenz.
Z Gastroenterol.
2004;
42
984-1032
Reference Ris Wihthout Link
- 10
Goebell H.
Stellenwert von Aktivitätsindizes bei der Begutachtung von chronisch-entzündlichen
Darmkrankheiten.
Med Sach.
2000;
96 (6)
176-178
Reference Ris Wihthout Link
- 11
Baumgart D C, Sandborn W J.
Inflammatory bowel disease: clinical aspects and established and evolving therapies.
Lancet.
2007;
369
1627-40
Reference Ris Wihthout Link
- 12 World Health Organisation .International Classification of functioning, disability and health. Geneva; WHO 2001
Reference Ris Wihthout Link
- 13
Klaus J, Armbrecht G, Steinkamp M. et al .
High prevalance of osteoporotic vertebral fractures in patients with Crohn’s disease.
Gut.
2002;
51
654-658
Reference Ris Wihthout Link
- 14
Reinshagen M, Tirpitz von C.
Osteoporosis and other extraintestinal symptoms and complications of inflammatory
bowel disease.
Dig Dis.
2003;
21
138-145
Reference Ris Wihthout Link
- 15
Mintz R, Feller E, Bahr R L. et al .
Ocular manifestations of inflammatory bowel disease.
Inflamm Bowel Dis.
2004;
10
135-139
Reference Ris Wihthout Link
- 16
Schulte C MS.
Review article: bone disease in inflammatory bowel disease.
Aliment Pharmacol Ther.
2004;
20
43-49
Reference Ris Wihthout Link
- 17
Itin P H, Rufli T.
Hautsymptome bei Erkrankungen im Bereich des Magen-Darm-Trakts.
Therapeutischen Umschau.
1995;
52
236-242
Reference Ris Wihthout Link
- 18
Fornaciari G, Salvarani C, Beltrami M. et al .
Muscoloskeletal manifestations in inflammatory bowel disease.
Can J Gastroenterol.
2001;
15
399-403
Reference Ris Wihthout Link
- 19
Palm Ø, Moum B, Jahnsen J. et al .
The prevalence and incidence of peripheral arthritis in patients with inflammatory
bowel disease, a prospective population-based study/the IBSEN study).
Rheumatology.
2001;
40
1256-1261
Reference Ris Wihthout Link
- 20
Husain A, Triadafilopoulos G.
Communicating with patients with inflammatory bowel disease.
Inflamm Bowel Dis.
2004;
10
444-450
Reference Ris Wihthout Link
- 21
Deter H C, Rapf M, Gladisch R. et al .
Psychodiagnostische Verlaufsuntersuchungen vom Morbus-Crohn-Patienten während der
internistischen Intensivbehandlung.
Z Gastroenterol.
1993;
31
703-710
Reference Ris Wihthout Link
- 22
North C S, Alpers D H.
A review of studies of psychiatric factors in Crohn’s disease: etiologic implications.
Annals of Clinical Psychiatry.
1994;
6 (2)
117-124
Reference Ris Wihthout Link
- 23
Küchenhoff J, Manz R, Mathes L.
Was beeinflusst den Krankheitsverlauf des Morbus Crohn?.
Nervenarzt.
1995;
66
41-48
Reference Ris Wihthout Link
- 24
Feiereis H.
Zur Psychotherapie des M. Crohn.
Langenbecks Arch Chir.
1984;
Kongressbericht
364
Reference Ris Wihthout Link
- 25
Irvine E J.
Review article: patients’ fears and unmet needs in inflammatory bowel disease.
Aliment Pharmacol Ther.
2004;
20 (Suppl 4)
54-59
Reference Ris Wihthout Link
- 26
Irvine E J.
Quality of life in inflammatory bowel disease: Bias and other factors affecting scores.
Scand J Gastroenterol.
1995;
30 (Suppl 208)
136-40
Reference Ris Wihthout Link
- 27
Nordin K, Påhlman L, Larsson K. et al .
Health-related quality of life and psychological distress in a population-based sample
of swedish patients with inflammatory bowel disease.
Scand J Gastroenterol.
2002;
37
450-457
Reference Ris Wihthout Link
- 28
Porcelli P, Zaka S, Centonze S. et al .
Psychological distress and levels of disease activity in inflammatory bowel disease.
Ital J Gastroenterol.
1994;
26
111-115
Reference Ris Wihthout Link
- 29
Guthrie E, Jackson J, Shaffer J. et al .
Psychological disorder and severity of inflammatory bowel disease predict health-related
quality of life in ulcerative colitis and Crohn’s disease.
Am J Gastroenterol.
2002;
97
1994-1999
Reference Ris Wihthout Link
- 30
Acosta-Ramírez D, Pagán-Ocasio V, Torres E A. et al .
Profile of the inflammatory bowel disease patient with depressive disorder.
PRHSJ.
2001;
20 (3)
215-220
Reference Ris Wihthout Link
- 31
Andrews H, Barczak P, Allan R N.
Psychiatric illness in patients with inflammatory bowel disease.
Gut.
1987;
28
1600-1604
Reference Ris Wihthout Link
- 32
Farrokhyar F, Marshall J K, Easterbrook B. et al .
Functional gastrointestinal disorders and mood disorders in patients with inactive
inflammatory bowel disease: prevalence and impact on health.
Inflamm Bowel Dis.
2006;
12 (1)
38-46
Reference Ris Wihthout Link
- 33
Maunder R G, Greenberg G R.
Comparison of a disease activity index and patients’ self-reported symptom severity
in ulcerative colitis.
Inflamm Bowel disease.
2004;
10
632-636
Reference Ris Wihthout Link
- 34
Leibig T, Wilke E, Feiereis H.
Zur Persönlichkeitsstruktur von Patienten mit Colitis ulcerosa und Morbus Crohn, eine
testpsychologische Untersuchung während der Krankheitsremission.
Zsch psychosom Med.
1985;
31
380-392
Reference Ris Wihthout Link
- 35
Maunder R G, Lancee W J, Hunter J J. et al .
Attachment insecurity moderates the relationship between disease activity and depressive
symptoms in ulcerative colitis.
Inflamm Bowel Dis.
2005;
11
919-926
Reference Ris Wihthout Link
- 36
Mittermaier C, Dejaco C, Waldhoer T. et al .
Impact of depressive mood on relapse in patients with inflammatory bowel disease:
a prospective 18-month follow-up study.
Psychosom Med.
2004;
66
79-84
Reference Ris Wihthout Link
- 37
Kurina L M, Golacre M J, Yeates D. et al .
Depression and anxiety in people with inflammatory bowel disease.
J Epidemiol Community Health.
2001;
55
716-720
Reference Ris Wihthout Link
- 38
Simrén M, Axelsson J, Gillberg R. et al .
Quality of life in inflammatory bowel disease in remission: the impact of IBS-like
symptoms and associated psychological factors.
Am J Gastroenterol.
2002;
97
389-396
Reference Ris Wihthout Link
- 39
Addolorato G, Capristo E, Stefanini G F. et al .
Inflammatory bowel disease: a study of the association between anxiety and depression,
physical morbidity and nutritional status.
Scan J Gastroenterol.
1997;
32
1013-1021
Reference Ris Wihthout Link
- 40
Porcelli P, Leoci C, Guerra V.
A prospective study of relationship between disease activity and psychologic distress
in patients with inflammatory bowel disease.
Scand J Gastroenterol.
1996;
31
792-796
Reference Ris Wihthout Link
- 41
Mardini H E, Kip K E, Wilson J W.
Crohn’s disease: a two-year prospective study of the association between psychological
distress and disease activity.
Dig Dis Sci.
2004;
49 (3)
492-497
Reference Ris Wihthout Link
- 42
North C S, Alpers D H, Helzer J E. et al .
Do life events or depression exacerbate inflammatory bowel disease?.
Annals of Internal Medicine.
1991;
114
381-386
Reference Ris Wihthout Link
- 43
Porcelli P, Leoci C, Guerra V. et al .
A longitudinal study of alexithymia and psychological distress in inflammatory bowel
disease.
J Psychsom Res.
1996;
41 (6)
569-573
Reference Ris Wihthout Link
- 44
Arapakis G, Lyketsos C G, Gerolymatos K. et al .
Low dominance and high intropunitiveness in ulcerative colitis and irritable bowel
syndrom.
Psychother Psychosom.
1986;
46
171-176
Reference Ris Wihthout Link
- 45
Riley S A, Mani V, Goodman M J. et al .
Why do patients with ulcerative colitis relapse?.
Gut.
1990;
31
179-183
Reference Ris Wihthout Link
- 46
Helzer J E, Chammas S, Norland C C. et al .
A study of the association between Crohn’s disease and psychiatric illness.
Gastroenterology.
1984;
86
324-30
Reference Ris Wihthout Link
- 47
Robertson D AF, Ray J, Diamond I. et al .
Personality profile and affective state of patients with inflammatory bowel disease.
Gut.
1989;
30
623-626
Reference Ris Wihthout Link
- 48
Magni G, Bernasconi G, Mauro P. et al .
Psychiatric diagnosis in ulcerative colitis – a controlled study.
British Journal of Psychiatry.
1991;
158
413-415
Reference Ris Wihthout Link
- 49
Tarter R E, Switala J, Carra J. et al .
Inflammatory bowel disease: psychiatric status of patients before and after disease
onset.
Int J Psychiatry in Medicine.
1987;
17
173-181
Reference Ris Wihthout Link
- 50
Schwarz S p, Blanchard E B, Berreman C F. et al .
Psychological aspects of irritable bowel syndrom: comparison with inflammatory bowel
disease and nonpatient controls.
Behav Res Ther.
1993;
31
297-304
Reference Ris Wihthout Link
- 51
Cabré E, Gassull M A.
Nutritional and metabolic issues in inflammatory bowel disease.
Curr Opin Clin Nutr Metabol Care.
2003;
6
569-576
Reference Ris Wihthout Link
- 52
Spiller G A, Freeman H J.
Recent advances in dietary fiber and colorectal disease.
Am J Clin Nutr.
1981;
34
1145-1152
Reference Ris Wihthout Link
- 53
Burke A, Lichtenstein G R, Rombeau J L.
Nutrition and ulcerative colitis.
Bailliére’s Clinical Gastroenterology.
1997;
11 (1)
153-174
Reference Ris Wihthout Link
- 54
Russel M G, Engels L G, Muris J W. et al .
`Modern life` in the epidemiology of infammatory bowel disease: a case-control study
with special emphasis on nutritional factors.
Eur J Gastroenterol Hepatol.
1998;
10
243-249
Reference Ris Wihthout Link
- 55
Jowett S L, Seal C J, Pearce M S. et al .
Influence of dietary factors on the clinical course of ulcerative colitis: a prospective
cohort study.
Gut.
2004;
53
1479-1484
Reference Ris Wihthout Link
- 56
Brandes J W, Lorenz-Meyer H.
Zuckerfreie Diät: Eine neue Perspektive zur Behandlung des Morbus Crohn.
Z Gastroenterologie.
1981;
19
1-12
Reference Ris Wihthout Link
- 57
Bjørkkjær T, Brunborg L A, Arslan G. et al .
Reduced joint pain after short-term duodenal administration of seal oil in patients
with inflammatory bowel disease: comparison with soy oil.
Scan J Gastroenterol.
2004;
39
1088-1094
Reference Ris Wihthout Link
- 58
Arslan G, Brunborg L A, Frøyland L. et al .
Effect of duodenal seal oil administration in patients with inflammatory bowel disease.
Lipids.
2002;
37
935-940
Reference Ris Wihthout Link
- 59
Ganguli S C, Cawdron R, Irvine E J.
Alternative medicine use by canadian ambulatory gastroenterology patients: Secular
trend or epidemic?.
Am J Gastroneterol.
2004;
99 (2)
319-326
Reference Ris Wihthout Link
- 60
Moser G, Tillinger W, Sachs G. et al .
Relationship between the use of unconventional therapies and disease-related concerns:
a study of patients with inflammatory bowel disease.
J Psychosom Res.
1996;
40 (5)
503-509
Reference Ris Wihthout Link
- 61
Burgmann T, Rawsthorne P, Bernstein C N.
Predictors of alternative and complementary medicine use in inflammatory bowel disease:
do measures of conventional health care utilization relate to use?.
Am J Gastroenterol.
2004;
99 (5)
889-893
Reference Ris Wihthout Link
- 62
Langmead L, Chitnis M, Rampton D S.
Use of complementary therapies by patients with IBD may indicate psychosocial distress.
Inflamm Bowel Dis.
2002;
8
174-179
Reference Ris Wihthout Link
- 63
Hilsden R J, Verhoef M J, Best A. et al .
Complementary and alternative medicine use by Canadian patients with inflammatory
bowel disease: results from a national survey.
Am J Gastroenterol.
2003;
98
1563-1568
Reference Ris Wihthout Link
- 64
Joos S, Brinkhaus B, Maluche C. et al .
Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized
controlled study.
Digestion.
2004;
69
131-139
Reference Ris Wihthout Link
- 65
Cottone M.
Stress and physical activity: are they risk factors for IBD?.
Ital J Gastroenterol Hepatol.
1998;
30
252-3
Reference Ris Wihthout Link
- 66
Levenstein S.
Stress and ulcerative colitis: convincing the doubting thomases.
AJG.
2003;
98
2112-2114
Reference Ris Wihthout Link
- 67
Hershfield N.
Hans Selye, inflammatory bowel disease and placebo response.
Can J Gastroenterol.
1997;
11 (7)
623-625
Reference Ris Wihthout Link
- 68
Farrell R J, Peppercorn M A.
Ulcerative colitis.
Lancet.
2002;
359
331-340
Reference Ris Wihthout Link
- 69
Drossmann D A.
Presidential address: gastrointestinal illness and the biopsychosocial model.
Psychosom Med.
1998;
60
258-267
Reference Ris Wihthout Link
- 70
Niess J H, Mönnikes H, Dignass A U. et al .
Review on the influence of stress on immun mediators, neuropeptides and hormones with
relevance for inflammatory bowel disease.
Digestion.
2002;
65
131-140
Reference Ris Wihthout Link
- 71
LeResche L, Dworkin S F.
The role of stress in inflammatory bowel disease, including peridontal disease: review
of concepts and current finding.
Peridentology.
2002;
30
91-103
Reference Ris Wihthout Link
- 72
Levenstein S, Prantera C, Varva V. et al .
Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled
in remission.
Am J Gastroenterol.
2000;
95
1213-1220
Reference Ris Wihthout Link
- 73
Bitton A, Sewitch M J, Peppercorn M A. et al .
Psychosocial determinant of relapse in ulcerative colitis: a longitudinal study.
Am J Gastroenterol.
2003;
98
2203-2208
Reference Ris Wihthout Link
- 74
Li J, Nørgárd B, Hansen Precht D. et al .
Psychological stress and inflammatory bowel disease: a follow-up study in parents
who lost a child in Denmark.
Am J Gastroenterol.
2004;
99 (6)
1129-1133
Reference Ris Wihthout Link
- 75
Wietersheim von J, Overbeck A, Kiel K. et al .
Die Bedeutung rezidivauslösender Ereignisse bei Patienten mit chronisch entzündlichen
Darmerkrankungen. Ergebnisse einer prospektiven Längsschnittstudie über 3 Jahre.
Psychother Psychosom med Psychol.
1994;
44
58-64
Reference Ris Wihthout Link
- 76
Kosarz P, Traue H C.
Alltagsstress und Colitis ulcerosa.
Psychother Psychosom med Psychol.
1997;
47
117-122
Reference Ris Wihthout Link
- 77
Maunder R G.
Evidence that stress contributes the inflammatory bowel disease: evaluation, synthesis,
and future directions.
Inflamm Bowel Dis.
2005;
11 (6)
600-608
Reference Ris Wihthout Link
- 78
Greene B R, Blanchard E D, Wan C K.
Long-term monitoring od psychosocial stress amd symptomatology in inflammatory bowel
disease.
Behav Res Ther.
1994;
32 (2)
217-226
Reference Ris Wihthout Link
- 79
Garrett V D, Brantley P J, Jones G N. et al .
The relation between daily stress and Crohn’s disease.
J Behav Med.
1991;
14 (1)
87-96
Reference Ris Wihthout Link
- 80
Head K A, Jurenka J S.
Inflammatory bowel disease part I: Ulcerative Colitis – pathophysiology and conventional
and alternative treatment options.
Altern Med Rev.
2003;
8 (3)
247-283
Reference Ris Wihthout Link
- 81
Krishnan A, Korzenik J R.
Inflammatory bowel disease and environmental influences.
Gastroenterol Clin N Am.
2002;
31
21-39
Reference Ris Wihthout Link
- 82
Danese S, Sans M, Fiocchi C.
Inflammatory bowel disease: the role of environmental factors.
Autoimmunity Reviews.
2004;
3
394-400
Reference Ris Wihthout Link
- 83 Peppercorn M A. Definition of and risk factors for inflammatory bowel disease. 2006 www.uptodate.com
Reference Ris Wihthout Link
- 84 Snapper S B, Podolsky D K. Epidemiology and genetic and environmental factors in inflammatory bowel disease. 2006 www.uptodate.com
Reference Ris Wihthout Link
- 85
Loftus E V.
Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental
influences.
Gastroenterology.
2004;
126
1504-1517
Reference Ris Wihthout Link
- 86
Irvine E J, Farrokhyar F, Swarbrick E T.
A critical review of epidemiological studies in inflammatory bowel disease.
Scan J Gastroenterol.
2001;
1
2-15
Reference Ris Wihthout Link
- 87
Nakamura Y, Kobayashi M, Nagai M. et al .
A case-control study of ulcerative colitis in Japan.
J Clin Gastroenterol.
1994;
18 (1)
72-79
Reference Ris Wihthout Link
- 88
Joachim G.
Inflammatory bowel disease: effects on lifestyle.
Journal of Advanced Nursing.
1987;
12
483-487
Reference Ris Wihthout Link
- 89
Hagerstown M D.
Inflammatory bowel disease impact and patient characteristics.
Gastroenterology nursing.
1993;
15
147-154
Reference Ris Wihthout Link
- 90
Kinash R G, Fischer D G, Luckie B E. et al .
Coping patterns and related characteristics in patients with IBD.
Rehabilitation Nursing.
1993;
18
12-19
Reference Ris Wihthout Link
- 91
Herrmann U, Rose M, Klapp B F. et al .
Personale Ressourcen und Coping von Patienten mit chronisch entzündlichen Darmerkrankungen
(CED).
Z Med Psychol.
2005;
14
59-65
Reference Ris Wihthout Link
- 92
Martin A, Leone L, Castagliuolo I. et al .
What do patients want to know about their inflammatory bowel disease.
Ital J Gastroenterol.
1992;
24
477-480
Reference Ris Wihthout Link
- 93
O’Sullivan M A, Mahmud N, Kelleher D P. et al .
Patient knowledge and educational needs in irritable bowel syndrome.
Eur J Gastroenterol Hepatol.
2000;
12
39-43
Reference Ris Wihthout Link
- 94
Polglase A L, McDermott F T, Hughes E SR.
Ulcerative colitis and Crohn’s disease – What your patient want to know.
Australian Family Physician.
1984;
13
422-424
Reference Ris Wihthout Link
- 95
Zander W.
Psychosomatische Grundlagenforschung: Theoretische Überlegungen und experimentelle
Untersuchungen.
Zschr psychosom Med.
1982;
28
126-128
Reference Ris Wihthout Link
- 96
Moser G.
Psychosomatik in der Gastroenterologie.
Wien Med Wschr.
2000;
150
209-212
Reference Ris Wihthout Link
- 97
Frenzer A, Binek J, Hammer B.
Soziale Folgen und Lebensqualität bei Patienten mit chronisch entzündlichen Darmerkrankungen.
Schweiz Med Wochenschr.
1996;
126
97S-99S
Reference Ris Wihthout Link
- 98
Lask B.
Psychological aspects of inflammatory bowel disease.
Wien Med Wschr.
1986;
98
544-546
Reference Ris Wihthout Link
- 99
Ringel Y, Drossmann D A.
Psychosocial aspects of Crohn’s disease.
Surgical Clinics of North America.
2001;
81
231-252
Reference Ris Wihthout Link
- 100
Küchenhoff J.
Biopsychosoziale Wechselwirkungen im Krankheitsverlauf des Morbus Crohn.
Zsch psychosom Med.
1995;
43
306-328
Reference Ris Wihthout Link
- 101
Karlinger K, Györke T, Makö E. et al .
The epidemiology and the pathogenesis of inflammatory bowel disease.
Eur J Radiol.
2000;
35
154-167
Reference Ris Wihthout Link
- 102
Dudley-Brown S.
Prevention of psychological distress in persons with inflammatory bowel disease.
Issues in Mental Health Nursing.
2002;
23
403-422
Reference Ris Wihthout Link
- 103
Casati J, Toner B B.
Psychosocial aspects of inflammatory bowel disease.
Biomed & Pharmacother.
2000;
54
388-93
Reference Ris Wihthout Link
- 104
Murray J B.
Psychological factors in ulcerative colitis.
The Journal of General Psychology.
1984;
110
201-221
Reference Ris Wihthout Link
- 105
Gerbert B.
Psychological aspects of Crohn’s disease.
J Behav Med.
1980;
3
41-58
Reference Ris Wihthout Link
- 106
Timmer A.
Environmental influence on inflammatory bowel disease manifestation.
Dig Dis.
2003;
21
91-104
Reference Ris Wihthout Link
- 107
Ringel Y, Drossmann D A.
Psychosocial aspects of Crohn’s disease.
Surgical Clinics of North America.
2001;
81 (1)
231-252
Reference Ris Wihthout Link
- 108
Zuckerman M J, Briones D F.
Inflammatory bowel disease: overview and psychosomatics.
Texa Medicine.
1989;
85
32-36
Reference Ris Wihthout Link
- 109
Enck P, Schäfer R.
Psychosoziale Faktoren beim M. Crohn – eine Übersicht.
Z Gastroenterol.
1996;
34
708-713
Reference Ris Wihthout Link
- 110
Sewitch M J, Abrahamowicz M, Bitton A. et al .
Psychosocial correlates of patient-physician discordance in inflammatory bowel disease.
Am J Gastroenterol.
2002;
97
2174-2183
Reference Ris Wihthout Link
- 111
Turnbull G K, Vallis T M.
Quality of life in inflammatory bowel disease: the interaction of disease activity
with psychosocial function.
Am J Gastroenterol.
1995;
90
1450-1454
Reference Ris Wihthout Link
- 112
Petrak F, Hardt J, Clement T. et al .
Impaired health-related quality of life in inflammatory bowel disease: psychosocial
impact and coping styles in a national German sample.
Scand J Gastroenterol.
2001;
36
375-382
Reference Ris Wihthout Link
- 113
Walker E A, Gelfand M D, Gelfant A N. et al .
The relationship of current psychiatric disorders to functional disability and distress
in patients with inflammatory bowel disease.
General Hospital Psychiatry.
1996;
18
220-229
Reference Ris Wihthout Link
- 114
Schwartz R A, Schwartz I K.
Psychiatric disorders associated with Crohn’s disease.
Psychiatry in Medicine.
1982;
12
67-73
Reference Ris Wihthout Link
- 115
Mussell M, Böcker U, Nagel N. et al .
Predictors of disease-related concers and other aspects of health-related quality
of life in outpatients with inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
2004;
16
1273-1280
Reference Ris Wihthout Link
- 116
Paar G H, Bezzenberger U, Lorenz-Meyer H.
Über den Zusammenhang von psychosazialem Stress und Krankheitsaktivität bei Patienten
mit Morbus Crohn und Colitis ulcerosa.
Z Gastroenterologie.
1988;
26
648-657
Reference Ris Wihthout Link
- 117
Turnbull G K, Vallis T M.
Quality of life in inflammatory bowel disease: the interaction of disease activity
with psychosocial function.
Am J Gastroenterol.
1995;
90 (9)
1450-1454
Reference Ris Wihthout Link
- 118
Eijk van der I, Vlachonikolis I G, Munkholm P. et al .
The role of qualitiy of care in health-related quality of life in patients with IBD.
Inflamm Bowel Dis.
2004;
10
392-398
Reference Ris Wihthout Link
- 119
Gerson M J, Schonholtz J, Grega C H. et al .
The importance of the family context in inflammatory bowel disease.
Mt Sinai J Med.
1998;
65
398-403
Reference Ris Wihthout Link
- 120
Van Hemert A, Hengeveld M W, Bolk J H. et al .
Psychiatric disorders in relation to medical illness among patients of a general medical
out-patient clinic.
Psychological Medicine.
1993;
23
167-173
Reference Ris Wihthout Link
- 121
Tanaka M, Kazuma K.
Ulcerative colitis: factors affecting difficulties of life and psychological well
being of patients in remission.
J Clin Nurs.
2005;
14
65-73
Reference Ris Wihthout Link
- 122
Sewitch M J, Abrahamowicz M, Bitton A. et al .
Psychological distress, social support and disease activity in patients with inflammatory
bowel disease.
Am J Gastroenterol.
2001;
96 (5)
1470-1479
Reference Ris Wihthout Link
- 123
Sainsbury A, Heatley R V.
Review article: psychosocial factors in the quality of life of patients with inflammatory
bowel disease.
Aliment Pharmacol Ther.
2005;
21
499-508
Reference Ris Wihthout Link
- 124
Levenstein S.
Embracing complexity: what determines quality of life in inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
2004;
16
1253-1255
Reference Ris Wihthout Link
- 125
Mussell M, Böcker U, Nagel N. et al .
Predictors of disease-related concerns and other aspects of health-related quality
of life in outpatients with inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
2004;
16
1273-1280
Reference Ris Wihthout Link
- 126
Cuntz U. et al .
Determinanten der subjektiven Belastung durch Darmerkrankungen.
Psychther Psychosom med Psychol.
1999;
49
493-500
Reference Ris Wihthout Link
- 127
Barrett S ML, Standen P J, Lee A S. et al .
Personality, smoking and inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
1996;
8
651-655
Reference Ris Wihthout Link
- 128
Janke K H, Klump B, Gregor M. et al .
Determinants of life satisfaction in inflammatory bowel disease.
Inflamm Bowel Dis.
2005;
11
272-286
Reference Ris Wihthout Link
- 129
Pizzi L T, Weston C M, Goldfarb N I. et al .
Impact of chronic conditions on quality of life in patients with inflammatory bowel
disease.
Inflamm Bowel Dis.
2006;
12
47-52
Reference Ris Wihthout Link
- 130
Deter H C, Manz R, Becker M. et al .
Soziale Unterstützung in der Beziehung zu körperlichen und seelischen Befunden bei
Morbus Crohn-Patineten.
Zsch psychosom Med.
1991;
37
45-59
Reference Ris Wihthout Link
- 131
Birtwistle J.
The role of cigarette and nicotine in the onset and treatment of ulcerative colitis.
Postgrad Med J.
1996;
72
714-718
Reference Ris Wihthout Link
- 132
Timmer A, Sutherland L R, Martin F. et al .
Smoking, use of oral contraceptives, and medical induction of remission were rsik
factors for relapse in Crohn’s disease.
Gut.
1999;
44
311-312
Reference Ris Wihthout Link
- 133
Forbes A.
Smoking and inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
1996;
8
761-763
Reference Ris Wihthout Link
- 134
Zijlstra F J.
Smoking and nicotine in inflammatory bowel disease: good or bad for cytokines?.
Mediators of Inflammation.
1998;
7
153-155
Reference Ris Wihthout Link
- 135
Sercombe J.
Inflammatory bowel disease and smoking.
Professional Nurse.
2000;
15 (7)
439-442
Reference Ris Wihthout Link
- 136
Miner P B.
Factors influencing the relapse of patients with inflammatory bowel disease.
Am J Gastroenterol.
1997;
92 (12)
1S-4S
Reference Ris Wihthout Link
- 137
Birrenbach T, Böcker U.
Inflammatory bowel disease and smoking – a review of epidemiology, pathophysiology,
and therapeutic implications.
Inflamm Bowel Dis.
2004;
10
848-859
Reference Ris Wihthout Link
- 138
Picco M F, Bayless T M.
Tobacco consumption and disease duration are associated with fistulizing and stricturing
behaviors in the first 8 years of Crohn’s disease.
Am J Gastroenterol.
2003;
98
363-368
Reference Ris Wihthout Link
- 139
Russel M G, Nieman F H, Bergers J M. et al .
South Limburg IBD Study Group: Cigarette smoking and quality of life in patients with
inflammatory bowel disease.
Eur J Gestroenterol Hepatol.
1996;
8
1075-1081
Reference Ris Wihthout Link
- 140
Bustamante M, Nos P, Hoyos M. et al .
Relationship between smoking and colonic involment in inflammatory bowel disease.
Rev Esp Enferm Dig.
1998;
90 (12)
837-840
Reference Ris Wihthout Link
- 141
Thomas G AO, Rhodes J, Green J T. et al .
Role of smoking in inflammatory bowel disease: implications for therapy.
Postgrad Med J.
2000;
76
273-279
Reference Ris Wihthout Link
- 142
Ashley M J.
Smoking and disease of the gastrointestinal system: An epidemiological review with
special references to sex differences.
Can J Gastroenterol.
1997;
11 (4)
345-352
Reference Ris Wihthout Link
- 143
Cosnes J, Carbonnel F, Carrat F. et al .
Effects of current and former cigarette smoking on the clinical course of Crohn’s
disease.
Aliment Pharmacol Ther.
1999;
13
1403-1411
Reference Ris Wihthout Link
- 144
Abraham N, Selby W, Lazarus R. et al .
Is smoking an indirect risk factor for the development of ulcerative colitis? An age-
and sex-matched case-control study.
J Gastroenterol Hepatol.
2003;
18
139-146
Reference Ris Wihthout Link
- 145
Yamamoto T, Keighley M RB.
Smoking and disease recurrence after operation for Crohn’s disease.
British Journal of Surgery.
2000;
87
398-404
Reference Ris Wihthout Link
- 146
Manguso F, Sanges M, Staiano T. et al .
Cigarette smoking and appendectomy are risk factors for extraintestinal manifestations
in ulcerative colitis.
Am J Gastroenterol.
2004;
99 (2)
327-334
Reference Ris Wihthout Link
- 147
Radford-Smith G L, Edwards J E, Purdie D M. et al .
Protective role of appendicectomy on onset and severity of ulcerative colitis and
Crohn’s disease.
Gut.
2002;
51
808-813
Reference Ris Wihthout Link
- 148
Johnson G J, Cosnes J, Mansfield J C.
Review article: smoking cessation as primary therapy to modify the course of Crohn’disease.
Aliment Pharmacol Ther.
2005;
21
921-931
Reference Ris Wihthout Link
- 149
Breuer-Katschinski B D, Holländer N, Goebell H.
Effect of cigarette smoking on the course of chrohn’s disease.
Eur J Gastroenterol Hepatol.
1996;
8 (3)
225-228
Reference Ris Wihthout Link
- 150
Corrao G, Tragnone A, Caprilli R. et al .
Risk of inflammatory bowel disease attributable to smoking, oral contraception and
breastfeeding in Italy: a nationwide case-control study.
Int J Epidemiol.
1998;
27
397-404
Reference Ris Wihthout Link
- 151
Medina C, Vergara M, Casellas F. et al .
Influence of smoking habit in the surgery of inflammatory bowel disease.
Rev Esp Enferm Dig.
1998;
90 (11)
775-778
Reference Ris Wihthout Link
- 152
Odes H S, Fich A, Reif S. et al .
Effects of current cigarette smoking on clinical course of Crohn’s disease and Ulcerative
colitis.
Dig Dis Sci.
2001;
46 (8)
1717-1721
Reference Ris Wihthout Link
- 153
Fraga X F, Vergara M, Medina C. et al .
Effect of smoking on the presentation and clinical course of inflammatory bowel disease.
Eur J Gastroenterol Hepatol.
1997;
9
683-687
Reference Ris Wihthout Link
- 154
Kane S V, Flicker M, Katz-Nelson F.
Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease
after surgically induced remission.
J Clin Gastroenterol.
2005;
39
32-35
Reference Ris Wihthout Link
- 155
Sicilia B.
Environmental rsik factors and Crohn’s disease: a population-based, case-control study
in Spain.
Digest Liver Dis.
2001;
33
762-767
Reference Ris Wihthout Link
- 156
Cosnes J, Mion-Larmurier I, Afchain P. et al .
Gender differences in the response of colitis to smoking.
Clin Gastroenterol Hepatol.
2004;
2
41-48
Reference Ris Wihthout Link
- 157
Cosnes J, Carbonnel F, Beaugerie L. et al .
Effects of cigarette smoking on the long-term course of Crohn’s disease.
Gastroenterology.
1996;
110
424-431
Reference Ris Wihthout Link
- 158
Cosnes J, Beaugerie L, Carbonnel F. et al .
Smoking cessation and the course of Crohn’s disease: an intervention study.
Gastroenterology.
2001;
120
1093-1099
Reference Ris Wihthout Link
- 159
Timmer A, Sutherland L R, Martin F.
Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease.
Gastroenterology.
1998;
114
1143-1150
Reference Ris Wihthout Link
- 160
Rooy E C, Toner B B, Maunder R G. et al .
Concerns of patients with inflammatory bowel disease: results from a clinical population.
Am J Gastroenterol.
2001;
96
1816-1821
Reference Ris Wihthout Link
- 161
Drossman D A, Patrick D L, Mitchell C M. et al .
: Health-related quality of life in inflammatory bowel disease – functional status
and patients worries and concerns.
Dig Dis Sci.
1989;
34 (9)
1379-1386
Reference Ris Wihthout Link
- 162
Blondel-Kucharski de F, Chircop C, Marquis P. et al .
Health-realted quality of life in Crohn’s disease: a prospective longitudinal study
in 231 patients.
Am J Gastroenterol.
2001;
96
2915-2920
Reference Ris Wihthout Link
- 163
Ananthakrishnan A N.
Does it Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide
Analysis of Hospital Volume.
Digestive Disease Week.
2008;
Abstract #T1167
, www.ddw.org; Stand: 21.7.2008
Reference Ris Wihthout Link
- 164 Indikationskatalog für Anschlussrehabilitation (AHB), Stand: 11.1.2008. http://www.deutsche-rentenversicherung-bund.de; Stand: 21.7.2008
Reference Ris Wihthout Link
- 165 Qualitätsberichte der Reha-Zentren der Deutschen Rentenversicherung Bund. www.deutsche-rentenversicherung-bund.de
Reference Ris Wihthout Link
- 166 Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e.V .Verzeichnis der Rehabilitationskliniken bei Morbus Crohn und Colitis ulcerosa. DCCV 2007
Reference Ris Wihthout Link
- 167
Jaghult S, Larson J, Wredling R. et al .
A multiprofessional education programme for patients with inflammatory bowel disease:
a randomized controlled trial.
Scand J Gastroenterol.
2007;
42 (12)
1452-1459
Reference Ris Wihthout Link
- 168
Oxelmark L, Magnusson A, Lofberg R. et al .
Group-based intervention program in inflammatory bowel disease patients: effects on
quality of life.
Inflamm Bowel Dis.
2007;
13 (2)
182-190
Reference Ris Wihthout Link
- 169
Waters B M, Jensen L, Fedorak R N.
Effects of formal education for patients with inflammatory bowel disease: a randomized
controlled trial.
Can J Gastroenterol.
2005;
19 (4)
235-244
Reference Ris Wihthout Link
- 170
Bregenzer N, Lange A, Furst A. et al .
Patient education in inflammatory bowel disease does not influence patients knowledge
and long-term psychosocial well-being.
Z Gastroenterol.
2005;
43 (4)
367-371
Reference Ris Wihthout Link
- 171
Brown S A.
Studies of educational interventions and outcomes in diabetic adults: a meta-Analysis
revisited.
Patient Educ Couns.
1990;
16
189-215
Reference Ris Wihthout Link
- 172
Devine E C, Pearcy J.
Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive
pulmonary disease.
Patient Educ Couns.
1996;
29
167-178
Reference Ris Wihthout Link
- 173
Devine E C, Reifschneider E.
A meta-analysis of the effects of psychoeducational care in adults with hypertension.
Nurs Res.
1995;
44 (4)
237-245
Reference Ris Wihthout Link
- 174
Mazzuca S A.
Does patient education in chronic disease have therapeutic value?.
J Chron Dis.
1982;
35
521-529
Reference Ris Wihthout Link
- 175
Roter D L, Hall J A, Merisca R. et al .
Effectiveness of the interventions to improve patient compliance: a meta-analysis.
Med Care.
1998;
36 (8)
1138-1161
Reference Ris Wihthout Link
- 176
Quan H, Present J W, Sutherland L R.
Evaluation of educational programs in Inflammatory bowel disease.
Inflamm Bowel Dis.
2003;
9 (6)
356-362
Reference Ris Wihthout Link
- 177
Verma S, Tsai H H, Giaffer M H.
Does better disease-related education improve quality of life? A survey of IBD patients.
Dig Dis Sci.
2001;
46 (4)
865-869
Reference Ris Wihthout Link
- 178
Jones S C, Gallacher B, Lobo A J. et al .
A patient knowledge questionnaire in Inflammatory bowel disease.
J Clin Gastroenterol.
1993;
17 (1)
21-24
Reference Ris Wihthout Link
- 179
Rezailashkajani M, Roshandel D, Ansari S. et al .
Knowledge of disease and health information needs of the patients with inflammatory
bowel disease in a developing country.
Int J Colorectal Dis.
2006;
21 (5)
433-40
Reference Ris Wihthout Link
- 180
Gensichen J, Muth C, Buttzlaff M. et al .
Die Zukunft ist chronisch: Das Chronic Care-Modell in der deutschen Primärversorgung.
Übergreifende Behandlungsrinzipien einer proaktiven Versorgung für chronische Kranke.
Z ärztl Fortbild Qual Gesundhwes.
2006;
100
365-374
Reference Ris Wihthout Link
- 181 Classen M, Dierkesmann R, Heimpel H. et al .Rationelle Diagnostik und Therapie in der Inneren Medizin. München, Jena; Urban und Fischer 2001
Reference Ris Wihthout Link
- 182
Moser G.
Bedeutung von Stress und Depression bei chronisch entzündlichen Darmerkrankungen.
J Gastroenterol Hepatol Erkr.
2005;
3 (2)
26-30
Reference Ris Wihthout Link
- 183
Kunzendorf S, Jantschek G, Straubinger K. et al .
The Luebeck Interview for Psychosocial Screening in Patients with Inflammatory Bowel
Disease.
Inflamm Bowel Dis.
2007;
13 (1)
33-41
Reference Ris Wihthout Link
- 184
Bjorkkjaer T, Brun J G, Valen M. et al .
Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio
in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease.
Lipids Health Dis.
2006;
5
6
Reference Ris Wihthout Link
- 185
Cozzi F, Podswiadek M, Cardianle G. et al .
Mud-bath treatment in spondylitis associated with inflammatory bowel disease – a pilot
randomised clinical trial.
Joint Bone Spine.
2007;
74 (5)
436-439
Reference Ris Wihthout Link
- 186
Goldberg R J, Katz J.
A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation
for inflammatory joint pain.
Pain.
2007;
129 (1 – 2)
210-223
Reference Ris Wihthout Link
- 187
Koretz R L, Avenell A, Lipman T O. et al .
Does enteral nutrition affect clinical outcome? A systematic review of the randomized
trials.
Am J Gastroenterol.
2007;
102 (2)
412-429
Reference Ris Wihthout Link
- 188
Duffy L C, Zielezny M A, Marshall J R. et al .
Relevance of major stress events as an indicator of disease activity prevalence in
inflammatory bowel disease.
Behav Med.
1991;
17 (3)
101-10
Reference Ris Wihthout Link
- 189
Hjortswang H, Järnerat G, Curman B. et al .
The influence of demographic and disease-related factors on health-related quality
of life in patients with ulcerative colitis.
Eur J Gastroenterol Hepatol.
2003;
15
1011-1020
Reference Ris Wihthout Link
- 190
Hjortswang H, Ström M, Almer S.
Health-related quality of life in Swedish patients with ulcerative colitis.
Am J Gastroenterol.
1998;
93
2203-2211
Reference Ris Wihthout Link
- 191
Ng V, Millard W, Lebrun. et al .
Low-intensity exercise improves quality of life in patients with Crohn’s disease.
Clin J Sport Med.
2007;
17 (5)
384-388
Reference Ris Wihthout Link
- 192
Langhorst J, Mueller T, Luedtke R. et al .
Effects of a comprehensive lifestyle modification program on quality-of-life in patients
with ulcerative colitis: a twelve-month follow-up.
Scand J Gastroenterol.
2007;
42 (6)
734-745
Reference Ris Wihthout Link
- 193
Elsenbruch S, Langhorst J, Popkirowa K. et al .
Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune
functions in patients with ulcerative colitis.
Psychother Psychosom.
2005;
74 (5)
277-287
Reference Ris Wihthout Link
- 194
Oliveira S, Zaltman C, Elia C. et al .
Quality-of-life measurement in patients with inflammatory bowel disease receiving
social support.
Inflamm Bowel Dis.
2007;
13 (4)
470-474
Reference Ris Wihthout Link
- 195 ÄZQ, AWMF .Deutsches Instrument zur methodischen Leitlinienbewertung. 2005 www.delbi.de
Reference Ris Wihthout Link
- 196 Becker E, Horn S, Hussla B. et al .Sozialmedizinische Leistungsbeurteilung bei chronisch entzündlichen Darmerkrankungen. Deutsche Gesellschaft für Sozialmedizin, autorisiert für elektronische Veröffentlichung AWMF online März 2005
Reference Ris Wihthout Link
- 197
Carter M J, Lobo A J, Travis S PL. et al .
Guideline of the management of inflammatory bowel disease in adults.
Gut.
2004;
53 (suppl V)
v1-v16
Reference Ris Wihthout Link
- 198
Caprilli R, Gassull M A, Escher J C. et al .
European evidence based consensus on the diagnosis and management of Crohn’s disease:
special situations.
Gut.
2006;
55 (Suppl I)
i36-i58
Reference Ris Wihthout Link
- 199
Stange E F, Travis S PL, Vermeire S. et al .
European evidence based consensus on the diagnosis and management of Crohn’s disease:
definitions and diagnosis.
Gut.
2006;
55 (Suppl I)
i1-i15
Reference Ris Wihthout Link
- 200
Travis S PL, Stange E F, Lemann M. et al .
European evidence based consensus on the diagnosis and management of Crohn’s disease:
current management.
Gut.
2006;
55 (Suppl I)
i16-i35
Reference Ris Wihthout Link
- 201 Centre for Evidence-based Medicine .Oxford Centre for Evidence-based Medicine Levels of Evidence. 2001 www.cebm.net
Reference Ris Wihthout Link
- 202
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften .
Das Leitlinien-Manual: Entwicklung und Implementierung von Leitlinien in der Medizin.
Z Ärztl Fortbild Qualitätssich.
2001;
95 (Suppl 1)
1-84
Reference Ris Wihthout Link
- 203 Scottish Intercollegiate Guidelines Network .Postal Address: SIGN, 28 Thistle Street, Edinburgh EH 2 1EN. www.sign.ac.uk
Reference Ris Wihthout Link
Prof. Dr. med. Dr. phil. Heiner Raspe
Institut für Sozialmedizin, UK S-H
Beckergrube 43 – 47
23552 Lübeck
Telefon: 04 51/7 99 - 25 20
Fax: 04 51/7 99 - 25 22
eMail: heiner.raspe@uk-sh.de