Aim: To investigate whether nasal salmon calcitonin (CT; 200 U/day) given in addition to calcium helps to restore the bone mass after parathyroidectomy (PTX) in patients with primary hyperparathyroidism (PHPT). Methods: Twenty patients with PHPT were enrolled after successful PTX and received 1 g calcium per os daily for 1 year. They were randomly assigned either to nasal CT (CT group) or to no treatment. The bone mass was measured using dual-energy X-ray absorptiometry at multiple sites. Results: Eight patients in each group completed the study. After 12 months, the bone mass increased significantly at whole-body level and at lumbar spine in both groups, increased at hip and epiphyses of tibia or radius in the CT group only, and did not change at diaphyses of tibia and radius in either group. Conclusions: Bone mass increases after PTX for PHPT in patients receiving oral calcium. CT may help to restore the bone mass at sites of the appendicular skeleton, where trabecular bone predominates.
Scientific and policy targets of the National Research Program on Health Care Efficiency. Following a brief review of the general background, the specific goals of the program are presented: the realization of a solid scientific and interdisciplinary basis in the field of systematic health-system-research in Switzerland. After a review of the criteria which were employed to select out of one hundred offers some twenty research projects, a summary of these projects permits to illustrate the architecture of the whole program.
L'auteur, après avoir souligné le caractère interdisciplinaire qui sous-tend la notion d'efficacité dans le domaine de la santé, s'efforce de montrer l'évolution du concept d'efficacité selon le degré de désagrégation du système sanitaire qui est considéré.
The author emphasizes the necessity of an interdisciplinary approach in the field of exploring efficiency of the health system. He attempts to show how the notion of efficiency depends on the degree of aggregation of the considered components of the health system.
