BackgroundIn Switzerland, General Practitioners (GPs) play an important role for out-of-hours emergency care as one service option beside freely accessible and costly emergency departments of hospitals. The aim of this study was to evaluate the services provided and the economic consequences of a Swiss GP out-of-hours service.MethodsGPs participating in the out-of-hours service in the city of Zurich collected data on medical problems (ICPC coding), mode of contact, mode of resource use and services provided (time units; diagnostics; treatments). From a health care insurance perspective, we assessed the association between total costs and its two components (basic costs: charges for time units and emergency surcharge; individual costs: charges for clinical examination, diagnostics and treatment in the discretion of the GP).Results125 GPs collected data on 685 patient contacts. The most prevalent health problems were of respiratory (24%), musculoskeletal (13%) and digestive origin (12%). Home visits (61%) were the most common contact mode, followed by practice (25%) and telephone contacts (14%). 82% of patients could be treated by ambulatory care. In 20% of patients additional technical diagnostics, most often laboratory tests, were used. The mean total costs for one emergency patient contact were €144 (95%-CI: 137-151). The mode of contact was an important determinant of total costs (mean total costs for home visits: €176 [95%-CI: 168-184]; practice contact: €90 [95%-CI: 84-98]; telephone contact: €48 [95%-CI: 40-55]). Basic costs contributed 83% of total costs for home visits and 70% of total costs for practice contacts. Individual mean costs were similarly low for home visits (€30) and practice contacts (€27). Medical problems had no relevant influence on this cost pattern.ConclusionsGPs managed most emergency demand in their out-of-hours service by ambulatory care. They applied little diagnostic testing and basic care. Our findings are of relevance for policy makers even from other countries with different pricing policies. Policy makers should be interested in a reimbursement system promoting out-of-hours care run by GPs as one valuable service option.

Our results confirm recent criticisms that the professional quality of expertises does not suffice. This is hardly acceptable in face of the financial and personal consequences. There is an obvious need for further research using larger samples and for educational programmes on all levels.

BackgroundA high quality of timely delivered medical appraisals is crucial for social and other insurances to judge possible occupational reintegration measures for patients with medical conditions who are in danger to lose their job. However, little is known about the satisfaction of staff of insurance companies with medical appraisals that they have commissioned.Our questionnaire survey prospectively included all medical appraisals arriving at Swiss insurances from FEB to APR 2008. We assessed the satisfaction of the commissioner with medical appraisals performed by medical assessors. In addition, we evaluated the contribution of several factors to overall satisfaction. The unit of sample was the medical appraisal.FindingsWe analysed 3165 medical appraisals, 2444 (77%) of them from the public disability insurance, 678 (22%) from private accident, liability and loss of income insurances and 43 (1%) from other insurances. Overall satisfaction of staff of insurance companies in Switzerland was high, but satisfaction of the disability insurance with appraisals was generally lower compared to satisfaction of private insurances. The staff of the disability insurance judged time for preparation as too long in 30%. For staff of private insurance companies 20% of appraisals were not "worth its price". Well-grounded and comprehensible conclusions were the single most important factor for high overall satisfaction (OR 10.1; 95%-CI: 1.1-89.3).ConclusionsFrom the viewpoint of staff of insurance companies, a relevant part of medical appraisals arrives too late. Medical assessors have to take the specific needs of insurances into account, to perform more appraisals with sound conclusions in due time.

When assessing the safety of existing structures it is often not economic to use the design codes, which may be rather conservative in nature. In this paper, safety is measured in terms of the factor of safety, defined as the ratio of available strength to total load effect. The paper examines the sensitivity of the safety factor of two example concrete slab bridges to: (1) the method of structural analysis and failure criterion; (2) the inclusion of updated strength information; and (3) the application of site-specific loading. It is shown that in certain cases plastic analysis methods can predict the ultimate load capacity more accurately than conventional elastic analysis. Methods are suggested for calculating the material strength values based on test results so as to better reflect the true in situ strength of the bridge. Finally, the use of a bridge-specific load model is suggested which may lead to an increase of the factor of safety.

Many laboratory studies have shown the beneficial effects of weld improvement methods on the fatigue strength of welded details. However, no structural codes systematically include weld improvement methods in detail classification. The purpose of this paper is to discuss the possibilities of using these methods in practice on either new or existing structures. This paper provides the reader with practical rules for designing and computing the fatigue strength of improved welded joints. A computation method based on the concept of effective stress range is introduced to model the effects of peening improvement methods on fatigue strength. For the most popular improvement methods, the fatigue strength of improved details can be deduced from the extensive existing database of full-scale test results. However, for nonclassified details, or when fabrication and improvement processes require validation, testing of the improved details is the only method available to guarantee the fatigue strength of a particular detail. In this paper a recent application of validation through testing in the case of longitudinal attachments is described.