Horten-Centre for patient oriented research and knowledge transfer

The Horten-Centre for patient oriented research and knowledge transfer was founded in 1999 and opened in 2000. The aims of the Centre are to generate medical knowledge directly bearing on patient care and transfer medical knowledge from medical academia to medical practice. The Horten-Centre is part of the University of Zurich and connected to the Clinic and Policlinic for Internal Medicine at the University Hospital.
The core funding of the Centre comes from the Helmut Horten Foundation. In addition the Swiss National Science Foundation, the European Union and further foundations support different research projects.
In the last ten years the Horten-Centre has gained international reputation in the field of clinical research. Members of the Centre have established collaborations with national institutions as well as in Europe and the United States. 
The main research fields in the first ten years were the development of new concepts in the domain of diagnostic research, the build up and organization of cohort studies in different clinical areas and the creation of a database with short summaries of scientific articles, which are relevant for clinicians and practitioners. 
In cooperation with other universities the Horten-Centre has a doctoral program, which allows students to get a PhD. Each year the Centre supports between 4 and 8 medical students to prepare and write their thesis to get a doctor degree in medicine. Some of these students obtained positions in leading institutes.

The focus of the Horten-Centre

A general internist would have to read almost 20 articles in medical journals per day to stay up to date. It goes without saying that this is impossible and probably not all of these publications are that relevant for practicing medicine on high quality level. The Horten-Centre identifies some of the clinically relevant publications, summarizes the paper such that the most important information can be read within less than two minutes, and publishes the summary online. 

Patient oriented research

A major challenge in medical practice is to establish a correct diagnosis in an efficient way. Only after knowing the illness causing the complaints of the patient an adequate treatment can be recommended. In one study the Centre could demonstrate that the prevailing concept of doing research in the diagnostic domain does not work well and the results of these studies are difficult to apply in medical practice. 
The new concept the Horten-Centre is developing is based on the fact that experts are better diagnosticians thannovices. Following from this the Centre elaborated a method for garnering the knowledge of experts and provide this knowledge to less experienced physicians. The same method can be applied to generate knowledge that can support physicians in recommending treatments. With these projects the Centre laid the theoretical base for a medical expert system assisting doctors in their practice.

A second focus in patient oriented research is the build up of cohorts. The first cohort who has been initiated by members of the Horten-Centre together with pneumologists from Switzerland and Netherlands includes patients with chronic obstructive pulmonary disease (COPD). COPD is one of the most frequent chronic illnesses leading to disability and early death. It is important to know which patients are at moderate to high risk for complications, like acute exacerbations, in order to recommend them preventive measures and to treat complications at an early stage. Further questions in such a cohort study are which patients should undergo a pulmonary rehabilitation program.

A second cohort study initiated at the Horten-Centre in cooperation with urologists and pathologists is the ProCoc study. In this study patients with new diagnosed localized prostate cancer are included. In addition to clinical information blood, urine and prostate specimen are collected and stored. One aim of this cohort study, which is planed to become nation wide, is the identification of parameters and biomarkers allowing more precise information about the prognosis of the person. One of the main challenges in caring for patients with prostate cancer is to find out which treatment is the most adequate one. Some men with diagnosed prostate cancer will live for ten to twenty years without getting any symptoms from cancer, whereas in others the behavior of the cancer is completely different and the patient, if untreated, will get serious sick within short time. The Horten-Centre hopes that with the upcoming results of this cohort study it can contribute to increase the knowledge about treatment indications. An international advisory board is supervising the project.

A third clinical research project was started in 2010 including patients with lumbar spinal stenosis. This illness, mainly occurring in elderly people, is a narrowing of the spinal canal in the lower back causing low back pain radiating to the buttocks and thighs. The pain is mainly provoked by walking and standing in upright position. The narrowing of the spinal canal can be verified by various imaging procedures, the most often used method nowadays is the Magnetic Resonance Imaging. The goals of this study with more than 600 patients is first to identify radiological criteria to describe lumbar spinal stenosis reliably, second to develop a new instrument to describe and quantify clinical signs of patients with stenosis and, third, to establish a method to predict the outcome after surgery more precise than is possible now. Patients with lumbar spinal stenosis are most of them older and have comorbidities and therefore and increased peri- and postoperative risk.
For each of the larger projects in the Horten-Centre a board of international experts is installed to supervise the projects, give feedback and therewith support high quality research.

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