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Hintergrund: Das System der pflegerischen Versorgung in Deutschland befindet sich in einer Umbruchphase. Seit Jahren wird über eine Weiterentwicklung der Kooperation im Gesundheitswesen und damit über eine Veränderung der Aufgabenverteilung zwischen den Gesundheitsberufen diskutiert. Im Jahr 2008 hat der Gesetzgeber die Einführung von Modellvorhaben zur Übertragung von Heilkunde auf Pflegende gem. § 63 Abs. 3c SGB V ermöglicht. Die Umsetzung verläuft sehr schleppend. Das Ziel der Untersuchung war, die Gründe für diese schleppende Umsetzung aus Sicht der gesetzlichen Krankenkassen zu analysieren.
Methode: Quantitative Befragung aller gesetzlichen Krankenkassen (n=124) in Deutschland.
Ergebnisse: Zur Sicherstellung der Versorgung halten 94 % der Krankenkassen die Übertragung von Heilkunde auf nichtärztliche Leistungserbringer für einen sinnvollen Ansatz. Sie wird von 96 % der Krankenkassen als sehr wichtig empfunden. Zwar befürworten 96 % der Krankenkassen grundsätzlich die Durchführung von Modellvorhaben, tatsächlich sind aber nur 8 % an derartigen Verträgen beteiligt; 71 % der Krankenkassen planen auch keine eigenen Modellvorhaben für die Zukunft.
Als mögliche Ursachen für die bislang schleppende Umsetzung werden aus Sicht der GKV insbesondere rechtliche Hürden (90 %), Widerstand durch ärztliche Standesvertreter (84 %), ungeklärte Finanzierungs- (74 %) und Haftungsfragen (70 %) sowie nicht-praxistaugliche Regelungen in der G-BA-Richtlinie (79 %) und im Gesetz (85 %) angeführt. Weniger als die Hälfte (46 %) der Krankenkassen vermutet hohe Kosten als Ursache für die schleppende Umsetzung.
Diskussion: Die vom Gesetzgeber im aktuellen Pflegeberufereformgesetz (PflBRefG) vorgenommenen Änderungen, insbesondere die Tatsache, dass Krankenkassen entsprechende Modellvorhaben bis zum 31. Dezember 2020 vereinbaren und durchführen sollen, sind vor dem Hintergrund der geäußerten Kritik als zielführend und adäquat zu bezeichnen.
Library of Congress Subject Headings (LCSH) are popular for indexing library records. We studied the possibility of assigning LCSH automatically by training classifiers for terms used frequently in a large collection of abstracts of the literature on hand and by extracting headings from those abstracts. The resulting classifiers reach an acceptable level of precision, but fail in terms of recall partly because we could only train classifiers for a small number of LCSH. Extraction, i.e., the matching of headings in the text, produces better recall but extremely low precision. We found that combining both methods leads to a significant improvement of recall and a slight improvement of F1 score with only a small decrease in precision.
Mastitis is one of the most important diseases threatening modern dairy herds. The idea of fighting the disease through colonising the udder with lactic acid bacteria (LAB), thereby building a beneficial biofilm, is the base for a probiotic approach towards mastitis control. The purpose of this study was to screen 13 LAB strains (eleven wild strains, two ATCC strains) inhibitory to the growth of mastitis-causing pathogens for their in vitro ability to form a biofilm and to adhere to bovine glandular mammary epithelium in order to assess their probiotic potential. Furthermore, we aimed to gain knowledge about the chemical nature of the adhesins involved by subjecting the bacteria to various chemical and enzymatical pre-treatments. The biofilms were grown on hydrophilic glass and on hydrophobic polypropylene in de Man, Rogosa and Sharpe (MRS) broth and afterwards quantified with a crystal violet assay. Biofilm formation was observed in all strains. However, the extent strongly depended on the strain, surface charge and medium. The adhesion assay also revealed a strong strain dependency, but this trait was also present in all of the investigated LAB isolates. Depending on the strain, chemical or enzymatical pre-treatment revealed carbohydrate molecules as well as proteins and lipids to be crucial for the adhesion of LAB to epithelial cells. The seven strains showing the strongest biofilm formation and/or adhesion represent promising candidates for further investigation in order to develop a probiotic remedy for the treatment of mastitis. Still, their safety for consumers and patients as well as their capability to colonise the udder remain to be investigated in in vivo studies.
The growing importance of renewable generation connected to distribution grids requires an increased coordination between transmission system operators (TSOs) and distribution system operators (DSOs) for reactive power management. This work proposes a practical and effective interaction method based on sequential optimizations to evaluate the reactive flexibility potential of distribution networks and to dispatch them along with traditional synchronous generators, keeping to a minimum the information exchange. A modular optimal power flow (OPF) tool featuring multi-objective optimization is developed for this purpose. The proposed method is evaluated for a model of a real German 110 kV grid with 1.6 GW of installed wind power capacity and a reduced order model of the surrounding transmission system. Simulations show the benefit of involving wind farms in reactive power support reducing losses both at distribution and transmission level. Different types of setpoints are investigated, showing the feasibility for the DSO to fulfill also individual voltage and reactive power targets over multiple connection points. Finally, some suggestions are presented to achieve a fair coordination, combining both TSO and DSO requirements.
Food protein hydrolysates are often produced in unspecific industrial batch processes. The hydrolysates composition underlies process-related fluctuations and therefore the obtained peptide fingerprint and bioactive properties may vary. To overcome this obstacle and enable the production of specific hydrolysates with selected peptides, a ceramic capillary system was developed and characterized for the continuous production of a consistent peptide composition. Therefore, the protease Alcalase was immobilized on the surface of aminosilane modified yttria stabilized zirconia capillaries with a pore size of 1.5 μm. The loading capacity was 0.3 μg enzyme per mg of capillary with a residual enzyme activity of 43%. The enzyme specific peptide fingerprint produced with this proteolytic capillary reactor system correlated with the degree of hydrolysis, which can be controlled over the residence time by adjusting the flow rate. Common food proteins like casein, sunflower and lupin protein isolates were tested for continuous hydrolysis in the developed reactor system. The peptide formation was investigated by high-performance liquid chromatography. Various trends were found for the occurrence of specific peptides. Some are just intermediately occurring, while others cumulate by time. Thus, the developed continuous reactor system enables the production of specific peptides with desired bioactive properties.
Organisation der IT-Sicherheit in der Produktion : in zehn Schritten zur sicheren Produktionsanlage
(2018)
Der folgende Beitrag befasst sich mit der IT-Sicherheit von Produktionsanlagen aus Betreibersicht. Hierbei liegt der Fokus auf den organisatorischen Aspekten der IT-Sicherheit. In einer Bestandsaufnahme werden zunächst die Probleme herausgearbeitet, die entstehen, sofern sich eine Organisation im Wesentlichen auf technische Aspekte der IT-Sicherheit konzentriert. Daraus wird die Notwendigkeit organisatorischer Maßnahmen abgeleitet. Eine Betrachtung von Normen und Standards, die sich mit den organisatorischen Aspekten der IT-Sicherheit in der Produktion befassen, liefert das Grundgerüst für die Ableitung eines Maßnahmenplans. Der daraus resultierende 10-Punkte-Plan zur Umsetzung der IT-Sicherheit in der Produktion schließt den Beitrag ab.
Background: Given both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124).
Methods: The measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 “exploration of the situation”, interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 “development of measures to improve collaboration”, ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study "study part 3" four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses.
Results: Six measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a “main contact person” was not considered as an improvement.
Conclusions: Six measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research.
Trial registration: Not applicable.
Staphylococcus aureus is recognized worldwide as one of the major agents of dairy cow intra-mammary infections. This microorganism can express a wide spectrum of pathogenic factors used to attach, colonize, invade and infect the host. The present study evaluated 120 isolates from eight different countries that were genotyped by RS-PCR and investigated for 26 different virulence factors to increase the knowledge on the circulating genetic lineages among the cow population with mastitis. New genotypes were observed for South African strains while for all the other countries new variants of existing genotypes were detected. For each country, a specific genotypic pattern was found. Among the virulence factors, fmtB, cna, clfA and leucocidins genes were the most frequent. The sea and sei genes were present in seven out of eight countries; seh showed high frequency in South American countries (Brazil, Colombia, Argentina), while sel was harboured especially in one Mediterranean country (Tunisia). The etb, seb and see genes were not detected in any of the isolates, while only two isolates were MRSA (Germany and Italy) confirming the low diffusion of methicillin resistance microorganism among bovine mastitis isolates. This work demonstrated the wide variety of S. aureus genotypes found in dairy cattle worldwide. This condition suggests that considering the region of interest might help to formulate strategies for reducing the infection spreading.
A nonblinded, positively controlled, noninferiority trial was conducted to evaluate the efficacy of an alternative, nonantibiotic therapy with Masti Veyxym® to reduce ineffective antibiotic usage in the treatment of nonsevere clinical mastitis (CM) in cows with longer lasting udder diseases. The solely intramammary treatment with Masti Veyxym® (three applications, 12 hr apart) and the combined treatment with Masti Veyxym® and antibiotics as usual on the farm according to label of the respective product were compared with the reference treatment of solely antibiotic therapy. The matched field study was conducted on eight free-stall dairy farms located in Eastern Germany. Cases of mild-to-moderate CM in cows with longer lasting high somatic cell counts in preceding dairy herd improvement test days and with previous CM cases in current lactation were randomly allocated to one of the three treatment groups. A foremilk sample of the affected quarter was taken before treatment and again approximately 14 days and 21 days after the end of therapy for cyto-bacteriological examination. Primary outcomes were clinical cure (CC) and no CM recurrence within 60 days after the end of treatment (no R60). Bacteriological cure (BC) and quarter somatic cell count (QSCC) cure were chosen as secondary outcomes although low probabilities of BC and QSCC cure for selected cows were expected. The study resulted in the following findings: the pathogens mostly cultured from pretreatment samples were Streptococcus uberis, followed by Staphylococcus aureus and coagulase-negative staphylococci. There were no significant differences between the two test treatments in comparison with the reference treatment regarding all outcome variables. The sole therapy with Masti Veyxym® resulted in a numerically lower likelihood of BC without significant differences to the reference treatment. The combined therapy group showed a numerically higher nonrecurrence rate than the two other treatment groups and noninferiority compared to the reference treatment was proven. Having regard to the selection criteria of cows in this study, the findings indicated that sole treatment with Masti Veyxym® in nonsevere CM cases may constitute an alternative therapy to reduce antibiotics. However, noninferiority evaluations were mostly inconclusive. Further investigations with a larger sample size are required to confirm the results and to make a clear statement on noninferiority.
Medical devices are health care products distinguished from drugs for regulatory purposes in most countries based on mechanism of action. Unlike drugs, medical devices operate via physical or mechanical means and are not dependent on metabolism to accomplish their primary intended effect. Developing new medical devices requires clinical investigations and approval process goes through similar process like drugs. Medical device approvals in the period of 2010 to 2014 were searched from USFDA website. Disease burden data in the similar period was searched from centers for disease control and prevention website. Collected data was analyzed to know number of approved devices, top therapy areas, and mechanism of action of these devices. Out of a total of 200 medical devices approvals in the time period of 2010 to 2014, maximum number of devices (51; 25.5%) were approved in the year 2011, cardiovascular (78; 39%) was the top therapy area. Highest number (180; 90%) of approved medical devices belonged to the category III and maximum number (73; 36.5%) of approved medical devices had ―mechanical‖ mechanism of action. The top 3 causes of deaths in USA during 2010 to 2014 were heart disease, cancer and followed by respiratory infection. There was a match between the top diseases and the medical device approvals for top 2 diseases in USA i.e. heart disease, and cancer. With respect to respiratory infections and ailments which was the 3rd leading cause of death only one device was approved out of 200 approvals in total.