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The German Corona Consensus (GECCO) established a uniform dataset in FHIR format for exchanging and sharing interoperable COVID-19 patient specific data between health information systems (HIS) for universities. For sharing the COVID-19 information with other locations that use openEHR, the data are to be converted in FHIR format. In this paper, we introduce our solution through a web-tool named “openEHR-to-FHIR” that converts compositions from an openEHR repository and stores in their respective GECCO FHIR profiles. The tool provides a REST web service for ad hoc conversion of openEHR compositions to FHIR profiles.
Techno-economic analysis that allocate costs to the energy flows of energy systems are helpful to understand the formation of costs within processes and to increase the cost efficiency. For the economic evaluation, the usefulness or quality of the energy is of great importance. In exergy-based methods, this is considered by allocating costs to the exergy instead of energy. As exergy represents the ability of performing work, it is often named the useful part of energy. In contrast, the anergy, the part of energy, which cannot perform work, is often assumed to be not useful.
However, heat flows as used e.g. in domestic heating are always a mixture of a relative small portion of exergy and a big portion of anergy. Although of lower quality, the anergy is obviously useful for these applications. The question is, whether it makes sense to differentiate between exergy and anergy and take both properties into account for the economic evaluation.
To answer this question, a new methodical concept based on the definition of an anergy-exergy cost ratio is compared to the commonly applied approaches of considering either energy or exergy as the basis for economic evaluation. These three different approaches for the economic analysis of thermal energy systems are applied to an exemplary heating system with thermal storages. It is shown that the results of the techno-economic analysis can be improved by giving anergy an economic value and that the proposed anergy-cost ratio allows a flexible adaptation of the evaluation depending on the economic constraints of a system.
This research focuses on the fundamental ideas and underlying principles of E-Learning technology, as well as theoretical considerations for an optimal learning environment. This theoretical exploration was then used as a basis for the design and construction of a new, interactive Web-Based ESH-Training. The quality and effectiveness of this new course was then compared with that of the existing analog PDF-Training via a test with a diverse sample of employee learners. Learners were later surveyed to ascertain their views on both trainings in terms of the quality of the content, facilitator, resources, and length. Results clearly showed that regardless of demographic factors, most employee learners preferred the new, Web-Based ESH-Training to the analog PDF-Training.
Der Bericht über die Mitgliederversammlung gliedert sich in vier Teile: Einen kurzen Bericht über die formalen Anteile der Versammlung (1), die kurze Vorstellung der mit dem Cora-Baltussen-Förderpreis ausgezeichneten Abschlussarbeiten (2), eine Paraphrase des Vortrags von Armin Nassehi (3) sowie eine kritisch-kommentierende Diskussion des Fishbowls über Führungskräfte in der klinischen Pflege (4).
Zu den Phänomenen digitalisierter Kommunikation ist inzwischen auch die Chatberatung zu zählen. Vor diesem Hintergrund zeigt sich die Notwendigkeit, Kommunikation via Chat phänomenologisch zu durchdringen, sozialtheoretisch einzuordnen und beratungsethisch kritisch zu reflektieren. Dies geschieht am Beispiel der Chatseelsorge, die zugleich von Beratung unterschieden wird.
Introduction
Atopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system.
Methods
In this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017.
Results
9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026.
Conclusions
Despite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI.
Background and Objectives:
Drawing causal conclusions from real-world data (RWD) poses methodological challenges and risk of bias. We aimed to systematically assess the type and impact of potential biases that may occur when analyzing RWD using the case of progressive ovarian cancer.
Methods:
We retrospectively compared overall survival with and without second-line chemotherapy (LOT2) using electronic medical records. Potential biases were determined using directed acyclic graphs. We followed a stepwise analytic approach ranging from crude analysis and multivariable-adjusted Cox model up to a full causal analysis using a marginal structural Cox model with replicates emulating a reference randomized controlled trial (RCT). To assess biases, we compared effect estimates (hazard ratios [HRs]) of each approach to the
HR of the reference trial.
Results:
The reference trial showed an HR for second line vs. delayed therapy of 1.01 (95% confidence interval [95% CI]: 0.82e1.25). The corresponding HRs from the RWD analysis ranged from 0.51 for simple baseline adjustments to 1.41 (95% CI: 1.22e1.64) accounting for immortal time bias with time-varying covariates. Causal trial emulation yielded an HR of 1.12 (95% CI: 0.96e1.28).
Conclusion:
Our study, using ovarian cancer as an example, shows the importance of a thorough causal design and analysis if one is expecting RWD to emulate clinical trial results.
Aim
Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns.
Subject and methods
German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected.
Results
In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level.
Conclusion
This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.