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Background
In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention.
Methods
This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed.
Discussion
This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers.
With an increasing complexity and scale, sufficient evaluation of Information Systems (IS) becomes a challenging and difficult task. Simulation modeling has proven as suitable and efficient methodology for evaluating IS and IS artifacts, presupposed it meets certain quality demands. However, existing research on simulation modeling quality solely focuses on quality in terms of accuracy and credibility, disregarding the role of additional quality aspects. Therefore, this paper proposes two design artifacts in order to ensure a holistic quality view on simulation quality. First, associated literature is reviewed in order to extract relevant quality factors in the context of simulation modeling, which can be used to evaluate the overall quality of a simulated solution before, during or after a given project. Secondly, the deduced quality factors are integrated in a quality assessment framework to provide structural guidance on the quality assessment procedure for simulation. In line with a Design Science Research (DSR) approach, we demonstrate the eligibility of both design artifacts by means of prototyping as well as an example case. Moreover, the assessment framework is evaluated and iteratively adjusted with the help of expert feedback.
Background:
Multiple Sclerosis (MS) is a chronic inflammatory, immune mediated disease of the central nervous system, with Relapsing Remitting MS (RRMS) being the most common type. Within the last years, the status of high disease activity (HDA) has become increasingly important for clinical decisions. Nevertheless, little is known about the incidence, the characteristics, and the current treatment of patients with RRMS and HDA in Germany. Therefore, this study aims to estimate the incidence of HDA in a German RRMS patient population, to characterize this population and to describe current drug treatment routines and further healthcare utilization of these patients.
Methods:
A claims data analyses has been conducted, using a sample of the InGef Research Database that comprises data of approximately four million insured persons from around 70 German statutory health insurances (SHI). The study was conducted in a retrospective cohort design, including the years 2012–2016. Identification of RRMS population based on ICD-10 code (ICD-10-GM: G35.1). For identification of HDA, criteria from other studies as well as expert opinions have been used. Information on incidence, characteristics and current treatment of patients with RRMS and HDA was considered.
Results:
The overall HDA incidence within the RRMS population was 8.5% for 2016. It was highest for the age group of 0–19 years (29.4% women, 33.3% men) and lowest for the age group of ≥ 50 years (4.3% women, 5.6% men). Mean age of patients with RRMS and incident HDA was 38.4 years (SD: 11.8) and women accounted for 67.8%.
Analyses of drug utilization showed that 82.4% received at least one disease-modifying drug (DMD) in 2016. A percentage of 49.8% of patients received drugs for relapse therapy. A share of 55% of RRMS patients with HDA had at least one hospitalization with a mean length of stay of 13.9 days (SD: 18.3 days) in 2016. The average number of outpatient physician contacts was 28.1 (SD: 14.0).
Conclusions:
This study based on representative Germany-wide claims data from the SHI showed a high incidence of HDA especially within the young RRMS population. Future research should consider HDA as an important criterion for the quality of care for MS patients.
Microservices is an architectural style for complex application systems, promising some crucial benefits, e.g. better maintainability, flexible scalability, and fault tolerance. For this reason microservices has attracted attention in the software development departments of different industry sectors, such as ecommerce and streaming services. On the other hand, businesses have to face great challenges, which hamper the adoption of the architectural style. For instance, data are often persisted redundantly to provide fault tolerance. But the synchronization of those data for the sake of consistency is a major challenge. Our paper presents a case study from the insurance industry which focusses consistency issues when migrating a monolithic core application towards microservices. Based on the Domain Driven Design (DDD) methodology, we derive bounded contexts and a set of microservices assigned to these contexts. We discuss four different approaches to ensure consistency and propose a best practice to identify the most appropriate approach for a given scenario. Design and implementation details and compliance issues are presented as well.
The reactivity of graphene at its boundary region has been imaged using non-linear spectroscopy to address the controversy whether the terraces of graphene or its edges are more reactive. Graphene was functionalised with phenyl groups, and we subsequently scanned our vibrational sum-frequency generation setup from the functionalised graphene terraces across the edges. A greater phenyl signal is clearly observed at the edges, showing evidence of increased reactivity in the boundary region. We estimate an upper limit of 1 mm for the width of the CVD graphene boundary region.
Self-directed learning is an essential basis for lifelong learning and requires constantly changing, target groupspecific and personalized prerequisites in order to motivate people to deal with modern learning content, not to overburden them and yet to adequately convey complex contexts. Current challenges in dealing with digital resources such as information overload, reduction of complexity and focus, motivation to learn, self-control or psychological wellbeing are taken up in the conception of learning settings within our QpLuS IM project for the study program Information Management and Information Management extra-occupational (IM) at the University of Applied Sciences and Arts Hannover. We present an interactive video on the functionality of search engines as a practical example of a medially high-quality and focused self-learning format that has been methodically produced in line with our agile, media-didactic process and stage model of complexity levels.
Aim:
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods:
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results:
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions:
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
Background:
Hereditary angioedema (HAE) is a rare genetic disease and characterized by clinical features such as paroxysmal, recurrent angioedema of the skin, the gastrointestinal tract, and the upper airways. Swelling of the skin occurs primarily in the face, extremities and genitals. Gastrointestinal attacks are accompanied by painful abdominal cramps, vomiting and diarrhea. Due to the low prevalence and the fact that HAE patients often present with rather unspecific symptoms such as abdominal cramps, the final diagnosis is often made after a long delay. The aim of this German-wide survey was to characterize the period between occurrence of first symptoms and final diagnosis regarding self-perceived health, symptom burden and false diagnoses for patients with HAE.
Results:
Overall, 81 patients with HAE were included and participated in the telephone-based survey. Of those, the majority reported their current health status as “good” (47.5%) or “very good” (13.8%), which was observed to be a clear improvement compared to the year before final diagnosis (“good” (16.3%), “very good” (11.3%)). Edema in the extremities (85.2%) and in the gastrointestinal tract (81.5%) were the most currently reported symptoms and occurred earlier than other reported symptoms (mean age at onset 18.1 and 17.8 years, respectively). Misdiagnoses were observed in 50.6% of participating HAE patients with appendicitis and allergy being the most frequently reported misdiagnoses (40.0 and 30.0% of those with misdiagnosis, respectively). Patients with misdiagnosis often received mistreatment (80.0%) with pharmaceuticals and surgical interventions as the most frequently carried out mistreatments (65.6 and 56.3% of those with mistreatment, respectively). The mean observed diagnostic delay was 18.1 years (median 15.0 years). The diagnostic delay was higher in older patients and index patients.
Conclusions:
This study showed that self-perceived status of health for patients is much better once the final correct diagnosis has been made and specific treatment was available. Further challenge in the future will still be to increase awareness for HAE especially in settings which are normally approached by patients at occurrence of first symptoms to assure early referral to specialists and therefore increase the likelihood of receiving an early diagnosis.
Der vorliegende Beitrag beschreibt Einsatzpotenziale des Energiemanagementprofils PROFIenergy in der Prozessindustrie.
Der Blick auf den Status von Energieeffizienzmaßnahmen in der Prozessindustrie zeigt, dass diese im Wesentlichen innerhalb der verfahrenstechnischen Optimierung angesiedelt sind. Noch hat sich der durchgängige Einsatz von technischen Energiemanagementsystemen
(tEnMS) nicht etabliert. Diese Arbeit fokussiert Vorteile des tEnMS-Einsatzes und präsentiert „Best Practice“- Beispiele in der Prozessindustrie. Abschließend wird aufgezeigt, welches Potenzial das Energiemanagementprofil PROFIenergy liefern kann und welche Anwendungsfälle sich damit abdecken lassen.
After kidney transplantation graft rejection must be prevented. Therefore, a multitude of parameters of the patient is observed pre- and postoperatively. To support this process, the Screen Reject research project is developing a data warehouse optimized for kidney rejection diagnostics. In the course of this project it was discovered that important information are only available in form of free texts instead of structured data and can therefore not be processed by standard ETL tools, which is necessary to establish a digital expert system for rejection diagnostics. Due to this reason, data integration has been improved by a combination of methods from natural language processing and methods from image processing. Based on state-of-the-art data warehousing technologies (Microsoft SSIS), a generic data integration tool has been developed. The tool was evaluated by extracting Banff-classification from 218 pathology reports and extracting HLA mismatches from about 1700 PDF files, both written in german language.