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The Logical Observation Identifiers, Names and Codes (LOINC) is a common terminology used for standardizing laboratory terms. Within the consortium of the HiGHmed project, LOINC is one of the central terminologies used for health data sharing across all university sites. Therefore, linking the LOINC codes to the site-specific tests and measures is one crucial step to reach this goal. In this work we report our ongoing efforts in implementing LOINC to our laboratory information system and research infrastructure, as well as our challenges and the lessons learned. 407 local terms could be mapped to 376 LOINC codes of which 209 are already available to routine laboratory data. In our experience, mapping of local terms to LOINC is a widely manual and time consuming process for reasons of language and expert knowledge of local laboratory procedures.
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.
Purpose: Radiology reports mostly contain free-text, which makes it challenging to obtain structured data. Natural language processing (NLP) techniques transform free-text reports into machine-readable document vectors that are important for creating reliable, scalable methods for data analysis. The aim of this study is to classify unstructured radiograph reports according to fractures of the distal fibula and to find the best text mining method.
Materials & Methods: We established a novel German language report dataset: a designated search engine was used to identify radiographs of the ankle and the reports were manually labeled according to fractures of the distal fibula. This data was used to establish a machine learning pipeline, which implemented the text representation methods bag-of-words (BOW), term frequency-inverse document frequency (TF-IDF), principal component analysis (PCA), non-negative matrix factorization (NMF), latent Dirichlet allocation (LDA), and document embedding (doc2vec). The extracted document vectors were used to train neural networks (NN), support vector machines (SVM), and logistic regression (LR) to recognize distal fibula fractures. The results were compared via cross-tabulations of the accuracy (acc) and area under the curve (AUC).
Results: In total, 3268 radiograph reports were included, of which 1076 described a fracture of the distal fibula. Comparison of the text representation methods showed that BOW achieved the best results (AUC = 0.98; acc = 0.97), followed by TF-IDF (AUC = 0.97; acc = 0.96), NMF (AUC = 0.93; acc = 0.92), PCA (AUC = 0.92; acc = 0.9), LDA (AUC = 0.91; acc = 0.89) and doc2vec (AUC = 0.9; acc = 0.88). When comparing the different classifiers, NN (AUC = 0,91) proved to be superior to SVM (AUC = 0,87) and LR (AUC = 0,85).
Conclusion: An automated classification of unstructured reports of radiographs of the ankle can reliably detect findings of fractures of the distal fibula. A particularly suitable feature extraction method is the BOW model.
Key Points:
- The aim was to classify unstructured radiograph reports according to distal fibula fractures.
- Our automated classification system can reliably detect fractures of the distal fibula.
- A particularly suitable feature extraction method is the BOW model.
The Wnt signaling pathway has been associated with many essential cell processes. This study aims to examine the effects of Wnt signaling on proliferation of cultured HEK293T cells. Cells were incubated with Wnt3a, and the activation of the Wnt pathway was followed by analysis of the level of the β-catenin protein and of the expression levels of the target genes MYC and CCND1. The level of β-catenin protein increased up to fourfold. While the mRNA levels of c-Myc and cyclin D1 increased slightly, the protein levels increased up to a factor of 1.5. Remarkably, MTT and BrdU assays showed different results when measuring the proliferation rate of Wnt3a stimulated HEK293T cells. In the BrdU assays an increase of the proliferation rate could be detected, which correlated to the applied Wnt3a concentration. Oppositely, this correlation could not be shown in the MTT assays. The MTT results, which are based on the mitochondrial activity, were confirmed by analysis of the succinate dehydrogenase complex by immunofluorescence and by western blotting. Taken together, our study shows that Wnt3a activates proliferation of HEK293 cells. These effects can be detected by measuring DNA synthesis rather than by measuring changes of mitochondrial activity.
Harmonisation of German Health Care Data Using the OMOP Common Data Model – A Practice Report
(2023)
Data harmonization is an important step in large-scale data analysis and for generating evidence on real world data in healthcare. With the OMOP common data model, a relevant instrument for data harmonization is available that is being promoted by different networks and communities. At the Hannover Medical School (MHH) in Germany, an Enterprise Clinical Research Data Warehouse (ECRDW) is established and harmonization of that data source is the focus of this work. We present MHH’s first implementation of the OMOP common data model on top of the ECRDW data source and demonstrate the challenges concerning the mapping of German healthcare terminologies to a standardized format.
Diese Arbeit thematisiert die unausgeschöpften Potentiale der von Designer*innen erzeugten Formen. Um zu klären, welche Wichtigkeit der Formfindung innerhalb des gestalterischen Prozesses zukommt, wird die Form mit anderen Parametern der Gestaltung verglichen. Es wird untersucht, welche Wirkungen die Formen auf Menschen haben können, die mit ihnen interagieren wollen oder müssen. Auf der Suche nach Möglichkeiten, die so ermittelten Potentiale freizuschalten, wird der bisher begrenzende Rahmen betrachtet. In einem phänomenologischen Versuch wird geprüft, welche Mannigfaltigkeit von dem generativen Prozess einer künstlichen Intelligenz vorgeschlagen werden kann. Das Ergebnis sind verschobene Grenzen, die zahlreiche Felder der Formausprägung zu einem Größeren erschließen. Eine absolute Entgrenzung des Formendenkens muss derweil scheitern.
The NOA project collects and stores images from open access publications and makes them findable and reusable. During the project a focus group workshop was held to determine whether the development is addressing researchers’ needs. This took place before the second half of the project so that the results could be considered for further development since addressing users’ needs is a big part of the project. The focus was to find out what content and functionality they expect from image repositories.
In a first step, participants were asked to fill out a survey about their images use. Secondly, they tested different use cases on the live system. The first finding is that users have a need for finding scholarly images but it is not a routine task and they often do not know any image repositories. This is another reason for repositories to become more open and reach users by integrating with other content providers. The second finding is that users paid attention to image licenses but struggled to find and interpret them while also being unsure how to cite images. In general, there is a high demand for reusing scholarly images but the existing infrastructure has room to improve.
Die vorliegende Bachelorarbeit untersucht Onboarding-Prozesse wissenschaftlicher Bibliotheken, insbesondere anhand einer Analyse der Universitätsbibliothek der Friedrich-Alexander-Universität Erlangen-Nürnberg. Im ersten Teil werden organisationstheoretische und interdisziplinäre Grundlagen beleuchtet. Dabei liegt ein Fokus auf den Herausforderungen, Nutzen und Zielen von Onboarding-Maßnahmen in Abhängigkeit ihres Zeitpunktes und der Zielgruppe. Im Praxisteil werden die gewonnenen Erkenntnisse auf die spezifischen Anforderungen von wissenschaftlichen Bibliotheken angewendet. Die Analyse von Onboarding-Prozessen der Universitätsbibliothek der Friedrich-Alexander-Universität Erlangen-Nürnberg beinhaltet eine Mitarbeitendenbefragung von Onboardees und beteiligten Personen. Die Ergebnisse werden nach der SWOT-Methode eingeordnet. Anschließend folgen Konzepte zur Entwicklung von Arbeitsmaterialien, Unterlagen interner Kommunikation und ein Datenbankkonzept.
Schließlich erfolgt eine ableitende Handlungsempfehlung für eine effektive Umsetzung von Onboarding in wissenschaftlichen Bibliotheken. Das Fazit fasst die wichtigsten Erkenntnisse zusammen, während der Anhang alle Informationen zu den durchgeführten Befragungen, deren Auswertung und die erstellten Arbeitsmaterialien bzw. deren Konzept enthält.
Building a well-founded understanding of the concepts, tasks and limitations of IT in all areas of society is an essential prerequisite for future developments in business and research. This applies in particular to the healthcare sector and medical research, which are affected by the noticeable advances in digitization. In the transfer project “Zukunftslabor Gesundheit” (ZLG), a teaching framework was developed to support the development of further education online courses in order to teach heterogeneous groups of learners independent of location and prior knowledge. The study at hand describes the development and components of the framework.
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.
In this poster we present the ongoing development of an integrated free and open source toolchain for semantic annotation of digitised cultural heritage. The toolchain development involves the specification of a common data model that aims to increase interoperability across diverse datasets and to enable new collaborative research approaches.
This paper aims to provide a structured overview of four open, participatory formats that are particularly applicable in inquiry-based teaching and learning contexts: hackathons, book sprints, barcamps, and learning circles. Using examples, mostly from the work and experience context of the Open Science Lab at TIB Hannover, we address concrete processes, working methods, possible outcomes and challenges.
The compilation offers an introduction to the topic and is intended to provide tools for testing in practice.
Diese Bachelorarbeit untersucht den Einfluss von Fitness-Influencer*innen auf Instagram auf die Körperzufriedenheit der Rezipierenden. Sie untersucht die Auswirkungen von Fitness-Influencer*innen und dessen Internetauftritt auf die Zufriedenheit mit dem eigenen Körper der Rezipierenden unter Einbeziehung sozialer Vergleichsprozesse. Um empirische Befunde liefern zu können, wurde eine standardisierte Online-Befragung durchgeführt.
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.
Hate Speech hat im Zeitalter des Web 2.0 eine neue Dimension und Dynamik angenommen. Der Wunsch nach Regulierung ist moralisch begründbar und erste Staaten haben bereits reagiert. Dabei sind die Verfechter der freien Rede tief gespalten. Wo endet das Recht auf freie Meinungsäußerung und wann sollte Hassrede strafbar sein? Die Vereinten Nationen liefern mit dem Rabat Plan of Action eine Hilfestellung für eine qualifizierte Entscheidung. In dieser Studienarbeit werden die Gefahren der Hate Speech und damit die Chancen ihrer Regulierung wie auch deren Risiken aus ethischer Sicht erörtert und die Bedeutung des Rabat Threshold Test vor diesem Hintergrund beleuchtet; ehe sie mit einer persönlichen Stellungnahme schließt.
New Work als innovativer Ansatz zur Überwindung des Fachkräftemangels in der Veranstaltungsbranche
(2023)
In der vorliegenden Arbeit wird mittels einer Einzelfallstudie über die Live-Kommunikations Agentur Klubhaus untersucht, ob New Work ein Ansatz zur Überwindung des Fachkräftemangels sein kann. Die Veranstaltungsbranche leidet derzeit unter einem Fachkräftemangel. Zentrale Gründe dafür sind die Corona Pandemie und ein schlechtes Branchenimage im Hinblick auf die Arbeitsbedingungen. Folgen des Fachkräftemangels in der Veranstaltungsbranche sind eine eingeschränkte Geschäftsfähigkeit der Akteur*innen, ein Kompetenzverlust der Branche, eine sinkende Mitarbeitendenzufriedenheit, steigende Personalkosten und der Wegfall kleinteiliger Branchenstrukturen. Die Veranstaltungsbranche ist geprägt von herausfordernden, personalbezogenen Strukturen, wie einer hohen Anzahl an Soloselbstständigen und einer projektorientierten Arbeitsweise. Darüber hinaus stellen die Digitalisierung, der demografische Wandel und der gesellschaftliche Wertewandel zentrale Herausforderungen für das Personalmanagement dar. Um diesen angemessen zu begegnen, sind Strategien zur Personalbindung und -rekrutierung notwendig. Eine Strategie kann die Implementierung von New Work Merkmalen sein. Das Ziel von New Work ist, die Arbeit so zu transformieren, dass die Arbeit dem Menschen und nicht der Mensch der Arbeit dient. Die Ausübung einer sinnstiftenden Tätigkeit und eine selbstbestimmte Arbeitsweise zählen z.B. zu New Work. Innovative Bürokonzepte, Agilität und flache Hierarchien, Flexibilität sowie Personalentwicklung sind zudem moderne New Work Merkmale. Für eine erfolgreiche Implementierung und Ausübung von New Work ist der regelmäßige Austausch über die New Work Merkmale im gesamten Team elementar. Zu einer nachhaltigen Fachkräftebindung und -rekrutierung können vor allem sinnstiftende Tätigkeiten und eine selbstbestimmte Arbeitsweise beitragen. Doch auch die modernen New Work Merkmale tragen zu einer nachhaltigen Fachkräftebindung und -rekrutierung bei. Wichtig zu beachten ist, dass ein branchenweiter Wandel in Richtung New Work zur Überwindung des Fachkräftemangels notwendig ist. Die Umsetzung von New Work Merkmalen ist auch in einer unter Fachkräftemangel leidenden und zugleich wachsenden Branche möglich. Insgesamt stellt die Kombination aus New Work und einem erhöhten Gehaltsniveau den zentralen Ansatz zur Überwindung des Fachkräftemangels in der Veranstaltungsbranche dar.
Purpose: The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information.
Methods: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients’ and referring physicians’ preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models.
Results: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, “Postoperative complication rate” (20.6%; level range of 1.164) was rated highest, followed by “Mobility at hospital discharge” (19.9%; level range of 1.127), and ‘‘The number of cases treated” (18.5%; level range of 1.045). In contrast, referring physicians valued most the ‘‘One-year revision surgery rate’’ (30.4%; level range of 1.989), followed by “The number of cases treated” (21.0%; level range of 1.372), and “Postoperative complication rate” (17.2%; level range of 1.123).
Conclusion: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.
Die fortschreitende Digitalisierung unserer modernen Welt betrifft zwangsläufig auch den Bereich der Nachlässe. Fast jede verstorbene Person hinterlässt nicht nur Hausrat, Bücher, Bargeld oder Wohnungen, sondern auch digitale Spuren in Form von Daten auf heimischen Computern sowie E-Mail Konten, Chatverläufe in Nachrichtensofortdiensten auf Smartphones, Online-Bankkonten, Konten bei Bezahldiensten, Internethandelsplattformen, sozialen Netzwerken, sowie Daten unterschiedlichster Art in Cloudspeicherorten oder in anderer nicht genannter Form im World-Wide-Web. Wahrscheinlich werden diese digitalen Speicherorte oder Zugangsdaten deshalb noch nicht grundsätzlich in Vorsorgevollmachten bzw. Testamenten benannt, weil sie noch nicht im nachlass-verwaltenden Bewusstsein der Bevölkerung verankert sind. Der nahezu selbstverständlich gewordene Umgang mit den digitalen Formaten sollte diese jedoch in die Auflistung des Nachlasses miteinschließen, damit eine Erbengemeinschaft die Möglichkeit erhält, sich auch um diesen Teil des Nachlasses adäquat kümmern zu können.
Chronic kidney disease is one of the main causes of mortality worldwide. It affects more than 800 million patients globally, accounting for approximately 10% of the general population. The significant burden of the disease prompts healthcare systems to implement adequate preventive and therapeutic measures. This systematic review and meta-analysis aimed to provide a concise summary of the findings published in the existing body of research about the influence that mobile health technology has on the outcomes of patients with the disease. A comprehensive systematic literature review was conducted from inception until March 1st, 2023. This systematic review and meta-analysis included all clinical trials that compared the efficacy of mobile app-based educational programs to that of more conventional educational treatment for the patients. Eleven papers were included in the current analysis, representing 759 CKD patients. 381 patients were randomly assigned to use the mobile apps, while 378 individuals were assigned to the control group. The mean systolic blood pressure was considerably lower in the mobile app group (MD -4.86; 95%-9.60, -0.13; p=0.04). Meanwhile, the mean level of satisfaction among patients who used the mobile app was considerably greater (MD 0.75; 95% CI 0.03, 1.46; p=0.04). Additionally, the mean self-management scores in the mobile app groups were significantly higher (SMD 0.534; 95% CI 0.201, 0.867; p=0.002). Mobile health applications are potentially valuable interventions for patients. This technology improved the self-management of the disease, reducing the mean levels of systolic blood pressure with a high degree of patient satisfaction.
Der Bericht bezieht sich auf ein Forschungssemester, das die Relevanz und Zukunft der Inhaltserschließung zum Gegenstand hatte. Er beschreibt den Verlauf des Semesters zwischen Wunsch und Wirklichkeit und erörtert Fehler, die in den verschiedenen Phasen des Projekts gemacht wurden. Aus der Beschreibung wird deutlich, dass Motivation, Leidenschaft und vor allem Spaß wichtige Voraussetzungen dafür sind, dass Forschung gelingt bzw. als gelungen erlebt werden kann.
Im Bachelorstudiengang Informationsmanagement – berufsbegleitend der HS Hannover werden seit zehn Jahren Fachangestellte für Medien- und Informationsdienste (FaMIs) für höhere Aufgaben im Bibliotheksbereich qualifiziert. Die Studierenden sind in öffentlichen oder wissenschaftlichen Bibliotheken tätig. Zum Studium gelangen sie entweder mit schulischer Zugangsberechtigung oder über den Weg der Offenen Hochschule Niedersachsen (FaMI-Ausbildung + mindestens dreijährige einschlägige Berufserfahrung). Anlässlich einer bevorstehenden Studienreform wurden die 125 Alumni der ersten sieben Jahrgänge im Februar 2023 in einer Onlinebefragung zu ihrem weiteren beruflichen Werdegang und ihrer retrospektiven Einschätzung des Studiums befragt (Rücklaufquote 93%). Die Ergebnisse zeigen eine sehr große Zufriedenheit mit Studium und beruflicher Entwicklung. Sie liefern zudem Anhaltspunkte für eine Ergänzung bzw. Vertiefung des Curriculums um Themen wie Personalmanagement und Open Science. Die 116 Antwortenden machten zudem deutlich, dass sie zwar als qualifizierte Fachkräfte auf dem Arbeitsmarkt willkommen sind, aber während des Studiums nicht genug Unterstützung von ihren Arbeitgebern bekommen haben. Ein Drittel von ihnen wechselte spätestens nach dem Studium die Einrichtung.
Fragebogen zur Absolvent:innenstudie 2023 - Studiengang Informationsmanagement berufsbegleitend
(2023)
Der Fragebogen stellt das Erhebungsinstrument einer Absolvent:innenstudie des Bachelorstudiengangs „Informationsmanagement – berufsbegleitend“ der Hochschule Hannover dar, die im Februar 2023 als Onlinebefragung durchgeführt wurde. In dem Studiengang werden Fachangestellte für Medien- und Informationsdienste (FaMIS) für höhere Aufgaben im Bibliotheksbereich qualifiziert. Gegenstand der Untersuchung, in die alle 125 Alumni der Jahrgänge 2012 bis 2018 einbezogen wurden, war deren weiterer beruflicher Werdegang und ihre retrospektive Einschätzung des Studiums. Im Einzelnen enthält der Fragebogen Fragekomplexe zu Ausgangssituation, Berufslaufbahn und Berufstätigkeit der Zielgruppe, zu ihrem Feedback auf das Studium sowie zur Unterstützung durch die Arbeitgeber und zu der Vereinbarkeit von Studium und Beruf. Die Ergebnisse der Studie wurden auszugsweise auf dem 111. BiblioCon 2023 in Hannover vorgestellt.
In diesem Kurzbericht wird zusammenfassend ein Projekt vorgestellt, welches von Studierenden der Hochschule Hannover im Rahmen des berufsbegleitenden Studiengangs Informationsmanagement in Kooperation mit der Stadtbibliothek Hannover durchgeführt wurde. Das Ziel des Projekts war es, einen Kriterienkatalog zu erstellen, mit dem die Diversitätskompetenz von Bibliotheken evaluiert werden kann. Er soll dabei helfen, Strategien zu entwickeln, um passende Angebote für Nutzende aus vielfältigen Facetten der Diversität anzubieten. Konkret geht es um die Facetten Körperliche Behinderung, Geistige Behinderung, Neurodivergenz, Geschlechtsidentität und Queerness, sowie Armut und Obdachlosigkeit. Die zentrale Fragestellung lautete, wie gut Bibliotheken darin sind, nutzbare und relevante Dienstleistungen für diese Bevölkerungsgruppen anzubieten. Erstellt wurde dieser Katalog mit Hilfe von Interviews mit Personen, die den jeweiligen Facetten angehören. Angewandt wurde der Kriterienkatalog beispielhaft an der Zentralbibliothek der Stadtbibliothek Hannover.
Der Kriterienkatalog kann zusätzlich als Tabellendokument zur Nachnutzung heruntergeladen werden.
Ausführlichere Informationen zum Projekt und dem erarbeiteten Kriterienkatalog erscheinen in einem Artikel in der Ausgabe Dezember 2023 der Zeitschrift "BuB : Forum Information und Dokumentation".
Die Generation Z stellt Arbeitgebende vor eine Herausforderung. In Zeiten, in denen in vielen Branchen Fachkräftemangel herrscht und der Beschäftigten-Nachwuchs in seiner Anzahl wesentlich geringer ist als die Lücken, die Pensionierte bei ihrem Rentenantritt hinterlassen, ist eine hohe Arbeitgebendenattraktivität nicht nur viel Wert, sondern fundamental. Gerade im Hinblick auf die gewünschten Mitarbeitenden jüngerer Generationen müssen Unternehmen neu denken und ihre gewohnten Kommunikationsaktivitäten anpassen. Ein erfolgreiches Employer Branding kennt die Ansprüche und Charakteristika seiner Zielgruppen und schöpft gängige Instrumente und Maßnahmen aus, um den gewünschten Effekt nach außen zu erzeugen. Allerdings wird Sprache auch in dieser Disziplin nicht aktiv in all ihrer Komplexität und mitsamt all ihren Möglichkeiten betrachtet. Ein Instrument, dessen theoretische Fundierung eine lange Zeit zurückreicht, welches jedoch in der dazugehörigen Fachliteratur gemeinhin als wirkungsstark gilt, ist die metaphorische Redewendung.
Die vorliegende Masterarbeit befasst sich mit der Forschungslücke, welche aus der Überschneidung der Themenbereiche Metaphernforschung, Employer Branding (Kommunikation) und (Werten der) Generation Z besteht. Ziel dieser Masterthesis ist das Bestimmen des Status Quos hinsichtlich der Verwendung von Metaphern im Kontext von zielgruppenspezifischer Employer Branding Kommunikation in der deutschen Medienbranche. Mit Bezug auf die Zielgruppe der Generation Z wird die Vermittlung von Werten ebendieser Zielgruppe durch Metaphern in den Fokus genommen.
Background: Autism Spectrum Disorder (ASD) is characterized by impairments in social communication, limited repetitive behaviors, impaired language development, and interest or activity patterns, which include a group complex neurodevelopmental syndrome with diverse phenotypes that reveal considerable etiological and clinical heterogeneity and are also considered one of the most heritable disorders (over 90%). Genetic, epigenetic, and environmental factors play a role in the development of ASD.
Aim: This study was designed to investigate the extent of DNA damage in parents of autistic children by treating peripheral blood mononuclear cells (PBMCs) with bleomycin and hydrogen peroxide (H2O2).
Methods: Peripheral blood mononuclear cells (PBMCs) were isolated by the Ficoll method and treated with a specific concentration of bleomycin and H2O2 for 30 min and 5 min, respectively. Then, the degree of DNA damage was analyzed by the alkaline comet assay or single cell gel electrophoresis (SCGE), an effective way to measure DNA fragmentation in eukaryotic cells.
Results: Our findings revealed that there is a significant difference in the increase of DNA damage in parents with affected children compared to the control group, which can indicate the inability of the DNA molecule repair system. Furthermore, our study showed a significant association between fathers’ occupational difficulties (exposed to the influence of environmental factors), as well as family marriage, and suffering from ASD in offspring.
Conclusion: Our results suggested that the influence of environmental factors on parents of autistic children may affect the development of autistic disorder in their offspring. Subsequently, based on our results, investigating the effect of environmental factors on the amount of DNA damage in parents with affected children requires more studies.
Clio-Guide: Bibliotheken
(2023)
Das Kapitel definiert den Begriff Bibliothek, erläutert die wichtigsten Aufgaben und Dienstleistungen von Bibliotheken und stellt die wichtigsten Elemente des deutschen Bibliothekswesens vor. Darüber hinaus werden typologisch die wichtigsten Gattungen bibliothekarischer Informationsressourcen und -systeme darbestellt. Die behandelten Beispiele berücksichtigen insbesondere die Bedürfnisse von Forschung und Lehre in den historisch arbeitenden Fächern.
Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories “governance”, “modeling” and “standards”, the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.
Die verpflichtende Nachhaltigkeitsberichterstattung ist auf dem Weg das Nachhaltigkeitsreporting von Unternehmen zu verändern. Eine wachsende Zahl an Unternehmen muss immer häufiger Informationen offenlegen, die sie vormals bewusst nicht publizierten. Einige Unternehmen könnten dies als ein Hindernis sehen, andere erkennen darin womöglich eine Chance für die Unternehmenskommunikation. Indem sie über gesetzlichen Mindestanforderungen hinaus publizieren und sich damit für eine umfassendere und transparentere Berichterstattung entscheiden, könnten Unternehmen von Profilierungsmöglichkeiten und Wettbewerbsvorteile profitieren. Das Ziel dieser Arbeit ist die Frage zu beantworten, welche Determinanten die freiwillige Offenlegung von Informationen, die über die gesetzlichen Mindestanforderungen der nichtfinanziellen Erklärung (NfE) hinausgehen, beeinflussen. Um die Forschungsfrage zu beantworten, wurde eine quantitative Inhaltsanalyse von 200 nach dem § 289b Handelsgesetzbuch (HGB) berichtspflichtigen Unternehmen durchgeführt. Hierzu wurden die nichtfinanziellen Erklärungen und weitere nachhaltigkeitsbezogene Informationen auf ihrer Unternehmenswebsite analysiert. Zudem wurde ein Offenlegungsscore konzipiert, um den Grad der zusätzlichen freiwilligen Offenlegung zu messen. Anschließend wurde untersucht, inwieweit Einflussfaktoren eine über die gesetzlichen Mindestanforderungen hinausgehende Offenlegung erklären können. Die Ergebnisse zeigen einen signifikanten Zusammenhang zwischen den Determinanten Unternehmensgröße, Berichtshistorie, Vorstandsgröße sowie dem Anteil ausländischer Vorstandsmitglieder und dem Offenlegungsgrad von freiwilligen zusätzlichen nichtfinanziellen Informationen. Hingegen konnte kein signifikanter Zusammenhang zwischen dem Offenlegungsgrad und den Determinanten Branchenzugehörigkeit, Kapitalmarktorientierung und Frauenanteil im Vorstand beobachtet werden.
Social Scoring in China
(2023)
In den zurückliegenden Jahren hat eine Nachricht Schlagzeilen gemacht, die besonders in der westlichen Welt für Aufruhr gesorgt hat: Die Regierung der Volkrepublik China implementiere ein Sozialkreditsystem, das die Menschen in ihrem alltäglichen Verhalten bewerte und zu „Wohlverhalten" zwingen solle.
Diese Arbeit beschäftigt sich mit den Hintergründen des „Sozialkreditsystem", seiner Entstehung, Umsetzung und der Rezeption durch die chinesische Bevölkerung. Abschließend wird ein Vergleich mit ähnlichen Systemen in Deutschland versucht.
Economic and political/governmental infrastructural factors are major contributors to the economic development/growth of all sectors of a country, such as in the area of healthcare systems and clinical research, including the pharmaceutical industry. But what is the interaction between economic, and political/governmental infrastructural factors and the development of healthcare systems, especially, the performance of the pharmaceutical industry? Information from selected articles of a literature search of PubMed and by using Google Advanced Search led to the generation of five categories of infrastructural factors, and were filled with data from 41 African Countries using the World Health Organization data repository. Median changes over time were given and tested by Wilcoxon signed-rank test and Friedman test, respectively. Analysis of factors related to availability of healthcare facilities showed that physicians and pharmacies were significant increased, with insignificantly decreased number of hospital beds. Healthcare Financing by the Government showed notable differences. Private health spending decreased significantly unlike Gross National Income. Analysis of infrastructural factors showed that stable supply of electricity and the associated use of the Internet improved significantly. The low level of data on the expansion of paved road networks suggests less developed medical services in remote rural areas. Healthcare systems in African countries improved over the last two decades, but differences between the individual countries still prevail and some of the countries cannot yet offer an attractive sales market for the products of pharmaceutical companies.
Einfluss politischer Social-Media-Kommunikation auf journalistische Zeitungsberichterstattung
(2023)
Auswirkungen strategischer Social-Media-Kommunikation politischer Akteure auf Zeitungsartikel: Inwiefern Themenframes auf sozialen Netzwerken die deutsche Presse beeinflussen.
Wahlkämpfe sind ein ständiges Ringen um die Deutungshoheit über Themen in den Massenmedien zwischen politischen Parteien und Akteuren. Dabei wirkt sich die Art der Medienberichterstattung über den Wahlkampf auf die Meinungsbildung der Rezipient*innen aus und beeinflusst ihr Wahlverhalten. Diese Forschungsarbeit setzt einen anderen Blickwinkel auf die Wahlkampfberichterstattung und untersucht, wie politische Parteien im Wahlkampf Themen in sozialen Netzwerken darstellen (framen) und inwieweit diese Themenframes von Journalist*innen in Zeitungsartikel übernommen werden. Der SPD-Landesverband Niedersachsen veröffentlichte im gesamten Landtagswahlkampf eine sehr geringe Anzahl an Pressemitteilungen. Im Untersuchungszeitraum (08.09-06.10.2022), den letzten vier Wochen des Wahlkampfes, waren es drei Stück. Demnach liegt die Schlussfolgerung nahe, dass Pressemitteilungen kein relevantes Kommunikationsmittel im Wahlkampf (mehr) sind und Inhalte stattdessen über soziale Netzwerke kommuniziert werden.
Methodik
Das Forschungsthema wurde mithilfe einer Input-Output-Analyse bearbeitet. Im ersten Schritt wurde eine qualitative Input-Inhaltsanalyse der Social-Media-Kommunikation durchgeführt. Es wurden 52 Beiträge auf Twitter und Instagram auf ihre inhaltliche Gestaltung analysiert. Auf Grundlage dieser Ergebnisse wurde eine quantitative Output-Inhaltsanalyse durchgeführt. Darin wurden 427 Zeitungsartikel aus elf Tageszeitungen untersucht. Das Codebuch zur Output-Analyse zielte darauf ab, verwendeten Themen, Themenframes sowie Übernahmen von Originaltönen der Social-Media-Beiträge in Zeitungsartikeln zu ermitteln.
Ergebnisse
Journalist*innen übernehmen Inhalte aus Social-Media-Beiträgen (noch) zu einem geringen Anteil in Zeitungsartikel. Die Themenauswahl zwischen Social-Media-Beiträgen und Zeitungsartikeln war sehr ähnlich, die Frame-Übernahme fiel hingegen gering aus. Wenn Frames übernommen wurden, wurden sie überwiegend ohne Einordnung oder Kritik vermittelt. Inhalte und Originaltöne aus Social-Media Beiträgen des SPD-Landesverbands Niedersachsen übernahmen Journalist*innen im Großteil der Stichprobenartikel nicht. Insgesamt fiel auf, dass regionale Tageszeitungen häufiger SPD-Frames und Originaltöne aus Social-Media-Inhalten in ihre Berichterstattung übernahmen als überregionale Tageszeitungen. Im Hinblick auf Quellen in Zeitungsartikeln fiel auf, dass die SPD und dessen Akteure im Vergleich zu anderen Parteien und Parteiakteuren häufiger als Quelle verwendet wurden. Die Untersuchungsergebnisse lassen auf eine journalistisch unabhängige Arbeit und Artikelaufbereitung schließen. Für das Kommunikationsmanagement ist das jedoch möglicherweise eine Zeit des Umbruchs, weil eine Tendenz, zumindest in der politischen Kommunikation, zu beobachten ist: weg von klassischer Pressearbeit, hin zu sozialer Netzwerkkommunikation.
Soziale Medien ermöglichen es ihren Nutzern besondere Beziehungen untereinander aufzubauen und zu vertiefen. Manche User bauen dabei eine weitreichende Followerschaft auf, die sogenannten Influencer. Die vorliegende Arbeit untersucht die Beziehung von Followern zu Influencer, indem der aktuelle Forschungsstand zu (trans-)parasozialen Beziehungen sowie gefühlter Interkonnektivität herangezogen wird. Mithilfe einer Online-Befragung werden die Auswirkungen einer intensiven parasozialen Beziehung zu Influencern auf verschiedene Erwartungsdimensionen untersucht. Die Ergebnisse werden vor dem Hintergrund der Theorie diskutiert und mögliche Forschungslücken herausgestellt.
Monitoring of clinical trials is a fundamental process required by regulatory agencies. It assures the compliance of a center to the required regulations and the trial protocol. Traditionally, monitoring teams relied on extensive on-site visits and source data verification. However, this is costly, and the outcome is limited. Thus, central statistical monitoring (CSM) is an additional approach recently embraced by the International Council for Harmonisation (ICH) to detect problematic or erroneous data by using visualizations and statistical control measures. Existing implementations have been primarily focused on detecting inlier and outlier data. Other approaches include principal component analysis and distribution of the data. Here we focus on the utilization of comparisons of centers to the Grand mean for different model types and assumptions for common data types, such as binomial, ordinal, and continuous response variables. We implement the usage of multiple comparisons of single centers to the Grand mean of all centers. This approach is also available for various non-normal data types that are abundant in clinical trials. Further, using confidence intervals, an assessment of equivalence to the Grand mean can be applied. In a Monte Carlo simulation study, the applied statistical approaches have been investigated for their ability to control type I error and the assessment of their respective power for balanced and unbalanced designs which are common in registry data and clinical trials. Data from the German Multiple Sclerosis Registry (GMSR) including proportions of missing data, adverse events and disease severity scores were used to verify the results on Real-World-Data (RWD).
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.
Purpose
This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians.
Methods
We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May–June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs.
Results
Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified “complication rate” and “the number of cases treated” as most important for the hospital referral decision making; PROs were rated slightly less important.
Conclusions
This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.
Schattenbibliotheken sind Lösungen, die sich aus einem Literaturmangel in der Forschung ergeben haben. Urheberrechtlich geschützte Inhalte werden hier online jedem frei zur Verfügung gestellt. In der vorliegenden Arbeit wird versucht, das Wirken dieser Dokumentsammlungen einzuordnen. So wird die Entstehung von Schattenbibliotheken aufgezeigt, auf den rechtlichen Umgang mit diesen Plattform eingegangen, zwei Schattenbibliotheken beispielhaft näher betrachtet und deren Auswirkungen abgebildet, bevor die Arbeit mit einem persönlichen Fazit abschließt.
Background
To perform a systematic review about the effect of using clinical pathways on length of stay (LOS), hospital costs and patient outcomes. To provide a framework for local healthcare organisations considering the effectiveness of clinical pathways as a patient management strategy.
Methods
As participants, we considered hospitalized children and adults of every age and indication whose treatment involved the management strategy "clinical pathways". We include only randomised controlled trials (RCT) and controlled clinical trials (CCT), not restricted by language or country of publication. Single measures of continuous and dichotomous study outcomes were extracted from each study. Separate analyses were done in order to compare effects of clinical pathways on length of stay (LOS), hospital costs and patient outcomes. A random effects meta-analysis was performed with untransformed and log transformed outcomes.
Results
In total 17 trials met inclusion criteria, representing 4,070 patients. The quality of the included studies was moderate and studies reporting economic data can be described by a very limited scope of evaluation. In general, the majority of studies reporting economic data (LOS and hospital costs) showed a positive impact. Out of 16 reporting effects on LOS, 12 found significant shortening. Furthermore, in a subgroup-analysis, clinical pathways for invasive procedures showed a stronger LOS reduction (weighted mean difference (WMD) -2.5 days versus -0.8 days)).
There was no evidence of differences in readmission to hospitals or in-hospital complications. The overall Odds Ratio (OR) for re-admission was 1.1 (95% CI: 0.57 to 2.08) and for in-hospital complications, the overall OR was 0.7 (95% CI: 0.49 to 1.0). Six studies examined costs, and four showed significantly lower costs for the pathway group. However, heterogeneity between studies reporting on LOS and cost effects was substantial.
Conclusion
As a result of the relatively small number of studies meeting inclusion criteria, this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies. Considering the clinical areas for implementation, clinical pathways seem to be effective especially for invasive care. When implementing clinical pathways, the decision makers need to consider the benefits and costs under different circumstances (e.g. market forces).
Background:
The increase in food intolerances poses a burgeoning problem in our society. Food intolerances not only lead to physical impairment of the individual patient but also result in a high socio-economic burden due to factors such as the treatment required as well as absenteeism. The present study aimed to explore whether lactose intolerant (LI) patients exhibit more frequent comorbidities than non-LI patients.
Methods:
The study was conducted on a case-control basis and the results were determined using routine data analysis. Routine data from the IMS Disease Analyzer database were used for this purpose. A total of 6,758 data records were processed and analyzed.
Results:
There were significant correlations between LI and the incidence of osteoporosis, changes in mental status, and the presence of additional food intolerances. Comparing 3,379 LI vs. 3,379 non-LI patients, 34.5% vs. 17.7% (P<0.0001) suffered from abdominal pain; 30.6% vs. 17.2% (P<0.0001) from gastrointestinal infections; and 20.9% vs. 16.0% (P=0.0053) from depression. Adjusted odds ratios (OR) were the highest for fructose intolerance (n=229 LI vs. n=7 non-LI; OR 31.06; P<0.0001), irritable bowel syndrome (n=247 LI vs. n=44 non-LI; OR 5.23; P<0.0001), and bloating (n=351 LI vs. n=68 non-LI; OR 4.94; P<0.0001).
Conclusion:
The study confirms that LI should not be regarded as an isolated illness but considered a possible trigger for further diseases. Additional research is necessary to assert more precise statements.
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.
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.
Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis
(2009)
Background and Aim:
Oral bisphosphonates have been shown to reduce the risk of fractures in patients with osteoporosis. It can be assumed that the clinical effectiveness of oral bisphosphonates depends on persistence with therapy.
Methods:
The influence of persistence with and adherence to oral bisphosphonates on fracture risk in a real-life setting was investigated. Data from 4451 patients with a defi ned index prescription of bisphosphonates were included. Fracture rates within 180, 360, and 720 days after index prescription were compared between persistent and non-persistent patients. In an extended Cox regression model applying multiple event analysis, the influence of adherence was analyzed. Persistence was defined as the duration of continuous therapy; adherence was measured in terms of the medication possession ratio (MPR).
Results:
In patients with a fracture before index prescription, fracture rates were reduced by 29% (p = 0.025) comparing persistent and non-persistent patients within 180 days after the index prescription and by 45% (p < 0.001) within 360 days. The extended Cox regression model showed that good adherence (MPR ≥ 0.8) reduced fracture risk by about 39% (HR 0.61, 95% CI 0.47–0.78; p < 0.01).
Conclusions:
In patients with osteoporosis-related fractures, good persistence and adherence to oral bisphosphonates reduced fracture risk significantly.
Background:
Huntington’s disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data.
Methods:
The source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients.
Results:
A 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4–2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3–10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60–69 years (16.8 per 100,000 persons; 95%-CI: 13.4–21.0) and decreasing afterwards.
The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%).
The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently.
Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%).
Conclusions:
Based on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.
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.
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.
Background
Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available.
Methods
A systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables.
Results
In total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy.
Conclusions
A variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches.
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.
For the introduction of technical nursing care innovations, a usability assessment survey is conducted by nursing staff. The questionnaire is used before and after the introduction of technical products. This poster contribution shows the latest comparison of pre- and post-surveys on selected products.
Catalogs of competency-based learning objectives (CLO) were introduced and promoted as a prerequisite for high-quality, systematic curriculum development. While this is common in medicine, the consistent use of CLO is not yet well established in epidemiology, biometry, medical informatics, biomedical informatics, and nursing informatics especially in Germany. This paper aims to identify underlying obstacles and give recommendations in order to promote the dissemination of CLO for curricular development in health data and information sciences. To determine these obstacles and recommendations a public online expert workshop was organized. This paper summarizes the findings.
Social comparison theories suggest that ingroups are strengthened whenever important outgroups are weakened (e.g., by losing status or power). It follows that ingroups have little reason to help outgroups facing an existential threat. We challenge this notion by showing that ingroups can also be weakened when relevant comparison outgroups are weakened, which can motivate ingroups to strategically offer help to ensure the outgroups' survival as a highly relevant comparison target. In three preregistered studies, we showed that an existential threat to an outgroup with high (vs. low) identity relevance affected strategic outgroup helping via two opposing mechanisms. The potential demise of a highly relevant outgroup increased participants’ perceptions of ingroup identity threat, which was positively related to helping. At the same time, the outgroup’s misery evoked schadenfreude, which was negatively related to helping. Our research exemplifies a group's secret desire for strong outgroups by underlining their importance for identity formation.