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Schmalstieg-Bahr K, Gladstone DJ, Hummers E, Suerbaum J, Healey JS, Zapf A, Köster D, Werhahn SM, Wachter R. Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial. Eur J Gen Pract 2024; 30:2327367. [PMID: 38497412 PMCID: PMC10949835 DOI: 10.1080/13814788.2024.2327367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies. OBJECTIVES We investigated six blood biomarkers for predicting paroxysmal AF in general practice. METHODS This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation. RESULTS Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706). CONCLUSION Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.
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Affiliation(s)
- Katharina Schmalstieg-Bahr
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - David J. Gladstone
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, and Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Johanna Suerbaum
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Köster
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie M. Werhahn
- Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany
| | - Rolf Wachter
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
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Zhang Q, Alter T, Strauch E, Eichhorn I, Borowiak M, Deneke C, Fleischmann S. German coasts harbor non-O1/non-O139 Vibrio cholerae with clinical virulence gene profiles. Infect Genet Evol 2024; 120:105587. [PMID: 38518953 DOI: 10.1016/j.meegid.2024.105587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
Non-O1/non-O139 Vibrio cholerae (NOVC) are ubiquitous in aquatic ecosystems. In rare cases, they can cause intestinal and extra-intestinal infections in human. This ability is associated with various virulence factors. The presence of NOVC in German North Sea and Baltic Sea was observed in previous studies. However, data on virulence characteristics are still scarce. Therefore, this work aimed to investigating the virulence potential of NOVC isolated in these two regions. In total, 31 NOVC strains were collected and subjected to whole genome sequencing. In silico analysis of the pathogenic potential was performed based on the detection of genes involved in colonization and virulence. Phenotypic assays, including biofilm formation, mobility and human serum resistance assays were applied for validation. Associated toxin genes (hlyA, rtxA, chxA and stn), pathogenicity islands (Vibrio pathogenicity island 2 (VPI-II) and Vibrio seventh pathogenicity island 2 (VSP-II)) and secretion systems (Type II, III and VI secretion system) were observed. A maximum likelihood analysis from shared core genes revealed a close relationship between clinical NOVCs published in NCBI and environmental strains from this study. NOVC strains are more mobile at 37 °C than at 25 °C, and 68% of the NOVC strains could form strong biofilms at both temperatures. All tested strains were able to lyse erythrocytes from both human and sheep blood. Additionally, one strain could survive up to 60% and seven strains up to 40% human serum at 37 °C. Overall, the genetic virulence profile as well as the phenotypic virulence characteristics of the investigated NOVC from the German North Sea and Baltic Sea suggest potential human pathogenicity.
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Affiliation(s)
- Quantao Zhang
- School of Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität Berlin, Königsweg 69, 14163 Berlin, Germany.
| | - Thomas Alter
- School of Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität Berlin, Königsweg 69, 14163 Berlin, Germany.
| | - Eckhard Strauch
- Department of Biological Safety, German Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany.
| | - Inga Eichhorn
- School of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Robert-von-Ostertag-Straße 7-13, 14163 Berlin, Germany; Robert Koch Institute, Genome Competence Centre (MF1), Seestraße 10, 13353 Berlin, Germany.
| | - Maria Borowiak
- Department of Biological Safety, German Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany.
| | - Carlus Deneke
- Department of Biological Safety, German Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany.
| | - Susanne Fleischmann
- School of Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität Berlin, Königsweg 69, 14163 Berlin, Germany.
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Venditti S, Salmeron I, Tafalla PN, Hobus I, Kolisch G, Hansen J. Biochar from recovered cellulose as new admixture in constructed wetlands for micropollutant removal: A circular approach. Sci Total Environ 2024; 927:172055. [PMID: 38608911 DOI: 10.1016/j.scitotenv.2024.172055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
This study aimed to evaluate the suitability of biochar produced by pyrolysis from recovered wastewater cellulose and activated biologically as an admixture in Constructed Wetlands (CWs) when applied as a post-treatment step to remove micropollutants (MPs) from municipal wastewater effluent. Two planted vertical flow mesocosm CWs with cellulose-based admixtures of different origins (plant residue and recovered toilet paper) were fed with a municipal wastewater effluent representative for rural catchments. The results showed an average MPs elimination of 89.1 % for the activated biochar produced from recovered cellulose when 15 relevant compounds are considered and a reduction of the risk from compounds cocktail below the maximum acceptable level having diclofenac, carbamazepine, PFOS, ciprofloxacin and clarithromycin as main risk drivers (Risk Quotient > 1). The implementation of a circular approach to reduce MPs was finally conducted for the Blies catchment (Saarland region in Germany) characterized by low population density and small, sensitive water bodies. This approach demonstrates the feasibility of combining cellulose recovery with a fine sieve in large wastewater treatment plants (WWTPs) and providing biochar produced from recovered cellulose as an admixture to small WWTP where CW is an affordable solution for MP mitigation.
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Affiliation(s)
- Silvia Venditti
- University of Luxembourg, Chair of Urban Water Management, 6, rue Coudenhove-Kalergi, L-1359, Luxembourg.
| | - Irene Salmeron
- University of Luxembourg, Chair of Urban Water Management, 6, rue Coudenhove-Kalergi, L-1359, Luxembourg
| | - Paula Nunez Tafalla
- University of Luxembourg, Chair of Urban Water Management, 6, rue Coudenhove-Kalergi, L-1359, Luxembourg
| | - Inka Hobus
- Wupperverbandsgesellschaft für integrale Wasserwirtschaft mbH, Untere Lichtenplatzer Straße 100, D-42289 Wuppertal, Germany
| | - Gerd Kolisch
- Wupperverbandsgesellschaft für integrale Wasserwirtschaft mbH, Untere Lichtenplatzer Straße 100, D-42289 Wuppertal, Germany
| | - Joachim Hansen
- University of Luxembourg, Chair of Urban Water Management, 6, rue Coudenhove-Kalergi, L-1359, Luxembourg
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Schmidt PW. Inference under superspreading: Determinants of SARS-CoV-2 transmission in Germany. Stat Med 2024; 43:1933-1954. [PMID: 38422989 DOI: 10.1002/sim.10046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/11/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
Superspreading, under-reporting, reporting delay, and confounding complicate statistical inference on determinants of disease transmission. A model that accounts for these factors within a Bayesian framework is estimated using German Covid-19 surveillance data. Compartments based on date of symptom onset, location, and age group allow to identify age-specific changes in transmission, adjusting for weather, reported prevalence, and testing and tracing. Several factors were associated with a reduction in transmission: public awareness rising, information on local prevalence, testing and tracing, high temperature, stay-at-home orders, and restaurant closures. However, substantial uncertainty remains for other interventions including school closures and mandatory face coverings. The challenge of disentangling the effects of different determinants is discussed and examined through a simulation study. On a broader perspective, the study illustrates the potential of surveillance data with demographic information and date of symptom onset to improve inference in the presence of under-reporting and reporting delay.
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Laepple M, Beil-Hildebrand MB. Community Nurses' Perspectives on Conceptual Challenges Related to the Need for Nursing Care in Germany: A Constructivist Grounded Theory Study. Policy Polit Nurs Pract 2024; 25:119-126. [PMID: 38263677 DOI: 10.1177/15271544241228507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
In Germany, a person's need for nursing care is assessed by evaluators according to the federal legal definition of the statutory long-term care insurance (LTCI). This definition and the associated standardized assessment tool constitute the conditions for providing nursing care in a community care setting in Germany. Furthermore, the community care setting is regulated by state law and negotiations between long-term care funds and associations of providers of nursing care. During nursing care, nurses engage in a variety of interactions with people. The extent to which the legal definition of the need for nursing care leads to challenges in these interactions is unclear. To address this knowledge gap, we conducted 22 problem-centered interviews with nurses in the community and analyzed the data using the constructivist grounded theory. The results revealed that the negotiation processes are settled within professional-family relationships and vary between the constructs of closeness and distance, advocacy and submission of responsibility, and ethos and technocracy; these are the central challenges nurses encounter in this setting. We discuss the implications and questions that arise from the findings for the nursing profession regarding its own current and future role as well as the design of nursing support in the community, to nurture more advanced nurse practitioners and community health nurses.
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Affiliation(s)
- Miriam Laepple
- University of Koblenz - Faculty 1: Educational Sciences, Institute of Nursing Science, Koblenz, Rhineland-Palatinate, Germany
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Zozaya N, Villaseca J, Fernández I, Abdalla F, Cadenas-Noreña B, Calleja MÁ, Gómez-Pajuelo P, Mestre-Ferrándiz J, Oliva-Moreno J, Trillo JL, Hidalgo-Vega Á. A Review of Current Approaches to Evaluating and Reimbursing New Medicines in a Subset of OECD Countries. Appl Health Econ Health Policy 2024; 22:297-313. [PMID: 38214848 DOI: 10.1007/s40258-023-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES The aim of this study was to review the current evaluation and funding processes for new drugs in different developed countries, to provide a comparative framework with detailed, homogeneous, and up-to-date information. METHODS Scientific publications, reports and websites were reviewed between July and December 2021 using PubMed, Google Scholar, and grey literature sources. The main items searched were actors and processes, including timelines, characteristics of clinical and economic evaluations, participation of stakeholders, elements of price and reimbursement decisions, cost-effectiveness thresholds and specific funds. The analysed 13 countries were Australia, Canada, England, France, Germany, Italy, Japan, the Netherlands, Portugal, Scotland, South Korea, Spain and Sweden. RESULTS Eight countries perform the assessment process separated from the pricing decision. Countries measure each drug's added therapeutic value through multi-attribute value scales, algorithms, non-prescriptive lists of criteria, or quality-adjusted life years (QALYs). Health technology assessment (HTA) methodologies differ in their outcome measures, elicitation techniques, comparators, and perspectives. The criteria used for pricing and reimbursement include humanistic, clinical, and economic aspects. Only Scotland, England, the Netherlands, Canada and Portugal use explicit efficiency thresholds. Health care professionals participate in all assessment committees, and patients are becoming increasingly involved in most countries. The official time from marketing authorisation to the completion of the evaluation and pricing processes varied from 126 to 540 days. CONCLUSIONS Most analysed countries show a trend towards value-based approaches that consider value for money to society, but also other economic, clinical, and humanistic criteria. Good practices included robustness, transparency, independence, and participation.
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Affiliation(s)
- Néboa Zozaya
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain.
- Department of Quantitative Methods in Economics and Management, Faculty of Economics, Business and Tourism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Javier Villaseca
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | - Irene Fernández
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | - Fernando Abdalla
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | | | | | | | | | - Juan Oliva-Moreno
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Toledo, Spain
| | - José Luis Trillo
- Department of Pharmacy, Health Area of the Malvarrosa Valencia Clinical Department, Valencia, Spain
| | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Toledo, Spain
- Weber Foundation, Madrid, Spain
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Abdul-Khaliq H, Gomes D, Meyer S, von Kries R, Wagenpfeil S, Pfeifer J, Poryo M. Trends of mortality rate in patients with congenital heart defects in Germany-analysis of nationwide data of the Federal Statistical Office of Germany. Clin Res Cardiol 2024; 113:750-760. [PMID: 38436738 PMCID: PMC11026207 DOI: 10.1007/s00392-023-02370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany. METHODS Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups. RESULTS During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age < 1 year) and 28.2% in neonates (age ≤ 28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome (n = 1498, 13.2%), left ventricular outflow tract obstruction (n = 1009, 8.9%), atrial septal defects (n = 771, 6.8%), ventricular septal defects (n = 697, 6.2%), and tetralogy of Fallot (n = 673, 5.9%), and others (n = 6666, 58.9%). Among all patients, annual CHD-related mortality rates declined significantly between 1998 and 2010 (p < 0.0001), followed by a significant annual increase until 2018 (p < 0.0001). However, mortality rates in 2018 in all ages were significantly lower than in 1998. CONCLUSION Mortality in CHD patients decreased significantly between 1998 and 2010, but a substantial number of deaths still occurred and even significantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was influenced mainly by high-risk neonates and infants. Assessment of factors influencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD.
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Affiliation(s)
- Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany.
- Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
| | - Delphina Gomes
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Section of Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany
| | - Rüdiger von Kries
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
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Paddenberg E, Dees A, Proff P, Kirschneck C. Individual dental and skeletal age assessment according to Demirjian and Baccetti: Updated norm values for Central-European patients. J Orofac Orthop 2024; 85:199-212. [PMID: 36239773 PMCID: PMC11035409 DOI: 10.1007/s00056-022-00431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/16/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Chronological age often differs from dental and skeletal age. With orthopantomograms and lateral cephalograms, dental and skeletal development can be determined according to the methods published by Demirjian et al. and Baccetti et al. However, gender and skeletal class as possible confounders were frequently not considered and available norm values are not up-to-date. This retrospective cross-sectional study thus aimed to evaluate effects of skeletal class and gender on dental and skeletal age of growing patients and to generate updated norm values for contemporary Central-European patients. METHODS A total of 551 patients were included in the dental and 733 in the skeletal age assessment, respectively. Dental analysis was based on tooth mineralisation stages in orthopantomograms (Demirjian) and skeletal age was defined by cervical vertebrae maturation stages (CVMS) in lateral cephalograms (Baccetti). Skeletal class was determined by the individualised ANB angle of Panagiotidis/Witt. With nonlinear regression analysis a formula for determining dental age was established. Effects of gender and skeletal class were evaluated and updated norm values generated. RESULTS Inter- and intrarater reliability tests revealed at least substantial measurement concordance for tooth mineralisation and CVMS. Demirjian stages and CVMS significantly depended on gender with girls developing earlier. Skeletal class significantly affected skeletal age only, but without clinical relevance. Updated norm values for dental age differed significantly from the original values of Demirjian and the values for skeletal age differed from those published by Baccetti. CONCLUSION Optimised norms, separated by gender, increase precision in determining individual dental and skeletal age during orthodontic treatment planning. Further studies analysing the effect of skeletal class on dental and skeletal development are needed.
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Affiliation(s)
- Eva Paddenberg
- Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Adrian Dees
- Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Proff
- Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Nashan B. Assessment and Evaluation for Patients With Alcohol Use Disorder: The German Allocation Policy. Transplantation 2024; 108:1053-1055. [PMID: 38150494 DOI: 10.1097/tp.0000000000004884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Björn Nashan
- The Transplantation Center, First Affiliated Hospital, School of Life Sciences and Medical Center, University of Sciences and Technology of China, Hefei, Anhui, China
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Gür D, Offergeld C, Fabry G, Wünsch A. [Communication training in otorhinolaryngology education : Comparison of an online and a classroom-based training course]. HNO 2024; 72:334-340. [PMID: 38597969 DOI: 10.1007/s00106-024-01475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Communication skills are among the most important key qualifications of the medical profession. To what extent these can also be acquired online in medical education in otolaryngology is investigated in this study. OBJECTIVE A voluntary online training for the teaching of communication skills was compared with a corresponding face-to-face format. The question of the extent to which acceptance of the two formats and students' self-assessment of their communicative skills differed was investigated. MATERIALS AND METHODS In the online training, students were prepared for the topic asynchronously via a video. Thereafter, they were able to conduct consultations with simulation patients online and synchronously. The face-to-face training was comparable in structure and duration and took place in an earlier semester. The acceptance of both seminars was assessed by a questionnaire with 19 items on a five-point Likert scale. Self-assessment of communication skills was measured by a 10-cm visual analog scale pre/post with 16 items. RESULTS Both formats achieved high acceptance with an average score (M) of 2.08 (standard deviation, SD = 0.54) for the online format and M = 1.97 (SD = 0.48) for the face-to-face event. Students' self-assessments of communication skills showed a twofold increase in the online group (M = 1.54, SD = 0.94) compared to the face-to-face group (M = 0.75, SD = 0.87). CONCLUSION This study shows that teaching communication skills in the online format was well accepted and resulted in significant changes in students' self-assessment of communication skills.
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Affiliation(s)
- Deniz Gür
- Klinik für Psychosomatische Medizin und Psychotherapie, Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104, Freiburg im Breisgau, Deutschland.
| | - Christian Offergeld
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Götz Fabry
- Medizinische Psychologie, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Alexander Wünsch
- Klinik für Psychosomatische Medizin und Psychotherapie, Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104, Freiburg im Breisgau, Deutschland
- Medizinische Onkologie, Psychoonkologischer Dienst, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
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Kriegl B, Woratschek H, Raab A. Antecedents of innovative work behavior among leading physicians: Empirical evidence from German hospitals. Health Serv Manage Res 2024; 37:99-107. [PMID: 37098412 DOI: 10.1177/09514848231172073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Healthcare professionals' innovative work behavior (IWB) plays a key role in the development and implementation of innovative solutions in hospitals. However, relevant antecedents of IWB have not been fully captured to date. This study empirically examines the relationships between proactive personality, collaborative competence, innovation climate, and IWB. Hypotheses were tested using a sample of 442 chief physicians from 380 German hospitals. The results indicate a positive and significant influence of proactive personality, collaborative competence, and innovation climate on IWB, with collaborative competence having a stronger influence on IWB than innovation climate. Managers should note that important resources for IWB are accessible through a variety of actors and relationships. To leverage these resources and thus promote IWB, more emphasis should be placed on an employee's network.
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Affiliation(s)
- Bettina Kriegl
- Ingolstadt University of Applied Sciences, Ingolstadt, Germany
| | | | - Andrea Raab
- Ingolstadt University of Applied Sciences, Ingolstadt, Germany
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van Bonn SM, Grajek JS, Rettschlag S, Schraven SP, Mlynski R. [Interactive electronic visualization formats in student teaching]. HNO 2024; 72:341-349. [PMID: 38393668 DOI: 10.1007/s00106-024-01436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND In the context of contact restrictions, conventional teaching is currently in need of optimization and expansion. The range of digital teaching formats in student training is very heterogeneous and their effectiveness uncertain. This study aims to investigate the extent to which an electronic ward round can be used as an alternative to the conventional ENT attendance practical course, and whether the use of electronic teaching formats has an influence on the quality of teaching. MATERIALS AND METHODS Instead of regular attendance practicals, bedside teaching took place once a week in real time as a video stream via tablet. A total of 43 students in the seventh semester (winter semester 2020/2021) were included in the prospective study. Evaluation forms were used to examine the subjective didactic value of different visualization formats for the students. Examination results from previous years were used for comparison. RESULTS The majority of students reported knowledge gain from the electronic rounds (93.02%) and that they were a good alternative to the traditional attendance clerkship (69.77%). The quality of the video and audio transmission as well as the comprehensibility of the case studies presented were consistently rated as good to very good. The students' examination results tended to be slightly worse in the test group compared to the control students of previous years. CONCLUSION Integration of innovative interactive visualization options into teaching shows promising prospects as a supplement to conventional face-to-face teaching. The results of this study can contribute to the further expansion of digital teaching. Scaling up this model could be considered especially in countries with limited availability of face-to-face teaching.
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Affiliation(s)
- Sara M van Bonn
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137, 18057, Rostock, Deutschland.
| | - Jan S Grajek
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137, 18057, Rostock, Deutschland
| | - Stefanie Rettschlag
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137, 18057, Rostock, Deutschland
| | - Sebastian P Schraven
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137, 18057, Rostock, Deutschland
| | - Robert Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137, 18057, Rostock, Deutschland
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Manthey J, Gobiņa I, Isajeva L, Neneman J, Reile R, Štelemėkas M, Rehm J. The Impact of Raising Alcohol Taxes on Government Tax Revenue: Insights from Five European Countries. Appl Health Econ Health Policy 2024; 22:363-374. [PMID: 38386271 PMCID: PMC11021250 DOI: 10.1007/s40258-024-00873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Reducing the affordability of alcoholic beverages by increasing alcohol excise taxation can lead to a reduction in alcohol consumption but the impact on government alcohol excise tax revenue is poorly understood. This study aimed to (a) describe cross-country tax revenue variations and (b) investigate how changes in taxation were related to changes in government tax revenue, using data from Estonia, Germany, Latvia, Lithuania and Poland. METHODS For the population aged 15 years or older, we calculated the annual per capita alcohol excise tax revenue, total tax revenue, gross domestic product and alcohol consumption. In addition to descriptive analyses, joinpoint regressions were performed to identify whether changes in alcohol excise taxation were linked to changes in alcohol excise revenue since 1999. RESULTS In 2022, the per capita alcohol excise tax revenue was lowest in Germany (€44.2) and highest in Estonia (€218.4). In all countries, the alcohol excise tax revenue was mostly determined by spirit sales (57-72% of total alcohol tax revenue). During 2010-20, inflation-adjusted per capita alcohol excise tax revenues have declined in Germany (- 22.9%), Poland (- 19.1%) and Estonia (- 4.2%) and increased in Latvia (+ 56.8%) and Lithuania (+ 49.3%). In periods of policy non-action, alcohol consumption and tax revenue showed similar trends, but tax level increases were accompanied by increased revenue and stagnant or decreased consumption. CONCLUSIONS Increasing alcohol taxation was not linked to decreased but increased government revenue. Policymakers can increase revenue and reduce alcohol consumption and harm by increasing alcohol taxes.
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Affiliation(s)
- Jakob Manthey
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Inese Gobiņa
- Department of Public Health and Epidemiology, Riga Stradiņš University, Riga, Latvia
- Institute of Public Health, Riga Stradiņš University, Riga, Latvia
| | - Laura Isajeva
- Department of Public Health and Epidemiology, Riga Stradiņš University, Riga, Latvia
- Institute of Public Health, Riga Stradiņš University, Riga, Latvia
| | - Jarosław Neneman
- Institute of Economics, Faculty of Economics and Sociology, University of Lodz, Lodz, Poland
| | - Rainer Reile
- Department for Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jürgen Rehm
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Program on Substance Abuse, Program on Substance Abuse and WHO CC, Public Health Agency of Catalonia, Barcelona, Spain
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Cooke AK, Willkommen S, Broda S. Analysing agricultural plant protection product concentrations in groundwater in Germany: Nationwide database with site and compound insights. Environ Res 2024; 248:118231. [PMID: 38301764 DOI: 10.1016/j.envres.2024.118231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
Pesticides from agricultural practices are among the most pressing reasons why groundwater sources do not reach the good chemical status standards as required by the European Water Framework directive. Complementary to previous federal pesticide reports, we analysed groundwater-monitoring data from 13 German Länder assembled in a database consisting of 26.192 groundwater measuring sites sampled between 1973 and 2021 of in total 521 parent compounds and metabolites. This study focuses on agricultural plant protection products. The monitored substance spectrum and site density developed over time and differs between Länder. More than 95 % of all samples lie below the respective (multiple) limits of quantification (LOQ). We thus report the frequency of exceedance above concentration thresholds, which allows to compare measurements temporally and spatially. Pesticide detections were found in all aquifer types, land uses and well screen depths. Most detections of higher concentrations were found in agricultural areas, at shallow screen depth in porous aquifers. Karst aquifers showed also a higher percentage of samples in higher concentration classes. Metabolites with high mobility and persistence were found in higher concentration ranges. Herbicides and metabolites thereof dominate the top 20 of pesticides that most frequently exceed 0.1 μg L-1. The ranking for 2010-2019 includes both authorised and banned compounds and their occurrence is discussed in the context of their mobility, persistence and underlying monitoring density. Yearly exceedance frequencies above 0.05, 0.1 μg L-1 and higher thresholds of metazachlor and its esa-metabolite, and national sales data of the parent compound did not show a temporal correlation in subsequent years. This study stresses the need for the harmonisation of heterogeneous pesticide data. Further, a characterisation of the groundwater data used to analyse pesticide occurrence in selected concentration ranges for relevant site factors and compound properties and provides a pesticide ranking based on exceedance frequencies is provided.
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Affiliation(s)
- Anne-Karin Cooke
- Federal Institute for Geosciences and Natural Resources, Wilhelmstraße 25-30, 13593, Berlin, Germany.
| | - Sandra Willkommen
- Federal Institute for Geosciences and Natural Resources, Wilhelmstraße 25-30, 13593, Berlin, Germany
| | - Stefan Broda
- Federal Institute for Geosciences and Natural Resources, Wilhelmstraße 25-30, 13593, Berlin, Germany
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15
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Grajek JS, Rettschlag S, Schneider A, Schraven SP, Mlynski R, van Bonn SM. [Multidimensional formats of surgical anatomy in otorhinolaryngology student teaching-a comparison of effectivity]. HNO 2024; 72:357-366. [PMID: 38324064 DOI: 10.1007/s00106-024-01427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Technological change in healthcare and the digital transformation of teaching require innovations in student teaching in medicine. New technologies are needed to enable the delivery and use of diverse teaching and learning formats by educational institutions independent of time and place. The aim of this study is to analyze the effectiveness of different multidimensional formats in student teaching in surgical ENT medical anatomy. MATERIALS AND METHODS During the summer semester 2022 and winter semester 2022/2023, the digital teaching and learning program was expanded by testing different visualization formats (3D glasses, cardboards, or VR glasses) with students in the context of a highly standardized surgical procedure, namely cochlear implantation. A pre- and post-intervention knowledge assessment was carried out in all groups, followed by an evaluation. RESULTS Of 183 students, 91 students fully participated in the study. The post-intervention knowledge assessment showed a significant increase in correct answers regardless of visualization format. In a direct comparison, the operating room (OR) group answered correctly significantly more often than the cardboard group (p = 0.0424). The majority of students would like to see 3D teaching as an integral part of the teaching program (87.9%) and more streaming of live surgeries (93.4%). They see the use of the various technologies as a very good addition to conventional surgical teaching (72.5%), as good visualization (89%) increases retention (74.7%) and motivation (81.3%). CONCLUSION Application and use of new visualization technologies in everyday clinical practice is a promising approach to expanding student training. Mobile, interactive, and personalized technical formats can be adapted to the learning behavior of students. Last but not least, the use of new media influences learning motivation. An expansion of digital teaching and learning formats can be expressly recommended on the basis of this study.
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Affiliation(s)
- Jan S Grajek
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137, 18057, Rostock, Deutschland
| | - Stefanie Rettschlag
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137, 18057, Rostock, Deutschland
| | - Armin Schneider
- Jade Hochschule, Fachbereich Ingenieurwissenschaften, Friedrich-Paffrath-Str. 101, 26389, Wilhelmshaven, Deutschland
| | - Sebastian P Schraven
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137, 18057, Rostock, Deutschland
| | - Robert Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137, 18057, Rostock, Deutschland
| | - Sara M van Bonn
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Str. 137, 18057, Rostock, Deutschland.
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16
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Schmitz L, Betz CS, Böttcher A, Häußler SM, Praetorius M. [How much digitization do ENT curricula need? : Opportunities and limits from the perspective of students and teachers]. HNO 2024; 72:325-333. [PMID: 38372803 DOI: 10.1007/s00106-024-01437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Digitalization has long been an integral part of students' everyday lives and increasingly also of their medical training. It seems to be an unwritten law that "digital natives" want as much digitalization as possible. This study aims to shed more light on how students in the clinical phase of medical studies perceive the increasing digitalization of teaching and what they need for good education. MATERIALS AND METHODS This study analyzed two surveys that were conducted using an online questionnaire. On the one hand, students in the 5th-9th semesters of the medical faculty at the University of Hamburg (n = 282) were surveyed (survey 1). Another survey addressed all employees of ENT clinics in Germany (n = 175; survey 2). RESULTS A total of 76 students took part in survey 1 and 123 lecturers in survey 2. The results show that both students and lecturers do not want face-to-face teaching to be completely replaced by digital formats. A total of 72.7% of students reject the possibility of teaching practical skills through digital formats. The majority of students surveyed stated that offline formats improve their concentration (61.1%), participation probability (63.9%), and motivation to learn (76.6%). In contrast, 40.2% of lecturers see digitalization as a way to reduce the workload without any relevant loss in teaching quality. CONCLUSION Digital teaching formats have a negative impact on the medical education of the students surveyed. Interaction and physical presence are needed to increase the motivation to learn. This leads to the first conclusion that students are critical of the increasing digitalization of medical studies.
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Affiliation(s)
- Lisa Schmitz
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Christian S Betz
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Arne Böttcher
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sophia M Häußler
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Mark Praetorius
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Rak K, Kaulitz S, Voelker J, Müller-Graff T, Engert J, Spahn B, Hackenberg S, Grasso P, Hagen R. [Online training for hearing implant surgery : A new approach to otological training. German version]. HNO 2024; 72:317-324. [PMID: 38530381 DOI: 10.1007/s00106-024-01451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is a need to broaden education facilities in an on-line format. Therefore, a first basic on-line training for otosurgery was developed. MATERIALS AND METHODS The system consists of an artificial temporal bone model together with a set of basic surgical instruments and implant dummies. As an essential part of the training kit, a high-resolution camera set is included that allows for connection to a video streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, a pre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. RESULTS Over the three courses held to date, 28 participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of a questionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. CONCLUSION The presented program of an otosurgical online training allows for basal education in practical exercises on a remote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.
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Affiliation(s)
- Kristen Rak
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - Stefan Kaulitz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Johannes Voelker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Tassilo Müller-Graff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Jonas Engert
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Björn Spahn
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Stephan Hackenberg
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Peter Grasso
- MED-EL Elektromedizinische Geräte Gesellschaft m.b.H., Innsbruck, Österreich
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Degen CV, Schwitzing F, Long S, Gickel L, Behrends M, Busch CJ, Steffens S, Mikuteit M. [Open educational resources for otorhinolaryngology : A pilot study on needs assessment and implementation]. HNO 2024; 72:310-316. [PMID: 38625372 DOI: 10.1007/s00106-024-01465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Open educational resources (OER) are educational materials licensed openly by authors, permitting usage, redistribution, and in some instances, modification. OER platforms thereby serve as a medium for distributing and advancing teaching materials and innovative educational methodologies. OBJECTIVE This study aims to determine the present state of OER in otorhinolaryngology and to examine the prerequisites for seamlessly integrating OER into the curricular teaching of medical schools, specifically through the design of two OER blended learning modules. METHODS OER content in the field of otorhinolaryngology was analyzed on OER platforms, ensuring its relevance to the German medical curriculum. Data protection concerns were addressed with legal counsel. The blended learning modules were developed in collaboration with medical students and subsequently published as OER. RESULTS AND CONCLUSION This project yielded the first OER from a German ENT department, tailored to the German medical curriculum. One significant barrier to OER use in medicine, more than in other fields, is data protection. This challenge can be navigated by obtaining consent to publish patient data as OER. OER hold the promise to play a pivotal role in fostering cooperation and collaboration among educators, aiding educators in lesson preparation, and simultaneously enhancing didactic quality.
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Affiliation(s)
- C V Degen
- Studiendekanat - Curriculumsentwicklung, Medizinische Hochschule Hannover, Hannover, Deutschland.
- Klinik für Hals-Nasen-Ohrenheilkunde, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Klinikum Nürnberg Nord, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland.
| | - F Schwitzing
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - S Long
- Studiendekanat - Curriculumsentwicklung, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - L Gickel
- Studiendekanat - Curriculumsentwicklung, Medizinische Hochschule Hannover, Hannover, Deutschland
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - M Behrends
- Peter L. Reichertz Institut für Medizinische Informatik der TU Braunschweig und der Medizinischen Hochschule Hannover, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C J Busch
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - S Steffens
- Studiendekanat - Curriculumsentwicklung, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Mikuteit
- Studiendekanat - Curriculumsentwicklung, Medizinische Hochschule Hannover, Hannover, Deutschland
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Holter M, Avian A, Weger M, Strini S, Michelitsch M, Brenk-Franz K, Wedrich A, Berghold A. Measuring patient activation: the utility of the Patient Activation Measure administered in an interview setting. Qual Life Res 2024; 33:1389-1400. [PMID: 38388807 DOI: 10.1007/s11136-024-03614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Patient activation is an emerging field in healthcare research concerning knowledge, skills, and confidence of patients in managing their health. This is particularly important for patients with chronic diseases, who often require more complex care management and self-care skills. However, due to temporary or longer-lasting visual impairments, certain patient groups cannot answer a questionnaire independently. The main objective is to investigate the psychometric properties of the German Patient Activation Measure® (PAM) survey in an everyday clinical setting where it has to be read aloud. METHODS Outpatients with macular edema participated in this questionnaire-based cross-sectional study. The study assessed patient activation by the PAM® survey, self-rated health, self-efficacy, quality of life, and general mood. Interviewers read questionnaires aloud to patients. Psychometric properties of the PAM® survey were investigated by item response theory (IRT), Cronbach's α and trait-trait correlations. RESULTS The analysis included N = 554 patients. Median age was 69 (IQR 62.0-76.0) years and mean overall activation score 74.1 (SD 13.7). All items showed ceiling effects. Empirical reliability from the IRT model and Cronbach's α were 0.75. The PAM® survey showed a Spearman correlation of 0.54 with self-efficacy, 0.51 with quality of life and 0.34 with general mood. CONCLUSION The read-aloud PAM® survey has been shown to provide to adequate measurement precision and convergent validity to be used as a screening tool in an everyday clinical setting. Objective assessment in an interview setting with the PAM® survey is possible. PAM® items are good in distinguishing lower to middle activated patients, but not patients with high activation. Further, issues with structural validity need more investigation.
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Affiliation(s)
- Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
| | - Martin Weger
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Sanja Strini
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Monja Michelitsch
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Lawson McLean AC, Maurer S, Nistor-Gallo D, Moritz I, Tourbier M. Survey on Training Satisfaction among German Neurosurgical Trainees. J Neurol Surg A Cent Eur Neurosurg 2024; 85:269-273. [PMID: 36914157 DOI: 10.1055/a-2053-3108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND There has been a fivefold increase of neurosurgeons over the last three decades in Germany, despite a lesser increase in operations. Currently, there are approximately 1,000 neurosurgical residents employed at training hospitals. Little is known about the overall training experience and career opportunities for these trainees. METHODS In our role as resident representatives, we implemented a mailing list for interested German neurosurgical trainees. Thereafter, we created a survey including 25 items to assess the trainees' satisfaction with their training and their perceived career prospects, which we then distributed through the mailing list. The survey was open from April 1 until May 31 2021. RESULTS Ninety trainees were enrolled in the mailing list and we received 81 completed responses to our survey. Overall, 47% of the trainees were very dissatisfied or dissatisfied with their training. Sixty-two percent of the trainees reported a lack of surgical training. Fifty-eight percent of trainees found it difficult to attend courses or classes and only 16% had consistent mentoring. There was an expressed desire for a more structured training program and mentoring projects. In addition, 88% of trainees were willing to relocate for fellowships outside their current hospitals. CONCLUSIONS Half of the responders were dissatisfied with their neurosurgical training. There are various aspects that require improvement, such as the training curriculum, structured mentoring, and reduction of the amount of administrative work. We propose the implementation of a modernized structured curriculum, which addresses the mentioned aspects, in order to improve neurosurgical training and, consecutively, patient care.
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Affiliation(s)
| | - Stefanie Maurer
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Ina Moritz
- Department of Neurosurgery, Vivantes Hospital Berlin Neukölln, Berlin, Germany
| | - Meriem Tourbier
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
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21
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Bokemeyer B, Plachta-Danielzik S, Steiner IM, Pohlschneider D, Urzica E, Hartmann P, Zemke J, Tappe U, Schreiber S, Steinkat N, Langbrandtner J, Hüppe A, Stargardt T. Inflammatory bowel disease (IBD) patients with impaired quality of life on biologic therapy benefit from the support of an IBD nurse specialist: Results of a randomised controlled trial in Germany (IBD BIO-ASSIST study). Aliment Pharmacol Ther 2024; 59:1082-1095. [PMID: 38429885 DOI: 10.1111/apt.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/16/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND IBDBIO-ASSIST was a randomised controlled trial assessing the efficacy of care provided by IBD nurse specialists in Germany in improving health-related quality of life (QoL) in IBD patients on biologic therapy. AIM To evaluate patient-related outcomes and economic consequences associated with integrating IBD nurses into usual care. METHODS We randomly assigned 1086 patients with IBD on biologic therapy to a control group (CG) receiving usual care or an intervention group (IG) receiving additional care from an IBD nurse specialist. The primary outcome was disease-specific QoL (sIBDQ) assessed at 6, 12 and 18 months. RESULTS At baseline, patients in both groups were highly satisfied with their treatment situation and had relatively high sIBDQ values (range: 1-7; CG: 5.12; IG: 4.92). In the intention-to-treat (ITT) analysis of the overall sample, there was no significant difference in sIBDQ between groups at the assessment time points. However, a per-protocol analysis of patients with impaired QoL at baseline (EQ-VAS < 75 [median]), showed improvement in sIBDQ over 6 months that became significant at month 12 and remained significant through month 18 (baseline: IG 4.24; CG 4.31; 18 months: IG 5.02; CG 4.76; p = 0.017). CONCLUSION High baseline satisfaction of IBD patients with treatment and the relatively high baseline sIBDQ values may have contributed to the lack of significant difference in sIBDQ scores for the overall sample. However, patients with impaired QoL derived significant benefit from additional care provided by an IBD nurse specialist, leading to meaningful improvements in sIBDQ over the long term.
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Affiliation(s)
- Bernd Bokemeyer
- Competence Network IBD, Kiel, Germany
- Interdisciplinary Crohn Colitis Centre, Minden, Germany
- Clinic of General Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sandra Plachta-Danielzik
- Competence Network IBD, Kiel, Germany
- Institute of Human Nutrition and Food Science, Christian-Albrechts University, Kiel, Germany
| | - Isa Maria Steiner
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
| | | | | | | | | | | | - Stefan Schreiber
- Clinic of General Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - Jana Langbrandtner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Centre for Population Medicine and Health Services Research, University of Lübeck, Lübeck, Germany
| | - Angelika Hüppe
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Centre for Population Medicine and Health Services Research, University of Lübeck, Lübeck, Germany
| | - Tom Stargardt
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
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22
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Böll J, Alashkar F, Aramayo-Singelmann C, Hoferer A, Jarisch A, Kamal H, Oevermann L, Schwarz M, Cario H. [Transition in sickle cell disease - recommendations of the transition initiative sickle cell disease]. Dtsch Med Wochenschr 2024; 149:579-586. [PMID: 38657597 DOI: 10.1055/a-2252-8113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Sickle cell disease is a rare, but complex multi-systemic disorder with high need of interdisciplinary and specialized care and new structural requirements. Besides care of those chronically sick patients, transition process is a vulnerable phase which highly influences further treatment. To make matters worse, patients often have migration background with subsequent communication problems. A national guidance for a standardized transition process is lacking in Germany. In context of a structured consensus process, the "transition initiative sickle cell disease" developed specific recommendations for a structured transition of sickle cell patients on the basis of the S3 transition guideline of the DGfTM. These recommendations should improve this vulnerable process in this complex disease to ensure adequate further treatment and to avoid acute and chronic complications but also mental, social or job-related issues. Besides improvement of quality of life, medical treatment and survival, health economic aspects arise. Documents were developed to support and facilitate the transition process and are available under www.sichelzellkrankheit.info/transition/.
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Affiliation(s)
- Janine Böll
- Uniklinik Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Klinik I für Innere Medizin, Köln
| | - Ferras Alashkar
- Universitätsklinikum Essen, Klinik für Hämatologie und Stammzelltransplantation, Westdeutsches Tumorzentrum, Universität Duisburg-Essen, Essen
| | | | - Anette Hoferer
- Robert-Bosch-Krankenhaus, Abteilung für Hämatologie, Onkologie und Palliativmedizin, Stuttgart
| | - Andrea Jarisch
- Universitätsklinikum Frankfurt, Klinik für Kinder- und Jugendmedizin, Schwerpunkt Stammzelltransplantation, Immunologie und Intensivmedizin, Frankfurt am Main, GPOH-Konsortium Sichelzellkrankheit
| | | | - Lena Oevermann
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Berlin, GPOH-Konsortium Sichelzellkrankheit
| | - Michaela Schwarz
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Berlin
| | - Holger Cario
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Zentrum für seltene Störungen der Hämatopoese und Immundefekte, Ulm, GPOH-Konsortium Sichelzellkrankheit
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23
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Wienke A, Seibert KV. [Consequences of poor patient compliance : Or: The Taming of the Shrew]. HNO 2024; 72:375-376. [PMID: 37801100 DOI: 10.1007/s00106-023-01359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Albrecht Wienke
- Wienke & Becker - Köln, Sachsenring 6, 50677, Köln, Deutschland.
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24
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Giovannetti AM, Rosato R, Galán I, Toscano A, Anglada E, Menendez R, Hoyer J, Confalonieri P, Giordano A, Pakenham KI, Pöttgen J, Solari A. Cross-cultural validity and reliability of the comprehensive assessment of acceptance and commitment therapy processes (CompACT) in people with multiple sclerosis. Qual Life Res 2024; 33:1359-1371. [PMID: 38401014 DOI: 10.1007/s11136-024-03609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE The Comprehensive assessment of Acceptance and Commitment Therapy (CompACT) is a 23-item questionnaire measuring psychological flexibility, a quality of life protective factor. An 18-item version was recently produced. We assessed validity and reliability of CompACT, and equivalence of paper and electronic (eCompACT) versions in people with multiple sclerosis (PwMS) in Italy, Germany and Spain. METHODS We used confirmatory factor analysis and assessed CompACT-23 and CompACT-18 measurement invariance between the three language versions. We assessed construct validity (Spearman's correlations) and internal consistency (Cronbach's alpha). Test-retest reliability (intraclass correlation coefficient, ICC) and equivalence of paper and eCompACT (ICC and linear regression model for repeated measures) were assessed in subsamples of PwMS. RESULTS A total of 725 PwMS completed the study. The three-factor structure of the CompACT-23 showed poor fit (RMSEA 0.07; CFI 0.82; SRMR 0.08), while the fit of the CompACT-18 was good (RMSEA 0.05; CFI 0.93; SRMR 0.05). Configural and partial metric invariance were confirmed, as well as partial scalar invariance (reached when five items were allowed to vary freely). The CompACT-18 showed good internal consistency (all alpha ≥ 0.78); and test-retest reliability (all ICCs ≥ 0.86). Equivalence between paper and eCompACT was excellent (all ICCs ≥ 0.86), with no mode, order, or interaction effects. CONCLUSION Results support using the refined CompACT-18 as a three-factor measure of psychological flexibility in PwMS. Paper and eCompACT-18 versions are equivalent. CompACT-18 can be used cross-culturally, but sub-optimal scalar invariance suggests that direct comparison between the three language versions should be interpreted with caution.
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Affiliation(s)
- Ambra Mara Giovannetti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, (Unit of Neuroepidemiology), Via Celoria 11, 20133, Milan, Italy.
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.
- Fondazione IRCCS Istituto Neurologico Carlo Besta, (Unit of Neuroimmunology and Neuromuscular Diseases), Milan, Italy.
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - Ingrid Galán
- Centre d'Esclerosi Múltiple de Catalunya-Cemcat, Barcelona, Spain
| | - Anna Toscano
- Department of Psychology, University of Turin, Turin, Italy
| | - Elisenda Anglada
- Centre d'Esclerosi Múltiple de Catalunya-Cemcat, Barcelona, Spain
| | - Rebeca Menendez
- Centre d'Esclerosi Múltiple de Catalunya-Cemcat, Barcelona, Spain
| | - Jürgen Hoyer
- Technische Universitaet Dresden, Dresden, Germany
| | - Paolo Confalonieri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, (Unit of Neuroimmunology and Neuromuscular Diseases), Milan, Italy
| | - Andrea Giordano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, (Unit of Neuroepidemiology), Via Celoria 11, 20133, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Solari
- Fondazione IRCCS Istituto Neurologico Carlo Besta, (Unit of Neuroepidemiology), Via Celoria 11, 20133, Milan, Italy
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25
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Römer T, Frenz AK, Dietrich-Ott S, Fiedler A. The use of LNG-IUS-19.5 mg in daily gynecological routine practice in Germany: data from the Kyleena™ Satisfaction Study (KYSS). Arch Gynecol Obstet 2024; 309:2021-2030. [PMID: 38421421 PMCID: PMC11018657 DOI: 10.1007/s00404-024-07421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The Kyleena™ Satisfaction Study (KYSS) provided the first data on 19.5 mg levonorgestrel-releasing intrauterine system (LNG-IUS-19.5 mg) use in routine clinical practice. Here we report results from the German participants in KYSS. METHODS This prospective, observational, single-arm cohort study recruited women who independently chose to use LNG-IUS-19.5 mg during routine counseling in Germany. Overall satisfaction and bleeding profile satisfaction, continuation rates, and safety profile were evaluated at 12 months or premature end of observation (EoO). RESULTS In the German study population, LNG-IUS-19.5 mg placement was attempted in 508 women and successful in 506 women. Mean age was 32.3 years, and 60.0% (n = 305/508) were parous. Placement was considered easy and associated with no more than mild pain, even in younger and nulliparous participants. Of those with satisfaction data available, 87.6% (n = 388/443) were satisfied with LNG-IUS-19.5 mg at 12 months/EoO. Satisfaction was similar for parous (86.9%, n = 238/274) and nulliparous (88.8%, n = 150/169) women, and was independent of age, prior contraceptive method, or reason for choosing LNG-IUS-19.5 mg. Most participants (73.6%, n = 299/406) were also satisfied with their bleeding profile at 12 months/EoO, independent of parity, age, prior contraceptive method, presence of amenorrhea or dysmenorrhea severity. The 12-month continuation rate was 84.1% (n = 427/508). Most discontinuations were due to loss to follow-up (8.5%, n = 43/508) or treatment-emergent adverse events (TEAEs) (4.7%, n = 24/508). TEAEs were reported in 12.6% (n = 64) of participants, with 9.3% (n = 47) considered to have an LNG-IUS-19.5 mg-related TEAE. CONCLUSION Our real-world findings on LNG-IUS-19.5 mg use in German KYSS participants reflected its suitability for a broad population, including young and nulliparous women. CLINICAL TRIAL REGISTRATION NCT03182140 (date of registration: June 2017).
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Affiliation(s)
- Thomas Römer
- Obstetrics and Gynecology Department, Academic Hospital Weyertal, University of Cologne, Cologne, Germany.
| | | | | | - Anja Fiedler
- Medical Practice of Obstetrics and Gynecology, Gera/Jena, Germany
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26
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Everad F, Seifert L, Mansour N, Hofauer B, Knopf A, Offergeld C. [Virtual training of practical competences in sonography]. HNO 2024; 72:350-356. [PMID: 38587663 DOI: 10.1007/s00106-024-01476-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE During the COVID-19 pandemic, a particular challenge in the transition to digital teaching was to teach practical skills such as sonography of the head and neck online. The aim of this study was to validate the digital sonography course for medical students established at the Freiburg University Hospital ENT Department. METHODS Participants were 178 students of human medicine. The study group simulated the sonography examination at home with a dummy transducer using the Peyton method under the guidance of a tutor via video seminar. In a subsequent learning success check, the results of the students in the online course were compared with those of the control group, who learned sonography in the classroom. RESULTS Students of the online course achieved comparable results to the classroom group. CONCLUSION This study shows that practical skills which require extensive equipment such as a sonography machine can be taught to a certain extent digitally or at least in a hybrid form.
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Affiliation(s)
- F Everad
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - L Seifert
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Mansour
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - B Hofauer
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde Innsbruck, Innsbruck, Österreich
| | - A Knopf
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Offergeld
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
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27
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Mitteilungen der Deutschen Gesellschaft für Pathologie. Pathologie (Heidelb) 2024; 45:233-4. [PMID: 38661929 DOI: 10.1007/s00292-024-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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28
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Hildenbrand T, Kuhn S, Everad F, Hassepaß F, Neudert M, Offergeld C. [Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training]. HNO 2024; 72:303-309. [PMID: 38587662 DOI: 10.1007/s00106-024-01468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes. OBJECTIVE The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany. MATERIALS AND METHODS A questionnaire with nine questions on digital transformation was sent to the assistant professors of 37 national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®. RESULTS Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors. CONCLUSION Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID 19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.
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Affiliation(s)
- T Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - S Kuhn
- Institut für Digitale Medizin, Universitätsklinikum Gießen-Marburg & Philipps-Universität Marburg, Marburg, Deutschland
| | - F Everad
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - F Hassepaß
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - M Neudert
- Klinik für Hals-Nasen- und Ohrenheilkunde, Universitätsklinikum Carl-Gustav-Carus, Dresden, Deutschland
| | - C Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Offergeld C, Kuhn S, Kromeier J, Heermann S, Widder A, Flayyih O, Everad F, Knopf A, Albrecht T, Burkhardt V, Hildenbrand T, Ramackers W. [Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]. HNO 2024; 72:367-374. [PMID: 38578464 DOI: 10.1007/s00106-024-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality. MATERIALS AND METHODS Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians. RESULTS The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception. CONCLUSION Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.
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Affiliation(s)
- C Offergeld
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Kuhn
- Institut für Digitalisierung in der Medizin, Universitätsklinikum Gießen-Marburg, Marburg, Deutschland
| | - J Kromeier
- Klinik für Radiologie, St. Josef-Krankenhaus Freiburg, Freiburg, Deutschland
| | - S Heermann
- Institut für Anatomie und Zellbiologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Widder
- Studiendekanat der Med. Fak., Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - O Flayyih
- Studiendekanat der Med. Fak., Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - F Everad
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Knopf
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Albrecht
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - V Burkhardt
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Hildenbrand
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - W Ramackers
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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Ständer S, Ketz M, Akumo D, Kossack N, Pignot M, Chavda R, Gabriel S. Comorbidities, healthcare resource utilization & treatment pattern among patients with prurigo nodularis, compared to a benchmark in Germany: A real-world evidence claims data study. J Eur Acad Dermatol Venereol 2024; 38:883-894. [PMID: 38078642 DOI: 10.1111/jdv.19700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/25/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) is a rare chronic inflammatory skin disease with a high disease burden, but data on clinical and economic burden are still scarce. OBJECTIVE To describe the real-world epidemiologic, clinical and therapeutic characteristics and related economic burden of patients with PN compared to a benchmark population in Germany. METHODS This retrospective study was based on an excerpt of German Statutory Health Insurance data of patients with an initial PN diagnosis between 2012 and 2016. PN cohort contained no record of PN in eight quarters before the index quarter and was followed up for eight quarters (unless deceased). Benchmark cohort without PN was calculated using direct standardization and 1:1 matching to PN cohort. RESULTS Out of 4,536,002 insured patients, 2309 incident patients with PN were identified and matched to the benchmark cohort out of 3,018,382 patients without PN. Patients were mostly between 45 and 80 years when diagnosed with PN. Higher comorbidity rates were reported for PN than benchmark, with a rising disease burden at follow-up. Most patients with PN (91.3%) were diagnosed outpatient and had >50% more outpatient visits than the benchmark cohort. Hospitalization rates were higher in PN (53.9%) versus benchmark (35.1%), yielding twice longer mean hospital stays for PN (12 days) compared to benchmark (6 days) (p < 0.001). The most common initial therapy for patients with PN was topical corticosteroids (47.6%); ≥10% of patients were treated with antidepressants, antihistamines or systemic corticosteroids. Therapy rates were higher for PN compared to benchmark (p < 0.001). Mean initial costs were twofold higher in PN versus benchmark for outpatient, inpatient and drugs. During follow-up, an increase of >70% in mean PN costs compared to benchmark was identified for outpatient, inpatient and concomitant treatments (p < 0.001). CONCLUSION This study highlights the significantly higher clinical and economic burden incurred by PN compared to benchmark patients in Germany, reflecting the unmet medical need for PN.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - Miriam Ketz
- DtoD - Data to Decision - Corp, Hamburg, Germany
| | - Divine Akumo
- ZEG - Berlin Center for Epidemiology and Health Research Ltd, Berlin, Germany
| | - Nils Kossack
- WIG2 Ltd. - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Marc Pignot
- ZEG - Berlin Center for Epidemiology and Health Research Ltd, Berlin, Germany
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Heming M, Angerer P, Apolinário-Hagen J, Liszio S, Nater UM, Skoluda N, Weber J. Hair cortisol concentration and its association with acute stress responses and recovery in a sample of medical students in Germany. Psychoneuroendocrinology 2024; 163:106986. [PMID: 38367529 DOI: 10.1016/j.psyneuen.2024.106986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/19/2024] [Accepted: 02/03/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Experiencing acute and chronic stress can contribute to adverse health outcomes. Responses to acute stress differ between individuals (i.e., stress reactivity) and the experience of chronic stress has been discussed to be associated with acute stress responses and stress recovery. This study thus aims to investigate whether hair cortisol concentration (HCC), being an indicator for hypothalamus-pituitary-adrenal (HPA) axis activity over a prolonged period of time, is associated with acute stress responses and recovery in a sample of medical students. MATERIAL AND METHODS From July 2020 to July 2021, medical students (n = 54) underwent a virtual-reality Trier Social Stress Test in which their blood pressure and heart rate variability (HRV) were measured, and hair samples were taken to determine HCC. Piecewise linear growth analyses were used to investigate whether HCC (categorized into low, medium and high levels) is associated with acute stress responses and recovery regarding blood pressure and HRV. RESULTS Significant interaction effects in piecewise linear growth analyses showed that participants with higher levels of HCC had lower systolic and diastolic blood pressure responses compared to participants with medium levels of HCC. No significant interaction effects were observed for HRV responses or for recovery measures. CONCLUSIONS The study suggests that higher levels of HCC are associated with a lower cardiovascular response in terms of blood pressure to an acute stressor in medical students. Therefore, long-term HPA-axis activity may contribute to different magnitudes of acute stress responses in the autonomic nervous system. As the shown lower blood pressure responses to acute stress in individuals with increased long-term HPA-axis activity may represent inadequate stress responses, these should be further studied in order to find out more about their interaction and potential subsequent disease risks.
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Affiliation(s)
- Meike Heming
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Stefan Liszio
- Center for Virtual and Extended Reality in Medicine, University Hospital Essen, Germany
| | - Urs Markus Nater
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; University Research Platform "The Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Nadine Skoluda
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; University Research Platform "The Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Jeannette Weber
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Schoonemann J, Nagelkerke J, Seuntjens TG, Osinga N, van Liere D. Applying XGBoost and SHAP to Open Source Data to Identify Key Drivers and Predict Likelihood of Wolf Pair Presence. Environ Manage 2024; 73:1072-1087. [PMID: 38372749 DOI: 10.1007/s00267-024-01941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/20/2024] [Indexed: 02/20/2024]
Abstract
Wolves have returned to Germany since 2000. Numbers have grown to 209 territorial pairs in 2021. XGBoost machine learning, combined with SHAP analysis is applied to predict German wolf pair presence in 2022 for 10 × 10 km grid cells. Model input consisted of 38 variables from open sources, covering the period 2000 to 2021. The XGBoost model predicted well, with 0.91 as the AUC. SHAP analysis ranked the variables: distance to the closest neighboring wolf pair was the main driver for a grid cell to become occupied by a wolf pair. The clustering tendency of related wolves seems to be an important explanatory factor here. Second was the percentage of wooded area. The next eight variables related to wolf presence in the preceding year, except at fifth, eighth and tenth position in the total order: human density (square root) in the grid, percentage arable land and road density respectively. Other variables including the occurrence of wild prey were the weakest predictors. The SHAP analysis also provided crucial added value in identifying a variable that had threshold values where its contribution to the prediction changed from positive to negative or vice versa. For instance, low density of people increased the probability of wolf pair presence, whereas a high density decreased this probability. Cumulative lift techniques showed that the model performed almost four times better than random prediction. The combination of XGBoost, SHAP and cumulative lift techniques is new in wolf management and conservation, allowing for the focusing of educational and financial resources.
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Affiliation(s)
| | | | | | - Nynke Osinga
- Institute for Coexistence with Wildlife, Heuvelweg 7, 7218 BD, Almen, Nederland
| | - Diederik van Liere
- Institute for Coexistence with Wildlife, Heuvelweg 7, 7218 BD, Almen, Nederland
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García-Parra B, Guiu JM, Povedano M, Mariño EL, Modamio P. Geographical distribution of clinical trials in amyotrophic lateral sclerosis: a scoping review. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:376-381. [PMID: 38393299 DOI: 10.1080/21678421.2024.2320881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Introduction: Clinical trials location is determined by many factors, including the availability of patient populations, regulatory environment, scientific expertise, and cost considerations. In clinical drug development of amyotrophic lateral sclerosis (ALS), where genetic differences have been described and may be related to geographic setting, this could have implications for the clinical interpretation of results in underrepresented geographic settings. Objective: The aim of this study was to review country participation in ALS clinical research based on available data from clinical trial registries and databases. Methods: We performed a scoping review with available information about clinical trials on ALS in ClinicalTrials.gov (CT), EU clinical trials register (EudraCT), WHO International Clinical Trials Registry Platform (ICTRP) and Web of Science (WOS). Inclusion criteria were clinical trials in phase 2 and 3 to treat ALS, recruiting or active not recruiting, from 23/06/2018 to 23/06/2023. Results: The total number of clinical trials identified were 188; 54 studies in CT, 38 in EudraCT, 47 in ICTRP and 49 in WOS. We identified 77 clinical trials after deleting duplicates and applying exclusion criteria. The countries with most studies conducted were the US with 35 studies (10.9%), followed by the United Kingdom, Belgium, France and Germany with 21 studies each one of them (6.5%). Conclusion: The data obtained in our review showed a non-homogeneous distribution in clinical trials at the international level, which may influence the interpretation of the results obtained.
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Affiliation(s)
- Beliu García-Parra
- Clinical Neurophysiology Section - Neurology Service, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Guiu
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain, and
| | - Mónica Povedano
- Clinical Neurophysiology Section - Neurology Service, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
- Motor Neuron Diseases Unit, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain, and
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain, and
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Xue B, King M, Deindl C, Lacey R, Di Gessa G, McMunn A. Do Health and Well-Being Change Around the Transition to Informal Caring in Early Adulthood? A Longitudinal Comparison Between the United Kingdom and Germany. J Adolesc Health 2024; 74:885-891. [PMID: 38206223 DOI: 10.1016/j.jadohealth.2023.11.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17-29 years old) influenced health and life satisfaction in the United Kingdom and Germany. METHODS Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009-2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care. RESULTS In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany. DISCUSSION The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.
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Affiliation(s)
- Baowen Xue
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.
| | - Markus King
- Department of Social Sciences, TU Dortmund University, Dortmund, Germany; Department of Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Christian Deindl
- Department of Social Sciences, TU Dortmund University, Dortmund, Germany
| | - Rebecca Lacey
- Department of Epidemiology and Public Health, University College London, London, United Kingdom; Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Schröder S, Schulze Westhoff M, Pfister T, Bleich S, Wedegärtner F, Krüger TH, Heck J, Groh A. Characteristics of clinical-pharmacological recommendations in psychiatry in Germany. Int J Psychiatry Med 2024; 59:393-405. [PMID: 37194304 DOI: 10.1177/00912174231177230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Psychiatric patients in general, and elderly psychiatric patients in particular, are at risk of adverse drug reactions due to comorbidities and inappropriate polypharmacy. Interdisciplinary and clinical-pharmacologist-led medication reviews may contribute to medication safety in the field of psychiatry. In this study, we reported the frequency and characteristics of clinical-pharmacological recommendations in psychiatry, with a particular focus on geriatric psychiatry. METHOD A clinical pharmacologist, in collaboration with the attending psychiatrists and a consulting neurologist, conducted interdisciplinary medication reviews in a general psychiatric ward with a geropsychiatric focus at a university hospital over a 25-week period. All clinical and pharmacological recommendations were recorded and evaluated. RESULTS A total of 316 recommendations were made during 374 medication reviews. Indications/contraindications of drugs were the most frequently discussed topics (59/316; 18.7 %), followed by dose reductions (37/316; 11.7 %), and temporary or permanent discontinuation of medications (36/316; 11.4 %). The most frequent recommendations for dose reduction involvedbenzodiazepines (9/37; 24.3 %). An unclear or absent indication was the most common reason for recommending temporary or permanent discontinuation of the medication (6/36; 16.7 %). CONCLUSION Interdisciplinary clinical pharmacologist-led medication reviews represented a valuable contribution to medication management in psychiatric patients, particularly the elderly ones.
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Affiliation(s)
- Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tabea Pfister
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Wedegärtner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tillmann Hc Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kutzler J, Polettini AE, Bleicher S, Sauer C, Schultis W, Neukamm MA, Auwärter V. Synthetic cannabinoids in hair-Prevalence of use in abstinence control programs for driver's license regranting in Germany. Drug Test Anal 2024; 16:518-531. [PMID: 37731292 DOI: 10.1002/dta.3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
Although the use, structural variety, and prevalence of synthetic cannabinoids (SCs) have steadily increased on the drug market, they are rarely analyzed in abstinence control programs for driver's license regranting. The aim of this study was to determine the SC prevalence in these programs by analyzing hair samples collected between March 2020 and March 2021 from various regions in Germany, mainly Bavaria (40%). Specimens were analyzed quantitatively for drugs of abuse and qualitatively for 107 SCs. Hair samples were screened by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and to search for unknown SC analogs, positive samples were additionally screened by liquid chromatography-high resolution time of flight mass spectrometry (LC-qTOF/MS). The analysis of 5097 hair samples resulted in 181 SC detections (3.6%), showing a wide range of 44 SCs, with up to 13 different compounds found in a single sample. The most prevalent compounds were 5F-MDMB-PICA and MDMB-4en-PINACA; furthermore, 10 new substances not initially covered by LC-MS/MS analysis were detected by LC-qTOF/MS. The SC positivity rate was comparable to cocaine (5.4%) and amphetamine (2.6%). Only in 35 cases (0.7%), SC analysis was requested by the clients, highlighting the insufficient coverage of SC consumption in the studied collective. In summary, hair sample analysis proved to be a valuable tool to monitor the use of SCs. In order to keep pace with newly emerging SC analogs, an up-to-date analytical method is essential. Prospectively, SCs should be more routinely screened in hair analysis for abstinence control to avoid cannabis substitution by SCs.
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Affiliation(s)
- Johannes Kutzler
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Postgraduate Course for Toxicology and Environmental Toxicology, Institute for Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Aldo Eliano Polettini
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
- Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Sergej Bleicher
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Christoph Sauer
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Wolfgang Schultis
- Department of Forensic Toxicology & Drug Analysis, SYNLAB MVZ Weiden GmbH, Weiden, Germany
| | - Merja A Neukamm
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Pilgram L, Meurers T, Malin B, Schaeffner E, Eckardt KU, Prasser F. The Costs of Anonymization: Case Study Using Clinical Data. J Med Internet Res 2024; 26:e49445. [PMID: 38657232 DOI: 10.2196/49445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/14/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Sharing data from clinical studies can accelerate scientific progress, improve transparency, and increase the potential for innovation and collaboration. However, privacy concerns remain a barrier to data sharing. Certain concerns, such as reidentification risk, can be addressed through the application of anonymization algorithms, whereby data are altered so that it is no longer reasonably related to a person. Yet, such alterations have the potential to influence the data set's statistical properties, such that the privacy-utility trade-off must be considered. This has been studied in theory, but evidence based on real-world individual-level clinical data is rare, and anonymization has not broadly been adopted in clinical practice. OBJECTIVE The goal of this study is to contribute to a better understanding of anonymization in the real world by comprehensively evaluating the privacy-utility trade-off of differently anonymized data using data and scientific results from the German Chronic Kidney Disease (GCKD) study. METHODS The GCKD data set extracted for this study consists of 5217 records and 70 variables. A 2-step procedure was followed to determine which variables constituted reidentification risks. To capture a large portion of the risk-utility space, we decided on risk thresholds ranging from 0.02 to 1. The data were then transformed via generalization and suppression, and the anonymization process was varied using a generic and a use case-specific configuration. To assess the utility of the anonymized GCKD data, general-purpose metrics (ie, data granularity and entropy), as well as use case-specific metrics (ie, reproducibility), were applied. Reproducibility was assessed by measuring the overlap of the 95% CI lengths between anonymized and original results. RESULTS Reproducibility measured by 95% CI overlap was higher than utility obtained from general-purpose metrics. For example, granularity varied between 68.2% and 87.6%, and entropy varied between 25.5% and 46.2%, whereas the average 95% CI overlap was above 90% for all risk thresholds applied. A nonoverlapping 95% CI was detected in 6 estimates across all analyses, but the overwhelming majority of estimates exhibited an overlap over 50%. The use case-specific configuration outperformed the generic one in terms of actual utility (ie, reproducibility) at the same level of privacy. CONCLUSIONS Our results illustrate the challenges that anonymization faces when aiming to support multiple likely and possibly competing uses, while use case-specific anonymization can provide greater utility. This aspect should be taken into account when evaluating the associated costs of anonymized data and attempting to maintain sufficiently high levels of privacy for anonymized data. TRIAL REGISTRATION German Clinical Trials Register DRKS00003971; https://drks.de/search/en/trial/DRKS00003971. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1093/ndt/gfr456.
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Affiliation(s)
- Lisa Pilgram
- Junior Digital Clinician Scientist Program, Biomedical Innovation Academy, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thierry Meurers
- Medical Informatics Group, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bradley Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elke Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian Prasser
- Medical Informatics Group, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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Camilleri JA, Volkening J, Heim S, Mochalski LN, Neufeld H, Schlothauer N, Kuhles G, Eickhoff SB, Weis S. SpEx: a German-language dataset of speech and executive function performance. Sci Rep 2024; 14:9431. [PMID: 38658576 DOI: 10.1038/s41598-024-58617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
This work presents data from 148 German native speakers (20-55 years of age), who completed several speaking tasks, ranging from formal tests such as word production tests to more ecologically valid spontaneous tasks that were designed to mimic natural speech. This speech data is supplemented by performance measures on several standardised, computer-based executive functioning (EF) tests covering domains of working-memory, cognitive flexibility, inhibition, and attention. The speech and EF data are further complemented by a rich collection of demographic data that documents education level, family status, and physical and psychological well-being. Additionally, the dataset includes information of the participants' hormone levels (cortisol, progesterone, oestradiol, and testosterone) at the time of testing. This dataset is thus a carefully curated, expansive collection of data that spans over different EF domains and includes both formal speaking tests as well as spontaneous speaking tasks, supplemented by valuable phenotypical information. This will thus provide the unique opportunity to perform a variety of analyses in the context of speech, EF, and inter-individual differences, and to our knowledge is the first of its kind in the German language. We refer to this dataset as SpEx since it combines speech and executive functioning data. Researchers interested in conducting exploratory or hypothesis-driven analyses in the field of individual differences in language and executive functioning, are encouraged to request access to this resource. Applicants will then be provided with an encrypted version of the data which can be downloaded.
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Affiliation(s)
- Julia A Camilleri
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany.
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Julia Volkening
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- PeakProfiling GmbH, Eschenallee 36, 14050, Berlin, Germany
| | - Stefan Heim
- Institute of Neuroscience and Medicine (INM-1 Structural and Functional Organisation of the Brain), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Lisa N Mochalski
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Hannah Neufeld
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Natalie Schlothauer
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Gianna Kuhles
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Susanne Weis
- Institute of Neuroscience and Medicine (INM-7 Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428, Jülich, Germany
- Institute of Systems Neuroscience, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Ludwig S, Jenner S, Berger R, Tappert S, Kurmeyer C, Oertelt-Prigione S, Petzold M. Perceptions of lecturers and students regarding discriminatory experiences and sexual harassment in academic medicine - results from a faculty-wide quantitative study. BMC Med Educ 2024; 24:447. [PMID: 38658938 DOI: 10.1186/s12909-024-05094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences. METHODS In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité-Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators. RESULTS The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment. CONCLUSIONS Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace.
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Affiliation(s)
- Sabine Ludwig
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany.
- Institute of Diversity in Medicine, Medical University Innsbruck, Innsbruck, Austria.
| | - Sabine Jenner
- Equal Opportunities Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralph Berger
- Department for Teaching and Learning, Quality Assurance Section, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvie Tappert
- Department for Teaching and Learning, MediCoach, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Kurmeyer
- Equal Opportunities Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Bielefeld University, Bielefeld, Germany
| | - Mandy Petzold
- Department for Teaching and Learning, Quality Assurance Section, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Giebel GD, Abels C, Plescher F, Speckemeier C, Schrader NF, Börchers K, Wasem J, Neusser S, Blase N. Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study. J Med Internet Res 2024; 26:e49982. [PMID: 38652508 DOI: 10.2196/49982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/24/2023] [Accepted: 01/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. OBJECTIVE The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. METHODS Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. RESULTS A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. CONCLUSIONS There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.
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Affiliation(s)
- Godwin Denk Giebel
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Felix Plescher
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Nils Frederik Schrader
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
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Beil-Hildebrand MB, Kundt Sari F, Kutschar P, Birkholz L. What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland. Leadersh Health Serv (Bradf Engl) 2024; ahead-of-print. [PMID: 38639984 DOI: 10.1108/lhs-09-2023-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE Nurse leaders are challenged by ethical issues in today's complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries. DESIGN/METHODOLOGY/APPROACH This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries. FINDINGS The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries. ORIGINALITY/VALUE Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.
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Affiliation(s)
| | - Firuzan Kundt Sari
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Lorri Birkholz
- School of Nursing, Chatham University, Pittsburgh, Pennsylvania, USA
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Rakhmani I, Yusuf AA, Saleh H, Sakhiyya Z, Pertiwi K, Nasir S, Wiratraman HP, Juliandi B, Nugroho Y, Jompa J. Reflecting on Indonesia's young academy movement. Proc Natl Acad Sci U S A 2024; 121:e2307213121. [PMID: 38621134 DOI: 10.1073/pnas.2307213121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
In the past three decades, there has been a rise in young academy movements in the Global North and South. Such movements, in at least Germany and the Netherlands, have been shown to be quite effective in connecting scientific work with society. Likewise, these movements share a common goal of developing interdisciplinary collaboration among young scientists, which contributes to the growth of a nation's-but also global-scientific endeavors. This paper focuses on the young academy movement in the fourth-largest country hosting the biggest Muslim population in the world, which is also the third-most populous democracy: Indonesia. We observe that there has been rising awareness among the young generation of scientists in Indonesia of the need to advocate for the use of sciences in responding to upcoming and current multidimensional crises. Science advocacy can be seen in their peer-based identification of Indonesia's future challenges, encompassing the fundamental areas for scientific inquiry, discovery, and intervention. We focus on the Indonesian Young Academy of Sciences (ALMI) and its network of young scientists. We describe ALMI's science communication practice, specifically SAINS45 and Science for Indonesia's Biodiversity, and how they have been useful for policymakers, media, and school engagements. The article closes with a reflection on future directions for the young academy movement in Indonesia and beyond.
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Affiliation(s)
- Inaya Rakhmani
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Department of Communication and Asia Research Centre, Universitas Indonesia, Depok 16424, Indonesia
| | - Arief Anshory Yusuf
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Department of Economics, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Hasnawati Saleh
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Public Health, Universitas Hasanuddin, Makassar 90245, Indonesia
- The Australia-Indonesia Centre, Makassar 90245, Indonesia
| | - Zulfa Sakhiyya
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Languages and Arts, Universitas Negeri Semarang, Semarang 50229, Indonesia
| | - Kanti Pertiwi
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Department of Communication and Asia Research Centre, Universitas Indonesia, Depok 16424, Indonesia
- Faculty of Business and Economics, The University of Melbourne, Melbourne 3052, Australia
| | - Sudirman Nasir
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Public Health, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Herlambang P Wiratraman
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Law, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Berry Juliandi
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Mathematics and Natural Sciences, Bogor Agricultural University (IPB) University, Bogor 16680, Indonesia
| | - Yanuar Nugroho
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Driyarkara School of Philosophy, Jakarta 10520, Indonesia
- Institute of Southeast Asian Studies (ISEAS)-Yusof Ishak Institute, Singapore 119614, Singapore
- Manchester Institute of Innovation Research, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Jamaluddin Jompa
- Indonesian Young Academy of Sciences (ALMI), Jakarta 10110, Indonesia
- Faculty of Public Health, Universitas Hasanuddin, Makassar 90245, Indonesia
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Falk D, Wings O, Unitt R, Wade J, McNamara ME. Fossilized anuran soft tissues reveal a new taphonomic model for the Eocene Geiseltal Konservat-Lagerstätte, Germany. Sci Rep 2024; 14:7876. [PMID: 38654038 DOI: 10.1038/s41598-024-55822-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 04/25/2024] Open
Abstract
The Eocene Geiseltal Konservat-Lagerstätte (Germany) is famous for reports of three dimensionally preserved soft tissues with sub-cellular detail. The proposed mode of preservation, direct replication in silica, is not known in other fossils and has not been verified using modern approaches. Here, we investigated the taphonomy of the Geiseltal anurans using diverse microbeam imaging and chemical analytical techniques. Our analyses confirm the preservation of soft tissues in all body regions but fail to yield evidence for silicified soft tissues. Instead, the anuran soft tissues are preserved as two layers that differ in microstructure and composition. Layer 1 comprises sulfur-rich carbonaceous microbodies interpreted as melanosomes. Layer 2 comprises the mid-dermal Eberth-Katschenko layer, preserved in calcium phosphate. In addition, patches of original aragonite crystals define the former position of the endolymphatic sac. The primary modes of soft tissue preservation are therefore sulfurization of melanosomes and phosphatization of more labile soft tissues, i.e., skin. This is consistent with the taphonomy of vertebrates in many other Konservat-Lagerstätten. These findings emphasize an emerging model for pervasive preservation of vertebrate soft tissues via melanosome films, particularly in stagnation-type deposits, with phosphatization of more labile tissues where tissue biochemistry is favorable.
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Affiliation(s)
- Daniel Falk
- School of Biological, Earth and Environmental Sciences, University College Cork, Distillery Fields, North Mall, Cork, T23 TK30, Ireland.
- Environmental Research Institute, University College Cork, Lee Rd, Cork, T23 XE10, Ireland.
| | - Oliver Wings
- Natural History Museum Bamberg, Staatliche Naturwissenschaftliche Sammlungen Bayerns, Fleischstraße 2, 96047, Bamberg, Germany
| | - Richard Unitt
- School of Biological, Earth and Environmental Sciences, University College Cork, Distillery Fields, North Mall, Cork, T23 TK30, Ireland
- Environmental Research Institute, University College Cork, Lee Rd, Cork, T23 XE10, Ireland
- Copper Coast UNESCO Global Geopark, Knockmahon, Bunmahon, X42 T923, Ireland
| | - Jon Wade
- Department of Earth Sciences, University of Oxford, South Parks Road, Oxford, OX1 3AN, UK
| | - Maria E McNamara
- School of Biological, Earth and Environmental Sciences, University College Cork, Distillery Fields, North Mall, Cork, T23 TK30, Ireland
- Environmental Research Institute, University College Cork, Lee Rd, Cork, T23 XE10, Ireland
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Löffler F, Brüggeshemke J, Freienstein FM, Kämpfer S, Fartmann T. Urban rooftops near sports pitches provide a safe haven for a declining shorebird. Sci Rep 2024; 14:9248. [PMID: 38649736 PMCID: PMC11035604 DOI: 10.1038/s41598-024-59693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
Urbanisation has contributed to a severe decline in biodiversity worldwide. However, urban ecosystems can also play an important role in the conservation of threatened species, including ground-nesting birds such as the Eurasian Oystercatcher (Haematopus ostralegus). While the coastal populations of this shorebird have declined sharply, there is growing evidence that pairs nesting on urban flat roofs have high reproductive success. However, the reasons for rooftop nesting and the species' habitat use in urban areas remain poorly understood. In this study, we investigate the territory selection and foraging behaviour of the Eurasian Oystercatcher in the city of Münster (NW Germany). All nesting sites were located on flat roofs (N = 24), most of which were covered with gravel. Overall, reproductive success was high. This was mainly because the roofs provided protection from mammalian predators, leading to increased nest and chick survival. Moreover, breeding performance in the study area was favoured by the proximity of sports pitches. According to our observations, they provided a large amount of easily accessible prey throughout the breeding season. Overall, our study highlights that the reproductive success of the Eurasian Oystercatcher in urban environments is highly dependent on both safe nesting sites on flat roofs and the availability of suitable foraging habitats. Although our study suggests that breeding in urban areas can be beneficial for the model organism, the species' strong territory fidelity makes it very sensitive to the rapid environmental changes occurring in cities. The value of urban ecosystems for bird conservation should therefore be better integrated into urban planning and management.
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Affiliation(s)
- Franz Löffler
- Department of Biodiversity and Landscape Ecology, Osnabrück University, Barbarastraße 11, 49076, Osnabrück, Germany.
| | - Jonas Brüggeshemke
- Department of Biodiversity and Landscape Ecology, Osnabrück University, Barbarastraße 11, 49076, Osnabrück, Germany
| | - Felix Maximilian Freienstein
- Department of Biodiversity and Landscape Ecology, Osnabrück University, Barbarastraße 11, 49076, Osnabrück, Germany
| | - Steffen Kämpfer
- Department of Biodiversity and Landscape Ecology, Osnabrück University, Barbarastraße 11, 49076, Osnabrück, Germany
| | - Thomas Fartmann
- Department of Biodiversity and Landscape Ecology, Osnabrück University, Barbarastraße 11, 49076, Osnabrück, Germany
- Institute of Biodiversity and Landscape Ecology (IBL), An der Kleimannbrücke 98, 48157, Münster, Germany
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Kerksieck P, Kujanpää M, de Bloom J, Brauchli R, Bauer GF. A new perspective on balancing life domains: work-nonwork balance crafting. BMC Public Health 2024; 24:1099. [PMID: 38649890 PMCID: PMC11034155 DOI: 10.1186/s12889-024-18646-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Self-initiated and proactive changes in working conditions through crafting are essential for shaping work and improving work-related well-being. Recently, the research stream of job crafting has been extended to other life domains. The present paper aims to study a novel crafting concept-work-nonwork balance crafting-investigating the role of its antecedents and identifying relevant outcomes. Work-nonwork balance crafting is defined as individuals' unofficial techniques and activities to shape their work-nonwork balance, here considering their life domain boundary preferences. METHODS In the study, 1,060 employees in three European countries (Austria, Germany and Switzerland) were surveyed in a longitudinal three-wave study with three-month intervals. We explored the influences of job/home demands and resources as antecedents of work-nonwork balance crafting. Important constructs for employee health and well-being (i.e., work engagement, work-related burnout, mental well-being and detachment from work) were investigated as outcomes. RESULTS The findings suggest that resources and demands in the context of work or home are key antecedents of work-nonwork balance crafting. Work-nonwork balance crafting was also predictive for important employee health and well-being outcomes over three months, mainly in a positive and health-promoting way. CONCLUSION This study provides insights into the antecedents of proactive efforts to balance the complex interplay of life domains. By studying work-nonwork balance crafting, we provide a new perspective on crafting beyond job crafting, which may help maintain or improve employees' mental health and well-being.
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Affiliation(s)
- Philipp Kerksieck
- Public and Organizational Health / Center of Salutogenesis, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Miika Kujanpää
- School of Business, University of South-Eastern Norway, Hønefoss, Norway
| | - Jessica de Bloom
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | | | - Georg F Bauer
- Public and Organizational Health / Center of Salutogenesis, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Waeschle RM, Epperlein T, Demmer I, Hummers E, Quintel Q. Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies. BMC Health Serv Res 2024; 24:497. [PMID: 38649877 PMCID: PMC11034040 DOI: 10.1186/s12913-024-10963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.
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Affiliation(s)
- R M Waeschle
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - T Epperlein
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - I Demmer
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - E Hummers
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - Q Quintel
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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von Gönner J, Gröning J, Grescho V, Neuer L, Gottfried B, Hänsch VG, Molsberger-Lange E, Wilharm E, Liess M, Bonn A. Citizen science shows that small agricultural streams in Germany are in a poor ecological status. Sci Total Environ 2024; 922:171183. [PMID: 38408653 DOI: 10.1016/j.scitotenv.2024.171183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
Agricultural pesticides, nutrients, and habitat degradation are major causes of insect declines in lowland streams. To effectively conserve and restore stream habitats, standardized stream monitoring data and societal support for freshwater protection are needed. Here, we sampled 137 small stream monitoring sites across Germany, 83 % of which were located in agricultural catchments, with >900 citizen scientists in 96 monitoring groups. Sampling was carried out according to Water Framework Directive standards as part of the citizen science freshwater monitoring program FLOW in spring and summer 2021, 2022 and 2023. The biological indicator SPEARpesticides was used to assess pesticide exposure and effects based on macroinvertebrate community composition. Overall, 58 % of the agricultural monitoring sites failed to achieve a good ecological status in terms of macroinvertebrate community composition and indicated high pesticide exposure (SPEARpesticides status class: 29 % "moderate", 19 % "poor", 11 % "bad"). The indicated pesticide pressure in streams was related to the proportion of arable land in the catchment areas (R2 = 0.23, p < 0.001). Also with regards to hydromorphology, monitoring results revealed that 65 % of the agricultural monitoring sites failed to reach a good status. The database produced by citizen science groups was characterized by a high degree of accuracy, as results obtained by citizen scientists and professionals were highly correlated for SPEARpesticides index (R2 = 0.79, p < 0.001) and hydromorphology index values (R2 = 0.72, p < 0.001). Such citizen-driven monitoring of the status of watercourses could play a crucial role in monitoring and implementing the objectives of the European Water Framework Directive, thus contributing to restoring and protecting freshwater ecosystems.
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Affiliation(s)
- Julia von Gönner
- Helmholtz Centre for Environmental Research (UFZ), Department Biodiversity and People, Permoserstr. 15, 04318 Leipzig, Germany; Friedrich Schiller University Jena, Institute of Biodiversity, Dornburgerstr.159, 07743 Jena, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstr. 4, 04103 Leipzig, Germany.
| | - Jonas Gröning
- Helmholtz Centre for Environmental Research (UFZ), System-Ecotoxicology, Permoserstr. 15, 04318 Leipzig, Germany; RPTU Kaiserslautern-Landau, Institute for Environmental Sciences, Fortstr. 7, 76829 Landau, Germany
| | - Volker Grescho
- Helmholtz Centre for Environmental Research (UFZ), Department Biodiversity and People, Permoserstr. 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstr. 4, 04103 Leipzig, Germany
| | - Lilian Neuer
- Friends of the Earth Germany e.V. (BUND), Kaiserin-Augusta-Allee 5, 10553 Berlin, Germany
| | | | - Veit G Hänsch
- Saaletreff Jena, Beutnitzer Straße 5, 07749 Jena, Germany
| | - Eva Molsberger-Lange
- Adolf-Reichwein-Schule, Heinrich-von-Kleist-Straße 14, 65549 Limburg an der Lahn, Germany
| | - Elke Wilharm
- Ostfalia University of Applied Sciences, Salzdahlumer Straße 46/48, 38302 Wolfenbüttel, Germany
| | - Matthias Liess
- Helmholtz Centre for Environmental Research (UFZ), System-Ecotoxicology, Permoserstr. 15, 04318 Leipzig, Germany; RWTH Aachen University, Institute of Ecology & Computational Life Science, Templergraben 55, 52056 Aachen, Germany
| | - Aletta Bonn
- Helmholtz Centre for Environmental Research (UFZ), Department Biodiversity and People, Permoserstr. 15, 04318 Leipzig, Germany; Friedrich Schiller University Jena, Institute of Biodiversity, Dornburgerstr.159, 07743 Jena, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstr. 4, 04103 Leipzig, Germany
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48
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van Baal K, Hemmerling M, Stahmeyer JT, Stiel S, Afshar K. End-of-life care in Germany between 2016 and 2020 - A repeated cross-sectional analysis of statutory health insurance data. BMC Palliat Care 2024; 23:105. [PMID: 38643167 PMCID: PMC11031961 DOI: 10.1186/s12904-024-01387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/15/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The Hospice and Palliative Care Act of 2015 aimed at developing and regulating the provision of palliative care (PC) services in Germany. As a result of the legal changes, people with incurable diseases should be enabled to experience their final stage of life including death according to their own wishes. However, it remains unknown whether the act has impacted end-of-life care (EoLC) in Germany. OBJECTIVE The present study examined trends in EoLC indicators for patients who died between 2016 and 2020, in the context of Lower Saxony, Germany. METHODS Repeated cross-sectional analysis was conducted on data from the statutory health insurance fund AOK Lower Saxony (AOK-LS), referring to the years 2016-2020. EoLC indicators were: (1) the number of patients receiving any form of outpatient PC, (2) the number of patients receiving generalist outpatient PC and (3) specialist outpatient PC in the last year of life, (4) the onset of generalist outpatient PC and (5) the onset of specialist outpatient PC before death, (6) the number of hospitalisations in the 6 months prior to death and (7) the number of days spent in hospital in the 6 months prior to death. Data for each year were analysed descriptively and a comparison between 2016 and 2020 was carried out using t-tests and chi-square tests. RESULTS Data from 160,927 deceased AOK-LS members were analysed. The number of patients receiving outpatient PC remained almost consistent over time (2016 vs. 2020 p = .077). The number of patients receiving generalist outpatient PC decreased from 28.4% (2016) to 24.5% (2020; p < .001), whereas the number of patients receiving specialist outpatient PC increased from 8.5% (2016) to 11.2% (2020; p < .001). The onset of generalist outpatient PC moved from 106 (2016) to 93 days (2020; p < .001) before death, on average. The onset of specialist outpatient PC showed the reverse pattern (2016: 55 days before death; 2020: 59 days before death; p = .041). CONCLUSION Despite growing needs for PC at the end of life, the number of patients receiving outpatient PC did not increase between 2016 and 2020. Furthermore, specialist outpatient PC is being increasingly prescribed over generalist outpatient PC. Although the early initiation of outpatient PC has been proven valuable for the majority of people at the end of life, generalist outpatient PC was not initiated earlier in the disease trajectory over the study period, as was found to be true for specialist outpatient PC. Future studies should seek to determine how existing PC needs can be optimally met within the outpatient sector and identify factors that can support the earlier initiation of especially generalist outpatient PC. TRIAL REGISTRATION The study "Optimal Care at the End of Life" was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019).
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Affiliation(s)
- Katharina van Baal
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Melissa Hemmerling
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Jona Theodor Stahmeyer
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kambiz Afshar
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Frankenberger J, Ballouard JM, Caron S, Zablotski Y, Kölle P. Body condition scoring facilitates healthcare monitoring in Hermann's Tortoises (Testudo hermanni ssp.). PLoS One 2024; 19:e0301892. [PMID: 38635596 PMCID: PMC11025769 DOI: 10.1371/journal.pone.0301892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Clinical assessment of body condition is crucial in captive and free-ranging reptiles, since a large percentage of diseases result from inadequate nutrition. However, preventive health care is restricted by the lack of a practical method for the assessment in tortoises. Pre-existing evaluation systems based on weight and shell measurements are laborious and ignore the clinical presentation of the animal. The present study aimed to facilitate the assessment by establishing a body condition score. A total of 373 Hermann's Tortoises (Testudo hermanni) (n = 281 tortoises kept as pets in Germany and n = 92 tortoises originating from a free-ranging population (68) or a rearing station (24) in France) were examined and data (weight (g), carapace length (cm), width (cm), height (cm)) were recorded in a standard protocol between October 2020 and October 2021. A modified version of a body condition score for Mojave Desert Tortoises (Gopherus agassizii) (1 = cachectic, 3 = ideal, 5 = obese) was utilized and tested against pre-existing shell measurement systems (Jackson's ratio, body condition index, volume condition index, circumferential product). German captive tortoises were significantly heavier and larger than French specimens. In the Spearman's correlation matrix, the body condition score showed a statistically significant correlation with all measurement methods in the total population of captive tortoises (Testudo hermanni boettgeri), with a medium correlation strength, and a lack of correlation in free-ranging tortoises (Testudo hermanni hermanni). However, individual animal data suggested misleading results of mathematical equations in terms of body condition. Clinical evaluation of tortoises, including a body condition score, should be considered essential to provide good healthcare and should be an integral part of general examination.
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Affiliation(s)
- Julia Frankenberger
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Jean-Marie Ballouard
- Station d’Observation et de Protection des Tortues et de leurs Milieux (SOPTOM), CRCC, Gonfaron, France
| | - Sebastien Caron
- Station d’Observation et de Protection des Tortues et de leurs Milieux (SOPTOM), CRCC, Gonfaron, France
| | - Yury Zablotski
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Petra Kölle
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
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Hammerich J, Schulz C, Probst R, Lüdicke T, Luthardt V. Carbon content and other soil properties of near-surface peats before and after peatland restoration. PeerJ 2024; 12:e17113. [PMID: 38646486 PMCID: PMC11032657 DOI: 10.7717/peerj.17113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/26/2024] [Indexed: 04/23/2024] Open
Abstract
Peatland restoration usually aims at restarting the peatlands' function to store carbon within peat. The soil properties of the near-surface peat can give a first understanding of this process. Therefore, we sampled pH value, total organic carbon content (TOC), total nitrogen content (TN), C/N ratio as well as dry bulk density (BD), and describe the structure of near-surface peats in six restored fens in North-East Germany before (2002-2004) and after (2019-2021) restoration. Before restoration, the study sites showed peat degradation to various extents in their near-surface peats. pH values remained relatively stable over time. Comparing the degraded peat horizons, TOC increased significantly in four study sites, ranging from 35.7% to 47.8% in 2002-2004 and from 42.5% to 54.0% in 2019-2021. TN varied from 1.5% to 3.5% in 2002-2004 and from 1.8% to 3.2% in 2019-2021, but changes were only significant in one site, showing a slight decrease. In three sites, the increase in C/N ratio was significant, indicating lower nutrient availability. BD ranged from 0.08 to 0.48 g/cm3 in 2002-2004 and from 0.10 to 0.16 g/cm3 in 2019-2021, decreasing significantly in four sites. The structure of the degraded peat horizons changed after restoration to a more homogenous, sludge mass with larger re-aggregates. In three sites, new peat moss peat layers above the degraded soil horizon were present in 2019-2021, with a mean thickness of 6.8 to 36.1 cm. The structure was comparable to typical, slightly decomposed peat moss peat. Our findings suggest that within about 17 years after fen restoration, and thereby a water table rise close to surface, TOC of the near-surface peats increased to values that are typical for undisturbed peatlands. This indicates that restoration can lead to the re-establishment of peatlands as potential carbon sinks, with TOC within the near-surface peat as one key factor in this process. Further, we assume that the decrease in nutrient availability, decrease of BD, and new, undisturbed peat layers can favor the establishment of mire-specific biodiversity and support ecosystem services similar to near-natural mires.
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Affiliation(s)
- Jenny Hammerich
- Faculty of Landscape Management & Nature Conservation, Eberswalde University for Sustainable Development, Eberswalde, Brandenburg, Germany
- Center of Methods & Faculty of Sustainability, Leuphana University, Lüneburg, Lower Saxony, Germany
| | - Corinna Schulz
- Faculty of Landscape Management & Nature Conservation, Eberswalde University for Sustainable Development, Eberswalde, Brandenburg, Germany
- Institute of Botany and Landscape Ecology, Greifswald University, Greifswald, Mecklenburg-Western Pomerania, Germany
| | - Robert Probst
- Faculty of Landscape Management & Nature Conservation, Eberswalde University for Sustainable Development, Eberswalde, Brandenburg, Germany
| | - Thomas Lüdicke
- UWEG Engineers & Analytics GmbH, Eberswalde, Brandenburg, Germany
| | - Vera Luthardt
- Faculty of Landscape Management & Nature Conservation, Eberswalde University for Sustainable Development, Eberswalde, Brandenburg, Germany
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