Search

This chapter begins with an assertion that, beyond the cultural traditions that affirm childhood as a period of special and lasting importance, a new science of child development reveals an influence of the early years throughout the life course. Through processes of “biological embedding,” early developmental experiences and exposures become neurobiologically instantiated in the brain and genome, thereby affecting trajectories of health and development for the remainder of life. The socioeconomic maldistribution of exposures to adversities and misfortune allots a disproportionate share of physical and mental morbidities to those growing up in conditions of poverty and disadvantage. These outcomes now appear related to epigenetic interactions between aspects of allelic variation-based vulnerability and the assaultive or supportive conditions of early life. Future research should thus address how epigenetic regulation of gene expression is linked to the neurobiological processes underpinning developmental psychopathology and other maladaptive outcomes. Richer understanding of how early environments can amplify or diminish the impacts of adversity exposure will provide new insights to guide the construction of novel, effective, and early interventions., (Copyright 2018, The Author(s).)

This open access White Paper details the status of hip and knee arthroplasty care in Germany. Hip and knee replacements are amongst the most frequently performed procedures and usually become necessarily due to age-related wear of the joint, osteoarthritis and fractures of the femoral neck. In light of demographic change, demands with regard to standards of care and the procedures are likely to rise., (Copyright 2018, The Editor(s) (if applicable) and The Author(s). This book is an open access publication.)

Prostate cancer is a common and increasing malignancy in men. Tissue is generally obtained using prostate biopsy for diagnosis and risk stratification. There are many prostate biopsy techniques. Historically, the transrectal approach has been the most adopted. In many centers, however, there has a been a shift towards transperineal prostate biopsies, increasingly performed under local anesthetic. The transperineal approach has proven advantages, including better sampling of the anterior area of the prostate and lower infection rates. Biopsies are typically performed using a combination of a systematic and targeted approach. Targeting of lesions identified by magnetic resonance imaging can be performed cognitively, assisted by a fused imaging approach with the transrectal ultrasound, or directly within the magnetic resonance imaging scanner. There are several novel developments in the field, which include robotic techniques to guide biopsy needles based on fusion images or directly targeting lesions robotically during in-bore magnetic resonance imaging., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

Gathering and sharing by individuals of their health-related data to enhance their medical care or personal wellness are popular and growing rapidly. As a relatively new field, nomenclature is variable, but this is termed patient-generated health data, person-generated health data, or simply PGHD. This chapter introduces the concept of PGHD. Essential nomenclature is provided, and a model of the purpose, flow, and use of PGHD is presented and discussed. Benefits and challenges are noted, and legal, regulatory, and ethical issues are briefly outlined. Although benefits of PGHD are perceived or inherently believed, the available empirical evidence for improved and collaborative healthcare monitoring and management is slight. Also, there are many challenges. Some of these noted challenges include smart device regulation and reliability, data quality, integration into healthcare processes (adoption), and data integration into records (interoperability). Furthermore, there are legal, regulatory, and ethical issues. Widespread adoption and use of PGHD will require more definitive research into evidence of benefits, and efficient and effective resolution of the challenges., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

Patients with epilepsy often experience comorbid cognitive and behavioral problems. These problems are often caused by neurodevelopmental disorders such as autism spectrum disorder and attention-deficit hyperactivity disorder. Although the etiology of epilepsy is unclear in many patients, there is increasing evidence for the existence of genetic traits common to both epilepsy and neurodevelopmental disorders. These include chromosomal abnormalities, copy number variations, and single gene diseases. This chapter examines several genetic disorders that may underlie epilepsy and several neurodevelopmental disorders. There is substantial evidence that the same gene mutations are associated with both epilepsy and neurodevelopmental disorders. Alternative biological models are considered that could explain the association and causal links between the two disorders. It is likely that epilepsy and neurodevelopmental disorders both lie on a single continuum, and that greater understanding of the overlap between these disorders and epilepsy would help to provide more tailored interventions., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

During the first decade of the 21 st century, the landscape of epilepsy genetics started to take shape with the discovery of many new genes linked to epilepsy. These genetic discoveries advanced our understanding of the molecular and cellular pathways involved in epilepsy. Over the following ten years, the availability of clinical genetic testing along with rapidly growing knowledge of epilepsy genetics transformed patient care; most profoundly affecting management of childhood-onset epilepsies. This new genomic era offers great opportunities for the advancement of health outcomes and epilepsy research. It has also created new demands and challenges for physicians practicing in this rapidly evolving field, which requires specialized expertise in order to provide best care for patients and their families. This chapter reviews epilepsy genetics advancements and its impact on clinical practice., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

Epilepsy is one of the most common episodic neurological disorders, affecting 1% population worldwide. The genetic variations of γ-aminobutyric acid type A (GABA A ) receptor, including missense, nonsense, splice site and frameshift variants in GABRA1-6, GABRB1-3, GABRG1-3 , and GABRD , have been identified as some of the primary genetic causes of epilepsy. However, the lack of a complete understanding of the association between epilepsy syndromes and GABA A receptor variants makes it challenging to develop effective therapeutics. Here, we summarize a comprehensive list of over 150 epilepsy-associated variants in the major α1, β2, β3, and γ2 subunits of GABA A receptors and their functional defects. In addition, their spatial distribution is visualized in the cryo-EM structures of GABA A receptors. Many of the variants lead to reduced receptor surface expression and thus loss of function due to protein conformational defects and impaired trafficking. This knowledge aids the development of precision medicine-based therapeutic strategies to treat epilepsy., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

Paroxysmal alteration of neurological function caused by an excessive hypersynchronous neuronal discharge in the brain is known as seizure. Non-epileptic seizure is short-lived while epilepsy is a neurological condition characterized by two or more provoked seizures. The hippocampus, amygdala, frontal cortex, temporal cortex, and olfactory cortex are the common areas involved in seizures. According to the ‘dormant basket cell’ theory, loss of excitatory input from the dentate mossy cells makes inhibitory basket cells dormant while according to the ‘mossy fiber’ theory, mossy fibers induce the formation of excitatory circuits resulting in hyperexcitability. Amygdala is present at the anterior end of the inferior horn of the lateral ventricle; basolateral part plays an important role in temporal lobe epilepsy. The thalamus is an ovoid mass of grey matter; midline nuclei of the thalamus is involved in memory function and arousal, while it plays a crucial role in controlling seizures. Dendrites are short post-synaptic neural processes; in pathological conditions dendrites can cause hyperexcitability in neuronal circuits and lead to decreased seizure thresholds and progressive epileptogenesis. Regions specialized for learning/memory are most prone to seizures, particularly, the neocortical regions and the hippocampus., (Copyright: The Authors.; The authors confirm that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

Epilepsies are a complex and heterogeneous group of disorders mainly characterized by the presence of recurrent, spontaneous, and unpredictable seizures. Epilepsy affects 1–2% of the global population and its incidence varies according to age, gender, race, type of epilepsy syndrome and socioeconomic conditions. The International League Against Epilepsy (ILAE) proposed a new classification framework in 2017 which included six etiologic categories of seizures and epilepsies. This chapter focuses on the proposed etiologies of epilepsy and some of the basic pathophysiological mechanisms that underlie them. Some aspects of current epilepsy treatments, and future directions related to therapeutics are discussed., (Copyright: The Authors.; The author confirms that the materials included in this chapter do not violate copyright laws. Where relevant, appropriate permissions have been obtained from the original copyright holder(s), and all original sources have been appropriately acknowledged or referenced.)

In this paper, we discuss how phenomenology might cogently express the way painful experiences are layered with complex intersubjective meaning. In particular, we propose a critical conception of pain as an intricate multi-levelled phenomenon, deeply ingrained in the constitution of one’s sense of bodily self and emerging from a web of intercorporeal, social, cultural, and political relations. In the first section, we review and critique some conceptual accounts of pain. Then, we explore how pain is involved in complex ways with modalities of pleasure and displeasure, enacted personal meaning, and contexts of empathy or shame. We aim to show why a phenomenology of pain must acknowledge the richness and diversity of peculiar painful experiences. The second section then weaves these critical insights into Husserlian phenomenology of embodiment, sensation, and localisation. We introduce the distinction between Body-Object and Lived-Body to show how pain presents intersubjectively (e.g. from a patient to a clinician). Furthermore, we stress that, while pain seems to take a marginal position in Husserl’s whole corpus, its role is central in the transcendental constitution of the Lived-Body, interacting with the personal, interpersonal, and intersubjective levels of experiential constitution. Taking a critical-phenomenological perspective, we then concretely explore how some people may experience structural conditions which may make their experiences more or less painful., (Copyright 2021, The Author(s).)

Medical implants that require recharging typically use magnetic resonant coupling of transmit (external) and receive (internal) RF coils. Apart from magnetic field, the transmit coil creates a time-varying electric field that excites currents not only in the receive coil but also in the surrounding tissues. Radio frequency (RF) exposure assessment for inductive systems used in wireless powering and telemetry is done using electric field, specific absorption rate (SAR), and induced current as metrics. Full-wave analysis using RF simulation tools such as Ansys HFSS is generally used to estimate these metrics, and the results are widely accepted. However, such simulation-based analysis is quite rigorous and time-consuming, let alone the complexities with setting up the simulation. In this paper, we present a simple approach to estimating exposure (electric field, SAR, induced current) from fundamental electromagnetic principles enabling ability to arrive at results quickly. It significantly reduces the computational time in iterative approaches where multiple simulation runs are needed., (Copyright 2021, The Author(s).)

Chaplaincy documentation practices in the United States have evolved over time. Variation in practice remains. However, the trend in the profession is toward the expectation that chaplains will document their care. There is also an increased expectation regarding the content of that documentation. This paper highlights the history and current practice of chaplaincy documentation within the Memorial Hermann Health System in Houston, Texas, from the perspective of a spiritual caregiver working there. It includes a discussion of the “who,” “what,” “where,” “when,” “how,” and “why” of chaplaincy documentation. Memorial Hermann chaplains strive to document our care in a manner that bears witness to the holistic humanity of our care recipients. We also want to describe our care in a way that helps others understand the important ways professional chaplains contribute to the well-being of others. Chaplaincy documentation demands clarity, conciseness, care, and confidentiality and should be carried out in a manner one would wish for oneself or one’s loved ones if the roles were reversed., (Copyright 2020, The Author(s).)

Pastoral documentation is developing rapidly in Switzerland: as part of the palliative complex treatment required by hospitals, developed independently by pastoral teams in the interprofessional context of large hospitals, it has also found its way into current standard papers of pastoral expert committees. In order to understand how pastoral care professionals throughout Switzerland think about documentation, a survey of German-speaking pastoral care professionals was conducted in 2019. The response rate was 54%, so that the results of the survey provide a good insight into the Swiss situation. The results show that there is also a major upheaval in the minds of pastoral care professionals. While about 50% of all pastoral professionals in Switzerland document pastoral work in some form, more than 70% of those who do not currently document could imagine – under certain conditions – documenting. The article informs about the development of the pastoral documentation, contexts and framework conditions of the healthcare system and the church, and their meaning from the point of view of the pastoral professionals themselves., (Copyright 2020, The Author(s).)

Documentation in medical records is an important aspect of providing care in Australian healthcare services. Documenting spiritual care has evolved over many decades. A brief historical overview of the models of chaplaincy in Victoria, Australia, from the 1950s shows the development from faith-based models to more professional models over the last two decades. Models may include spiritual care faith representatives and volunteers, and access to medical records differs for each of these providers. The collection of data and the description of pastoral interventions in an Allied Health project at Austin Health, Heidelberg, Victoria, in the 1990s were a key milestone, as was the inclusion of pastoral care intervention codes in the Australian ICD-10_AM/ACHI/ACS codes in 2002. Reporting on spiritual care activity to the Victorian government’s Department of Health and Human Services emphasised this requirement to develop a minimum dataset and to educate the spiritual care sector. Three case studies of Victorian hospitals illustrate how documenting in electronic and paper medical records currently meets the Spiritual Health Victoria guidelines. Documentation assists with the integration of spiritual care in the health service, with internal reporting and with research. It also enables spiritual care activity to be visible and available electronically for reporting to government as required., (Copyright 2020, The Author(s).)

This final contribution draws together the various lines of discussion. It outlines the main arguments as well as the points of convergence between transnational developments. Taking up the introductory chapters, the reasons for the rapid development of chaplaincy documentation in the last two decades are examined. The rise of charting spiritual care is understood as an aspect of the ongoing digitalization of society and healthcare. At least three further drivers are clearly identifiable: the emergence of a new paradigm of healthcare chaplaincy, the development of interprofessional spiritual care, and remarkable changes in Western societies concerning the role of religion and spirituality in public spaces. In current discussions about recording spiritual care in EMRs, there is a growing convergence on at least four points. First, used as a tool for planning, coordination, and self-evaluation, digital charting can benefit the work of chaplains. Second, it can also have undesired side effects. Third, any future healthcare chaplaincy will have to be a part of the evolving process of digital recording. Fourth, the ongoing change in healthcare and society forces chaplains to become clearer about its nature and role. In sum, the task of charting spiritual care into EMRs might be seen as a bureaucratic burden. However, with its questions of the “who,” the “what,” and the “how,” it touches the heart of chaplaincy as a spiritual profession in healthcare. The paper concludes with an outline of a possible future for the practice of charting spiritual care., (Copyright 2020, The Author(s).)

In this theoretical paper, we argue that menstruation is a source of social stigma for women. The word stigma refers to any stain or mark that renders the individual’s body or character defective. This stigma is transmitted through powerful socialization agents in popular culture such as advertisements and educational materials. We demonstrate, in our review of the psychological literature concerning attitudes and experiences of predominantly American girls and women, that the stigmatized status of menstruation has important consequences for their health, sexuality, and well-being. We argue that the stigma of menstruation both reflects and contributes to women’s lower social status and conclude with suggestions for ways to resist the stigma., (Copyright 2020, The Author(s).)

An Equal Burden forms the first scholarly study of the Army Medical Services in the First World War to focus on the roles and experiences of the men of the ranks of the Royal Army Medical Corps (RAMC). These men, through their work as stretcher-bearers and orderlies, provided a range of labour, both physical and emotional, in aid of the sick and wounded. They were not professional medical caregivers, yet were called upon to provide medical care, however rudimentary; they served in uniform, under military discipline, yet were forbidden, as non-combatants, from carrying weapons. Their service as men in wartime was thus unique. Structured both chronologically and thematically, this study examines the work that RAMC rankers undertook and its importance to the running of the chain of medical evacuation. It additionally explores the gendered status of these men within the medical, military, and cultural hierarchies of a society engaged in total war, locating their service within the context of that of doctors, female nurses, and combatant servicemen. Through close readings of official documents, personal papers, and cultural representations, both verbal and visual, it argues that the ranks of the RAMC formed a space in which non-commissioned servicemen, through their many roles, defined and redefined medical caregiving as men’s work in wartime., (© Jessica Meyer 2019.)

This article explores the options for establishing a legal framework for posthumous medical data donation (PMDD). This concept has not been discussed in legal scholarship to date at all. The paper is, therefore, a first legal study of PMDD, aiming to address the gap and shed light on the most significant legal issues that could affect this concept. The paper starts by looking at the protection of the deceased’s health records and medical data, finding that this protection in law is more extensive than the general protection of the deceased’s personal data, or the protection of post-mortem privacy as a concept. The paper then investigates key issues around ownership and succession of personal data, including medical and health-related data, and how these could affect PMDD and its legal framework. The author then goes on to explore some parallels with organ donation to determine whether there are some lessons to be learned from this comparable regulatory framework. The paper concludes with the discussion around the need for a Code for posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute, and a more formal regime that would enable and facilitate this practice. Here, the author proposes key law reforms in the area of data protection and governance related to PMDD. These reforms would include amendments to the general data protection ideally, to ensure harmonisation and consistency across the EU, as well as between the general and sector-specific data protection laws and policies. These changes would contribute to legal and regulatory clarity and would help implement this important and valuable practice, which aims to facilitate research and advances in medical treatments and care., (Copyright 2019, The Author(s).)

Elicitation interviews are where participants are either shown items or asked to bring items to the interview in order to shape the direction of the conversation. This approach is often referred to as being part of ‘ visual methods ’. The chapter focuses in particular on when participants are asked to either bring everyday documents, such as photographs, or when they are asked to create a new document, with both sources serving as a ‘topic guide’ during interviews, which are directed by the participant. The advantage of this method over many documentary analysis methods is the presence of the author and the ability for the researcher to ask the author questions. This allows us to more easily establish meaning than in participant-absent documentary analysis. A detailed case study is presented of the research that aimed to understand health behaviours, such as smoking and drinking alcohol, during pregnancy. Ten women from deprived areas living on low incomes took part in elicitation interviews . Techniques of elicitation included life-history timelining (drawing a timeline of their life), collaging or using a paper template with thought bubbles to describe what it was like being pregnant, and sandboxing (that is, creating an image or scene using sand and a range of everyday items). Data was analysed using a narrative analysis , which is used to consider change over time. Guidance is provided on how to undertake narrative analysis . The findings highlighted a wide range of barriers and facilitators to abstain from alcohol and smoking during pregnancy, which were related to life circumstances. The key challenges of using such a method, including the ethical implications, are discussed. An exercise with additional data is provided to consolidate learning., (© 2019 Aimee Grant.)

Aortic aneurysmal disease of the thoracic and abdominal aorta is a potentially life-threatening disease and requires besides preventive measures early detection of the disease and if present for the patient-tailored interventional treatment. This paper will discuss the current role of imaging in the assessment of pre- and post-aortic endovascular intervention tailored to treat aortic aneurysmal disease of the thoracic and abdominal aorta., (Copyright 2019, The Author(s).)

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, knowledge, and capacity, and reducing hazard., (Copyright 2019, The Author(s).)

The annual rate of primary hip and knee arthroplasty has not increased since 2007. In the 70 years plus age group, the rate of primary hip arthroplasty was 1.1 % (in both 2007 and 2014) and the rate of primary knee arthroplasty was 0.7 % in 2007 and 0.6 % in 2014. In 2014, the prevalence of surgery in relation to the entire population was 0.26 % for the hip and 0.19 % for the knee. Approximately 219,000 primary hip replacements and 149,000 primary knee replacements were documented in Germany in 2014. The most common procedure performed on a joint was total replacement. Approximately 40 % of all primary hip or knee replacements are performed in patients in the 70 to 79 year age group; women are more frequently affected than men (ratio 2:1). In 2014, the absolute number of revisions (including revisions without replacements) amounted to approximately 30,000 for the hip and 20,000 for the knee. The number of revisions performed in any given year is not necessarily directly related to the number of primary replacements performed in the same year. Instead, the number of revisions should be considered in relation to the cumulative number of primary replacements performed over the past years and decades. As with primary arthroplasty, approximately 40 % of the revisions are performed on patients in the 70 to 79 years age group. However, the difference between men and women is less pronounced. Between 2007 and 2014, the rate of hip and knee revision replacements (including revision without replacements) also remained stable. In 2014, in the 70 years plus age group, the rate of revision replacements (including revision without replacements) was 0.19 % for the hip and 0.10 % for the knee. The annual utilization rate of primary hip and knee arthroplasty varies internationally. Regional differences also exist within Germany itself, as evaluations conducted by the statutory health insurances for the period from 2005 to 2011 have shown. A comparatively low utilization rate was associated in particular with low incidences of osteoarthritis, low social status, a high number of regional specialist physicians (orthopedists) and patients living in urban areas., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

The aim of this qualitative study was to test how social and cultural research methods can be used to anticipate opportunities and barriers to the use of consumer mobile devices by community health workers (CHWs) for HIV/AIDS prevention, testing and treatment. An exploratory study was conducted with CHWs (n = 19) at the regional capitals of Denpasar and Makassar in Indonesia in order to build to a clearer picture of how the participants have integrated personal mobile handsets into their daily professional and personal routine. A communicative ecologies framework was applied to the research design which included a range of qualitative methods including in-depth interviews, focus group discussions and communicative ecology mapping. Our main findings revealed that there was no bottom-up impetus for the introduction of a formal mHealth system to support client interactions. Existing client data collection systems were locked into paper-based systems to ensure compatibility with local government and/or funding body administrative systems; hence, mobile device-based data collection would require additional processes by the participants. Boundary issues were reported with regard to out of hours contact by clients. Some CHWs sent SMS medication reminders to clients but the strong preference indicated by all participating CHWs was to meet clients face-to-face in order to build and maintain trust through the in-person counselling process, rather than introduce mobile-mediated interaction., (Copyright 2018, Asian Development Bank.)

The previous chapters reviewed the status of knee and hip arthroplasty care based on existing literature. This chapter assesses the current situation from an expert perspective through the examination and analysis of available data. In August 2015, a workshop was conducted in preparation for this chapter, which was attended by a renowned panel of experts and stakeholders who play an important role in shaping the provision of healthcare services in Germany. This chapter presents the results following this workshop, the content of which has been approved by the relevant participants., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

In order for a medical device to be marketable in Europe it must bear the CE mark. CE certification is granted if the device conforms to specific safety and performance requirements. Monitoring is conducted by so-called »Notified Bodies«. Manufacturers can select any one of these certification bodies to certify a medical device. In Germany, the certification procedure for endoprostheses is regulated in the Medical Device Directive 93/42/EEC and is implemented through the Medical Devices Act and further decrees. Up to now, the AQUA Institute for Quality Improvement and Research in the Healthcare System (AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen) has been responsible for external inpatient quality assurance which is mandatory in Germany. The institute publishes detailed reports concerning the quality outcomes of patient care, which both hospitals and patients can use for comparisons with other establishments. As of 2016, the Institute for Quality Assurance and Transparency in the Healthcare System (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTiG)), which was founded by the Federal Joint Committee, has assumed this responsibility. The German arthroplasty registry »Endoprosthenregister Deutschland« was initiated in 2013 and aims to document quality outcomes of knee and hip arthroplasty across Germany. The purpose of the registry is to enable the tracking of typical service lives of implants used and to investigate reasons for undesired treatment outcomes. The validity of the registry is still limited as about only half of the hospitals that perform arthroplasty currently contribute to it and only a limited number of primary hip and knee arthroplasties are recorded. EndoCert is a certification system that was established by the German Society of Orthopedics and Orthopedic Surgery (Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC)) and the German arthroplasty association »Deutsche Gesellschaft für Endoprothetik (AE)« and the Professional Association of Orthopaedic Surgeons (Berufsverband der Fachärzte für Orthopädie und Unfallchirurgie e. V. (BVOU)). Initial results show a decline in complication rates and an improvement in outcome quality amongst a few certified institutions. Alongside representing the interests of their members and offering basic and specialty training, medical societies also assume an important role with regard to research and towards improving the quality of healthcare. The trauma registry »TraumaRegister of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie (DGU))« is affiliated with hospitals specializing in trauma surgery and aims to evaluate the effectiveness of methods used in medical treatment. The German arthroplasty association »Deutsche Gesellschaft für Endoprothetik (AE)« is a division of the German Society for Orthopaedics and Trauma (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)) and is involved in quality assurance of endoprosthetic care and in the development of new technologies., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

Arthroplasty is defined as the surgical replacement of a joint with artificially produced material. Total arthroplasty refers to the replacement of all joint surfaces concerned, while partial replacement involves the replacement of only one or some of the surfaces but not the entire joint. Hip and knee joints are those that are most frequently replaced. The most common indications for hip or knee arthroplasty are symptomatic osteoarthritis and femoral neck fractures (hip). When patients undergo hip or knee replacement for the first time (due to osteoarthritis) they are usually between 60 and 70 years of age. More than two thirds of patients who undergo arthroplasty due to femoral neck fractures are over 85 years of age. Primary arthroplasty refers to the first hip or knee replacement and revision arthroplasty refers to follow-up surgery on the same joint. The period of time (without complications) between primary arthroplasty and revision arthroplasty is termed as »service life«. In symptomatic osteoarthritis, arthroplasty is performed after all conservative and joint preserving therapy options have been exhausted. With regard to femoral neck fractures, joint replacement is usually the primary treatment option. Surgery aims to improve the quality of life, to restore the greatest possible functionality, mobility and freedom from pain, to assure a long service life with good weight-bearing capacity and to avoid secondary complications. These constitute important prerequisites for leading an independent life in old age., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

Challenges to hearing health are a significant public health problem. At least ten million Americans have a hearing loss that interferes with the understanding of normal speech. If lesser degrees of loss are included, the number rises to 28 million. Although there have been considerable advances in understanding the etiology of hearing loss, with genetic causes now thought to account for up to 50% of congenital losses, in many individual cases, the cause of hearing loss remains unknown. This lack of knowledge of the basic pathophysiology of hearing difficulties hampers prevention and treatment efforts. Growing interest in life course theory has led to suggestions that it could prove useful to apply a life course lens to the study of hearing loss, and of hearing health, throughout the life span. In this paper we consider the implications of the Life Course Health Development model for understanding the mechanisms, pathways, and determinants of hearing ability. We consider the implications of early hearing loss for health development over the life course and the factors through the life course that contribute to hearing ability in adult life. We consider the concept not just of hearing loss but of “hearing health” and how to achieve it, the research priorities that are suggested by this review, and the implications for policy and practice., (Copyright 2018, The Author(s).)

The costs incurred for knee and hip arthroplasty depend on the different type of treatments provided within the chain of medical care. Indirect costs of the disease, such as the incapacity to work resulting from the underlying diseases and intangible costs which cannot be evaluated in monetary terms, must also be taken into account. Patient care is financed through established remuneration systems. According to different publications, data extrapolations have shown that German statutory health insurances spent approximately 1.4 to 1.6 billion euros per year on hospital treatments for hip arthroplasty between 2003 and 2009. With regard to knee arthroplasty, expenditure for the same period was estimated at 1.0 to 1.3 billion euros per year. The direct costs for the associated inpatient stays are financed through case-based fees, which are in turn based on the actual average hospital costs. The most commonly remunerated case fees (hip arthroplasty/knee arthroplasty) have shown cost increases of a few percentage points over the last few years which are mainly due to the rising costs of personnel. In the two case-fee groups, implant costs constitute 21 % of the total cost for hip treatments and 25 % of the total cost for knee treatments. Particularly complicated cases such as infected hip endoprostheses are relatively more costly. With regard to indirect costs, the diagnosis »Osteoarthritis of hip« (ICD-10 M16) resulted in 2,585,157 days of incapacity to work amongst compulsory statutory health insurees (excluding pensioners) in 2011. For »Osteoarthritis of knee« (ICD-10 M17) the figure was almost double at 4,971,052. Some patients who are in employment are unable to return to work despite having undergone a joint replacement and either have to change profession or accept a loss of income that includes social security contributions. Osteoarthritis, which is the most common reason for hip or knee replacements, is associated with a significant, increasing and in part immeasurable disease burden. International studies have demonstrated that the disease is accompanied by a high degree of suffering on the part of the patient as the large majority (70 % or more) would be personally willing to finance the hip or knee arthroplasty at their own cost if the procedures were not included amongst those reimbursed by health insurance systems. Hospitals in Germany finance the costs of arthroplasty with one of several possible arthroplasty case fees selected according to the specific service provided and the circumstances of each case. The case fees are based on the average costs of a given treatment. The case fee figures in 2015, which were based on certain benchmarks, ranged between approximately 6,400 euros and 17,300 euros. However, case fees do not always seem to cover the hospital costs, particularly in the treatment of more complicated cases., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

Approximately half of all hospitals in Germany perform primary hip and knee arthroplasty. Symptomatic osteoarthritis is the cause of 80 % of primary hip replacements and 96 % of primary knee replacements. In accordance with mandatory external quality assurance measures for hospitals, an increase in the documentation of appropriate indications has been observed for a growing proportion of patients over the last few years and reached 96 % for both types of surgery in 2014. A limiting factor, however, is that some of the relevant indication criteria do not yet exist in a standardized or evidence-based format. Hip and knee replacements are amongst the most commonly performed inpatient procedures. Patients who undergo primary hip or knee replacement account for approximately 2 % of all full-time inpatients. Over the past years, the length of hospital stay for arthroplasty patients has been declining continuously with a greater decline relative to the average length of stay for all other types of hospital treatments. In 2014, the average length of stay was approximately 11.8 days and 10.6 days for total hip and for total knee arthroplasty respectively. Surgical complications during inpatient stays for primary arthroplasty have been declining for years and are now in the lower single-digit percentage range. Routine statutory health insurance data between 2005 and 2006 show that that 3.5 % of primary hip arthroplasty patients and 3.8 % of primary knee arthroplasty patients underwent premature revision total replacement within the first 2 years after surgery. The risk of complications from endoprosthetic surgery depends on numerous factors. Influencing factors include the implant itself and the type surgery performed (including the surgeon's experience, surgical techniques, the duration of surgery, etc.), the patient's medical characteristics (concomitant diseases, compliance, etc.) as well as the type of rehabilitation care and ambulatory follow-up care. To date, no relevant data on service lives and influencing factors have been systematically collected in Germany. However, this is expected to change thanks to the German arthroplasty registry »Endoprothesenregister Deutschland« which was established in 2011. Rehabilitation treatment should start soon after surgery and in the majority of cases this is commenced a few days after discharge from hospital. However, due to shorter lengths of hospital stays, patients in rehabilitation clinics have greater care requirements. Older multimorbid patients in particular, require targeted geriatric, interdisciplinary care. Surveys carried out on statutory health insurees have indicated that most patients show a significant reduction in symptoms after surgery and that this is still the case even 5 years after surgery. In addition, a large majority of patients are satisfied with the procedure. These effects are more pronounced in hip surgery patients than in patients who have undergone knee replacements. The vast majority of patients return to work following the procedure., (Copyright 2018, The Editor(s) (if applicable) and The Author(s).)

Based on ethnographic fieldwork in Germany’s first Dementia Village, this chapter explores the rewards as well as the trials and tribulations of community creation within the confines of the modern welfare state. The paper shows how the creation of a Dementia Village—created as a communal space for its residents that is governed by societal standards of care—ties into long-standing traditions in social thought and speaks to the tension of combining sociality with rationalised bureaucratic efficiency. Through a review of conversations and ethnographic observations, the paper argues that although care in a Dementia Village at first appeared to redraw the map of dementia care, the landscape remained unaltered. Just as in other care environments, both carers and residents lived and worked in an environment that locates intimacy and compassion in one place and the biomedical and bureaucratic exigencies of modern biomedicine and care philosophies in another., (Copyright 2018, The Author(s).)

This chapter presents the genesis and evolution of the public e-prescription information infrastructure (EPI) of Catalonia, Spain from 2000 to 2013. The implementation of the EPI required a transition from a mainly paper-based and asynchronous prescription model to a digital and synchronous one. This transition involved doing changes into the practices, systems and roles of the Catalan Health Service, doctors and health providers, pharmacists and Colleges of Pharmacists, and ultimately patients. Our narrative extols those changes and how the pre-existing technological and institutional resources of professionals shaped the design, and evolution of the infrastructure. Our narrative traces those events from the perspective of pharmacists, and shows how the exploitation and expansion of the installed base of pharmacists helped maintain the existing pharmacy model., (Copyright 2017, The Author(s).)