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152. [Possibilities of utilising official statistics for health services research]

Author

E, Swart

Subjects
Patient Admission, National Health Programs, Data Collection, Data Interpretation, Statistical, Germany, Humans, Health Services Research
Abstract

This report deals with the experiences and problems with using official statistics on a limited area level of Germany's 440 administrative districts. The data comprised health-related issues and were used for an ecological analysis of the determinants of hospital use. We obtained health statistics data from homepages of the German health report, the Federal statistics office, and the 16 statistics offices of the Federal states. We also made use of the data base of the joint regional statistics published by the Federal and regional statistics offices. Finally, there was a co-ordinated inquiry to the regional statistics offices about the supply of data on mortality, hospital discharges, structure of hospital care and several socio-economic indicators. The process of data collecting was mostly unproblematic. On the other hand, not all of the data were available on a limited area level in a satisfying form and quality. For reasons of data protection some information of small districts was transmitted incompletely. Additionally, there are procedural differences between regional statistics offices regarding the differentiation between some variables and in the exchange of data between the federal states. Finally, some problems were due to varying age classifications for different health indicators. For health services research the use of official statistics becomes increasingly comfortable via health reports and Internet. However, for specific questions of research some problems still remain, rising from missing standardised health indicators and deficient availability of limited area health data. Data collection is exacerbated by restrictive interpretation of data protection acts and the different handling of data inquiries in the regional statistics offices. Finally, there is a lack of data on morbidity and use of ambulatory care.

Published
2002

153. [Self-exercised health care and consultation of medical aid by single-parent mothers or fathers - results of a federal health survey]

Author

B, Hoffmann and E, Swart

Subjects
Adult, Adolescent, Mothers, Psychosocial Deprivation, Middle Aged, Health Surveys, Single Parent, Psychotherapy, Reference Values, Humans, Medicine, Attitude to Health, Referral and Consultation, Specialization
Abstract

Single parents are at high risk of economical poverty and social deprivation. In this study we investigated the association of single parenthood with self-reported health, self-perceived mental disorders and the use of medical services.The public users file of the German Health Survey 1998 were used for secondary analysis. Single-parent mothers aged 18 to 45 with at least one child under the age of 18 (n = 81) were compared with two control groups of the same age: mothers living in traditional nuclear families (n = 104) and women living in partnership status without children (n = 140).Single-parent mothers report less frequently than controls of a very good or excellent health status and more frequently of mental complaints (differences of single items of 10 to 15 percent). Feelings of discouragement and sadness are more common in this group. Overall, single-parent mothers do not use medical services more frequently than the control groups, but there are differences in the use of some specialists, especially psychotherapists.In respect of health, psychological stress is at a high level whereas the value of subjective health seems lower. The emphasis on situational parameters provides an insight into positive coping strategies and shifts the focus on influences that support health in a positive manner.

Published
2002

154. [Preparing for the G-DRG system: portfolio analysis of the hospitals in Saxony-Anhalt, Germany]

Author

B P, Robra and E, Swart

Subjects
Budgets, Cost Control, National Health Programs, Germany, Humans, Length of Stay, Hospital Charges, Diagnosis-Related Groups
Abstract

Diagnosis-Related Groups are scheduled for step-by-step introduction into the German hospital system. Initially DRG base rates will be specific to each hospital (i. e. in keeping with the present budget), but eventually (by 2007) a common base rate will be reached in each federal state. This development may have grave financial consequences for some hospitals where initial base rates are above average and hence likely to be reduced. Therefore, we grouped the remunerations paid by the AOK Saxony-Anhalt (i. e. the largest statutory health insurance company in this federal state) for a total of 308,495 hospital cases in fiscal year 2000 according to hospital and diagnoses, expressed them as a percentage difference from the average remuneration, and analysed them jointly with the average length of stay (LOS). We found considerable differences between hospitals in terms of the payments per case and the LOS, independent of the stratification of the cases. For example, Magdeburg University Clinical Centre registered hospitalisations that were short (below average) but expensive (well above average), hence there is less scope for further rationalization of the LOS in this hospital compared to others. Considerable adjustments will become necessary in due course when switching over from hospital-specific base rates to a common regional base rate.

Published
2002

155. [Does health status improve after re-assumption of ABM employment?]

Author

E, Swart and H, Mächler

Subjects
Adult, Male, Unemployment, Germany, Health Status, Humans, Female, Rehabilitation, Vocational, Middle Aged, Follow-Up Studies
Abstract

Due to structural problems of the East German economy the level of unemployment will probably remain high for the next ten years. Thus, thousands of health-employment-schemes are established to reduce negative social and financial consequences of unemployment for those groups that are most affected. In this study the effects of temporary re-employment on health within the bounds of a job-creating measure are examined. By questionnaire employees of two firms in Magdeburg that exclusively occupies former unemployed men and women were asked about their subjective health status and changes in health status since re-employment. 217 employees filled the questionnaire (response rate: 50%; mean age: 45 years, mean duration of former unemployment: 18 months). About one half of the employees (48%) report positive effects on health after re-employment. This percentage is highest in the age group 50 years and older. The frequency of health impairments remained unchanged for half of the workers, the rest mainly stated fewer impairments. Poor working conditions or physical overtaxing decreases the positive effects of re-employment. Employees who had a positive attitude towards their work report on positive effects on health and other aspects of life more than average.Negative consequences of unemployment on physical and psychological health are well understood. On the other hand, our study demonstrates positive effects on health and a reduction of health impairments by temporary job-creating measures. This is influenced by the working conditions and the social environment of the employees. Further investigation are needed for detailed medical evaluation of job-creating schemes.

Published
2000

156. [Surgery rates and small area variations]

Author

E, Swart, C, Wolff, P, Klas, S, Deh, and B P, Robra

Subjects
Hospitalization, Male, Insurance, Health, Data Interpretation, Statistical, Germany, Small-Area Analysis, Surgical Procedures, Operative, Humans, Female
Abstract

On the basis of the claims data of the statutory health insurance funds, surgery rates and small-area variations within the catchment area of the AOK Magdeburg were examined for the year 1997. Substantial variation can be constantly seen. The extremal quotient at the 30 most frequent ICPM groups ranged from 2 to 5. Generally, the extent of the variation was larger with elective procedures than with acute. Correlation analyses do not show clear associations with hospital bed supply and physician density in primary sectors. The extent of the small-area variation requires further research to evaluate possible determinants of surgery rates. Criteria for hospital admission and indications for surgery should be made explicit.

Published
2000

157. [Target agreements between insurance carriers and hospitals as instrument for modifying hospital length of stay]

Author

B P, Robra, E, Swart, P, Klas, and W D, Leber

Subjects
Cost Control, National Health Programs, Germany, Humans, Length of Stay
Abstract

In 1995 the statutory sickness fund (AOK) in Magdeburg arranged target agreements with 10 of 23 acute care hospitals in its district to exercise an influence on the development of the average length of hospital stay. With the aim of decreasing the length of stay as well as the administrative cost and effort, these agreements set upper limits on the average length of stay which were hospital-specific and period-specific. In return, with only a few exceptions, the AOK Magdeburg refrained from limiting the coverage of individual cases. Hospital cases discharged from 1994 and 1996 were analysed to determine whether the development of the length of stay in the ten hospitals with target agreements differed from that in the other 13 hospitals. Only some of the hospitals were successful in reaching their target agreements. The average length of stay dropped by 4.2% in the hospitals with target agreements and by 7.9% in those without target agreements. This must be considered in the context of the development of the case load and number of available hospital beds. For instance, in spite of a target agreement, one hospital showed a (compensatory) increase in the average length of stay in association with an increase in the number of authorized beds and a concurrent decrease in the number of cases. The number of days billed by AOK patients per authorized bed (as an indicator of hospital productivity) showed a more favourable development in the group of hospitals with target agreements than in the other group. This was not a controlled trial as far as the selection of the hospitals is concerned. The results suggest that there is no harm in incentives that induce hospitals to manage primarily on their own the average length of stay. The use of routine aggregate data in monitoring this development, rather than the current more expensive individual case approach, also seems reasonable. Well planned studies that further test the "tool" of target agreements can be recommended.

Published
1998

158. [When are recommended breast biopsies carried out, and what information does the physician responsible for mammography receive? Experiences with 317 breast biopsy in a regional quality assurance project for screening mammography]

Author

J M, Meyer, E, Swart, M L, Dierks, and B P, Robra

Subjects
Diagnosis, Differential, Patient Care Team, Quality Assurance, Health Care, Biopsy, Germany, Humans, Mass Screening, Breast Neoplasms, Female, Breast, Fibrocystic Breast Disease, Precancerous Conditions
Abstract

In a regional quality assurance project for screening mammography (German Mammography Study), 27,335 women were screened in 40 participating, office-based mammography units from 1990-1992. Screening led to 317 biopsies with a positive predictive value of 0.33. All biopsy documentation available to the mammography physicians was analysed with a view towards biopsy interval and completeness of information fed back to the Mx physicians. Biopsy recommendations were acted upon in 29% of cases within 2 weeks. With the exception of the dignity Mx physicians were incompletely informed about biopsy results. The surgical procedure was known in the doctors' offices in 62% of the cases. Specimen radiographies were not done regularly. A pathology report was available overall in 42 of 106 malignant cases, respectively. With the exception of the histological diagnosis itself, no variable mentioned in the reports was documented completely. Only one third of the physicians received such reports routinely. Fail-safe information are requested by Mx physicians and can help them to better target biopsy recommendations. A (regional) quality assurance center should be made responsible to analyse the flow of information in mammography screening, to fill in gaps and to speed up professional cooperation.

Published
1997

159. [Evaluation of Federal Health Insurance process data as instrument for structural and quality analysis of inpatient care]

Author

E, Swart, B P, Robra, and W D, Leber

Subjects
Adult, Male, Outcome and Process Assessment, Health Care, Patient Admission, National Health Programs, Quality Assurance, Health Care, Cost-Benefit Analysis, Data Collection, Germany, Humans, Female, Middle Aged, Aged
Abstract

Statistically based quality assurance, despite its advantages also has a few marked disadvantages. In particular, it is not proven that it promotes measures of internal quality assurance. Instead, processing data of the statutory health insurance bodies are shown as flexible and easily available data covering a defined population and region. Hence, these processing data may be the starting point for internal quality management in hospitals. As examples, from an analysis of hospitalised cases some questions were derived concerning the structure and quality of hospital care. These questions should be answered by common efforts of hospitals, health insurance bodies, and public institutions. This may guarantee good and efficient inpatient care.

Published
1997

161. [Analysis of regional differences in hospitalization rate and length of stay costs]

Author

E, Swart, I, Böhlert, P, Jakobs, B P, Robra, F, Schneider, W D, Leber, and U, Dembski

Subjects
Patient Care Team, Patient Admission, National Health Programs, Germany, Utilization Review, Costs and Cost Analysis, Humans, Length of Stay, Insurance, Hospitalization, Referral and Consultation, Diagnosis-Related Groups
Abstract

Performance of an analysis of hospitalised cases based on processed statutory health insurance data on inpatient treatments. Object of the examination were regional differences in the frequency of hospitalisation and in the volume of payable (invoised) days and the relevant determining parameters.The analysis is based on a total of 152,854 cases of hospitalisation recorded in 1994 by the Magdeburg Statutory Health Insurance Body. These include data (rendered anonymous) on each insured person and on the specialist branch of the referring physician, case characteristics as well as characterising features of the hospital. Additionally, 249,471 diagnosis recordings are available from the total of the recorded cases.There is considerable regional variation in the number of hospital care days within the area of the Magdeburg Statutory Health Insurance Body. These regional differences are noticeable both in the frequency of referrals (broken down according to the regional statutory health insurance offices) and in the average duration of stay (in the hospitals of the region). Reasons for this heterogeneity are evident from the structural conditions of medical care by the physicians under contact with the statutory health insurance body (greater frequency of referral to hospital in areas where there are fewer doctors per 10.000 inhabitants and with less voluminous practices) and from different management strategies of hospitals even if medical care services are well standardised.The results prompt more detailed analyses of inpatient care activities including structural parameters of the outpatient sector. Actually we can recognise certain limitations preventing a uniform patient care by statutory health insurance physicians and uniform inpatient care, in the sense imposed by the official policy to ensure such uniformity.

Published
1996

162. [Quality assurance by improved cooperation structures. The example of decentralized early detection mammography]

Author

E, Swart, B P, Robra, M L, Dierks, H J, Frischbier, and W, Hoeffken

Subjects
Adult, Breast Neoplasms, Middle Aged, Health Services Accessibility, Germany, Humans, Mass Screening, Education, Medical, Continuing, Female, Precancerous Conditions, Aged, Follow-Up Studies, Mammography, Neoplasm Staging
Abstract

The German Mammography Study investigated into quality assurance measures for screening mammography, proceeding in a decentralised manner and focussing especially on structure, process and outcome of the study. The field phase lasted for three years, and during this period the technology of the equipment used in mammography improved, also to the indicators of process and of early outcome. The annual interval of examinations was well received. To include mammography into the German cancer screening programme is no easy matter: it requires a comprehensive cooperative quality assurance programme incorporating various institutions of medical care. Appropriate recommendations have been made to the Federal Committee of Physicians and Sickness Insurance Bodies.

Published
1995

163. [Determinants of observer variability in early diagnostic mammography--a ROC analysis]

Author

E, Swart, B P, Robra, M L, Dierks, H, Reinerth, H J, Frischbier, J, Bahnsen, I, Schreer, and W, Hoeffken

Subjects
Observer Variation, Time Factors, ROC Curve, Germany, Humans, Sensitivity and Specificity, Mammography
Abstract

As part of the German mammographic study, the participating doctors were given test films of 30 histologically confirmed cases. Regarding the indications for biopsy there was good sensitivity (the median amongst 25 doctors was 0.87). Specificity (median 0.86) could be improved. Comparison of individual results with the majority showed considerable variability within the group of doctors performing mammography. ROC analysis indicated that there was considerable observer variability which was independent from the specialty or praxis characteristics of the participants. The inclusion of mammography in an early diagnostic programme requires continuing education of the participants in this technique. This should be supported by further methods of quality assurance.

Published
1993

165. MORBUS: Stichproben- und Auswertungskonzepte zum ersten Meldethema der Beobachtungspraxen in Niedersachsen

Author

A. Salje, W. Behrendt, S. Schach, M. Schlaud, Friedrich Wilhelm Schwartz, S. W. Kempff, E. Swart, Th. Schäfer, B.-P. Robra, E. Schach, and J. Grüger

Abstract

MORBUS ist ein vom BMFT geforderter „Modellversuch zur Erprobung regionaler Beobachtungspraxen zwecks Erhebung umweltbezogener Gesundheitsstorungen“. Mit MORBUS wird angestrebt, ein Instrumenatrium zur Erhebung von Gesundheitsstorungen in einem vorklinischen Stadium in der Praxis des niedergelassenen Arztes in drei Regionen Niedersachsens zu erproben und zu etablieren. Nach auslandischen Vorerfahrungen mit Sentinel-Modellen darf angenommen werden, das dieser Beobachtungsweg eine kostengunstige, thematisch und methodisch flexible Erfassung von Gesundheitsmerkmalen in der Bevolkerung ermoglicht, die in den Beobachtungspraxen nicht vollstandig, aber, bei geeigneter Themen- und Merkmalsauswahl, weitgehend unverzerrt gelingen kann. Zudem stellen Beobachtungspraxen einen schnellen, unburokratischen und Datenschutzerfordernissen gerecht werdenden Zugang zu personenbezogenen Daten dar, die sich sowohl auf individuelle Wirkungs- als auch auf (individuell wahrgenommene oder nachweisbare) Expositions- oder Stormerkmale erstrecken konnen.

Published
1992

166. Long-term neuropsychological outcome after severe head injury with good recovery

Author

M. Conzen, H. Ebel, F. Oppel, E. Swart, W. Skreczek, and M. Dette

Subjects
Adult, Male, medicine.medical_specialty, Neuroscience (miscellaneous), Poison control, Brain Edema, Neuropsychological Tests, Diagnosis, Differential, Midline shift, Head Injuries, Closed, Injury prevention, Activities of Daily Living, Developmental and Educational Psychology, medicine, Humans, Glasgow Coma Scale, Brain Concussion, business.industry, Glasgow Outcome Scale, Cognitive disorder, Neuropsychology, Middle Aged, medicine.disease, Surgery, Hematoma, Subdural, Anesthesia, Closed head injury, Chronic Disease, Brain Damage, Chronic, Female, Neurology (clinical), business, Follow-Up Studies
Abstract

The quality of outcome after severe closed head injury has become of increasing concern to neurosurgeons. The assessment of residual deficits in patients who have recovered from closed head injury can be very difficult. Many patients are classified as having a good recovery according to the Glasgow Outcome Scale (GOS), but this may be insufficiently focused or sensitive to demonstrate mental deficits objectively. We investigated 33 patients with severe closed head injury who subsequently were diagnosed as having made a good recovery according to the GOS. The severity of the injury was determined by the Glasgow Coma Scale (GCS) and by the presence of a midline shift in the preoperative CT scans. There was a minimal interval of 15 months (means = 1080.5 days, SD = 491 days) between injury and time of neuropsychological testing. Their performance was compared with that of 15 orthopaedic cases. Residual neuropsychological deficits can be demonstrated on the majority of measures in a group of patients who have achieved good recovery on the GOS. Midline shift in preoperative CT scans is not of prognostic value for long-lasting neuropsychological deficits.

Published
1992

167. Datenerfassung in der Primärversorgung durch Beobachtungspraxen — Aspekte der Datenqualität

Author

Friedrich Wilhelm Schwartz, B.-P. Robra, R. Colberg, J. Grüger, W. Behrendt, Th. Schäfer, J. Fontaine, and E. Swart

Abstract

Im englischen Sprachraum werden Beobachtungspraxen mit dem Wort “sentinel” (= „Wachposten“) bezeichnet. Das Wachteramt der Sentinels bezieht sich dabei auf die Beobachtung definierter Gesundheitsstorungen (Meldeereignisse) und deren Meldung an eine Zentrale, die fur die Koordinierung der Erhebung, die Datenhaltung und -auswertung zustandig ist. Mit einem Netz von Sentinel-Praxen konnen so stichprobenartig Daten uber den Gesundheitszustand der Bevolkerung aus der Primarversorgung erhoben werden.

Published
1991

169. Liver assist device as bridge for liver transplant in hepatic failure: A first in vivo step of tissue engineering development

Author

Mark L. Miller, Wen-Ming Hsu, A. Carraro, Eli J. Weinberg, Joseph P. Vacanti, B. Orrick, K. Morgan, Umberto Cillo, Craig M. Neville, E. Swart, J.T. Borenstein, Katherine M. Kulig, K. Bonner, and M.R. Kaazempur-Mofrad

Subjects
medicine.medical_specialty, Hepatology, Tissue engineering, business.industry, In vivo, law, Gastroenterology, medicine, Bioartificial liver device, business, Bridge (interpersonal), Surgery, law.invention
Published
2007

171. Coupling of a power plant with a low temperature Multi-effect desalination plant

Author

Leon Awerbuch, Aswath Maddagiri, Alfred N. Rogers, and Frederic E. Swart

Subjects
Engineering, Waste management, Power station, business.industry, Mechanical Engineering, General Chemical Engineering, General Chemistry, Multi effect, Desalination, Coupling (computer programming), General Materials Science, Seawater, Power cycle, business, Water Science and Technology
Abstract

The low-temperature heat discarded by a large power plant can produce large quantities of desalted seawater at low cost. This paper describes a system in which a horizontal tube multi-effect (HTME) desalination process is coupled to a large power plant (either nuclear or non-nuclear) in such a manner as not to interfere with the power cycle. The resulting product water is produced at a cost approximating present prices of water sold by water companies.

Published
1983

172. Effect of stochastic perturbations on a low-order spectral model of the atmospheric circulation

Author

H. E. Swart and Johan Grasman

Subjects
Physics, Atmospheric Science, 010504 meteorology & atmospheric sciences, Markov process, Thermodynamics, Dynamical system, Markov model, Oceanography, 01 natural sciences, Noise (electronics), symbols.namesake, Potential vorticity, Phase space, Barotropic fluid, symbols, Statistical physics, 0105 earth and related environmental sciences, Deterministic system
Abstract

The dynamics of a low-order spectral model of the barotropic potential vorticity equation, forced by random perturbations, is studied as a function of the memory and intensity of the noise. The unperturbed deterministic system has three equilibria, and for arbitrary initial conditions trajectories in phase space always tend to one of the two stable equilibria representing preferent circulation patterns of the atmosphere. The noise forces the system to visit alternately the two attraction domains of the stable equilibria. During the transition, the system will remain for some time in a neighbourhood of the unstable equilibrium. This indicates that the latter is important for the atmospheric dynamics. Characteristic residence times in the attraction domains and in the domain near the unstable equilibrium are calculated by combined analytical and numerical methods. Furthermore the alternation of preferent states is studied with a discrete state Markov process model. It consists of three states, which are related to the equilibria of the low-order spectral model. Transition probabilities are derived from the characteristic residence times of the stochastically forced dynamical system. The eigenvalues of the Markov model yield information about the time scale over which the effect of the initial state is present in the system. DOI: 10.1111/j.1600-0870.1987.tb00284.x

Published
1987

173. The doping of silicon with boron by rapid thermal processing

Author

C M Hasenack, J E Swart, and J P de Souza

Subjects
inorganic chemicals, Materials science, Silicon, Inorganic chemistry, Doping, Nanocrystalline silicon, Analytical chemistry, chemistry.chemical_element, Strained silicon, Condensed Matter Physics, Electronic, Optical and Magnetic Materials, chemistry, Rapid thermal processing, Materials Chemistry, LOCOS, Electrical and Electronic Engineering, Boron, Silicon oxide
Abstract

An alternative doping process to ion implantation for the production of very shallow p+-n junctions has been investigated. n-type silicon wafers covered with a boron-doped silicon oxide were submitted to thermal cycles with incoherent light radiation at temperatures between 900 and 1250 degrees C for times ranging from 20 to 120 s, in order to promote boron in-diffusion. The samples were characterised by sheet resistance measurements combined with sequential layer removal to obtain the carrier concentration-depth profiles. The results show the formation of a boron-rich surface layer above the normal boron solubility levels and a linear dependence of the sheet conductance on diffusion time, which suggests a chemical reaction at the silicon surface is the controlling factor for the boron in-diffusion. Moreover it was demonstrated that defect-free p+-n junctions with a junction depth as shallow as 50 nm are readily obtained.

Published
1988

174. New design of an anti-decubitus lying-down support

Author

Maarten E. Swart

Subjects
Pressure Ulcer, Tissue deformation, Maintenance, Computer science, Air, Rehabilitation, Bedding and Linens, Physical Therapy, Sports Therapy and Rehabilitation, Equipment Design, Nursing, Costs and Cost Analysis, Pressure, Humans, Lying, Design technology
Abstract

Reviewed is a new lying-down support which is developed and designed in order to prevent decubitus. The new design is based upon the new anti-decubitus theory about tissue deformation: the principle of minimal deformation of the supported body-tissues. Reviewed are the main problems of decubitus prevention in the lying situation. A comprehensive explanation of the operation of the new lying-down support is given. Attention is paid to the anti-decubitus quality, the users-friendliness for medical attendants, nursing attendants and the patient himself, the maintenance-friendliness and the cost-price. User-aspects, safety-aspects and the cost-factor are discussed in detail.

Published
1985

175. The Provision and Utilisation of Open Space for Sport and Recreation in Municipal Areas in South Africa

Author

J. N. Steyn and P. E. Swart

Subjects
Economic growth, Urban open space, Geography, Urban planning, Geography, Planning and Development, Ethnic group, General Earth and Planetary Sciences, Critical assessment, Space (commercial competition), Recreation
Abstract

The provision and development of urban open space have long frustrated and even annoyed town planners. especially at provincial and local levels. In this paper attention is given to the various norms presently used by planning bodies with regard to urban open space provision in South Africa. The present level of provision is discussed and the level and type of recreational open space development examined. This is followed by a critical assessment of the situation. The present system as norms was found to be unrealistic and some recommendations with respect to the system are made.

Published
1983

176. Kein erkennbarer Zusammenhang zwischen dem Niveau der Beteiligung am deutschen Krebsfrüherkennungsprogramm und der Entwicklung der Krebsmortalität der Frauen

Author

T. Possekel, B.-P. Robra, and E. Swart

Subjects
Cross-sectional study, business.industry, Mortality rate, Attendance, Obstetrics and Gynecology, Cancer, medicine.disease, language.human_language, German, Maternity and Midwifery, Cancer screening, language, Medicine, business, Mass screening, Demography, Cause of death
Abstract

Attendance rates of the German cancer screening programme and female cancer mortality rates (cancers of the uterus, breast, and colon-rectum) were calculated by age (5-year groups), region (Federal States) and period (annually; 1975-1982 for attendance rates, 1975-1984 for mortality rates). There was no apparent association of attendance and mortality pattern. This finding may be due to avoidable shortcomings in data collection. Programme effectiveness is unlikely to be demonstrated by more data of the same aggregate type. We have to collect information on screening histories linked to cause of death on a person-to-person basis. This can be done in retrospective case-control-studies or prospectively using records for cancer patients. Provisions for such studies are essential.

Published
1989

177. Epidermolysis bullosa

Author

D. G. Price and E. Swart

Subjects
Anesthesiology and Pain Medicine
Published
1968

179. The release of LH at oestrus in ewes on two planes of nutrition during lactation

Author

W J Stielau, A W Lishman, C. E. Swart, I. E. Dreosti, A. M. Stewart, and W A Botha

Subjects
Embryology, medicine.medical_specialty, Radioimmunoassay, Biology, Endocrinology, Animal science, Estrus, Pregnancy, Lactation, Internal medicine, medicine, Animals, Estrous cycle, Sheep, Obstetrics and Gynecology, Cell Biology, Luteinizing Hormone, medicine.anatomical_structure, Reproductive Medicine, Double antibody, Animal Nutritional Physiological Phenomena, Female, Food Deprivation, Secretory Rate
Abstract

as a prolongation (Hunter, 1962) or precipitated onset (Smith, 1962) of the seasonal period of sexual rest. It has been suggested that the ovarian quiescence noted in underfed animals may be the result of pseudohypophysectomy (Mulinos & Pomerantz, 1940; Lamming, 1966; Leathem, 1966). An acute release of LH at oestrus in ewes has been demonstrated by Nis¬ wender, Roche, Foster & Midgley, 1968; Goding, Catt, Brown, Kaltenbach, Cumming & Mole, 1969; Wheatley & Radford, 1969) and it is possible that changes in the pattern of LH release may indicate functional changes in the pituitary of ewes which become anoestrous after periods of inanition. This phenomenon was studied in an attempt to elucidate the mechanism involved in a premature cessation of breeding amongst ewes previously subjected to underfeeding. During August, September and October 1970 and 1971 and in October 1972, blood samples were obtained at oestrus from eighty-seven Merino ewes that had been fed either 100% (high plane) or 50% (low plane) of their esti¬ mated daily nutrient requirements during the preceding 84-day autumn lactation period. The experimental rations, changes in body mass and oestrous activity of the ewes have been described elsewhere (Lishman, Stielau & Botha, 1974). Jugular blood samples were obtained (indwelling cannulae) from at least five ewes, on each plane of nutrition, which exhibited oestrus after the com¬ mencement of a sampling period (i.e. August, September or October 1970 and 1971). The blood samples were taken at 2-hr (1970) or 1-hr (1971), intervals, commencing as soon as a ewe stood for service and sampling continued for up to 36 hr. During October 1972, the first blood was drawn approximately 12 hr before the expected onset of oestrus in thirteen ewes. Sampling was repeated at 4-hr intervals until mating commenced and thereafter at hourly intervals for 24 hr. A total of ninety-two oestrous periods were studied. In order to detect oestrus, vasectomized rams were placed with the ewes at intervals of not more than 2 hr, and the rams were frequently interchanged between various groups of ewes. As soon as a ewe permitted service, she was immediately removed from the presence of the ram. The double antibody radioimmunoassay for ovine LH, as described by

Published
1974

180. Keratolytic winter erythema or 'oudtshoorn skin': a newly recognized inherited dermatosis prevalent in South Africa

Author

G H, Findlay, G T, Nurse, T, Heyl, P R, Hull, T, Jenkins, H, Klevansky, J G, Morrison, J, Sher, E J, Schulz, E, Swart, I J, Venter, and D A, Whiting

Subjects
Foot Dermatoses, Male, Leg, Adolescent, Foot, Infant, Hand Dermatoses, Leg Dermatoses, Hand, Erythema, Terminology as Topic, Humans, Female, Seasons, Child, Genes, Dominant
Abstract

A hitherto undescribed inherited dermatosis, traceable to certain 19th-century inhabitants of Oudtshoorn, CP, has been transmitted as an autosomal dominant to a large number of their present-day descendants. The disease consists of intermittent and recurrent centrifugal peeling, with redness, of the palms and soles in particular. In more severe cases similar patches are found extending up the limbs to the buttocks and the trunk generally. The inconvenience is usually moderate, but it may be incapacitating. Some temporary relief, but so far nothing permanent, can be offered through treatment.

Published
1977

181. [Disseminated herpesvirus hominis infection. A case report]

Author

J S, Brink and E, Swart

Subjects
Adult, Male, Eczema, Humans, Herpes Simplex
Abstract

A case of disseminated Herpesvirus hominis (type I) in a 23-year-old White man with widespread eczema is reported. The grave prognosis of this disease is stressed.

Published
1978

182. [No apparent correlation between the level of participation in the German early cancer detection program and the development of cancer mortality in females. An ecologic analysis]

Author

B P, Robra, E, Swart, and T, Possekel

Subjects
Adult, Germany, West, Breast Neoplasms, Middle Aged, Cross-Sectional Studies, Risk Factors, Cause of Death, Uterine Neoplasms, Humans, Mass Screening, Female, Colorectal Neoplasms, Precancerous Conditions, Aged
Abstract

Attendance rates of the German cancer screening programme and female cancer mortality rates (cancers of the uterus, breast, and colon-rectum) were calculated by age (5-year groups), region (Federal States) and period (annually; 1975-1982 for attendance rates, 1975-1984 for mortality rates). There was no apparent association of attendance and mortality pattern. This finding may be due to avoidable shortcomings in data collection. Programme effectiveness is unlikely to be demonstrated by more data of the same aggregate type. We have to collect information on screening histories linked to cause of death on a person-to-person basis. This can be done in retrospective case-control-studies or prospectively using records for cancer patients. Provisions for such studies are essential.

Published
1989

183. [Clinical characteristics and genetic identity of the basal cell nevus syndrome (Gorlin-Goltz syndrome)]

Author

H S, Breytenbach, G S, Gericke, C J, Muller, C J, Nortjé, B C, Shanley, E, Swart, and C W, Van Wyk

Subjects
Adult, Male, Syndrome, Pedigree, Phosphates, Radiography, Carcinoma, Basal Cell, Parathyroid Hormone, Child, Preschool, Pseudohypoparathyroidism, Cyclic AMP, Bone Cysts, Humans, Female, Child, Pigmentation Disorders, Jaw Diseases
Abstract

The clinical, genetic, radiological, dental and dermatological aspects of 3 patients with the autosomal dominant basal cell naevus syndrome are reported. An analysis of the phenotypic features of 72 cases described in the literature is presented and compared with a previous analysis. Ash leaf hypopigmentation similar to that found in tuberous sclerosis represents a unique finding in this syndrome. Other similarities to the phacomatoses are discussed. We were able to support a previous report that patients with the basal cell naevus syndrome have a normal end-organ response to parathormone stimulation, and that it is most probably not related to pseudohypoparathyroidism, as earlier reports suggested.

Published
1975

184. The clinical value of lymphography in cervical cancer, FIGO-stage Ib-IIa

Author

E, Swart, J, Bouma, and K, Schuur

Subjects
Adult, Evaluation Studies as Topic, Lymphatic Metastasis, Carcinoma, Carcinoma, Squamous Cell, Humans, Lymph Node Excision, Lymphography, Uterine Cervical Neoplasms, Female, Adenocarcinoma, Middle Aged, Aged
Abstract

We report the limited value of lymphography in detecting lymphnode-metastases in 54 patients with operable cervical cancer, FIGO-stage Ib-IIa. A low predictive value of the positive lymphogram and low sensitivity of lymphography were found. This was not affected by the use of strict criteria in assessing the lymphograms. Analysis of the sensitivity of lymphography showed poor ability of the radiologist in localising a metastasis in a patient. High accuracy of lymphography and high specificity were found relatively easy to achieve. They are of minor clinical importance. Only 29 percent of patients with proved lymphnode-metastases had lymphographical evidence at the site of these metastases. It was decided not to continue the routine use of lymphography in this group of patients.

Published
1989

186. Physico-mechanical aspects of decubitus prevention

Author

Maarten E. Swart

Subjects
Pressure Ulcer, Tissue deformation, medicine.medical_specialty, Rehabilitation, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Rehabilitation research, Physical medicine and rehabilitation, medicine, Pressure, Humans, Support system, Psychology, Lying, Gravitation
Abstract

Reviewed is the theory of tissue deformation as cause of decubitus, as developed in cooperation with two Dutch Rehabilitation Institutes and two Dutch Rehabilitation Research Institutes. Also reviewed are the conditions of the prevention of decubitus concerning the support of the human body in the lying situation. The consequences of the new anti-deformation theory for the lying-support are discussed. A classification is given of the existing lying-down support systems. Examples of the three categories of existing lying-down support systems are given and discussed in general.

Published
1985

192. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Author

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Hodnett P, Hoffman M, Hogan C, Holmes Z, Rees DH, Hotchkiss D, Huang P, Humbert J, Hutchens E, Iachini K, Ibarra M, Igbokidi O, Ilahi T, Imbrognio M, Ipp E, Iteld B, Jacques G, Jafri A, Jafry B, Jardula M, Jefferson D, Jenkins R, Johnson E, Johnson J, Jones S, Kawahara M, Kelehan S, Kelly R, Kendall T, Kereiakes D, Khan M, Khan S, Kick J, Kimmel M, King T, King A, Kirkland S, Kissel S, Kitchens D, Klein P, Klugherz B, Korban E, Koren M, Korte M, Kostis J, Kotek L, Kozak M, Kreutter F, Kusnick B, Labovitz R, Lail J, Lamance J, Lamas G, Lambert J, Lambert C, Landzberg J, Langdon J, Lavoie W, Ledger G, Lee T, Lee K, Lehman R, Leimbach W, Lennard M, Lepor N, Lester F, Levin P, Levinson L, Lewis D, Lillo J, Link L, Long C, Longaker R, Lorch G, Lucksinger G, Lynd S, Rhudy JM, Madder R, Magness K, Maheshwari A, Alan A, Malek M, Maletz L, Malhotra V, Malhotra S, Mandviwala M, Mani CK, Manuel J, Marchelletta N, Marshall L, Marsters M, Martin L, Martinez E, Mavromatis K, Maynard R, Mays M, Mays B, Mbulaiteye A, Mcalister R, Mccoy C, Mccrary D Jr, Mccullough-O'Brien H, Mcdonald M, Mcgill J, Mcgrew F, Mckenzie C, Mclaurin B, Mclellan BA, Mcneil D, Mcneill R, Mehrle A, Melbie K, Melliza T, Messina T, Meyer R, Michel K, Mikdadi G, Miller C, Miller R, Miller A, Miller G, Miller W, Mitchell J, Moats DJR, Mody F, Moffat J, Molk B, Molter D, Monroe T, Montero H, Montgomery R, Mookherjee D, Moran J, Moriarty P, Morrison J, Morton D, Moshayedi P, Mosley J, Moustafa M, Munshi K, Murray A, Mustafa J, Nadar V, Naidu R, Nalley J, Navy S, Neil L, Neutel JM, Niblack P, Nicely V, Nicolai M, Nijmeh G, Nikas A, Nikyar A, Nixon S, Norman L, Noto G, Nour K, Nugent A, Ocman B, Odegard A, Olsen S, Ortiz-Carrasquillo R, Ossino N, Paez H, Palchick B, Paliwal Y, Pannell R, Parfait V, Partridge J, Patel B, Patel R, Patel M, Patel S, Paysor C, Pena A, Pereira S, Perez M, Perez A, Perkins H, Perry B, Peters P, Phillippi C, Phillips A, Phillips A, Piacente R, Pintado M, Pish R, Pitt W, Poling T, Pomposini 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Subjects
0301 basic medicine, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, c-reactive protein, Randomized controlled trial, law, Cardiovascular Disease, middle aged, double-blind method, antibodies, Myocardial infarction, humans, Stroke, interleukin-1beta, biology, Antibodies, Monoclonal, drug, General Medicine, Lipid, Aged, anti-inflammatory agents, monoclonal, humanized, atherosclerosis, cardiovascular diseases, dose-response relationship, female, incidence, infections, lipids, male, myocardial infarction, neutropenia, secondary prevention, stroke, Anti-Inflammatory Agent, aged, Editorial, Atherosclerosi, Monoclonal, Human, medicine.drug, medicine.medical_specialty, Neutropenia, Antibodies, Monoclonal, Humanized, Infections, Placebo, antibodies, monoclonal, dose-response relationship, drug, infection, medicine (all), 03 medical and health sciences, Internal medicine, medicine, Dose-Response Relationship, Drug, business.industry, Antiinflammatory Therapy, Canakinumab, for Atherosclerotic Disease, C-reactive protein, medicine.disease, Surgery, Canakinumab, 030104 developmental biology, biology.protein, business
Abstract

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.)

Published
2017

193. [Things are Moving Forward! But History is not Yet Made].

Author

March S, Swart E, and Hoffmann F

Subjects
Germany, History, 21st Century, History, 20th Century, Forecasting, Humans, Periodicals as Topic trends, Periodicals as Topic history
Abstract

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Published
2024
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194. Sepsis incidence, suspicion, prediction and mortality in emergency medical services: a cohort study related to the current international sepsis guideline.

Author

Piedmont S, Goldhahn L, Swart E, Robra BP, Fleischmann-Struzek C, Somasundaram R, and Bauer W

Subjects
Humans, Retrospective Studies, Incidence, Female, Male, Middle Aged, Aged, Adult, Cohort Studies, Aged, 80 and over, Young Adult, Adolescent, Sepsis mortality, Sepsis diagnosis, Sepsis epidemiology, Emergency Medical Services statistics & numerical data
Abstract

Purpose: Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction., Methods: Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics' and emergency physicians' EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools' intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis., Results: Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously., Conclusion: Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic., (© 2024. The Author(s).)

Published
2024
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195. [An Experience Report on the Evaluation of New Forms of Care for People with Mental Illness: Pros and Cons of the Use of SHI Claims Data].

Author

Neumann A, Kliemt R, Baum F, Seifert M, Kubat D, March S, Weinhold I, Swart E, and Schmitt J

Subjects
Germany, Humans, Insurance Claim Review, Mental Health Services, Health Services Research, Mental Disorders therapy, Mental Disorders epidemiology, National Health Programs
Abstract

The present article describes the special features of an evaluation of research in mental health services in Germany. The experiences of the evaluation of flexible and integrated treatment options with a global treatment budget in psychiatric hospitals based on routine data of more than 70 statutory health insurance (SHI) funds (EVA64 study) are systematically presented. Using the EVA64 study as an example, recommendations for the use of claims data in the field of mental health services research and in general are derived. (1) First, the study and its use of claims data is described and classified. (2) The individual outcomes of the study are presented and evaluated in order to (3) derive criteria, identify strengths and suggest potential uses of claims data. (4) Finally, recommendations for the further development of claims data from SHI funds as a basis for evaluation are described., Competing Interests: ZEGV, WIG2 und ISMG wurden im Rahmen der EVA64-Studie, der Bundesweit einheitlichen Wissenschaftlichen Evaluation von Modellprojekten nach § 64b SGB V, finanziert. Die Förderung dieser Studie erfolgt von einem Konsortium bestehend aus mehr als 70 GKVen., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Published
2024
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196. VersKiK qualitative study design: actual follow-up needs of paediatric cancer survivors, their informal caregivers and follow-up stakeholder perceptions in Germany.

Author

Aleshchenko E, Swart E, Voigt M, Langer T, Calaminus G, Glogner J, and Baust K

Subjects
Humans, Adult, Child, Adolescent, Caregivers, Follow-Up Studies, Survivors, Health Personnel, Cancer Survivors, Neoplasms therapy
Abstract

Introduction: This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors' transition from paediatric to adult healthcare., Methods and Analysis: We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement., Ethics and Dissemination: The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above., Trial Registration Number: Registered at German Clinical Trial Register, ID: DRKS00026092., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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197. Changes in patient care through flexible and integrated treatment programs in German psychiatric hospitals: meta-analyses based on a series of controlled claims-based cohort studies.

Author

Neumann A, Schmitt J, Seifert M, Kliemt R, March S, Häckl D, Swart E, Pfennig A, and Baum F

Subjects
Adult, Adolescent, Child, Humans, Cohort Studies, Hospitalization, Ambulatory Care, Germany, Hospitals, Psychiatric, Mental Disorders therapy
Abstract

Background: Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals., Methods: We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models., Results: The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals., Conclusions: Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions., Trial Registration: This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713)., (© 2024. The Author(s).)

Published
2024
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198. Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis.

Author

Fleischmann-Struzek C, Rose N, Ditscheid B, Draeger L, Dröge P, Freytag A, Goldhahn L, Kannengießer L, Kimmig A, Matthäus-Krämer C, Ruhnke T, Reinhart K, Schlattmann P, Schmidt K, Storch J, Ulbrich R, Ullmann S, Wedekind L, and Swart E

Subjects
Humans, Patient Acceptance of Health Care, Inpatients, Outpatients, Disease Progression, Critical Pathways, Sepsis therapy
Abstract

Background: Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation., Methods: Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques., Discussion: The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae., Trial Registration: Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023)., (© 2024. The Author(s).)

Published
2024
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199. [Determinants of the utilization of cancer screening among older adults in Saxony-Anhalt-What is the influence of health literacy?]

Author

Kannengießer L, Ulbrich R, Hasenpusch C, Hrudey I, Walter S, Stallmann C, Swart E, and March S

Subjects
Humans, Aged, Early Detection of Cancer, Cross-Sectional Studies, Germany epidemiology, Health Literacy, Neoplasms diagnosis, Neoplasms prevention & control
Abstract

Background: In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region., Methods: In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (n = 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use., Results: Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation., Conclusion: The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education., (© 2023. The Author(s).)

Published
2024
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200. [Skin cancer screening in the aging population in Saxony-Anhalt : Utilization, facilitating, and hindering factors].

Author

Walter S, Hasenpusch C, Hrudey I, Holstiege J, Bätzing J, Faßhauer H, March S, Swart E, and Stallmann C

Subjects
Aged, Female, Humans, Male, Aging, Early Detection of Cancer, Germany epidemiology, Middle Aged, Melanoma, Skin Neoplasms diagnosis
Abstract

Background: Statutory skin cancer screening (gHKS) can counteract severe courses of various types of skin cancer. The example of malignant melanoma shows that screening is important for older adults in view of the average age of onset of this disease: 62 (women) and 68 years (men). For Saxony-Anhalt (ST), as a state particularly affected by demographic change, little gHKS data are available regarding its usage., Objectives: For the study, gHKS participation rates for persons aged 55 and older are presented for ST in comparison to the rest of Germany. Reasons for and barriers to participation from those eligible as well as possible fields of action are shown., Materials and Methods: For the target group, outpatient billing data from the Central Institute for Statutory Health Insurance Physicians in Germany (Zi) on gHKS from 2011-2020 are cross-sectionally and longitudinally analysed. Guideline-based telephone interviews with 18 residents using qualitative content analysis according to Kuckartz serve to identify reasons for and barriers to the use of gHKS., Results: The gHKS was rarely and irregularly used in ST and other federal states of Germany from 2011-2020; the annual utilisation rate was about 8.0% (national average: 8.4%). Between 2011 and 2020, 50% of eligible people aged 55 years and older did not participate in the gHKS. The highest utilisation rates were among men aged 70-79 years. In addition to district-specific differences, which indicate possible gaps in care, information deficits appear to be the main reason for low participation., Conclusion: The low utilisation of gHKS, partly due to a lack of information among those entitled to it, requires target group-specific information services., (© 2023. The Author(s).)

Published
2024
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