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Tim Bothe,1 Anne-Katrin Fietz,2 Elke Schaeffner,1 Antonios Douros,3– 5 Anna Pöhlmann,2 Nina Mielke,1 Cédric Villain,1,6 Muhammad Helmi Barghouth,1 Volker Wenning,7 Natalie Ebert1 1Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany; 2Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany; 3Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 4Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany; 5Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; 6Normandie Univ UNICAEN, INSERM U1075 COMETE, service de Gériatrie, CHU de Caen, Caen, France; 7AOK Nordost – Die Gesundheitskasse, Potsdam, GermanyCorrespondence: Tim Bothe, Charité – Universitätsmedizin Berlin, Institute of Public Health, Charitéplatz 1, Berlin, DE-10117, Germany, Tel +49 30 450 570054, Email tim.bothe@charite.dePurpose: The validity of ICD-10 diagnostic codes for chronic kidney disease (CKD) in health claims data has not been sufficiently studied in the general population and over time.Patients and Methods: We used data from the Berlin Initiative Study (BIS), a prospective longitudinal cohort of community-dwelling individuals aged ≥ 70 years in Berlin, Germany. With estimated glomerular filtration rate (eGFR) as reference, we assessed the diagnostic validity (sensitivity, specificity, positive [PPV], and negative predictive values [NPV]) of different claims-based ICD-10 codes for CKD stages G3-5 (eGFR < 60mL/min/1.73m²: ICD-10 N18.x-N19), G3 (eGFR 30–< 60mL/min/1.73m²: N18.3), and G4-5 (eGFR < 30mL/min/1.73m²: N18.4– 5). We analysed trends over five study visits (2009– 2019).Results: We included data of 2068 participants at baseline (2009– 2011) and 870 at follow-up 4 (2018– 2019), of whom 784 (38.9%) and 440 (50.6%) had CKD G3-5, respectively. At baseline, sensitivity for CKD in claims data ranged from 0.25 (95%-confidence interval [CI] 0.22– 0.28) to 0.51 (95%-CI 0.48– 0.55) for G3-5, depending on the included ICD-10 codes, 0.20 (95%-CI 0.18– 0.24) for G3, and 0.36 (95%-CI 0.25– 0.49) for G4-5. Over the course of 10 years, sensitivity increased by 0.17 to 0.29 in all groups. Specificity, PPVs, and NPVs remained mostly stable over time and ranged from 0.82– 0.99, 0.47– 0.89, and 0.66– 0.98 across all study visits, respectively.Conclusion: German claims data showed overall agreeable performance in identifying older adults with CKD, while differentiation between stages was limited. Our results suggest increasing sensitivity over time possibly attributable to improved CKD diagnosis and awareness.Keywords: CKD, diagnostic validity, health claims data, sensitivity, specificity

This study explores the synthesis, characterization, and biomedical applications of silver nanoparticles (AgNPs) synthesized using Simarouba glauca leaf extract. The biogenic AgNPs were characterized through UV–visible spectroscopy, X-ray diffraction (XRD), particle size analysis, zeta potential analysis, energy dispersive X-ray spectroscopy (EDX), Fourier-transform infrared spectroscopy (FTIR), atomic force microscopy (AFM), and high-resolution transmission electron microscopy (HR-TEM). The nanoparticles exhibited a distinct absorbance peak at 413.5 nm, confirming their synthesis and surface plasmon resonance. XRD and HR-TEM analyses revealed a face-centered cubic structure with an average size of 12.45 nm, while AFM indicated a mean particle size of 18.34 nm. The particles demonstrated moderate stability with a zeta potential of −41.4 mV and exhibited various elemental compositions as confirmed by EDX. In the biomedical evaluation, the anticancer potential of SG-AgNPs was tested on L-132 and A549 cell lines using MTT, live/dead, and DNA damage assays. Results showed dose-dependent cytotoxicity, with significant effects observed at higher concentrations, particularly against A549 cells. Additionally, the protective effects of SG-AgNPs were assessed in Caenorhabditis elegans using survival and paralysis assays. The nanoparticles significantly improved survival rates and reduced paralysis in worms infected with Pseudomonas aeruginosa PAO1 and Staphylococcus aureus. These findings highlight the potential of biogenic SG-AgNPs as effective agents with both anticancer and antimicrobial properties. Future research should focus on elucidating the mechanisms underlying these effects and optimizing their therapeutic applications.

Clitoria ternatea L. flowers were used for the green synthesis of silver nanoparticles (CT-AgNPs) with a focus on their anticancer and antimicrobial properties. The CT-AgNPs were characterized using a variety of techniques, including UV–Vis spectroscopy, XRD, EDX, TEM, FTIR, and DLS, revealing spherical, polycrystalline nanoparticles with an average size of 16 nm and excellent colloidal stability. Anticancer activity was assessed on A549 and L-132 cell lines, demonstrating a dose-dependent cytotoxic effect on A549 cells with an LC50 of 4.88 μg mL−1, while the CT-AgNPs exhibited no significant toxicity towards L-132 cells up to 30 μg mL−1. Additionally, the antibacterial potential of CT-AgNPs was evaluated using Caenorhabditis elegans survival assays, where they significantly reduced paralysis rates and improved nematode survival when exposed to pathogenic bacteria (Pseudomonas aeruginosa and Staphylococcus aureus) at concentrations of 20 and 40 μg mL−1. The results highlight the promising dual therapeutic potential of CT-AgNPs for both anticancer and antimicrobial applications, with future directions focusing on in vivo validation and exploration of their molecular mechanisms in higher biological systems.

Understanding the limits of animal models as predictors of human biology: lessons learned from the sbv IMPROVER species translation challenge. The spectrum of physiological models is vast: ranging from proteomics[1] to animal models[2] and extending into the realm of laboratory[3] and applied human physiology.[4] They assist in deconstructing complex biological phenomena into constituent parts. For instance, while animal and cellular models are informative, they do not perfectly represent the complex intricacies of human physiology. [Extracted from the article]

Abstract In recent years, carbon quantum dots (CQDs) have garnered considerable attention as a promising material for biomedical applications because of their unique optical and biological properties. In this study, CQDs were derived from the leaves of Hibiscus rosa-sinensis Linn. via microwave-assisted technique and characterized using different techniques such as ultraviolet–visible, Fourier transform infrared, fluorescence spectrometry, X-ray diffraction, dynamic light scattering, transmission electron microscopy and energy-dispersive X-ray spectroscopy. Subsequently, their potential for biomedical applications was investigated through in vitro assays assessing scratch healing, anti-inflammatory, antibacterial, and cytotoxicity properties. It was found that the CQDs were fluorescent, polycrystalline, quasi-spherical, ~ 12 nm in size with presence of –OH and –COOH groups on their negatively charged surfaces, and demonstrated good anti-inflammatory by inhibiting protein denaturation, cyclooxygenase-2 and regulating inflammatory cytokines. The CQDs also exhibited antimicrobial activity against Klebsiella pneumoniae and Bacillus cereus, good biocompatibility, along with excellent promotion of cell proliferation in vitro, indicating their potential as a anti-inflammatory and wound healing material. The properties were more enhanced than their precursor, H. rosa-sinensis leaf extract. Hence, the CQDs synthesized from the leaves of H. rosa-sinensis can serve as a potential biomedical agent.

The weed Martynia annua traditionally known as Kakanasika is annual herbaceous plant known for its multiple medicinal properties such as anthelmintic, analgesic, antipyretic, antibacterial, anti-convulsant, anti-fertility, antinociceptive, antioxidant, CNS depressant and wound healing activity. The aqueous root extract of M. annua was subjected to qualitative analysis, revealing the presence of terpeniods, indicative of its rich phytochemicals composition. Utilizing a green synthesis approach, silver nanoparticles (AgNPs) were successfully synthesized from the plant extract. Characterization through UV-Visible spectroscopy, FTIR, DLS, and SEM/EDX confirmed the formation of AgNPs with polygonal morphology and an average size of 64 nm, with the PDI of 0.385. Additionally, the AgNPs demonstrated moderate stability, evidenced by a zeta potential of −21.6 mV. Evaluation of the synthesized AgNPs focused on their anti-diabetic potential. The green synthesized R-AgNPs were potent antioxidant agents. They exhibited significant inhibition of alpha amylase, a pivotal enzyme in carbohydrate metabolism, suggesting their efficacy as anti-diabetic agents. Moreover, the AgNPs enhanced glucose uptake by yeast cells, indicating their promising therapeutic role in managing diabetes mellitus. This study highlights the pharmacological importance of M.annua, particularly its aqueous root extract, in the eco-friendly synthesis of AgNPs with potential therapeutic implications. Further investigation into the mechanism of action and clinical efficacy of these AgNPs in diabetes management is warranted.

Objective: Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring., Results: Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns., Conclusions: Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.

Objective: Accurate blood pressure (BP) measurement is crucial for the diagnosis, risk assessment, treatment decision-making, and monitoring of cardiovascular diseases. Unfortunately, cuff-based BP measurements suffer from inaccuracies and discomfort. This study is the first to access the feasibility of machine learning-based BP estimation using impedance cardiography (ICG) data., Methods: We analyzed ICG data from 71 young and healthy adults. Nine different machine learning algorithms were evaluated for their BP estimation performance against quality controlled, oscillometric (cuff-based), arterial BP measurements during mental (Trier social stress test), and physical exercise (bike ergometer). Models were optimized to minimize the root mean squared error and their performance was evaluated against accuracy and regression metrics., Results: The multi-linear regression model demonstrated the highest measurement accuracy for systolic BP with a mean difference of -0.01 mmHg, a standard deviation (SD) of 10.79 mmHg, a mean absolute error (MAE) of 8.20 mmHg, and a correlation coefficient of r = 0.82. In contrast, the support vector regression model achieved the highest accuracy for diastolic BP with a mean difference of 0.15 mmHg, SD = 7.79 mmHg, MEA = 6.05 mmHg, and a correlation coefficient of r = 0.51., Conclusion: The study demonstrates the feasibility of ICG-based machine learning algorithms for estimating cuff-based reference BP. However, further research into limiting biases, improving performance, and standardized validation is needed before clinical use., (© 2025 The Author(s). Acta Physiologica published by John Wiley & Sons Ltd on behalf of Scandinavian Physiological Society.)

Rationale & Objective: The benefits of kidney transplantation compared with treatment with dialysis, including in older adults, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors., Study Design: Secondary analysis of the Berlin Initiative Study, a population-based cohort., Setting & Participants: 2,069 adults aged≥70 years in Germany., Exposure: Age and sex., Outcome: Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey., Analytical Approach: Descriptive analysis., Results: Among the 2,069 participants (median age 80 years, 53% women, median eGFR 63mL/min/1.73m 2 ), 93% had≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using 2 published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively)., Limitations: GFR was not measured, and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data., Conclusions: One in 20 older adults were potentially suitable for living kidney donation, and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults., Plain-Language Summary: Although potentially beneficial, kidney transplantation remains infrequent among older adults aged≥70 years with kidney failure. Study evaluated the potential to increase living kidney donation among older adults, including their medical suitability as well as willingness to donate. Among 2,069 community-dwelling older adults (median age 80 years), 5% to 6% had no exclusion to donation. Among these individuals, 11% to 12% remained suitable for donation during 8 years of follow-up. Most exclusions were not related to eGFR and albuminuria. Willingness to living donation was high (73%). These findings highlight the potential benefits from expanding the pool of transplantable kidneys through the use of living donation in older adults., (Copyright © 2024. Published by Elsevier Inc.)

Background: The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.) AIMS: The aim of this study is to identify the barriers and enablers for the implementation of this guideline. The results of this project, together with quantitative evaluation against quality indicators for CKD in primary care will inform an update to the guideline., Methods: We performed 17 semi-structured interviews with GPs practicing in Berlin and Brandenburg. Transcripts were analysed using qualitative content analysis as described by Mayring., Results: We found that the perception of low clinical priority of CKD compared to other chronic diseases, opportunity cost of using guidelines, as well as poor patient understanding were significant barriers. GPs expressed that improved graphic design or integration of guideline recommendations in clinical decision support systems were enabling factors. Clinical problems concerning CKD were mostly solved by recourse to informal communication with specialists. GPs reported that they rarely consulted CKD guidelines as an aide to clinical decision making., Conclusion: The most significant barrier to use was that guidelines were not used as step-by-step decision aide in consultations with patients. Our analysis suggests that informal contact between primary and secondary care is significant conduit for evidence-based information on CKD in German primary care. Implementation projects should support the development of these relationships., (© 2024. The Author(s).)

Objectives: Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults., Methods: Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.1 years. Multinomial and logistic regression analyses were performed to assess the association of social support using Oslo Social Support Scale-3 with frailty transition and incidence, respectively. Gender differences were explored using stratified analyses., Results: At baseline, frailty prevalence in the study population [mean (SD) age 84.3 (5.6) years; 55.8% women] reached 33.1% with 47.0, 29.4 and 23.6% of the participants reporting moderate, strong and poor social support, respectively. Over the follow-up period, social support was not significantly associated with the frailty transition categories in the adjusted model. Conversely, the adjusted logistic regression analysis showed that participants with poor social support had twice the odds of becoming frail compared to those with strong social support (OR 2.07; 95% CI 1.08-3.95). Gender-stratified analyses showed comparable estimates to the main analysis but were statistically non-significant., Discussion: Our study results underpin the role of social factors in frailty incidence and highlight social support as a potential target for frailty-preventing interventions in older adults. Therefore, it is important to adopt a biopsychosocial model rather than a purely biomedical model to understand and holistically improve the health of community-dwelling older adults., Competing Interests: NE received honoraria as member of an EAB for Bayer AG, Leverkusen. ES receives honoraria from AstraZeneca and from the National Kidney Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Barghouth, Klein, Bothe, Ebert, Schaeffner and Mielke.)

Background: Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults., Methods: In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73m 2 and/or an albumin-creatinine ratio ≥ 30 mg/g. Incident frailty was assessed at follow-up using Fried criteria. Logistic regression was applied to assess (1) the association of different polypharmacy definitions with incident frailty and (2) effect modification by CKD., Results: In this cohort study, out of 757 non-frail participants (mean age 82.9 years, 52% female, 74% CKD), 298 (39%) participants reported polypharmacy. Over the observation period of 2.1 years, 105 became frail. Individuals with polypharmacy had 1.96 adjusted odds (95% confidence interval (CI): 1.20-3.19) of becoming frail compared to participants without polypharmacy. The effect of polypharmacy on incident frailty was modified by CKD on the additive scale (relative excess risk due to interaction: 1.56; 95% CI 0.01-3.12)., Conclusions: This study demonstrates an association of polypharmacy and incident frailty and suggests strong evidence for an effect modification of CKD on polypharmacy and incident frailty. Revision of prescriptions could be a target strategy to prevent frailty occurrence, especially in older adults with CKD., (© 2024. The Author(s).)

Background: Sick leave due to mental disorders poses a relevant societal and economic burden. Research on sick leave over a patient journey of individuals who received one of two treatment approaches - either behavioral (BT) or psychodynamic (PDT) psychotherapy - is scarce., Methods: We conducted a cohort study on anonymized German claims data for propensity-score matched patients who received short-term outpatient BT or PDT. We analyzed sick leave days and direct health care costs one year before, during, and one year after psychotherapy., Results: We analyzed data of patients who received BT and PDT, with N = 14 530 patients per group after matching. Patients showed sick leave days per person year of 33.66 and 35.05 days before, 35.99 and 39.74 days during, and 20.03 and 20.95 days after BT and PDT, respectively. Sick leave rates were overall higher in patients who received PDT. Both patient groups showed reductions of roughly 14 sick leave days per year, or 40%, from before to after therapy without a difference between BT and PDT (difference-in-difference [DiD] = -0.48, 95%-confidence interval [CI] -1.61 to 0.68). Same applies to direct health care costs which reduced in both groups by roughly 1800 EUR (DiD = 0, 95%-CI -158 to 157)., Conclusions: Results suggest similar reductions in sick leave days and direct health care costs from before to after BT and PDT. As sick leave is discussed to serve as an indicator of overall health and functioning in mental disorders, both treatments may have a similar positive impact on mental health.

Background: Chronic kidney failure (CKF) is often treated with dialysis, which is invasive and costly and carries major medical risks. The existing studies of patients with CKF requiring dialysis that are based on claims data from German statutory health insurance (SHI) carriers employ varying definitions of this entity, with unclear consequences for the resulting statistical estimates., Methods: We carried out a cohort study on four random samples, each consisting of 62 200 persons aged 70 or above, from among the insurees of the SHI AOK Nordost, with one sample for each of the years 2012, 2014, 2016, and 2018. The prevalence, incidence, mortality, and direct health care costs of CKF requiring dialysis were estimated and compared on the basis of four different definitions from literature and a new definition developed by the authors in reference to billing data., Results: The different definitions led to variation in 12-month prevalences (range: 0.33-0.61%) and 6-month incidences (0.058-0.100%). The percentage of patients with prior acute kidney injury (AKI) ranged from 27.6% to 61.8%. Among incident patients, three-month survival ranged from 70.2% to 88.1%, and six-month survival from 60.5% to 81.3%. In CKF patients without prior AKI, the survival curves differed less across definitions (80.2-91.8% at three months, 70.7-84.4% at six months). The monthly health care costs ranged from €6010 to €9606, with marked variability across definitions in the costs of inpatient and outpatient care., Conclusion: The lack of a standardized definition of CKF requiring dialysis in German SHI claims data leads to variability in the estimated case numbers, mortality, and health care costs. These differences are most probably in part due to the variable inclusion of inpatients who received short-term dialysis after AKI.

Background: The Cockcroft-Gault equation (CrCl C-G ) is recommended for dose adjustment of direct oral anticoagulant drugs (DOACs) to kidney function. We aimed to assess whether defining DOAC dose appropriateness according to various kidney function estimators changed the associations between dose appropriateness and adverse events in older adults with atrial fibrillation (AF)., Methods: Participants of the Berlin Initiative Study with AF and treated with DOACs were included. We investigated CrCl C-G and estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration and European Kidney Function Consortium equations based on creatinine and/or cystatin C. Marginal structural Cox models yielded confounder-adjusted hazard ratios for the risk of mortality, thromboembolism and bleeding associated with dose status., Results: A total of 224 patients were included in the analysis (median age 87 years). Using CrCl C-G , 154 (69%) had an appropriate dose of DOACs, 52 (23%) were underdosed and 18 (8%) were overdosed. During a 39-month median follow-up period, 109 (14.9/100 person-years) participants died, 25 (3.6/100 person-years) experienced thromboembolism and 60 (9.8/100 person-years) experienced bleeding. Dose status was not associated with mortality and thromboembolism, independent of the equation. Underdose status was associated with a lower risk of bleeding with all the equations compared with the appropriate dose group. In participants with discrepancies in dose status using CrCl C-G and eGFR equations, the occurrence of endpoints did not differ between participants having an appropriate dose using CrCl C-G or eGFR., Conclusion: In older adults with AF, the association of DOAC dose status with adverse events did not differ when using CrCl C-G or eGFR. Our results suggest that eGFR equations are not inferior to CrCl C-G within this context., Competing Interests: N.E. received fees from Bayer AG Leverkusen as a member of an editorial advisory board outside the submitted work. E.S. received a research grant from Bayer unrelated to the topic of the article and receives a stipend from the National Kidney Foundation. The other authors declare no conflicts of interests., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

Objective: To investigate what competencies and attributes preregistrant pharmacists draw upon in job interviews., Methods: We used a virtual mock job interview assessment asking preregistrant pharmacists to apply for an entry-level pharmacist position. Data were analyzed using a team-based framework analysis using an inductive and deductive approach and mapping responses to the National Competency Standards., Results: A total of 143 interview transcripts were included in the analysis. The top skills mentioned were leadership of self (98.6%) and communication and collaboration (96.5%). Despite graduating from a course with an integrated research curriculum, participants rarely reflected on research skills (31.5%) and no participant discussed any expertise in clinical topics or knowledge of specific professional services. Responses generally lacked specific skills and skills were spoken about broadly without relating to evidence/experience and were often not targeted to the job description. A proposal for educators aligned with competency standards was also developed based on the findings., Conclusion: Preregistrant pharmacists perceive experience within the workforce and communication and collaboration as the most desired by employers for entry-level pharmacy positions. Education and research competencies were seen as least useful to the job. There was a disconnect between skills gained in university and translation to practice. Academics could enhance the better preregistrant pharmacists' reflection of the skills and competencies they have developed employability by (1) providing portfolio management from the beginning of the course that collects evidence and maps to competencies; (2) integrating learning opportunities across all competencies; and (3) regular skills coaching/mentoring from practicing pharmacists to ensure students are aware of current needs in the job market., Competing Interests: Declaration of Competing Interests None declared., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background: Chronic kidney disease (CKD) is a common condition, especially in the elderly. In order to prevent progression and complications of the disease, guideline-adherent outpatient care of patients with CKD should be prioritized. Quality indicators (QIs) can be used to measure and evaluate the quality of ambulatory care for patients with CKD. QIs specifically made for evaluating CKD care in Germany are not yet available. The goal of this work was to develop QIs for the quality assessment of outpatient care for patients over the age of 70 with CKD not requiring dialysis., Materials and Methods: QIs were operationalized from the recommendations of the German national guideline for CKD and others were proposed based on a published review of international QIs. The resulting QIs were divided into sets based on routine data (e.g., health insurance billing data) and data collection in practices (chart review). A panel of experts from various disciplines as well as a patient representative evaluated the proposed QIs in a two-stage Delphi process via online survey in October 2021 and January 2022 and a final consensus conference in March 2022. In addition, ranking lists of the most important QIs from each set were created., Results: An incidence indicator and a prevalence indicator were established; these were not subject to vote. Further, 21 QIs were voted upon by the expert panel. The seven most important QIs in each set (billing data or chart review) were selected. Only one QI was rated by the expert panel as not suitable for additional use in adults under the age of 70 years., Discussion: The QIs will enable the evaluation of the quality of outpatient care for patients with CKD with the long-term aim of optimizing guideline-adherent outpatient care., (© 2023. The Author(s).)

Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH-change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43-5.20]), stable low category (OR 3.32; 95% CI [1.65-6.70]), decline category (OR 1.87; 95% CI [1.34-2.62]), and improvement category (OR 2.01; [1.33-3.05]) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.

Objective: Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively., Method: We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis., Results: In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments., Discussion: Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN., (© 2021 Wiley Periodicals LLC.)

Background: Post-traumatic stress disorders (PTSD) pose a high burden for individuals and societies. Although prevalence rates are rather low, high co-occurrence rates and overall impairments cause deleterious suffering and significant costs. Still, no long-term data on costs and trends in cost developments are available., Methods: Claims data from a German research database were analysed regarding direct and indirect costs occurring for individuals with incident diagnoses of PTSD. Results were compared to non-exposed average insurants matched on age and gender. Costs were analysed over a 5-year period from 2 years preceding until 3 years following an incident diagnosis of PTSD., Results: Overall costs for PTSD account for approximately 43,000 EUR per individual, which is three times higher than costs for non-exposed controls. Of these costs, 59% are caused by mental disorders, 18% specifically by PTSD. In the control group, costs for mental disorders account for 19% of total costs. Costs increase by 142% in the year after an incident diagnosis of PTSD but return to the initial level 2 years later. Still, costs are at least twice as high in every year as in those for the comparison group., Conclusions: Individuals with PTSD seem to suffer from far more impairments in their general health conditions and incur many more costs than average insurants. Most of these seem to be caused by co-occurring mental disorders and show their maximum in the index year. Nevertheless, as costs decrease to their initial level, treatments seem to have counterbalanced the impairments due to PTSD. Thus, treatments for PTSD can be considered as beneficial and their cost-effectiveness should be further investigated.

Exact geometric calibration of optical devices like projectors or cameras is the basis for utilizing them in quantitative metrological applications. The common state-of-the-art photogrammetric pinhole-imaging-based models with supplemental polynomial corrections fail in the presence of nonsymmetric or high-spatial-frequency distortions and in describing caustics efficiently. These problems are solved by our vision ray calibration (VRC), which is proposed in this paper. The VRC takes an optical mapping system modeled as a black box and directly delivers corresponding vision rays for each mapped pixel. The underlying model, the calibration process, and examples are visualized and reviewed, demonstrating the potential of the VRC.

The advantages of spatial phase shifting (SPS) compared with temporal phase shifting in the field of electronic speckle pattern interferometry are described. Some periodic phase reconstruction errors occurring in SPS are discussed. It is shown that these errors become minimal for a spatial phase-shift angle of 2pi/3. Furthermore, a modified phase reconstruction formula is presented by which the noise in the reconstructed phase map is reduced.