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BackgroundFor evaluating the quality of care provided by hospitals, special interest lies in the identification of performance outliers. We study a setting where the decision to classify hospitals as performance outliers or non-outliers is based on the observed result of a single binary quality indicator.MethodsWe propose to embed the classification of providers into a Bayesian decision theoretical framework which enables the derivation of optimal decision rules with respect to the expected decision consequences. We argue that these consequences depend upon for which pathway to quality improvement the profiling of hospitals takes place. We propose paradigmatic utility functions for the two pathways external reporting and change in care delivery and compare the resulting optimal decision rules with regard to their threshold values, sensitivity and specificity. We further apply them to the area of hip replacement surgeries by analyzing data from the mandatory German hospital profiling program. Based on five quality indicators, we re-evaluate the performance of 1,277 hospitals which treated over 180,000 patients for hip-replacement surgeries during 2017.ResultsBased on the utilities we assigned to the classification decisions, the decision rule for change in care delivery classifies more high-volume providers as outliers compared to the decision rule for external reporting, with consequences for both sensitivity and specificity. The re-evaluation of the five quality indicators illustrates that classification decisions are highly dependent upon the underlying utilities.ConclusionAnalyzing the classification of hospitals as a decision theoretic problem and considering pathway-specific consequences of decisions can help to derive an appropriate decision rule. Contrasting decision rules with regard to their underlying assumptions about the utilities of classification consequences can be helpful to make implicit assumptions transparent and justifiable.

Im Jahr 2017 hat der Gemeinsame Bundesausschuss das Verfahren planungsrelevante Qualitätsindikatoren eingesetzt [ref:1] und dafür 11 bestehende Qualitätsindikatoren (QI) der externen stationären Qualitätssicherung (QS) aus den Bereichen Gynäkologische Operationen,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 18. Deutscher Kongress für Versorgungsforschung (DKVF)

Background: Pulmonary arterial hypertension (PAH) is a lethal vasculopathy characterized by remodelling of distal pulmonary arteries associated with inflammation, endothelial cells (EC) dysfunction and a pro-proliferative/anti-apoptotic phenotype in pulmonary arterial smooth muscle cells (PASMC). Tet methylcytosine dioxygenase 2 (Tet2) is a key enzyme in cytosine demethylation that is crucial for epigenetic control of gene expression. Deficiency of Tet2 expression in myeloid cellsresults in increased inflammatory cytokine levels. Moreover, impaired Tet2 expression in EC has also been associated with decreased autophagy, as well as EC dysfunction. In addition, Tet2 silencing contributes to pro-proliferative phenotype of SMC. Thus, we hypothesized that Tet2 deletion would contribute to PAH by upregulation of inflammation and induction of PASMC proliferation and EC dysfunction. Methods and Results: To assess the ability of Tet2 deficiency to induce PAH we assessed cardiopulmonary hemodynamics in a conditional hematopoietic and endothelial cells Tet2 -/- mouse model. Tet2 -/- mice developed PAH associated with significant increases of right ventricular systolic pressure (RVSP), elevation of total pulmonary resistance (TPR) and increased vascular wall thickness of distal pulmonary arteries. Tet2 -/- lung tissue as well as macrophages and EC sorted from the lung displayed aberrant inflammatory cytokine signalling with robust overexpression of IL1βnoted on a Nanostring immune gene expression panel. In vitro IL1βincreased PASMC proliferation measured using EDU. Downregulation of TET2 in PASMC using siRNA resulted in a similar PAH-like phenotype. Moreover, lung from Tet2 -/- mice exhibited an alteration of vasoactive mediator gene expression (increased endothelin-1 (ET1), Arginase 2 (Arg2) and decreased eNOS). Finally we showed that downregulation of Tet2 (achieved by nebulization of si-Tet2) in rats with monocrotaline-induced PAH exacerbated disease severity (increasing TPR adverse pulmonary vascular remodelling).This phenotype was independent of the sex, was associated with a moderate decrease in RV function but had no significant effect on LV hemodynamic parameters. Conclusions: Tet2 is a protective epigenetic regulator that when conditionally downregulated in hematopoietic and endothelial cells leads toPAH by inducing a state of inflammation that contributes to PASMC proliferation and EC dysfunction which drives adverse pulmonary vascular remodelling.

Representation on pension fund boards by state officials—often determined by statute decades past—is negatively related to the performance of private equity investments made by the pension fund, despite state officials’ relatively strong financial education and experience. Their underperformance appears to be partly driven by poor investment decisions consistent with political expediency, and is also positively related to political contributions from the finance industry. Boards dominated by elected rank-and-file plan participants also underperform, but to a smaller extent and attributable to lesser financial experience.

Fragestellung: Die Liposarkome sind eine heterogene Gruppe von Weichteilsarkomen, deren Spektrum von lokaler Problematik (Atypisches Lipom) bis zu hochmalignen Verläufen reicht. Ziel der Arbeit war es, die tumor- und stadiengerechten Therapie und Prognose aufzuzeigen. Methodik: Von 1983-2015[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)