The detection and prevention of adverse drug events in nursing home and home care patients: Study protocol of a quasi-experimental study

Aim: To estimate the cost-effectiveness of an intervention facilitating the early detection of adverse drug events through the means of health professional training and the application of a digital screening tool. Design: Multi-centred non-randomized controlled trial from August 2018 to March 2020 including 65 nursing homes or home care providers. Methods: We aim to estimate the effect of the intervention on the rate of adverse drug events as primary outcome through a quasi-experimental empirical study design. As secondary outcomes, we use hospital admissions and falls. All outcomes will be measured on patient-month level. Once the causal effect of the intervention is estimated, cost-effectiveness will be calculated. For cost-effectiveness, we include all patient costs observed by the German statutory health insurance. Results: The results of this study will inform about the cost-effectiveness of the optimized drug supply intervention and provide evidence for potential reimbursement within the German statutory health insurance system.TU Berlin, Open-Access-Mittel – 202

Antimicrobial use in pediatric oncology and hematology in Germany and Austria, 2020/2021: a cross-sectional, multi-center point-prevalence study with a multi-step qualitative adjudication process

Background Due to the high risk of severe infection among pediatric hematology and oncology patients, antimicrobial use is particularly high. With our study, we quantitatively and qualitatively evaluated, based on institutional standards and national guidelines, antimicrobial usage by employing a point-prevalence survey with a multi-step, expert panel approach. We analyzed reasons for inappropriate antimicrobial usage. Methods This cross-sectional study was conducted at 30 pediatric hematology and oncology centers in 2020 and 2021. Centers affiliated to the German Society for Pediatric Oncology and Hematology were invited to join, and an existing institutional standard was a prerequisite to participate. We included hematologic/oncologic inpatients under 19 years old, who had a systemic antimicrobial treatment on the day of the point prevalence survey. In addition to a one-day, point-prevalence survey, external experts individually assessed the appropriateness of each therapy. This step was followed by an expert panel adjudication based upon the participating centers’ institutional standards, as well as upon national guidelines. We analyzed antimicrobial prevalence rate, along with the rate of appropriate, inappropriate, and indeterminate antimicrobial therapies with regard to institutional and national guidelines. We compared the results of academic and non-academic centers, and performed a multinomial logistic regression using center- and patient-related data to identify variables that predict inappropriate therapy. Findings At the time of the study, a total of 342 patients were hospitalized at 30 hospitals, of whom 320 were included for the calculation of the antimicrobial prevalence rate. The overall antimicrobial prevalence rate was 44.4% (142/320; range 11.1–78.6%) with a median antimicrobial prevalence rate per center of 44.5% (95% confidence interval [CI] 35.9–49.9). Antimicrobial prevalence rate was significantly higher (p < 0.001) at academic centers (median 50.0%; 95% CI 41.2–55.2) compared to non-academic centers (median 20.0%; 95% CI 11.0–32.4). After expert panel adjudication, 33.8% (48/142) of all therapies were labelled inappropriate based upon institutional standards, with a higher rate (47.9% [68/142]) when national guidelines were taken into consideration. The most frequent reasons for inappropriate therapy were incorrect dosage (26.2% [37/141]) and (de-)escalation/spectrum-related errors (20.6% [29/141]). Multinomial, logistic regression yielded the number of antimicrobial drugs (odds ratio, OR, 3.13, 95% CI 1.76–5.54, p < 0.001), the diagnosis febrile neutropenia (OR 0.18, 95% CI 0.06–0.51, p = 0.0015), and an existing pediatric antimicrobial stewardship program (OR 0.35, 95% CI 0.15–0.84, p = 0.019) as predictors of inappropriate therapy. Our analysis revealed no evidence of a difference between academic and non-academic centers regarding appropriate usage. Interpretation Our study revealed there to be high levels of antimicrobial usage at German and Austrian pediatric oncology and hematology centers with a significant higher number at academic centers. Incorrect dosing was shown to be the most frequent reason for inappropriate usage. Diagnosis of febrile neutropenia and antimicrobial stewardship programs were associated with a lower likelihood of inappropriate therapy. These findings suggest the importance of febrile neutropenia guidelines and guidelines compliance, as well as the need for regular antibiotic stewardship counselling at pediatric oncology and hematology centers. Funding European Society of Clinical Microbiology and Infectious Diseases, Deutsche Gesellschaft für Pädiatrische Infektiologie, Deutsche Gesellschaft für Krankenhaushygiene, Stiftung Kreissparkasse Saarbrücken

“Whose Tomorrow is Tomorrow?”: Remembering (Past) Futures in Autobiographical Writings of the US-Nicaragua Solidarity Movement and Contra War, 1979-1991

Tracing the question of how life writing about the US-Nicaragua solidarity movement and Contra War comments on 1980s US society, this paper investigates the narrative construction of future visions through the plotted narratives of past presents and past futures in John Brentlinger’s The Best of What We Are: Reflections on the Nicaraguan Revolution and William R. Meara’s Contra Cross: Insurgency and Tyranny in Central America, 1979-1989

A review regarding the perspectives on rural care : an overview of internationally applied measures

Dieser Titel ist parallel zur Online-Version in gedruckter Form im Universitätsverlag der TU Berlin erschienen: ISBN 978-3-7983-2718-4; ISSN 2197-8123Hintergrund: Der demographische Wandel und die Zunahme chronischer Krankheiten, verbunden mit einer immer komplexer werdenden Pflegebedürftigkeit, stellen die deutsche Gesundheitspolitik vor immer neue Herausforderungen. Insbesondere in den strukturschwachen, ländlichen Regionen besteht Handlungsdruck, um hier eine bedarfsgerechte medizinische Versorgung zu gewährleisten. Wichtig ist es in diesem Zusammenhang, die Zusammenarbeit von Ärzten und anderen Gesundheitsprofessionen neu zu organisieren. Dies ist möglich indem innovative Versorgungsformen gefördert und neue Gesundheitsprofessionen geschaffen werden, da die Versorgung chronisch Kranker und alter Menschen mehr als nur eine akute Versorgung erfordert. Ziel: Dieser Review betrachtet inwieweit international angewandte Maßnahmen zur Rekrutierung von Gesundheitspersonal einem Fachkräftemangel im ländlichen Raum entgegenwirken können. Außerdem werden neue Professionen und innovative Strukturen der Versorgung im ländlichen Raum beschrieben. Methodik: Für die Untersuchung erfolgte eine Literaturrecherche mittels einer umfangreichen Suchstrategie in den Datenbanken PubMed und Scopus. Eingeschlossen wurden Studien, die im Zeitraum 1990-2013 durchgeführt wurden, die Maßnahmen zur Rekrutierung von Gesundheitspersonal in den ländlichen Raum beschrieben und die neue Versorgungsformen vorstellten. Ergänzend wurde eine Expertenbefragung per E-Mail durchgeführt. Insgesamt wurden 65 Experten über das „Health Systems and Policy Monitor-Netzwerk“ angeschrieben, überdies wurden Experteninformation aus dem Europäischen Forschungsprojekt MUNROS verwendet. Ergebnisse: Für einen Großteil der betrachteten Maßnahmen liegt keine Evidenz vor, ein ländlicher Hintergrund jedoch gilt als am besten evaluiert und als wirksamste Maßnahme zu Rekrutierung von Ärzten in den ländlichen Raum. Inkonsistente Ergebnisse zeigen medizinische Fakultäten in ländlichen Gebieten sowie eine finanzielle Unterstützung während des Studiums mit einhergehender Verpflichtung im ländlichen Raum tätig zu werden. Studienergebnisse ergeben, dass die Berufsgruppen der PAs und NPs eine qualitativ hochwertige und kosteneffektive Arbeit leisten. In den USA, Kanada, Neuseeland, Australien und Großbritannien konnten die meisten neuen Versorgungsmodelle identifiziert werden, jedoch besteht hier das Problem, dass diese häufig noch nicht evaluiert worden sind. Schlussfolgerungen: Insgesamt ist deutlich geworden, dass keine der betrachteten Maßnahmen allein gegen einen zukünftigen Fachkräftemangel wirken kann. Verschiedene Modelle wenden daher bereits Kombinationen aus den vorgestellten Ansätzen an. Hierbei sollte auf eine Vertrautheit des medizinischen Personals mit den speziellen Gegebenheiten in ländlichen Regionen sowie auf eine attraktive Gestaltung der Arbeitsbedingungen geachtet werden.Background: The demographic change and the increase of chronic diseases, combined with the increasingly complex need for care, presents new challenges to health policy in Germany. Especially in underdeveloped rural regions the need for action exists in order to ensure an appropriate medical care in these regions. In this context it is important to organize collaboration between physicians and other health care professionals. This is possible with the support of innovative forms of health care and the creation of new roles for health professionals, as the care of chronically ill people and the elderly requires more than just acute care. Objective: This review depicts, to what extent internationally applied measures for the recruitment of health care professionals, are able to counteract the shortage of skilled professionals in rural areas. Moreover, new professional roles and innovative structures of health care in rural areas are described. Methods: A literature review was conducted by means of a comprehensive search strategy in the databases PubMed and Scopus. We included studies which were conducted between the years 1990 and 2003, which described measures for recruitment of health care personal into rural areas and introduced new ways of health care. In addition, an expert survey was conducted via e-mail. Overall 65 experts were contacted via the „Health Systems and Policy Monitor-Network“, besides expert information from the European research project MUNROS was used. Results: For the majority of considered measures no evidence is available, however, a rural background is classified as the best evaluated and most effective measure to recruit physicians into rural areas. Measures as the establishment of medical faculties in rural areas and financial support during the studies along with the obligation to practice in a rural area show inconsistent results. Study results illustrate that the professional groups of the PAs and the NPs provide a high quality and cost effective work. In the USA, Canada, New Zealand, Australia and the UK most of the new care delivery models could be identified, however most of them have often not yet been evaluated. Conclusions: Overall, it has become clear that none of the considered measures can act alone against a future health professional’s shortage in rural areas. Therefore, different models are already applying combinations of the presented approaches. In this context a familiarity with the specific context of the medical personal should be regarded as well as an attractive design of the working conditions

Stochastic Reasoning About Channel-Based Component Connectors

Abstract. Constraint automata have been used as an operational model for component connectors that coordinate the cooperation and communication of the components by means of a network of channels. In this paper, we introduce a variant of constraint automata (called continuous-time constraint automata) that allows us to specify time-dependent stochastic assumptions about the channel connections or the component interfaces, such as the arrival rates of communication requests, the average delay of enabled I/O-operations at the channel ends or the stochastic duration of internal computations. This yields the basis for a performance analysis of channel-based coordination mechanisms. We focus on compositional reasoning and discuss several bisimulation relations on continuous-time constraint automata. For this, we adapt notions of strong and weak bisimulation that have been introduced for similar stochastic models and introduce a new notion of weak bisimulation which abstracts away from invisible non-stochastic computations as well as the internal stochastic evolution.

Missing data in phytosociological relevés of mesic broad-leaved forests due to season of study

Die Bestandesentwicklung eines Stellario-Carpinetum, Subassoziationsgruppe von Stachys sylvatica, und eines Galio odorati-Fagetum im Raum Lüneburg (Niedersachsen, Nordwestdeutschland) wird vom Erstfrühling bis zum Herbst durch wiederholte Vegetationserfassung zu 13 Terminen dokumentiert. Die sich in Abhängigkeit vom Aufnahmezeitpunkt einstellenden Erfassungsdefizite hinsichtlich des Gesamtartenbestandes und der Deckungsgrade der Arten sowie der errechneten mittleren Zeigerwerte werden ermittelt und diskutiert.The stand development of the Stachys sylvatica subassociation group of a Stellario-Carpinetum and of a Galio odorati-Fagetum is documented from early spring to autumn near Lüneburg (Lower Saxony, northwestern Germany), based on 13 phytosociological relevés. The species which appear to have been missed due to the time of year of the inventories are estimated and discussed