Die Bedeutung des Behandlungsprozesses in Deutschland: Eine Discrete-Choice-Analyse zu Patientenpräferenzen in der komplementären und konventionellen Medizin

Hintergrund: Die Auswirkungen von gesundheitlichen Interventionen sind häufig komplex. Es wird argumentiert, dass sie mehr umfassen als reine Veränderungen in den klinischen Parametern. Die Aspekte des Behandlungsprozesses, so genannte „benefits beyond health“, werden bei der Evaluierung von gesundheitlichen Interventionen oft übergangen, können jedoch von Bedeutung für den Patienten sein. Zielsetzung: Ziel dieser Studie war es, die Präferenzen von Patienten und ihre Zahlungsbereitschaft hinsichtlich des Behandlungsprozesses und seiner Merkmale zu erheben. Dabei wurden die Behandlungssettings der Akupunktur, Homöopathie und Allgemeinmedizin betrachtet. Methoden: Eine systematische Literatursuche, sechs halbstrukturierte Interviews und ein Stakeholder Involvement wurden durchgeführt, um die Merkmale des Behandlungsprozesses zu ermitteln. Fünf Prozessmerkmale und ein Kostenmerkmal wurden verwendet, um das experimentelle Design der Discrete-Choice-Analyse (DCA) (6 × 3), welche eine Querschnittserhebung ist, zu konstruieren. Die Patienten wurden von niedergelassenen Ärzten aus Berlin und München rekrutiert. Die Prozessmerkmale wurden effektkodiert und die Daten in einem „conditional“ Logit-Regressionsmodell analysiert. Ergebnisse: Die Daten von 263 Patienten wurden ausgewertet. Die DCA-Ergebnisse zeigten, dass die Merkmale des Behandlungsprozesses „aktives Zuhören“ und „Zeit“ für alle Patienten am relevantesten waren. Die Präferenzen der Merkmale „ganzheitliche Behandlung“ und „Information“ schienen sich zwischen den Gruppen leicht zu unterscheiden. Ersteres war eher relevant für die Gruppen Akupunktur und Homöopathie und letzteres für die Allgemeinmedizin-Gruppe. Die Zahlungsbereitschaft war höher in den Gruppen Akupunktur und Homöopathie. Schlussfolgerungen: Die Zeit, die sich die Ärzte für die Patienten nehmen und das Ausmaß, in dem sie ihnen aufmerksam zuhören, sind für die Patienten aller Gruppen die wichtigsten Merkmale des Behandlungsprozesses. Beide Merkmale sind dabei von ähnlich großer Bedeutung für die Patienten. Diese Ergebnisse können einen Beitrag zur Debatte über eine patientenorientiertere Gesundheitsversorgung leisten. Sie sprechen für eine Stärkung der medizinischen Gesprächsleistung im deutschen Gesundheitswesen. Wir schlagen vor, den Ärzten die Möglichkeit zu geben, mehr Zeit für ihre Patienten aufbringen zu können. Dies könnte ggf. durch eine Änderung der allgemeinen Vergütungsbedingungen erreicht werden (z.B. die verbesserte Vergütung des ärztlichen Gesprächs).Background: The effects of health interventions are often complex, and it is argued that they comprise more than pure changes in clinical parameters. Aspects of the treatment process, socalled ‘benefits beyond health’, are often overlooked in the evaluation of health interventions but can be of value to the patients. Objectives: The aim of this study was to assess patients’ preferences and willingness to pay regarding the treatment process and its attributes in patients using acupuncture, homeopathy or general medicine (GM). Methods: A systematic literature search, six semi-structured interviews and a stakeholder involvement were conducted to determine the attributes of the treatment process. Five process attributes and one cost attribute were used to construct the experimental design of the discrete choice experiment (DCE) (6 × 3), a cross sectional survey method. Patients were recruited by outpatient physicians practicing in Berlin and Munich, Germany. Process attributes were effects-coded. Data were analyzed in a conditional logit regression. Results: Data from 263 patients were analyzed. DCE results showed that the treatment process attributes ‘active listening’ and ‘time’ were most relevant to all patients. Preferences for the attributes ‘holistic treatment’ (more relevant to the acupuncture and homeopathy groups) and ‘information’ (more relevant to the GM group) seemed to differ slightly between the groups. Willingness-to-pay values were higher in the acupuncture and homeopathy groups. Conclusions: The time physicians take and the extent to which they listen attentively are most important and are equally important to all patients. These results may contribute to the debate about more patient-centered healthcare. They support a strengthening of medical consultations in the German healthcare system. We suggest giving physicians the opportunity to spend more time with their patients, which may be achieved by changing the general conditions of remuneration (e.g., improved reimbursement of medical consultations). German Clinical Trial Register DRKS00013160

Wiedza o Polsce i jej kulturze dla młodzieży polskiej ze Wschodu na przykładzie CJiKP UMCS

Zadanie pt. Digitalizacja i udostępnienie w Cyfrowym Repozytorium Uniwersytetu Łódzkiego kolekcji czasopism naukowych wydawanych przez Uniwersytet Łódzki nr 885/P-DUN/2014 zostało dofinansowane ze środków MNiSW w ramach działalności upowszechniającej naukę

IMPLEMENTING E-LEARNING IN THE ROMANIAN EDUCATIONAL SYSTEM - A PRIORITY IN THE CONTEXT OF EU INTEGRATION

This paper intends to examine the development of e-Learning in Romania and to evaluate the gap between Romania and other members of the European Union (EU). Considering that Romania is part of the EU since 2007, it is imperative to achieve, in the shortest possible time, a real convergence with other member states. This requires finding the most effective ways to accelerate the development and increase the competitiveness. Using extensive IT&C technologies represent such a way, and public services – education, too – are among the development priorities on the agendas of all policies, both nationally and European. Thus, the subject treated in the paper is not only present but also of strategic importance for the immediate future of Romania.e-learning, e-education, IT&C

Foundational Ontologies meet Ontology Matching: A Survey

Ontology matching is a research area aimed at finding ways to make different ontologies interoperable. Solutions to the problem have been proposed from different disciplines, including databases, natural language processing, and machine learning. The role of foundational ontologies for ontology matching is an important one. It is multifaceted and with room for development. This paper presents an overview of the different tasks involved in ontology matching that consider foundational ontologies. We discuss the strengths and weaknesses of existing proposals and highlight the challenges to be addressed in the future

Decarbonising is easy: Beyond market neutrality in the ECB's corporate QE

Christine Lagarde, the President of the European Central Bank (ECB), has recently promised to explore every avenue for greening the ECB’s operations, including its quantitative easing (QE) programme. Yet the current corporate QE programme remains biased towards carbon-intensive sectors: these sectors are over-represented in the ECB purchases, when compared to their contribution to the euro area employment and economic activity. An important consequence of the carbon bias is that it may lower the cost of borrowing (an implicit subsidy) and encourage more debt issuance by the most carbon intensive firms relative to low-carbon firms. By favouring access to finance for highly polluting companies, this carbon bias is an important barrier to the decarbonisation of the euro area economies. We argue that the ECB should abandon its market neutrality approach, the key driver of this carbon bias, and adopt alternative low-carbon strategies. We suggest two such strategies in which carbon-intensive bonds are replaced with more climate-friendly bonds. These strategies would significantly reduce the climate footprint of the ECB corporate QE and would make companies’ access to finance more aligned with the targets of the Paris Agreement

Antibiotic Resistance Is Associated with Integrative and Conjugative Elements and Genomic Islands in Naturally Circulating Streptococcus pneumoniae Isolates from Adults in Liverpool, UK

Pneumonia is the sixth largest cause of death in the UK. It is usually caused by Streptococcus pneumoniae, which healthy individuals can carry in their nose without symptoms of disease. Antimicrobial resistance further increases mortality and morbidity associated with pneumococcal infection, although few studies have analysed resistance in naturally circulating pneumococcal isolates in adult populations. Here, we report on the resistome and associated mobile genetic elements within circulating pneumococcus isolated from adult volunteers enrolled in the experimental human pneumococcal colonisation (EHPC) research program at the Liverpool School of Tropical Medicine, UK. Pneumococcal isolates collected from 30 healthy asymptomatic adults who had volunteered to take part in clinical research were screened for antibiotic susceptibility to erythromycin and tetracycline, and whole-genome sequenced. The genetic context of resistance to one or both antibiotics in four isolates was characterised bioinformatically, and any association of the resistance genes with mobile genetic elements was determined. Tetracycline and macrolide resistance genes [tet(M), erm(B), mef(A), msr(D)] were detected on known Tn916-like integrative and conjugative elements, namely Tn6002 and Tn2010, and tet(32) was found for the first time in S. pneumoniae located on a novel 50 kb genomic island. The widespread use of pneumococcal conjugate vaccines impacts on serotype prevalence and transmission within the community. It is therefore important to continue to monitor antimicrobial resistance (AMR) genes present in both vaccine types and non-vaccine types in response to contemporary antimicrobial therapies and characterise the genetic context of acquired resistance genes to continually optimise antibiotic therapies

Cellulose in Foliage and Changes during Seasonal Leaf Development of Broadleaf and Conifer Species.

Stable isotope approaches are widely applied in plant science and many improvements made in the field focus on the analysis of specific components of plant tissues. Although technical developments have been very beneficial, sample collection and preparation are still very time and labor-consuming. The main objective of this study was to create a qualitative dataset of alpha-cellulose content of leaf tissues of arboreal species. We extracted alpha-cellulose from twelve species: Abies alba Mill., Acer pseudoplatanus L., Fagus sylvatica L., Larix decidua Mill., Picea abies (L.) Karst., Pinus sylvestris L., Quercus cerris L., Quercus petrea (Matt.) Liebl., Quercus pubescens Wild., Quercus robur L., Tilia platyphyllos Scop. and Ulmus glabra Huds. While these species show an increase in cellulose yield from bud break to full leaf development, the rates of increase in cellulose content and the duration of the juvenile phase vary greatly. Moreover, the veins display significantly higher alpha-cellulose content (4 to 11%) compared to blade tissues, which reflects their different structural and biochemical functions. A guide for the mass of sample material required to yield sufficient alpha-cellulose for a standard stable isotope analysis is presented. The additional benefits of the assessment of the mass of required sample material are reduced sample preparation time and its usefulness in preparing samples of limited availability (e.g., herbarium material, fossil samples)

Image formation in the scanning helium microscope

The scanning helium microscope (SHeM) is a new addition to the array of available microscopies, particularly for delicate materials that may suffer damage under techniques utilising light or charged particles. As with all other microscopies, the specifics of image formation within the instrument are required to gain a full understanding of the produced micrographs. We present work detailing the basics of the subject for the SHeM, including the specific nature of the projection distortions that arise due to the scattering geometry. Extension of these concepts allowed for an iterative ray tracing Monte Carlo model replicating diffuse scattering from a sample surface to be constructed. Comparisons between experimental data and simulations yielded a minimum resolvable step height of (67 ± 5) µm and a minimum resolvable planar angle of (4.3 ± 0.3)° for the instrument in question.acceptedVersio