Evaluation der größten Follow-Up-II-Einrichtung des Neugeborenen-Hörscreenings in Mittel- und Nordhessen

Die frühzeitige Diagnose und Versorgung einer angeborenen Hörstörung ist von hoher Bedeutung. Dies soll mit dem Neugeborenen-Hörscreening, welches in Deutschland zum 01.01.2009 flächendeckend und verpflichtend eingeführt wurde, gewährleistet werden. Eine erste Evaluation des Neugeborenen-Hörscreenings für den Zeitraum 2011/2012, die im Auftrag des Gemeinsamen Bundesauschusses erstellt wurde, bezeichnet die Umsetzung des Neugeborenen-Hörscreenings in Deutschland als erfolgreich. Doch das Screening-Programm ist nur so gut, wie das einem auffälligen Erstscreening folgende Follow-Up-I und -II. Während die Prozess-, Struktur- und Ergebnisqualität insbesondere der Geburtseinrichtungen und der Screening-Zentralen ausgiebig evaluiert wurden, findet sich eine solche Evaluation für eine Follow-Up-II- Einrichtung kaum. Aus diesem Grund analysiert die vorliegende Studie, inwieweit die größte Follow-Up-II-Einrichtung Mittel- und Nordhessens, die Pädaudiologie des Universitätsklinikums Marburg, vor dem Hintergrund der Nachfragesteigerung die vom Gemeinsamen Bundesausschuss definierten Zielvorgaben einhalten konnte. Zur Evaluation der Follow-Up-II-Einrichtung wurden die Daten von 2.705 Neugeborenen, die sich im Rahmen des Neugeborenen-Hörscreenings von 2009 bis 2016 in der Pädaudiologie Marburg vorstellten, erfasst. Analysiert wurden unter anderem neben Erstvorstellungs-, Diagnose- und bei Vorliegen einer permanenten Hörstörung Versorgungsalter auch der Vorstellungsgrund bzw. die abschließende Diagnose als mögliche Einflussfaktoren. Des Weiteren erfolgte die Auswertung der prozentualen Häufigkeit der permanent hörgestörten Neugeborenen, die innerhalb der ersten drei Lebensmonate diagnostiziert bzw. innerhalb der ersten sechs Lebensmonate versorgt wurden. Zudem wurde der Effekt der bei zunehmender Nachfrage erfolgten Sprechstundenumstrukturierung auf die Prozessqualität und damit auf das Gesamtergebnis des Neugeborenen-Hörscreenings der Follow-Up-II-Einrichtung geprüft. Von 2009 bis 2016 stiegen die jährlichen Patientenzahlen in der Follow-Up-II-Einrichtung deutlich um 91,4%. Insgesamt lag das Erstvorstellungsalter von 2009 bis 2016 im Median bei 5,6 Wochen, das Diagnosealter bei 6,3 Wochen. Erstvorstellungs- und Diagnosealter erwiesen sich als abhängig vom Vorstellungsgrund und der Diagnose. Hierbei wurden Erstscreening-Neugeborene signifikant früher vorgestellt als Follow-Up- bzw. Risikofaktoren-Neugeborene (Median 4,6 versus 5,3 bzw. 8,0 Wochen; p < 0,001). Neugeborene mit einer peripheren Normakusis wurden signifikant früher vorgestellt und diagnostiziert als solche mit einer permanenten bzw. einer passageren Hörstörung (Median des Erstvorstellungsalters: 5,4 versus 6,1 bzw. 7,6 Wochen; p < 0,01 bzw. p < 0,001; Median des Diagnosealters: 5,9 versus 11,4 bzw. 23,1 Wochen; p < 0,001). Das Versorgungsalter permanent hörgestörter Neugeborener lag von 2009 bis 2016 bei im Median 14,1 Wochen. Bei 60% der permanent hörgestörten Neugeborenen gelang die Diagnosesicherung wie gefordert bis Ende des 3. bzw. bei 80,2% eine Versorgung bis Ende des 6. Lebensmonats. Von 2009 bis 2014 stieg das Erstvorstellungsalter bei Follow-Up- und Risikofaktoren- Neugeborenen signifikant. Bei Neugeborenen mit einer peripheren Normakusis und einer permanenten Hörstörung stiegen sowohl Erstvorstellungs- als auch Diagnosealter signifikant, bei passager hörgestörten Neugeborenen zumindest numerisch. Diese Parameter konnten dank der Umstrukturierungsmaßnahmen der Sprechstunde des Neugeborenen-Hörscreenings bis 2016 überwiegend wieder signifikant gesenkt werden. Die Nachfragesteigerung an Untersuchungen in der Follow-Up-II-Einrichtung nach Einführung des Neugeborenen-Hörscreenings war im untersuchten Zeitraum von 2009 bis 2016 immens. Die Abhängigkeit des Erstvorstellungs- und Diagnosealters vom Vorstellungsgrund bzw. der gesicherten Diagnose deckt hierbei die Notwendigkeit weiterer Optimierung des gesamten Neugeborenen-Hörscreenings-Prozesses auf. Vor allem sollte die Anbindung aller Neugeborenen an eine Follow-Up-II-Einrichtung zukünftig früher erfolgen, so wie tatsächlich auch vom Gemeinsamen Bundesauschuss gefordert. Diese frühzeitige Anbindung ermöglicht erst das, was schlussendlich mit dem flächendeckenden und verpflichtenden Neugeborenen-Hörscreening bezweckt werden soll: Die frühzeitige Detektion und Versorgung einer angeborenen Hörstörung. In der hier untersuchten Follow-Up-II-Einrichtung wurde die Follow-Up-II-Untersuchung des Neugeborenen-Hörscreenings effektiv und effizient umgesetzt mit durchweg besseren Ergebnissen der zentralen Zielparameter im nationalen und internationalen Vergleich. Trotz deutlicher Nachfragesteigerung bei gleichbleibenden Ressourcen konnte vielen Neugeborenen eine hochwertige pädaudiologische Versorgung angeboten werden. Das diagnostische Vorgehen in der hier untersuchten Follow-Up-II-Einrichtung ist damit ein gutes Vorbild dafür, wie trotz steigender Nachfrage die Qualität des Neugeborenen-Hörscreenings inklusive Follow-Up erhalten und eine effektive wie effiziente Umsetzung des Screening-Programmes erzielt werden kann

Prefrontal involvement in imitation learning of hand actions : effects of practice and expertise.

In this event-related fMRI study, we demonstrate the effects of a single session of practising configural hand actions (guitar chords) on cortical activations during observation, motor preparation, and imitative execution. During the observation of non-practised actions, the mirror neuron system (MNS), consisting of inferior parietal and ventral premotor areas, was more strongly activated than for the practised actions. This finding indicates a strong role of the MNS in the early stages of imitation learning. In addition, the dorsolateral prefrontal cortex (DLPFC) was selectively involved during observation and motor preparation of the non-practised chords. This finding confirms Buccino et al.’s (2004a) model of imitation learning: for actions that are not yet part of the observer’s motor repertoire, DLPFC engages in operations of selection and combination of existing, elementary representations in the MNS. The pattern of prefrontal activations further supports Shallice’s (2004) proposal of a dominant role of the left DLPFC in modulating lower-level systems, and of a dominant role of the right DLPFC in monitoring operations

Three-Dimensional Software- and MR-Imaging-Based Muscle Volumetry Reveals Overestimation of Supraspinatus Muscle Atrophy Using Occupation Ratios in Full-Thickness Tendon Tears

Supraspinatus muscle atrophy is widely determined from oblique-sagittal MRI by calculating the occupation ratio. This ex vivo and clinical study aimed to validate the accuracy of 3D software- and MR-imaging-based muscle volumetry, as well as to assess the influence of the tear pattern on the occupation ratio. Ten porcine muscle specimens were volumetrized using the physical water displacement volumetry as a standard of reference. A total of 149 individuals with intact supraspinatus tendons, partial tears, and full-thickness tears had 3T MRI. Two radiologists independently determined occupation ratio values. An excellent correlation with a Pearson's r of 0.95 for the variables physical volumetry using the water displacement method and MR-imaging-based muscle volumetry using the software was found and formed the standard of reference for the patient study. The inter-reader reliability was 0.92 for occupation ratios. The correlation between occupation ratios and software-based muscle volumes was good in patients with intact tendons (0.84) and partial tears (0.93) but considerably lower in patients with full-thickness tears (0.68). Three-dimensional-software- and MR-imaging-based muscle volumetry is reliable and accurate. Compared to 3D muscle volumetry, the occupation ratio method overestimates supraspinatus muscle atrophy in full-thickness tears, which is most likely due to the medial retraction of the myotendinous unit

Neuro-explicit semantic segmentation of the diffusion cloud chamber

For decades, in diffusion cloud chambers, different types of subatomic particle tracks from radioactive sources or cosmic radiation had to be identified with the naked eye which limited the amount of data that could be processed. In order to allow these classical particle detectors to enter the digital era, we successfully developed a neuro-explicit artificial intelligence model that, given an image from the cloud chamber, automatically annotates most of the particle tracks visible in the image according to the type of particle or process that created it. To achieve this goal, we combined the attention U-Net neural network architecture with methods that model the shape of the detected particle tracks. Our experiments show that the model effectively detects particle tracks and that the neuro-explicit approach decreases the misclassification rate of rare particles by 73% compared with solely using the attention U-Net

Hematopoietic islands mimicking osteoblastic metastases within the axial skeleton

Background Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. In contrast, focal hematopoietic islands within the axial skeleton are a rare entity and can confuse with osteoblastic metastases. This study aimed to characterize typical MRI and CT findings of hematopoietic islands in distinction from osteoblastic metastases to help both radiologists and clinicians, on the one hand, not to overdiagnose this entity and, on the other hand, to decide on a reasonable work-up. Methods We retrospectively analyzed the imaging findings of 14 hematopoietic islands of the axial skeleton in ten patients (nine females, median age = 65.5 years [range, 49–74]) who received both MRI and CT at initial diagnosis between 2006 and 2020. CT-guided biopsy was performed in five cases to confirm the diagnosis, while the other five patients received long-term MRI follow-up (median follow-up = 28 months [range, 6–96 months]). Diffusion-weighted imaging was available in three, chemical shift imaging respectively 18 F- fluorodeoxyglucose PET/CT in two, and Technetium 99 m skeletal scintigraphy in one of the patients. Results All lesions were small (mean size = 1.72 cm 2 ) and showed moderate hypointense signals on T1- and T2-weighted MRI sequences. They appeared isointense to slightly hyperintense on STIR images and slightly enhanced after gadolinium administration. To differentiate this entity from osteoblastic metastases, CT provides important additional information, as hematopoietic islands do not show sclerosis. Conclusions Hematopoietic islands within the axial skeleton can occur and mimic osteoblastic metastases. However, the combination of MRI and CT allows for making the correct diagnosis in most cases

Facilitators and barriers of routine psychosocial distress assessment within a stepped and collaborative care model in a Swiss hospital setting

BACKGROUND Stepped and Collaborative Care Models (SCCMs) have shown potential for improving mental health care. Most SCCMs have been used in primary care settings. At the core of such models are initial psychosocial distress assessments commonly in form of patient screening. We aimed to assess the feasibility of such assessments in a general hospital setting in Switzerland. METHODS We conducted and analyzed eighteen semi-structured interviews with nurses and physicians involved in a recent introduction of a SCCM model in a hospital setting, as part of the SomPsyNet project in Basel-Stadt. Following an implementation research approach, we used the Tailored Implementation for Chronic Diseases (TICD) framework for analysis. The TICD distinguishes seven domains: guideline factors, individual healthcare professional factors, patient factors, professional interactions, incentives and resources, capacity for organizational change, and social, political, and legal factors. Domains were split into themes and subthemes, which were used for line-by-line coding. RESULTS Nurses and physicians reported factors belonging to all seven TICD domains. An appropriate integration of the psychosocial distress assessment into preexisting hospital processes and information technology systems was the most important facilitator. Subjectivity of the assessment, lack of awareness about the assessment, and time constraints, particularly among physicians, were factors undermining and limiting the implementation of the psychosocial distress assessment. CONCLUSIONS Awareness raising through regular training of new employees, feedback on performance and patient benefits, and working with champions and opinion leaders can likely support a successful implementation of routine psychosocial distress assessments. Additionally, aligning psychosocial distress assessments with workflows is essential to assure the sustainability of the procedure in a working context with commonly limited time

Association of Different Restriction Levels With COVID-19-Related Distress and Mental Health in Somatic Inpatients: A Secondary Analysis of Swiss General Hospital Data

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and related countermeasures hinder health care access and affect mental wellbeing of non-COVID-19 patients. There is lack of evidence on distress and mental health of patients hospitalized due to other reasons than COVID-19-a vulnerable population group in two ways: First, given their risk for physical diseases, they are at increased risk for severe courses and death related to COVID-19. Second, they may struggle particularly with COVID-19 restrictions due to their dependence on social support. Therefore, we investigated the association of intensity of COVID-19 restrictions with levels of COVID-19-related distress, mental health (depression, anxiety, somatic symptom disorder, and mental quality of life), and perceived social support among Swiss general hospital non-COVID-19 inpatients. METHODS We analyzed distress of 873 hospital inpatients not admitted for COVID-19, recruited from internal medicine, gynecology, rheumatology, rehabilitation, acute geriatrics, and geriatric rehabilitation wards of three hospitals. We assessed distress due to the COVID-19 pandemic, and four indicators of mental health: depressive and anxiety symptom severity, psychological distress associated with somatic symptoms, and the mental component of health-related quality of life; additionally, we assessed social support. The data collection period was divided into modest (June 9 to October 18, 2020) and strong (October 19, 2020, to April 17, 2021) COVID-19 restrictions, based on the Oxford Stringency Index for Switzerland. RESULTS An additional 13% (95%-Confidence Interval 4-21%) and 9% (1-16%) of hospital inpatients reported distress related to leisure time and loneliness, respectively, during strong COVID-19 restrictions compared to times of modest restrictions. There was no evidence for changes in mental health or social support. CONCLUSIONS Focusing on the vulnerable population of general hospital inpatients not admitted for COVID-19, our results suggest that tightening of COVID-19 restrictions in October 2020 was associated with increased COVID-19-related distress regarding leisure time and loneliness, with no evidence for a related decrease in mental health. If this association was causal, safe measures to increase social interaction (e.g., virtual encounters and outdoor activities) are highly warranted. TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT04269005

Evaluation of patients with respiratory infections during the first pandemic wave in Germany: characteristics of COVID-19 versus non-COVID-19 patients

BACKGROUND Characteristics of COVID-19 patients have mainly been reported within confirmed COVID-19 cohorts. By analyzing patients with respiratory infections in the emergency department during the first pandemic wave, we aim to assess differences in the characteristics of COVID-19 vs. Non-COVID-19 patients. This is particularly important regarding the second COVID-19 wave and the approaching influenza season. METHODS We prospectively included 219 patients with suspected COVID-19 who received radiological imaging and RT-PCR for SARS-CoV-2. Demographic, clinical and laboratory parameters as well as RT-PCR results were used for subgroup analysis. Imaging data were reassessed using the following scoring system: 0 - not typical, 1 - possible, 2 - highly suspicious for COVID-19. RESULTS COVID-19 was diagnosed in 72 (32,9%) patients. In three of them (4,2%) the initial RT-PCR was negative while initial CT scan revealed pneumonic findings. 111 (50,7%) patients, 61 of them (55,0%) COVID-19 positive, had evidence of pneumonia. Patients with COVID-19 pneumonia showed higher body temperature (37,7~± 0,1 vs. 37,1~± 0,1 °C; p = 0.0001) and LDH values (386,3~± 27,1 vs. 310,4~± 17,5 U/l; p = 0.012) as well as lower leukocytes (7,6~± 0,5 vs. 10,1~± 0,6G/l; p = 0.0003) than patients with other pneumonia. Among abnormal CT findings in COVID-19 patients, 57 (93,4%) were evaluated as highly suspicious or possible for COVID-19. In patients with negative RT-PCR and pneumonia, another third was evaluated as highly suspicious or possible for COVID-19 (14 out of 50; 28,0%). The sensitivity in the detection of patients requiring isolation was higher with initial chest CT than with initial RT-PCR (90,4% vs. 79,5%). CONCLUSIONS COVID-19 patients show typical clinical, laboratory and imaging parameters which enable a sensitive detection of patients who demand isolation measures due to COVID-19

Impact of reconstruction parameters on the accuracy of myocardial extracellular volume quantification on a first-generation, photon-counting detector CT

Background: The potential role of cardiac computed tomography (CT) has increasingly been demonstrated for the assessment of diffuse myocardial fibrosis through the quantification of extracellular volume (ECV). Photon-counting detector (PCD)-CT technology may deliver more accurate ECV quantification compared to energy-integrating detector CT. We evaluated the impact of reconstruction settings on the accuracy of ECV quantification using PCD-CT, with magnetic resonance imaging (MRI)-based ECV as reference. Methods: In this post hoc analysis, 27 patients (aged 53.1 ± 17.2 years (mean ± standard deviation); 14 women) underwent same-day cardiac PCD-CT and MRI. Late iodine CT scans were reconstructed with different quantum iterative reconstruction levels (QIR 1−4), slice thicknesses (0.4−8 mm), and virtual monoenergetic imaging levels (VMI, 40−90 keV); ECV was quantified for each reconstruction setting. Repeated measures ANOVA and t-test for pairwise comparisons, Bland–Altman plots, and Lin’s concordance correlation coefficient (CCC) were used. Results: ECV values did not differ significantly among QIR levels (p = 1.000). A significant difference was observed throughout different slice thicknesses, with 0.4 mm yielding the highest agreement with MRI-based ECV (CCC = 0.944); 45-keV VMI reconstructions showed the lowest mean bias (0.6, 95% confidence interval 0.1–1.4) compared to MRI. Using the most optimal reconstruction settings (QIR4. slice thickness 0.4 mm, VMI 45 keV), a 63% reduction in mean bias and a 6% increase in concordance with MRI-based ECV were achieved compared to standard settings (QIR3, slice thickness 1.5 mm; VMI 65 keV). Conclusions: The selection of appropriate reconstruction parameters improved the agreement between PCD-CT and MRI-based ECV. Relevance statement: Tailoring PCD-CT reconstruction parameters optimizes ECV quantification compared to MRI, potentially improving its clinical utility