Moderne informationstechnologische Werkzeuge bei der Realisierung von medizinischen Leitlinien-Servern

Leitlinien sind systematisch entwickelte Darstellungen und Empfehlungen mit dem Zweck, Ärzte und Patienten bei der Entscheidung über zweckdienliche Maßnahmen der Krankenversorgung (Prävention, Diagnostik, Therapie und Nachsorge) unter spezifischen klinischen Umständen zu unterstützen. In Deutschland gibt es über 550 von Fachgesellschaften entwickelte Leitlinien. Sie integrieren unter Zuhilfenahme des Instruments der Evidence Based Medicine (EBM) wissenschaftliche Erkenntnisse im Hinblick auf eine konkrete Problemstellung und formulieren eine standardisierte Abfolge sinnvoller Schritte sowie zulässige Abweichungen vom sog. Behandlungskorridor. Sie sollen den neuen Erkenntnissen und der modernen Entwicklung flexibel und rasch angepasst werden. Sie sollen vor allem der Verbesserung der Qualität und der Steigerung der Effizienz im Bereich der Gesundheitsversorgung dienen

Technologische Aspekte bei der Realisierung von Leitlinienservern in der intensivmedizinischen Versorgung

In dem vorliegenden Artikel werden grundlegende Aussagen zum Einsatz von Leitlinien im Bereich der Intensivmedizin gemacht und Möglichkeiten ihrer Umsetzung mit modernen Mitteln und Methoden der Informationsverarbeitung dargestellt. Eine prozessorientierte Methode der Wissensakquisition sowie GLIF- und UML-basierte Formalisierungstechniken stehen im Mittelpunkt der technologischen Betrachtungen. Am Beispiel der Applikation hepaRisk werden die technologischen Aspekte bei der Realisierung eines Leitlinienservers zur Thromboembolie-Prophylaxe in der Intensivmedizin dargestellt

TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: Performance of a rapid deployment aortic valve

Background: The TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) trial (NCT01700439) evaluated the performance of the INTUITY rapid deployment aortic valve replacement (RDAVR) system in patients with severe aortic stenosis. Methods: TRANSFORM was a prospective, nonrandomized, multicenter (n 1�4 29), single-arm trial. INTUITY is comprised of a cloth-covered balloon- expandable frame attached to a Carpentier-Edwards PERIMOUNT Magna Ease aortic valve. Primary and effectiveness endpoints were evaluated at 1 year. Results: Between 2012 and 2015, 839 patients underwent RDAVR. Mean age was 73.5 8.3 years. Full sternotomy (FS) was used in 59% and minimally invasive surgical incisions in 41%. Technical success rate was 95%. For isolated RDAVR, mean crossclamp and cardiopulmonary bypass times for FS were 49.3 26.9 minutes and 69.2 34.7 minutes, respectively, and for minimally invasive surgical 63.1 25.4 minutes and 84.6 33.5 minutes, respectively. These times were favorable compared with Society of Thoracic Surgeons data- base comparators for FS: 76.3 minutes and 104.2 minutes, respectively, and for minimally invasive surgical, 82.9 minutes and 111.4 minutes, respectively (P<.001). At 30 days, all-cause mortality was 0.8%; valve explant, 0.1%; throm- boembolism, 3.5%; and major bleeding, 1.3%. In patients with isolated aortic valve replacement, the rate of permanent pacemaker implantation was 11.9%. At 1 year, mean effective orifice area was 1.7 cm2; mean gradient, 10.3 mm Hg; and moderate and severe paravalvular leak, 1.2% and 0.4%, respectively

The Behavioral and Physiological Effects of High-fat Diet and Alcohol Consumption: Sex Differences in C57BL6/J Mice

Background and Objective: Animal studies can be a great tool to investigate sex differences in a variety of different ways, including behavioral and physiological responses to drug treatments and different “lifestyle variables” such as diets. Consumption of both high-fat diets and alcohol is known to affect anxiety behaviors and overall health. This project investigated how high-fat diet and alcohol access and its combination affected the behavior and physiology of male and female C57BL/6J mice. Method: Mice were separated into three food groups: high-fat diet, 10% fat diet, and regular chow, and each group was paired with either water or 10% alcohol. Behavioral assays included diet and alcohol preference, light-dark box, open field, and feeding and drinking measurements. Physiological measures included glucose tolerance tests and measurement of brain-derived neurotrophic factor, insulin, and leptin levels. Results: Females and males differed in the open field, as male mice decreased activity, while females increased activity when consuming high-fat diet. While females consumed more ethanol than males, alcohol consumption was able to improve glucose tolerance and increase anxiety in both sexes. Lastly, females were more resistant to the physiological changes caused by high-fat diet than males, as females consuming high-fat diet exhibited decreased insulin secretion, less change to brain-derived neurotrophic factor levels, and better glucose tolerance than males consuming high-fat diet. Conclusion: These results suggest that the response to high-fat diet and alcohol consumption is sex dependent and that males are more affected both behaviorally and physiologically by high-fat diet compared to females