Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin – eine Bedarfserhebung bei Ärzten in Weiterbildung

Einleitung: Die Anwendung von Komplementärer und Integrativer Medizin (CIM, engl. Complementary and Integrative Medicine) ist in Deutschland weit verbreitet. Aus Umfragen ist bekannt, dass über 60% der Allgemeinärzte komplementärmedizinische Methoden anwenden. Bereits im Jahr 2002 wurden Inhalte aus den Bereichen der klassischen Naturheilverfahren in die ärztliche Approbationsordnung curricular verankert. In der Weiterbildungsordnung zum Facharzt für Allgemeinmedizin (FA AM) sind allerdings bisher keine Kompetenzen aus diesem Bereich definiert. Inwiefern Ärzte während ihrer Weiterbildungszeit zum FA AM Kompetenzen zu CIM Verfahren erwerben, ist weitestgehend unklar. Ziel der vorliegenden Dissertation war es, vor dem Hintergrund der häufigen Anwendung von CIM durch FÄ AM, Einstellungen, Haltungen, Anwendung und Inanspruchnahme von CIM sowie Weiterbildungsbedarf von Ärzten in Weiterbildung (ÄiW) zum FA AM zu erheben. Methoden: Im Zeitraum vom November 2015 bis Januar 2016 erfolgte eine Querschnittsbefragung (online- und papierbasierte Befragung) von ÄiW zum FA AM im Rahmen des Weiterbildungsprogramms VerbundweiterbildungPlus in Baden-Württemberg. Der Fragebogen bestand aus insgesamt 33 Fragen (inkl. fünf Filterfragen) zu fünf Dimensionen: Einstellung zur CIM, Anwendung der CIM, Wissen in der CIM, Weiterbildung in der CIM, sowie Anmerkungen zur CIM und Soziodemografie. Für die Auswertung erfolgte eine deskriptive Datenanalyse mittels SPSS. Ergebnisse: Bei der onlinebasierten Befragung wurden n=490 Teilnehmer angeschrieben (Rücklaufquote 19,2%), bei der papierbasierten Umfrage wurden n=57 Fragebögen verteilt (Rücklaufquote 77,2%). Insgesamt nahmen n=138 Teilnehmer an der Umfrage teil (Gesamtrücklauf 28%). In der deskriptiven Analyse zeigen 67% der befragten Ärzte ein hohes Interesse für CIM und die große Mehrheit der ÄiW gibt an, dass die Integration von CIM in die hausärztliche Versorgung Vorteile für die Patienten bringt. Knapp 70% der befragten ÄiW streben eine CIM Zusatzweiterbildung an und etwa zwei Drittel der Befragten befürworten die Vermittlung von Kompetenzen aus dem Bereich der CIM während ihrer Weiterbildung zum FA AM. Die Ergebnisse zeigen zudem, dass unter ÄiW eine deutliche Unsicherheit sowohl inhaltlicher wie auch formaler Art (z.B. Kostenübernahme und gesetzliche Regelungen) in Bezug auf CIM vorliegt. Dies zeigte sich insbesondere bei Fragen zur Selbsteinschätzung von Wissen und Kompetenzen im Bereich der CIM. Diskussion: Die Ergebnisse zeigen, dass sich ÄiW mit dem Thema CIM auseinandersetzen und ein hohes Interesse besteht. Gleichzeitig werden von den ÄiW dabei deutliche Unsicherheiten im Bereich der CIM wahrgenommen. Dies spiegelt einen derzeit noch ungedeckten Weiterbildungsbedarf zu CIM Themen wider. Daraus lassen sich folgende Handlungsimplikationen ableiteten, um CIM Inhalte nachhaltig in die allgemeinmedizinische Weiterbildung zu implementieren: Es bedarf einer Liste an Basiskompetenzen zu CIM, welche angehende Allgemeinmediziner im Laufe ihrer Weiterbildung zum FA AM erwerben sollten. Unter Beteiligung der Arbeitsgruppe Komplementärmedizin der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) wird derzeit ein Kompetenzbasiertes Curriculum zur CIM ausgearbeitet, welches in das Kompetenzbasierte Curriculum Allgemeinmedizin der DEGAM integriert werden könnte. Ebenso bedarf es entsprechender Lehrformate, welche diese CIM Kompetenzen abbilden und an den jeweiligen Kompetenzzentren für die Weiterbildung Allgemeinmedizin in Deutschland angeboten werden. Dadurch sollten zukünftige Allgemeinmediziner inhaltlich wie formal in der Lage dazu sein, ihre Patienten bei häufigen Beratungsanlässen kompetent zu Nutzen und Risiken der CIM zu informieren und aufzuklären

Integrated care in German mental health services as benefit for relatives – a qualitative study

Background: As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives’ experiences with severely mentally ill patients in different integrated care service providers. Methods: Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. Results: Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges. Conclusion: Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community

Biomedical Teleacupuncture between China and Austria Using Heart Rate Variability, Part 1: Poststroke Patients

Background. Acupuncture has been reported to affect the human autonomic system. Within this pilot study, teleacupuncture between China and Austria is used for the first time for quantifying the effects of heart rate variability (HRV) in poststroke rehabilitation. Methods. In 29 Chinese post-stroke patients (15 f, 14 m; mean age ± SD 64.7 ± 11.3 years; range 40–80 years) electrocardiographic signals before, during, and after acupuncture at the acupoint Tongli (HT 5) were recorded in Harbin and analyzed in Graz using teleacupuncture via internet. HRV data were analyzed in the time and frequency domain, and a protocol from Austria was sent to the team in China immediately after the treatment and recording session. Results. Acupuncture does not change heart rate in the post-stroke patients; however, total HRV increased significantly (P < .05) during and 5–10 minutes after acupuncture. In addition, balance between sympathetic and parasympathetic activity (low frequency/high frequency HRV ratio) changes markedly during treatment. Conclusions. Based on innovative HRV analysis, it could be demonstrated that teleacupuncture between China/Harbin and Austria/Graz over a distance of about 8,500 km is no longer a future vision; it has become reality

Spong3d: 3D printed facade system enabling movable fluid heat storage

Spong3D is an adaptive 3D printed facade system that integrates multiple functions to optimize thermal performances according to the different environmental conditions throughout the year. The proposed system incorporates air cavities to provide thermal insulation and a movable liquid (water plus additives) to provide heat storage where and whenever needed. The air cavities have various dimensions and are located in the inner part of the system. The movable liquid provides heat storage as it flows through channels located along the outer surfaces of the system (on the indoor and outdoor faces of the façade). Together, the composition of the channels and the cavities form a complex structure, integrating multiple functions into a singular component, which can only be produced by using an Additive Manufacturing (AM; like 3D printing) technology

Spong3d: 3D printed facade system enabling movable fluid heat storage

Spong3D is an adaptive 3D printed facade system that integrates multiple functions to optimize thermal performances according to the different environmental conditions throughout the year. The proposed system incorporates air cavities to provide thermal insulation and a movable liquid (water plus additives) to provide heat storage where and whenever needed. The air cavities have various dimensions and are located in the inner part of the system. The movable liquid provides heat storage as it flows through channels located along the outer surfaces of the system (on the indoor and outdoor faces of the façade). Together, the composition of the channels and the cavities form a complex structure, integrating multiple functions into a singular component, which can only be produced by using an Additive Manufacturing (AM; like 3D printing) technology

Stellar Astrophysics and Exoplanet Science with the Maunakea Spectroscopic Explorer (MSE)

The Maunakea Spectroscopic Explorer (MSE) is a planned 11.25-m aperture facility with a 1.5 square degree field of view that will be fully dedicated to multi-object spectroscopy. A rebirth of the 3.6m Canada-France-Hawaii Telescope on Maunakea, MSE will use 4332 fibers operating at three different resolving powers (R ~ 2500, 6000, 40000) across a wavelength range of 0.36-1.8mum, with dynamical fiber positioning that allows fibers to match the exposure times of individual objects. MSE will enable spectroscopic surveys with unprecedented scale and sensitivity by collecting millions of spectra per year down to limiting magnitudes of g ~ 20-24 mag, with a nominal velocity precision of ~100 m/s in high-resolution mode. This white paper describes science cases for stellar astrophysics and exoplanet science using MSE, including the discovery and atmospheric characterization of exoplanets and substellar objects, stellar physics with star clusters, asteroseismology of solar-like oscillators and opacity-driven pulsators, studies of stellar rotation, activity, and multiplicity, as well as the chemical characterization of AGB and extremely metal-poor stars.Comment: 31 pages, 11 figures; To appear as a chapter for the Detailed Science Case of the Maunakea Spectroscopic Explore

Single-spacecraft techniques for shock parameters estimation: A systematic approach

Spacecraft missions provide the unique opportunity to study the properties of collisionless shocks utilising in situ measurements. In the past years, several diagnostics have been developed to address key shock parameters using time series of magnetic field (and plasma) data collected by a single spacecraft crossing a shock front. A critical aspect of such diagnostics is the averaging process involved in the evaluation of upstream/downstream quantities. In this work, we discuss several of these techniques, with a particular focus on the shock obliquity (defined as the angle between the upstream magnetic field and the shock normal vector) estimation. We introduce a systematic variation of the upstream/downstream averaging windows, yielding to an ensemble of shock parameters, which is a useful tool to address the robustness of their estimation. This approach is first tested with a synthetic shock dataset compliant with the Rankine-Hugoniot jump conditions for a shock, including the presence of noise and disturbances. We then employ self-consistent, hybrid kinetic shock simulations to apply the diagnostics to virtual spacecraft crossing the shock front at various stages of its evolution, highlighting the role of shock-induced fluctuations in the parameters’ estimation. This approach has the strong advantage of retaining some important properties of collisionless shock (such as, for example, the shock front microstructure) while being able to set a known, nominal set of shock parameters. Finally, two recent observations of interplanetary shocks from the Solar Orbiter spacecraft are presented, to demonstrate the use of this systematic approach to real events of shock crossings. The approach is also tested on an interplanetary shock measured by the four spacecraft of the Magnetospheric Multiscale (MMS) mission. All the Python software developed and used for the diagnostics (SerPyShock) is made available for the public, including an example of parameter estimation for a shock wave recently observed in-situ by the Solar Orbiter spacecraft.</p

Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): study protocol for a cluster-randomized trial

Background: Strategies to improve the care of elderly, multimorbid patients frequently focus on implementing evidence-based knowledge by structured assessments and standardization of care. In Germany, disease management programs (DMPs), for example, are run by general practitioners (GPs) for this purpose. While the importance of such measures is undeniable, there is a risk of ignoring other dimensions of care which are essential, especially for elderly patients: their spiritual needs and personal resources, loneliness and social integration, and self-care (i.e., the ability of patients to do something on their own except taking medications to increase their well-being). The aim of this study is to explore whether combining DMPs with interventions to address these dimensions is feasible and has any impact on relevant outcomes in elderly patients with polypharmacy. Methods: An explorative, cluster-randomized controlled trial with general practices as the unit of randomization will be conducted and accompanied by a process evaluation. Patients aged 70 years or older with at least three chronic conditions receiving at least three medications participating in at least one DMP will be included. The control group will receive DMP as usual. In the intervention group, GPs will conduct a spiritual needs assessment during the routinely planned DMP appointments and explore whether the patient has a need for more social contact or self-care. To enable GPs to react to such needs, several aids will be provided by the study: a) training of GPs in spiritual needs assessment and training of medical assistants in patient counseling regarding self-care and social activity; b) access to a summary of regional social offers for seniors; and c) information leaflets on nonpharmacological interventions (e.g., home remedies) to be applied by patients themselves to reduce frequent symptoms in old age. The primary outcome is health-related self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary outcomes are general self-efficacy (using the General Self-Efficacy Scale (GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)), patient activation (using the Patient Activation Measure (PAM)), medication adherence (using the Medication Adherence Report Scale (MARS)), beliefs in medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction with GP care (using selected items of the European Project on Patient Evaluation of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the mechanisms, feasibility, and acceptability of the interventions. Discussion: If the interventions prove to be effective and feasible, large-scale implementation should be sought and evaluated by a confirmatory design. Trial registration: German Clinical Trials Register (DRKS), DRKS00015696 . Registered on 22 January 2019

Distributed learning on 20 000+ lung cancer patients - The Personal Health Train

Background and purpose Access to healthcare data is indispensable for scientific progress and innovation. Sharing healthcare data is time-consuming and notoriously difficult due to privacy and regulatory concerns. The Personal Health Train (PHT) provides a privacy-by-design infrastructure connecting FAIR (Findable, Accessible, Interoperable, Reusable) data sources and allows distributed data analysis and machine learning. Patient data never leaves a healthcare institute. Materials and methods Lung cancer patient-specific databases (tumor staging and post-treatment survival information) of oncology departments were translated according to a FAIR data model and stored locally in a graph database. Software was installed locally to enable deployment of distributed machine learning algorithms via a central server. Algorithms (MATLAB, code and documentation publicly available) are patient privacy-preserving as only summary statistics and regression coefficients are exchanged with the central server. A logistic regression model to predict post-treatment two-year survival was trained and evaluated by receiver operating characteristic curves (ROC), root mean square prediction error (RMSE) and calibration plots. Results In 4 months, we connected databases with 23 203 patient cases across 8 healthcare institutes in 5 countries (Amsterdam, Cardiff, Maastricht, Manchester, Nijmegen, Rome, Rotterdam, Shanghai) using the PHT. Summary statistics were computed across databases. A distributed logistic regression model predicting post-treatment two-year survival was trained on 14 810 patients treated between 1978 and 2011 and validated on 8 393 patients treated between 2012 and 2015. Conclusion The PHT infrastructure demonstrably overcomes patient privacy barriers to healthcare data sharing and enables fast data analyses across multiple institutes from different countries with different regulatory regimens. This infrastructure promotes global evidence-based medicine while prioritizing patient privacy

A large scale hearing loss screen reveals an extensive unexplored genetic landscape for auditory dysfunction

The developmental and physiological complexity of the auditory system is likely reflected in the underlying set of genes involved in auditory function. In humans, over 150 non-syndromic loci have been identified, and there are more than 400 human genetic syndromes with a hearing loss component. Over 100 non-syndromic hearing loss genes have been identified in mouse and human, but we remain ignorant of the full extent of the genetic landscape involved in auditory dysfunction. As part of the International Mouse Phenotyping Consortium, we undertook a hearing loss screen in a cohort of 3006 mouse knockout strains. In total, we identify 67 candidate hearing loss genes. We detect known hearing loss genes, but the vast majority, 52, of the candidate genes were novel. Our analysis reveals a large and unexplored genetic landscape involved with auditory function