Teaching implementation science in a new Master of Science Program in Germany: a survey of stakeholder expectations

Background: Implementation science in healthcare is an evolving discipline in German-speaking countries. In 2015, the Medical Faculty of the University of Heidelberg, Germany, implemented a two-year full-time Master of Science program Health Services Research and Implementation Science. The curriculum introduces implementation science in the context of a broader program that also covers health services research, healthcare systems, research methods, and generic academic skills. Our aim was to assess the expectations of different stakeholder groups regarding the master’s program. Methods: An online survey listing desired competencies of prospective graduates was developed and administered to four groups: national experts in the field (including potential employers of graduates), teaching staff, enrolled students, and prospective students (N = 169). Competencies were extracted from the curriculum’s module handbook. A five-point Likert scale was used for the assessment of 42 specific items. Data were analyzed descriptively. Results: A total of 83 people participated in the survey (response rate 49%). The online survey showed a strong agreement across the groups concerning the desired competencies of graduates. About two-thirds of the listed competencies (27 items) were felt to be crucial or very important by 80% or more of participants, with little difference between stakeholder groups. Of the eight items specifically related to implementation in practice, six were in this category. Knowledge of implementation strategies (90% very important), knowledge of barriers and enablers of implementation (89%), and knowledge of evidence-based practice (89%) were the top priorities. Conclusions: The master’s program is largely orientated towards the desired competencies of graduates according to students, teaching staff, and national experts

Improving continuity of patient care across sectors: study protocol of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

Background: Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a structured programme (VESPEERA) to improve the admission and discharge process. Methods: We will conduct an open quasi-experimental multi-centre study with four intervention arms. A cohort selected from insurance claims data will serve as a control group reflecting usual care. The intervention will be implemented in 25 hospital departments and 115 general practices in 9 districts in Baden-Wurttemberg. Eligibility criteria for patients are: age > 18 years, hospital admission or hospitalisation, insurance at the sickness fund “AOK Baden-Wurttemberg”, enrolment in general practice-centred care contract. Each study arm will receive different intervention components based on the point of study enrolment and the patient’s medical need. The interventions comprise a) a structured assessment in the general practice prior to admission resulting in an admission letter b) a discharge conversation by phone between hospital and general practice, c) a structured assessment and care plan post-discharge and d) telephone monitoring for patients with a high risk of rehospitalisation. The assessments are supported by a software tool (“CareCockpit”), originally developed for structured case management programmes. The primary outcome (rehospitalisation due to the same indication within 90 days) and a range of secondary outcomes (rehospitalisation due to the same indication within 30 days; hospitalisations due to ambulatory care-sensitive conditions; delayed prescription of medication and medical products/ devices and referral to other health practitioner/s after discharge; utilisation of emergency or rescue services within 3 months; average care cost per year and patient participating in the VESPEERA programme) and quality indicators will be determined based on insurance claims data and CareCockpit data. Additionally, a patient survey on satisfaction with cross-sectoral care and health related quality of life will be conducted. Discussion: Based on the results, area-wide implementation in usual care is well sought. This study will contribute to an improvement of cross-sectoral care during the admission and discharge process. Trial registration: DRKS00014294 on DRKS / Universal Trial Number (UTN): U1111–1210-9657, Date of registration 12/06/2018

Common Genetic Variation And Age at Onset Of Anorexia Nervosa

Background Genetics and biology may influence the age at onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to AN age at onset and to investigate the genetic associations between age at onset of AN and age at menarche. Methods A secondary analysis of the Psychiatric Genomics Consortium genome-wide association study (GWAS) of AN was performed which included 9,335 cases and 31,981 screened controls, all from European ancestries. We conducted GWASs of age at onset, early-onset AN (< 13 years), and typical-onset AN, and genetic correlation, genetic risk score, and Mendelian randomization analyses. Results Two loci were genome-wide significant in the typical-onset AN GWAS. Heritability estimates (SNP-h2) were 0.01-0.04 for age at onset, 0.16-0.25 for early-onset AN, and 0.17-0.25 for typical-onset AN. Early- and typical-onset AN showed distinct genetic correlation patterns with putative risk factors for AN. Specifically, early-onset AN was significantly genetically correlated with younger age at menarche, and typical-onset AN was significantly negatively genetically correlated with anthropometric traits. Genetic risk scores for age at onset and early-onset AN estimated from independent GWASs significantly predicted age at onset. Mendelian randomization analysis suggested a causal link between younger age at menarche and early-onset AN. Conclusions Our results provide evidence consistent with a common variant genetic basis for age at onset and implicate biological pathways regulating menarche and reproduction.Peer reviewe

Shared genetic risk between eating disorder- and substance-use-related phenotypes:Evidence from genome-wide association studies

First published: 16 February 202

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Rare coding variants in PLCG2, ABI3, and TREM2 implicate microglial-mediated innate immunity in Alzheimer's disease

We identified rare coding variants associated with Alzheimer’s disease (AD) in a 3-stage case-control study of 85,133 subjects. In stage 1, 34,174 samples were genotyped using a whole-exome microarray. In stage 2, we tested associated variants (P<1×10-4) in 35,962 independent samples using de novo genotyping and imputed genotypes. In stage 3, an additional 14,997 samples were used to test the most significant stage 2 associations (P<5×10-8) using imputed genotypes. We observed 3 novel genome-wide significant (GWS) AD associated non-synonymous variants; a protective variant in PLCG2 (rs72824905/p.P522R, P=5.38×10-10, OR=0.68, MAFcases=0.0059, MAFcontrols=0.0093), a risk variant in ABI3 (rs616338/p.S209F, P=4.56×10-10, OR=1.43, MAFcases=0.011, MAFcontrols=0.008), and a novel GWS variant in TREM2 (rs143332484/p.R62H, P=1.55×10-14, OR=1.67, MAFcases=0.0143, MAFcontrols=0.0089), a known AD susceptibility gene. These protein-coding changes are in genes highly expressed in microglia and highlight an immune-related protein-protein interaction network enriched for previously identified AD risk genes. These genetic findings provide additional evidence that the microglia-mediated innate immune response contributes directly to AD development

Influence of physician networks on prescribing a new ingredient combination in heart failure: a longitudinal claim data-based study

Background!#!Since 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure. The adoption of new drugs may be influenced by collaboration and exchange between physicians. We aimed to determine whether characteristics of the professional networks of prescribing physicians were associated with the prescribing of ARNI in Germany.!##!Methods!#!We conducted a longitudinal analysis based on claims data in 2016-2018 in Germany. The characteristics of ambulatory care physicians' networks were determined in the analysis of the patient-sharing networks of physicians in 2017. Binary logistic regression analysis with the outcome 'prescribes ARNI in 2018' (present or absent) was carried out, using network characteristics as predictors, adjusted for specialty and sociodemographic characteristics of physicians.!##!Results!#!The network analysis included 8370 physicians, who had 144,636 connections. Prescribers had more connections to other physicians compared to non-prescribers (median 31 vs. 23). Regression analysis showed that the numbers of linkages to prescribers of ARNI were positively associated with prescribing ARNI. For 6-10 connections, the average marginal effect (AME) was 0.04 (confidence interval [CI] 95% 0.01-0.06) and for &amp;gt; 10 links the AME 0.07 (CI 95% 0.05-0.10) compared to 0-5 connections to prescriber.!##!Conclusion!#!Physicians who shared patients with many other physicians were more likely to prescribe ARNI, independent of physicians' specialty. This suggested that collaboration and exchange on the basis of patient-sharing with other physicians influenced their medication prescribing decisions

The ILIAS project for selective isobar suppression by laser photodetachment

Laser photodetachment is the process when the extra electron of a negative ion is removed by means of laser radiation. This can happen only if the photon energy is larger than the electron affinity of the ion. The process can be used in mass spectrometry to selectively suppress unwanted isobars, provided that the electron affinity of the unwanted isobar is lower than that of the isobar under investigation.At the Ion Laser InterAction Setup (ILIAS) at the University of Vienna laser photodetachment of negative atomic and molecular ions is studied and its applicability for selective isobar suppression in accelerator mass spectrometry (AMS) is evaluated. The setup provides mass separated beams of negative ions with energies up to 30 keV. Negative ions are produced in a Middleton type cesium sputter ion source, mass selected and overlapped with a strong continuous wave laser beam. In order to extend the interaction time of ions and laser, the ion beam is decelerated to thermal energies in a gas-filled radio frequency quadrupole cooler. For an appropriate choice of the photon energy, unwanted isobars are neutralized while the isobar of interest is unaffected and remains negatively charged.A description of the ILIAS setup and results from the commissioning phase of the RFQ cooler are presented. Up to 8% ion beam transmission could be achieved after a recent redesign of the extraction system. Furthermore first results of photodetachment experiments of 63Cu− within the RFQ cooler are presented

Selective laser photodetachment of intense atomic and molecular negative ion beams with the ILIAS RFQ ion beam cooler

The Ion Laser InterAction Setup (ILIAS) project at the University of Vienna aims at the exploration of negative ion beam filtering by selective laser photodetachment for applications in accelerator mass spectrometry (AMS). A gas-filled radio frequency quadrupole (RFQ) is used to decelerate and cool negative atomic and molecular ion beams with intensities of up to several hundred nA, and overlap them collinearly with a continuous wave (cw) laser beam. Ion-laser interaction times ranging from 500 μs to several ms allow for highly efficient, selective photodetachment depletion of disturbing ion species within these beams. The elemental selectivity of this technique is based on the differences in electron affinities, and therefore does not depend on relative differences in atomic numbers. It may therefore provide sufficient isobar suppression for new trace isotopes, which are not accessible with existing AMS techniques. The ILIAS RFQ cooler was characterized at a purpose-built test bench with respect to ion beam transmission, ion cooling capabilities and ion residence times as a function of injected ion current to assess its suitability for future AMS use. $A ^{63}Cu−$ test beam of 600 nA was photodetached with more than 99.999% efficiency with a 532 nm laser at 10.8 W power. At the same time, ions of interest having electron affinities higher than the photon energy passed the cooler unaffected. Total ion losses were thus found to be below 50% of the sputter source output. Finally, first photodetachment experiments in connection with $^{26}Al$ detection demonstrated selective isobar suppression of MgO− vs. AlO− by more than 4 orders of magnitude. Currently, the RFQ cooler is moved to a new injector beamline at the Vienna Environmental Research Accelerator (VERA) for first applications of this novel technique at a state-of-the-art AMS facility