A Retrospective Observational Single-Centre Study on the Burden of Immune Thrombocytopenia (ITP)

Background: German data on economic consequences of immune thrombocytopenia (ITP) are limited. Patients and Methods: A retrospective, observational study based on chart review of adult patients with a confirmed diagnosis of ITP was conducted at a German university hospital. Costs are presented from the hospital perspective. Results: Of 50 eligible patients, 45 could be classified by disease duration: 19 patients = 3 to = 12 months (38%, chronic ITP). Complications included 85 bleeding events in 43 patients, including 3 intracranial haemorrhages. Documented were 955 outpatient visits in 43 patients (86%) and 92 inpatient hospital admissions in 45 patients (90%). Of the 46 patients (92%) treated, all received corticosteroids, 25 (50%) intravenous immunoglobulin, and 7 (14%) further therapies. 12 patients (24%) underwent splenectomy. Average total direct medical costs (mean (standard deviation)) were (sic) 17,091 ((sic) 18,859) per patient, (sic) 12,749 ((sic) 11,663) in 17 newly diagnosed ITP patients with a 0.88-month (0.65 months) average disease duration, and (sic) 29,868 ((sic) 29,397) in 13 chronic ITP patients with a 33.5-month (16.8 months) average disease duration. Inpatient stays were the main cost drivers. Conclusion: These data concerning current healthcare provision for ITP patients in Germany indicate considerable resource consumption and the need for more effective treatment options in individual patients

Budgethilfe als entwicklungspolitische Strategie: Grundlagen zur internationalen Diskussion

Budgethilfe ist ein relativ neues Instrument der Entwicklungsfinanzierung, mit dem im Rahmen der Bemühungen um wirksamere Entwicklungszusammenarbeit große Hoffnungen verknüpft werden. Immer mehr Geber, darunter auch Österreich, setzen Budgethilfe in zunehmendem Maße ein. Das vorliegende Dokument beschäftigt sich mit diesem Trend und erörtert sowohl grundlegende Aspekte dieser entwicklungspolitischen Strategie wie auch Detailfragen in ausgewählten Bereichen. Budgethilfe, also die in regelmäßigen, meist jährlichen Abständen direkt an das Budget des Empfängerlandes eingezahlten Mittel sind ein wichtiger Baustein einer neuen entwicklungspolitischen Agenda der internationalen Gemeinschaft. Der eigentliche Paradigmenwechsel besteht in einem partnerschaftlichen Ansatz, der die Eigenverantwortung der Empfängergesellschaften respektieren soll und nationale Entwicklungsprioritäten bzw. -programme zum Leitbild der Zusammenarbeit erklärt. Die quantitativen Trends weisen sowohl im Hinblick auf den Anteil der Budgethilfe an den gesamten EZA-Leistungen der Geber als auch in Prozenten des Bruttoinlandsproduktes einzelner Empfänger ein klares Bild aus: Die Bedeutung der Budgethilfe stieg insbesondere in den letzten Jahren signifikant an und die bereits gemachten Zusagen setzen diese Entwicklung fort. ...Budget support as an increasingly popular instrument of development cooperation enjoys broad optimism within the international community. This paper outlines not only definitions, underlying principles, facets, modes of implementation and experiences made so far, but critically analyses the various donor positions including the European Union, the international financial institutions and the OECD. The last chapter is a case study of the education sector in Burkina Faso demonstrating the contradictory implications of budget support on povertyrelated aspects of development

Myelodysplastic syndromes: Aspects of current medical care and economic considerations in Germany

Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases mainly affecting older people. The use of an increasing number of therapeutic options depends on a systematic risk stratification of the patients. A high percentage of MDS patients need blood transfusions as supportive care, which influence quality of life and cause a great part of the costs generated by MDS therapy. In this article which is based on a workshop about the burden of MDS held in October 2006 in Munich, MDS is discussed with regard to different aspects: current therapies, transfusion medicine, geriatrics, quality of life, and health economic aspects

Barkhausen Noise and Critical Scaling in the Demagnetization Curve

The demagnetization curve, or initial magnetization curve, is studied by examining the embedded Barkhausen noise using the non-equilibrium, zero temperature random-field Ising model. The demagnetization curve is found to reflect the critical point seen as the system's disorder is changed. Critical scaling is found for avalanche sizes and the size and number of spanning avalanches. The critical exponents are derived from those related to the saturation loop and subloops. Finally, the behavior in the presence of long range demagnetizing fields is discussed. Results are presented for simulations of up to one million spins.Comment: 4 pages, 4 figures, submitted to Physical Review Letter

Zum Stand der ergänzenden Hilfen zur Erziehung

Seit einigen Jahren wird in der Schweiz zunehmend die Bezeichnung «Ergänzende Hilfen zur Erziehung» als Sammelbegriff für ambulante und (teil-)stationäre Leistungen für vulnerable Kinder, Jugendliche und deren Familien verwendet. Der Begriff erscheint auch in kantonalen Gesetzesinitiativen und Entwicklungsprojekten. Vor diesem Hintergrund wird hier den Fragen nachgegangen: Inwieweit und wie haben sich die ergänzenden Hilfen zur Erziehung mittlerweile etabliert? Tragen die kantonalen Initiativen und Entwicklungen dazu bei, Strukturprobleme der Kinder- und Jugendhilfe abzuschwächen

Randomized Controlled Clinical Trial of Blood Glucose Awareness Training (BGAT III) in Switzerland and Germany

Although both diabetes and the efficacy of medical management are international issues, psycho-educational interventions might be culturally bound. Blood Glucose Awareness Training (BGAT) is a psycho-educational program for patients with type 1 diabetes mellitus. It is focused on improving recognition and management of extreme blood glucose levels, and is the best documented American psycho-educational program for this purpose. A randomized controlled clinical trial of BGAT's long-term benefits in a non-American setting has been lacking. One hundred and eleven adults with type 1 diabetes mellitus from Switzerland and Germany participated. After a 6 months baseline assessment, subjects were randomly assigned to receive either 2 months of BGAT (n = 56) or a physician-guided self-help control intervention (n = 55). BGAT improved recognition of low (p = 0.008), high (p = .03), and overall blood glucose (p = 0.001), and reduced frequency of severe hypoglycemia (p = 0.04), without compromising metabolic control. BGAT reduced both the external locus of control (p < 0.02) and fear of hypoglycemia (p < 0.02). BGAT was efficacious in reducing adverse clinical events and achieving clinically desirable goals in a European, as well as American settin

Management of Febrile Neutropenia - a German Prospective Hospital Cost Analysis in Lymphoproliferative Disorders, Non-Small Cell Lung Cancer, and Primary Breast Cancer

Background: Febrile neutropenia/leukopenia (FN/FL) is the most frequent dose-limiting toxicity of myelosuppressive chemotherapy, but German data on economic consequences are limited. Patients and Methods: A prospective, multicentre, longitudinal, observational study was carried out to evaluate the occurrence of FN/FL and its impact on health resource utilization and costs in non-small cell lung cancer (NSCLC), lymphoproliferative disorder (LPD), and primary breast cancer (PBC) patients. Costs are presented from a hospital perspective. Results: A total of 325 consecutive patients (47% LPD, 37% NSCLC, 16% PBC; 46% women; 38% age >= 65 years) with 68 FN/FL episodes were evaluated. FN/FL occurred in 22% of the LPD patients, 8% of the NSCLC patients, and 27% of the PBC patients. 55 FN/FL episodes were associated with at least 1 hospital stay (LPD n = 34, NSCLC n = 10, PBC n = 11). Mean (median) cost per FN/FL episode requiring hospital care amounted to (sic) 3,950 ((sic) 2,355) and varied between (sic) 4,808 ((sic) 3,056) for LPD, (sic) 3,627 ((sic) 2,255) for NSCLC, and (sic) 1,827 ((sic) 1,969) for PBC patients. 12 FN/FL episodes (LPD n = 9, NSCLC n = 3) accounted for 60% of the total expenses. Main cost drivers were hospitalization and drugs (60 and 19% of the total costs). Conclusions: FN/FL treatment has economic relevance for hospitals. Costs vary between tumour types, being significantly higher for LPD compared to PBC patients. The impact of clinical characteristics on asymmetrically distributed costs needs further evaluation

High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany : a prospective screening analysis of 28,809 patients

Background and Aims: The prevalence of hepatitis C virus (HCV) antibodies in Germany has been estimated to be in the range of 0.4–0.63%. Screening for HCV is recommended in patients with elevated ALT levels or significant risk factors for HCV transmission only. However, 15–30% of patients report no risk factors and ALT levels can be normal in up to 20–30% of patients with chronic HCV infection. The aim of this study was to assess the HCV seroprevalence in patients visiting two tertiary care emergency departments in Berlin and Frankfurt, respectively. Methods: Between May 2008 and March 2010, a total of 28,809 consecutive patients were screened for the presence of anti-HCV antibodies. Anti-HCV positive sera were subsequently tested for HCV-RNA. Results: The overall HCV seroprevalence was 2.6% (95% CI: 2.4–2.8; 2.4% in Berlin and 3.5% in Frankfurt). HCV-RNA was detectable in 68% of anti-HCV positive cases. Thus, the prevalence of chronic HCV infection in the overall study population was 1.6% (95% CI 1.5–1.8). The most commonly reported risk factor was former/current injection drug use (IDU; 31.2%) and those with IDU as the main risk factor were significantly younger than patients without IDU (p<0.001) and the male-to-female ratio was 72% (121 vs. 46 patients; p<0.001). Finally, 18.8% of contacted HCV-RNA positive patients had not been diagnosed previously. Conclusions: The HCV seroprevalence was more than four times higher compared to current estimates and almost one fifth of contacted HCV-RNA positive patients had not been diagnosed previously

Integration of first-principles methods and crystallographic database searches for new ferroelectrics: Strategies and explorations

In this concept paper, the development of strategies for the integration of first-principles methods with crystallographic database mining for the discovery and design of novel ferroelectric materials is discussed, drawing on the results and experience derived from exploratory investigations on three different systems: (1) the double perovskite Sr(Sb$_{1/2}$Mn$_{1/2}$)O$_3$ as a candidate semiconducting ferroelectric; (2) polar derivatives of schafarzikite $M$Sb$_2$O$_4$; and (3) ferroelectric semiconductors with formula $M_2$P$_2$(S,Se)$_6$. A variety of avenues for further research and investigation are suggested, including automated structure type classification, low-symmetry improper ferroelectrics, and high-throughput first-principles searches for additional representatives of structural families with desirable functional properties.Comment: 13 pages, 5 figures, 4 table