Smart Camp: A Sustainable Digital Ecosystems Environment

Seamlessly integrating energy saving with the habits of daily life is an ambitious goal. It becomes even a bigger challenge in a remote area, like the Western-Australian Outback. Harsh environment, high temperatures and hard working conditions demand great exertion from humans and make one’s well-being an integral part of life. To bring both together – environmental sustainability and life quality – is a new interdisciplinary approach in the field of computer science. A “Smart Camp” is a new low rate wireless personal area network (LR-WPAN)-based solution, which provides accommodations in a remote mining site with a smart automation and information system to contribute toenvironmental sustainability and to provide amenities for its inhabitants. The Smart Camp intends to monitor and control household appliances with the aim to reduce the overall energy consumption. Additionally, multi-media components will be implemented, which aim to make the occupants life more pleasant by adding value to their habitat

GPs’ view on decision-making processes in the context of emergency department consultations

Hintergrund: Die Anzahl ambulanter Behandlungsfälle in Notaufnahmen steigt seit Jahren. Trotz der zentralen Stellung von Hausärztinnen und Hausärzten in der Versorgung ist bisher wenig untersucht worden, wie die Primärversorger die Inanspruchnahme von Notaufnahmen wahrnehmen und beurteilen. Die vorliegende qualitative Studie befasst sich daher mit der hausärztlichen Sicht auf Konsultati-onsmotive, Entscheidungsprozesse und Gesundheitskompetenzen von Notaufnahmepatientinnen und Notaufnahmepatienten sowie mit hausärztlich initiierten Notaufnahmevorstellungen. Methodik: Durchführung qualitativer Experteninterviews mit 15 Hausärztinnen und Hausärzten mittels semi-strukturiertem Leitfaden. Die Auswertung erfolgte auf Grundlage der qualitativen Inhaltsanalyse. Die vorliegende qualitative Studie ist Teil des Mixed-Methods-Forschungsprojektes EMACROSS, eine Studie des Berliner Versorgungsforschungsnetzwerkes EMANet. Ergebnisse: Hausärztlicherseits vermutete patientinnen- und patientenseitige Beweggründe und Entschei-dungsprozesse entsprechen in weiten Teilen den Begründungen von Hausärztinnen und Hausärzten für ärztlich veranlasste Notaufnahmevorstellungen. So wird die zeitnahe Verfügbarkeit eines erweiterten Spektrums diagnostischer und therapeutischer Möglichkeiten von den Befragten für beide Seiten als relevant hervorgehoben, zudem wird die Abklärung von patientinnen- und patienten-seitig subjektiv beunruhigenden Beschwerden betont. Ärztlicherseits befürchtete Versorgungslücken, z. B. an Wochenenden, und Zugangsbarrieren im ambulanten Bereich werden ebenfalls prominent thematisiert, zentral erscheinen Terminprobleme in der fachärztlichen Versorgung. Die Gesundheitskompetenz der Patientinnen und Patienten wird von den Hausärztinnen und Hausärzten als begrenzt wahrgenommen. Als bedeutsame Einflussfaktoren und Informationsquellen werden Medien (z. B. Internet) sowie die hausärztliche Beratung diskutiert. Schlussfolgerungen: Hinsichtlich einer Verminderung nicht-dringlicher Notaufnahmekonsultationen weisen die Ergebnisse darauf hin, dass eine Reduzierung organisatorischer Engpässe in der ambulanten Versorgung (begrenzte Sprechstunden, Terminproblematik) einen wichtigen Ansatzpunkt auf Seiten des Angebots darstellt. Nachfrageseitig erscheint eine Stärkung der individuellen Gesundheitskompetenz bedeutsam. Bei letzterer kommt der hausärztlichen Beratung eine relevante Rolle zu.Background: The number of outpatient consultations in emergency departments (EDs) has been rising for years. Despite the central role of general practitioners (GPs) in health care, it has not been extensively studied how primary care physicians perceive ED utilization. This qualitative study therefore examines the view of GPs on consultation motives, decision processes and health literacy of ED pa-tients as well as ED visits initiated by GPs. Methods: Qualitative expert interviews with 15 GPs based on a semi-structured interview guide were conducted. Qualitative content analysis was performed. This qualitative study is part of the mixed methods research project EMACROSS, a study of the Berlin health services research network EMANet. Results: Patient motives and decision processes assumed by GPs correspond in wide parts to the GPs’ reasoning in cases of physician-initiated ED consultations. The timely availability of an extended spectrum of diagnostic and therapeutic options is stressed by the interviewees as relevant for both patients and GPs, and diagnostic investigation in case of subjectively worrying symptoms on the patient side is also emphasized. Care gaps feared by the physicians, e.g. on weekends, and access barriers in the ambulatory sector are also prominently thematized, with a seemingly central role of appointment problems in specialist care. Patients’ health competence is experienced by the GPs as limited. Media information sources (e.g. internet) and counseling by the GP are discussed as important influencing factors in this context. Conclusion: In order to decrease non-urgent ED consultations, the results suggest that a reduction of organizational shortages in ambulatory care (limited consultation hours, appointment difficulties) could constitute a meaningful leverage point on the care provision side. On the demand side, strengthening individual health competence seems important. Counseling by the GP plays an important role in this regard

Emergency department consultations for respiratory symptoms revisited: exploratory investigation of longitudinal trends in patients' perspective on care, health care utilization, and general and mental health, from a multicenter study in Berlin, Germany

Background: Only few studies of emergency department (ED) consulters include a longitudinal investigation. The EMACROSS study had surveyed 472 respiratory patients in eight inner-city EDs in Berlin in 2017/2018 for demographic, medical and consultation-related characteristics. This paper presents the results of a follow-up survey at a median of 95days post-discharge. We aimed to explore the post hoc assessment of ED care and identify potential longitudinal trends. Methods: The follow-up survey included items on satisfaction with care received, beneft from the ED visit, potential alternative care, health care utilization, mental and general health, and general life satisfaction. Univariable between subject and within-subject statistical comparisons were conducted. Logistic regression was performed for multivariable investigations of determinants of dropout and of retrospectively rating the ED visit as benefcial. Results: Follow-up data was available for 329 patients. Participants of lower education status, migrants, and tourists were more likely to drop out. Having a general practitioner (GP), multimorbidity, and higher general life satisfaction were determinants of response. Retrospective satisfaction ratings were high with no marked longitudinal changes and waiting times as the most frequent reason for dissatisfaction. Retrospective assessment of the visit as benefcial was positively associated with male sex, diagnoses of pneumonia and respiratory failure, and self-referral. Concerning primary care as a viable alternative, judgment at the time of the ED visit and at follow-up did not difer signifcantly. Health care utilization post-discharge increased for GPs and pulmonologists. Self-reported general health and PHQ-4 anxiety scores were signifcantly improved at follow-up, while general life satisfaction for the overall sample was unchanged. Conclusions: Most patients retrospectively assess the ED visit as satisfactory and benefcial. Possible sex diferences in perception of care and its outcomes should be further investigated. Conceivable eforts at diversion of ED utilizers to primary care should consider patients’ views regarding acceptable alternatives, which appear relatively independent of situational factors. Representativeness of results is restricted by the study focus on respiratory symptoms, the limited sample size, and the attrition rate

Diverting less urgent utilizers of emergency medical services to primary care: is it feasible? Patient and morbidity characteristics from a cross-sectional multicenter study of self-referring respiratory emergency department consulters

Objective: Diversion of less urgent emergency medical services (EMS) callers to alternative primary care (PC) is much debated. Using data from the EMACROSS survey of respiratory ED patients, we aimed to characterize self-referred EMS patients, compare these with non-EMS patients, and assess scope and acceptability of a potential redirection to alternative PC. Results: Of n = 292 self-referred patients, n = 99 were transported by EMS. Compared to non-EMS patients, these were older, triaged more urgently and arrived out-of-hours more frequently. The share of chronically and severely ill patients was greater. Out-of-hours ED visit, presence of a chronic pulmonary condition as well as a hospital diagnosis of respiratory failure were identified as determinants of EMS utilization in a logistic model, while consultation for access and quality motives as well as migrant status decreased the probability. EMS-transported lower urgency outpatients visiting during regular physicians' hours were defined as potential PC cases and evaluated descriptively (n = 9). As a third was medically complex and potentially less suitable for PC, redirection potential could be estimated at only 6% of EMS cases. This would be reduced to 2% if considering patients' judgment concerning the appropriate setting. Overall, the scope for PC diversion of respiratory EMS patients seems limited

Emergency department consultations for respiratory symptoms revisited: exploratory investigation of longitudinal trends in patients’ perspective on care, health care utilization, and general and mental health, from a multicenter study in Berlin, Germany

Background: Only few studies of emergency department (ED) consulters include a longitudinal investigation. The EMACROSS study had surveyed 472 respiratory patients in eight inner-city EDs in Berlin in 2017/2018 for demographic, medical and consultation-related characteristics. This paper presents the results of a follow-up survey at a median of 95 days post-discharge. We aimed to explore the post hoc assessment of ED care and identify potential longitudinal trends. Methods: The follow-up survey included items on satisfaction with care received, benefit from the ED visit, potential alternative care, health care utilization, mental and general health, and general life satisfaction. Univariable between-subject and within-subject statistical comparisons were conducted. Logistic regression was performed for multivariable investigations of determinants of dropout and of retrospectively rating the ED visit as beneficial. Results: Follow-up data was available for 329 patients. Participants of lower education status, migrants, and tourists were more likely to drop out. Having a general practitioner (GP), multimorbidity, and higher general life satisfaction were determinants of response. Retrospective satisfaction ratings were high with no marked longitudinal changes and waiting times as the most frequent reason for dissatisfaction. Retrospective assessment of the visit as beneficial was positively associated with male sex, diagnoses of pneumonia and respiratory failure, and self-referral. Concerning primary care as a viable alternative, judgment at the time of the ED visit and at follow-up did not differ significantly. Health care utilization post-discharge increased for GPs and pulmonologists. Self-reported general health and PHQ-4 anxiety scores were significantly improved at follow-up, while general life satisfaction for the overall sample was unchanged. Conclusions: Most patients retrospectively assess the ED visit as satisfactory and beneficial. Possible sex differences in perception of care and its outcomes should be further investigated. Conceivable efforts at diversion of ED utilizers to primary care should consider patients'views regarding acceptable alternatives, which appear relatively independent of situational factors. Representativeness of results is restricted by the study focus on respiratory symptoms, the limited sample size, and the attrition rate

What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients' perspectives in Berlin, Germany

Background: While motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated. Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit. Methods: Qualitative descriptive study. Semi-structured, face-To-face interviews with a sample of 17 respiratory ED patients in Berlin, Germany. Interviews were recorded and transcribed verbatim. Qualitative content analysis was performed. The study was embedded into the EMACROSS (Emergency and Acute Care for Respiratory Diseases beyond Sectoral Separation) cohort of ED patients with respiratory symptoms, which is part of EMANet (Emergency and Acute Medicine Network for Health Care Research). Results: Three patterns of GP utilization could be differentiated: long-Term regular consulters, sporadic consulters and patients without GP. In sporadic consulters and patients without GP, an ambivalent or even aversive view of GP care was prevalent, with lack of confidence in GPs' competence and a deficit in trust as seemingly relevant influencing factors. Regardless of utilization or relationship type, patients frequently made contact with a GP before visiting an ED. Conclusions: With regard to respiratory symptoms, our qualitative data suggest a hypothesis of limited relevance of patients' primary care utilization pattern and GP-patient relationship for ED consultation decisions

Redirecting emergency medical services patients with unmet primary care needs: the perspective of paramedics on feasibility and acceptance of an alternative care path in a qualitative investigation from Berlin, Germany

Background: Against the backdrop of emergency department (ED) overcrowding, patients' potential redirection to outpatient care structures is a subject of current political debate in Germany. It was suggested in this context that suitable lower-urgency cases could be transported directly to primary care practices by emergency medical services (EMS), thus bypassing the ED. However, practicality is discussed controversially. This qualitative study aimed to capture the perspective of EMS personnel on potential patient redirection concepts. Methods: We conducted qualitative, semi-structured phone interviews with 24 paramedics. Interviews were concluded after attainment of thematic saturation. Interviews were transcribed verbatim, and qualitative content analysis was performed. Results: Technical and organizational feasibility of patients' redirection was predominantly seen as limited (theme: "feasible, but only under certain conditions") or even impossible (theme: "actually not feasible"), based on a wide spectrum of potential barriers. Prominently voiced reasons were restrictions in personnel resources in both EMS and ambulatory care, as well as concerns for patient safety ascribed to a restricted diagnostic scope. Concerning logistics, alternative transport options were assessed as preferable. Regarding acceptance by stakeholders, the potential for releasing ED caseload was described as a factor potentially promoting adoption, while doubt was raised regarding acceptance by EMS personnel, as their workload was expected to conversely increase. Paramedics predominantly did not consider transporting lower-urgency cases as their responsibility, or even as necessary. Participants were markedly concerned of EMS being misused for taxi services in this context and worried about negative impact for critically ill patients, as to vehicles and personnel being potentially tied up in unnecessary transports. As to acceptance on the patients' side, interview participants surmised a potential openness to redirection if this would be associated with benefits like shorter wait times and accompanied by proper explanation. Conclusions: Interviews with EMS staff highlighted considerable doubts about the general possibility of a direct redirection to primary care as to considerable logistic challenges in a situation of strained EMS resources, as well as patient safety concerns. Plans for redirection schemes should consider paramedics' perspective and ensure a provision of EMS with the resources required to function in a changing care environment

How to decide adequately? Qualitative study of GPs' view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany

Objectives: Patients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients' decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs' perception of such patients. This qualitative study explores the GPs' view regarding motives and competences of patients self-referring to EDs, and also GPs' rationale for or against physician-initiated ED referrals. Design: Qualitative study with semi-structured, face-toface interviews; qualitative content analysis. Setting: GP practices in Berlin, Germany. Participants: 15 GPs (female/male: 9/6; mean age 53.6 years). Results: The interviewed GPs related a wide spectrum of factors potentially influencing their patients' decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients' surmised rationale corresponded to GPs' reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients' health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy. Conclusions: Health education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals

Self-referred walk-in patients in the emergency department - who and why? Consultation determinants in a multicenter study of respiratory patients in Berlin, Germany

Background: Emergency department (ED) consultations are on the rise, and frequently consultations by non-urgent patients have been held accountable. Self-referred walk-in (SRW) consulters supposedly represent a predominantly less urgent patient population. The EMACROSS study aimed to explore consultation determinants and motives in SRW patients with respiratory symptoms. Methods: Multicenter survey of adult ED patients with respiratory complaints in eight emergency departments in central Berlin, Germany. Secondary hospital records data including diagnoses was additionally assessed. Characteristics of SRW and non-SRW patients were compared. Determinants of SRW consultation were evaluated by binary logistic regression. Consultation motives were analyzed descriptively. As a supplemental approach, network analysis (lasso-regularized mixed graphical model) was performed to explore connections between consultation determinants, consultation features and motives. Results: Between June 2017 and November 2018, n = 472 participants were included, the median age was 55 years (range 18–96), 53.2% of patients were male and n = 185 cases (39.2%) were SRW consulters. The SRW group showed lower proportions of potentially severe (pneumonia and respiratory failure, p < 0.001, χ2 test) and chronic pulmonary conditions. Determinants of SRW consultation identified by logistic regression were younger age (p < 0.001), tertiary education (p = 0.032), being a first-generation migrant (p = 0.002) or tourist (p = 0.008), having no regular primary care provider (p = 0.036) and no chronic pulmonary illness (p = 0.017). The area under the curve (AUC) for the model was 0.79. Personal distress and access problems in ambulatory care were stated most frequently as consultation motives in the SRW group; network analysis showed the scarcity of associations between demographic and medical SRW determinants and motives triggering the actual decision to consult. Conclusions: As to "who" consults, this study identified demographic and medical predictors of SRW utilization. The said markers seem only remotely connected to "why" people decide for SRW visits. To alleviate ED crowding by addressing frequent SRW consultation motives, interventions focused on the ability for symptom self-assessment and at better-accessible alternative care seem sensible

The polymorphism in insulin receptor substrate-1 gene and birth weight in neonates at term

Wstęp: Mutacja genu substratu 1 receptora insuliny (IRS-1, insulin receptor substrate-1) jest jednym z genetycznych czynników ryzyka, przypuszczalnie związanych z występowaniem zjawiska oporności na insulinę lub predyspozycją do wystąpienia cukrzycy typu 2. Celem niniejszego badania była ocena potencjalnych zależności między polimorfizmem Gly972Arg w genie IRS-1 a masą ciała u noworodków urodzonych o czasie. Materiał i metody: W badaniu wzięło udział 100 noworodków urodzonych o czasie (38-42 tydzień ciąży), których matki nie chorowały podczas ciąży. Po wyekstrahowaniu genomowego DNA z leukocytów krwi pępowinowej przeprowadzono z użyciem metody PCR ocenę polimorfizmu Gly972Arg genu IR-1. Wyniki: Urodzeniowa masa ciała była istotnie niższa u noworodków z polimorfizmem Gly972Arg genu IRS-1 w porównaniu z grupą kontrolną (3161,75 &#177; 380,86 g vs. 3427,92 &#177; 468,86 g). U noworodków z tym polimorfizmem zaobserwowano również mniejszą długość ciała oraz mniejszy obwód głowy (odpowiednio: 54,38 &#177; 3,13 cm vs. 52,69 &#177; 2,91 cm oraz 34,08 &#177; 1,47 cm vs. 33,63 &#177; 0,81 cm). Wnioski: Wyniki sugerują, że genotyp Gly972Arg u noworodków urodzonych o czasie wiąże się z niższą urodzeniową masą ciała, mniejszą długością ciała oraz mniejszym obwodem głowy.Background: The mutation of the IRS-1 gene is one of the genetic risk factors which, it is speculated, is associated with insulin resistance or predisposition to type 2 diabetes. The aim of our study was to evaluate the association between the Gly972Arg polymorphism in the IRS-1 gene and birth weight in newborn children with adequate gestational age. Material and methods: 100 newborn children with adequate gestational age (38&#8211;42 weeks), whose mother had no disorders during pregnancy, were studied. Genomic DNA was extracted from umbilical cord blood leukocytes, and Gly972Arg polymorphism in the IRS-1 gene was genotyped using the PCR-based method. Results: Birth weight was significantly lower in the newborn with the IRS-1 Gly972Arg polymorphism compared with a control group (3161.75 &#177; 380.86 g vs. 3427.92 &#177; 468.86 g). Body length and head circumference at birth were also lower in the neonates with that polymorphism (54.38 &#177; 3.13 cm vs. 52.69 &#177; 2.91 cm, and 34.08 &#177; 1.47 vs. 33.63 &#177; 0.81, respectively). Conclusions: The results suggest that the Gly972Arg genotype is associated with lower birth weight, body length and head circumference in neonates with adequate gestational age