Healthcare Utilization and Costs in Sepsis Survivors in Germany-Secondary Analysis of a Prospective Cohort Study

Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized

Landscape and climate on the northern Tibetan Plateau during the late Quaternary

Palaeoclimate reconstruction on the northern Tibetan Plateau resulted in a large spectrum of different and partly divergent interpretations for the climate evolution during the late glacial and the Holocene. In some cases this is caused by incomplete understanding of the geomorphological processes influencing the different proxies used. To overcome these limitations and to enhance the understanding of the complex process interactions in a sensitive and highly dynamical environment a detailed analysis of different members of the sedimentary system at Lake Heihai on the northern Tibetan Plateau was conducted. Lake level variations during the late Pleistocene were influenced by sediment supply to an alluvial fan. This sediment surplus resulted in the temporary blocking of the outflow of Lake Heihai. High sediment supply presumably occurred during or shortly after large glaciations in the Kunlun Shan. The spatial distribution of aeolian sediments revealed a strong relationship to possible source areas. This resulted in a spatially heterogeneous distribution of the aeolian sediments. Furthermore, topographic effects have an important influence on the preservation of the sediments. Aeolian sediments deposited in sheltered positions might not be comparable with other archives with a similar grain size. Nevertheless, deposition of loess during the mid-Holocene indicates a shift to wetter climate conditions on the northern Tibetan Plateau. This might be caused by the intrusion of the East Asian Summer monsoon into the area. During the late Holocene, the Asian summer monsoon retreated and aeolian sediments were reactivated. (C) 2017 Elsevier B.V. All rights reserved

General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

Background Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied.Objectives The aim of this study is to describe GPs’ views and experiences of caring for postsepsis patients and of participating a specific outreach training.Design Semistructured qualitative interviews.Setting 14 primary care practices in the metropolitan area of Berlin, Germany.Participants 14 GPs who had participated in a structured sepsis aftercare programme in primary care.Results Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP’s experiences during their patient’s critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice.Conclusions GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit–GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare.Trial registration number ISRCTN61744782