Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS). DESIGN: Systematic review and meta-analysis of observational cohort studies. DATA SOURCES: Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases. STUDY SELECTION: Observational cohort studies with participants parity from 0 to 1. MAIN OUTCOME MEASURES: Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between interpregnancy BMI change on five outcomes. RESULTS: 925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m2) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m2 at first pregnancy. CONCLUSIONS: Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes. TRIAL REGISTRATION NUMBER: CRD42016041299

General practitioner-centred paediatric primary care reduces risk of hospitalisation for mental disorders in children and adolescents with ADHD: findings from a retrospective cohort study

Background: General practitioners (GPs) play an essential role in the sustainable management of attention-deficit/hyperactivity disorder (ADHD). To our knowledge, the healthcare programme described here is the first integrated care programme for paediatric ambulatory care embedded in GP-centred-healthcare in Germany. Objectives: To compare the health-service-utilisation of patients with ADHD enrolled in a GP-centred-paediatric-primary-care-programme with usual care in terms of disease-related hospitalisation, pharmacotherapy and psychotherapy. Methods: In 2018, we conducted a retrospective cohort study of 3- to 18-year-old patients with ADHD in Baden-Wuerttemberg, southern Germany. The intervention group (IG) comprised patients enrolled in a GP-centred-paediatric-primary-healthcare-programme and consulted a participating GP for ADHD at least once. GP-centred-paediatric-primary-care provides high continuity of care, facilitated access to specialist care, extended routine examinations and enhanced transition to adult healthcare. Patients in the control group (CG) received usual care, meaning they consulted a non-participating GP for ADHD at least once. Main outcomes were disease-related hospitalisation, pharmacotherapy and psychotherapy. Multivariable logistic regression was performed to compare groups. Results: A total of 2317 patients were included in IG and 4177 patients in CG. Mean age was 8.9 ± 4.4. The risk of mental-disorder-related hospitalisations was lower in IG than CG (odds ratio (OR): 0.666, 95% confidence interval (CI): 0.509-0.871). The prescription rate for stimulants was lower in IG (OR: 0.817; 95% CI: 0.732-0.912). There was no statistically significant difference in the participation rate of patients in cognitive behavioural therapy between groups (OR: 0.752; 95% CI: 0.523-1.080). Conclusion: Children and adolescents with ADHD enrolled in GP-centred-paediatric-primary-care are at lower risk of mental-disorder-related hospitalisation and less likely to receive stimulants. Keywords: ADHD; claims data; health-care-utilisation; multivariate analysis; primary care

Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes

Objective: To evaluate a novel healthcare programme for the treatment of patients with hip and knee osteoarthritis in southern Germany in terms of clinical and health economic outcomes. The study is based on claims data from 2014 to 2017. Methods: We conducted a retrospective comparative cohort study of 9768 patients with hip and knee osteoarthritis, of whom 9231 were enrolled in a collaborative ambulatory orthopaedic care programme (intervention group), and 537 patients received usual orthopaedic care (control group). Key features of the programme are coordinated care, morbidity-adapted reimbursement and extended consultation times. Multivariable analysis was performed to determine effects on health utilisation outcomes. The economic analysis considered annual costs per patient from a healthcare payer perspective, stratified by healthcare service sector. Besides multivariable regression analyses, bootstrapping was used to estimate confidence intervals for predicted mean costs by group. Results: Musculoskeletal-disease-related hospitalisation was much less likely among intervention group patients than control group patients [odds ratio (OR): 0.079; 95% CI: 0.062–0.099]. The number of physiotherapy prescriptions per patient was significantly lower in the intervention group (RR: 0.814; 95% CI: 0.721–0.919), while the likelihood of participation in exercise programmes over one year was significantly higher (OR: 3.126; 95% CI: 1.604–6.094). Enrolment in the programme was associated with significantly higher ambulatory costs (€1048 vs. €925), but costs for inpatient care, including hospital stays, were significantly lower (€1003 vs. €1497 and €928 vs. €1300 respectively). Overall annual cost-savings were €195 per patient. Conclusions: Collaborative ambulatory orthopaedic care was associated with reduced hospitalisation in patients with hip and knee osteoarthritis. Health costs for programme participants were lower overall, despite higher costs for ambulatory care

Standardisation of magnetic nanoparticles in liquid suspension

Suspensions of magnetic nanoparticles offer diverse opportunities for technology innovation, spanning a large number of industry sectors from imaging and actuation based applications in biomedicine and biotechnology, through large-scale environmental remediation uses such as water purification, to engineering-based applications such as position-controlled lubricants and soaps. Continuous advances in their manufacture have produced an ever-growing range of products, each with their own unique properties. At the same time, the characterisation of magnetic nanoparticles is often complex, and expert knowledge is needed to correctly interpret the measurement data. In many cases, the stringent requirements of the end-user technologies dictate that magnetic nanoparticle products should be clearly defined, well characterised, consistent and safe; or to put it another way—standardised. The aims of this document are to outline the concepts and terminology necessary for discussion of magnetic nanoparticles, to examine the current state-of-the-art in characterisation methods necessary for the most prominent applications of magnetic nanoparticle suspensions, to suggest a possible structure for the future development of standardisation within the field, and to identify areas and topics which deserve to be the focus of future work items. We discuss potential roadmaps for the future standardisation of this developing industry, and the likely challenges to be encountered along the way

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Biomechanical analysis of screw fixation vs. K-wire fixation of a slipped capital femoral epiphysis model

Die Epiphyseolysis capitis femoris (ECF) wird als nichttraumatischer Epiphysenabrutsch definiert und tritt meist während des pubertären Wachstumsschubes auf. Frühere Daten haben gezeigt, dass aufgrund der technischen Leichtigkeit, geringen Morbidität und niedrigen Komplikationsrate die singuläre In-situ-Verschraubung den aktuellen Therapiestandard darstellt. Eine Multi-Implantat-Fixation mittels Kirschner-Drähten (K-Drähte) wird in Zusammenhang mit einer höheren Inzidenz schwerwiegender Komplikationen gebracht. Unklar ist die biomechanische Belastbarkeit der Implantate, speziell im Bereich der instabilen ECF. Das Ziel dieser Belastungsstudie ist es, die Einzel- mit der Multi-Implantat-Fixation in einem Tiermodell zu vergleichen. Darüber hinaus werden verschiedene Schraubendesigns, einschließlich der Teleskopschraube, bezüglich Steifigkeit und Fixierungsversagen ausgewertet. Vierzig proximale Schweinefemora werden entlang der Wachstumsfugenlinie unter Zuhilfenahme einer Gigli-Säge durchtrennt. Die ECF-Fixation erfolgt mit vier verschiedenen Implantaten: mit einer 7.3-mm SCFE Schraube, mit einer dynamischen Teleskopschraube, je drei 1.6-mm und je drei 2.0-mm durchmessenden K-Drähten. Unter axialer Femurbelastung wird die Bruchlast (N) und Steifigkeit (N/mm) ermittelt. Die Ergebnisse dieser biomechanischen Analyse machen deutlich, dass die Bruchlast- und Steifigkeitswerte der beiden Schraubengruppen vergleichbar sind. Die 2.0-mm K-Drähte bieten die größte Steifigkeit, während die 1.6-mm K-Drähte, ohne das statistische Signifikanzniveau zu erreichen, die niedrigsten Steifigkeitswerte aufweisen. Bezüglich des Fixationsversagens treten keine Femurschaftfrakturen auf. Eine Stabilisierung der instabilen ECF mit drei 2.0-mm K-Drähten führt zur höheren Stabilität als die solitäre Schrauben- und 1.6-mm K-Draht-Fixierung. Doch keine der beiden untersuchten Schrauben scheint hinsichtlich Stabilität und Fixationsversagen überlegen zu sein.Previous data have shown that due to the technical ease, low-morbidity, and lower complication rates, the in situ single-implant fixation is the current standard for stabilization of slipped capital femoral epiphysis (SCFE) fixation. Multiple-implant fixation is thought to be combined with a higher incidence of serious complications. The purpose of the current study was to evaluate single- vs. multiple-implant fixation regarding strength and stiffness. Furthermore, different screw designs, including telescopic screw, were evaluated regarding the stiffness, strength, and especially fixation failure. Forty porcine proximal femurs were sectioned through the physeal line using a gigli saw and stabilized with a 7.3-mm stainless steel AO screw, a dynamic telescopic screw, three 1.6-mm Kirschner wires (K-wires), and three 2.0-mm K-wires. The femurs were biomechanically tested to determine failure load (N) and stiffness (N/mm). No significant differences were found regarding failure load and stiffness between the two screw groups. The 2.0-mm K-wire construct was significantly the strongest and stiffest fixation. The 1.6-mm K-wire fixation had the lowest values, but not statistically significant. Regarding the fixation failure, no femoral shaft fracture occurred. SCFE stabilization with three 2.0-mm K-wires leads to increased stability over single-screw fixation and 1.6-mm K-wire fixation. However, none of the two screws seemed to be superior in fixation stability and fixation failure

Providing an interactive undergraduate elective on safety culture online – concept and evaluation

Background: The COVID-19 pandemic has made it more difficult to maintain high quality in medical education. As online formats are often considered unsuitable, interactive workshops and seminars have particularly often been postponed or cancelled. To meet the challenge, we converted an existing interactive undergraduate elective on safety culture into an online event. In this article, we describe the conceptualization and evaluation of the elective. Methods: The learning objectives of the safety culture elective remained unchanged, but the teaching methods were thoroughly revised and adapted to suit an online setting. The online elective was offered as a synchronous two-day course in winter semester 2020/21 during the “second wave” of the COVID-19 pandemic in Germany. At the end of each day, participating students evaluated the elective by completing an online survey. Items were rated on a six-point Likert scale. We used SPSS for data analysis. Results: Twenty medical undergraduates completed the elective and rated it extremely positively (1.1 ± 0.2). Students regard safety culture as very important and felt the learning objectives had been achieved. Moreover, they were very satisfied with the design and content of the elective, and especially with interactive elements like role-play. Around 55% of participants would recommend continuing to offer the online elective after the pandemic. Conclusions: It makes sense to offer undergraduate medical students online elective courses on safety culture, especially during a pandemic. The elective described here can serve as a best practice example of how to teach safety culture to undergraduates, especially when physical presence is unfeasible. Electives requiring a high degree of interaction can also function well online

Subjektive Informiertheit von Patient*innen zum Thema Patientensicherheit: Ergebnisse einer Bevölkerungsbefragung in Deutschland

INTRODUCTION The growing number of people with multimorbidity and polypharmacy in Germany has led to increasing complexity in health care and risks to patient safety. A high priority should therefore be placed on identifying and preventing avoidable adverse events. The patient perspective plays an important role in improving patient safety. In this study, we conducted a representative, population-based survey of knowledge, perceptions and experiences of patient safety, especially of subjectively experienced errors in health care. Our aim was in particular to assess patient safety from the patients' point of view, and to analyze differences in assessments of risk and preventability between persons that felt well or poorly informed about patient safety topics. METHODS In 2019, computer-assisted telephone interviews were conducted nationwide as part of the "TK-Monitor Patient Safety" project. Recruitment was carried out by using multistage selection and forming a stratified random sample. Adults (18 years and older) with sufficient knowledge of German were included. The survey was conducted using a structured guideline containing 21 questions concerning perceptions and experiences of patient safety, and 12 questions on sociodemographic factors. The results were analyzed both descriptively and using inferential statistical methods. RESULTS Of a total of 1,000 respondents (51% female), approx. half (52%) were gainfully employed, and 57% rated their state of health as "very good" or "good". The patients regarded data protection, medication errors, hospital infections and diagnostic (un)certainty as of major relevance to patient safety. Overall, 55% of the respondents rated their knowledge of patient safety as "very good" or "good". The results showed that subjective knowledge was negatively associated with important outcome parameters such as having experience of medication errors or suspecting errors had been made in a medical examination or treatment. Patients that considered themselves well-informed also reckoned they could contribute towards increasing safety in health care. DISCUSSION The respondents considered diagnostic uncertainty to be one of the greatest risks to their person. This shows that they recognized a need for further information and felt this need was inadequately satisfied in the German research landscape. With regard to the correlation between subjective knowledge and outcome parameters, it is also necessary to analyze whether the respondents' subjective knowledge reflects their actual knowledge, as this would be necessary for preventive measures to be effective. This question will be the subject of further studies. CONCLUSION The patient perspective is an important addition to the study of the safety of medical care in Germany. Factors influencing subjective knowledge should be investigated. Furthermore, regular surveys would be desirable in order to gain greater insight into the topic.Hintergrund Die Zunahme von Multimorbidität und Multimedikation in Deutschland führt zu einer steigenden Komplexität der Gesundheitsversorgung und damit zu vermehrten Sicherheitsrisiken. Vermeidbare unerwünschte Ereignisse zu identifizieren und zu verhindern muss eine hohe Priorität haben. Bei der Verbesserung der Patientensicherheit spielt die Perspektive von Patientinnen und Patienten eine wichtige Rolle. In dieser Studie wurde eine Befragung zu Wissen, Wahrnehmung und Erfahrungen der Bevölkerung zum Thema Patientensicherheit, dabei vor allem zu subjektiv erlebten Fehlern im Versorgungsgeschehen, durchgeführt. Ziel war es insbesondere, den Stand der Patientensicherheit aus Sicht der Patientinnen und Patienten zu erheben und Unterschiede zwischen den Gruppen der subjektiv gut und den subjektiv schlecht zum Thema Patientensicherheit Informierten hinsichtlich der Einschätzung von Risiken und deren Vermeidbarkeit zu analysieren. Methode Im Rahmen des „TK-Monitor Patientensicherheit“ wurden bundesweit computer-assistierte Telefoninterviews durchgeführt. Die Rekrutierung erfolgte durch ein mehrstufiges Auswahlverfahren unter Bildung einer geschichteten Stichprobe. Eingeschlossen wurden Erwachsene (≥ 18 Jahre) die über ausreichend Deutschkenntnisse verfügten. Die Befragung erfolgte mittels eines strukturierten Leitfadens mit 21 Fragen zur Wahrnehmung und Erfahrung mit Patientensicherheit sowie 12 Fragen zu soziodemographischen Daten. Die Ergebnisse wurden deskriptiv und mittels inferenzstatistischen Verfahren ausgewertet. Ergebnisse Von insgesamt 1000 teilnehmenden Personen (51% weiblich) war etwa die Hälfte (52%) erwerbstätig und 57% schätzten ihren Gesundheitszustand als „sehr gut“ oder „gut“ ein. Insbesondere Datenschutz, Arzneimittelfehler, Infektionen im Krankenhaus und Diagnose(un)sicherheit wurden als besonders sicherheitsrelevante Problemfelder betrachtet. 55% der Befragten schätzen ihren subjektiven Informationsstand zum Thema Patientensicherheit als „sehr gut“ oder „gut“ ein. Der subjektive Informationsstand war negativ assoziiert mit wesentlichen Outcome-Parametern wie erlittenen Medikationsfehlern oder vermuteten Fehlern bei einer medizinischen Untersuchung oder Behandlung. Auch gaben subjektiv gut Informierte eher an, selbst zu einer sicheren Gesundheitsversorgung beitragen zu können. Diskussion Das Thema der Diagnose(un)sicherheit stellt aus Sicht der Bevölkerung eine der größten persönlichen Gefährdungen dar. Hier zeigt sich ein Bedarf der Befragten an Bearbeitung und Information, der in der Forschungslandschaft in Deutschland bislang zu wenig abgedeckt ist. Bei den Zusammenhängen zwischen subjektivem Informationsstand und Outcome-Parametern bleibt zu analysieren, ob der subjektive Informationsstand den tatsächlichen Informationsstand abbildet, der wiederum für wirksame eigene Präventionsmaßnahmen nötig wäre. Dieser Frage sollte in weiteren Studien nachgegangen werden. Schlussfolgerung Die Perspektive von Patientinnen und Patienten ist eine wichtige Ergänzung in der Betrachtung der Sicherheit der medizinischen Versorgung in Deutschland. Einflussfaktoren auf die subjektive Informiertheit sollten untersucht und die subjektive Informiertheit der Bevölkerung erhöht werden. Weitere, regelmäßige Erhebungen sind wünschenswert, um die Thematik zu vertiefen

Serum and cerebrospinal fluid Neudesin concentration and Neudesin Quotient as potential circulating biomarkers of a primary brain tumor

Abstract Background Despite the previously suggested role of Neudesin in tumorigenesis and its potential as a novel target for the treatment of cancers, its prognostic value has never been examined. Thus, the aim of the study was to evaluate Neudesin concentrations in primary brain tumor patients and make a comparison with non-tumoral individuals. Methods Cerebrospinal fluid (CSF) and serum Neudesin concentration was evaluated by means of the ELISA method. Results The total group of brain tumor patients had statistically lower serum Neudesin concentrations compared to the non-tumoral group (P = 0.037). The meningeal tumor subgroup also had statistically lower serum Neudesin concentrations compared to the non-tumoral group (P = 0.012). The Astrocytic brain tumor subgroup had significantly higher CSF Neudesin concentrations compared to the non-tumoral group (P = 0.046). Neudesin Quotient (CSF concentration divided by serum concentration) in the astrocytic brain tumor subgroup was statistically higher compared to the non-tumoral group (P = 0.023). Males had statistically lower concentrations of the serum Neudesin compared to females (P = 0.047). Univariate linear regression analysis revealed that for women the serum Neudesin concentration was 1.53 times higher than for men. In the model of multivariate linear regression analysis, predictor variables influencing serum Neudesin concentrations included CSF Neudesin concentration and the Neudesin Quotient, if other model parameters are fixed. The developed model explains 82% of the variance in serum Neudesin concentration. Both linear regression models, univariate and multivariate, pointed to fewer factors with a potential to influence the Neudesin Quotient compared to serum Neudesin concentration. Conclusions In astrocytic brain tumor patients Neudesin concentrations within the cerebrospinal fluid are higher compared with non-tumoral individuals. Serum Neudesin concentration strongly correlates with its CSF level. In primary brain tumor patients serum Neudesin concentration is clearly gender-dependent. Linear regression models pointed to fewer factors that may influence the Neudesin Quotient value, which suggests it is a better biomarker of astrocytic brain tumors than serum and CSF Neudesin concentrations alone

Utilization of a patient-centered asthma passport tool in a subspecialty clinic

<p><i>Introduction</i>: Despite available and effective tools for asthma self-assessment (Asthma Control Test, ACT) and self-management (Asthma Action Plan, AAP), they are underutilized in outpatient specialty clinics. We evaluated the impact of a patient-centered checklist, the Asthma Passport, on improving ACT and AAP utilization in clinic. <i>Methods</i>: This was a randomized, interventional quality-improvement project in which the Asthma Passport was distributed to 120 pediatric asthma patients over the duration of 16 weeks. The passport's checklist consisted of tasks to be completed by the patient/family, including completion of the ACT and AAP. We compared rates of completion of the ACT and AAP for those who received the passport versus the control group, and assessed patient/caregiver and provider satisfaction. <i>Results</i>: Based on electronic medical record data from 222 participants, the ACT completion rate was not significantly different between the passport and control groups, however, the AAP completion rate was significantly greater than control (30.0% vs. 17.7%, <i>p</i> = 0.04). When per-protocol analysis was limited to groups who completed and returned their passports, ACT and AAP completion rates were significantly greater than control (73.8% vs. 44.1% (<i>p</i> = 0.002) and 35.7% vs. 17.7% (<i>p</i> = 0.04), respectively). Nearly all participants reported high satisfaction with care, and surveyed providers viewed the passport favorably. <i>Conclusions</i>: A patient-centered checklist significantly improved the completion rate of the AAP. For patient's who completed and returned the asthma passport, the ACT completion rate was also improved. Participants and providers reported high satisfaction with the checklist, suggesting that it can effectively promote asthma self-management and self-assessment without burdening clinicians or clinic workflow.</p