The Rediscovery of the Social Side of Medicine: Philosophy and Value of the International Classification of Functioning, Disability and Health (ICF)

oai:ojs2.medtech.ichsmt.org:article/2Medicine is at a risk to slide into a sole repair service for the malfunction of organs. But the patients’ hopes and confidence toward doctors practicing this repair work go far beyond that: after acute medical treatment, many patients suffer from chronic impairments due to the natural course of disease or as a result of medical interventions. Despite the resulting handicaps, patients aim toward participating in family and social life, retaining a workplace, and receiving support to remain a valued member of family and community. Doctors should therefore not only concentrate on the natural science and technological part of medicine but also consider the background of their patients and their involvement in life situations, including environmental and personal factors, as these may influence functioning and disability as facilitators or barriers. Health insurances must organize, finance, and control the achievements of the post-acute treatment process with the goal of participation. Public health must combine and assess individual views to prepare reasonable population-based social, economic, and political decisions. The philosophy and structure of the International Classification of Functioning, Disability and Health (ICF) is supporting this attitude of medicine to complement the International Classification of Diseases (ICD) as a basis for health reports

Challenges to establish new medical technologies, that are not yet contractually stipulated with the insurers, into the daily medical routine

Advances in medical care are to a large extent brought forward by new medical technologies. Their implementation into daily medical routine requires a careful handling to be of rational use for individual patients and to avoid harm as well. For this responsible task critical key questions are listed for the deciding  medical doctor treating an individual patient, for a  conclusive scientific evaluation and as a decision support for insurers and policy makers to assess the economic potentials and regulatory challenges of new medical technologies and innovations

The Assessment of Long-Term-Care, its Quality Assurance and Results -The German Perspective-

The consequences of demographic aging caused an impulse for German politics to establish an independent Social Long-Term-Care Insurance in 1995. Since then the assessment for long-term-care became stepwise more comprehensive to cover the bio-psycho-social needs of an increasing part of the population. Nowadays, about 3.3 Million persons receive benefits from this social insurance which help to cover a great part (but not in full) of financial and material support to overcome the impacts of long-term-care. About 2.5 Million persons are assessed every year with continuously increasing tendency by nursing experts working for the Statutory Medical Service mostly performing home visits. They assess the appropriate scores for mobility, cognitive and communicative abilities, behavior, attitudes, habits and psychic problems, self-sufficiency, coping and handling of requirements due to disease and therapy, management of everyday life and maintaining social contacts, adding up to one of 5 grades, the need for technical aids, flat conversion, therapeutic procedures, rehabilitation and educative support. The assessment guidelines and the monitoring of the quality of their realization are presented as well as the outcome for the Long-Term-Care Insurance on the federal level. Twenty-five years of Long-Term-Care Insurance have led to a well established and steadfast insurance but with increasing expenses as well as rising social security contributions to face the challenges of a human and dignified evening of life for an increasing part of the population

Highlighting the achievements of the fourth International Congress on Health Sciences and Medical Technologies

This is an editorial reporting the fourth International Congress on Health Sciences and Medical Technologies ICHSMT. After the success of three versions of the international congress ICHSMT, The fourth congress was established from 5 to 7 December 2019 at Tlemcen, Algeria. With the cooperation of University of Tlemcen, Knowledge Kingdom Publishing and other partners, the congress attracted an important number of researchers from several domains and affiliations. Aiming to contributing the scientific progress and the promotion of the community of health sciences and medical technologies. The congress was established virtually and in-person which challenged the political and technical problems.&nbsp

The Rediscovery of the Social Side of Medicine: Philosophy and Value of the International Classification of Functioning, Disability and Health (ICF)

oai:ojs2.ichsmt.org:article/2Medicine is at a risk to slide into a sole repair service for the malfunction of organs. But the patients’ hopes and confidence toward doctors practicing this repair work go far beyond that: after acute medical treatment, many patients suffer from chronic impairments due to the natural course of disease or as a result of medical interventions. Despite the resulting handicaps, patients aim toward participating in family and social life, retaining a workplace, and receiving support to remain a valued member of family and community. Doctors should therefore not only concentrate on the natural science and technological part of medicine but also consider the background of their patients and their involvement in life situations, including environmental and personal factors, as these may influence functioning and disability as facilitators or barriers. Health insurances must organize, finance, and control the achievements of the post-acute treatment process with the goal of participation. Public health must combine and assess individual views to prepare reasonable population-based social, economic, and political decisions. The philosophy and structure of the International Classification of Functioning, Disability and Health (ICF) is supporting this attitude of medicine to complement the International Classification of Diseases (ICD) as a basis for health reports

Multimorbidity, a challenge for medical treatment, research and health care management

Multimorbidity is a highly prevalent phenomenon in the elderly and of growing public health impact in aging societies due to rising life expectancies, more effective medical treatment and comprehensive social care facilities, resulting in longevity[1-3]. The increasing number of patients at an age of 60 and more are expected to have between 5 to 7 active diagnoses with multiple conditions and pathological states, varying recommendations for therapy and diverse personal wishes and contextual factors influencing. Disease-disease interactions have an impact on patient management processes, disease-disease medication interactions must be considered and balanced and potential medication-medication interactions kept in mind and avoided. Furthermore the interaction between somatic and psychiatric diseases is a completely underestimated field of conflicts and misjudgements. Multimorbidity is an important field of research as well. Thusthe lack of guidelines covering multimorbidity is more the rule than an exemption if not explicitely addressing old age. Multimorbidity is going along with multiple changing of medical consultations, the need for a comprehensive care by different professions with time-consuming and strenuous transitions and communication routes, repeated hospital treatments, polypharmacy with frequently undesired mutual actions of drugs, unnecessary or redundant examinations and conflicting instructions for therapy resulting in accumulating complications unless rationally analyzed. Multimorbidity is more than an addition of different diseases. It is a complex net of mutually influencing factors like physical functioning, mental well-being, social relationships and environmental factors. Thereforetherapy of multimorbidity is more sensitive for contextual factors, needs multimodal and multidisciplinary support with attention for the patients’ resources and an increasing need for prevention, therapy, rehabilitation, assistive technologies and social care at the place of residence or nearby [4]

Handreichung Anrechnung Teil 1. Ein theoretischer Überblick

Diese Handreichung gibt in neun Kapiteln einen theoretischen Einblick in das Thema Anrechnung. Dabei werden u. a. Anrechnungsverfahren, zentrale Konzepte und Bezugsrahmen sowie die Qualitätssicherung in Anrechnungsprozessen in den Blick genommen. Die Handreichung wird ergänzt durch einen zweiten Teil, der Praxiserfahrungen mit Anrechnung einbezieht. Diese Publikation ist im Rahmen der wissenschaftlichen Begleitung des Bund-Länder-Wettbewerbs „Aufstieg durch Bildung: offene Hochschulen“ entstanden. (Hrgs.

Neuronally derived extracellular vesicle α-synuclein as a serum biomarker for individuals at risk of developing Parkinson disease

IMPORTANCE: Nonmotor symptoms of Parkinson disease (PD) often predate the movement disorder by decades. Currently, there is no blood biomarker to define this prodromal phase. OBJECTIVE: To investigate whether α-synuclein in neuronally derived serum-extracellular vesicles identifies individuals at risk of developing PD and related dementia. DESIGN, SETTING, and PARTICIPANTS: This retrospective, cross-sectional multicenter study of serum samples included the Oxford Discovery, Marburg, Cologne, and Parkinson’s Progression Markers Initiative cohorts. Participants were recruited from July 2013 through August 2023 and samples were analyzed from April 2022 through September 2023. The derivation group (n = 170) included participants with isolated rapid eye movement sleep behavior disorder (iRBD) and controls. Two validation groups were used: the first (n = 122) included participants with iRBD and controls and the second (n = 263) included nonmanifest GBA1N409S gene carriers, participants with iRBD or hyposmia, and available dopamine transporter single-photon emission computed tomography, healthy controls, and patients with sporadic PD. Overall the study included 199 participants with iRBD, 20 hyposmic participants with available dopamine transporter single-photon emission computed tomography, 146 nonmanifest GBA1N409S gene carriers, 21 GBA1N409S gene carrier patients with PD, 50 patients with sporadic PD, and 140 healthy controls. In the derivation group and validation group 1, participants with polysomnographically confirmed iRBD were included. In the validation group 2, at-risk participants with available Movement Disorder Society prodromal markers and serum samples were included. Among 580 potential participants, 4 were excluded due to alternative diagnoses. EXPOSURES: Clinical assessments, imaging, and serum collection. MAIN OUTCOME AND MEASURES: L1CAM-positive extracellular vesicles (L1EV) were immunocaptured from serum. α-Synuclein and syntenin-1 were measured by electrochemiluminescence. Area under the receiver operating characteristic (ROC) curve (AUC) with 95% CIs evaluated biomarker performance. Probable prodromal PD was determined using the updated Movement Disorder Society research criteria. Multiple linear regression models assessed the association between L1EV α-synuclein and prodromal markers. RESULTS: Among 576 participants included, the mean (SD) age was 64.30 (8.27) years, 394 were male (68.4%), and 182 were female (31.6%). A derived threshold of serum L1EV α-synuclein distinguished participants with iRBD from controls (AUC = 0.91; 95% CI, 0.86-0.96) and those with more than 80% probability of having prodromal PD from participants with less than 5% probability (AUC = 0.80; 95% CI, 0.71-0.89). Subgroup analyses revealed that specific combinations of prodromal markers were associated with increased L1EV α-synuclein levels. Across all cohorts, L1EV α-synuclein differentiated participants with more than 80% probability of having prodromal PD from current and historic healthy control populations (AUC = 0.90; 95% CI, 0.87-0.93), irrespective of initial diagnosis. L1EV α-synuclein was increased in at-risk participants with a positive cerebrospinal fluid seed amplification assay and was above the identified threshold in 80% of cases (n = 40) that phenoconverted to PD or related dementia. CONCLUSIONS AND RELEVANCE: L1EV α-synuclein in combination with prodromal markers should be considered in the stratification of those at high risk of developing PD and related Lewy body diseases

DICOM’s Standardization in Histo-Pathology

Background: The Digital Imaging and Communications in Medicine (DICOM) standard helps to represent, store, and to exchange healthcare images associated with its data. DICOM develops over time and is continuously adapted to match the rigors of new clinical demands and technologies. An uphill battle in this regard is to conciliate new software programs with legacy systems. Methods: This work discusses the essential aspects of the standard and assesses its capabilities and limitations in a multisite, multivendor healthcare system aiming at Whole Slicing Image (WSI) procedures. Selected relevant DICOM attributes help to develop and organize WSI applications that extract and handle image data, integrated patient records, and metadata. DICOM must also interface with proprietary file formats, clinical metadata and from different laboratory information systems. Standard DICOM validation tools to measure encoding, storing, querying and retrieval of medical data can verify the generated DICOM files over the web. Results: This work investigates the current regulations and recommendations for the use of DICOM with WSI data. They rely mostly on the EU guidelines that help envision future needs and extensions based on new examination modalities like concurrent use of WSI with in-vitro imaging and 3D WSI. Conclusion: A DICOM file format and communication protocol for pathology has been defined. However, adoption by vendors and in the field is pending. DICOM allows efficient access and prompt availability of WSI data as well as associated metadata. By leveraging a wealth of existing infrastructure solutions, the use of DICOM facilitates enterprise integration and data exchange for digital pathology. In the future, the DICOM standard will have to address several issues due to the way samples are gathered and encompassing new imaging technologies