267 research outputs found
Een nobele en pieuse carriere: Predikanten aan het negentiende-eeuwse Oranjehof
Lieburg, F.A. van [Promotor]Schutte, G.J. [Copromotor
Hardware/Software Co-design Applied to Reed-Solomon Decoding for the DMB Standard
This paper addresses the implementation of Reed-
Solomon decoding for battery-powered wireless
devices. The scope of this paper is constrained by the
Digital Media Broadcasting (DMB). The most critical
element of the Reed-Solomon algorithm is implemented
on two different reconfigurable hardware
architectures: an FPGA and a coarse-grained
architecture: the Montium, The remaining parts are
executed on an ARM processor. The results of this
research show that a co-design of the ARM together
with an FPGA or a Montium leads to a substantial
decrease in energy consumption. The energy
consumption of syndrome calculation of the Reed-
Solomon decoding algorithm is estimated for an FPGA
and a Montium by means of simulations. The Montium
proves to be more efficient
Outcome und Charakteristika internistischer Notfallpatienten mit dem Schwerpunkt der Identifikation und Bewertung von PrĂ€diktoren fĂŒr die intrahospitale MortalitĂ€t
Einleitung Das Patientenaufkommen in deutschen KrankenhÀusern und Notaufnahmen
steigt kontinuierlich an. DemgegenĂŒber steht die stetige Verknappung der
Ressourcen im Gesundheitssystem. Dies betrifft nicht nur die Reduktion von
KrankenhÀusern und Krankenhausbetten, sondern auch Einsparungen im
Personalbereich. Zeitgleich steigt der Anteil unbesetzter Arztstellen. Im
Bereich der Notfallmedizin muss eine adÀquate und effiziente Notfallversorgung
trotz knapper Ressourcen und erhöhtem Patientenaufkommen gewÀhrleistet werden.
Um diesen Anforderungen zu entsprechen, wird durch den Einsatz von
Triageverfahren, Behandlungsalgorithmen, Risikoscores und detaillierten
Standard Operating Procedures (SOPs) ein möglichst effizienter und
standardisierter Notaufnahmeprozess angestrebt. Durch diese MaĂnahmen sollen
lange Wartezeiten oder eine ungerechtfertigte Entlassung von Patienten
verhindert werden. Die initiale Untersuchung liefert essentielle Daten zur
Risikostratifizierung der Patienten. Ziel der vorliegenden Arbeit ist es,
unter diesen bei Aufnahme erhobenen Vital- und Laborparametern geeignete
PrĂ€diktoren fĂŒr die intrahospitale MortalitĂ€t von unselektierten
internistischen Notfallpatienten zu identifizieren. Methodik Es handelt sich
um eine prospektive Beobachtungsstudie. Der Studienzeitraum erstreckte sich
vom 15. Februar 2009 bis zum 15. Februar 2010. Es wurden Daten von zwei
Notaufnahmen der Charité verwendet. Insgesamt wurden 34.333 Patienten in diese
Studien einbezogen. Bei den verwendeten Daten handelt es sich um SekundÀrdaten
aller konservativer Patienten, welche im Rahmen von
QualitĂ€tssicherungsmaĂnahmen aus dem Krankenhausinformationssystem (KIS)
abgefragt wurden. Patienten, welche lebend entlassen wurden und im Krankenhaus
verstorbene Patienten wurden hinsichtlich ihrer Charakteristika, Diagnosen und
bezĂŒglich des Krankenhausverlaufes verglichen. Labor- und Vitalparameter,
welche bei Aufnahme erhoben wurden, wurden als PrĂ€diktoren fĂŒr einen fatalen
intrahospitalen Verlauf bivariat, in multivariaten Regressionsmodellen, sowie
anhand von ROC-Kurven (receiver operating characteristics), analysiert.
Ergebnisse Sowohl in bivariaten Analysen, als auch unter Verwendung
multivariater Regressionsmodelle und CART-Analyse, konnten insbesondere die
Biomarker C-reaktives Protein (CRP) und die Erythrozytenverteilungsbreite
(RDW) als PrĂ€diktoren fĂŒr das Versterben der Patienten wĂ€hrend des initialen
Krankenhausaufenthaltes identifiziert werden. C-reaktives Protein zeigte in
der bivariaten Analyse ein relatives Risiko fĂŒr den intrahospitalen Exitus von
7,6 (95%-Konfidenzintervall: 6,4-8,9) bei einem Cut-Off von 7,19 mg/dl und
erzielte eine FlÀche unter der ROC-Kurve von 0,795 (95%-Konfidenzintervall:
0,776-0,813). RDW zeigte in der bivariaten Analyse ein relatives Risiko von
6,9 (95%-Konfidenzintervall: 5,9-8,1) bei einem Cut-Off von 16,2% und erzielte
eine FlÀche unter der ROC-Kurve von 0,805 (95%-Konfidenzintervall:
0,788-0,823). In einem multivariaten Regressionsmodell gemeinsam mit anderen
PrÀdiktoren konnten diese Ergebnisse bestÀtigt werden, die ermittelten Odds
Ratios unter Verwendung der oben genannten Cut-Offs waren fĂŒr CRP 3,7
(95%-Konfidenzintervall: 3,01-3,52) und fĂŒr RDW 2,91 (95%-Konfidenzintervall:
2,37-3,58). Die Kombinierte ROC-Kurve aus allen Parametern des endgĂŒltigen
Modelles zeigte eine FlÀche unter der Kurve von 0,863 (95%-Konfidenzintervall:
0,848-0,877). Schlussfolgerung Die beschriebenen Ergebnisse zeigen, dass CRP
und RDW Potential fĂŒr die Risikostratifizierung unselektierter,
internistischer Notfallpatienten aufweisen. Eine Kombination dieser Marker
gemeinsam mit dem Alter der Patienten scheint generell dazu geeignet,
Patienten mit einem erhöhten MortalitÀtsrisiko zeitnah nach der Aufnahme zu
identifizieren. Eine Risikostratifizierung anhand dieser Parameter könnte
insbesondere in Situationen des Overcrowdings in der Notaufnahme hilfreich
sein. Inwiefern die Zuweisung von Patienten mit erhöhtem Risiko zu einem
priorisierten Behandlungsprozess geeignet ist das Outcome der Patienten zu
verbessern muss in Interventionsstudien untersucht werden.Introduction In German hospitals and Emergency Departments a time trend of
ever increasing patient numbers has been observed over recent years while, at
the same time, resources, including number of hospitals, hospital beds and
also qualified personnel have been decreasing. In order to assure an adequate
and efficient treatment despite these facts, the importance of effective
triage-systems, early risk-stratification and a good quality management with
detailed standard operating procedures (SOPs) is increasing. The first
physical and laboratory examinations of the patients, usually performed early
after admission to the ED, provide essential information for an early risk-
assessment. In this analysis, the value of the routine vital and laboratory
parameters obtained at admission was assessed for their potential role in risk
stratification. The investigated endpoint was the in-hospital mortality.
Methods In this observational study, secondary data of all patients who
attended the internal Emergency Departments of the Charité Campus Virchow
Klinikum and Benjamin Franklin between 15th February 2009 and 15th February
2012 were retrieved from the hospital information system in an IT-supported,
automated way (n=34.333). Laboratory and vital parameters were investigated as
potential predictors for a fatal in-hospital outcome in bivariate and
multivariate analyses. Additionally, the area under the ROC-Curve (receiver
operating characteristic) was calculated for every single predictor and also
for the final regression model. Results C-reactive protein (CRP) and Red cell
distribution width (RDW) were the best predictors of mortality in bivariate
analysis with an area under the ROC-curve of 0.805 (95%-Confidence interval:
0.788-0.823) and 0.795 (95%-Confidence interval: 0.776-0.813) respectively. In
univariate analysis, CRP showed a relative risk of 7.6 (95%-Confidence
interval: 6.4-8.9) at a cut-off value of 7.19 mg/dl. The relative risk for RDW
was 6.9 (95%-Confidence interval: 5.9-8.1) at a cut-off-level of 16.2%. In
multivariate analysis, the odds ratios at the respective cut-off points were
3.7 (95%-Confidence interval: 3.01-3.52) for CRP and 2.91 (95%-Confidence
interval: 2.37-3.58) for RDW. All predictors in the final regression model in
combination achieved an area under the curve of 0.863 (95%-Confidence
interval: 0.848-0.877). Additionally, CART-Analysis was performed and revealed
similar results. Conclusion The results of this analysis are indicating that
CRP and RDW have potential as predictors for an unfavorable in-hospital course
in unselected internal ED-patients. Both markers in combination with age might
be useful for the early identification of patients with an increased risk for
in-hospital mortality. Risk stratification by the identified markers might be
particularly useful in the setting of overcrowding. The clinical impact of
risk-stratification and prioritized treatment of high-risk patients on
patientÂŽs outcome needs to be evaluated in further interventional studies
Pointâofâcare testing for influenza in a university emergency department: A prospective study
Background: Seasonal influenza is a burden for emergency departments (ED). The aim of this study was to investigate whether point-of-care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures. Objectives The aim of this study was to investigate whether point-of-care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures.
Methods: Using a cross-over design, the cobas (R) Liat (R) Influenza A/B POC PCR test (Liat) was compared with standard clinical practice during the 2019/2020 influenza season. All adult patients (aged >= 18 years) with fever (>= 38 degrees C) and respiratory symptoms were included. Primary end points were the prevalence of influenza infections in the ED and staff sick days. Secondary end points were frequency of antiviral and antibacterial therapy, time between admission and test result or treatment initiation, patient disposition, ED length of stay (LOS), and for inpatients mortality and LOS. Nurses were interviewed about handling and integration of POC testing. The occurrence of SARS-CoV-2 infections coincided with the second half of the study. Results A total of 828 patients were enrolled in the study. All 375 patients of the intervention group were tested with Liat, and 103 patients of them (27.6%) tested positive. During the intervention period, staff sick days were reduced by 34.4% (P = .023). Significantly, more patients in the intervention group received antiviral therapy with neuraminidase inhibitors (7.2% vs 3.8%, P = .028) and tested patients received antibiotics more frequently (40.0% vs 31.6%, P = .033). Patients with POC test were transferred to external hospitals significantly more often (5.6% vs 1.3%, P = .01).
Conclusion: We conclude that POC testing for influenza is useful in the ED, especially if it is heavily frequented by patients with respiratory symptoms
Influence of Weekday and Seasonal Trends on Urgency and In-hospital Mortality of Emergency Department Patients
Background: Given the scarcity of resources, the increasing use of emergency departments (ED) represents a major challenge for the care of emergency patients. Current health policy interventions focus on restructuring emergency care with the help of patient re-direction into outpatient treatment structures. A precise analysis of ED utilization, taking into account treatment urgency, is essential for demand-oriented adjustments of emergency care structures.
Methods: Temporal and seasonal trends in the use of EDs were investigated, considering treatment urgency and hospital mortality. Secondary data of 287,119 ED visits between 2015 and 2017 of the two EDs of Charité UniversitÀtsmedizin Berlin, Campus Charité Mitte and Campus Virchow Klinikum were analyzed.
Result: EDs were used significantly more frequently on weekends than on weekdays (Mdn = 290 vs. 245 visits/day; p < 0.001). The proportion of less urgent, outpatient emergency visits on weekends was above average. Holiday periods were characterized by at least 6, and at most 176 additional ED visits. In a comparison of different holidays, most ED visits were observed at New Year (+68% above average). In addition, a significant increase in in-hospital mortality on holidays was evident among inpatients admitted to hospital via the ED (3.0 vs. 3.2%; p < 0.001), with New Year's Day being particularly striking (5.4%).
Conclusion: These results suggest that, in particular, the resource planning of outpatient emergency treatment capacities on weekends and holidays should be adapted to the increased volume of non-urgent visits in EDs. Nevertheless, treatment capacities for the care of urgent, inpatient emergencies should not be disregarded and further research projects are necessary to investigate the causes of increased mortality during holiday periods
Suitability of current definitions of ambulatory care sensitive conditions for research in emergency department patients: a secondary health data analysis
Objective: The aim of this study was to investigate the suitability of existing definitions of ambulatory care sensitive conditions (ACSC) in the setting of an emergency department (ED) by assessing ACSC prevalence in patients admitted to hospital after their ED stay. The secondary aim was to identify ACSC suitable for specific application in the ED setting.
Design: Observational clinical study with secondary health data.
Setting: Two EDs of the Charite-Universitatsmedizin Berlin.
Participants: All medical ED patients of the 'The Charite Emergency Medicine Study' (CHARITEM) study, who were admitted as inpatients during the 1-year study period (n=13 536).
Outcome measures: Prevalence of ACSC.
Results: Prevalence of ACSC in the study population differed significantly depending on the respective ACSC set used. Prevalence ranged between 19.1% (95% CI 18.4% to 19.8%; n=2586) using the definition by Albrecht et al and 36.6% (95% CI 35.8% to 37.5%; n=4960) using the definition of Naumann et al. (p<0.001). Overall ACSC prevalence (ie, when using all diagnoses used in any of the assessed ACSC-definitions) was 48.1% (95% CI 47.2% to 48.9%; n=6505). Some frequently observed diagnoses such as 'convulsion and epilepsy' (prevalence: 3.4%, 95% CI 3.1% to 3.7%; n=455), 'diseases of the urinary system' (prevalence: 1.4%; 95% CI 1.2% to 1.6%; n=191) or 'atrial fibrillation and flutter' (prevalence: 1.0%, 95% CI 0.8% to 1.2%, n=134) are not included in all of the current ACSC definitions.
Conclusions: The results highlight the need for an optimised, ED-specific ACSC definition. Particular ACSC diagnoses (such as 'convulsion and epilepsy' or 'diseases of the urinary system' and others) seem to be of special relevance in an ED population but are not included in all available ACSC definitions. Further research towards the development of a suitable and specific ACSC definition for research in the ED setting seems warranted
a qualitative study comparing urban and rural sites
Objectives: The increasing number of low-acuity visits to emergency
departments (ED) is an important issue in Germany, despite the fact that all
costs of inpatient and outpatient treatment are covered by mandatory health
insurance. We aimed to explore the motives of patients categorised with low-
acuity conditions for visiting an ED. Methods: We conducted a qualitative
study in two urban and one rural ED. We recruited a purposive sample of
adults, who were assigned to the lowest two categories in the Manchester
triage system. One-to-one interviews took place in the ED during patients'
waiting time for treatment. Interview transcripts were analysed using the
qualitative data management software MAXQDA. A qualitative content analysis
approach was taken to identify motives and to compare the rural with the urban
sites. Results: A total of 86 patients were asked to participate; of these,
n=15 declined participation and n=7 were excluded because they were admitted
as inpatients, leaving a final sample of 40 female and 24 male patients. We
identified three pathways leading to an ED visit: (1) without primary care
contact, (2) after unsuccessful attempts to see a resident specialist or
general practitioner (GP) and (3) recommendation to visit the ED by an
outpatient provider. The two essential motives were (1) convenience and (2)
health anxiety, triggered by time constraints and focused usage of
multidisciplinary medical care in a highly equipped setting. All participants
from the rural region were connected to a GP, whom they saw more or less
regularly, while more interviewees from the urban site did not have a
permanent GP. Still, motives to visit the ED were in general the same.
Conclusions: We conclude that the ED plays a pivotal role in ambulatory acute
care which needs to be recognised for adequate resource allocation. Trial
registration number: DRK S0000605
- âŠ