PROMs im Akutspital : Erfahrungen und Erwartungen aus Patientensicht

Ausgangslage: Patient Reported Outcome Measures (PROMs) erfassen den individuell wahrgenommenen Wert oder Nutzen einer Behandlung aus Patientenperspektive. In der Schweiz gewinnen patientenrelevante Ergebnisparameter zur Evaluation von Behandlungen in den letzten Jahren zunehmend an Bedeutung. Sie nehmen in der Qualitätssicherung eine immer wichtigere Rolle ein. PROMs sind im unterschiedlichen Ausmass im Gesundheitssystem integriert. Heute messen vor allem einzelne Spitäler in der Schweiz PROMs, wie z.B. das Kantonsspital Winterthur. PROMs helfen, eine medizinische Versorgung auf die Bedürfnisse, Werte und Präferenzen von Patienten und Patientinnen auszurichten. Dies fördert die Arzt-Patienten-Beziehung und bildet die Grundlage, um gemeinsame Behandlungsentscheidungen zu treffen. Bisher fehlt es an Klarheit, ob PROMs dieses Versprechen halten und im klinischen Alltag praxistauglich sind. Die Anwendung von PROMs, wie z. B. im Arzt-Patienten-Gespräch, sind noch nicht ausreichend untersucht und es ist unklar, wie sich Patienten und Patientinnen den Einbezug von PROMs in ihre Versorgung vorstellen. Ziel: Das Ziel dieser Arbeit ist es, ein vertieftes Verständnis über die Erlebnisse und Erfahrungen aus Patientensicht im Akutspital mit der PROMs-Befragung zu erlangen. Erkenntnisse können wichtige Hinweise für die Implementierung von PROMs in der Gesundheitsversorgung liefern. Methodik: Für die Beantwortung der Fragestellungen werden leitfadengestützte Experteninterviews mit Patienten und Patientinnen im Kantonsspital Winterthur im Fachbereich Orthopädie durchgeführt. Erfahrungen und Erwartungen aus Patientensicht hinsichtlich ihrer Erlebnisse mit der Erhebung und der Anwendung von PROMs werden detailliert und umfassend untersucht. Resultate: Patienten und Patientinnen machen unterschiedliche Erfahrungen mit der Erhebung von PROMs. Mehr als die Hälfte schätzt es, mithilfe von PROMs ihren Gesundheitszustand zu reflektieren. Zudem wird PROMs als Hilfsmittel wahrgenommen, um sich auf die Konsultation vorzubereiten oder die selbst eingeschätzte Gesundheit dem Arzt in der Konsultation mitzuteilen. Jedoch glauben mehr als die Hälfte der befragten Personen, keinen Nutzen durch die Befragung zu erleben. Die Interviewpersonen glauben, dass PROMs eher für ärztliche Zwecke oder für Dokumentationszwecke erhoben werden als aus persönlichen Gründen. PROMs werden mehrheitlich nicht in die Konsultation einbezogen. Demnach bestanden auch wenige Erwartungen an die Erhebung und Anwendung von PROMs. Fazit: Patienten und Patientinnen sollen darüber informiert sein, dass die PROMs-Befragung ermöglicht, die eigene Wahrnehmung des Gesundheitszustandes einzuschätzen und mitzuteilen. Es ist wichtig, dass alle Beteiligten von der Relevanz und Bedeutung von PROMs überzeugt sind. PROMs sollen im Arzt-Patienten-Gespräch integriert sein, um Patienten und Patientinnen mit ihren Bedürfnissen in den Mittelpunkt der Versorgung zu stellen. Weitere Forschungen können sich auf den Einbezug von PROMs im Arzt- Patienten-Gespräch fokussieren und wie PROMs kommuniziert werden sollten

The importance of scientific competencies in German medical curricula - the student perspective

Background: Scientific competencies are of great importance for physicians; not only for conducting reliable research, but also for patient care. However, there is growing concern that a lack of scientific competencies among physicians may lead to a deterioration in the quality on biomedical research. This study aims at assessing medical students’ perspectives on the implementation of scientific competency training in German medical curricula. Methods: An online survey was conducted in order to collect German medical students’ opinions on the importance of acquiring scientific competencies during their medical studies and to provide us with an assessment of their current levels of basic scientific competencies by having them conduct a self-evaluation. Moreover, we wanted to understand their perceptions of current curricular content and to receive suggestions for improving scientific competency training. Participants were reached via the mailing lists of the German Medical Students’ Association, as well as of local medical student committees, and the German Medical Students’ Associations social media channel on Facebook. Results: In total, 2380 medical students from across all 37 German medical faculties participated in the survey. The majority of students agreed that the ability to critically evaluate the relevant literature is an important competency for physicians, and that every student should conduct a research project during their medical studies. However, the students evaluated their scientific competencies as unsatisfactory, especially with regard to statistics and scientific writing. They were strongly in favor of receiving extended research training. Conclusion: Our study provides insight into German medical students’ self-perception in relation to both patient care and biomedical research, and makes recommendations for potential improvements in scientific training. The study demonstrates that scientific competencies are of great importance to medical students in Germany. Students are not lacking motivation for scientific practice and have numerous ideas for enhancing scientific teaching opportunities. Scientific training should follow a holistic approach based on three pillars: (i) a scientific core curriculum, (ii) intracurricular research projects, and (iii) special research programs for students strongly interested in medical research

Allais for the poor

This paper complements evidence on the Allais paradox from advanced countries and educated people by a novel investigation in a poor rural area. The share of Allais-type behavior is indeed high and related to characteristics of 'lacking ability', such as poor education, unemployment, and little financial sophistication. Based on prospective reference theory, we extend these characteristics by biased processing of probabilistic information. Finally, we reveal that Allais-type behavior is linked to risk-related characteristics, such as risk tolerance and optimism. This indicates a potential problem as exactly the more dynamic among the poor tend to make inconsistent decisions under uncertainty

Comparative analysis of hypoxic response of human microvascular and umbilical vein endothelial cells in 2D and 3D cell culture systems

In vitro cultivation conditions play a crucial role in cell physiology and the cellular response to external stimuli. Oxygen concentrations represent an essential microenvironmental factor influencing cell physiology and behaviour both in vivo and in vitro. Therefore, new approaches are urgently needed to monitor and control oxygen concentrations in 2D and 3D cultures, as well as cell reactions to these concentrations. In this work, we modified two types of human endothelial cells–human microvascular (huMECs) and umbilical vein endothelial cells (huVECs) with genetically encoded hypoxia biosensors and monitored cell reactions in 2D to different oxygen concentrations. Moreover, we fabricated 3D cell spheroids of different cell numbers and sizes to reveal the onset of hypoxia in huVECs and huMECs. We could demonstrate a quantitative sensor response of two cell types to reduced oxygen supply in 2D and reveal different thresholds for hypoxic response. In 3D cell spheroids we could estimate critical construct sizes for the appearance of a hypoxic core. This work for the first time directly demonstrates different hypoxic signatures for huVECs and huMECs in 2D and 3D cell culture systems

Early Determinants of Childhood Blood Pressure at the Age of 6 Years:The GECKO Drenthe and ABCD Study Birth Cohorts

Background There is still uncertainty about the nature and relative impact of early determinants on childhood blood pressure. This study explored determinants of blood pressure at the age of 6 years in 2 Dutch birth cohorts. Methods and Results Results of hierarchical multiple linear regression analyses in GECKO (Groningen Expert Center for Kids With Obesity) Drenthe study (n=1613) were replicated in ABCD (Amsterdam Born Children and Their Development) study (n=2052). All analyses were adjusted for child's age, sex, height, and body mass index (BMI), and maternal education and subsequently performed in the combined sample. No associations were found between maternal smoking during pregnancy and childhood blood pressure. In the total sample, maternal prepregnancy BMI was positively associated with systolic blood pressure (SBP) (β [95% CI], 0.09 [0.02-0.16] mm Hg) and diastolic blood pressure (β [95% CI], 0.11 [0.04-0.17] mm Hg). Children of women with hypertension had higher SBP (β [95% CI], 0.98 [0.17-1.79] mm Hg). Birth weight standardized for gestational age was inversely associated with SBP (β [95% CI], -6.93 [-9.25 to -4.61] mm Hg) and diastolic blood pressure (β [95% CI], -3.65 [-5.70 to -1.61] mm Hg). Longer gestational age was associated with lower SBP (β [95% CI] per week, -0.25 [-0.42 to -0.08] mm Hg). Breastfeeding for 1 to 3 months was associated with lower SBP (β [95% CI], -0.96 [-1.82 to -0.09] mm Hg) compared with no or <1 month of breastfeeding. Early BMI gain from the age of 2 to 6 years was positively associated with SBP (β [95% CI], 0.41 [0.08-0.74] mm Hg) and diastolic blood pressure (β [95% CI], 0.37 [0.07-0.66] mm Hg), but no effect modification by birth weight was found. Conclusions Higher maternal prepregnancy BMI, maternal hypertension, a relatively lower birth weight for gestational age, shorter gestational age, limited duration of breastfeeding, and more rapid early BMI gain contribute to higher childhood blood pressure at the age of 6 years

Markov Chain Monte Carlo Estimation of Quantum States

We apply a Bayesian data analysis scheme known as the Markov Chain Monte Carlo (MCMC) to the tomographic reconstruction of quantum states. This method yields a vector, known as the Markov chain, which contains the full statistical information concerning all reconstruction parameters including their statistical correlations with no a priori assumptions as to the form of the distribution from which it has been obtained. From this vector can be derived, e. g. the marginal distributions and uncertainties of all model parameters and also of other quantities such as the purity of the reconstructed state. We demonstrate the utility of this scheme by reconstructing the Wigner function of phase-diffused squeezed states. These states posses non-Gaussian statistics and therefore represent a non-trivial case of tomographic reconstruction. We compare our results to those obtained through pure maximum-likelihood and Fisher information approaches.Comment: 8 pages, 8 figures. Accepted for publication in Phys. Rev.

Assessing Rationality in Discrete Choice Experiments in Health: An Investigation into the Use of Dominance Tests.

BACKGROUND: Dominance tests are often applied to test for the rationality in the choice behavior of participants in discrete choice experiments (DCEs). OBJECTIVES: To examine how dominance tests have been implemented in recent DCE applications in health and discuss their theoretical and empirical interpretation. METHODS: Health-related DCEs published in 2015 were reviewed for the inclusion of tests on choice behavior. For studies that implemented a dominance test, information on application and interpretation of the test was extracted. Authors were contacted for test choice sets and observed proportions of subjects who chose the dominated option. Coefficients corresponding to the choice set were extracted to estimate the expected probability of choosing the dominated option with a logistic model and compared with the observed proportion. The theoretical range of expected probabilities of possible dominance tests was calculated. RESULTS: Of 112 health-related DCEs, 49% included at least one test for choice behavior; 28 studies (25%) included a dominance test. The proportion of subjects in each study who chose the dominated option ranged from 0% to 21%. In 46% of the studies, the dominance test led to the exclusion of participants. In the 15 choice sets that were analyzed, 2 had larger proportions of participants choosing the dominated option than expected (P < 0.05). CONCLUSIONS: Although dominance tests are frequently applied in DCEs, there is no consensus on how to account for them in data analysis and interpretation. Comparison of expected and observed proportions of participants failing the test might be indicative of DCE quality

Status-quo-Analyse und regionale Eignungsprüfung bestehender Erfassungs-, Kommunikations- und Honorierungsansätze gesellschaftlicher Leistungen des Ökolandbaus

Der Ökolandbau leistet einen wichtigen Beitrag zu vielen ökologischen und sozialen gesellschaftlichen Zielen, die in den Nachhaltigkeitszielen der Vereinten Nationen („Sustainable Development Goals“ – SDGs) manifestiert sind (vgl. Dwyer et al. 2015). Einen wichtigen Ansatzpunkt für das regiosöl-Projekt bildet die Feststellung, dass der Ökolandbau aufgrund seines Systemansatzes mehrere ökologische Leistungen im Verbund erbringen kann und deshalb „die aggregierte Wirkung bei der Bewertung […] eine wichtige Rolle spielen sollte“ (Sanders & Heß, 2019). Soziale und kulturelle Leistungen werden gegenüber den ökologischen und ökonomischen Leistungen bislang vernachlässigt. Die Wirkungszusammenhänge der ökologischen Leistungen sind jedoch eng verflochten mit den vornehmlich sozialen Leistungen der Landwirtschaft. Zur Bewertung sozial-ökologischer Kriterien in der Landwirtschaft haben sich in den letzten Jahren verschiedene Bewertungssysteme entwickelt. Sie widmen sich aus einer jeweils eigenen Blickrichtung unterschiedlichen Kriterien und Ebenen. werden existierende Ansätze der Erfassung, Kommunikation und Honorierung analysiert, um die Lücken – insbesondere mit Blick auf soziale und regionale Leistungen des Ökolandbaus – zu identifizieren. Basierend auf dieser Status-quo-Analyse konkretisiert dieses erste Arbeitspapier die Zielsetzungen des regiosöl-Projektes. So sollen Ziele und Ansatzpunkte für die regiosöl-Ansätze der Erfassung, Kommunikation und Honorierung definiert werden

Interlaboratory study on rheological properties of cement pastes and reference substances: comparability of measurements performed with different rheometers and measurement geometries

This paper presents the results of an interlaboratory study of the rheological properties of cement paste and ultrasound gel as reference substance. The goal was to quantify the comparability and reproducibility of measurements of the Bingham parameters yield stress and plastic viscosity when measured on one specific paste composition and one particular ultrasound gel in different laboratories using different rheometers and measurement geometries. The procedures for both in preparing the cement paste and carrying out the rheological measurements on cement paste and ultrasound gel were carefully defined for all of the study’s participants. Different conversion schemes for comparing the results obtained with the different measurement setups are presented here and critically discussed. The procedure proposed in this paper ensured a reasonable comparability of the results with a coefficient of variation for the yield stress of 27% and for the plastic viscosity of 24%, despite the individual measurement series’ having been performed in different labs with different rheometers and measurement geometries

Protective immune trajectories in early viral containment of non-pneumonic SARS-CoV-2 infection

The antiviral immune response to SARS-CoV-2 infection can limit viral spread and prevent development of pneumonic COVID-19. However, the protective immunological response associated with successful viral containment in the upper airways remains unclear. Here, we combine a multi-omics approach with longitudinal sampling to reveal temporally resolved protective immune signatures in non-pneumonic and ambulatory SARS-CoV-2 infected patients and associate specific immune trajectories with upper airway viral containment. We see a distinct systemic rather than local immune state associated with viral containment, characterized by interferon stimulated gene (ISG) upregulation across circulating immune cell subsets in non-pneumonic SARS-CoV2 infection. We report reduced cytotoxic potential of Natural Killer (NK) and T cells, and an immune-modulatory monocyte phenotype associated with protective immunity in COVID-19. Together, we show protective immune trajectories in SARS-CoV2 infection, which have important implications for patient prognosis and the development of immunomodulatory therapies