Messung der internen Kundenzufriedenheit betr. Facility Management-Leistungen in Spitälern – Vorschläge für die Praxis : ergänzende Publikation zu KenkaS – Kennzahlenkatalog für nicht-medizinische Supportleistungen in Spitälern

Das Messen von Kundenzufriedenheit für Facility Management-Leistungen im Gesundheitswesen [FM in HC] wurde bisher kaum durchgeführt, stellt aber ein Bedürfnis von FM-Verantwortlichen in Spitälern dar. Ziel war es deshalb, für alle Fachbereiche gemäss Leistungszuordnungsmodell für nicht-medizinische Supportleistungen in Spitälern [LemoS] eine möglichst einfache, standardisierte Grundlage zu schaffen, so dass der Aspekt der spitalinternen Kundenzufriedenheit in zukünftige Benchmarking-Initiativen einfliessen kann. In einem explorativen Ansatz wurden anhand von Literaturrecherchen Lösungen erarbeitet, welche in einer Expertenbefragung zwischenvalidiert wurden. Vorgestellt werden drei Befragungsintensitäten: Die 1. Stufe „Basic“ ist auf die drei Kernfragen der Zufriedenheitsforschung reduziert und bildet den Fokus dieses Working Papers. Die 2. Stufe “Service Barometer” beinhaltet die 19 Fragen des FM Service-Barometers. Die 3 Stufe „Customized“ wird auf den jeweiligen Fall zugeschnitten und abgestimmt. Mit den vorliegenden Vorschlägen liegen erste systematische Grundlagen für ein abgestimmtes Vorgehen von Kundenzufriedenheitsmessungen von FM in HC-Leistungen vor, welche durch den Einsatz in der Praxis und durch den Dialog mit Spitalpartnern (im Kontext mit Benchmarkinginitiativen) validiert werden sollen

Supplementary publication on KenkaS - Key performance catalogue for non-medical support services in hospitals Version 1.0 – based on German original

The measurement of customer satisfaction for facility management services in health care [FM in HC] has rarely been carried out until now, although it is clearly necessary for FM managers in hospitals. The aim was therefore to create, in accordance with the performance allocation model for non-medical support services in hospitals [LemoS], a standardized - and as simple as possible - basis for all departments, so that internal hospital customer satisfaction could be incorporated into future benchmarking initiatives. In an exploratory approach, solutions were developed based on literature research, which were validated in the interim by means of interviewing experts. Three surveying intensities are presented: The first level "Basic" is reduced to the three core questions of satisfaction research and forms the focus of this working paper. The second stage "Service Barometer" contains the 19 questions of the FM Service Barometer. The third level "Customized" is matched to the specific case. The proposals presented provide the first systematic basis for a coordinated approach of customer satisfaction measurements of FM in HC services. These proposals should be validated through use in practice and through dialogue with hospital partners (in the context of benchmarking initiatives)

Insulin gene polymorphisms in type I diabetes, Addison's disease and the polyglandular autoimmune syndrome type II

Background: Polymorphisms within the insulin gene can influence insulin expression in the pancreas and especially in the thymus, where self-antigens are processed, shaping the T cell repertoire into selftolerance, a process that protects from ß-cell autoimmunity. Methods: We investigated the role of the -2221Msp(C/T) and -23HphI(A/T) polymorphisms within the insulin gene in patients with a monoglandular autoimmune endocrine disease [patients with isolated type 1 diabetes (T1D, n = 317), Addison´s disease (AD, n = 107) or Hashimoto´s thyroiditis (HT, n = 61)], those with a polyglandular autoimmune syndrome type II (combination of T1D and/or AD with HT or GD, n = 62) as well as in healthy controls (HC, n = 275). Results: T1D patients carried significantly more often the homozygous genotype "CC" -2221Msp(C/T) and "AA" -23HphI(A/T) polymorphisms than the HC (78.5% vs. 66.2%, p = 0.0027 and 75.4% vs. 52.4%, p = 3.7 × 10-8, respectively). The distribution of insulin gene polymorphisms did not show significant differences between patients with AD, HT, or APS-II and HC. Conclusion: We demonstrate that the allele "C" of the -2221Msp(C/T) and "A" -23HphI(A/T) insulin gene polymorphisms confer susceptibility to T1D but not to isolated AD, HT or as a part of the APS-II

Xenotropic Murine Leukemia Virus–related Gammaretrovirus in Respiratory Tract

Xenotropic murine leukemia virus–related gammaretrovirus (XMRV) has been recently associated with prostate cancer and chronic fatigue syndrome. To identify nucleic acid sequences, we examined respiratory secretions by using PCR. XMRV-specific sequences were detected in 2%–3% of samples from 168 immunocompetent carriers and ≈10% of samples from 161 immunocompromised patients

Year-round under-ice research on MOSAiC using a remotely operated vehicle

To provide easy and reliable access to the underside of the sea-ice during the MOSAiC expedition, the Alfred-Wegener-Institute will operate its new remotely operated vehicle during the full duration of the drift directly from an access hole on the ice. The vehicle has proven its capabilities during several Arctic field campaigns and provides a stable sensor platform, as well as inspection and intervention capabilities. It has a maximum range of 300m from the designated access hole(s) and a depth rating of 100m. The ROV operations under sea ice will allow repeat measurements during the entire drift with little impact to the sea ice, the upper ocean, the ecosystem and other objects of interest. In the current setup, the vehicle comprises various video cameras, a still camera, single and multibeam bathymetric sonar, scanning sonar, a CTD, triplet fluorometer as well as sensors for hyperspectral irradiance, radiance, extinction, dissolved oxygen, pH and nitrate. The vehicle position is recorded by acoustic positioning tied into the floe fixed reference frame of all observations on the central observatory floe. Beyond this, the vehicle also provides several additional power outlets and data ports that allow connecting additional systems to the vehicle. Currently, the integration of a current profiler (ADCP), a zooplankton camera, different nets for zooplankton sampling, as well as a water sampling system are under development. All data are recorded, timestamped on site, and will be uploaded to an open data portal, which will be easily accessible for the scientific community. The main task of the vehicle will be repeated mapping of the spatial variability of the various parameters on a weekly basis. In addition, we plan to use it for deployment and retrieval of under-ice sensor packages and perform inspection and manipulation tasks. The ROV operations can easily be conducted by a small on-board sea-ice team due to the reliable and redundant system architecture. Altogether, measurements give a comprehensive picture of the spatio-temporal evolution of the sea-ice and its associated ecosystem. They link upper ocean dynamics with the thermodynamic and dynamic development of the ice cover. In combination with surface measurements, like aerial photography and terrestrial laser scanning, a full 3D characterization of the local ice cover will enable areal upscaling of the obtained results also using remote sensing data. Ideally these high resolution measurements at the MOSAiC central observatory will be extended with regular missions of an autonomous underwater vehicle (AUV), which can travel longer distances in spite of a small logistical footprint, to tie the local observations into the context of the larger spatial scale of the MOSAiC distributed measurement network

Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries

Objective: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler®+tiotropium (TIO) HandiHaler® vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). Methods: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden. Results: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8–15%. Sensitivity analyses showed that results were overall robust. Conclusion: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries.publishedVersio

Stamen-derived bioactive gibberellin is essential for male flower development of Cucurbita maxima L.

Gibberellin (GA) signalling during pumpkin male flower development is highly regulated, including biosynthetic, perception, and transduction pathways. GA 20-oxidases, 3-oxidases, and 2-oxidases catalyse the final part of GA synthesis. Additionally, 7-oxidase initiates this part of the pathway in some cucurbits including Cucurbita maxima L. (pumpkin). Expression patterns for these GA-oxidase-encoding genes were examined by competitive reverse transcription-PCR (RT-PCR) and endogenous GA levels were determined during pumpkin male flower development. In young flowers, GA20ox3 transcript levels are high in stamens, followed by high levels of the GA precursor GA9. Later, just before flower opening, transcript levels for GA3ox3 and GA3ox4 increase in the hypanthium and stamens, respectively. In the stamen, following GA3ox4 expression, bioactive GA4 levels rise dramatically. Accordingly, catabolic GA2ox2 and GA2ox3 transcript levels are low in developing flowers, and increase in mature flowers. Putative GA receptor GID1b and DELLA repressor GAIPb transcript levels do not change in developing flowers, but increase sharply in mature flowers. Emasculation arrests floral development completely and leads to abscission of premature flowers. Application of GA4 (but not of its precursors GA12-aldehyde or GA9) restores normal growth of emasculated flowers. These results indicate that de novo GA4 synthesis in the stamen is under control of GA20ox3 and GA3ox4 genes just before the rapid flower growth phase. Stamen-derived bioactive GA is essential and sufficient for male flower development, including the petal and the pedicel growth