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Sinn, Marianne, Christiane Pollich, Hanno Riess, et al. "GECAT - German Evaluation of Cancer Associated Thrombosis: A Prospective Register Trial for Patients with Active Cancer and Venous Thromboembolism (VTE) in Berlin." Blood 134, Supplement_1 (2019): 4969. http://dx.doi.org/10.1182/blood-2019-128166.
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Background: National and international guidelines for the diagnosis and treatment of cancer associated venous thromboembolism (CAT) recommend anticoagulation treatment for 3 to 6 months and a re-evaluation for resumption depending on the individual risk of every patient. In CAT low molecular weight heparin (LMWH) was estimated to be the most effective and safest treatment option in 2015. However, it remains unclear how cancer patients with VTE were (treated in clinical daily care in Germany. In former register trials, the specific characteristics of individual cancer patients were insufficiently characterized and inadequately discussed. Special aspects of daily care are lacking in most publications. Methods: The GECAT register was set up for Berlin´s two main hospital companies Charité-Universitaetsmedizin Berlin and Vivantes, (both covering about 50 % of the hospital beds in Berlin) to document prospectively patients with a newly diagnosed VTE . Patients with the diagnosis of cancer within 2 years prior to the VTE got basis documentation by a physician after informed consent. A follow up of these patients was scheduled after 3 and 6 months per telephone interview. Points of interest were: kind and location of the VTE event, diagnostic procedures, drug and dosage of initial and follow-up anti-coagulation treatment, relapse of VTE or bleeding complications, serious adverse events, mortality, and date and reason for determination of anticoagulation. Primary objective was to evaluate the treatment reality of patients with cancer associated VTE in clinical daily practice. Results: Between May 2015 and May 2017, 382 patients (pts) with active cancer within the last 2 years and newly diagnosed VTE gave consent to this register trial. 193 (50.5%) were female, median age was 65 years (range 19-89). For 133 pts (34.8%), VTE was the primary reason for admission at hospital, 34.3% were referred by their oncologist, 13,6% by their general practitioner, 15,5% by other treating physicians and 36.6% directly via the emergency department. 182 pts (47.6%) had pulmonary embolism, 268 pts (70.2%) had venous thrombosis and 18,6%71 pts (18.6%) had both. The most common cancer sites were lung (n=57, 14,9%), gynecological (n=44, 11,5%), colorectal (n=40, 10,5%) and pancreatic cancer (n=33 8,6%); 204 pts (56%) with solid tumors presented with stage IV diseases; 60 pts (15.7%) had hematological malignancies. 279 pts (73%) received anticancer treatments at the time of diagnosis of VTE. 148 (38.7%) pts died in the 6 months study period (20 pts died in hospital after admission, 90 pts within the first 3 months and 38 pts within the 6 months follow up). Initially, the majority of pts (n=350; 91.6%) was treated with LMWH. After discharge from hospital 78.7% remained on LMWH and 12.7% were treated with direct oral anticoagulants (DOACs). After 3 months 64.9% of pts received LMWH and 26.1% DOACs; after 6 months 48.4% LMWH and 44% DOACs. Responsible for the anticoagulation treatment decisions was mostly the oncologist (58%), followed by the general practitioner (26.3%) and other physicians (15,7%) . During the initial hospital stay, 2.6% of pts had a bleeding complication and 0.8% were diagnosed with a progress of VTE. At 6 months follow up, 6.4% reported bleeding complications and 2.4% recurrent VTE. Conclusion: The GECAT register trial gives new and clinically relevant information about the clinical daily care practice of cancer patients with newly diagnosed VTE in Berlin, Germany. The treating oncologist is in most cases responsible for the treatment. Disclosures Sinn: LEO: Research Funding; Bayer Healthcare AG: Research Funding; Servier: Honoraria, Research Funding; Astra Zeneca: Honoraria, Research Funding; Amgen: Honoraria; Sanofi: Honoraria. Scholz:Celgene: Consultancy; GILEAD: Consultancy, Speakers Bureau; Roche: Consultancy; Janssen-Cilag: Consultancy; Hexal: Consultancy; Novartis: Consultancy; Pfizer: Speakers Bureau; Takeda: Consultancy; Daiichi Sankio: Consultancy. Klamroth:Bayer, Biomarin, CSL Behring, Novo Nordisk, Octapharma, Pfizer, Roche, SOBI, Takeda: Consultancy; Bayer, Novo Nordisk, SOBI: Research Funding.
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Heuschmann, Peter U., Sarah Zweynert, Jan Sobesky, et al. "Effects of a Public Awareness Campaign on Time to and Way of Hospital Admission After Stroke." SAGE Open 11, no. 1 (2021): 215824402198927. http://dx.doi.org/10.1177/2158244021989275.
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Public education campaigns are recommended to increase awareness for stroke. The effect of a public advertising and education campaign in an urban region in Germany was assessed and compared with a control region. We hypothesized that such a campaign would increase the number of patients being admitted by emergency medical services (EMS). A multimedia campaign and targeted education of health care professionals and the public was employed in Berlin during six consecutive months to disseminate knowledge about stroke symptoms and appropriate actions to take. Data on time to hospital admission and details on transport were retrieved from registries for the episode before, during, and after the campaign. To test the effect of the campaign, it was compared with another urban region in Germany (Ruhr-Area), where no campaign had been conducted. Between January 2010 and February 2011, 9,166 patients with stroke or transient ischemic attack (TIA) were documented in Berlin and 9,994 in the Ruhr-Area. In both regions, following the campaign period, patients were more often admitted to hospital within the first 2 hr after onset (Berlin: odds ratio [OR] = 1.16, 95% confidence interval [CI] = [1.02, 1.32]; Ruhr-Area: OR = 1.18, 95% CI = [1.05, 1.34]). Patients were more likely being admitted via EMS after the campaign (Berlin: OR = 1.71, 95% CI = [1.50, 1.94]; Ruhr-Area: OR = 1.34, 95% CI = [1.17, 1.53]). The results suggest that an increased uptake of EMS triggered shorter time to hospital admission. A reduction in delay to hospitalization and an increased uptake of EMS were observed over the study period for both regions. No effect of the campaign was identified.
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Rodríguez-Farré, Eduardo, Marcel Roberfroid, and Giovanni N. Fracchia. "Research and Development of In Vitro Pharmacotoxicology: A European Perspective." Alternatives to Laboratory Animals 21, no. 2 (1993): 285–93. http://dx.doi.org/10.1177/026119299302100224.
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The experts taking part in the Workshop were: E. Rodríguez-Farré ( Coordinator); G.N. Fracchia, (Secretary); M. Adolphe, École des Hautes Études, Paris, France); P.H. Bach (University of East London, UK); M. Baeder (Hoechst Ltd, Hattersheira, Germany); R. Bass (BGA, Berlin, Germany); H.G. Baumgarten (Frei Universität, Berlin, Germany); H. Bazin (DGXII, CEC, Brussels, Belgium); P. Bentley (Ciba-Geigy, Basle, Switzerland); A. Boobis (Royal Postgraduate Medical School, London, UK); J. Castell (Hospital La Fé, Valencia, Spain); J.P. Contzen (DGXII, CEC, Brussels, Belgium); A. Cordier (Sandoz Pharma Ltd, Basle, Switzerland); J. Diezi (Université de Lausanne, Switzerland); L. Dubertret (INSERM U-312, Creteil, France); P.M. Fasella (DGXII, CEC, Brussels, Belgium); J.H. Fentem (FRAME, Nottingham, UK); A. Guillouzo (INSERM U-49, Rennes, France); I. Kimber (Zeneca, Macclesfield, UK); T. Krieg (Universität zu Koln, Germany); A. Mantovani (Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy); K. Miller (BIBRA, Carshalton, UK); J.P. Morin (INSERM U-295, Rouen, France); D. Paul (Fraunhofer Institut für Toxikologie und Aerosolforschung, Hannover, Germany); P.W.J. Peters (Riijkinstituut voor Volksgezondheid en Milieuhygiene, Bilthoven, The Netherlands); J. Picard (Faculté des Sciences, Louvain la Neuve, Belgium); D. Poggiolini (Ministry of Health, Rome, Italy); C.M. Regan (University College, Dublin, Ireland); C.A. Reinhardt (SIAT, Zurich, Switzerland); B. Robaire (McGill University, Montreal, Canada); M. Roberfroid (Université Catholique de Louvain, Brussels, Belgium); V. Rogiers (Vrije Universiteit Brussels, Belgium); J. Rueff (Istituto de Higiene e Medicina Tropical, Lisbon, Portugal); H. Spielmann (ZEBET, Berlin, Germany); H. Stolte (Medizinische Hochschule, Hannover, Germany); J. van Noordwijk (European Pharmacopeia Commission, Bosch en Duin, The Netherlands); E. Walum (University of Stockholm, Sweden); D.C. Williams (Trinity College, Dublin, Ireland); and M. Yaniv (Institut Pasteur, Paris, France), and their contributions are gratefully acknowledged.
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Moog, Rainer. "Professor Rainer Moog: Head of Blood Donation Service of Hospital Laboratory Network Brandenburg-Berlin, Germany." Transfusion and Apheresis Science 43, no. 2 (2010): 201. http://dx.doi.org/10.1016/j.transci.2010.07.018.
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Poggensee, Ulrich, and Dorit Schüler. "Rapid diagnosis of malaria with the QBC® system in a hospital in Berlin, Germany." Transactions of the Royal Society of Tropical Medicine and Hygiene 86, no. 1 (1992): 6. http://dx.doi.org/10.1016/0035-9203(92)90413-7.
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Aichberger, M. C., A. Heredia Montesinos, Z. Bromand, et al. "Suicide attempt rates and intervention effects in women of Turkish origin in Berlin." European Psychiatry 30, no. 4 (2015): 480–85. http://dx.doi.org/10.1016/j.eurpsy.2014.12.003.
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AbstractPurpose:Ethnic minority groups show elevated suicide attempt rates across Europe. Evidence suggests a similar trend for women of Turkish origin in Germany, yet data on suicidal behaviour in minorities in Germany is scarce. The objective was to examine rates of suicidal behaviour, underlying motives, and to explore the effectiveness of an intervention program.Methods:From 05/2009–09/2011, data on all suicide attempts among women of Turkish origin who presented at a hospital-based emergency unit in Berlin, Germany, were collected. A multi-modal intervention was conducted in 2010 and the effects of age, generation and the intervention on suicide attempt rates were examined.Results:At the start, the highest rate was found in women aged 18–24 years with 225.4 (95% CI = 208.8–242.0)/100,000. Adjustment disorder was the most prevalent diagnosis with 49.7% (n = 79), being more common in second-generation women (P = .004). Further analyses suggested an effect of the intervention in the youngest age group (trend change of ß = –1.25; P = .017).Conclusion:Our findings suggest a particularly high rate of suicide attempts by 18–24-year-old, second-generation women of Turkish origin in Berlin. Furthermore, our results suggest a trend change in suicide attempts in women aged 18–24 years related to a population-based intervention program.
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Märten, Angela, and Rachel Jenkins. "What could the future hold for treatment sequencing in cancer medicine? An interview with Angela Märten." Future Oncology 15, no. 25 (2019): 2891–93. http://dx.doi.org/10.2217/fon-2019-0176.
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Professor Angela Märten speaks to Rachel Jenkins, Commissioning Editor Angela Märten earned her PhD at Humboldt University of Berlin, Germany, in 2000, after working for several years as an oncology nurse. Upon completion of her PhD, she assumed responsibility for Phase I trials and translational research for the University Hospital of Bonn, Germany. In 2002, the University Hospital of Bonn appointed her as Assistant Professor for Experimental Haematology and Oncology. In 2003, she accepted a new position at the University of Heidelberg, Germany, heading the Immunotherapeutic Group and the Oncology Trial Department. The University of Heidelberg appointed her as Associate Professor in 2006 while she completed her Master of Sciences in Clinical Research in 2008. Professor Märten has been principal investigator of several clinical trials and has published more than 100 papers, with a particular focus on pancreatic carcinoma and lung cancer. She joined Boehringer Ingelheim in 2009, where she built up the German Medical Affairs Oncology team, before joining the Global Afatinib team in 2013. She is currently Global Senior Medical Advisor, Therapeutic Area of Oncology at Boehringer Ingelheim.
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David, M., A. M. Radke, and K. Pietzner. "The Prescription of the Morning-After Pill in a Berlin Emergency Department Over a Four-Year Period – User Profiles and Reasons for Use." Geburtshilfe und Frauenheilkunde 72, no. 05 (2012): 392–96. http://dx.doi.org/10.1055/s-0031-1298446.
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Questions: There are no current health care studies from Germany regarding the “morning-after pill”. This paper will use routine data to analyse details regarding the usersʼ profiles, reasons for using it and the utilisation of hospital outpatient facilities. Patient Collective and Methods: Retrospective analysis of all triage sheets in the emergency department of the Virchow Hospital Campus/Charité University Hospital, Berlin, over a four-year period from 2007 to 2010 that were coded with the ICD diagnosis Z30 (= contraception advice) and statistical processing of the associated administrative data. Results: 860 triage sheets were included in the analysis. The emergency department is used most frequently for the prescription of the “morning-after pill” at the weekend. The average age of the users was 25.1 years. The most common reason cited for needing emergency contraception was unprotected sexual intercourse, with the second-most common being “condom failure”. Around half of the women attended the department within 12 hours of having unprotected sex. Less than 2 % (n = 14) of all women decided against a prescription of emergency contraceptive after counselling. Conclusions: The user profile and reasons for using emergency oral contraception correlate largely with the information contained in international literature. Although the “morning-after pill” is probably prescribed mainly in general practices in Germany, and despite the availability of new drugs with a permitted post-exposure interval of up to 120 hours after unprotected sex, there appears to still be a high demand for counselling and prescriptions of the “morning-after pill” in the context of the emergency department.
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Maehle, Andreas-Holger. "Doctors in Court, Honour, and Professional Ethics: Two Scandals in Imperial Germany." Gesnerus 68, no. 1 (2011): 61–79. http://dx.doi.org/10.1163/22977953-06801004.
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Comparing two public medical affairs which involved disciplinary proceedings and libel actions, one from Bavaria and one from Prussia, this article analyzes the dynamics behind legal conflicts over doctors’ professional ethics in Imperial Germany. In both the case of Dr Maurice Hutzler, who com mitted suicide after conflicts with senior colleagues at the Gisela Children’s Hospital and a sentence of the court of honour of the Munich Medical District Society, and the Berlin “patient trade” affair, in which the medical professors Ernst von Leyden, Hermann Senator, Karl Anton Ewald and Carl Posner were accused of having made payments to middlemen for bringing them lucrative private patients, notions of personal and professional honour played a central role. The Munich case highlighted shortcomings of the Bavarian medical court of honour system, which was less developed than its Prussian counterpart. The analysis of the two cases suggests that the ethics of medical practice in early twentieth-century Germany should be viewed as part of a culture of honour.
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Kleinschmidt, M., T. Floeth, and M. Greuél. "The German “netzwerk psychische gesundheit”: Establishing home treatment for patients with severe chronic mental disorders from a systemic approach." European Psychiatry 26, S2 (2011): 547. http://dx.doi.org/10.1016/s0924-9338(11)72254-4.
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IntroductionHome treatment models in treating severe chronic mental disorders including crisis intervention show more and more evidence to offer an excellent alternative to hospital treatment. In Germany, having higher hospitalization rates than almost any other country in Europe, it is even more necessary to evaluate such alternative option to hospital treatment.Objective/aim of studyAfter establishing a home treatment model based on Swedish, Finnish and Italian experiences in cooperation with a big German health insurance in Berlin, we present data evaluation after the first year of implementation.Methods150 Patients out of a model region in Berlin being included in the first year of the project are evaluated with respect to their socio-demographic data and diagnostic spectrum, psychopathology ratings and quality of life assessments, as well as to health economic dimensions (different financial positions of spending economic treatment resources). Using an advanced statistical method of predictive modeling, we can compare the actual hospitalization rates to the statistically predicted ones.ResultsThere are predominantly patients with psychosis (50%), depressive disorders (30%) and BPD (15%). Actual hospitalization rates are extremely low compared to the statistical prediction. Health economic balance is difficult, mainly due to high starting expenses of a treatment setting which had to be built completely new.ImplicationsThe model in the meantime is being applied to the entire city of Berlin as well as to 4 other German counties (Schleswig-Holstein, Bremen, Bayern, Niedersachsen), other regions will follow shortly.
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Hoffmeister, Bodo. "Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany." Microorganisms 9, no. 9 (2021): 1941. http://dx.doi.org/10.3390/microorganisms9091941.
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Outcome of falciparum malaria is largely influenced by the standard of care provided, which in turn depends on the available medical resources. Worldwide, the COVID-19 pandemic has had a major impact on the availability of these resources, even in resource-rich healthcare systems such as Germany’s. The present study aimed to determine the under-explored factors associated with hospital length of stay (LOS) in imported falciparum malaria to identify potential targets for improving management. This retrospective observational study used multivariate Cox proportional hazard regression with time to discharge as an endpoint for adults hospitalized between 2001 and 2015 with imported falciparum malaria in the Charité University Hospital, Berlin. The median LOS of the 535 cases enrolled was 3 days (inter-quartile range, IQR, 3–4 days). The likelihood of being discharged by day 3 strongly decreased with severe malaria (hazard ratio, HR, 0.274; 95% Confidence interval, 95%CI: 0.190–0.396) and by 40% with each additional presenting complication (HR, 0.595; 95%CI: 0.510–0.694). The 55 (10.3%) severe cases required a median LOS of 7 days (IQR, 5–12 days). In multivariate analysis, occurrence of shock (adjusted HR, aHR, 0.438; 95%CI 0.220–0.873), acute pulmonary oedema or acute respiratory distress syndrome (aHR, 0.450; 95%CI: 0.223–0.874), and the need for renal replacement therapy (aHR, 0.170; 95%CI: 0.063–0.461) were independently associated with LOS. All patients survived to discharge. This study illustrates that favourable outcomes can be achieved with high-standard care in imported falciparum malaria. Early recognition of disease severity together with targeted supportive care can lead to avoidance of manifest organ failure, thereby potentially decreasing LOS and alleviating pressure on bed capacities.
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Velasco, Edward, Antina Ziegelmann, Tim Eckmanns, and Gérard Krause. "Eliciting views on antibiotic prescribing and resistance among hospital and outpatient care physicians in Berlin, Germany: results of a qualitative study." BMJ Open 2, no. 1 (2012): e000398. http://dx.doi.org/10.1136/bmjopen-2011-000398.
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Schreiter, Stefanie, Sascha Heidrich, Jamie Zulauf, et al. "Housing situation and healthcare for patients in a psychiatric centre in Berlin, Germany: a cross-sectional patient survey." BMJ Open 9, no. 12 (2019): e032576. http://dx.doi.org/10.1136/bmjopen-2019-032576.
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ObjectiveTo determine the housing situation among people seeking psychiatric treatment in relation to morbidity and service utilisation.DesignCross-sectional patient survey.SettingPsychiatric centre with a defined catchment area in Berlin, Germany, March–September 2016.Participants540 psychiatric inpatients including day clinics (43.2% of all admitted patients in the study period (n=1251)).Main outcome measuresHousing status 30 days prior the interview as well as influencing variables including service use, psychiatric morbidity and sociodemographic variables.ResultsIn our survey, 327 participants (68.7%) currently rented or owned an own apartment; 62 (13.0%) reported to be homeless (living on the street or in shelters for homeless or refugees); 87 (18.3%) were accommodated in sociotherapeutic facilities. Participants without an own apartment were more likely to be male and younger and to have a lower level of education. Homeless participants were diagnosed with a substance use disorder significantly more often (74.2%). Psychotic disorders were the highest among homeless participants (29.0%). Concerning service use, we did neither find a lower utilisation of ambulatory services nor a higher utilisation of hospital-based care among homeless participants.ConclusionsOur findings underline the need for effective housing for people with mental illness. Despite many sociotherapeutic facilities, a concerning number of people with mental illness is living in homelessness. Especially early interventions addressing substance use might prevent future homelessness.
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Haeusler, Karl Georg, Serdar Tütüncü, Claudia Kunze, et al. "Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry." EP Europace 21, no. 11 (2019): 1621–32. http://dx.doi.org/10.1093/europace/euz199.
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Abstract Aims The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. Methods and results This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively. Conclusion About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.
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Sayegh-Jodehl, Sabine, Rebecca Mukowski-Kickhöfel, Diane Linke, Claudia Müller-Birn, and Matthias Rose. "Use of Instant Messaging Software in a German Hospital—An Exploratory Investigation among Physicians." International Journal of Environmental Research and Public Health 19, no. 19 (2022): 12618. http://dx.doi.org/10.3390/ijerph191912618.
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Internationally, evidence exists that physicians use instant messaging services for communication tasks in everyday clinical practice However, there are only few data on physicians in Germany in this regard. Therefore, at the initiation of our project “DocTalk-Dialog meets Chatbot: Collaborative Learning and Teaching in the Process of Work”, we conducted a stakeholder survey with an exploratory research approach. The aim was to gain initial insights into use of instant messaging software and attitudes towards data security and advantages and disadvantages before implementing a data-secure in-house messaging platform. N = 70 physicians at Charité-Universitätsmedizin Berlin completed an exploratory questionnaire with closed and open-ended questions. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. The use of messenger software was not widespread in the sample studied. Physicians most frequently used face-to-face contact for communication. On average, up to ten instant messages were exchanged per day, mainly among colleagues, to answer mutual questions, and to send pictures. With a high awareness of privacy-related restrictions among participating physicians, advantages such as fast and uncomplicated communication were also highlighted. An instant messenger solution that complies with the German data protection guidelines is needed and should be investigated in more detail.
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Correia, Tânia Sofia Pereira, Maria Manuela F. P. S. Martins, Fernando F. Barroso, et al. "The Implications of Family Members’ Absence from Hospital Visits during the COVID-19 Pandemic: Nurses’ Perceptions." International Journal of Environmental Research and Public Health 19, no. 15 (2022): 8991. http://dx.doi.org/10.3390/ijerph19158991.
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Background: In response to the COVID-19 pandemic, several measures were taken to prevent the transmission of infection in the hospital environment, including the restriction of visits. Little is known about the consequences of these directives, but it is expected that they will have various implications. Thus, this study aimed to understand the consequences of measures to restrict visits to hospitalized individuals. Methods: A qualitative interpretive study was conducted through semistructured interviews with 10 nurses chosen by convenience. Content analysis was performed using Atlas.ti software, version 22 (Berlin, Germany). Results: Twenty-two categories and eight subcategories were identified and grouped according to their scope: implications for the patient, implications for the family, and implications for care practice. Conclusions: The identified categories of implications of restricting hospital visits (implications for patients, relatives, and care practices) are incomparably more negative than positive and have a strong potential to cause safety events in the short to long term, also jeopardizing the quality of care. There is the risk of stagnation and even setback due to this removal of families from the hospital environment, not only in terms of safety and quality of care but also with regard to person- and family-centered care.
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Moos, Merilyn. "Truth and the Novel." European Journal of Life Writing 1 (December 5, 2012): C8—C11. http://dx.doi.org/10.5463/ejlw.1.38.
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It was not till late middle age that I finally found out about my family’s past. My parents had hidden it with reason. I had been aware that ours was a particularly small family, but my father had told me - and it was a legend I embraced eagerly - that he had fled Nazi Germany because of his radical theatre activities, walking his way from Berlin to France. From Paris, my parents had come to London. It was when my mother, already in her 90s, went into hospital, that I got hold of their old letters and documents. The first letters I found lying on the table in the downstairs room, as if she had wanted me to read them. Grey bits of paper, thin as tissue, all crumpled up together, all in German. And so began my adventures into the tunnel of the past.
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Henke, Corinna C., Jan Cabri, Lothar Fricke, et al. "Strength and endurance training in the treatment of lung cancer patients staged IIIA/IIIB/IV." Journal of Clinical Oncology 30, no. 15_suppl (2012): 9033. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.9033.
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9033 Background: This RCT tested the effect of a specially designed strength and endurance training on the independence in activities of daily living and quality of life in lung cancer patients staged IIIA/IIIB/IV while receiving palliative chemotherapy. The aim was to break the vicious circle created through the connection of physical inactivity and the worsening of symptoms and side effects. Methods: Between August 2010 and December 2011 lung cancer patients staged IIIA/IIIB/IV with a good performance status receiving an inpatient palliative chemotherapy treatment at the Vivantes Hospital Neukölln/Berlin, were randomized into an intervention and control group. The Barthel Index and the EORTC QLQ-C30/ LC13 questionnaire were used for evaluation. The Six-Minute-Walk-Test and stair walking in combination with the Modified Borg Scale have been used to test the patient’s endurance capacity. Furthermore muscle strength was examined. Non-parametrical data were statistically analyzed with the Wilcoxon and Mann-Whitney-U test. For parametric data student t- tests were used. A significance level of p< .05 was accepted. Results: Out of 46 patients, who signed the informed consent, 29 patients completed the trial (18= Intervention group, 11= Control group). Significant differences between the groups were detectable in the Barthel Index (IGmean(SD)=92.08 (15.15); CGmean=81.67 (14.98); p=.041), and in single scores of the EORTC QLQ C-30/LC-13 questionnaire (Physical Functioning p=.025; Haemoptysis p=.019, Pain in Arms or Shoulder p=.048, Peripheral Neuropathy p=.050, Cognitive functioning p=.050). Significant differences were found between the groups concerning the 6MWT, stair walking and strength capacity (IG>CG). Additionally the level of dyspnoea decreased significantly in the IG while performing submaximal walking activities. Conclusions: The training program has a positive impact on the patient’s independence in carrying out activities of daily living. Although it does not have a significant impact on the patient’s quality of life, single factors can be significantly improved. Moreover it has a positive effect on the patient’s endurance and strength capacity. The dyspnoea perception is improved.
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Spackova, Michaela, Doris Altmann, Tim Eckmanns, Judith Koch, and Gerard Krause. "High Level of Gastrointestinal Nosocomial Infections in the German Surveillance System, 2002–2008." Infection Control & Hospital Epidemiology 31, no. 12 (2010): 1273–78. http://dx.doi.org/10.1086/657133.
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Objective.Surveillance of nosocomial infections (NIs) is well established in many countries but often does not include gastrointestinal infections. We sought to determine the proportion of NIs among all hospitalized cases for the 4 most prevalent types of gastrointestinal infections in Germany.Methods.We analyzed all notifications of laboratory-confirmed or epidemiologically linked gastrointestinal infections due to norovirus, rotavirus,Salmonellaspecies, andCampylobacterspecies reported to the Robert Koch Institute in Berlin, Germany, from 2002 through 2008. Infections were considered nosocomial if disease onset was more than 2 days after hospitalization for norovirus, rotavirus, andSalmonellainfection and more than 5 days after hospitalization forCampylobacterinfection.Results.During the study period, 710,725 norovirus, 394,500 rotavirus, 395,736Salmonella, and 405,234Campylobactergastrointestinal infections were reported. Excluding cases for which nosocomial status could not be determined, we identified 39,424 (49%) of 80,650 norovirus, 11,592 (14%) of 83,451 rotavirus, 3,432 (8%) of 43,348Salmonella, and 645 (2%) of 33,503Campylobactergastrointestinal infections as definite nosocomial cases. Multivariate analysis confirmed higher risk of gastrointestinal NIs for patients aged more than 70 years (relative risk [RR], 7.0 [95% confidence interval {CI}, 6.7–7.2];P< .001) and residents of western states (RR, 1.3 [95% CI, 1.2–1.3];P< .001) and lower risk for female patients (RR, 0.9 [95% CI, 0.9–0.9;P< .001). Yearly NI proportions remained stable except for norovirus.Conclusions.The investigated gastrointestinal NIs in Germany do not show a clear trend, but they are at high level, revealing potential for public health action and improvement of hospital infection control mainly among older patients. National prevalence studies on gastrointestinal NIs would be of additional value to give more insight on how and where to improve hospital infection control.
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Weiss, Björn, Fridtjof Schiefenhövel, Julius J. Grunow, et al. "Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study." Journal of Clinical Medicine 10, no. 13 (2021): 2908. http://dx.doi.org/10.3390/jcm10132908.
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Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol. Methods: This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents. Results: One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031). Conclusion: Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
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Olkowski, Roman. "FORGOTTEN HERO: JAN MORAWIŃSKI (1907–1949). PART TWO." Muzealnictwo 63 (August 4, 2022): 95–105. http://dx.doi.org/10.5604/01.3001.0015.9467.
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Having been discharged from hospital in January 1945, Jan Morawiński became a curator at a new Branch of the National Museum in Warsaw. His main task was guardianship of the collection and Palace’s preservation. On 13 January 1946, Morawiński left for Berlin’s Polish Military Mission as a specialist in restituting Polish cultural assets from Germany. Morawiński’s scope of activities covered first of all the issues of the restitution of Polish cultural assets, acquisition of Polonica from German collections, and purchase of art works. In the course of his mission he operated mainly within the British occupation zone in Germany. The Polish claims submitted by Morawiński to the British were related mainly to the Grasleben depository and the bells amassed in Hamburg. After months-long efforts, he succeeded in leaving for Hamburg in order to ascertain the presence of about a thousand bells of Polish provenance there. Furthermore, Morawiński operated within the Soviet occupation zone. In Saxony’s Nossen he discovered nine paintings which had come from Cracow. One of his greatest successes was to win the permission of the English to recover the archival resources originally from Gdansk, Elbląg, Szczecin, and Toruń. With the financing provided by the Ministry of Culture and Art he purchased, among others, the painting by Teodor Lubieniecki Family in the Park Background, a cup of Augustus II (1698), and two etchings featuring John III Sobieski. Having finished his Berlin assignment, he became head of the Polish Military Mission in the French occupation zone in Germany. In May 1949, he returned to Poland to become a Cultural Counselor at Poland’s Embassy in Rome. Morawiński died suddenly in Warsaw on 13 December 1949.
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Carvajal, Theodore M. "Tomas C. Carvajal, MD (1936 - 2013)." Philippine Journal of Otolaryngology-Head and Neck Surgery 28, no. 1 (2013): 44. http://dx.doi.org/10.32412/pjohns.v28i1.513.
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“My Mentor… My Inspiration… My Dad”
 
 “The righteous who walks in his integrity—blessed are his children after him! ”
 Proverbs 20:7 
 
 Dr. Tomas Carvajal at 76 years old, had practiced for over 40 years as an Emeritus Consultant at Our Lady of Lourdes Hospital in Sta. Mesa, Manila, where he started his Residency Training. Early on, he learned to love the ENT specialty and underwent preceptorship under the wing of Dr. Ariston Bautista. At that time, there was no training program in the Philippines. He went abroad and was accepted to train in Berlin, Germany at the Rodolf Virchow Krankenhaus Department of Ear Nose and Throat under Professor Peffniz. After his training in Germany, to further hone his knowledge and skills, he underwent post graduate training at the Royal National Ear, Nose and Throat Hospital in London, England and Wakayama Medical Center in Osaka, Japan specializing in Nasal Allergy.
 On returning to Manila, he was invited to be an Assistant Professor in Otorhinolaryngology at the Far Eastern University – College of Medicine and a Consultant at the FEU Hospital then in Morayta, Manila. He was also appointed Medical Specialist Examiner under the then Ministry of Health. Later, he became the first Chairman of the Department of Ear Nose Throat – Head and Neck Surgery (1986-1993) at the FEU Hospital. During the same time he was also Chairman at the Quirino Medical Center Department of Eye Ear Nose and Throat (EENT).
 Since then he had helped a lot of people-- including colleagues, friends and neighbors, and he was thus invited by former President Erap Estrada and Senator Jinggoy Estrada to run for city councilor in San Juan City where he served for two consecutive terms (2000-2006).
 My father lived a fruitful and blessed life. He was loved and praised by everyone. It was he who inspired me to become an ENT doctor, it was he who guided me, giving me pointers during my residency training, and it was he who taught me too about LIFE….
 “Thank you Dad!”
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Hoffmann, Christina, Uta Liebers, Philipp Humbsch, et al. "An adaptation strategy to urban heat: hospital rooms with radiant cooling accelerate patient recovery." ERJ Open Research 7, no. 3 (2021): 00881–2020. http://dx.doi.org/10.1183/23120541.00881-2020.
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BackgroundPatients with respiratory diseases are vulnerable to the effects of heat. Therefore, it is important to develop adaptation strategies for heat exposure. One option is to optimise the indoor environment. To this end, we equipped hospital patient rooms with radiant cooling. We performed a prospective randomised clinical trial to investigate potentially beneficial effects of the hospitalisation in rooms with radiant cooling on patients with a respiratory disease exacerbation.MethodsRecruitment took place in June, July and August 2014 to 2016 in the Charité – Universitätsmedizin Berlin, Germany. We included patients with COPD, asthma, pulmonary hypertension, interstitial lung disease and pneumonia. 62 patients were allocated to either a standard patient room without air conditioning or a room with radiant cooling set to 23°C (73°F). We analysed the patients’ length of stay with a Poisson regression. Physiological parameters, fluid intake and daily step counts were tested with mixed regression models.ResultsPatients hospitalised in a room with radiant cooling were discharged earlier than patients in standard rooms (p=0.003). The study participants in chambers with radiant cooling had a lower body temperature (p=0.002), lower daily fluid intake (p<0.001), higher systolic blood pressure (p<0.001) and an increased daily step count (p<0.001).ConclusionThe results indicate that a radiant cooling system in hospital patient rooms provides clinical benefits for patients with respiratory disease exacerbations during the warm summer months, which may contribute to an earlier mobilisation. Radiant cooling is commended as a suitable adaptation strategy to reduce the clinical impact of climate warming.
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Correia, Tânia S. P., Maria Manuela F. P. S. Martins, Fernando F. Barroso, et al. "Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members." Journal of Personalized Medicine 12, no. 10 (2022): 1546. http://dx.doi.org/10.3390/jpm12101546.
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Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.
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Hoffmeister, Bodo, and Abner D. Aguilar Valdez. "‘Run them dry’: a retrospective experience with a restrictive fluid management strategy in severe imported falciparum malaria from a tertiary care university hospital in Berlin, Germany." Transactions of The Royal Society of Tropical Medicine and Hygiene 115, no. 5 (2021): 520–30. http://dx.doi.org/10.1093/trstmh/trab027.
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Abstract Background Due to the unique pathophysiology with progressive mircocirculatory obstruction and simultaneously increased vascular permeability, overhydration can be rapidly harmful in patients with falciparum malaria. The outcome in all 558 cases hospitalised during 2001–2015 in the Charité University Hospital, Berlin, was favourable, independent of the antimalarial used. Here, the fluid management strategy in the most severely affected subgroup is examined. Methods All fluids in 32 patients requiring treatment on intensive care units (ICUs) for &gt;48 h were retrospectively quantified. All malaria-specific complications were followed up over the whole ICU stay. Results Strong linear relationships between fluid intake and positive balances reflecting dehydration and increased vascular permeability were evident over the whole stay. With 2.2 (range: 0.7–6.9), 1.8 (0.6–6.1) and 1.3 (0.3–5.0) mL/kg/h on day 1, day 2 and over the remaining ICU stay, respectively, median fluid volumes remained below the actual WHO recommendations. No evidence for deterioration of any malaria-specific complication under such restrictive fluid management was found. The key prognostic parameter metabolic acidosis improved significantly over 48 h (p=0.02). All patients survived to discharge. Conclusions These results suggest that in the face of markedly increased vascular permeability, a restrictive fluid management strategy is clinically safe in adults with severe imported falciparum malaria.
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Valenzuela-Rodríguez, Germán V., Alfonso J. Rodriguez-Morales, Roxana Mamani-Quiroz, et al. "Factores de riesgo cardiovascular y evolución de pacientes con COVID-19 atendidos en un Hospital Nacional de Referencia de Lima, P." Revista Peruana de Investigación en Salud 5, no. 3 (2021): 195–200. http://dx.doi.org/10.35839/repis.5.3.1071.
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Introduction: Coronavirus disease 2019 (COVID-19) fatal outcomes have been associated with multiple cardiovascular risk factors. In new epidemic areas, such as Latin America, there is a lack of studies about this. Objectives: To evaluate demographic data, signs and symptoms during emergency arrival, prevalence of cardiovascular risk factors, laboratory and ECG findings and their influence in mortality, in a retrospective cohort of patients in a national reference hospital of Lima, Peru. Methods: Review the clinical records of the patients attended at Hospital Rebagliati Hospital during March 6th and April 30th, 2020, using rRT-PCR was used for the detection of the RNA of SARS-CoV-2 following the protocol Charité, Berlin, Germany, from nasopharyngeal swabs at the National Institute of Health. Bivariate analysis and multivariate analysis using logistic regression was done. Values of p < 0.05 were considered significant for all analyses. Results: One hundred six hospitalized patients were evaluated. The mean age of patients was 61.58 years (SD 16.81). Cardiovascular risk factors among them were hypertension (46.2%), diabetes (28.3%), and obesity (28.3%), among others. Fifty-six patients died (52.8%). Mortality associated factors at the multivariate analysis were arterial hypertension (OR=1.343, 95% 1.089-1.667), myocardial injury (OR=1.303, 95% 1.031-1.642), and mechanical ventilation (OR 1.262, 95% 1.034-1.665), as associated factors. Conclusion: Cardiovascular risk factors and cardiovascular signs or symptoms are common during emergency arrival in patients with COVID-19. Arterial hypertension, myocardial injury and mechanical ventilation were associated with mortality in multivariate analysis, as observed in other regions of the world.
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Kosian, Philipp, Wolfgang Henrich, Michael Entezami, and Alexander Weichert. "Furcate insertion of the umbilical cord: pathological and clinical characteristics in 132 cases." Journal of Perinatal Medicine 48, no. 8 (2020): 819–24. http://dx.doi.org/10.1515/jpm-2019-0459.
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AbstractObjectivesFurcate cord insertion is a rare abnormality affecting approximately 0.1% of all pregnancies. Macroscopically, the umbilical vessels separate before reaching the placenta, lose their Wharton’s jelly, and insert at the placenta centrally, eccentrically, or marginally. The aim of this retrospective study was to determine the prevalence of furcate cord insertion more accurately, the pathological characteristics, and clinical outcomes.MethodsWe conducted a retrospective study of 132 cases of furcate insertion of the umbilical cord using the pathological database of the Charité University Hospital Berlin, Germany, between 1993 and 2016. This included 99 cases, including one termination of pregnancy within our institution and 33 cases from external hospitals. An analysis of the pathological features of the 132 cases and the perinatal outcome of the 98 cases within our institution were performed.ResultsFurcate cord insertion occurred in 0.16% pregnancies. Of the 132 cases, seven cases of intrauterine fetal deaths were observed. Three of those could be linked to the furcate cord insertion. In two of those cases, single umbilical vessel rupture was identified as the cause of fetal death.ConclusionsIn most cases of furcate cord insertion, the outcome is good; however, intrauterine fetal death occurs in approximately 1.02% of cases.
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Diefenbacher, A., and J. J. Strain. "Effects of Somatopsychic Comorbidity on Lagtime and Length of Stay in Patients Referred to a Psychiatric Consultation Service in Germany." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70619-4.
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It is not clear whether psychiatric comorbidity in medically ill patients contributes to longer lengths of hospital stay (LOS), and whether interventions carried out by psychiatric consultation-liaison (c-l) services lead to a reduction of LOS. Furthermore, the lagtime paradigm, i.e. the notion that the earlier a psychiatric consultation takes place, the shorter LOS of the resp. patients are, has been questioned. To study if different degrees of somatopsychic comorbidity have effects upon Lagtime and LOS of patients seen by a c-l-psychiatric service. Patients consecutively referred to a c-l-service in Berlin during a one year study period were categorized into six groups of different somatopsychic comorbidity using a count-approach based upon ICD-10 psychiatric, and ICD-9 somatic diagnoses. The groups with more psychiatric than somatic diagnoses show shorter LOS and shorter Lagtimes. Patients with only psychiatric diagnoses overall show the shortest average LOS and Lagtime. For the groups, however, with more somatic than psychiatric diagnoses, LOS and lagtimes are longer. In the groups with equal numbers of psychiatric and somatic diagnoses, there is a trend with higher numbers of somatic diagnoses showing longer LOS and Lagtimes. On the other hand, in both groups with 2 and more somatic diagnoses, a trend can be seen toward shorter LOS and Lagtimes in such patients with more than 1 psychiatric diagnosis. Psychiatric comorbidity in medically ill patients does not sufficiently explain differences in LOS and Lagtime of patients seen in psychiatric c-l-services, but a complex interplay of somatopsychic comorbidity has to be taken into account.
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Diefenbacher, A., and J. J. Strain. "Effects of Somatopsychic Comorbidity on Lagtime and Length of Stay in Patients Referred to a Psychiatric Consultation Service in Germany." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71136-8.
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It is not clear whether psychiatric comorbidity in medically ill patients contributes to longer lengths of hospital stay (LOS), and whether interventions carried out by psychiatric consultation-liaison (c-l) services lead to a reduction of LOS. Furthermore, the lagtime paradigm, i.e. the notion that the earlier a psychiatric consultation takes place, the shorter LOS of the resp. patients are, has been questioned. To study if different degrees of somatopsychic comorbidity have effects upon Lagtime and LOS of patients seen by a c-l-psychiatric service. Patients consecutively referred to a c-l-service in Berlin during a one year study period were categorized into six groups of different somatopsychic comorbidity using a count-approach based upon ICD-10 psychiatric, and ICD-9 somatic diagnoses. The groups with more psychiatric than somatic diagnoses show shorter LOS and shorter Lagtimes. Patients with only psychiatric diagnoses overall show the shortest average LOS and Lagtime. For the groups, however, with more somatic than psychiatric diagnoses, LOS and lagtimes are longer. In the groups with equal numbers of psychiatric and somatic diagnoses, there is a trend with higher numbers of somatic diagnoses showing longer LOS and Lagtimes. On the other hand, in both groups with 2 and more somatic diagnoses, a trend can be seen toward shorter LOS and Lagtimes in such patients with more than 1 psychiatric diagnosis. Psychiatric comorbidity in medically ill patients does not sufficiently explain differences in LOS and Lagtime of patients seen in psychiatric c-l-services, but a complex interplay of somatopsychic comorbidity has to be taken into account.
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Obermeier, Patrick E., Lea D. Seeber, Maren Alchikh, Brunhilde Schweiger, and Barbara A. Rath. "Incidence, Disease Severity, and Follow-Up of Influenza A/A, A/B, and B/B Virus Dual Infections in Children: A Hospital-Based Digital Surveillance Program." Viruses 14, no. 3 (2022): 603. http://dx.doi.org/10.3390/v14030603.
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Influenza virus (IV) coinfection, i.e., simultaneous infection with IV and other viruses, is a common occurrence in humans. However, little is known about the incidence and clinical impact of coinfection with two different IV subtypes or lineages (“dual infections”). We report the incidence, standardized disease severity, and follow-up of IV dual infections from a hospital-based digital surveillance cohort, comprising 6073 pediatric patients fulfilling pre-defined criteria of influenza-like illness in Berlin, Germany. All patients were tested for IV A/B by PCR, including subtypes/lineages. We assessed all patients at the bedside using the mobile ViVI ScoreApp, providing a validated disease severity score in real-time. IV-positive patients underwent follow-up assessments until resolution of symptoms. Overall, IV dual infections were rare (4/6073 cases; 0.07%, incidence 12/100,000 per year) but showed unusual and/or prolonged clinical presentations with slightly above-average disease severity. We observed viral rebound, serial infection, and B/Yamagata-B/Victoria dual infection. Digital tools, used for instant clinical assessments at the bedside, combined with baseline/follow-up virologic investigation, help identify coinfections in cases of prolonged and/or complicated course of illness. Infection with one IV does not necessarily prevent consecutive or simultaneous (co-/dual) infection, highlighting the importance of multivalent influenza vaccination and enhanced digital clinical and virological surveillance.
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Geisler, Frederik, Syed F. Ali, Martin Ebinger, et al. "Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients." International Journal of Stroke 14, no. 4 (2018): 400–408. http://dx.doi.org/10.1177/1747493018806194.
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Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany. We investigated whether the TM-score (comprising six parameters), Face Arm Speech Time test, and individual patient characteristics were able to differentiate cerebrovascular disease from stroke mimic patients. Results We included 423 patients (299 (70.7%) cerebrovascular disease and 124 (29.3%) stroke mimic) in the final analysis. A TM-score > 30 indicated a high probability of a cerebrovascular disease and a score ≤15 of a stroke mimic. The TM-score performed well to identify stroke mimics (area under the curve of 0.74 under receiver-operating characteristic curve analysis). The cerebrovascular disease patients were older (74.8 vs. 69.8 years, p = 0.001), had more often severe strokes (NIHSS > 14 25.8% vs. 11.3%, p = 0.001), presented more often with weakness of the face (70.9% vs. 42.7%, p = 0.001) or arm (60.9% vs. 33.9%, p = 0.001), dysarthria (59.5% vs. 40.3%, p < 0.001), history of atrial fibrillation (38.1% vs. 21.0%, p = 0.001), arterial hypertension (78.9% vs. 53.2%, p < 0.001), and less often with seizure (0.7% vs. 21.0%, p < 0.001). Conclusions The TM-score and certain patient characteristics can help paramedics and emergency physicians in the field to identify stroke mimic patients and select the most appropriate hospital destination.
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Boxall, Nicole, Matthias David, Elisabeth Schalinski, Jürgen Breckenkamp, Oliver Razum, and Lars Hellmeyer. "Perinatal Outcome in Women with a Vietnamese Migration Background – Retrospective Comparative Data Analysis of 3000 Deliveries." Geburtshilfe und Frauenheilkunde 78, no. 07 (2018): 697–706. http://dx.doi.org/10.1055/a-0636-4224.
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Abstract Introduction Perinatal data of women with a Vietnamese migration background have not been systematically studied in Germany to date. Numerous details of important maternal and child outcomes were compared and analysed. The studyʼs primary parameters were the frequency of and indication for c-section. Methodology The perinatal data from a Berlin hospital were analysed retrospectively. The women (Vietnamese migration background vs. autochthonous) were grouped using name analysis. Datasets of 3002 women giving birth, including 999 women with a Vietnamese migration background, were included. The associations between primary or secondary cesarean delivery and different child outcomes depending on the migration background (exposure) were studied using logistical regression analysis. Results Women with a Vietnamese migration background have a lower c-section rate of 8.0% for primary and 12.6% for secondary c-section than women without a migration background (11.1% primary and 16.4% secondary c-section respectively). Regression analysis shows that the odds that women with a Vietnamese migration background will have a primary (OR 0.75; p = 0.0884) or secondary c-section (OR 0.82; p = 0.1137) are not significantly lower. A Vietnamese migration background was associated with higher odds for an episiotomy but not for a grade 3 – 4 perineal tear. A Vietnamese migration background does not have a significant influence on poor 5-min Apgar scores ≤ 7 and low umbilical cord arterial pH values ≤ 7.10. Newborns of mothers with a Vietnamese migration background have higher odds of a relatively higher birth weight (> 3110 g). Summary There was no evidence that women with a Vietnamese migration background are delivered more often by caesarean section. There were also no differences as regards important child outcome data from women in the comparator group. Overall, the results do not provide any evidence for poorer quality of care of women with a Vietnamese migration background in Berlin despite the cultural and communication barriers in the reality of care provision.
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Doulamis, Anastasios, Nikolaos Doulamis, Aikaterini Angeli, et al. "A Non-Invasive Photonics-Based Device for Monitoring of Diabetic Foot Ulcers: Architectural/Sensorial Components & Technical Specifications." Inventions 6, no. 2 (2021): 27. http://dx.doi.org/10.3390/inventions6020027.
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This paper proposes a new photonic-based non-invasive device for managing of Diabetic Foot Ulcers (DFUs) for people suffering from diabetes. DFUs are one of the main severe complications of diabetes, which may lead to major disabilities, such as foot amputation, or even to the death. The proposed device exploits hyperspectral (HSI) and thermal imaging to measure the status of an ulcer, in contrast to the current practice where invasive biopsies are often applied. In particular, these two photonic-based imaging techniques can estimate the biomarkers of oxyhaemoglobin (HbO2) and deoxyhaemoglobin (Hb), through which the Peripheral Oxygen Saturation (SpO2) and Tissue Oxygen Saturation (StO2) is computed. These factors are very important for the early prediction and prognosis of a DFU. The device is implemented at two editions: the in-home edition suitable for patients and the PRO (professional) edition for the medical staff. The latter is equipped with active photonic tools, such as tuneable diodes, to permit detailed diagnosis and treatment of an ulcer and its progress. The device is enriched with embedding signal processing tools for noise removal and enhancing pixel accuracy using super resolution schemes. In addition, a machine learning framework is adopted, through deep learning structures, to assist the doctors and the patients in understanding the effect of the biomarkers on DFU. The device is to be validated at large scales at three European hospitals (Charité–University Hospital in Berlin, Germany; Attikon in Athens, Greece, and Victor Babes in Timisoara, Romania) for its efficiency and performance.
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Roll, Stephanie, Marc Nocon, and Stefan N. Willich. "Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial." British Journal of Nutrition 105, no. 1 (2010): 118–22. http://dx.doi.org/10.1017/s000711451000317x.
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Dietary supplements have been suggested in the prevention of the common cold, but previous investigations have been inconsistent. The present study was designed to determine the preventive effect of a dietary supplement from fruits and vegetables on common cold symptoms. In a randomised, double-blind, placebo-controlled trial, healthcare professionals (mainly nursing staff aged 18–65 years) from a university hospital in Berlin, Germany, were randomised to four capsules of dietary supplement (Juice Plus+®) or matching placebo daily for 8 months, including a 2-month run-in period. The number of days with moderate or severe common cold symptoms within 6 months (primary outcome) was assessed by diary self-reports. We determined means and 95 % CI, and differences between the two groups were analysed by ANOVA. A total of 529 subjects were included into the primary analysis (Juice Plus+®: 263, placebo: 266). The mean age of the participants was 39·9 (sd 10·3) years, and 80 % of the participants were female. The mean number of days with moderate or severe common cold symptoms was 7·6 (95 % CI 6·5, 8·8) in the Juice Plus+® group and 9·5 (8·4, 10·6) in the placebo group (P = 0·023). The mean number of total days with any common cold symptoms was similar in the Juice Plus+® and in the placebo groups (29·4 (25·8, 33·0) v. 30·7 (27·1, 34·3), P = 0·616). Intake of a dietary supplement from fruits and vegetables was associated with a 20 % reduction of moderate or severe common cold symptom days in healthcare professionals particularly exposed to patient contact.
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Herges, Katja. "Writing autohistoria-teoría: agency and illness in German life narratives by Evelyne Leandro and Mely Kiyak." Medical Humanities 46, no. 2 (2020): e1-e1. http://dx.doi.org/10.1136/medhum-2019-011746.
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Health concerns by migrants have been neglected in the German healthcare system, and they are impacted by discriminating discourses of othering. By analysing two autobiographical illness narratives by immigrants in contemporary Germany, this article exposes limitations in existing discourses of migration health and argues for more relational and affirmative theories of illness and care. Evelyn Leandro’s diary The Living Death: The Struggle with a Long-Forgotten Illness (2017) describes her own drawn-out therapy against leprosy as a Brazilian in Berlin. In Mr Kiyak Thought That the Best Part of His Life Will Start Now (2013), the Turkish-German journalist Mely Kiyak narrates her father’s experience with advanced lung cancer in a German hospital. Drawing on medical anthropology, postcolonial theory and material (eco)feminism, I argue that these narratives establish migrant health and agency in transnational assemblages that include chemotherapy, lungs and skin, family networks, healthcare providers, food cultures and health policies. These assemblages of illness are connected with the narratives’ hybrid and relational aesthetics and politics: similar to Gloria Anzaldúa’s practice of autohistoria-teoría, I show how Kiyak’s and Leandro’s life writing combines personal and communal storytelling with critical theorising to include diverse voices, languages, histories and identities. By transgressing identities of self and other, German and foreign, patient and physician, human and non-human, the narratives inspire a greater sense of the extent to which (all) bodies, histories, cultures, technology and medicine are entangled in a dense network of relations. This article envisions a relational and hybrid ontology and aesthetics of migration health and thereby intervenes into the growing field of transcultural medicine and medical humanities.
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Ayele, Roman A., Emily Lawrence, Marina McCreight, et al. "Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from non-VA Hospitals to Primary Care in a Single VA Healthcare System." Journal of Hospital Medicine, Volume 15, Issue 03 (October 23, 2019): 133–39. http://dx.doi.org/10.12788/jhm.3320.
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BACKGROUND: Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non-VA hospitals. These dual-use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions. OBJECTIVES: The aim of this study was to understand the barriers and facilitators to providing high-quality continuum of care for veterans transitioning from non-VA hospitals to the VA primary care setting. DESIGN: Guided by the practical robust implementation and sustainability model (PRISM) and the ideal transitions of care, we conducted a qualitative assessment using semi-structured interviews with clinicians, staff, and patients. SETTING: This study was conducted at a single urban VA medical center and two non-VA hospitals. PARTICIPANTS: A total of 70 participants, including 52 clinicians and staff (23 VA and 29 non-VA) involved in patient transition and 18 veterans recently discharged from non-VA hospitals, were included in this study. APPROACH: Data were analyzed using a conventional content analysis and managed in Atlas.ti (Berlin, Germany). RESULTS: Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non-VA hospital medical records to VA primary care, (3) obtain follow-up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination. CONCLUSIONS: All participants perceived the current transition-of-care process across healthcare systems to be inefficient. Efforts to improve quality and safety in transitional care should address the challenges clinicians and patients experience when transitioning from non-VA hospitals to VA primary care.
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Rozanski, Michal, Carolin Waldschmidt, Alexander Kunz, et al. "Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage." Cerebrovascular Diseases 43, no. 1-2 (2016): 76–81. http://dx.doi.org/10.1159/000453460.
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Background: Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting. Methods: We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO). STEMO is a stroke ambulance staffed by a specialized team including a neurologist and equipped with a computed tomography scanner plus a point-of-care laboratory. The STEMO ambulance is integrated in the emergency medical system of Berlin, Germany. Following prehospital stroke diagnosis, blood was drawn and subsequently analysed using research assays from Roche diagnostics. The clinical accuracy of plasma GFAP was tested using a cut-off value of 0.29 ng/ml. Results: Blood samples of 74 patients were analysed. Twenty-five patients had ICH (mean age 69 ± 11 years, median National Institutes of Health Stroke Scale (NIHSS) 15) and 49 IS (mean age 75 ± 10 years, median NIHSS 6). Nine ICH (0 IS patients) had GFAP-levels above 0.29 ng/ml. The sensitivity and specificity of GFAP for differentiating between ICH and AIS were 36.0 and 100%. The sensitivity for ICH volume >15 ml was 61.5%. ICH patients without GFAP elevation had significantly smaller hemorrhage volumes (median 4.5 vs. 37.6 ml, p = 0.004) and were less likely to deteriorate (19 vs. 56%, p = 0.087). Conclusions: GFAP levels >0.29 ng/ml were seen only in ICH, thus confirming the diagnosis of ICH during prehospital care. However, sensitivity is low particularly in smaller hemorrhages.
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Diehl-Wiesenecker, Eva, Noa Galtung, Oliver Liesenfeld, Florian Uhle, Timothy E. Sweeney, and Wolfgang Bauer. "1726 Integrating established clinical scores with a novel transcriptomic severity classifier augments early risk assessment in the ED." Emergency Medicine Journal 39, no. 12 (2022): A969.3—A970. http://dx.doi.org/10.1136/emermed-2022-rcem2.14.
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Aims, Objectives and BackgroundReliable risk assessment in patients presenting to emergency departments (ED) with suspected infection is of utmost importance to support clinical decisions. Vital sign-based scoring systems such as NEWS2 or qSOFA enable a rapid first assessment of patient urgency at triage. However, their inherent high sensitivity might drive over-utilization of healthcare resources. Our aim was to evaluate if adding the result of a transcriptomic severity classifier can synergistically improve current score-based risk assessment in the ED.Method and DesignWe performed a secondary analysis of a patient cohort (n=312) enrolled in the Charité University hospital ED (Berlin, Germany) with suspected infection and at least one vital sign alteration. The expression of 29-host mRNAs in PAXgene-stabilized whole blood was quantified using NanoString nCounter® SPRINT. The proprietary machine learning classifier IMX-SEV-3 was applied to calculate a score that falls into pre-defined interpretation bands: low/moderate/high severity. NEWS2 and qSOFA were documented on admission and combined with the classifier results to analyze the incidence of two clinical endpoints: ‘need for critical care’ (composite of need for ventilation, dialysis, and/or vasopressors) within 7d and ‘28d mortality’.Results and ConclusionAmong enrolled patients, 22 (7.1%) died and 66 (21.1%) required ICU-level care. Of patients with a high NEWS2 (≥5 points; n=184), there was a stepwise increase in mortality among the low (0%; n=0/47), medium (10.1%; n=12/119) and high (44.4% n=8/18) IMX-SEV-3 severity subgroups. A similar stratification was achieved across the low (17%), moderate (31%), and high (61%) IMX-SEV-3 subgroups for prediction of critical care. More granular risk stratification could also be confirmed when using IMX-SEV-3 in combination with high qSOFA (≥2 points; n=76): 0/10.6/50% mortality and 23.5/40.4/66% need for critical care in the low/moderate/high subgroups, respectively.In summary, the combined use of immune-based IMX-SEV-3 results for ED patients with high clinical scores allows improved prediction of mortality and the need for critical care.
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Altmann, J., J. Kummer, F. Herse, et al. "Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany." Archives of Gynecology and Obstetrics, October 4, 2021. http://dx.doi.org/10.1007/s00404-021-06264-8.
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Abstract Background In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. Objective The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. Methods We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. Results We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. Conclusion Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.
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Altmann, J., J. Kummer, F. Herse, et al. "Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany." Archives of Gynecology and Obstetrics, October 4, 2021. http://dx.doi.org/10.1007/s00404-021-06264-8.
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Abstract Background In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. Objective The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. Methods We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. Results We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. Conclusion Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.
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V, Seidel, Scheffer B, Heinz A, et al. "Quality of Migrant Care: Results of an Interprofessional Survey." Austin Journal of Obstetrics and Gynecology 8, no. 4 (2021). http://dx.doi.org/10.26420/austiniobstetgynecol.2021.1175.
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Background: Migration is a global phenomenon. Nevertheless, there are still data lacking about physicians and other health care provider perceptions and expectations concerning the management of patients with migration background. This national survey was therefore conducted. Method: Physicians and psychotherapists working at Charite Universitatsmedizin Berlin and Vivantes Hospital Group clinics, as well as resident doctors and psychotherapists, were invited to participate in this quantitative online-survey. The statistical analysis was anonymous and descriptive. Results: Overall, 355 questionnaires could be analyzed. The quality of care for migrants and non-migrants was rated as “good” or “very good” by at least 88% of the participants. The respondents estimated that 1% of the migrants were “not at all satisfied”. Of the respondents, 58% were dissatisfied at least once a week due to a language barrier. A specific training program on dealing with migrants and migrant care was desired by 61%. Conclusions: The topic of migrant care in the German health care system is relevant. Structured and systematic training on intercultural competence should be offered to improve migrant patient care quality and medical staff satisfaction. Institutionalized professional language translation could possibly improve the satisfaction of migrant patients and medical staff.
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"Sociolinguistics." Language Teaching 36, no. 3 (2003): 224. http://dx.doi.org/10.1017/s0261444803271950.
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03–532 Marx, Nicole. Never quite a ‘native speaker’: accent and identity in the L2 – and the L1. The Canadian Modern Language Review/La Revue Ccanadienne des Langues Vivantes, 59, 2 (2002), 264–281.03–533 Olk, H. (Canterbury Christ Church University College UK; Email: ho1@cant.ac.uk). Cultural knowledge in translation. ELT Journal, 57, 2 (2003), 167–174.03–534 Schmenk, Barbara (Ruhr Üniversität Bochum, Germany). Fremdsprachenlernen – Frauensache? Einige Überlegungen zur Kategorie Geschlecht in der Fremdsprachenforschung. [Foreign language learning – A girl thing? Some reflections on gender in foreign language research.] Zeitschrift für Fremdsprachenforschung (Berlin, Germany), 13, 2 (2002), 1–62.
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"Sociolinguistics." Language Teaching 36, no. 2 (2003): 120–57. http://dx.doi.org/10.1017/s0261444803271937.
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03—373 Appleby, Roslyn, Copley, Kath, Sithirajvongsa, Sisamone and Pennycook, Alastair (U. of Technology, Sydney, Australia). Language in development constrained: Three contexts. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 323—46.03—374 Bruthiaux, Paul (Nat. U. of Singapore). Hold your courses: Language education, language choice, and economic development. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 275—96.03—375 Cleghorn, Ailie (Concordia U., Montreal, Quebec, Canada) and Rollnick, Marissa. The role of English in individual and societal development: A view from African classrooms. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 347—72.03—376 Derwing, Tracey M. (U. of Alberta, Edmonton, Canada; Email: tracey.derwing@ualberta.ca), Rossiter, Marian J. and Ehrensberger-Dow, Maureen. ‘They speaked and wrote real good’: Judgements of non-native and native grammar. Language Awareness (Clevedon, UK), 11, 2 (2002), 84—99.03—377 Gebhard, Meg (U. of Massachusetts, USA). Fast capitalism, school reform, and second language literacy practices. The Canadian Modern Language Review/La Revue canadienne des langues vivantes (Toronto, Ont.), 59, 1 (2002), 15—52.03—378 Lin, Angel (City U. of Hong Kong) and Luk, Jasmine. Beyond progressive liberalism and cultural relativism: Towards critical postmodernist, sociohistorically situated perspectives in classroom studies. The Canadian Modern Language Review/La Revue canadienne des langues vivantes (Toronto, Ont.), 59, 1 (2002), 97—124.03—379 Markee, Numa (U. of Illinois at Urbana-Champaign, USA). Language in development: Questions of theory, questions of practice. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 265—74.03—380 Pavlenko, Aneta (Temple U., USA). ‘We have room for but one language here’: Language and national identity in the US at the turn of the 20th century. Multilingua (Berlin, Germany), 21, 2/3 (2002), 163—96.03—381 Pomerantz, Anne (U. of Pennsylvania, USA). Language ideologies and the production of identities: Spanish as a resource for participation in a multilingual marketplace. Multilingua (Berlin, Germany), 21, 2/3 (2002), 275—302.03—382 Ramanathan, Vai (U. of California at Davis, USA). What does ‘literate in English’ mean?: Divergent literacy practices for vernacular- vs. English-medium students in India. The Canadian Modern Language Review/La Revue canadienne des langues vivantes (Toronto, Ont.), 59, 1 (2002), 125—51.03—383 Schmidt Sr., Ronald. Racialization and language policy: The case of the U.S.A. Multilingua (Berlin, Germany), 21, 2/3 (2002), 141—61.03—384 Vavrus, Frances (Columbia U., New York, USA). Postcoloniality and English: Exploring language policy and the politics of development in Tanzania. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 373—97.03—385 Williams, Eddie (U. of Reading, UK) and Cooke, James. Pathways and labyrinths: Language and education in development. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 297—322.
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Hellmeyer, Lars, Zahavah Zinn-Kirchner, and Josefine T. Königbauer. "Maternal mortality in the city of Berlin: consequences for perinatal healthcare." Journal of Perinatal Medicine, December 31, 2021. http://dx.doi.org/10.1515/jpm-2021-0604.
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Abstract Objectives The fifth of the United Nations’ Millennium Development Goals proposed for 2000–2015 was to improve maternal health, which has only partially been achieved. Worldwide, the maternal mortality ratio is currently estimated at 216/100.000 livebirths, compared to 380/100,000 in 1990. As yet, there has been no published comprehensive analysis of maternal mortality data as it pertains to Berlin and by extension Germany. Aim of the study was to evaluate and analyze the maternal mortality rate of Berlin as a result of shortcomings in healthcare provision and identify possible solutions. Methods The Institute for Quality and Transparency in the Healthcare Sector sourced external quality control from the Qualitätsbüro Berlin to provide maternal mortality data from Berlin hospitals from 2007 to 2020. Results Nineteen maternal deaths were registered between 2007 and 2020 in total. Case analysis shows that two main events occur: thrombosis and hemorrhage at 31.6%, respectively, followed by hypertensive disorder (15.8%), and sepsis (15.8%). After detailed analysis of each case report, we determined 8/19 (42.1%) maternal deaths as being potentially preventable given slightly altered circumstances. Consequences The system of registration of perinatal data in Germany does not allow for a comprehensive recording of maternal death and requires alteration to provide a more accurate picture of the phenomenon of maternal mortality; presumably, there exist twice as many unreported cases. Conclusions Symptoms, risks, and primary prevention tactics of thromboembolism during pregnancy and birth should be imparted to every licensed professional in individual hospital settings, along with evidence-based simulation training for the event of obstetric or prepartum hemorrhage.
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Fischer-Rosinský, Antje, Anna Slagman, Ryan King, et al. "INDEED–Utilization and Cross-Sectoral Patterns of Care for Patients Admitted to Emergency Departments in Germany: Rationale and Study Design." Frontiers in Public Health 9 (April 16, 2021). http://dx.doi.org/10.3389/fpubh.2021.616857.
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Introduction: The crowding of emergency departments (ED) has been a growing problem for years, putting the care of critically ill patients increasingly at risk. The INDEED project's overall aim is to get a better understanding of ED utilization and to evaluate corresponding primary health care use patterns before and after an ED visit while driving forward processes and methods of cross-sectoral data merging. We aim to identify adequate utilization of EDs and potentially avoidable patient contacts as well as subgroups and clusters of patients with similar care profiles.Methods: INDEED is a joint endeavor bringing together research institutions and hospitals with EDs in Germany. It is headed by the Charité–Universitätsmedizin Berlin, collaborating with Otto von Guericke University Magdeburg, Technische Universität Berlin, the Central Research Institute of Ambulatory/Outpatient Health Care in Germany (Zi), and the AOK Research Institute as part of the Federal Association of AOK, as well as experts in the technological, legal, and regulatory aspects of medical research (TMF). The Institute for Information Technology (OFFIS) was involved as the trusted third party of the project. INDEED is a retrospective study of approximately 400,000 adult patients with statutory health insurance who visited the ED of one of 16 participating hospitals in 2016. The routine hospital data contain information about treatment in the ED and, if applicable, about the subsequent hospital stay. After merging the patients' hospital data from 2016 with their outpatient billing data from 2 years before to 1 year after the ED visit (years 2014–2017), a harmonized dataset will be generated for data analyses. Due to the complex data protection challenges involved, first results will be available in 2021.Discussion: INDEED will provide knowledge on extracting and harmonizing large scale data from varying routine ED and hospital information systems in Germany. Merging these data with the corresponding outpatient care data of patients offers the opportunity to characterize the patient's treatment in outpatient care before and after ED use. With this knowledge, appropriate interventions may be developed to ensure adequate patient care and to avoid adverse events such as ED crowding.
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Hoffmann, Christina, Mariam Maglakelidze, Erika von Schneidemesser, Christian Witt, Peter Hoffmann, and Tim Butler. "Asthma and COPD exacerbation in relation to outdoor air pollution in the metropolitan area of Berlin, Germany." Respiratory Research 23, no. 1 (2022). http://dx.doi.org/10.1186/s12931-022-01983-1.
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Abstract Background Ambient air pollution poses a major risk for the development and aggravation of respiratory diseases. Evidence suggests that even in low-level air pollution environments there is a risk for an increase in adverse respiratory symptoms. We examined whether variations in daily air pollution levels of nitrogen dioxide, ozone, or particulate matter in Berlin, Germany were associated with hospital admissions of chronic obstructive pulmonary disease (COPD) and asthma patients in a time series analysis. Methods We calculated single and multi-pollutant models, investigated possible lags in effect, and analysed the influence of meteorological variables on the results. Data from January 2005 through December 2015 were used to quantify the concentration–response. Results The risk ratio for asthma patients to be hospitalised on the same day of NO2 exposure was 1.101 per 10 µg/m3 NO2 increase (95% CI: 1.013 to 1.195), for COPD patients 1.123 (95% CI: 1.081 to 1.168). Neither the exposure to ozone (95% CI: 0.904 to 1.020), PM10 (95% CI: 0.990 to 1.127), nor PM2.5 (95% CI: 0.981 to 1.148) was associated with an increased risk ratio for asthma patients to be hospitalised. Risk ratios for the hospital admission of COPD patients were also not increased due to ozone (95% CI: 0.981 to 1.033), PM10 (95% CI: 0.988 to 1.032), or PM2.5 (95% CI: 0.966 to 1.019) exposure. The presented risk ratios and confidence intervals relate to the day of exposure. We found no increased hospitalisation risks with a delayed occurrence on subsequent days. Conclusions A quantifiable, statistically significant increase in risk for asthma and COPD exacerbations owing to NO2 exposure at levels well below European regulatory limit values was observed.
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Sauzet, Odile, Matthias David, Baharan Naghavi, Theda Borde, Jalid Sehouli, and Oliver Razum. "Adequate Utilization of Emergency Services in Germany: Is There a Differential by Migration Background?" Frontiers in Public Health 8 (January 8, 2021). http://dx.doi.org/10.3389/fpubh.2020.613250.
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Background: The role of emergency services (ES) is to provide round-the-clock acute care. In recent years, inadequate use of ES has been internationally thematised because of overcrowding and the associated cost. Evidence shows that migrant populations tend to use more ES than non-migrant but it remains to show if there is a differential in inadequacy.Method: Quantitative data from consecutive patients visiting three ES in Berlin (hospital-based outpatient clinics for internal medicine or gynecology) from July 2017 to July 2018 were obtained. Utilization was defined as adequate if the patient was admitted to hospital and/or if all of the three following criteria were fulfilled: reported to have been sent by medical staff; reported strong pain; and reported a high urgency (both ≥7, scale from 0 to 10). Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression.Results: Of the 2,327 patients included, 901 had a migration background. Adjusting for gender, age, gynecological hospital-based outpatient clinic, and the number of chronic diseases, 1st generation migrant patients (n = 633) had significantly lower odds than non-migrants to have an adequate utilization of services [OR 0.78, 95% confidence interval (0.62, 0.99), p-value 0.046]. For 2nd generation patients (n = 268), no statistically significant difference was found [OR 0.80, 95% confidence interval (0.56, 1.15), p-value 0.231]. Only adjusting for gynecological hospital-based outpatient clinic did weaken the association between migration status on adequacy but interactions between type of hospital-based outpatient clinic and migration were not significant.Discussion: First generation migrants show lower odds of adequate ES use compared to non-migrants. Only visiting a gynecological hospital-based outpatient clinic as opposed to internal medicine could partly explain the lower odds of adequate use among immigrants. This indicates a need for structural changes in the healthcare system: The threshold of access to general practices needs to be lowered, considering the needs of diverse subgroups of migrant patients.
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Sauzet, Odile, Matthias David, Baharan Naghavi, Theda Borde, Jalid Sehouli, and Oliver Razum. "Adequate Utilization of Emergency Services in Germany: Is There a Differential by Migration Background?" Frontiers in Public Health 8 (January 8, 2021). http://dx.doi.org/10.3389/fpubh.2020.613250.
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Background: The role of emergency services (ES) is to provide round-the-clock acute care. In recent years, inadequate use of ES has been internationally thematised because of overcrowding and the associated cost. Evidence shows that migrant populations tend to use more ES than non-migrant but it remains to show if there is a differential in inadequacy.Method: Quantitative data from consecutive patients visiting three ES in Berlin (hospital-based outpatient clinics for internal medicine or gynecology) from July 2017 to July 2018 were obtained. Utilization was defined as adequate if the patient was admitted to hospital and/or if all of the three following criteria were fulfilled: reported to have been sent by medical staff; reported strong pain; and reported a high urgency (both ≥7, scale from 0 to 10). Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression.Results: Of the 2,327 patients included, 901 had a migration background. Adjusting for gender, age, gynecological hospital-based outpatient clinic, and the number of chronic diseases, 1st generation migrant patients (n = 633) had significantly lower odds than non-migrants to have an adequate utilization of services [OR 0.78, 95% confidence interval (0.62, 0.99), p-value 0.046]. For 2nd generation patients (n = 268), no statistically significant difference was found [OR 0.80, 95% confidence interval (0.56, 1.15), p-value 0.231]. Only adjusting for gynecological hospital-based outpatient clinic did weaken the association between migration status on adequacy but interactions between type of hospital-based outpatient clinic and migration were not significant.Discussion: First generation migrants show lower odds of adequate ES use compared to non-migrants. Only visiting a gynecological hospital-based outpatient clinic as opposed to internal medicine could partly explain the lower odds of adequate use among immigrants. This indicates a need for structural changes in the healthcare system: The threshold of access to general practices needs to be lowered, considering the needs of diverse subgroups of migrant patients.
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"Extracellular matrix proteins in hepatocellular carcinoma . Institute of Pathology, University of Mainz, Germany, and Medical Clinic, and Department Gastroenterology, University Hospital Benjamin Franklin, Berlin-Steglitz, Germany." Hepatology 22, no. 4 (1995): A187. http://dx.doi.org/10.1016/0270-9139(95)94474-5.
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Terliesner, Nicolas, Alexander Rosen, Angela M. Kaindl, et al. "Maintenance of Elective Patient Care at Berlin University Children's Hospital During the COVID-19 Pandemic." Frontiers in Pediatrics 9 (August 30, 2021). http://dx.doi.org/10.3389/fped.2021.694963.
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Background: In Germany, so far the COVID-19 pandemic evolved in two distinct waves, the first beginning in February and the second in July, 2020. The Berlin University Children's Hospital at Charité (BCH) had to ensure treatment for children not infected and infected with SARS-CoV-2. Prevention of nosocomial SARS-CoV-2 infection of patients and staff was a paramount goal. Pediatric hospitals worldwide discontinued elective treatments and established a centralized admission process.Methods: The response of BCH to the pandemic adapted to emerging evidence. This resulted in centralized admission via one ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatment during the first wave, but maintenance of elective care and decentralized admissions during the second wave. We report numbers of patients treated and of nosocomial SARS-CoV-2 infections during the two waves of the pandemic.Results: During the first wave, weekly numbers of inpatient and outpatient cases declined by 37% (p &lt; 0.001) and 29% (p = 0.003), respectively. During the second wave, however, inpatient case numbers were 7% higher (p = 0.06) and outpatient case numbers only 6% lower (p = 0.25), compared to the previous year. Only a minority of inpatients were tested positive for SARS-CoV-2 by RT-PCR (0.47% during the first, 0.63% during the second wave). No nosocomial infection of pediatric patients by SARS-CoV-2 occurred.Conclusion: In contrast to centralized admission via a ward exclusively dedicated to children with unclear SARS-CoV-2 status and discontinuation of elective treatments, maintenance of elective care and decentralized admission allowed the almost normal use of hospital resources, yet without increased risk of nosocomial infections with SARS-CoV-2. By this approach unwanted sequelae of withheld specialized pediatric non-emergency treatment to child and adolescent health may be avoided.