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Hintergrund
Die Anämie hat eine hohe Prävalenz bei Patienten vor Hüftgelenkrevisionsoperation und ist mit einer erhöhten Komplikationsrate assoziiert. Die vorliegende Arbeit untersucht erstmals den Zusammenhang von Kosten, realen DRG-Erlösen und Falldeckung der präoperativen Anämie bei elektiven Hüftgelenkrevisionsoperationen.
Methoden
Für alle Patienten, die sich von 2010 bis 2017 an 2 Campi der Charité – Universitätsmedizin Berlin einer Hüftgelenkrevisionsoperation unterzogen, wurden Daten zu Patienten sowie Transfusionen, Kosten und Erlösen gesammelt. Subgruppen- und lineare Regressionsanalysen untersuchten die Falldeckung anämischer und nichtanämischer Patienten.
Ergebnisse
Von 1187 eingeschlossenen Patienten waren 354 (29,8 %) präoperativ anämisch. Insgesamt wurden 565 (47,6 %) Patienten, mit einem deutlichen Überwiegen anämischer Patienten (72,6 % vs. 37,0 %, p < 0,001), transfundiert. Kosten (12.318 € [9027;20.044 €] vs. 8948 € [7501;11.339 €], p < 0,001) und Erlöse (11.788 € [8992;16.298 €] vs. 9611 € [8332;10.719 €], p < 0,001) waren für anämische Patienten höher, die Fallkostendeckung defizitär (−1170 € [−4467;1238 €] vs. 591 € [−1441;2103 €] €, p < 0,001). Bei anämischen Patienten nahm die Falldeckung mit zunehmender Transfusionsrate ab (p ≤ 0,001). Komorbiditäten hatten keinen signifikanten ökonomischen Einfluss.
Schlussfolgerung
Die präoperative Anämie und perioperative Transfusionen bei Hüftgelenkrevisionsoperationen sind mit erhöhten Behandlungskosten und einer finanziellen Unterdeckung für Kostenträger im Gesundheitswesen verbunden. Konzepte zur Behandlung der präoperativen Anämie (z. B. Patient Blood Management) könnten mittelfristig Behandlungskosten senken.
This paper investigates four different mobile robots with respect to their drivingcharacteristics and soil preservation properties in an agricultural environment.Thereby, robots of classical design from agriculture as well as systems from spacerobotics with advanced locomotion concepts are considered to determine theindividual advantages of each rover concept with respect to the application domain.Locomotion experiments were conducted to analyze the general driving behavior,tensile force, and obstacle‐surmounting capability and ground interaction of eachrobot. Various soil conditions typical for the area of application are taken intoaccount, which are varied in terms of moisture and density. The presented workcovers the specification of the conducted experiments, documentation of theimplementation as well as analysis and evaluation of the collected data. In theevaluation, particular attention is paid to the change in driving characteristics underdifferent soil conditions, as well as to the soil stress caused by driving, since soilquality is of critical importance for agricultural applications. The analysis shows thatthe advanced locomotion concepts, as used in space robotics, also have positiveimplications for certain requirements in agricultural applications, such as maneuver-ability in wet conditions and soil conservation. The results show potential for designinnovations in agricultural robotics that can be used, to open up new fields ofapplication for instance in the context of precision farming.
BACKGROUND: Postoperative delirium (POD) is an acute and common complication after surgery that can increase morbidity and mortality. Few previous studies with inconsistent findings have examined the association of preoperative pain and POD. Our purpose is to investigate the association of preoperative chronic pain and POD.
METHODS: This prospective observational cohort study included 200 patients ≥ 18 years scheduled for elective surgery under general anaesthesia in a tertiary care hospital. POD was defined as meeting diagnostic criteria during the study visits (according to delirium screening tests and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), or by diagnosis of the responsible physicians. Chronic pain was defined as pain lasting six months or longer. Features of chronic pain were assessed with the German Pain Questionnaire, including the Depression Anxiety and Stress Scale-21 (DASS-21). Associations with POD were assessed using logistic regression analysis adjusting for confounding factors.
RESULTS: Thirty-nine (22%) out of 176 patients developed POD. Chronic pain was not associated with POD after adjustment for ASA physical status, duration of anesthesia and DASS-21 Anxiety score (Odds ratio [OR], 95%-Confidence Interval [CI], 2.216 [0.968;5.070], P=0.060). A subgroup analysis of chronic pain patients revealed that current pain intensity was higher in patients with POD.
CONCLUSIONS: Preoperative chronic pain was no independent predictor for POD. Current pain intensity was higher in chronic pain patients with POD. This indicates that certain features of pain might be influential. Further research is needed to examine different forms of preoperative pain and their possible influence on POD.
Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.
The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.
Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.
Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.
In recent years, ISO, IFS, BRC and FSSC 22000 standards in the areas of quality, environment and occupational health and safety have been increas-ingly implemented in companies in various industries. The main focus of these developed standards are the processes. But the past shows that the factor human is another very important factor, which should be much more in the middle in organization. The new developed guideline has the human factor in the foreground. In particular, the attitude and awareness of occupational safe-ty and health protection in the behaviour of employees at all levels of the or-ganisation are at the centre of consideration.
Inspired by this approach, a group of experts from the fields of quality scienc-es, standardisation and certification as well as consulting for system-relevant companies in the agricultural and food industry came together to form a committee during the Corona crisis in spring 2020. The common goal is to develop a new standard. The first step is to establish criteria for a guideline.
and establish an evaluation system for several pillars of a House of Total Safety Culture (HSC) tailored to the entire value chains of the agri-food sec-tor. In addition, the essential building blocks of the guideline must be defined. The attitude of managers and employees, their behaviour and their compe-tence form the roof of the standard. The integrated management system with a continuous improvement process forms the foundation of the House of To-tal Safety Culture across the company in value chains. Qualification and communication are the main pillars and thus further elements of the HSC. Particular attention is paid to the fields of action of occupational safety and health protection, food safety, animal and environmental protection as well as sustainability and digitisation. They form the four inner pillars of the House of Total Safety Culture. The design of the respective certification levels is con-sidered as a “construction phase”. As part of the standardisation process, the coordination of the respective requirements for safety culture has not yet been completed. This article first provides an overview of the state of knowledge in relation to the established standards and norms of the agri-food industry with special consideration of the Safety Culture Ladder model. The procedure for developing and establishing the new guideline is then ex-plained. For this purpose, the composition of the expert forum is presented before the concrete steps to establish the guideline are presented. The model of the House of Total Culture is presented below. Building on this, the proce-dure for assessing the degree of maturity and possible concepts of continuing training are explained before the conclusion of this article.
Die vorliegende Bachelorarbeit behandelt das Thema das betriebliche Ideenmanagement. Das Ziel ist den Prozess zur Einreichung, Evaluierung und Umsetzung von Ideen weiterzuentwickeln und zu digitalisieren.
Um das Ziel zu erreichen, werden Primärdaten mit Hilfe von fünf qualitativen Interviews und einer quantitativen Umfrage mit 50 Mitarbeitern erhoben. Abgesehen davon wurden auch Daten aus der Sekundärforschung erfasst, deren Bestandteile die internen Unterlagen zum bestehenden Ideenmanagement dem Status quo, und wissenschaftliche Quellen sind.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Dynamic Controlled Atmosphere-Chlorophyll Fluorescence storage (DCA-CF) uses a fluorescence-based measurement method to detect fermentation in apples (Malus × domestica BORKH.) caused by low-oxygen levels at an early stage. In recent years, it has been observed that individual apples of the same variety and origin can exhibit different fermentation behavior when stored under completely identical conditions. The causes of the different fermentation behavior must be found in order to be able to use DCA storage optimally. This study aimed to find the causes of the different fermentation behaviors of individual apples. Our results show that fruit ripeness can affect the lower oxygen limit (LOL), especially immediately after harvest, when the starch degradation in the fruit is not yet complete. A significant increase in the LOL was observed in ‘Elstar’ (2020: 0.3 kPa, 0.6 kPa, 0.9 kPa; 2021: 0.3 kPa, 0.4 kPa, 0.6 kPa). ‘Braeburn’ also exhibited this behavior regarding the LOL at a lower level. The LOL could not be identified for some of the fruit (varying from 12.5% to 41.7% of the examined apples) previously stored in Ultra Low Oxygen (ULO) storage for 4 months. Also, the chlorophyll content in the apple skin influences the fluorescence measurement method. Within 2 weeks, the chlorophyll content in the apple skin was halved. If the chlorophyll content drops, the reliability of the fluorescence measurement also decreases. It turned out that apples with an Fv/Fm < 0.7 were unsuitable for valid LOL identification.
Recording of Low-Oxygen Stress Response Using Chlorophyll Fluorescence Kinetics in Apple Fruit
(2023)
Long-term storage of apples (Malus x domestica, Borkh.) is increasingly taking place under Dynamic Controlled Atmosphere (DCA). The oxygen level is lowered to ≤ 1 kPa O2 and the apples are stored just above the Lower Oxygen Limit (LOL). Low oxygen stress during controlled atmosphere storage can lead to fermentation in apples if oxygen levels are too low. Chlorophyll fluorescence can be used to detect low-oxygen stress at an early stage during storage. The currently available non-imaging fluorescence systems often use the minimal fluorescence (Fo) parameter. In contrast, the use of chlorophyll fluorescence kinetics is insufficiently described. Therefore, this study aimed to gain more knowledge about the response of chlorophyll fluorescence kinetics to low oxygen stress in apples using a fluorescence imaging system. The results show that the kinetic fluorescence curves differ under aerobic and fermentation conditions. The fermentative conditions initiated a decrease in fluorescence intensity upon application of the saturation pulses during exposure to actinic light. This result was made at 18 °C and 2 °C ambient temperatures. Interestingly, the kinetic curve changed at 2 °C before fermentation products accumulated in the apples. Non-photochemical quenching (NPQ) decreased under fermentation conditions in the dark phase after relaxation. Upon entering the dark relaxation phase after Kautsky induction, ɸPSII began to increase. Under atmospheric oxygen conditions, ɸPSII reached values of 0.81 to 0.76, while under fermentation, ɸPSII values ranged from 0.57 to 0.44.