610 Medizin, Gesundheit
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Institute
Ohmic heating (OH) is an alternative sustainable heating technology that has demonstrated its potential to modify protein structures and aggregates. Furthermore, certain protein aggregates, namely amyloid fibrils (AF), are associated with an enhanced protein functionality, such as gelation. This study evaluates how Ohmic heating (OH) influences the formation of AF structures from ovalbumin source under two electric field strength levels, 8.5 to 10.5 and 24.0–31.0 V/cm, respectively. Hence, AF aggregate formation was assessed over holding times ranging from 30 to 1200 sunder various environmental conditions (3.45 and 67.95 mM NaCl, 80, 85 and 90 °C, pH = 7). AF were formed under all conditions. SDS-PAGE revealed that OH had a higher tendency to preserve native ovalbumin molecules. Furthermore, Congo Red and Thioflavin T stainings indicated that OH reduces the amount of AF structures. This finding was supported by FTIR measurements, which showed OH samples to contain lower amounts of beta-sheets. Field flow fractioning revealed smaller-sized aggregates or aggregate clusters occurred after OH treatment. In contrast, prolonged holding time or higher treatment temperatures increased ThT fluorescence, beta-sheet structures and aggregate as well as cluster sizes. Ionic strength was found to dominate the effects of electric field strength under different environmental conditions.
Olive oil holds significant importance in the European diet and is renowned globally for its sensory attributes and health benefits. The effectiveness of producing olive oil is greatly influenced by factors like the maturity and type of olives used, as well as the milling techniques employed. Generally, mechanical methods can extract approximately 80% of the oil contained in the olives. The rest 20% of the oil remains in the olive waste generated at the end of the process. Additionally, significant amounts of bioactive compounds like polyphenols are also lost in the olive pomace. Traditionally, heat treatment, enzymes, and other chemicals are used for the enhancement of oil extraction; however, this approach may impact the quality of olive oil. Therefore, new technology, such as pulsed electric field (PEF), is of great benefit for nonthermal yield and quality improvements.
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.
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.
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.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
Background
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
Die vollständig überarbeitete Neuauflage des Lehrbuchklassikers jetzt ergänzt durch ein zusätzliches Kapitel und mit neuem Layout.
Dieses Standardwerk umfasst sämtliche Themengebiete der Lebensmittelphysik und behandelt u. a. die thermischen, rheologischen, akustischen und elektrischen Eigenschaften sowie die Dichte und Textur von Lebensmitteln. Zudem wird ausführlich auf die Funktion von online-Sensoren und deren Bedeutung für die Prozessautomatisierung in der Lebensmittelindustrie eingegangen.
Für Studierende der Lebensmittelwissenschaften und der Lebensmitteltechnologie ist dieses Lehrbuch mit vielen vorgerechneten Beispielen die Basis für ein grundlegendes Verständnis der Lebensmittelphysik. Ingenieure, Technologen und Techniker in der Lebensmittelproduktion können die aufgelisteten Anwendungsbeispiele am Ende jedes Kapitels nutzen, um ihre Kenntnisse für zukünftige physikalische Verfahren zu vertiefen.
This textbook provides a comprehensive foundation of food physics by addressing the physical properties of food, food ingredients, and their measurements. Physical properties of food play a key role in all fields where modern technological processes are applied for the generation of food raw materials and the production of food. The determination of the physical properties of food and related products is a pre-requisite for product and process development, production engineering and automation in today’s food, pharmaceutical and cosmetics industries, as well as related quality control activities.
Following the success of its first edition published in 2007, the book has been updated to reflect recent industrial applications of novel physical food processing technologies. Each chapter begins with basic principles and progresses to a comprehensive coverage of the topic. The authors enriched this second edition with several didactic elements, including definition boxes, examples, and chapter-end summaries.
This textbook helps readers to build up their knowledge of the important aspects surrounding the physical properties of foods and food ingredients. It is also an essential resource for students of food science and technology to complement textbooks in food chemistry and food microbiology, as well as for food and chemical engineers, technologists, and technicians in the food industry.
Innovationen sind die stärksten Gestaltungsfaktoren für eine neue vielversprechende Zukunft, da sie die wichtigsten Treiber für Wachstum und Ertrag in unserer Wirtschaft sind. Die aktuelle Zeitenwende zeigt uns sehr deutlich, dass wir ohne Innovationen bzw. Veränderungen und Anpassungen kaum noch wettbewerbsfähig bleiben, sowohl als Nation bzw. als Gesellschaft und insbesondere als Unternehmen.
Die hohe Dynamik und Komplexität der wirtschaftlichen und sozialen Prozesse setzt neue Maßstäbe an die Innovationsstrategien von Institutionen und Unternehmen.
Neue Technologien, neue Märkte, neues Kundenverhalten und der stetige Wandel sowohl in der Arbeitswelt als auch in unserem gesellschaftlichen Umfeld, wie z.B. die Digitalisierung, zeigen uns, dass allein eine Produktinnovation als solche heute nicht mehr ausreicht. Unter den genannten Randbedingungen müssen Innovationen auch in der Gestaltung von Geschäftsprozessen und Realisierung der "Work-Life-Balance" neu erdacht bzw. überprüft werden.
Der Vorsprung innovativer Produkte im viralen Wettbewerb ist oft nur kurz. Ein ganzheitliches Innovationsmanagement hat alle Bereiche des Unternehmens einzubeziehen und führt zu neuen Geschäftsmodellen, die etablierte Geschäftspraktiken verdrängen, ebenso tauchen durch neue Technologien in immer stärkerem Maße neue Anbieter auf, die die Spielregeln in den Märkten verändern.
Der 1. Deutsche Innovations-Kongress will Impulse setzen, Best-Practice-Modelle als Vorbilder anbieten und im Austausch zwischen den Referent*innen und den Teilnehmer*innen neue Wege bzw. Perspektiven eröffnen.
Wir freuen uns auf alle Teilnehmer*innen und den Erfahrungsaustausch, um aktuelle und nachhaltige Innovations-Impulse zu setzen und neue Wege erfolgversprechende Wege zu beschreiben, womit die bereits fruchtbaren Kooperationen zwischen Wirtschaft und Wissenschaft im Großraum Osnabrück noch weiter belebt werden soll.
Aktuell tragen auch 8 Studierendengruppen des Masterstudiengangs "Entwicklung und Produktion" der Hochschule Osnabrück in der Fakultät I u. I im Rahmen des Moduls "Innovationsmanagement" in Kooperation mit Unternehmen aus der Region durch die Entwicklung neuer innovativer Produkte zum Erfolg des Kongresses bei. Die Zwischenergebnisse dazu werden in einer Poster-Ausstellung präsentiert. Die Innovationsprojekte werden unter der Leitung von Prof. Dr. Jens Schäfer durchgeführt.