[The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]. / Das SCATTER-Projekt: Computerbasierte Simulation zur Unterstützung bei der strategischen Verlegung von Intensivpatienten.

BACKGROUND: The need for a concept for the nationwide strategic transfer of critical care patients in Germany was highlighted during the COVID-19 (coronavirus disease 2019) pandemic. Despite the cloverleaf concept developed specifically for this purpose, the transfer of large numbers of critical care patients represents a major challenge. With the help of a computer simulation, the SCATTER research project uses a fictitious example to test, develop, and recommend transfer strategies. METHOD: The simulation was programmed after collecting procedural and structural data on critical care transports within Germany. The simulation allows altering various parameters and testing different transfer scenarios. In a fictitious scenario, nationwide transfers starting from Schleswig-Holstein were simulated and evaluated using predetermined criteria. RESULTS: In the case of ground-based transfers, it became apparent that, depending on the selected target region, not all patients could be transferred due to the limited range of ground-based vehicles. Although a higher number of patients can be transferred by air, this is associated with additional gurney changes and potential risk to the patient. A distance-dependent transport strategy led to the identical results as purely air-bound transport, since air-bound transport was always chosen due to the long distances. DISCUSSION: The simulation can be used to develop recommendations and to draw important conclusions from different transfer strategies.

[Use of support and relief services for parents of children in need of care: Results of the FamBer observational study]. / Inanspruchnahme von Unterstützungs- und Entlastungsdiensten für Eltern pflegebedürftiger Kinder.

Use of support and relief services for parents of children in need of care: Results of the FamBer observational study Abstract: Background: Parents of children in need of care in Germany can fall back on a variety of relief and support services. So far, however, there has been a lack of systematic studies and quantitative data on the use of such offers at the individual level of parents and other legal guardians. Aim: The study on the compatibility of care and work for parents with a child in need of care (FamBer; funding: Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, Germany) examines the knowledge of relief and support services, their use and the perceived benefits of these offers. Methods: 1070 parents answered a multidimensional online questionnaire in the cross-sectional study that was developed based on the Kindernetzwerk Study 2 from 2013 and the German socio-economic panel (SOEP). In addition to descriptive analyses, group comparisons were carried out using Chi2, Mann-Whitney U or Kruskal-Wallis H tests. Results: 43 to 58% of parents are aware of the respective legal options for taking time off work, but only very few families make use of them. The other support offers differ significantly in terms of the level of knowledge and utilization; these vary primarily with the education of the parents and the care needs of the child. They assessed the used services for consultation and advice as only little helpful. Conclusions: Due to the study design, we cannot rule out that the findings are also based on personal characteristics of the parents and their living conditions. Nevertheless, a large number of problems (e.g. a lack of information, low using, ineffectiveness of support services) can be identified that need to be overcome.

Item distribution, scalability and internal consistency of the QUALIDEM quality of life assessment for patients with dementia in acute hospital settings.

BACKGROUND: Quality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD's QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not yet demonstrated their feasibility in acute hospitals because their use takes up too much time or their validity depends on observation periods that usually exceed the average length of hospital stays. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed. METHODS: Data stem from a study that analyzed the impact of a special care concept on the QoL of patients with dementia in acute hospitals. Total sample size consisted of N = 526 patients. Study nurses were trained in using an assessment questionnaire and conducted the data collection from June 2016 to July 2017. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis. RESULTS: For people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two (positive self-image, feeling at home) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65-0.91). Only the item social relations had insufficient reliability (ρ = 0.55). CONCLUSIONS: In comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is necessary because the qualification of the nurses and the length of stay of the patients in the hospital differ from the previous investigations of the inter-rater reliability of QUALIDEM in the nursing home.

[Comparing Community Capacities by Local Actors and External Experts: An Audit of Health Promotion Activities in Lenzsiedlung, Hamburg]. / Evaluation von Gemeinde-Kapazitäten durch Quartiersakteur*innen und externe Expert*innen im Vergleich ­ Ergebnisse der Auditierung der Gesundheitsförderungsaktivitäten in der Hamburger Lenzsiedlung.

AIM: The questionnaire "Capacity building in Neighbourhoods (KEQ)" has five dimensions which are regarded as intermediary outcome results of community health promotion. The questionnaire was to be completed by local actors and thus has some features of self-evaluation. We wanted to find out whether external experts make similar or more critical assessments. METHODS: We conducted an audit of the health promotion activities in our intervention area (Hamburg neighbourhood Lenzsiedlung) in two steps. Five external health promotion experts functioned as auditors with experience in evaluating good practice projects of health promotion. The first part of the audit was a document-based evaluation, the second part a visit-based one during a two-day stay in the intervention area. RESULTS: In the comparison of local actors' assessments (KEQ questionnaire results) with those of external experts in the document-based audit, the judgements of external experts were more positive on all five dimensions of the questionnaire (deviations from +0.1 to +0.9 on a scale from 1 to 5). In the visit-based audit, there was convergence in the assessments of the local actors and the external experts. They were partly identical; only the dimension "local leadership" was viewed slightly more critically by the external experts. CONCLUSIONS: Based on our discussion of the four methodical problems of the comparison, we conclude that, on the whole, local actors do not tend to evaluate their activities too positively. However, if resources are available, one should try to confirm local views of outcomes by external assessments.

Self-help friendliness in cancer care: A cross-sectional study among self-help group leaders in Germany.

BACKGROUND: Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self-help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self-help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration. METHODS: A cross-sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self-Help and the federal associations of cancer self-help. RESULTS: According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities. CONCLUSIONS: The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs. PATIENT OR PUBLIC CONTRIBUTION: The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self-help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants.

["And she turns around and sees it fully " Psychological consequences in children of survivors of the "Hamburg Firestorm" (1943) in a systematic evaluation]. / "Und sie dreht sich um und sieht das voll " Psychische Folgen bei Kindern von Überlebenden des "Hamburger Feuersturms" (1943) in einer systematischen Evaluation.

"And she turns around and sees it fully …" Psychological consequences in children of survivors of the "Hamburg Firestorm" (1943) in a systematic evaluation Objectives: Is there a transmission of traumatic war experiences through the generations? In an interdisciplinary research project at Hamburg University psychoanalysts and historians investigated the long-term psychological effects of World War II bombing attacks in the "Hamburg Firestorm" (Operation Gomorrha) in 1943. In the frame of this work the paper asks for the psychological consequences in the following generation Methods: Evaluation of 45 completely transcribed life-historical interviews (28 female and 17 male of an average age of 50.2 years) with descendants of contemporary witnesses (at the time of the firestorm between 3 and 27 years old) by systematic diagnostic assessment. Results: There are no certain consequences for everyone. Most of the consequences occurred, when the mother was the contemporary witness and the child the daughter. Conclusion: Different assessments on the intergenerational consequences of experiences of violence in World War II can be explained by the heterogeneity of the findings.

Do multiple community-based interventions on health promotion tackle health inequalities?

BACKGROUND: Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS: The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS: More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS: Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.

Effectiveness of Community-Based Health Promotion Interventions in Urban Areas: A Systematic Review.

Over the past few decades, a community-based approach was seen to be the "gold standard" for health promotion and disease prevention, especially in the field of socially deprived neighborhoods in urban areas. Up to the beginning of the 2000s, earlier reviews provide valuable information on activities in this context. However, in their conclusions they were limited to North America and Europe. Therefore, we conducted a systematic literature review on community-based health promotion and prevention programs worldwide. The Pubmed and PsycINFO databases were screened for relevant articles published between January 2002 and December 2018, revealing 101 potentially eligible publications out of 3646 hits. After a systematic review process including searching the reference lists, 32 papers met the inclusion criteria and were included in the review. Twenty-four (75.0%) articles reported improvements in at least one health behavior, health service access, health literacy, and/or a range of health status outcomes. Large-scale community-based health promotion programs, however, often resulted in limited or missing population-wide changes. Possible reasons are methodological limitations, concurrent context effects, and limitations of the interventions used. Our results confirm that community-based interventions are promising for health promotion and disease prevention but so far their potential is not fully realized. For the future, such interventions should aim at proximal outcomes and invest in community capacity building.

[Participation in self-help groups: impact on self-management and knowledge]. / Teilnahme an Selbsthilfegruppen: Wirkungen auf Selbstmanagement und Wissenserwerb.

BACKGROUND: Self-help groups (SHGs) are an inherent part of patient involvement and play an important role in the healthcare system. Until now, however, there has been a lack of systematic investigations and quantitative data about the individual impact of self-help for patients and relatives. OBJECTIVES: This study presents the results of a comparison between members of SHGs and non-members. Thereby, the effects of self-help shall be described in terms of empowerment and self-management. The study is part of the project "Health-related Collective Self-Help in Germany" (Gesundheitsbezogene Selbsthilfe in Deutschland-SHILD) funded by the Federal Ministry of Health. MATERIALS AND METHODS: The study was conducted with patients from five therapeutic areas (diabetes mellitus type 2, prostate cancer, multiple sclerosis, tinnitus, relatives of dementia patients). Participants administered a multidimensional questionnaire (paper-and-pencil or online). Of the 2870 participants in this analysis, 49% were active members of SHGs. RESULTS: Statistical analysis showed some significant, but small differences between the two groups in five out of seven scales of the Health Education Impact Questionnaire (heiQ) in favour of the SHG members. Furthermore, SHG members performed better in specific knowledge tests. Members see the importance of their group especially in social inclusion, psychosocial relief, coping with the disease and new insights in dealing with the disease. CONCLUSIONS: With respect to the study design we cannot rule out that differences might be based on personal characteristics influencing the decision to participate in a SHG or not. But as the results are controlled for confounders, the hypothesis that SHG participation has a positive impact on the outcomes rather than vice versa seems supported.

Involving self-help groups in health-care institutions: the patients' contribution to and their view of 'self-help friendliness' as an approach to implement quality criteria of sustainable co-operation.

BACKGROUND: The importance of patient participation and involvement is now widely acknowledged; in the past, few systematic health-care institution policies existed to establish sustainable co-operation. In 2004, in Germany, the initiative 'Self-Help Friendliness (SHF) and Patient-Centeredness in Health Care' was launched to establish and implement quality criteria related to collaboration with patient groups. OBJECTIVES: The objective of this study was to describe (i) how patients were involved in the development of SHF by summarizing a number of studies and (ii) a new survey on the importance and feasibility of SHF. SETTING AND PARTICIPANTS: In a series of participative studies, SHF was shaped, tested and implemented in 40 health-care institutions in Germany. Representatives from 157 self-help groups (SHGs), 50 self-help organizations and 17 self-help clearing houses were actively involved. The second objective was reached through a survey of 74 of the 115 member associations of the biggest self-help umbrella organization at federal level (response rate: 64 %). RESULTS: Patient involvement included the following: identification of the needs and wishes of SHGs regarding co-operation, their involvement in the definition of quality criteria of co-operation, having a crucial role during the implementation of SHF and accrediting health-care institutions as self-help friendly. The ten criteria in total were positively valued and perceived as moderately practicable. CONCLUSIONS: Through the intensive involvement of self-help representatives, it was feasible to develop SHF as a systematic approach to closer collaboration of professionals and SHGs. Some challenges have to be taken into account involving patients and the limitations of our empirical study.

Implementing 'self-help friendliness' in German hospitals: a longitudinal study.

In Germany, the term 'self-help friendliness' (SHF) describes a strategy to institutionalize co-operation of healthcare institutions with mutual aid or self-help groups of chronically ill patients. After a short explanation of the SHF concept and its development, we will present findings from a longitudinal study on the implementation of SHF in three German hospitals. Specifically, we wanted to know (i) to what degree SHF had been put into practice after the initial development phase in the pilot hospitals, (ii) whether it was possible to maintain the level of implementation of SHF in the course of at least 1 year and (iii) which opinions exist about the inclusion of SHF criteria in quality management systems. With only minor restrictions, the findings provide support for the usefulness, practicability, sustainability and transferability of SHF. Limitations of our empirical study are the small number of hospitals, the above average motivation of their staff, the small response rate in the staff-survey and the inability to get enough data from members of self-help groups. The research instrument for measuring SHF was adequate and fulfils the most important scientific quality criteria in a German context. We conclude that the implementation of SHF leads to more patient-centredness in healthcare institutions and thus improves satisfaction, self-management, coping and health literacy of patients. SHF is considered as an adequate approach for reorienting healthcare institutions in the sense of the Ottawa Charta, and particularly suitable for health promoting hospitals.

["The flames engulfed us from all sides and the air roared" - A systematic diagnostic evaluation of the survivors of the "Hamburg Firestorm" of 1943]. / "Hier und überall lechzten die Flammen und es brüllte die Luft« - eine systematisierte diagnostische Eindrucksbildung an Überlebenden des ¼Hamburger Feuersturms" (1943).

QUESTION: In an interdisciplinary research project at Hamburg University, psychoanalysts and historians investigated the long-term psychological effects of World War II bombing attacks during the "Hamburger Feuersturm" (Operation Gomorrha) in 1943. The paper looks at the experiences from that time and the different modalities of how they were processed and compares them with the mental repercussions today. METHOD: Evaluation of completely transcribed interviews with 31 female and 29 male contemporary witnesses (at the time of the firestorm between 3 and 27 years old) using "systematic diagnostic assessment."A matrix of the rated diagnostic characteristics was subjected to factor analysis and scales of severity were established in order to calculate correlation coefficients and to determine the degree of interdependence of the diagnostic characteristics. RESULTS: The primary experience of those interviewed was being bombed out of their homes, often with a complete loss of all personal belongings. In particular, the sight of dead bodies has remained in their thoughts to this day. The persistent psychological consequences include anxiety, nightmares, and an aversion to certain noises and smells that continue to be associated with the firestorm. The initial experiences after the war proved to be crucial to their subsequent well-being. Discussions of their dreadful experience remained mostly rare, but when they did occur, they were beneficial to their overcoming the associated trauma. CONCLUSIONS: We successfully quantified the essential qualitative information. Long-term psychological outcome appears to depend not only on the severity and circumstances of the - often traumatic - experiences during the war. The individual experiences in the years after the war held an important sway over subsequent well-being to the present day.

Generalized data model for real-world capacitated lot-sizing problems with linked lot sizes and backorders.

This data article establishes the first data model for the Multi-Level Capacitated Lot-Sizing Problem with Linked Lot Sizes and Backorders (MLCLSP-L-B) for tablets manufacturing processes. The dataset consists out of nine tables and collects all required meta-information for capacitated lot-sizing problems with linked lot sizes and backorders. Furthermore, it is compatible to store information for single- and multi-level lot-sizing problem instance information. An exact field description and field type is provided for each table. Anonymized real-world data represents four single-level packaging and five multi-level tablets manufacturing processes that are shared with lot-sizing research community by the standardized data template.

A matheuristic for customized multi-level multi-criteria university timetabling.

Course timetables are the organizational foundation of a university's educational program. While students and lecturers perceive timetable quality individually according to their preferences, there are also collective criteria derived normatively such as balanced workloads or idle time avoidance. A recent challenge and opportunity in curriculum-based timetabling consists of customizing timetables with respect to individual student preferences and with respect to integrating online courses as part of modern course programs or in reaction to flexibility requirements as posed in pandemic situations. Curricula consisting of (large) lectures and (small) tutorials further open the possibility for optimizing not only the lecture and tutorial plan for all students but also the assignments of individual students to tutorial slots. In this paper, we develop a multi-level planning process for university timetabling: On the tactical level, a lecture and tutorial plan is determined for a set of study programs; on the operational level, individual timetables are generated for each student interlacing the lecture plan through a selection of tutorials from the tutorial plan favoring individual preferences. We utilize this mathematical-programming-based planning process as part of a matheuristic which implements a genetic algorithm in order to improve lecture plans, tutorial plans, and individual timetables so as to find an overall university program with well-balanced timetable performance criteria. Since the evaluation of the fitness function amounts to invoking the entire planning process, we additionally provide a proxy in the form of an artificial neural network metamodel. Computational results exhibit the procedure's capability of generating high quality schedules.

Strategic planning of operating room session allocation using stability analysis.

Operating room (OR) resources are limited, and for this reason there is usually a competition among surgeons to win them. However, the methods developed for allocating OR sessions are mostly based on optimisation methods which compensate the preferences of surgeons or surgical specialities in favour of the productivity of the entire OR department. This leads to conflict and dissatisfaction among surgeons. To overcome this problem, a methodology based on game theoretic solutions is presented in this paper that formulates the allocation problem as a simple game. The surgeons or specialities as players then jointly pursue the goal of achieving overall stability. Stability is defined and measured using a method called Power Index. The proposed method is then combined with the Monte-Carlo technique to deal with uncertainties. To demonstrate the capability of the suggested procedures, they are applied to a case study from the literature and a set of hypothetical scenarios.

Family health partners in regional network structures (NEST): A non-randomized controlled trial among parents of chronically ill and disabled children.

BACKGROUND: The overarching project goal is to evaluate the effectiveness of a cross-sectoral and cross-service provider offering professional support for families with chronically ill and disabled children: so-called Family Health Partners (in German: 'Familien-Gesundheits-Partner' or FGP). This needs-oriented service, which is anchored in regional networks, aims to provide 'holistic' support for families with children in need of care. METHODS: We are carrying out a non-randomized controlled trial with four points of measurement (t0-t3 in 18 months), beginning in January 2022. Both intervention and control group include 102 families. Primary outcome measure is the quality of life, secondary outcomes are resilience factors and associated measures as well as the access to care. Multilevel regression models will be used to analyze the longitudinal data. DISCUSSION: The strength of this study is that it looks at the health and resilience of all family members involved by examining how a FGP can influence the entire family system with regard to increasing quality of life, resilience and self-efficacy. The network structures of FGP also open up better to previously unknown regional supply offers. There are, however, a number of limitations (e.g. type of outcomes, sample size). TRIAL REGISTRATION: This study was first registered on the German Clinical Trials Register before enrolment of participants started (ID: DRKS00027465, 4 January 2022). In order to promote its dissemination, it was also retrospectively registered on ClinicalTrials.gov (ID: NCT05418205, 14 June 2022).

Mapping spatial and temporal trends of atmospheric deposition of nitrogen at the landscape level in Germany 2005, 2015 and 2020 and their comparison with emission data.

Mosses are particularly suitable for recording the accumulation of atmospheric substance inputs in large areas at relatively many locations. In Europe, this has been done every five years since 1990 as part of the European Moss Survey. In this framework, mosses were collected at up to 7312 sites in up to 34 countries and chemically analyzed for metals (since 1990), nitrogen (since 2005), persistent organic pollutants (since 2010) and microplastic (since 2015). The present investigation aimed at determining the nitrogen accumulated in three-year-old shoots from mosses collected in Germany in 2020 by quality-controlled sampling and chemical analysis according to the European Moss Survey Protocol (ICP Vegetation 2020). The spatial structure of the measurement values was analyzed by means of Variogram Analysis, and the respective function was used for Kriging-Interpolation. In addition to mapping the nitrogen values according to the international classification, maps based on 10 percentile classes were calculated. Maps for the Moss Survey 2020 data were compared with respective maps produced from the 2005 and 2015 Moss Survey data. Trends in Germany-wide nitrogen medians over the past three campaigns (2005, 2015 and 2020) show that nitrogen medians decreased by -2 % between 2005 and 2015 and increased by +8 % between 2015 and 2020. These differences are not significant and do not match the emission trends. Therefore, emission register data needs to be controlled by monitoring nitrogen deposition with technical and biological samplers and deposition modelling.

Digitization in health-related self-help - Results of an online survey among self-help organizations in Germany.

Background: Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design: The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30-40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results: SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a "high" or "very high" benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions: At many points in the survey it was shown that digital media can be a useful extension of "traditional" collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution: The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.

A comparison of conventional and retrospective measures of change in symptoms after elective surgery.

BACKGROUND: Measuring change is fundamental to evaluations, health services research and quality management. To date, the Gold-Standard is the prospective assessment of pre- to postoperative change. However, this is not always possible (e.g. in emergencies). Instead a retrospective approach to the measurement of change is one alternative of potential validity. In this study, the Gold-Standard 'conventional' method was compared with two variations of the retrospective approach: a perceived-change design (model A) and a design that featured observed follow-up minus baseline recall (model B). METHODS: In a prospective longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients (T0: 7-8 days pre-operative; T1: 14 days post-operative and T2: 6 months post-operative) changes in symptoms (Hernia: 9 Items, Cholecystectomy: 8 Items) were assessed at the three time points by patients and the conventional method was compared to the two alternatives. Comparisons were made regarding the percentage of missing values per questionnaire item, correlation between conventional and retrospective measurements, and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects. RESULTS: Single item missing values in model A were more frequent than in model B (e.g. Hernia repair at T1: model A: 23.5%, model B: 7.9%. In all items and at both postoperative points of measurement, correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B, correlation with the change calculated with the conventional method was higher at T1 than at T2. Compared to the conventional model both models A and B also overestimated symptom-change (i.e. improvement) with similar frequency, but the overestimation was higher in model A than in model B. In both models, overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy. CONCLUSIONS: The retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method. Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method (at least for hernia repair and laparoscopic cholecystectomy).

Simulation-based multi-criteria decision making: an interactive method with a case study on infectious disease epidemics.

Whenever a system needs to be operated by a central decision making authority in the presence of two or more conflicting goals, methods from multi-criteria decision making can help to resolve the trade-offs between these goals. In this work, we devise an interactive simulation-based methodology for planning and deciding in complex dynamic systems subject to multiple objectives and parameter uncertainty. The outline intermittently employs simulation models and global sensitivity analysis methods in order to facilitate the acquisition of system-related knowledge throughout the iterations. Moreover, the decision maker participates in the decision making process by interactively adjusting control variables and system parameters according to a guiding analysis question posed for each iteration. As a result, the overall decision making process is backed up by sensitivity analysis results providing increased confidence in terms of reliability of considered decision alternatives. Using the efficiency concept of Pareto optimality and the sensitivity analysis method of Sobol' sensitivity indices, the methodology is then instantiated in a case study on planning and deciding in an infectious disease epidemic situation similar to the 2020 coronavirus pandemic. Results show that the presented simulation-based methodology is capable of successfully addressing issues such as system dynamics, parameter uncertainty, and multi-criteria decision making. Hence, it represents a viable tool for supporting decision makers in situations characterized by time dynamics, uncertainty, and multiple objectives.