[Health service aspects of electroconvulsive therapy: analysis of external referrals to a university medical center]. / Versorgungsaspekte der Elektrokonvulsionstherapie: Analyse der externen Zuweisungen an ein universitäres Zentrum.

BACKGROUND: The application of ECT in Germany varies widely depending on regional availability. This shortfall in ECT supply is partly compensated via referrals to hospitals with ECT services, yet restricted by limited resources in these clinics. OBJECTIVE: External referrals for ECT were investigated at the University Medical Center Göttingen. We analyzed the referring institutions, patient characteristics, pharmacotherapy according to current guidelines before indications for ECT, and clinical outcome in cases of treatment with ECT. MATERIAL AND METHODS: All external referrals were systematically recorded and retrospectively evaluated for the time span of 1 year. Besides descriptive presentation of the data, pharmacological pretreatment was compared with the current guideline recommendations. We used overall clinical impression (CGI-I) to determine the treatment response post-ECT. RESULTS: External referrals were made for N = 52 patients, 82.7% of whom were from the inpatient setting and from a distance of up to 300 km. The most common diagnoses were unipolar depression (57.7%), followed by schizophrenia spectrum (36.5%). Prior to referral, at least one guideline-based pretreatment was given in the majority of cases. ECT was performed in 18 patients in our hospital, of whom 72.7% showed a good to very good response. CONCLUSION: Both numbers and radius of external referrals indicate a high unmet need for ECT and thus limited access to this evidence-based and guideline-recommended therapy. As treatment close to home should be the goal, more hospitals are needed to establish (or expand) ECT services; however, even with considerable delays which are often associated with external referrals, the response rate is good across all diagnoses.

Human-robot interaction: how worker influence in task allocation improves autonomy.

Task allocation research is often efficiency-focussed, but procedural and work-psychological perspectives are required to enable human-centred human-robot interaction (HRI). Hence, the motivational and cognitive outcomes of the degree of worker influence over task allocation are relevant to research objects for allocation process design. In a laboratory experiment, 87 participants manufactured goods in collaboration with a robot under three conditions: (1) a support system decided the allocation, (2) a support-system allocation could be revised, (3) the participant determined the allocation. Conditions affected mental effort, process control and autonomy, resulting in higher values when participants allocated tasks themselves. Satisfaction with the process appears lower with no worker influence. Trust in the support-system moderates the condition effect, with higher satisfaction depending on trust when a system is involved in allocation. An allocation made by the workers and adaptability is preferred. Results show the importance of worker influence over task allocation in HRI. Practitioner Summary: Our experiment on allocation processes seeks to satisfy the gap in human-centred psychological research on task allocation in human-robot interaction (HRI). For successful, ergonomic HRI, it is found that workers should be provided with influence over task allocation.

Pancreas utilization rates in the UK - an 11-year analysis.

Utilization of pancreases for transplantation remains inferior to that of other organs. Herein, we analysed UK pancreas discards to identify the reasons for the low utilization rates. Data on all pancreases offered first for solid organ transplantation between 1st January 2005 and 31st December 2015 were extracted from the UK Transplant Registry. The number of organs discarded, reasons and the time point of discard were analysed. A centre specific comparison was also undertaken. 7367 pancreases were offered first for solid organ transplantation. 35% were donors after circulatory death (DCD). 3668 (49.7%) organs were not retrieved. Of the 3699 pancreases retrieved, 38% were initially accepted but subsequently discarded. 2145 (29%) grafts offered were transplanted as simultaneous pancreas-kidney or solitary pancreas. 1177 (55%) were transplanted on the first offer whilst the remaining 968 were transplanted after a median of three offers. 52% DBD pancreases were accepted and transplanted on the first offer compared with 68% DCD grafts. There were significant differences in discard rates between centres (30-80% for DBD and 3-78% for DCD, P < 0.001). A significant number of solid pancreases are discarded. Better graft assessment at retrieval could minimize unnecessary organ travel and discards. Closer links with islet programmes may allow for better utilization of discarded grafts.