The KTx360°-study: a multicenter, multisectoral, multimodal, telemedicine-based follow-up care model to improve care and reduce health-care costs after kidney transplantation in children and adults.

BACKGROUND: Follow-up care after kidney transplantation is performed in transplant centers as well as in local nephrologist's practices in Germany. However, organized integrated care of these different sectors of the German health care system is missing. This organizational deficit as well as non-adherence of kidney recipients and longterm cardiovascular complications are major reasons for an impaired patient and graft survival. METHODS: The KTx360° study is supported by a grant from the Federal Joint Committee of the Federal Republic of Germany. The study will include 448 (39 children) incident patients of all ages with KTx after study start in May 2017 and 963 (83 children) prevalent patients with KTx between 2010 and 2016. The collaboration between transplant centers and nephrologists in private local practices will be supported by internet-based case-files and scheduled virtual visits (patient consultation via video conferencing). At specified points of the care process patients will receive cardiovascular and adherence assessments and respective interventions. Care will be coordinated by an additional case management. The goals of the study will be evaluated by an independent institute using claims data from the statutory health insurances and data collected from patients and their caregivers during study participation. To model longitudinal changes after transplantation and differences in changes and levels of immunosuppresive therapy after transplantation between study participants and historical data as well as data from control patients who do not participate in KTx360°, adjusted regression analyses, such as mixed models with repeated measures, will be used. Relevant confounders will be controlled in all analyses. DISCUSSION: The study aims to prolong patient and graft survival, to reduce avoidable hospitalizations, co-morbidities and health care costs, and to enhance quality of life of patients after kidney transplantation. TRIAL REGISTRATION: ISRCTN29416382 (retrospectively registered on 05.05.2017).

[Current status and analysis of diagnostic and therapeutic guidelines in the area of chronic obstructive respiratory tract diseases in adulthood]. / Bestandsaufnahme und Analyse von Diagnose- und Therapieleitlinien im Bereich der chronisch obstruktiven Atemwegserkrankungen im Erwachsenenalter.

UNLABELLED: GOAL OF THE INVESTIGATION: It was investigated (1) whether guidelines for the treatment of bronchial asthma and chronic obstructive pulmonary diseases (chronic obstructive bronchitis and lung emphysema) are distributed in Germany, (2) whether they are accepted by general practitioners and physicians for internal medicine without subspecialty, and (3) how much they are used. METHODS: (1) The mostly read medical journals have been screened. (2) 1200 physicians have been questioned with regard to the main criteria of these guidelines. (3) 600 physicians were asked to write a documentation for two patients each with bronchial asthma and chronic obstructive pulmonary disease. 344 of the questionnaires (28.7%) and 544 of the documentations could be analyzed (22.7%). RESULTS: Guidelines for the treatment of bronchial asthma are published in all leading journals. Substantially less references were found for the therapy of chronic obstructive bronchitis. The main concepts of training, diagnosis of the disease's severity, and physical therapy are all known by the practitioners. The training plays a sufficient role in only half of the questioned physicians. The self-measurement of the patient is not every where accepted. The treatment according to a stage by stage pharmacological therapy cannot be seen in one third of the questioned physicians. CONCLUSIONS: Differential diagnosis and therapy are not sufficiently emphasized in the current guidelines. Practitioners should participate in the development of guidelines, to include the aspects of realization.

[Implementation of perinatal regionalization: frequency of high-risk deliveries outside of specialized perinatal care centres]. / Zur Regionalisierung der perinatalen Versorgung - Wie häufig sind Fehlplatzierungen von Risikogebärenden?

BACKGROUND: The concentration of high-risk deliveries in specialized perinatal care centres contributes to the reduction of infant mortality and morbidity. This study investigates the frequency of high-risk deliveries in hospitals with inadequate level of perinatal care. METHODS: From the files of a German statutory health insurance we draw a random sample of 3.967 women who gave birth april to june 2002. The women received a questionnaire and were asked to send in their "maternity logbook", a document that every pregnant woman receives and where prenatal visits and births are documented by the obstetricians in standardized form. From the 1,593 responders (response rate 40.2 %) we selected 559 high-risk cases. 83 of these (14.8 %) delivered at a specialized perinatal care centre. The remaining 476 deliveries were subjected to an individual analysis of their data. Based on published guidelines for antenatal transport and on data about the perinatal care facilities of German hospitals the adequacy of the delivery hospital was rated for each case. RESULTS: 2.4 % of the whole sample (38/1,503) were classified as "inadequate hospital of delivery". 17 of these 38 cases were considered as potentially avoidable because significant antepartal risk factors were documented. 5 (25 %) of the 20 highest risk cases (twins < 36 weeks of gestational age, singletons < 32 weeks, infants < 1.500 g) were classified as avoidable referrals to inadequate hospitals. CONCLUSIONS: Regionalization of perinatal care must be enhanced by adequate appreciation of antenatal risk factors and counselling of pregnant women on the choice of place of delivery.

[What kind of information is expected to be provided by medical information services?]. / Welche Informationen erwarten Patienten und Versicherte von medizinischen Informationsdiensten?

OBJECTIVE: The improvement of health-related information services is one major issue in reforming the German health care system to provide more transparency in health care services for patients and persons covered by the German statutory health insurance system. To meet the general need for specific medical information a telephone-based health information service may give individual advice and provide a helpful selection of information. The study aims at users expectations and preferences with regard to health information services. More particularly, users perception concerning the type of health information and the ways of choosing the information were to be explored. METHOD: The study included 160 participants of different ages. Prototypical medical advice conversations were presented to the participants consisting of/identifying the consumer's inquiry, followed by the expert's answering sequence. The answers were based on typical inquiries from medical information providers focussing on treatment methods and illnesses. Health information from these conversations with its special contents were ranked by preference judgements resulting in Thurstone scalings. RESULTS: In terms of different health questions, the participants' judgements showed general preference structures for special health information, independent from any personal attitude towards medical information services. Great emphasis was placed on the medical conversation competence of the service provider, which is evident from recognising the specific needs and selection of information of a caller. Overall such health information was preferred that strengthened the patient's and user's autonomy and ability for decision making. CONCLUSION: Patients and persons covered by German statutory health insurance are characterised as users of information by special preferences. Identifying these preferences permits a reasonable selection of information and individual advice. Therefore, these services provide a major advantage over non-interactive health information services (print media, internet sites).

[Effectiveness of secondary preventive programs for patients with asthma and rhinitis in the baking industry]. / Effektivität eines Sekundär-Präventionsprogramms für asthmatisch und rhinitisch Erkrankte im Bäckerhandwerk.

Since 1992 the German industrial professional association for the food industry and gastronomy (Berufsgenossenschaft Nahrungsmittel und Gaststätten), which is responsible for statutory accident insurance has been offering a specific patient education programme to bakers suffering from occupationally induced obstructive pulmonary disease or allergic rhino-conjunctivitis, who do not quit their jobs and wish to continue working as bakers. The programme aims at preventing aggravation of the disease 74 male bakers with a mean duration of illness of 10 years on entering the programme were examined between 1 and 5 years (mean: 2.9) after participating in the patient education seminar. For a subpopulation of 55 of these patients spirometric measurements were available for the time before programme entry and at follow-up. Data on time spent at the bakehouse, prevalence of symptoms, frequency of symptoms at the site of working and during leisure hours, sleep disturbances and emergency situations were collected at the follow-up examination both for the time before programme entry and at follow-up, respectively. Direct ratings of the amount of changes in distress caused by the disease and of the quality of life were also obtained. The prevalence of 8 of the 9 most frequently reported symptoms decreased significantly, e.g. dysponoea from 70% to 42% and fear of suffocation from 30% to 3%. Participants reported on highly significant reductions in the frequency of disease-specific complaints during work and outside the working place, sleep disturbances and situations requiring immediate medical intervention. Between 64% and 85% of the patients experienced improvement of distress, physical and work performance, private and family life, and ability for self-management. Lung function did not deteriorate: mean FEV1 was 88% (+/- 23) at first and 90% (+/- 19) at second measurement. These results could not be explained by changes in medication. It is concluded that the programme is effective in reducing symptoms and distress and in improving quality of life in bakers with occupational respiratory disease who voluntarily continue to work as bakers.

[Do bacteriologic-chemical drinking water studies of households with suspected SIDS have significance?]. / Haben bakteriologisch-chemische Trinkwasseruntersuchungen in Haushalten mit SIDS-Verdacht Bedeutung?

In 30 households with SIDS the drinking-water was studied microbiologically and chemically regarding its bacteriological contents, also it was checked for Pb and Cu. Three test solutions of 45 bacteriologically researched samples revealed significant data. One sample showed 2400 cfu "colony forming unit" which is more than double the number of germs permissable in an drinking-water container according to the standards of drinking-water (TrinkwV) 1(3). Also Ps. aeruginosa were found. A further sample contained 3300 cfu Coliforme (E. cloace in 100 ml). The lower quality of a further samples with 2.6 x 10(6) cfu could be retrospectively explained by works done by the Berlin City Works (Berliner Wasserwerke). Enteric bacteria could not be revealed. The remaining 42 samples were within the criteria Section 1 [(1), (2), (3)] of the drinking-water standard. Samples which fulfilled the norms of Section 1 (3) TrinkwV for reserve containers with up to 1000 cfu can be explained by the known fact that water in pipes (containers) can easily be contaminated from outside, for instance through germs like Pseudomonades. In none of the samples a connection between water quality and bacteriological post-mortem findings could be found. In two groups concerning the research for heavy metal the amount of Pb did not surpass the limit of drinking-water standards. In several cases the amount of Cu surpassed that of Pb. Bacteriological-chemical water research in households with suspicion of SIDS are only useful if anamnestical, clinical and autoptic data can be brought into a close temporary and spatial order and if the findings can be controlled through repeated research.(ABSTRACT TRUNCATED AT 250 WORDS)

[Job strain as a risk factor for occupational accidents among hospital nursing staff]. / Psychischer Stress als Risikofaktor für Arbeitsunfälle bei Pflegekräften im Krankenhaus.

In a cross-sectional questionnaire study the influence of psychological job strain and nine other factors on the occurrence of accidents at work were examined. Data were collected by a national survey of nursing personnel in Germany. The sample of this study consists of 874 nurses working in acute care hospitals. Job strain was operationalised according to Karasek's demand-control model and measured by a self-developed questionnaire. 32 % had experienced at least one accident during the 12 months preceding the survey (mostly accidental cuts or needle punctures). No association with accident risk was found for age, sex, professional status (supervising function) and hours of overtime work. The six factors significantly associated with accident risk in univariate analyses were entered into a logistic regression model: high job strain, working in a functional unit (e. g. laboratory), full-time work, less than 3 years of occupation in the present department, having children of less than 3 years of age and being a single parent. In the multivariate analyses high job strain turned out to be the most important risk factor for occupational accidents (odds ratio: 2.4, 95 % C.I.: 1.7-3.3). Significantly elevated risks were found for full-time work, less than 3 years of occupation in the present department and being a single parent (odds ratios between 1.5 and 1.8). Having at least one child of less than 3 years of age was a protective factor (odds ratio 0.5, 95-% C.I.: 0.4-0.8).