Nutzung von Routinedaten unterschiedlicher gesetzlicher Krankenkassen: Ein Erfahrungsbericht aus der TIM-HF2-Studie zur Datenerschließung, -validierung und -aufbereitung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Im Rahmen der randomisierten, kontrollierten und klinischen Studie „TIM-HF2“ wurde der Nutzen von Telemonitoring bei...     

A 100-channel system for real time detection and storage of extracellular spike waveforms.

As extracellular electrode arrays with 100 or more active recording sites become more widely used for simultaneous recording of neural ensembles, practical data acquisition systems that can efficiently accommodate high electrode counts are needed. To reduce the high data rates associated with extracellular recordings from these arrays, various algorithms and systems have been designed to provide complete online detection and classification of extracellular spike waveforms. However, many of these algorithms require significant user supervision to ensure accurate performance. In this paper, we discuss the design and validation of a 100-channel PC-based system that can be used with arrays of extracellular electrodes such as the Utah Electrode Array. Instead of comprehensive online spike analysis, the system performs online detection and storage of the spike waveforms for offline classification. This strategy preserves the data of interest, reduces system complexity, and requires less user supervision during experiments.     

Upper clayx reno-vascular obstruction in children: Fraley's syndrome

Intrarenal vascular obstruction of the upper calyceal infundibulum has been distinguished by Fraley as an entity separate from an asymptomatic vascular impression. Clinically, this form of intrarenal vascular obstruction presents as nephralgia or hematuria. This infundibular obstruction is caused by normal renal vessels, usually the upper segmental artery: radiologically, the vessels produce a constant well-defined filling defect in the infundibulum at IVP, and, the upper calyx group is distended and shows delay in emptying. We found this condition in 14 children from 1968–1975. Control studies showed no progression in the radiological findings, even over a long period. In one of our cases angiography was indicated to exclude tumour or cyst; in another case, surgery was necessary. Complications are urinary tract infection or stone formation. Therefore, children with Fraley's syndrome require regular clinical examination.Presented at the 12th Meeting of the European Society of Pediatric Radiology, Stockholm, Sweden, May 19–22, 1976     

The effects of continuous superfusion of L-aspartate and L-glutamate on horizontal cells of the turtle retina

We have studied the effects of prolonged superfusion with L-aspartate and L-glutamate on the membrane potential and photoresponses recorded in luminosity type horizontal cells in the turtle retina using an everted eyecup preparation. These acidic amino acids produce effects which are a function of the past history of the impaled cell. Initial prolonged superfusions with 30 mM of either drug has no pronounced effect on the membrane potential and photoresponses of horizontal cells. Subsequent superfusions with either agent eventually produce depolarizations with reductions in the amplitudes of the light evoked responses. These effects, however, are transient; the horizontal cell rehyperpolarizes and the light evoked response grows with time. In a retina which had been stored at 4 degrees centrigrade for 20 hours, an initial superfusion with L-aspartate solution produced an immediate depolarization of the horizontal cell and complete suppression of the light evoked response for as long as the amino acid was present. The data are consistent with the existence of powerful amino acid uptake mechanisms operating at a number of sites within the inner and outer retina but also raise questions about the role of acidic amino acids in the outer plexiform layer of the turtle retina.     

Der pl?tzliche Herztod – ein überraschendes Ereignis?

Wir untersuchten in einer prospektiven Studie die Randbedingungen des Eintritts des pl?tzlichen Herztodes bei 406 konsekutiven Patienten, bei denen der Notarzt unserer Klinik hinzugezogen wurde. Hierzu wurden die n?heren Umst?nde des Geschehens erfa?t und Augenzeugen unmittelbar an der Einsatzstelle befragt. Das mittlere Alter der Patienten betrug 69,6 Jahre, 60% (n=242) waren m?nnlich. Bei Eintreffen des Rettungsdienstes lag bei 39% (n=159) der Patienten Kammerflimmern vor, bei 42% (n=171) Asystolie, bei 19% (n=76) eine pulslose elektrische Aktivit?t. 100 der 406 Patienten (25%) konnten zun?chst erfolgreich reanimiert werden. Der Kollaps ereignete in 72% (n=294) der F?lle in h?uslicher Umgebung. Augenzeugen waren in 67% (n=272) vorhanden (davon 75% Angeh?rige), in 14% (n=57) wurden ein Laienreanimationsversuch unternommen. Ersthelferreanimation war mit 27% bei Kollaps in der ?ffentlichkeit relativ h?ufiger als bei Ereignis in h?uslicher Umgebung mit 10% (p=0,0002). Bei 323 Patienten konnten Anwesende zum Geschehen befragt werden. Danach hatten 222 Patienten (69%) vor dem Kollaps pr?monitorische Warnsymptome. Am h?ufigsten wurde über Brustschmerz berichtet (40%, n=88), gefolgt von Luftnot (27%, n=61) und Pr?synkopen/Synkopen (10%, n=22) bzw. anderen Symptomen (23%, n=51). Die Warnsymptome dauerten bei 58% (n=128) der Patienten über 30 Minuten an, wobei das charakteristische Symptom „Brustschmerz“ am h?ufigsten l?nger als 30 Minuten toleriert wurde. Eine eindeutig gesicherte – meist koronare – Herzerkrankung lag bei 36% (n=116) der Patienten vor, bei weiteren 39% (n=127) war eine koronare Herzerkrankung sehr wahrscheinlich und/oder sie waren wegen Risikofaktoren in Behandlung. Eine Strategie der Bek?mpfung des pl?tzlichen Herztodes setzt nach unseren Ergebnissen voraus, da? Risikopatienten und Angeh?rige lernen in Notsituationen gezielt zu reagieren. Zum notwendigen Wissen geh?rt offenbar vor allem das Erkennen von Warnsymptomen mit konsekutiver rechtzeitiger Alarmierung des Rettungsdienstes neben Kenntnissen der lebensrettenden Ersthelferreanimation.     

Postoperative Radiotherapy in the Treatment of Ewing Tumors: Influence of the Interval between Surgery and Radiotherapy

Background: The impact of the timing of postoperative irradiation was evaluated in patients with Ewing tumors who received postoperative radiation. Patients and Methods: 153 patients treated in the CESS 86 and EICESS 92 trials were evaluated in a retrospective analysis. They received surgery and postoperative irradiation as local treatment modalities. In 46 patients, postoperative irradiation was started within 60 days after surgery, in 107 patients after more than 60 days. A median dose of 45 Gy was administered. The median follow-up was 70 months. Results: There was no substantial difference between the two groups concerning risk factors for local failure and survival. The local control rate after 5 years was 98% in the group with early onset of radiation and 92% in the group with later onset (n. s.). There is no difference in event free survival between the two groups (both 64% after 5 years). If the cutpoint of the onset of postoperative irradiation was chosen after 90 days, there was no difference in local control or event free survival. Conclusions: Patients with early onset of postoperative irradiation show a trend for improved local control compared to patients with a later onset; the difference is statistically not significant. This trend has no influence on survival. Hintergrund: Der Einfluss des Beginns der postoperativen Strahlentherapie wurde bei Patienten mit Ewing-Tumoren evaluiert, die in den Studien CESS 86 und EICESS 92 behandelt wurden. Patienten und Methode: 153 Patienten aus den Studien CESS 86 und EICESS 92 wurden in einer retrospektiven Auswertung analysiert. Die Lokaltherapie bestand aus einer Resektion und einer postoperativen Bestrahlung. Bei 46 Patienten wurde die postoperative Bestrahlung innerhalb von 60 Tagen nach der Operation begonnen, bei 107 Patienten später. Die mediane Nachbeobachtungszeit betrug 70 Monate. Ergebnisse: Zwischen beiden Gruppen gab es keine wesentliche Unterschiede bzgl. Risikofaktoren für ein Lokalrezidiv und für das Überleben. Die lokale Kontrollrate nach 5 Jahren war 98% in der Gruppe mit frühzeitigem Beginn und 92% in der Gruppe mit späteren Beginn der Radiotherapie (n. s.). Es gab keinen Unterschied im ereignisfreien Überleben zwischen beiden Gruppen (beide 64% nach 5 Jahren). Wenn 90 Tage als Grenze für den Beginn der postoperativen Behandlung gewählt wurde, konnte kein Unterschied in der lokalen Kontrolle und im ereignisfreien Überleben festgestellt werden. Schlussfolgerungen: Patienten mit einem frühen Beginn der postoperativen Bestrahlung zeigten eine tendenziell bessere lokale Kontrollrate; der Unterschied ist statistisch nicht signifikant. Dieser Trend hat keinen Einfluss auf das Überleben.     

Behandlungsassoziierte Spätfolgen nach Strahlentherapie maligner Erkrankungen im Kindes- und Jugendalter

BACKGROUND AND PURPOSE: Radiogenic late effects in children and adolescents have been evaluated retrospectively in most analyses, with small patient numbers. The German Group of Pediatric Radiation Oncology (APRO) has generated a concept for a prospective evaluation of radiation-associated late effects in childhood. The aim of this study was to evaluate the feasibility of a nationwide central database for the documentation of radiation parameters and side effects of all children treated within therapy protocols of the German Society of Pediatric Oncology and Hematology (GPOH). PATIENTS AND METHODS: A study center has been implemented in Muenster, the documentation has started in July 2001 in few centers in a pilot phase. Since February 2004 the documentation is done countrywide. Detailed documentation forms have been designed for treatment parameters and for doses applied at organs at risk. Furthermore, a uniform toxicity documentation, according to the RTOG/EORTC criteria, was chosen. Patients were reported from the study centers of the GPOH to the study center. All information was collected and analyzed in the study center. RESULTS: Till July 31, 2005, 438 documentations of radiation and 579 toxicity documentations of side effects have been collected in the study center. 46 centers for radiotherapy in Germany and one center each in Austria and in Switzerland took part in the documentation. The quality of documentation regarding completeness and plausibility fulfilled the expected criteria in most cases. This feasibility analysis showed that important information about organ dose levels and side effects was documented in a large number of patients (Figures 1 and 2). CONCLUSION: This prospective evaluation of radiotherapy and radiogenic side effects in children and adolescents will allow correlating doses at organs at risk and the incidence of acute and late sequelae in Germany. Further documentations and a longer follow-up are necessary to obtain powerful results.     

Medical resource use and costs of health care after acute stroke in Germany

The purpose of this study was to determine the 12 months medical resource use following admission to hospital with acute stroke and to calculate costs from a societal perspective. Data of consecutive patients with confirmed stroke were analysed. Acute hospital data were taken from medical records, socio-demographic variables from patients' interviews. A follow-up questionnaire about resource utilization was completed by patients or proxies 12 months after acute hospital admission. Costs were calculated by multiplying medical resource units used with cost factors per unit. Mean age of a total of 383 patients was 65 years and 41% were female. The median length of the initial stay in the acute hospital was 12 days at an average cost of 4650 per patient (49% of direct costs). Rehabilitation (16%), readmission (11%), medication (9%), and nursing costs (6%) were other contributors to the direct costs which amounted to a total of 9452 +/- 7599 per patient during 12 months. Indirect cost amounted to a total of 2014 +/- 5312. Patients' age, severity and type of stroke influenced the total stroke-associated costs. The large economic burden of stroke indicates the need for assessing and improving efficient health care for affected patients.     

Irren ist menschlich—soziale und medizinische Aspekte psychischer Erkrankungen

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