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https://www.readbyqxmd.com/read/29216841/medical-overuse-and-quaternary-prevention-in-primary-care-a-qualitative-study-with-general-practitioners
#1
Kathrin Alber, Thomas Kuehlein, Angela Schedlbauer, Susann Schaffer
BACKGROUND: Medical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention)...
December 8, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/29216679/the-role-of-extracorporeal-membrane-oxygenator-therapy-in-the-setting-of-type-a-aortic-dissection
#2
Ibrahim Sultan, Andreas Habertheuer, Tyler Wallen, Mary Siki, Wilson Szeto, Joseph E Bavaria, Matthew Williams, Prashanth Vallabhajosyula
BACKGROUND AND AIM: Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post-cardiotomy shock. We sought to determine the utility of ECMO implementation post-TAAD repair. METHODS: The Pennsylvania Health Care Cost Containment Council (PHC4) database, maintained by an independently functioning state agency, was retrospectively reviewed from 2004 to 2014...
December 7, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29212101/invitation-letters-increase-participation-in-colorectal-cancer-screening-results-from-an-observational-study
#3
Tianzuo Zhan, Thomas Hielscher, Asmé Bilge, Thomas Giese, Christoph Schäfer, Jürgen F Riemann, Matthias P Ebert, Sebastian Belle
Background and Aim Participation rates in the German colorectal cancer screening program are low. Starting in 2013, a large health insurance plan in Bavaria, Germany, is sending an additional invitation letter to insured individuals when they turn 50 or 55 years and become eligible for participation in the program. The letter provides detailed information on colorectal cancer screening. We assessed the impact of the invitation letter on utilization rates. Methods Insurance claims data of a total of 48 343 individuals who had turned 50 or 55 years between 2012 to 2014 were reviewed for utilization rates of screening colonoscopy and fecal blood tests...
December 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/29202769/impact-of-systolic-blood-pressure-limits-on-the-diagnostic-value-of-triage-algorithms
#4
Tobias Neidel, Nicolas Salvador, Axel R Heller
BACKGROUND: Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally...
December 4, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29197327/re-evaluation-of-the-haarlem-archaeopteryx-and-the-radiation-of-maniraptoran-theropod-dinosaurs
#5
Christian Foth, Oliver W M Rauhut
BACKGROUND: Archaeopteryx is an iconic fossil that has long been pivotal for our understanding of the origin of birds. Remains of this important taxon have only been found in the Late Jurassic lithographic limestones of Bavaria, Germany. Twelve skeletal specimens are reported so far. Archaeopteryx was long the only pre-Cretaceous paravian theropod known, but recent discoveries from the Tiaojishan Formation, China, yielded a remarkable diversity of this clade, including the possibly oldest and most basal known clade of avialan, here named Anchiornithidae...
December 2, 2017: BMC Evolutionary Biology
https://www.readbyqxmd.com/read/29186724/-establishing-prevention-reporting-in-bavaria-concept-implementation-and-first-results
#6
Veronika Reisig, Joseph Kuhn, Franziska Poppe, Wolfgang H Caselmann
Background Bavaria is currently embarking on the endeavour of building up systematic prevention reporting. Prevention reporting is meant to support the implementation of the Bavarian Prevention Plan and the German Prevention Law and to further the ongoing development in the field of health promotion and health-related prevention in Bavaria. Goals Prevention reporting in Bavaria aims to draw on general health reporting and complement it with specific prevention-related data taking into special consideration the Bavarian Prevention Plan...
November 29, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/29184335/johann-bernhard-aloys-von-gudden-and-the-mad-king-of-bavaria
#7
Kalyan B Bhattacharyya
Bernhard von Gudden was a psychiatrist in Prussia and he was summoned in March 1886 to examine King Ludwig II for his apparently insane activities like, profligate spending and erratic behaviour. A team of four estimable psychiatrists pronounced that he was not capable ruling. Consequently, he was dethroned and kept in a castle under supervision of von Gudden. Gudden championed the idea of 'no restraint' and advocated free movement of insane persons and one evening in June, he accompanied the King during an evening stroll to a lake...
October 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/29100643/risk-aversion-and-public-reporting-part-1-observations-from-cardiac-surgery-and-interventional-cardiology
#8
REVIEW
David M Shahian, Jeffrey P Jacobs, Vinay Badhwar, Richard S D'Agostino, Joseph E Bavaria, Richard L Prager
Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the two specialties from which almost all risk aversion observations have been derived...
November 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29100640/risk-aversion-and-public-reporting-part-2-mitigation-strategies
#9
REVIEW
David M Shahian, Jeffrey P Jacobs, Vinay Badhwar, Richard S D'Agostino, Joseph E Bavaria, Richard L Prager
Part 1 of this review summarizes the consequences of risk aversion and the observational studies and surveys relevant to this phenomenon, almost all of which are derived from cardiac surgery and interventional cardiology. In Part 2, we describe the root cause of risk aversion-the belief by providers that current risk adjustment is inadequate to account for the severity of their highest-risk patients, thereby prejudicing their publicly reported performance scores. Evidence supporting the robustness of current risk adjustment is presented, as well as nine potential strategies to further mitigate risk aversion: optimization of data source, risk models, and performance measures; exclusion of high-risk patients; exclusion of non-procedure-related end points; separate reporting of high-risk patients; reporting by condition or diagnosis rather than by procedures; reporting at the hospital or program level rather than the physician level; collaborative, cross-disciplinary decision making; active surveillance for risk aversion; and improved stakeholder education...
November 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29096864/care-high-cascade-screening-and-registry-for-high-cholesterol-in-germany
#10
Nina Schmidt, Tanja Grammer, Ioanna Gouni-Berthold, Ulrich Julius, Ursula Kassner, Gerald Klose, Christel König, Ulrich Laufs, Britta Otte, Elisabeth Steinhagen-Thiessen, Christoph Wanner, Winfried März
INTRODUCTION: Familial hypercholesterolemia (FH) is an inherited disorder of the LDL metabolism, leading to cardiovascular disease, even at young age. This risk can be significantly lowered by early diagnosis and treatment. About 270,000 patients affected in Germany are not diagnosed correctly and only a small number is treated properly. To improve FH diagnosis in the general population a cascade screening and registry data is warranted, yet missing in Germany. This project aims to fill this gap...
November 2017: Atherosclerosis. Supplements
https://www.readbyqxmd.com/read/29090421/alveolar-echinococcosis-in-germany-1992-2016-an-update-based-on-the-newly-established-national-ae-database
#11
Julian Schmidberger, Wolfgang Kratzer, Klaus Stark, Beate Grüner
PURPOSE: Alveolar echinococcosis is a rare disease caused by the parasite Echinococcus multilocularis. The newly established national database should enable us to determine high-risk areas and evaluate the endemic levels. METHODS: The national database was implemented using SQL Workbench. We used EpiInfo™ software to display the prevalence of disease. Moran's I geodata analysis according to cluster and high risk areas was performed with GeoDa™. SAS Version 9...
October 31, 2017: Infection
https://www.readbyqxmd.com/read/29067710/standardized-ileal-digestibility-of-amino-acids-in-european-soya-bean-and-rapeseed-products-fed-to-growing-pigs
#12
C Kaewtapee, R Mosenthin, S Nenning, M Wiltafsky, M Schäffler, M Eklund, P Rosenfelder-Kuon
This study was conducted to determine the chemical composition and standardized ileal digestibility coefficients (SID) of crude protein (CP) and amino acids (AA) of European soya bean and rapeseed products in pigs. Six soya bean and two rapeseed products were used as the sole dietary source of CP and AA, including raw (FFSB) and roasted full-fat soya beans (FFSBRoasted ), soya bean (SBC) and rapeseed cake (RSC), and rapeseed meal (RSM) from Bavaria (Germany), soya bean meal (SBM) from the Danube region (Austria; SBMAustria ), a commercially available standard SBM (SBMStd ) and an imported genetically modified organism-free SBM (SBMGMO-free )...
October 25, 2017: Journal of Animal Physiology and Animal Nutrition
https://www.readbyqxmd.com/read/29063155/-regional-life-expectancy-rankings-methodological-artefacts-in-population-updates
#13
REVIEW
Franziska Poppe, Rolf Annuß, Joseph Kuhn
For the calculation of life expectancy on a regional level, data from the mortality statistics and population numbers are needed. The latter are derived from population censuses, which have to be undertaken every 10 years according to the EU regulation No. 763/2008. In Germany, the last census took place in 2011 (Census 2011). The current population numbers are calculated on the basis of the most recent population census (population update). Births, deaths, immigration and migration, in addition to other data, are taken into account in this calculation...
October 23, 2017: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/29061608/impact-of-regional-socioeconomic-variation-on-coordination-and-cost-of-ambulatory-care-investigation-of-claims-data-from-bavaria-germany
#14
Michael Mehring, Ewan Donnachie, Antonius Schneider, Martin Tauscher, Roman Gerlach, Constanze Storr, Klaus Linde, Andreas Mielck, Werner Maier
OBJECTIVES: A considerable proportion of regional variation in healthcare use and health expenditures is to date still unexplained. The aim was to investigate regional differences in the gatekeeping role of general practitioners and to identify relevant explanatory variables at patient and district level in Bavaria, Germany. DESIGN: Retrospective routine data analysis using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. PARTICIPANTS: All patients who consulted a specialist in ambulatory practice within the first quarter of 2011 (n=3 616 510)...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29035851/mitochondrial-genotyping-of-fascioloides-magna-from-bavaria-germany
#15
Eva Bazsalovicsová, Ludmila Juhásová, Ivica Králová-Hromadová, Steffen Rehbein
In last few years, a great effort has been made to understand genetic interrelationships of European and North American populations of giant liver fluke Fascioloides magna (Trematoda, Fasciolidae). In Europe, spatial distribution of this parasite is evidently dynamic and ongoing process since new F. magna populations have constantly been emerging. Most recently, occurrence of F. magna in red deer (Cervus elaphus), sika deer (Cervus nippon), fallow deer (Dama dama), roe deer (Capreolus capreolus), and wild boar (Sus scrofa) was reported from north-eastern Bavaria in Germany...
December 20, 2017: Acta Parasitologica
https://www.readbyqxmd.com/read/29034258/migrants-and-refugees-in-europe-challenges-experiences-and-contributions
#16
REVIEW
Tobias Schilling, Stephan Rauscher, Christian Menzel, Simon Reichenauer, Martina Müller-Schilling, Stephan Schmid, Michael Selgrad
Due to the current geopolitical situation more refugees from crisis countries were and will be treated in Europe. In 2015 the number of displaced people reached an unprecedented level, with more than one million crossing into Europe. The migration itself can impair both mental and physical health. Therefore, the provision of medical care for refugees and migrants is a novel and major challenge for the health care systems in Europe. In this article we describe our experiences and contribution in providing medical care for refugees who have newly arrived in Stuttgart, Baden-Wuerttemberg, Germany...
August 2017: Visceral Medicine
https://www.readbyqxmd.com/read/29027001/cancer-incidence-in-urban-rural-and-densely-populated-districts-close-to-core-cities-in-bavaria-germany
#17
M Radespiel-Tröger, K Geiss, D Twardella, W Maier, M Meyer
OBJECTIVE: An ecologic study on the level of districts was performed to evaluate the possible association between district type and risk of cancer in Bavaria, Southern Germany. METHODS: Cancer incidence data for the years 2003-2012 were obtained from the population-based cancer registry Bavaria according to sex and cancer site. Data on district type, socio-economic area deprivation, particulate matter exposure, tobacco consumption, and alcohol consumption were obtained from publicly available sources...
October 12, 2017: International Archives of Occupational and Environmental Health
https://www.readbyqxmd.com/read/29018531/magnetic-resonance-imaging-to-detect-local-tissue-reactions-after-vaccination-in-sheep-in-vivo
#18
Maren Bernau, Prisca Valerie Kremer-Rücker, Lena Sophie Kreuzer, Sebastian Schwanitz, Klaus Cussler, Andreas Hoffmann, Armin Manfred Scholz
OBJECTIVES: Vaccination is one of the most effective methods to keep up the health status in humans and in livestock. Therefore, farm animals are vaccinated several times during their lifetime. Although vaccines are being checked regarding their local reactogenicity, side effects occur frequently-especially in the case of the application of adjuvanted products. Many reports exist about local reactions in sheep. The present study aimed at testing MRI as a method to document injection site reactions three-dimensionally...
2017: Veterinary Record Open
https://www.readbyqxmd.com/read/28992658/-the-pl%C3%A3-ner-model-for-the-school-entry-screening-is-a-role-model-for-the-future
#19
Josef Weigl
Background The Plöner Model is a stepwise-selective model, similar to the one practised in all of Bavaria since 2008. It was already developed in 2002/2003 for the school entry screening and has been in use since then. Such models are intermittently criticized since not each child is seen by a doctor. Methods The procedure and data of the Plöner Model are analyzed and put into a wider context within Germany and beyond. The current programs in place are therefore categorized into 3 groups and compared with regard to public heath ethics criteria...
October 9, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28959624/single-dose-activated-charcoal-for-gut-decontamination-application-by-medical-non-professionals-a-prospective-study-on-availability-and-practicability
#20
Rudolf Pfab, Sabrina Schmoll, Gabriele Dostal, Jochen Stenzel, Alexander Hapfelmeier, Florian Eyer
CONTEXT: Oral activated charcoal (AC) for toxin absorption should be applied as soon as possible. Extra-hospital AC-application on site by medical laypersons with pre-emptive obtained AC may save time, but may be inferior to AC-application by medical professionals. OBJECTIVE: 1) Availability and incidence of pre-emptive stockpiling of AC on site in the German region Bavaria 2) time saved by AC-stockpiling and application on site, 3) quality of AC-application defined by completeness of the applied AC-dose, time needed, incidence of side-effects in lay-care and in professional-care, considering confounding variables: AC-formulation/powder/tablets, recommended AC-dose, patient's age...
2017: Toxicology Reports
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