Background Vulnerable groups, e.g. persons with mental illness, neurological deficits or dementia, are often excluded as participants from research projects because obtaining informed consent can be ...difficult and tedious. This may have the consequence that vulnerable groups benefit less from medical progress. Vulnerable persons are often supported by a legal guardian in one or more demands of their daily life. We examined the attitudes of legal guardians and legally supervised persons towards medical research and the conditions and motivations to participate in studies. Methods We conducted a cross-sectional study with standardized surveys of legal guardians and legally supervised persons. Two separate questionnaires were developed for the legal guardians and the supervised persons to asses previous experiences with research projects and the reasons for participation or non-participation. The legal guardians were recruited through various guardianship organizations. The supervised persons were recruited through their legal guardian and from a previous study among psychiatric patients. The data were analysed descriptively. Results Alltogether, 82 legal guardians and 20 legally supervised persons could be recruited. Thereof 13 legal guardians (15.6%) and 13 legally supervised persons (65.0%) had previous experience with research projects. The majority of the guardians with experience in research projects had consented the participation of their supervised persons (n = 12 guardians, 60.0%; in total n = 16 approvals). The possible burden on the participating person was given as the most frequent reason not to participate both by the guardians (n = 44, 54.4%) and by the supervised persons (n = 3, 30.0%). The most frequent motivation to provide consent to participate in a research study was the desire to help other patients by gaining new scientific knowledge (guardians: n = 125, 78.1%; supervised persons: n = 10, 66.6%). Conclusions Overall, an open attitude towards medical research can be observed both among legal guardians and supervised persons. Perceived risks and no sense recognized in the study are reasons for not participating in medical research projects.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Telemedical care and monitoring programs for patients with chronic heart failure have shown beneficial effects on survival in several small studies. The utility in routine care remains ...unclear.
Methods
We evaluated a large‐sized telemedicine program in a routine care setting, enrolling in total 2,622 patients (54.7 percent male, mean age: 73.7 years) with chronic heart failure. We used reimbursement data from a large statutory health insurance and approached a matched control analysis. In a complex propensity score matching procedure, 3,719 suitable controls (54.2 percent male, mean age: 74.5 years) were matched to 1,943 intervention patients (54.1 percent male, mean age: 74.4 years). The primary endpoint of our analysis was survival after 1 year.
Results
Analyses revealed a higher survival probability among subjects of the intervention group compared to controls group after 1 year (adjusted OR: 1.47, CI 95 percent: 1.21–1.80, p < .001) and 2 years (adjusted OR: 1.51, CI 95 percent: 1.28–1.77, p < .001), respectively.
Conclusions
The probabilities to survive after 1 and 2 years were significantly increased in the intervention group. Our findings confirm previous results of controlled trials and importantly indicate that patients with chronic heart failure may benefit from telemonitoring programs in routine care.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many ...parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system.
Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen's kappa, between the two paediatricians. We have also included patient and assessor demographics.
A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician's and telemedicine paediatrician's urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient's condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen's weighted kappa was 0.64 (95% CI: 0.49-0.79), indicating a substantial agreement between the specialists.
Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals' organisational processes. The processes should include intensive training for the doctors involved in telemedical triage.
DRKS00013207.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health ...inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness.
Methods
Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross‐referencing was performed using a standardised searching algorithm. Randomised and non‐randomised controlled trials, controlled before‐and‐after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265).
Results
Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal‐coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance.
Conclusions
The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.
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BFBNIB, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract A Central Data Management (CDM) system based on electronic data capture (EDC) software and study specific databases is an essential component for assessment and management of large data ...volumes in epidemiologic studies. Conventional CDM systems using web applications for data capture depend on permanent access to a network. However, in many study settings permanent network access cannot be guaranteed, e.g. when participants/patients are visited in their homes. In such cases a different concept for data capture is needed. The utilized EDC software must be able to ensure data capture as stand-alone instance and to synchronize captured data with the server at a later point in time. This article describes the design of the mobile information capture (MInCa) system an EDC software meeting these requirements. In particular, we focus on client and server design, data synchronization, and data privacy as well as data security measures. The MInCa software has already proven its efficiency in epidemiologic studies revealing strengths and weaknesses concerning both concept and practical application which will be addressed in this article.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Findings on the association between cardiorespiratory fitness (CRF) and moderate-to-vigorous physical activity (MVPA) may be distorted if patterns of accumulated MVPA over a week exist but are ...ignored. Our aim was to identify MVPA patterns and to associate them to CRF. Two hundred twenty-four 40–75-year-old adults wore accelerometers for 7 days. CRF was measured by peak oxygen uptake (
V
′O
2,peak
) assessed on a cycle ergometer via standardized cardiopulmonary exercise testing. Growth mixture modeling indicated four MVPA patterns: “low/stable” (57%, Mean MVPA time (
M
) = 21 min day
−1
), “medium/stable” (20%,
M
= 46 min day
−1
), “medium/weekend high” (14%,
M
= 47 min day
−1
), and “high/weekend low” (9%,
M
= 71 min day
−1
).
V
′O
2,peak
was higher for persons with “high/weekend low” and “medium/weekend high” patterns compared to “low/stable” and “medium/stable” (
p
values < 0.001). The same total amount of MVPA may have greater benefit if performed on fewer days during the week but with a longer duration than if performed every day but with a lower duration.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Objectives
To plan dental services, a spatial estimation of future demands and supply is required. We aimed at estimating demand and supply in 2030 in Northern Germany based on the expected local ...socio‐demography and oral‐health‐related morbidity, and the predicted number of dentists and their working time.
Methods
All analyses were performed on zip‐code level. Register data were used to determine the number of retiring dentists and to construct regression models for estimating the number of dentists moving into each zip‐code area until 2030. Demand was modelled using projected demography and morbidities. Demand‐supply ratios were evaluated and spatial analyses applied. Sensitivity analyses were employed to assess robustness of our findings.
Results
Compared with 2011, the population decreased (−7% to −11%) and aged (from mean 46 to 51 years) until 2030. Oral‐health‐related morbidity changed, leading to more periodontal and fewer prosthetic treatments needs, with the overall demand decreasing in all scenarios (−25% to −33%). In contrast, the overall number of dentists did only limitedly change, resulting in moderate decrease in the supplied service quantities (max. −22%). Thus, the demand–supply ratio increased in all but the worst case scenario, but was unequally distributed between spatial units, with several areas being over‐ and some being under‐ or none‐serviced in 2030.
Conclusions
Within the limitations of the underlying data and the required assumptions, this study expects an increasingly polarized ratio of dental services demand and supply in Northern Germany. Our estimation allows to assess the impact of different influence factors on demand or supply and to specifically identify potential challenges for workforce planning and regulation in different spatial units.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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