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DiGA, Nicht-DiGA und Praxisrealität: eine Fragebogenstudie zu Chancen und Herausforderungen von Gesundheits-Apps im Bereich der psychischen Gesundheitsversorgung
No full textHintergrund
Die Digitalisierung im deutschen Gesundheitssystem schreitet voran. Immer häufiger werden digitale Angebote in die psychische Gesundheitsversorgung einbezogen.
Fragestellung
Diese Fragebogenstudie untersucht die Einschätzung von Fachpersonal, welches in der psychischen Gesundheitsversorgung tätig ist, bezüglich Chancen und Herausforderungen digitaler Gesundheitsangebote. Dabei werden digitale Gesundheitsanwendungen (DiGA) und Nicht-DiGA (Apps und Webangebote ohne staatliche Regulierung und Rückerstattung durch Krankenkassen) berücksichtigt.
Methode
Die Onlineumfrage umfasste u. a. Likert-Skalen zur Bewertung des Therapieerfolgs, der Versorgungsqualität, des Arzt-Patienten-Verhältnisses sowie der Fortbildungsbereitschaft. Die quantitativen Fragen wurden durch Freitextkommentarfelder ergänzt.
Ergebnisse
Basierend auf 200 Teilnahmen zeigt die Analyse, dass die geringfügige Mehrheit keine digitalen Angebote in die Therapie einbezieht. Die Befragten gaben überwiegend an, dass digitale Angebote in der Prävention und Psychoedukation unterstützen können; ob sie jedoch den Anforderungen in weiteren Bereichen der Psychotherapie gerecht werden könnten, wurde meist als fraglich angesehen. Herausforderungen wurden größtenteils in den hohen Kosten und unzureichenden Informationsmöglichkeiten der Behandelnden gesehen. Zudem wurde das Risiko einer Verstärkung gesundheitlicher Ungleichheiten (u. a. durch unzureichende digitale Kompetenz) thematisiert.
Diskussion
Es lässt sich folgern, dass digitale Angebote in der psychischen Gesundheitsversorgung durchaus einen Mehrwert leisten können. Ihre nachhaltige Integration in die Versorgung ist jedoch an eine Verbesserung der strukturellen Rahmenbedingungen (wie das Kosten-Nutzen-Verhältnis und eine bessere Informiertheit der Behandelnden) sowie Berücksichtigung und Ausgleich sozial ungleicher Zugangsbedingungen gebunden.Background: Digitalization in the German healthcare system is advancing. Digital services are increasingly being incorporated into mental healthcare.
Research question: This questionnaire study examined the assessment of professionals working in mental healthcare regarding the opportunities and challenges of digital health services. It takes digital health applications (DiGA) and non-DiGA (apps and web services without reimbursement and governmental regulation) into account.
Method: The online questionnaire included e.g. Likert scales for assessing the success of therapy, the quality of care, the doctor-patient relationship and the willingness to undergo further training. The quantitative questions were supplemented by free text comment fields.
Results: Based on 200 participants the analysis shows that a slight majority do not incorporate digital services into their therapy. The majority of respondents stated that digital services can support prevention and psychoeducation; however, whether they could meet the requirements in other areas of psychotherapy was mostly considered questionable. Challenges were largely seen in the high costs and insufficient information available to practitioners. In addition, the risk of exacerbating health inequalities (e.g., due to insufficient digital literacy) was discussed.
Discussion: It can be concluded that digital services can certainly add value to mental healthcare; however, the sustainable integration into care is linked to improvements in structural conditions (such as the cost-benefit ratio and better information for those providing treatment) as well as consideration and compensation for socially unequal access conditions
Impact of FMS-like tyrosine kinase 3 inhibitor maintenance on post-transplant outcomes in acute myeloid leukemia with FMS-like tyrosine kinase 3 mutations: a real-world German registry analysis highlighting sorafenib
No full textFLT3-mutation occurs in 25-30% of AML and confers high relapse risk and inferior survival. Allogeneic hematopoietic cell transplantation (allo-HCT) offers curative potential, yet relapse remains a major post-transplant challenge. Maintenance therapy with FLT3 inhibitors (FLT3i) after allo-HCT has emerged as a promising strategy, but real-world evidence remains limited. This study aimed to assess the impact of FLT3i maintenance on transplant outcomes. We analyzed 523 adults with FLT3-ITD AML in first complete remission who underwent allo-HCT between 2011 and 2023 in 13 German transplant centers participating in the national DRST registry; 22% received FLT3i maintenance (sorafenib 49%, midostaurin 37%, gilteritinib 5%, unknown 9%). In multivariable analyses (MVA), FLT3i maintenance improved OS (HR 2.25, 95% CI [1.28; 3.95], p=0.005), RFS (HR 1.72, 95% CI [1.05; 2.81], p=0.030), non-relapse mortality (HR 3.62, 95% CI [1.08; 12.11], p=0.037), and GVHD- and relapse-free survival (HR 1.59, 95% CI [1.06; 2.40], p=0.025). The cumulative incidence of relapse did not differ. In univariate analyses (UVA), OS benefits were observed in MRD-positive (HR 2.35, 95% CI [1.04; 5.31], p=0.025) and MRD-negative patients (HR 2.64, 95% CI [1.05; 6.68], p=0.020. Sorafenib maintenance (n=50) demonstrated superior efficacy with 5-year OS of 85% versus 62% (HR 2.979, p=0.0045) and RFS of 84% versus 55% (HR 2.771, p=0.0043) compared to no maintenance. These real-world findings, while limited by the retrospective design and potential selection bias, align with randomized trial data and support the use of FLT3i maintenance as part of post-transplant care for FLT3-ITD AML
PO490 / #720 European standard clinical practice (ESCP) for pediatric pheochromocytoma and paraganglioma: a consensus-based approach [Abstract]
No full text
Is navigated transcranial magnetic stimulation capable of detecting different motor cell clusters within the precentral gyrus using a single pulse protocol?
No full textObjective: In 2021, Rossi et al. developed a cortical mapping algorithm that enabled a reliable mapping of an anatomical subdivision of the precentral gyrus. This approach allowed for the differentiation between an anterior subregion, characterized by lower excitability and slower motor responses, and a posterior subregion (named "M1 proper"), exhibiting higher excitability and faster motor responses. Based on these findings, we conducted a navigated transcranial magnetic stimulation (nTMS) study to investigate whether this anatomical subdivision can also be identified using a non-invasive mapping technique.
Methods: Fifteen healthy volunteers were examined. Using nTMS, the motor cortex at the hand knob area was subdivided into four distinct strips aligned parallel to the central sulcus: s, precentral non-proper, precentral proper, and postcentral. After determining the resting motor threshold (RMT), 10 stimulation points in each strip were stimulated with 150% RMT. Electromyographic (EMG) amplitudes and latencies were recorded and compared across the four stimulation strips to detect potential differences.
Results: Although descriptively higher mean EMG amplitudes were observed in the precentral proper strip, generalized linear mixed-effects modeling revealed no statistically significant differences in EMG amplitude between the precentral proper and non-proper regions, nor across any of the four stimulation strips.
Conclusions: Using the applied protocol, a clear delineation between a functionally separated ventral and dorsal subdivision of the precentral gyrus could not be observed. However, it is noteworthy that the application of relatively high stimulation intensity may have masked subtle differences. Further examinations at the lower end of the stimulation spectrum (e.g., 90% or 100% RMT) or a specific paired pulse protocol may allow for a more precise differentiation between these two anatomical areas
Bedarfe von Menschen mit schweren psychischen Erkrankungen
Get PDFBackground: Due to illness-related functional limitations, a significant proportion of individuals with severe mental illness are dependent on external assistance to navigate their daily lives and achieve an optimal level of independence and wellbeing.
Objectives: The present study sought to investigate the needs, the coverage of needs and the influencing factors among people with severe mental illness in Germany.
Methods: The study included patients diagnosed with severe mental illness. The met and unmet needs, as well as the potential influencing factors, were collected using Camberwell Assessment of Need (CAN) and Client Sociodemographic and Service Receipt Inventory (CSSRI) and subsequently analysed descriptively and exploratively.
Results: The mean number of reported needs was 6.4, with an average of 40.6% of these needs being met. The vast majority of patients (98%) require professional support, which is, from their perspective, inadequate (9-86% depending on the area concerned). Additionally, many patients also receive support from relatives (7-57% depending on the area concerned). The diagnosis, age, functioning, household income, and housing situation have an influence on the number and coverage of needs.
Conclusions: The findings indicate that patients have diverse and complex needs, which are not fully met. Notably, the support provided by professional services is perceived as inadequate.Hintergrund
Aufgrund krankheitsbedingter Funktionseinschränkungen sind viele Menschen mit schweren psychischen Erkrankungen auf Unterstützung und Hilfe im Alltag angewiesen, um ein möglichst selbstständiges und gutes Leben führen zu können.
Ziel der Arbeit
Die Studie untersuchte die Bedarfe, die Bedarfsdeckung sowie deren Einflussfaktoren bei Menschen mit schweren psychischen Erkrankungen in Deutschland.
Methodik
Eingeschlossen wurden Menschen mit schweren psychischen Erkrankungen. Die Bedarfe und Bedarfsdeckung sowie die potenziellen Einflussfaktoren wurden mittels Camberwell Assessment of Need (CAN) und Client Sociodemographic and Service Receipt Inventory (CSSRI) erfasst und deskriptiv sowie explorativ analysiert.
Ergebnisse
Im Mittel haben die Betroffenen 6,4 Bedarfe, von denen im Schnitt 40,6 % gedeckt sind. Fast alle Betroffenen (98 %) benötigen professionelle Unterstützung, die jedoch aus der Perspektive der Betroffenen unzureichend ist (je nach Themenbereich 9–86 %). Viele Betroffene erhalten zudem Unterstützung durch Angehörige (je nach Themenbereich 7–57 %). Die Faktoren Diagnose, Alter, Funktionalität, Haushaltseinkommen und Wohnsituation zeigen einen Einfluss auf die Bedarfszahl und -deckung.
Diskussion
Den Ergebnissen lässt sich entnehmen, dass die Betroffenen vielfältige und komplexe Bedarfe haben, die jedoch unvollständig gedeckt sind. Insbesondere die Unterstützung durch professionelle Dienste wird als unzureichend wahrgenommen
The role of scarcity behavior in inventory management
No full textA well-known phenomenon related to inventory, but often neglected in inventory management, is the scarcity effect, i.e., the increase in the demand if inventory is low. We consider a repeated purchase setting with a single firm and multiple buyers and address the question of whether inventory management decisions concerning the control policy and the service configuration (determining when and how much to order) impact scarcity behavior arising from buyers’ stock-out perception. We study common inventory control policies that assume a demand independent of the inventory management, and we challenge this critical assumption of an exogenous demand. This research explores two prevalent classes of inventory policies widely used in practice (periodic and continuous) configured according to fill rates, a popular way of measuring service. We conduct a laboratory experiment with four automated inventory management treatments (2 policies
2 configurations) where participants act as buyers. We observe stock-out induced scarcity and find support for the hypothesis that the periodic policy leads to a stronger effect compared to the continuous policy if the service level is low. The study also supports the hypothesis that buyers act forward-looking as their demand peaks before the inventory reaches its lowest level. Overall, our research provides a new perspective on inventory management as it reveals that the chosen control policy and the selected service configuration influence stock-out pressure induced inventory runs. Inventory managers should be aware of scarcity effects and its consequences, like the disadvantages of a periodic policy for low service level
Single-cell RNA sequencing of platelets: challenges and potential
No full textPlatelets are small, anuclear cells crucial for hemostasis, coagulation, immune responses, and vascular diseases. While unable to produce their own RNA, platelets inherit RNA from their megakaryocyte precursors, exchange RNA with other cells, and possess all the necessary machinery for protein synthesis. However, several challenges, including their limited RNA content, high reactivity of these small cells leading to their activation, have hindered single-cell transcriptomic studies of these cells. The primary objective of this study is to perform single-cell RNA sequencing (scRNA-seq) on platelets obtained from whole blood. Peripheral whole blood from a healthy donor was obtained by venipuncture and was purified to obtain platelet-rich plasma (PRP). ScRNA-seq was performed using the 10X genomics platform on PRP for the first time. Data normalization and UMAP clustering with cluster-specific differential gene expression analysis were performed. ScRNA-seq performed on platelets identified three distinct clusters, with one enriched for platelet-specific lineage markers, such as PPBP and PF4. Mitochondrial RNA was highly expressed accounting for approx. 14% of the total RNA counts. Despite procedural challenges and technical considerations including high exhaustion potential and sensitivity to handling, small cell size and limited RNA content, this pilot study demonstrates feasibility of scRNA-seq of platelets from whole blood. This advancement paves the way for groundbreaking insights into platelet biology and more focus for clinician researchers on potential research avenues
Machine learning-based short-term forecasting of COVID-19 hospital admissions using routine hospital patient data
No full textDuring the COVID-19 pandemic, the field of infectious disease modeling advanced rapidly, with forecasting tools developed to track trends in transmission dynamics and anticipate potential shortages of critical resources such as hospital capacity. In this study, we compared short-term forecasting approaches for COVID-19 hospital admissions that generate forecasts one to five weeks ahead, using retrospective electronic health records. We extracted different features (e.g., daily emergency department visits) from an individual-level patient dataset covering six hospitals located in the region of Bern, Switzerland, from February 2020 to June 2023. We then applied five methods – last-observation carried forward (baseline), linear regression, XGBoost and two types of neural networks – to time series using a leave-future-out training scheme with multiple cutting points and optimized hyperparameters. Performance was evaluated using the root mean square error between forecasts and observations. Generally, we found that XGBoost outperformed the other methods in predicting future hospital admissions. Our results also show that adding features such as the number of hospital admissions with fever and augmenting hospital data with measurements of viral concentration in wastewater improves forecast accuracy. This study offers a thorough and systematic comparison of methods applicable to routine hospital data for real-time epidemic forecasting. With the increasing availability and volume of electronic health records, improved forecasting methods will contribute to more precise and timely information during epidemic waves of COVID-19 and other respiratory viruses, thereby strengthening evidence-based public health decision-making