Suchergebnisse

Vor dem Hintergrund der dynamischen Entwicklung des Bedarfs an Gesundheitsleistungen und der Zunahme älterer Bevölkerungsanteile birgt die Versorgung von Patienten mit Hirnleistungsstörungen im Alter eine wachsende medizinische, soziale und gesundheitspolitische Herausforderung. Diese Gruppe von Erkrankungen stellt eine der häufigsten Ursachen für Pflegebedürftigkeit dar und gehört zu den wichtigsten Kostenfaktoren in Gesundheitssystemen westlicher Industrieländer. Es wird ein Überblick über epidemiologische und gesundheitsökonomische Aspekte von Hirnleistungsstörungen im Alter in Deutschland, wie auch im internationalen Vergleich gegeben. Die Prävalenz bei über 65jährigen wird in Deutschland auf rund 8% geschätzt mit einer jährlichen Inzidenz von knapp 2%. Die jährlichen Kosten für die medizinische und pflegerische Betreuung liegen bei rund 30.000 - pro Betroffenen. Es lassen sich damit für Deutschland jährliche Krankheitskosten von insgesamt rund 35 Mrd. - kalkulieren. In den nächsten Jahrzehnten ist von einer Zunahme der Häufigkeit von Hirnleistungsstörungen im Alter auszugehen und die damit verbundenen volkswirtschaftlichen Belastungen dürfen nicht unterschätzt werden.

*Weitere Angaben Verfasser: Der Schriftsteller Franz Hessel (1880-1941) ist als Berliner Flaneur und literarischer 'Geheimtip' präsent. Zu seinen Lebzeiten überaus prominent, heute jedoch fast vergessen ist der Feuilletonist des "Berliner Tageblatts" Victor Auburtin (1870-1928), der hier erstmals im Zentrum einer umfassenden Studie steht. Beide verfaßten unzählige, häufig kurze und in der Großstadt angesiedelte Prosatexte, deren souveräner Stil und leichter Ton gerühmt werden, deren Gesten kultivierten Beiseitestehens und intellektuell-moralischer Unentschiedenheit aber seit je irritieren. Dagegen erhellt dieses Buch mit Blick auf ihre Berlin- und Parisprosa und auf den darin wirksamen Nationalcharakter-Diskurs, wie im Rücken eines Feuilleton-Plauderstils Zeitbezüge arbeiten, wie Themenpolitik stattfindet, wie Positionen in der verkehrs- und medientechnischen Moderne austariert werden

Background: Health economic parameters are increasingly considered as variables in health care decisions, but decision makers are interested in country-specific evaluations. However, a large number of studies are performed in foreign countries or in a multinational setting, which limits the transferability to a single nation's context. Objective: The present analysis summarises several of the most common international methods for generating health economic analyses based on clinical studies from different settings. Methods: A narrative literature review was performed to identify potential reasons for limited transferability of health economic evaluation results from one country to another. Based on these results, we searched the methodological literature for analytic approaches to handle the restrictions. Additionally we describe the possibility of transferring foreign economic study results to the country of interest by matching trial data with routine data of national databases. Results: The main factors for limited transferability of health economic findings were found in country-specific differences in resource consumption and the resulting costs. These differences are affected by a number of influencing cofactors (demography, epidemiology and individual patient's factors) and the overall health care system structures (e.g. payment systems, health provider incentives). However, despite the limitations country-specific health economic assessments could be realised using the pooled/ split analyses approach, some statistical approaches and modelling approaches. Conclusion: A variety of methods for identifying and adjusting country-specific differences in costs, effects and cost-effectiveness was established during the past decades. Multinational studies will continue to play a crucial role in the evaluation of cost-effectiveness at national levels. It seems likely that the growing interest in multinational studies will lead to continued developments in adaptation methods.

Background: Peripheral arterial disease (PAD) is highly prevalent among individuals of higher age or those with one or more cardiovascular risk factors. Screening for PAD is recommended, since it is often linked to atherothrombotic manifestations in the coronary or carotid circulation and associated with a substantial increase in all-cause and cardiovascular mortality. We aimed to assess patients with newly diagnosed, suspected and confirmed PAD in the primary care setting with regards to clinical characteristics, diagnostic and therapeutic management (including referral to specialists), and medium-term outcomes. Methods: This was a multicentre, prospective, observational cohort study with a cross-sectional and a longitudinal part. A total of 2,781 general practitioners across Germany were cluster randomised to document five consecutive patients each in one of the strata: (1) patients with intermittent claudication (IC) or other typical PAD-related complaints (group A) or (2) patients >55 years of age with one or more risk factors (group B) for PAD (current smoking, diabetes, previous myocardial infection and/or previous stroke). Patients with confirmed PAD will be followed up for diagnostic procedures, therapy and vascular events over 18 months. Results: In group A, a total of 2,131 patients with suspected PAD (80.1% confirmed, 75.9% with referral to specialists) and in group B 9,921 patients were included (44.6% confirmed, 54.6% referral). The ankle-brachial index was calculated in 41.3% and 33.5% only. Mean age was 66.6 years (group A) and 68.4 years (group B), respectively. Vascular risk factors were prevalent in both groups, in particular smoking (group A 44.6%, group B 44.4%), hypertension (73.2 and 78.1%), hypercholesterolaemia (64.6 and 70.6%) and diabetes mellitus (41.7 and 60.6%). Concomitant atherothrombotic morbidities were frequent in both groups. In patients with the respective diseases, antihypertensive, antidiabetic, lipid-lowering and antithrombotic therapies were prescribed in group A in 96.6, 96.0, 91.1 and 89.7% and in group B in 98.3, 97.4, 94.1 and 91.2%. Conclusion: The cross-sectional part of the study indicates a substantial burden of disease in PAD patients in primary care. Treatment rates appear to have improved compared to earlier surveys. In the follow-up period, outcomes of these patients and their association with disease stages, guideline-oriented treatment or patient compliance and disease-coping strategies, among other factors, will be determined.

Aim: Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods: The Patient Care Evaluation-Peripheral Arterial Disease Study (PACE-PAD) was a multicenter, cluster randomized, prospective, longitudinal cohort study of patients with PAD in primary care, who were followed up for death or vascular events over 18 months. Guideline orientation was assumed if patients received anticoagulant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results: Of the 5,099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% male subjects) who were followed up, 22.5, 34.6, 30.1, 7.8, and 3.5% (1.5% not specified) were in Fontaine stages I, IIa, IIb, III, and IV. Comprehensive guideline orientation was reported in 28.4% only; however, patients in lower Fontaine stages received guideline-oriented therapy more often (I: 30.3%, IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had unstable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines and those who were not. Conclusion: The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and non-guideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, and patient's noncompliance with therapy.

Der Forschungsverbund zur Frühintervention bei substanzbezogenen Störungen (Research Collaboration in Early Substance Use Intervention (EARLINT) ist eine Zusammenarbeit von Wissenschaftlern, die Synergien ihrer gemeinsamen Forschung nutzen. Das Ziel des Arbeitsprogramms lautet, Kurzinterventionsansätze bei alkohol- oder tabakrauch-assoziierten Störungen für den Einsatz in Einrichtungen der medizinischen Versorgung und der Allgemeinbevölkerung zu entwickeln. Theoretische Grundlagen bilden das Transtheoretische Modell der Verhaltensänderung nach Prochaska und DiClemente und die Motivierende Gesprächsführung nach Miller und Rollnick. EARLINT umfasst zur Zeit sechs Forschungsprojekte, die alle die Prüfung der Wirksamkeit von Interventionen mittels experimenteller Felduntersuchungen beinhalten. Dazu gehören auch gesundheitsökonomische Analysen.