Ingolstadt, Germany
Ingolstadt, Germany

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Orth M.,Institute For Laboratoriumsmedizin | Aufenanger J.,Klinikum Ingolstadt GmbH | Hoffmann G.,Trillium GmbH | Hofmann W.,Stadtisches Klinikum Munich GmbH | And 7 more authors.
LaboratoriumsMedizin | Year: 2014

Eine labormedizinische Diagnostik ist bei vielen Patienten für eine erfolgreiche medizinische Behandlung notwendig. Sowohl aus ökonomischen als auch aus ethischen Gründen sollten labormedizinische Leistungen weder zu häufig (als .,Wiederholungsuntersuchungen") noch zu selten angefordert werden. Mit diesen Empfehlungen werden für eine Reihe von labormedizinischen Untersuchungen anhand von Studien, pathophysiologischen Zusammenhängen und Konsensus Empfehlungen für eine sinnvolle Wiederholungsfrequenz gegeben. Diese Empfehlungen betreffen das minimale Zeitintervall zwischen 2 Messungen sowie die Kriterien zur Durchführung einer Wiederholungsbestimmung. Ergänzt werden diese Empfehlungen mit grundsätzlichen Überlegungen zur Indikation und Untersuchungsfrequenz von labormedizinischen Untersuchungen. © 2014 by De Gruyter 2014.


Aufenanger J.,Klinikum Ingolstadt GmbH | Schernikau E.,Zentralinstitut For Klinische Chemie Und Laboratoriumsmedizin | Wieland E.,Zentralinstitut For Klinische Chemie Und Laboratoriumsmedizin
LaboratoriumsMedizin | Year: 2010

Although the costs for laboratory medication are only very minor compared to the total expenditures in the healthcare system, cost-cutting is frequently focused on hospital laboratories. Only 7.3% of German hospitals have a laboratory headed by a laboratory physician. To discontinue this trend it is mandatory that the hospital is not considered as a cost centre any longer but should be transformed into a profit and competence centre. To achieve this goal, the laboratory needs to show that it adds to the value of patient care and that it is an essential link in the value chain of the total hospital enterprise. The hospital laboratory should be a workflow management system. In particular, microbiology can serve as an example to demonstrate the economic advantage of a local hospital laboratory. The competence of the medical laboratory and its staff has to be offered to the hospital and its medical disciplines around the clock. However, in the future it will also be necessary to provide laboratory competence and excellence to outpatients. To achieve this, hospital laboratories have to consolidate and cooperate in regional networks. © 2010 by Walter de Gruyter Berlin New York 2010.


Orth M.,Institute for Laboratory Medicine | Aufenanger J.,Klinikum Ingolstadt GmbH | Hoffmann G.,Trillium GmbH | Hofmann W.,Stadtisches Klinikum Munich GmbH | And 7 more authors.
LaboratoriumsMedizin | Year: 2015

Laboratory testing is crucial for the successful medical treatment of many patients. Laboratory tests should neither be ordered too infrequently nor too frequently (in the form of repeat testing). These recommendations summarize the intervals for repeat testing based on studies, pathophysiology and consensus, in regard to both the time intervals between two tests and the additional criteria for the repeat testing. These recommendations are complemented by general principles for the indication and testing frequency of laboratory testing.


Ruth M.,Klinikum Ingolstadt GmbH | Weber M.,Lauenforde | Zenz M.,Universitatsklinik For Anaesthesiologie
Schmerz | Year: 2010

Background: The goal of this study was to evaluate the efficacy of laser acupuncture for the clinical picture of chronic back pain under everyday conditions using a randomized, double-blind, placebo-controlled study design. A further aim was to analyze to what extent placebo effects also influence the outcome of acupuncture under these conditions. Patients and methods: The study included male and female patients with chronic back pain (lasting longer than 6 months) aged between 30 and 77 years with a pain score of at least 5 on a visual analog scale. The main criterion was achieving alleviation of pain by at least 50% 3 months after the start of treatment. The assessment tools used were the Von Korff questionnaire supplemented by the FFbH, FABQ, and SF-12. In addition, the participants were questioned about whether they perceived anything during the treatment and how certain they were that they had received treatment with active or inactive lasers. Results: A total of 111 patients were included in the study and were treated according to the randomization list in two groups each consisting of 51 subjects. The study was completed as scheduled by 102 participants. Analysis of the primary outcome measure, improvement of the pain score by more than 50% over baseline, revealed improvements in both treatment groups between the time points used for measurement. The placebo group exhibited better levels than the group that received laser treatment. No efficacy advantage of laser acupuncture over placebo treatment could be determined. Conclusion: It was possible to completely blind the acupuncture forms with the study design employed. Perhaps the consistent exclusion of nonspecific treatment effects contributed to this result. It cannot be ruled out that the effects of acupuncture are based on a strong placebo effect. © Deutsche Gesellschaft zum Studium.


Orth M.,Institute For Laboratoriumsmedizin | Aufenanger J.,Klinikum Ingolstadt GmbH | Hoffmann G.,Trillium GmbH Medizinischer Fachverlag | Lichtinghagen R.,Institute For Klinische Chemie | And 2 more authors.
LaboratoriumsMedizin | Year: 2016

Commercial providers in wellness and lifestyle offer their customers numerous apps for the presentation of customers' health data. In Germany, the government patronizes the use of nation-wide electronic health records by the so-called "E-health legislation". This electronic health record should also contain laboratory reports. However, a prerequisite in laboratory medicine for this electronic record is the harmonization of pre-preanalytics (terminology, testing profiles, testing intervals), preanalytics (time of sampling, patient preparation, transport and storage of samples, analytics (sample quality, method, calibration, quality assurance) up to postanalytics (units, data format, reference intervals, decision values). Because of the high number of tests and the test specifications in laboratory medicine, this harmonization process is still ongoing despite numerous long-term national and international activities. Other challenges of electronic health records are related to data security (i.e. the integrity of laboratory reports) and to data privacy in particular with respect to the informational self-determination of the patients and the German Gene Diagnostics Act (GenDG). Recommendation: We recommend for reasons of patient safety to include only a few, selected laboratory tests which are commonly used to adjust the medication of the patient in the national electronic health record. © 2016 Walter de Gruyter GmbH, Berlin/Boston.


Dirscherl T.,University of Regensburg | Rickhey M.,Klinikum Ingolstadt GmbH | Bogner L.,University of Regensburg
Zeitschrift fur Medizinische Physik | Year: 2012

Introduction: A biologically adaptive radiation treatment method to maximize the TCP is shown. Functional imaging is used to acquire a heterogeneous dose prescription in terms of Dose Painting by Numbers and to create a patient-specific IMRT plan. Method and Materials: Adapted from a method for selective dose escalation under the guidance of spatial biology distribution, a model, which translates heterogeneously distributed radiobiological parameters into voxelwise dose prescriptions, was developed. At the example of a prostate case with 18F-choline PET imaging, different sets of reported values for the parameters were examined concerning their resulting range of dose values. Furthermore, the influence of each parameter of the linear-quadratic model was investigated. A correlation between PET signal and proliferation as well as cell density was assumed. Using our in-house treatment planning software Direct Monte Carlo Optimization (DMCO), a treatment plan based on the obtained dose prescription was generated. Gafchromic EBT films were irradiated for evaluation. Results: When a TCP of 95% was aimed at, the maximal dose in a voxel of the prescription exceeded 100. Gy for most considered parameter sets. One of the parameter sets resulted in a dose range of 87.1. Gy to 99.3. Gy, yielding a TCP of 94.7%, and was investigated more closely. The TCP of the plan decreased to 73.5% after optimization based on that prescription. The dose difference histogram of optimized and prescribed dose revealed a mean of -1.64. Gy and a standard deviation of 4.02. Gy. Film verification showed a reasonable agreement of planned and delivered dose. Conclusion: If the distribution of radiobiological parameters within a tumor is known, this model can be used to create a dose-painting by numbers plan which maximizes the TCP. It could be shown, that such a heterogeneous dose distribution is technically feasible. © 2012.


Gross-Fengels W.,Abteilung Radiologie | Heuser L.,Ruhr University Bochum | Vorwerk D.,Klinikum Ingolstadt GmbH | Helmberger T.,Institute For Diagnostische Und Interventionelle Radiologie Und Nuklearmedizin
Radiologe | Year: 2011

Diagnosis and therapy of vascular diseases are increasingly being performed following a multimodal, interdisciplinary and less invasive approach. The introduction of specialized, organ-related centers is a logical consequence in view of a better treatment quality and a more effective use of resources. The German societies of radiology, vascular surgery and angiology jointly developed a process of certification, which has been successfully applied to more than 100 units in Germany. In this article the terms and results of the process are described and possible effects on the quality and structures of the healthcare system are discussed. © 2011 Springer-Verlag.


Orth M.,Institute For Laboratoriumsmedizin | Aufenanger J.,Klinikum Ingolstadt GmbH | Klosson R.J.,Institute For Laboratoriumsmedizin
LaboratoriumsMedizin | Year: 2012

Benchmarking is a systematic and continuous process to compare products, services, and processes - in quantitative and qualitative aspects. Benchmarking in labo ratory medicine departments of hospitals is a frequently used but only poorly standardized method. Sophisticated procedures for data collection are necessary due to large heterogeneity and complexity of activities performed in laboratory medicine with regard to type of testing, response times, availability and amount of different resources needed for single analysis and reporting. These prerequisites are difficult to fulfill. In internal benchmarking projects - i.e., monitoring of productivity, costs, and revenues within one laboratory over an extended period of time - the current tools for data collection are generally suited for use. In external benchmarking, however, several pitfalls may obscure the results. Broadly, external benchmarking projects compare only partial processes with sufficient validity. Differences in benchmarking have to be controlled for improvements of data collection and for changes of surrounding conditions outside the laboratory. This review lists different approaches for benchmarking projects in laboratory medicine departments and describes their strengths and weaknesses.


Systemic autoimmune diseases often present with diffuse symptoms. Laboratory diagnosis therefore plays a fundamental role and may facilitate confirmation or negation of a clinical diagnosis, differential diagnosis, evaluation of activity and prognosis, involvement of organs and drug side effects. However, results must be interpreted in clinical context. The most important laboratory parameters are autoantibodies and inflammation markers. The basic laboratory evaluation should be performed in the first line to support an early presentation of the patient to the specialist or in the hospital, allowing initiation of a specific therapy to prevent irreversible organ damage. Verification of certain autoantibodies is included in the classification criteria or in the definition of a disease entity. © Georg Thieme Verlag KG Stuttgart New York.


PubMed | Klinikum Ingolstadt GmbH
Type: Journal Article | Journal: Schmerz (Berlin, Germany) | Year: 2010

The goal of this study was to evaluate the efficacy of laser acupuncture for the clinical picture of chronic back pain under everyday conditions using a randomized, double-blind, placebo-controlled study design. A further aim was to analyze to what extent placebo effects also influence the outcome of acupuncture under these conditions.The study included male and female patients with chronic back pain (lasting longer than 6 months) aged between 30 and 77 years with a pain score of at least 5 on a visual analog scale. The main criterion was achieving alleviation of pain by at least 50% 3 months after the start of treatment. The assessment tools used were the Von Korff questionnaire supplemented by the FFbH, FABQ, and SF-12. In addition, the participants were questioned about whether they perceived anything during the treatment and how certain they were that they had received treatment with active or inactive lasers.A total of 111 patients were included in the study and were treated according to the randomization list in two groups each consisting of 51 subjects. The study was completed as scheduled by 102 participants. Analysis of the primary outcome measure, improvement of the pain score by more than 50% over baseline, revealed improvements in both treatment groups between the time points used for measurement. The placebo group exhibited better levels than the group that received laser treatment. No efficacy advantage of laser acupuncture over placebo treatment could be determined.It was possible to completely blind the acupuncture forms with the study design employed. Perhaps the consistent exclusion of nonspecific treatment effects contributed to this result. It cannot be ruled out that the effects of acupuncture are based on a strong placebo effect.

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