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Duschek S.,UMIT University for Health Sciences, Medical Informatics and Technology | Worsching J.,Ludwig Maximilians University of Munich | Reyes Del Paso G.A.,University of Jaen

The study investigated interactions between autonomic cardiovascular regulation and cortical activity. In 54 healthy subjects, baroreflex sensitivity (BRS) and respiratory sinus arrhythmia (RSA) were assessed at resting conditions. As an EEG indicator of cortical excitability, the contingent negative variation (CNV) was induced using a constant foreperiod reaction time task. At bivariate level, only RSA showed a moderate positive correlation with the CNV recorded at frontal electrodes. However, when common variance of BRS and RSA was controlled for in multiple regression analysis, an inverse association between BRS and the frontal CNV also arose. The inverse association between BRS and the CNV is discussed as reflecting bottom-up modulation of cortical excitability by baroreceptor afferents. The positive correlation between RSA and the CNV may relate to the interplay between prefrontal processing and cardiac vagal tone. © 2013 Society for Psychophysiological Research. Source

Sroczynski G.,UMIT University for Health Sciences, Medical Informatics and Technology
Nature reviews. Gastroenterology & hepatology

A new study has reported the long-term effectiveness and cost-effectiveness of the direct-acting antivirals telaprevir and boceprevir for the treatment of chronic hepatitis C. These findings have the potential to be used to guide clinical and reimbursement decisions for treating populations with a high prevalence of HCV infection. Source

Romeyke T.,UMIT University for Health Sciences, Medical Informatics and Technology
Global journal of health science

The distinctive characteristics of the German health system are medical progress and financial pressure-and this is especially true of the hospitals. These challenges must be met by strategic management instruments for quality assurance, and by reducing costs. This article presents the instrument "clinical pathway" (also known as "clinical treatment pathway") and describes the possibilities it offers, both for quality assurance and risk management, and for cost reduction. The clinical pathway presented here will be that for "multimodal pain therapy", as used in the context of acute inpatient care in Germany. A general presentation of the risks in hospital is followed by consideration of the risks associated with core processes. A comprehensive total cost analysis is performed for those patients who meet the pathway entry criteria and who fulfil the requirements for the structure of care provided within multimodal pain therapy. Multimodal pain therapy places high demands on the structural, procedural and outcome quality of the medical, nursing and therapeutic services provided, and these demands are reflected in high costs for the provision of this care. The treatment process involves many different professional groups. These complex interfaces can potentially generate risks, which can lead to the possibility of legal liability. A clinical pathway must structure the core process and then combine elements of quality assurance in order to optimise patient care and minimise risk. The examination of costs reveals significant potential savings (patients with clinical pathway: EUR 3086±212; patients without clinical pathway: EUR 3774±460; Mann-Whitney U test; p<0.001). For the managers of a hospital, the clinical pathway represents a strategic management instrument that can serve for continual cost control and cost reduction, and can contribute in the form of quality assurance towards a transparent provision of services. Source

Huebner-Bloder G.,UMIT University for Health Sciences, Medical Informatics and Technology
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium

Cross-institutional longitudinal Electronic Health Records (EHR), as introduced in Austria at the moment, increase the challenge of information overload of healthcare professionals. We developed an innovative cross-institutional EHR query prototype that offers extended query options, including searching for specific information items or sets of information items. The available query options were derived from a systematic analysis of information needs of diabetes specialists during patient encounters. The prototype operates in an IHE-XDS-based environment where ISO/EN 13606-structured documents are available. We conducted a controlled study with seven diabetes specialists to assess the feasibility and impact of this EHR query prototype on efficient retrieving of patient information to answer typical clinical questions. The controlled study showed that the specialists were quicker and more successful (measured in percentage of expected information items found) in finding patient information compared to the standard full-document search options. The participants also appreciated the extended query options. Source

Siebert U.,UMIT University for Health Sciences, Medical Informatics and Technology
Inflammatory bowel diseases

Inflammatory bowel disease can decrease the quality of life and induce work disability. We sought to (1) identify and quantify the predictors of disease-specific work disability in patients with inflammatory bowel disease and (2) assess the suitability of using cross-sectional data to predict future outcomes, using the Swiss Inflammatory Bowel Disease Cohort Study data. A total of 1187 patients were enrolled and followed up for an average of 13 months. Predictors included patient and disease characteristics and drug utilization. Potential predictors were identified through an expert panel and published literature. We estimated adjusted effect estimates with 95% confidence intervals using logistic and zero-inflated Poisson regression. Overall, 699 (58.9%) experienced Crohn's disease and 488 (41.1%) had ulcerative colitis. Most important predictors for temporary work disability in patients with Crohn's disease included gender, disease duration, disease activity, C-reactive protein level, smoking, depressive symptoms, fistulas, extraintestinal manifestations, and the use of immunosuppressants/steroids. Temporary work disability in patients with ulcerative colitis was associated with age, disease duration, disease activity, and the use of steroids/antibiotics. In all patients, disease activity emerged as the only predictor of permanent work disability. Comparing data at enrollment versus follow-up yielded substantial differences regarding disability and predictors, with follow-up data showing greater predictor effects. We identified predictors of work disability in patients with Crohn's disease and ulcerative colitis. Our findings can help in forecasting these disease courses and guide the choice of appropriate measures to prevent adverse outcomes. Comparing cross-sectional and longitudinal data showed that the conduction of cohort studies is inevitable for the examination of disability. Source

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