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Reyes del Paso G.A.,University of Jaén | Langewitz W.,University of Basel | Mulder L.J.M.,University of Groningen | van Roon A.,University of Groningen | Duschek S.,UMIT University for Health Sciences, Medical Informatics and Technology
Psychophysiology | Year: 2013

This article evaluates the suitability of low frequency (LF) heart rate variability (HRV) as an index of sympathetic cardiac control and the LF/high frequency (HF) ratio as an index of autonomic balance. It includes a comprehensive literature review and a reanalysis of some previous studies on autonomic cardiovascular regulation. The following sources of evidence are addressed: effects of manipulations affecting sympathetic and vagal activity on HRV, predictions of group differences in cardiac autonomic regulation from HRV, relationships between HRV and other cardiac parameters, and the theoretical and mathematical bases of the concept of autonomic balance. Available data challenge the interpretation of the LF and LF/HF ratio as indices of sympathetic cardiac control and autonomic balance, respectively, and suggest that the HRV power spectrum, including its LF component, is mainly determined by the parasympathetic system. © 2013 Society for Psychophysiological Research.

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 Jaén
Psychophysiology | Year: 2013

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.

Sroczynski G.,UMIT University for Health Sciences, Medical Informatics and Technology
Nature reviews. Gastroenterology & hepatology | Year: 2013

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.

Siebert U.,UMIT University for Health Sciences, Medical Informatics and Technology
Inflammatory bowel diseases | Year: 2013

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.

Romeyke T.,UMIT University for Health Sciences, Medical Informatics and Technology
Global journal of health science | Year: 2012

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.

Huebner-Bloder G.,UMIT University for Health Sciences, Medical Informatics and Technology
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium | Year: 2012

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.

Ammenwerth E.,UMIT University for Health Sciences, Medical Informatics and Technology
Methods of Information in Medicine | Year: 2015

Background: Health IT is expected to have a positive impact on the quality and efficiency of health care. But reports on negative impact and patient harm continue to emerge. The obligation of health informatics is to make sure that health IT solutions provide as much benefit with as few negative side effects as possible. To achieve this, health informatics as a discipline must be able to learn, both from its successes as well as from its failures. Objectives: To present motivation, vision, and history of evidence-based health informatics, and to discuss achievements, challenges, and needs for action. Methods: Reflections on scientific literature and on own experiences. Results: Eight challenges on the way towards evidence-based health informatics are identified and discussed: quality of studies; publication bias; reporting quality; availability of publications; systematic reviews and meta-analysis; training of health IT evaluation experts; translation of evidence into health practice; and post-market surveillance. Identified needs for action comprise: establish health IT study registers; increase the quality of publications; develop a taxonomy for health IT systems; improve indexing of published health IT evaluation papers; move from meta-analysis to meta-summaries; include health IT evaluation competencies in curricula; develop evidence-based implementation frameworks; and establish post-marketing surveillance for health IT. Conclusions: There has been some progress, but evidence-based health informatics is still in its infancy. Building evidence in health informatics is our obligation if we consider medical informatics a scientific discipline. © Schattauer 2015.

Welk M.,UMIT University for Health Sciences, Medical Informatics and Technology
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2013

This paper is concerned with the theoretical analysis of structure-adaptive median filter algorithms that approximate curvature-based PDEs for image filtering and segmentation. These so-called morphological amoeba filters, introduced by Lerallut et al. and further developped by Welk et al., achieve similar results as the well-known geodesic active contour and self-snakes PDEs. In the present work, the PDE approximated by amoeba active contours is derived in the general case. This PDE is structurally similar but not identical to the geodesic active contour equation. Implications for the qualitative behaviour of amoeba active contours as well as for the approximation of the pre-smoothed self-snakes equation are investigated. © 2013 Springer-Verlag.

Hofheinz M.,Neuromuskulares Therapiezentrum Dresden | Schusterschitz C.,UMIT University for Health Sciences, Medical Informatics and Technology
Clinical Rehabilitation | Year: 2010

Objective: The aim is to examine the validity and reliability of the Timed Up and Go Test with dual task for predicting the risk of falls. Standard values for the TUG with dual task were determined, taking account of age and gender. Design: Validation study Setting: Data was recorded for 120 volunteers in an outpatient physiotherapy centre. Subjects: The sample comprised 120 healthy men and women aged 60 to 87 years living at home. Twenty-three subjects selected at random were tested again, after one day and after one week, in order to ascertain the retest reliability. Main measures: Berg Balance Scale, times for Timed Up and Go Test with manual dual task (TUGman) and with cognitive dual task (TUGcog). Results: Strong correlations between the TUGman and the BBS (r = -0.72) and between the TUGcog and the BBS (r = -0.66) indicate high criterion validity. The retest reliability of the TUGman (rT1-T2 = 0.97 and rT1-T3 = 0.98) and TUGcog (rT1-T2 = 0.98 and r T1-T3 = 0.98) is very good. The intra-rater reliability is very high with an ICC = 0.99 for the TUGman and an ICC = 0.94 for the TUGcog. The mean time needed to perform the TUGman is 11.6 s (95% CI 11.2ĝ€"11.9) ; the mean time needed to perform the TUGcog is 9.8 s (95% CI 9.5ĝ€"10.2). Conclusions: The tests with dual task can be recommended because they possess high criterion validity and very good retest reliability. Faster and simpler performance of the TUG-DT is another factor in its favour. © The Author(s), 2010.

Duschek S.,UMIT University for Health Sciences, Medical Informatics and Technology | Werner N.S.,Ludwig Maximilians University of Munich | Reyes del Paso G.A.,University of Jaén
Psychophysiology | Year: 2013

The baroreflex consists of a negative feedback loop adjusting heart activity to blood pressure fluctuations. This review is concerned with interactions between baroreflex function and behavior. In addition to changes in baroreflex cardiac control subject to behavioral manipulations, interindividual differences in reflex function predicted psychological and central nervous features. The sensitivity of the reflex was inversely related to cognitive performance, evoked potential amplitudes, experimental pain sensitivity, and the severity of clinical pain. Possible variables moderating the strength of the associations are tonic blood pressure, gender, and psychiatric disease. It is suggested that these observations reflect inhibition of higher brain function by baroreceptor afferents. While in many cases increased baroreflex function implies stronger inhibition, individual and situational factors modulate the behavioral impact of cardiac regulation. © 2013 Society for Psychophysiological Research.

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