Wismar, Germany
Wismar, Germany

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Mueller S.,University of Wismar | Agostini H.,Albert Ludwigs University of Freiburg | Ehlken C.,Albert Ludwigs University of Freiburg | Bauer-Steinhusen U.,Bayer AG | And 2 more authors.
Ophthalmology | Year: 2016

Purpose The objective of our study was to investigate preferences of patients with neovascular age-related macular degeneration (nAMD) for different anti-vascular endothelial growth factor (VEGF) treatment schemes. Design We used a discrete choice experiment (DCE) design as part of a telephone interview. Participants Patients with nAMD aged at least 50 years were included in the study. Methods Telephone interviews were done between November 2012 and October 2013. Main Outcome Measures In our DCE survey, we measured patient preferences toward specific levels of attributes that describe different options in the everyday intravitreal injection treatment setting: (1) treatment scheme; (2) change of visual acuity (VA); and (3) time the patient needs for each visit to the eye specialist. Results A total of 284 patients with nAMD with a mean age of 77.4±7.1 years (women: 59.9%) completed the DCE interviews. Of them, 22.9% had poor VA at study inclusion, 54.9% had moderate VA, and 14.1% had good VA; VA was not available for 8.1% of the patients. Generally, patients preferred the attribute levels "improvement in VA" and "short time per specialist visit." The results for the attribute "treatment scheme" were inconclusive because none of the attribute levels (injections every 4 weeks, every 8 weeks, and pro re nata) were associated with statistically significant utility differences. This also mirrors the relative importance of the different attributes in patient decisions: "Change of VA" influenced decision making for a treatment option in 73.6% of cases; "waiting, treatment, and travel time" influenced decision making in 21.0% of cases; and "treatment scheme" influenced decision making for a treatment option in 5.4% of cases. To obtain improved VA instead of a worsening VA, patients in our study stated to be willing to accept a very long time needed per physician visit of 21.2 hours (8.5 hours for improved rather than stable VA and 12.7 hours for stable VA rather than worsening VA). Conclusions To prevent deterioration of VA, patients with nAMD seem to be willing to accept a high treatment burden with regular intravitreal injections at short intervals and long periods of waiting, treatment, and traveling for their consultations. © 2016 by the American Academy of Ophthalmology Published by Elsevier Inc.


Wilke T.,University of Wismar | Mueller S.,University of Wismar | Groth A.,University of Wismar | Fuchs A.,AOK PLUS | And 5 more authors.
Cardiovascular Diabetology | Year: 2015

Background: The aim of this study was to analyse which factors predict the real-world macro-/microvascular event, hospitalisation and death risk in patients with type 2 diabetes mellitus. Furthermore, we aimed to investigate whether there exists both an under- and over-treatment risk of these patients. Methods: We used a German claims/clinical data set covering the years 2010-12. Diabetes-related events were defined as (1) macro-, (2) microvascular events leading to inpatient hospitalisation, (3) other hospitalisations with type 2 diabetes mellitus as main diagnosis, (4) all-cause death and (5) a composite outcome including all event categories 1-4. Factors associated with event risk were analysed by a Kaplan-Meier curve analysis and by multivariable Cox regression models. Results: 229,042 patients with type 2 diabetes mellitus (mean age 70.2years; mean CCI 6.03) were included. Among factors that increased the event risk were patients' age, male gender, the adapted Charlson Comorbidity Index, the adapted Diabetes Complication Severity Index, previous events, and number of prescribed chronic medications. For systolic blood pressure/HbA1C, a double-J/U-curve pattern was detected: HbA1C of 6-6.5% (42-48mmol/mol) and systolic blood pressure of 130-140mmHg (17.3-18.7kPa) were associated with the lowest event risk, values below/above that range were associated with higher risk. However, this pattern was mainly driven by the death risk and was much less clearly observed for the macrovascular/microvascular/hospitalization risk and for young/less comorbid patients. Conclusions: Both blood pressure and HbA1C seem to be very important treatment targets, especially in comorbid old patients. It is of particular clinical importance that both over- and under-treatment pose a threat to patients with type 2 diabetes mellitus. © 2015 Wilke et al.


Wilke T.,University of Wismar | Groth A.,University of Wismar | Mueller S.,University of Wismar | Pfannkuche M.,Boehringer Ingelheim | And 5 more authors.
Europace | Year: 2013

AimsBased on an analysis of claims-based data of 8.298 million members of two German statutory health insurance funds, the aim of this contribution is to quantify age-/gender-specific prevalence/incidence of atrial fibrillation (AF) in a German setting.Methods and resultsPatients were classified as AF prevalent, if they had received at least two outpatient diagnoses of AF (ICD10-Code I48.1-) in two different quarters of the year and/or had received at least one main AF diagnosis during inpatient treatment between 1 January 2007 and 12 December 2008. They were considered to have had new onset AF in 2008 under the following conditions; first, there was no AF diagnosis in 2007; secondly, patients had not received oral anticoagulant medication in 2007; and thirdly, patients had received either one inpatient/two outpatient diagnoses of AF in 2008. In our sample, a total of 176 891 patients had AF. AF prevalence was 2.132%. The average age of these AF patients was 73.1 years, and 55.5% (98 190 patients) were male. The incidence of AF in our sample was 4.358 cases/1000 person-years in men and 3.868 cases/1000 person-years in women.ConclusionA comparison of the distribution of AF prevalence/incidence in our population with that in already published studies showed that our figures were higher, especially in the age groups above 70 years. Our data show that in a large industrial nation such as Germany care provision structures are going to be challenged by a requirement to treat more AF patients in the future. © The Author 2012.


Jakunschin J.,University of Wismar | Heuer A.,University of Rostock | Raab-Dusterhoft A.,University of Wismar
Communications in Computer and Information Science | Year: 2015

This paper, describes an application of social media, database and data-mining techniques for the analysis of conflicting trends and opinions in a spatial area. This setup was used to demonstrate the distribution of interests during a global event and can be used for several social media datamining tasks, such as trend prediction, sentiment analysis and social-psychological feedback tracing. To this end the application clusters trends in social text media streams, such as Twitter and detects the different opinion differences within a single trend based on the temporal, spatial and semantic-pragmatic dimensions. The data is stored in a multidimensional space to detect correlations and combine similar trends into clusters, as it is expanded over time. The results of this work provide a system, with the focus to trace several clusters of conflicts within the same trend, as opposed to the common approach of tag-based filtering and sorting by occurrence count. © Springer International Publishing Switzerland 2015.


Wolff B.,Philipp Muller Strasse 14 | Wolff B.,University of Wismar | Wolff B.,University of Rostock
Advanced Materials Research | Year: 2013

The use of lime plaster as a protection of building units against moisture is very common in the monument preservation, but controversially discussed. Historical buildings often demonstrate the problems of the two building materials, in particular the insufficient adherence between earth and lime in the course of time. Previous results of research brought out contradictory statements. The project especially focuses on the compressed, hydrophobic polished lime plaster Tadelakt, which can act as a protection of surfaces in wet rooms with climatically extreme conditions like increased humidity and high temperature. Reported are the results yielded in the research project which covers the investigations to improve the mechanical adherence and to analyze the chemical reaction between the both building materials. © (2013) Trans Tech Publications, Switzerland.


Wilke T.,University of Wismar | Moock J.,University of Greifswald | Muller S.,University of Wismar | Pfannkuche M.,Boehringer Ingelheim | Kurth A.,Johannes Gutenberg University Mainz
Clinical Orthopaedics and Related Research | Year: 2010

Background: According to some current guidelines, extended thromboprophylaxis after hip and knee arthroplasties is recommended. Outpatient prophylaxis with low molecular weight heparins (LMWH) is an important part of this prophylaxis, although the rates of adherence to these regimens is not known. Questions/purposes: We determined (1) the degree of nonadherence (NA) of patients with LMWH outpatient prophylaxis, and (2) whether specific independent factors explain NA. Methods: NA was determined by syringe count and by indirect and direct questions to patients. We defined six different NA indicators. To identify factors explaining LMWH NA, we used three different logistic regression models. Results: NA rates ranged between 13% and 21% depending on the indicator used for measurement. Patients who were nonadherent missed between 38% and 53% of their outpatient LMWH injections. If patients attended an outpatient rehabilitation program, the probability for their NA increased substantially. Moreover, the NA probability increased with each additional day between acute hospitalization and start of rehabilitation (linking days). NA was lower for patients who feared thrombosis or who believed antithrombotic drugs to be the most important measure in thromboprophylaxis. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2010 The Association of Bone and Joint Surgeons®.


Berg M.M.,University of Kiel | Berg M.M.,University of Wismar
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2015

Spoken Dialogue Systems have enormously improved during the last couple of years and gave rise to voice-controlled mobile assistants. While the abilities of these systems are very sophisticated, there is a lack of tools enabling us to easily describe a natural dialogue that can afterwards be processed by a dialogue engine without having to programme the engine itself. In this paper we present NADIA, a dialogue engine that can process an easy to define XML-based dialogue description. © Springer International Publishing Switzerland 2015.


Dahlbacka J.,Novia University of Applied Sciences | Lillhonga T.,Novia University of Applied Sciences | Doring M.,University of Wismar
Journal of Near Infrared Spectroscopy | Year: 2013

Biogas production through anaerobic digestion (AD) plays an important role in the effort to reduce the amount of greenhouse gas emissions from energy production. At the same time commercial digestion processes are commonly operated well below their maximal capacity. One reason for this is the lack of suitable sensors for monitoring key parameters in the process. Near infrared (NIR) spectroscopy is seen as a potentially interesting technique for liquid phase measurements in AD processes. In this work, the concentrations of the important constituents, ammonium, acetate, propionate and total volatile fatty acids (TVFA), were measured by combining NIR transmittance measurements and partial least-squares (PLS) models. In order to obtain additional calibration data without having to perform additional reference measurements, and in order to enhance the constituent specific correlation in the calibration data, a spiking procedure was implemented according to a central composite design. This methodology reduced the root mean square error of prediction (RMSEP) for ammonium from 176 mg L-1 to 127 mg L-1, for acetate from 334 mg L-1 to 260 mg L-1 for propionate from 258 mg L -1 to 203 mg L-1 and for TVFA from 858 mg L-1 to 704 mg L-1. The spiking procedure also significantly increased the correlation between model predictions on pure constituent spectra and reference values, compared to that of models based on non-spiked data. © IM Publications LLP 2013 All rights reserved.


Wilke T.,University of Wismar | Muller S.,University of Wismar | Neumann K.,University of Wismar | Loder T.,Pharmacy LUX99
Pharmaceutical Medicine | Year: 2011

Introduction: The objective of this study was to discover whether over-the-counter (OTC) package designs differ in their ability to transfer drug-safety-related information to pharmacy customers. The research was intended to answer two questions: (i) how well and quickly do customers comprehend, and what are the main characteristics of customers who have difficulty understanding relevant medical information on a package; and (ii) do alternative package designs provide for significantly different levels of comprehension? Methods: We performed cross-sectional face-to-face interviews with 452 pharmacy customers in 17 German pharmacies. In each of three sequential experiments (one OTC brand per experiment), each participant was shown two packages of the same brand and was asked three drug-related questions per package. The different abilities of the three package designs to transfer information correctly and rapidly were compared by descriptive statistics; the significance of differences was tested by Wilcoxon tests. Results: Older people, those with physical problems, people not in a receptive mood, and those with a poor doctor-patient relationship or a lack of trust in medicines in general, answered the questions with a significantly higher number of errors and/or required significantly more time to do so, than the remainder of the sample. When compared with two other package designs, one of the tested designs with special design characteristics proved superior. Conclusions: The design of a medication package can measurably influence the quality and speed of information transfer to pharmacy customers. Because drug safety and adherence are associated with drug knowledge, the design of packaging should be given more attention. © 2011 Adis Data Information BV. All rights reserved.


Wilke T.,University of Wismar | Muller S.,University of Wismar
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2010

The necessity for extended medication-based thromboprophylaxis after hip/knee-replacement surgery (major orthopedic surgery) has been acknowledged in international guidelines. In this article, we review and critically appraise the literature regarding patients nonadherence (NA) in outpatient thromboprophylaxis after major orthopedic surgery. We conducted a systematic literature review. All studies published since 1990 and that were found to report research about NA in outpatient thrombosis prophylaxis after major orthopedic surgery were included. Only six relevant contributions could be identified. All these studies dealt with parenteral low-molecular-weight heparins or fondaparinux prophylaxis. The extent of NA (defined as existing when a patient fails to take the prescribed medication on at least 1 day) ranged from 13 to 37%. In one large German survey, patients who were nonadherent missed between 38 and 43% of their outpatient low-molecular-weight heparin injections. Subjective factors can play a role in increasing NA; such factors include a lack of knowledge of or having no fear concerning thrombosis in general and a lack of specific knowledge regarding measures to prevent it, as well as a negative evaluation of injections as the form of therapy application. Waiting times between acute in-hospital treatment and admission to rehabilitation clinics, as well as abstention from stationary rehabilitation programs, form objective adherence barriers. Therefore, NA is a phenomenon influenced by subjective patient-related factors as well as objective, care-provision structural factors. Current trends in patient care (e.g., shorter hospital stays and lengthened ambulant care) are likely to increase both the number of nonadherent patients and the extent of NA, if the current state of knowledge proves an accurate predictor of the future. At present, it appears that between one and two of every five patients are not adherent when parenteral prophylaxis is used. Whether or not new oral anticoagulation alternatives will be capable of improving the situation remains open for future research. © 2010 Expert Reviews Ltd.

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