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SeptiFast versus blood culture in clinical routine: A report on 3 years experience

SeptiFast versus blood culture in clinical routine: A report on 3 years experience

29 , 35 – 38 ]. With a 5-h run time, SF is considerably faster than conventional BC testing [ 24 , 39 , 40 ]. The SF test was introduced into the daily clinical routine of our institution as an add-on to the conventional laboratory sepsis diagnostics. During the first 3 years paired BC and SF testing was implemented because clinical data regarding the performance of SF were sparse at that time. In the present study, we retro- spectively analysed SF and BC results of this period from patients with sepsis and/or evidence of other se- vere systemic infectious diseases in association with parameters, such as clinical indications, ward and antimicrobial therapy. For a subset of ICU patients the impact of positive results on total hospital as well as ICU stay and mortality rate was also investigated.
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Feasibility of prehospital teleconsultation in acute stroke : a pilot study in clinical routine

Feasibility of prehospital teleconsultation in acute stroke : a pilot study in clinical routine

trials, the fact that most of the in-hospital personnel were not aware of the measuring can explain such findings that represent clinical routine. Both stroke centers had several neurologists who received only a few patients notified via telemedicine compared to many ‘‘regular patients’’. It is understandable that the few study patients did not influence the routine procedures of the stroke centers. If this telemedical approach would be implemented into daily routine, the chance of improving in-hospital processes would emerge. But even in the first phase of the inter-hospital telestroke project TEMPiS, only 74% of the acute stroke patients (onset #3 hours) received brain imaging within the first hour after arrival in the study group [22]. Chatterjee et al. found median times from triage to completion of brain imaging of 30 (IQR 18-59) minutes in patients with symptoms ,3 hours and 102 (IQR 48-164) minutes in patients with an onset of symptoms .3 hours [23]. Our collective was mixed with patients with an onset of symptoms ,3 and .3 hours. Therefore the detected door to brain imaging intervals seem to be no exceptionally unusual finding, but this must not be a justification and the need for improvement is obvious.
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Advanced quantification for fully-integrated PET/MRI: implementing MRI-based attenuation correction in clinical routine / submitted by Ivo Florian Rausch

Advanced quantification for fully-integrated PET/MRI: implementing MRI-based attenuation correction in clinical routine / submitted by Ivo Florian Rausch

MR-AC for human imaging, in particular for whole-body applications, remains a matter of debate [102,114,118,119]. Standard MR-AC relies on segmentation-based approaches (see section 1.3.2). These are simple in terms of calculation effort and, more importantly, are based on fast MRI sequences [72], thus leaving ample time for diagnostic MRI examination. However, these standard sequences come with various shortcomings (see section 1.3.2). For example, they neither account for patient specific variations in attenuation coefficients of different tissues, nor do they include bone information. All of these issues challenge an absolute quantification in PET/MRI. Nevertheless, in routine clinical applications absolute quantification is desirable, but not always mandatory. Surveys assessing the protocols used in PET/CT today, indicate that quantitative values by means of SUV are used mainly in therapy monitoring [19,28]. Here, a pre-treatment PET examination is performed and followed by a subsequent PET examination at some time point during-, or after the treatment [100,105,120]. The response is assessed by a decline in SUV; that is, relative changes in SUV are considered sufficient to evaluate therapy response [100]. However, in this setting, the reproducibility of the SUV values is of utmost importance. Reproducibility of SUV depends on various factors [31], for example, the time between tracer injection and PET examination [105] or the image reconstruction algorithm in use [121]. Most of these influences are understood and can be managed by standardized procedures
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Tissue microarray based identification of molecular cancer therapy targets in clinical routine

Tissue microarray based identification of molecular cancer therapy targets in clinical routine

In all six cases with confirmed homogeneous Her2/neu positivity, a Trastuzumab therapy was discussed with the attending physicians. A therapy was not started im- mediately because either the clinical situation was not demanding further therapy or because the treating physicians were hesitant given the lack of clinical trials dealing, for example, with Her2/neu amplified colon cancer. The concept of treating can- cers with homogeneous Her2/neu-positivity was tested in one case of colon cancer initially diagnosed in 2006. In this case we could detect homogeneous Her2/neu- positivity in the primary tumor, multiple lymph node metastases and pulmonary metastases while we were conducting further tests in April 2010. The patient re- ceived standard chemotherapy, which could not stop tumor progression. After the discovery of the Her2/neu positivity he was treated with Trastuzumab as a single agent, which resulted in a partial response.
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Molecular profiling in breast cancer - ready for clinical routine?

Molecular profiling in breast cancer - ready for clinical routine?

Immunohistochemically defined prognostic and pre- dictive markers, such as estrogen- (ER) and proges- terone receptor (PR), human epidermal growth factor receptor 2 (HER2) and the proliferation marker Ki67 still govern the therapy recommendation in early breast cancer in many cases [ 3 ]. However, the dis- covery that these characteristics are mirrored by well- defined patterns in gene expression allowed a fur- ther precision of prognostication and facilitated the development of transcriptome-based multigenomic assays that correlate well with pathological markers but still provide independent prognostic and in some instances, predictive information [ 4 , 5 ]. Especially in ER-positive luminal-type early breast cancer, ad- ditional prognostic information is often required to provide patients with a valid and effective therapy recommendation. Whereas endocrine therapy is of- fered for most patients with luminal breast cancer, only a subset of patients derives clinical benefit from adjuvant chemotherapy. Whereas patients with low- proliferative luminal A disease do not benefit from the addition of adjuvant chemotherapy to endocrine therapy, adjuvant chemotherapy should be offered to patients with more aggressive and highly proliferative luminal B disease [ 6 ]. Although luminal A and B dis- ease might be identified by immunohistochemical markers, especially by the proliferation marker Ki67, determination is subjected to significant inter- and intraobserver variability that impair objective and reproducible measurements [ 7 ]. Quantitative analy- sis of the RNA expression of several relevant genes of luminal tumors might capture tumor biology in a more accurate and reproducible way. Commercially available multigenomic assays are able to discrimi- nate luminal A from luminal B biology and provide patients with a clinically valid therapy recommenda- tion.
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Personalized treatment of advanced non-small-cell lung cancer in routine clinical practice

Personalized treatment of advanced non-small-cell lung cancer in routine clinical practice

Abstract Personalized treatment of patients with ad- vanced non-small-cell lung cancer based on clinical and molecular tumor features has entered clinical routine prac- tice. The 2015 pathological classification of lung cancer mandates immunohistochemical and molecular analysis. Therapeutic strategies focused on inhibition of angiogen- esis and growth factor receptor signaling. Inhibitors of angiogenesis and monoclonal antibodies directed against the epidermal growth factor receptor have shown efficacy in combination with chemotherapy. Mutations in the epi- dermal growth factor receptor and anaplastic lymphoma kinase have become clinically relevant therapeutic targets. Immune checkpoint inhibitors are also entering routine clinical practice. Identification of predictive biomarkers is essential and faces several challenges including tumor heterogeneity and dynamic changes of tumor features over time. Liquid biopsies may overcome some of these challenges in the future.
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Machine learning: from radiomics to discovery and routine

Machine learning: from radiomics to discovery and routine

Tworecent advances have furtheracceler- ated the development of machine learn- ing in radiology. First, the acquisition volume of medical imaging data is accel- erating. Worldwide, during 2000–2007, an estimated 3.6 billion radiologic, den- tal radiographic, and nuclear medicine examinations were performed per year [ 18 ]. Medical imaging data are expected to soon amount to 30% of worldwide data storage [ 9 ]. Second, recent algorith- mic development in the machine learning field together with new hardware, such as powerful graphics processing units (GPU), have yielded a dramatic improve- ment in the capability of these techniques. Here, we review the current state of the art and the possible roles machine learn- ing can play in medical imaging covering clinical routine and research. After sum- marizing the basics of machine learning, we discuss the most pressing challenges and structure the review around four core questions:
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Measuring the Routine and Non-Routine Task Content of 427 Four-Digit ISCO-08 Occupations

Measuring the Routine and Non-Routine Task Content of 427 Four-Digit ISCO-08 Occupations

The rest of the paper is organized as follows. Chapter 2 provides an overview of occupational and survey-based data sources that are commonly used to create task content measures. It shows examples of how researchers utilize the databases to generate task indexes. Chapter 3 presents the International Standard Classification of Occupations 2008, which is our data source. Chapter 4 describes the classification process in which we assign 3,264 occupation-specific tasks into five task categories – non-routine analytic, non-routine interactive, routine cognitive, routine manual and non-routine manual. The chapter extensively discusses the possibility of misclassifying tasks and the potential implications of such misclassifications. Chapter 5 outlines the empirical methodology for calculating the five task measures. The empirical results are presented in Chapter 6. In line with expectations, we find that analytic and interactive tasks are most prevalent in the work of Managers and Professionals, routine cognitive tasks are typically performed by Clerical Support Workers, and routine manual and non-routine tasks are largely concentrated in the work of Plant and Machine Operators and Assemblers and Elementary Occupations, respectively. In Chapter 7 we compare our routine indexes with Acemoglu and Autor (2011), Frey and Osborne (2017) and Dengler, Matthes and Paulus (2014). To this end, we convert their indexes to four-digit ISCO-08 occupations. In Chapter 8, inspired by Frey and Osborne (2017), we provide a back of the envelope estimation of the number of occupations that might be at risk of automation. We find that approximately 16 percent of the 427 ISCO-08 occupations are comprised of 70 percent or more routine tasks, and therefore they fall into the high risk of automation category, as defined by Frey and Osborne (2017). Finally, Chapter 9 concludes and provides a discussion of the strengths and limitation of the present analysis.
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Routine childhood vaccinatio in Germany - well-founded?

Routine childhood vaccinatio in Germany - well-founded?

Background: Varicella is the most frequent vaccine preventable disease of childhood inGermany. Though usually mildly proceeding severe complications may occur, particularlyamong pregnant women, neonates, adults and the immunocompromised. Later in life 10-20% are afflicted by herpes zoster (HZ) through reactivation of the dormant varicella zostervirus (VZV). With regard to >750 000 varicella cases annually and consequent societal costs Germany has introduced VZV immunization into the routine childhood vaccination schedule in July 2004. As this recommendation is a matter of controversial discussion wereconsidered the underlying data in order to revise it. Method: A literature search about VZV in developed countries was performed regarding publications from 2001-2005 on disease burden, vaccination including cost-effectiveness and public perception. Available data were.summarized and analyzed with regard to the current VZV vaccination recommendation in Germany. Results: Data on basic aspects of VZV vaccination vary considerably:Complications of varicella infections occur in >1% children up to ≤6% of all cases,hospitalization rates range at 0,85- 24,7/100 000 person years, mortality at 0,01-0,1/100 000 person years. The available vaccine, a life attenuated monovalent preparation, has been empirically proven to be safe and efficacious with 80- 100% of seroconversion. Yet risks of lacking persistance, of a rise in the average age of infection followed by a higher rate of complications and of a growing incidence of HZ could not be excluded. Statements on the effective dosage go from 439 to15 850 PFU1. Effectiveness in terms of decreasing morbidity requires a minimum of 70% coverage, elimination acc. to author 85-97%. Breakthrough infections (milder than natural) occur in at least 1-5% of vaccinees, risk factors include low dosage, 3- 5-year interval since immunization and vaccination age <15 months.Costeffectiveness of general VZV vaccination
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Einführung eines Therapieplanungssystems für die Protonentherapie von
Augentumoren in die klinische Routine

Einführung eines Therapieplanungssystems für die Protonentherapie von Augentumoren in die klinische Routine

Nach An- bindung des Berliner Dosisberechnungsmoduls stellte das Deutsche Krebsforschungszentrum den Prototyp des neuen Bestrahlungsplanungsprogramms zur Verfügung, mit dem erste Ver- s[r]

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Routine dosimetry with phosphate glasses

Routine dosimetry with phosphate glasses

A particular simplification of personnel monitoring in nuclear installations is the fact that the phosphate glass dosimeter used in Karlsruhe is a single dosimeter wh1eh 1s emp19yed for [r]

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Anzeige von Weshalb eine Routine im Homeoffice essenziell ist

Anzeige von Weshalb eine Routine im Homeoffice essenziell ist

Um eine bessere Rou�ne zu entwickeln, ist es sinnvoll, sich die eigenen Gewohnheiten aufzuschreiben, diese in gute und schlechte Gewohnheiten zu strukturieren und sich einen Überblick zu[r]

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„Early TIPS“ bei Varizenblutungen: Ergebnisse aus der klinischen Routine

„Early TIPS“ bei Varizenblutungen: Ergebnisse aus der klinischen Routine

Die „strikten Kriterien“ für eine Ear- ly-TIPS-Implantation erfüllten 68 Pa- tienten, sie erhielten jedoch erst nach 72 h bis 28 Tagen einen TIPS (TIPS- Kontrollgruppe: 50 % beschichtete[r]

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Comparative advantage in (non-)routine production

Comparative advantage in (non-)routine production

In the micro-foundation of our production function, we showed that firing re- strictions naturally have such an effect. The strictness of employment protection legislation (EPL) has the predicted positive sign on both samples, but it is only a significant predictor of export specialization on the EU sample with countries that are relatively similar in most other dimensions. Among EU countries, EPL is the most robust predictor of export specialization when different dimensions are included simultaneously. Countries that enacted laws and regulations to make fir- ing workers more costly and to restrict temporary employment tend to specialize in more routine-intensive tasks. Note that these results should not be interpreted causally. While EPL might have caused or contributed to the trade specialization, as in our model, it is also possible that labor regulations were enacted in response to sectoral specialization.
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Mehr als nur Routine: Iran wählt ein neues Parlament

Mehr als nur Routine: Iran wählt ein neues Parlament

Nach den Gesetzen dieser Republik wäre derartigen Personen auch vor 2009 das Wahl- recht verweigert worden, aber Revolutionsführer Ali Khamenei dehnte das Verbot nun auch auf die- jeni[r]

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Präoperative Detektion der Alkoholkrankheit (AUD) im Rahmen der klinischen
Routine einer Anästhesieambulanz

Präoperative Detektion der Alkoholkrankheit (AUD) im Rahmen der klinischen Routine einer Anästhesieambulanz

Aber auch Schlussfolgerungen, wieweit Alter, Geschlecht, Ausbildungslevel und andere Basischarakteristika der Anästhesisten deren Detektionsrate von Alkoholkrankheit bei [r]

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Damit Psychopillen nicht zur Routine werden : Psychopharmaka im Altenpflegeheim ; Handlungsbedarf auf allen Ebenen

Damit Psychopillen nicht zur Routine werden : Psychopharmaka im Altenpflegeheim ; Handlungsbedarf auf allen Ebenen

I m Altenheim gehören Psycho- pharmaka ganz selbstverständlich zum Pflegealltag. Damit daraus kei- ne gefährliche Routine entsteht, hat ein Team aus Gerontopsychiatern, Medizinethikern und Juristen der Johann Wolfgang Goethe-Universi- tät ein Frankfurter Pflegeheim auf dessen Wunsch hin unter die Lupe genommen. Ihr Maßnahmenkata- log gibt allen beteiligten Personen und Institutionen und sogar der Po- litik Hinweise, wie mehr Achtsam- keit im Umgang mit diesen Medika- menten erreicht werden kann. Es geht nämlich keineswegs darum, Psychopharmaka generell zu ver- teufeln. In manchen Fällen bemän- geln die Fachleute, dass notwendige Antidementiva oder Antidepressiva nicht verschrieben wurden, in an- deren wurden dagegen Doppelme- dikation und oft zu lange Therapie- dauer gerügt. Die Wissenschaftler entwickeln über 70 Handlungsemp- fehlungen, mit denen die Versor- gung optimiert und somit die Le- bensqualität der Bewohner erhöht werden kann.
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PPP zwischen politischem Projekt, medialer Diskussion und administrativer Routine - Zur Einführung

PPP zwischen politischem Projekt, medialer Diskussion und administrativer Routine - Zur Einführung

29.10.2012, S. 11). In der entsprechenden Antwort der Bundesregierung (BT-Drucksache 17/13749) wird zunächst darauf verwiesen, dass zwischen 2002 und 2013 187 PPP- Projekte im Hoch- und Tiefbau mit einem Volumen von insgesamt ca. 7,5 Mrd. € reali- siert worden seien. Das Dokument enthält zudem einen Abriss der PPP-Geschichte aus Sicht der Bundesregierung: Mit dem ‚ÖPP-Beschleunigungsgesetz‘ 2005 waren demnach die Bedingungen für die Realisierung sektorübergreifender vertraglicher Kooperation deutlich verbessert worden. 2006 sei der Leitfaden zur „Wirtschaftlichkeitsuntersuchung bei PPP-Projekten“ von Bund und Ländern entwickelt worden. 2007 habe ein Bund-Län- der Arbeitsausschuss Empfehlungen zur haushaltsrechtlichen und -systematischen Be- handlung von PPP publiziert. 2008 wurde die ÖPP Deutschland AG gegründet, die öffent- lichen PPP-Interessenten objektive und neutrale Beratung anbiete. Ein ‚ÖPP-Vereinfach- ungsgesetz‘ sei 2009 vom Kabinett zwar verabschiedet, aber vom Parlament nicht wieter verfolgt worden. In den Folgejahren wurden die vorhandenen administrativen Instrumente weiter entwickelt. So wurde die Arbeitsanleitung zu Wirtschaftlichkeitsuntersuchungen überarbeitet, für Bauaufgaben des Bundes die obligatorische Berücksichtigung der PPP- Variante verankert und ein Excel-basiertes Rechenmodell für Wirtschaftlichkeitsuntersu- chungen entwickelt. Der Bericht der Bundesregierung hat verdeutlicht, dass vertragliche PPP als eine Form der „Collaborative Governance“ (Ansell/Gash 2007, S. 543) auf dem Weg zu einer administrativen Routine sind bzw. diesen beschreiten sollen. 3
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Domestic microdramas: everyday life as routine and chaos

Domestic microdramas: everyday life as routine and chaos

If we turn to documentations of domestic media life in the 1970s, media consumption may seem rather routine to a present-day observer. Let’s take a peek at the family assembled on the TV sofa, where everyone has their own place. In comparison to earlier generations they have acquired some multitasking competences. The radio has already moved out of its once sacred position in the living room and there is now a transistor in the kitchen. The first person to get up each morning turns the radio on, and for the rest of the day it provides a soundscape for their kitchen activities. People learn to listen to the news, leaf through the morning paper and have breakfast – all at the same time. The wife sets up her ironing board in the living room so that she can iron and watch television simultaneously. It feels restful. Special tapes even provide entertainment while driving the car. Also common to this time are worries about teenagers who insist that they can do their homework while listening to music at the same time—something that was seen as the ultimate challenge to intellectual work. The threat comes from the cassette recorders now to be found in the teenagers’ rooms.
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Essays on stimulating non-routine performance in competitive environments

Essays on stimulating non-routine performance in competitive environments

Why is research on the interplay between competitive incentives and creative performance important? Looking into organizations nowadays, one can observe two pervasive practices: first, firms use contest-based types of incentives like rank-order tournaments, e.g. for bonus payments or promotions, and higher prize spreads are thought to be mechanisms for higher performance (Lazear & Rosen 1981). Second, modern workplaces are less characterized by routine work and more by non-routine, innovative environments, which demands for a higher amount of creativity (Bradler et al. 2019). While the results of DePaola et al. (2018) obviously contradict neo- classical theory (i.e. positive incentive effects), there are also studies finding positive effects of competition on creativity (see e.g. Bradler et al. 2019). Hence, it remains unclear how and under what circumstances incentives and particularly competition affect non-routine performance, and one can ask if the standard tournament theory prediction of performance increasing with prize spreads also holds for tasks of creative nature. My study reveals that risk aversion could such an important circumstance.
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