bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nachhaltige Implementierung evidenzbasierter Programme in der Gesundheitsförderung: Theoretischer Bezugsrahmen und ein Konzept zum interaktiven Wissenstransfer
Authors: Rütten A. , Wolff A. , Streber A. 
Published: May 2015

Zusammenfassung
Ziele: Der Beitrag diskutiert 2 aktuelle Probleme im Bereich der Public Health-Forschung: 1) Übertragung wissenschaftlicher Erkenntnisse in die Praxis und 2) Nachhaltige Implementierung von Modellprojekten. Der Beitrag zielt auf die Integration von wissenschaftlicher und praktischer Evidenzproduktion im Implementierungskontext und auf die Überwindung deduktiver Modelle des Wissenstransfers.
Methodik: Vor dem Hintergrund bestehender theoretischer Ansätze, Pilotstudien sowie eigener konzeptioneller Überlegungen werden anhand einer modellhaften Darstellung des Zusammenspiels von Wissenschaft, Politik und Präventionspraxis Überlegungen zur nachhaltigen Implementierung von Gesundheitsförderungsprogrammen aufgezeigt. Das Konzept beschreibt 4 zentrale Prozesse des Zusammenspiels: Interaktiver Wissenstransfer, Kapazitätsentwicklung, Adaptierung des Programms und Veränderungen im Implementationskontext.
Ergebnisse: Die Sicherung der Nachhaltigkeit von Gesundheitsförderungsprogrammen erfordert eine Integration von wissenschaftlicher und praktischer Evidenzproduktion im Implementierungskontext. Für den Prozess der Integration werden interaktive Ansätze der Wissensproduktion und Umsetzung in Handeln (interactive knowledge to action) diskutiert. Hier sind insbesondere Ansätze der Befähigung und Kapazitätsentwicklung über Beteiligung und systematische Zusammenarbeit relevanter Stakeholder erfolgsversprechend. Durch diese Zusammenarbeit werden Prozesse der dynamischen Interaktion zwischen dem jeweiligen Gesundheitsförderungsprogramm, den Zielgruppen, beteiligten Organisationen sowie dem sozialen, kulturellen und politischen Kontext ausgelöst. Die wechselseitige Adaptation von Programm und Schlüsselkomponenten des Implementierungskontextes fördert dabei gleichzeitig die Wirksamkeit des Programms und die Nachhaltigkeitsentwicklung.
Schlussfolgerung: Die nachhaltige Implementierung evidenzbasierter Gesundheitsförderungsprogramme erfordert Alternativen zu den vorherrschenden deduktiven Modellen des Wissenstransfers. Interaktive Ansätze erweisen sich als erfolgsversprechende Alternativen. Sie verändern aber gleichzeitig die Zuständigkeiten von Wissenschaft, Politik und Public-Health-Praxis. Traditionelle Abgrenzungen zwischen Disziplinen und Sektoren werden z. B. durch die Konstituierung transdisziplinärer Teams sowie gemeinsamer Agenden und Vorgehensweisen überwunden. Diese Ansätze erfordern u. a. auch Anpassungen der Rahmenbedingungen von Forschungsprojekten, wie z. B. längere Förderzeiträume.
Analyse von Kosten und Erlösen der 10 häufigsten angiografischen Interventionen bei einem Krankenhaus der Maximalversorgung
Authors: Rennert J. , Mrosek S. , Stroszczynski C. , Schöffski O. , Schreyer A. 
Published: May 2015

Zusammenfassung
Ziel: Kostenanalyse und Evaluation der Vergütung durch GKV und PKV der 10 häufigsten angiografischen Verfahren an einem Universitätsklinikum.
Material und Methoden: Retrospektive Auswertung aller angiografischen Eingriffe des Jahres 2010 und Evaluation der 10 am häufigsten durchgeführten (Port-, Dialysekatheter, PTA von Ober- (OS) und Unterschenkel (US), TACE, Stents (Becken, viszeral, supraaortal), SIRT, zerebrale Coilembolisation). Berechnung der DRG-Anteile und Analyse, ob die Interventionen die DRGs modifizierten und Mehreinnahmen erzeugten. Kalkulation der Vergütung gemäß GOÄ für stationäre und ambulante Patienten. Berechnung von Material-, Personal- und Sachkosten für die Interventionen.
Ergebnisse: Folgende Werte (in €) wurden errechnet [Gesamt-, Material-, Personalkosten, DRG-Anteil, GOÄ (stat., amb.)]: Portkatheter: 375, 266, 59, 328, 260, 612; Dialysekatheter 456, 349, 59, 272, 343, 807; PTA OS: 595, 445, 99, 1 240, 425, 1 077; PTA US: 732, 552, 129, 1 082, 425, 1 184; Stent Becken: 1 523, 1 338, 135, 1 323, 815, n/a; Stent viszeral: 2 124, 1 875, 199, 1 326, 912, n/a; Stent supraaortal: 1 901, 1 713, 138, 6 705, 1 138, n/a; TACE: 1 359, 1 120, 188, 2 588, 598, n/a; SIRT: 1 251, 1 054, 147, 2 289, 1 107, n/a; Coiling zerebral: 6 684, 6 367, 266, 6 531, n/a, n/a. Es konnte keine Abhängigkeit der DRGs von den durchgeführten Interventionen nachgewiesen werden.
Schlussfolgerung: Die Auswertungen ergaben bei Analyse der DRG-Anteile ein Mischbild aus Verlusten (Port- und Dialysekatheter, Stent Becken und viszeral) und rechnerischen Mehreinnahmen (PTA OS/US, Stent supraaortal, TACE, SIRT). Das Coiling erscheint wirtschaftlich neutral. Eine reine Abrechnung nach GOÄ führt lediglich im ambulanten Sektor zu Gewinnen. Einschränkend muss jeder radiologische Eingriff natürlich ebenfalls als Teil der gesamten DRG gesehen werden.
Self-Reported Scoliosis is Not a Valid Method for Estimating Concordance Rates of Adolescent Idiopathic Scoliosis in a Danish Twin Population
Authors: Simony Ane , Kyvik Kirsten Ohm , Andersen Mikkel O. 
Published: May 2015

Introduction The etiology of adolescent idiopathic scoliosis is still unclear and the true mode of inheritance has yet to be established. From the Danish twin cohort concordance rates in monozygotic twins have previously been reported to be 0.13 and in dizygotic twins 0. Studies on concordance in twin pairs provide a basis for analyzing the influence of genetic versus environmental factors. In this study, we wanted to validate if self-reported scoliosis is a valid method to establish incidence and concordance rates in a twin population. Patients and Methods All 46,418 twins registered in the Danish Twin Registry born from 1931 to 1982 were sent a questionnaire, which included questions about scoliosis. The questionnaire was returned by 34,944 (75.3%) representing 23,204 pairs. A total of 548 individuals representing 274 complete twin pairs, where at least 1 has self-reported scoliosis were invited to a clinical and a radiologic examination. Zygosity was established by genetic testing. Results A total of 182 individuals (33.2% of the cohort) participated. Overall, 128 of these individuals had self-reported scoliosis. The total number of participants consisted of 91 twin pairs, where one or both twins had scoliosis and 36 individuals whose twin did not want to participate. Overall, 35 individuals (27.3%) of the 128 participants with self-reported scoliosis presented a clinical and radiological confirmed curve. Of these were 5 twin pairs (four monozygotic pairs and one dizygotic pair) with scoliosis in both twins and 16 twin pairs with scoliosis in only 1 twin and 9 individuals where only one twin participated. Calculating concordance in twins with curves greater than 10 degrees, we found that the pairwise concordance rate was 0.4 (range, 0.12–0.74) for monozygotic and 0.05 (range, 0.01–0.25) for dizygotic twin pairs, probandwise concordance was 0.45 for monozygotic and 0.1 for dizygotic pairs. Conclusion Self-reported scoliosis in a Danish twin population is not a valid method to establish the true concordance rates. Although it is not statistically significant the differences in monozygotic and dizygotic pairs indicate that hereditary parameters have an impact.
Epidemiology of Traumatic Cervical Spine Fractures in the Norwegian Population
Authors: Fredø Hege Linnerud , Bakken Inger J. , Lied Bjarne , Rønning Pål , Helseth Eirik 
Published: May 2015

Introduction The incidence of traumatic cervical spine fractures (CS-fx) in the general population is largely unknown. Former published data describe the incidence in different subpopulations, such as trauma center patients, head injury patients, osteoporotic patients, and military populations. Norway is a small country in Northern Europe with 5 million inhabitants. All acute traumatic cervical spine injuries are treated in government- owned public health care. The aim of this study was to estimate the incidences of CS-fx and of open surgical fixation of CS-fx in the Norwegian population. Material and Methods The Norwegian Patient Register (NPR) is an administrative database that contains activity data from all Norwegian government-owned hospitals and outpatient clinics. Reporting to NPR is mandatory and linked to the funding of health services. The diagnoses and procedures are coded according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the NOMESCO Classification of Surgical Procedures (NCSP), respectively. We retrieved information on all CS-fx between 2009 and 2012 from the NPR. Updated information on the date of death is included through routine linkage to the General Register Office. Results Between 2009 and 2012, a total of 2,963 patients had one or more CS-fx. The median age was 54 years, and 69% of the patients were male. The incidence of CS-fx was 15.0/100,000/year. A total of 19% of the patients were treated with open surgery, resulting in an estimated incidence of 2.9/100,000/ year for surgery for CS-fx in the Norwegian population. The 1- and 3-month mortality rates were 4 and 6%, respectively. Conclusion To the best of our knowledge, this is the first registry-based study of the epidemiology of CS-fx in a general population. Our estimate of the incidence of CS-fx in the total Norwegian population was 15/100,000/year. The incidence of open surgery for CS-fx in the Norwegian population was estimated to be 2.9/100,000/year.
Anterior or Posterior Release for Severe Rigid Scoliosis: Which is Safer and More Effective?
Authors: Liu Zhen , Xie Dingding , Zhu Zezhang , Yu Yang , Wang Bin , Sun Xu , Qian Bang-Ping , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction Various correction methods have been developed to treat severe rigid scoliosis. The anterior release was performed for many years to improve the flexibility of rigid scoliosis, however, the safety and efficacy of combined anterior/posterior approach were questioned by many authors. This study aimed to evaluate the efficacy and safety of two-stage posterior surgery for severe rigid scoliosis and to determine whether posterior release is safer and more effective than anterior release. Patients and Methods A total of 27 patients undergoing the staged posterior procedure were included in P–P group and 32 patients undergoing staged anterior/posterior procedure were included in A–P group. Halo-femoral traction was used after the release procedure for both the groups. The flexibility and correction rate were evaluated to quantify the contribution of spinal release and traction to curve flexibility. Radiographic outcomes were compared between the two groups before surgery, after release and traction, immediately postoperatively, and at the last follow-up. Results Gender, release and fusion segments, duration and weight of traction, main curve magnitude, and curve type were similar between the two groups. Significant lower flexibility of main curve ( p = 0.001) and higher global kyphosis ( p < 0.001) was found in P–P group. For patients in the P–P group, the flexibility of major curve averaged 14.1% before surgery, which increased to 32.5% after posterior release and Halo-femoral traction ( p < 0.001) and showed 44.9% correction postoperatively. Compared with patients in A–P group, patients in the P–P group seemed more benefited from release and Halo-femoral traction (18.4 vs.12.9%, p = 0.021) although they had significantly more rigid scoliosis before surgery (14.1 vs. 21.0%, p < 0.001). Besides, the final correction rate of the main curve was similar between the two groups (50.1 vs. 44.9%, p = 0.094). Five patients in the A–P group were found to have respiratory system related complications, whereas only one patient in P–P group experienced superficial pin site infection combined with deep venous thrombosis of the left limb. Conclusion Staged posterior surgery provides a safe and effective option for the treatment of severe rigid scoliosis. And posterior release seems superior for anterior release regarding the surgical outcomes.
Modification in Surgical Technique for Posterior Vertebral Column Resection
Authors: Aydinli Ufuk , Mutlu Muren , Yaray Osman , Kara Kursat 
Published: May 2015

Introduction Surgical treatment of severe and rigid spinal deformities is usually difficult and challenging to perform. The goal of surgical treatment is to obtain a satisfactory balance both in sagittal and coronal planes. In rigid deformities, the osteotomies are usually insufficient; vertebral column resection is the only option of treatment. To reduce the operation time and complications, a single stage, posterior vertebral column resection (PVCR) is defined by Suk et al. It enables rotational and translational correction of spinal column and provides an opportunity for manipulation of anterior and posterior column simultaneously. In the original PVCR, posterior elements of resection side were removed first and then the anterior part removed and correction was performed. The authors decided to make a modification in PVCR as performing the posterior total laminectomy, facetectomy, and pediclectomy after vertebral body resection. This method has two major advantages; minimization of the blood loss from epidural veins after laminectomy and protection of the neural elements from direct injury during vertebral body resection. Patients and Methods A total of 11 patients between the age of 3 and 63 years, diagnosed with severe spinal deformity with limited flexibility, who underwent modified PVCR were reviewed. The average follow-up was 2 years (range, 5 months–3 years). There were six female and five male patients with a mean age of 18 years. Severe congenital scoliosis was found in seven patients, congenital kyphosis in two patients, neurofibromatosis in one patient, and posttraumatic kyphosis in one patient. The surgery consisted of temporary fixation of vertebral column, resection of vertebral body first then resection of posterior elements, followed by deformity correction and fusion. Results The mean estimated blood loss was 1,072 mL (range, 350–2,000 mL). Overall, 39.45% (range, 33–50%) of total blood loss occurred after vertebral body resection, 60.91% (range, 50–67%) occurred after posterior elements removal. The ratio of estimated blood loss to estimated body blood volume was 26% (range, 19–52%). The deformity correction was 60% in the coronal plane. No neurological complications were encountered. Conclusion The PVCR is a complicated, technically demanding procedure with possible risks for major complications. All correction attempts must be performed under direct inspection, palpation of tension in the spinal cord by a highly experienced surgeon. Spinal cord neuromonitoring is a must to prevent neurological injuries. The authors modified the original technique defined by Suk and performed by various surgeons. The authors believe that making vertebral body resection before laminectomy would decrease the blood loss and protect the spinal cord. The validity of this new modified technique should be demonstrated in a prospective, randomized, controlled study with a larger patient population allowing comparison of age-matched subgroups.
Powdered Vancomycin versus Povidone Iodine in Spinal Fusion Deep Infection Prophylaxis: A Comparative Study in Trauma Patients
Authors: Cancado Sergio , Reis Marco Tulio , Malheiros Jose Augusto , Alves Belo Joao Tiago , Goncalves Diogo , Zanini Rocha Guilherme 
Published: May 2015

Introduction Incidence of deep surgical site infection (SSI) in spinal fusion varies from 0.3 to 20% according to the international literature. Instrumentation is a well-established risk factor for this complication. Higher morbidity and mortality rates and increased cost of treatment up to fourfold are associated with this complication. Prophylaxis with intravenous antibiotic is consensual, but few studies have evaluated the efficacy of topical agents in the surgical site with prophylactic intent. Irrigation with 3.5% povidone iodine and application of lyophilized vancomycin powder in surgical site have shown benefit, but there are no studies comparing these two methods. A comparative study using topic povidone iodine and vancomycin powder was conducted to reduce this knowledge gap. Patients and Methods The medical records of 439 patients who underwent spinal fusion with instrumentation for traumatic spinal lesion treatment were analyzed. Procedures were consecutively performed at Joao XXIII Hospital (level 1 trauma center). Patients were combined in the following two groups, according to the prophylactic agent used: Povidone iodine (PVPI) historical series ( n = 181), performed from January 2009 to April 2012 and vancomycin (VANCO) cohort study ( n = 239) conducted from May 2012 to December 2013. The surgical site in PVPI group was irrigated with 5% topic iodine solution during 3 minutes, before deep lumbar fascia closure. One gram of vancomycin powder was applied directly to the hardware in VANCO group. Both the groups received 2 g of intravenous cefazolin 30 minutes before surgery and had surgical site exhaustively washed with saline 0.9%, before closure in PVPI group and prior to apply vancomycin powder in VANCO group. Results No difference according to mean age, sex, and lesion level distribution (cervical × thoracolumbar) was observed between the two groups. Number of levels instrumented, coexisting infection, and surgical access were not compared because of a lack of information in medical records, especially those from PVPI series. SSI rate was lower in VANCO group (1.67%) compared with PVPI group (6.62%), this difference was statistically significant (chi-square test with Yates correction = 5.618; p = 0.018; IC 0.069–0.824). Conclusion The application of 1 g vancomycin powder in surgical site was superior to irrigation with 5% povidone iodine in the prophylaxis of deep surgical site infection. These results are valid for patients with spinal trauma who underwent instrumented fusion. Variability in surgical team, difference in the interval admission surgery (patients recently are being operated earlier), and number of levels instrumented are possible bias to this study. The low cost and easy applicability of topic prophylactic measures justify new studies with better statistical power (multicenter and randomized).
Combination of Fusion and Motion Preservation in the Surgical Treatment of Degenerative Cervical Disc Disease
Authors: Bank Andras , Szollosi Balazs , Varga Peter 
Published: May 2015

Introduction Our clinical study design was prospective, concurrently enrolled, and single-center trial of the combination of fusion (intervertebral cage with or without ventrofixation) and cervical disc prosthesis implantation in the treatment of patients with multiple level degenerative disc disease. The cervical disc arthroplasty become more and more popular in the surgical treatment of the degenerative cervical disc disease. The goals of the cervical disc arthroplasty are to maintain or restore intervertebral height, spinal balance and mobility, and to avoid adjacent segment degeneration. However, in most of the patients with multisegmental degenerative disc disease, the certain segments show different stage of degeneration and instability. The study was designed to investigate the clinical effects of the combination of cervical fusion and arthroplasty and to observe the stability, range of motion, and the cervical spine sagittal balance in the follow-up period. Patients and Methods Since December 2007 to September 2012, 36 patients with symptomatic cervical radiculopathy and/or myelopathy underwent surgery with this combined method. In 14 cases, the surgery involved two level, in 16 cases was three level, and 6 cases was four level. At the follow-up period, the patients' pain, neurologic function, and the radiographic parameters (range of motion at the level of prosthesis and the adjacent segments, the intervertebral disc height of the adjacent segments, lordosis of the whole cervical spine, and heterotopic ossification) were evaluated. Results Early clinical experiences are promising. The segment of the prosthesis ultimately showed preservation of motion when compared with preoperative levels. The pre-op average ROM was 8.2 degrees (flexion/extension), the post-op average ROM 7.6 degrees. The whole cervical spine lordosis was pre-op 1.7 degrees the post-op 16.2 degrees. We have no implant-related failure. Conclusion The most important potential advantages of this method is that we can treat the multisegmental degeneration in each segment with the proper method including motion preservation and fusion, and restore the sagittal balance of the cervical spine. Although early results are promising, long-term follow-up studies required to prove its efficacy in the surgical treatment of the multisegmental degenerative cases.
Biomechanical Stability of the Stalif-C Stand-Alone Spacer in Multi-level and Hybrid Cervical Fusion Constructs
Authors: Kang Daniel , Lehman Ronald , Wagner Scott 
Published: May 2015

Introduction Anterior plate constructs for cervical discectomy and fusion have been linked to postoperative dysphagia, increased operative times, and wider surgical exposures. Several “low profile” integrated stand-alone spacers (SAS) have been developed. While these spacers have demonstrated successful clinical outcomes and similar biomechanical stability to anterior plate constructs in single-level fusions, their biomechanical stability in multi-level constructs has not yet been established. Methods Twelve human cadaveric cervical spines (C2-T2) were nondestructively tested with a six-degree-of-freedom simulator under axial rotation (AR), flexion-extension (FE), and lateral bending (LB) loading. After intact analysis, each specimen underwent sequential instrumentation and testing: (A) C5-6 spacer/plate with C6-7 SAS; (B) C5-7 SAS; (C) C5-7 spacer/plate. Range of motion (ROM) data was obtained and analyzed with paired t-tests and Bonferroni correction. Results The 2-level plate construct significantly reduced flexion-extension ROM compared to the 2-level SAS (5.6 ± 3.4 degrees versus 11.6 ± 4.6 degrees, respectively; p < 0.05). There was a significantly increased segmental ROM in the 2-level SAS construct compared to the 2-level hybrid construct in flexion-extension as well (11.6 ± 4.6 degrees versus 7.2 ± 2.4 degrees, respectively, p < 0.05). There was no significant difference in lateral bending and axial rotation ( p > 0.05) between the three different 2-level constructs. Conclusions Our study found that hybrid and 2-level SAS constructs are comparable to conventional anterior plate constructs in lateral bending and axial rotation, but there was an increase in flexion-extension motion allowed with constructs that incorporated a SAS. Stand-alone cervical spacers with integrated screws for hybrid and 2-level SAS constructs are reasonable alternatives to two-level plate fixation; however, clinical trials are necessary to determine if the increased ROM in flexion-extension noted in the SAS constructs translates to clinical outcome.