A case study applying a novel approach to estimate the social impact of a medical innovation - the use of secukinumab for psoriatic arthritis in Germany.

Objectives: Psoriatic arthritis (PsA) is associated with serious productivity impairment. Secukinumab, a fully human IL-17A inhibitor, provides sustained relief from PsA symptoms. This study estimates the societal economic benefits of using secukinumab instead of conventional disease-modifying anti-rheumatic drugs (DMARDs) for treating patients with active PsA in Germany from 2016 to 2030.

Pre-clinical study on a telemetric gastric sensor for recognition of acute upper gastrointestinal bleeding: the "HemoPill monitor".

Background: Acute upper gastrointestinal bleeding is a life-threatening medical condition with a relevant risk of re-bleeding even after initial endoscopic hemostasis. The implantable HemoPill monitor contains a novel telemetric sensor to optically detect blood in the stomach allowing the surveillance of high-risk patients for re-bleedings.

Methods: In this pre-clinical porcine study, bleeding has been simulated by injecting porcine blood into the stomach of a pig through an implanted catheter using a syringe pump.

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative.

Background: All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly.

Managing large lead vegetations in transvenous lead extractions using a percutaneous aspiration technique.

Background: Treatment of patients with systemic infections of cardiac implantable electronic devices and large lead vegetations are a clinical challenge. In such situations patients potentially had to undergo open surgical extraction in the past. The objective of this study was to evaluate the results of a concomitant percutaneous, minimal-invasive aspiration procedure with the use of an extracorporeal circulation in transvenous lead extraction procedures in patients with large lead vegetations.

How anesthetists manage growing demands with dwindling resources in German university hospitals: Overview and outlook.

As a central service provider in medical care, anesthetists manage the growing demand on medical services, thereby increasing specialization and patient morbidity. Various indicators and measurements have been used to match staff capacity, competence, and workload. It remains unclear whether the problems are due to real shortages or "just" to a wrong distribution.

Improving female physician's careers in academic medicine: Chances and challenges.

University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals.

Management of Progressive Pulmonary Nodules Found during and outside of CT Lung Cancer Screening Studies.

Although the effectiveness of screening for lung cancer remains controversial, it is a fact that most lung cancers are diagnosed at an advanced stage outside of lung cancer screening programs. In 2013, the U.S.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

Background: All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries.

Growing Pains at Hospitals: Opportunities and Issues of Service Expansion in Maximum Care.

Purpose: Due to the demographic change morbidity raises the demand for medical hospital services as well as a need for medical specialization, while economic and human resources are diminishing. Unlike other industries hospitals do not have sufficient data and adequate models to relate growing demands and increasing performance to growth in staff capacity and to increase in staff competences.

Method: Based on huge medical data sample covering the years from 2010 to 2014 with more than 150,000 operations of the Department for Anesthesiology at the University Hospital Muenster, Germany, comparisons are drawn between the development of medical services and the development of personnel capacity and expertise.

Efficacy and safety of the remOVE System for OTSC and FTRD clip removal: data from a PMCF analysis.

Introduction: The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system.

Material And Methods: A total of 74 patients underwent clip extraction.

Future of robotic surgery in urology.

Objectives: To provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives.

Materials And Methods: A non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine.

Cost-effectiveness of grass pollen SCIT compared with SLIT and symptomatic treatment.

Background: Whereas specific immunotherapy (SIT) has already been shown to be cost-effective in the treatment of allergic rhinitis compared with symptomatic treatment, only a small number of investigations have compared sublingual (SLIT) and subcutaneous (SCIT) immunotherapeutic approaches. This analysis discusses the cost-effectiveness of SCIT compared with SLIT and a symptomatic treatment modality. At the same time, particular attention is paid to preparation-specific characteristics.

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal.

Background: University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions.

Frontiers of robotic endoscopic capsules: a review.

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd.

Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death.

Laparoscopic gastro-jejunal anastomosis using novel r2 deflectable instruments in an ex vivo model.

Objective: A novel 5 mm steerable instrument system (r2-DRIVE) was developed with active tip deflection and tip and shaft rotation. The feasibility and training effect of the r2 instruments were determined in a phantom model.

Material And Methods: Experienced laparoscopic surgeons and untrained novices performed laparoscopic gastro-jejunal anastomoses using porcine tissue and r2 DRIVE-instruments.

Design and Performance of a Low-Cost Telemetric Laparoscopic Tactile Grasper.

Tactile feedback is completely lost in laparoscopic surgery, which would provide information about tissue compliance, texture, structural features, and foreign bodies. We developed a system with artificial tactile feedback for laparoscopic surgery that consists of a telemetric tactile laparoscopic grasper, a remote PC with customized software, and a commercial video-mixer. A standard, nonsensorized laparoscopic grasper was customized to allow the integration of a tactile sensor and its electronics.

Methods for Health Economic Evaluation of Vaccines and Immunization Decision Frameworks: A Consensus Framework from a European Vaccine Economics Community.

Background: Incremental cost-effectiveness and cost-utility analyses [health economic evaluations (HEEs)] of vaccines are routinely considered in decision making on immunization in various industrialized countries. While guidelines advocating more standardization of such HEEs (mainly for curative drugs) exist, several immunization-specific aspects (e.g.

Porcine survival model to simulate acute upper gastrointestinal bleedings.

The existing animal models used for the simulation of acute gastrointestinal bleedings are usually non-survival models. We developed and evaluated a new porcine model (domestic pig, German Landrace) in which the animal remains alive and survives the artificial bleeding without any cardiovascular impairment. This consists of a bleeding catheter which is implanted into the stomach, then subcutaneously tunnelled from the abdomen to the neck where it is exteriorized and fixed with sutures.

A miniaturized robotic platform for natural orifice transluminal endoscopic surgery: in vivo validation.

Background: Natural orifice transluminal endoscopic surgery (NOTES) involves accessing the abdominal cavity via one of the body natural orifices for enabling minimally invasive surgical procedures. However, the constraints imposed by the access modality and the limited available technology make NOTES very challenging for surgeons. Tools redesign and introduction of novel surgical instruments are imperative in order to make NOTES operative in a real surgical scenario, reproducible and reliable.

Comparison of 'anatomically designed' and 'point-by-point' catheter ablations for human atrial fibrillation in terms of procedure timing and costs in German hospitals.

Aims: The purpose of the FAST-PVI study was to compare 'traditional' ablation tools based on 'point-by-point' technology with the new 'anatomically designed' technologies in terms of procedure times and related costs for the treatment of paroxysmal atrial fibrillation.

Methods And Results: Four hundred and fifty-two consecutive ablation procedures (222 'anatomically designed', 136 Arctic Front® and 86 PVAC®) and 230 'point-by-point' ablations (100 CARTO XP and 130 NavX navigation systems) performed by nine university centres across Germany from 2006 to 2010 were evaluated retrospectively. Staffing and resources times for each procedure were documented together with patient morbidities, complications, and pulmonary veins isolations.