Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers' perspective.

BACKGROUND: If infants with a very low birth weight (VLBW) are to be fed exclusively with human milk, it is essential to focus on lactation initiation. The aim of the study is to learn more about the current state of lactation initiation and human milk provision in neonatal intensive care units in Germany from the mothers' perspective. METHODS: Written surveys were conducted with mothers of VLBW infants to learn more about the timing of initiation of lactation, pumping frequency during the first three days postpartum and feeding of the preterm infant during hospitalisation. RESULTS: The data of 437 mothers (response rate: 44.7%) were included in the analyses. Of these, only 7.8% stated that they had initiated lactation immediately after delivery and 38.2% within 6 h. In terms of pumping frequency, 50.1% pumped 7-9 times a day within the first 3 days postpartum; 60.9% reported that their infant received formula feedings during the hospital stay. CONCLUSION: Overall, deficits were still evident with regard to the initiation of lactation in mothers of VLBW infants in Germany, resulting in a large proportion of VLBW infants receiving formula in the hospital. TRIAL REGISTRATION: German Clinical Trial Register: DRKS00017755 .

[The Willingness to Consent to the Linkage of Primary and Secondary Data: An Analysis Based on a Survey of Patients with Primary Breast Cancer in Northrhine Westfalia]. / Die Bereitschaft zum Datenlinkage von Routinedaten und Primärdaten ­ Eine Analyse auf Basis der Befragung von Patientinnen und Patienten mit primärem Mammakarzinom in NRW.

Introduction: By linking data it is possible to merge, for example, survey data with routine data from statutory health insurance (GKV), to gain benefit from the advantages of both. As personal data is involved, it is necessary to obtain consent. Previous studies show that willingness to release this kind of data for scientific research is limited. This fact restricts the number of participants and can cause selection bias. The aim of our study was to analyze willingness to consent to the linkage of survey data with statutory health insurance data in patients with primary breast cancer. Associations between approval and socio-demographic characteristics were explored. Method: In the annual survey of patients with primary breast cancer in certified breast centers in North Rhine-Westphalia, all included patients were questioned concerning their willingness to consent to data linkage. We distinguished between patients insured by AOK Rhineland/Hamburg and all other patients: based on cooperation with AOK Rhineland/Hamburg, we obtained consent to actually link the data for all patients insured there. All other patients were questioned in terms of their insurance and their willingness to consent in general. Results: A total of 2,387 questionnaires were returned, giving a return rate of 49.3%. For the AOK Rhineland/Hamburg-insured patients, the consent rate was at 89.6%. At 75.7%, positive attitudes towards data linkage turned out to be a bit lower for patients with other insurers. Under the assumption that all non-responders disapprove data linkage, still 38.1% of patients showed a positive attitude towards data linkage. As a result of the multivariable model, insurance status (private vs. statutory) and first language turned out to be the only significant factors influencing the response. The consent of patients insured by AOK Rhineland/Hamburg is not significantly influenced by any of the measured socio-demographic factors. Conclusion: Currently, there is not much knowledge on the acceptance of data linkage in patients suffering from an acute illness. Although our results are restricted to breast cancer patients, they are able to uncover problems and chances concerning data linkage.

[Thrombolysis for acute stroke--a nationwide analysis of regional medical care]. / Thrombolyse des akuten Schlaganfalls--Eine deutschlandweite Analyse der regionalen Versorgung.

BACKGROUND: This study aims at investigating ischaemic stroke therapy in Germany by using secondary data. The focus lies on the performance of thrombolysis. METHODS: Statutory quality report data for 2010 were obtained. All hospitals (n = 1302) treating patients suffering from an ischaemic stroke either on a neurological, internal, geriatric or intensive care unit were analysed. The treatment situation, defined as the experience in performing thrombolysis, was displayed cartographically. Potential variables that may influence the thrombolysis rate were analysed. RESULTS: 78 % of the 198,500 ischaemic stroke cases were treated on a ward specialised in the stroke treatment (i. e., a stroke unit). The mean thrombolysis rate in neurological departments was 9.1 %. Thrombolysis rates between departments ranged from 0 to 38 %. Significant factors influencing the thrombolysis rate were the total number of ischaemic strokes treated as well as the existence of a stroke unit. DISCUSSION: In Germany, to date regional differences in the treatment of ischaemic stroke exist. Experience in the treatment of ischaemic stroke patients and the availability of a stroke unit both increase the thrombolysis rate. Data suggest that in Germany there is still room for improvement of appropriate ischaemic stroke treatment.

[Adjusting for patient characteristics when evaluating questionnaire data]. / Adjustierung für Patientenmerkmale bei der Auswertung von Befragungsdaten.

INTRODUCTION: Patient questionnaires are a frequently used instrument within the framework of quality management in in- and outpatient care. Often such questionnaires enable a comparison of care suppliers with the consequence that one turns out to be visibly better or poorer than another. This process, in turn, makes it necessary to check whether differences found upon evaluation of the questionnaires are not merely the result of different compositions of the questioned populations. Although frequently demanded, such adjustments are not usually made. The present article describes the choice of variables for adjustments and the statistical procedures for a relatively homogeneous sample of breast cancer patients. In addition, the utility and limitations of adjustments are discussed. METHODS: On the basis of questionnaire data from 3 840 breast cancer patients of 52 breast cancer centres in North Rhine-Westphalia collected during 2010, we examined which patient characteristics can be employed for the adjustment of satisfaction ratings and to what extent the observed values for the centres differed from the expected results. Independent variables taken into consideration were age, educational level, native language, stage, grading, ASA classification, afffected breast, type of operation, insurance status, partnership status as well as time between operation and receipt of the filled out questionnaire. RESULTS: The variance revealed by the independent variables is low. The expected values showed minimal differences which can be attributed to the high homogeneity of the patients collectives and the centres. CONCLUSION: The use of adjustments remains limited in the study population. The variance of the independent variables revealed by the adjustors is small. Finally, in our opinion, no clear recommmendation for or against case-mix adjustments can be made in patient populations such as the one examined here. Thus, even when small, effects for a more correct reporting of patient questionnaires are faced with unresolvable methodological challenges. Also of importance but an as yet only rarely discussed factor is the factual intepretation of the association of patient characteristics with a better or poorer evaluation of questionnaires. An adjustment for the respective characteristics would eliminate these findings and not make any contribution to an improvement in health care.

Risk factors for development of chronic superficial keratitis in dogs.

Proportional hospital accession ratios for chronic superficial keratitis (CSK) of dogs were determined for 16 US veterinary teaching hospitals participating in the Veterinary Medical Data Base between Jan 1, 1976 and Dec 31, 1991. The prevalence of CSK was significantly correlated (r = 0.90) with altitude of residence, but not with latitude, longitude, mean annual solar radiation, or mean annual relative humidity. Medical records of dogs with (n = 595) and without (n = 72,877) CSK examined at the Colorado State University Veterinary Teaching Hospital between Jan 1, 1976 and Oct 28, 1991 were also reviewed. Belgian Tervuren, German Shepherd Dogs, Border Collies, Greyhounds, Siberian Huskies, and Australian Shepherds were disproportionately affected. Dogs between 4 and 7 years old were 2.36 times more likely to develop lesions than were dogs < 4 years old (P < 0.05). Among dogs < 4 years old, spayed females, sexually intact males, and castrated males were more likely to develop the condition (P < 0.05) than were sexually intact females. Altitude of residence was a significant risk factor in the development of CSK among dogs in Colorado. Dogs living at altitudes > 7,000 ft above sea level were 7.75 times more likely to develop lesions than were dogs living at elevations between 3,000 and 5,000 ft.