ABSTRACT
The development of the new S3 guideline "Epidemiology, diagnosis, treatment and follow-up of the bladder exstrophy-epispadias complex" was funded by the German Innovation Fund of the Federal Joint Committee (G-BA). Despite the relatively low level of evidence of the identified literature, a systematic approach and consistent evaluation of the literature enabled the formulation of a large number of evidence-based recommendations across a variety of topics. In addition, a patient guideline is under development in order to disseminate the guideline recommendations and to enhance self-management and understanding among patients and their relatives. A needs analysis had been carried out in order to adequately assess the topics that are most important for patients and relatives. Upon completion of the German guideline, an English translation in cooperation with the eUROGEN network is planned.
Subject(s)
Bladder Exstrophy , Epispadias , Humans , Bladder Exstrophy/diagnosis , Epispadias/diagnosis , Follow-Up Studies , Urinary BladderABSTRACT
BACKGROUND: Dementia is an age-specific disease with increasing care needs over the course of the disease. Care is predominantly conducted by caregivers. Caregiver burden is a core criterion for the evaluation of the care situation. The aims of this examination are to identify predictors of caregiver burden and to analyze the course of the caregiver burden over a 12 months period. METHODS: The Bavarian Dementia Survey (BayDem) is a supra-regional, longitudinal study carried out at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) as defined by ICD-10 and their informal caregivers. Data was collected by standardized face-to-face interviews in cooperation with local actors. For statistical analysis, a multiple regression as well as a mixed ANOVA (Analysis of Variance) and repeated measures ANOVAs were used. RESULTS: In this analysis, 295 pwd and 276 caregivers were studied. Key factors influencing caregiver burden were gender of the pwd, behavioral and psychological symptoms and a decline of everyday functioning of the pwd as well as gender of the informal caregivers, their relation to the pwd and if they live at the same household as the pwd. Analysis showed a significant main effect of time over the course of the caregiver burden. CONCLUSION: A permanent high caregiver burden can cause health problems for the caregivers. However, caregivers can be supported according to the specific factors of the caregiver burden. One approach in order to support caregivers could be a combination of pharmacological and non-pharmacological interventions for the treatment of disease-specific symptoms and an empowerment as well as the provision of support services for the caregivers. Furthermore, tailored services for specific target groups can be meaningful.
Subject(s)
Caregivers , Dementia , Cost of Illness , Dementia/nursing , Germany , Humans , Longitudinal Studies , Quality of Life , Surveys and QuestionnairesABSTRACT
BACKGROUND: The increasing prevalence of dementia raises challenges concerning the care of people with dementia (pwd). The care of pwd is mainly conducted by informal caregivers who are faced with several burdens; however, use of care services is generally low. The aim of this study was to identify predictors of the use of outpatient care services. METHODS: The Bavarian Dementia Survey (BayDem) is a multi-centre, longitudinal study that was conducted at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) (according to ICD-10) and their informal caregivers. Data were collected by standardised face-to-face interviews using well-designed instruments in cooperation with local partners. Logistic regression analysis was carried out in order to identify predictors of the use of outpatient care services. RESULTS: In total, 364 pwd and 339 informal caregivers were included at the beginning of the study BayDem. The use of supportive care services was generally low. One-third of all participants used outpatient care services. In the logistic regression analysis, the following significant predictors for the use of outpatient care services 6 months after baseline were identified: severity of cognitive impairment of the pwd; use of outpatient care at the beginning of the study. CONCLUSION: The low use of outpatient care services is a well-known paradoxical phenomenon. Such services can help give relief to informal caregivers. In order to enhance the use of supportive outpatient care services, there should be more focus on innovative health service delivery models with a low access threshold barrier. Besides more public campaigns, more guidance for existing offers is needed.
Subject(s)
Ambulatory Care , Caregivers , Dementia , Ambulatory Care/standards , Dementia/nursing , Dementia/therapy , Germany , Humans , Longitudinal Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: Dementia is usually a life-limiting disease. However, evidence-based guidelines for palliative care for people with dementia (PwD) are currently lacking. One reason for this is the dearth of reliable empirical data on PwD at the end of life. The aim of this study is to describe the symptom burden, causes of death, places of death and the use of various health services for PwD at the end of life. METHODS: The Bavarian Dementia Survey (BayDem) was a multi-center, longitudinal study at 3 different sites in Bavaria, Germany (Dachau, Kronach, Erlangen). Participants were PwD defined by ICD-10 and their informal caregivers. Data were collected in standardized face-to-face interviews in cooperation with local actors. In order to obtain comparable groups, deceased and non-deceased PwD were matched using 1:1 propensity score matching. For the statistical analyses, McNemar tests as well as paired t-tests were used. RESULTS: In this analysis, 58 deceased and 58 non-deceased PwD were studied (n=116). In most cases, PwD died at home (36.2%), in hospital (25.9%) or in a nursing home (19.0%), but no one in palliative care. The most common causes of death were respiratory (13.8%) and cardiovascular complications (12.1%) as well as stroke (12.1%). PwD at the end of life showed more pronounced physical comorbidities than the other PwD (Charlson-Index: M=2.75 vs. M=1.80; p=0.030, Cohen's d=0.425) and were therefore admitted to hospital (46.6 vs. 12.1%, p<0.001, OR=6.250) or emergency departments (22.4 vs. 3.4%, p=0.007, OR=6.500) more frequently. Behavioral and psychological symptoms were very pronounced (NPI Score: M=31.67 vs. M=24.77, p=0.118, Cohen's d=0.303). Nevertheless, the utilization of outpatient health services was low. CONCLUSION: The results underline the need to develop evidence-based guidelines to provide palliative care specifically adapted to the needs of PwD at the end of life. In this context, the high incidence of behavioral and psychological symptoms should be taken into account, as should the high incidence of physical comorbidities. Considering the frequent hospital admissions, special attention should also be paid to the development of recommendations for the inpatient sector (acute hospital and palliative care unit).
Subject(s)
Cause of Death , Dementia , Facilities and Services Utilization , Terminal Care , Caregivers , Cost of Illness , Dementia/mortality , Dementia/therapy , Germany/epidemiology , Humans , Longitudinal Studies , Quality of Life , Surveys and QuestionnairesABSTRACT
BACKGROUND: In many cases, people with dementia (PWD) receive their first diagnosis at an advanced stage of the disease. A timely diagnosis, however, is crucial for the utilization of therapies and support services for PWD and their caregivers. So far, only a few international studies have analysed predictors of the time lapse between the first perceived symptoms and diagnosis. The aim of this study was to assess the time span from the first symptoms of dementia until the first dementia diagnosis and to identify predictors of a timely diagnosis. METHODS: The Bavarian Dementia Survey (BayDem) is a multi-centre, longitudinal study at 3 different sites in Bavaria, Germany. Participants were PWD as defined by ICD-10 and their informal caregivers. Data was collected by standardized face-to-face interviews in cooperation with local actors. For the analysis of potential sociodemographic predictors of a timely diagnosis within 9 months after the perception of the first symptoms, binary logistic regressions were used. RESULTS: The median length from the perception of the first symptoms until diagnosis was 16 months. Predictors of a timely diagnosis for male PWD were age at the time of the first perceived symptoms and education. There was no association between a timely diagnosis and the place of residence or living situation of the PWD. CONCLUSIONS: Diagnosis of dementia is often made with a huge delay. Therefore, it is necessary to enhance structured access routes to a timely diagnosis in primary care.
Subject(s)
Dementia , Early Diagnosis , Aged , Caregivers , Cross-Sectional Studies , Dementia/diagnosis , Female , Germany , Humans , Longitudinal Studies , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
The emission band for Flugi-2 solvated in dimethyl sulfoxide (DMSO) is obtained from the combined quantum-classical simulations in which the quantum mechanics/molecular mechanics excitation energies are evaluated at the equilibrated segment of the classical molecular dynamics trajectory on the lowest-excited-state potential energy surface. The classical force-field parameters were obtained and validated specifically for the purpose of the present work. The calculated gas-phase to DMSO solvatochromic shift amounts to -0.21 eV, which is in line with the experimentally determined difference between the maxima of the emission bands for Flugi-2 in decane and in DMSO (-0.26 eV). The used model describes rather well the effect of DMSO on the broadening of the emission band. The solvatochromic shift in DMSO originates from two competing effects. The structural deformation of Flugi-2 due to the interaction with DMSO, which results in a positive contribution, and the negative contribution of a larger magnitude due to favorable specific interactions with the solvent. The latter is dominated by a single hydrogen bond between the oxygen atom of a DMSO molecule and the N3 hydrogen atom of the Flugi-2 molecule in which the proton of N3 acts as the donor.
ABSTRACT
Correction for 'Different hydrogen bonding environments of the retinal protonated Schiff base control the photoisomerization in channelrhodopsin-2' by Yanan Guo et al., Phys. Chem. Chem. Phys., 2018, 20, 27501-27509.
ABSTRACT
The first event of the channelrhodopsin-2 (ChR2) photocycle, i.e. trans-to-cis photoisomerization, is studied by means of quantum mechanics/molecular mechanics, taking into account the flexible retinal environment in the ground state. By treating the chromophore at the ab initio multiconfigurational level of theory, we can rationalize the experimental findings based on pump-probe spectroscopy, explaining the different and more complex scenario found for ChR2 in comparison to other rhodopsins. In particular, we find that depending on the hydrogen bonding pattern, different excited states are involved, hence making it possible to suggest one pattern as the most productive. Moreover, after photoisomerization the structure of the first photocycle intermediate, P5001, is characterized by simulating the infrared spectrum and compared to available experimental data. This was obtained by extensive molecular dynamics, where the chromophore is described by a semi-empirical method based on density functional theory. The results clearly identify which counterion is responsible for accepting the proton from the retinal Schiff base: the side chain of the glutamic acid E123.
