Biobanking in times of crisis – The COVID-19 Autopsy and Biosample Registry Baden-Wuerttemberg
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ABSTRACT:
SUBMITTER: Domke L
PROVIDER: S-EPMC9250824 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has emerged as an unprecedented global crisis challenging health systems. This paper aims to assess and characterise SARS-CoV-2 outbreaks in the state of Baden-Wuerttemberg to identify groups at greatest risk, to establish early measures to curb transmission. We analysed all mandatory notified (i.e. laboratory-confirmed) coronavirus disease (COVID-19) outbreaks with more than two cases in Baden-Wuerttemberg from calendar weeks 18-49 (from 27 April to 6 December 2020). We used the following classification for settings: asylum and refugee accommodation, care homes, care facilities, day care child centres, hobby-related, hospitality, hospitals, households, other, residence halls, schools, supported housing, training schools, transportation, treatment facilities and workplace (occupational). We used R program version 3.6.3 for analysis. In our analysis, 3219 outbreaks with 22 238 individuals were included. About 48% were in household and hobby-related settings. Care homes accounted for 9.5% of outbreaks and 21.6% of cases. The median age across all settings was 43 (interquartile range (IQR) 24-63). The median age of cases in care homes was 81 (IQR 56-88). Of all reported cases in care homes, 72.1% were women. Over 30% (466/1511) of hospitalisations were among cases in care homes compared to 17.7% (268/1511) in households. Overall, 70% (500/715) of all deceased persons in outbreaks in the study period were in care homes compared to 4.2% in household settings (30/715). We observed an exponential increase in the number of notified outbreaks starting around the 41st week with N = 291 outbreaks reported in week 49. The median number of cases in outbreaks in care homes and care facilities after the 40th week was 14 (IQR 5-29) and 11 (IQR 5-20), respectively, compared to 3 (IQR 3-5) in households. We observed an increase in hospitalisations, and mortality associated with COVID-19 outbreaks in care homes after the 40th week. We found the care home demographic to be at greatest risk after the 40th week, based on the exponential increase in outbreaks, the number of cases, hospitalisations and mortality trends. Our analysis highlights the necessity of targeted, setting-specific approaches to control transmission in this vulnerable population. Regular screening of staff members and visitors' using rapid antigen point-of-care-tests could be a game-changer in curbing transmission in this setting.
| S-EPMC8111206 | biostudies-literature
Project description:BACKGROUND:The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ?50?years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18-50?years. Data from a consecutive and prospective stroke registry was analyzed that covers a federal state with 10.8 million inhabitants in southwest Germany. METHODS:Our analysis comprises 51,735 ischemic stroke patients aged 18-80?years and hospitalized from January 2008 to December 2012. Of these, 4,140 (8%) were aged 18-50?years and 7,529 (15%) underwent IVT. Data on 8,439 patients (16% of the study population) were missing for National Institutes of Health stroke severity score at admission and/or modified Rankin Scale (mRS) at discharge and were excluded from outcome analysis. In sensitivity analysis, patients with incomplete data were also examined. Binary logistic regression models were used adjusted for patient, hospital, and procedural parameters and stratified by age group (18-50 and 51-80?years, subgroup analyses 18-30, 31-40, and 41-50?years) to assess the relationship between IVT and mRS at discharge. RESULTS:IVT appears equally effective in young adults 18-50?years (adjusted odds ratio 1.40, 95% confidence interval 1.12-1.75; p?=?0.003), compared to patients 51-80?years of age (1.33, 1.23-1.43; p?<?0.001). Age-stratified analyses suggest an inverse relation of age and effectiveness, which appears to be highest in very young patients 18-30?years of age (2.78, 1.10-7.05; p?=?0.03). DISCUSSION:Ischemic stroke etiology, vascular dynamics, and recovery in young patients differ from those of middle and older age. The evidence from routine hospital care in Germany indicates that IVT in young stroke patients appears to be at least equally effective as in the elderly.
| S-EPMC4631948 | biostudies-literature
Project description: Not available
| S-EPMC9073019 | biostudies-literature
Project description:BackgroundDuring the first wave of the COVID-19 pandemic various ambulatory health care models (SARS-CoV-2 contact points: Subspecialised Primary Care Practices, Fever Clinics, and Special Places for Corona-Testing) were organised in a short period in Baden-Wuerttemberg, a region in Southern Germany. The aim of these SARS-CoV-2 contact points was to ensure medical treatment for patients with (suspected) and without SARS-CoV-2 infection. The present study aimed to assess the beliefs and practices of primary care physicians who either led a Subspecialised Primary Care Practice or a Primary Care Practice providing care as usual in Baden-Wuerttemberg during the first wave of the COVID-19 pandemic.MethodsThis cross-sectional study was based on a paper-based questionnaire in primary care physicians during the first wave of the pandemic. Participants were identified via the web page of the Association of Statutory Health Insurance Physicians Baden-Wuerttemberg. The questionnaire was distributed in June and July 2020. It measured knowledge, practices, self-efficacy and fears towards SARS-CoV-2, using newly developed questions. Data was descriptively analysed.ResultsOne hundred fifty-five participants (92 leads of SARS-CoV-2 contact points/ 63 leads of primary care practices) completed the questionnaire. Out of 92 leads of SARS-CoV-2 contact points 74 stated to lead n Subspecialised Primary Care Practices. About half participants of both groups did not fear an own infection with the novel virus (between 50.8% and 62.2%), however about 75% feared financial loss. Knowledge was gained using various sources; main sources were the Association of Statutory Health Insurance Physicians (between 82.5% and 83.8%) and the German Society for Hygiene and Microbiology (RKI) (between 88.9% and 95.9%). Leads of Subspecialised Primary Care Practice felt more confident to perform anamnestic/diagnostic procedures (p < 0.001). The same was found for the confidence level regarding decision-making concerning the further treatment (p < 0.001). Several prevention measures to contain the spread of SARS-CoV-2 were adopted. Subspecialised Primary Care Practice had treated on average more patients with (suspected) COVID-19 (mean 408.12) than primary care practices (mean 83.8) (p < 0.001).ConclusionThe results of this study suggest that the Subspecialised Primary Care Practice that were implemented during the first wave of the SARS-CoV-2 pandemic contributed containment of the pandemic. Leads of Subspecialised Primary Care Practice indicated that physical separation of patients with potential SARS-CoV-2 infection was easier compared to those who continued working in their own practice. Additionally, leads of Subspecialised Primary Care Practice felt more confident in dealing with patients with SARS-CoV-2 infection.Trial registrationThe study has been prospectively registered at the German Clinical Trial Register (DRKS00022224).
| S-EPMC8099434 | biostudies-literature
Project description:By early May 2020, the number of new COVID-19 infections started to increase rapidly in Chile, threatening the ability of health services to accommodate all incoming cases. Suddenly, ICU capacity planning became a first-order concern, and the health authorities were in urgent need of tools to estimate the demand for urgent care associated with the pandemic. In this article, we describe the approach we followed to provide such demand forecasts, and we show how the use of analytics can provide relevant support for decision making, even with incomplete data and without enough time to fully explore the numerical properties of all available forecasting methods. The solution combines autoregressive, machine learning and epidemiological models to provide a short-term forecast of ICU utilization at the regional level. These forecasts were made publicly available and were actively used to support capacity planning. Our predictions achieved average forecasting errors of 4% and 9% for one- and two-week horizons, respectively, outperforming several other competing forecasting models.
| S-EPMC7806165 | biostudies-literature
Project description:As other crises before, the COVID-19 pandemic put established discursive routines at stake. By framing the pandemic as a crisis, an immediate search for adequate counter-measures started to define proper means of mitigation and protection for the population. In the early stages of COVID-19, when little reliable information on the virus and its transmission behaviour was available, an intense use of metaphor to explain and govern the crisis had to be expected. Beside its well-known impact on (geo-)politics, a thorough analysis especially of the use of spatial metaphors to reason about the crises is still missing. In our approach, we rely on the foundational work of Lakoff and Johnson (1980) on image schemata, and prior work on spatial metaphors as part of argumentation patterns from cultural geography (Schlottmann, 2008). After a thorough analysis of prominent examples according to the argumentation scheme of Toulmin (1976 [1958]), we explored examples from the pre-existing corpus on COVID-19, deliberately compiled by DWDS for analysis of language patterns used throughout the pandemic. In a subsequent filter-refinement approach building on methods from cognitive linguistics and utilising a chunk of the same corpus, we were able to obtain and discuss results on the variety of spatial metaphors used at that time.
| S-EPMC9360696 | biostudies-literature
Project description:BackgroundStakeholders in the German state of Baden-Wuerttemberg agreed upon the central aims for healthcare planning. These include a focus on geographical districts; a comprehensive, cross-sectoral perspective on healthcare needs and services; and use of regional data for healthcare planning. Therefore, healthcare data at district level is needed. Nevertheless, decision makers face the challenge to make a selection from numerous indicators and frameworks, which all have limitations or do not well apply to the targeted setting. The aim of this study was to identify district level indicators to be used in Baden-Wuerttemberg for the purpose of cross-sectoral and needs-based healthcare planning involving stakeholders of the health system.MethodsA conceptual framework for indicators was developed. A structured search for indicators identified 374 potential indicators in indicator sets of German and international institutions and agencies (n = 211), clinical practice guidelines (n = 50), data bases (n = 35), indicator databases (n = 25), published literature (n = 35), and other sources (n = 18). These indicators were categorised according to the developed framework dimensions. In an online survey, institutions of various stakeholders were invited to assess the relevance of these indicators from December 2016 until January 2017. Indicators were selected in terms of a median value of the assessed relevance.Results22 institutions selected 212 indicators for the five dimensions non-medical determinants of health (20 indicators), health status (25), utilisation of the health system (34), health system performance (87), and healthcare provision (46).ConclusionsStakeholders assessed a large number of indicators as relevant for use in healthcare planning on district level.Trial registrationNot applicable.
| S-EPMC8157415 | biostudies-literature
Project description:Aim:Media as a source of information can shape public opinion regarding the COVID-19 response. Identifying how and where people seek information during the COVID-19 outbreak is vital to convey the most effective message about managing the COVID-19 crisis. The purpose of this study was to determine the sources of information and investigate the role of various demographic factors-age, gender, educational attainment and perceived economic level-on sources of information. Subject and methods:An online survey (n?=?4624) was conducted on Turkish public during the early stages of the COVID-19. Results:The results showed that internet journalism and social media were the most preferable sources of information. Higher age, educational attainment and economic level were related to higher levels of seeking information from TV, newspaper, internet journalism and informative meetings. Females obtained information more from their friends and family and social media than males. High school graduates or below watched more TV and obtained less information from internet journalism, while university graduates sought information from their families and friends, and postgraduates attended informative meetings and read newspapers. People with medium and high economic status, respectively, watched more TV and read more newspapers, while people with low socioeconomic status attended informative meetings less. Conclusion:In sum, this study provides evidence that a source of information might be influenced by demographic factors. Researchers and policymakers can use a source of information to develop crisis-response strategies by considering variations in the demographic factors.
| S-EPMC7552946 | biostudies-literature
Project description:Prior research has shown that that management control practices change in response to global crises, yet we have little understanding of the behavioral consequences of these changes. The purpose of this study is to explore the behavioral effects that stem from crisis-induced changes to management control practices and the factors that intensify or diminish these effects. Using survey data from business unit managers in the Netherlands, our results show that firms tighten their budget controls in response to a negative impact of Covid-19. In turn, the tightening of budget controls is positively associated with employees’ emotional exhaustion because of increased perceptions of role ambiguity and role conflict. We furthermore find that the effect of tighter budget controls on role ambiguity is mitigated when managers perceive that the budget controls are used in an enabling way prior to the crisis but heightened with increased trust in senior management. These results suggest that if firms use their budgets to help managers acquire a deeper understanding of their tasks and responsibilities, they are better able to respond to a negative shock and the accompanying tightening of budget controls, which helps mitigate the undesired behavioral response of increased role ambiguity and emotional exhaustion. Our findings also suggest that trust, which usually is beneficial to organizations, has a ‘dark’ side in that managers will push themselves harder to reciprocate the trust they have in their senior managers, which exacerbates the effect of tighter budget controls on role ambiguity and, in turn, emotional exhaustion.
| S-EPMC8801259 | biostudies-literature
Project description:Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account. Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician. Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length. Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model's focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program's implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildungplus® program.
| S-EPMC7958914 | biostudies-literature