München, Techn. Univ., Diss., 2004.

End-stage conditions such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have shown some of the most dramatic increases in mortality in the developed world over the past 40 years. Both are therefore leading causes of morbidity and mortality worldwide and should be considered as a major economic and social burden that is both substantial and increasing. In these conditions, exercise therapy should play an integral part in maintaining the patient’s maximal level of independence and functioning, as well as slowing or possibly even stopping the progression of the condition. In this context the main objectives of these doctoral theses are: a. Proving the safety of different exercise modalities. b. Identifying the most effective exercise interventions in regards to clinical parameters. c. Proving the feasibility of outpatient rehabilitation programmes for these high risk populations. This work, therefore, combines three studies looking into the effects of non-pharmaceutical interventions – predominantly different exercise regimes in the two major conditions in the mortality statistics of CHF and COPD - both with a very poor prognosis. In conclusion it can be said that the results and experience of all three studies demonstrate the safe feasibility of different outpatient exercise interventions and suggest specific positive adaptations in patients with heart failure and COPD which also led to a lower hospitalisation rate. There are clear hints that the therapy spectrum could be supplemented significantly by specific training interventions. The financial implications for any health care system are also highly relevant.

Zugl.: Bielefeld, Universiẗat, Diss., 2009.

Ziel dieser Studie ist, einen aktuellen Statusbericht zu Standortdichte, räumlicher Bedarfsabdeckung und demografischen Rahmenbedingungen für die ambulante und stationäre hos-pizliche und palliative Versorgung in Sachsen zu erstellen. Dabei sollen aktuelle Versorgungslücken identifiziert und der künftige Bedarf (2020–2030–2050) an Angeboten auf Ebene der Landkreise und Kreisfreien Städte herausgearbeitet werden. Für die Ableitung der Normwerte zeigt sich, dass angesichts der hohen Sterblichkeitsunterschiede zwischen den Bundesländern eine Bedarfsermittlung auf der Basis bundesdurchschnittlicher Normwerte je Bevölkerung nicht zufriedenstellend ist. Deshalb empfiehlt die Studie, in der regionalen Planung der Hospiz- und Palliativversorgung auf die erwarteten Sterbefälle abzustellen, die sich unter Berücksichtigung der Altersstruktur ergeben. Dieses bedeutet, dass die Normwerte der DGP zur Berechnung der Sollwerte um Bevölkerungsstruktur und Sterblichkeit korrigiert werden. In einer abschließenden Bewertung werden – vor dem Hintergrund einer Stärken- und Schwächenanalyse aus Experteninterviews – weitere Handlungsempfehlungen abgeleitet, die auch die Dimensionen von Qualität der Leistungserbringung, Ausbildung, Finanzierung und deren Anreizwirkung sowie Integration einbeziehen.

Background: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.

Calif., Univ., Dep. of Management Science and Engineering, Diss.--Stanford, 2004. / Kopie, ersch. im Verl. UMI, Ann Arbor, Mich. - Enth. 4 Beitr.

Background: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.

Ziel dieser Studie ist, einen aktuellen Statusbericht zu Standortdichte, räumlicher Bedarfsabdeckung und demografischen Rahmenbedingungen für die ambulante und stationäre hos-pizliche und palliative Versorgung in Sachsen zu erstellen. Dabei sollen aktuelle Versorgungslücken identifiziert und der künftige Bedarf (2020–2030–2050) an Angeboten auf Ebene der Landkreise und Kreisfreien Städte herausgearbeitet werden. Für die Ableitung der Normwerte zeigt sich, dass angesichts der hohen Sterblichkeitsunterschiede zwischen den Bundesländern eine Bedarfsermittlung auf der Basis bundesdurchschnittlicher Normwerte je Bevölkerung nicht zufriedenstellend ist. Deshalb empfiehlt die Studie, in der regionalen Planung der Hospiz- und Palliativversorgung auf die erwarteten Sterbefälle abzustellen, die sich unter Berücksichtigung der Altersstruktur ergeben. Dieses bedeutet, dass die Normwerte der DGP zur Berechnung der Sollwerte um Bevölkerungsstruktur und Sterblichkeit korrigiert werden. In einer abschließenden Bewertung werden – vor dem Hintergrund einer Stärken- und Schwächenanalyse aus Experteninterviews – weitere Handlungsempfehlungen abgeleitet, die auch die Dimensionen von Qualität der Leistungserbringung, Ausbildung, Finanzierung und deren Anreizwirkung sowie Integration einbeziehen.:1 Ausgangssituation 13 2 Aufgabenbeschreibung 14 3 Bestandsaufnahme der Hospiz- und Palliativversorgung in Sachsen 16 3.1 Definition und Abgrenzung der Hospiz- und Palliativversorgung 16 3.1.1 Hospizversorgung 16 3.1.2 Palliativversorgung 17 3.2 Datengrundlagen 19 3.3 Ambulante Hospiz- und Palliativversorgung 20 3.3.1 Ambulante Hospizdienste (AHD) 21 3.3.2 Spezialisierte Ambulante Palliativversorgung (SAPV) 23 3.4 Stationäre Hospiz- und Palliativversorgung 23 3.4.1 Stationäre Hospize 24 3.4.2 Palliativstationen in Krankenhäusern 25 3.5 Räumliche Verteilung der Versorgungsangebote in Sachsen 25 3.5.1 Region Chemnitz 25 3.5.2 Region Dresden 26 3.5.3 Region Leipzig 27 4 Bewertung und Vergleich der hospizlichen und palliativen Versorgungsstrukturen Sachsens 28 4.1 Versorgungsangebote in anderen Ländern 28 4.1.1 Ambulante Hospizdienste 28 4.1.2 Allgemeine ambulante und spezialisierte Palliativversorgung 30 4.1.3 Stationäre Hospizversorgung für Erwachsene 33 4.1.4 Stationäre Palliativversorgung für Erwachsene 34 4.1.5 Hospiz- und Palliativversorgung für Kinder 34 4.2 Zusammenfassung des Vergleichs mit anderen Bundesländern 35 4.3 Benchmarks für die Versorgung 36 4.3.1 Vorgaben des DHPV und der DGP 37 4.3.2 Empfehlungen der Spitzenverbände 39 4.4 Fazit des Vergleichs 40 5 Bedarfsberechnung 41 5.1.1 Ambulante Hospiz- und Palliativversorgung 42 5.1.2 Stationäre Hospiz- und Palliativversorgung 46 6 Bedarfsprognose auf Kreisebene 50 6.1 Bevölkerungsprognose 50 6.2 Prognose der Gestorbenen für das Berechnungsmodell des zukünftigen Versorgungsbedarfs 53 6.3 Prognose für die ambulanten Hospiz- und Palliativdienste 54 6.3.1 Ambulante Hospizdienste 54 6.3.2 Spezialisierte Ambulante Palliativversorgung 55 6.4 Stationäre Hospiz- und Palliativeinrichtungen 57 6.4.1 Hospizbetten 57 6.4.2 Palliativbetten 59 7 Weiterentwicklung der Hospiz- und Palliativarbeit in Sachsen 62 7.1 Bewertung der Ist-Situation der hospizlichen Versorgung in Bezug auf die Zweite Landeshospizkonzeption 62 7.1.1 Grundsätze und Ziele 62 7.1.2 Öffentliche Förderung der Hospiz- und Palliativversorgung 63 7.2 SWOT-Analyse aus Experteninterviews 67 7.2.1 Zur Hospizversorgung 67 7.2.2 Zur Palliativversorgung 70 7.3 Handlungsfelder und Kriterien zur Weiterentwicklung von Hospiz- und Palliativversorgung 71 7.3.1 Zur Hospizversorgung 72 7.3.2 Zur Palliativversorgung 74 7.3.3 Weitere Handlungsempfehlungen 76 8 Literaturverzeichnis 78 Anhang 84 Aktuelle Standorte der Hospiz- und Palliativeinrichtungen 84 Kartenteil 90 Bevölkerung 90 Hospiz- und Palliativeinrichtungen 2012 105

Im Rahmen der Performancekunst in Nordamerika und Europa seit 1970 lassen sich Performances ausmachen, die sich inhaltlich mit dem Sterben befassen. Die vorliegende Dissertation widmet sich der Frage, inwiefern sich die existenzielle Performancekunst als Medium zur Evokation von Sterblichkeitsbewusstsein eignet. Den Untersuchungsgegenstand bilden 19 Performances, die als existenzielle Performancekunst bezeichnet werden. Die Performer*innen zeigen ihr „Spiel mit dem Sterben“ oder laden dazu ein, bei der Auseinandersetzung mit dem Sterben mitzuspielen. Es wird analysiert, auf welche Weise sich die elf Performer*innen in existenzieller Performance mit Sterblichkeit befassen. Dabei fällt auf, dass es einerseits eine spielerische, liminoide Auseinandersetzung mit dem Thema gibt. Andererseits lassen sich existenzielle Performances ausmachen, die eine ernste, liminale Auseinandersetzung mit der Sterblichkeit aufzeigen, da sich der Künstler/die Künstlerin Schmerzen zufügt bzw. zufügen lässt oder gar in die Gefahr begibt, während der Performance zu sterben. Jene dichotomischen Aspekte, wie sie bereits der Anthropologe Victor Turner beschrieb, werden konkretisiert mit existenzieller Performancekunst in Zusammenhang gebracht und zudem auf Überlegungen der Theaterwissenschaftlerin Erika Fischer-Lichte zur Liminalität bezogen und weiterentwickelt. Im Fokus stehen somit auftretende und sich auflösende Dichotomien, sowie die Interpersonalität zwischen Performenden und Teilnehmenden. Darüber hinaus werden Primäraspekte existenzieller Performancekunst herausgearbeitet. Die Primäraspekte und die dichotomischen Aspekte werden im Hinblick auf die Evokation von Sterblichkeitsbewusstsein untersucht. Die vorliegende Dissertation reflektiert darüber hinaus Fragen der Medialität von existenzieller Performancekunst. / Within the context of performance art in North America and Europe since 1970 several performances that consider mortality can be identified. This dissertation deals with the question, whether existential performance art is suitable as medium to evoke an awareness of mortality. The research object consists of 19 performances that are designated as existential performance art. The performers show their „play with dying“ or invite to participate in the involvement with dying. It is analysed in which kind of way the eleven performer deal with mortality in existential performance art. As can be noticed, on the one hand there is a ludic and liminoid involvement with dying. On the other hand art performances can be identified that demonstrate serious and liminal involvement with dying, because of the artist`s willingness to suffer or even to run the risk of losing his or her life while performing. Those dichotomic aspects, as already described by anthropologist Victor Turner, are made concrete and brought into connection with existential performance art in this dissertation. Furthermore the dissertation refers to Erika Fischer-Lichte`s thoughts concerning liminality, but extends the ideas related to existential performance art and mortality. Oscillating dichotomies are focussed on as well as the interpersonal encounter between performer and participant. Primary aspects of existential performance art are worked out. Both dichotomic and primary aspects are examined concerning their role in evoking an awareness of mortality. Moreover this dissertation reflects on mediality of existential performance art.

Background: Long-term health sequelae of the Coronavirus Disease 2019 (COVID-19) are a major public health concern. However, evidence on post-acute COVID-19 syndrome (post-COVID-19) is still limited, particularly for children and adolescents. Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults. Methods and findings: We used routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020. The base population included all individuals insured for at least 1 day in 2020. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. The date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). The study population included 11,950 children/adolescents (48.1% female, 67.2% aged between 0 and 11 years) and 145,184 adults (60.2% female, 51.1% aged between 18 and 49 years). The mean follow-up time was 236 days (standard deviation (SD) = 44 days, range = 121 to 339 days) in children/adolescents and 254 days (SD = 36 days, range = 93 to 340 days) in adults. COVID-19 and control cohort were well balanced regarding covariates. The specific outcomes with the highest IRR and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28, 95% CI: 1.71 to 3.06, p < 0.01, IR COVID-19: 12.58, IR Control: 5.51), cough (IRR: 1.74, 95% CI: 1.48 to 2.04, p < 0.01, IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72, 95% CI: 1.39 to 2.12, p < 0.01, IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69, 95% CI: 5.88 to 7.60, p < 0.01, IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33, 95% CI: 3.01 to 3.68, p < 0.01, IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88, 95% CI: 2.74 to 3.02, p < 0.01, IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, 95% CI: 1.25 to 1.35, p < 0.01, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33, 95% CI: 1.31 to 1.34, p < 0.01, IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias. Conclusions: In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults