ELSID-diabetes study-evaluation of a large scale implementation of disease management programmes for patients with type 2 diabetes. Rationale, design and conduct : a study protocol

Background: Diabetes model projects in different regions of Germany including interventions such as quality circles, patient education and documentation of medical findings have shown improvements of HbA1c levels, blood pressure and occurrence of hypoglycaemia in before-after studies (without control group). In 2002 the German Ministry of Health defined legal regulations for the introduction of nationwide disease management programs (DMP) to improve the quality of care in chronically ill patients. In April 2003 the first DMP for patients with type 2 diabetes was accredited. The evaluation of the DMP is essential and has been made obligatory in Germany by the Fifth Book of Social Code. The aim of the study is to assess the effectiveness of DMP by example of type 2 diabetes in the primary care setting of two German federal states (Rheinland-Pfalz and Sachsen-Anhalt). Methods/Design: The study is three-armed: a prospective cluster-randomized comparison of two interventions (DMP 1 and DMP 2) against routine care without DMP as control group. In the DMP group 1 the patients are treated according to the current situation within the German-Diabetes-DMP. The DMP group 2 represents diabetic care within ideally implemented DMP providing additional interventions (e.g. quality circles, outreach visits). According to a sample size calculation a sample size of 200 GPs (each GP including 20 patients) will be required for the comparison of DMP 1 and DMP 2 considering possible drop-outs. For the comparison with routine care 4000 patients identified by diabetic tracer medication and age (> 50 years) will be analyzed. Discussion: This study will evaluate the effectiveness of the German Diabetes-DMP compared to a Diabetes-DMP providing additional interventions and routine care in the primary care setting of two different German federal states

TOT Approach in stress urinary incontinence (SUI) – outcome in obese female

BACKGROUND: Only limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. We would like to verify the objective and subjective outcomes of TOT in women with a higher body mass index (BMI). METHODS: We evaluated the records of 116 patients who had undergone TOT, stratifying by BMI into normal weight (n = 31), overweight (n = 56), and obese (n = 29) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TOT, complications, and quality of life assessed by validated questionnaires (ICIQ-SF and KHQ). RESULTS: The median follow-up was 21 months. There were no significant differences between different groups in terms of objective cure rate and subjective success, quality of life scores and postoperative complications. CONCLUSIONS: Our data demonstrate that TOT procedure is safe and effective. BMI did not influence the outcome of TOT procedures at a median of 21 months after surgery and represents no contraindication for continence surgery. The success of the outcome of TOT procedure in females and the occurrence of complications are not negatively affected by obesity

The dynamics of quality: a national panel study of evidence-based standards

This is the final version of the article. Available from NIHR Health Technology Assessment Programme via the DOI in this record.Background Shortfalls in the receipt of recommended health care have been previously reported in England, leading to preventable poor health. Objectives To assess changes over 6 years in the receipt of effective health-care interventions for people aged 50 years or over in England with cardiovascular disease, depression, diabetes or osteoarthritis; to identify how quality varied with participant characteristics; and to compare the distribution of illness burden in the population with the distributions of diagnosis and treatment. Setting and participants Information on health-care quality indicators and participant characteristics was collected using face-to-face structured interviews and nurse visits in participants’ homes by the English Longitudinal Study of Ageing in 2004–5, 2006–7, 2008–9 and 2010–11. A total of 16,773 participants aged 50 years or older were interviewed at least once and 5114 were interviewed in all four waves; 5404 reported diagnosis of one or more of four conditions in 2010–11. Main outcome measures Percentage of indicated health care received by eligible participants for 19 quality indicators: seven for cardiovascular disease, three for depression, five for diabetes and four for osteoarthritis, and condition-level quality indicator achievement, including achievement of a bundle of three diabetes indicators. Analysis Changes in quality indicator achievement over time and variations in quality with participant characteristics were tested with Pearson’s chi-squared test and logistic regression models. The size of inequality between the hypothetically wealthiest and poorest participants, for illness burden, diagnosis and treatment, was estimated using slope indices of wealth inequality. Results Achievement of indicators for cardiovascular disease was 82.7% [95% confidence interval (CI) 79.9% to 85.5%] in 2004–5 and 84.2% (95% CI 82.1% to 86.2%) in 2010–11, for depression 63.3% (95% CI 57.6% to 69.0%) and 59.8% (95% CI 52.4% to 64.3%), for diabetes 76.0% (95% CI 74.1% to 77.8%) and 76.5% (95% CI 74.8% to 78.1%), and for osteoarthritis 31.2% (95% CI 28.5% to 33.8%) and 35.6% (95% CI 34.2% to 37.1%). Achievement of the diabetes care bundle was 67.8% (95% CI 64.5% to 70.9%) in 2010–11. Variations in quality by participant characteristics were generally small. Diabetes indicator achievement was worse in participants with cognitive impairment [odds ratio (OR) 0.5, 95% CI 0.4 to 0.7] and better in those living alone (OR 1.7, 95% CI 1.3 to 2.0). Hypertension care was better for those aged over 74 years (vs. 50–64 years) (OR 3.2, 95% CI 2.0 to 5.3). Osteoarthritis care was better for those with severe (vs. mild) pain (OR 1.8, 95% CI 1.4 to 2.2), limiting illness (OR 1.8, 95% CI 1.5 to 2.1), and obesity (OR 1.6, 95% CI 1.2 to 2.0). Previous non-achievement of the diabetes care bundle was the biggest predictor of non-achievement 2 years later (OR 3.3, 95% CI 2.2 to 4.7). Poorer participants were always more likely than wealthier participants to have illness burden (statistically significant OR 3.9 to 16.0), but not always more likely to be diagnosed or receive treatment (0.2 to 5.3). Conclusions Shortfalls in quality of care for these four conditions have persisted over 6 years, with only half of the level of indicated health care achieved for osteoarthritis, compared with the other three conditions. Quality for osteoarthritis improved slightly over time but remains poor. The relatively high prevalence of specific illness burden in poorer participants was not matched by an equally high prevalence of diagnosis or treatment, suggesting that barriers to equity may exist at the stage at diagnosis. Further research is needed into the association between quality and health system characteristics at the level of clinicians, general practices or hospitals, and regions. Linkage to routinely collected data could provide information on health service characteristics at the individual patient level.Funding for this study was provided by the Health Services and Delivery Research programme of the National Institute for Health Research

Determining the Drivers of Anti-Tropical Distributions Across the Fish Tree of Life

Anti-tropical distributions are those where populations of a single species, or multiple closely related taxa, are distributed outside of, and on opposing sides of, the tropics. These latitudinally disjunct distributions have been noted for over a century. Despite this long history of interest, little has been concluded regarding the actual mechanisms that drive this pattern, with several prominent hypotheses competing with one another in the literature. Here I review the proposed drivers of anti-tropicality, and subsequently test them using fishes with a variety of life history and taxonomic differences. This includes (1) a temperately restricted family with anti-tropical distributions – Cheilodactylidae, (2) a tropical reef fish family with a single temperate anti-tropical genus – Prionurus, and (3) a variety of fishes from across the fish tree of life that have populations split by the tropics. Using complete taxonomic sampling, and phylogenomic approaches coupled with fossil calibration points, I find evidence for recent equatorial divergence events in the Pleistocene and Pliocene, as well as divergence events dating to the Miocene for both Cheilodactylidae and Prionurus. Furthermore, taxonomic issues were detected, and explored within both of these groups. To disentangle the multiple hypotheses that can explain recent transitions, I used ecological niche models coupled with extant distributional data for a variety of species across the fish tree of life that exhibit intra-specific anti-tropicality. These data reveal distinct support for both glacial dispersal, and biotic exclusion from the tropics. These results are then interpreted in a comprehensive framework to determine what drives anti-tropical distributions in marine systems. Overall, multiple mechanisms seem responsible that act in concert over time to produce these distributions. Certain equatorial divergence events are recovered in time periods currently not associated with any anti-tropical hypotheses. It seems likely that stochastic crossing events may be important in the initial colonization of a new hemisphere

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The use of Enterprise Architecture, IT Strategy and IT Governance at StatoilHydro

The master thesis will extend the students depth study. Through the master thesis the student shall study and evaluate how IT Governance, Enterprise Architecture and IT Strategy are related in StatoilHydro. The student shall also research StatoilHydro´s awareness of the concepts. The student shall propose improvements and/or changes based on this evaluation