Bundeswehr Joint Medical Service

Background and aim: To implement Clinical Pharmaceutical Services (CPS) in routine hospital care with limited resources, their use should be prioritized. We present an objectifiable approach to planning development particularly for pharmaceutical staff. Investigations: We designed a Human Resource Development Score (HRD): HRD=P-([I+F]/2) with P: prioritization score of CPS assessed by a pharmaceutical expert panel; I: intensity score of CPS currently offered in routine care; F: frequency score of CPS offered; all scores ranged from 0[min]4[max]. An HRD<0 indicates a future decrease, HRD=0 no change and HRD>0 a desirable increase in the pharmaceutical staff development. To obtain an estimated future development (ΔHRD), we multiplied HRD as a weighting factor by the proportion of current or evaluated for the start of the respective CPS pharmaceutical staff positions (n, median per hospital pharmacy) as follows: ΔHRD=HRD*n. We calculated the ΔHRD in 155 of 162 CPS for which all required data were available. Results: In the "Top-5 categories to be increased", the pharmaceutical staff positions (n) and the Human Resource Development (ΔHRD=HRD*n) were as follows (median per hospital pharmacy): 1. "Interfaces"/"Closed-loop concepts" (n: 1.850; ΔHRD: +7.400), 2. "Progress-management"/"Interdisciplinary ward-rounds" (2.000; +2.000), 3. "Progress-management"/"Nursing ward-rounds" (1.000; +2.000). 4. "Interfaces"/"Electronic-prescription and knowledge-support" (0.300; +1.200), 5. "Progress-management"/"Ward-rounds for high-risk-patients" (1.100; +1.100). The most relevant categories whose resources could potentially be decreased to support other CPS were assessed as: "Indication-related (non-patient-related) drug analysis" (0.500; -0.250) and "Oncology consultations" (0.275; -0.275). Conclusions: With the help of a weighted Human Resource Development Score based on an expert panel, proposals for Human Resource Development in CPS were calculated.

PurposeAccording to the ‘constrained model’, there are compensations in resting metabolic rate (RMR) at high levels of physical activity (PA). Here, we have used a standardized combat-swimmer training protocol (CST) to investigate whether changes in RMR (i) confirm the ‘constraint model’, and (ii) differ between successful participants and dropouts.MethodsControlled 84d CST in 44 male soldiers with 13 finally successful. Fat mass (FM) and fat-free mass (FFM) were measured using Quantitative Magnetic Resonance. RMR was assessed by indirect calorimetry, VO2max, and work efficiency by treadmill spiroergometry. Plasma levels of thyroid hormones, testosterone, and cortisol were analysed by standard laboratory methods.ResultsCST increased VO2max (+ 6.9%) and exercise efficiency at low workloads of 10 and 12 km/h (+ 8.7 and + 6.5%; both p < 0.05). As energy balance was moderately negative (−356 ± 383 kcal/d), FFM and FM decreased (−2 and −16%; both p < 0.05). There was a considerable inter-individual variance but no change in in the mean values of RMR and RMRadjFFM. RMRadjFFM before CST had a negative association with its decrease with CST (p < 0.005). Concomitantly, plasma hormone levels were unchanged. When compared with dropouts, successful participants had a higher VO2max at baseline (5.2 ± 0.6 vs. 4.9 ± 04 l/min; p < 0.05) that increased with CST (+ 4.4 vs. −0.4%; p < 0.05) at similar changes in body composition and energy balance.ConclusionWhile CST increased VO2max and exercise efficiency as a compensation, there was an inter-individual variance in exercise-related compensation of RMR with no differences between ‘completers’ and ‘non-completers’.Trial registration DRKS00018850, November 27, 2019.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Key words travel medicine - malaria - repellents - chemoprophylaxis - pediatric travelers - pregnant travelers

Key words travel medicine - travel vaccines - immunocompromised travelers - paediatric travelers - pregnant travelers

BackgroundThe Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases.ObjectiveThe present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp.MethodsDPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation.ResultsFor three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed.ConclusionsWe concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps.