Roland Mills United (Germany)

ObjectiveIn this analysis, we examined differences between rechargeable and non-rechargeable spinal cord stimulation (SCS) devices in patients with pain.MethodsWe conducted a retrospective, longitudinal claims data analysis using a German research database comprising 5 million statutory insured patients (2012–2017). Outcomes of demographics, patient pathways, and health care resource utilization (HCRU) in patients with initial SCS were collected.ResultsOf 150 patients in the database, 73 (49%) received a rechargeable device and 77 (51%) a non-rechargeable device. The average age was 62.5 years (51% female and 49% male patients). A significant decrease over a 3-year follow-up was observed in analgesic prescriptions (−18%), number of patient visits to a physician, and number of patients who were hospitalized. HCRU-related figures for patients with non-rechargeable neurostimulators increased in the last follow-up year whereas the group receiving rechargeable neurostimulators showed a steady decrease.ConclusionsSCS seems to be an effective way for patients with chronic pain to decrease pain and improve quality of life. Rechargeable devices seem to be superior to non-rechargeable devices owing to greater longevity and were found to be associated with continuous reduction of pain diagnoses, hospitalization, physician visits, and use of pain medication in our study.

The healthcare sector is one of the biggest digital data providers, accounting for one third of global digital data volumes. This chapter aims to identify relevant artificial intelligence (AI) use cases that really move the needle for health insurers and give an overview on key strategic imperatives to derive an AI strategy that can best utilize their untapped data treasures. A wealth of use cases for AI has emerged that are gaining increasing traction both outside and inside health insurance. In general, use cases can be classified into three different levels: standard AI solutions, tailor-made AI solutions, and explainable AI solutions. There is no right or wrong approach; however, health insurers need to start treating AI as a strategic asset that can help them in achieving their overall strategic goals. The chapter provides a four-step approach that can help decision-makers find the right starting point, and to plot a way forward.

Background and purpose — The number of hip replacements in Germany has increased considerably during the last 2 decades but lately levelled off with no significant increase in operation rates. We analyzed the future trend of hip arthroplasty and projected the number of primary hip replacements that will be performed in Germany until 2040.Patients and methods — We used prevalence data of hip arthroplasty patients from 2010 to 2016 from the nationwide inpatient statistics and population forecasts from the German Federal Bureau of Statistics up to the year 2040. We used Poisson regression to estimate the expected annual number of arthroplasty surgeries with calendar year and patient age as covariates to account for differences among age groups and changes over time.Results — The number of primary hip replacements performed in Germany in 2040 was estimated to grow by 27% to 288 x 103 (95% CI 250 x 103–332 x 103) from 2010. Projected counts were highest for patients aged 60 to 70 years. The estimated incidence rate was projected to 360 (95% CI 312–414) per 100,000 residents. However, incidence rates for individual age classes were found to be constant with a slight decrease over time for individual age classes.Interpretation — Our findings suggest a growth in the total hip arthroplasty count whereas incidence rate remained constant over age classes. We consider the future demographic change to an older population as well as the increasing life expectancy to be the main reasons for the increasing patient numbers rather than a general increase in the operation frequency.

Latin American formation dancing ranks among the technical-compositional types of sport and represents a discipline of dance sport due to its performance- and competition-orientated mode. Despite its high degree of popularity and a movement profile favouring injuries, there has been a lack of studies as to health hazards and damage in Latin American formation dancing. The aim of this study is to analyse formation dance-related health hazards and their causes. A total of n = 100 (m: n = 52, f: n = 48) Latin American dancers of the German top-level league participated in this anonymised retrospective cross-sectional investigation. Mean weights of the male dancers were 75.2 kg and respectively 58.2 kg for the females, mean body height/size were 1.82 m (m) and 1.67 m (f) and mean BMI 22.2 (m) and 20.0 (f), respectively. At least one each traumatic injury/chronic damage was sustained by 69.3 % (m) and77.6 % (f) of the dancers in the course of their dance sport activities. Almost all (97.9 %) injuries occurred during the training. A total of 409 injuries/overuse damages (= 4.1 injuries/athlete) wasreported with 80.4 % traumatic injuries and 19.5 % chronic damages. Female dancers were more often injured than their male counterparts. The lower extremity was the most commonly affected body region [64.5 % (m) and, respectively, 71.2 % (f)], followed by upper extremity (m: 21.2 %, f: 17.6 %) and spinal column/trunk region (m: 12.0 %, f: 8.5 %). Blockages and pulled muscles were the most common complaints reported by males with contusions and pulled muscles being reported by females. Chondropathy/osteoarthrosis were the most frequent chronic diseases. Of all injuries sustained, circa two thirds were caused by extrinsic and circa one third by intrinsic factors. The injury profiles/patterns in Latin American formation dancing show on the one hand parallels to the individual partner dances. On the other hand, typical and gender-specific movement elements seem to reflect in the injuries and chronic damages/diseases of formation dancers. This is to be taken into account when injury prevention measures are considered. There is also a need for further studies to allow a more differentiated analysis.

1. Anthoceros punctatus L.Contributors: B. Cykowska and F. MogroBolivia: Dept. Tarija, Prov. Arce, near Reserva de Fauna Tariquia reserve, next to the road from Sidras to Camberi, 22°12′09·7″S, 64°...

A prospective, nonrandomized multicenter study of lumbar disc nucleus replacement using the DASCOR Disc Arthroplasty Device. An interim analysis of clinical results is presented, obtained from European patients enrolled in 2 studies. To determine the safety and efficacy of the DASCOR Device for the treatment of symptomatic single-level degenerative disc disease (DDD). Patients suffering from DDD have been limited to a choice between nonoperative therapies or invasive surgical treatments such as total disc replacement or spinal fusion. The DASCOR Device was developed to provide an alternative treatment with a less invasive surgical intervention. A total of 85 patients from 11 European centers were enrolled in 1 of 2 studies between February 2003 and July 31, 2007. Data were collected before surgery and after surgery at 6 weeks and at 3, 6, 12, and 24 months. The clinical outcome measures were obtained from the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI), radiographic assessments, and records of analgesic medication use. Mean VAS and ODI scores improved significantly after 6 weeks and throughout the 2 years. Radiographic results demonstrated, at a minimum, maintenance of disc height with no device expulsion and, despite Modic-Type 1 changes, no subsidence. Fourteen patients had serious adverse events including device explants in 7 patients (7 of 85), in which the main complication was resumed back pain after time. Patients' rate of analgesic medication decreased dramatically over time, with all patients experiencing significant improvements after 3 months and nearly no analgesic medication or narcotic drug use at 2 years. The interim outcomes showed significant improvements in mean ODI and VAS scores. The results of these European studies suggest that the DASCOR Device may be a safe and effective less-invasive surgical option for patients with DDD.

Bei ungebohrter Nagelung einer einfachen Tibifraktur kam es zu Sprengung der Tibia im mittleren Drittel. Eine solche intraoperative Komplikation wird in der Regel durch den Nagel stabilisiert und heilt meistens problemlos aus. Im vorliegenden Fall wurde erstmals nach 9 Monaten deutlich, dass der Nagel teilweise dorsal „im Freien” stand. Eine Plattenosteosynthese zur Stabilisierung der zumindest nicht atrophen Pseudarthrose bei liegendem Nagel und 2 Plattenosteosynthesen nach Entfernung des Nagels und korrekter Einstellung der Achse scheiterten. Letzendlich konnte eine Ausheilung erst durch Resektion der Pseudarthrose und Callusdistraktion erzielt werden.