Supporting regional pandemic management by enabling self-service reporting-A case report

BACKGROUND

The COVID-19 pandemic revealed a need for better collaboration among research, care, and management in Germany as well as globally. Initially, there was a high demand for broad data collection across Germany, but as the pandemic evolved, localized data became increasingly necessary. Customized dashboards and tools were rapidly developed to provide timely and accurate information. In Saxony, the DISPENSE project was created to predict short-term hospital bed capacity demands, and while it was successful, continuous adjustments and the initial monolithic system architecture of the application made it difficult to customize and scale.

METHODS

To analyze the current state of the DISPENSE tool, we conducted an in-depth analysis of the data processing steps and identified data flows underlying users' metrics and dashboards. We also conducted a workshop to understand the different views and constraints of specific user groups, and brought together and clustered the information according to content-related service areas to determine functionality-related service groups. Based on this analysis, we developed a concept for the system architecture, modularized the main services by assigning specialized applications and integrated them into the existing system, allowing for self-service reporting and evaluation of the expert groups' needs.

RESULTS

We analyzed the applications' dataflow and identified specific user groups. The functionalities of the monolithic application were divided into specific service groups for data processing, data storage, predictions, content visualization, and user management. After composition and implementation, we evaluated the new system architecture against the initial requirements by enabling self-service reporting to the users.

DISCUSSION

By modularizing the monolithic application and creating a more flexible system, the challenges of rapidly changing requirements, growing need for information, and high administrative efforts were addressed.

CONCLUSION

We demonstrated an improved adaptation towards the needs of various user groups, increased efficiency, and reduced burden on administrators, while also enabling self-service functionalities and specialization of single applications on individual service groups.

An OHDSI ATLAS Extension to Support Feasibility Requests in a Research Network

Checking the feasibility of real-world data to answer a certain research question is crucial especially in a multi-site research network. In this work we present an extension of the ATLAS user interface for the OMOP common data model that integrates into an existing national feasibility network and thus foster capabilities for future participation in international research studies.

Adaption of the OMOP CDM for Rare Diseases

The OMOP Common Data Model (OMOP CDM) is an option to store patient data and to use these in an international context. Up to now, rare diseases can only be partly described in OMOP CDM. Therefore, it is necessary to investigate which special features in the context of rare diseases (e.g. terminologies) have to be considered, how these can be included in OMOP CDM and how physicians can use the data. An interdisciplinary team developed (1) a Transition Database for Rare Diseases by mapping Orpha Code, Alpha ID, SNOMED, ICD-10-GM, ICD-10-WHO and OMOP-conform concepts; and (2) a Rare Diseases Dashboard for physicians of a German Center of Rare Diseases by using methods of user-centered design. This demonstrated how OMOP CDM can be flexibly extended for different medical issues by using independent tools for mappings and visualization. Thereby, the adaption of OMOP CDM allows for international collaboration, enables (distributed) analysis of patient data and thus it can improve the care of people with rare diseases.

Specification and Distribution of Vocabularies Among Consortial Partners

Due to the variety of different software systems and disparate observational databases, the need for a uniform data representation rises. Common data models (CDM) support the harmonisation of data. A powerful but compact software setup and a minimum vocabulary set has been composed via Docker to facilitate analysis of data across ten university hospitals. The presented approach also creates the possibility to use a concise database which is easy to deploy.

[Guide to geriatric treatment in Bremen]

The demographic pressure exerted on the national health care system has led to the establishment of specialised geriatric centres. These centres aim at an early, patient-related coordination of the medical aspects of treatment with a concept for rehabilitation. Acute geriatric care, rehabilitation, and social medicine are practically integrated in contrast to the segmentation practised in other branches of medical care. The necessary assessment of patients in terms of "disease sequelae" according to the ICD is inadequate while the ICIDH as an alternative still has no legal foundation. The "Guide to Geriatric Treatment in Bremen" provides the necessary organisational structure with regard to aspects of quality assurance. To this end, guidelines for patient identification by means of expert medical evaluation and geriatric assessment on the basis of the ICIDH were developed as well as rules for the overall organisation and interaction of the geriatric centres with other specialties, with health insurers, and with the medical services of health insurers. The total duration of treatment of a patient was established as the primary parameter for determining professional and economic efficiency. The introduction of a specific nomenclature to be used by all parties involved reflects the "geriatrification" of the system.

Evolution of orthologous intronless and intron-bearing globin genes in two insect species

While globin genes ctt-2beta and ctt-9.1 in Chironomus thummi thummi each have a single intron, all of the other insect globin genes reported so far are intronless. We analyzed four globin genes linked to the two intron-bearing genes in C. th. thummi. Three have a single intron at the same position as ctt-2beta and ctt-9.1; the fourth is intronless and lies between intron bearing genes. Finally, in addition to its intron, one gene (ctt-13RT) was recently interrupted by retrotransposition. Phylogenetic analyses show that the six genes in C. th. thummi share common ancestry with five globin genes in the distantly related species C. tentans, and that a 5-gene ancestral cluster predates the divergence of the two species. One gene in the ancestral cluster gave rise to ctn-ORFB in C. tentans, and duplicated in C. th. thummi to create ctt-11 and ctt-12. From parsimonious calculations of evolutionary distances since speciation, ctt-11, ctt-12, and ctn-ORFB evolved rapidly, while ctn-ORFE in C. tentans evolved slowly compared to other globin genes in the clusters. While these four globins are under selective pressure, we suggest that most chironomid globin genes were not selected for their unique function. Instead, we propose that high gene copy number itself was selected because conditions favored organisms that could synthesize more hemoglobin. High gene copy number selection to produce more of a useful product may be the basis of forming multigene families, all of whose members initially accumulate neutral substitutions while retaining essential function. Maintenance of a large family of globin genes not only ensured high levels of hemoglobin production, but may have facilitated the extensive divergence of chironomids into as many as 5000 species.

[Evaluating the noise problem in regional town planning]

While looking for enough living quarters for the town people regional planners are often confronted with high levels of noise due to traffic, highways and railways near the planning area. This may change or even stop the procedure of town planning. Generally, health authorities--who are more or less involved in the process of planning--should take the chance to demand compatibility of special planning with health care regarding noise. However, most guidelines on health-compatible noise levels are not legally binding. This paper describes the variety of health problems accompanied by moderate to high levels of noise. In regions with traffic noise problems efforts should be directed at maximum health compatibility coupled to highly imaginative planning. It is suggested that levels of noise of 55 dB(A) (daytime) and of 45 dB(A) (nighttime) should be tolerated near to the building. This would ensure tolerable levels of noise of 35 dB(A) (daytime) and of 30 dB(A) (nighttime) in the dwellings. Examples of different arrangements of buildings are shown. They demonstrate that these tolerable noise levels could even be observed in areas with traffic problems. It mostly depends on the planner's imagination whether the need for dwelling houses in problem areas could be met in keeping with health demands.

[Health screening at school entry--foreign models and prospective considerations]

In Germany, all pupils are subjected to medical examination at school entry. This is in fact one of the primary tasks of the School Health Services in respect of importance and the amount of work involved. Nevertheless, neither are these results properly evaluated, nor has their epidemiological relevance been explored. The examination criteria are not uniform, and results are therefore greatly at variance. This has given rise to much criticism when comparing the german approach to that in other countries. With particular reference to experiences in Great Britain, Australia and the Netherlands, we should discourage a general medical examination at school entry that focuses on the status of each individual from a medical point of view, as has been the practice in Germany to date. Instead, selective examinations should be performed with greater emphasis on expert pedagogic knowledge with the aim of assessing whether a child is mentally and sociologically sufficiently mature to attend school (the German term for this concept is "Schulreife", a non-translatable word somewhat equivalent to "school age maturity").

Lymphocytotoxicity to tumor target cells and interference of serum factors or tumor antigen with lymphocytotoxicity in patients suffering from different stages of breast carcinoma

The in vitro cytotoxicity of lymphocytes from patients suffering from breast carcinoma against autochthonous, allogeneic and established breast carcinoma cells was evaluated. Lymphocytotoxicity to breast carcinoma cells was observed in all stages of the disease. Control lymphocytes from healthy donors or patients suffering from other carcinoma are not cytotoxic for the breast carcinoma cell lines. A follow-up study of the cell mediated immune reactions before and after surgical removal of the breast carcinoma showed that the cytotoxic lymphocyte population which is demonstrated in the presence of the tumor disappears quickly after excision of the carcinoma. The non-reactivity of lymphocytes is not due to a general immune defect. Serum of the tumor bearers did not block the lymphocytotoxicity in early stage breast carcinoma; in metastatic disease inhibition occurred in more than half of the cases. Preincubation of lymphocytes with antigen preparations of allogeneic breast carcinoma cells did not inhibit the cytotoxicity to breast carcinoma cells whereas autologous serum preincubated with the antigen preparation diminished the lymphocyte reactivity to the target cells in some cases.

Solubility fo fibrin clots in monochloroacetic acid. A reflection of serum pepsinogen levels

Fibrin clots formed from normal plasma dissolve readily in 1% monochloroacetic acid at 37 C. However, if the clots are washed thoroughly before the acid is added, they are no longer soluble. The agent present in the serum which causes dissolution of the fibrin clot was isolated and identified as pepsinogen. Because of the low pH of monochloroacetic acid the pepsinogen is activated and the clots are digested, simulating the dispersion of a fibrin clot which occurs in the absence of fibrin-stabilizing factor (factor XIII). Because of its higher pH, urea will not activate pepsinogen and is therefore a better agent to screen factor XIII deficiencies.