Decreasing Number of Urodynamics in Urological and Gynaecological Clinics Reflects Decreased Importance for Surgical Indications: German Population-Based Data from 2013 to 2019

<b><i>Introduction:</i></b> The routine use of urodynamic studies (UDS) has been questioned. Additionally, the material and personnel costs are poorly remunerated. We aimed to analyse the UDS utilization in Germany. <b><i>Methods:</i></b> We analysed UDS performed by hospitals based on quality reports from 2013 to 2019. A representative sample of 4 million insured persons was used to estimate outpatient UDS utilization from 2013 to 2018. <b><i>Results:</i></b> There was an overall decrease of 14% in UDS in Germany from 2013 to 2018 (60,980 to 52,319; <i>p</i> = 0.003). In the outpatient sector, there was a slight non-continuous drop of 11% from 34,551 to 30,652 from 2013 to 2018 (<i>p</i> = 0.06). UDS utilization in hospitals decreased by 26% from 26,429 in 2013 to 19,453 in 2019 (<i>p</i> = 0.004). University hospitals showed a smaller decrease (3,007 to 2,685; <i>p</i> = 0.02). In urology, the number of UDS (11,758 to 6,409; <i>p</i> &#x3c; 0.001) and the number of performing departments (328 to 263 clinics; <i>p</i> &#x3c; 0.001) decreased. Gynaecological departments also showed a decrease in UDS (1,861 to 866; <i>p</i> &#x3c; 0.001) and performing departments (159 to 68; <i>p</i> &#x3c; 0.001). However, in paediatrics, there was an increase in UDS (1,564 to 2,192; <i>p</i> = 0.02). By age, the number of children remained constant (1,371 to 1,252; <i>p</i> = 0.2), but there was a strong decrease seen in 60- to 79-year-olds (9,792 to 5,564; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> UDS appear to be less important in the indication for surgery. Despite high resource expenditure and low remuneration, the decrease in urodynamics in the outpatient sector is less pronounced, indicating a trend to perform UDS in an outpatient setting.

Establishing Stroke Services in the Republic of Georgia

<b><i>Introduction:</i></b> This article summarizes the medical experience in establishing stroke units and systemic thrombolysis in Georgia, which, like many other post-Soviet countries, still faces problems in organizing stroke care even after 30 years of independence. <b><i>Patients and Methods:</i></b> We created an example of treating acute stroke with systemic thrombolysis and introduced stroke units in several hospitals in the country, including standardization of the diagnostic and treatment process, consistent evaluation, and monthly feedback to the stroke unit staff. <b><i>Results:</i></b> Systemic thrombolysis has become a clinical routine in some large hospitals and is meanwhile reimbursed by the state insurance. The data of consecutive 1,707 stroke patients in 4 major cities demonstrated significant time lost at the prehospital level, due to failure in identifying stroke symptoms, delay in notification, or transportation. The consequent quality reports resulted in a dramatic increase in adherence to the European and national guidelines. A mandatory dysphagia screening and subsequent treatment led to a decrease in pneumonia rates. <b><i>Discussion:</i></b> We discuss our experience and suggestions on how to overcome clinical, financial, and ethical problems in establishing a stroke services in a developing country. <b><i>Conclusion:</i></b> The Georgian example might be useful for doctors in other post-Soviet countries or other parts of the world.

Cardiovascular involvement in patients with 2019 novel coronavirus disease

2019 novel coronavirus disease (COVID-19) is caused by the infection of severe acute respiratory syndrome novel coronavirus (SARS-CoV-2). It is characterized by substantial respiratory symptoms and complicated with widespread other organ injuries. Cardiovascular impairment is one of the notable extrapulmonary manifestations, in terms of the deterioration of pre-existing cardiovascular diseases and newly onset acute events. We hereby review the high-quality reports about cardiovascular involvement in COVID-19 and summarize the main clinical characteristics of cardiac relevance for the all the first line clinical physicians. Additionally, the possible underlying mechanisms and the rationale for the application of specific medications, such as renin-angiotensin-aldosterone system inhibitors and hydroxychloroquine are also discussed.

Post-editing Machine Translation in MateCat: a classroom experiment

Advances in machine translation resulted in an increase of both volume and quality of machine-translated texts. However, machine translation still requires humans to post-edit the translation. This paper proposes a product-based approach of a post-editing (PE) experiment that was carried out with a total of 10 MA translation students. The goal of this study comprised both the analysis of the post-editing results performed by student translators involving a machine-translated text in MateCat and the subsequent error markup. By comparing the quality reports obtained at the end of the post-editing process, we analysed the linguistic quality results and observed a heterogeneous error distribution, considerable divergence in severity level ratings and a huge span of TTE (time to edit). This study aims at making a contribution to the integration of post-editing activities into the translation technology classroom for students without prior experience in PE.

Letter to the Editor: Analysis of stroke patient migration for mechanical thrombectomy and changes in neurointerventional center size in Germany

Aim and methods To analyse nationwide changes in neurointerventional center size of all German hospitals performing mechanical thrombectomy (MT) in stroke patients from 2016 to 2019. Furthermore, we assessed cross-district patient migration for MT for the first time using hospitals’ structured quality reports and German Diagnosis-Related Groups data in 2019. Findings Number of hospitals performing more than 100 MT procedures/year doubled in Germany from 2016 (n = 36) to 2019 (n = 71), and these neurointerventional centers performed 71% of all MT procedures in 2019. The overall increase in MT procedures was largely driven by these high-volume neurointerventional centers with ability to perform MT 24/7 (121% increase as compared with 8% increase in hospitals performing less than 100 MT procedures/year). The highest cross-district patient mobility/transfer of stroke patients for MT was observed in districts adjacent to these high-volume neurointerventional centers with existing neurovascular networks. Conclusion The substantial increase in MT procedures observed in Germany between 2016 and 2019 was almost exclusively delivered by high-volume stroke centers performing more than 100 MT procedures per year in established neurovascular networks. As there is still a reasonable number of districts with low MT rates, further structural improvement including implementation of new or expansion of existing neurovascular networks and regional tailored MT triage concepts is needed.

Gestión de calidad para los procesos de rendición de cuentas en instituciones públicas del Ecuador

La eficiencia y eficacia en los procesos que comprenden la gestión de las entidades públicas tiene más importancia en la sociedad ecuatoriana, a partir del principio constitucional donde se reconoce como derecho ciudadano y obligación de la institucionalidad pública, constituyéndose como un logro para la ciudadanía a fin de exigir transparencia en el accionar de las organizaciones. Este artículo tiene por objetivo analizar los sustentos teóricos de la gestión de calidad para los procesos de rendición de cuentas en instituciones públicas del Ecuador, permitiendo aplicar una metodología de tipo descriptiva basada en la revisión bibliográfica y documental porque procura obtener, seleccionar, compilar, organizar, interpretar y analizar información sobre las variables de estudios a partir de fuentes documentales. Que permiten compilar una revisión teórica de las variables gestión de calidad y rendición de cuentas, así como de los procesos y etapas que las instituciones públicas deben cumplir para la generación de informes de calidad y pueda cumplir con un proceso de calidad acorde a este estándar internacional para alcanzar las metas establecidas. Palabras clave: Gestión; calidad; rendición de cuentas, instituciones públicas, responsabilidad social. ABSTRACT Efficiency and effectiveness in the processes that comprise the management of public entities is more important in Ecuadorian society, based on the constitutional principle where it is recognized as a citizen’s right and an obligation of public institutions, becoming an achievement for citizens in order to demand transparency in the actions of organizations. This article aims to analyze the theoretical underpinnings of quality management for accountability processes in public institutions in Ecuador, allowing the application of a descriptive methodology based on bibliographic and documentary review because it seeks to obtain, select, compile, organize , interpret and analyze information on the study variables from documentary sources. That allow compiling a theoretical review of the variables quality management and accountability, as well as the processes and stages that public institutions must comply with for the generation of quality reports and can comply with a quality process according to this international standard to achieve the established goals. Keywords: Quality; accountability, public institutions, social responsability.