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Janosch A Priebe,1 Katharina K Haas,1 Leida F Moreno Sanchez,1,2 Karin Schoefmann,1 Daniel A Utpadel-Fischler,1 Paul Stockert,1 Reinhard Thoma,3 Christine Schiessl,3 Linda Kerkemeyer,4 Volker Amelung,4 Siegfried Jedamzik,2 Jan Reichmann,5 Ursula Marschall,6 Thomas R Toelle1 1Center of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; 2Bayerische TelemedAllianz (BTA), Ingolstadt, Germany; 3Pain Clinic, Algesiologikum Pain Center, Munich, Germany; 4Institute for Applied Health Services Research, inav GmbH, Berlin, Germany; 5StatConsult GmbH Magdeburg, Magdeburg, Germany; 6Barmer Hauptverwaltung, Wuppertal, GermanyCorrespondence: Thomas R ToelleCenter of Interdisciplinary Pain Medicine, Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, Munich 81675, GermanyTel +49-89-4140-4613Email thomas.toelle@tum.dePurpose: Non-specific low back pain (NLBP) causes an enormous burden to patients and tremendous costs for health care systems worldwide. Frequently, treatments are not oriented to existing guidelines. In the future, digital elements may be promising tools to support guideline-oriented treatment in a broader range of patients. The cluster-randomized controlled “Rise-uP” trial aims to support a General Practitioner (GP)-centered back pain treatment (Registration No: DRKS00015048) and includes the following digital elements: 1) electronic case report form (eCRF), 2) a treatment algorithm for guideline-based clinical decision making of GPs, 3) teleconsultation between GPs and pain specialists for patients at risk for development of chronic back pain, and 4) a multidisciplinary mobile back pain app for all patients (Kaia App).Methods: In the Rise-uP trial, 111 GPs throughout Bavaria (southern Germany) were randomized either to the Rise-uP intervention group (IG) or the control group (CG). Rise-uP patients were treated according to the guideline-oriented Rise-uP treatment algorithm. Standard of care was applied to the CG patients with consideration given to the “National guideline for the treatment of non-specific back pain”. Pain rating on the numeric rating scale was the primary outcome measure. Psychological measures (anxiety, depression, stress), functional ability, as well as physical and mental wellbeing, served as secondary outcomes. All values were assessed at the beginning of the treatment and at 3-month follow-ups.Results: In total, 1245 patients (IG: 933; CG: 312) with NLBP were included in the study. The Rise-uP group showed a significantly stronger pain reduction compared to the control group after 3 months (IG: M=− 33.3% vs CG: M=− 14.3%). The Rise-uP group was also superior in secondary outcomes. Furthermore, high-risk patients who received a teleconsultation showed a larger decrease in pain intensity (− 43.5%) than CG patients (− 14.3%). ANCOVA analysis showed that the impact of teleconsultation was mediated by an increased training activity in the Kaia App.Conclusion: Our results show the superiority of the innovative digital treatment algorithm realized in Rise-uP, even though the CG also received relevant active treatment by their GPs. This provides clear evidence that digital treatment may be a promising tool to improve the quality of treatment of non-specific back pain. In 2021, analyses of routine data from statutory health insurances will enable us to investigate the cost-effectiveness of digital treatment.Keywords: NLBP, eHealth, mHealth, digital medicine, guideline-oriented treatment, chronic pain, STarT Back

Advanced driver assistance systems (ADAS) can be designed to adapt to the driver's current needs, for example, taking the traffic conditions in the immediate vicinity of the ego vehicle into account. This motivates the design of a system intended to measure the local traffic conditions in a way, which corresponds to the driver's perception of traffic conditions. A new method of measurement is introduced. It is based on automotive sensor technology. A stochastic approach is employed to optimise and evaluate the relationship between the subjective measurements made by the driver and the objective measurements presented. To this end, the drivers' subjective ratings are taken as reference. The analysis presented here is based on simulation data. The outcomes show that the design of the developed simulation environment is applicable to this work. It is shown that the objective measures correspond to the driver's subjective ratings. Thus, it is possible to estimate the driver's perception of traffic conditions using a technical measurement. The algorithm in its presented form is appropriate to give an estimation, which can be used as an input parameter for ADAS. [ABSTRACT FROM AUTHOR]

Access to current workload is regarded as crucial for new driver assistance systems that aim at optimising drivers' workload in addition to their specific functionalities (e.g. coordinate, prioritise information). As stress factors change dynamically within the driving context, workload assessment should be dynamic and continuous rather than discrete. Here, the effects of two dynamically changing stress factors (traffic density and different demands within the manoeuvre ‘entering the motorway’) on workload are examined. The aim of the study is to analyse whether the influence of these stress factors on workload can be measured using a continuous subjective rating method. The results demonstrate that the use of the subjective rating method allowed the assessment of detailed information on the influence of varying stress factors on subjective strain. Furthermore, the significant interaction between the stress factors demonstrated the importance of precise description of the relations among different dynamically changing stress factors and resulting subjective driver strain. By integrating the current findings with results from the previous studies, the wider aim of the research, the development of a qualitative and quantitative model of stress and strain, is discussed. [ABSTRACT FROM AUTHOR]

Introduction: Studies on opioid use in terminally ill cancer patients have shown a prefinal dose increase in the majority of patients. Mostly oral opioids were used. Due to the pharmacokinetic properties of opioids, it is rather difficult to get a reliable estimate of the true opioid need from those results.Materials and Methods: Retrospectively, we analyzed opioid use during the last week of life of 30 consecutive outpatients with cancer on intravenous (i.v.) morphine patient-controlled analgesia (PCA). A dose increase (decrease) was defined as an increase (decrease) of the patient's individual daily dose by at least 30% with respect to their prior daily dose. We also analyzed circadian variations in morphine use.Results: Thirty patients fulfilled the primary study inclusion criteria. Fulfilling the exclusion criteria, seven patients had to be excluded from analysis (n = 3, on PCA for less than 7 days; n = 4, PCA was finished before death). Twenty-three patients with a total of 161 treatment days were analyzed. The patients' median age was 57 years (range, 4 to 72). The median duration of intravenous morphine PCA was 19 days (range, 8 to 58). The median daily intravenous morphine dose during the last week of life was 96 to 115 mg, without significant change over time/from day to day (Friedman test). On 144/161 days (89.2%), morphine dose remained stable. On 9 treatment days (5.6%), the dose increased, and on 8 days (5.0%), it decreased. In three patients, only dose increases, and in four patients, only dose decreases were observed. In four patients, both dose increases and decreases were observed. Twelve patients showed no change in daily morphine dose. Opioid use lacked a diurnal pattern.Conclusion: During their end-of-life phase, cancer patients on i.v. morphine PCA showed a stable daily opioid need. [ABSTRACT FROM AUTHOR]

Driver assistance and information systems are gaining more and more importance in modern vehicles. In addition to their specific functionalities, these systems also aim to optimise drivers' current strain, because overload as well as underload can increase errors, lead to critical situations and can create furthermore unpleasant experiences for the driver. As workload changes in a highly dynamic way, these systems have to react in a similarly dynamic manner. This requires a fast and dynamically changing estimation of the driver's strain. In recent studies, the author described the relationship among strain changes, driving manoeuvres and environmental factors. In order to further examine this dependency, a simulator study was conducted where traffic densities were varied and strain was measured continuously with the aim to analyse the level and time course of drivers' current strain. Implications for workload adaptive advanced driver assistance systems are discussed. [ABSTRACT FROM AUTHOR]

Background: In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare.Materials and Methods: Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used.Results: Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period.Conclusion: PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect. [ABSTRACT FROM AUTHOR]

Presents a letter in response to the comments made by professor Wolfgang Uter and colleagues on authors' study "Reproducibility of Patch Tests: Comparison of Identical Test Allergens From Different Commercial Sources."