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The purpose of this study was to explore the effects of the integration of machine learning into daily radiological diagnostics, using the example of the machine learning software mdbrain ® (Mediaire GmbH, Germany) in the diagnostic MRI workflow of patients with multiple sclerosis at the University Medicine Greifswald. The data were assessed through expert interviews, a comparison of analysis times with and without the machine learning software, as well as a process analysis of MRI workflows. Our results indicate a reduction in the screen-reading workload, improved decision-making regarding contrast administration, an optimized workflow, reduced examination times, and facilitated report communication with colleagues and patients. Our results call for a broader and quantitative analysis.

Background: Multiple Sclerosis is an autoimmune inflammatory disease of the central nervous system that often leads to premature incapacity for work. Therefore, the MSnetWork project implements a new form of care and pursues the goal of maintaining or even improving the state of health of MS patients and having a positive influence on their ability to work as well as their participation in social life. A network of neurologists, occupational health and rehabilitation physicians, psychologists, and social insurance suppliers provide patients with targeted services that have not previously been part of standard care. According to the patient's needs treatment options will be identified and initiated., Methods: The MSnetWork study is designed as a multicenter randomized controlled trial, with two parallel groups (randomization at the patient level with 1:1 allocation ratio, planned N = 950, duration of study participation 24 months). After 12 months, the patients in the control group will also receive the interventions. The primary outcome is the number of sick leave days. Secondary outcomes are health-related quality of life, physical, affective and cognitive status, fatigue, costs of incapacity to work, treatment costs, out-of-pocket costs, self-efficacy, and patient satisfaction with therapy. Intervention effects are analyzed by a parallel-group comparison between the intervention and the control group. Furthermore, the long-term effects within the intervention group will be observed and a pre-post comparison of the control group, before and after receiving the intervention in MSnetWork, will be performed., Discussion: Due to the multiple approaches to patient-centered, multidisciplinary MS care, MSnetWork can be considered a complex intervention. The study design and linkage of comprehensive, patient-specific primary and secondary data in an outpatient setting enable the evaluation of this complex intervention, both on a qualitative and quantitative level. The basic assumption is a positive effect on the prevention or reduction of incapacity for work as well as on the patients' quality of life. If the project proves to be a success, MSnetWork could be adapted for the treatment of other chronic diseases with an impact on the ability to work and quality of life., Trial Registration: The trial MSnetWork has been retrospectively registered in the German Clinical Trials Register (DRKS) since 08.07.2022 with the ID DRKS00025451 ., (© 2022. The Author(s).)

'Mind the gap!' refers to both the gap between the identification and validation of biomarkers and the gap in knowledge between the stakeholder groups, where the researchers who discover the biomarkers often have little knowledge about the commercialization process. This gap is addressed here in a survey with relevant stakeholders conducted by the project 'Biomarker Commercialization' (BIC)., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Depressive comorbidity is common with physically ill inpatients and is associated with many negative medical and economic effects (e. g., increased morbidity and mortality, increased length of stay, poorer quality of life and increased utilization of health services). The aim of this study is to clarify the question whether the additional costs caused by comorbid depressive diseases are recovered by additional G-DRG-specific revenues in order to finance necessary diagnostics and therapies of this comorbidity., Methods: We analysed the revenues generated by depressive secondary diagnoses. Consequently, we selected patients with relevant F-diagnoses according to ICD-10 from billing data of the University Hospital Greifswald between 2010 and 2014. We recoded each case without a comorbid depression, taking into account the specifications of the relevant accounting year. Subsequently, the revenues with and without coding the comorbidity were compared (n=6,563)., Results: In 115 out of 6,563 patients (1.75%), mainly with unspecific recurrent depressions, the documentation and coding of a comorbid depression led to a change in the proceeds. Taking into account the applicable base rate between 2010 and 2014, the coding leads to an additional revenue of 216,737.01 Euro for the entire observation period. This corresponds to an increase of approximately 1,885 Euro per patient (n=115). In relation to the total number of patients with comorbid depressions (n=6,563) it is a surplus of 33.02 Euro. However, predominantly unspecific depressive diagnoses (e. g., F 32.8) are encoded, which do not increase the level of severity in the DRG system and, thus, have no effect on the proceeds., Discussion: In very few cases, the inclusion of depressive comorbidities leads to an increase in revenue. Only some depressive diagnoses have a CCL. Due to the relatively low CCL (1 or 2), depressive comorbidities often show no effect on PCCL of multimorbid patients. Currently there is no adequate financial incentive for the hospitals to recognize and treat depressions, since the additional costs do not lead to increased revenues. In the context of a systemic treatment, depression will have to be taken into account more strongly in the financing system, especially in view of the numerous negative effects of this comorbidity., Competing Interests: Die Autoren geben an, dass keine Interessenkonflikte bestehen. Diese Publikation ist im Rahmen des Forschungsverbundes MENON – Medizintheoretische, normative und ökonomische Evaluation der Systemmedizin entstanden. Das MENON-Konsortium wurde finanziert vom Bundesministerium für Bildung und Forschung (01GP1408A)., (© Georg Thieme Verlag KG Stuttgart · New York.)

Research and innovation in healthcare can change existing practices aiming at constant improvement of diagnosis, treatment and prevention. As a new holistic approach Systems Medicine (SM) may revolutionize the healthcare system. This paper analyzes ethical and economic obstacles of SMs development from a niche innovation to a standard solution. We adapt a model of innovation theory to structure the barriers of adopting SM to become standard in the medical system. SM has the potential to change the medical system if barriers to this innovation can be overcome. The article discusses the potential of SM in becoming the future health paradigm considering these barriers and provides an overview of the current situation.

Objective: The number of implantation of cochlear implants has steadily risen in recent years. Reasons for this are an extension of indication criteria, demographic change, increased quality of life needs and greater acceptance. The consequences are rising expenditure for statutory health insurance (SHI) for cochlear implantation. A detailed calculation of lifetime costs from SHI's perspective for postlingually deafened adolescents and adults is essential in estimating future cost developments., Methods: Calculations are based on accounting data from the Hannover Medical School. With regard to further life expectancy, average costs of preoperative diagnosis, surgery, rehabilitation, follow-ups, processor upgrades and electrical maintenance were discounted to their present value at age of implantation., Results: There is an inverse relation between cost of unilateral cochlear implantation and age of initial implantation. From SHI's perspective, the intervention costs between 36,001 and 68,970 € ($ 42,504-$ 81,429). The largest cost components are initial implantation and processor upgrades., Conclusion: Compared to the UK the cost of cochlear implantation in Germany seems to be significantly lower. In particular the costs of, rehabilitation and maintenance in Germany cause only a small percentage of total costs. Also, the costs during the first year of treatment seem comparatively low. With regard to future spending of SHI due to implant innovations and associated extension of indication, increasing cost may be suspected., (© Georg Thieme Verlag KG Stuttgart · New York.)

When alpha factor binds to the yeast alpha factor receptor a signal is transmitted via a tripartite G protein that prepares the cell for conjugation. As a result of alpha factor binding the receptor also undergoes a regulated internalization and hyperphosphorylation. Using cells that lack activity of this tripartite G protein, we show that G protein-mediated pheromone signal transduction is not necessary for regulation of receptor internalization or hyperphosphorylation. Therefore, the processes of signal transduction and down regulation can be uncoupled. We propose that binding of alpha factor to its receptor results in a receptor conformation change that permits receptor hyperphosphorylation and interaction with the endocytic machinery.

Analogues of the des-1-tryptophan,3-beta-cyclohexylalanine-alpha-factor of Saccharomyces cerevisiae, where the glycyl residue of position 9 was replaced by D-Ala, L-Ala, D-Leu, and L-Leu, were synthesized and evaluated by morphogenesis assays and circular dichroism spectroscopy. Synthesis was accomplished in solution phase with mixed anhydrides and p-nitrophenyl active esters as the coupling agents. All crude dodecapeptides were purified to greater than 98% homogeneity by preparative high-performance liquid chromatography on a reversed-phase column. The Gly9, D-Ala9, and D-Leu9 analogues elicited morphogenic alterations in MATa strains of S. cerevisiae at concentrations of 1-2 micrograms/mL and exhibited similar CD patterns in both trifluoroethanol and tris(hydroxymethyl)aminomethane buffer, pH 7.4. In contrast, the L-Ala9 and L-Leu9 analogues were more than 200 times less active in the morphogenesis assay and had markedly different CD spectra. These results demonstrate that the position 9 residue plays an important role in determining the biological activity and solution conformation of alpha-factor. We suggest the presence of a type II beta-turn in the Lys7-Gln10 region when the alpha-factor assumes its biologically active conformation.