Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis

Objective To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus. Design Collaborative network meta-analysis. Data sources Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels for the US Food and Drug Administration. Manufacturers and trialists provided additional data. Review methods Network meta-analysis with a mixed treatment comparison method to combine direct within trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point. Results 35 trials in 3852 people with diabetes and 10 947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes. Conclusion In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes.

Etwas gross aufschreiben. Quellenkritische Anmerkungen zum "Zeytregister" des Ulmer Chronisten Hans Heberle (1597-1677)

Das "Zeytregister" des Ulmer Bauern und Landhandwerkers Hans Heberle ist in seiner Art eine einzigartige Hinterlassenschaft eines bäuerlichern Schriftstellers des 17. Jahrhunderts. Der Gesichtskreis Heberles geht weit über den engen Horizont der Wirtschaftsführung hinaus, indem er persönliche Erfahrungen mit der Schilderung der Kriegsereignisse seiner Zeit verbindet. Unter Berücksichtigung von Schreibintention und -praxis relativieren sich indes die Möglichkeiten einer persönlichkeitsnahen Ausschöpfung der Quelle im Sinne eines 'Ego-Dokuments'. So sind den im wesentlichen auf Geburt und Tod beschränkten Notaten über die eigene Familie, über persönliche Erlebnisse und Beobachtungen aus näherer Anschauung durch die absorbierende Kriegsschilderung Grenzen auferlegt. Die selektive Auswahl der Themenpunkte und das weitestgehende Zurücktreten affektiver Momente erklärt sich auch durch die technische Verfahrensweise Heberles, der nach Ausweis inhaltlicher und formaler Aspekte der Handschrift in deutlichem zeitlichem Ereignisabstand an seiner Chronik arbeitete.