Background Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems. We conducted an inventory study to calculate TB underreporting in Germany in 2013–2017. Methods Acquisition of two pseudonymized case-based data sources (national TB notification data and antibiotic resistance surveillance data) was followed by two-source Capture-recapture (CRC) analysis, as case-based data from a third source was unavailable. Aggregated data on consumption of a key anti-TB drug (pyrazinamide [PZA]) was compared to an estimated need for PZA based on TB notification data to obtain an independent underreporting estimation. Additionally, notified TB incidence was compared to TB rate in an aggregated health insurance fund dataset. Results CRC and PZA-based approaches indicated that between 93 and 97% (CRC) and between 91 and 95% (PZA) of estimated cases were captured in the national TB notification data in the years 2013–2017. Insurance fund dataset did not indicate TB underreporting on the national level in 2017. Conclusions Our results suggest that more than 90% of estimated TB cases are captured within the German TB surveillance system, and accordingly the TB notification rate is likely a good proxy of the diagnosed TB incidence rate. An increase in underreporting and discrepancies however should be further investigated.
ZusammenfassungIm Rahmen der nationalen Influenzapandemieplanung wurden in Deutschland neben dem Meldewesen gemäß Infektionsschutzgesetz (IfSG) weitere Überwachungssysteme etabliert. Ziel dieser Systeme sind die Beschreibung, Analyse und Bewertung der Situation bei akuten respiratorischen Erkrankungen (ARE), die Identifikation der hauptsächlich zirkulierenden Atemwegserreger und die Beschreibung des zeitlichen Verlaufs. Seit Beginn der COVID-19-Pandemie wurden die Systeme erweitert, um auch Infektionen mit SARS-CoV‑2 erfassen zu können.In diesem Beitrag werden drei verschiedene Surveillance-Systeme für ARE vorgestellt: GrippeWeb, die Arbeitsgemeinschaft Influenza mit dem SEEDARE-Modul (Sentinel zur elektronischen Erfassung von Diagnosecodes) und das Krankenhaus-Sentinel ICOSARI (ICD-10-code-basierte Krankenhaus-Surveillance schwerer akuter respiratorischer Infektionen). Mit diesen Systemen können ARE auf Bevölkerungsebene, im ambulanten und im stationären Bereich überwacht werden. Zusammen mit dem Monitoring der Mortalität liefern sie wichtige Hinweise zur Häufigkeit verschieden schwerer Krankheitsverläufe in der Bevölkerung. Um die Systeme für SARS-CoV‑2 zu erweitern, waren nur wenige Anpassungen notwendig.Da die Falldefinitionen für ARE nicht geändert wurden, können in den beschriebenen Systemen historische Zeitreihen zum Vergleich herangezogen werden. Alle Systeme sind so aufgebaut, dass stabile und etablierte Bezugsgrößen für die Berechnung von wöchentlichen Anteilen und Raten zur Verfügung stehen. Dies ist eine wichtige Ergänzung zum Meldewesen gemäß IfSG, welches stark von Testkapazitäten und -strategien sowie veränderten Falldefinitionen abhängt. Die Surveillance-Systeme haben sich in der COVID-19-Pandemie auch im internationalen Vergleich als praktikabel und effizient erwiesen.
Delirium and dementia as organically caused mental disorders exhibit similarities in the clinical and neurological sense and often occur together. The existence of one appears to increase the risk for the development of the other. Although delirium is a very common disorder especially among the elderly, it is often not recognized. For the diagnosis of delirium, an exact family and case history including medication, clinical examination and determination of routine laboratory values are not infrequently necessary. Causal treatment of delirium is possible and not necessarily complicated. Both non-medicative and medicative measures are available for the symptomatic treatment. The non-medicative measures are to a large extent applied by nursing staff and comprise, among others, orientation guidance and attaining a balance between perceptual overload and deprivation. A good knowledge of symptomatology is decisive, also from the prevention point of view (nurses specialized in delirium). For symptomatic medicative treatment neuroleptic agents appear to be favorable. With regard to extrapyramidal side effects atypical neuroleptics are better than the typical ones. The use of cholinesterase inhibitors is not robustly supported by the literature. The use of benzodiazepines is rather discouraged except for the treatment of withdrawal delirium. Preparations with short half-lives and absence of active metabolites can be used as accompanying measures for a short time. Prevention appears to be extremely important for which the treating personnel require a good knowledge of risk factors and their management. The occurrence of delirium among cases of alpha-synucleinopathies represents a special case. Both international and German guidelines on the management of delirium are available.
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