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  1. Article ; Conference proceedings: Die mobile Patientenakte in der Neurologie: Evaluation der Praxistauglichkeit am Beispiel der neuroradiologischen Diagnostik

    Fleischmann, R / Hupperts, H / Leiske, S / Duhm, J / Brandt, S

    Klinische Neurophysiologie

    2014  

    Abstract: Seit 2011 ist die Neurologie der Charité an der klinischen Implementierung einer Mobilen Patientenakte beteiligt, die über einen Tablet-PC den Zugriff auf relevante Patientendaten, Befunde, radiologische Bilder, Laborwerte, sowie klinische Aufgaben und ... ...

    Event/congress 58. Jahrestagung der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung (DGKN), Berlin, 2014
    Abstract Seit 2011 ist die Neurologie der Charité an der klinischen Implementierung einer Mobilen Patientenakte beteiligt, die über einen Tablet-PC den Zugriff auf relevante Patientendaten, Befunde, radiologische Bilder, Laborwerte, sowie klinische Aufgaben und Verlaufsnotizen gestattet (SAP-EMR). Im Unterschied zu anderen elektronischen Informationssystemen, die PC-basiert z.B. in Verbindung mit entsprechend ausgestatteten Visitenwägen zu Verfügung stehen, werden die mobilen Endgeräte (z.B. ein IPad-Mini®) in der Kitteltasche der Mitarbeiter mitgeführt. Dies ermöglicht potentiell den zeit- und ortsunabhängigen (z.B. Besprechungen, Visiten, Untersuchungsräumen) Zugriff auf in Echtzeit aktualisierte behandlungsrelevante Daten zur Evaluierung des diagnostischen und therapeutischen Fortschritts sowie der weiteren Behandlungsplanung. Ziel des Evaluationsprojektes in der Neurologie war es, in einem randomisierten kontrollierten Verfahren die Verwendung der mobilen Krankenakte mit bereits etablierten Verfahren (analoge Akte inkl. laptopbasiertem Visitenwagen) zu vergleichen. Durch präzise Erfassung von zeitlichen quantitativen und qualitativen Parametern (in Form eines strukturierten Fragebogens für beteiligte Mitarbeiter) wurde der Einfluss der ständigen Verfügbarkeit behandlungsrelevanter Daten auf klinische Arbeitsabläufe in einem sechswöchigen Zeitraum untersucht. Als primärer Endpunkt wurde der Unterschied eines Index aus Gesamtvisitendauer sowie deren Vor- und Nachbereitungszeit für die untersuchten Systeme gewählt. Die vorläufige Auswertung der Evaluationsdaten deutet auf einen signifikanten Unterschied des primären Endpunkts; dieser scheint u.a. durch eine Verkürzung des Vor- und Nachbereitungszeit bei Nutzung eines mobilen Endgeräts bedingt. Die durchschnittliche Dauer pro Recherche, Anzahl redundanter Befundeinsichten und der Dokumentationsaufwand für weitere Prozeduren war gegenüber herkömmlichen Verfahren überlegen. Der Beitrag wird neben den ausführlichen Evaluationsergebnissen auch die formalen Erfordernisse des Datenschutzes kritisch diskutieren.
    Language German
    Publishing date 2014-03-12
    Publishing place Stuttgart ; New York
    Document type Article ; Conference proceedings
    ZDB-ID 80107-0
    ISSN 1439-4081 ; 1434-0275 ; 0012-7590
    ISSN (online) 1439-4081
    ISSN 1434-0275 ; 0012-7590
    DOI 10.1055/s-0034-1371291
    Database Thieme publisher's database

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  2. Article: Furosemide-sensitive K+ (Rb+) transport in human erythrocytes: modes of operation, dependence on extracellular and intracellular Na+, kinetics, pH dependency and the effect of cell volume and N-ethylmaleimide.

    Duhm, J

    The Journal of membrane biology

    1987  Volume 98, Issue 1, Page(s) 15–32

    Abstract: The effect of extracellular and intracellular Na+ (Nao+, Nai+) on ouabain-resistant, furosemide-sensitive (FS) Rb+ transport was studied in human erythrocytes under varying experimental conditions. The results obtained are consistent with the view that a ...

    Abstract The effect of extracellular and intracellular Na+ (Nao+, Nai+) on ouabain-resistant, furosemide-sensitive (FS) Rb+ transport was studied in human erythrocytes under varying experimental conditions. The results obtained are consistent with the view that a (1 Na+ + 1 K+ + 2 Cl-) cotransport system operates in two different modes: mode i) promoting bidirectional 1:1 (Na+-K+) cotransport, and mode ii) a Nao+-independent 1:1 ki+ exchange requiring Nai+ which, however, is not extruded. The activities of the two modes of operation vary strictly in parallel to each other among erythrocytes of different donors and in cell fractions of individual donors separated according to density. Rb+ uptake through Rbo+/Ki+ exchange contributes about 25% to total Rb+ uptake in 145 mM NaCl media containing 5 mM RbCl at normal Nai+ (pH 7.4). Na+-K+ cotransport into the cells occurs largely additive to K+/K+ exchange. Inward Na+-Rb+ cotransport exhibits a substrate inhibition at high Rbo+. With increasing pH, the maximum rate of cotransport is accelerated at the expense of K+/K+ exchange (apparent pK close to pH 7.4). The apparent KmRbo+ of Na+-K+ cotransport is low (2 mM) and almost independent of pH, and high for K+/K+ exchange (10 to 15 mM), the affinity increasing with pH. The two modes are discussed in terms of a partial reaction scheme of (1 Na+ + 1 K+ + 2 Cl-) cotransport with ordered binding and debinding, exhibiting a glide symmetry (first on outside = first off inside) as proposed by McManus for duck erythrocytes (McManus, T.J., 1987, Fed. Proc., in press). N-ethylmaleimide (NEM) chemically induces a Cl--dependent K+ transport pathway that is independent of both Nao+ and Nai+. This pathway differs in many properties from the basal, Nao+-independent K+/K+ exchange active in untreated human erythrocytes at normal cell volume. Cell swelling accelerates a Nao+-independent FS K+ transport pathway which most probably is not identical to basal K+/K+ exchange. Ko+ less than Nao+ less than Lio+ less than Mgo2+ reduce furosemide-resistant Rb+ inward leakage relative to cholineo+.
    MeSH term(s) Bumetanide/pharmacology ; Erythrocytes/cytology ; Erythrocytes/drug effects ; Erythrocytes/metabolism ; Ethylmaleimide/pharmacology ; Furosemide/pharmacology ; Humans ; Hydrogen-Ion Concentration ; Kinetics ; Models, Biological ; Potassium/blood ; Rubidium/blood ; Sodium/blood
    Chemical Substances Bumetanide (0Y2S3XUQ5H) ; Furosemide (7LXU5N7ZO5) ; Sodium (9NEZ333N27) ; Rubidium (MLT4718TJW) ; Ethylmaleimide (O3C74ACM9V) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 1987
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3082-x
    ISSN 1432-1424 ; 0022-2631
    ISSN (online) 1432-1424
    ISSN 0022-2631
    DOI 10.1007/bf01871042
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  3. Book: Der Flussbau

    Duhm, Julius

    Gewässerkunde, Gewässerregulierung u. Deichbau

    (Technische Handbücher für Baupraktiker ; Bd. 2, T. 1)

    1946  

    Author's details Julius Duhm
    Series title Technische Handbücher für Baupraktiker ; Bd. 2, T. 1
    Collection
    Keywords Flussbau ; Deichbau ; Hydrologie
    Subject Gewässerkunde ; Hydrographie ; Hydrografie ; Gewässerforschung ; Wasserforschung ; Deichwesen
    Language German
    Size X, 333 S.
    Publisher Fromme
    Publishing place Wien
    Publishing country Austria
    Document type Book
    HBZ-ID HT008545447
    Database Catalogue ZB MED Nutrition, Environment, Agriculture

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  4. Article ; Online: Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study.

    Fleischmann, Robert / Duhm, Julian / Hupperts, Hagen / Brandt, Stephan A

    Journal of neurology

    2015  Volume 262, Issue 3, Page(s) 532–540

    Abstract: Demographic changes require physicians to deliver needed services with fewer resources. Neurology as an interdisciplinary domain involves complex diagnostic procedures and time-consuming data handling. Tablet PCs might streamline clinical workflow ... ...

    Abstract Demographic changes require physicians to deliver needed services with fewer resources. Neurology as an interdisciplinary domain involves complex diagnostic procedures and time-consuming data handling. Tablet PCs might streamline clinical workflow through mobile access to patient data. This study examined the impact of tablets running an electronic medical record on ward round performance. We hypothesised that tablet use should reduce ward round time and decrease the time needed to check medical records thereby increasing physicians' bedside availability. Nine resident neurologists participated in a controlled prospective crossover trial over 14 weeks. In the experimental condition, tablets were used in addition to the established medical record. In the control condition, physicians used established systems only. The combined primary outcome measure included changes in total ward round time and relative time shifts between associated work processes. The secondary outcome measure was physicians' time required to check a medical record vs. physicians' bedside time. There was a significant main effect on the primary outcome measure (p = 0.01). Tablet use accelerated preparing (p = 0.004) and post-processing (p < 0.001) of ward rounds. Time for conducting ward rounds was unaffected (p = 0.19). Checking medical records was faster with tablets (p = 0.001) increasing physicians' bedside time (p < 0.001). Tablet use led to significant time savings during preparing and post-processing of ward rounds. It was further associated with time savings during checking medical data and an increase in physicians' bedside time. Tablets may facilitate clinical data handling and promote workflow.
    MeSH term(s) Adult ; Analysis of Variance ; Computers, Handheld ; Cross-Over Studies ; Electronic Health Records/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Physicians ; Practice Patterns, Physicians' ; Prospective Studies ; Time Factors ; Young Adult
    Language English
    Publishing date 2015-03
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-014-7581-7
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  5. Article: Intrazelluläre Elektrolyte und Bluthochdruck. Membran-Theorie der essentiellen Hypertonie.

    Duhm, J

    MMW, Munchener medizinische Wochenschrift

    1983  Volume 125, Issue 45, Page(s) 1045–1049

    Title translation Intracellular electrolytes and high blood pressure. Membrane theory of essential hypertension.
    MeSH term(s) Biological Transport, Active ; Blood Vessels/metabolism ; Calcium/metabolism ; Erythrocytes/metabolism ; Humans ; Hypertension/metabolism ; Ion Channels/metabolism ; Lithium/metabolism ; Potassium/metabolism ; Sodium/metabolism
    Chemical Substances Ion Channels ; Lithium (9FN79X2M3F) ; Sodium (9NEZ333N27) ; Potassium (RWP5GA015D) ; Calcium (SY7Q814VUP)
    Language German
    Publishing date 1983-11-11
    Publishing country Germany
    Document type English Abstract ; Journal Article ; Review
    ZDB-ID 200445-8
    ISSN 0341-3098 ; 0027-2973 ; 0724-8210
    ISSN 0341-3098 ; 0027-2973 ; 0724-8210
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  6. Article: Mobile Electronic Medical Records Promote Workflow: Physicians' Perspective From a Survey.

    Duhm, Julian / Fleischmann, Robert / Schmidt, Sein / Hupperts, Hagen / Brandt, Stephan A

    JMIR mHealth and uHealth

    2016  Volume 4, Issue 2, Page(s) e70

    Abstract: Background: As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with ... ...

    Abstract Background: As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians' perceptions of this tool within an inpatient setting.
    Objective: This study examined physicians' perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR.
    Methods: We developed a 57-item survey questionnaire designed to examine users' perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians' patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use.
    Results: Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians' satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently.
    Conclusions: Although tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation.
    Language English
    Publishing date 2016-06-06
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2719220-9
    ISSN 2291-5222
    ISSN 2291-5222
    DOI 10.2196/mhealth.5464
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  7. Article: Effects of 2,3-diphosphoglycerate on functional properties of hemoglobin and on glycolysis of human erythrocytes.

    Duhm, J

    Advances in experimental medicine and biology

    1976  Volume 75, Page(s) 81–88

    MeSH term(s) Allosteric Site ; Blood Glucose/metabolism ; Carbon Dioxide/blood ; Carbon Dioxide/pharmacology ; Diphosphoglyceric Acids/blood ; Diphosphoglyceric Acids/pharmacology ; Erythrocytes/metabolism ; Glycolysis/drug effects ; Hemoglobins/metabolism ; Humans ; Hydrogen-Ion Concentration ; Lactates/blood ; Oxyhemoglobins/metabolism
    Chemical Substances Blood Glucose ; Diphosphoglyceric Acids ; Hemoglobins ; Lactates ; Oxyhemoglobins ; Carbon Dioxide (142M471B3J)
    Language English
    Publishing date 1976
    Publishing country United States
    Document type Journal Article
    ISSN 2214-8019 ; 0065-2598
    ISSN (online) 2214-8019
    ISSN 0065-2598
    DOI 10.1007/978-1-4684-3273-2_11
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  8. Article: Dual effect of 2,3-diphosphoglycerate on the Bohr effects of human blood.

    Duhm, J

    Pflugers Archiv : European journal of physiology

    1976  Volume 363, Issue 1, Page(s) 55–60

    Abstract: The influence of the red cell concentration of 2,3-diphosphoglycerate (2,3-DPG, 0.5-26 mumoles/g erythrocytes) on the "CO2-Bohr effect" (pH varied by CO2 at constant base excess) and the "fixed acid-Bohr effect" (pH varied by fixed acid or base at ... ...

    Abstract The influence of the red cell concentration of 2,3-diphosphoglycerate (2,3-DPG, 0.5-26 mumoles/g erythrocytes) on the "CO2-Bohr effect" (pH varied by CO2 at constant base excess) and the "fixed acid-Bohr effect" (pH varied by fixed acid or base at constant PCO2) was studied in human blood at plasma pH values ranging between pH 7.2 and pH 7.6. Elevation of red cell 2,3-DPG concentration leads to a numerical decrease of the "CO2-Bohr coefficient" referring to plasma pH. The "fixed acid-Bohr coefficients" are numerically smaller than the corresponding "CO2-Bohr coefficients" and exhibit a maximum at normal red cell 2,3-DPG concentrations. The Bohr coefficients referring to red cell pH are distinctly higher than those referring to plasma pH, especially at high 2,3-DPG levels. This is due on the one hand to the physico-chemical properties of the intact red cell membrane, and on the other hand to a 2,3-DPG-induced decrease in the ratio deltapHcell/deltapHplasma. From the results it is concluded that 2,3-DPG exerts a dual effect on the Bohr coefficients of whole blood which is mediated 1. by the direct effect of 2,3-DPG on the allosteric properties of hemoglobin (as reflected by changes of the Bohr coefficients referring to red cell pH), and 2. by the effect of 2,3-DPG on deltapHcell/deltapHplasma.
    MeSH term(s) Carbon Dioxide/blood ; Diphosphoglyceric Acids/blood ; Erythrocytes/metabolism ; Hemoglobins/metabolism ; Humans ; Hydrogen-Ion Concentration ; Oxygen/blood
    Chemical Substances Diphosphoglyceric Acids ; Hemoglobins ; Carbon Dioxide (142M471B3J) ; Oxygen (S88TT14065)
    Language English
    Publishing date 1976-05-06
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 6380-0
    ISSN 1432-2013 ; 0031-6768
    ISSN (online) 1432-2013
    ISSN 0031-6768
    DOI 10.1007/bf00587402
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  9. Article: Influence of 2,3-diphosphoglycerate on the buffering properties of human blood: role of the red cell membrane.

    Duhm, J

    Pflugers Archiv : European journal of physiology

    1976  Volume 363, Issue 1, Page(s) 61–67

    Abstract: The effect of the concentration of red cell 2,3-diphosphoglycerate (2,3-DPG, 0.5-21 mumoles/g cells) on the buffering properties and on the slope of the relation between the extracellular and intracellular pH (deltapHi/deltapHe) of human blood was ... ...

    Abstract The effect of the concentration of red cell 2,3-diphosphoglycerate (2,3-DPG, 0.5-21 mumoles/g cells) on the buffering properties and on the slope of the relation between the extracellular and intracellular pH (deltapHi/deltapHe) of human blood was studied. The results were evaluated in connection with previous findings concerning the effect of 2,3-DPG on the Donnan ratio rH+ = H+e/H+i. deltapHi/deltapHe decreases with rising red cell 2,3-DPG content as well as with rising extracellular pH. deltapHi/deltapHe and rH+ can be related to each other by the empirical equation deltapHi/deltapHe = 1 + log rH+ = 1 + pHi - pHe. The validity of this equation appears to be restricted to conditions where the Donnan ratio rH+ is altered between 0.3 and 1 either by changes of the red cell concentration of buffering anions such as 2,3-DPG or by changes of the extracellular pH. As determined in suspensions of red cells with intact membranes, the 2,3-DPG-and pH-induced changes of deltapHi/deltapHe lead to proportional changes in the buffering power of the non-bicarbonate buffers of erythrocytes. Due to this effect the buffering power of suspensions of cells containing 5 times the normal concentration of the buffer 2,3-DPG is lower than that of cells with normal 2,3-DPG content (at extracellular pH values above 7). These findings demonstrate that the action of intracellular non-bicarbonate buffers in blood is effectively modulated by the physico-chemical properties of the red cell membrane.
    MeSH term(s) Biological Transport ; Buffers ; Cell Membrane Permeability ; Diphosphoglyceric Acids/blood ; Erythrocytes/metabolism ; Humans ; Hydrogen-Ion Concentration
    Chemical Substances Buffers ; Diphosphoglyceric Acids
    Language English
    Publishing date 1976-05-06
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 6380-0
    ISSN 1432-2013 ; 0031-6768
    ISSN (online) 1432-2013
    ISSN 0031-6768
    DOI 10.1007/bf00587403
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  10. Article: Glycolysis in human erythrocytes containing elevated concentrations of 2, 3-P2-glycerate.

    Duhm, J

    Biochimica et biophysica acta

    1975  Volume 385, Issue 1, Page(s) 68–80

    Abstract: In studies on the mechanism of the inhibitory effect of 2, 3-diphosphoglycerate on glycolysis in human erythrocytes, the following results were obtained: 1) Glucose consumption and lactate production are reduced by 70 and 40 per cent relative to normal ... ...

    Abstract In studies on the mechanism of the inhibitory effect of 2, 3-diphosphoglycerate on glycolysis in human erythrocytes, the following results were obtained: 1) Glucose consumption and lactate production are reduced by 70 and 40 per cent relative to normal erythrocytes in red blood cells containing five times the normal amount of 2, 3, -P2-glycerate ("high-diphosphoglycerate" cells) at an extracellular pH of 7.4. The marked dependency of glycolysis on the extracellular pH observed in normal erythrocytes is almost completely lost in the "high-diphosphoglycerate" cells. 2) About 50 per cent of the inhibition of glycolysis in "high-diphosphoglycerate" cells can be accounted for by the 2, 3-P2-glycerate-induced decrease of the red-cell pH. This fall of the red-cell pH which occurs as a conswquence of the Donnan effect of the non-pentrating 2, 3-P2-glycerate anion leads to a reduction of the glycolytic rate due to the properties of the enzyme phosphofructokinase. 3) The remaining part of the inhibitory effect must be attributed to an inhibition by 2, 3-P2-glycerate of glycolytic enzymes. From measurements of glycolytic rates and of the concentrations of glycolytic intermediates in the absence and presence of methylene blue it is concluded that the hexokinase reaction is inhibited by an elevation of 2, 3-P2-glycerate concentration in "high-diphosphoglycerate" cells suggests that also the enzyme pyruvate kinase is inhibited by 2, 3-P2-glycerate. 4) The dependencies of net-change of 2, 3-P2-glycerate concentration on the red-cell pH are identical in normal and "high-diphosphoglycerate" cells indicating that the balance between formation and decomposition of 2, 3-P2-glycerate is the same in erythrocytes with normal and very high compositions of 2, 3-P2-glycerate.
    MeSH term(s) Adenosine Triphosphate/metabolism ; Diphosphoglyceric Acids/blood ; Diphosphoglyceric Acids/pharmacology ; Erythrocytes/metabolism ; Glucose/metabolism ; Glucosephosphates/metabolism ; Glycolysis/drug effects ; Hemoglobins/metabolism ; Hexokinase/metabolism ; Humans ; Hydrogen-Ion Concentration ; Lactates/metabolism ; Methylene Blue/pharmacology ; Phosphates/metabolism ; Pyruvate Kinase/metabolism
    Chemical Substances Diphosphoglyceric Acids ; Glucosephosphates ; Hemoglobins ; Lactates ; Phosphates ; Adenosine Triphosphate (8L70Q75FXE) ; Hexokinase (EC 2.7.1.1) ; Pyruvate Kinase (EC 2.7.1.40) ; Glucose (IY9XDZ35W2) ; Methylene Blue (T42P99266K)
    Language English
    Publishing date 1975-03-14
    Publishing country Netherlands
    Document type Comparative Study ; Journal Article
    ZDB-ID 60-7
    ISSN 1879-2596 ; 1879-260X ; 1872-8006 ; 1879-2642 ; 1879-2618 ; 1879-2650 ; 0006-3002 ; 0005-2728 ; 0005-2736 ; 0304-4165 ; 0167-4838 ; 1388-1981 ; 0167-4889 ; 0167-4781 ; 0304-419X ; 1570-9639 ; 0925-4439 ; 1874-9399
    ISSN (online) 1879-2596 ; 1879-260X ; 1872-8006 ; 1879-2642 ; 1879-2618 ; 1879-2650
    ISSN 0006-3002 ; 0005-2728 ; 0005-2736 ; 0304-4165 ; 0167-4838 ; 1388-1981 ; 0167-4889 ; 0167-4781 ; 0304-419X ; 1570-9639 ; 0925-4439 ; 1874-9399
    DOI 10.1016/0304-4165(75)90075-6
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