The incidence of ulcerative colitis (UC) among children and adolescents is rising globally, albeit with notable discrepancies across countries. This systematic review and meta-analysis aims to provide a comprehensive overview of the incidence rates of pediatric UC in various countries and explore potential influencing factors. A systematic literature search was conducted in PubMed and EMBASE (via OVID) for studies published between January 1, 1970, and December 31, 2019. Additionally, a manual search was performed to identify relevant systematic reviews. Meta-analyses and meta-regressions were employed to determine the overall incidence rate and examine potential factors that may influence it. A total of 66 studies were included in the qualitative analysis, while 65 studies were included in the meta-analysis and 50 studies were meta-regression. The study reports a rising incidence of pediatric UC in several countries but significant differences across geographic regions, with no discernible global temporal trend. In addition, our meta-regression analysis showed that geographic location and socioeconomic factors significantly influenced the incidence of UC.Conclusion: Our findings indicate a rising incidence of pediatric UC in numerous countries since 1970, but with significant geographical variation, potentially presenting challenges for respective healthcare systems. We have identified geographic and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These findings provide a foundation for future research and health policies, aiming to tackle the growing burden of UC among children and adolescents. What is Known:• The incidence of ulcerative colitis in childhood and adolescence appears to be increasing worldwide and varies internationally.• Environmental and lifestyle factors are suspected as potential causes. What is New:• Our results highlight that the heterogeneity in incidence rates can be attributed to geographic and socio-economic factors.

The healthcare sector is notable for its reliance on discrete, self-contained information systems, which are often characterised by the presence of disparate data silos. The growing demands for documentation, quality assurance, and secondary use of medical data for research purposes has underscored the necessity for solutions that are more flexible, straightforward to maintain and interoperable. In this context, modular systems have the potential to act as a catalyst for change, offering the capacity to encapsulate and combine functionalities in an adaptable manner. The objective of this scoping review is to determine the extent to which modular systems are employed in the medical field. The review will provide a detailed overview of the effectiveness of service-oriented or microservice architectures, the challenges that should be addressed during implementation, and the lessons that can be learned from countries with productive use of such modular architectures. The review shows a rise in the use of microservices, indicating a shift towards encapsulated autonomous functions. The implementation should use HL7 FHIR as communication standard, deploy RESTful interfaces and standard protocols for technical data exchange, and apply HIPAA security rule for security purposes. User involvement is essential, as is integrating services into existing workflows. Modular architectures can facilitate flexibility and scalability. However, there are well-documented performance issues associated with microservice architectures, namely a high communication demand. One potential solution to this problem may be to integrate modular architectures into a cloud computing environment, which would require further investigation.

Aims: An increasing number of children and adolescents worldwide suffer from inflammatory bowel disease (IBD) such as Crohn’s disease (CD) and ulcerative colitis (UC). The present work aims to investigate the incidence, prevalence and future trends of IBD in children and adolescents in Saxony, Germany. Methods: The Saxon Pediatric IBD Registry collected data on patients up to 15 years of age from all 31 pediatric hospitals and pediatric gastroenterologists in Saxony over a 15-year period (2000–2014). In 2019, an independent survey estimated a registry completeness of 95.7%. Age-standardized incidence rates (ASR) per 100,000 person-years (PY) and prevalence per 100,000 children and adolescents were calculated. Evaluation was also been performed in sex and age subgroups. Joinpoint and Poisson regression were used for trend analyses and projections. Results: 532 patients with confirmed IBD during 2000–2014 were included in the epidemiological evaluation. 63.5% (n = 338) patients had CD, 33.1% (n = 176) had UC and 3.4% (n = 18) had unclassified IBD (IBD-U). The 15-year IBD prevalence was 111.8 [95%-CI: 102.3–121.3] per 100,000. The incidence ASR of IBD per 100,000 PY over the whole observation period was 7.5 [6.9–8.1]. ASR for the subtypes were 4.8 [4.3–5.3] for CD, 2.5 [2.1–2.9] for UC and 0.3 [0.1–0.4] for IBD-U. The trend analysis of ASR using the joinpoint regression confirmed a significant increase for incidence of IBD as well as CD. For IBD, the ASR per 100,000 PY increased from 4.6 [2.8–6.3] in 2000 to 8.2 [7.5–13.6] in 2014; projected incidence rates for IBD in Germany are 12.9 [6.5–25.5] in the year 2025 and 14.9 [6.7–32.8] in 2030, respectively. Thus, the number of new IBD diagnoses in Germany would more than triple (325%) in 2030 compared to 2000. The increase is expected to be faster in CD than UC, and be more in males than in females. The expected number of newly diagnosed children with IBD in Germany is projected to rise to about 1,584 [1,512–1,655] in 2025, and to about 1,918 [1,807–2,29] in 2030. Conclusion: The incidence of IBD in children and adolescents in Saxony increased at a similar rate as in other developed countries during the observation period. Given this trend, the health care system must provide adequate resources for the care of these young patients in the future.

Zusammenfassung: Die digitalen Fortschrittshubs Gesundheit pilotieren die Erweiterbarkeit der Konzepte und Lösungen der Medizininformatik-Initiative für eine Verbesserung der regionalen Gesundheitsversorgung und -forschung. Die 6 geförderten Projekte adressieren dabei unterschiedliche Erkrankungen, Stationen in der regionalen Gesundheitsversorgung und Methoden der institutionsübergreifenden Datenverknüpfung und -nutzung. Trotz der Verschiedenheit der Szenarien und regionalen Voraussetzungen sind die technischen, regulativen und organisatorischen Herausforderungen und Hürden, auf die die Fortschrittshubs bei der konkreten Implementierung der Lösungen treffen, oft ähnlich. Daraus ergeben sich teilweise gemeinsame Lösungsansätze, teilweise aber auch Forderungen an die Politik, die über das aus Sicht der Fortschrittshubs begrüßenswerte Gesundheitsdatennutzungsgesetz hinausgehen.In diesem Beitrag stellen wir die digitalen Fortschrittshubs vor und diskutieren Erreichtes, Herausforderungen und Lösungsansätze, die eine gemeinsame Nutzung von Daten aus den Universitätskliniken und den nichtakademischen Institutionen des Gesundheitssystems ermöglichen und auch nachhaltig zu einer Verbesserung von medizinischer Versorgung und Forschung beitragen können.

Background: Retrospective research on real-world data provides the ability to gain evidence on specific topics especially when running across different sites in research networks. Those research networks have become increasingly relevant in recent years; not least due to the special situation caused by the COVID-19 pandemic. An important requirement for those networks is the data harmonization by ensuring the semantic interoperability. Aims: In this paper we demonstrate (1) how to facilitate digital infrastructures to run a retrospective study in a research network spread across university and non-university hospital sites; and (2) to answer a medical question on COVID-19 related change in diagnostic counts for diabetes-related eye diseases. Materials and methods: The study is retrospective and non-interventional and runs on medical case data documented in routine care at the participating sites. The technical infrastructure consists of the OMOP CDM and other OHDSI tools that is provided in a transferable format. An ETL process to transfer and harmonize the data to the OMOP CDM has been utilized. Cohort definitions for each year in observation have been created centrally and applied locally against medical case data of all participating sites and analyzed with descriptive statistics. Results: The analyses showed an expectable drop of the total number of diagnoses and the diagnoses for diabetes in general; whereas the number of diagnoses for diabetes-related eye diseases surprisingly decreased stronger compared to non-eye diseases. Differences in relative changes of diagnoses counts between sites show an urgent need to process multi-centric studies rather than single-site studies to reduce bias in the data. Conclusions: This study has demonstrated the ability to utilize an existing portable and standardized infrastructure and ETL process from a university hospital setting and transfer it to non-university sites. From a medical perspective further activity is needed to evaluate data quality of the utilized real-world data documented in routine care and to investigate its eligibility of this data for research.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Digitization offers a multitude of opportunities to gain insights for current diagnostics and therapy from retrospective data. In this context, real-world data and its accessibility are of increasing importance to support unbiased and reliable research on big data. However, routinely collected data are not readily usable for research due to the unstructured nature within healthcare systems and the lack of interoperability between these systems. This challenge is very evident in drug data. Objective: In this research, we present an approach that identifies and increases the structuredness of drug data while ensuring standardization according to ATC. Methods: Our approach is based on available drug prescriptions and a drug catalog and consists of four steps. First, we perform an initial analysis of the structuredness of local drug data to define a point of comparison for the effectiveness of the overall approach. Second, we apply three algorithms to unstructured data that translate text into ATC codes based on string comparisons in terms of ingredients and product names, and similarity comparisons based on Levenshtein distance. Third, we validated the results of the three algorithms with expert knowledge based on the 1000 most frequently used prescription texts. Fourth, we performed a final evaluation to determine the increased degree of structuredness. Results: Initially, 52.3% of the 1,768,153 drug prescriptions were classified as unstructured. With the application of the three algorithms, we were able to increase the degree of structuredness to 85.18% based on the 1000 most frequent medication prescriptions. In this regard, the combination of Algorithm 1, 2, and 3 resulted in a correctness level of 100% (with 57,264 ATC codes identified), Algorithm 1 and 3 of 99.6% (with 152,404 codes identified), and Algorithm 1 and 2 resulted in 95.9% (with 39,472 codes identified). Conclusions: As shown in the first analysis steps of our approach, the availability of a product catalog to select from during the documentation process is not sufficient to generate over structured data. Our four-step approach reduces the problems and reliably increases the structuredness automatically. Similarity matching shows promising results, especially for entries with no connection to a product catalog. However, further enhancement of the correctness of such a similarity matching algorithm needs to be investigated in future work. Clinical Trial: no trial registration The research was approved by the Ethics Committee at the Technical University of Dresden as a retrospective, observational, non-interventional, non-human subject study (SR-EK-521112021).