diff --git a/input/fsh/instances/casestudies/1-tvt-by-form/1-tvt-CompositionByForm.fsh b/input/fsh/instances/casestudies/1-tvt-by-form/1-tvt-CompositionByForm.fsh index 0864dc0a..6d76597e 100644 --- a/input/fsh/instances/casestudies/1-tvt-by-form/1-tvt-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/1-tvt-by-form/1-tvt-CompositionByForm.fsh @@ -7,7 +7,7 @@ Usage: #example * meta.versionId = "1" * meta.lastUpdated = "2022-10-20T17:04:38.520+00:00" * text.status = #additional -* text.div = "
Case study 1

Suspicion of deep vein thrombosis

A patient, Tobias Timmermann, presents to Dr. med. Marc Mustermann at the Olten group practice on 09.03.2016. He verbally identifies himself via his master data as Tobias Timmermann, 01.01.1981. He reports unclear leg pain in the left lower leg as well as simultaneously occurring respiratory pain and cough. The doctor carries out the anamnesis and physical examination and prescribes the following laboratory parameters:

The doctor carries out the Blood count and the CRP determination himself by means of point of care diagnostics, the D-dimer diagnostics is prescribed as quantitative diagnostics in an external sending laboratory. To obtain the sample, a Blood sample is taken lying down (1 EDTA tube, 2 citrate tubes of 5 ml). The order is transmitted to the external laboratory and the sample is sent to the external dispatch laboratory by courier ordered by telephone. The results of the internal point of care diagnostics (Blood count and CRP) are entered in the patient`s laboratory sheet in the doctor`s office software (manually or via locally installed electronic interfaces). A prescription is therefore issued by the doctor to the patient for self-administration of an anti-thrombotic agent. The results of the sending-in laboratory arrive electronically at the GP`s on the same evening and are also entered in the patient`s laboratory sheet. By using the present exchange format, this process can be fully automated. After a telephone enquiry by the doctor at the sending laboratory due to a borderline D-dimer result, the information is given that a deep vein thrombosis cannot be ruled out in this situation by means of D-dimer and the patient is therefore called back the next day for a sonography of the legs.

Matching FHIR questionnaire that meets this specification: 1-tvt.xml 1-tvt.json

As it is probably a primary leg vein thrombosis, Dr Eva Erlenmeier from the Pipette laboratory sends feedback to Dr Mustermann with the recommendation to carry out a thrombophilia screening, which includes the following analyses: Quick, aPTT, fibrinogen, antithrombin (funct.), thrombin time I 2.5 NIH/ml, APC resistance, D-dimers, protein C, (aPTT method), protein S antigen. The analyses can be carried out directly from the samples of the citrate tubes sent along.

" +* text.div = "
Case study 1

Suspicion of deep vein thrombosis

A patient, Tobias Timmermann, presents to Dr. med. Marc Mustermann at the Olten group practice on 09.03.2016. He verbally identifies himself via his master data as Tobias Timmermann, 01.01.1981. He reports unclear leg pain in the left lower leg as well as simultaneously occurring respiratory pain and cough. The doctor carries out the anamnesis and physical examination and prescribes the following laboratory parameters:

The doctor carries out the Blood count and the CRP determination himself by means of point of care diagnostics, the D-dimer diagnostics is prescribed as quantitative diagnostics in an external sending laboratory. To obtain the sample, a Blood sample is taken lying down (1 EDTA tube, 2 citrate tubes of 5 ml). The order is transmitted to the external laboratory and the sample is sent to the external dispatch laboratory by courier ordered by telephone. The results of the internal point of care diagnostics (Blood count and CRP) are entered in the patient`s laboratory sheet in the doctor`s office software (manually or via locally installed electronic interfaces). A prescription is therefore issued by the doctor to the patient for self-administration of an anti-thrombotic agent. The results of the sending-in laboratory arrive electronically at the GP`s on the same evening and are also entered in the patient`s laboratory sheet. By using the present exchange format, this process can be fully automated. After a telephone enquiry by the doctor at the sending laboratory due to a borderline D-dimer result, the information is given that a deep vein thrombosis cannot be ruled out in this situation by means of D-dimer and the patient is therefore called back the next day for a sonography of the legs.

As it is probably a primary leg vein thrombosis, Dr Eva Erlenmeier from the Pipette laboratory sends feedback to Dr Mustermann with the recommendation to carry out a thrombophilia screening, which includes the following analyses: Quick, aPTT, fibrinogen, antithrombin (funct.), thrombin time I 2.5 NIH/ml, APC resistance, D-dimers, protein C, (aPTT method), protein S antigen. The analyses can be carried out directly from the samples of the citrate tubes sent along.

" // ---- Sender and Receiver ---- * extension[0].extension.url = "enterer" diff --git a/input/fsh/instances/casestudies/2-pertussis-by-form/2-pertussis-CompositionByForm.fsh b/input/fsh/instances/casestudies/2-pertussis-by-form/2-pertussis-CompositionByForm.fsh index 4c1a8d99..d6ab023e 100644 --- a/input/fsh/instances/casestudies/2-pertussis-by-form/2-pertussis-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/2-pertussis-by-form/2-pertussis-CompositionByForm.fsh @@ -7,7 +7,7 @@ Usage: #example * meta.versionId = "1" * meta.lastUpdated = "2021-02-18T17:04:38.520+00:00" * text.status = #additional -* text.div = "
Case study 2

Suspicion of whooping cough

A mother visits the family doctor Peter Presto of the Olten group practice with her 6-year-old son Emil Kummer, born 5 May 2014, because the child has been coughing increasingly for a fortnight, with cramping cough attacks, and has a fever. The doctor`s receptionist measures the fever, takes a fingertip Blood sample from the son, determines the CRP and prepares a Blood smear. The doctor suspects a viral infection, but wants to rule out whooping cough, although the child has been vaccinated against it. As he is under time pressure due to an emergency, he does not want to do the necessary throat swab himself, but asks the mother to accompany the child to the nearby laboratory to have the swab done in peace. He prepares a laboratory order to carry out a pertussis PCR on the child`s throat swab and gives the order to the mother. The mother herself is not sure whether she herself has been vaccinated against pertussis. Consequently, the family doctor Peter Presto gives her the pertussis vaccination right away and recommends that the same be done for the child`s father and grandparents. In the meantime, the MPA has looked at the son`s Blood smear under the microscope and finds a lot of reactive lymphocytes, which seem suspicious to her. She is unsure and asks the doctor, who gives the order to give the child`s Blood smears to the mother and also to have them examined more closely in the laboratory. The mother arrives at the laboratory with her son, where the doctor`s order is first to establish the son`s identity. Then a pharyngeal swab and a right cubital venepuncture are taken from the child in the laboratory`s Blood collection room and passed on to the laboratory together with the Blood smears and the doctor`s examination order.

Matching FHIR questionnaire that meets this specification: 2-pertussis.xml 2-pertussis.json

" +* text.div = "
Case study 2

Suspicion of whooping cough

A mother visits the family doctor Peter Presto of the Olten group practice with her 6-year-old son Emil Kummer, born 5 May 2014, because the child has been coughing increasingly for a fortnight, with cramping cough attacks, and has a fever. The doctor`s receptionist measures the fever, takes a fingertip Blood sample from the son, determines the CRP and prepares a Blood smear. The doctor suspects a viral infection, but wants to rule out whooping cough, although the child has been vaccinated against it. As he is under time pressure due to an emergency, he does not want to do the necessary throat swab himself, but asks the mother to accompany the child to the nearby laboratory to have the swab done in peace. He prepares a laboratory order to carry out a pertussis PCR on the child`s throat swab and gives the order to the mother. The mother herself is not sure whether she herself has been vaccinated against pertussis. Consequently, the family doctor Peter Presto gives her the pertussis vaccination right away and recommends that the same be done for the child`s father and grandparents. In the meantime, the MPA has looked at the son`s Blood smear under the microscope and finds a lot of reactive lymphocytes, which seem suspicious to her. She is unsure and asks the doctor, who gives the order to give the child`s Blood smears to the mother and also to have them examined more closely in the laboratory. The mother arrives at the laboratory with her son, where the doctor`s order is first to establish the son`s identity. Then a pharyngeal swab and a right cubital venepuncture are taken from the child in the laboratory`s Blood collection room and passed on to the laboratory together with the Blood smears and the doctor`s examination order.

" // ---- Sender and Receiver ---- * extension[0].extension.url = "enterer" diff --git a/input/fsh/instances/casestudies/3-gyn-by-form/3-gyn-CompositionByForm.fsh b/input/fsh/instances/casestudies/3-gyn-by-form/3-gyn-CompositionByForm.fsh index d676c5e8..5290e3d0 100644 --- a/input/fsh/instances/casestudies/3-gyn-by-form/3-gyn-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/3-gyn-by-form/3-gyn-CompositionByForm.fsh @@ -7,7 +7,7 @@ Usage: #example * meta.versionId = "1" * meta.lastUpdated = "2021-02-18T17:04:38.520+00:00" * text.status = #additional -* text.div = "
Case study 3

Annual gynaecological check-up

The doctor`s assistent of the gynaecology department in the Olten group practice, Dr Peter Pap, prepares the next day`s consultations. As the practice only has a minimal laboratory of its own, certain patients are sent to the nearby Pipette laboratory outpatient clinic before the appointment, including the young patient Ms Marina Rubella, born 8. 8. 1992. In her practice software, the MPA prescribes the standard analyses agreed with the laboratory for the gynaecological 3-year check-up for patient Rubella. This also includes the Blood sample for the serotonary for any follow-up prescriptions. The laboratory transmits the results to the practice no later than 90 minutes after the Blood sample has been taken. Dr Pap prescribes the following orders during the consultation:

Matching FHIR questionnaire that meets this specification: 3-gyn.xml 3-gyn.json

" +* text.div = "
Case study 3

Annual gynaecological check-up

The doctor`s assistent of the gynaecology department in the Olten group practice, Dr Peter Pap, prepares the next day`s consultations. As the practice only has a minimal laboratory of its own, certain patients are sent to the nearby Pipette laboratory outpatient clinic before the appointment, including the young patient Ms Marina Rubella, born 8. 8. 1992. In her practice software, the MPA prescribes the standard analyses agreed with the laboratory for the gynaecological 3-year check-up for patient Rubella. This also includes the Blood sample for the serotonary for any follow-up prescriptions. The laboratory transmits the results to the practice no later than 90 minutes after the Blood sample has been taken. Dr Pap prescribes the following orders during the consultation:

" // ---- Sender and Receiver ---- * extension[0].extension.url = "enterer" diff --git a/input/fsh/instances/casestudies/4-sepsis-by-form/4-sepsis-CompositionByForm.fsh b/input/fsh/instances/casestudies/4-sepsis-by-form/4-sepsis-CompositionByForm.fsh index cd1a471c..1834e839 100644 --- a/input/fsh/instances/casestudies/4-sepsis-by-form/4-sepsis-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/4-sepsis-by-form/4-sepsis-CompositionByForm.fsh @@ -7,7 +7,7 @@ Usage: #example * meta.versionId = "1" * meta.lastUpdated = "2021-02-18T17:04:38.520+00:00" * text.status = #additional -* text.div = "
Case study 4

Suspected sepsis

The patient Sara Speckmann, born 12. 12. 1975, has been in the Cantonal Hospital for some time. Last night her general condition deteriorated massively. As there is a suspicion of sepsis, the senior physician in charge, Dr Hans Hauser, orders Blood to be taken from her in the morning for a Blood culture. 30 minutes later, another aerobic and an anaerobic Blood culture is taken, as well as a urine sample. All five samples are further processed in the external laboratory Pipette. There, germs are detected in all materials and then identified by mass spectrometry. The pathogens “Klebsiella pneumoniae” and “Escherichia coli” were detected in the four Blood culture bottles, and the bacterium “Streptococcus mitis” was also detected in one aerobic bottle. The germ identified in the urine sample is normally not pathogenic. An antibiogram is made of all three pathogens detected in the Blood. This shows that the two active substances “amoxicillin+clavulanic acid” and “ceftriaxone” are effective against all three germs. The microbiologist regularly informs Dr Hans Hauser about the various partial results.

Matching FHIR questionnaire that meets this specification: 4-sepsis.xml 4-sepsis.json

" +* text.div = "
Case study 4

Suspected sepsis

The patient Sara Speckmann, born 12. 12. 1975, has been in the Cantonal Hospital for some time. Last night her general condition deteriorated massively. As there is a suspicion of sepsis, the senior physician in charge, Dr Hans Hauser, orders Blood to be taken from her in the morning for a Blood culture. 30 minutes later, another aerobic and an anaerobic Blood culture is taken, as well as a urine sample. All five samples are further processed in the external laboratory Pipette. There, germs are detected in all materials and then identified by mass spectrometry. The pathogens “Klebsiella pneumoniae” and “Escherichia coli” were detected in the four Blood culture bottles, and the bacterium “Streptococcus mitis” was also detected in one aerobic bottle. The germ identified in the urine sample is normally not pathogenic. An antibiogram is made of all three pathogens detected in the Blood. This shows that the two active substances “amoxicillin+clavulanic acid” and “ceftriaxone” are effective against all three germs. The microbiologist regularly informs Dr Hans Hauser about the various partial results.

" // ---- Sender and Receiver ---- * extension[0].extension.url = "enterer" diff --git a/input/fsh/instances/casestudies/5-biol-monit-by-form/5-biol-monit-CompositionByForm.fsh b/input/fsh/instances/casestudies/5-biol-monit-by-form/5-biol-monit-CompositionByForm.fsh index c098e0cd..956e8fc6 100644 --- a/input/fsh/instances/casestudies/5-biol-monit-by-form/5-biol-monit-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/5-biol-monit-by-form/5-biol-monit-CompositionByForm.fsh @@ -7,7 +7,7 @@ Usage: #example * meta.versionId = "1" * meta.lastUpdated = "2021-02-18T17:04:38.520+00:00" * text.status = #additional -* text.div = "
Case study 5

Collective order “SUVA biological monitoring”

Companies that work with substances hazardous to health and in which employees are exposed to special risks are subject to occupational health screening by SUVA. Biological monitoring is one of the control options. This assesses the exposure of workers to chemical agents by determining the agents or metabolites in biological material (e.g. urine). The Occupational Medical Prevention (AMV) of SUVA sends the laboratory a monthly list with the following information per company (collective order):

Biological monitoring SUVA

Matching FHIR questionnaire that meets this specification: 5-bio-monit.xml 4-sepsis.json

" +* text.div = "
Case study 5

Collective order “SUVA biological monitoring”

Companies that work with substances hazardous to health and in which employees are exposed to special risks are subject to occupational health screening by SUVA. Biological monitoring is one of the control options. This assesses the exposure of workers to chemical agents by determining the agents or metabolites in biological material (e.g. urine). The Occupational Medical Prevention (AMV) of SUVA sends the laboratory a monthly list with the following information per company (collective order):

" * extension[0].extension.url = "enterer" * extension[=].extension.valueReference = Reference(PauloPorcelliniSuva) * extension[=].url = "http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-epr-dataenterer" diff --git a/input/fsh/instances/casestudies/6-histopath-by-form/6-histopath-CompositionByForm.fsh b/input/fsh/instances/casestudies/6-histopath-by-form/6-histopath-CompositionByForm.fsh index 496fee94..aefbb0af 100644 --- a/input/fsh/instances/casestudies/6-histopath-by-form/6-histopath-CompositionByForm.fsh +++ b/input/fsh/instances/casestudies/6-histopath-by-form/6-histopath-CompositionByForm.fsh @@ -8,7 +8,7 @@ Usage: #example * meta.lastUpdated = "2022-10-20T17:04:38.520+00:00" * text.status = #additional * text.div = "
Case study 6

Suspected Melanoma, order for histopathology examination

A 45-year-old female patient Simone Studer came for her regular skin check to the Arztpraxis of Dermatologist Armin Ahrens, and this lesion was noted: Junctions nevi consisting of seborrheic area top end and atypical network constructed of many seperate dots, structures , etc , suggesting melanocytic involvement. Excision. Attachement of dermatoscopic images Specimen: 29 x 11 x 5 mm skin ellipse Body Site: Back paralumbar left -

The skin sample, including the order form and the dermatoscopic image are sent to the laboratory.

Matching FHIR questionnaire that meets this specification: 6-histopath.xml 6-histopath.json

" +

The skin sample, including the order form and the dermatoscopic image are sent to the laboratory.

" // ---- Sender and Receiver ---- * extension[0].extension.url = "enterer" diff --git a/input/includes/menu.xml b/input/includes/menu.xml index 203cc743..cbee3ee0 100644 --- a/input/includes/menu.xml +++ b/input/includes/menu.xml @@ -80,24 +80,10 @@ - - - diff --git a/input/pagecontent/document-lo-by-form.md b/input/pagecontent/document-lo-by-form.md index c0bafcb6..cd830e7c 100644 --- a/input/pagecontent/document-lo-by-form.md +++ b/input/pagecontent/document-lo-by-form.md @@ -7,4 +7,9 @@ This exchange format is defined as a [document type](https://www.hl7.org/fhir/do {% include img.html img="LabOrderByForm.png" caption="Fig.: Laboratory Order with Questionnaire" width="40%" %} * **Profile**: [CH LAB-Order Document by Form](StructureDefinition-ch-lab-order-document-by-form.html) + * **Example**: CH LAB-Order Document by Form ([XML](Bundle-ch-lab-order-by-form.xml.html), [JSON](Bundle-ch-lab-order-by-form.json.html)) + +* **Specification:** [Specificaton Questionnaire](Questionnaire-LabOrder-form.html) + +* **Example Form:** [Questionnaire Lab Order](https://laborprojektgruppe.ch/questionnaire/) diff --git a/input/pagecontent/document-lo.md b/input/pagecontent/document-lo.md index 26e91af5..445c413a 100644 --- a/input/pagecontent/document-lo.md +++ b/input/pagecontent/document-lo.md @@ -6,6 +6,6 @@ This exchange format is defined as a [document type](https://www.hl7.org/fhir/do {% include img.html img="LabOrderBySR.png" caption="Fig.: Laboratory Order without Questionnaire" width="40%" %} -* **Profile**: [CH LAB-Order Document by Service Request](StructureDefinition-ch-lab-order-document.html) +* **Profile:** [CH LAB-Order Document by Service Request](StructureDefinition-ch-lab-order-document.html) * **Example**: CH LAB-Order Example Document by Service Request ([XML](Bundle-ch-lab-order-document.xml.html), [JSON](Bundle-ch-lab-order-document.json.html)) diff --git a/input/pagecontent/usecases-english.md b/input/pagecontent/usecases-english.md index 4fea9631..6e77dbc8 100644 --- a/input/pagecontent/usecases-english.md +++ b/input/pagecontent/usecases-english.md @@ -11,9 +11,7 @@ The order document is sent to the laboratory information system (LIS). He can also add information about the clinical context to the laboratory order: problem list, current medication list, questions about the prescribed analyses -Example document: - -best-practice +Example document: [CH LAB-Order 0-best-practice](Bundle-0-best-practice-document.html) ### Use Case 2: Lab Order by Form @@ -45,9 +43,7 @@ A form (Questionnaire) is presented to the client, which contains the following Outside of this use case: the results are then reported back to the client. -Example document: - -tvt by Form +Example document: [CH LAB-Order 1-tvt by Form](Bundle-1-tvt-document-by-form.html) ### Use Case 3: Requesting additional examinations of the same sample @@ -73,7 +69,7 @@ Examples are: * Food industry: investigation on employee hygiene (e.g. salmonella contamination) * Police investigations -Example document: [CH LAB-Order 5-biol-monit](https://build.fhir.org/ig/hl7ch/ch-lab-order/branches/master/Bundle-5-biol-monit-document.html). Work lists are processed, which last over a longer period of time (days/weeks). Generally, specific examinations are requested on multiple patients. +Example document: [CH LAB-Order 5-biol-monit](Bundle-5-biol-monit-document.html). Work lists are processed, which last over a longer period of time (days/weeks). Generally, specific examinations are requested on multiple patients. ### Use Case 6: Suggestion of additional or alternative examinations by the laboratory physician (order recipient, receiver) diff --git a/input/pagecontent/usecases-french.md b/input/pagecontent/usecases-french.md index 36a9d78c..a2a8751b 100644 --- a/input/pagecontent/usecases-french.md +++ b/input/pagecontent/usecases-french.md @@ -11,9 +11,7 @@ Le client (par exemple, un médecin) nécessite divers examens de laboratoire po Il peut également ajouter des informations sur le contexte clinique à la commande de laboratoire : liste des problèmes, liste des médicaments en cours, questions sur les analyses prescrites. -Document d'exemple : - -Meilleure pratique +Document d'exemple: [CH LAB-Order 0-best-practice](Bundle-0-best-practice-document.html) ### Cas d'utilisation 2: Laboratoire Commande par Formulaire @@ -45,7 +43,7 @@ Un formulaire (Questionnaire) est présenté au donneur d'ordre, qui contient le En dehors de ce cas d'utilisation : les résultats sont ensuite communiqués au donneur d'ordre. -tvt par Formulaire +Document d'exemple: [CH LAB-Order 1-tvt by Form](Bundle-1-tvt-document-by-form.html) ### Cas d'utilisation 3: Demande d'analyses supplémentaires du même échantillon @@ -70,7 +68,7 @@ En voici quelques exemples : * Industrie alimentaire : enquête sur l'hygiène des employés (p.ex. contamination par salmonelles) * Enquêtes de police -Exemple de formulaire : [CH LAB-Order 5-biol-monit](https://build.fhir.org/ig/hl7ch/ch-lab-order/branches/master/Bundle-5-biol-monit-document.html). Des listes de travail sont traitées, qui s'étendent sur une longue période (jours/semaines). En règle générale, certains examens sont demandés pour plusieurs patients. +Exemple de formulaire : [CH LAB-Order 5-biol-monit](Bundle-5-biol-monit-document.html). Des listes de travail sont traitées, qui s'étendent sur une longue période (jours/semaines). En règle générale, certains examens sont demandés pour plusieurs patients. ### Cas d'utilisation 6: Suggestion d'examens supplémentaires ou alternatifs par le médecin de laboratoire (destinataire de l'ordonnance) diff --git a/input/pagecontent/usecases-german.md b/input/pagecontent/usecases-german.md index d9a7de0d..4e6d1a65 100644 --- a/input/pagecontent/usecases-german.md +++ b/input/pagecontent/usecases-german.md @@ -10,8 +10,7 @@ Der Auftraggeber (zum Beispiel ein Arzt) benötigt verschiedene Laboruntersuchun Er kann auch Informationen zum klinischen Kontext der Laborbestellung hinzufügen: Problemliste, aktuelle Medikamentenliste, Fragen zu den verordneten Analysen. -Beispielformular: -best-practice +Beispielformular: [CH LAB-Order 0-best-practice](Bundle-0-best-practice-document.html) ### Use Case 2: Laborverordnung unter Verwendung von Questionnaire und QuestionnaireResponse @@ -41,9 +40,7 @@ Dem Kunden wird ein Formular (Fragebogen) vorgelegt, das folgende Informationen Außerhalb dieses Anwendungsfalls: Die Ergebnisse werden dann dem Kunden zurückgemeldet. -Beispiel-Dokument: - -tvt by Form +Beispiel-Dokument: [CH LAB-Order 1-tvt by Form](Bundle-1-tvt-document-by-form.html) ### Use Case 3: Anfordern von zusätzlichen Untersuchungen der gleichen Probe @@ -68,7 +65,7 @@ Beispiele dazu sind: * Lebensmittelindustrie: Untersuchung zu Mitarbeiterhygiene (z.B. Salmonellen-Kontaminierung) * Polizeiliche Untersuchungen -Beispielformular: [CH LAB-Order 5-biol-monit](https://build.fhir.org/ig/hl7ch/ch-lab-order/branches/master/Bundle-5-biol-monit-document.html). Es werden Arbeitslisten abgearbeitet, welche über eine längere Zeit (Tage/Wochen) andauern. In der Regel werden bestimmte Untersuchungen zu mehreren Patienten angefordert. +Beispielformular: [CH LAB-Order 5-biol-monit](Bundle-5-biol-monit-document.html). Es werden Arbeitslisten abgearbeitet, welche über eine längere Zeit (Tage/Wochen) andauern. In der Regel werden bestimmte Untersuchungen zu mehreren Patienten angefordert. ### Use Case 6: Vorschlag von zusätzlichen oder alternativen Untersuchungen durch den Laborarzt (Auftragsempfänger, receiver)