Journal articles on the topic 'Medical care – Political aspects – Germany'
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Elstner, S. "German mental health care in people with intellectual and developmental disabilities (idd) in comparison to other European countries." European Psychiatry 41, S1 (April 2017): S598. http://dx.doi.org/10.1016/j.eurpsy.2017.01.925.
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IntroductionIn Germany, mental health care in people with IDD is mostly determined by experts’ opinions. Particularities of the psychiatric assessment and treatment of people with IDD and a co-morbid psychiatric disorder are taught neither at medical schools nor in the scope of the medical training of psychiatrists.ObjectivesThe present study examined the influence of socio-political aspects of health care on quality and organisation of mental health care in people with IDD.MethodsVarious aspects of health care systems in Germany and three other European countries were explored and juxtaposed subsequently with a special developed questionnaire.ResultsThe health care systems of four different European countries differ in socio-economical, educational and system-financed aspects.ConclusionsDiffering organisational levels of national health care systems and socio-economical aspects within these countries contribute to the organisation of the mental health care system in people with IDD. Suggestions for a better harmonisation of European mental health care in people with IDD are offered.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Giese, Constanze. "German Nurses, Euthanasia and Terminal Care: a Personal Perspective." Nursing Ethics 16, no. 2 (March 2009): 231–37. http://dx.doi.org/10.1177/0969733008100368.
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The nursing profession in Germany is facing a public debate on legal and ethical questions concerning euthanasia on request and physician-assisted suicide. However, it seems questionable if the profession itself, individual nurses or the professional associations are prepared to be involved in such a public debate. To understand this hesitation, the present situation is considered in the light of the tradition and history of professional care in Germany. Obedience to medical as well as to religious authorities was long part of nurses' professional identity, but is no longer relevant. The lack of reflection and discussion on how to take a balanced view of ethical and political questions concerning nursing, and the role and responsibility of nurses in end-of-life decisions and situations of caring for dying people are discussed using the situation of nurses in the Netherlands as a comparison.
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Shlapko, T., M. Starynskyi, and V. Myrhorod-Karpova. "European landmarks for health care reform in Ukraine compared to Germany." Uzhhorod National University Herald. Series: Law, no. 68 (March 24, 2022): 96–103. http://dx.doi.org/10.24144/2307-3322.2021.68.16.
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The article is devoted to improving the legal regulation of health care in Ukraine in the light of European integration processes, using the experience of Germany. This issue is relevant both in Ukraine and abroad, as the health care systems of many countries are currently in need of improvement and indepth research, especially during the COVID-19 pandemic.
As a country with a vector to join the European Union, Ukraine must meet precise criteria for membership in this economic and political union and continue to reform the health care system. This article discusses the main German regulations concerning the health care system. The main problems that arise during medical services and their financing are summarized. The newest aspects of health care development are considered; in particular, the influence of digitalization on the development of health care, in general, is studied. The emergence, development, and further prospects of digitalization in Germany and Ukraine are analyzed in detail. The latest information and electronic technologies are mentioned, based on which there is a direct connection between patients, healthcare professionals and other participants in relations in healthcare field.
Initiatives for digitalization in European countries, including Germany, which are gradually improving the functioning of the electronic health care system in Germany, are considered because the Federal Ministry of Health receives feedback from consumers of innovative technologies, namely ePa, eHealth, and others. The introduction of new technologies is not unilateral but rather bilateral because citizens can express their views on the functioning of the new electronic system. Ukraine, in turn, is adopting the experience of Germany and implementing it in our electronic healthcare system.
The conclusion is made about perspective directions of state regulation in the sphere of reforming the health care system in Ukraine, taking into account the European experience. Particular attention is paid to highlighting what Ukraine can borrow from Germany to improve its health care system and ensure and improve the quality of medical services.
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Suttmeier, Richard P. "Chinese Scientists and Responsibility: Ethical Issues of Human Genetics in Chinese International Contexts. Edited by OLE DÖRING. [Hamburg: Institut für Asienkunde, Mitteilungen des Instituts für Asienkunde, 1999. 257 pp. DM 38.00. ISBN 3-88910-227-1.]." China Quarterly 181 (March 2005): 183–84. http://dx.doi.org/10.1017/s0305741005280104.
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It has been more than 80 years since Chinese intellectuals, struggling with the complexities of “science and philosophy of life,” debated the challenges of finding the moral wisdom needed to apply new scientific knowledge in ethically responsible ways. Could a moral compass be found? Would it be discovered in Chinese culture, or would it come from the West?Advances in science and technology during the course of the 20th century have often outpaced progress in understanding “science and philosophy of life.” Nevertheless, the importance of the ethical dimensions of science and technology has increased in all countries, and there is little doubt that the new technologies of the early 21st century are already bestowing on us new moral conundrums. As advanced technologies and scientific research capabilities diffuse around the world, the ethical traditions which inform moral choice seemingly become more heterogeneous, and the need for reasoned, cross-cultural moral discourse increases. The Institut für Asienkunde in Hamburg is therefore to be congratulated for convening the “First International and Interdisciplinary Symposium on Aspects of Medical Ethics in China,” from which the 15 papers in this volume come.There is no easy way to summarize the diversity of views presented in this provocative conference report. The authors include practising scientists from China and students of bioethics from China, Malaysia, Germany and the United States. But, the theme of eugenics – especially the ways in which advances in human genetics affect our moral stance towards eugenics – link a number of the papers. The atrocities of Nazi Germany strongly condition the views of the Western authors. Reacting, perhaps, to China's 1994 Law on Maternal and Infant Health Care, the latter seem to be urging Chinese researchers, medical practitioners, ethicists and policymakers to take the German experience to heart – even as China embraces the promises of the new genetic technologies. Thus, historian Sheila Faith Weiss' “Prelude to the maelstrom,” an informative account of the origins of Nazi eugenics in the 19th and early 20th-century culture of German medicine, is not so subtly subtitled, “A cautionary tale for contemporary China?” The Chinese authors acknowledge this “cautionary tale,” but also speak to the ethical challenges of new genetic technologies from a tradition with its own understandings of how practical knowledge and moral purpose are related, and how individual and collective well-being are reconciled.
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Gattermann, Norbert, Wolf-Karsten Hofmann, Axel Meessen, Stephan Schmitz, Anton Tsamaloukas, Tanja Vollmer, Ulrich Wedding, Carlotta Plesnila-Frank, Wolfgang Schramm, and Karin Berger. "Myelodysplastic Syndromes: Aspects of Current Medical Care and Economic Considerations in Germany." Onkologie 31, no. 8-9 (2008): 5. http://dx.doi.org/10.1159/000142900.
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Renger, F., and A. Czirfusz. "Aspects of the Level of Digitisation in Medical Care in Germany: Development of a Typology." Clinical Social Work and Health Intervention 13, no. 5 (September 22, 2022): 26–31. http://dx.doi.org/10.22359/cswhi_13_5_05.
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Introduction. Today, most people own smartphones, which fit into their pockets and are more powerful than the first supercomputers, and which they can use to communicate, stream music or measure their pulse. There is no end in sight to this rapid technological development. This also applies to the rapidly growing volume of health-related data. Objectives: In doctor’s practices, medical data, such as medical history, blood test results and diagnostic findings, are recorded directly in the computer system. In biomedical research entire genomes, for example those of malignant tumors, are sequenced almost routinely and are also stored and processed electronically. And, more and more people are themselves using smartphone apps, wearables and in future perhaps also implanted biosensors for continuously measuring their blood pressure, blood sugar levels and pulse. Methodology: In qualitative social research, there are only a few approaches that involve a detailed explanation and systematization of the typology process. As the concept of type is of central importance for qualitative social research, it is crucial to clarify the concept and the process of typology, as presented by Kluge in her essay published in the FQM (Forum for Qualitative Social Research). In the evaluation of secondary data from the KBV (National Association of Statutory Health Insurance Physicians), the methodology of this approach is based on the procedure of typology development according to Kluge (2000), with the aim of demonstrating a systematic and transparent development of types and typologies in the digitization process.
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Mueller, Evelyn, Georg Bollig, Gerhild Becker, and Christopher Boehlke. "Lessons Learned from Introducing Last Aid Courses at a University Hospital in Germany." Healthcare 9, no. 7 (July 16, 2021): 906. http://dx.doi.org/10.3390/healthcare9070906.
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In recent years, so called “Last Aid courses”, concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care of the dying) are especially high, and may differ from the general population. To evaluate if Last Aid courses are feasible in hospital settings, and if informational needs of hospital staff are met by the curriculum, we introduced Last Aid courses at a university hospital. Five courses were offered; participants of courses 1 and 2 completed surveys with open-ended questions; the answers were used to develop the evaluation questionnaire employed in courses 3–5. In these three courses, 55 of the 56 participants completed an evaluation survey to explore their learning goals and obtain feedback. Courses were fully booked; participants were heterogeneous with regard to their professional background. The most prevalent learning goals were “preparation for emotional aspects in care of dying” (65.5% ratings “very important”), “preparation for medical/care aspects in care of dying” (60.0%), and “knowledge of supportive services and facilities” (54.5%). Overall, the evaluation showed that Last Aid courses were more suitable to educate non-medical hospital staff about care of the dying. Medical staff, in contrast to non-medical staff, more often requested courses with an extended curriculum in order to meet their learning goals. Last Aid courses were well accepted and helped to reduce information deficits on care of the dying in a heterogeneous population of hospital staff.
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Dröschel, Daniel, Stefan Walzer, and Lutz Vollmer. "Integrated Care Models in Germany – potential Market Access route for Medical Devices?" International Journal of Integrated Care 17, no. 5 (October 17, 2017): 428. http://dx.doi.org/10.5334/ijic.3748.
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GANDJOUR, AFSCHIN. "Autonomy, Coercion, and Public Healthcare Guarantees: The Uptake of Sofosbuvir in Germany." Cambridge Quarterly of Healthcare Ethics 30, no. 1 (December 29, 2020): 90–102. http://dx.doi.org/10.1017/s0963180120000596.
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AbstractHealth insurance coverage for incarcerated citizens is generally acceptable by Western standards. However, it creates internal tensions with the prevailing justifications for public healthcare. In particular, a conceptualization of medical care as a source of autonomy enhancement does not align with the decreased autonomy of incarceration and the needs-based conceptualization of medical care in cases of imprisonment; and rejecting responsibility as a criterion for assigning medical care conflicts with the use of responsibility as a criterion for assigning punishment. The recent introduction of sofosbuvir in Germany provides a particularly instructive illustration of such tensions. It requires searching for a refined reflective equilibrium regarding the scope, limits, and justifications of publicly guaranteed care.
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GIAIMO, SUSAN. "Health Care Reform in Britain and Germany: Recasting the Political Bargain with the Medical Profession." Governance 8, no. 3 (July 1995): 354–79. http://dx.doi.org/10.1111/j.1468-0491.1995.tb00215.x.
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Fryszer, Lina Ana, Melanie Büttner, Saskia Etzold, Elisabeth Muetzel, Katharina Rall, Julia Schellong, and Matthias David. "Recommendations for Care and Support of Female Rape Victims." Geburtshilfe und Frauenheilkunde 82, no. 04 (April 2022): 384–91. http://dx.doi.org/10.1055/a-1687-9584.
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Abstract Introduction According to prevalence studies, at least 5% of all women in the Federal Republic of Germany experience rape during their lifetime. While the effects vary according to the individual, rape has serious consequences for the somatic, psychological, and psychosocial health of the victim. The medical care that is provided to presumed rape victims is of special importance, as this care can have a positive influence on the patientʼs ability to process their experience and engage in healing following such a traumatic event. Furthermore, doctors are the professionals whose help is most often sought in this context. Primary care following rape consists of three aspects: the forensic medical examination, medical care, and psychological care. In this position paper, each of these aspects are discussed in detail. Recommendations for follow-up care are also provided. Methods In a multi-tiered process, a selective literature review was performed and a consensus among representative experts from different areas of specialization was formulated. Goals The goal of this paper is to contribute to the further improvement and standardization of the medical care provided to women who are presumed rape victims.
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Rolle, Udo, and Andrea Schmedding. "Decentralized Rather than Centralized Pediatric Surgery Care in Germany." European Journal of Pediatric Surgery 27, no. 05 (September 28, 2017): 399–406. http://dx.doi.org/10.1055/s-0037-1607026.
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Introduction Pediatric surgery has emerged from general surgery to take better care of the needs of surgically ill children. The development of pediatric surgery in Germany started in the early 19th century and is still ongoing. This study was performed to investigate how pediatric surgery is organized in Germany. Materials and Methods Data were obtained from the following sources: German Society, Information System of the Federal Health Monitoring, German Medical Association, Joined Federal Committee, Federal Bureau of Statistics, and Perinatal Centers. Results Pediatric surgery in Germany was started in the beginning of the 19th century. In 1962, there were approximately 20 units. The number increased to 98 in 2005 and to 129 in 2017. Presently, there are 769 pediatric surgeons registered in Germany. The current growth of pediatric surgery is attributed to a political decision of implementing centers for the care of preterm babies who need pediatric surgeons. Most work performed by pediatric surgeons in Germany can be categorized as low-risk, high-volume surgery. Currently, there is a trend of spontaneous centralization for some high-risk, low-volume pediatric surgical procedures. Conclusion Pediatric surgery in Germany shows a development toward a nearly complete coverage of the country, thus providing increasing number of children with specialist care. Rare diseases, such as in oncology or newborn surgery, are generally not centralized and rarely performed by small units. New approaches for better quality measurements may lead to centralization even without political action in the future.
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Woltanowska, Martyna, Piotr Woltanowski, Andrzej Wincewicz, and Magdalena Woltanowska. "Heritage of Stanisław Ostrowski - the only one medical doctor who became State Polish President - Patriae Semper Fidelis." Medicine and Pharmacy Reports 91, no. 1 (January 30, 2018): 129–42. http://dx.doi.org/10.15386/cjmed-883.
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Aim. Our purpose was to write a biography of Stanisław Ostrowski that would address in the first place the medical aspect of his professional life, with a comprehensive approach of others fields of his activity.Methods. We essentially grounded the paper on primary resources that were papers authored by Ostrowski including his scientific publications, memories, speeches as well as contemporaneous official documents that referred to Ostrowski. Second resources were also used to double check some data from primary resources and to place the biography of Stanisław Ostrowski in a proper background with special care to social, professional and political context. In this study, second resources comprised papers, that were prepared after the death of Stanisław Ostrowski.Results. Stanisław Ostrowski, MD was a meticulous military medical doctor with an academic engagement at the King John Casimir University of Lvov. In addition, he was an excellent organizer, who soon got involved in politics to serve the local community with essential projects in public health particularly anti-tuberculosis campaigns in Lvov district. His quiet and proficient nature made him an ideal statesman with incredible skills to reconcile social, national and political enemies. Ostrowski was elected a member of parliament three times. He also held the position of President of the city of Lvov until World War Two. During the war, he was imprisoned and deported to Siberia, Soviet Union, in years 1939-1941. Subsequently he fought against Nazi Germans in the Polish II Corps. Ostrowski survived the war providing medical service in the various military units. Afterwards, he ran his medical practice in the UK. Stanisław Ostrowski was the only dermatologist who became a state president. He held an office of state president of the Polish Republic on exile in London.Discussion and conclusion. His life is not a simple story, but a great lesson that provides clear guidelines how to find a stable ground for lifetime being a medical doctor in the turbulent times of the 20th century even during wartime.
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Thelen, Tatjana, and Carolin Leutloff-Grandits. "Self-sacrifice or natural donation? A life course perspective on grandmothering in new zagreb (Croatia) and east Berlin (Germany)." Horizontes Antropológicos 16, no. 34 (December 2010): 427–52. http://dx.doi.org/10.1590/s0104-71832010000200018.
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In this article we explore grandmaternal care and its interpretations in two European capitals of former socialist countries, Zagreb and Berlin. We describe the scope and variety of grandmaternal care practices both field sites and then contrast two grandmotherly interpretations of their intensive caring for grandchildren The different appraisal of their similar practice as self-sacrifice and natural donation respectively is embedded in different life course experiences of these two women. Both grandmothers lived in socialist states and made the experience of profound change with political and economic restructuring. But while socialist eastern Germany and Croatia had many similar traits they also differed in important aspects. While our interlocutors attributed their practice generally to post-socialist developments, they based their judgements on different aspects of state responsibility. While demographic developments might create similar opportunities for child care, national and local contexts vary and local actors attribute different meanings to their action.
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Helm, Paul C., Elisabeth J. Sticker, Roland Keuchen, Marc-André Koerten, Gerhard-Paul Diller, Oktay Tutarel, and Ulrike M. M. Bauer. "Is having a job a protective factor? Employment status and state of medical care as subjectively perceived by adults with CHD in Germany." Cardiology in the Young 27, no. 6 (November 10, 2016): 1110–17. http://dx.doi.org/10.1017/s1047951116002146.
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AbstractBackgroundMost patients born with CHD nowadays reach adulthood, and thus quality of life, life situation, and state of medical care aspects are gaining importance in the current era. The present study aimed to investigate whether patients’ assessment depends on their means of occupation. The findings are expected to be helpful in optimising care and for developing individual treatment plans.MethodsThe present study was based on an online survey conducted in cooperation with patient organisations. Participants were recruited from the database of the German National Register for Congenital Heart Defects. In total, 1828 individuals (777 males, 1051 females) took part. Participants were asked to rate aspects such their state of health on a six-tier scale (1=worst specification). Response behaviour was measured against the background of occupational details.ResultsTraining for or pursuing a profession was found to be significantly associated with participants’ rating of five of the six examined aspects (p<0.05). Sex seemed to play an important part in four of the six aspects.ConclusionsAn optimal treatment plan for adults with CHD should always consider aspects such as sex and employment status. To work out such an optimal and individual treatment plan for each adult CHD patient, an objective tool to measure patients’ actual CHD-specific knowledge precluding socially accepted response bias would be very useful.
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Khushf, George. "The Case for Managed Care: Reappraising Medical and Socio-Political Ideals." Journal of Medicine and Philosophy 24, no. 5 (October 1, 1999): 415–33. http://dx.doi.org/10.1076/jmep.24.5.415.2519.
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Berendonk, Charlotte, and Vera Caine. "Life story work with persons with dementia in nursing homes: A Grounded Theory study of the perspectives of care staff." Dementia 18, no. 1 (September 15, 2016): 282–302. http://dx.doi.org/10.1177/1471301216669236.
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In Germany, the use of life story work as an approach to care in nursing homes has not been implemented successfully. Using Grounded Theory, we explored care staff’s understandings of life story work when caring for persons with dementia. Thirty-six staff from seven nursing homes participated in semi-structured interviews or group discussions. In this paper we discuss new aspects and theoretical connections between understandings and practices of life story work. For some participants, obtaining ‘true facts’ about a resident’s course of life was considered the most important topic. Others highlighted the importance of narratives as well as embodied stories told by persons with dementia, as aspects that generated emotionally meaningful situations. Delivering sound life story work can be challenging for care staff working with persons with dementia. To enhance care in nursing homes, the importance of life story work needs to be further developed.
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Brzoska, Patrick, Odile Sauzet, Yüce Yilmaz-Aslan, Teresia Widera, and Oliver Razum. "Satisfaction with rehabilitative health care services among German and non-German nationals residing in Germany: a cross-sectional study." BMJ Open 7, no. 8 (August 2017): e015520. http://dx.doi.org/10.1136/bmjopen-2016-015520.
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ObjectivesRehabilitation following medical conditions is largely offered as in-patient service in Germany. Foreign-national residents use rehabilitative services less often than Germans and attain less favourable treatment outcomes. These differences are independent of demographic, socioeconomic and health characteristics. Satisfaction with different aspects of rehabilitative care presumably affects the effectiveness of rehabilitative services. We compared the degree of satisfaction with different domains of the rehabilitative care process between Germans and non-German nationals residing in Germany.MethodsWe used data from a cross-sectional rehabilitation patient survey annually conducted by the German Statutory Pension Insurance Scheme. The sample comprises 274 513 individuals undergoing medical rehabilitation in 642 hospitals during the years 2007–2011. Participants rated their satisfaction with different domains of rehabilitation on multi-item scales. We dichotomised each scale to low/moderate and high satisfaction. For each domain, a multilevel adjusted logistic regression analysis was conducted to examine differences in the levels of satisfaction between German and non-German nationals. Average marginal effects (AMEs) and 99.5% CI were computed as effect estimates. AMEs represent differences in the probability for the occurrence of the outcome.ResultsTurkish nationals had a higher probability for being less satisfied with most aspects of their rehabilitation, with AMEs ranging between 0.05 (99.5% CI 0.00 to 0.09) for ‘satisfaction with psychological care’ and 0.11 (99.5% CI 0.08 to 0.14) for ‘satisfaction with treatments during rehabilitation’. Patients from former Yugoslavia and from Portugal/Spain/Italy/Greece were as satisfied as Germans with most aspects of their rehabilitation.ConclusionsTurkish nationals are less satisfied with their rehabilitative care than other population groups. This may be attributable to the diversity of the population in terms of its expectations towards rehabilitation. Rehabilitative care institutions need to provide services that are sensitive to the needs of all clients. Diversity management can contribute to this process.
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Sochinskaya, M. V. "Features of health insurance: an analysis of the German experience." Collected Works of Uman National University of Horticulture 2, no. 99 (December 22, 2021): 195–203. http://dx.doi.org/10.31395/2415-8240-2021-99-2-195-203.
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The article examines the models of health insurance in Western countries. A comparative analysis of forms of social insurance and sources of financing payments for four models of medical insurance is carried out. The practical aspects of the functioning of compulsory health insurance in Germany are investigated, its positive features are revealed. Attention is paid to medical insurance, which provides insurance in case of loss of health for any reason. It provides greater accessibility, quality and completeness to meet the diverse needs of the population in the provision of medical services, and is more effective than government funding of the health care system. In addition, the social and economic efficiency of health insurance related to reimbursement of citizens' expenses related to receiving medical care, as well as other expenses aimed at maintaining health, depends on how comprehensively the concept of developing insurance medicine in the country has been worked out. The positive and negative aspects of health insurance are analyzed. The forms of health insurance are considered: compulsory health insurance and voluntary health insurance. It was found that one of the first countries where health insurance was introduced was Germany. There are two types of health insurance in Germany: public and private. Germany's state health insurance is compulsory. That is, every employee, as well as persons trained in production (Auszubildende), are subject to compulsory state health insurance and must be members of one of their freely chosen state health insurance funds. At the same time, if a person wishes to receive medical services that are not included in the list of compulsory health insurance, he can conclude a supplementary health insurance contract with the insurance company. Voluntary health insurance allows you to choose an inpatient medical institution and the conditions of stay in it, special services of a personal physician.
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Richter, J. G., G. Chehab, P. Stachwitz, J. Hagen, D. Larsen, J. Knitza, M. Schneider, A. Voormann, and C. Specker. "POS0377 ONE YEAR OF DIGITAL HEALTH APPLICATIONS (DiGA) IN GERMANY – RHEUMATOLOGISTS’ PERSPECTIVES." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 443.2–443. http://dx.doi.org/10.1136/annrheumdis-2022-eular.510.
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BackgroundBased on given legislation (§§ 33a and 139e SGB V, Social Code Book V) the German approach to digital health applications (Digitale Gesundheitsanwendungen, DiGA) allows reimbursed prescription of approved therapeutic software products (listed in the DIGA directory https://diga.bfarm.de/de/verzeichnis) for patients since October 6th, 2020.ObjectivesTo evaluate the level of knowledge on DiGA among members of the German Society for Rheumatology (DGRh) after one year of DiGA under the conditions of the COVID-19 pandemic using the DiGA Toolbox of the ‘health innovation hub’ (hih), a think tank and sparrings partner of the German Federal Ministry of Health.MethodsAnonymous cross-sectional online survey using LimeSurvey (https://limesurvey.org). The survey was promoted by newsletters sent out to DGRh newsletter recipients and Twitter posts. Ethical approval was obtained.Results75 valid participants reported that they care more than 80% of their working time for patients with rheumatic diseases. Most were working in outpatient clinics (54%) and older than 40 years of age (84%). Gender distribution was balanced (50%).70% were aware of the possibility to prescribe DiGA. Most were informed on this for the first time via trade press (63%), and only 8% via the professional society. 46% expect information on DiGA from professional societies and the medical chambers (36%) but rarely from the manufacturer (10%) and the responsible ministry (4%). Respondents would like to be informed about DIGA via continuing education events (face-to-face 76%, online 84%), trade press (86%), and manufacturers test accounts (64%).Only 7% have already prescribed a DiGA, 46% planned to do so, and 47% did not intend DiGA prescriptions. Relevant aspects for prescription are given in Figure 1.Figure 1.Aspects relevant for DiGA prescriptions; sorted by importance/number of mentions (participants needed to pick their three most relevant aspects from a pre-given list)86% believe that using DiGA / medical apps would at least partially be feasible and understandable to their patients.83% thought that data collected by the patients using DiGA or other digital solutions could at least partially influence health care positively.51% appreciated to get DiGA data directly into their patient documentation system resp. clinical electronic health record (EHR) and 29% into patients’ owned EHR.ConclusionDiGA awareness was high whereas prescription rate was low. Mostly, physician-desired aspects for DiGA prescriptions were proven efficacy and efficiency for physicians and patients, risk of adverse effects and health care costs were less important. Evaluation of patients’ barriers and needs are warranted. Our results will contribute to the implementation and dissemination of DIGA.Disclosure of InterestsJutta G. Richter: None declared, Gamal Chehab: None declared, Philipp Stachwitz: None declared, Julia Hagen: None declared, Denitza Larsen: None declared, Johannes Knitza Consultant of: Vila Health, ABATON, Medac, Matthias Schneider: None declared, Anna Voormann: None declared, Christof Specker: None declared
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Papke, Jens Hermann, Eberhard A. Lux, Kerstin Marggraf, and Ruth Fricker. "Specialized outpatient palliative care: Results from a representative survey among physicians in Germany." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 143. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.143.
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143 Background: Specialized ambulatory palliative care (SAPV) allows patients with incurable diseases and limited life expectancy to be cared for until death in their familiar surroundings. In Germany, these services must be prescribed by a physician. Little is known about structure, organization and work pattern within the SAPV teams. Methods: An online survey was carried out between Sept. 2013 and March 2014 with 124 physicians in Germany with regard to aspects related to physicians’ qualification, networks and palliative care teams. Aim of this survey was to evaluate status quo of SAPV from physicians´ viewpoint. Results: All 124 respondents were enrolled in SAPV; 18.3% of them (n=22) were on a direct contract with a health insurance provider. An additional qualification for palliative medicine and for pain therapy was reported by 96.7% and 21.5% of the physicians, respectively. In average, 11.6 physicians are organized in a SAPV-network. The networks comprise general practitioners (in 88.6% of the networks) anesthesiologists (in 62.3%), hematologists/oncologists (in 57.9%) and internists (in 43.9% of the networks) as well as a large proportion of non-medical professions such as pastors, pharmacists, social workers, psychologists and nurses. In most cases, SAPV networks are linked to one or more medical practices, hospitals or welfare institutions. 96% of the respondents assessed the cooperation within the network as “very good”/“good”. Patients admitted to SAPV were mostly suffering from cancer, but also from cardiovascular, neurological and respiratory diseases. The mean duration of care was 26.6 days; 81.4% of them could die in familiar domestic surroundings. On average, one physician is treating 9.7 SAPV-patients at the same time. Documentation requires 25.9% of time spent for medical care. Problems concerning reimbursement were reported by 75.8% of respondents. Conclusions: This survey provides the status quo of the German SAPV concept. Physicians enrolled in SAPV are highly qualified for palliative care and pain therapy. SAPV is a domain of outpatient care sector. While interdisciplinary cooperation within the SAPV networks is good, documentation and reimbursement remains a problem.
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Baldewijns, Karolien, Hans-Peter Brunner-La Rocca, Lieven de Maesschalck, Aleidis Devillé, and Josiane Boyne. "Unravelling heart failure nurses’ education: Content comparison of heart failure nurses’ education in three European Society of Cardiology states and the Heart Failure Association heart failure curriculum." European Journal of Cardiovascular Nursing 18, no. 8 (July 19, 2019): 711–19. http://dx.doi.org/10.1177/1474515119863179.
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Aims: The European Society of Cardiology (ESC) guidelines state that heart failure nurse specialists (heart-failure nurses) with specific competences are essential for a successful heart-failure-management programme. Thus, the Heart Failure Association (HFA) of the ESC developed the heart failure nurse curriculum (HFA curriculum). Several ESC member states developed cardiovascular education programmes to enable nurses to deliver high specialist care, but little is known of whether these curricula are in line with the HFA curriculum. Therefore, this paper describes the extent to which cardiovascular education programmes in Belgium, The Netherlands and Germany correspond to the HFA curriculum. Methods and results: A case study approach was adopted to obtain an in-depth understanding of the programme contents in relation to the HFA curriculum. For this purpose, representatives of the educational programmes and/or delegates of the national cardiovascular nursing organization shared their educational curricula. All of the studied cardiovascular education programmes aim to provide heart failure and/or cardiovascular nurses with essential competences for implementation of evidence based and guideline derived care. However, every cardiovascular education programme has a different focus/area of attention. Cardiovascular education in Belgium discusses aspects of all core-learning objectives of the HFA curriculum and emphasizes mostly knowledge aspects of these. Learning objectives in cardiovascular education in The Netherlands focus on chronic diseases in general and on learning objectives concerning patient education, support in self-care and management of device and pharmacological therapy. Cardiovascular education in Germany discusses most learning objectives; however, not all learning objectives receive equal attention. Conclusions: Although local cardiovascular education programmes adopt certain aspects of the HF curriculum, the curriculum as a whole is not adopted.
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Zschock, Dieter K. "Medical Care Under Social Insurance in Latin America." Latin American Research Review 21, no. 1 (1986): 99–122. http://dx.doi.org/10.1017/s0023879100021889.
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Social insurance entitlements represent one of the more controversial aspects of social sector development in Latin America. The most comprehensive critique of social security views the system's coverage and organization as a reflection of the region's social stratification (Mesa-Lago 1978). According to this view, power groups in public administration, private industry, and labor unions exercise control over the organization and financing of sickness, invalidity, and pension funds, and they seek to restrict benefits to their respective memberships. The noninsured lack market power and political organization because of their low levels of human resources development and lack of social cohesion. Mesa-Lago's critique may be more justified for the lower-income than for the higher-income countries in Latin America, however, at least regarding medical care, which is the system's largest single entitlement program in most Latin American countries.
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Black, Douglas. "Expensive Medical and Surgical Technology." International Journal of Technology Assessment in Health Care 5, no. 3 (July 1989): 308–12. http://dx.doi.org/10.1017/s0266462300007376.
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The very title - “Expensive Medical and Surgical Technology” - expresses in coded form a myth that is widely prevalent among those who consider the political and economic aspects of health care. Strangely, it is a myth that finds favor mainly at the extreme ends of the range of attitudes toward health care. Monetarists see it as an incentive toward increasing private provision of health care, while extreme egalitarians see it as another example of unjust privilege. The content of the myth is that there is a definable group of costly procedures, which can somehow be isolated from the general practice of medicine and surgery, after which such procedures can either be made the subject of special private provision or, alternatively, discarded from a rationed system of health care.
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Hornung, W. Peter, and Gerhard A. E. Rudolf. "What Provision Is Made by Practicing Physicians for Psychogeriatric Patients in Western Germany?" International Psychogeriatrics 7, no. 1 (March 1995): 105–14. http://dx.doi.org/10.1017/s104161029500189x.
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This study examined some aspects of psychogeriatric care in Münster, Germany. The diagnostic and therapeutic attitudes of 94 general practitioners/internists and neurologists/psychiatrists toward demented patients were investigated by questionnaire. This figure represents a return rate of approximately 55% on the questionnaires. As is typical in Germany, no physicians were specializing in geriatric patients, and fewer general practitioners/internists than neurologists/psychiatrists had undergone supplementary psychogeriatric training. A higher percentage of the latter group estimated more than 10% of their elderly patients were demented. Both estimated Alzheimer's disease as less frequent than multi-infarct dementia. Physicians with training in psychogeriatrics claimed to treat more elderly patients than physicians with out it. With regard to therapeutic procedure, physicians with psychogeriatric training prescribed nootropics more guardedly. The data from this pilot study suggest that there are no eminent discrepancies between the different medical groups with regard to psychogeriatric care, but there is a great need for supplementary training.
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Andreev, Dmitry A., Aleksandr A. Zavyalov, and Asan Yu Kashurnikov. "Management of the quality control and safety of medical activities in the field of «oncology» on the example of Western European countries." Health Care of the Russian Federation 64, no. 6 (December 30, 2020): 311–17. http://dx.doi.org/10.46563/0044-197x-2020-64-6-311-317.
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Introduction. Quality assurance plays a pivotal role in the health industry. The countries of Western Europe demonstrate good outcomes of cancer care. The purpose of the study. This paper focuses on various backbones of quality assurance systems in oncology in Belgium, Germany, and the Netherlands. Material and methods. Authors retrieved information from PubMed (Medline), Google, and public websites. The key phrases related to the organization of quality management systems for cancer care were used. About 40 informational sources were selected, including scientific articles and media. Discussion. All reviewed countries equipped with the quality management structures affecting such cancer care aspects as: •Creating regulatory acts and policy for next-generation healthcare in oncology; •Employing the top-qualified personnel; •Updating the clinical guidelines and improving medical processes; •Organizing the cyclical processes for monitoring the quality of cancer care and patient needs; •Implementing the innovations; •Implementing the principles of «transparency» in assessing the quality of cancer care. Conclusion. It seems logical to further study Western Europe’s experience in developing quality management systems for cancer care.
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Roemmele, Christoph, Johannes Manzeneder, Helmut Messmann, and Alanna Ebigbo. "Impact of the COVID-19 outbreak on endoscopy training in a tertiary care centre in Germany." Frontline Gastroenterology 11, no. 6 (June 10, 2020): 454–57. http://dx.doi.org/10.1136/flgastro-2020-101504.
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ObjectiveThe COVID-19 crisis has impacted on all aspects of health care including medical education and training. We describe the disruption of endoscopy training in a tertiary care center in Germany.Design/MethodThe reorganization of a high-volume endoscopy unit during the German COVID-19 outbreak is described with special focus on endoscopy trainees. Changes in case volume of gastroenterology fellows were evaluated and compared to a year prior to the outbreak.ResultsReallocation of resources led to the transfer of gastroenterology fellows to intensive care and infectious disease units. Case volume of fellows declined between January and April 2020 by up to 63%. When compared with data from the year prior to the outbreak, endoscopy performed by fellows reduced by up to 56%. Educational meetings and skill evaluation were cancelled indefinitely.ConclusionThe COVID-19 outbreak has had a negative impact on endoscopy training of gastroenterology fellows in a high-volume center in Germany. This must be taken into consideration when planning “return-strategies” after the pandemic.
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Gempt, Jens, Oliver Gautschi, Andreas Demetriades, David Netuka, Dominique Kuhlen, Karl Schaller, Florian Ringel, and Martin Stienen. "Neurosurgical Resident Training in Germany." Journal of Neurological Surgery Part A: Central European Neurosurgery 78, no. 04 (November 30, 2016): 337–43. http://dx.doi.org/10.1055/s-0036-1594012.
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Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany. Methods An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time). Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42–3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25–3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11–0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13–2.96; p = 0.015). Conclusion Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities.
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Hamowy, Ronald. "Medical Responsibility." Journal of Law, Medicine & Ethics 40, no. 3 (2012): 532–36. http://dx.doi.org/10.1111/j.1748-720x.2012.00686.x.
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These comments seek to take issue with the contention that society has a responsibility to provide its members with any needed health care. In order to deal with this claim, we must first make clear exactly what it meant by the proposition. I take it that those who embrace this view mean considerably more than that each of us has a moral obligation to contribute to those in need of medical attention who are unable, for one reason or another, to afford the necessary care. This is a moral proposition and is traditionally dealt with under the heading of charity. But the contention, as here used, means considerably more since its main implications are not moral but primarily political.
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Dräger, Dagmar, Reinhold Kreutz, Adelheid Kuhlmey, Andrea Budnick, and Dagmar Draeger. "The Pain Situation of Older Home-Care Recipients and Influencing Factors." Innovation in Aging 4, Supplement_1 (December 1, 2020): 204–5. http://dx.doi.org/10.1093/geroni/igaa057.662.
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Abstract Chronic pain is a common symptom among older people. The international prevalence rate reaches 50% for older home-care recipients (aged ≥60). The most common causes of pain among older people are degenerative arthropathy and musculoskeletal diseases. Care recipients (81% aged ≥65) constitute a specific sub-group among pain patients, due to the restrictions they experience. In Germany, the prevalence rate in this group is 70%. Currently, no comprehensive information on the pain situation of older home-care recipients exists in Germany. The findings presented are based on a cross-sectional study of older (aged ≥65) home-care recipients (SGB XI) in Berlin, with chronic pain (n=225), capable of self-report (MMST≥18). Structured interviews comprised the primary data source. The pain situation was determined using the German Brief Pain Inventory (BPI-NH). Multiple regression analysis was applied to test how the most severe pain (dependent variable) was influenced by socio-demographic and medical parameters, mental and physical restrictions and pain medication. Analyses of the pain situation show a value of M=4.81 (SD±1.88) on the BPI intensity index, and a BPI pain interference index of M=5.47 (SD±2.15). The most intense pain averaged 6.96 (SD±2.15). On average, respondents reported 16.20 (SD±13.25) pain locations (range: 0-65). The number of pain locations, alongside other factors, had a significant influence, R²=0.038 (corrected R²=0.034), F (1.219) = 8.760, p<0.01), on pain intensity. The findings show severe pain intensity among older home-care recipients not reported in previous findings (e.g. in long-term in-patient care). Action in medical care, nursing care and educational aspects is urgently needed.
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Podolskiy, Vadim A. "Social policy in Germany." Proceedings of the Southwest State University. Series: History and Law 11, no. 6 (2021): 145–55. http://dx.doi.org/10.21869/2223-1501-2021-11-6-145-155.
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Relevance. German social policy solutions became an example for imitation for other countries, including Russia, and are usually considered to be a standard due to their coverage and efficiency. Studying the German experience is valuable for development of the political science and for reforming the social policy systems. Purpose – to describe the origins and implementation of the social state in Germany. Objectives: to present the development and functioning of the pension and medical insurance systems, unem-ployment insurance and measures of the public social support. Methodology: comparative and historical approach, analysis of legal documents and institutions. Results. The foundations of the social assistance in Germany were created in the end of the XIX century and the beginning of the XX century, with introduction of programs of insurance funding for medical expenses and old-age and disability pensions, followed by unemployment insurance. The system operates for more than a century and effectively accomplishes the task of risk pooling, and it mainly relies on self-government. In the second half of the XX century the law that regulated the social assistance in Germany was extended significantly, the burden on the budget increased, as well as size of the insurance contributions. Citizens obtained the right for family benefits, the role of the housing benefits, unemployment and low-income support was increased. In the end of the XX century Germany introduced insurance to fund the long-term care. Conclusion. A developed system of social support exists in Germany, it relies on centuries-old traditions of local and corporative mutual help, with coordination and subsidies coming from the federal centre. The most powerful elements of the German social policy, which secure its’ efficiency, are historically established self-government and soli-darity
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Baecker, Daniel, Do Thi Mai Dung, Hai Pham-The, and Nguyen Hai-Nam. "Comparison of the University Pharmacy Education Programs in Germany and Vietnam." Pharmacy 10, no. 6 (November 2, 2022): 146. http://dx.doi.org/10.3390/pharmacy10060146.
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During the global COVID pandemic, the importance of professionals in the health care sector has been put in a new light, including pharmacists. In this context, the focus is also on how pharmacists are trained in different countries. Through an exchange of pharmacy teaching staff from a German to a Vietnamese university, the pharmacy education programs in both countries were compared. Aspects such as access to studies, structure of studies, and further training opportunities were considered. Differences and similarities emerged. In both countries, students first acquire basic knowledge and then delve deeper into pharmaceutical content in main studies. There is, expectedly, a great overlap in the content of the courses. Overall, the education at Vietnamese universities seems to be more practice-oriented due to a large number of placements. This also allows a specialization, which can be pursued in Germany with self-interest after graduation. There, the preparation for everyday work in the community pharmacy is separated from the university by a mandatory practical year. For the future, efforts are being made in both countries to strengthen the importance of clinical pharmacy in the curriculum. To this end, the Vietnamese are taking their inspiration from abroad in many cases, including Germany.
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Kurniawan, I. Gede Agus. "The Reconstruction of Subjectum Litis in Term of Reflections on Constitutional Dissolution of Political Parties." Jurnal Akta 9, no. 1 (April 26, 2022): 104. http://dx.doi.org/10.30659/akta.v9i1.20970.
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This legal research aims to examine the awarding of political parties currently in force in Indonesia through the Constitutional Court and provide a conclusive elaboration on the comparison of the dissolution of political parties in Indonesia with Germany and Slovenia. The respect for all aspects of human rights has become the obligation of every people in citizen, including respect for the political rights of citizens. In addition, citizens have the right to participate in the dynamics of government, including the possibility of the public applying for the dissolution of political parties. This legal research statute approach, comparative approach, and conceptual approach to legislation were based on primary legal materials, secondary legal materials, and non-legal materials. The study results stated that the Subjectum Litis to the dissolution of political parties was only carried out by executive relations alone; so the public cannot apply for dissolution of political parties. Thus, this may indicate that arbitrariness also reflects the existence of particular political interests that dominate the executive's domination and try to intervene in the juridical aspect. Therefore, the researcher provides recommendations for reconstructing political subjects through various schemes; who can expand the applicant in the process of political dissolution, the applicant in the dissolution of a political party is only extended to all Indonesian people not for their official or position, and the applicant for political dissolution is carried out by the legislative and executive institutions as is practiced in Germany and Slovenia.
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Gillissen, Adrian, Tonja Kochanek, Michaela Zupanic, and Jan Ehlers. "Medical Students’ Perceptions towards Digitization and Artificial Intelligence: A Mixed-Methods Study." Healthcare 10, no. 4 (April 13, 2022): 723. http://dx.doi.org/10.3390/healthcare10040723.
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Digital technologies in health care, including artificial intelligence (AI) and robotics, constantly increase. The aim of this study was to explore attitudes of 2020 medical students’ generation towards various aspects of eHealth technologies with the focus on AI using an exploratory sequential mixed-method analysis. Data from semi-structured interviews with 28 students from five medical faculties were used to construct an online survey send to about 80,000 medical students in Germany. Most students expressed positive attitudes towards digital applications in medicine. Students with a problem-based curriculum (PBC) in contrast to those with a science-based curriculum (SBC) and male undergraduate students think that AI solutions result in better diagnosis than those from physicians (p < 0.001). Male undergraduate students had the most positive view of AI (p < 0.002). Around 38% of the students felt ill-prepared and could not answer AI-related questions because digitization in medicine and AI are not a formal part of the medical curriculum. AI rating regarding the usefulness in diagnostics differed significantly between groups. Higher emphasis in medical curriculum of digital solutions in patient care is postulated.
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Tullo, Ellen StClair, Tony Johnstone Young, and Richard Philip Lee. "Medical students’ views about person-centred communication in dementia care." Dementia 17, no. 5 (May 28, 2016): 573–84. http://dx.doi.org/10.1177/1471301216651981.
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Adopting principles of person-centred communication has been highlighted as one strategy to improve care of people living with dementia (PLWD) in health and social care settings. However, person-centred communication is interpreted and applied variably in different settings, and healthcare professionals’ views about communicating with PLWD are under-explored. This study aimed to investigate medical students’ views about the principles and applicability of a model of person centred communication – the Dementia Model of Effective Communication (DeMEC) – to clinical practice. Quantitative and qualitative data was collected using questionnaires ( n = 531), focus groups ( n = 21) and interviews ( n = 10). Students generally endorsed the person-centred approach to communication, but two aspects were highlighted as complex and divisive – the acceptability or otherwise of lying, and of communicating with family in advance of the PLWD. We discuss the nature of these communicative dilemmas, implications for the education and training of medical students, and future directions for research.
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Scholten, Nadine, Charlotte Leisse, Vanessa Brandes, Charlotte Oberröhrmann, Peter Ihle, Sophie Peter, Anna Hagemeier, et al. "Outpatient parenteral antimicrobial therapy in Germany: a prospective cohort study protocol." BMJ Open 12, no. 11 (November 2022): e061417. http://dx.doi.org/10.1136/bmjopen-2022-061417.
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IntroductionOutpatient parenteral antimicrobial therapy (OPAT) means intravenous administration of antibiotics outside the hospital. The antibiotics are administered at the patient’s home. The advantages are the shortening of the inpatient stay, which means that patients can remain in their familiar environment, the reduction of nosocomial infections as well as the reduction of hospital and therapy costs. Nevertheless, OPAT is rarely performed in Germany, despite its international application. Therefore, systematic data on OPAT are not available in Germany. The project objective is to investigate the medical care using OPAT under medical, epidemiological and economic aspects within the framework of the Cologne Network of Infectious Diseases.Methods and analysisObservational study with mixed-methods approach, qualitative analysis to identify physician-side factors to assess the attitude of general practitioners in Cologne with regard to possible implementation barriers of an OPAT. Longitudinal analysis of an OPAT patient cohort with respect to clinical and patient-relevant outcomes using descriptive and conclusive statistics.Ethics and disseminationThe study has been approved by the Institutional Review Board of the University of Cologne, Germany (19-1284-1). Written informed consent was obtained from all participants. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registration numberNCT04002453.
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Paal, Piret, Anne Müller, Woukelyne Gil, Gil Goldzweig, and Frank Elsner. "Nurturing Socioculturally and Medically Appropriate Palliative Care Delivery: Lessons Learned by Israeli Medical Faculty." Journal of Religion and Health 61, no. 2 (March 9, 2022): 1469–89. http://dx.doi.org/10.1007/s10943-022-01522-8.
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AbstractIsrael is one of the few countries worldwide with a national policy and defined standards of palliative care (PC); its culture is highly diverse and more traditionally oriented in comparison with Western countries. This study describes the current state of PC in Israel through examination of: (1) its current status, self-image and structural factors; (2) its relation to cultural and political characteristics; and (3) the chances, goals and obstacles of advancing PC in Israel. Face-to-face interviews were conducted at all five public medical faculties in Israel from November 2017 to February 2018. The following findings are reported: (1) definition of palliative care, (2) multidisciplinary approach, (3) special role of nurses, (4) personal perceptions of death, (5) understanding the role of medicine, (6) specialty palliative medicine, (7) religious, spiritual and cultural aspects, (8) political and economic aspects, (9) obstacles and weaknesses, and (10) prospects and goals of palliative care. Participants perceive PC as an integrative healthcare service that should be available to all patients, including children and their families, at any stage of illness. They internalize that PC principles apply regardless of ethnic, cultural, and religious background. Utilizing nurses’ leadership, enhancing multidisciplinary teamwork, and person-centered approach, supports better PC to more people.
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Eisen, Peter. "Potential for Psychiatric Leadership in Health Care." Australian & New Zealand Journal of Psychiatry 20, no. 2 (June 1986): 107–11. http://dx.doi.org/10.3109/00048678609161323.
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Some individual Australian psychiatrists have held influential positions in the administration of health care, academic institutions and medical research. It is timely to assess whether individual or group action best meets psychiatry's professional and service needs. Through an exploration of aspects of professionalism, power, leadership, change in the nature and control of health care, and psychiatry's political roles, a case is made for corporate action aimed at psychiatry establishing leadership roles in Australian health care.
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Kertzscher, Lisa, Sabrina Baldofski, Elisabeth Kohls, Georg Schomerus, and Christine Rummel-Kluge. "Stable through the COVID-19 pandemic: Results from a longitudinal telephone interview study in psychiatric outpatients." PLOS ONE 17, no. 11 (November 3, 2022): e0276982. http://dx.doi.org/10.1371/journal.pone.0276982.
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Background The COVID-19 pandemic was associated with far-reaching changes all over the world. Health care systems were and are also affected. Little is known about the impact of these changes and the duration of the pandemic on people with mental disorders. The aim of this longitudinal follow-up study was to investigate the mental health status, medical care provision, and attitudes towards the pandemic of these people at the end of the second pandemic lockdown in Germany in 2021, and to compare these findings with the results of 2020. Methods People with mental disorders currently receiving treatment in the psychiatric outpatient department of the University Hospital Leipzig, Germany, were asked about depressive symptoms (PHQ-9), self-reported medical care provision, attitudes and social and emotional aspects of the pandemic (social support [ESSI], perceived stress [PSS-4], loneliness [UCLA-3-LS], and resilience [BRS]) using structured telephone interviews. Results In total, N = 75 participants who had already participated in the first survey in 2020 took part in the follow-up telephone interviews. The most frequent clinician-rated diagnoses were attention deficit disorder/attention deficit hyperactivity disorder (n = 21; 28.0%) and obsessive-compulsive disorder (n = 16; 21.3%). In comparison to 2020, a significantly higher proportion of participants reported no problems in receiving medical care provision. Compared to the previous year, the resilience of the participants had significantly decreased. Depressive symptoms, social support, perceived stress, and loneliness remained stable. Significantly more participants felt restricted by the pandemic-related government measures in 2021 than in 2020. Conclusions This study highlights the importance for continued efforts to maintain stable medical care provision for people with mental disorders during the COVID-19 pandemic, as except for a decrease in resilience, mental health status remained stable. Nonetheless there is still a need for continued treatment to stabilise and improve this status.
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Falkenstein, Lina, Nathalie Eckel, Simone B. Kadel, Jochem Koenig, David Litaker, and Michael Eichinger. "Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study." BMJ Open 12, no. 10 (October 2022): e054054. http://dx.doi.org/10.1136/bmjopen-2021-054054.
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IntroductionPublic health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators.Methods and analysisThe study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage.Ethics and disseminationThe study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020–650N). Study results will be published in journals with external peer-review.
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Perleth, Matthias, Bernhard Gibis, and Britta Göhlen. "A short history of health technology assessment in Germany." International Journal of Technology Assessment in Health Care 25, S1 (July 2009): 112–19. http://dx.doi.org/10.1017/s0266462309090515.
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Objectives: To provide an overview of the development of health technology assessment (HTA) in Germany since the 1990s.Methods: Analysis of key documents (e.g. literature, laws, and other official documentation) and personal experiences.Results: Health technology assessment (HTA) entered the political agenda in Germany only in the mid-1990s, basically as the result of a top-down approach toward more efficiency in health care, but with a strong impetus of an evidence-based medicine movement. Accordingly, HTA became part of several healthcare reform laws since 1997, which led to the establishment of the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWiG) in 2004. This tandem construction aims at using evidence in decision-making processes for coverage and other decisions.Conclusions: These developments have led to a considerable impact of HTA in Germany. In addition, a broad spectrum of activities at universities and in other organizations, such as the German Institute for Medical Documentation and Information (DIMDI), can be observed that contribute to both teaching and research in HTA. German researchers in the field of HTA are actively involved in international projects, such as EUNetHTA, and contribute to scientific conferences and journals.
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Hofmeister, Stephan. "HEALTH SYSTEMS ISSUES IN GERMANY RELEVANT TO WELL-BEING AND BURN-OUT." International Journal of Person Centered Medicine 9, no. 2 (April 7, 2021): 57–63. http://dx.doi.org/10.5750/ijpcm.v9i2.970.
Full textAbstract:
Background: The German ambulatory care sector is mainly sustained by more
than 177 000 statutory health insurance physicians and psychotherapists. They
provide approximately 650 million high quality treatments per year (versus around
20 million treatments in hospitals) including ambulatory emergency care around
the clock. The system is based on self-employment with doctors and psychotherapists
running their own practices. They are organized within a system of self-government
on a regional and a national level. Satisfaction with working conditions and income
is high.
Objectives: This article considers the difference between employed and selfemployed
doctors as the main key to understanding reasons by which employed
doctors are prone to a higher risk of suffering from burn-out than self-employed
doctors. It further describes how working conditions are changing and which
challenges arise for doctors both in the ambulatory sector and in hospitals.
Method: In addressing these objectives, this article considers databases and several
surveys performed by the Kassenärztliche Bundesvereinigung and German health
profession organizations.
Results and Discussion: Owing to several factors, the number of employed doctors
in the ambulatory care sector is rising. As for employed physicians in the hospital
sector, the employed doctors in the ambulatory care sector show significantly
lower satisfaction rates with their working conditions. This group is at higher risk
of experiencing burn-out or at least limited well-being within their professional
lives.
Conclusion: To prevent doctors in the ambulatory care sector from suffering
burn-out it is important to reinforce the principles of self-employment within
owner-run practice structures. It is also important to improve the efficiency of
doctoral working hours by reducing the currently expanding bureaucracy and by
cautiously considering the appointment of non-medical professionals that operate
under strict guidance of doctors in addressing aspects of ambulatory care that
would be suitable for this task-shifting. It is also essential to improve and
implement e-health technologies, and for instance facilitate remote treatment in
rural areas.
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Sichert, Markus, and Christina Walser. "The Management of Chronic Diseases in the Netherlands and in Germany." European Journal of Social Security 9, no. 3 (September 2007): 243–75. http://dx.doi.org/10.1177/138826270700900303.
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Chronic diseases pose significant challenges to health insurance systems. On the one hand, the supply of medical care to patients suffering from chronic diseases is very costly; on the other hand, more and more people are becoming chronically ill, and many of them suffer from diabetes. Against this background, steering mechanisms that address chronic disease management are needed, not only to cope with cost containment, but also to improve quality and to overcome obstructive interfaces of supply structures. This article analyses how these challenges are being dealt with and how the respective chronic diseases – the focus will be on diabetes – are managed in the Netherlands and in Germany. The approaches taken in each of these countries present examples of how structures for political and legal steering have been established within health care systems that are subject to frequent reform. Each approach is assessed by analysing the priority given to either regulatory or competitive elements, and particular reference will be made to (subordinated) implementation structures, contracts or models.
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Werner, Anne, Maria Popp, Falk Fichtner, Christopher Holzmann-Littig, Peter Kranke, Anke Steckelberg, Julia Lühnen, et al. "COVID-19 Intensive Care—Evaluation of Public Information Sources and Current Standards of Care in German Intensive Care Units: A Cross Sectional Online Survey on Intensive Care Staff in Germany." Healthcare 10, no. 7 (July 15, 2022): 1315. http://dx.doi.org/10.3390/healthcare10071315.
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Backround: In February 2021, the first formal evidence and consensus-based (S3) guidelines for the inpatient treatment of patients with COVID-19 were published in Germany and have been updated twice during 2021. The aim of the present study is to re-evaluate the dissemination pathways and strategies for ICU staff (first evaluation in December 2020 when previous versions of consensus-based guidelines (S2k) were published) and question selected aspects of guideline adherence of standard care for patients with COVID-19 in the ICU. Methods: We conducted an anonymous online survey among German intensive care staff from 11 October 2021 to 11 November 2021. We distributed the survey via e-mail in intensive care facilities and requested redirection to additional intensive care staff (snowball sampling). Results: There was a difference between the professional groups in the number, selection and qualitative assessment of information sources about COVID-19. Standard operating procedures were most frequently used by all occupational groups and received a high quality rating. Physicians preferred sources for active information search (e.g., medical journals), while nurses predominantly used passive consumable sources (e.g., every-day media). Despite differences in usage behaviour, the sources were rated similarly in terms of the quality of the information on COVID-19. The trusted organizations have not changed over time. The use of guidelines was frequently stated and highly recommended. The majority of the participants reported guideline-compliant treatment. Nevertheless, there were certain variations in the use of medication as well as the criteria chosen for discontinuing non-invasive ventilation (NIV) compared to guideline recommendations. Conclusions: An adequate external source of information for nursing staff is lacking, the usual sources of physicians are only appropriate for the minority of nursing staff. The self-reported use of guidelines is high.
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Ernstmann, Nicole, Anna Enders, Sarah Halbach, Hannah Nakata, Christina Kehrer, Holger Pfaff, and Franziska Geiser. "Psycho-oncology care in breast cancer centres: a nationwide survey." BMJ Supportive & Palliative Care 10, no. 4 (April 13, 2019): e36-e36. http://dx.doi.org/10.1136/bmjspcare-2018-001704.
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ObjectiveTo describe psycho-oncological care structures and processes in German breast cancer centres from the perspective of the centre administration.MethodsThe findings are based on a postal survey of a representative random sample of surgical sites of certified breast cancer centres in Germany. Data were collected in 2013 and 2014. The questionnaire included questions about infrastructure, patient information standards, psycho-oncological services and aspects of organisational culture. Data analyses included frequencies, means and bivariate relationships.ResultsThe return rate was 88.3% (53 hospital sites). Psycho-oncological care is provided by permanent employees in 87%. The average number of full-time-equivalent employees (FTE) is 1.23. Most breast cancer centres engage the occupational group of psycho-oncologists for psycho-oncological care (90%), followed by the medical service (80%) and breast care nurses (78%) (multiple answers were possible). The correlation coefficient between FTEs and surgical treatments per year is not significant (r=0.292, p=0.051). Hospitals are screening every inpatient for the need of psycho-oncological support in 76% of all sites. Frequently used screening instruments are distress thermometer (19%), clinical interview (13%) and basic psycho-oncological documentation (11%).ConclusionOur data provide insights into the self-reported structural and procedural quality of psycho-oncological care in German breast cancer centres. Further research should examine patient and caregiver perspective on the psycho-oncological services provided by breast cancer centres.
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Brönneke, Jan Benedikt, Jennifer Müller, Konstantinos Mouratis, Julia Hagen, and Ariel Dora Stern. "Regulatory, Legal, and Market Aspects of Smart Wearables for Cardiac Monitoring." Sensors 21, no. 14 (July 20, 2021): 4937. http://dx.doi.org/10.3390/s21144937.
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In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access are often evolving slowly, sometimes creating market barriers. This article gives a brief overview of the existing clinical studies regarding the use of smart wearables in cardiac monitoring and provides insight into the main regulatory and legal aspects that need to be considered when such products are intended to be used in a health care setting. Based on this brief overview, the article elaborates on the specific requirements in the main areas of authorization/certification and reimbursement/compensation, as well as data protection and data security. Three case studies are presented as examples of specific market access procedures: the USA, Germany, and Belgium. This article concludes that, despite the differences in specific requirements, market access pathways in most countries are characterized by a number of similarities, which should be considered early on in product development. The article also elaborates on how regulatory and legal requirements are currently being adapted for digitally driven wearables and proposes an ongoing evolution of these requirements to facilitate market access for beneficial medical technology in the future.
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Cattapan, Alana. "Medical Necessity and the Public Funding of In Vitro Fertilization in Ontario." Canadian Journal of Political Science 53, no. 1 (October 24, 2019): 61–77. http://dx.doi.org/10.1017/s000842391900074x.
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AbstractThe recognition of a health care service as medically necessary under the Canada Health Act is contingent on a variety of practical and political factors. This article examines how in vitro fertilization (IVF) came to be understood as a medically necessary service in Ontario, focusing on the establishment of public funding for one cycle of treatment. The article argues that the legitimacy of medical necessity in the contemporary period is tied to three interrelated factors: the recognition of a service as sufficiently “medical,” as efficient and as urgent—that is, something to be funded now and not later. By applying this framework to the case of IVF in Ontario, the article demonstrates not only the ongoing malleability of medical necessity but also how the government of Ontario has mobilized the three aspects of medical necessity to make a case for the public funding of a highly contested health care service.
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Debus, Eike Sebastian, Dorothee Van Moreau, Dorothee Van Moreau, Karin Holzwarth, David Baaß, and Ralph Spintge. "Where music meets medicine:." Music and Medicine 14, no. 4 (October 30, 2022): 261–65. http://dx.doi.org/10.47513/mmd.v14i4.897.
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The first Science and Sounds conference in Germany took place in early September 2022. Attendees were provided with an overview of standards and significant results of scientific research on the use of music as therapeutic intervention in medical settings. An international faculty of experts from USA, Finland, and Europe presented a scientific program ranging from definitions in MusicMedicine and Music Therapy, latest results from brain research about important impacts of musical stimuli on neuronal networks -explaining therapeutic results as well as directions for occupational care for musicians. General aspects and global developments in furthering implementation of interdisciplinary approaches in research and application including enhancement of professional environment in health care institutions were discussed and practically demonstrated during clinical excursions to UKE facilities. This article will provide an overview of the conference and will highlight our opening of the new Centre.
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Jahn, Rosa, Louise Biddle, Sandra Ziegler, Stefan Nöst, and Kayvan Bozorgmehr. "Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers." BMJ Open 12, no. 11 (November 2022): e063012. http://dx.doi.org/10.1136/bmjopen-2022-063012.
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ObjectivesIn many high-income countries, structural, legal, social and political barriers to adequate healthcare interfere with the ability of health professionals to respond to the healthcare needs of a fluctuating and superdiverse population of asylum seekers. However, the relationship between individual, interpersonal and structural factors is not well understood. We explore the views and experiences of physicians working with asylum seekers in Germany and aim to identify how these may impact the provision of medical care.MethodsA secondary analysis of 16 semistructured interviews conducted in two qualitative studies was performed. These explored the delivery of medical care to asylum seekers in Germany. In order to examine physicians’ views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal relationships, workplace factors, the external environment, the physician’s own self and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix.ResultsPhysicians perceive the provision of medical care to asylum seekers as ‘different’. This ‘difference’ is conceptualised at three levels: patients’ perceived cultural attributes, the workplace or contextual level. Evaluative judgements on patients perceived as ‘other’ and the difference of the space of care provision were found to impede appropriate care, while physicians emphasising contextual factors reported more responsive medical practices.ConclusionsConcepts of difference at patient level resemble processes of ‘othering’ asylum seekers as a ‘different patient group’, while differences in rules, norms and practices in settings of medical care to asylum seekers create heterotopic spaces. Both appear to endanger the doctor–patient relationship and responsiveness of care, while an understanding of differences attributed to context seemed to foster a more caring approach. Training in contextual competence, sufficient physical and human resources and encouraging support between physicians working with asylum-seeking patients could counteract these processes.
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Nowicka, Magdalena. "State of normality: Transnational migrants’ shifting views of state institutions and their obligations." Journal of Sociology 57, no. 1 (February 15, 2021): 77–93. http://dx.doi.org/10.1177/1440783321991239.
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The power of nationalism is evident in how people perceive the world around them as ‘normal’. A national normality is constituted through education and media but also in everyday encounters with the state or state-regulated institutions in the fields of education, welfare provisions, medical care, finance and others. When people migrate between countries, their sense of ‘normality’ can become disturbed. Migration might impact how people think of their relationship to the state and its institutions. This article is based on analysis of 120 interviews with Polish migrants in the UK and Germany. It asks if migration creates a ‘post-national situation’ in which national categories are questioned and negotiated anew. The contexts of Poland, which is undergoing a return to conservative national identity, the UK and its struggle over Brexit, and Germany in its claim to European leadership, provide an instructive case for the discussion of intersections between nationalism and post-nationalism.