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The symposium “Endpoints in Oncology: Impulses for Future Clinical Research and Benefit Assessment” took place for the fourth time. According to Wolfgang van den Bergh, editor-in-chief of the Ärzte Zeitung and director of news and politics at Springer Medizin - the organizer of the symposium - “to provide impulses and keep the discussion going” was and is the goal of the professional meeting sponsored by Pfizer and MSD Berlin. Not only were new findings discussed in the context of the endpoint discussion, but this year it was made particularly clear how far apart the perspectives of the individual and the system are, perhaps even further than ever.
04.06.2018
Where do individual European countries stand when it comes to implementing a patient record (ePA)? The Institute for Applied Health Services Research (inav) investigated this question on behalf of the Münch Foundation. In the publication “European Scorecard on the status of the implementation of electronic patient records at national level / First Update 2018” it is once again clear: Germany is doing poorly with regard to the ePA - in contrast to the Scandinavian countries.
04.06.2018
In retail research, spatial interaction models have been used for decades to estimate and analyze customer inflows, including in the area of local supply in the food trade, which is closely related to healthcare (Wieland 2011, 2015a). These models have now also found their way into regional health services research (Bauer/Groneberg 2016, Fülop et al. 2011, Jia et al. 2015). Before the exemplary application of spatial interaction models takes place, some general considerations must first be made about the usefulness of their use.
04.06.2018
In the healthcare system, users are increasingly required to be able to find, understand, assess and apply health information to their own situation in order to make decisions, for example, about the treatment and care of illnesses or the recovery and maintenance of health. The knowledge, motivation and skills to deal with health-related information are referred to by experts as health literacy (Sørensen et al. 2012). Health literacy is the interaction of personal abilities and the requirements and complexity of situations and systems in which people move (Schaeffer et al. 2018). But people often face difficulties in dealing with health information.
04.06.2018
Dementia is a chronic disease that affects between 5 % and 7 % of people aged 60 years and over [1]. The number of people suffering from dementia is expected to rise to 66 million worldwide by 2030 and to 115 million by 2050. In Germany the prevalence is very high with over a million people suffering from dementia [2]. Since dementia is associated with poor quality of life [3] and psychiatric disorders (e.g. depression and anxiety) [4,5], there is a need for better prevention, diagnosis, treatment and management measures regarding this neurodegenerative disease.
04.06.2018
Delivering bad news poses a special challenge for every doctor. We would like to argue pointedly that a doctor who has mastered the diagnosis and treatment of illnesses but is not able to convey his sympathy and offer of support to the patient is one not fulfilling a significant part of his professional duties. The reality of everyday medical practice and clinic shows, however, that the doctor can hardly find the time required to let the person seeking help speak out and to translate the patient's problem into a billable format. This medical limitation is all the more critical given that numerous studies have shown that professional doctor-patient communication has a positive effect on the success of care (1,2). Placebo research also shows that everything the doctor does in interaction with the patient has a therapeutic effect, including communication in particular (3). The “perception of life-changing diagnoses by patients and their relatives” has rarely been examined through surveys. For them, the transmission of bad news is an exceptional psychological situation that requires special attention and mindfulness (3, 4). One of the first surveys on the subject was conducted among Iranian nurses, which also included the transmission of cancer diagnoses (5). With the present survey we want to show that ultimately the perception of the conversation by the patient and/or his relatives and not the conversation itself should be the indicator for the value of the conversation.
04.06.2018
The most comprehensive study on the prevalence of COPD to date is the international Burden of Obstructive Lung Disease (BOLD) study (Buist & McBurnie, 2007). In Germany, the Hanover region took part in this work. The lung function was examined in 683 volunteers over the age of 40 and a survey was carried out as to their state of health. Overall, more than 13 percent of the study participants in the Hanover area were diagnosed with COPD, a good 7 percent had a mild, 5 percent a moderate and almost 1 percent a severe disease stage. Since the test subjects came from the Hanover metropolitan region, it cannot be said with certainty whether the numbers are representative for the whole of Germany. However, the overall evaluation of the BOLD study suggests this. According to this, every tenth of the more than 9,000 study participants in the twelve countries involved suffers from chronic obstructive pulmonary disease in stage II or higher. The current figures on the development of COPD in Germany were based on 6.8 million COPD cases in 2010. By 2030, the number of people affected is expected to rise to 7.9 million. (Geldmacher & Biller, 2008). COPD is also important from an economic perspective. One study determined the total costs of COPD by weighting the costs per level of severity. The main part of the costs is caused by hospital stays (26%), medications (23%) and early retirement (17%). (Herse & Kiljander, 2015); (Grønseth & S.-A., 2014); (Nowak & Dietrich, 2004). Early detection of COPD is of great importance, as timely cessation of exposure to the triggering noxa can at least partially prevent disease progression. (Vogelmeier & Buhl, 2018). There is also evidence that the natural course of the disease can be significantly influenced by the early onset of drug treatment. (Troosters & Celli, 2010).
04.06.2018
Economic aspects of health care have become significantly more important in the last 20 years and justify the introduction of health economics into the training of medical students. That is why the cross-sectional area Q3 “Health Economics / Health System / Public Health” was anchored in the medical licensing regulations in 2002. The design of the topics and the form of teaching was left to the institutes offering them, so that the theoretical content and the time scope of these lessons are not uniformly defined. The subject is not tied to any specific institute and is therefore shaped in Germany from the perspectives of different academic sub-fields. This results in major differences in the teaching offerings. The “Health System” and “Public Health Care” sub-areas of Q3 result from existing care structures, while the “Health Economics” sub-area has so far only existed as a discipline in economics. In addition to the 21 compulsory subjects, the medical course includes 14 cross-sectional subjects (e.g. Q1: epidemiology/medical biometry/medical informatics, Q7: medicine of aging and the elderly, Q14: palliative medicine) as well as block internships and elective subjects.
04.06.2018
Of all the discussions about “Big Data”, we are only interested in a small excerpt here: the ideas that have been made explicit on this topic in German health research or that have implicitly influenced the discussion. It is important to examine this section in more detail because biomedical research worldwide is in the process of significantly expanding its range of instruments. Unfortunately, the term “big data” does little to help us understand this process – on the contrary. It is about the historically unprecedented opportunity to observe large numbers of people with regard to the natural development of their health and to study the application and impact of interventions available on a mass scale. This approach has potential that has not yet been realized. The question of what access Germany will find to this development arises precisely from this perspective.
04.06.2018
The term delirium describes an etiologically unspecific organic brain syndrome that is characterized by simultaneous disorders of consciousness and attention, perception, thinking, memory, psychomotor skills, emotionality and the sleep-wake rhythm. The duration and severity can vary greatly [Dilling H et al., 2014]. Delirious syndromes are a common complication in the inpatient treatment of elderly patients. While delirious syndromes with a prevalence of 1-2 % were rarely found in outpatients over 65 years of age (Lange et al., 2013; Davies et al., 2013), there were sometimes very high prevalence rates of up to 70% in nursing homes (between 1.4% and 70.3%) and up to 82% in hospitals (between 7% and 82%) (Inouye et al., 2014, Lange et al., 2013). The wide range of these findings depends primarily on the diagnostic criteria used, the age of the patient and the dementia rate. In general, delirium is associated with increased length of stay, increased care needs, increased institutionalization, and ultimately increased mortality rates (Inouye et al., 2014; Pendleburry et al., 2015). It is known that delirium often goes undetected in both inpatient and outpatient settings (Lange de, et al. 2013, Jenkin et al., 2016). Therefore, identifying risk factors is particularly important in order to initiate preventative measures as early as possible (e.g., Kratz et al., 2015; Pendlebury et al., 2017). This applies in particular to preventive diagnostic instruments, such as those used, for example. B. were introduced for delirium in dementia (Richardson et al., 2017). However, there is little information on the prevalence and risk factors of delirium in the outpatient care sector (Lixouriotis et al., 2011; Lange et al., 2013). The aim of this study was therefore to determine the prevalence of documented delirium diagnoses in a large sample of patients in German general practices and to investigate whether risk factors that make the occurrence of delirium more likely can be identified.