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As part of the 1st Northeast Children's Report of the Northeast Health Sciences Institute of the AOK Nordost, the development of antibiotic use in the pediatric setting was also examined (Witte et al. 2017). In general usage and also in the clinical context, antibiotics refer to active ingredients that inhibit the growth of bacteria or kill them. Due to decades of excessive and untargeted use of antibiotics, the increase in insensitivity of bacterial pathogens has developed into a significant public health problem worldwide. Patients and doctors are increasingly confronted with bacterial strains that are resistant to many common antibiotic agents (WHO 2011). As a result of the increase in so-called multi-resistant pathogens, the duration of treatment, the severity of the disease and the risk of death from serious infections are increasing. The same applies to the resulting costs of appropriate medical care (Aloush et al. 2006; Maragakis et al. 2008; Song et al. 2003; Qavi et al. 2005).
06.12.2017
Germany has a care problem. What has long remained in the silence of the daily struggle of nurses to somehow provide adequate care for their patients is now reaching the public and is being taken up prominently in the political process. For example, the EU-funded RN4CAST study, which was carried out from 2009 to 2011, provided objective evidence of the “nursing crisis”1: while in the USA a nurse cared for an average of 5.3 patients in a hospital and in Norway for 3.4 to While 8.2 patients were responsible, the care ratio in Germany was between 7.5 and 19.2. This means that the best facilities in Germany were only slightly better than the worst in Norway. Germany is therefore at the bottom of all countries considered.
06.12.2017
There has been a clear volume dynamic on the German pharmaceutical market for several years [1]. In addition, factors such as demographic change, medical-technical progress and the increase in outpatient therapy options lead to increasing pharmaceutical expenditure [2]. The legislature took up this progressive development by introducing the Medicines Market Reorganization Act (AMNOG) in 2011. Since then, new medications have been evaluated for their additional benefits. It turns out that a large number of new pharmaceutical products continue to come onto the German market, the additional benefit of which often cannot be proven or for which only a small additional benefit has been identified [3]. In addition, in the period from 2013 to the beginning of 2014, drugs that had already been approved were assessed as part of the AMNOG with regard to their additional benefit (so-called existing market call).1 The only group of active ingredients whose process was completed include the DPP-4 inhibitors (also gliptins).
06.12.2017
Psychogenic eating disorders include various types of eating disorders that differ in their symptoms. Psychogenic eating disorders include anorexia nervosa (AN), also known as “anorexia”. In addition to bulimia nervosa (BN), also known as “bulimia” or “eating addiction”, and binge eating disorder (BES, also “eating addiction”), AN is one of the most researched forms of eating disorders. Depending on the type of eating disorder, different symptoms are characteristic of psychogenic eating disorders (DGPM/DKPM 2010). The risk of chronicity in eating disorders is high. Those affected usually have to struggle with the disease for several years, require several treatment attempts and the symptoms sometimes persist even after successful therapy. In addition, it is assumed that most of those affected do not attract attention in the healthcare system and that only a fraction of those who do seek treatment (Hoek 2006; DGPM/DKPM 2010; Smink 2016). In addition, eating disorders are accompanied by numerous physical sequelae. The earlier the disease breaks out, the higher the risk of chronic damage (Holtkamp/Herpertz-Dahlmann 2005). In addition, deaths due to an eating disorder are often due to the physical consequences. Overall, mortality in eating disorders is significantly higher: in bulimia by a factor of 1.9 and in anorexia by a factor of 5.9 (Smink 2016).
06.12.2017
The Hospital Structure Act, which came into force on January 1, 2016, provides for the inclusion of quality data in inpatient health care that is relevant to remuneration and planning. In order to be able to categorize quality, the legislator uses Donabedian's model for structural, process and result quality (e.g.: §136 Social Security Code V). This model implies that improving the quality of structure and processes can improve the quality of results (Donabedian 1966; Donabedian et al. 1987). In this context, good evidence about the strength of the controllable influence of structure- and/or process-related interventions on the treatment outcome was called for early on (Donabedian 1980; Institute of Medicine 1990). Following the implementation of the KHSG, the G-BA published both planning-relevant structural indicators and a cross-sectoral guideline for the design of internal quality management (Joint Federal Committee 2015, 2016). From the perspective of evidence-based medicine, however, it can be said that previous reviews indicated that there was often weak evidence for influencing the quality of results through complex interventions at the structural or process level (Conry et al. 2012; Khan/Ollenschläger 2014). However, a current critical analysis of the published studies on the effect of complex quality interventions in the setting of the German healthcare system is currently missing. We therefore analyzed the literature on the influence of planned complex interventions at the structural and/or process level on the quality of results in inpatient settings in the German healthcare system using a systematic review.
06.12.2017
The regional disparities in the provision of health services have come to the fore, particularly against the background of the discussion about demographic change. The focus here is primarily on existing and expected supply bottlenecks in rural areas (Greß/Stegmüller 2011, Lessing/Herr 2015, Ried 2016). The system of statutory health needs planning has been criticized in the past, particularly with regard to its spatial control function, with the planning areas considered too large for both analysis and planning purposes and the failure to take into account the actual accessibility of health facilities (Greß/Stegmüller 2011: 22ff.). In the course of the reform of demand planning in 2013, this problem was already addressed through smaller-scale planning levels and the possibility of regional adjustments to demand (KBV 2013, Schulz et al. 2015).
06.12.2017
It has been known since the Middle Ages that sufficient exercise and sleep, a balanced diet, little alcohol and appropriate handling of stress protect health. This traditional prevention quintet, supplemented by nicotine abstinence to form a sextet and better implemented through the development of a “preventive self” in the 20th century, needs to be expanded to include a dimension: stratified prevention. In particular, the findings based on large biomedical data sets and physiological measurements in everyday life will in the near future make it possible to assess individual health risks more precisely than before and to develop more precise prevention strategies. The immense opportunities of this development, which enables a more targeted, effective and less risky prevention of diseases, are offset by legitimate concerns and considerable dangers when faced with a “transparent person”, with problems of equal opportunities or with what is medically sensible for most people, but in individual cases endangering health Measures should be warned. This article summarizes the discussions at an interdisciplinary conference in Augsburg with the participation of cardiologists, epidemiologists, lawyers, techno-economists, ethicists and health managers. The participants tried together to identify the goals of stratified prevention. This prevention requires that clinical pictures be defined more narrowly. The starting point and guiding principle is the self-responsible patient, who is to be informed in a lifelong health educational mission that goes beyond school and is also individualized using digital technology. The social security law and the new prevention law rightly underline the considerable need for research that is necessary to develop ethical, effective and evidence-based stratified prevention and make it generally accessible. The necessary interdisciplinary research in the area of this precise prevention, which is only just beginning, should be scientifically strengthened and better anchored in society through better regulation of biodatabases and research consent that enables donations “for science”.
06.12.2017
What issues have dominated health policy in recent years? From a patient's perspective, the emphasis on quality of care as a steering and decision-making criterion has been extremely welcome. The Hospital Structure Act (KHSG) has transformed the buzzword "quality" from mere lip service into a tangible goal of government action. The second important area revolves around the Innovation Fund. Not only does this fund stimulate the acquisition of information through healthcare research, but it also seeks out beneficial innovations for actual patient care. The third focus, the promotion of e-health through the relevant legislation, follows a similar direction.
24.07.2017
Actually, with a mini-questionnaire consisting of only three questions with a sensitivity of 0.81 and specificity of 0.75, the suspicion of migraine could be concluded, but this would then still have to be verified by a specialist diagnosis. But because no one does this and migraine is usually not considered a serious illness by both patients and doctors, it is largely not treated adequately. Migraine is not a life-threatening disease, “but it is one that reduces the quality of life,” as Prof. Dr. Zaza Katsarava, specialist in neurology at the Evangelical Hospital in Unna, explained and asked Novartis at the NeuroScience update on the occasion of the DGN 2017 in Leipzig: “Either we are a civilized society that accepts the reduction in people's quality of life or not.” Accepted also means: sufficient treated. But that's exactly what doesn't happen in Germany or anywhere else in the world. Antibodies against the calcitonin gene-related peptide (CGRP) or its receptor are currently in clinical development - hence the update from Novartis - which means - according to Prof. Dr. Dr. Stefan Evers from the Department of Neurology at the Lindenbrunn Hospital in Coppenbrügge – “Now for the first time there is the prospect of urgently needed, effective medication developed specifically for the prophylaxis of migraines.”
24.07.2017
The research project "Supporting older people with cognitive impairments during and after hospitalization" is funded by the "Healthy – A Lifetime" initiative of the Federal Ministry of Education and Research (BMBF) with approximately €1.7 million. This project, managed by the Rostock/Greifswald site of the German Center for Neurodegenerative Diseases (DZNE) and involving institutions from Jena (Thuringia), Bethel (North Rhine-Westphalia), and Greifswald (Mecklenburg-Western Pomerania), aims to investigate how older people with dementia can be better supported during the transition from inpatient care in an acute care hospital to outpatient treatment and care in their own homes.