[Patient orientation of websites of otorhinolaryngologists in private practice in Bavaria]. / Patientenorientierung von Websites niedergelassener Hals-Nasen-Ohren-Ärzte in Bayern.

OBJECTIVE: The internet plays an important role in the search for health-specific information. So far, only a few studies exist on the user-friendliness of medical websites. This study thus examines the web presence of otorhinolaryngologists in private practice in Bavaria. METHODS: All otorhinolaryngologists registered with statutory health insurance in Bavaria were evaluated using a standardized checklist. IBM SPSS version 25 (IBM Corp., Armonk, NY, USA) statistical software was used for the analysis. RESULTS: Among all otorhinolaryngologists (n = 448), 73.0% (n = 327) had their own functioning website. Only a minority of websites (1.5%) had options to adjust the font size. Regarding functional possibilities of the websites, 18.3% of the physicians offered an online appointment calendar and 3.7% the possibility of feedback. A liability disclaimer was missing on 21.6% of all websites. CONCLUSION: The results exhibit an inadequate use of criteria catalogues for web presence. A patient-oriented website configuration could help to improve customer acquisition and satisfaction, which is particularly relevant for cities with a high density of physicians.

[Elderly trauma patients with proximal femur fractures : Statistical evaluation of regular process data from a trauma center for the elderly]. / Alterstraumatologische Patienten mit proximaler Femurfraktur : Auswertung von Routinedaten eines Alterstraumazentrums.

BACKGROUND/AIMS: Proximal femoral fractures are one of the most frequently occurring injuries among elderly people. High rates of inpatient treatment indicate the importance of optimized clinical care. OBJECTIVES: Based on selected outcome parameters in elderly trauma patients with proximal femoral fractures, the current situation of medical care in a trauma center for geriatric patients is presented. METHODS: For a descriptive evaluation of outcome parameters, 250 patients aged 70 years and older have been included. A clinical register of a trauma center for the elderly served as the database. RESULTS: The average length of stay was approximately 25 days. Sixty-seven percent of the patients underwent surgical treatment within 24 h of admission to the hospital. More than half of the patients were taking anticoagulant drugs. Around 18 % of patients presented with one or more complications. Mortality rate was 5.2 %. Thirty-two percent of those patients who had been living at home before admission had been discharged to a nursing home. DISCUSSION AND CONCLUSIONS: Analyzing the data of a trauma registry enables critical reflection upon the clinical outcome of interdisciplinary treatment procedures. The low rate of mortality may be a result of the geriatric co-treatment, starting right from admission. It remains unclear whether the influence of preoperative interdisciplinary treatment outweighs the effect of a timely surgical procedure.

Patient satisfaction in cardiology after cardiac catheterization : Effects of treatment outcome, visit characteristics, and perception of received care.

BACKGROUND: Patient satisfaction is a key indicator for quality of care. However, recent data on determinants of satisfaction in invasive cardiology are lacking. Hence this study was conducted to identify determinants of patient satisfaction after hospitalization for cardiac catheterization. PATIENTS AND METHODS: Data were obtained from 811 randomly selected patients discharged from ten hospitals responding to a mailed post-visit questionnaire. The satisfaction dimension was measured with a validated 42-item inventory assessing demographic and visit characteristics as well as medical, organizational, and service aspects of received care. Bivariate and multivariate statistical analyses were performed to identify predictors of satisfaction. RESULTS: Patients were most satisfied with the kindness of medical practitioners and nurses. The lowest ratings were observed for discharge procedures and instructions. Multivariate analysis revealed five predictors of satisfaction: treatment outcome (OR, 2.14), individualized medical care (OR, 1.64), clear reply to patient's inquiries by physicians (OR, 1.63), kindness of nonmedical professionals (OR, 3.01), and room amenities (OR, 2.02). No association between demographic data and overall satisfaction was observed. CONCLUSION: Five key determinants that can be addressed by health-care providers in order to improve patient satisfaction were identified. Our findings highlight the importance of the communicational behavior of health-care professionals and the transparency of discharge management.

[Analysis of ambulatory coding quality in Saxony and Thuringia using AOK PLUS billing data - utilisation of the qualifying character "Z" in the documentation of diagnoses]. / Analyse der ambulanten Kodierqualität in Sachsen und Thüringen anhand von Leistungsdaten der AOK PLUS - die Verwendung des Zusatzkennzeichens "Z" in der Diagnosedokumentation.

As a part of the health care reform 2007 the German risk structure compensation scheme was extended so as to connect the financial cash flow towards the payers to morbidity information from ambulatory care. Within this context, morbidity information consists of prescriptions as well as coded ambulatory diagnoses. Accordingly, a high quality of coding is essential for a morbidity compatible allocation of funds. The aim of this study was to evaluate coding quality via qualifying characters as well as to identify future challenges. It focuses on diagnoses which are qualified as "assured" or "post-treatment" from about 350 million diagnoses of about 11 k practitioners' treatment of 2.7 million AOK PLUS insurants in Saxony and Thuringia during the years 2007-2010. The practitioners' documented diagnoses were aggregated within several groups according to the code of specialisation which is attached to the practitioner's 9-digit lifelong identification number (LANR). As a result, the number of "assured" diagnoses generally rose from year to year. Furthermore, diagnoses marked as "assumption" or "exclusion" remain constant over time. We identified a lack of diagnosis coding precision regarding the condition after certain medical events. In particular, general practitioners tend to use diagnosis codes qualified as "post-treatment" instead of using correct "assured" diagnoses qualified for conditions after certain events. Consequently, we expect adverse effects evaluating the cost of diseases as only "assured" diagnoses are considered within the risk transfer compensation scheme.

Non-invasive continuous core temperature measurement by zero heat flux.

Reliable continuous core temperature measurement is of major importance for monitoring patients. The zero heat flux method (ZHF) can potentially fulfil the requirements of non-invasiveness, reliability and short delay time that current measurement methods lack. The purpose of this study was to determine the performance of a new ZHF device on the forehead regarding these issues. Seven healthy subjects performed a protocol of 10 min rest, 30 min submaximal exercise (average temperature increase about 1.5 °C) and 10 min passive recovery in ambient conditions of 35 °C and 50% relative humidity. ZHF temperature (T(zhf)) was compared to oesophageal (T(es)) and rectal (T(re)) temperature. ΔT(zhf)-T(es) had an average bias ± standard deviation of 0.17 ± 0.19 °C in rest, -0.05 ± 0.18 °C during exercise and -0.01 ± 0.20 °C during recovery, the latter two being not significant. The 95% limits of agreement ranged from -0.40 to 0.40 °C and T(zhf) had hardly any delay compared to T(es). T(re) showed a substantial delay and deviation from T(es) when core temperature changed rapidly. Results indicate that the studied ZHF sensor tracks T(es) very well in hot and stable ambient conditions and may be a promising alternative for reliable non-invasive continuous core temperature measurement in hospital.

[Quality of life and care of members of the Saxonian branch of the German Society for Multiple Sclerosis. Results of a written questionnaire]. / Lebens- und Versorgungsqualität von Mitgliedern des Sächsischen Landesverbandes der Deutschen Multiple Sklerose Gesellschaft. Ergebnisse einer schriftlichen Befragung.

Although multiple sclerosis is the most common neurological inflammatory disease among young adults in Europe and Northern America, population-based studies on the quality of life and care of persons affected by multiple sclerosis have not yet been frequently published in Germany. The aim of this study was to assess the quality of life and care as seen by members of the Saxonian branch of the German Society for Multiple Sclerosis. Between October 2002 and January 2003 a representative survey of the members (n=757) of the Saxonian branch of the German Society for Multiple Sclerosis was conducted on the basis of a written questionnaire. Multiple linear and logistical regression analyses were used to find determinants of the self-assessed quality of life and medical care. As a result of these multivariate analyses, the strong impact of disease-specific factors on the physical, mental and social well-being of participants was confirmed. The study hereby revealed that with disease progression the quality of life of affected persons, particularly elderly and invalid patients, patients with bladder and stool problems, and patients with mental problems, was significantly reduced. For these patients symptomatic treatment, which can mitigate the serious consequences of the disease, is of high importance. The fact that these patient groups partly reported a stronger dissatisfaction with their medical care situation indicates that it may not be adequate. With regard to drug treatment with beta interferons and azathioprin, a strong difference was observed between the number of patients who had already taken a beta interferon in the past and the number of patients who were currently on beta interferon, which indicates a high rate of patients breaking off the treatment. The results of this study suggest that there is potential for improvement of the medical and therapeutic care of persons affected by Multiple Sclerosis in Saxony. Adequate care, which takes into consideration the individually diverging disease courses, symptoms and psychosocial consequences, is required in order to maintain or optimize the quality of life.

[Health behaviour and health status of nursing staff--a review of the literature]. / Gesundheitsverhalten und Gesundheitszustand von Krankenpflegepersonal--Eine Literaturübersicht.

Presently around 1.1 million nurses are employed in the German health care system. Due to increased workload and staff reduction, studies on the health behaviour and health condition of nursing staff are increasingly important. Hence we reviewed the literature on health behaviour and health condition of nursing staff. Articles available in Medline and Embase from 1978 to 2000 were included, focussing on smoking, alcohol consumption, substance abuse, eating habits, body-mass index, dental health status, risk behaviour in traffic, workload, burnout syndrome, sports and recreation, job satisfaction, subjective health status, subjective complaints, vaccinations and quality of life. Health behaviour was divided in unhealthy and healthy behaviour. It became obvious that most of the studies focussed on investigation of unhealthy behaviour, such as smoking, alcohol consumption, substance abuse and poor eating habits. Health promotion was mainly seen as avoiding these unhealthy habits. Only in current studies definitions of health promoting behaviour were developed as a part of a comprehensive life-style.

[What do medical students know about cause and epidemiology of the Creutzfeldt-Jakob disease in Germany?]. / Wie schätzen Medizinstudierende die Entstehungsursachen und die Inzidenz der Creutzfeldt-Jakob-Krankheit ein?

Due to the increase of patients with the variant Creutzfeldt-Jakob disease (vCJD) in Great Britain and the first cases of autochthonous BSE cases in Germany, the study tried to investigate the knowledge of medical students about the epidemiology of CJD in Germany and how they assess the influence of different factors on the etiology of CJD. Altogether 63 first year medical students, 96 third year medical students and 50 nurses were included in an anonymous questionnaire survey. They were asked to estimate the annually incidence of CJD in Germany and to assess, by using analogue-scales, the influence of different factors on the risk of contracting CJD. For the medical students the median was 100 and for the nurses the median was 10 annual CJD cases. All participants, and especially the males, emphasised the influence of "risk behaviour" and "environmental factors" on the risk of contracting CJD, the factor "stress/ emotional strain" was seen as most unimportant. No significant differences between female and male participants in the knowledge about the incidence of CJD in Germany were found. It becomes obvious, that epidemiological knowledge about CJD in medical staff is associated with different and gender-specific views on the etiology. Medical education should consider this to avoid endangering medical staff and patients due to overprotection or insufficient precautions.

[Vaccination status of medical students in munich - results of a questionnaire survey]. / Befragung zum Impfstatus bei Medizinstudierenden in München.

BACKGROUND: Vaccinations, e. g., against hepatitis B, are recommended for health care workers in order to minimize the risk of occupational infections. While medical students come into contact with patients early in their medical education, sufficient vaccination is not routinely checked during their training. Hence, we wanted to assess the prevalence of medical students (fourth year) not sufficiently vaccinated against occupationally relevant infectious diseases (hepatitis A and B, measles, mumps, German measles, poliomyelitis) at the two medical schools in Munich. METHODS: One hundred and forty nine students of the medical school at the Ludwig-Maximilians-University and 89 students of the medical school at the Technical University completed a standardized questionnaire on demographic data, vaccination status and personal attitude towards vaccinations. RESULTS: Nine percent of the students at the Ludwig-Maximilans-University and one percent of the medical students at the Technical University reported not to have been vaccinated against hepatitis B. The relative frequency of students not vaccinated against hepatitis A was higher and did not differ between the medical schools (LMU: 35.9 %, TU: 40.5 %; 95 % Confidence Interval for the difference: -17.7-+ 8.5 %). The prevalence of vaccination especially against German measles among women was unsatisfactory. Individual vaccination status of the students seemed to be related to their personal attitude towards vaccinations. CONCLUSION: In order to increase the prevalence of hepatitis B vaccination among medical students they should be informed more intensively about the free of charge vaccination early during their education, e. g., before the beginning of their medical training.

Problems reported by elderly patients with multiple sclerosis.

Multiple sclerosis (MS) is one of the most common organic neurological diseases of the central nervous system. Because of improved therapies, nurses are confronted with elderly MS patients, but little is known about the specific problems of these patients. This survey analyzed problems in elderly MS patients. Fifty-three MS patients (44 female, 9 male; average age 73 years, average course of MS 25.3 years) from the Berlin Section of the German Multiple Sclerosis Association were evaluated by using a standardized questionnaire, considering social situation, daily problems, disease course, and disabilities, and by using the expanded disability status scale (EDSS). Elderly MS patients reported impaired mobility and inability to use public transportation; about 96% presented EDSS scores above 6.0. Nearly 50% complained about spasticity and pain due to spasticity. More than 70% suffered from bladder dysfunction. Problems with sleep and fatigue were present in less than 20%, but interrupted sleep was common. Selfcare impairments were reported by 50%-75% of the patients, and most of them required professional help. Depressive moods and thoughts about committing suicide were mentioned by more than 30% of the patients. Elderly MS patients experience physical and psychosocial impairments. Healthcare professionals should consider increasing independence and avoiding nursing home admissions in the management of elderly MS patients.

Assessment of HIV transmission risks in clinical situations in health care students from Germany, Lithuania and Namibia.

Due to the increasing global HIV prevalence, comprehensive knowledge about clinical HIV transmission risks in health care professionals is essential. Mainly medical and nursing students are at risk, because they are working close to infected patients. By using an anonymous questionnaire, the study analysed the assessments of German medical/dental students (n = 182), Lithuanian medical students (n = 176) and Namibian student nurses (n = 135) on the risk of getting HIV infected in different clinical situations. It became obvious that the Namibian student nurses overestimated the risk of HIV transmission in several situations (eg changing dirty linen, physical examination). In comparison, the Lithuanian students showed the most realistic assessments, while the German students also tended to overestimate the risks of HIV transmission. The results indicate that assessments on the risk of HIV transmission in clinical situations are influenced by the national prevalence and daily contacts with HIV patients. Education of health care students should consider this and focus more on epidemiological aspects and infection control procedures, to avoid endangering students and patients.

Poor assessment of HIV epidemiology and occupational HIV transmission risk by medical students.

Due to the increasing global number of HIV-positive patients, the potential risk of acquiring infection with HIV during routine clinical care is on the increase. Assessments of the knowledge of medical students about occupational HIV transmission are therefore important. This study analysed the knowledge of 397 first year and 75 fifth year medical students about the epidemiology of HIV in Germany and their assessment of the risk of acquiring HIV in different clinical situations. Medical students overestimated the incidence and mortality of HIV in Germany, with fewer than 30% knowing the correct numbers. They also overestimated the risk of occupational HIV infection in several clinical settings, such as changing dirty linen or wound dressings. Few differences were found between first and fifth year medical students. For their later work as physicians medical students still need more information and counselling about the epidemiology of HIV, prevention of occupational HIV infections and care for patients with HIV/AIDS.

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome.

Continuous positive airway pressure (CPAP) is an established treatment of obstructive sleep apnoea syndrome (OSAS). While it is known that CPAP reverses the pathological breathing pattern and improves daytime sleepiness, there are no sufficient data on the long-term influence of CPAP on quality of life in patients with OSAS. Thirty-nine patients with polysomnographically verified OSAS (apnoea/hypopnoea index (AHI): (mean+/-SD) 46.8+/-21.8 events x h(-1)) were prospectively studied. All patients answered three quality of life measures (Complaint List, Nottingham Health Profile Part 1 (NHP), and Verbal Analogue-Scale "quality of life") prior to the initiation of CPAP therapy. After a mean of 9 months they were re-evaluated by polysomnography, and completed the questionnaires once again. As expected, CPAP was effective in treating the sleep-related breathing disorder. AHI decreased significantly from (mean+/-SD) 46.8+/-21.8 events x h(-1) to 3.3+/-6.3 events x h(-1), and minimum oxygen saturation increased from 77.1+/-9.3% to 89.9+/-3.4%, while body mass index did not change significantly (31.3+/-5.4 versus 30.8+/-4.8 kg x m(-2)). During long-term treatment with CPAP the Complaint List revealed a significant improvement of the extent of subjective impairment due to physical and general complaints (26.4+/-9.9 versus 20.4+/-11.1), and NHP a significant improvement of emotional reactions (19.8+/-21.7 versus 11.1+/-14.0) and energy (50.8+/-36.6 versus 32.1+/-36.7), but not of pain, physical mobility, sleep, social isolation, and quality of life as assessed by the It is concluded that long-term continuous positive airway pressure therapy is effective in improving not only pathological breathing patterns but also parameters that estimate quality of life in patients with obstructive sleep apnoea syndrome.

[What do medical students know about the epidemiology of tetanus and tuberculosis in Germany?--A comparison of epidemiologic knowledge regarding a rare and a prevalent infectious disease]. / Was wissen Medizinstudierende über die Epidemiologie von Tetanus und Tuberkulose in Deutschland?--Ein Vergleich der epidemiologischen Kenntnisse über eine seltene und eine häufige Infektionskrankheit.

A Comparison of Epidemiological Knowledge About a Rare and a Common Infectious Disease: Tetanus and tuberculosis are still worldwide health problems. Due to an increasing number of insufficiently vaccinated persons, mainly in adults, tetanus in Germany requires more and more medical attention. At the same time, due to global migration and an increasing number of immunocompromised patients, the probability of getting infected with tuberculosis is on the increase. For preventing infectious diseases it is necessary to analyse to what extent medical students are informed about the epidemiology of tetanus and tuberculosis in Germany. This knowledge is a mainstay for later differential diagnosis. After completing medical training it is expected that they are capable of diagnosing both diseases properly and that they are trained to inform the population about necessary vaccinations. The following study analysed the incidence estimation of medical students (n = 472) on tetanus and tuberculosis morbidity in Germany. It is obvious that medical students still have gaps in their knowledge about the epidemiology of tetanus and tuberculosis. They overestimated the incidence of tetanus cases per year around 10-1,000 times. In comparison, they underestimated the incidence of tuberculosis. The study shows a distorted assessment of importance of medical problems by the students of medicine. Medical education should consider this and focus more on epidemiology of infectious diseases including tetanus and tuberculosis.

[Vaccination status of medical and dental students]. / Zum Impfstatus von Medizin- und Zahnmedizinstudierenden.

Infectious diseases are still a worldwide health problem, and hence physicians are responsible for providing the population with sufficient vaccinations. Until now, however, comprehensive studies on vaccination behaviour in German medical/dental students, the future physicians/dentists, are lacking. The study analysed vaccinations of medical/dental students against tetanus, diphtheria, poliomyelitis, hepatitis A + B and tried to find possible influences on the vaccination behaviour. 126 medical and 99 dental students participated by working on an anonymous questionnaire related to sociodemographic data, smoking/drinking habits, drug abuse and vaccinations. The response rate was between 76 and 85%. Altogether, the investigated students were not sufficiently vaccinated. Nevertheless, they were better vaccinated than a normal reference sample. Except for a significantly better immunisation against hepatitis B in dental students, no differences between medical and dental students were found. In comparison to male students, female students presented better immunisation. On the other hand, students from the former West Germany, smoking students and students who are taking illegal drugs, were more insufficiently immunised than the other students. To optimise vaccinations in future physicians and dentists, medical/dental education should focus more on infectious diseases and knowledge about vaccinations. This would help to protect future physicians and dentists against preventable infectious diseases. Additionally, they are better skilled to prevent infectious diseases by providing the population with information and vaccinations.

[Neglect of tuberculosis in medical education. How medical students perceive the incidence of tuberculosis in Germany]. / Vernachlässigung der Tuberkulose im Medizinstudium. Wie Medizinstudierende die Tuberkulosehäufigkeit in Deutschland einschätzen.

BACKGROUND: Tuberculosis is still a health problem. Due to an increasing number of immunosuppressed patients the probability of getting infected with tuberculosis in the hospital rises up. SUBJECTS AND METHODS: For prevention of infections, medical students play a critical role: Firstly, because of bedside-teaching in the hospital, medical students are at risk of getting infected with tuberculosis. Secondly, immediately after university training, it is expected that they are capable to diagnose tuberculosis. The following study analysed the incidence-estimation of medical students (n = 278) of tuberculosis-morbidity and tuberculosis-mortality in Germany. RESULTS: It becomes obvious, that medical students still have gaps in their knowledge about tuberculosis. They underestimated the incidence of tuberculosis and they overestimated the mortality of tuberculosis. CONCLUSION: The study indicates a misperception of relevant health problems which may be due to the study situation at German Medical Schools. Medical students need more information and counselling about epidemiology of infectious diseases including tuberculosis.

[The anxious patient during magnetic resonance tomography (MRI) examination. Health care economic aspects of patient education]. / Der ängstliche Patient während der Magnetresonanztomographie (MRT)-Untersuchung. Gesundheitsökonomische Aspekte der Patientenaufklärung.

Due to the increasing debate of limiting costs in the public health system, the use of magnetic resonance imaging (MRI) has been under discussion for several times. Diagnostic imaging by means of MRI is an expensive but informative and safe method. Instead of looking on cost-benefit analysis, it is shown how the efficiency of MRI can be increased by improving patient information about this imaging method. Because of the technical conditions, up to 40% of the patients show anxiety-related-reactions. These reactions include slight discomfort up to claustrophobic reactions and panic attacks. Therefore, correct and complete informing of patients prior to MRI examinations by the physicians is very important. The given information should include technical aspects about MRI and in addition, the physician has a chance to evaluate the patients' disposition to anxiety-related-reactions. To prepare risk patients for successful MRI technics like music, prone positioning, sedatives and relaxation exercises are available. By taking patients' anxiety into consideration and using the techniques mentioned above, unnecessary costs for unsuccessful or repeated MRI examinations can be avoided and the overall costs for clinical diagnostics will be reduced.