Needlestick and sharps injuries at a German university hospital: epidemiology, causes and preventive potential - a descriptive analysis.

OBJECTIVES: To analyze the number, epidemiology and circumstances of needlestick and sharps injuries (NSSI) and exposures to body fluids and to identify further preventive measures to improve the occupational safety of health care workers (HCW). MATERIAL AND METHODS: Setting: German university tertiary-care referral center. Retrospective study based on injury documentation sheets of the hospital's staff and faculty health service and, if given, on reports by continuity doctors and by the accident and emergency department in January 2014-June 2016. RESULTS: Altogether, 567 injuries were registered with a significant decrease of cases over the study period. The majority of accidents occurred in the operating theater (35%). Stress, time pressure, overstrain, carelessness and distraction were found to be the main reasons for injuries. At least 30% of the cases were preventable, mainly by wearing personal protective equipment (PPE), by proper disposal of an item and by early replacement of overfilled sharps containers (SC). In 20% of the cases involving an item, the injury was caused by a safety-engineered device (SED). Almost one-third of these injuries were attributable to an improper use of the SED. CONCLUSIONS: Despite many efforts made to reduce their number, NSSI still occur. Health care workers and students should be offered regular trainings to be sensitized to this topic and to learn the appropriate use of SED. Moreover, organizational measures must be taken, such as the provision of suitable PPE and safe SC. Strategies need to be established to improve the working conditions and reduce the stress level of HCW. Int J Occup Med Environ Health. 2022;35(5):497-507.

Psychometric properties of the Posttraumatic Diagnostic Scale (PDS) in alcohol-dependent patients.

BACKGROUND: A high prevalence of comorbid posttraumatic stress disorder (PTSD) is found in patients with substance use disorders (SUDs). In the few existing studies, mixed results regarding the psychometric properties of common screening instruments for PTSD have been reported for patients with SUDs. No results are available for the Posttraumatic Diagnostic Scale (PDS), an established self-report measure for PTSD. METHODS: The authors assessed 105 patients with alcohol dependence according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (70% male) 2 weeks after their admission to an inpatient detoxification unit. Participants were administered the PDS, the PTSD module of the Structured Clinical Interview for DSM-IV (SCID), as well as measures of depression and anxiety. Patients with other substance use disorders were excluded as were patients reporting no traumatic event. RESULTS: Internal consistencies were good to very good for the total scale (.93) and the subscales of the PDS (.82-.91). In our sample, the PDS had a high specificity (.89) but only moderate sensitivity (.57). Diagnostic agreement with the SCID was 83% (.46). The results of a receiver operating characteristic (ROC) analysis suggested that a PDS score of 8 was the optimal cutoff to screen for PTSD. The highest diagnostic agreement between PDS and SCID (89%; .60) was achieved using a cutoff score of 24. CONCLUSIONS: These findings confirm previous results suggesting that the psychometric properties of self-report measures of PTSD in patients with SUDs might differ from those in the general population. When the PDS is used in recently detoxified patients with alcohol dependence, it seems advisable to modify the cutoff score of this instrument to improve its sensitivity and diagnostic accuracy.

[Internet presence of neurologists, psychiatrists and medical psychotherapists in private practice]. / Internetauftritte niedergelassener Neurologen, Psychiater und ärztlicher Psychotherapeuten.

OBJECTIVE: The world wide web provides new options to physicians in terms practice marketing, information brokerage, and process optimization. This study explores prevalence and content of homepages of neurologists, psychiatrists and medical psychotherapists in private practice. METHODS: Through the legal bodies of physicians in private practice in six northern German states neurologists, psychiatrists and medical psychotherapists were identified. According to a standardized and operationalized criteria catalogue, homepages were rated. RESULTS: 1804 physicians were identified, 352 (19.5 %) had operated a homepage. Higher frequencies of homepages found for male physicians (vs. female physicians), practice centres (vs. single practices) and urban practices (vs. rural practices). In average, practices reached 18.8 (±â€Š5.3) of 42 points; contact data and accessibility information were generally available; information as to qualification and specialization was provided more infrequently. Legal specifications were not considered in more than every second homepage, interactive elements like online appointment of follow-up prescription were only rarely offered. CONCLUSIONS: Only every fifth neurological or psychiatric practice operates an own homepage, higher competition (urban area) and higher professionalization (practice centres) seem to act as promotors. The legal framework has to be focused, and patient needs should be taken into account.

Effect of medical education on students' attitudes toward psychiatry and individuals with mental disorders.

OBJECTIVE: This study aimed to explore the effect of medical education on students' attitudes toward psychiatry and psychiatric patients, and examined the usefulness of a new evaluation tool: the 6-item Psychiatric Experience, Attitudes, and Knowledge (PEAK-6). METHOD: Authors studied the attitudes of 116 medical students toward psychiatry and individuals with mental disorders, using two questionnaires before and after a 12-week module of "psychosocial medicine." Results of the 30-item questionnaire Attitudes Toward Psychiatry (ATP-30) were compared with the results of PEAK-6. RESULTS: With the ATP-30, no change in attitudes toward psychiatry was observed at the end of the module. With the PEAK-6, the item "attitude toward psychiatry" significantly improved. Knowledge of and experience with psychiatry as well as knowledge of and experience with individuals with mental disorders improved significantly; however, attitudes toward individuals with mental disorders did not improve. CONCLUSION: PEAK-6 seems to be a promising tool with regard to nuanced information about psychiatric learning experiences. Participation in a psychiatric module may be associated with a positive effect on students' knowledge about, experience with, and attitudes toward psychiatry, but not attitudes toward psychiatric patients.

Drug safety evaluation of olanzapine pamoate.

INTRODUCTION: Olanzapine pamoate is one of three second-generation antipsychotics available as depot medication. While non-adherence is a major problem in the treatment of schizophrenia, olanzapine pamoate can improve adherence, though its use is limited by its safety profile. AREAS COVERED: The review covers data on efficacy with a focus on tolerability and safety of olanzapine pamoate using the known databases including PubMed, Psychinfo and Embase using keywords. Relevant websites were also reviewed. EXPERT OPINION: Olanzapine is an efficacious antipsychotic that can be used in its oral and depot formula (olanzapine pamoate) for the treatment of patients with schizophrenia. It has demonstrated superiority over conventional and some other atypical antipsychotics, with both formulas having comparable low rates of motor side effects. The side effects on body weight and glucose homeostasis are also similar in both formulas and limit its use. The only clear difference regarding side effects is 'the risk that 0.07% of injections in preclinical trials have led to a post-injection delirium/sedation syndrome event which requires a risk management plan'. Especially in outpatients this could cause inconveniences that should be overcome by offering, for example, psychological therapies or psychoeducation to effectively use the time when patients have to remain in the healthcare facilities.

Sustained change in didactic skills--does teacher training last?

Teacher training programmes are necessary assets in faculty development. Few data exist on their long-term effects on participants' teaching skills. Our aim was to study participants' didactic competencies up to four years after attending a newly established faculty development workshop at Hamburg Medical School. Of the 322 participants who attended our teacher training between 2006 and 2009, 313 received a self-assessment and evaluation questionnaire in 2010. This follow-up self-assessment (t2) was compared with their self-assessment of the same didactic competencies before (t0) and directly after (t1) the training. Correlations between participants' personal reasons to attend the workshop and their assessment of didactic competencies were investigated. Self-assessment was significantly higher at the time of follow-up (t2) for all cohorts compared to the assessment before the workshop (t0). Personal reasons for participation differed greatly between voluntary and mandatory. However, self-assessment of the didactic competencies (t2) was not different between these groups. Participants involved in objective structured clinical examinations (OSCE) rated their competency in this field higher than participants without OSCE involvement. In conclusion, teacher training can be effective in the long run even when participation is mandatory. Competencies seem to be retained best when the content of the training fits participants' teaching activities.

Structural barriers in the context of opiate substitution treatment in Germany--a survey among physicians in primary care.

BACKGROUND: Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST. METHODS: An anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively. RESULTS: The response rate was 25.5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future. CONCLUSION: Despite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.

A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia.

BACKGROUND: While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient-centred care. OBJECTIVE: To estimate the concordance between patients' and psychiatrists' (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self-explicated method in valuing a large number of treatment goals. DESIGN: Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5-point Likert scale. Three scores were calculated based on the ranking (1-20), rating (Likert scale) (1-5) and a self-explicated method estimated as the product of rating and ranking score (1-100). Concordance was tested using Spearman's rho for overall ordinal rankings and via anova and F-test for the cardinal values assigned to a specific treatment goal. PARTICIPANTS: A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. RESULTS: Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self-explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self-explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly (P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. CONCLUSIONS: While there is an overall concordance between patients' and psychiatrists' valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on 'textbook' outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference-based methods, such as the self-explicated method, in the study of concordance.

Valuation and attainment of treatment goals in schizophrenia: perspectives of patients, relatives, physicians, and payers.

OBJECTIVE: This study investigated and compared the valuation and perceived attainment of multiple treatment goals in schizophrenia from the perspectives of four different groups of stakeholders. METHOD: Twenty treatment goals (identified in a qualitative patient-based pre-study) were ranked and rated according to their relevance in standardized interviews. Goal attainment was also rated. A rank correlation was computed to identify congruencies among the stakeholder groups. A hierarchical cluster analysis of the data from the stakeholders groups was also conducted. RESULTS: In this study, 105 outpatients, 160 physicians, 50 relatives, and 30 payers were interviewed. All goals were considered very relevant by all stakeholder groups. "Improved cognitive abilities" was ranked among the top three goals by patients, physicians, and relatives, while "reduced disease-related symptoms" was ranked first by relatives and second by physicians. Payers gave the highest priority to goals that were more likely to affect costs (i.e., ability to resume work, reduced disease-related symptoms, less hospitalization/ need for outpatient visits). Pairwise agreement rates ranged from 38.9% to 63.3%. Rank correlations were found between relatives and patients (r=0.51; P=0.002), relatives and physicians (r=0.43; P=0.008), and payers and patients (r=0.43; P=0.008). The cluster analysis revealed a relevant congruency among patients, relatives, and physicians. Goal attainment was rated lower than goal relevance by all groups, with patients judging attainment the best on average, followed by relatives, physicians, and payers. Reduction in disease-related symptoms was rated as the goal that was best achieved. CONCLUSION: Discordances among the groups with respect to their valuation of treatment goals should encourage stakeholders to better understand others' preferences as a prerequisite for improved shared decision making and potentially improved treatment outcomes.

Homepages of German medical faculties--an overview.

INTRODUCTION: The Internet represents a central communication medium for patients and physicians. Some national information is available regarding the design of physicians' homepages and patient requirements regarding homepages of physicians in private practice. To date, no data are available for homepages of medical faculties and their users' needs. METHODS: In 2008 the homepages of the 36 German medical faculties were analyzed according to a catalogue of 128 criteria assigned to five domains which had been developed from the literature. Structure, content and extent were compared. RESULTS: The homepages covered the criteria to a very different extent. The best homepage reached 80%, the worst only 26% of the achievable points. The mean was slightly above 50% . Faculties addressed mainly applicants and students as their target groups, less frequently lecturers and alumni. CONCLUSION: This study shows differences in quality and quantity of the "teaching section" on websites of medical faculties. The results allow faculties to use the criteria to adjust their websites with regard to addressing the relevant target groups of students, applicants, lecturers and alumni comprehensively.

Cinemeducation in psychiatry: a seminar in undergraduate medical education combining a movie, lecture, and patient interview.

OBJECTIVE: Psychiatric educators are often faced with students' negative attitudes toward psychiatry. A new type of seminar has been established in order to enable students to gain a deeper understanding of psychiatric illness. METHOD: A "cinemeducation seminar," combining a movie, a lecture, and a patient interview, has been established as part of the undergraduate curriculum at Hamburg Medical School, where 1,032 students attended 39 cinemeducation seminars between 2005 and 2008. A student evaluation covering different aspects of education took place after each seminar. RESULTS: The students valued the combination of a movie and a seminar and found the movie and the additional patient interview useful for accessing the subject of Psychiatry and understanding the underlying psychiatric illnesses shown in the movies. CONCLUSION: From the students' perspective, this type of seminar seems to be helpful for providing an impression of psychiatric illnesses and enabling students to put themselves in the position of a person suffering from these illnesses. Therefore, we judged the cinemeducation seminar to be an appropriate teaching format in undergraduate medical education.

Lectures based on cardinal symptoms in undergraduate medicine - effects of evaluation-based interventions on teaching large groups.

Despite critical voices lectures are still an important teaching format in current medical curricula. With the curricular reform at Hamburg Medical Faculty in the year 2004, all subject specific lectures were replaced by cardinal symptom oriented lectures (LSV) in the new clinical curriculum. LSVs are taught throughout all six thematic blocks in years three to five. Since regular student evaluations after each thematic block seemed to demand improvement of the LSVs, this study was carried out using evaluations of individual LSVs by the participating students and by trained auditors (final year students and academic staff). Based on these evaluations feedback containing the individual evaluation data was given in written form to the lecturers combined with information material on planning an LSV using modern didactic techniques. In a second evaluation period, the effects of this intervention were studied. Only small improvements in the LSVs' quality were noted regarding the level of marks achieved. When individual items were evaluated, especially the didactic quality, significant improvements were noticeable. Overall, on the basis of individual items students ranked the quality of the LSVs significantly higher than trained auditors during the first evaluation period. This effect was no longer seen after the second evaluation period. The inter rater reliability among the auditors was very good. This study shows that regular quality assurance is needed on the structural levels and for staff to accompany the process of embedding teaching formats into curricular concepts. Further investigation is needed to determine the adequate frequency of evaluation and the format of feedback to guarantee sustainable effects of the didactic quality of lectures.

Criteria for the successful completion of medical dissertations - A multicenter study.

OBJECTIVE: In order to acquire the academic title "doctor" in Germany, it is essential to complete a dissertation. A high number of publications at German universities are based on medical dissertations. The reasons why some dissertations are successfully accomplished and why some are not completed - despite far-reaching consequences - have been barely investigated to date. METHODS: 467 students in the ninth semester at five German universities participated in this study in 2003. A questionnaire (return rate 93.5%) was used, asking details about the circumstances of a current or completed dissertation (Group A), an abandoned doctoral project (Group B), or one which was never started (Group C). RESULTS: Students in Group A referred significantly more often to their supervisor as being essential for choosing the topic of their dissertation project. Furthermore, students in Group A worked together with other students in self-organized support groups to debate methodological questions. They also discussed their project more frequently with a statistician. Students in Group C gave "interference with undergraduate studies" and "no time" as the most common reasons for not starting a dissertation. CONCLUSIONS: As the supervisor seems to play an important role for the successful completion of dissertations, universities should think about professional programs that would prepare supervisors for this educational task. Courses for doctoral candidates in scientific research methodology could also be a helpful tool toward successfully accomplishing a doctoral thesis or scientific projects in general.

Benefits and pitfalls of scientific research during undergraduate medical education.

OBJECTIVE: The integration of scientific research into medical education is a widely discussed topic. Most research training programs are offered on a voluntary basis. In Germany, it is mandatory to complete a doctoral thesis to obtain the academic title "doctor". The reasons why students start a dissertation project and the influence of this project on their undergraduate studies and later career choices are not well known. METHOD: This study was conducted at five German universities in 2003, with a total of 437 fifth-year students participating in it. A standardised questionnaire was used to ask participants about their current or finished dissertation (group A), a dissertation they had discontinued (group B) or why they had never started a dissertation project (group C). RESULTS: The two most important reasons for students from group A to start a dissertation were "interest in the topic" and "advantage for job applications". Compared with group B, they mentioned "improved ability to critically appraise scientific studies" and "doing scientific work independently" significantly more often as a result of working on their dissertation. Starting a dissertation project early during undergraduate studies was correlated with a less successful outcome. Moreover, working on a dissertation significantly reduced time spent on undergraduate studies. Students from group C named the "workload of undergraduate studies" and "no time" most frequently as reasons for not having started a dissertation. CONCLUSION: Students who have been working successfully on a dissertation rate items regarding the acquisition of scientific research skills significantly more positively, and participation in undergraduate studies seems to be negatively affected by working on a dissertation project. Therefore, basic training in scientific research methodology should become an integrated part of the medical undergraduate curriculum, while special programs should be offered for students with a particular interest in scientific research programs or an academic career.

Attitudes of medical students towards psychiatry : effects of training, courses in psychiatry, psychiatric experience and gender.

OBJECTIVE: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. METHODS: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on "Attitudes Towards Psychiatry" (ATP-30). RESULTS: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. CONCLUSION: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.

[Is a reformation of the medical training worthwhile? The quality of the Hamburg curriculum under the old and the new board certification law]. / Lohnt sich eine Reform der klinischen Ausbildung? Die Qualität des Hamburger Curriculums unter der alten und der neuen Approbationsordnung im Vergleich.

This paper presents the results of the evaluation of a new undergraduate curriculum at the Medical Faculty of Hamburg University. This curriculum is based on the new law on medical board certification of 2002, and was tested for the first time in the summer term of 2004. The results were compared with those obtained under the previous law. The data show a substantial increase in student subjective learning effectiveness and satisfaction with the new program. The reasons discerned were the increased practice orientation of the program, the problem-oriented seminars, and the increased motivation of the teaching staff.