[Potential of Information and Communications Technology to Improve Intersectoral Processes of Care: A Case Study of the Specialised Outpatient Palliative Care]. / Potenziale der Informations- und Kommunikationstechnologie zur Optimierung intersektoraler Versorgungsprozesse: Ein Fallbeispiel der spezialisierten ambulanten Palliativversorgung.

OBJECTIVE: The added value of information and communications technologies should be demonstrated precisely in such areas of care in which the importance of intersectoral and interdisciplinary cooperation is particularly high. In the context of the accompanying research of a supply concept for palliative care patients, the potential of a digital documentation process was comparatively analysed with the conventional paper-based workflow. METHODS: Data were collected in the form of a multi-methodological approach and processed for the project in 3 stages: (1) Development and analysis of a palliative care process with the focus on all relevant steps of documentation. (2) Questionnaire design and the comparative mapping of specific process times. (3) Sampling, selection, and analysis of patient records and their derivable insights of process iterations. RESULTS: With the use of ICT, the treatment time per patient is reduced by up to 53% and achieves a reduction in costs and workload by up to 901 min. The result of an up to 213% increase in the number of patient contacts allows a higher continuity of care. Although the 16% increase in documentation loyalty improves the usability of cross-team documented information, it partially extends the workload on the level of individual actors. By using a digital health record around 31% more patients could be treated with the same staffing ratio. CONCLUSIONS: The multi-stage analysis of the palliative care process showed that ICT has a decisive influence on the process dimension of intersectoral cooperation. Due to favourable organisational conditions the pioneering work of palliative care also provides important guidance for a successful use of ICT technologies in the context of innovative forms of care.

[On the comprehensibility of German hospital quality reports: systematic evaluation and need for action]. / Zur Verständlichkeit der Qualitätsberichte deutscher Krankenhäuser: Systematische Auswertung und Handlungsbedarf.

OBJECTIVE: This paper focuses on the current resolutions for quality reports of German hospitals as released in 2007 as well as on comprehensibility of these reports for patients. It is meant to analyse the textual information given by these quality reports. Its main objective was to attain a reliable assessment of their comprehensibility for patients on the basis of objective measuring methods. A further goal was to qualify eventual differences between large and small or private and public hospital operators. On the basis of the attained results conclusions on the appropriateness of the current legal situation and the existing criteria for quality reports were to be drawn. METHOD: The textual system part of 200 German hospital reports was analysed as published in the Internet (latest download 28th May, 2007). The selection took place by means of a controlled sample. The sample structure essentially corresponds to the German hospital system structure in terms of bed numbers and its ratio of public and private operators. The analysis measured all formal text patterns as well as technical terms by means of a computer-aided device. The readability index for each text was calculated according to all known readability formulas for the German language. RESULTS: German hospital quality reports are readable only for those patients who dispose of above-average communicative skills. The analysed reports contain more than 10% technical terms while 17% of the chosen words and 60% of all sentences are too long. 10% of all sentences are too complex and 25% comprise more than three technical terms. To understand these texts at least an entrance qualification for higher education is required in accordance to readability indices. The texts' degree of complexity is comparable to that of philosophical papers. Most textual information given by German hospital quality reports is proven to be unreadable and incomprehensible for most patients. There are no fundamental differences concerning hospital size and operator. CONCLUSIONS: The reports' readability and comprehensibility for patients have only scarcely been considered in the current legal resolutions, and there is no undergoing process of improvement. The analysis has shown that there is in fact an urgent need for action. Future reports should therefore ensure that their textual content is formulated in a readable and comprehensible recipient-friendly manner. To enhance customer-oriented transparency within the German public health service patients should be able to fully understand what hospitals want to communicate. Therefore the further process of research will focus on the development of specific criteria for the production of textual reports. This has to be done in co-operation with patients and resident general practitioners.

Effects of classical swine fever virus infection on the porcine leukocyte subsets.

The effects of classical swine fever (CSF) virus infection on the porcine leukocyte subsets were investigated by flow cytometry in acute, chronic and convalescent forms of the disease. The virus antigen could be first detected in the monocytes on postinfection (p.i.) day 10 while in the lymphocytes on p.i. day 13. It could be established that the ratio of CD6+ cells decreased until p.i. day 6, but afterwards it started to increase and reached different values. The CD4+CD8+, the CD8+ and the CD6- cells were obviously higher virus positive than the CD4+ and the CD4-CD8-subsets, but essentially all subsets could be infected. The ratio of CD8+ cells increased during the disease, while the number of double positive cells decreased, and that of the CD4+ cells was variable. The viral antigen could be detected in a lower percentage of the CD4+CD8+, CD8+, CD6+ and CD6- cells of the pigs affected with the chronic form of the disease than in those with the acute form. During the experiments no viral antigen could be detected in the leukocytes of the pig that became convalescent, though the changes in its leukocyte subsets were very similar to those seen in pigs in which the viral antigen could be detected. The studies have revealed that essentially all leukocyte subsets can be infected with the CSF virus, but in very different amounts.

[Comprehensive quality management in hospitals--experience and recommendations]. / Umfassendes Qualitätsmanagement im Krankenhaus--Umsetzungserfahrungen und -empfehlungen.

Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.

Contact sensitization to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI). A European multicentre study.

The frequency of positive reactions to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI) were studied at 22 European contact dermatitis clinics over a period of 1 year. A total of 4713 patients participated. All the patients were patch tested with nickel sulphate, formaldehyde, paraben-mix, and MCI/MI. 19.4% of the patients had positive patch tests to nickel, making this the most common allergen. 3% of the patients reacted to 100 ppm MCI/MI, while 2.6% reacted to formaldehyde and 1.1% to parabens. There was great variation in the frequency of MCI/MI sensitivity among the 22 centres. MCI/MI contact allergy was most common among women and in patients with facial dermatitis, while it was rarely seen in patients with dermatitis on the lower legs. There were no fluctuations in the number of positive patch tests to MCI/MI on a monthly basis when the results from all centres were combined. 117 of the 141 MCI/MI sensitized patients included in the study were retested. 88% had positive patch tests when retested. 101 of the MCI/MI-sensitive patients participated in a double-blind, placebo-controlled product use test. This test showed that 31% of the MCI/MI-sensitive patients had a positive reaction to a MCI/MI-preserved product. Only a few patients reacted to a control product. It is concluded that the preservative MCI/MI is an important new contact allergen.

[Housing status and social networks for the elderly]. / Wohnsituation und Hilfenetze im Alter.

There is a provable correlation between the housing conditions of elderly persons and their being attached to a network of aid they can rely on in cases of emergency and strain. The elderly living in one or two-family houses, for example, have several options of being supported. The elderly living in big city tenements on the other hand often lack such an abundance of relations. Integration into the circle of family members and relatives plays the major role for these quantitative framework conditions as well as for the immediate availability of assistance. Having a house of one's own increases the possibility of developing a well-functioning cross-generation support system within the family. If promotion of house construction was further adapted to this operating mechanism, support effects for social policy could be reached. At the same time it is imperative to encourage the development of informal support systems within the framework of socio-political initiatives. With the number of childless elderly persons increasing, such systems would partially compensate for the lack of family assistance through neighbourhood and other forms of self-support.

Nickel dermatitis in medical workers.

The incidence of contact allergy to nickel in medical workers has increased from 9.4 to 26.2 per cent during the past decade. Despite the many occupational nickel sources in a hospital or outpatient department, the incidence and prevalence of hypersensitivity to this metal are no higher in female medical workers than in the female population in general. Also, most of the cases of nickel allergy have been acquired before working life or are attributable to nonoccupational sources such as earrings, wristwatches, and clothing buckles. Occupational nickel sensitization is rare. Nickel allergy is a handicap in many medical jobs, and persons suffering from it need career advice.

[Role of the social support network in caring for the aged]. / Zur Rolle der sozialen Beziehungsnetze in der Altenpflege.

This study presents the results of an investigation of the reasons for the elderly people being cared for as residents of nursing homes or as outpatients. With regard to the reasons for being outpatients or being residents of nursing homes it can be pointed out: elderly people as outpatients can only be cared for as long as there are intact social relations. If services for outpatients are not supplemented by social relations the stay in a nursing home cannot be avoided.

Family size effects: a review.

Larger families are more frequent with early marriage and rapid birth of the first child. In larger families, child rearing becomes more rule ridden, less individualized, with corporal punishment and less investment of resources. Smaller families tend to result in higher IQ, academic achievement, and occupational performance. Large families produce more delinquents and alcoholics. Perinatal morbidity and mortality rates are higher in large families as birth weights decrease. Mothers of large families are at higher risk of several physical diseases. Common methodological errors are indicated and exemplary studies are described.

Child spacing effects: a comparison of institutionalized and normal children.

Data were collected on 52 psychiatrically abnormal and 101 normal children, as part of a study of the effects of sibship constellation variables on intellect, achievement, personality traits, and social adjustment. The two groups are closely equivalent with respect to age, social class (lower and lower-middle) and sibship size. There was a significantly higher percentage of psychiatrically abnormal than normal children having a sibling less than two years older. conversely, the normal children had a significantly higher percentage of widely spaced (to the next older) than did the psychiatrically abnormal children. Unwantedness by parents (especially the mother) may be a factor in increasing the likelihood of learning and behavioral difficulties and other social disarticulation.

Sibship-constellation effects on psychosocial development, creativity, and health.

PIP: This contribution provides a summary and integration of the abundant research findings culled from over 2000 articles dealing with the effects of sibship variables on child development. The review covers the effects of each of the sibship variables: sibship size, ordinal position, and sibling age spacing with regard to intelligence, achievement, creativity, personality, and health. All descriptions included are based on at least 1 reported research finding. Speculative literature is consistently excluded. Each and all of the sibship variables have effects, from just demonstrable to uncommonly powerful, on intelligence, academic achievement, occupational success, creativity, emotional control, socialization, health, and longevity. Despite the fact that they are derived from variously oriented and designed investigations, the studies reviewed present overall amazingly consistent results. Intelligence and personality traits are powerfully influenced by parental behavior and sibling interaction, particularly during the child's 1st 3 years of life. Yet, both cognitive and conative characteristics lend themselves to improvement by positively altering parental behavior through psychotherapy, or better yet, by widespread open recognition of the importance and the intricacies of child rearing which has been almost totally left to parental whims and folklore The available basic knowledge needs to be used as a foundation for high school and college cources aimed at upgrading child rearing practies. Reseach and clinical evidence strongly and definitely indicate that socially desirable personality traits result from small families in which the children are spaced 3 or more years apart. Both the displaced and displacing child are seriously disturbed by close spacing -- the displaced child showing the greatest disturbance. Early displacement leads to early and persistent cognitive effects on intelligence and psychosocial development. Considering the effects of size of the family: large families seem to produce greater risk of arthritis, peptic ulcer, and cancer, as well as greater neonatal and early childhood morbidity and higher mortality rates. The goal in family planning and education in parenting would be to have each child wanted and welcomed and to have the parents devote sufficient time to the child to understandhis/her needs. widely spaces and fewer children are associated not only with upward mobilithy and an improved standard of living but also with greater overall individual ability, well being, and creativity.^ieng