[Tobacco Cessation - The Underused Potential in Clinical Routine]. / Tabakentwöhnung ­ die bisher wenig genutzte Chance im ärztlichen Alltag.

Tobacco control, psychosocial and medical assistance regarding tobacco cessation is still a hidden potential within the German health care system. So far doctors rarely talk to their patients about their smoking status and physical and psychological benefits of quitting.This paper focusses on recommended current diagnostic and treatment standards, as well as evidence-based methods to address the topic on how to stop smoking and its association with certain diseases such as COPD, lung cancer and COVID-19 infection. The role of e-cigarettes as a cessation tool and its health related risks are critically examined. Consequences and advice how to implement smoking cessation procedures into daily practice are presented.

Evaluation of long-term quitters: who stays smoke free forever?

BACKGROUND: Smoking cessation is one of the most powerful health promotion tools in the Western world. Behavioral group therapies are regarded as very promising interventions in this field. Quitting rates are usually evaluated after 6-12 months and lie between 30 and 45%. So far, there are no scientific data on potential protective indicators to remain successfully smoke free after this period. Therefore, the aim of this study was to detect the current smoking status of former participants of a cessation service in an urban German surrounding. We investigated reasons for relapses, quitting strategies, and psychosocial parameters. METHODS: In 2019, 130 former patients (2011-2017; mean age 54 years; 37 pack/years; Fagerstroem = 5.75; 58.5% male, 41.5% female; 66% physical comorbidities; 35% psychiatric diagnoses) were invited to participate in a mailed survey (including WHO 5, SF 12, self-efficacy scale) and were asked about their current smoking status, personal history of smoking, and individual experiences with stopping after the 1­year abstinence date. RESULTS: A total of 53 persons replied (RR 41%), 29 (54%) of whom are currently smoke free; 24 relapsed intermittently or permanently, 9 experimented with e­cigarettes, and 2 became dual users. Daily hassles as well as physical and mental challenges were the main reasons for relapsing. CONCLUSION: Due to the low response rate, conclusions are limited; however, the 1­year abstinence rate might not be as reliable as thought so far; long-term "sober" nicotine addicts remain at risk of relapse.

A pilot study evaluation of psychosocial competency training for junior physicians working in oncology and hematology.

BACKGROUND: This pilot and feasibility study evaluated a work-related self-care competency training in oncology and hematology medicine for junior physicians working in oncology and hematology medicine. METHODS: A pilot study was conducted with 80 physicians working in oncology and hematology hospital departments in Germany. Physicians were distributed to either the intervention group receiving competency training or a comparison group. The intervention took place in groups over a period of 12 weeks. Training content included work-related self-care strategies, problem-solving techniques solution-focused counselling. The outcomes studied were changes in work-related stress, emotional exhaustion, emotion regulation, and job satisfaction. Follow-up assessments were arranged after 12 weeks (T1), after 24 weeks (T2), and after 36 weeks (T3). RESULTS: Intervention group reached a decrease in perceived job stress and emotional exhaustion. Self-perceived improvements were also obvious regarding enhanced emotion regulation skills. Future oncologists valued the intervention with high scores for training design, content, received outcome, and overall training satisfaction. CONCLUSIONS: This study provided first indications that an innovative self-care competency training might be a supportive approach for junior physicians starting work in oncology and hematology. However, replication studies are needed to verify the results in the medical working context.

Being prepared to work in Gynecology Medicine: evaluation of an intervention to promote junior gynecologists professionalism, mental health and job satisfaction.

BACKGROUND: Dealing with work-related stress is highly prevalent for employees in Gynecology Medicine. Junior physicians, in particular, have to face high working demands and challenges while starting their medical career after graduation. Job resources (i.e., social support) and personal resources (coping skills) might reduce job strain. The evidence for supportive and effective mental health interventions for clinicians is limited. Offering psychosocial skill training for entrants in Gynecology Medicine is expected to be highly beneficial. Following this, the present pilot study focused on strengthening physicians' psychosocial skills and analyzed the effects of innovative training for junior gynecologists working in German hospitals. METHODS: Coping skills training for junior gynecologists was offered as group training for 12 weekly sessions over a time period of 3 months. Physicians were randomized to either an intervention group (IG) receiving the training (n = 38) or a control group (CG; n = 40). Training content involved developing and learning coping skills as well as solution-focused and cognitive behavioral counselling for junior gynecologists. Study outcomes were (1) perceived occupational stress, (2) emotional exhaustion, (3) resilience coping behavior, (4) emotion regulation skills and (5) job satisfaction. Surveys were distributed at baseline (T0), after the training (T1), after 3 (T2) and 6 months (T3). RESULTS: Junior gynecologists (IG) reported a significant decrease in perceived job stress and emotional exhaustion from baseline to all follow-ups, whereas the control group did not show any comparable results. A clear positive value of the mental health promotion program was also noticeable with regard to job satisfaction and increased coping skills (i.e., emotion regulation). Overall satisfaction with the skill training was high: gynecologists reported high scores for training design, content, received outcome and overall satisfaction with the training. CONCLUSIONS: In this pilot study, participating in a psychosocial skills training course adapted for gynecology clinicians was associated with reductions in perceived job stress, exhaustion and improvements in coping skills and satisfaction. Modified psychosocial skills training may be a time-efficient tool to support gynecologists in their performance and well-being, which may have positive implications for patient care.

Prevention of study-related stress symptoms: health-promoting behavior among dental students.

BACKGROUND: Training to become a dentist is one of the most demanding professional education experiences. There are very few studies on strategies and activities to cope with study-related stress during dental training. We therefore evaluated the prevalence of burnout symptoms and coping activities among dental students. METHODS: A cross-sectional survey was performed analyzing a sample of 239 dental students from Germany. Students were asked to complete a survey containing questions about burnout symptoms and coping behavior. RESULTS: A total of 38% of the dental students perceived symptoms of emotional exhaustion; 17% reported symptoms of personal accomplishment and 11% perceived scores of depersonalization. Students reported on coping activities, ranging from health-promoting techniques, such as exercising, to less recommendable health harming relaxation strategies, such as taking drugs. CONCLUSION: Our results indicate the need for relevant health promotion and may aid decision makers in developing health promotion programs.

Surgeons' work engagement: influencing factors and relations to job and life satisfaction.

BACKGROUND: Work engagement has become a topic of great interest in recent years. However, clinicians' work engagement has rarely been studied and relatively little is known about its predictors and consequences. Therefore the objective of this cross-sectional questionnaire study was to test a model of possible institutional and personal predictors and significant relations to job and life satisfaction. METHODS: 123 clinicians specializing in Surgery Medicine participated in the study. Self-administered questionnaires, including the Copenhagen Psychosocial Questionnaire, the Utrecht Work Engagement Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism, were administered. Bivariate analyses and a stepwise regression analysis were performed. RESULTS: The whole sample of surgeons rated work engagement with a high mean of M = 4.38; SD = .91. Job satisfaction and perceived quality of life have been rated with moderate scores. The results show that job resources have a greater impact on surgeons' work engagement than their job demands. Significant correlations between surgeons' work engagement, their job satisfaction and quality of life were found. Moreover, work engagement mediated the relation between institutional factors and surgeons' job satisfaction. CONCLUSION: Our research suggests that strengthening surgeons' work engagement will contribute to a more sustainable workplace, in terms of both individual and hospital performance. Therefore, increasing work engagement among surgeons should be of concern for supervisors and hospital managers. Future research should focus on further predictors that may have an influence on health professionals' work engagement. Another field for future research is to study potential effects of interventions on work engagement.

[Smoke-free in Psychiatry - A Qualitative Analysis of Staff Perspectives]. / Rauchfrei in der Psychiatrie ­ Eine qualitative Analyse der Ansichten von Mitarbeiter:innen.

BACKGROUND: People with mental illness are more likely to be nicotine-dependent and they have a shorter life expectancy as a result of smoking. Although guidelines recommend smoking cessation support, this is rarely provided by psychiatric staff who often view the implementation of smoke-free policies critically. METHOD: We undertook inductive thematic analysis of the free-text fields of a staff survey on smoking. RESULTS: Feedback on the topic was often emotional and related to the areas patient care, staff and the protection of non-smokers. Participants were often concerned that smoking cessation could worsen the patient's psychiatric condition or lead to aggressive behavior. CONCLUSIONS: There is no scientific evidence for these concerns. It is important to counteract false assumptions by providing the appropriate training on smoking cessation.

[Tobacco cessation - the underused potential in clinical routine]. / Tabakentwöhnung ­ die bisher wenig genutzte Chance im ärztlichen Alltag.

Tobacco control, psychosocial and medical assistance regarding tobacco cessation is still a hidden potential within the German health care system. So far doctors rarely talk to their patients about their smoking status and physical and psychological benefits of quitting.This paper focusses on recommended current diagnostic and treatment standards, as well as evidence-based methods to address the topic on how to stop smoking and its association with certain diseases such as COPD, lung cancer and COVID-19 infection. The role of e-cigarettes as a cessation tool and its health related risks are critically examined. Consequences and advice how to implement smoking cessation procedures into daily practice are presented.

Eating behavior and nutrition knowledge among musical theatre students.

Eating is a central part in human (social) life. Athletic performance and physical attractiveness are linked to appropriate nutritional behavior, especially for performing artists. Eating behavior and nutrition knowledge have not been examined in musical theatre students so far, which this study aims to analyze. We administered a cross-sectional questionnaire study to 37 musical theatre students. Results for the Eating Disorder Examination-Questionnaire (EDE-Q) showed non-pathological values for 92% of all participants, but 81% of participants answered correctly on only 30-59% of questions on the General Nutrition Knowledge Questionnaire (GNKQ). Our study results reveal the need for specific nutritional knowledge transfer programs for this target group.

A Qualitative Investigation of Staff Feedback on an Online Learning Module on Smoking Cessation in a German Healthcare Company.

Quitting smoking is a powerful way for patients to improve their own wellbeing and to significantly reduce the risk of health problems. Evidence shows that health professionals can effectively intervene in order to prevent and stop tobacco smoking in their patients. Online learning modules have proved to be effective in terms of transferring knowledge and skills. In an urban community hospital setting in Germany, a novel e-learning course for staff on the treatment of tobacco dependence was implemented in 2021. In this study, we analyzed free-text feedback of participants completing this online module in order to examine the feasibility and acceptance of this new format. We were able to reach a reasonable proportion of staff. Our qualitative analysis showed that most feedback was positive and described the module as well-designed and helpful. Some staff, however, expressed extremely negative views and did not see smoking cessation support as essential to their role in healthcare. We argue that in order to achieve a shift in attitude in healthcare staff, a change in German policy is required which includes the creation of smoke-free environments and the adherence to smoke-free policies on hospital sites. Furthermore, the provision of smoking cessation support in line with the WHO Framework Convention on Tobacco Control and a true understanding of the role of all healthcare professionals in promoting health of patients and staff will be essential.

Improving quality of medical treatment and care: are surgeons' working conditions and job satisfaction associated to patient satisfaction?

BACKGROUND: Over the last decades, surgeons, researchers, and health administrators have been working hard to define standards for high-quality treatment and care in Surgery departments. However, it is unclear whether patients' perceptions of medical treatment and care are related and affected by surgeons' perceptions of their working conditions and job satisfaction. The aim of this study was to evaluate patients' satisfaction in relation to surgeons' working conditions. METHODS: A cross-sectional survey with 120 patients and 109 surgeons working in Surgery hospital departments was performed. Surgeons completed a survey evaluating their working conditions and job satisfaction. Patients assessed quality of medical care and treatment and their satisfaction with being a patient in this department. RESULTS: Seventy percent of the patients were satisfied with performed surgeries and services in their department. Surgeons' job satisfaction and working conditions rated with moderate scores. Bivariate analyses showed correlations between patients' satisfaction and surgeons' job satisfaction and working conditions. Strongest correlations were found between kindness of medical staff, treatment outcome and overall patient satisfaction. CONCLUSION: This study demonstrates strong associations between surgeons' working conditions and patient satisfaction. Based on these findings, hospital managements should improve work organization, workload, and job resources to not only improve surgeons' job satisfaction but also quality of medical treatment and patient satisfaction in Surgery departments.

Doctors' working conditions in emergency care units in Germany: a real-time assessment.

BACKGROUND AND OBJECTIVES: As interest in doctors' work in Germany has increased over the last few years, this study determines how doctors spend their work time in emergency departments. The study also provides information on patient load and working conditions in emergency units. METHODS AND MATERIAL: An observational time-and-motion study was carried out at three emergency departments. A single investigator followed emergency doctors and recorded the time spent on various work activities. Job activities were classified into 12 different main categories, including direct or indirect patient care. RESULTS: The data showed that doctors in emergency departments had to work overtime (M=09.17 h). They performed more than 80 tasks per day and were forced to handle multitasking situations. Indirect patient care and administrative duties were the main tasks doctors spent time on during the day. Direct patient care and contact represented only a small proportion of work time. CONCLUSION: Doctors working in emergency care units have to deal with highly unpredictable workloads and overtime work, and simultaneously should also care for patients and interact with a large number of different persons during each work shift. The findings of this study are useful in efforts to improve emergency medical care and doctors' working conditions.

Neuroenhancement among German university students: motives, expectations, and relationship with psychoactive lifestyle drugs.

Recent research has indicated that neuroenhancement (NE), the use of legal or illegal drugs by healthy individuals to improve their cognitive performance, is widely practiced among students in both the United States and Germany. The primary objective of this study was to identify the motives for and beliefs regarding the benefits and risks of practicing NE among a sample of German university students and graduates. The secondary objective was to determine the relationship between the use of neuroenhancers and the use of several common psychoactive lifestyle drugs. A web-based survey was used to interview students and postgraduates. Of the 1,324 participants, 93 reported having practiced NE for the primary motives of improving concentration (55%) and increasing vigilance (49%). Participants who reported having practiced NE were more likely to assess NE as more beneficial and less harmful compared to participants who reported not having practiced NE. The former also reported greater use of all lifestyle drugs except alcohol compared to the latter. The primary motives for practicing NE are associated with management of a high level of stress and a large academic workload. As such, decreasing the prevalence of NE among students requires implementation of strategies targeting stress reduction and workload management.

Cognitive-enhancing substance use at German universities: frequency, reasons and gender differences.

BACKGROUND: The purpose of this study was to give an overview whether German students regularly use stimulants for enhancing their academic performance. Reasons associated with the use of these substances were explored. Moreover, gender differences were analyzed. METHODS: A cross-sectional survey study was performed analyzing a random sample of 1,053 students of different fields of study in Germany. Students were asked to complete an anonymous self-administered web-based survey containing questions on cognitive performance-enhancing substance use. We used statistical analyses, e.g. non-parametric tests to evaluate the data of our questionnaire. RESULTS: Among 1,053 students, 61 % responded to our questionnaire. The average age was M = 24.58; 635 participants were female and 418 were male students. Total 1-13 % of the participating students have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to support concentration, to relax and to increase alertness. We found significant gender differences with regard to frequency and reason for using performance-enhancing substances. CONCLUSIONS: Our study results give an overview about the actual situation on frequency and reasons for taking performance-enhancing substances. Departments of Public Health should address this issue in national health debates and discussions. Based on our study findings health education programmes should be developed.

Stress, health and satisfaction of Australian and German doctors--a comparative study.

BACKGROUND: Currently no study exists focusing on international differences in perception of stress, working conditions and satisfaction of hospital staff. Therefore the present study aimed to examine and compare the work and privacy situation of Australian and German physicians. METHODS: The present study was designed as a cross-sectional comparison using questionnaire data. The population consisted of representative samples of 310 German and 256 Australian hospital doctors who received mailed questionnaires. The questionnaires contained items on demography, perception of stress, working conditions, job satisfaction and Life satisfaction. RESULTS: According to the comparison, German physicians perceived higher values of work stress. They work significantly longer hours than Australian doctors. In general, work intensity and demands are highly rated in both countries. In terms of job and life satisfaction, Australian doctors responded more positively than German doctors. CONCLUSION: This is the first comparative study illustrating a subjective evaluation of physicians' perception of stress, their work and privacy situation in two different countries. Based on these results health policy decisions can be developed.

Survey of health problems in musical theater students: a pilot study.

UNLABELLED: Musical theater performers are the "triathletes" in the performing arts. The field requires versatility in a combination of skills including dancing, singing, and drama in a high frequency of performances. The aim of this study was to analyze and evaluate the health situation of musical theater students using a complete musical educational institute as an example (n = 37). METHODS: The basis for the evaluation was a questionnaire survey (standardized F 1000). All students of the school participated (20 males, 17 females). RESULTS: Of the students, 62% have a part-time job for financial reasons, and 67.7% state only a "partial satisfaction" with their body. Regarding injury, 45.9% claim to sustain an orthopaedic injury up to twice a year, and 29.7% up to three or four times. A total of 49 acute injuries (1.3/student) and 42 chronic complaints (1.1/student) were stated. The lower extremity was the most common acutely injured region (65.3%), followed by the spine (16.3%) and upper extremity (14.3%). Of chronic complaints, the lumbar spine was the most commonly affected area, followed by the hip joint and pelvic area. Thirty-three and 24% of acute injuries occurred during "spins" and/or "stretching," respectively. There were various causes for physical and mental problems. DISCUSSION: The results show both parallels and differences to the relevant literature. It is shown that health hazards already arise in the education of musical performers. This provides particulars for the implementation of injury prevention measures during the theoretical and practical education of musical students.

Cancer care and residents' working hours in oncology and hematology departments: an observational real-time study in German hospitals.

BACKGROUND: Physicians currently working in hematology and oncology wards are often frustrated with their working conditions. They express dissatisfaction with the working hours, poor organization of work and a low salary compared with the burdens of cancer care. However, to date, there have been no real-time observational studies to verify these subjective reports. Therefore, this study is the first to provide objective data about residents' workload. METHODS: A real-time task analysis was conducted by individually observing 21 hematology and oncology residents at German hospitals. A total of 626 h of observation were performed using an Ultra Mobile PC. RESULTS: The residents observed in this study worked an average of 9 h 56 min per day, during which time was divided among the following activities: 31.20% for internal communication, 22.06% for indirect patient care and 10.99% for ward rounds. Per workday residents spent an average 6.20% of their shift time talking to patients. CONCLUSIONS: This study provides the basis for future analyses on physicians' workflow. Some key results may be used to recommend measures to improve physicians' work performance and the quality of cancer care.

[Shift- and Nightwork - a scientometric analysis]. / Schicht- und Nachtarbeit - eine szientometrische Analyse.

Economic restructuring processes in Germany require changes within all social and health care systems regarding night shiftwork. The aim of this paper was to analyse research results referring to shift- and nightwork using scientometric methods. A total of 3092 items could be detected. A constant increase in the number of publications per year since 1977, especially since 1990' was obvious. One third of the research results, a total of 884 articles could be assigned to the USA. Great Britain could be identified with 365 articles and France with 244 published articles. Sleep, Ergonomics and Chronobiology International are the most prolific journals. The Swedish scientist Torbjörn Akerstedt is to this date the most acclaimed researcher referring to his issue. He has written 105 articles about shift- and nightwork. He is not only a most efficient author, but also has the highest h-index [30]. Self-citations and multiple co-authorships distort parameters like impact factor and h-index enormously and should be regarded from a critical point of view.

Time and motion study of anesthesiologists' workflow in German hospitals.

BACKGROUND: The purpose of this study was to investigate anesthesiologists' workflow in real time. METHODS: Anesthesiologists were observed for a total of 60 workdays. All tasks performed during this time were recorded in real time. RESULTS: The anesthesiologists were shadowed for a total of 517:16:36 hours. The average workday lasted 08:37:17 hours. Overall they spent 28.5% of each workday on indirect patient care, 14.7% on direct patient care and 18.8% on administrative work. Communication took up 19.9% of anesthesiologists' time, breaks and disruptions 15.2% and other job tasks 2.9%. CONCLUSIONS: The results comprise objective data about the workflow and working conditions in anesthesiology. We found support of the large imbalance between the direct patient care and the heavy administrative workload reported by physicians. These results may be useful in future efforts to improve anesthesiologists' working conditions and workflow optimization.