[Harmful health effects of flavors in e-cigarettes]. / Gesundheitsschädliche Wirkungen von Aromen in E-Zigaretten.

BACKGROUND: Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD: Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS: Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS: The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.

[Harmful health effects of flavors in e-cigarettes]. / Gesundheitsschädliche Wirkungen von Aromen in E-Zigaretten.

BACKGROUND: Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD: Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS: Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS: The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.

[Scientific Rationale for the Directive on Opioid Substitution Treatment of the German Medical Association: A Summary]. / Zusammenfassende Darstellung der wissenschaftlichen Grundlagen der Richtlinie der Bundesärztekammer zur Durchführung der substitutionsgestützten Behandlung Opioidabhängiger.

BACKGROUND: According to the Narcotic Drugs Prescription Ordinance (BtMVV), the German Medical Association was commissioned to issue a directive on opioid substitution treatment (OST) based on the current state of scientific medical knowledge. METHOD: For the publication of the initial version of the German Medical Association's directive in 2002, an extensive literature research had been conducted, categorizing the results by levels of evidence. Subsequent revisions in 2010 and 2017 included recent systematic reviews, studies of evidence levels I-III and international guidelines. RESULTS: OST showed its potential in the pursuit of health- and addiction-related as well as psychological and social goals. There was a decline in the rate of mortality, and high risk consumption of illegally acquired opioids was eliminated in 70 to 80% of patients in OST. Psycho-social assistance was found to enhance treatment outcome. Scientific evidence was lacking for the identification of patient groups suitable for different duration of take-home prescription. CONCLUSIONS: With its 2017 amendment, the guideline of the German Medical Association was revised on the basis of the current state of science on substitution treatment. This creates more legal certainty for doctors, and treatment can be delivered in accordance with the existing scientific knowledge. Whether the effects of OST observed in this study have an impact on the care of opioid addicts by attracting more doctors to participate in their treatment needs further evaluation.

[Continuity of care--the perspective of nurses responsible for Pflegeüberleitung]. / Versorgungskontinuität--die Perspektive von Pflegeüberleitungskräften.

Until a few years ago, continuity of care in connection with a client's transition from one care setting to another was not considered part of the primary objectives of the health system, due to a strict division of intramural and extra-mural care systems. Nowadays, epidemiological as well as sociographic developments have changed the situation fundamentally. As their common main objective, the different approaches towards Pflegeüberleitung focus on the management of interfaces by reducing breaks in co-ordination, thereby improving the quality of the service. As part of an extensive research project in three hospitals from March 2000 to February 2002 on securing continuity of care through Pflegeüberleitung, specific attention was rendered to the views of nurses involved in it. One of the main findings emerging from the self-assessment focuses on the uncertainty of the nurses involved in Pflegeüberleitung about their own work within the hospital context. This reflects the still insufficient integration of Pflegeüberleitung in the hospital system. Here, organization is still centered on "discharge" as the main work aim rather than the patients' interests reaching beyond system borders.

[Continuity of care--the perspective of patients and their relatives]. / Versorgungskontinuität durch Pflegeüberleitung--die Perspektive von Patienten und Angehörigen.

As part of an extensive research project on securing continuity of care through Pflegeüberleitung, data on experiences of patients and their relatives regarding discharge from hospital were collected and analysed by means of a qualitative study. Ten focused interviews were conducted and analysed with five patients and five relatives, respectively. From the results of the patient interviews, the subjective experience of being ill was identified as a main issue, constituting a dimension which pervades all other categories of the results. Patients judge nursing measures regarding the discharge planning in the light of this dimension. The results of the interviews with relatives indicate the lack of interdisciplinary cooperation and coordination. Relatives complain about the missing attempts to come to agreements and about their perspective not being considered regarding care needs as well as the date of discharge. There is a need for the development of new approaches to care and treatment in the hospital which allow for the patient's and the relatives' participation and co-shaping, thereby recognizing an altered understanding of the respective roles. In order to achieve systematic integration of the clients' perspectives, thus securing individual continuity of care, programmes for professional consultancy play an important part of these new approaches.

[Continuity of care by Pflegeüberleitung? Results of participant observation]. / Versorgungskontinuität durch Pflegeüberleitung? Ergebnisse einer teilnehmenden Beobachtung.

Continuity of care between health care institutions is of increasing importance. In a two-year research project on this topic extensive participant observation was carried out for data gathering in three hospitals in Düsseldorf (Germany). In each institution four patients were observed until their discharge and all interactions between them and health care professionals were documented using a semi-structured data-gathering instrument. Furthermore, the researchers questioned the involved professionals after each situation. Altogether a total of 980 situations were documented during 100 shifts, thus professional activities aiming at continuity of care can be regarded as extensively covered. The results show that care professionals (nurses, physicians, social workers etc.) in the three participating hospitals only incompletely assess individual needs or even fail to do so at all. In addition, there is no regular interprofessional collaboration and the professionals' horizon is essentially limited to their own institution. Patients and their relatives are not systematically involved and their views rarely considered. Two cases are used as examples to illustrate these aspects. A third example shows that also successful processes were observed. In most cases, however, the implicit logic of the hospital system dominates over individual needs and therefore a successful continuity of care processes cannot be assumed. Finally, the necessity for a fundamental change of this counterproductive systems logic is briefly discussed.

[Shared decision making. The perspective of practicing physicians]. / "Shared Decision Making"Gemeinsame Entscheidungsfindung aus der ärztlichen Perspektive.

BACKGROUND AND PURPOSE: More and more, patients want to participate in medical decision making. They expect a patient-centered communication as well as adequate information. However, little is known about the physicians' perspective and skills regarding shared decision making (SDM). This paper presents data about the physicians' perspective and allows focused comparison with the patients' views. METHODS: Standardized survey of 502 physicians from ambulatory care practices and of 1,512 German-speaking people, aged 18-79 years. Patient data were collected from a population-based random sample of an access panel. The following topics were included in this survey: medical decision making in daily practice, communication skills and behavior of physicians from the perspectives of physicians and patients. RESULTS: A majority of physicians approve the concept of SDM. Especially younger physicians favor the concept of SDM. Overall, physicians underestimate their patients' preference to participate in medical decision making. Physicians also tend to overestimate their information and communication skills. CONCLUSION: Not only in the general public, but also among physicians, a model of SDM is widely accepted. The communication skills necessary for this process appear to exist. However, they need to be promoted and extended. Learning to communicate adequately should receive a greater focus in medical education and postgraduate training.

[Psychiatric morbidity in homeless single men]. / Psychiatrische Morbidität bei allein stehenden wohnungslosen Männern.

AIM: The aim of this cross sectional study was to establish the extent of psychiatric morbidity among homeless men and compare this group with a sample of formerly homeless. METHOD: [corrected] 82 homeless and a comparison group of 37 formerly homeless were interviewed using a psychopathological interview according to AMDP (Arbeitsgemeinschaft für medizinische Dokumentation) as well as selected modules of the CIDI (Composite International Diagnostic Interview). Diagnoses were established according to ICD-10. RESULTS: The lifetime prevalence of psychiatric disorders was 95.1 %, the current prevalence was 87.8 %. Substance related disorders were the most common group of disorders. In the formerly homeless prevalences were slightly lower. CONCLUSIONS: Psychiatric morbidity among the homeless is high. Services have to be tailored to meet the needs of this special group. Formerly homeless continue to need intensive psychiatric input.

[Prevalence of physical diseases, health behavior and health care utilization in single homeless men: a cross sectional study]. / Prävalenz körperlicher Erkrankungen, Gesundheitsverhalten und Nutzung des Gesundheitssystems bei alleinstehenden wohnungslosen Männern: eine Querschnittsuntersuchung.

OBJECTIVE: The aim of this cross-sectional study was to establish the prevalence of physical diseases, the subjective evaluation of their own health and health care utilization in the actually homeless and a comparison group of formerly homeless. METHODS: A representative sample of 82 homeless and 37 formerly homeless was studied. Instruments were a physical examination and a standardized interview. The latter included parts of the assessment of the German cardiovascular disease prevention study and the questionnaire "Funktionseinschränkungen" (functional impairments) by Potthoff (1982). RESULTS: Disease prevalence was high. The main diagnoses fell within the categories of defective dental status (over 80%), ophthalmologic diseases (over 60%) and diseases of the liver and musculoskeletal system (over 40% each). Morbidity in the formerly homeless was even higher. In both groups the subjective evaluation of their own health was unrealistically positive. Risk factors for cardiovascular diseases were high. Health care utilization was mainly acute. CONCLUSIONS: The medical care of the homeless in standard medical services is insufficient and could be improved by especially tailored projects which should include education about risk factors. Formerly homeless continue to show high disease prevalence.

[Methadone substitution--a scientific review in the context of out-patient therapy in Germany]. / Methadon-substitution-- wissenschaftliche Studienlage im Kontext ambulanter Rahmenbedingungen in Deutschland.

The German Betäubungsmittelverschreibungsverordnung BtmVV (prescription regulation of narcotics), 5 part 2, 01 July 2001 commissioned the German Medical Association to establish guidelines on methadone maintenance therapy according to the medical-scientific state of the art. A joint commission of the German Medical Association and the National Association of Statutory Health Insurance Physicians developed guidelines for substitution therapy of opiate dependence which were adopted by the board of the German Medical Association in March 2002 and were published in the Deutsche Arzteblatt in May 24, 2002. The present study is a systematic review of the scientific literature on successful treatment in general, as well as on particular aspects of methadone substitution therapy considered by the German Medical Association's guidelines. The literature was updated until January 2004. Older randomised controlled trials and more recent quasi-experimental studies provide evidence that methadone maintenance therapy is an effective strategy to reduce illicit drug use, to improve the health situation of drug users, to diminish criminal behaviour, and to promote rehabilitation of opiate-dependent individuals. The evaluation of international studies clearly shows that access criteria to substitution therapy beyond the diagnosis of opiate dependence, e.g. the presence of a life-threatening co-morbidity, is not a prerequisite for substitution in other countries, and therefore is not discussed in the international literature. Study evidence shows that the German Medical Association's guidelines for substitution therapy of opiate dependence reflect the best evidence available from scientific studies and apply it to the conditions of the German healthcare system.

[Family physicians, the internet and new knowledge. Utilization and judgment of efficiency of continuing education media by general physicians and internists in family practice]. / Hausärzte, Internet und neues Wissen. Nutzung und Effizienzeinschätzung von Fortbildungsmedien durch Allgemeinärzte und hausärztlich tätige Internisten.

BACKGROUND AND OBJECTIVE: The application of new information technologies has a lasting impact on the physicians' working environment. Not only practice administration is undergoing substantial change, increasingly, individual learning preferences and continuing medical education are influenced by new media. This survey is designed to demonstrate current methods of and demand for continuing medical education by primary care physicians. METHODS: Standardized survey of 72 primary care physicians (21% female, 79% male) regarding three topics: medical knowledge acquired after medical school, current use of and expectations for continuing medical education tools. RESULTS: Primary care physicians estimate the fraction of their knowledge which was acquired after medical school at 60%. For their continuing medical education primary care physicians predominantly use scientific journals, colleagues and quality circles. The internet, scientific staff at research institutions and pharmaceutical representatives were less valued and less used. The most favored attributes for continuing medical education tools were: reliable, relevant for daily practice, and user-friendly. CONCLUSION: Continuing medical education is important and necessary. Thus far, new media still have a minor role among the relevant educational media for primary care physicians. The introduction of modern information technologies may become more successful if primary care physicians' preferences are better understood and education tools are designed according to these preferences.

[www.evidence.de--assessment and utilization of clinical guidelines by primary care physicians and internists]. / www.evidence.de--Netzbasierte Leitlinien im Praxistest. Beurteilung und Nutzung von evidenzbasierten und netzgestützten Leitlinien durch Allgemeinärzte und hausärztlich tätige Internisten.

BACKGROUND AND OBJECTIVE: Compared to the generation of new scientific results, implementation and utilization of evidence based knowledge is lacking far behind. Strengths and weaknesses of evidence- and HTML-based guidelines were evaluated in an academic network of primary care physicians to better understand the expectations and information needs of GPs. METHODS: Standardized survey of 72 primary care physicians (21% female, 79% male) regarding three network based issues: "frequency of guideline use", "reasons to use/not to use guidelines", "evaluation and overall judgement of guidelines". RESULTS: 62.9% of participating had used net based guidelines at least once, the percentage of more frequent users (> 2 times in two months) was 40.3%. Curiosity and non-specific interest as well as a concrete medical question were the main reasons for utilization of guidelines. The overall judgement of the guidelines was positive, however, only a minority of participating physicians viewed them as a concrete help in daily practice. CONCLUSION: Transformation of new scientific medical knowledge into daily primary care practice is only insufficiently developed. Netbased instruments of continuing medical education may serve as catalysts and should be further developed as well as evaluated.