Establishing a standing patient advisory board in family practice research: A qualitative evaluation from patients' and researchers' perspectives.

INTRODUCTION: Patient and public involvement is vital for high-quality research. Integrating patients' and providers' perspectives early in research enhances the feasibility and relevance of study results. Within our family practice-based research network ForN, we established a standing patient advisory board (PAB) to include patients with diverse conditions and experiences. In this paper, we aim to describe the establishment and functioning of a standing PAB in family medicine research from patients' and researchers' perspectives. METHODS: After each PAB meeting, patients and researchers were asked to name anonymously positive and challenging moments in a feedback form with open questions. Researchers were also asked to reflect on how they implemented the discussion content in their research projects. The responses from both groups were transferred to MAXQDA 2018 and analyzed separately using thematic analysis. RESULTS: We analyzed 40 feedback forms from patients and 14 feedback forms from researchers. The dominant theme in the patients' feedback was 'exchange': They positively emphasized the 'exciting and open discussions' and the exchange of perspectives with one another and researchers. The clarity of the researchers' presentations and the research topics were appreciated. Researchers also positively highlighted the open atmosphere of the discussions. Presenting their research to the PAB helped most researchers reflect on their research topics from patients' perspectives and implement changes. However, researchers also mentioned several barriers to the implementation of PAB members' feedback. CONCLUSION: The establishment of a standing PAB in family practice research is feasible and productive both from patients' and researchers' perspectives. PATIENT OR PUBLIC CONTRIBUTION: This study reports the evaluation of the establishment of a standing PAB in family practice research. Board members are involved in the design of studies, the co-production of interventions and information material, and the interpretation of data.

A drug recommender system for the treatment of hypertension.

BACKGROUND: One third (20% to 30%) of patients suffering from hypertension show increased blood pressure resistant to treatment. This resistance often has multifactorial causes, like therapeutic inertia and inappropriate medication but also poor patient adherence. Evidence-based guidelines aim to support appropriate health care decisions. However, (i) research and appraisal of clinical guidelines is often not practicable in daily routine care and (ii) guidelines alone are often insufficient to make suitable and personalized treatment decisions. Shared decision-making (SDM) can significantly improve patient adherence, but is also difficult to implement in routine care due to time constraints. METHODS: Clinical Decision Support Systems (CDSSs), designed to support clinical decision-making by providing explainable and personalized treatment recommendations, are expected to remedy the aforementioned issues. In this work we describe a digital recommendation system for the pharmaceutical treatment of hypertension and compare its recommendations with clinical experts. The proposed therapy recommender algorithm combines external evidence (knowledge-based) - derived from clinical guidelines and drugs' professional information - with information stored in routine care data (data-based) - derived from 298 medical records and 900 doctor-patient contacts from 7 general practitioners practices. The developed Graphical User Interface (GUI) visualizes recommendations along with personalized treatment information and intents to support SDM. The CDSS was evaluated on 23 artificial test patients (case vignettes), by comparing its output with recommendations from five specialized physicians. RESULTS: The results show that the proposed algorithm provides personalized treatment recommendations with large agreement with clinical experts. This is true for agreement with all experts (agree_all), with any expert (agree_any), and with the majority vote of all experts (agree_majority). The performance of a solely data-based approach can be additionally improved by applying evidence-based rules (external evidence). When comparing the achieved results (agree_all) with the inter-rater agreement among experts, the CDSS's recommendations partly agree more often with the experts than the experts among each other. CONCLUSION: Overall, the feasibility and performance of medication recommendation systems for the treatment of hypertension could be shown. The major challenges when developing such a CDSS arise from (i) the availability of sufficient and appropriate training and evaluation data and (ii) the absence of standardized medical knowledge such as computerized guidelines. If these challenges are solved, such treatment recommender systems can support physicians with exploiting knowledge stored in routine care data, help to comply with the best available clinical evidence and increase the adherence of the patient by reducing site-effects and individualizing therapies.

Associations of an Easy-to-Understand Patient Letter on the Health Literacy of Patients after Discharge from Hospital: Results of a Randomized Controlled Intervention Study. / Assoziationen eines leicht verständlichen Patientenbriefs zur Gesundheitskompetenz nachstationärer Patienten. Ergebnisse einer randomisiert kontrollierten Interventionsstudie.

BACKGROUND: 54% of the German population has limited health literacy, which is associated with poorer health outcomes and higher utilization of the healthcare system. AIM OF THE STUDY: The aim of this pilot study was to examine the effects of an easy-to-understand patient letter on patients' health literacy after discharge from a Clinic for Internal Medicine and to analyze patients' need for written, easy-to-understand information. METHOD: In a randomized controlled trial (2016-2018), the effects of the patient letter on health literacy were examined by means of the HLS-EU-Q47 questionnaire. The intervention group (IG, n=242) received an easy-to-understand patient letter 3 days after discharge, the control group (KG, n=175) received only the usual medical discharge letter. RESULTS: 60% of post-discharge patients were found to have limited health literacy. The study could not show any effect of patient letters on overall health literacy. The analysis of single items of health literacy showed positive effects of these letters on patients' comprehension of medical advice as well as their understanding and implementation of medication instructions (Cohens d≥0.20). Furthermore, patients expressed their wish for information after discharge from hospital (99%) and rated the patient letter as informative, understandable and helpful. CONCLUSIONS: Patients wish to receive and are empowered by an easy-to-understand letter after discharge from hospital with medical information and medical instructions that they can implement at home.

[SaxoForN-a transregional primary care research network in Dresden and Frankfurt am Main : Design of a practice-based research infrastructure]. / SaxoForN ­ Transregionales allgemeinmedizinisches Forschungspraxennetz Dresden und Frankfurt am Main : Konzept einer innovativen Forschungspraxeninfrastruktur.

Establishing primary care research networks (PCRNs) makes it easier to conduct clinical trials and health services research in a general-practice setting. Since February 2020, the German Federal Ministry of Education and Research (BMBF) has sponsored the development of six PCRNs and a coordination unit throughout Germany, with the aim of setting up a sustainable outpatient research infrastructure to raise the quantity and quality of primary care.The present article describes the design of a PCRN in Dresden and Frankfurt am Main - SaxoForN - and explains its structure and how it operates. The network is a transregional alliance between the two regional PCRNs named "SaxoN" (Dresden/Saxony) and "ForN" (Frankfurt am Main/Hesse), both of which run transregional and local research projects. For this purpose, joint standards and harmonized structures, for example with respect to the data infrastructure, qualifications, participation, and accreditation, were agreed upon and implemented at both sites.A critical success factor will be whether and to what extent the standards and structures, as well as resource planning, can be designed sustainably enough to permit the PCRNs to carry out high-quality research over the long term. To achieve this, the PCRNs will have to attract new practices and build up lasting relationships with them, qualify the research practices in order to standardize processes as far as possible, and regularly document their basic information and healthcare data.

[Regional Influences on Home Visits - Is Care in Rural Areas Secured in the Long Term?] / Regionale Einflüsse auf die Hausbesuchstätigkeit ­ Ist die ländliche Versorgung auf Dauer gesichert?

BACKGROUND: Demographic change and urbanisation are proceeding at a rapid pace in Germany. Although the need for care is increasing due to a growing older and multimorbid generation, the number of home visits by general practitioners has been declining since years. Previous studies have shown that the workload for general practitioners is increasing, especially in rural areas. Research question What kind of structural practice characteristics are associated with the frequency of GP home visits? What influence do regional characteristics of GP practices have? METHODS: In a study of family doctors̓ practices in Saxony, 4286 home visits were documented by questionnaires from 303 participating practices over a period of one year. Each practice surveyed the home visits within a randomly assigned week. In addition to the characteristics of the home visits, information about the practice, such as regional location, home visit organization and patient numbers was also collected. The frequency of home visits was based on information provided by the doctors surveyed. Subsequently, the data based on the postal code were supplemented with structural information from the State Statistical Office and data from the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung-KV). The data were first analysed regarding bivariate associations. Significantly associated variables were finally tested in a multivariate regression model. RESULTS: According to their own statements, the interviewed general practitioners carried out an average of 14.5 (SD 9.5) home visits per week, which included the care of 32.0 (SD 30.0) nursing home patients. The number of home visits correlated significantly negatively with the number of inhabitants and significantly positively with the average age of the region. In the multivariate analysis, the age of the doctor was found to be the largest predictor of the number of home visits per week, with younger doctors making significantly fewer home visits. CONCLUSION: The number of home visits per week continues to decline compared to preliminary studies. In the regression model, the great influence of the doctor̓s age on the number of home visits is striking. While regional-structural characteristics fade into the background, a changed attitude towards home visits must be assumed, with telemedicine and delegation coming to the fore.

Need-based care of multi-morbid patients - supporting general practitioners with algorithm-generated recommendations of healthcare services (telemedicine-project ATMoSPHÄRE).

BACKGROUND: The patient-oriented and need-based care of multi-morbid patients with healthcare services and assistive products can be a highly complex task for the general practitioners (GPs). An algorithm-based digital recommendation system (DRS) for healthcare services was developed within the context of the telemedicine research project ATMoSPHÄRE. The plausibility of the DRS was tested and the results used to examine if, and to what degree, the DRS provides useful assistance to GPs. METHODS: The plausibility of the recommendations of the DRS were tested with the Delphi procedure (n = 8) and Interviews (n = 4) in collaboration with the GPs. They proposed services and assistive products they considered appropriate for two multi-morbid patients. Furthermore, GPs had to report whether, and to what degree they deemed the algorithm-generated recommendations appropriate. Significant quantitative differences between the GPs', and the algorithm-generated, recommendations were evaluated with paired-samples-Wilcoxon-test. RESULTS: The first Delphi round revealed a high variability regarding the amount and character of services recommended by the physicians (1 to 10 recommendations, mean = 5.6, sd = 2.8). These professional recommendations converged after consideration of the algorithm-generated recommendations. The number of algorithm-generated recommendations which were judged as appropriate ranged between 7 and 17 of a total of 20 (mean = 11.9, sd = 2.5). The interviews revealed that the additional algorithm-generated recommendations which were judged appropriate contained mainly social care services. CONLUSION: The DRS provides GPs with additional appropriate recommendations for the need-based care of patients, which may not have been previously considered. It can therefore be assessed as a helpful complement in the primary care of multi-morbid patients.

Tobacco Smoking and Smokeless Tobacco Use among Domestic and International Medical Students in Hungary.

BACKGROUND: Medical students as future physicians will have an important role in tobacco control; therefore, their tobacco use behavior is of particular interest. Consumption of combustible tobacco (cigarettes, waterpipes, cigars, and pipes) is prevalent throughout Europe, whereas smokeless tobacco use is common mainly in the Nordic countries. Objectives: Aim of our study is to assess tobacco use among medical students from different countries studying in Hungary with special focus on students from Norway where smokeless tobacco is widely used. A self-administered questionnaire survey was carried out to measure current tobacco use. Results: The survey included 1337 students from Hungary, Norway, Germany, and from other countries (Multinational group). The lowest prevalence of cigarette smoking was found among students from Norway (13.0%) when compared with students from Hungary (21.5%), Germany (34.2%), or with students in the Multinational group (29.5%). Conversely, prevalence of smokeless tobacco use was the highest among students from Norway (40.9%) when compared with students from Hungary (1.4%), Germany (2.6%), or with students in the Multinational group (6.2%). Waterpipes, cigars, and pipes were rarely used, mostly only 1-3 times a month in all groups. More than half of Norwegian students used some form of tobacco (smokeless and/or combustible tobacco). Conclusions: Considering the impending role of medical students in tobacco control, faculties of medicine should sensitize their students on the topic of possible health risks associated with combustible and smokeless tobacco products. Culturally tailored tobacco cessation programs need to be offered to medical students coming from different cultural backgrounds.

[Delegation of Home Visits and Qualification of Health Care Assistants in Family Practices in Saxony, Germany - Results of the Cross-Sectional Study SESAM-5]. / Delegation von Hausbesuchen und Qualifikation nicht-ärztlicher Mitarbeiter in sächsischen Hausarztpraxen ­ Ergebnisse der Querschnittstudie SESAM-5.

BACKGROUND: In the context of demographic changes and the shortage of family physicians in the primary care sector in Germany, the delegability of home visits to health care assistants is discussed. There is little information on the extent of home visits delegated. The aim of this article is to examine differences in the socio-demographic and organizational profile of delegating vs. non-delegating family doctors in Saxony and to describe the level of qualification of health care assistants. METHODOLOGY: This cross-sectional study is part of a series of epidemiological studies in the federal state of Saxony, Germany. All family doctors in Saxony were contacted in 2014 (n=2677), of whom 11,2% participated. In a period of 12 months, family practices documented home visits within a randomly assigned week. Socio-demographic characteristics of the family practice and the level of qualification of health care assistants were surveyed. RESULTS: A total of 274 family practices participated; 52,9% of all participating family doctors declared their willingness to delegate home visits, but only 8,5% of home visits were made by health care assistants. There were non-significant trends between the willingness to delegate and self-employment vs. being employed (92,4 vs. 84,6%, p=0,06), establishment in a single vs. shared practice (35,2 vs. 31,4%, p=0,09) and higher patient numbers per 3 months (x̄+= 1183,08 vs. 1092,16, p=0,07). The 224 health care assistants that participated in the study were mostly trained in nursing (39,7%) or as medical assistants (50,8%). The vast majority of the health care assistants (82,5%) had no further training or additional qualification; 19,6% completed further training that qualified them to have home visits formally delegated to them. CONCLUSION: Among family doctors in Saxony there is a reported high willingness to delegate, which is not implemented sufficiently in practice. Delegation is based on personal confidence in health care assistants without formal qualification. Qualified delegation ensures high standards in patient care and this potential is not used in Saxony, particularly in rural areas with imminent shortages of medical care. More education about the opportunities of qualified delegation seems necessary.

[Assessment of care in patients with dementia in house calls by general practitioners]. / Beurteilung der Betreuung dementer Patienten im allgemeinärztlichen Hausbesuch.

BACKGROUND: Patients with dementia (PD) are a special challenge for the healthcare system. They are responsible for 5% of the expenditure in the German healthcare service. The disease-related deficits and the associated need for care leads to the fact that patients are not able to live in their own residence and rely on the care of nursing homes (NH). OBJECTIVE: How is the overall care in PD assessed in house calls (HC)? Does the regional situation influence the living conditions of PD? MATERIAL AND METHODS: As part of the SESAM­5 study 303 participating general practices in Saxony were asked to document their HC within a period of 1 year whereby 4286 HC were documented through questionnaires and analyzed for content and structural data. RESULTS: The prevalence of dementia in HC patients was 27.5% and 72.6% of PD lived in a NH or assisted living home. The medical staff assessed the overall care of PD in the NH to be significantly better than in their own residence. This discrepancy was greater in rural compared to urban regions although in urban regions significantly more patients live in NHs (27% vs. 51%). CONCLUSIONS: The overall care of PD in HC was assessed predominantly as good by medical personnel, whereby PD in NH were assessed comparatively better than those in their own residence. This could be explained by the high need of care in PD. The difference between rural and urban regions is explainable through differences in the infrastructure and also in the organization in rural areas, where relatives participate in care significantly more frequently. In the future more focus could be placed on alternative types of housing because in PD cognitive deficits are in the foreground.

Increasing Prevalence of Electronic Cigarette Use among Medical Students. Repeated Cross-Sectional Multicenter Surveys in Germany and Hungary, 2016-2018.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) is gaining popularity among young adults. Medical students' nicotine use behavior is of particular interest because of their impending role in health promotion. Objectives: Aim of our study is to assess changes that occurred between 2016 and 2018 in the prevalence of e-cigarette use among medical students and to explore associations between e-cigarette use, demographic characteristics, and cigarette smoking. Self-administered questionnaire surveys were used to obtain cross-sectional data of medical students in Budapest and Pécs, Hungary, and Dresden, Germany. Results: Sample sizes for 2016 and 2018 were 2297 and 1514, respectively. In the whole sample, past-30-day use of e-cigarettes increased from 4.5% to 8.0% (p < 0.001). The increase in e-cigarette use was significant in both genders (from 3.6% to 5.6% among females, p = 0.028, and from 5.9 to 11.4% among males, p < 0.001). Prevalence of e-cigarette use was higher among Hungarian students than among German students (2.2% versus 5.7% in 2016, and 4.1% versus 10.5% in 2018, p < 0.05 for both years). There was no significant difference in e-cigarette use among different academic years. The ratio of e-cigarette users increased significantly among current cigarette smokers but not among nonsmokers. We could not detect a decrease in cigarette smoking. Conclusions: Prevalence of e-cigarette use increased significantly among medical students without a reduction in cigarette smoking. Medical schools should add the topic of e-cigarettes to their curricula and need to develop cessation programs to help their students quit both cigarettes and e-cigarettes.

Pertussis vaccination status and vaccine acceptance among medical students: multicenter study in Germany and Hungary.

BACKGROUND: Medical students are at risk of contracting and transmitting infectious diseases such as pertussis. Complete vaccination status is important to protect own, patient and public health. Knowing own vaccination status is elementary for following current vaccination recommendations, including boosters. We aimed to assess pertussis vaccination status and vaccination acceptance among medical students of different nationalities. METHODS: A cross-sectional multicenter health survey at German and Hungarian universities enclosed international medical students in the 1st, 3rd and 5th year of study. Self-reported data from 2655 students regarding pertussis vaccination status were analyzed. Subgroup analysis enclosed data of German (n = 1217), Hungarian (n = 960) and other nationality (n = 478) students ("other"). RESULTS: More Hungarians reported basic immunization (39.0% vs 15.8% Germans vs 24.3% others, p ≤ 0.05). Booster vaccination was reported more by Germans (60.5% vs 43.6% Hungarians vs 36.0% others, p ≤ 0.05). Germans were more likely to report being unvaccinated (3.7% vs 0.9% Hungarians, p ≤ 0.05). More medical students of other nationalities were unaware of their pertussis vaccination status (37.4% vs 20.0% Germans/ 16.5% Hungarians, p ≤ 0.05). 75.2% (n = 1931) rated pertussis vaccinations as absolutely necessary (86.2% Hungarians vs 69.8% Germans/ 66.1% others, p ≤ 0.05). CONCLUSIONS: Positive attitudes towards vaccinations were reported but a large group reported insufficient vaccination status and being not aware of their status, especially among international students. Hungarians possibly have a better vaccination status than reported, based on mandatory vaccinations in childhood. The low awareness of vaccination status has implications for future booster vaccinations. All students should be informed about current recommendations and receive vaccination offers in frames of low-threshold medical services.

The workload for home visits by German family practitioners: an analysis of regional variation in a cross-sectional study.

BACKGROUND: In Germany, home visits account for a considerable workload for many family practitioners, substantial rural-urban disparities are assumable with regards to home visit frequency and duration. Considering the ongoing demographic change and a rural-urban migration a significant regional difference in the provision of care is assumable. There is a lack of reliable data on the current provision of home visits and how their organisational procedures can be ensured in the future. The aim of this study was to describe and assess the average workload of family practitioners during home visits and compare their rural-urban variations. METHODS: A cross-sectional study over a period of 12 months was conducted in Saxony as part of the fifth project of the Saxon Epidemiologic Studies in General Practice (SESAM-5). Over a 1-week period, family practitioners documented every home visit and answered questionnaires about sociodemographic, organisational and clinical characteristics. According to common categorizations in empirical studies four regional groups (rural, semi-rural, semi-urban, urban) were analysed and compared by non-parametric tests: Kruskal-Wallis followed by Dunn's, Jonckheere-Terpstra and Mann-Whitney-U. Multinomial logistic regression analyses were carried out using a collection of plausible predictors to assess influences for a high frequency and a long duration of home visits. RESULTS: The sample included 3673 home visits conducted by 253 family practitioners. On average, 14.5 home visits were carried out per week with an average duration of almost 28 min. After comparing regional areas, the number and total duration per home visit showed significant differences between the regions: 8.2 h (rural), 7 h (semi-rural), 6.6 h (semi-urban) and 5 h (urban). The regression analyses found that a high frequency of home visits was most likely accomplished in rural regions and a long duration was most likely performed in private homes. CONCLUSIONS: Workload of home visits is strongly associated with the regional location of the practice, leading to rural-urban disparities. Strategies to reduce regional disparities to ensure the future provision of care in the German and comparable health care systems should be discussed, e.g. by financial incentives (short-term), exploiting the potential of delegation (medium-term) and discussing the implementation of substitution (long-term).

What keeps medical students healthy and well? A systematic review of observational studies on protective factors for health and well-being during medical education.

BACKGROUND: Despite the growing evidence of a negative impact of medical school on students' health and well-being, little is known about protective factors for staying healthy and well during medical education. Therefore, a systematic review of peer-reviewed studies aiming to identify such predictors was conducted. METHODS: Medline, Embase, and PsychInfo were systematically searched by using preselected MeSH terms to identify English- and German-language peer-reviewed articles (observational studies) examining predictors for medical students' health and well-being, published between January 2001 and April 2018. Two authors independently selected abstracts reporting predictors for medical students' health and well-being. Further, two authors extracted information from the identified studies, needed for methodological quality assessment of the studies, as well as for comprehensive description of identified predictors. RESULTS: From 5013 hits in the database search, six observational studies met the inclusion criteria and were included in the final analysis. These studies were of heterogeneous design and quality. They featured a wide variety of health and well-being related outcomes and of its predictors. Lower levels of perceived stress, as well as lower levels of neuroticism were found to predict better health-related outcomes. CONCLUSIONS: Further research, by using harmonized tools for the assessment of outcomes, as well as predictors, is needed to determine what keeps students healthy and well during medical education. Identifying protective factors is an essential prerequisite for the design of evidence-based health-promoting interventions.

[Interface Problems Between Inpatient, GP and Outpatient Specialist Care: Viewpoint of General Practitioners in Dresden]. / "Da kann man sich ja totklingeln, geht ja keiner ran" ­ Schnittstellenprobleme zwischen stationärer, hausärztlicher und ambulant-fachspezialisierter Patientenversorgung aus Sicht Dresdner Hausärzte.

OBJECTIVES: The aim of the study was to identify interface problems between inpatient, GP and outpatient specialist care from the perspective of general practitioners in Dresden, especially in older multimorbid patients. METHODS: The data were collected in the context of the pilot study "Multimedication and its Consequences for the Primary Care of Patients in Saxony" and included guided interviews with 7 general practitioners. The interviews were transcribed and analyzed according to the inductive content analysis of Mayring. RESULTS: At the interface of inpatient to outpatient care, several problems regarding discharge management, intersectoral communication and cooperation as well as in the management of medication were found. Concerning the interface between general practitioners and outpatient specialist care, problems were particularly marked with regard to free choice of doctors, appointment management, medical decision-making process, medication management as well as the use of the electronic health card. Regardless of the interfaces, the lack of communication could be worked out as a central challenge. CONCLUSION: There are several problems with all adjacent interfaces. What is striking here is the lack of communication and cooperation between all parties involved. Possible causes were the often very different working methods and framework conditions, human and material resources and therapeutic intentions and approaches between the different interfaces. One possible approach to improve the situation may be the law regarding secure digital communications and healthcare applications, which exists since 2016. Among other things, it promises a secure and rapid inter- and intrasectoral exchange of patient data. The overall goal of healthcare in Germany should be an optimized and process-oriented interface management in order to ensure a secure and seamless sectoral transition to patients.

Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Tobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students' smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students. METHODS: In a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson's chi2-tests and multivariate binary logistic regression analyses were performed. RESULTS: The largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6-19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0-5.7%), that of e-cigarette 0.9% (95% CI 0.5-1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status. CONCLUSIONS: Cigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students' health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.

[Interprofessional multistation practical training in the auditorium : Implementation of the national competence-based catalog of learning objectives for undergraduate medical education in the cross-sectorial area medicine of aging and the aged at the TU Dresden]. / Interprofessionelles Multistationen-Hörsaalpraktikum : Umsetzung des Nationalen Kompetenzbasierten Lernzielkatalogs Medizin im Querschnittsbereich Medizin des Alterns und des alten Menschen an der TU Dresden.

BACKGROUND: The German national competence-based catalogue of learning objectives for undergraduate medical education (NKLM) newly introduced in 2015, provides a variety of learning objectives, competences, as well as practical skills for the cross-sectorial area 7 "Medication of Aging and the Aged" (QB7). Against this background an interdisciplinary teaching concept to mediate all required teaching contents should be developed. OBJECTIVE: Can an interdisciplinary multistation practical course in the auditorium, in which different tasks and skills are trained at each station meet the requirements of the NKLM? MATERIAL AND METHODS: Evaluation by questionnaire and rating of answers on a 6-stage Likert scale. Analysis of the qualitative and quantitative evaluation results of 235 participating students and 13 lecturers in 2016. RESULTS: The interdisciplinary multistation practical course in the auditorium is fully compliant with the NKLM. All theoretical and practical contents and competences could be depicted. The subjective learning effect was assessed by students as good (mean = 2.66; SD = 0.94; N = 230). The available teaching time was rated as being too short in qualitative statements. The lecturers attested a high degree of interest by the students (mean = 2.15; SD = 0.86; N = 13), but criticized that the noise level was too loud. DISCUSSION: Compact, hands-on and interdisciplinary teaching concepts in the QB7 help to make the best use of human and spatial resources and convey all theoretical and practical teaching contents and competences from the NKLM; however, the planning, organization and implementation are very time-consuming.

Do socio-cultural factors influence medical students' health status and health-promoting behaviors? A cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Physical and mental health is important for coping with the high requirements of medical studies that are associated with a higher risk for severe stress, insomnia, smoking, harmful alcohol consumption and easier access to drugs. Health behaviors of medical students influence not just their own health but also the health of their future patients. We examined whether socio-cultural factors can explain differences in students' health status and health-promoting behaviors. METHODS: A multicenter cross-sectional survey in Germany (Dresden, Munich) and Hungary (Budapest, Pécs) enclosed international medical students in their 1st, 3rd and 5th academic years. The students were invited to voluntarily and anonymously complete a questionnaire on different aspects of health behavior during obligatory seminars and lectures in 2014. The response rate of the total sample was 56.2 % (n = 2935); the subgroup analysis enclosed data of German (n = 1289), Hungarian (n = 1057) and Norwegian (n = 148) students. RESULTS: A high number of Norwegian students (84.5 %) assessed their health status as very good/excellent. In comparison, only 60.3 % of the Hungarian and 70.7 % of the German participants reported a very good/excellent health status. The distributions were comparable between the study sites. Although gender, financial situation and nationality were significant health status predictors, they could explain only 8.2 % of the total variance of health status in the multivariable model. A comparably high number of Hungarian students (95.3 % vs. 67.4 % German and 56.7 % Norwegian) reported that they can currently do a lot/very much for their health. In contrast, a significant number of Norwegians (73.0 % vs. 63.7 % Hungarian and 51.5 % German) reported that they currently do a lot/very much for their health (chi(2)-test, p ≤ 0.001). Financial situation, study site and study year were the strongest predictors for health promotion activities (Nagelkerkes R(2) = 0.06). CONCLUSIONS: Based on our study, gender and study year played only a minor role in the health status and health promotion beliefs and activities of medical students. Structural (study site) and somewhat socio-cultural factors (nationality, financial situation) mainly explained the differences regarding health promoting behaviors. Obligatory, free-of-charge courses for health promotion (activity and relaxation) should be included in study curriculums.

Why do family doctors prescribe potentially inappropriate medication to elderly patients?

BACKGROUND: Based on changes in pharmacokinetics and -dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. METHODS: This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients' records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs' medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. RESULTS: Content analysis of 1846 patients' records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. CONCLUSIONS: It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs' experiences in daily practice, FPs' knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs' daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs' advanced training.

Vaccination status among nurses in hospitals. Results of a cross sectional study at Harzklinikum Dorothea Christiane Erxleben Quedlinburg / Impfstatus bei Pflegepersonal. Ergebnisse einer Querschnittstudie am Harzklinikum Dorothea Christiane Erxleben Quedlinburg

Background: Health care workers can be multiplicators for infectious diseases due to their patient contacts. Vaccinations are not mandatory in Germany but there are recommendations for people at higher risk such as health care workers. There is no representative data regarding vaccination status of health care workers in Germany. Aim: We examined vaccination status among nurses regarding diphtheria, tetanus, pertussis, poliomyelitis, hepatitis A (HA) and hepatitis B (HB) as well as correlations between age, professional years, vaccination status and acceptance. Methods: An anonymous cross sectional survey concerning health burden and health behavior including vaccination was conducted among health care workers. Statistical analysis using SPSS included descriptive analysis, subgroup specific differences of distribution were tested by chi2-tests. Results: Regardless of age or professional years, 99 % of the nurses evaluated that vaccinations are at least "partly necessary". Sufficient vaccination status was reported more often concerning tetanus (82 %) and HB (70 %) but less often regarding diphtheria (52 %), poliomyelitis (49 %), HA (43 %) and pertussis (42 %). With respect to some vaccinations, proportion of nurses not knowing their vaccination status was higher than 20 %. Conclusions: Despite the high vaccination acceptance, vaccination status among participating nurses was not sufficient. Implementation of vaccination measures targeting health care workers should be strengthened to reach higher vaccination coverages to prevent vaccination preventable infectious diseases among health care workers and patients in hospitals.

Gaining information about home visits in primary care: methodological issues from a feasibility study.

BACKGROUND: Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs' care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs' home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. METHODS: We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. RESULTS: Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. CONCLUSIONS: The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.