[Evaluation of the decision aid "Entscheidungshilfe Prostatakrebs" from the patients' view : Results from the first three months]. / Evaluation der Entscheidungshilfe Prostatakrebs aus Patientensicht : Ergebnisse der ersten 3 Monate.

BACKGROUND: The decision aid "Entscheidungshilfe Prostatakrebs" is available online free of charge since June 2016. It is designed to support patients with their treatment decision-making and to lighten the burden on their treating urologists. This study evaluates usage data from the first 3 months. MATERIALS AND METHODS: The ICHOM standard set was applied to allow a personalised presentation and to collect relevant data for subsequent counselling. Additionally, personal preferences and psychological burden were assessed amongst others. We collected anonymous data. A multivariate model evaluated predictors for high user satisfaction. RESULTS: From June through August 2016 a total of 319 patients used the decision aid, showing a continuous monthly increase in the number of users. There were n = 219 (68.7%) complete questionnaires. Median age was 66.1 ± 8.0 years. The oncological risk was low in 30.3%, intermediate in 43.6% and high in 26.1%. A majority of 57.5% used the decision aid together with their partner, 35.1% alone and 5.5% with their children. In all, 54.8% were "very satisfied" and 32.0% were "satisfied" with the decision aid for a total satisfaction rate of about 87%. The only predictors of total satisfaction were the usage mode and reported distress level. CONCLUSIONS: As shown by the continuously increasing number of users this decision aid is becoming well established in German urology. Patients' overall ratings are very positive. The majority of patients use the decision aid with their partner. This represents a significant advantage of a multimedia approach compared to print media.

[Decision aids for patients are widely accepted by German urologists : A survey among members of the German Society of Urology (DGU) and the Federation of German Urologists (BDU)]. / Entscheidungshilfen für Patienten finden bei deutschen Urologen breite Akzeptanz : Umfrage unter Mitgliedern von DGU und BDU.

BACKGROUND: Treatment decision making remains a complex task for localized prostate cancer. Decision aids for patients can support the medical consultation. However, it is not known if German urologists accept decision aids for patients. Comparative data exist from a current survey among american urologists and radio oncologists. MATERIALS AND METHODS: From October through November 2014 we conducted an online survey consisting of 11 multiple-choice questions and an optional free text commentary among the members of DGU and BDU. All data was processed anonymously. We received 464 complete responses for a 6.6 % return rate. For group comparison we applied the Chi2-test. RESULTS: Respondents' median age was 50 (range 26-87) years and 15 % were female. 7 % were residents, 31 % employed at a clinic, and 57 % in private practice. Due to the low response rate of younger colleagues the results were not representative for the basic population. Regardless of age (p = 0.2) and professional environment (p = 1) shared decision making was preferred by 89 %. When counseling their patients with localized prostate cancer 20 % relied exclusively on conversation. To support their conversation 63 % used print media, 49 % decision aids, 33 % contact offers to support groups, 24 % Internet resources and 13 % video material. From using decision aids 86 % expected positive effects for patients and 78 % for physicians (p = 0.017). 15 % expected a change of the treatment decision. 77 % would motivate their patients to use a decision aid. CONCLUSIONS: In comparison to the opinion of american urologists and radio oncologists the acceptance of decision aids for patients among German urologists is significantly higher.

[Patient centeredness and decision-making in localised prostate cancer: possible fields of health services research in urology]. / Patientenorientierung und Entscheidungsfindung bei lokal begrenztem Prostatakarzinom : Mögliche Felder urologischer Versorgungsforschung.

BACKGROUND: Quality of care is essential for health services research. Therefore, our patients' preferences are of major importance and this can be illustrated by decision-making in localised prostate cancer. MATERIAL AND METHODS: A total of 349 patients reported on their preferred mode of decision-making, on their habits of information procurement, and on their feeling of being well informed. Moreover, we tried to objectify their actual knowledge. Their mean age was 63.0 years and mean PSA level 9.4 ng/ml. As 40% had a higher level of education we investigated possible influences of this feature by applying the chi-square test. RESULTS: Half of the patients preferred to share the treatment decision and 39% wanted to choose for themselves considering their physician's recommendation. The most important sources of information were treating physicians (88%) and the Internet (77%). All patients felt well informed and 94% knew their latest PSA count. Patients with a higher level of education had better knowledge of their clinical data and used the Internet more (84 vs 71%; p=0.007). CONCLUSIONS: Our patients actively take part in medical decision-making and thereby contribute significantly to everyday health care. Based on this aspect, the whole scope of urology is developed as a promising field of health services research.

[Long-term consequences of postoperative delirium]. / Langzeitfolgen eines postoperativen Delirs.

A patient reported anxiety and sleeping problems 9 months after reconstruction of the anterior floor of the mouth following tumor surgery. These symptoms had been initiated by a postoperative delirium with hallucinations, which had not been detected during its occurrence. One session of psychotherapy 9 months later reduced the symptoms. Patients in intensive care units should be asked and informed about delirium symptoms. This might prevent long-term psychological distress.

[Online support groups for localized prostate cancer: qualitative analysis of decision making]. / Selbsthilfe im Onlineforum bei lokal begrenztem Prostatakarzinom : Qualitative Analyse der Entscheidungsfindung.

BACKGROUND: In localized prostate cancer individual treatment decisions cannot be reached relying exclusively on medical data. Therefore, social interaction is of considerable importance and online support groups allow us to get to know a facet of this communication. MATERIAL AND METHODS: We investigated 82 thematically relevant threads representing 5% of the largest German online support group on prostate cancer (http://forum.prostatakrebs-bps.de). Two independent investigators used methods derived from grounded theory and linguistic conversation analysis to characterize the sample. RESULTS: Users report on personal experience and provide subjective recommendations. At the same time those seeking advice are encouraged to weigh the information and to decide for themselves. Some urologists contribute to the discussion and seem to have a corrective influence, but their involvement is judged diversely. As mainly lay people with different levels of knowledge are involved in the discussion, a tentative language style is frequently used. The disease itself appears to be a linguistic taboo. Besides treatment recommendations, emotional support is of major concern. Being personally affected establishes a sense of unity, which adds to the subjective value of the communication. CONCLUSIONS: Patients readily receive information, advice and emotional support in online support groups. Knowledge of such online services is useful in ensuring good counselling for our patients.

Evaluation of a modified German version of the Q16 questionnaire for neurotoxic symptoms in workers exposed to solvents.

OBJECTIVES: To assess sensitivity and specificity of a questionnaire designed to detect neurotoxic symptoms in workers exposed to solvents and in patients with a psycho-organic syndrome. METHODS: The Swedish Q16 is a self administered questionnaire for neurotoxic symptoms. The modified German version consists of 18 questions. The results were analysed from 1166 questionnaires which were completed by adults belonging to the following groups; 483 workers with occupational exposure to solvents and 193 non-exposed controls, 25 patients with a psycho-organic syndrome, 25 sex and age matched patients with a lung disease, and a sample of 440 people from the general population. RESULTS: The German Q18 was easy to handle and quick to perform. Workers exposed to solvents reported significantly more complaints than controls (2.9 v 2.5). All patients with a psycho-organic syndrome had five or more complaints. This was true for only 32% of patients with lung disease. These comparisons showed that chronic exposure to solvents was associated with subjective complaints related particularly to cognitive functions. In the sample of the general population, age, education level, smoking habits, and time of performance showed no significant influence on the Q18 result. Women had significantly more complaints than men (3.2 v 2.3). People who reported drinking alcohol occasionally or moderately had significantly fewer complaints than teetotalers. CONCLUSIONS: The German Q18 has an acceptable sensitivity and reliability, a reasonable specificity, and a good practicability. It is a useful instrument for screening workers exposed to solvents. A cut off point of 5 for men is recommended, and a cut off point of 6 for women is proposed.

[Magnetic resonance tomography of the brain in workers with chronic occupational manganese dioxide exposure]. / Magnetresonanztomographie des Gehirns bei Beschäftigten mit chronischer beruflicher Mangandioxide-Exposition.

AIM: Changes within the brain detected by MRI after chronic manganese poisoning raised the question whether morphological changes of the basal ganglia, particularly of the globus pallidus, could be detected after chronic occupational exposure to manganese dioxide. METHOD: In a cross-sectional study, healthy workers (48 male and 27 female) at a dry cell battery factory were examined. Actual internal exposure was quantified by the analysis of manganese in the blood using atomic absorption spectrometry. Chronic exposure was defined as a cumulative index (CBI) including duration of exposure, individual workplace factors, and previously measured concentrations of MnO2 in dust samples. A Philips Gyroscan T5-II (0.5 T) was used for the MRI of the brain. The following indicators were taken to ascertain possible manganese-induced changes; Pallidum-Index (PI), width of 3rd ventricle and cella media index in addition to clinical examinations. RESULTS: No cases of parkinsonism were detected in clinical examinations or by other means. The mean manganese concentration in blood was 12 micrograms/l (range: 3.9-23.3 micrograms/l). In comparison to the upper reference value of 10 micrograms/l, 42 workers (56%) had a higher body burden. A significant positive correlation between manganese levels in blood and the PI (indicated by T1-shortening) was observed as well as between the CBI and workplace-specific exposure. Brain atrophy was not detected in any of the observed cases. CONCLUSIONS: Long-term exposure to manganese dioxide dust correlates with the Pallidum-Index in MRI scans. Although the MRI findings have no current clinical relevance for individuals, further studies are necessary to evaluate specificity and potential prognostic value.