[Social rights claims for malignant melanoma patients : Providing patient information in German dermatological practices]. / Sozialrechtliche Ansprüche beim malignen Melanom : Aufklärung von Patienten in deutschen dermatologischen Praxen.

BACKGROUND: Treatment of patients with malignant melanoma includes informing the patients about their rights regarding social/disability benefits. In particular, every patient has the right to rehabilitation treatment according to SGB V and IX (SGB: Sozialgesetzbuch; Social Security Code) and to an examination regarding the classification of the disability. OBJECTIVES: The present study examines the extent to which patients with invasive malignant melanoma are informed after initial diagnosis about their social rights to medical rehabilitation measures and the classification of disability. MATERIALS AND METHODS: In the course of a survey in 2014, n = 1800 German dermatological practices were contacted and provided a standardized questionnaire on several care-relevant questions, including the aforementioned ones. RESULTS: Evaluable questionnaires were submitted by n = 424 practices. In all, 52% of dermatologists stated that they regularly provided information on the right to rehabilitation, 15% sometimes, 41% rarely or never. Furthermore, 44% of dermatologists regularly, 17% sometimes and 38% rarely or never informed their patients about the classification of disability. Relevant differences were found in regional comparisons. CONCLUSIONS: Practicing dermatologists seem to transfer the information requirement to the clinics involved in the treatment. It would be beneficial if the information were also provided again by the dermatologists in private practice. In view of the known limited capacity to receive new information from patients with newly diagnosed melanoma, repeated counselling appears to be more patient-friendly.

Decreasing sunbed use in the German population between 2001 and 2015: survey in 155 679 working persons.

BACKGROUND: UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE: To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS: Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS: Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P < 0.001). There were significantly higher rates of sunbed use in women (12.5%/2.0%) vs. men (7.3%/1.3%; P < 0.001), in younger persons and in participants with darker skin (type II and III) vs. fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; P = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001-2008 and 2.2% in 2009-2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening programme. CONCLUSION: Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening programme may have contributed to this.

Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation.

OBJECTIVE: To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia. METHOD: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages. RESULTS: There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West. CONCLUSION: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

The economics of daily dialysis.

Research suggests that daily hemodialysis improves clinical outcomes and patient quality of life when compared with conventional hemodialysis; however, little is known about its economic impact. In this article, we review the literature on the costs of daily hemodialysis (n = 170). We also present updated results from an economic model we constructed that compares 1-year treatment costs for short daily in-center, short daily at-home, nocturnal, and conventional hemodialysis. Clinical parameters for the model were drawn from our review of the clinical literature. Resource use during daily hemodialysis was modeled after the experience of 2 ongoing programs in the United States, a short daily program in California (n = 26) and a nocturnal program in Virginia (n = 13). Reports from the literature and our economic model suggest daily hemodialysis might provide better outcomes and savings when compared with conventional hemodialysis. However, larger, longer controlled studies are needed to see if daily dialysis fulfills these promises. We discuss several issues researchers should keep in mind in designing future studies about the economics of daily dialysis.

The case for daily dialysis: its impact on costs and quality of life.

Research suggests daily hemodialysis may improve clinical outcomes. To date, a comprehensive review of its implications on quality of life has not been performed, and little is known about its economic impact. We conducted an economic evaluation comparing short daily or nocturnal hemodialysis with thrice-weekly conventional in-center dialysis. Data on the quality of life and clinical effects of daily dialysis were obtained from more than 60 reports from 13 daily dialysis programs around the world (n = 197). Cost data were derived principally from the US Renal Data System, Centers for Disease Control, and Medicare Payment Advisory Commission. Resource use during daily hemodialysis was modeled after two ongoing programs in the United States. Results suggest that patients feel better and direct treatment costs could be reduced with daily dialysis. Costs are sensitive to assumptions about the effect of daily dialysis on hospital days. Reductions of at least 8% in hospital days are required for these modalities to be cost saving compared with documented reductions of 30% to 100%. Larger well-controlled studies of daily versus conventional dialysis would be helpful to determine whether daily dialysis fulfills these promises. Medicare policy, which limits payment for most patients to three dialysis treatments weekly, poses a disincentive to more widespread adoption among dialysis centers. Given this constraint to broader acceptance, we address several policy options to gain a better understanding of the potential risks and benefits of daily dialysis.

Critical access hospitals: how many rural hospitals will meet the requirements?

Although the Medicare Rural Hospital Flexibility Program (MRHFP), which establishes a new designation for limited-service hospitals called critical access hospitals (CAH), intends to assist small rural hospitals having financial difficulty, it is unclear how many hospitals will qualify for the program. Potential CAHs are identified and the strategic issues that will impact actual participation in the program are discussed. Potential CAHs are identified by applying the legislative criteria for designation to a data set created from both the 1992-1995 Medicare Hospital Cost Report Information System and the 1993 and 1995 Prospective Payment System's Impact files. Descriptive analyses are used to identify potential CAHs by three parameters: distance to nearest hospital, average daily census and operating margin. Results indicate that the majority of potential CAHs have low volume and report poorer operating margins than other rural hospitals. Findings also show that the mileage requirements significantly impact the number of potential CAHs. There is more than a ninefold difference between the 93 hospitals that meet the mileage criterion and the 864 hospitals that might be eligible if certified by the state as "necessary providers," regardless of distance to the nearest hospital. The MRHFP is designed to prevent small, isolated hospitals from closing and thus to ensure continued access to care for rural residents. However, the number of potential CAHs that participate will clearly hinge on the flexibility of the program and the ability of states to determine "necessary providers."

The societal costs of severe to profound hearing loss in the United States.

OBJECTIVE: Severe to profound hearing impairment affects one-half to three-quarters of a million Americans. To function in a hearing society, hearing-impaired persons require specialized educational, social services, and other resources. The primary purpose of this study is to provide a comprehensive, national, and recent estimate of the economic burden of hearing impairment. METHODS: We constructed a cohort-survival model to estimate the lifetime costs of hearing impairment. Data for the model were derived principally from the analyses of secondary data sources, including the National Health Interview Survey Hearing Loss and Disability Supplements (1990-91 and 1994-95), the Department of Education's National Longitudinal Transition Study (1987), and Gallaudet University's Annual Survey of Deaf and Hard of Hearing Youth (1997-98). These analyses were supplemented by a review of the literature and consultation with a four-member expert panel. Monte Carlo analysis was used for sensitivity testing. RESULTS: Severe to profound hearing loss is expected to cost society $297,000 over the lifetime of an individual. Most of these losses (67%) are due to reduced work productivity, although the use of special education resources among children contributes an additional 21%. Lifetime costs for those with prelingual onset exceed $1 million. CONCLUSIONS: Results indicate that an additional $4.6 billion will be spent over the lifetime of persons who acquired their impairment in 1998. The particularly high costs associated with prelingual onset of severe to profound hearing impairment suggest interventions aimed at children, such as early identification and/or aggressive medical intervention, may have a substantial payback.

Vulnerability of rural hospitals to Medicare outpatient payment reform.

Because the Balanced Budget Act (BBA) of 1997 requires implementation of a Medicare prospective payment system (PPS) for hospital outpatient services, the authors evaluated the potential impact of outpatient PPS on rural hospitals. Areas examined include: (1) How dependent are rural hospitals on outpatient revenue? (2) Are they more likely than urban hospitals to be vulnerable to payment reform? (3) What types of rural hospitals will be most vulnerable to reform? Using Medicare cost report data, the authors found that small size and government ownership are more common among rural than urban hospitals and are the most important determinants of vulnerability to payment reform.

The use of percutaneous endoscopic gastrostomy (PEG) feeding tubes in patients with neurological disease.

Percutaneous endoscopic gastrostomy (PEG) is being used increasingly in the treatment of patients with neurogenic dysphagia to improve nutrition and prevent choking and aspiration pneumonia. PEG is used in a wide range of general medical conditions, but its role in clinical neurology is sometimes controversial. This paper reviews the place of PEG in the management of 32 patients with a variety of chronic and progressive neurological disorders. All the patients found it to be an effective and acceptable method of feeding that prevented weight loss, reduced chest infections, facilitated nursing care and improved their quality of life. PEG has an important role in neurological rehabilitation.

Blame and punishment: attitudes to juvenile and criminal offending.

Responses of 139 undergraduate social welfare students and 79 community members to a questionnaire regarding contemporary issues in juvenile and general justice were partially accounted for by a Punitive-Internal factor. Scores on a resultant 8-item index of punitive-internal attitudes were positively correlated with scores on belief in a just world and were lower for social welfare students than for community members. In a follow-up study with a second sample of 78 community members, scores on the Punitive-Internal index were significantly related to ratings on measures of attitude toward authority and political conservatism but not to reported experience of crime. Findings are consistent with previous research and indicate that opinions on juvenile offending have a similar attitudinal basis to opinions on offending in general.

[The responsibility for confidentiality--private insurance medicine information--data protection]. / Schweigepflicht--Versicherungsgeheimnis--Datenschutz.

1. Professional discretion/insurance discretion and data privacy protection are dependent, they overlap and supplement. The insurance discretion has contractual foundations, which originate in the personal insurance's unique confidential relationship. Data privacy protection is conceptually based on the Federal Data Protection Law, signed on Jan. 27, 1977. Insurance discretion and data privacy protection are of the upmost universal personal rights protected under the constitution. 2. Violation of either the "doctor's duty of discretion" or the "personal insurance's duty of discretion" is punishable by law. 3. The regulations regarding the policy holder's violation of his duty to disclose substantial risks and their verification are supplemented by contractual stipulations calling for a release from the duty of professional discretion. 4. The data privacy protection clause, also a contractual stipulation, takes into account the "relativity of the personal domain" in view of the insurance companies' mass business and the particulars of the "community of risks". 5. Professional discretion/insurance discretion and data privacy protection have experienced a legally ensured and practical interpretation. However this does not exonerate the insurance medical doctors, especially in borderline cases, from reflecting with great care and according to standard legal principle on the observance of professional discretion.

Is routine computerised axial tomography in epilepsy worth while?

The value of routine computerised axial tomography of the brain (CT scanning) was assessed in 220 consecutive patients with epilepsy or isolated seizures. Abnormal CT scans were found in more than half the patients with focal seizures associated with focal signs or a delta focus on the electroencephalogram (EEG). In patients without focal features the CT scan was normal in 94%. Only a quarter of the abnormalities found on CT scanning were potentially treatable by surgery, and only 10% of all the patients had their management changed as a result of CT scanning. In 3 patients with tumours the first scan had been normal. Careful clinical assessment and examination supported by an EEG remain of paramount importance in the management of epilepsy, and CT scanning should be reserved for patients with focal features.