[Differences between German and Turkish-speaking participants in a chronic heart failure management program]. / Unterschiede zwischen deutsch- und türkischsprachigen Teilnehmenden an einem strukturierten Herzinsuffizienz-Versorgungsmodell.

BACKGROUND: German and Turkish-speaking patients were recruited for a chronic heart failure management program. So far little is known about the special needs and characteristics of Turkish-speaking patients with chronic heart failure; therefore, the aim of this study was to examine sociodemographic and illness-related differences between German and Turkish-speaking patients with chronic heart failure. METHODS: German and Turkish-speaking patients suffering from chronic heart failure and insured with the AOK Rheinland/Hamburg or the BARMER GEK health insurance companies and living in Cologne, Germany, were enrolled. Recruitment took place in hospitals, private practices and at information events. Components of the program were coordination of a guideline-oriented medical care, telemonitoring (e.g., blood pressure, electrocardiogram, and weight), a 24-h information hotline, attendance by German and Turkish-speaking nurses and a patient education program. Data were collected by standardized interviews in German or Turkish language. Data were analyzed with descriptive measures and tested for significance differences using Pearson's χ2-test and the t­test. RESULTS: A total of 465 patients (average age 71 years, 55 % male and 33 % Turkish-speaking) were enrolled in the care program during the study period. Significant differences between German and Turkish-speaking patients were found for age, education, employment status, comorbidities, risk perception, knowledge on heart failure and fear of loss of independence. DISCUSSION: The response rate could be achieved with the help of specific measures for patient enrollment by Turkish-speaking integration nurses. The differences between German and Turkish-speaking patients should in future be taken into account in the care of people with chronic heart failure.

[Qualitative Research in Health Services Research - Discussion Paper, Part 3: Quality of Qualitative Research]. / Qualitative Studien in der Versorgungsforschung - Diskussionspapier, Teil 3: Qualität qualitativer Studien.

The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research.

Can a stressed oncologist be good in a consultation? A qualitative study on the oncologists' perception.

The aim of this exploratory study was to examine how the working conditions and job stress of private practice oncologists (PPOs) affect their interaction with patients. Data for the study were collected through semi-structured interviews with PPOs selected based on purposeful sampling criteria. The data were evaluated using content analysis. Factors perceived by PPOs to influence their level of stress and patient care were some of their own personal characteristics as well as working conditions both within and outside their practices. Apart from being able to name specific stressors (e.g., dysfunctional organisational workflow and interruptions during medical encounters), the oncologists also mentioned individual and organisational resources (e.g., professional experience, well-educated nurses and good work organisation) for coping with job stress and improving interaction with patients. Within this study, we identified some obstacles on the individual and organisational level for good patient care, as working conditions which might lead to time pressure and stress, which subsequently have an impact on quality in patient care (e.g., less time for personal issues during patient consultations). Future stress research should conduct a more in-depth investigation of these and other interventions at both the individual and organisational levels in order to improve patient care.

[Thrombolysis for acute stroke--a nationwide analysis of regional medical care]. / Thrombolyse des akuten Schlaganfalls--Eine deutschlandweite Analyse der regionalen Versorgung.

BACKGROUND: This study aims at investigating ischaemic stroke therapy in Germany by using secondary data. The focus lies on the performance of thrombolysis. METHODS: Statutory quality report data for 2010 were obtained. All hospitals (n = 1302) treating patients suffering from an ischaemic stroke either on a neurological, internal, geriatric or intensive care unit were analysed. The treatment situation, defined as the experience in performing thrombolysis, was displayed cartographically. Potential variables that may influence the thrombolysis rate were analysed. RESULTS: 78 % of the 198,500 ischaemic stroke cases were treated on a ward specialised in the stroke treatment (i. e., a stroke unit). The mean thrombolysis rate in neurological departments was 9.1 %. Thrombolysis rates between departments ranged from 0 to 38 %. Significant factors influencing the thrombolysis rate were the total number of ischaemic strokes treated as well as the existence of a stroke unit. DISCUSSION: In Germany, to date regional differences in the treatment of ischaemic stroke exist. Experience in the treatment of ischaemic stroke patients and the availability of a stroke unit both increase the thrombolysis rate. Data suggest that in Germany there is still room for improvement of appropriate ischaemic stroke treatment.

[Qualitative research in health services research - discussion paper, Part 1: What is the idea?]. / Qualitative Studien in der Versorgungsforschung - Diskussionspapier, Teil 1: Gegenstandsbestimmung.

In this first part of a 3-part discussion paper the working group "Qualitative Methods" in the German Network of Health Services Research (DNVF) identifies the potentials and opportunities qualitative research methods provide for health services research. Many research questions relevant for health services research require the use of qualitative methods. However, the potential of and need for qualitative research in health services research has not yet received sufficient attention from funding bodies. We discuss the applicability and importance of qualitative research for the field of health services research. We then move on to describe the key characteristics of qualitative research that need to be taken into account in health services research. We discuss characteristics such as open-ended (qualitative) data, interpretation of meanings, the search for contradictions, closeness to everyday life, openness towards change or modification of the research question and processes in the context of health services research. To ensure a high-quality approach in qualitative methods for the health services research, sufficient competency in methods and appropriate settings that account for the peculiarities of qualitative methods need to be developed. These include an appropriate time frame and sufficient and qualified personnel to conduct qualitative research. Qualitative research is not a research paradigm in itself rather it comprises of many different and diverging approaches. The goal of this paper is to show the diversity of qualitative research methods, its importance for health services research, and to open up the discussion on strategies for integrating qualitative methods into health services research.

[Qualitative research in health services research - discussion paper, Part 2: Qualitative research in health services research in Germany - an overview]. / Qualitative Studien in der Versorgungsforschung - Diskus-sionspapier, Teil 2: Stand qualitativer Versorgungsforschung in Deutschland - ein exemplarischer Überblick.

BACKGROUND: This is the second part of a 3-part discussion paper by the working group on "Qualitative Methods" in the German network of health services research (DNVF) that shall contribute to the development of a memorandum concerning qualitative health services research. It aims to depict the different types of qualitative research that are conducted in health services research in Germany. In addition, the authors present a specific set of qualitative data collection and analysis tools to demonstrate the potential of qualitative research for health services research. QUALITATIVE RESEARCH IN HEALTH SERVICES RESEARCH - AN OVERVIEW: To give an overview of the types of qualitative research conducted in German health services research, the abstracts of the 8th German Conference on Health Services Research were filtered to identify qualitative or mixed-methods studies. These were then analysed by looking at the context which was studied, who was studied, the aims of the studies, and what type of methods were used. Those methods that were mentioned most often for data collection and analysis are described in detail. QUALITATIVE RESEARCH AT THE CONFERENCE FOR HEALTH SERVICES RESEARCH 2009: Approximately a fifth of all abstracts (n=74) had a qualitative (n=47) or a mixed-methods approach combining quantitative and qualitative methods (n=27). Research aims included needs assessment (41%), survey development (36%), evaluation (22%), and theorizing (1%). Data collection mostly consisted of one-on-one interviews (n=45) and group discussions (n=29). Qualitative content analysis was named in 35 abstracts, 30 abstracts did not reference their method of analysis. In addition to a quantitative summary of the abstract findings, the diversity of fields addressed by qualitative methods is highlighted. CONCLUSION: Although drawing conclusions on the use of qualitative methods in German health services research from the analysis of conference abstracts is not possible, the overview we present demonstrates the diversity of methods used for data collection and analysis and showed that a few select methods are extensively used. One of the tasks a memorandum of qualitative health services research should accomplish is to highlight underutilized research methods, which may help to develop the potential of qualitative methodology in German health services research.

[Methods for organisational health services research]. / Methoden für die organisationsbezogene Versorgungsforschung.

On 1 July 2009, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned below and published in this journal (Gesundheitswesen 2009; 71: 505-510). The focus of this part of the Memorandum III "Methods for health services research" is on the questions and methods of organisational health services research. In a first step, we describe the central questions which are at the core of organisational health services research. In a second step, we describe the methodological standards and requirements with regard to a) sampling, b) measurement and c) research design. We present a phase model for complex intervention trials. This model allows to conduct high quality organisational health services research, to integrate different methods of social research and to show in which phase they are of special importance.

Rhabdomyosarcoma spheroids with central proliferation and differentiation.

A novel type of multicellular spheroids was established and characterized with regard to growth behavior, proliferation, and differentiation. The spheroids were grown from clonal rat rhabdomyosarcoma cells using the spinner flask technique. The cell aggregates showed several unique properties that were different from those observed in most of the spheroids investigated to date. These properties include a non-Gompertzian volume growth; the coexistence of undifferentiated mononuclear cells and of differentiated, myotube-like giant cells with numerous nuclei; a relatively homogeneous intraspheroidal distribution of proliferating mononuclear cells with thymidine labeling even in the center of spheroids greater than 1 mm; the absence of necrosis in such large spheroids, and the accumulation of myotube-like cells in the center of these spheroids instead. There was a decrease in the overall proliferative activity of the mononuclear cells with increasing proportion of giant cells in the rhabdomyosarcoma spheroids.

Pathophysiological approaches to identifying tumor hypoxia in patients.

The present report summarizes observations of the authors on tumor oxygenation and on techniques for characterizing tumor hypoxia in patients. Cryospectrophotometric measurements of HbO2 saturations in tumor microvessels allow for estimates of the proportion of well oxygenated tissue regions. Labeling of tissue areas at oxygen (O2) tensions (pO2) less than 10 mm Hg with misonidazole may be used for a general characterization of the oxygenation status in patient tumors rather than for the determination of the radiobiologically hypoxic cell fraction. Quantitative bioluminescence and single photon imaging make it possible to determine ATP concentrations in absolute terms with a spatial resolution at the cellular level. It is shown that the ATP distribution reflects the efficiency of the O2 supply to tumors. Since all these techniques rely on biopsy material, the measured values can be assessed in relation to the histological structure and vascular pattern of the tumors. Such a direct interrelationship is not obtained when using polarographic microelectrodes in tumor tissue. However, a novel technology, the "computerized pO2 histography" has enabled direct polarographic measurements of pO2 values in patients, in extended and systematic clinical trials. Preliminary results in cervix and breast cancers demonstrate that pO2 values are lower in tumors than in adjacent normal tissues, and that great intra- and intertumoral differences occur even among tumors of the same clinical stages and histological grades, illustrating the necessity of such a pathophysiological approach to an "individualization" of tumor therapy.