Palliative care for patients with hematologic malignancies in Germany: a nationwide survey on everyday practice and influencing factors from the perspective of treating physicians.

Integrating palliative care into the treatment of patients with advanced hematological malignancies (HM) remains challenging. To explore treating physicians' perspectives on current palliative care practice and to evaluate factors influencing integration, we conducted a nationwide online survey. Based on literature and expert review, the survey addressed the importance of palliative care, communication about life-threatening conditions, challenges in establishing goals of care, and factors influencing the integration of palliative care. 207 physicians treating patients with HM in Germany participated. We used standard descriptive statistics to analyze quantitative data and a content structuring approach. Most physicians considered palliative care in HM to be very important (60.6%) and discussed life-threatening conditions with more than half of their patients (52%), especially when goals of care were changed (87.0%) or when patients raised the topic (84.0%). Disease-related factors, different professional perspectives on prognosis, and patient hopes were the main barriers to changing goals of care, but collaboration with colleagues and multidisciplinary teams provided important support. Time constraints were identified as the main barrier to integrating palliative care. The majority worked well with palliative care teams. Referral processes and conditions were perceived as minor barriers. The study highlights the need to address barriers to integrating palliative care into the management of patients with advanced HM. Future research should aim at optimizing palliative care for patients with HM.

A comparative analysis of the doctoral regulations at the medical faculties in Germany.

Objective: In order to be allowed to use the title "Dr. med." in Germany, an independent scientific achievement under the supervision of an established scientist is necessary. The research question, analysis and results are essentially carried out and developed independently by the doctoral student. The doctorate serves as proof that the doctoral candidate is capable of independent academic work. The acquisition of scientific skills and knowledge is of particular importance in medicine, as Germany´s international competitiveness is based on the education of today´s young academics. Fair conditions and uniform quality standards for doctoral studies are therefore indispensable to attract future young scientists at an early stage. Methods: The currently valid doctoral regulations of the medical faculties in Germany were analysed with regards to the following target criteria; update date, dissertation language, possibility of publication-based dissertation and its details (number of first and total authorships, publication organ), knowledge of methods and consideration of "Good Medical Practice" (GMP), plagiarism check, review process and disputation. Results: All faculties with the right to award doctorates, and, thus 40 valid regulations were included in the analysis. This revealed a great divergence in the requirements for doctoral candidates. Although a publication-based doctorate is now possible at 93% (n=37) of the faculties, in addition to the monographic dissertation, the required first and total authorships vary from one required first authorship (n=26, 70%) to two or three first authorships (n=5, 14%), as well as some faculties having no information regarding the number of publications (n=6, 16%). The quality of the publication organ was not described in detail in seven faculties (19%). To ensure quality, requirements have increasingly been anchored in the regulations, so that 22 regulations (56%) now stipulate participation in courses on GMP or qualification programmes. The regulations leave a lot of room for manoeuvre in terms of content and do not allow for comparability of the conditions for preparing doctoral researchers. The specifications range from mere mention, to instruction, to compulsory course participation. Another means of quality assurance is the prevention of plagiarism through the applications of software systems. However, this simple and effective means is not yet mentioned in 65% of the regulations (n=26). While the other regulations make use of this possibility, it is not an obligatory application. A total of 34 regulations provide for the regular drawing up of a supervision agreement to define the rights and obligations of the actors involved. Conclusion: The analysis showed a divergent picture. Although imprecise regulations or gaps in information allow scope for design, they also prevent transparency. Despite revisions of many regulations in the past, these revisions have not led to any significant harmonisation. The implementation of standardised and structured doctoral programmes is desirable and could be tackled within the framework of the planned amendment of medical studies. This opens up the possibility of dealing efficiently with the scarce resource of time in the face of competing curriculum content and of making a doctoral project more attractive to potential young scientists at an early stage.

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID-19.

BACKGROUND: Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. METHODS: Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed. RESULTS AND DISCUSSION: Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.

[The COVID-pandemic and specialist training in Head and Neck oncology: A Survey among Physicians]. / Die COVID-19-Pandemie und ihr Einfluss auf die ärztliche Weiterbildung in der Kopf-Hals-Onkologie.

OBJECTIVE: The COVID-19 pandemic has had a profound impact on the healthcare system and medical education. In this publication, the influence of the pandemic on the education of physicians active in Head and Neck oncology was examined using a survey. METHODS: A survey comprising 53 questions was conducted to gather data on work settings, daily activities, team events, and educational aspects during the pandemic. A total of 497 oncologists participated, including 131 individuals working in the field of Head and Neck oncology. This subgroup consisted of 99 (75.6%) radiation oncologists, 10 (7.6%) maxillofacial specialists, and 22 (16.8%) otolaryngologists. RESULTS: Nearly half of the participants reported experiencing increased clinical burden, which resulted in reduced engagement in scientific activities. Digital platforms became the predominant mode of continuing education, albeit with reduced accessibility. The pandemic significantly impacted clinical training that involved direct patient interaction. On the other hand, positive effects were observed in terms of cost and availability for external educational events such as conferences. CONCLUSION: The findings highlight the detrimental effects of the COVID-19 pandemic on various aspects of medical education. While digitalization has accelerated in response, many physicians expressed a lack of professional interaction. Developing alternative digital learning platforms can provide a means to better cope with similar situations in the future. However, the importance of personal contact with colleagues and supervisors should not be overlooked when considering the quality of teaching.

Under- or overexpansion of education? Trends in qualification mismatch in the United Kingdom and Germany, 1984-2017.

Prominent theoretical positions in sociology and labor economics disagree whether educational expansion has outstripped the demand for qualified labor (overexpansion), or whether economies face a skill shortage despite increases in education (underexpansion). Focusing on the United Kingdom and West Germany, two countries with dissimilar skill formation institutions, patterns of expansion, and labor markets, this paper asks to what degree expansion of education has been absorbed. I point out shortcomings of wage-centered analyses and develop an approach that focuses on trends in self-assessed over- and underqualification. Using repeated surveys among workers and official labor market statistics, I estimate regression models that link the cohort-level expansion of education to the cohort-level prevalence of mismatch. Results suggest overexpansion in the United Kingdom, with overqualification increasing and underqualification decreasing over historical times and cohorts. West Germany, on the other hand, shows signs of underexpansion. While dominant theoretical accounts focus on the under-/overexpansion of tertiary education, my results show that mismatch-dynamics in both contexts are strongest for workers without university degrees.

Community Nurses' Perspectives on Conceptual Challenges Related to the Need for Nursing Care in Germany: A Constructivist Grounded Theory Study.

In Germany, a person's need for nursing care is assessed by evaluators according to the federal legal definition of the statutory long-term care insurance (LTCI). This definition and the associated standardized assessment tool constitute the conditions for providing nursing care in a community care setting in Germany. Furthermore, the community care setting is regulated by state law and negotiations between long-term care funds and associations of providers of nursing care. During nursing care, nurses engage in a variety of interactions with people. The extent to which the legal definition of the need for nursing care leads to challenges in these interactions is unclear. To address this knowledge gap, we conducted 22 problem-centered interviews with nurses in the community and analyzed the data using the constructivist grounded theory. The results revealed that the negotiation processes are settled within professional-family relationships and vary between the constructs of closeness and distance, advocacy and submission of responsibility, and ethos and technocracy; these are the central challenges nurses encounter in this setting. We discuss the implications and questions that arise from the findings for the nursing profession regarding its own current and future role as well as the design of nursing support in the community, to nurture more advanced nurse practitioners and community health nurses.

Disaster Preparedness Evaluation Tool (DPET): Adaptation and psychometric evaluation for nurses in Germany.

Background: The Disaster Preparedness Evaluation Tool (DPET) with 47 items was developed to assess the disaster preparedness level among nurses in the USA. Aim: This study aimed (1) to adapt and validate the DPET for the nursing context in Germany and (2) to perform its psychometric evaluation. Methods: The DPET items were translated to German (DPET-GER). Adaptation was performed to identify irrelevant items and content validity was estimated using the scale-level content validity index (S-CVI) based on expert ratings. Psychometric evaluation was performed based on data from an online survey of 317 nurses. Internal consistency (Cronbach's alpha) and factor structure were assessed with an exploratory factor analysis. Results: Ten items were unanimously rated as irrelevant by four experts and removed. Based on ratings by further seven experts, the content validity of DPET-GER was low for all 37 items (S-CVI of 0.53) or moderate for 19 items rated as relevant (S-CVI of 0.74). The internal consistency of DPET-GER was high (Cronbach's alpha of 0.94) and 37 items were reduced to five factors that explain 55% of variance in all items. Conclusions: The DPET-GER has acceptable psychometric properties (internal consistency and factor structure). However, low content validity indicates that further adaptation of the DPET-GER is required before it could be used to assess disaster preparedness among nurses in Germany. More research is also needed to contextualize the construct of disaster preparedness.

[Critical care nurses' decision-making regarding verification of blindly inserted gastric tubes: A cross-sectional questionnaire study]. / Entscheidungsfindung von Intensivpflegefachpersonen zur Verifikation blind applizierter Magensonden.

Critical care nurses' decision-making regarding verification of blindly inserted gastric tubes: A cross-sectional questionnaire study Abstract: Background: The placement and verification of the correct position of blindly applied gastric tubes is regularly performed by nurses in clinical practice. International guidelines recommend a radiological verification as a "first-line" method or if pH measurement is not possible. For Germany, neither evidence-based recommendations nor current data are available. Question: Which methods are used by nurses in German intensive care units for verification of the correct position of blindly applied gastric tubes and how do they assess the reliability of different methods? Methods: Multicenter questionnaire survey. Intensive care units in a non-probability, citeria-based sampling of hospitals in and around Cologne, Germany were included. One nurse was included per participating ward. Analyses were mostly descriptive. Results: In 22 hospitals, 38 wards agreed to participate and 32 (84%) responded to the survey. Auscultation of the upper abdomen with simultaneous air insufflation and aspiration of gastric secretions are frequently used methods for determining the position of gastric tubes. Participants consider auscultation, aspiration of gastric secretions, and radiological control as reliable methods. Conclusions: The findings are in contrast to international recommendations and support the need for evidence-based best practice recommendations and training. Likewise, there is a need for research on feasible bedside methods.

[Decision-Making Behaviour in Physician-Rating Portals: Results of a Vignette Study in the New Federal States of Germany]. / Das Entscheidungsverhalten in Arztbewertungsportalen. Ergebnisse einer Vignettenstudie in den neuen Bundesländern.

BACKGROUND: The extent to which relevant information is taken into consideration in the decision process for or against the choice of certain physicians when searching for physicians via physician-rating portals is largely unknown. In particular, the question of whether longer travel distances to a doctor's office are accepted in favour of a good rating is investigated in this study. METHODS: In a vignette study, 192 respondents from new German states were shown ten hits each from a fictitious search for a primary care physician. A total of 1881 choice probabilities were evaluated with cluster-corrected regressions. RESULTS: A good rating and a short distance to the doctor's office were the most important determinants of a positive probability of choice. Longer distances were not accepted in favour of a good rating. Arabic-sounding names strongly reduced the probability of choice, although the respondents only assigned subordinate importance to the doctors' names as a basis for decision-making. CONCLUSION: The area served by physicians in private practice does not increase if they receive good grades on rating portals. Service quality is important, but not the most important factor in the rating score.

[Income of physicians in private practice in Germany: Results of a micro census]. / Einkommen von niedergelassenen Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus.

EINLEITUNG: Daten zum Einkommen von Ärzt:innen in Deutschland sind bisher nur teilweise verfügbar. Die Einkommen der niedergelassenen Ärzteschaft werden vor allem aus den Praxiserträgen abgeleitet, was aber große Interpretationsspielräume eröffnet. Ziel des Artikels ist es, diese Lücke zu schließen. METHODIK: Hierfür werden die Einkommensangaben aus dem Mikrozensus 2017 ausgewertet - mit besonderem Fokus auf niedergelassene Ärzt:innen. Neben dem persönlichen Einkommen erfolgt eine Darstellung der Einkommenssituation auf Haushaltsebene. Die Einkommensziffern werden nach Tätigkeitsumfang, Tätigkeitsgruppe (Allgemein-/Fach-/Zahnärzte), Geschlecht und Stadt/Land differenziert. ERGEBNISSE UND SCHLUSSFOLGERUNG: Das verfügbare persönliche Nettoeinkommen niedergelassener Ärzt:innen beträgt bei Vollzeittätigkeit im Mittel knapp 7.900 € pro Monat. Fachärzt:innen liegen bei 8.250 €, Allgemein- und Zahnärzt:innen bei ca. 7.700 €. Eine finanzielle Benachteiligung von Landärzt:innen lässt sich nicht feststellen, Allgemeinärzt:innen aus Gemeinden<5.000 Einwohnerinnen und Einwohner haben mit 8.700 € sogar das höchste Durchschnittseinkommen - bei einer mittleren Arbeitszeit von 51 Stunden pro Woche. Ärztinnen arbeiten häufiger in Teilzeit als Ärzte. Ein niedrigeres Einkommen resultiert überwiegend aus einem geringeren Tätigkeitsumfang. INTRODUCTION: Data on the income of physicians in Germany are only partially available to date. The income of physicians in private practice is derived primarily from practice income, but this opens up considerable scope for interpretation. The aim of this article is to close this gap. METHODOLOGY: For this purpose, the income data from the 2017 micro census were evaluated, with a special focus on physicians in private practice. In addition to personal income, the income situation was presented at the household level. The income figures were differentiated according to the scope of activity, activity group (general practitioners/specialists/dentists), gender and city/country. RESULTS AND CONCLUSION: The disposable personal income of physicians in private practice was just under € 7,900 per month on average for full-time employment. Specialists earned € 8,250, while general practitioners and dentists earned about € 7,700. Rural physicians were not found to suffer from financial disadvantages; general practitioners from municipalities with<5,000 inhabitants even had the highest average income of € 8,700, with an average working time of 51 hours per week. Female physicians worked part-time more often than did male physicians. A lower income resulted primarily from a lower scope of activity.

[Specific Workloads among Employees with a Migration Background in Nursing and Geriatric Care: A Systematic Review]. / Spezifische Arbeitsbelastungen bei Mitarbeitenden mit Migrationshintergrund in der Kranken- und Altenpflege: Ein systematisches Review.

BACKGROUND: Multimorbidity, increasing numbers of chronically ill patients and demographic change are leading to increased care costs in Germany with an increasing shortage of staff in skilled nursing and geriatric care. In this context, more and more caregivers with a migration background of the 1st generation (PmMH) are being recruited and integrated into existing (corporate) cultures. This represents an important starting point for a permanent and needs-based supply landscape. THE AIM OF THE STUDY: The aim of the study was to identify and analyze the specific stresses of PmMH at the workplace in nursing and geriatric care MATERIAL AND METHODS: A systematic literature search was carried out in relevant specialist databases (Pubmed, PsychInfo, Web of Science, Cochrane), supplemented by an extended snowball and hand search. This was followed by a descriptive presentation of the results of the study content, which in a subsequent step was iteratively brought together and consolidated into thematic categories by several people. RESULTS: A total of 15 publications were identified as relevant and included in the analysis. Specific, migration-associated stress factors could be identified. In particular, the categories: "Discrimination and racism", "Language and communication problems" and "Cultural adjustment" characterized the (collaborative) work in nursing and care for the elderly and led to additional stress for employees and patients. DISCUSSION: The present review article identified and summarized specific burdens of PmMH. At this point it can be assumed that these affect both PmMH and patients. So far, operational concepts do not seem to be able to adequately solve the challenges, so that effective, sustainable approaches have to be found. The extent to which the specificed stress factors only affect PmMH is not considered in this context, so that further research is needed.

[Primary Care Aspects in the German Coalition Agreement 2021]. / Allgemeinmedizinische und hausärztliche Aspekte im Koalitionsvertrag 2021.

INTRODUCTION: Despite statewide rising numbers of family physicians during the last legislative period, their overall health care providing capacity has declined, mainly due to their working part-time. In the legislative period starting in 2021, this trend appears likely to continue. The German Health System Advisory Council foresees the number of general practitioners (GPs) who will have to be replaced by the next federal election in 2025 as exceeding 26,000. This results in a need for political action to sustain the primary care workforce. METHODS: We conducted a content analysis of the coalition agreement 2021 between SPD, Greens and FDP with regard to explicit and related topics of GP care. A mixed inductive-deductive classification of the included text passages was used to thematically structure the results. RESULTS: A total of 34 relevant text passages were identified between pages 8 to 139 of the coalition agreement. Family physician care was explicitly addressed only once, when the planned abolition of budgeting was discussed. Other proposals which affect family physicians work included reduction of bureaucracy, prevention, or easier access to medical care for disadvantaged groups. Other passages of the coalition agreement regarding security of medical supply, included demand planning, innovative healthcare models, and cross-sectoral care. One focus of the coalition agreement was on digitalization. It mentions e. g., a digitization strategy for the healthcare sector, telemedicine services, and the electronic medical record, including opt-out possibility. Other assessed passages included projects to facilitate research or climate change and health. CONCLUSION: Despite the lack of mention of family physicians in the coalition agreement, many projects relate to the work of family physicians. Some of the ideas mentioned have also already been written down by the German Society for General Practice and Family Medicine (DEGAM) in its positions on the future of general practice, digitization or climate change and health. The planned projects in the coalition agreement have the potential to strengthen health care by family doctors and also make it more attractive for young doctors. However, further measures may be necessary to maintain GP care in the short and long term.

[Differences in Billing Patterns Between GPs and Pediatricians Using Early Diagnostics in Children and Adolescents as an Example: Analysis of Nationwide Data from Statutory Health Insurance Physicians]. / Kompensation von Leistungen zwischen Hausärzten und Kinder- und Jugendmedizinern am Beispiel der Früherkennungsuntersuchungen bei Kindern und Jugendlichen ­ Analyse von bundesweiten KBV-Daten.

BACKGROUND: Despite a 13.1% increase in the number of pediatricians between 2011 - 2020, the capacity of pediatric care has largely stagnated. This is due to increasing flexibility in working hours and a declining willingness of doctors to establish practices. In addition, there is an imbalance in the distribution of pediatric medical care capacities. While metropolitan areas are often characterized by oversupply, there is an increasing shortage of pediatricians, especially in rural areas. As a result, general practitioners in rural areas are increasingly taking over part of pediatric care. We quantify this compensation effect using the example of examinations of general health and normal child development (U1-U9). METHODS: Basis of the analysis was the Doctors' Fee Scale within the Statutory Health Insurance Scheme (Einheitlicher Bewertungsmaßstab, EBM) from 2015 (4th quarter). Nationwide data from the National Association of Statutory Health Insurance Physicians (KBV) for general practitioners and pediatricians from 2015 was evaluated. In the first step, the EBM was used to determine the potential overlap of services between the two groups of doctors. The actual compensation between the groups was quantified using general health and normal child development as an example. RESULTS: In section 1.7.1 (early detection of diseases in children) of the EBM, there is a list of 16 options for services that can be billed (fee schedule positions, GOP) by general practitioners and pediatricians. This particularly includes child examinations U1 to U9. The analysis of the national data of the KBV for the early detection of diseases in children showed significant differences between rural and urban regions in the billing procedure. Nationwide, general practitioners billed 6.6% of the services in the area of early detection of diseases in children in 2015. In rural regions this share was 23% compared to 3.6% in urban regions. The analysis of the nationwide data showed that the proportion of services billed by general practitioners was higher in rural regions than in urban regions. CONCLUSION: The EBM allows billing of services by both general practitioners and pediatricians, especially in the area of general GOP across all medical groups. The national billing data of the KBV shows that general practitioners in rural regions bill more services from the corresponding sections than in urban regions.

Acceptance of preventive home visits by nurses - The user perspective.

OBJECTIVE: The aim of this study was to investigate acceptance of preventive home visits (PHVs) for older adults in rural Germany. DESIGN: Qualitative descriptive approach. SAMPLE: We investigated the personal, individual perspective of adults aged 65 to 85, who were not yet eligible for benefits from the long-term care insurance, were able to understand and speak German, and who lived in the municipality under study. MEASUREMENTS: Fifteen semi-structured interviews were conducted between 02/2019 and 08/2020. They were transcribed, coded using MAXQDA, and content analyzed. Ethical approval was obtained. RESULTS: The acceptance of PHVs was extremely high and characterized by five main effects: very close relationship with the nurse, well-being, empowerment, satisfaction, ambivalence. Participants wish to receive PHVs in the future and would recommend it to others. Even those with a healthy or health-promoting lifestyle are thankful to be able to refer to the counselling sessions if life circumstances should deteriorate. Those who became care-dependent wish to continue and perceive it as a valuable addition to their care. CONCLUSION: From the participants' point of view, this low-threshold counselling-and-support approach should be maintained in the future. PHVs can support health and independence in older adults and therefore prevent them from becoming care-dependent.

[Work Participation after Multimodal Rehabilitation due to Diseases of the Digestive System. Representative Analyses using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund von Erkrankungen des Verdauungssystems. Repräsentative Analysen auf Basis der Routinedaten der Deutschen Rentenversicherung.

PURPOSE: Diseases of the digestive system such as Crohn's disease (CD) or ulcerative colitis (UC) are associated with problems in occupational participation, but they only make up a very small part of all rehabilitation services provided by the German Pension Insurance. Rehabilitation is a very good treatment option, but its effectiveness is largely unclear. So far, several studies exist on the return to work after medical rehabilitation. However, representative findings and the relevant influencing factors are still lacking. This is the aim of the present analysis. METHODS: We used the rehabilitation statistics database of the German Pension Insurance. Patients were included with completed medical rehabilitation due to a disease of the digestive system in 2017. The analyses were carried out for the entire group as well as differentiated according to the diagnosis groups CD, UC, diverticular diseases (DI) as well as pancreatic diseases (PA). Occupational participation was operationalised both via a monthly information up to 24 months after rehabilitation and as a rate of all persons who were employed after 12 or 24 months in the survey month and the 3 preceding months. For the analysis of the influencing factors on stable occupational participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 8,795 data sets were included in the analysis (CD: n=1,779, 20%; UC: n=1,438, 16%; DI: 1,282, 15%; PA: n=761, 9%). The average age in the groups ranged from 44 (CD) to 54 (DI) years; the proportion of women ranged from 28% (PA) to 57% (CD). Between 16% (DI) and 32% (PA) of the rehabilitation participants had sickness absences of 6 or more months in the year before rehabilitation. Two years after rehabilitation, the return-to-work rates were 69% (CD), 71% (UC), 68% (DI) and 58% (PA). The strongest influencing factors on stable occupational participation were time of sick leave and wage before rehabilitations well as work ability at admission. CONCLUSION: Two years after gastroenterological rehabilitation in Germany, 6 to 7 out of 10 affected persons return to stable work participation. Relevant influencing factors are the time of sick leave and the level of remuneration. The results support an expansion of rehabilitation concept to include work-related aspects.

[Work Participation after Multimodal Rehabilitation due to Neurological Diseases - Representative Analyses Using Routine Data of the German Pension Insurance]. / Berufliche Teilhabe nach einer medizinischen Rehabilitation aufgrund neurologischer Erkrankungen.

PURPOSE: There is little representative evidence for the German rehabilitation system on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a neurological disease, it is therefore important to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. METHODS: The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 due to a neurological disease. The analyses were carried out for the entire group and also in a differentiated manner for the 2 main diseases, cerebrovascular diseases (CD) and multiple sclerosis (MS). Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyse the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 42,230 data sets were included in the analysis (CD: n=18,368, 44%; MS: n=6,343, 15%). Patients with neurological diseases were 50 years old on average, 43% were female. We found that approximately15% of patients reported no absenteeism, whereas 17% stated an absence leave of six months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 31 and 44% of the cases respectively. Nearly 48% of patients with CD returned to work two years after rehabilitation. For MS patients, the percentage was slightly higher at 54%. The amount of sick leave of the rehabilitated individual, their gross/net income prior to rehabilitation as well their work capacity prior to admission were the three strongest influencing factors on their return to the labour market. CONCLUSION: About half of all persons with neurological diseases return to sustainable work after medical rehabilitation in Germany. The amount of sick leave and the income before rehabilitation are determining factors as to whether the person will return to work. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a neurological disease for the first time.

[Some aspects of ensuring patients' rights and accessibility of medical care in Austria, Belgium, Germany and Estonia].

The article devoted to ensuring the rights of patients and the availability of medical care in Austria, Belgium, Germany and Estonia notes the experience of creating an institute of independent ombudsmen who plays an important role in this issue. Basically, in these countries, the choice of a medical organization and a doctor is possible, and in Belgium the right to choose an insurance organization is granted. Patients in these countries are given the right to control the process of providing them with medical care, including its payment and joint decision-making with the doctor on treatment tactics. The State also ensures the patient's right to receive preventive and restorative services provided to children free of charge, and compensated for adults in 80% of cases. It is impossible not to recognize the high percentage of citizens of these countries, reaching 98%, satisfied with the medical services provided to them. However, in some countries there is an imbalance in the availability of medical care, which is expressed by high availability of family doctor services and low availability of specialist services, as in Estonia. Nevertheless, this does not cause an increase in the level of corruption in the medical spheres of these countries, which is below the European average. According to the totality of indicators of the availability of medical care, Germany is the leader among the analyzed countries.

Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO).

The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.

Observed and personally experienced discrimination: findings of a cross-sectional survey of physicians and nursing staff.

BACKGROUND: Discrimination against hospital staff based on ascribed features is prevalent in healthcare systems worldwide. Detrimental effects on health and quality of patient care have been shown. Our study aims to describe and analyse the discrimination experiences of both physicians and nurses, specifically for the German hospital context. METHODS: A cross-sectional online survey on observed and personally experienced discrimination at work addressed staff from 22 hospitals of two organizations in Germany. Sociodemographic and occupational as well as institutional characteristics served as independent variables. In multivariable analyses, block- and stepwise logistic regressions were calculated for the two dependent variables (witness and victim of discrimination). Sensitivity analyses with imputed data for missings were performed. RESULTS: N = 800 healthcare professionals (n = 243 physicians, n = 557 nurses; response rate: 5.9%) participated in the survey. 305 respondents (38.1%) were witnesses of discrimination, while 108 respondents (13.5%) were victims of discrimination in their wards. Reasons for observed discriminatory acts were predominantly attributed to the ethnicity of the person concerned, their appearance and language, whereas personally affected staff most frequently cited gender as a reason, followed by ethnicity, and physical appearance. In multivariable models, cultural competence significantly increased the likelihood of witnessing discrimination (ß = .575; p = .037). In terms of the likelihood of being a victim of discrimination, in addition to cultural competence (ß = 2.838; p = < .001), the interaction of the effects of gender and professional group was statistically significant (ß = .280; p = .010). CONCLUSIONS: Given the extent of experienced and observed discrimination, appropriate institutional responses are needed. Further research on discriminatory structures in the German-speaking health care system should focus on discrimination at the intersection of ethnicity, gender and occupation.

Rural-urban differences in workplace health promotion among employees of small and medium-sized enterprises in Germany.

BACKGROUND: Rural and urban areas hold different health challenges and resources for resident small and medium-sized enterprises (SMEs) and their employees. Additionally, residents of urban and rural areas differ in individual characteristics. This study aims at investigating potential rural-urban differences (1) in the participation rate in workplace health promotion (WHP) and (2) in the relationship of WHP and health relevant outcomes in residents living in rural or urban German areas and working in SMEs. METHODS: Data of a large German Employee Survey in 2018 were used and analyzed by chi-square and t-tests and regression analyses regarding job satisfaction, sick days, and psychosomatic complaints. A total of 10,763 SME employees was included in analyses (23.9% living in rural, 76.1% living in urban areas). RESULTS: Analyses revealed higher participation rates for SME employees living in rural areas. SME employees living in urban areas reported more often the existence of WHP. Results showed (a) significance of existence of WHP for psychosomatic complaints and (b) significance of participation in WHP for job satisfaction in SME employees living in urban but not for those living in rural areas. CONCLUSION: The revealed disparities of (1) higher participation rates in SME employees living in rural areas and in (2) the relationship of WHP aspects with health relevant outcomes are of special interest for practitioners (, e.g. human resource managers), politicians, and researchers by providing new indications for planning and evaluating WHP measures.