Turnover intention of foreign trained physicians in German rehabilitation facilities-a quantitative study.

BACKGROUND: Germany's medical specialist shortage is an acute challenge, especially in the rehabilitation segment. One countermeasure is to recruit foreign trained physicians (FTP), but the high turnover of FTP is a burden on the departments that train them and integrate them professionally. Preliminary research showed that currently one in three physician positions in German Pension Insurance (DRV) contract facilities is filled by FTP.This paper examines factors related to turnover intention of FTP in German rehabilitative departments. METHODOLOGY: In spring 2022, we surveyed FTP across all inpatient and outpatient rehabilitation departments under the German Pension Insurance, using a two-stage cross-sectional approach. We conducted an online survey of FTP and developed a specialized questionnaire that captured sociodemographic, occupation related and professional biographical data, turnover intention, satisfaction, difficulties with professional integration and departmental structural characteristics. To analyze retention within the rehabilitation field, we used a measure of turnover intention, taking into account the direction of potential turnover, residency requirements and considerations of returning to the rehabilitation field. The data was evaluated in a subgroup analysis comparing FTP with and without turnover intention using Fisher's exact tests. RESULTS: The sample includes n = 145 FTP, 119 stating no turnover intention and 27 with turnover intention. More than half of FTP with turnover intention wished to move to an acute care hospital. FTP with turnover intention are comparatively younger and came to Germany and were employed in the rehabilitation departments more recently, indicating an earlier career stage. Besides, career-related and regional factors show the strongest relation to turnover intention. DISCUSSION AND CONCLUSION: The results reveal a group of "established FTP" whose professional integration has been successfully completed. FTP with turnover intention are comparatively younger, career-oriented physicians for whom work in a rehabilitative facility is a career springboard to gain a foothold in acute care clinics. A limitation is that FTP with turnover intention are difficult to reach and may be underrepresented in our sample.

Retention and turnover intention of foreign-trained physicians (FTPs): A scoping review.

BACKGROUND: In many high-income countries, there is a regional or indication-specific shortage of physicians. One way to alleviate these shortages is to recruit physicians from abroad. However, the high turnover rate of foreign-trained physicians (FTPs) makes it difficult to maintain stable medical care. The purpose of this scoping review was to analyze recent studies on turnover intentions and retention in order to, first, understand how they are assessed and, second, to identify the parameters that contribute to reducing turnover and improving the retention of FTPs. METHOD: A total of six articles were included, and a thematic analysis was conducted. The literature search was limited to English-language articles from bibliographic databases related to public health and health services research (MEDLINE, CINAHL, Web of Science, PsycINFO) between 2010 and 2022. RESULTS: The topis identified were: (1) the quality of working relationships, (2) the quality of the work environment, (3) personal life and migration issues, (4) employment-related issues, and (5) career and training opportunities. Three approaches were considered in examining the retention and turnover intentions of FTPs: satisfaction, motivation for migration, and professional integration. Underrepresented fields are discrimination and social integration. CONCLUSIONS: The processes of turnover intention and retention are still poorly understood. Standardizing definitions and certain parts of the methodology would help researchers navigate the process with more accuracy. Further studies should look at the causal relationships that can be collected in the form of qualitative data, as these are currently lacking.

[How can assisted technology support family caregivers in everyday care? Results of a feasibility study for the Liv app]. / Wie kann eine assistierte Technologie pflegende Angehörige im Pflegealltag unterstützen? Ergebnisse einer Machbarkeitsstudie zur App Liv.

Background: Because of the constantly aging population and the number of people suffering from chronic illnesses in old age, the number of family caregivers and their role in care provision is increasing. Most of these people are acting without any prior experience in the care sector, have a limited understanding of the healthcare system and carry out the tasks alongside the demands of their own day to day lives. Technical support solutions such as the Liv app (developed in the project münster.land.leben) are therefore gaining traction.The objective of the Liv app is to improve the digital healthcare expertise of the vulnerable group of family caregivers in Germany. Objective of the paper research question: The goal of this study was to test the prototype of the Liv app and refine the concept with the participation of family caregivers. Material and methods: Qualitative online interviews were conducted with 10 family caregivers with the aid of a prototype of the app and evaluated using a structured, qualitative content analysis. Results: The family caregivers rated the layout and the simplicity of the features as positive overall. As a condition for them to use the app, the interviewees stressed its ease of use and the quantity of documentation provided. Suggestions for enhancements were related to specifying activities, including additional forms of communication, reminders and confirmation, providing links to more information, integrating the app into other digital systems and enabling important documents to be saved. Discussion: From the perspective of those affected, the app meets a huge unserved need. Based on the interviewees' suggestions six enhancements to the app are under discussion. To avoid cluttering up the app, their usefulness needs to be tested in another study.

Diagnostic Accuracy of the Telephone Interview for Cognitive Status for the Detection of Dementia in Primary Care.

PURPOSE: Cognitive diagnostic work-up in primary care is not always physically feasible, owing to chronic disabilities and/or travel restrictions. The identification of dementia might be facilitated with diagnostic instruments that are time efficient and easy to perform, as well as useful in the remote setting. We assessed whether the Telephone Interview for Cognitive Status (TICS) might be a simple and accurate alternative for remote diagnostic cognitive screening in primary care. METHODS: We administered the TICS (range, 0-41) for 810 of 1,473 older people aged 84.5 (SD, 2.4) years. We scrutinized electronic health records for participants with TICS scores ≤30 and for a random sample of participants with TICS scores >30 for a dementia diagnosis using all data from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial for 8-12 years of follow-up. We used multiple imputation to correct for verification bias. RESULTS: Of the 810 participants, 155 (19.1%) had a TICS score ≤30, and 655 (80.9%) had a TICS score >30. Electronic health records yielded 8.4% (13/154) dementia diagnoses for participants with TICS ≤30 vs none with TICS >30. Multiple imputation for TICS >30 yielded a median of 7/655 (1.1%; interquartile range, 5-8) estimated dementia cases. After multiple imputation, the optimal cutoff score was ≤29, with mean sensitivity 65.4%, specificity 87.8%, positive predictive value 11.9%, negative predictive value 99.0%, and area under the curve 77.4% (95% CI, 56.3%-90.0%). CONCLUSIONS: In the present older population, the TICS performed well as a diagnostic screening instrument for excluding dementia and might be particularly useful when face-to-face diagnostic screening is not feasible in family practice or research settings. The potential reach to large numbers of people at low cost could contribute to more efficient medical management in primary care.

[What Measures Help with the Professional Integration of Migrated Doctors in Rehabilitation Clinics?] / Welche Maßnahmen helfen bei der beruflichen Integration von migrierten Ärzt:innen in Rehabilitationskliniken?

BACKGROUND: National and international literature and our own preliminary work indicate that the professional integration of migrant doctors in rehabilitation clinics poses a considerable challenge. METHOD: The STIR project worked with four rehabilitation clinics in Germany to develop various measures to ensure the structured transition and professional integration of migrated doctors. The selected measures include a short film, a website, management training, intercultural training, a peer support programme and a strategy for initial discussions. In this article we describe the preparation, implementation and evaluation of the prototypes of the above measures as part of a feasibility study with regard to acceptance, practicability and integrability. OUTCOME: It turns out that the measures can be easily implemented in everyday clinical practice and are accepted and considered useful by the participants. Options for optimisation are described. CONCLUSION: The study provides initial indications of interventions which promote the professional integration of migrated doctors. Additional analyses of sustainability and precise customisation to the local target group are recommended.

The Role of Complementary and Alternative Medicine in the Healthcare System: A German Paradox.

BACKGROUND: This paper examines a paradox in the German healthcare system: Complementary and alternative medicine (CAM) practices are a major element of medical encounters in Germany. Patients seek them, physicians provide them, and public health insurances pay for them in part. Despite all this, CAM practices are not acknowledged as scientifically valid. MATERIAL AND METHOD: I will examine this situation in detail based on 2 ethnographic studies. The first study refers to an attempt to introduce homeopathic education at a German university. The second one is a study in the context of cancer and CAM. These cases are perfect examples of the current power struggles that are impeding the expansion of CAM practices in Germany. RESULTS: The results should be seen from the theoretical angle of the study of science. The conventional method of proving scientific validity is in contradiction to those frameworks in which the impact of CAM might be demonstrated. There are economic interests invested in preventing the integration of CAM into existing scientific structures. However, the current hybridization of CAM with conventional medicine might be a step towards an institutionalized heterogenization of medical practices in Germany. CONCLUSIONS: A broader understanding of scientific methods within the CAM community could provide a useful frame for future research. I suggest that the CAM community more actively takes part in the discourse with representatives of conventional medicine and come out of the closet.

Appropriating depression: biomedicalizing Ayurvedic psychiatry in Kerala, India.

The appropriation of biopsychiatric concepts such as depression, and their reframing in clinical and academic discussions, are important parts of the revitalization of bhut vidya as Ayurvedic psychiatry. Drawing on ethnographic fieldwork conducted in Kerala from 2009 to 2011, in this article we explore the process and the controversies of translating and correlating the biopsychiatric notion of depression, as a discrete and biologic pathological entity, with Ayurvedic notions of body, mind, and mental distress. Depression, conceptualized as a neurochemical imbalance, is, we argue, relatively compatible with Ayurvedic notions of a fluent body and mind, and so is easier to correlate with Ayurvedic concepts of do[Formula: see text]ic imbalances and blockages of channels than the former psychoanalytically dominated model of depression. The appropriation of depression within Ayurvedic discourse challenges the dichotomy of universal and culture-specific disorders, and this has a significant impact on mental health programs in Kerala.

Transforming the self and healing the body through the use of testimonies in a divine retreat center, Kerala.

In this article, we analyze the collective healing process that takes place on a weekly basis in the Divine Retreat Center (DRC) in Muringoor, Kerala. We argue that disease in the DRC is understood either as a psycho-somatic or as a spirito-somatic phenomenon. In contrast to other Charismatic communities, however, the body is the locus on which the medical effects of the healing become visible. The whole process is divided into several phases: First, there is a cleansing and disengagement procedure that aims to purify and liberate the participants through confession and counseling. Thereafter comes a climatic phase of personal emptying, transition and re-orientation during which the healing itself takes place. The procedure is finally completed with the person being spiritually "refilled" by the Holy Spirit. The dominant recurring element in the whole process is the continuous statement of healing "testimonies." As an integral part of the healing procedure, these statements are used to share personal experiences among the participants in the center. They are produced in a strict format in order to be spread far beyond through various media (TV, newspaper, Internet, etc.). They thereby constitute a speech genre that follows specific rules and patterns. Through shaping one's own biography in the frame of the testimonies, so we argue, the actual transformation of the self and therefore the miracle healing takes place.

Prediction of engraftment after autologous peripheral blood progenitor cell transplantation: CD34, colony-forming unit-granulocyte-macrophage, or both?

BACKGROUND: The rate of hematologic recovery after peripheral blood progenitor cell (PBPC) transplantation is influenced by the dose of progenitor cells. Enumeration of cells that express CD34+ on their surface is the most frequently used method to determine progenitor cell dose. In vitro growth of myeloid progenitor cells (colony-forming unit-granulocyte-macrophage [CFU-GM]) requires more time and resources, but may add predictive information. STUDY DESIGN AND METHODS: A series of 323 patients, who underwent autologous PBPC transplantation for multiple myeloma, malignant lymphoma, or locally advanced breast cancer, were studied for the effect of CD34+ dose and CFU-GM dose on hematologic recovery. Measures for engraftment were days to absolute granulocyte and platelet (PLT) counts to greater than 500 per muL and than 20 x 10(9) per L, respectively, and number of PLT transfusions and red cell units required. RESULTS: The CD34+ dose had a median of 8.4 x 10(6) per kg, and the CFU-GM dose a median of 84.9 x 10(4) per kg. The CD34+ and CFU-GM doses showed significant correlation (R = 0.63; p < 0.0001) but a wide variation in the ratio of CD34+ and CFU-GM. Both CD34+ and CFU-GM doses had significant correlation with the measures of engraftment, but for all measures the relationship of CD34+ was stronger. Multivariate analysis and subgroup analysis of patients receiving CD34+ doses of less than 5 x 10(6) per kg also did not reveal an independent predictive value for CFU-GM. CONCLUSION: For prediction of hematologic recovery after autologous PBPC transplantation, determination of CFU-GM dose does not add to the predictive value of the CD34+ dose.