Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment.

BACKGROUND: There has been an increase in model-based economic evaluations of interventions for dementia. The most recent systematic review of economic evaluations for dementia highlighted weaknesses in studies, including lack of justification for model assumptions and data inputs. OBJECTIVE: This study aimed to update the last published systematic review of model-based economic evaluations of interventions for dementia, including Alzheimer's disease, with a focus on any methodological improvements and quality assessment of the studies. METHODS: Systematic searches in eight databases, including PubMed, Cochrane, Embase, CINAHL, PsycINFO, EconLit, international HTA database, and the Tufts Cost-Effectiveness Analysis Registry were undertaken from February 2018 until August 2022. The quality of the included studies was assessed using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. The findings were summarized through narrative analysis. RESULTS: This review included 23 studies, comprising cost-utility analyses (87%), cost-benefit analyses (9%) and cost-effectiveness analyses (4%). The studies covered various interventions, including pharmacological (n = 10, 43%), non-pharmacological (n = 4, 17%), prevention (n = 4, 17%), diagnostic (n = 4, 17%) and integrated (n = 1, 4%) [diagnostics-pharmacologic] strategies. Markov transition models were commonly employed (65%), followed by decision trees (13%) and discrete-event simulation (9%). Several interventions from all categories were reported as being cost effective. The quality of reporting was suboptimal for the Methods and Results sections in almost all studies, although the majority of studies adequately addressed the decision problem, scope, and model-type selection in their economic evaluations. Regarding the quality of methodology, only a minority of studies addressed competing theories or clearly explained the rationale for model structure. Furthermore, few studies systematically identified key parameters or assessed data quality, and uncertainty was mostly addressed partially. CONCLUSIONS: This review informs future research and resource allocation by providing insights into model-based economic evaluations for dementia interventions and highlighting areas for improvement.

Referring physicians' intention to use hospital report cards for hospital referral purposes in the presence or absence of patient-reported outcomes: a randomized trial.

PURPOSE: This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians. METHODS: We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May-June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs. RESULTS: Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified "complication rate" and "the number of cases treated" as most important for the hospital referral decision making; PROs were rated slightly less important. CONCLUSIONS: This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.

How to further develop quality competition in the German healthcare system? Results of a Delphi expert study.

INTRODUCTION: Many international healthcare systems use quality competition to improve the quality of care. The corresponding instruments include quality measurement, public reporting, selective contracting, and pay for performance. The German healthcare system clearly shows that the possibilities are often limited in the status quo. Therefore, a need for practicable and evidence-based proposals are necessary to further the development of quality competition. METHODS: We conducted a national analysis and an international comparison (Switzerland, Netherlands and USA) as a pre-study to derive recommendations. On this basis, we designed a Delphi study with a consensus objective. Experts from relevant stakeholder groups in the German healthcare system were selected using purposive sampling for this study. RESULTS: The experts saw potential for quality improvement in the further development of quality competition. Quality measurement and public reporting were rated as empowering tools. There was mostly disagreement on whether quality competition should be further developed in a more regulatory or entrepreneur-based manner. However, there was a clear consensus that further development must be coordinated between the stakeholders, step-by-step and scientifically supported. In addition, the impulse should be supported by a legislatively introduced reform. CONCLUSIONS: Finally, these empirically based recommendations highlight the need for a coordinated coexistence of a top-down and a bottom-up approach. The developed blueprint proposal serves as an impetus for practical considerations of implementation.

[On the Effectiveness of Digital Workplace Health Promotion in Times of Home Office: A Systematic Review]. / Zur Wirksamkeit der digitalen betrieblichen Gesundheitsförderung in Zeiten von Home-Office: Eine systematische Übersichtsarbeit.

BACKGROUND: In the face of an increasingly aging, multimorbid, chronically ill workforce, company health promotion (BGF) is an important instrument for promoting and maintaining the health of employees in the workplace. Due to digitization and the increasing possibilities of working from home, digital offers for workplace health promotion (dBGF) are being used increasingly in organizations. The portfolio of offers ranges from fitness trackers, online platforms, and health apps to so-called wearables, so that a broad, individual selection is possible for both organizations and employees. THE AIM OF THE STUDY: The aim of the study was to identify and analyze randomized controlled trials (RCT) with regard to the health-promoting effectiveness of dBGF. MATERIAL AND METHODS: A systematic literature search was carried out in relevant specialist databases (PubMed, Livivo, Cochrane Library). The identified studies were selected, evaluated and then descriptively presented by several people systematically and independently. RESULTS: 17 relevant contributions could be identified and analyzed. Above all, measures to promote physical activity and programs to improve mental health were identified in the RCT studies that were carried out. The results of the studies carried out indicate that dBGF can promote health in a variety of ways and support organizations in providing a health-promoting working environment. DISCUSSION: The effectiveness of dBGF could be proven on the basis of the studies identified, whereby the effects are undoubtedly influenced and determined by the employees, above all by their health competence. In order to ensure the long-term effectiveness of dBGF, it will be necessary in the future to increase the interest and motivation of employees with regard to personal health promotion and illness prevention.

[The presumed consent legislation - A success factor or a disruptive factor for tissue donation? A qualitative study based on multidisciplinary interviews with experts]. / Die Widerspruchslösung ­ Erfolgs- oder Störfaktor für die Gewebespende? Eine qualitative Studie auf Basis multidisziplinärer Expert*inneninterviews.

INTRODUCTION: Tissue transplantation can improve the quality of life of patients in a very wide range of applications. In 2021, around 900 people in Germany agreed to donate organs after death - the number of tissue donors was significantly higher. Nevertheless, there is a shortage of organs and tissues in Germany. In order to counteract this, the introduction of a presumed consent legislation has been discussed time and again. However, the debates focused on possible positive effects for organ donation, whereas potential consequences for tissue donation have so far not been considered in the political discourse or in research. Using an exploratory approach, this paper aims to contribute to closing this research gap: Multidisciplinary interviews with experts were conducted to investigate whether the presumed consent legislation is a key success factor for increasing the number of tissue donors in Germany and which other approaches might be promising. METHODS: We conducted qualitative interviews with 14 experts who worked as employees in different positions in tissue banks/networks, ophthalmologists performing corneal transplantation, medical ethicists, lawyers or scientists. These interviews were evaluated using the structuring content analysis according to Mayring. In reporting, we followed the Standards for Reporting Qualitative Research (SQRQ). RESULTS: The majority of experts did not consider presumed consent legislation to be a key factor in increasing the donation rate in Germany. Instead, an improvement of processes and structures in tissue donation was cited as the most important optimization potential. Furthermore, communication measures were postulated to create transparency about the characteristics of tissue donation as distinct from organ donation. These should address not only the general population, but also the professional groups involved in the tissue donation process. CONCLUSION: The present study indicates that the presumed consent legislation is not a success factor for increasing the number of tissue donors in Germany. It would be far more effective to improve structures and processes in order to identify the large number of potential tissue donors and to be able to conduct informed conversations with their relatives. Information measures for the general public and professionals, which clearly differentiate between tissue donation and organ donation, are also more promising than fruitless debates about the introduction of the presumed consent legislation.

[Terra incognita of tissue donation: A systematic literature review analyzing institutional factors influencing the willingness to donate tissue]. / Terra incognita Gewebespende: Ein systematischer Literaturreview zur Analyse institutioneller Einflussfaktoren auf die Bereitschaft zur Gewebespende.

INTRODUCTION: Partly because of a lack of governmental commitment in educational work, tissue donation is largely unknown in the German population, although it has an increasing relevance for patient care. Due to the progress in research, the shortage of donor tissues in Germany is constantly increasing and has to be compensated by imports. In contrast, nations such as the USA are self-sufficient in donor tissue and can even export it. Since not only individual but also institutional factors (e.g., legal framework, allocation principles and the organization of tissue donation) can lead to these national differences in donor rates, the present systematic literature review will investigate how these factors influence the willingness to donate tissue. METHODS: Relevant publications were systematically searched in seven databases. The search command consisted of English and German terms for the two search components "tissue donation" and "health care system". Papers published in English or German between 2004 and May 2021 and focusing on the analysis of institutional factors influencing the willingness to donate tissue post-mortem for transplantation were included (inclusion criteria); studies on blood and organ and living donation as well as publications not dealing with institutional factors influencing the willingness to donate tissue were excluded (exclusion criteria). In reporting, we followed the PRISMA 2020 statement. RESULTS: Of 1,398 hits, seven were finally included after screening. Many of the remaining studies focused on organ donation or non-institutional aspects of tissue donation. Only two studies considered the central population perspective. Furthermore, five publications originate from an Australian research group and focus on the international allocation of tissues. The results highlight the inadequate state of research and at the same time suggest that both tissue bank organization and allocation principles may influence the willingness to donate tissue. At the same time, the publications indicate that tissue donors are often not informed about a potential commercial use or an international allocation of tissues, which represents an ethical-legal conflict. CONCLUSION: The results indicate that institutional factors may influence people's willingness to donate. In particular, the lack of societal awareness of the issue results in various areas of tension for which recommendations for action have been developed. In order to prevent a slump in tissue donations because of socially unacceptable practices, further population-based studies should explore the institutional framework conditions that society demands for tissue donation.

[Strengthening the Role of Public Health Service: a Comparison of the Public Health Service Quota Selection Procedures in Germany]. / Die Rolle des Öffentlichen Gesundheitsdiensts stärken ­ ein Vergleich der ÖGD-Quotenauswahlverfahren in Deutschland.

To combat the shortage of skilled workers in the Public Health Service sector, the federal states of Bavaria, Hesse, Rhineland-Palatinate, and Saxony-Anhalt have a study placement system for students of Public Health Service. A comparison of the selection procedures showed that three out of the four federal states (Bavaria, Hesse, and Rhineland-Palatinate) used a two-step procedure. In the second step, eligibility for was determined based on interviews to assess social and communication skills as well as personal aptitude of the applicants to study and work in the Public Health Service. To find out whether the role of the Public Health Service and public health care is strengthened by the quotas, a nationwide comparison of the selection procedures including evaluation is necessary.

[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.

[Cognitive and Non-Cognitive, Doctor-Relevant Competencies for the Selection of Prospective Country Doctors in Bavaria: Corona-Compliant Selection Process Across Institutes]. / Kognitive und nicht-kognitive, arztrelevante Kompetenzen zur Auswahl angehender Landärzt*innen in Bayern: Institutsübergreifendes Corona-konformes Auswahlverfahren.

OBJECTIVE: The challenge is to counteract the undersupply of doctors in rural areas in Bavaria. As one possibility, the "Country Doctor Quota" measure provides for the allocation of dedicated medical study places for prospective specialists with general practice activities. A specific selection process for future medical students was established and safely implemented under the safety and hygiene conditions of the corona pandemic. METHOD: In Bavaria, a two-stage selection process was developed and used in full for the first time in 2021 for the selection of students. Due to the corona pandemic, only the results of stage 1 of the process for the selection of prospective students were taken into account in the previous year. Cognitive and non-cognitive criteria were included in a 2-stage selection process. In the second stage, physician-relevant competencies (e. g. resilience, problem-solving ability, empathy and compassion, communication skills, ethical decision-making, as well as consulting and social skills) were assessed by Bavarian family doctors in four multiple mini interviews and a 10-minute, semi-structured individual interview. A maximum of 100 points could be achieved. A digital, contact-free selection process was established and successfully implemented to ensure protection and hygiene conditions in the context of the interviews. RESULTS: A total of 436 people applied as part of the Bavarian country doctor quota for the 2021/2022 winter semester; 226 applicants were invited to the selection interviews at the second stage, of which 115 applicants received a place at the university. 64% of the participants had already completed medical vocational training, the high school graduation grade average was 2.4. CONCLUSION: The developed selection process identified applicants as part of the Bavarian country doctor quota and selected using objective criteria. All available medical study places were filled with the 115 finally selected applicants. To what extent the selected applicants (can) counteract the impending shortage of prospective specialists with general practitioner work remains to be seen.

The use intention of hospital report cards among patients in the presence or absence of patient-reported outcomes.

BACKGROUND: So far, the adoption of hospital report cards (HRCs) falls short of expectations. One promising strategy is to modify the content of HRCs by presenting patient-reported outcomes (PROs). OBJECTIVE: To identify the key determinants influencing patients to use HRCs for hospital decision making and determine the effect of presenting PROs on HRCs on their use intention. METHODS: Primary survey data were collected (5/6-2021) on a sample of 2000 randomly selected insurees from a German statutory health insurance who have undergone elective hip arthroplasty surgery. RESULTS: Overall, 447 participants (mean age 66.56) completed the survey and were included in the analysis. Respondents rated "PROs" as most important for the hospital choice followed by "Mobility at hospital discharge" and "Confirmed diagnosis rate". Patients generally perceive HRCs to be a good idea that makes searching for a hospital more interesting. We identified attitude and social influence as the most important determinants for using HRCs (p<.001 each). The presence of PROs on HRCs was not associated with an increased intention to use HRCs neither in our descriptive analysis (p=.593), nor in our research model (p=.763). CONCLUSIONS: Patients value PROs to be an important information for choosing a hospital. Nevertheless, health policy makers should note that presenting PROs on HRCs as a single approach is not likely to increase the use of HRCs.

The First Year of Noninvasive Remote Telemonitoring in Chronic Heart Failure Is not Cost Saving but Improves Quality of Life: The Randomized Controlled CardioBBEAT Trial.

Introduction: Remote telemonitoring (RTM) for patients with chronic heart failure (HF) holds promise to improve prognosis and well-being beyond the standard of care (SoC). The CardioBBEAT trial assessed the health economic and clinical impact of an interactive bidirectional RTM system (Motiva®) versus SoC for patients with HF and a reduced ejection fraction (HFrEF), in Germany. Methods: This multicenter, randomized controlled trial enrolled 621 patients with HFrEF (mean age 63.0 ± 11.5 years, 88% men). The primary endpoint was the integrated effect of the intervention on total costs and nonhospitalized days alive after 12 months, reported as incremental cost-effectiveness ratio (ICER). Costs (in k€) were based on actual charges of patients' statutory health insurance. Among secondary outcome measures were mortality and disease-specific quality of life. Results: We found a neutral effect on nonhospitalized days alive (RTM mean 341 ± 59 days, SoC 346 ± 45 days; p = 0.298) associated with increased total costs (RTM 18.5 ± 39.5 k€, SoC 12.8 ± 22.0 k€; p = 0.046). This yielded an ICER of -1.15 k€/day. RTM did not impact mortality risk. All quality of life scales were consistently and meaningfully improved in the RTM group at 12 months compared to SoC (all p < 0.01). Conclusions: The first 12 months of RTM were not cost-effective compared to SoC in patients with HFrEF, but associated with a relevant improvement in disease-specific quality of life. The balanced assessment of the potential benefit of RTM requires integration of both the societal and patient perspective. ClinTrials.gov (NCT02293252).

[Heidelberg Milestones Communication (HeiMeKOM) - Experiences, Best Practice Examples and Recommendations from the Final Symposium on January 30 and 31 in 2020]. / Heidelberger Meilenstein Kommunikation (HeiMeKOM) ­ Erfahrungen, Best Practice Beispiele und Empfehlungen aus dem Abschluss-Symposium am 30./31. Januar 2020.

The National Cancer Plan emphasises the importance of medical communication and calls for its integration into medical education and training. In this context, the Milestone Communication Approach meets the communicative challenges in dealing with lung cancer patients. Interprofessional tandems, consisting of doctors and nurses, conduct structured conversations at defined moments with patients and their relatives. The concept aims at shared decision making, continuity in the care of lung cancer patients and the early integration of palliative care. During the symposium on the Heidelberg Milestone Communication in January 2020, recommendations on the care situation of lung cancer patients in advanced stages were developed. In addition, the further adaptability of HeiMeKOM to other settings and hospitals and to other diseases was discussed as well as the possibility of implementing such a concept in standard care. This article presents the experiences, best practice examples and recommendations discussed during the symposium in order to enable their extrapolation to other similarly oriented projects. The long-term goal is to transfer the milestone concept to other hospital, primarily certified lung cancer centers, and to ensure permanent funding. For further dissemination of the concept and, above all, to have it established in standard care, health policy awareness and support are required in addition to the integration of the concept in competence catalogues of continuing medical and nursing education.

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis.

BACKGROUND: Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. METHODS: Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries' sex, age, and governorate. RESULTS: Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. CONCLUSIONS: Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

Cross-sectional survey to describe medicine use among Syrian asylum seekers and refugees in a German federal state: looking beyond infectious diseases.

OBJECTIVES: The aim of our study was to describe medicine use and document self-reported diseases or conditions for which medicines were used among Syrian asylum seekers and refugees (AS&Rs) in the German state of North Rhine-Westphalia (NRW). We examined in this study differences in the use of medicines among different age and sex groups of the study participants. SETTING: Fifteen different refugee shared accommodation centres in the greater Cologne area, a community centre with a language school and consultation office, and other places frequented by the Syrian community. PARTICIPANTS: Syrian AS&Rs registered in NRW and residing in the city of Cologne or surrounding areas. PRIMARY OUTCOME MEASURES: The prevalence of using at least one medicine in the 7 days preceding data collection, and the use of prescribed medicines and self-medication. RESULTS: Of the 1641 Syrian AS&Rs who took part in our study, the overall 7-day prevalence of medicine use was 34.9%. Among adults, headache and hypertension were the most common indications that led to medicine use. By dose, hypertension (954 doses) and diabetes (595 doses) were the first and second most frequent indication. Among children, fever and cough were the most common indication; ibuprofen and hederae helicis folium preparations were the most used medicines. Low prevalence was found of medicine use for the treatment of either infectious diseases or mental disorders. CONCLUSION: Among the Syrian AS&Rs in NRW who participated in the study, non-communicable diseases (NCDs) were common presumed causes of use of medication among adults. We encourage future studies to pay more attention to NCDs medicine use among AS&Rs. Researchers should also consider reaching AS&Rs who live in private housing and not limit studies only to newly arrived AS&Rs who live in shared accommodation centres.

Correction: Aljadeeah, S., et al. Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State. Int. J. Environ. Res. Public Health 2021, 18, 519.

In the original article [...].

Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State.

In Germany, asylum seekers and refugees (AS&Rs) face challenges when accessing healthcare services including medicines. The aim of this study was to explore the barriers to accessing medicines among Syrian AS&Rs in the state of North Rheine-Westphalia, and to provide an understanding of their perspectives towards taking medicines that contain alcohol or pork products. This study is based on a cross-sectional survey using a combination of sampling methods. We used descriptive statistics to analyze quantitative data. Participants' answers to an open-ended question yielded qualitative data that were categorized based on the thematic areas they discussed or addressed. Among the 1641 respondents, language barriers had more of an effect on the access to medicines than any other factor studied. The effect of language barriers on access to medicines was more pronounced for female participants, those who were older than 50 years, and participants who had chronic diseases in comparison to the other groups of participants. Male participants and those younger than 50 years of age showed more acceptance towards taking medicines that contain alcohol or pork products. Based on our results, we recommend providing more support for AS&Rs to learn the German language, particularly for female refugees, older refugees, and those with chronic diseases or disabilities. We also recommend providing translated medical leaflets for patients who wish to receive them in their native language. Healthcare providers should try to consider the special conditions of AS&Rs patients and take into account their perspectives about treatments and diseases.

Outpatient Antibiotic Dispensing for the Population with Government Health Insurance in Syria in 2018-2019.

Little is known about antibiotic uses at the population level in Syria. The aim of our study is to present outpatient antibiotic dispensing (OAD) patterns and rates for patients with health insurance in the parts of Syria that are controlled by the Syrian government using different indicators. Outpatient data on all dispensed antibiotics for 81,314 adults with health insurance were obtained and stratified according to age, sex, governorate and annual season. OAD was mainly expressed as the number of defined daily doses (DDDs) per 1000 people per day (DID). OAD patterns were assessed according to the anatomical therapeutic classification (ATC) and the Access, Watch and Reserve (AWaRe) classification. OAD was 20.13 DID. Amoxicillin/clavulanic acid and clarithromycin were the most dispensed antibiotics (5.76 and 4.4 DID, respectively). Overall, a predominant consumption of broad-spectrum antibiotics was noted. The Watch group of the AWaRe classification had the biggest percentage of OAD (13.26 DID), followed by the Access and the Reserve groups (6.55 and 0.17 DID, respectively). There was a significant difference in OAD between the sex and age groups. The seasonal and regional variations in OAD were also significant. Broad-spectrum antibiotics dispensing was high compared to other studies from different countries. These results are concerning, as they can contribute to antibiotic resistance.

[Health Care for Asylum Seekers in Germany according to Asylum Seekers' Benefits Act: Public Perceptions and Preferences]. / Gesundheitsversorgung von Asylsuchenden in Deutschland nach Asylbewerberleistungsgesetz: Wahrnehmung und Präferenzen der Bevölkerung.

OBJECTIVE: This study analyses public perceptions and preferences regarding scope, access and funding of health care for asylum seekers (AS). METHODS: Standardized survey addressing the population >18 years, combined quota plan, descriptive and inferential statistics. RESULTS: The sample (n=419) was rather badly informed about this topic. We found heterogeneous preferences. 47.0% preferred to maintain current regulations of the scope of health care, 22.7% wanted an expansion. 56.1% favored a health card. The EU, tax payers, countries of origin and AS were preferred as funders. CONCLUSION: A consideration of preferences might strengthen the acceptance and legitimation of decisions. Our results indicate that this would lead to moderate changes in health care for AS. Since participants were not well informed subjectively, we suggest qualitative research.

Organ Transplantation in the Face of Donor Shortage - Ethical Implications with a Focus on Liver Allocation.

BACKGROUND: Transplantation medicine is associated with several ethical issues related to the lack of organs. Major questions concern the regulations for giving permission for organ removal, informing the public about organ donation, setting of organ allocation priorities, waiting list access, and strategies to counteract scarcity. METHODS: This contribution is based on analyses of legal regulations, guidelines of self-regulatory bodies, administrative data, and literature from medical, normative, and empiric disciplines. It addresses the above-mentioned issues descriptively with a focus on Germany and liver transplantation. RESULTS: The basic principle of beneficence justifies a shift from voluntariness towards an obligation to document one's decision regarding organ donation. Organ allocation is obviously tangent to fundamental values and concepts of justice. At that, there is no consistent agreement on whether to prioritize the sickest patient or to maximize the overall health benefit. Restrictions relating to waiting list access are the subject of controversies. The reasons for denial of access are largely related to high demands on the prospect of success. Strategies to counteract organ scarcity partly conflict with the respect for autonomy, non-maleficence, beneficence, or justice. CONCLUSION: We propose to focus on recent most promising strategies to counteract scarcity in the short-term: demanding a documented decision on organ donation and an orientation towards the Spanish model of organization. Concepts for waiting list access should constantly be reviewed considering all medical evidence and must not be based on moralism. Moreover, we suggest to consider public preferences for organ allocation and strengthen the confidence in transplantation medicine.