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1.
Int J Public Health ; 66: 1604210, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34483810

RESUMEN

Objectives: In the COVID-19 pandemic, critical health literacy (CHL-P) has been proposed as a means of addressing issues of complexity, uncertainty, and urgency. Our study aimed to identify CHL-P clusters among university students in Germany and to analyze associations with potential determinants. Methods: In May 2020, students at four German universities participated in the COVID-19 International Student Well-Being Study, an online survey that yielded a non-probabilistic sample of N = 5,021. CHL-P, COVID-19-related knowledge, worries, risk perception, and adherence to protective measures were measured in an online questionnaire with self-constructed items. We conducted a cluster analysis of the five CHL-P items and performed logistic regression analyses. Results: Two CHL-P clusters were identified: high vs. moderate CHL-P. Belonging to the high-CHL-P cluster (31.2% of students) was significantly associated with older age, female/other gender, advanced education, higher levels of parental education, and moderate importance placed on education. In addition, higher levels of knowledge, risk perception and worries, and adherence to protective measures were associated with high CHL-P cluster membership. Conclusion: Students would benefit from educational measures that promote CHL-P at German universities.


Asunto(s)
COVID-19 , Alfabetización en Salud , Pandemias , Estudiantes , Adulto , COVID-19/epidemiología , Análisis por Conglomerados , Femenino , Alemania/epidemiología , Alfabetización en Salud/estadística & datos numéricos , Humanos , Masculino , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades , Adulto Joven
2.
Ann Palliat Med ; 10(8): 9136-9148, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34488399

RESUMEN

BACKGROUND: As the aging population continues to increase worldwide, the prevalence of cardiovascular diseases and muscular dystrophy/sarcopenia in the elderly has escalated significantly. Cardiovascular diseases elevate the risk of muscular atrophy/sarcopenia, which results in increased disability and mortality of patients. This study analyzed the current available literature related to the relationship between cardiovascular diseases and muscular atrophy/sarcopenia in the aging population. METHODS: The Science Citation Index Expanded (SCI-E) database was searched for related literature published between 1900 and March 14, 2021. The subject search was performed using the search terms "muscular atrophy" and "sarcopenia". The search formula was "muscular atrophy OR sarcopenia". The search scope was limited to "cardiovascular diseases OR cardiac & cardiovascular systems". All search results and cited references were exported in plain text format and Citespace software was used to analyze the publications in terms of year of publication, country and institution, journal of publication, authors, and keywords. RESULTS: A total of 1,004 related research documents were obtained, with a citation frequency of 26,705 times. The top five countries for the highest number of published documents were the United States, Japan, Germany, South Korea, and Italy. The top five countries involved in research cooperation were the United States, Japan, the United Kingdom, Spain, and Germany, however, overall, there was little cooperation between countries, institutions, and authors. A number of researchers from Germany published the most documents. The author with the most cited publication was Cruz-Jentoft et al. from Spain, which deserves special attention. Professional journals of in the field of geriatrics play a significant role in this research topic. Analysis of the keywords showed that current researchers are mainly concerned with the associated risk of death. CONCLUSIONS: The relationship between muscular atrophy/sarcopenia and cardiovascular diseases is currently a hot topic of research in geriatrics and cardiovascular disease, and further studies examining the mechanisms involved and potential prevention strategies are warranted.


Asunto(s)
Enfermedades Cardiovasculares , Sarcopenia , Anciano , Bibliometría , Alemania , Humanos , Reino Unido , Estados Unidos
3.
Z Gastroenterol ; 59(9): 944-953, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34507373

RESUMEN

Refractory celiac disease (RCD) refers to a rare subgroup of patients with celiac disease who show clinical signs of malabsorption despite a gluten-free diet. RCD is divided into an autoimmune phenotype (RCD type I) and pre-lymphoma (RCD type II). To reflect the clinical reality in managing this disease in Germany, a national register was established based on a questionnaire developed specifically for this purpose. Between 2014 and 2020, a total of 53 patients were registered. The diagnosis of RCD was confirmed in 46 cases (87%). This included 27 patients (59%) with RCD type I and 19 patients (41%) with RCD type II. A wide range of diagnostic and therapeutic measures was used. Therapeutically, budesonide was used in 59% of the RCD patients regardless of the subtype. Nutritional therapy was used in only 5 patients (11%). Overall mortality was 26% (12 patients) with a clear dominance in patients with RCD type II (9 patients, 47%). In summary, RCD needs to become a focus of national guidelines to increase awareness, establish standards, and thus enable the treating physician to make the correct diagnosis in a timely manner. Moreover, we concluded that when treating such patients, contacting a specialized center is recommended to ensure sufficient management.


Asunto(s)
Enfermedad Celíaca , Linfoma , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/epidemiología , Enfermedad Celíaca/terapia , Dieta Sin Gluten , Alemania/epidemiología , Humanos , Sistema de Registros
4.
Z Gastroenterol ; 59(9): 954-960, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34507374

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established. OBJECTIVE: We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany. METHODS: All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015-2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19. RESULTS: Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms >24 h before presenting to the emergency department. CONCLUSION: Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).


Asunto(s)
COVID-19 , Pandemias , Control de Enfermedades Transmisibles , Servicio de Urgencia en Hospital , Alemania/epidemiología , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , SARS-CoV-2
5.
Artículo en Alemán | MEDLINE | ID: mdl-34507383

RESUMEN

For many years now, effective pharmacological and non-pharmacological treatment approaches for acute and chronic pain exist, as well as organisational strategies for their implementation in hospitals. Nevertheless, there remain considerable deficits in pain management and the portion of patients with severe or long-lasting pain in non-surgical units is often high. There is a considerable potential to improve quality and structures of pain mangement in non-surgical hospital settings in Germany. Recently, legal requirements to establish a structured perioperative pain management were introduced. This should not be seen as a signal that pain management is less important in non-surgical disciplines. On the contrary - it should raise awareness for more clinical and health services research to further develop and validate appropriate approaches and concepts to improve pain treatment in this field.


Asunto(s)
Manejo del Dolor , Dolor , Alemania , Hospitales , Humanos , Dimensión del Dolor
6.
BMC Public Health ; 21(1): 1636, 2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34493250

RESUMEN

BACKGROUND: Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. METHODS: Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions. RESULTS: In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts. CONCLUSIONS: Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.


Asunto(s)
Sepsis , Atención a la Salud , Alemania/epidemiología , Humanos , Incidencia , Sepsis/epidemiología , Clase Social
7.
Sci Rep ; 11(1): 17798, 2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34493765

RESUMEN

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (- 17.7% vs. - 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (- 292 ml/min, - 7.0%), oxygen pulse (- 2.4 ml/beat, - 10.4%), and respiratory minute volume (VE) (- 18.9 l/min, - 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.


Asunto(s)
Atletas/estadística & datos numéricos , Rendimiento Atlético/estadística & datos numéricos , COVID-19/fisiopatología , Corazón/fisiopatología , Pulmón/fisiopatología , Adulto , Infecciones Asintomáticas , Rendimiento Atlético/fisiología , COVID-19/diagnóstico , COVID-19/virología , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , Ecocardiografía/estadística & datos numéricos , Prueba de Esfuerzo/estadística & datos numéricos , Alemania , Corazón/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , ARN Viral/aislamiento & purificación , Estudios Retrospectivos , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/patogenicidad , Espirometría/estadística & datos numéricos , Adulto Joven
8.
J Headache Pain ; 22(1): 106, 2021 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-34503443

RESUMEN

BACKGROUND: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients' daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany. METHODS: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics. RESULTS: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. CONCLUSIONS: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.


Asunto(s)
Trastornos Migrañosos , Anticonvulsivantes/uso terapéutico , Alemania/epidemiología , Humanos , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/prevención & control , Encuestas y Cuestionarios , Insuficiencia del Tratamiento
9.
BMC Health Serv Res ; 21(1): 947, 2021 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-34503507

RESUMEN

BACKGROUND: Rare diseases are difficult to diagnose. Due to their rarity, heterogeneity, and variability, rare diseases often result not only in extensive diagnostic tests and imaging studies, but also in unnecessary repetitions of examinations, which places a greater overall burden on the healthcare system. Diagnostic decision support systems (DDSS) optimized by rare disease experts and used early by primary care physicians and specialists are able to significantly shorten diagnostic processes. The objective of this study was to evaluate reductions in diagnostic costs incurred in rare disease cases brought about by rapid referral to an expert and diagnostic decision support systems. METHODS: Retrospectively, diagnostic costs from disease onset to diagnosis were analyzed in 78 patient cases from the outpatient clinic for rare inflammatory systemic diseases at Hannover Medical School. From the onset of the first symptoms, all diagnostic measures related to the disease were taken from the patient files and documented for each day. The basis for the health economic calculations was the Einheitlicher Bewertungsmaßstab (EBM) used in Germany for statutory health insurance, which assigns a fixed flat rate to the various medical services. For 76 cases we also calculated the cost savings that would have been achieved by the diagnosis support system Ada DX applied by an expert. RESULTS: The expert was able to achieve significant savings for patients with long courses of disease. On average, the expert needed only 27 % of the total costs incurred in the individual treatment odysseys to make the correct diagnosis. The expert also needed significantly less time and avoided unnecessary examination repetitions. If a DDSS had been applied early in the 76 cases studied, only 51-68 % of the total costs would have incurred and the diagnosis would have been made earlier. Earlier diagnosis would have significantly reduced costs. CONCLUSION: The study showed that significant savings in the diagnostic process of rare diseases can be achieved through rapid referral to an expert and the use of DDSS. Faster diagnosis not only achieves savings, but also enables the right therapy and thus an increase in the quality of life for patients.


Asunto(s)
Economía Médica , Calidad de Vida , Ahorro de Costo , Alemania , Humanos , Estudios Retrospectivos
10.
Anticancer Res ; 41(9): 4401-4405, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34475060

RESUMEN

BACKGROUND/AIM: We previously found in Swedish patients with inflammatory bowel disease (IBD), crypts in symmetric fission (CSF) and in asymmetric fission (CAF). This study aimed to examine CSF and CAF in a cohort of German patients with IBD. PATIENTS AND METHODS: H&E-sections from 106 IBD-patients [59 ulcerative colitis (UC) and 47 Crohn colitis (CCs)] were analysed. RESULTS: A total of 588 crypts in fission (CF) were found; 342 (58.2%) in UC and 246 (41.8%) in CCs. Out of the 505 CAFs found, 304 (60.2%) were recorded in UC, and 201(39.8%) in CCs (p=0.15272). CONCLUSION: Despite that German and Swedish populations reside in disparate geographical regions with different ecological milieus, the proportions of CAF and CSF were similar, thereby suggesting that CAF and CSF develop in IBD independently of the local environmental conditions in the two regions.


Asunto(s)
Colitis Ulcerosa/patología , Colitis/patología , Enfermedad de Crohn/patología , Biopsia , Estudios de Cohortes , Colitis/epidemiología , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Alemania/epidemiología , Humanos , Factores de Riesgo , Suecia/epidemiología
13.
An Acad Bras Cienc ; 93(4): e20210543, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34495206

RESUMEN

The world is looking forward to a prompt response by the scientific community in order to overcome the first pandemic of the 21st century. This study aimed to provide an overview of scientific output on COVID-19 during its first year. We assembled information regarding 60,830 articles related to COVID-19 indexed in the WoS database from January 24 to December 13, 2020. Only 4 countries accounted for about 60% of the articles (USA, China, Italy, and England) and 12 countries accounted for about 95% of the world scientific output on COVID-19 (USA, China, Italy, England, India, Canada, Germany, Spain, Australia, Brazil, Iran, and Turkey). 25 research centers around the world contributed with more than 500 papers on COVID-19. Papers were scattered throughout 6,133 journals, with 12 journals with > 250 articles. 20 articles (0.03%) have already received more than the 1,000 citations. The response of the scientific endeavor to this acute global public health emergency has been fast and robust. The overview provided by the analysis of the scientific response to the pandemic may contribute to further studies aiming to evaluate the impact and changes in the scientific endeavor for the next years in light of the forthcoming new world framework.


Asunto(s)
COVID-19 , Pandemias , Bibliometría , Alemania , Humanos , SARS-CoV-2
14.
Gesundheitswesen ; 83(8-09): e41-e48, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34496443

RESUMEN

OBJECTIVE: Well-established mortality ratio methodology can contribute to a fuller picture of the SARS-CoV-2/COVID-19 burden of disease by revealing trends and informing mitigation strategies. This work examines respective data from Germany by way of example. METHODS: Using monthly and weekly all-cause mortality data from January 2016 to June 2020 (published by the German Federal Statistical Institute) for all ages,<65 years and≥65 years, and specified for Germany's federal states, we explored mortality as sequela of COVID-19. We analysed standardized mortality ratios (SMRs) comparing 2020 with 2016-2019 as reference years with a focus on trend detection. RESULTS: In Germany as a whole, elevated mortality in April (most pronounced for Bavaria) declined in May. The states of Hamburg and Bremen had increased SMRs in all months under study. In Mecklenburg-Western Pomerania, decreased SMRs in January turned monotonically to increased SMRs by June. Irrespective of age group, this trend was pronounced and significant. CONCLUSIONS: Increased SMRs in Hamburg and Bremen must be interpreted with caution because of potential upward distortions due to a "catchment bias". A pronounced excess mortality in April across Germany was confirmed and a hitherto undetected trend of increasing SMRs for Mecklenburg-Western Pomerania was revealed. To meet the pandemic challenge and to benefit from research based on data collected in standardized ways, national authorities should regularly conduct SMR analyses. For independent analyses, national authorities should also expedite publishing raw mortality and population data, including detailed information on age, sex, and cause of death, in the public domain.


Asunto(s)
COVID-19 , Anciano , Alemania/epidemiología , Humanos , Mortalidad , Pandemias , SARS-CoV-2
15.
Gesundheitswesen ; 83(8-09): 581-592, 2021 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-34496446

RESUMEN

AIM: The aim of this review is to identify epidemiological studies on the risk of infection with SARS-CoV-2 during travel by train and bus and to critically evaluate them also with regard to extrapolating the findings to the German situation. METHODS: Systematic review based on searching two electronic databases (PubMed, Web of Science) according to the principle of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) for epidemiological studies on SARS-CoV-2 or COVID-19 and travel by train or bus. RESULTS: Searches of the two electronic databases yielded 746 publications. Of these, 55 met the selection criteria and were included in the full-text search. Finally, 5 original publications were used to answer the question about SARS-CoV-2 infections related to long-distance travel by train and 4 related to bus travel. The studies were very heterogeneous and referred almost exclusively to long-distance travel in China. They consistently showed a risk of infection when infected persons travelled in the same train, car or bus without mouth-to-nose (MNB) coverage. The risk was not limited to those sitting in close proximity to an infected fellow traveler. Despite all the differences between travel by train and bus in China and Germany, there is no fundamental doubt that the reported results from China can also be extrapolated to Germany in qualitative terms. However, it must be taken into account that the results of the three key publications predominantly included the period before the lockdown in China without the strict use of MNB. Thus, the question remains whether the results would be similar under current conditions with MNB and more virulent viral mutations. No single study was found related to infection when using public transportation. CONCLUSIONS: There are several lines of evidence that travel by train is associated with a significantly lower risk of infection compared with the risk of infection in the home environment. Due to a lack of observational data, one will need to model the risk of infection for long-distance travel by bus and use of local public transport based on air exchange in the passenger compartment, travel duration, distance from other passengers, and ultimately passenger density.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Estudios Epidemiológicos , Alemania/epidemiología , Humanos , SARS-CoV-2 , Viaje
17.
Bone Joint J ; 103-B(9): 1526-1533, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34465160

RESUMEN

AIMS: The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. METHODS: A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. RESULTS: A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). CONCLUSION: With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526-1533.


Asunto(s)
Fracturas del Fémur/epidemiología , Traumatismo Múltiple/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Casas de Salud/estadística & datos numéricos , Prevalencia , Calidad de Vida , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos
19.
BMC Health Serv Res ; 21(1): 925, 2021 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-34488746

RESUMEN

BACKGROUND: Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? METHODS: Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS: Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. CONCLUSIONS: Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.


Asunto(s)
Telemedicina , Alemania , Humanos , Casas de Salud , Derivación y Consulta , Población Rural
20.
BMC Health Serv Res ; 21(1): 919, 2021 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-34488753

RESUMEN

BACKGROUND: Telemedicine offers additional ways of delivering medical care, e.g., in primary care in rural areas. During the last decades, projects including telemedicine are being implemented worldwide. However, implementation of telemedicine is in some countries, e.g., Germany somewhat slower compared to northern European countries. One important part of successful implementation is to include the citizen perspective. The aims of this study were to explore the perception of representatives of the local government regarding telemedicine in the context of a perceived GP shortage and to tailor future telemedicine offers according to these perceived needs. METHODS: Considering the multidisciplinary assessment suggested by the Model for Assessment of Telemedicine a questionnaire with 19 questions was developed by identifying determinants of telemedicine out the literature. After pre-testing, the questionnaire was sent to all 2199 mayors from the federal states of Schleswig-Holstein (North Germany) and Baden-Württemberg (South Germany) as representatives of the citizens (cross- sectional study; full population survey). The final questionnaire contained sections for socio-demographic data, telemedicine and perceived GP shortage. All responses from November 2018 until 2019 were included and analyzed descriptively. RESULTS: The response rate was 32% (N = 699), of which 605 were included in the analysis. A majority of the participants stated they live in a rural area and 46% were in the office for up to 8 years. The mayors had predominantly a positive perception about telemedicine (60%) and 76% of them stated, their community would benefit from telemedicine. A GP shortage was reported by 39% of the participants. The highest risk of telemedicine was seen in misdiagnosing. In case of an emergency situation 291 (45%) of the participants considered data privacy as not as relevant. Mayors from a community with a perceived GP shortage had a more negative perception regarding telemedicine. CONCLUSION: The acceptance of telemedicine is rapidly rising compared to former studies. Communities with a perceived GP shortage had a more negative perception. Barriers like data security concerns were seen as less important in case of an emergency. The highest risk of telemedicine was seen in misdiagnosing. These findings need to be considered in designing future telemedicine offers.


Asunto(s)
Gobierno Local , Telemedicina , Estudios Transversales , Alemania , Humanos , Encuestas y Cuestionarios
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