Healthcare planning across healthcare sectors in Baden-Wuerttemberg, Germany: a stakeholder online survey to identify indicators.

BACKGROUND: Stakeholders in the German state of Baden-Wuerttemberg agreed upon the central aims for healthcare planning. These include a focus on geographical districts; a comprehensive, cross-sectoral perspective on healthcare needs and services; and use of regional data for healthcare planning. Therefore, healthcare data at district level is needed. Nevertheless, decision makers face the challenge to make a selection from numerous indicators and frameworks, which all have limitations or do not well apply to the targeted setting. The aim of this study was to identify district level indicators to be used in Baden-Wuerttemberg for the purpose of cross-sectoral and needs-based healthcare planning involving stakeholders of the health system. METHODS: A conceptual framework for indicators was developed. A structured search for indicators identified 374 potential indicators in indicator sets of German and international institutions and agencies (n = 211), clinical practice guidelines (n = 50), data bases (n = 35), indicator databases (n = 25), published literature (n = 35), and other sources (n = 18). These indicators were categorised according to the developed framework dimensions. In an online survey, institutions of various stakeholders were invited to assess the relevance of these indicators from December 2016 until January 2017. Indicators were selected in terms of a median value of the assessed relevance. RESULTS: 22 institutions selected 212 indicators for the five dimensions non-medical determinants of health (20 indicators), health status (25), utilisation of the health system (34), health system performance (87), and healthcare provision (46). CONCLUSIONS: Stakeholders assessed a large number of indicators as relevant for use in healthcare planning on district level. TRIAL REGISTRATION: Not applicable.

Implementation of a Standardized Initial Assessment for Demand Management in Outpatient Emergency Care in Germany: Early Qualitative Process Evaluation.

BACKGROUND: Inadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment-Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)-aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective. OBJECTIVE: This study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED. METHODS: An early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data. RESULTS: Health care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED. CONCLUSIONS: Initial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014.

[Quo vadis 116117? Nationwide Overview of the Status Quo and Current Changes]. / Quo vadis 116117? Bundesweiter Überblick über den Status quo und aktuelle Veränderungen.

BACKGROUND: The on-call service (emergency service) has been reachable under 116117 in Germany since 2012. Nevertheless, this number is almost unknown to most Germans. A literature review of emergency service has shown that information which can be found is often incomplete and unclear. Thus, the aim of this study was to cover the status quo regarding 116117 at the federal level in Germany. METHODS: In February 2019 all physicians working with a statutory health insurance were asked to fill in an online survey. The survey was based on a literature review regarding emergency service and on-call service at the federal level in Germany. The questionnaire covered different areas. In this paper only results regarding 116117 will be reported. Data were analyzed descriptively. RESULTS: The organization and range of services as well as the qualifications of the staff are structured differently at the federal level. Services provided by 116117 are arrangements for home visits, out-of-hours service appointments, consulting, and forwarding to 112. Staff includes physician assistants, nurses, and physicians. CONCLUSION: Standardized regulations at the federal level might improve transparency. The planned extension of 116117 to include a standardized initial medical assessment as well as 24/7 accessibility could facilitate patient access to adequate medical treatment.

Repetitive dynamic stereo test improved processing time in young athletes.

BACKGROUND: Current studies revealed the importance of perceptual training for the treatment of amblyopia. To improve stereo vision on a higher level, visual tasks have to be completed within a limited time window like in repetitive visual function tests. "Processing time" as the reaction time in which the absence or presence of depth was identified correctly, is of better predictive value for perceiving the depth than the stereo threshold only. OBJECTIVE: To examine the long-term effects of repetitive dynamic testing of stereopsis on processing time. METHODS: 15 male soccer athletes (13.3±3.2 years) underwent twelve sessions of a 15 minutes repetitive dynamic stereovision training over a period of six weeks, presented on a polarized 3D-TV in a four-alternative forced choice setup. We measured the response time of correct identified visual tasks of 11, 22, 44, 55, 66, 77 and 88arcsecs disparity before, after six sessions, after twelve sessions and after six month without testing. As response time is the sum of stereo processing time plus the motor reaction time, we defined the difference between the response times at 11 and 88arcsecs as "stereo processing time at 11arcsecs". A Wilcoxon Signed Rank Test was conducted between the testing sessions to evaluate significant changes in response time and stereo processing time. RESULTS: After six sessions the mean stereo processing time at 11arcsecs decreased significantly from 804.4 ms to 403.7 ms (Z = -2.499, p = 0.012). Six months after the last training the stereo processing time at 11arcsecs remained at the level of the last session. CONCLUSION: Our results suggest that repetitive testing of stereovision is effective in improving processing time of stereoscopic tasks in young male athletes significantly long-term.

Quantification of Nighttime Micturition With an Ambulatory Sensor-Based System.

Among elderly males, benign prostate syndrome (BPS) is the most common urinary disorder. Nocturia is one of the major symptoms of BPS and has a considerable influence on the quality of life. For assessment of BPS (including nocturia), the International Prostate Symptom Score is widely used, but questionnaires are prone to bias. To date, there is no objective measurement system available for nocturia. In this study, we present an unobtrusive and nonstigmatizing device for objective measurement of nighttime micturition. In a preliminary study of six males diagnosed with BPS and nighttime micturition ≥ 2×, we showed that the device is accurate, with an average misdetection rate of 0.32 events and a mean absolute deviation of 3.8% when comparing the average number of nighttime micturition occurrences. In this extended study, an additional nine males were recorded and data from an occupancy sensor were also included. The results of the preliminary study were confirmed with an average misdetection rate of 0.33 events and a mean absolute deviation of 9.1%. The system can, therefore, be used to objectively measure nighttime micturition and, thereby, provide the basis for treatment, e.g., medication efficacy assessment.

Extended stereopsis evaluation of professional and amateur soccer players and subjects without soccer background.

Stereopsis is one of several visual depth cues. It has been evaluated for athletes of different types of sports in the past. However, most studies do not cover the full range of stereopsis performance. Therefore, we propose computer-supported stereopsis tests that provide an extended assessment and analysis of stereopsis performance including stereo acuity and response times. By providing stationary and moving stimuli they cover static and dynamic stereopsis, respectively. The proposed stereopsis tests were used to compare professional and amateur soccer players with subjects without soccer background. The soccer players could not perform significantly (p ≤ 0.05) superior than the subjects without soccer background. However, the soccer players showed significantly (p ≤ 0.01) superior choice reaction times for monocular stimuli. The results are in congruence with previous findings in literature.

An ambulatory sensor-based system for quantification of nighttime micturition for accurate nocturia assessment.

Nocturia is a widespread condition where patients need to micturate frequently during the nighttime. In order to define treatment and measure therapeutic success in nocturia, questionnaires are traditionally used for ambulatory assessment. However, questionnaires were reported to suffer from compliance, embarrassment and subjective bias. An automatic sensor-based system for quantification of nighttime micturition for accurate nocturia assessment would not suffer from these disadvantages, and its development was therefore the purpose of this study. We defined a sensor-based system for ambulatory use, consisting of a sensor watch and a room occupancy sensor. Using this system, we so far collected data from 6 participants and 82 nights in an ongoing study. We report the details of the system, as well as the data analysis. The system is very accurate, with an average misdetection rate of 0.32 and a mean absolute deviation of 3.8 % when comparing the average number of nighttime micturitions. This novel sensor-based nighttime micturition quantification system has the potential to be used as an objective ambulatory assessment tool for nocturia diagnosis and treatment.

["General Practice is a great job anyway" - a qualitative study with vocational trainees]. / "Allgemeinmedizin ist trotzdem ein schönes Fach" - eine qualitative Studie mit Ärzten in Weiterbildung.

BACKGROUND AND PURPOSE: Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. METHODS: A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. RESULTS: In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. CONCLUSION: The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession.

Automated quality assessment of retinal fundus photos.

OBJECTIVE: Automated, objective and fast measurement of the image quality of single retinal fundus photos to allow a stable and reliable medical evaluation. METHODS: The proposed technique maps diagnosis-relevant criteria inspired by diagnosis procedures based on the advise of an eye expert to quantitative and objective features related to image quality. Independent from segmentation methods it combines global clustering with local sharpness and texture features for classification. RESULTS: On a test dataset of 301 retinal fundus images we evaluated our method on a given gold standard by human observers and compared it to a state of the art approach. An area under the ROC curve of 95.3% compared to 87.2% outperformed the state of the art approach. A significant p-value of 0.019 emphasizes the statistical difference of both approaches. CONCLUSIONS: The combination of local and global image statistics models the defined quality criteria and automatically produces reliable and objective results in determining the image quality of retinal fundus photos.