Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

Background

The number of service members of the German armed forces suffering from deployment-related mental health problems is steadily rising. Preliminary studies have shown that less than 50 % seek professional help. There is little knowledge about the factors influencing the development of an adequate level of patient competence to cope with the complexity of the clinical picture and the care of people with operational disabilities in the interprofessional network.

Methods

The article presents data gathered by semi-structured, guided interviews from 14 affected individuals analyzing salient beliefs about the perceived factors influencing their patient competence and care through the interprofessional network of supporters inside and outside the German armed forces. Data evaluation was carried out by means of content-structuring, qualitative content analysis using the method of deductive-inductive category formation.

Findings

Based on the interviews conducted, we identified four groups of salient beliefs having an influence on patient competence: identify changes and limitations, recognize illness, redirect one’s life, help shape one‘s life again, and four groups of salient beliefs having an influence on care: intangible / material support, medical supplies, psychosocial support, third-party support. All main topics could be assigned to three levels of influence (individual, individual-contextual, contextual) and stored with a total of 70 topics (codes).

Interpretation

The development of an effective “social structure” was named by those affected as an important influencing factor. Family members, comrades, superiors, and military GPs appear to have a significant impact on patient competence and care. The respondents' opinions about the importance of internal factors such as the soldier's self-image and fear of stigmatization are consistent with previous findings. Structural factors like supply procedures were mentioned as specific German armed forces phenomena.

Introduction

Guidelines may play an important role in the process of adopting a planetary health perspective in clinical medicine. Current issues relating to the integration of planetary health aspects in guidelines were discussed during a workshop at the German Network for Evidence-Based Medicine conference in 2023.

Methods

In a multidisciplinary workshop, 25 persons with an interest in guideline development selected important planetary health dimensions that could be promptly included in guidelines. Group discussions addressed the challenges of integrating planetary health aspects in guidelines and feasible solutions.

Results

Participants recommended to first integrate the dimensions Environmental impacts, Prevention & co-benefits and Choosing wisely and provided corresponding rationales. Updating evidence to decision frameworks and including relevant climate outcomes (e.g., CO₂ equivalents) in clinical trials were regarded as crucial. Pragmatic steps to integrate planetary health aspects such as an adapted guideline layout and prioritization of recommendations were proposed.

Discussion

Changes in the guideline development processes are necessary to incorporate the planetary health perspective into guidelines. Capacity building for guideline developers and modifications to frameworks are important next steps. Public discussion and cooperation between guideline developing bodies are therefore essential to move beyond the results of this workshop.

Conclusion

The aforementioned workshop underpins the strong interest to integrate planetary health aspects into guideline frameworks to eventually promote planetary health in clinical medicine.

Objective

The article tackles various issues arising in the context of the process of digitalization in the health sector. The communication and availability of health data, health registers, the electronic health record, consent procedures for the transfer of data and access to health data for research are considered.

Methods

The study is based on a computer-assisted telephone survey (dual-frame) of a random sample of adult people living in Germany. Data was collected in the period between June 01 and June 27, 2022 (n = 1,308).

Results

The level of knowledge concerning the transmission of health data to health insurers is good, whereas the existence of central death-, vaccination- and health registers as well as the access to health data by treating physicians is overestimated. The general acceptance of medical registers is very high. Half the population is unfamiliar with the electronic health record, and the willingness to use it is rather low. An opt-in procedure is preferred when transferring data, and more than eighty percent would release data in their electronic health file for research purposes. Three quarters would consent that their health data be handed over to general research, especially if reserach facilities were situated at German universities, under the condition that their data be treated confidentiallly. The willingness to release data correlates with the level of trust in the press as well as in universities and colleges and decreases when a data leak is considered to be serious.

Discussion and conclusion

In Germany, as in other European countries, we observe a great willingness of people to release health data for research purposes. However, the propensity to use the electronic health file is comparatively low, as is the acceptance of an opt-out procedure, which in the literature is considered a prerequisite for the successful implementation of electronic health records in other countries. Unsurprisingly, a general trust in research and government agencies that process health data is a key factor.

Background

The COVID-19 pandemic posed major challenges to the health care system, particularly to nursing. Intensive care was often the focus of attention. However, home care nursing was also confronted with drastic changes, while it is largely unknown how the work situation changed for employees as a result of the pandemic – also depending on the sponsorship of home care nursing services.

Methods

A nationwide online survey of home-care nurses was conducted in May and June 2022. The Intensification of Job Demands Scale (IDS) and an open question regarding changes in the work situation due to the pandemic were used among other instruments.

Results

More than two-thirds of the 976 home-care nurses surveyed agreed with the respective statements regarding work intensification (e. g., taking fewer breaks, doing work activities at the same time, not having enough time). Additional factors for psychological workload during the pandemic primarily fell within the scope of work organization (e. g., staff absences due to illness and quarantine, vaccination related leaves and terminations, additional workload due to handling protective clothing). Employees of privately run care services experienced fewer COVID-19-related changes than home care nurses employed by non-profit providers.

Conclusion

In future crisis situations, good information management (e. g., uniform, consistent and comprehensible guidelines and recommendations for action) and ways to compensate for staff shortages should be created.

Background

Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited.

The aim of this project was to develop a list of criteria for the prospective assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised.

Methods

In this article we describe the development of the AGIL criteria (Assessment of Guidelines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results.

Results

The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence.

The response rate of the online survey for fully completed questionnaires was 31.0 % (N = 195; 630 guideline experts were contacted by email). For 90.3 % (n = 176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as “very important” or “important” (criteria 1–3: 75.3 %, 86.1 %, 85.2 %) and – with the exception of criterion 1 – comprehensibility as “very comprehensible” or “comprehensible” (criteria 1–3: 58.4 %, 75.9 %, 78.5 %).

The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e. g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e. g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e. g. strength of recommendation.

Discussion

The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be s