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Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

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Herausgeberkollegium / Editorial Board Herausgeberkollegium编委会
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-07-01 DOI: 10.1016/S1865-9217(25)00161-8
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引用次数: 0
The social delegitimization of individualism: Exploring potential drivers during the COVID-19 pandemic 个人主义的社会非合法性:探索COVID-19大流行期间的潜在驱动因素。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.001
Pascal René Marcel Kubin

Background

During the COVID-19 pandemic many people supported compulsory vaccination and other far-reaching restrictions for unvaccinated individuals. This indicates that the COVID-19 pandemic was accompanied by a social delegitimization of individualism, which undermined personal autonomy and informed consent.

Purpose & Method

Against this background, I intend to identify conceptual notions that can help to explain the drivers of the social delegitimization of individualism during the COVID-19 pandemic. For this purpose, I conceptually analyzed theories from social science research on vaccination behavior by applying the technique of concept mapping.

Results

The theoretical analysis reveals that (1) the essential need for health protection, (2) the demand for complexity reduction, (3) the optimization of social identity, (4) the reassurance of previous decisions, as well as (5) the feeling of being socially underprivileged may have contributed to the social delegitimization of individualism during the COVID-19 pandemic.

Conclusions

The five identified conceptual notions can explain the drivers behind the collective support for compulsory vaccination and other far-reaching restrictions against unvaccinated individuals. From a conceptual perspective, dynamic interactions between these drivers are likely. In the future, the identified notions may become relevant beyond COVID-19 if the social delegitimization of individualism continues to evolve into a ubiquitous phenomenon.
背景:在 COVID-19 大流行期间,许多人支持强制接种疫苗,并对未接种疫苗的个人施加其他影响深远的限制。这表明,COVID-19 大流行伴随着个人主义的社会去合法化,损害了个人自主权和知情同意权:在此背景下,我打算找出有助于解释 COVID-19 大流行期间个人主义社会去合法化驱动因素的概念。为此,我运用概念映射技术对社会科学研究中有关疫苗接种行为的理论进行了概念分析:理论分析表明:(1) 保护健康的基本需求,(2) 减少复杂性的要求,(3) 优化社会身份,(4) 对先前决定的保证,以及 (5) 社会地位低下的感觉可能是 COVID-19 大流行期间个人主义社会去合法化的原因:结论:所确定的五个概念可以解释集体支持强制疫苗接种和对未接种者实施其他影响深远的限制背后的驱动因素。从概念的角度来看,这些驱动因素之间可能存在动态的相互作用。未来,如果个人主义的社会去合法化继续演变成一种普遍现象,那么所确定的概念的相关性可能会超越 COVID-19。
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引用次数: 0
SHOW ME – Zeig mir die Evidenz: Merkmale eines Ansatzes, um Evidenz aus der Forschung zuverlässig denjenigen bereitzustellen, die sie benötigen 给我看证据:向需要证据的人可靠地提供证据的方法的特征。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.002
John N. Lavis , Jeremy M. Grimshaw , Ruth Stewart , Julian Elliott , Will Moy , Joerg J. Meerpohl
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引用次数: 0
Digitale Teilhabe mithilfe partizipativ entwickelter Informations- und Beratungskonzepte – eine qualitative Studie mit Senior:innen [在参与式发展的信息和咨询概念的帮助下进行数字参与-一项针对老年人的定性研究]。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.004
Marielle Schirmer , Denny Paulicke , Dietrich Stoevesandt , Patrick Jahn

Background

With the increasing digitalization of rural care structures, teaching digital skills to senior citizens is becoming more important. Telemedicine services, for example, offer the potential to compensate for a lack of access to specialist medical care. On the other hand, there is a lack of information services that enable access and support older people’s digital application skills. The aim of the study is to explore the perspectives of senior citizens on information and advice services on the topic of digitalization in health and care provision and thus to initiate a starting point for a participatory research project.

Methods

Exploratory, guideline-based focus groups were conducted with senior citizens in selected rural communities. The evaluation was carried out using content analysis according to Gläser and Laudel (2010) as part of an iterative data collection process.

Results

N = 21 people took part in the focus groups. Senior citizens perceive a clear decline in the municipal infrastructure, which affects the security of health care provision. They perceive digitalization in health and care provision as problematic and are concerned about being digitally disconnected. There is a lack of practical experience in everyday life and a lack of access to information. Gaining information on care-related topics should be made possible in a directional form through personal encounters.

Conclusions

There is a lack of tangible access to digitalization in health and care provision for senior citizens in rural regions. This means that aspects of the digital transformation are often negatively connoted due to a lack of exchange formats. Positive everyday experiences and continuous offers for digitally supported health care could broaden the general interest that exists.
背景:随着农村护理结构的日益数字化,向老年人传授数字技能变得越来越重要。例如,远程医疗服务有可能弥补无法获得专业医疗服务的情况。另一方面,缺乏能够使老年人获得和支持其数字应用技能的信息服务。这项研究的目的是探讨老年人对保健和护理提供数字化主题的信息和咨询服务的看法,从而为参与性研究项目启动一个起点。方法:在选定的农村社区对老年人进行探索性的、基于指南的焦点小组调查。评估是根据Gläser和Laudel(2010)的内容分析进行的,作为迭代数据收集过程的一部分。结果:N = 21人参加了焦点小组。老年人认为市政基础设施明显衰退,这影响到保健服务的安全性。他们认为健康和保健服务的数字化存在问题,并担心与数字脱节。他们在日常生活中缺乏实际经验,也缺乏获取信息的渠道。应该通过个人接触,有针对性地获取与护理有关的信息。结论:在农村地区,老年人的健康和护理服务缺乏数字化的切实途径。这意味着,由于缺乏交换格式,数字化转型的各个方面往往是消极的。积极的日常体验和对数字支持的医疗保健的持续提供可以扩大现有的普遍兴趣。
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引用次数: 0
National improvements in falls and pressure injuries in Swiss hospitals from 2011 to 2022: A secondary data analysis of national quality monitoring data 2011年至2022年瑞士医院在跌倒和压力伤害方面的改善:对国家质量监测数据的二次数据分析。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.006
Silvia Thomann, Raya Zimmermann, Joëlle Sina Riedweg, Niklaus Stefan Bernet

Introduction

National quality monitoring in healthcare and, in particular, the (transparent) comparison of results can trigger improvements at the structural and procedural levels and, thus, improve the outcome. In Switzerland, this kind of monitoring was conducted between 2011 and 2022 (except 2020 and 2021 due to the COVID-19 pandemic) for falls and pressure injuries in the hospital setting. The aim of this study was to examine the improvements in the quality of care for falls and pressure injuries in Swiss hospitals during the monitoring period.

Method

A secondary data analysis was conducted of the Swiss national quality monitoring data on falls and pressure injuries based on a multicenter cross-sectional design. Descriptive data analysis was performed.

Results

The hospital-acquired pressure injury prevalence rate varied between 3.6% and 5.8%, and the in-hospital fall rate was between 3.0% and 4.6%. The prevalence rates showed their greatest decrease after the first monitoring, with only a slight decrease/stagnation observed thereafter. An increase in prevalence rates was revealed after the two-year monitoring break due to the COVID-19 pandemic. The structural conditions improved (e.g., implementation of guidelines) and more processes were implemented at the patient level (e.g., use of preventive measures) over the monitoring period. At the same time, patients tended to be older, more multimorbid, and more at risk of pressure injuries.

Conclusion

Considering the change in the patient population (higher risk) and the findings on the structure and process indicators, the improvement in quality of care is likely to be more pronounced than the prevalence rates suggest.
导言:国家卫生保健质量监测,特别是结果的(透明)比较,可促使在结构和程序层面进行改进,从而改善结果。在瑞士,2011年至2022年期间(由于2019冠状病毒病大流行,2020年和2021年除外)对医院环境中的跌倒和压力伤害进行了此类监测。这项研究的目的是检查瑞士医院在监测期间对跌倒和压力伤害的护理质量的改善情况。方法:采用多中心横断面设计,对瑞士国家质量监测数据进行二次数据分析。进行描述性数据分析。结果:院内获得性压伤患病率为3.6% ~ 5.8%,院内跌倒率为3.0% ~ 4.6%。流行率在第一次监测后下降幅度最大,此后仅略有下降/停滞。在因COVID-19大流行而中断了两年的监测后,发现患病率有所上升。在监测期间,结构条件得到改善(例如,实施指南),并且在患者层面实施了更多流程(例如,使用预防措施)。与此同时,患者往往年龄更大,多种疾病更多,更有压力损伤的风险。结论:考虑到患者人群(高危人群)的变化以及结构和流程指标的发现,护理质量的改善可能比患病率所显示的更为明显。
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引用次数: 0
Kernkompetenzen von Physiotherapeut*innen für den Direktzugang von Patient*innen bei muskuloskelettalen Erkrankungen im deutschen Gesundheitssystem – ein Scoping Review [德国医疗保健系统中肌肉骨骼疾病患者直接接触实践的物理治疗师的核心能力-范围审查]。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.011
Jan Paul Iske , Pia Herz , Kerstin Lüdtke , Phillip Thies , Annika Schwarz

Introduction

In many countries, direct access to physiotherapy for patients with musculoskeletal disorders (MSKDs) has already been established. It presents an opportunity to optimize healthcare delivery within the German healthcare system, addressing the challenges of demographic changes and staff shortages. This study aims to identify the necessary competencies of physiotherapists for direct access practice, describes them, and compares them with the German Training and Examination Order for Physiotherapy (PhysTh-APrV) and the German Qualifications Framework for Lifelong Learning (DQR).

Method

A scoping review was conducted, including a systematic literature review in five databases (Medline, CINAHL, Cochrane Library, PEDro and ScienceDirect), supplemented by a non-systematic search in both Google Scholar and the gray literature. Publications were included if they described the necessary competencies for direct access to physiotherapy for patients with MSKDs in primary or emergency care. Non-German or non-English publications were excluded. Subsequently, content analysis of all included publications was performed. The competencies were analyzed, clustered into five categories, and compared to DQR and PhysTh-APrV.

Results

The literature search yielded 1,283 publications, 61 of which were included. A total of 24 competencies were identified and categorized into five domains: Assessment and Evaluation, Management and Interventions, Communication, Cooperation and Collaboration, Professionalism and Leadership. These competencies are covered by the DQR Level 6 competencies. The PhysTh-APrV does not provide sufficient qualifications for direct access practice.

Discussion and conclusion

The results highlight the required level of qualification for implementing direct access in the German healthcare system and define the competencies that physiotherapists need in this setting.
在许多国家,肌肉骨骼疾病(mskd)患者已经可以直接获得物理治疗。它提出了一个机会,以优化德国医疗保健系统内的医疗服务,解决人口变化和人员短缺的挑战。本研究旨在确定物理治疗师直接接触实践的必要能力,描述它们,并将它们与德国物理治疗培训和考试令(PhysTh-APrV)和德国终身学习资格框架(DQR)进行比较。方法:进行范围综述,包括在5个数据库(Medline、CINAHL、Cochrane Library、PEDro和ScienceDirect)中进行系统文献综述,并在谷歌Scholar和灰色文献中进行非系统检索。如果出版物描述了mskd患者在初级或急诊护理中直接获得物理治疗的必要能力,则纳入其中。非德语或非英语出版物被排除在外。随后,对所有纳入的出版物进行内容分析。对能力进行分析,聚类为5类,并与DQR和PhysTh-APrV进行比较。结果:共检索文献1283篇,纳入文献61篇。共确定了24项能力,并将其分为5个领域:评估与评价、管理与干预、沟通、合作与协作、专业精神与领导力。DQR 6级能力涵盖了这些能力。phth - aprv没有为直接准入实践提供足够的资格。讨论和结论:结果强调了在德国医疗保健系统中实施直接访问所需的资格水平,并定义了在这种情况下物理治疗师需要的能力。
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引用次数: 0
Inhaltsverzeichnis / Table of Contents 吸入物/目录
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/S1865-9217(25)00139-4
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引用次数: 0
Autofahren bei kognitiven Beeinträchtigungen: Ergebnisse des bevölkerungsbasierten Digitalen Demenzregisters Bayern (digiDEM Bayern) [驾驶认知障碍:基于人群的数字痴呆登记结果巴伐利亚- digiDEM Bayern]。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.03.007
Anne Keefer , Maren Dehler , Peter L. Kolominsky-Rabas , Elmar Gräßel , Nicole J. Saam , Katrin Drasch

Background

In Germany, the number of drivers aged 65 and over is increasing. However, the risk of physical and cognitive impairments that affect the ability to drive rises with increasing age. Those who give up driving are often confronted with constraints of their autonomy and quality of life. The study aims to identify socio-demographic and health-related determinants of non-driving in people with mild cognitive impairment (MCI) or mild to moderate dementia.

Methods

The data basis is the baseline survey of the multicentre, prospective registry study „Digital Dementia Register Bavaria – digiDEM Bayern“. The categorisation of people with MCI and people with mild to moderate dementia is based on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). A diagnosis may exist but is not a requirement. In addition to descriptive analyses, a binary logistic regression was conducted, and average marginal effects (AMEs) were interpreted.

Results

Out of 1,005 participants with a valid driving license, 410 people (40.8%) participate in road traffic as drivers. The probability that people use a car increases with age, peaking at around 70 years and then decreasing. Being female, living in an urban environment, and having a care degree are associated with a lower probability of driving a car, whilst no existing MCI or dementia diagnosis, higher cognitive abilities, and better independence in everyday life (ADLs) are associated with a higher probability.

Conclusion

The decision to continue driving a car depends on several factors, including age, sex, place of residence, and cognitive and physical abilities. Regular assessments of the fitness to drive should take place, and alternative mobility options should be offered to ensure road safety and maintain the quality of life of people with cognitive impairments for as long as possible. The professional and private environment of people with cognitive impairments plays a crucial role in dealing appropriately with these issues.
背景:在德国,65岁及以上的司机数量正在增加。然而,影响驾驶能力的身体和认知障碍的风险随着年龄的增长而增加。那些放弃驾驶的人经常面临着自主性和生活质量的限制。该研究旨在确定轻度认知障碍(MCI)或轻度至中度痴呆患者不开车的社会人口统计学和健康相关决定因素。方法:数据基础是多中心前瞻性登记研究“数字化痴呆登记巴伐利亚- digiDEM Bayern”的基线调查。轻度认知障碍患者和轻度至中度痴呆患者的分类是基于迷你精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)。诊断可能存在,但不是必需的。除描述性分析外,还进行了二元逻辑回归,并解释了平均边际效应(AMEs)。结果:在1005名持有有效驾照的参与者中,有410人(40.8%)以驾驶员身份参与道路交通。人们使用汽车的可能性随着年龄的增长而增加,在70岁左右达到顶峰,然后下降。作为女性,生活在城市环境中,拥有护理学位与驾驶汽车的可能性较低相关,而没有MCI或痴呆症诊断,更高的认知能力和更好的日常生活独立性(adl)与更高的可能性相关。结论:决定继续驾驶汽车取决于几个因素,包括年龄,性别,居住地,认知和身体能力。应定期对驾驶员的健康状况进行评估,并提供其他机动选择,以确保道路安全,并尽可能长时间地维持认知障碍患者的生活质量。认知障碍患者的专业和私人环境在妥善处理这些问题方面起着至关重要的作用。
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引用次数: 0
Herausgeberkollegium / Editorial Board Herausgeberkollegium编委会
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/S1865-9217(25)00138-2
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引用次数: 0
Using artificial intelligence (AI) for form and content checks of medical reports: Proofreading by ChatGPT4.0 in a neurology department 利用人工智能(AI)进行医学报告的形式和内容检查:在神经内科使用ChatGPT4.0进行校对。
IF 1.4 Q4 HEALTH POLICY & SERVICES Pub Date : 2025-06-01 DOI: 10.1016/j.zefq.2025.02.007
Maximilian Habs , Stefan Knecht , Tobias Schmidt-Wilcke

Introduction

Medical reports contain critical information and require concise language, yet often display errors despite advances in digital tools. This study compared the effectiveness of ChatGPT 4.0 in reporting orthographic, grammatical, and content errors in German neurology reports to a human expert.

Materials and Methods

Ten neurology reports were embedded with ten linguistic errors each, including typographical and grammatical mistakes, and one significant content error. The reports were reviewed by ChatGPT 4.0 using three prompts: (1) check the text for spelling and grammatical errors and report them in a list format without altering the original text, (2) identify spelling and grammatical errors and generate a revised version of the text, ensuring content integrity, (3) evaluate the text for factual inaccuracies, including incorrect information and treatment errors, and report them without modifying the original text. Human control was provided by an experienced medical secretary. Outcome parameters were processing time, percentage of identified errors, and overall error detection rate.

Results

Artificial intelligence (AI) accuracy in error detection was 35% (median) for Prompt 1 and 75% for Prompt 2. The mean word count of erroneous medical reports was 980 (SD = 180). AI-driven report generation was significantly faster than human review (AI Prompt 1: 102.4 s; AI Prompt 2: 209.4 s; Human: 374.0 s; p < 0.0001). Prompt 1, a tabular error report, was faster but less accurate than Prompt 2, a revised version of the report (p = 0.0013). Content analysis by Prompt 3 identified 70% of errors in 34.6 seconds.

Conclusions

AI-driven text processing for medical reports is feasible and effective. ChatGPT 4.0 demonstrated strong performance in detecting and reporting errors. The effectiveness of AI depends on prompt design, significantly impacting quality and duration. Integration into medical workflows could enhance accuracy and efficiency. AI holds promise in improving medical report writing. However, proper prompt design seems to be crucial. Appropriately integrated AI can significantly enhance supervision and quality control in health care documentation.
导读:医学报告包含重要信息,需要简洁的语言,然而,尽管数字工具的进步,经常显示错误。本研究比较了ChatGPT 4.0在向人类专家报告德语神经学报告中的正字法、语法和内容错误方面的有效性。材料和方法:10份神经病学报告包含10个语言错误,包括排版和语法错误,以及1个重大内容错误。ChatGPT 4.0使用三个提示进行审查:(1)检查文本的拼写和语法错误,并以列表格式报告,而不改变原始文本;(2)识别拼写和语法错误,并生成文本的修订版本,确保内容的完整性;(3)评估文本的事实不准确,包括不正确的信息和处理错误,并在不修改原始文本的情况下报告。人工控制由一位经验丰富的医疗秘书提供。结果参数为处理时间、识别错误的百分比和总体错误检出率。结果:人工智能(AI)对提示1的错误检测准确率为35%(中位数),对提示2的准确率为75%。错误医疗报告的平均字数为980(标准差 = 180)。人工智能驱动的报告生成速度明显快于人工审核(AI Prompt 1:10 . 2.4 s;AI提示2:209.4秒;人类:374.0 s;p 结论:人工智能驱动的医学报告文本处理是可行和有效的。ChatGPT 4.0在检测和报告错误方面表现出强大的性能。AI的有效性取决于即时设计,这对质量和持续时间有很大影响。集成到医疗工作流程中可以提高准确性和效率。人工智能有望改善医疗报告的写作。然而,适当的提示设计似乎至关重要。适当整合人工智能可以显著加强医疗保健文件的监督和质量控制。
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引用次数: 0
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Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen
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