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Lung cancer represents the second most frequent tumor entity worldwide with an increasing number of patients treated in specialized centers. The aim of the WiZen study was to find out whether treatment at hospitals certified by the German Cancer Society (GCS) was associated with long-term survival benefits.Data for this cohort study was derived from the largest German statutory health insurance (SHI) AOK, four regional population-based clinical cancer registries (CCR), and standardized hospital quality reports. The analyses were based on 173,999 incident lung cancer patients in the SHI dataset and 35,702 patients in the CCR dataset who received primary treatment for lung cancer (ICD-10-GM C33, C34, D38.1) between 2009 and 2017.Distributions of age, sex, comorbidities, and most tumor characteristics were similar among patients treated in certified and non-certified hospitals. The Kaplan-Meier estimator for 5-year overall survival was 28.0% for patients from certified and 16.9% from non-certified hospitals (SHI data; CCR data: 21.4% vs. 13.6%). Cox-regression adjusting for relevant confounders yielded hazard ratios of 0.97 (SHI data; 95%CI 0.94, 1.00) and 0.85 (CCR data; 95%CI 0.82, 0.88) for all-cause mortality. The adjusted hazard ratio for recurrence-free survival (CCR data, UICC stage I-III, R0 only) was 0.82 (95%CI 0.75, 0.90).The presented analyses show that treatment in certified lung cancer centers is associated with relevant survival benefits and should therefore be supported.

The aim of this study was to describe and analyse knowledge of women in childbed with and without a migration background about ante- and postnatal support services.Questionnaires were provided in 26 languages. In a cross-sectional survey, 641 women answered questions about their knowledge of 11 different regional support services, and information sources for these and other support service providers. Median split was used to derive mothers with good and poor knowledge.German was not the mother tongue of 30% of the participants (n=194) and were therefore defined as "mothers with migration background". Of these, 83% (n=161) were aware of services offered by midwives and<40% knew of other support services. Women with migration background were significantly less likely to know the support services (OR 0.16, 95% CI 0.11 to 0.23), even after controlling for other sociodemographic variables. Furthermore, they obtained significantly less frequently information about relevant services from gynaecologists, midwives, relatives/acquaintances or by themselves.Especially for mothers with migration background, knowledge about ante- and postnatal support services must be made more accessible. In this, midwives could play a decisive role.

Digital technologies are increasingly used in healthcare. In this context, perceived safety plays a critical role in their acceptance and implementation. Previous research had focused more on data security or specific digital technologies. There has also been a lack of participatory approaches to consider and empower healthcare recipients (and relatives), providers, and technology experts to broaden the phenomenon.The aim of this study was to present a comprehensive perspective on the needs, influencing factors and related outcomes in the context of feeling safe with digital technologies in healthcare.A qualitative, exploratory, and participatory methodology was used with five guide-based focus group workshops. Each workshop explored one of five digital technology demonstrations provided at the beginning: (1) electronic health records (EHR), (2) robotics, (3) artificial intelligence (AI), (4) smart home, and (5) smart hospital. All participants were invited for a guide-based discussion. The study focused on the levels of 'involvement' and 'collaboration' by also empowering participation. The workshop target groups were actively involved in the development and execution of the workshops and were empowered. The data were analysed via a content analysis approach, with a mostly inductive procedure.Feeling safe was found to affect thoughts, emotions, and actions. For example, a higher level of perceived safety increased the acceptance of digital technologies, whereas a lower level of perceived safety decreased it. The corresponding needs and influencing factors differed in terms of their scope and focus depending on the context. The aspect of 'control' was most frequently addressed by all the target groups and was viewed as relevant in all the workshops. In general, digital technologies were viewed as supplements rather than substitutes for healthcare providers.This study extends beyond the current state of research on perceived safety and the use of digital technologies in healthcare by providing a comprehensive overview of the corresponding needs and influencing factors at various levels, such as the individual, community-organizational, and system-society levels. The perceived safety of healthcare recipients and providers related to digital technologies should be taken into consideration to achieve positive implementation outcomes.

Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region in Germany. This made it possible to investigate the effectiveness of the intervention under routine care conditions and compare it with the results of the RCT.For this retrospective controlled analysis, data from routine care (2011-2022) were analysed together with data from the previous RCT (2009-2010). A three-arm comparison (routine care, previous RCT intervention group, previous RCT control group) on the primary outcome of symptom severity (BSI-18) and a longitudinal analysis of the routine care data were conducted. The telemedical intervention was conducted in the university hospital's psychiatric outpatient clinic in north-eastern Germany. All adult patients with an ICD-10 diagnosis of depression, anxiety or somatoform disorders could participate after discharge from the hospital. The telemedicine sessions included structured verbal questionnaires and conversational therapy concerning treatment goals and tasks. Repeated measures Welch ANOVA with the BSI-18 Global Severity Index and subscales (depression, anxiety and somatisation) was performed. A multivariate regression was conducted on the longitudinal regular care data.The n=254 subjects in the telemedical care in routine care arm (181 women, mean [95%CI] age 45.5 [44.0-47.1] years; 6-month follow-up) showed a BSI-18 score improvement M=- 4.1 [-5.3,-2.9], F(2)=3.50, p<0.05 compared to the preceding RCT intervention arms (61 women, mean [95%CI] age 44.7 [41.7-47.6] years. Telemedical care showed a significant difference in BSI-18 scores over a 10-year follow-up: M=- 3.9 [-5.4,-2.5], p<0.0001.The positive results of the 2009 RCT were replicable in routine care. The more patient-centred approach resulted in improved outcomes in this telemedical intervention.

Ultrasound (US) screening for thyroid cancer and other non-indicated US of the thyroid lead to the detection of mostly benign nodules or small papillary carcinomas. Although US screening for thyroid cancer is discouraged by guidelines, it continues to be performed. We aimed to explore the effects of thyroid US early in the diagnostic process on further diagnostic and therapeutic procedures in Germany.In a retrospective observational cohort study, we analysed claims data from 2012 to 2016 of patients without history of thyroid disease. After propensity score matching for sociodemographic characteristics, a selection of symptoms and diagnoses (e. g. fatigue, hypertension) and morbidity in the last year, patients with an initial TSH test and a thyroid US within 28 days after the test were compared to patients receiving an initial TSH test but no early US. Patients with hypo- or hyperthyroidism diagnosed directly after the initial TSH were excluded. Thyroid-specific morbidity, follow-up tests and therapeutic pathways were analysed.In total, 5,390 patients remained in each group after data selection and matching (mean age: 46.5 years (SD=15.0), 58% female). Early US was associated with higher thyroid-specific morbidity, especially regarding thyroid nodules. Additionally, more patients in the observation group received thyroid-related follow-up test. The utilization of ambulatory healthcare services in the first year was higher in this group, especially for internal medicine working in general practice, internal medicine, nuclear medicine, and radiology.Early use of US was associated with increased thyroid-specific morbidity, even after excluding patients with hypo- or hyperthyroidism after the initial TSH. Subsequently more diagnostic and therapeutic procedures were performed. Increased morbidity may be due to overtesting with diagnostic cascades resulting in overdiagnosis and overtreatment. Further research is needed to estimate the true number of overdiagnoses.

Improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant in times of climate change, energy transition, an aging population and skyrocketing social costs. The selection of an adequate fractionation schedule is of fundamental importance in the field of Radiation Oncology. We evaluated three internationally established fractionation schedules for definitive prostate cancer radiation therapy (RT) with respect to their ecological and health-economic impacts.We analyzed the data of 109 patients with prostate cancer, who underwent outpatient radiation therapy at Jena University Hospital in 2022. After determination of travel distances between their homes and the treatment facility, carbon dioxide (CO₂)-emissions and taxi costs were calculated for normofractionated RT (39 fractions, A), moderately hypofractionated RT (20 fractions, B) and ultrahypofractionated RT (5 fractions, C).Travel distances of 1616 km (A), 848 km (B) and 242 km (C) were calculated with corresponding costs ranging from 638 € (C) to 4255 € (A). According to the 2024 German physician's fee schedule, 9,604 € would be invoiced for medical treatment and transportation in (A), with transportation costs accounting for 44% of total treatment costs in normofractionated RT. The travel distance, CO₂-emissions and transportation costs could be reduced by up to 85% by hypofractionation.(Ultra-)hypofractionated radiation therapy for prostate cancer has great potential to lower healthcare costs and reduce environmental pollution. Given that and the non-inferiority of oncological outcome and toxicity, hypofractionation should appear beneficial from patient's and healthcare provider's point of view. Current reimbursement structures seem to be inappropriate regarding increased personnel and technical efforts required for highly precise dose application and might hinder comprehensive establishment of ultrahypofraktionated RT in Germany.

A reliable estimation of required resources is essential for sound research. So far, there have only been a few studies on researchers' time investment in qualitative studies. The aim of this study, therefore, was to provide an empirical account of the estimation of timescales of qualitative analysis.In this methodological study, time expenditure was documented and compared for the focused coding of transcripts of semi-structured interviews within five qualitative studies in health services research. Data were analyzed descriptively by means of absolute frequencies.Across studies, focused coding was assessed in 94 interviews with a total interview duration of 52 hours and 44 minutes. The number of interviews per study ranged from n=11 to n=27, with a mean duration of 36 minutes. Total coding time amounted to 76 hours, with a mean of 32 min per interview. Coding time per interview time ratio ranged from 0.75 to 1.52 minutes. On average, the time spent on focused coding roughly corresponds to the duration of the interviews. Focused coding tended to get quicker over time, though variation among studies was high.The results of this study provide a reference for estimating timescales of qualitative analysis and highlights the importance of considering factors such as composition of data and researchers' experience and involvement. In a specific research project, this effort must be balanced against the objective of the analysis, including the desired accuracy, detail and depth. Further research is needed to specify how specific parameters (i. e. nature of the study population, method of data analysis and use of concepts and theories) affect coding in qualitative analysis.

Newly approved therapies usually have unknown adverse events, although the clinical trials that led to approval had already tested them for safety and efficacy. One reason for this is that the inclusion and exclusion criteria of the trials often do not fully reflect the usually heterogeneous patient population in routine clinical care.The aim of the study was to analyse the extent to which patients with multiple sclerosis (MS) in routine clinical care fulfil the inclusion and exclusion criteria for the corresponding clinical phase III trial of the respective drug.Sociodemographic and clinical characteristics as well as (serious) adverse events ((S) AEs) were compared. Data were based on two national, prospective, observational, clinical, multicentre registries, the REGIMS registry and the DMSG MS registry.Patients (28%) in the REGIMS registry and 5% of the patients in the MS registry fulfilled the 4 predefined inclusion criteria and would therefore have been included in a phase III registration trial of the corresponding substance.Our results show a clear selection of patients by specific inclusion criteria in clinical trials of MS therapeutics compared to the patient population receiving this therapy after approval. However, this selection is not associated with a higher risk of AEs for those patients who would not have been included in the corresponding phase III clinical trial.