Gesundheitswesen
· 2026 Jan · PMID 41544659
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The Berlin anti-Semitism controversy of the 1880s contains numerous elements that have also played a role in connection with the SARS-CoV-2 pandemic and the Querdenken movement. The anti-Semitism controversy is character...The Berlin anti-Semitism controversy of the 1880s contains numerous elements that have also played a role in connection with the SARS-CoV-2 pandemic and the Querdenken movement. The anti-Semitism controversy is characterized by the spread of false information that has been scientifically refuted. However, this refutation had only a limited effect. This also applies to false narratives on pandemic-related topics that have been and continue to be spread by Querdenkern.
Gesundheitswesen
· 2026 Jan · PMID 41544658
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The delegation of medical tasks to Physician Assistants (PAs) is legally permissible in Germany but subject to clear limitations. Potential risks arise particularly from organizational deficiencies.Two fictitious clinica...The delegation of medical tasks to Physician Assistants (PAs) is legally permissible in Germany but subject to clear limitations. Potential risks arise particularly from organizational deficiencies.Two fictitious clinical case vignettes are used to analyze liability-relevant situations in which delegation decisions resulted in complications.Case 1 illustrates the risks associated with delayed physician oversight following PA-conducted examinations. Case 2 highlights the legal consequences of inadequately regulated invasive procedures. Both examples demonstrate that primary risks arise mainly from missing standard operating procedures (SOPs), unclear supervision structures, and insufficient documentation.Tasks legally reserved to physicians cannot be delegated. For delegable activities, civil and criminal liability requirements apply to physicians, PAs, and, in particular, to healthcare organizations. Ensuring patient safety requires not only individual responsibility but also clearly defined organizational structures.
Gesundheitswesen
· 2026 Mar · PMID 41534872
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Pediatric cancer leads to various health issues that call for long-term, cross-sectoral aftercare. Physical activity and exercise are effective regarding many outcomes, but remain underused in pediatric oncology. Initiat...Pediatric cancer leads to various health issues that call for long-term, cross-sectoral aftercare. Physical activity and exercise are effective regarding many outcomes, but remain underused in pediatric oncology. Initiatives like the German ActiveOncoKids network (NAOK) aim to integrate physical activity into usual care. Effective cross-sectoral networks require coordination and leadership. NAOK has made recent advancements in network coordination. This study aimed to better understand the role of network coordination to strengthen future network development and explored the tasks of network coordination and the required competencies from the viewpoint of NAOK stakeholders.In an exploratory approach, qualitative, partly structured interviews were led with 23 stakeholders of NAOK: members of the project team and the advisory board, physicians and exercise therapists from acute clinics and aftercare as well as affected families. The interviews were analyzed using structuring content analysis with concurrent deductive and inductive creation of main categories, dimensions and expressions.Based on the interviews, 3 main categories were created: current tasks on an organizational level, current tasks on an individual level and required competencies with 11 dimensions and 33 expressions overall. Regarding organizational-level tasks, network management as well as public relations were mentioned. Additionally, contact with locations such as clinics and both research and implementation efforts were stressed. Tasks at the individual level were identified by interviewees in counseling for both affected families as well as professionals. Mentioned competencies stretched across professional, socio-communicative and personal ones.The findings provide first insights into tasks and competencies in network coordination at NAOK. Both tasks and competencies that are being mentioned are very broad, which reflects the nature of pediatric oncology and cross-sectoral physical activity promotion. The study offers hints for future task allocation of network coordination and indicates the need for a competency framework.
Hagelskamp J, Witt K, Steiger E
… +2 more, Carnarius S, Stillfried D
Gesundheitswesen
· 2026 Jan · PMID 41525781
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Our-of-hours care is part of the statutory mandate of the Associations of Statutory Health Insurance Physicians (KVs) and guarantees outpatient care outside of regular consultation hours. Despite coordinated availability...Our-of-hours care is part of the statutory mandate of the Associations of Statutory Health Insurance Physicians (KVs) and guarantees outpatient care outside of regular consultation hours. Despite coordinated availability via the 116117 telephone number, there are structural and qualitative differences in the implementation of the out-of-hour care, particularly with regard to equipment and human resources. Against the background of increasing expectations of cross-sectoral care and the existing shortage of specialists, the question arises as to which lack of resources in the out-of-hours care leads to avoidable emergency admissions and to what extent telemedical options can help to relieve the burden from a medical perspective.A survey was conducted among physicians on out-of-hours care between June 1st, and August 31st 2023 using an anonymized online questionnaire. Participants were recruited by the Regional Statutory Health Insurance Physician Associations which organize out-of-hours care regionally. The questionnaire included demographic and professional items, questions about resource requirements and potential of telemedical services in the out-of-hours care. Data were subjected to descriptive analysis.A total of 4,052 physicians participated in the survey. Resource limitations most frequently associated with potentially avoidable hospital admissions were laboratory diagnostics, sonography and specialist expertise. The greatest perceived potential for telemedicine services lay in specialist consultation for diagnostic and therapeutic, as well as for radiological assessment. Approximately 67% of respondents indicated that home visits by healthcare assistants could be supported with telemedical support.Targeted use of telemedicine and improved access to diagnostic resources can, in the view of the surveyed physicians, strengthen the out-of-hours care and help avoid unnecessary hospital admissions. There is particular potential in specialist consultations, diagnostics, and the support of non-physician home visits-also as a response to the growing shortage of healthcare professionals. However, this requires careful implementation that takes legal, technical, personnel, and financial factors into account.
Gesundheitswesen
· 2026 Mar · PMID 41429141
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In health science studies and health reporting, maps are increasingly used due to the growing interest in regional issues. A lack of the necessary methodological knowledge for creating maps can cause problems with interp...In health science studies and health reporting, maps are increasingly used due to the growing interest in regional issues. A lack of the necessary methodological knowledge for creating maps can cause problems with interpreting cartographic presentations. Therefore, a group of experts from geography, cartography, epidemiology, and health sciences developed and initially revised the "Good Cartographic Practice in Healthcare (GKPiG)". This serves as a guide for creating and interpreting health-related maps according to current scientific standards. Prior to creating a map, a plan is essential to define the framework and requirements for its representation. This includes determining the objective, type of medium, and target audience. The following work process is divided into preparation, data processing, and the map creation process, which is separated into several aspects. Specific recommendations for implementation were provided for each of these work phases. To ensure the map's comprehensibility, guidelines should be provided to help end users interpret the map. Furthermore, corresponding recommendations for implementation were also formulated.
Panchyrz I, Aretz B, Harst L
… +7 more, Weber T, Andreas F, Haase T, von Wagner M, Weltermann B, Balzer K, Schmitt J
Gesundheitswesen
· 2026 Feb · PMID 41418816
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Pandemic preparedness requires complementary tasks and a coordinated approach with multidirectional interaction between research, contribution-based healthcare, and public health services. The National Pandemic Plan prov...Pandemic preparedness requires complementary tasks and a coordinated approach with multidirectional interaction between research, contribution-based healthcare, and public health services. The National Pandemic Plan provides the strategic framework for preparedness and emphasizes the importance of cross-sectoral cooperation. Practice-oriented approaches to regional stakeholder collaboration are only partly described so far and are further refined in this study.The BMFTR funded project PREPARED collected best practice examples from three healthcare regions (Frankfurt, Dresden, Bonn) and derived checklists for regional networks for pandemic preparedness and management. To this end, guided focus group discussions with 29 health experts were held in May 2023 and evaluated using content analysis. Stakeholders were selected based on a combination of typical cases and heterogeneous groups.The study identified five key stakeholder groups in regional care networks: 1) laboratory logistics, 2) public administration, 3) emergency and rescue services, 4) medical care, and 5) nursing and social support. The analysis of best practice examples highlighted the importance of transparent information presentation, cross-sectoral cooperation, and standardized procedures. Recommendations were derived from this analysis with the aim of strengthening resilience and networking at the state level in a sustainable manner. These included the establishment of a central coordination office, the standardization of hygiene standards, continuous monitoring, and the integration of emergency services and training programs. Based on these results, practical checklists were developed to support regional providers in crisis management.The study identified key strategies for effective regional pandemic preparedness and response: i) close and binding regional cooperation, ii) the establishment of cross-sector networks, and iii) standardized communication and coordination structures as well as flexible checklists for pandemic management. These approaches focus on strengthening the resilience of the healthcare system and enabling a flexible response to crisis situations.
Schmidt J, Gräßel E, Lauer N
… +3 more, Bösl S, Kratzer A, Pendergrass A
Gesundheitswesen
· 2026 Mar · PMID 41401938
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Since 2009, informal caregivers (CGs) have been able to obtain information on support options and receive initial relief through consultation as part of informal caregiver counselling (ICC) in accordance with § 7a SGB XI...Since 2009, informal caregivers (CGs) have been able to obtain information on support options and receive initial relief through consultation as part of informal caregiver counselling (ICC) in accordance with § 7a SGB XI. However, this offer has been used infrequently, and scientific evidence on non-users is lacking.The data were obtained from the cross-sectional study 'Progress in Home Care (ProCare)' and constituted a representative sample of CGs caring for care receivers (CRs) who were covered by statutory insurance in Bavaria (n=2,824). The analysis of use was based on Bradshaw's taxonomy of social need. The characteristics of (non-)users of ICC were identified descriptively (expressed need), and difference and regression analyses were computed (comparative need). For non-users of ICC, the reasons for non-use were evaluated (felt need), and the subjective and objective need for using ICC were compared (felt vs. normative need). Furthermore, information sources on care-related topics were analysed for CGs who were not aware that they were entitled to ICC.ICC was used by 20.97% (n=593) of CGs in the previous three months, of whom 85.91% stated that they benefited from the ICC. Multivariate binary logistic regression revealed that CGs of CRs who were older (OR=1.01) or had a higher level of care (OR=1.33) or dementia (OR=1.30) used ICC more frequently. Functional coping was also associated with more frequent use (OR=1.10). 53.99% of non-users stated that they had no need for ICC to date. However, only 36.73% of this group demonstrated no normative need. CGs who were not yet aware of ICC can be reached in the future via the Internet and social media (55.92%), doctors (53.13%), and their immediate environment (49.65%).The high level of satisfaction with ICC highlights its potential, underscoring the necessity for its utilisation to be augmented. In order to prevent high burden at an early stage, preventative, ongoing use should be achieved instead of the current late utilisation and functional coping strategies of CGs should be strengthened. Additionally, there is a large discrepancy between objective and subjective perceptions of CGs burden and associated needs, as well as a lack of knowledge about ICC. In order to raise awareness in CGs, a wider range of targeted information sources should be used.
Not least since the COVID-19-pandemic, digitalization has become increasingly important for the work of the public health service (PHS) in order to ensure the functionality at all levels of the PHS such as the exchange o...Not least since the COVID-19-pandemic, digitalization has become increasingly important for the work of the public health service (PHS) in order to ensure the functionality at all levels of the PHS such as the exchange of information between health authorities themselves and other stakeholders. The digital skills of employees in the local health authority (LHA) are an important factor for the digitalization und functionality of the PHS. This paper uses the example of a health authority to examine the question of what digital competence or digital skills public health service employees have and need. The digital skills were assessed using questionnaires for employees and IT contact persons as well as by analysing employee requests to the IT (IT ticket system). In a participatory approach of the real-world lab, employees of a LHA were involved in defining the basic level of digital skills and developing the survey methods. Almost all of the 37 participating employees rated their general digital skills at the basic level. Depending on the specific skill, between a quarter and all employees stated that they had mastered the specific skills at the basic level. Requests to both the IT contact persons and the IT ticket system were almost exclusively below the basic level. Face-to-face training is preferred for knowledge transfer. Lack of time has an inhibiting effect on the acquisition of digital skills. It turned out that employees overestimated their general digital skills. Digital skills should be assessed using various surveys and methods. A training concept should consider the basic digital skills, the sensitivity of this topic, the time required and personal assistance.
Demirer I, Schmitt J, Vogt V
… +4 more, Grill E, Härter M, Hoffmann W, Pfaff H
Gesundheitswesen
· 2026 Mar · PMID 41397451
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Health services research faces the challenge of providing sound recommendations for action for the further development of health systems and care. The application of causal inference methods offers health services resear...Health services research faces the challenge of providing sound recommendations for action for the further development of health systems and care. The application of causal inference methods offers health services researchers an excellent opportunity to identify causal relationships under everyday conditions. The role of clinical trials with a classic randomised controlled trial (RCT) design is recognised as suitable for gaining insights that help establish causal inference, but other methodological approaches to generating evidence also play an important role in health services research.The discussion paper presents key concepts and assumptions of causal inference and highlights their relevance for health services research. The paper makes it clear that in order to fulfil the assumptions, it is necessary to integrate theory, contextual knowledge, understanding of mechanisms and formal concepts, such as directed acyclic graphs (DAGs), into a suitable empirical study design. To this end, RCTs, quasi-experimental methods, causal machine learning, target trial emulation, in silico trials and the mixed-methods approach of integrated inference are presented and discussed in terms of their applicability in health services research and their internal and external validity.All of the approaches presented here can contribute to the estimation of causal effects when used in a targeted manner and in accordance with the central assumptions. Their suitability depends largely on the research question, data quality, theoretical modelling and contextual knowledge. The combination of complementary designs and high quality data sources can increase the robustness of causal conclusions.Causal inference in health services research is not only a methodological procedure, but an integrative process that systematically combines theory, methodology and contextual knowledge. By consistently linking these aspects, health services research can generate differentiated and actionable insights that go beyond correlative analyses and enable an understanding of the mechanisms of causal processes. This can lead, for example, to evidence-supported recommendations that critically examine the often non-evidence-based status quo and reliably evaluate the benefits of new models.
Germany coped with the coronavirus pandemic not least because of its well-equipped medical care system with a high density of doctors and hospitals. In the first wave in particular, the public health service also assumed...Germany coped with the coronavirus pandemic not least because of its well-equipped medical care system with a high density of doctors and hospitals. In the first wave in particular, the public health service also assumed responsibility for population medicine. The coronavirus crisis revealed the need for better equipment, expertise and sectoral coordination between health authorities. The pandemic exhibited the close connection between various health-related challenges, disease areas and health inequalities. Better coordination and cooperation between individual medical care, in particular general practitioners, and public health services responsible for population medicine is necessary for the future management of acute and chronic health problems. International experience shows how effective integration of these sectors can contribute to improving health care and reducing health inequalities. Against the background of the international health sciences debate, this article first presents the concepts of primary health care (PHC) and public health (PH). It then discusses the opportunities and challenges of a closer integration of primary health care and public health services, develops approaches for the corresponding further development of the German healthcare system and analyses the resulting options for improving population health.
Zerth J, Herberg S, Hanke-Ebersoll M
… +2 more, Müller S, Teuteberg F
Gesundheitswesen
· 2026 Jun · PMID 41365360
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Prevention and health promotion can be a way of helping to improve the autonomy, independence, well-being and quality of life of people who are at risk of, at the beginning of or already in need of care. This study is ba...Prevention and health promotion can be a way of helping to improve the autonomy, independence, well-being and quality of life of people who are at risk of, at the beginning of or already in need of care. This study is based on the hypothesis that frailty as a defined care risk can be contained or, if necessary, prevented so that people can live longer and age more healthily in their home environment. There is sufficient evidence that relationship and behavioral factors have a much stronger influence on development opportunities in old age than genetic and biological dispositions. Against this background, social legislation has established preventive measures in Social Code XI in addition to the preventive services offered in Social Code V with the introduction of the Prevention Act (PrävG) in 2015. In order to determine the potential for prevention, the Medical Service was obliged to check in each of its reports on the need for care whether preventive measures should be recommended beyond the current care situation. Based on anonymized routine data from a large long-term care insurance company, the Medical Service reports from 2022 and 2023 were analyzed nationwide to determine the need for long-term care. A mixed-methods approach was used to interpret potential indications between insurance-related aspects and the recommendation practice in the expert reports. Our study revealed a gap between preventive healthcare offered and recommendations for such support in the legislative codes. This gap needs to be closed to improve healthy aging.
Gesundheitswesen
· 2026 Feb · PMID 41365359
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Theda Borde, recipient of the 2025 Salomon Neumann Medal of the German Society for Social Medicine and Prevention (DGSMP), holds a degree in political science and a doctorate in Public Health. She served as Professor and...Theda Borde, recipient of the 2025 Salomon Neumann Medal of the German Society for Social Medicine and Prevention (DGSMP), holds a degree in political science and a doctorate in Public Health. She served as Professor and, for a period, as Rector at the Alice Salomon University of Applied Sciences Berlin. Her research and teaching focus on the social determinants of health, gender and health, interprofessional collaboration in healthcare, and migration and health. Four core principles that shaped the work of Salomon Neumann also characterize Theda Borde's scholarly contributions: addressing the needs of socioeconomically disadvantaged populations, generating scientific evidence on their health status, translating research findings into practice, and taking a public stance - particularly in times of populist resistance. Theda Borde's work, however, extends beyond Neumann's historical framework: participation and co-creation are central to her understanding of health equity and the advancement of social justice.
Gaertner T, Mappes A, Rau M
… +3 more, Grimm U, Hoffmann-Götz A, Schunda P
Gesundheitswesen
· 2025 Dec · PMID 41365358
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The new out-of-hospital intensive care (AKI) law, which is now included in social law, allows critically ill patients, most of whom are tracheostomy patients or require ventilation, to live a participatory life in a home...The new out-of-hospital intensive care (AKI) law, which is now included in social law, allows critically ill patients, most of whom are tracheostomy patients or require ventilation, to live a participatory life in a home environment as far as possible. As a service provided by statutory health insurance companies, it requires a special prescription from a statutory health insurance provider and, in the case of ventilated or tracheotomized patients, a qualified potential assessment for weaning and/or decannulation (removal of the tracheostomy tube). A mandatory assessment by the Medical Advisory Service (MAS) at the place of care is the basis for the health insurance company's decision for benefit approval. A secondary data analysis was carried out consisting of 1615 initial reports from the Hessian MAS of the first 17 months after the new regulations and requirements for AKI were implemented. Of the high proportion of tracheotomized patients (72.6%) of the total population, 27.7% received continuous or intermittent invasive ventilation. In 46.5% of cases, a potential assessment, which was mandatory at the time, was still pending. From a socio-medical perspective, in around 8.2% of all assessed cases, the AKI requirements were not met. The MAS assessment enables a more individual and differentiated picture of the special constellation according to ICF criteria with a view to the socio-medical necessity of AKI care. Furthermore, it helps to ensure adequate medical and nursing care on site and reviews any weaning potential that may have not been sufficiently exploited to this point.
Prettin CE, Schneider N, Herbst FA
… +1 more, Schleef T
Gesundheitswesen
· 2025 Dec · PMID 41338238
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The objective of the study is to provide a comprehensive description and analysis of the current state of research on communication between general practitioners and deaf patients, with particular reference to the utilis...The objective of the study is to provide a comprehensive description and analysis of the current state of research on communication between general practitioners and deaf patients, with particular reference to the utilisation of sign language and to identify research gaps in the field of communication with deaf patients in general practice.The study was designed as a scoping review in accordance with the methodological standards established by Arksey and O'Malley (2005). A search was conducted across the CINAHL, PubMed and Web of Science databases. The study incorporated research conducted on the provision of general practice care to deaf patients who use sign language. The data extraction process was conducted on 12 April 2022, with a subsequent follow-up search conducted on 27 February 2024. The publications were assessed in a blinded manner.Following the exclusion of duplicates, a total of 2,060 publications were subjected to review, and the full texts of 86 search results were subsequently examined. The review incorporated a total of seven studies, of which four employed quantitative survey methodologies and targeted physicians (2), deaf patients (1), or both physicians and deaf patients (1). Two qualitative studies were conducted, one focusing on deaf people and the other on sign language interpreters. One study utilised a mixed-methods approach and focused on deaf patients. In total, 316 deaf patients, 355 doctors, and 19 sign language interpreters were surveyed. Five topics were identified for further investigation: communication problems as perceived by deaf patients, communication from the perspective of general practitioners, strategies for improving communication, the use of sign language interpreters, and the consequences of communication barriers. The extant literature suggests a paucity of knowledge among general practitioners in dealing with their deaf patients. Strategies for overcoming communication problems are considered inadequate; sign language interpreters are rarely used in general practice.Communication between general practitioners and deaf patients is considered inadequate because communication aids are either unavailable or unsuitable and untrained lay interpreters are used. There is an absence of reliable statistics concerning the utilisation of qualified sign language interpreters in general practice within the German healthcare system. This gap should prompt further research efforts.