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Background: In German emergency medical services (EMS), the analgesia is restricted to physicians. In this prospective, interventional, multicentre trial, complications with and quality of telemedically delegated analgesia were evaluated.Methods: If prehospital analgesia was necessary, five telemedically equipped paramedic ambulances from four different districts could consult a telemedicine centre. Analgesics were delegated based on a predefined algorithm. Telemedically assisted cases were compared with local historical regular EMS missions using matched pairs. The primary outcome was the frequency of therapeutic complications (respiratory/circulatory insufficiency, allergic reactions). Secondary outcomes were quality of analgesia (11-point numerical rating scale, NRS) and the frequency of nausea/vomiting.Results: Analgesia was necessary in 106 telemedically assisted missions. In 23 cases, the telemedical procedure was used until an EMS physician arrived. Of the remaining 83 cases, 80 could be matched to comparable controls. Complications did not occur in either the study group or the control group (0 vs. 0; p = N/A). Complete NRS documentation was noted in 65/80 (study group) and 32/80 (control group) cases (p < 0.0001). Adequate initial pain reduction (quality indicator: reduction of NRS ≥ 2 points or NRS < 5 at end of mission) occurred in 61/65 versus 31/32 cases (p = 1.0); NRS reduction during mission was 3.78 ± 2.0 versus 4.38 ± 2.2 points (p = 0.0159). Nausea and vomiting occurred with equal frequency in both groups.Conclusions: Telemedical delegation of analgesics to paramedics was safe and led to a pain reduction superior to the published minimum standard in both groups. The documentation quality was better in the telemedicine group. WHAT DOES THIS STUDY ADD?: Little is known about the safety and quality of prehospital analgesia carried out by emergency medical services (EMS). Beside potential quality problems, in some countries meaningful pain reduction is limited by legal regulations that allow only physicians to administer analgesics. This first multicentre prospective trial for telemedically delegated analgesia demonstrates that remote analgesia is possible and safe and retains equivalent analgesic quality compared with that administered by onsite EMS physicians. [ABSTRACT FROM AUTHOR]

Background: We showed excellent adherence and satisfaction with our telehealth care (TC) approach for COPD. Here, the results of a consecutive randomized controlled trial are presented., Methods: Patients were randomly assigned to TC or standard care (SC). During TC, patients answered six daily questions online, and focused on the early recognition of exacerbations, in addition to SC., Results: The mean increase in COPD assessment test (CAT) was 1.8 vs. 3.6 points/year in the TC and SC groups, respectively (P = 0.0015). Satisfaction with care (VAS) at baseline was 8.2; at the end of SC, 8.5 (P = 0.062); and after TC, 8.8 (P < 0.001). We detected significantly more moderate exacerbations during TC., Conclusion: Whilst receiving TC, the slope of the CAT increase - an indicator of the naturally progressive course of COPD - was reduced by 50%. Satisfaction with care increased with TC. The higher number of detected moderate exacerbations probably indicates a higher diagnostic sensitivity than without TC., (© 2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Background: Informal caregivers of patients with loss of vision often have to give physical and emotional support because of the high level of dependence induced. Although it is known that these informal caregivers suffer a higher risk of being affected by burn-out syndrome or depression, the various dimensions of burden, especially of informal caregivers of patients with neovascular age-related macular degeneration (nv-AMD) have not yet been investigated., Objective: The objective of this study was the evaluation of the German version of the caregiver reaction assessment (CRA) questionnaire in a collective of informal caregivers of patients with nv-AMD. In this context the positive and negative influences on the informal caregivers were assessed., Material and Methods: Between January 2013 and July 2014 a total of 150 informal caregivers of patients with nv-AMD filled out the CRA independently using a questionnaire survey which had been translated into German. Based on this collective, the psychometric characteristics of the translated questionnaire were evaluated., Results: The informal caregivers of the current collective reported a lower burden in the five subgroups disrupted schedule, lack of family support, self-esteem, health problems and financial problems, compared to the previous CRA studies with caregivers of patients with other diseases. The informal caregivers saw the greatest burden as the disruption of their schedule. Through a principal component analysis the five subgroups could be identified as five factors. It was shown that 19 out of the 24 items could be assigned to the same factors as in the original English version. The internal consistency of the five subgroups was acceptable except for the subscale on self-esteem., Conclusion: In this study the CRA has been confirmed as a suitable instrument to assess both positive and negative reactions of informal caregivers related to caregiving of patients with nv-AMD. The results provide support for a five subscale structure of the CRA in the original English version but five items of the questionnaire could be assigned to another subscale.

Background: The authors report preliminary results from a prospective multicenter study (Nasopharyngeal Carcinoma [NPC] 2003 German Society of Pediatric Oncology and Hematology/German Children's Oncology Group [NPC-2003-GPOH/DCOG])., Methods: From 2003 to 2010, 45 patients (ages 8-20 years), including 1 patient with stage II NPC and 44 patients with stage III/IV NPC, were recruited to the study. The patient with stage II disease received radiotherapy (59.4 grays [Gy]). The patients with stage III/IV disease received 3 courses of neoadjuvant chemotherapy with cisplatin, 5-fluorouracil, and folinic acid. The cumulative irradiation dose was 54 Gy in 5 patients, who achieved complete remission after neoadjuvant chemotherapy, and 59.4 Gy in the remaining 40 patients. All patients received concomitant cisplatin during the first week and last week of irradiation. After irradiation, all patients received interferon beta for 6 months. Tumor response was evaluated by magnetic resonance imaging studies and positron emission tomography scans., Results: After the completion of treatment, 43 of 45 patients were in complete remission. In 2 patients, only a partial response was achieved, followed by distant metastases (1 patient) or local progression and distant metastases (1 patient), 6 months and 10 months after diagnosis, respectively. Another patient developed a solitary pelvic bone metastasis 21 months after diagnosis. After a median follow-up of 30 months (range, 6-95 months), the event-free survival rate was 92.4%, and the overall survival was 97.1%. Acute toxicity consisted mainly of leucopenia, mucositis, and nausea; and late toxicity consisted of hearing loss and hypothyroidism., Conclusions: Combined therapy with neoadjuvant chemotherapy, radiochemotherapy, and interferon beta was well tolerated and resulted in a very good outcome that was superior to the outcomes of published results from all other pediatric NPC study groups., (Copyright © 2012 American Cancer Society.)

Purpose: Little is known about the information newly diagnosed patients with lung cancer recall and how satisfied they are with physicians' communication., Patients and Methods: Seventy-one consecutive patients with newly diagnosed lung cancer were surveyed 1 to 3 days after the disclosure of diagnosis. Patients' recall of the given information was assessed, as well as their satisfaction with physicians' communication of diagnosis, treatment procedure, and goal of treatment as curative or palliative. Physicians who provided diagnosis were asked to complete a questionnaire concerning what information they had given to the patient. Congruence between physician information and patient recall of that information was then evaluated., Results: Ninety percent (62 of 69 patients) correctly recalled their physician's information about the diagnosis, 83% (55 of 66 patients) knew what treatment procedure their physicians proposed, and 49% (32 of 65 patients) accurately recalled information about the goal of treatment. Seventy-six and 73% of patients were highly satisfied with their physician's communication of diagnosis and treatment procedure, respectively. Only 39% were highly satisfied with communication of the treatment goal. Patients who correctly recalled information regarding the treatment procedure were significantly more satisfied with its communication., Conclusion: Recall of information about the intent of treatment is poor, and satisfaction with communication of the intent of treatment is lacking among newly diagnosed patients with lung cancer. Future studies should address whether specific interventions can improve these deficiencies.

In 1996, free choice of health insurers was introduced to the German social health insurance system. One objective was to increase efficiency through competition. A crucial precondition for effective competition among health insurers is that consumers search for lower-priced health insurers. We test this hypothesis by estimating the price elasticities of insurers' market shares. We use unique panel data and specify a dynamic panel model to explain changes in market shares. Estimation results suggest that short-run price elasticities are smaller than previously found by other studies. In the long-run, however, estimation results suggest substantial price effects., (Copyright (c) 2006 John Wiley & Sons, Ltd.)

The Asthma Quality of Life Questionnaire (University of Sydney [AQLQ-Sydney]) is a self-administered questionnaire that has been developed in Australia and validated in different languages in Australia, the USA and Spain. We developed a German translation of this questionnaire by applying a sequential forward and backward translation approach. The objective of this study was to validate a German translation of the AQLQ-Sydney questionnaire in an outpatient population of asthmatic patients in Switzerland. Outpatients were assessed for a diagnosis of asthma and those who consented were selected for the validation study. All patients had spirometry, methacholine challenge testing, fractional exhaled nitric oxide recorded and answered the German AQLQ-Sydney. A subgroup of 17 patients answered the questionnaire for a second time after receiving asthma treatment with combined steroids and bronchodilators for two months. Test-retest-reliability was tested in 12 stable asthmatic patients without treatment modification. Of 90 patients assessed, 57 were diagnosed with asthma and participated in the validation study. The total score did not significantly correlate with any of the objective measures of severity of asthma. However, the "Breathlessness" subscale score correlated weakly with PD20 methacholine. Internal consistency was high with Cronbach's alpha of 0.97 for the total score and 0.91-0.97 for the subscale scores. Test-retest reliability was also high for the total score and the subscale scores. The questionnaire detected a significant improvement in total quality of life score and "Breathlessness" and "Mood" subscale scores after a period of combined treatment with inhaled steroids and long acting bronchodilators. The German translation of the AQLQ-Sydney had a good internal consistency and test-retest-reliability in stable asthmatic patients. It shows responsiveness to treatment. Some correlations with objective markers were detected.