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The chemical properties of disulfides are leveraged in a wide array of applications, ranging from protein-drug conjugates for cancer treatment to self-healing materials. However, disulfide reduction strategies remain severely underdeveloped despite being the key to efficiently accessing the desired targets. Specifically, no homogeneous catalyst has been reported for this reaction, and conditions that allow the use of mild and green reductants (e.g., via electrochemical reduction) are not known. Herein, we unveil a vitamin B 12 -catalyzed, electrochemically driven protocol for efficiently reducing disulfide bonds in various aqueous buffers over a broad pH range. This robust and simple method is suitable for disulfide reductions of substrates ranging from small molecules to large proteins. Finally, one-pot reduction and conjugation of disulfide bonds in a monoclonal antibody were demonstrated to produce antibody conjugates.

Objectives: Breast cancer is the most common cancer and the most common cancer-related cause of death among women in Germany. The treatment in certified breast cancer centre networks is recommended to ensure high-quality care. The aim of the study was to determine the percentage of breast cancer patients receiving cancer treatment in certified breast cancer centre networks in Upper Franconia, Germany., Methods: This study considered the location of treatment and the certification status of providers with regard to initial diagnosis, surgery, chemotherapy, and radiation during breast cancer care. Based on this, we compared patient characteristics receiving cancer care in certified and non-certified cancer centres and their networks. The evaluation was based on a dataset of the Bavarian Cancer Registry (4/2017-3/2022)., Results: The analysis included 5,545 primary tumors from a total of 5,355 patients (age: 64.5±14.2 years; 99.2% female). The percentage of patients receiving care in certified breast cancer centre networks was 78.8% for initial diagnosis, 82.6% for surgery, 79.5% for chemotherapy, and 99.6% for radiation, respectively. The weighted mean across all treatment sequences was 84.3%. Patients receiving care in certified care networks were significantly younger for three therapy sequences (p+<+0.001). In addition, an above-average proportion of patients with advanced tumor stages were treated in non-certified care networks, especially for diagnosis and surgery (p+<+0.001)., Conclusions: Regarding the different treatment sequences, we found differences in the proportion of patients who received quality-assured treatment in certified breast cancer centre networks in Upper Franconia. When comparing similar analysis, the results show an average care percentage of patients receiving care in certified care networks. Furthermore, it should be ensured that patients receive comprehensive information about receiving care in certified cancer centre networks., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians., Methods: We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May-June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs., Results: Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified "complication rate" and "the number of cases treated" as most important for the hospital referral decision making; PROs were rated slightly less important., Conclusions: This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention., (© 2023. The Author(s).)

Background: Multimorbidity, increasing numbers of chronically ill patients and demographic change are leading to increased care costs in Germany with an increasing shortage of staff in skilled nursing and geriatric care. In this context, more and more caregivers with a migration background of the 1st generation (PmMH) are being recruited and integrated into existing (corporate) cultures. This represents an important starting point for a permanent and needs-based supply landscape., The Aim of the Study: The aim of the study was to identify and analyze the specific stresses of PmMH at the workplace in nursing and geriatric care MATERIAL AND METHODS: A systematic literature search was carried out in relevant specialist databases (Pubmed, PsychInfo, Web of Science, Cochrane), supplemented by an extended snowball and hand search. This was followed by a descriptive presentation of the results of the study content, which in a subsequent step was iteratively brought together and consolidated into thematic categories by several people., Results: A total of 15 publications were identified as relevant and included in the analysis. Specific, migration-associated stress factors could be identified. In particular, the categories: "Discrimination and racism", "Language and communication problems" and "Cultural adjustment" characterized the (collaborative) work in nursing and care for the elderly and led to additional stress for employees and patients., Discussion: The present review article identified and summarized specific burdens of PmMH. At this point it can be assumed that these affect both PmMH and patients. So far, operational concepts do not seem to be able to adequately solve the challenges, so that effective, sustainable approaches have to be found. The extent to which the specificed stress factors only affect PmMH is not considered in this context, so that further research is needed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: This study aimed to elicit preferences for attributes of current and novel long-acting antiretroviral therapy for human immunodeficiency virus treatment., Methods: Primary survey data were collected (July-October 2022) on a sample of 333 people living with human immunodeficiency virus in Germany from a patient recruitment agency. Respondents were invited by e-mail to respond to a web-based questionnaire. After performing a systematic literature review, we conducted qualitative semi-structured interviews to identify and select the key attributes of drug therapy for patients' preferences for human immunodeficiency virus treatment. Based on this, a discrete choice experiment survey elicited preferences for long-acting antiretroviral therapy characteristics, including the type of medication, frequency of dosing, the location of treatment, the risk of both short-term and long-term side effects, as well as possible interactions with other medications or (party) drugs. A statistical data analysis was performed using multinomial logit models. An additional latent class multinomial logit was performed to evaluate subgroup differences., Results: Overall, 226 respondents (86% male, mean age 46.1 years) were included in the analysis. The frequency of dosing (36.1%) and the risk of long-term side effects (28.2%) had the greatest influence on preferences. The latent class analysis identified two patient groups. While the first class (n = 135; 87% male, mean age 44.4 years) found the frequency of dosing (44.1%) to be most important, the second class (n = 91; 85% male, mean age 48.6 years) focused on the risk of long-term side effects (50.3%). The evaluation of structural variables showed that male respondents, those living in small cities or villages, and those with better health status results were significantly more likely to be assigned to the second class (p < 0.05 each)., Conclusions: All attributes included in our survey were important to participants when choosing an antiretroviral therapy. We found evidence that the frequency of dosing as well as the risk of long-term side effects have a particular impact on the acceptance of novel therapy regimens and should be considered in order to optimize adherence and satisfaction., (© 2023. The Author(s).)

Objective: The challenge is to counteract the undersupply of doctors in rural areas in Bavaria. As one possibility, the "Country Doctor Quota" measure provides for the allocation of dedicated medical study places for prospective specialists with general practice activities. A specific selection process for future medical students was established and safely implemented under the safety and hygiene conditions of the corona pandemic., Method: In Bavaria, a two-stage selection process was developed and used in full for the first time in 2021 for the selection of students. Due to the corona pandemic, only the results of stage 1 of the process for the selection of prospective students were taken into account in the previous year. Cognitive and non-cognitive criteria were included in a 2-stage selection process. In the second stage, physician-relevant competencies (e. g. resilience, problem-solving ability, empathy and compassion, communication skills, ethical decision-making, as well as consulting and social skills) were assessed by Bavarian family doctors in four multiple mini interviews and a 10-minute, semi-structured individual interview. A maximum of 100 points could be achieved. A digital, contact-free selection process was established and successfully implemented to ensure protection and hygiene conditions in the context of the interviews., Results: A total of 436 people applied as part of the Bavarian country doctor quota for the 2021/2022 winter semester; 226 applicants were invited to the selection interviews at the second stage, of which 115 applicants received a place at the university. 64% of the participants had already completed medical vocational training, the high school graduation grade average was 2.4., Conclusion: The developed selection process identified applicants as part of the Bavarian country doctor quota and selected using objective criteria. All available medical study places were filled with the 115 finally selected applicants. To what extent the selected applicants (can) counteract the impending shortage of prospective specialists with general practitioner work remains to be seen., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Human tissue-engineered matrices (hTEMs) have been proposed as a promising approach for in situ tissue engineered heart valves (TEHVs). However, there is still a limited understanding on how ECM composition in hTEMs develops over tissue culture time. Therefore, we performed a longitudinal hTEM assessment by 1) multiscale evaluation of hTEM composition during culture time (2, 4, 6-weeks), using (immuno)histology, biochemical assays, and mass spectrometry (LC-MS/MS); 2) analysis of protein pathways involved in ECM development using gene set enrichment analysis (GSEA); and 3) assessment of hTEM mechanical characterization using uniaxial tensile testing. Finally, as a proof-of-concept, TEHVs manufactured using 6-weeks hTEM samples were tested in a pulse duplicator. LC-MS/MS confirmed the tissue culture time-dependent increase in ECM proteins observed in histology and biochemical assays, revealing the most abundant collagens (COL6, COL12), proteoglycans (HSPG2, VCAN), and glycoproteins (FN, TNC). GSEA identified the most represented protein pathways in the hTEM at 2-weeks (mRNA metabolic processes), 4-weeks (ECM production), and 6-weeks (ECM organization and maturation). Uniaxial mechanical testing showed increased stiffness and stress at failure, and reduction in strain over tissue culture time. hTEM-based TEHVs demonstrated promising in vitro performance at both pulmonary and aortic pressure conditions, with symmetric leaflet coaptation and no stenosis. In conclusion, ECM protein abundance and maturation increased over tissue culture time, with consequent improvement of hTEM mechanical characteristics. These findings suggest that longer tissue culture impacts tissue organization, leading to an hTEM that may be suitable for high-pressure applications. STATEMENT OF SIGNIFICANCE: It is believed that the composition of the extracellular matrix (ECM) in the human tissue engineered matrices (hTEM) may favor tissue engineered heart valve (TEHV) remodeling upon implantation. However, the exact protein composition of the hTEM, and how this impacts tissue mechanical properties, remains unclear. Hence, we developed a reproducible rotation-based tissue culture method to produce hTEM samples. We performed a longitudinal assessment using different analytical techniques and mass spectrometry. Our data provided an in-depth characterization of the hTEM proteome with focus on ECM components, their development, and how they may impact the mechanical properties. Based on these results, we manufactured functional hTEM-based TEHVs at aortic-like condition in vitro. These outcomes pose an important step in translating hTEM-based TEHVs into clinics and in predicting their remodeling potential upon implantation., Competing Interests: Declaration of Competing Interest S.P.H. is a shareholder at Xeltis BV and LifeMatrix AG. M.Y.E. is a shareholder at LifeMatrix AG. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The COVID-19 pandemic posed challenges to governments in terms of contact tracing. Like many other countries, Germany introduced a mobile-phone-based digital contact tracing solution ("Corona Warn App"; CWA) in June 2020. At the time of its release, however, it was hard to assess how effective such a solution would be, and a political and societal debate arose regarding its efficiency, also in light of its high costs. This study aimed to analyze the effectiveness of the CWA, considering prevented infections, hospitalizations, intensive care treatments, and deaths. In addition, its efficiency was to be assessed from a monetary point of view, and factors with a significant influence on the effectiveness and efficiency of the CWA were to be determined. Mathematical and statistical modeling was used to calculate infection cases prevented by the CWA, along with the numbers of prevented complications (hospitalizations, intensive care treatments, deaths) using publicly available CWA download numbers and incidences over time. The monetized benefits of these prevented cases were quantified and offset against the costs incurred. Sensitivity analysis was used to identify factors critically influencing these parameters. Between June 2020 and April 2022, the CWA prevented 1.41 million infections, 17,200 hospitalizations, 4600 intensive care treatments, and 7200 deaths. After offsetting costs and benefits, the CWA had a net present value of EUR 765 m in April 2022. Both the effectiveness and efficiency of the CWA are decisively and disproportionately positively influenced by the highest possible adoption rate among the population and a high rate of positive infection test results shared via the CWA.

Straumann BLX is a novel implant system that has been proclaimed to provide an ideal primary stability in all types of bone. In the current study, the primary stability of the Straumann BLX implant systems with Straumann tapered effect (TE) implants have been comparatively assessed in bovine ribs by using a simultaneous sinus elevation and implant insertion model. In the study group, BLX (4.0 × 12 mm), TE (4.1 × 12 mm), BLX (4.5 × 12 mm), and TE (4.8 × 12 mm) were placed in each bony window, which resembles the sinus maxillaris. As a control, BLX and TE implants with the same sizes were inserted into the proximal diaphysis of the bovine ribs. A total of 40 implant insertions were performed. Stability was measured with resonance frequency analysis. In the study group, 4.8-mm TE implants showed significantly higher values compared with 4.5-mm BLX implants (P = .116). However, 4.0-mm BLX implants in the control group showed higher stability compared with 4.0-mm-diameter TE (P = .014). The primary stability of the BLX implants in the control group was significantly higher compared with the experimental group in both widths (P= .018 for BLX 4.0 mm and P = .002 for BLX 4.5 mm, respectively). The use of the TE design with a wide diameter in simultaneous implant placement with sinus lift could present higher implant stability quotient values and might be a more appropriate option for implant recipient sites with poor bone volume and quality. However, the advantage of BLX design in standard implant insertion protocols could be of value.

Background: So far, the adoption of hospital report cards (HRCs) falls short of expectations. One promising strategy is to modify the content of HRCs by presenting patient-reported outcomes (PROs)., Objective: To identify the key determinants influencing patients to use HRCs for hospital decision making and determine the effect of presenting PROs on HRCs on their use intention., Methods: Primary survey data were collected (5/6-2021) on a sample of 2000 randomly selected insurees from a German statutory health insurance who have undergone elective hip arthroplasty surgery., Results: Overall, 447 participants (mean age 66.56) completed the survey and were included in the analysis. Respondents rated "PROs" as most important for the hospital choice followed by "Mobility at hospital discharge" and "Confirmed diagnosis rate". Patients generally perceive HRCs to be a good idea that makes searching for a hospital more interesting. We identified attitude and social influence as the most important determinants for using HRCs (p<.001 each). The presence of PROs on HRCs was not associated with an increased intention to use HRCs neither in our descriptive analysis (p=.593), nor in our research model (p=.763)., Conclusions: Patients value PROs to be an important information for choosing a hospital. Nevertheless, health policy makers should note that presenting PROs on HRCs as a single approach is not likely to increase the use of HRCs., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: Patients increasingly express themselves about their medical rehabilitation stay, evaluate health service providers with star ratings, and write reviews on the internet. So far, no results are available regarding online patient satisfaction for inpatient medical rehabilitation in Germany. For the first time, this study conducted a systematic analysis of rehabilitation patient satisfaction on social media websites and hospital rating portals., Methods: We collected reviews of medical rehabilitation on the portal Klinikbewertungen.de and the social network Facebook for 8 indication groups (orthopedics, psychosomatics/psychotherapy, oncology, cardiology, neurology, internal medicine, pulmonology/dermatology, gastroenterology) with a full data extraction over 3 survey years (October 2014-September 2017) and for rehabilitation clinics with main bed occupancy of retirement insurance (N=497). The star ratings, aggregated according to indication groups, were evaluated to determine patient satisfaction (Pearson's chi-square test, Fisher's exact test, Phi coefficient)., Results: A total of 97.2% of the rehabilitation clinics were represented, with 24,806 ratings on Klinikbewertungen.de. The most frequently evaluated indication groups were orthopedics (38.5%) and psychosomatics/psychotherapy (27.1%). Facebook ratings (N=4,127) were collected for rehabilitation clinics with one department (38.6%) in order to ensure an indication group assignment. Almost the same number of ratings were determined on official (48.7%) and unofficial Facebook pages (51.3%), with no significant correlation between website management and overall satisfaction (p>0.05). On the Facebook pages of the rehabilitation clinics, 49.1% of the ratings were written by women (38.5% by men; 12.4% not assignable). Sociodemographic information on Klinikbewertungen.de was based solely on the status of the insured (89.1% of those with statutory insurance). Overall, 95.4% of the reviews were written by patients and 4.0% by relatives, with 77.5% of patients recommending the clinic to other users (relatives: 37.2%). Most patient ratings were positive. However, there were differences in overall satisfaction between the indication groups. Patients in oncology (77.9%) were more satisfied than those in neurology (59.0%)., Conclusions: Online ratings of inpatient medical rehabilitation were collected to a considerable extent. These were mostly positive. The results are comparable to standardized surveys. Despite restrictions in the use of social media data, the results indicated that the publicly available real-time online feedback from patients can provide useful information for the quality management of clinics as well as for patients in exercising their right to choose a rehabilitation clinic., Competing Interests: Die ZURESO-Studie („Zufriedenheit von Rehabilitanden in Erfahrungsberichten der sozialen Medien“) wurde von der Deutschen Rentenversicherung Bund von Februar 2018 bis Oktober 2019 gefördert.Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The objective of the current study is to retrospectively evaluate cycling related dental and maxillofacial injuries and to gain insight into the epidemiology and results of these accidents. Data of patients who were admitted due to the maxillofacial injuries between April 2018 and September 2020 were retrospectively evaluated regarding the patients' characteristics, helmet wearing, type of radiological assessment required for diagnosis and therapy, injury patterns, duration of hospitalization and concomitant injuries. Data of 162 patients were included. 86 (53.08%) patients presented with at least one maxillofacial fracture. A total of 186 maxillofacial bones were fractured. Zygomatico-maxillary complex was the most commonly affected region (n:103, 55,36%). Analysis of the dental traumata revealed that crown fracture without pulp exposure was the most commonly observed entity (n:37, 32.46%) and upper central incisors (n:61, 53.50%) were the most commonly affected teeth. The overall ratio of the number of the fracture line/fracture case was 2.80. However, this ratio was statistically higher in e-bike cases (4.25) compared to non-e-bike riders (2.34) (p:0.014). Bicycle related maxillofacial injuries could correlate with specific morbidity rates and result in severe injuries of the maxillofacial region., Competing Interests: Declaration of competing interest None., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Patients are increasingly using social media and review sites to get information on hospitals, to rate them or to write a review about their own experiences during hospital stay. Hospitals have the opportunity to use these patient reviews for internal quality assurance as well as online reputation marketing., Objective: The objective is to analyze the satisfaction ratings of previous hospitals stays by social media users on platforms such as "Google", as well as reviews from the German site "Klinikbewertungen.de", and to compare them., Methods: User reviews (n=16,691) for all hospitals (n=180) in the federal state of Lower Saxony (complete survey) for 2013-2018 were extracted from the platforms Google and the German Klinikbewertungen.de. Subsequently, a descriptive and inductive analysis (Chi²-test) of the user reviews and a comparison specific for the platforms were completed., Results: Most users are satisfied with their hospital stay, whereby users of the platform Google ratd their hospital stay worse (n=6,181; 57.6% satisfied) than users of the platform Klinikbewertungen.de (n=10,509; 65.4% satisfied). Features of the hospital (number of beds, specialist departments) and features of the users (author, type of insurance) were significantly associated with the rating for the hospital stay (star review). (Google: number of beds p<0.001; Klinikbewertungen.de: number of beds p<0.001, author p<0.001, specialist departments p<0.001, type of insurance p<0.001)., Conclusion: The online review of a hospital stay is associated with the number of beds, the specialist departments of hospitals, whether the author is the patient or a relative, and the type of health insurance they have, namely private or statutory. Online reviews and ratings for hospitals may be used for internal quality assurance or improvements of company online reputation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The aim of the current study was to document the long-term clinical results of the use of two prosthetic techniques for the rehabilitation of completely edentulous maxillae according to the "All-on-Four" concept: Fixed, screw-retained prosthesis mounted on a chrome-molybdenum framework with (1) metal-ceramic veneers and (2) Acrylic prosthesis with acrylic resin prosthetic teeth. A total of 34 patients were assigned to subgroups according to their own preference of the superstructure type (ceramics [n: 17] or acrylic resin [n: 17]). Prosthetic complications, marginal bone loss, plaque accumulation, bleeding on probing, bite force and oral-health-related quality of life were assessed over a period of 6 years. Marginal bone loss around implants of the ceramic group remained well within the limits for 'success', as defined by the 2007 Pisa consensus over the time (1.43 ± 0.35 mm). However, marginal bone loss was significantly more pronounced around the implants in the acrylic group (2.15 ± 0.30) and the difference between two groups was statistically significant (p: 0.00). Bleeding on probing and plaque accumulation showed also positive correlation with marginal bone loss. Both acrylic and ceramic suprastructures appeared to be equivalent after 6 years; however, ceramic suprastructures revealed superior clinical results in terms of bone loss and plaque accumulation. Current study determines the long-term clinical outcomes of different prosthetic management alternatives in All-on-Four and aids to increase dental professionals' ability to meet the patients' expectations., (© 2021. The Author(s).)

Objectives: Little is known about public reporting on long-term care facilities. In this study, we (1) identify the websites that are available for a search on long-term care facilities in Germany, (2) describe them systematically with regard to general information and range of functions, 3) capture the information on quality available on the websites and 4) evaluate the extent to which they can be useful for those in need., Methods: 1) Systematic internet search to identify the websites. 2) Analysis of the websites with regard to defined inclusion and exclusion criteria. 3) Data collection from the included websites. 4) Description of the general content and the range of functions of the websites. 5) Collection of quality-related information on long-term care facilities (structure, process and outcome quality, costs, quality inspections results, user feedback). 6) Evaluation of the usefulness of information by analyzing the information using a catalogue of criteria., Results: A total of 24 websites were identified with information on long-term care facilities. Only 4 websites allowed a direct online comparison of several facilities and 17% allowed consumer feedback online. All websites provided information on structural quality, but none on the outcome quality. Across all websites, the usefulness of information for the consumers amounted to 19%. The thematic area on location and accessibility of a facility offered relatively detailed information (79%), while only to 9% was dedicated to the thematic area on care., Conclusion: There is a large number of websites that can be searched for information on long-term care facilities. They show a range of heterogeneous functions and information. More websites should offer a function of comparison of multiple facilities. With regard to the information available, consumer preferences do not yet seem to be sufficiently taken into account. Further researches should focus on the evaluation of the impact of outcome quality on decision-making and the analysis of the validity of consumer feedback., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The aim of the current study was to comparatively assess the primary stability of different Straumann® implant designs (BLX, Straumann Tapered Effect, Bone Level Tapered, and Standard Plus) via resonance frequency analysis by using an implant insertion model in freshly slaughtered bovine ribs with and without cortical bone. Tapered Effect (4.1 × 10 mm), Bone Level Tapered (4.1 × 10 mm), Standard Plus (4.1 × 10 mm), and BLX (4.0 × 10 mm) implants were inserted into the distal epiphysis on the longitudinal axis of the freshly slaughtered bovine ribs. As a control, implants with the same sizes were inserted into the proximal diaphysis. The stability of the implants was examined with resonance frequency analysis., Results: BLX and Tapered Effect implants showed higher implant stability quotient values in both study and control groups. All implant systems showed a significant decrease of mechanical anchorage in the study group. BLX and Bone Level Tapered designs had a significantly lower loss of mechanical anchorage in the lack of cortical bone., Conclusion: Both Tapered Effect and BLX designs could ensure sufficient initial stability; however, BLX implants could be an appropriate option in the lack of cortical bone and poor bone quality at the implant recipient site., Clinical Relevance: BLX is a novel implant system, which could be especially beneficial in the presence of spongious bone type at posterior maxillae., (© 2021. The Author(s).)

Background: Feedback from patients is an essential element of a patient-oriented health care system. Physician rating websites (PRWs) are a key way patients can provide feedback online. This study analyzes an entire decade of online ratings for all medical specialties on a German PRW., Objective: The aim of this study was to examine how ratings posted on a German PRW have developed over the past decade. In particular, it aimed to explore (1) the distribution of ratings according to time-related aspects (year, month, day of the week, and hour of the day) between 2010 and 2019, (2) the number of physicians with ratings, (3) the average number of ratings per physician, (4) the average rating, (5) whether differences exist between medical specialties, and (6) the characteristics of the patients rating physicians., Methods: All scaled-survey online ratings that were posted on the German PRW jameda between 2010 and 2019 were obtained., Results: In total, 1,906,146 ratings were posted on jameda between 2010 and 2019 for 127,921 physicians. The number of rated physicians increased constantly from 19,305 in 2010 to 82,511 in 2018. The average number of ratings per rated physicians increased from 1.65 (SD 1.56) in 2010 to 3.19 (SD 4.69) in 2019. Overall, 75.2% (1,432,624/1,906,146) of all ratings were in the best rating category of "very good," and 5.7% (107,912/1,906,146) of the ratings were in the lowest category of "insufficient." However, the mean of all ratings was 1.76 (SD 1.53) on the German school grade 6-point rating scale (1 being the best) with a relatively constant distribution over time. General practitioners, internists, and gynecologists received the highest number of ratings (343,242, 266,899, and 232,914, respectively). Male patients, those of higher age, and those covered by private health insurance gave significantly (P<.001) more favorable evaluations compared to their counterparts. Physicians with a lower number of ratings tended to receive ratings across the rating scale, while physicians with a higher number of ratings tended to have better ratings. Physicians with between 21 and 50 online ratings received the lowest ratings (mean 1.95, SD 0.84), while physicians with >100 ratings received the best ratings (mean 1.34, SD 0.47)., Conclusions: This study is one of the most comprehensive analyses of PRW ratings to date. More than half of all German physicians have been rated on jameda each year since 2016, and the overall average number of ratings per rated physicians nearly doubled over the decade. Nevertheless, we could also observe a decline in the number of ratings over the last 2 years. Future studies should investigate the most recent development in the number of ratings on both other German and international PRWs as well as reasons for the heterogeneity in online ratings by medical specialty., (©Martin Emmert, Stuart McLennan. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.07.2021.)

The introduction of novel bioactive materials to manipulate living cell behavior is a crucial topic for biomedical research and tissue engineering. Biomaterials or surface patterns that boost specific cell functions can enable innovative new products in cell culture and diagnostics. This study investigates the influence of the intrinsically nano-patterned surface of nanoporous glass membranes on the behavior of mammalian cells. Three different cell lines and primary human mesenchymal stem cells (hMSCs) proliferate readily on nanoporous glass membranes with mean pore sizes between 10 and 124 nm. In both proliferation and mRNA expression experiments, L929 fibroblasts show a distinct trend toward mean pore sizes >80 nm. For primary hMSCs, excellent proliferation is observed on all nanoporous surfaces. hMSCs on samples with 17 nm pore size display increased expression of COL10, COL2A1, and SOX9, especially during the first two weeks of culture. In the upside down culture, SK-MEL-28 cells on nanoporous glass resist the gravitational force and proliferate well in contrast to cells on flat references. The effect of paclitaxel treatment of MDA-MB-321 breast cancer cells is already visible after 48 h on nanoporous membranes and strongly pronounced in comparison to reference samples, underlining the material's potential for functional drug screening., (© 2021 The Authors. Advanced Biology published by Wiley-VCH GmbH.)

Recent investigations on the anti-adhesive properties of polysulfobetaine methacrylate (pSBMA) coatings had shown promising potential as antifouling surfaces and have given the impetus for the present paper, where a pSBMA coating is applied via photopolymerization on a macro-roughened, sandblasted, and acid-etched titanium implant surface in order to assess its antifouling properties. Current emphasis is placed on how the coating is efficient against the adhesion of Enterococcus faecalis by quantitative assessment of colony forming units and qualitative investigation of fluorescence imaging and scanning electron microscopy. pSBMA coatings via photopolymerization of titanium surfaces seems to be a promising antiadhesion strategy, which should bring substantial benefits once certain aspects such as biodegradation and osseointegration were addressed. Additionally, commercial SAL-titanium substrates may be coated with the super-hydrophilic coating, appearing resistant to physiological salt concentrations and most importantly lowering E. faecalis colonization significantly, compared to titanium substrates in the as-received state. It is very likely that pSBMA coatings may also prevent the adhesion of other germs.

Introduction: Feedback from patients about aspects of rehabilitation services is increasingly provided online, for example, on specialized hospital comparison websites. Therefore, we examined which kind of online statements from rehabilitation patients published on the leading hospital comparison website "Klinikbewertungen.de" (KB) is associated with a positive recommendation of a rehabilitation clinic and which negative aspects are associated with a non-recommendation., Methods: For eight indication groups stratified online statements of rehabilitants at KB were evaluated qualitatively using content analysis. The relationship between positive (negative) statements and the (non-) recommendation was examined., Results: Content analysis of 911 experience reports revealed 20 categories. Most often, it was the "rehabilitation success" perceived by rehabilitation patients that was significantly associated with a recommendation or a non-recommendation of a hospital, and in five quality assurance (QA) comparison groups the category "catering" was associated with a positive or negative recommendation. In all QS comparison groups, there was an association with at least one of the following process-oriented rehabilitation categories: "rehabilitation measures", "rehabilitation plan and rehabilitation goals" and / or "diagnosis to discharge"., Discussion and Conclusion: Patient experiences with the perceived "rehabilitation success" and with the central processes of rehabilitation are particularly important for the recommendation or non-recommendation of a hospital for patients in all eight indication groups. On the basis of these results, rehabilitation hospitals can specifically identify the aspects of care that are important when patients recommend a hospital for rehabilitation. Online narratives of patients provide additional insights into the reasons for patients' satisfaction or dissatisfaction with their rehabilitation. These narratives are available to potential rehabilitation patients as a low-threshold source of information and decision-making aid., (Copyright © 2021. Published by Elsevier GmbH.)

Purpose: The aim of the study was to evaluate marginal adaptation properties of five different sealers used as root filling material., Materials: Apical resection was performed on 100 canals of 50 maxillary premolars in slaughtered pigs. The root end of 24 canals were retrogradely filled with Diaket™, 37 root canals with Super-EBA™ including 18 with Super-EBA™. Regular and 19 with Super-EBA™ fast, 20 canals with ProRoot® MTA and 19 canals with AH-Plus™. For quantitative examination, scanning electron microscope (SEM) analysis and for qualitative examination, microradiography was performed., Results: Diaket™ achieved an overall average of 4.872 microns gap value as the best result. The mean values of marginal gap widths of AH-Plus™ and Super-EBA™ were almost with 8.044 microns and 9.951 microns in about the same magnitude, followed by Super-EBA™ Regular with 11,560 microns. Highest marginal gap value was found for ProRoot® MTA with 18.343 microns ( p < 0.001)., Conclusions: Both in terms of its marginal integrity and material properties, Diaket™ is the most suitable material for retrograde obturation. A preliminary version of the current paper could be found at www.researchsquare.com/article/rs-6198/v1.

Objective: Social media websites, such as Facebook, have been gaining popularity. Little is known about the usefulness of such online ratings when searching for a hospital. We therefore assessed the association between online Facebook ratings and clinical quality of care measures as well as patient satisfaction for German hospitals in obstetrics care., Methods: (1) We identified all German hospitals providing services in obstetrics care based on the German external quality assurance system (2015) and gathered relevant data. (2) Based on a structured dialogue, we determined quality of care results for all hospitals and (3) assigned them to 3 different performance groups. (4) We collected Facebook online ratings as well as (5) patient satisfaction (Patients' Experience Questionnaire, PEQ) results for all included hospitals. (6) We applied the Spearman rank coefficient of correlation., Results: We could find a Facebook page for almost all of the included hospitals (728/752; 96.8%). Facebook hospital ratings in general were mostly positive, especially in obstetrics care. There was no association between Facebook hospital ratings (ρ=0.007; p=0.860) or those for obstetrics care (ρ=0.008; p=0.856) and clinical quality of care measures. In contrast, we could detect an association between Facebook ratings and patient satisfaction scores. The association was stronger for overall hospital ratings (ρ=0.383-0.543; p<0.001) than those for obstetrics care (ρ=0.111-0.250; p<0.05) in particular., Conclusion: So far, Facebook online ratings are of limited usefulness in guiding patients towards high-performing hospitals from a clinical point of view. However, our findings suggest that Facebook ratings may serve as an indicator of patient satisfaction when searching for hospitals., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Less than 10 years ago a breakthrough was made in the world of computer science and artificial intelligence (AI) with the application of deep neural networks, which initially found little attention in medicine. In 2017 the first high-ranking publications on the medical application of AI were published. The potential of AI became known to many both in clinical medicine as well as in clinical and biomedical research. At the end of 2019 a phase of upheaval is occurring: first concepts for regulatory procedures have appeared, a large number of start-ups but also established companies are endeavoring to introduce AI-based medical devices into the market. This article discusses the basic principles for understanding AI-based medical devices as well as an overview of current AI-based solutions specific to cardiac surgery.

Background: Hospitals report cards (HRCs) have had little impact on the hospital choice of patients. Thus, health policy makers should learn more about HRC consumers to better understand how to present and target hospital-related quality information., Objective: We sought to learn more about consumers of HRCs and determine the impact of the complexity and tailoring of HRCs on the hospital choice., Methods: We used primary data drawn from an onsite-based survey, conducted in 2017 at Germany's premier portal, Weisse Liste (N = 635). We performed hierarchical multivariate logistic regression models to identify main predictors associated with hospital choices., Results: HRC consumers differ from the national online population and the national population in general. Eighty percent of those patients or family members, who have used a HRC before, confirmed an impact on the hospital choice. The quality of hospital choices decreased with an increasing level of complexity (p < .001); the latter was identified as a significant predictor for making good choices. However, tailoring HRCs did not have an impact on the quality of the hospital choice (p > .05)., Conclusions: HRCs have a significant impact on the hospital choice among report card consumers. Health policy makers might focus on decreasing the level of complexity; this, more than tailoring report cards, may help consumers make good hospital choices., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Valvular heart disease is an increasing population health problem and, especially in the elderly, a significant cause of morbidity and mortality. The current treatment options, such as mechanical and bioprosthetic heart valve replacements, have significant restrictions and limitations. Considering the increased life expectancy of our aging population, there is an urgent need for novel heart valve concepts that remain functional throughout life to prevent the need for reoperation. Heart valve tissue engineering aims to overcome these constraints by creating regenerative, self-repairing valve substitutes with life-long durability. In this review, we give an overview of advances in the development of tissue engineered heart valves, and describe the steps required to design and validate a novel valve prosthesis before reaching first-in-men clinical trials. In-silico and in-vitro models are proposed as tools for the assessment of valve design, functionality and compatibility, while in-vivo preclinical models are required to confirm the remodeling and growth potential of the tissue engineered heart valves. An overview of the tissue engineered heart valve studies that have reached clinical translation is also presented. Final remarks highlight the possibilities as well as the obstacles to overcome in translating heart valve prostheses into clinical application., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims: We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation., Methods: The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010-2015) in adult UC patients undergoing adalimumab therapy., Results: A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease., Conclusion: Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.

Background: It has been suggested that patients with chronic non-specific low back pain (CNSLBP) perform poorly in postural tasks when compared to healthy individuals. Despite its importance in posture and alignment of the trunk in relation to the head, neck proprioception has not been examined in patients with low back pain. The purpose of this study was to compare neck proprioception in patients with CNSLBP with healthy individuals., Methods: Cervical joint reposition error was measured five times consecutively in the neutral head position, 30° and 60° left and right head rotation. The main outcome measure was the mean cervical joint repositioning error of the head., Results: Forty-six participants with (n = 24, 54 ± 16yrs SD, 14 females) and without (n = 22, 36 ± 13yrs SD, 13 females) CNSLBP were included in the study. Comparison of mean cervical joint repositioning error between patients and healthy controls showed no statistically significant group difference in any of the applied positions. The range of deviation in CNSLBP patients was between 1.57° and 3.27° compared to 1.46° to 2.26° in healthy controls. An overshooting tendency for both groups was found in the neutral head position., Conclusion: The ability to accurately position the head does not seem to be impaired in patients with CNSLBP. This may suggest that sensorimotor control is affected on other levels of the movement system and future research should focus on methods to identify the source of these aberrations., Competing Interests: The authors have declared no competing interests exist.

Background: In recent years, many different performance frameworks and quality assurance systems have been developed to measure health care quality. In Germany, an external quality assurance system for hospitals was introduced in 2005. The data of these systems are often reported by public reporting websites (PRWs) to inform patients and other stakeholders interested in health care systems about health care providers' quality. However, publication is obligatory (at least in Germany) for most of the existing quality assurance measures; some may be reported voluntarily. An important target group for this information is the group of all office-based physicians as they are crucial for patients' hospital choice. However, public reporting initiatives in Germany and other countries have not increased the use of quality reports for hospital choice., Objectives: (1) To summarize the criteria that office-based physicians consider to be of high, medium, and low importance for hospital selection when referring patients and (2) to examine whether German public reporting websites (PRWs) provide these hospital-related criteria., Methods: The analysis comprised four steps: 1) Five databases were systematically searched for peer-reviewed English- and German-language literature. 2) The selection of articles was based on compliance with inclusion criteria, and all the criteria relevant to the referral of patients to hospital were extracted. 3) The criteria were then divided into five main categories: structural quality, process quality, outcome quality, patient experience, and referring physicians' experience. In addition, the criteria were classified into three importance categories (high-, medium-, and low-priority criteria) according to their relevance to the referral decision. 4) We investigated whether German PRWs publicly report high-priority criteria., Results: A total of N=11 articles published in peer-reviewed journals met our inclusion criteria. The studies were published in Germany (n=4), the Netherlands (n=3), Denmark, France, Norway, and the USA (n=1 each). In total, N=86 criteria were identified, most of them relating to structural quality (n=43) and process quality (n=26). We found just n=3 outcome quality criteria, only one of which fell in the high-priority category (breast cancer indicators with clinically relevant differences). In total, n=25 low-, n=40 medium-, and n=34 high-priority criteria could be established, which is due to the fact that some criteria had been investigated in several studies evaluating the importance of some criteria differently. Most of the high-priority criteria were related to process quality. All the high-priority structural quality criteria and high-priority outcome quality criteria were available on German PRWs, whereas just 38.5 % of those relating to process quality could be identified on these portals. We also identified 66.7 % of the high-priority criteria regarding patient experience and 50.0 % concerning the referring physicians' experience. Overall, a larger amount of low- and medium-priority criteria are available on German PRWs than high-priority criteria., Discussion: A substantial amount of hospital information regarding structural quality and outcome quality is available on German PRWs. However, the development of further process quality criteria (which are currently underrepresented) should be considered, for example whether hospital physicians continue the medication initiated by office-based doctors. Also, hospital quality reports should be tailored for specific user groups, for instance for referring gynecologists or referring general practitioners (GPs)., (Copyright © 2018. Published by Elsevier GmbH.)

Objective: On physician-rating websites (PRW), patients have the opportunity to search for physicians and also evaluate their performance. PRW in Germany has been in existence for a decade; this study aims to provide an overview of the current level of their significance for both patients and the health care system., Methods: (1) A systematic internet search was carried out to identify German PRW. (2) Online-derived cross-sectional data (N=1,044 respondents) were analyzed with respect to awareness, usage, and impact of PRW as well as patient preferences when searching online for physicians. (3) An analysis of the structure of online ratings for a random sample of 11% of German dermatologists was conducted., Results: In total, we identified 29 PRWs. Slightly more than half of all respondents (54%) were aware of German PRW and every fourth respondent has already used PRW to search for a physician. Approximately 70% of all users stated they had already made a decision for or against a particular physician based on the quality ratings shown on PRW. Almost all dermatologists could be identified on PRW and 93% have already been rated on any PRW (mean number of ratings: 24.55). More than half of all ratings (55%) were positive., Conclusion: After one decade of development, PRWs seem to have gained significant importance in the German health care sector. However, high-quality and adequately powered randomized controlled trials are required to determine the impact of PRWs on patient steerage., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Previous surveys have shown that patient satisfaction varies with the regional supply of physicians. Online ratings on physician-rating websites represent a relatively new instrument to display patient satisfaction results. The aim of this study was (1) to assess the current state of online ratings for two medical disciplines (dermatologists and ear, nose and throat (ENT) specialists), and (2) to analyze online derived patient satisfaction results according to the physician density in Germany., Methods: We collected online ratings for 420 dermatologists and 450 ear, nose, and throat (ENT) specialists on twelve German physician-rating websites. We analyzed the online ratings according to the physician density (low, medium, high physician density). For this purpose, we collected secondary data from both physician-rating websites and the regional associations of statutory health insurance physicians. Data analysis was performed using Median tests and Chi-square tests., Results: In total, 10,239 online ratings for dermatologists and 8,168 online ratings for ENT specialists were analyzed. Almost all dermatologists (99.3 %) and ENT specialists (98.9 %) were listed on one of the physician-rating websites. A total of 93.5 % of all listed dermatologists and 96.9 % of ENT-specialists were rated on at least one of the physician-rating websites. Significant differences were found in the distribution (i.e., percentage of listed or rated physicians) of the ratings according to the regional physician density on only one physician-rating website (p<0.001). Furthermore, online ratings were shown to be better in regions with a higher physician density on two physician-rating website. On jameda.de, for example, dermatologist ratings were better in regions with a higher physician density compared to regions with a lower number of physicians (average rating: 2.16 vs. 2.67; p<0.001)., Conclusions: Online ratings of dermatologists and ENT specialists hardly differ in terms of regional physician density. Physician-rating websites thus do not appear to be appropriate to mirror differences in the health service delivery structure. Our findings thus do not confirm the results from previously published studies., (Copyright © 2018. Published by Elsevier GmbH.)

Background: Little is known about the usefulness of online ratings when searching for a hospital. We therefore assess the association between quantitative and qualitative online ratings for US hospitals and clinical quality of care measures., Methods: First, we collected a stratified random sample of 1000 quantitative and qualitative online ratings for hospitals from the website RateMDs. We used an integrated iterative approach to develop a categorization scheme to capture both the topics and sentiment in the narrative comments. Next, we matched the online ratings with hospital-level quality measures published by the Centers for Medicare and Medicaid Services. Regarding nominally scaled measures, we checked for differences in the distribution among the online rating categories. For metrically scaled measures, we applied the Spearman rank coefficient of correlation., Results: Thirteen of the twenty-nine quality of care measures were significantly associated with the quantitative online ratings (Spearman p = ±0.143, p < 0.05 for all). Thereof, eight associations indicated better clinical outcomes for better online ratings. Seven of the twenty-nine clinical measures were significantly associated with the sentiment of patient narratives (p = ±0.114, p < 0.05 for all), whereof four associations indicated worse clinical outcomes in more favorable narrative comments., Conclusions: There seems to be some association between quantitative online ratings and clinical performance measures. However, the relatively weak strength and inconsistency of the direction of the association as well as the lack of association with several other clinical measures may not enable the drawing of strong conclusions. Narrative comments also seem to have limited potential to reflect the clinical quality of care in its current form. Thus, online ratings are of limited usefulness in guiding patients towards high-performing hospitals from a clinical point of view. Nevertheless, patients might prefer different aspects of care when choosing a hospital.

Background: Healthcare IT (HIT) increasingly gains public attention and clinical daily relevance. A growing number of patients and physicians increasingly relies on IT services to monitor and support well-being and recovery both in their private and professional environment. This is assumed to develop rapidly in the upcoming years., Objective: This study examines the current status of HIT, its use and penetration among physicians in hospitals and researches utilization as well as future expectations regarding HIT., Methods: Physicians in Germany, Austria and Switzerland were addressed via e-mail to answer a standardized Internet-based questionnaire consisting of 17 multiple-choice and 3 open text questions. Parameters were evaluated in 5 categories: general use, frequency, acceptance, IT needs and future expectations., Results: An overall 234 physicians (response rate 83.6%) with a median age of 45 (range 25-60) responded and filled out the entire online questionnaire. A significant correlation between parameters gender, age and level of training (resident, specialist, consultant etc.) was proven. The professional, medical employment of technology shows a strong correlation with age as well as level of training. Whereas increasing age among physicians is associated with a decreasing level of application of HIT, a higher training level is accompanied by an increasing level of professional application of IT services and tools within the healthcare context. Routine employment of HIT is regarded as a necessary and positive standard. Most users assume the importance of HIT to strongly grow in the future in comparison to current use. A clear lack of trust towards data security and storage is recognized on both patient and physician sides. Needs are currently satisfied by employing privately acquired IT in the professional setup rather than the hospitals'. Future expectations from HIT show a clear demand for interoperability and exchangeability of data., Conclusions: The results display a clear gap between demand and expectations of IT for medical purposes. The rate of use of HIT applications generally correlates with age, gender as well as role within the hospital and type of employment within the healthcare sector. The current offering does not satisfy the needs of healthcare professionals., (© 2018 S. Karger AG, Basel.)

Left atrial appendage closure was originally described by Madden in 1949 who was the first to perform appendix amputation. This was a very invasive procedure with poor outcome, but preformed for stroke prevention. Much later, it was James Cox whom described the Cox-Maze procedure, which included multiple incisions to create a maze like pathway for the electrical impulse to go undisturbed from the sinus node down to the atrio-ventricular node. Since then cardiac surgeons stopped focusing on the left atrial appendage and went on about seemingly more important things. Only with the advent of catheter based options for stand alone left atrial appendage closure did the interest in the field light up again.

Background: Little knowledge is available about the importance of hospital report cards in the US from the patients' perspective. It also remains unknown whether specific report cards with a stronger emphasis on clinical measures have a greater impact on hospital choice than general report cards that focus on online-derived ratings., Objective: The aim of this study was to determine the awareness and usage of hospital report cards as well as their impact on hospital choice in the US., Methods: We conducted a cross-sectional study by surveying a stratified online sample (N = 1332) to ensure representativeness to the US online population (February 2015)., Results: Overall, 75% of all respondents (mean age 45.4 years; 54% female) were aware of hospital report cards. Among these, 56% had used a report card to search for a hospital, and 80% of report card users stated having been influenced by a report card. Both the awareness and usage of general report cards were shown to be higher than for specific report cards. No significant differences could be detected regarding the impact between general or specific report cards on hospital choice., Conclusions: Our results indicate that hospital report cards play a considerable role among patients when searching for a hospital in the US; however, patients do not seem to have a preference regarding the type of report cards they use when selecting a hospital.

Introduction: The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices., Methods: An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice., Results: The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices., Discussion: We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self-explanatory technical terms "actual and expected death rate" and "national average" are easy to understand and the comprehension is correlated with hospitals choices, we recommend using them for the presentation of measures which contain risk-adjusted mortality. The technical terms "risk-adjusted death rate" and "reference range" should stay in the background, since comprehension problems can be expected and explanations would have to be provided., (Copyright © 2017. Published by Elsevier GmbH.)

Objective: To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians' perspective., Data Sources/study Setting: Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03-06/2016)., Study Design: Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, [Formula: see text]=132, [Formula: see text]=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, [Formula: see text]=117; [Formula: see text]=130)., Principal Findings: Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16-8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72-4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information., Conclusions: Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.

Background: Physician-rating websites (PRWs) may lead to quality improvements in case they enable and establish a peer-to-peer communication between patients and physicians. Yet, we know little about whether and how physicians respond on the Web to patient ratings., Objective: The objective of this study was to describe trends in physicians' Web-based responses to patient ratings over time, to identify what physician characteristics influence Web-based responses, and to examine the topics physicians are likely to respond to., Methods: We analyzed physician responses to more than 1 million patient ratings displayed on the German PRW, jameda, from 2010 to 2015. Quantitative analysis contained chi-square analyses and the Mann-Whitney U test. Quantitative content techniques were applied to determine the topics physicians respond to based on a randomly selected sample of 600 Web-based ratings and corresponding physician responses., Results: Overall, physicians responded to 1.58% (16,640/1,052,347) of all Web-based ratings, with an increasing trend over time from 0.70% (157/22,355) in 2010 to 1.88% (6377/339,919) in 2015. Web-based ratings that were responded to had significantly worse rating results than ratings that were not responded to (2.15 vs 1.74, P<.001). Physicians who respond on the Web to patient ratings differ significantly from nonresponders regarding several characteristics such as gender and patient recommendation results (P<.001 each). Regarding scaled-survey rating elements, physicians were most likely to respond to the waiting time within the practice (19.4%, 99/509) and the time spent with the patient (18.3%, 110/600). Almost one-third of topics in narrative comments were answered by the physicians (30.66%, 382/1246)., Conclusions: So far, only a minority of physicians have taken the chance to respond on the Web to patient ratings. This is likely because of (1) the low awareness of PRWs among physicians, (2) the fact that only a few PRWs enable physicians to respond on the Web to patient ratings, and (3) the lack of an active moderator to establish peer-to-peer communication. PRW providers should foster more frequent communication between the patient and the physician and encourage physicians to respond on the Web to patient ratings. Further research is needed to learn more about the motivation of physicians to respond or not respond to Web-based patient ratings., (©Martin Emmert, Lisa Sauter, Lisa Jablonski, Uwe Sander, Fatemeh Taheri-Zadeh. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.07.2017.)

Objective: Hospitals report cards (HRC) are publicly available Internet websites that provide patients with quality-related information on hospitals and enable hospital comparisons. We aim to identify factors that explain the (intended) use of HRC, including differences between current users and non-users., Methods: Drawing on UTAUT (Unified Theory of Acceptance and Use of Technology), a cross-sectional study was conducted. Data were derived from an online survey with 1350 respondents and analyzed using structural equation modeling., Results: 42% of the survey participants had already used HRC to search for a hospital. Performance expectancy, facilitating conditions, and attitude were found to be significantly related to HRC use intention, with notable differences between users and non-users. Effort expectancy and social influence did not show any significant effects in both subsamples., Conclusion: Patients consider HRC to be a useful instrument and are willing to make the efforts it takes to use HRC. The greater effect of performance expectancy in the non-user sample (compared to the user sample) indicates a certain disillusion among users., Practice Implications: Health policy makers should focus on reviewing and restructuring the information content of HRC. In addition, coordinated efforts are still required to facilitate HRC access, especially for the 'less fortunate'., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology., Methods: A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists., Results: Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing., Conclusion: Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

Objective: To explore the impact of hospital report card design and incorporation of patient narrative comments on consumers' choices of hospitals., Data Sources: Primary data collected from an online survey with 1,350 respondents in February, 2015., Study Design: A randomized 2 (narrative comments: yes, no) × 3 (design: representation of clinical performance in textual, star, numerical formats) between-subject online-based cross-sectional experiment., Principal Findings: In 51 percent of all cases, respondents selected the hospital with the best clinical results. Report cards with a numerical design induced choices more focused on clinical ratings (56.0 percent chose the highest rated hospital) than those with textual information (48.1 percent) or star ratings (47.3 percent) (p < .001). Report cards without narrative comments (49.7 percent) and with narratives (51.4 percent) were not associated with significant difference in selecting top-rated clinical hospitals (p = .376). But there were significant interactions affecting choice of hospitals among exposure to narratives, formatting of clinical performance, and respondents' education., Conclusions: Consumers have a difficult time synthesizing quality data in various formats. Hospital report cards continue to pose challenging choices, especially for those with limited education. Narrative comments in their earliest emerging forms do not seem to be altering hospital choice as much as the literature has suggested for other providers, but they may have consequential impact on the choices of certain subsets of consumers., (© Health Research and Educational Trust.)

Background: Evidence from the US has demonstrated that hospital report cards might generate confusion for consumers who are searching for a hospital. So far, little is known regarding hospital ranking agreement on German report cards as well as underlying factors creating disagreement., Objective: This study examined the consistency of hospital recommendations on German hospital report cards and discussed underlying reasons for differences., Methods: We compared hospital recommendations for three procedures on four German hospital report cards. The agreement between two report cards was determined by Cohen's-Kappa. Fleiss' kappa was applied to evaluate the overlap across all four report cards., Results: Overall, 43.40% of all hospitals were labeled equally as low, middle, or top performers on two report cards (hip replacement: 43.2%; knee replacement: 42.8%; percutaneous coronary intervention: 44.3%). In contrast, 8.5% of all hospitals were rated a top performer on one report card and a low performer on another report card. The inter-report card agreement was slight at best between two report cards (κ max =0.148) and poor between all four report cards (κ max =0.111)., Conclusions: To increase the benefit of public reporting, increasing the transparency about the concept of - medical - "quality" that is represented on each report card seems to be important. This would help patients and other consumers use the report cards that most represent one's individual preferences., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A class of novel therapies leverages regenerative cell types in disease microenvironments. This complex interplay challenges established good manufacturing practices, as standards and analytical tools to measure regenerative potency are missing. That is, we can build the product right, but we do not know if we are building the right product. Here, we suggest that organ-chips, biomimetic in vitro phenotyping platforms, can serve as key quality assurance systems in regenerative medicine., (© 2016 American Society for Clinical Pharmacology and Therapeutics.)

Objectives: Recently, the number of hospital report cards that compare quality of hospitals and present information from German quality reports has greatly increased. Objectives of this study were to a) identify suitable methods for measuring the readability and comprehensibility of hospital report cards, b) to obtain reliable information on the comprehensibility of texts for laymen, c) to give recommendations for improvements and d) to recommend public health actions. Methods: The readability and comprehensibility of the texts were tested with a) a computer-aided evaluation of formal text characteristics (readability indices Flesch (German formula) and 1. Wiener Sachtextformel formula), b) an expert-based heuristic analysis of readability and comprehensibility of texts (counting technical terms and analysis of text simplicity as well as brevity and conciseness using the Hamburg intelligibility model) and c) a survey of subjects about the comprehensibility of individual technical terms, the assessment of the comprehensibility of the presentations and the subjects' decisions in favour of one of the 5 presented clinics due to the better quality of data. In addition, the correlation between the results of the text analysis with the results from the survey of subjects was tested. Results: The assessment of texts with the computer-aided evaluations showed poor comprehensibility values. The assessment of text simplicity using the Hamburg intelligibility model showed poor comprehensibility values (-0.3). On average, 6.8% of the words used were technical terms. A review of 10 technical terms revealed that in all cases only a minority of respondents (from 4.4% to 39.1%) exactly knew what was meant by each of them. Most subjects (62.4%) also believed that unclear terms worsened their understanding of the information offered. The correlation analysis showed that presentations with a lower frequency of technical terms and better values for the text simplicity were better understood. Conclusion: The determination of the frequency of technical terms and the assessment of text simplicity using the Hamburg intelligibility model were suitable methods to determine the readability and comprehensibility of presentations of quality indicators. The analysis showed predominantly poor comprehensibility values and indicated the need to improve the texts of report cards., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Aims of this study are to provide (i) a presentation of quality of care information about German hospitals on internet report cards, and (ii) derive a guidance tool for using certain report cards. Methods: We undertook (i) a systematic internet search to identify hospital report cards, (ii) whereby several inclusion and exclusion criteria were applied, (iii) We developed a scheme to describe the presented quality information, (iv) We also analysed the report cards and (v) evaluated the results and derived further usage guidance. Results: 18 report cards were included. 8 report cards present nationwide quality information while ten report cards focus on regional areas. The AOK Krankenhaus-navigator provides the most information about 5 clinical areas of the external quality assurance (§ 137 SGB V). Regarding the remaining 26 clinical areas, the TK Klinikführer, the Barmer Krankenhausnavi, and the Weisse Liste provide the largest amount of quality information. Qualitätskliniken.de reports on 9, the Klinikführer Rheinland on 8, the Bremer Krankenhausspiegel on 4, and the Hamburger Krankenhausspiegel on 2 additional clinical areas. Conclusions: This study shows that a differentiated view for each clinical area is necessary when searching for information about the quality of hospitals. Further studies should assess the quality of the report cards as well as the information that they display., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Physician-rating websites have become a popular tool to create more transparency about the quality of health care providers. So far, it remains unknown whether online-based rating websites have the potential to contribute to a better standard of care., Objective: Our goal was to examine which health care providers use online rating websites and for what purposes, and whether health care providers use online patient ratings to improve patient care., Methods: We conducted an online-based cross-sectional study by surveying 2360 physicians and other health care providers (September 2015). In addition to descriptive statistics, we performed multilevel logistic regression models to ascertain the effects of providers' demographics as well as report card-related variables on the likelihood that providers implement measures to improve patient care., Results: Overall, more than half of the responding providers surveyed (54.66%, 1290/2360) used online ratings to derive measures to improve patient care (implemented measures: mean 3.06, SD 2.29). Ophthalmologists (68%, 40/59) and gynecologists (65.4%, 123/188) were most likely to implement any measures. The most widely implemented quality measures were related to communication with patients (28.77%, 679/2360), the appointment scheduling process (23.60%, 557/2360), and office workflow (21.23%, 501/2360). Scaled-survey results had a greater impact on deriving measures than narrative comments. Multilevel logistic regression models revealed medical specialty, the frequency of report card use, and the appraisal of the trustworthiness of scaled-survey ratings to be significantly associated predictors for implementing measures to improve patient care because of online ratings., Conclusions: Our results suggest that online ratings displayed on physician-rating websites have an impact on patient care. Despite the limitations of our study and unintended consequences of physician-rating websites, they still may have the potential to improve patient care., Competing Interests: Conflicts of Interest: None declared.

This manuscript describes the systematic development of pyridine-type ligands, which promote the Pd catalyzed, non-directed amination of benzene in combination with novel, hydroxylamine-based electrophilic amination reagents. DFT calculations and mechanistic experiments provide insights into the factors influencing the arene C-H amination protocol.