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Zusammenfassung Hintergrund: Im Rahmen des Forschungsprojektes „Ganzheitliches Versorgungsprogramm für ältere Patienten zur Stärkung von spirituellen Bedürfnissen, sozialer Aktivität und Selbstfürsorge in der hausärztlichen Versorgung (HoPES3)“ wird die Implementierung von Spiritual Care in allgemeinärztlichen Praxen untersucht. Forschungsfragen: Wie reagieren kranke ältere Menschen auf das Angebot einer spirituellen Anamnese? Was sind hinderliche Faktoren für spirituelle Gespräche in Hausarztpraxen? Methode: Ärzte und Ärztinnen aus 24 Praxen boten 164 ihrer Patienten und Patientinnen eine spirituelle Anamnese an. Mit 29 der Patienten bzw. Patientinnen wurden bis zu sechs Monate später qualitative leitfadengestützte Interviews geführt. Die Interviews wurden mittels Reflexive Thematic Analysis (RTA) ausgewertet. Ergebnisse: Insgesamt hatten von den 29 befragten Patienten/Patientinnen nur elf das vollständige Anamnesegespräch geführt, die Mehrheit hatte das Gespräch abgelehnt. Als Gründe werden angegeben: Vorbehalte gegenüber religiösen Institutionen, Einschätzung der Thematik als „zu persönlich“ und ein Bedürfnis nach Selbstwirksamkeit. Die Beziehung zum Arzt oder der Ärztin wird mehrheitlich positiv geschildert, gleichzeitig wird ein allgemeines Bedürfnis nach einem Austausch auf Augenhöhe deutlich. Diskussion: In den Reaktionen der Patienten/Patientinnen kann die Wirkung einer Machtasymmetrie in der Arzt-Patienten-Beziehung beobachtet werden, verstärkt durch das strukturelle Setting der Praxis sowie durch Parallelen des Gesundheitssystems mit religiösen Systemen, die bei der spirituellen Anamnese zum Tragen kommen können. Schlussfolgerung: Bei Weiterbildungen im Feld Spiritual Care sollte die Sensibilität für das Thema Machtasymmetrien gestärkt werden.

Background The results of recent surveys indicate that more than 50% of the German population has experience with complementary and alternative medicine (CAM) or uses CAM regularly. This study investigated the CAM usage and CAM-related needs of hospitalized patients at university medical centres in the state of Baden-Württemberg, Germany. Methods A multi-centre, paper-based, pseudonymous survey was carried out by the members of the Academic Centre for Complementary and Integrative Medicine. Patients of all ages, regardless of sex, diagnosis and treatment, who were hospitalized in the Department of Cardiology, Gastroenterology, Oncology, Gynaecology or Surgery at the university medical centres in Freiburg, Heidelberg, Tübingen and Ulm were eligible for inclusion. Results Of the 1275 eligible patients, 67% (n = 854) consented to participate in the survey. Forty-eight percent of the study participants stated that they were currently using CAM. The most frequently used therapies were exercise (63%), herbal medicine (54%) and dietary supplements (53%). Only 16% of the patients discussed CAM usage with their attending physician. Half of the patients (48%) were interested in CAM consultations. More than 80% of the patients desired reliable CAM information and stated that physicians should be better informed about CAM. Conclusions The frequency of CAM usage and the need for CAM counselling among hospitalized patients at university medical centres in Baden-Württemberg are high. To better meet patients’ needs, CAM research and physician education should be intensified. Trial registration German Clinical Trial register (DRKS00015445).

Background Spiritual needs gain importance in old age but are often ignored in health care. Within the ‘Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care (HoPES3)’ a complex intervention was evaluated in a cluster-randomized trial. The aim of this study was to explore the acceptability, feasibility, benefits, and harms of a spiritual history taken by general practitioners (GPs) as part of the complex intervention. Methods In this mixed-methods study telephone interviews with 11 German GPs and 12 medical assistants (MAs) of the HoPES3 intervention group were conducted and analysed using a content-analytical approach. Furthermore, GPs were asked to complete a questionnaire after each spiritual history. One hundred and forty-one questionnaires from 14 GPs were analysed descriptively. Results GPs considered the spiritual history very/quite helpful for the patient in 27% (n= 38) and very/quite stressful in 2% (n = 3) of the cases. Interviews indicated that GPs found discussing spiritual history easier than anticipated. GPs and MAs saw a difficulty in that many patients associated spirituality with religion or church and reacted with surprise or rejection. Benefits for patients were seen in the opportunity to talk about non-medical topics, and increased awareness of their own resources. Benefits for GPs mainly related to information gain and an intensified patient–physician relationship. Conclusions A spiritual history in general practice has the potential to reveal important information about patients’ lives and to improve the patient–physician relationship. Implementation barriers identified in this study have to be considered and addressed.

Background This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy. Methods Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire. Results All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine. Discussion While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited. Conclusion To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/hcz-CKYOk8s

Zusammenfassung Ziel der Studie Aus Perspektive verschiedener Expertengruppen, die in der Versorgung onkologisch Erkrankter tätig sind, werden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsmaßnahmen identifiziert. Darauf aufbauend werden Handlungsempfehlungen zur Optimierung abgeleitet. Die Studie wurde von der Deutschen Rentenversicherung Bund (DRV) gefördert. Methodik Auf Basis einer Interviewstudie (N=61) wurde ein Fragebogeninstrument mit 55 Items zu möglichen Barrieren im Antragstellungsprozess konzipiert und online eingesetzt. Teilnehmer mit mehr als 33% fehlenden Werten wurden von den Analysen ausgeschlossen. Mittelwertanalysen wurden zur Identifikation der bedeutsamsten Relevanz angewendet. Um übergeordnete Dimensionen zu identifizieren, wurde eine exploratorische Faktorenanalyse durchgeführt. Ergebnisse Insgesamt wurden 606 Experten aus dem onkologischen Bereich in die Auswertung eingeschlossen. Darunter waren 249 Ärzte, 194 Sozialarbeiter, 105 Pflegefachkräfte / Medizinische Fachangestellte, 55 Psychologen / Psychoonkologen und 3 sonstige Berufsgruppen. Die befragten Experten waren im Mittel 51 Jahre alt (SD=10,4) und seit 17 Jahren (SD=9,8) im onkologischen Bereich tätig. Die Barrieren konnten folgenden 7 faktoranalytisch bestimmten Inhaltsbereichen zugeordnet werden: Krankheitsverarbeitung, Antragsverfahren, Rehafähigkeit, Koordination, soziale Verpflichtungen, Patientenwünsche und Stellenwert der Reha. Die Experten gaben an, dass insbesondere der Wunsch des Patienten nach Normalität, die zu starre Frist für die Anschlussrehabilitation (AHB) und das für Patienten mit Migrationshintergrund schlecht verständliche Antragsverfahren einer Antragstellung entgegenstehen kann. Außerdem wurde darauf hingewiesen, dass die Vermittlung von multimorbiden Patienten in die Rehabilitationseinrichtungen schwierig sei. Schlussfolgerung Aus der Expertenstudie können folgende Handlungsempfehlungen für einen erleichterten Rehabilitationszugang abgeleitet werden: Optimierung der Koordination zwischen verschiedenen Expertengruppen; Einrichtungen und mit den Kostenträgern, Flexibilisierung der AHB-Frist, Vereinfachung der Antragstellung, Bereitstellung von Anträgen / Informationsmaterialien in weiteren Sprachen, Ausrichtung der Reha-Kliniken auf spezifische Patientengruppen.

Our aim was to explore whether general practitioners (GPs) communicate with cancer patients on complementary and integrative medicine (CIM) in a patient-centred and case-specific manner.We designed two cases of standardised breast cancer patients and allocated 29 GPs to hold a consultation either with Case 1 or Case 2. Case 1 presented with fears of possible physical side effects of hormone treatment. Case 2 feared a loss in social functioning because of nausea and emesis as possible side effects of chemotherapy. Consultations were audiotaped and analysed using the Roter Interaction Analysis System (RIAS). We analysed whether recommended CIM treatments and GPs' focus on psychosocial or medical and therapy-related content differed according to whether they were counselling Case 1 or Case 2.In consultations with Case 1, GPs rather focused on medical and therapy-related content and most often recommended mistletoe, diets and sports. In contrast, GPs focused on psychosocial content and they most often recommended methods of self-care when counselling Case 2.The GPs in our sample reacted case-specifically to the patients' interest in CIM. Such responsive and patient-centred communication is a valuable resource but is often time-consuming. Adequate training and reimbursement should therefore be considered for GPs.

Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process. Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training. Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine. Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice. Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies., Hintergrund: Ein großer Anteil der Bevölkerung in Deutschland nimmt naturheilkundliche, komplementär- und integrativmedizinische Therapieverfahren in Anspruch. Mittlerweile existieren zahlreiche wissenschaftliche Studien, die einen Wirksamkeitsnachweis bei bestimmten Indikationen liefern. An deutschen Medizinischen Fakultäten werden ausgewählte Verfahren und deren Anwendung im Rahmen des Querschnittsbereichs 12 gelehrt, an einigen werden Wahlfächer mit eigenen Schwerpunktsetzungen angeboten. Bislang fehlt jedoch ein strukturiertes Curriculum, welches longitudinal die Lehre über das Medizinstudium hinweg verankert und alle Studierende befähigt, naturheilkundliche und komplementärmedizinische Optionen in der späteren Patientenversorgung zu berücksichtigen und wirksam in den Diagnostik- und Therapieprozess einzubinden. Zielsetzung: Ziel dieses Positionspapiers ist, die Relevanz des Themas für die medizinische Ausbildung darzustellen, begriffliche Klarheit zu schaffen sowie Kernkompetenzen und mögliche Implementierungsmöglichkeiten für die Ausbildung vorzustellen. Methode: Der Ausschuss Integrative Medizin und Perspektivenpluralismus der Gesellschaft für Medizinische Ausbildung erarbeitete in Zusammenarbeit mit dem Forum universitärer Arbeitsgruppen Naturheilverfahren und Komplementärmedizin das vorliegende Positionspapier in einem mehrstufigen konsensualen Prozess. Ergebnisse: Zunächst wurden unterschiedliche Oberbegriffe diskutiert und für die weitere Arbeit eine bestehende Definition für Integrative Medizin und Gesundheit ausgewählt. Darauf aufbauend wurde der Stand der Ausbildung und deren wissenschaftliche Fundierung in Deutschland im internationalen Kontext reflektiert. In einem weiteren Schritt wurde ein Kompetenzprofil für die medizinische Ausbildung, bestehend aus sieben Kompetenzbereichen, entwickelt und im Hinblick auf Naturheilverfahren, komplementäre und integrative Medizin detailliert dargestellt. Implementierungsmöglichkeiten wurden anhand möglicher Anknüpfungspunkte im Curriculum sowie anhand bereits etablierter Best-Practice-Beispiele aufgezeigt. Schlussfolgerung: Trotz unterschiedlicher Schwerpunktsetzungen an den einzelnen Fakultäten ist es gelungen, auf Grundlage einer gemeinsamen Begriffsdefinition eine Übereinkunft über die mögliche Kompetenzentwicklung und Verankerung in der medizinischen Ausbildung zu finden. Aktuell ist die Umsetzung in den Pflicht- und Wahlbereichen sehr heterogen. Im Rahmen der aktuellen Überarbeitung der Approbationsordnung bieten sich vielfache Anknüpfungspunkte für eine Einbindung naturheilkundlicher und komplementärmedizinischer Lehrinhalte insbesondere bei interprofessionellen und allgemeinmedizinischen Lehrangeboten. Durch die Implementierung und Begleitforschung zielgerichteter Lehr-Settings sollten die Grundlagen für eine langfristige und verbindliche Integration in die medizinische Ausbildung gelegt werden. Insgesamt wird deutlich, dass die Lehre im Bereich Naturheilverfahren und komplementäre und integrative Medizin das Potential zur Entwicklung umfangreicher ärztlicher Kernkompetenzen hat.

Zusammenfassung Ziel der Studie In dieser von der Deutschen Rentenversicherung (DRV) Bund geförderten Studie wurden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsleistungen aus Sicht von verschiedenen Expertengruppen untersucht. Methodik In einer exploratorischen multizentrischen qualitativen Querschnittsstudie wurden 61 teilstrukturierte Interviews mit in der onkologischen Versorgung tätigen Experten durchgeführt: Ärzte (n=26), Sozialarbeiter (n=22), Psychologen/Psychoonkologen (n=6), Pflegepersonal/Medizinische Fachangestellte (n=5), Verwaltungsangestellte der DRV (n=2). Mittels eines Leitfadens wurden die Teilnehmer zu ihren Erfahrungen mit Reha-Anträgen sowie ihren Einschätzungen und Bewertungen bezüglich möglicher Barrieren im Prozess der Antragstellung befragt. Die Auswertung der Interviewdaten erfolgte EDV-gestützt nach der qualitativen Inhaltsanalyse von Mayring. Ergebnisse Die Befragten waren im Mittel 52,51 Jahre alt (SD=10,06; min=25, max=71) und arbeiteten im Durchschnitt seit 19,26 Jahren (SD=10,15; min=1, max=42) in der Beratung oder Behandlung von onkologischen Patienten. Insgesamt wurden 854 Aussagen codiert und den folgenden drei Hauptkategorien zugeordnet: Expertenbezogene, Systembezogene und Patientenbezogene Barrieren. Zentral in der erstgenannten Hauptkategorie war die Skepsis bezüglich des Nutzens von Rehabilitationsleistungen und ein unzureichend gedeckter Informationsbedarf aufseiten der Experten. In der Hauptkategorie Systembezogene Barrieren wurden Aspekte erwähnt, die das Antragsverfahren, die geringe Verfügbarkeit z. B. von ambulanten Reha-Angeboten sowie die Abwesenheit eines funktionierenden Zuweisungssystems thematisierten. Die Hauptkategorie Patientenbezogene Barrieren umfasste psychosoziale Faktoren, wie bspw. verschiedene Themen der Krankheitsverarbeitung, wie den Wunsch des Patienten nach Hause zu kommen und den Alltag wieder erleben zu können sowie die Angst, mit der Krankheit konfrontiert zu werden. Schlussfolgerung Durch die explorative Studie konnten potenzielle Barrieren bei der Beantragung von onkologischen Rehabilitationsleistungen aus Expertensicht abgebildet werden. Die Befunde bilden insbesondere die Grundlage für ein multidimensionales Assessmentinstrument, mittels dessen die Barrieren standardisiert erfasst und individuelle Handlungsempfehlungen abgeleitet werden können.

To understand if GPs’ spiritual competence, their personal spirituality and attitude towards enquiring about spirituality in practice interrelate, we conducted a cross-sectional survey of 30 German GPs regarding issues of SC. We found correlations between GPs’ personal spirituality, their spiritual competence and their attitudes towards SC. The ability to perceive spiritual needs of patients was the competence most strongly related to GPs’ attitude towards SC. The competence with the strongest correlation to personal spirituality was Self-awareness and Proactive opening. No correlation was found between affiliation to a spiritual community and GPs’ attitude towards SC. The results show that GPs’ personal spirituality and spiritual competence are indeed related to addressing spirituality with their patients. To foster SC, training programmes should raise awareness for one’s personal spirituality and encourage one to reflect on spiritual competence.

According to international literature, patients with cancer wish to have information on complementary and integrative healthcare (CIH). Medical guidelines recommend actively approaching patients with cancer discussing potential benefits and risks of individual CIH methods. While some CIH methods, for example, acupuncture and yoga, have been proven effective in high-quality studies, other CIH methods lack studies or bear the risk of interactions with chemotherapeutics, for example, herbal drugs. Therefore, an evidence-based interprofessional counselling programme on CIH will be implemented at four Comprehensive Cancer Centres in the federal state of Baden-Wuerttemberg, Germany.A complex intervention consisting of elements on patient, provider and system levels will be developed and evaluated within a multilayer evaluation design with confirmatory evaluation on patient level. Patients with a cancer diagnosis within the last 6 months will receive three individual counselling sessions on CIH within 3 months (=intervention on patient level). The counselling will be provided by an interprofessional team of medical and nursing staff. For this purpose, an intensive online training programme, a CIH knowledge database and an interprofessional team-building process were developed and implemented (=intervention on provider level). Moreover, training events on the basics of CIH are offered in the outpatient setting (=intervention on system level). Primary outcome of the evaluation at the patient level is patient activation measured (PAM) with the PAM-13 after 3 months. Secondary outcomes, for example, quality of life, self-efficacy and clinical parameters, will be assessed at baseline, after 3 months and at 6 months follow-up. The intervention group (n=1000) will be compared with a control group (n=500, treatment as usual, no CIH counselling. The outcomes and follow-up times in the control group are the same as in the intervention group. Moreover, the use of health services will be analysed in both groups using routine data. A qualitative-quantitative process evaluation as well as a health economic evaluation will identify relevant barriers and enabling factors for later roll-out.The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen, No. 658/2019BO1. The results of these studies will be disseminated to academic audiences and in the community.DRKS00021779; Pre-results.

Background: The “Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care” (HoPES3) examines the implementation of a spiritual history (SH) as part of a multifaceted intervention in German general practices. While the effectiveness of the interventions was evaluated in a cluster-randomized trial, this article investigates the patients’ views concerning the acceptability of the SH and its effects. Methods: A mixed-methods study was conducted in which 133 patients of the intervention group filled in a standardized questionnaire after the intervention. Later, 29 of these patients took part in qualitative semi-standardized interviews. Results: According to the survey, 63% (n = 77) of patients found the SH helpful. In the interviews, however, many indicated that they either kept the conversation brief or declined the offer to talk about spirituality. Contents of longer conversations referred to difficult life events, personal sources of strength, and experiences with religious institutions. Many patients who had a longer conversation about spirituality reported that their relationship with their general practitioner (GP) had improved. Almost all patients recommended integrating a personal conversation of this kind into primary care. Conclusions: The SH seems to be a possible ‘door opener’ for a trusting doctor-patient relationship, which can then be built upon.

In the research project HoPES3, the effectiveness of a multifaceted intervention, where one of the aims was to encourage social activities among older patients, was investigated in a cluster-randomised controlled trial. Patients were offered a conversation about their spirituality (spiritual history) which also included questions about their social relationships. The aim of this study was to examine patients' experiences regarding the acceptability, feasibility, conversational content and perceived benefits and harms of the interventions focusing on social relationships and activities.Semi-structured interviews with 29 patients of the intervention group aged 70 years or older.Loneliness in old age is the result of a long history with underlying complex reasons. Activities proposed by the practice team were rarely carried out, but if they were, patients reported strong benefits. Patients reported their GPs' interest in their lives had resulted in a more trusting doctor-patient relationship. Almost all patients recommended to implement the intervention in general practices.When raising the topic of loneliness, it is crucial to give patients the opportunity to explain the biographical developments which led to their situation. Therefore, embedding the conversation into a broader context such as a spiritual history might be helpful.

OBJECTIVE The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. METHODS We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. RESULTS Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier-dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small- to medium-sized effects. CONCLUSION Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient-oriented publications. Suggestions for improving patients' health services accessibility are made.

About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113, 95% CI [1.056–1.174], p &lt, 0.001) or self-confidence in managing their chronic condition (OR: 1.188, 95% CI [1.048–1.346], 0.007) also showed higher adherence. Lonely patients (OR: 0.420, 95% CI [0.267–0.660], 0.001) and those with a need for inner peace (OR: 0.613, 95% CI [0.444–0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications’ usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety.

BACKGROUND: Self-efficacy is decisive for the quality of life of elderly, multimorbid persons. It may be possible to strengthen patients’ self-efficacy can be strengthened by the targeted reinforcement of individual spirituality, social activity, and self-care. This hypothesis was tested with the aid of a complex intervention. METHODS: A non-blinded, exploratory, cluster-randomized, controlled trial was carried out, with primary care practices as the randomization unit (registration number DRKS00015696). The patients included were at least 70 years of age, had at least three chronic diseases, were taking at least three medications, and were participating in a disease management program. In the intervention group, primary care physicians took a spiritual history, and medical assistants advised the patients on the use of home remedies (e.g., tea, application of heat/cold) and on regionally available programs for the elderly. The primary endpoint—health-related self-efficacy, measured using the SES6G scale—and further, secondary endpoints were evaluated with multistep regression analyses. RESULTS: Data from 297 patients treated in 24 primary care practices were evaluated. The analysis of the primary endpoint indicated no effect (mean difference between study arms 0.30 points, 95% confidence interval [-0.21; 0.81], d = 0.14, p = 0.25). Subgroup analysis revealed the following situation for the secondary endpoint “mental well-being” (SF-12 subscale): patients who had already been using home remedies before the trial began experienced a marked improvement (a difference of 7.3 points on a scale from 0 to 100; d = 0.77, p < 0.001). This was also the case for patients who stated that spirituality played a major role in their lives (a difference of 6.2 points on a scale from 0 to 100; d = 0.65; p = 0.002). CONCLUSION: The main hypothesis concerning health-related self-efficacy was not confirmed. The results of the analysis of secondary parameters indicate that some subgroups of patients can benefit from the interventional approach.

Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.

From the perspective of various expert groups involved in the care of oncological patients, barriers to the application process of oncological rehabilitation programs will be identified. The study was funded by the German Pension Insurance Association (DRV).Based on an interview study (N=61), a questionnaire instrument with 55 items describing possible barriers in the application process was designed and implemented online. Participants with more than 33% missing values were excluded from the analyses. Mean value analyses were used to identify the most significant relevance. To identify overall dimensions an explorative factor analysis was conducted .A total of 606 experts from the oncological field were included in the analyses. Among them were 249 doctors, 194 social workers, 105 nurses / medical assistants, 55 psychologists / psycho-oncologists and three other professional groups. The queried experts were on average 51 years old (The following recommendations for action to facilitate access to rehabilitation can be derived from the expert study: optimization of the coordination between different expert groups, institutions and the cost units, flexibilisation of the deadline for follow-up, simplifying the application process, providing applications/information material in additional languages, orienting rehabilitation clinics towards specific patient groups.Aus Perspektive verschiedener Expertengruppen, die in der Versorgung onkologisch Erkrankter tätig sind, werden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsmaßnahmen identifiziert. Darauf aufbauend werden Handlungsempfehlungen zur Optimierung abgeleitet. Die Studie wurde von der Deutschen Rentenversicherung Bund (DRV) gefördert.Auf Basis einer Interviewstudie (N=61) wurde ein Fragebogeninstrument mit 55 Items zu möglichen Barrieren im Antragstellungsprozess konzipiert und online eingesetzt. Teilnehmer mit mehr als 33% fehlenden Werten wurden von den Analysen ausgeschlossen. Mittelwertanalysen wurden zur Identifikation der bedeutsamsten Relevanz angewendet. Um übergeordnete Dimensionen zu identifizieren, wurde eine exploratorische Faktorenanalyse durchgeführt.Insgesamt wurden 606 Experten aus dem onkologischen Bereich in die Auswertung eingeschlossen. Darunter waren 249 Ärzte, 194 Sozialarbeiter, 105 Pflegefachkräfte / Medizinische Fachangestellte, 55 Psychologen / Psychoonkologen und 3 sonstige Berufsgruppen. Die befragten Experten waren im Mittel 51 Jahre alt (SD=10,4) und seit 17 Jahren (SD=9,8) im onkologischen Bereich tätig. Die Barrieren konnten folgenden 7 faktoranalytisch bestimmten Inhaltsbereichen zugeordnet werden: Krankheitsverarbeitung, Antragsverfahren, Rehafähigkeit, Koordination, soziale Verpflichtungen, Patientenwünsche und Stellenwert der Reha. Die Experten gaben an, dass insbesondere der Wunsch des Patienten nach Normalität, die zu starre Frist für die Anschlussrehabilitation (AHB) und das für Patienten mit Migrationshintergrund schlecht verständliche Antragsverfahren einer Antragstellung entgegenstehen kann. Außerdem wurde darauf hingewiesen, dass die Vermittlung von multimorbiden Patienten in die Rehabilitationseinrichtungen schwierig sei.Aus der Expertenstudie können folgende Handlungsempfehlungen für einen erleichterten Rehabilitationszugang abgeleitet werden: Optimierung der Koordination zwischen verschiedenen Expertengruppen; Einrichtungen und mit den Kostenträgern, Flexibilisierung der AHB-Frist, Vereinfachung der Antragstellung, Bereitstellung von Anträgen / Informationsmaterialien in weiteren Sprachen, Ausrichtung der Reha-Kliniken auf spezifische Patientengruppen.

Introduction: Self-care includes taking care of our psychosocial health. Many experts agree that self-care should be included in training for Family Medicine (FM) residents, though it is unclear to what extent and by what means. Objective: The aim of this study was to evaluate competencies of FM residents in self-care and changes in knowledge, skills and attitudes after an educational compact intervention. Methods: The authors performed a pre-post comparison on residents who were registered in the FM residency program KWBW VerbundweiterbildungPLUS© (n = 401). FM residents were offered participation in a self-care training (270 minutes featuring a broad spectrum of input and practical experience). The intervention group (IG) completed a questionnaire directly before the seminar (T1) and 10 weeks afterwards (T2). Non-attendees (=control group; CG) were asked to fill out a basic questionnaire once. Basic questionnaires for IG and CG covered previous experiences and skills while the follow-up questionnaire at T2 also focused on change of competencies and attitudes. All questionnaires contained free-text questions to capture qualitative impressions. Results: 287 FM residents (IG: n = 212; CG: n = 75) participated in the study. Generally, 86.4% of FM residents had worried that their profession might endanger their personal health (T1: n = 180, CG: n = 68). At T2, 59.5% of IG (n = 66/111) declared that they would not worry about their personal health anymore (T1:T2, p Conclusion: A compact intervention in self-care strengthens competencies, increases awareness, and helps FM residents identify their psychosocial health risks. Further research is necessary to specify the effectiveness of similar compact interventions in self-care and their long-term results.

In this study, which was funded by the German Federal Pension Fund (DRV), barriers in the application process for oncological rehabilitation services were examined from the perspective of various expert groups.In an exploratory multicentre qualitative cross-sectional study 61 semi-structured interviews with experts working in oncological care were conducted: Physicians (n=26), social workers (n=22), psychologists/psycho-oncologists (n=6), nurses/medical assistants (n=5), administrative staff of the DRV (n=2). In guided interviews the participants were asked about their experiences with rehabilitation applications as well as their estimations and evaluations regarding possible reasons for non-utilisation. The evaluation of the interviews was computerized and based on the qualitative content analysis by Mayring.The respondents had an average age of 52.51 years (SD=10.06; min=25, max=71) and were working in the consultation or treatment of oncological patients for an average of 19.26 years (SD=10.15; min=1, max=42). In total, 854 statements were coded and assigned to the following three main categories: expert-related, system-related and patient-related barriers. In the first main category, scepticism about the benefits of rehabilitation services and an insufficiently met need for information on the part of experts became the focus of attention. In the main category of system-related barriers, aspects were mentioned that addressed the application procedure, the low availability of, for example, outpatient rehabilitation services and the absence of a functioning referral system. The main category of patient-related barriers included psychosocial factors such as subcategories on the topic of coping with the disease which include the patient's desire to come home, experience everyday life again and the fear of being confronted with the disease.The exploratory study revealed potential barriers in the application process for oncological rehabilitation services from an expert perspective. In particular, the findings form the basis for a multi-dimensional assessment instrument that can be used to analyze the barriers in a standardised way and to derive individual recommendations for action.In dieser von der Deutschen Rentenversicherung (DRV) Bund geförderten Studie wurden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsleistungen aus Sicht von verschiedenen Expertengruppen untersucht.In einer exploratorischen multizentrischen qualitativen Querschnittsstudie wurden 61 teilstrukturierte Interviews mit in der onkologischen Versorgung tätigen Experten durchgeführt: Ärzte (n=26), Sozialarbeiter (n=22), Psychologen/Psychoonkologen (n=6), Pflegepersonal/Medizinische Fachangestellte (n=5), Verwaltungsangestellte der DRV (n=2). Mittels eines Leitfadens wurden die Teilnehmer zu ihren Erfahrungen mit Reha-Anträgen sowie ihren Einschätzungen und Bewertungen bezüglich möglicher Barrieren im Prozess der Antragstellung befragt. Die Auswertung der Interviewdaten erfolgte EDV-gestützt nach der qualitativen Inhaltsanalyse von Mayring.Die Befragten waren im Mittel 52,51 Jahre alt (SD=10,06; min=25, max=71) und arbeiteten im Durchschnitt seit 19,26 Jahren (SD=10,15; min=1, max=42) in der Beratung oder Behandlung von onkologischen Patienten. Insgesamt wurden 854 Aussagen codiert und den folgenden drei Hauptkategorien zugeordnet: Expertenbezogene, Systembezogene und Patientenbezogene Barrieren. Zentral in der erstgenannten Hauptkategorie war die Skepsis bezüglich des Nutzens von Rehabilitationsleistungen und ein unzureichend gedeckter Informationsbedarf aufseiten der Experten. In der Hauptkategorie Systembezogene Barrieren wurden Aspekte erwähnt, die das Antragsverfahren, die geringe Verfügbarkeit z. B. von ambulanten Reha-Angeboten sowie die Abwesenheit eines funktionierenden Zuweisungssystems thematisierten. Die Hauptkategorie Patientenbezogene Barrieren umfasste psychosoziale Faktoren, wie bspw. verschiedene Themen der Krankheitsverarbeitung, wie den Wunsch des Patienten nach Hause zu kommen und den Alltag wieder erleben zu können sowie die Angst, mit der Krankheit konfrontiert zu werden.Durch die explorative Studie konnten potenzielle Barrieren bei der Beantragung von onkologischen Rehabilitationsleistungen aus Expertensicht abgebildet werden. Die Befunde bilden insbesondere die Grundlage für ein multidimensionales Assessmentinstrument, mittels dessen die Barrieren standardisiert erfasst und individuelle Handlungsempfehlungen abgeleitet werden können.

BackgroundIn today's Western societies a high percentage of people experience increased or chronic stress. Acupuncture could serve as treatment for persons affected adversely by the increased stress.MethodsThe AkuRest study was a two-centre randomized controlled pilot study in adult persons with increased stress levels. Participants were randomly allocated to one of three groups: verum acupuncture treatment, sham acupuncture, and a waiting control group. The feasibility of the study was assessed. In addition, effects on stress level (measured by the Perceived Stress Questionnaire (PSQ-20)) and other variables were assessed at the end of treatment and a 3-month follow-up.ResultsAltogether, N = 70 persons were included in the study. At the end of the treatment 15.7% were lost to follow-up. The adherence to the protocol was good: 82.9% of the participants completed 100% of their treatment. The stress level of the participants was high at baseline (mean PSQ-20 score 75.5, SD = 8.2). Effect sizes (ES) at T1 showed that verum and sham acupuncture were superior to the waiting condition in reducing stress (ES (verum) = -1.39, 95%-CI = [-2.11; -0.67]: ES (sham) = -1.12, CI = [-1.78;-0.44]). At follow-up, effect sizes were in favour of the verum group (as compared to sham). However, confidence intervals and t-tests showed that these differences were not significant.ConclusionThe pilot study demonstrated the feasibility of the acupuncture RCT in persons with increased stress levels. Estimated parameters can be used to design a larger RCT to prove the-here indicated-efficacy of verum acupuncture to decrease stress.Trial registration numberISRCTN15259166.

Zusammenfassung Hintergrund In der deutschen Approbationsordnung für Ärzte sind Inhalte aus den Bereichen der Naturheilverfahren und Komplementärmedizin im Querschnittsbereich 12 „Rehabilitation, physikalische Medizin, Naturheilverfahren“ (QB12) curricular verankert. Diese werden an der Universität Heidelberg als Pflicht- und Prüfungsfach in Form von Vorlesungen und Praktika in Kleingruppen unterrichtet. In der vorliegenden Studie wurde die Evaluation von Medizinstudierenden im Bereich der Komplementärmedizin ausgewertet mit dem Ziel, Haltung, Lernbedürfnisse und Interessen von Studierenden in diesem Bereich zu explorieren. Methoden Die Lehrveranstaltungen wurden von Beginn an im Rahmen der fakultätseigenen Lehrevaluation wissenschaftlich begleitet. Die Freitexte der Evaluationen zwischen dem Wintersemester 2011/2012 und dem Sommersemester 2013 wurden gesammelt und mittels qualitativer Inhaltsanalyse nach Mayring ausgewertet. Ergebnisse Die Freitexte wurden in 3 deduktive Hauptkategorien (Haltung, Lernbedürfnisse und Interessen) und in weitere Subkategorien unterteilt. Als zentrales Thema fällt die Polarisierung unter den Medizinstudierenden im Hinblick auf Komplementärmedizin auf, die von regem Widerstand bis zu großer Begeisterung reicht. Auffällig häufig waren Kommentare, die erkennen ließen, dass Studierende eine hohe Erwartungshaltung in dem Sinne zeigen, dass sie von einem komplementärmedizinischen Thema oder einer Methode überzeugt werden wollen. Dies war insbesondere bei Lehrinhalten zu nicht medikamentösen Verfahren zu erkennen. Diskussion Aus den Ergebnissen geht hervor, dass die theoretische Vermittlung komplementärmedizinischer Lehrinhalte kombiniert mit praktischen Erfahrungen „am eigenen Leib“ zur kritischen Reflexion und zur Entwicklung einer ganzheitlichen, patientenorientierten Haltung unter Medizinstudierenden beitragen kann. Diese Ergebnisse können als Grundlage für die Planung, Implementierung und Umsetzung komplementärmedizinischer Lehre an anderen universitären Standorten dienen.

ZusammenfassungDas Ziel der qualitativen Studie war es, die Erfahrungen psychisch Erkrankter mit der Versorgung im NetzWerk psychische Gesundheit (NWpG) zu erheben. Die Rekrutierung erfolgte über die Netzwerke. Es fanden Fokusgruppen mit insgesamt 40 Patienten in 5 Netzwerken statt. Die Analyse der Fokusgruppen wurde mittels qualitativer Inhaltsanalyse durchgeführt. Die Versorgung im NWpG wurde durchwegs positiv wahrgenommen. Bedürfnisorientiertheit, 24-Stunden-Erreichbarkeit per Telefon, der Einbezug von Angehörigen sowie auch aufsuchende Betreuung wurden als relevant für die eigene Versorgung erlebt. Ein eigenverantwortliches und selbstständiges Dasein wird durch das NWpG gezielt unterstützt.

In 2002, the new version of the German Medical Licensure Act integrated Naturopathy and Complementary Medicine into the cross-sectoral unit 12 "Rehabilitation, Physical Medicine and Naturopathy" (QB12) of the medical undergraduate course. At the University of Heidelberg, Complementary Medicine (CAM) is an obligatory clinical subject of the medical undergraduate curriculum and is delivered in the form of lectures and small group work. As a central educational objective, medical students should be able to explain the principles of classical Naturopathy and the most commonly used CAM procedures. The aim was to explore the attitudes, learning needs and interests of medical students with regard to Naturopathy and CAM, and thus establish the teaching requirements. The lectures and internships were evaluated using a faculty-based teaching evaluation form. The free-text of the evaluation forms between winter semester 2011/2012 and summer semester 2013 were assessed using Mayring qualitative content analysis. The free-texts were divided into three deductive main categories (Attitudes, Learning Needs and Interests) and further subcategories. A central topic was the polarization of views in medical students regarding CAM; it ranged from lively resistance to great enthusiasm. Strikingly, comments often showed that students had significant reservations with respect to CAM and would require further evidence from the teachers in order to embrace this concept. This was particularly prominent in the use of non-pharmaceutical methods. Our results show that evidence-based teaching, combined with practical experience, contributes positively to the critical appraisal of CAM amongst medical students. These findings can serve as the basis for planning, implementation and realization of CAM teaching within mainstream undergraduate medical education. In der deutschen Approbationsordnung für Ärzte sind Inhalte aus den Bereichen der Naturheilverfahren und Komplementärmedizin im Querschnittsbereich 12 „Rehabilitation, physikalische Medizin, Naturheilverfahren“ (QB12) curricular verankert. Diese werden an der Universität Heidelberg als Pflicht- und Prüfungsfach in Form von Vorlesungen und Praktika in Kleingruppen unterrichtet. In der vorliegenden Studie wurde die Evaluation von Medizinstudierenden im Bereich der Komplementärmedizin ausgewertet mit dem Ziel, Haltung, Lernbedürfnisse und Interessen von Studierenden in diesem Bereich zu explorieren. Die Lehrveranstaltungen wurden von Beginn an im Rahmen der fakultätseigenen Lehrevaluation wissenschaftlich begleitet. Die Freitexte der Evaluationen zwischen dem Wintersemester 2011/2012 und dem Sommersemester 2013 wurden gesammelt und mittels qualitativer Inhaltsanalyse nach Mayring ausgewertet. Die Freitexte wurden in 3 deduktive Hauptkategorien (Haltung, Lernbedürfnisse und Interessen) und in weitere Subkategorien unterteilt. Als zentrales Thema fällt die Polarisierung unter den Medizinstudierenden im Hinblick auf Komplementärmedizin auf, die von regem Widerstand bis zu großer Begeisterung reicht. Auffällig häufig waren Kommentare, die erkennen ließen, dass Studierende eine hohe Erwartungshaltung in dem Sinne zeigen, dass sie von einem komplementärmedizinischen Thema oder einer Methode überzeugt werden wollen. Dies war insbesondere bei Lehrinhalten zu nicht medikamentösen Verfahren zu erkennen. Aus den Ergebnissen geht hervor, dass die theoretische Vermittlung komplementärmedizinischer Lehrinhalte kombiniert mit praktischen Erfahrungen „am eigenen Leib“ zur kritischen Reflexion und zur Entwicklung einer ganzheitlichen, patientenorientierten Haltung unter Medizinstudierenden beitragen kann. Diese Ergebnisse können als Grundlage für die Planung, Implementierung und Umsetzung komplementärmedizinischer Lehre an anderen universitären Standorten dienen.

To analyze the short-term thermogenic effects of footbaths with warm water alone (WA) versus when combined with medicinal powders.Randomized controlled trial with cross-over.Seventeen healthy volunteers (mean age 22.1 years, SD = 2.4; 11 female) received three footbaths with WA or WA combined with mustard (MU) or ginger (GI) in a randomized order. Self-perceived warmth (Herdecke warmth perception questionnaire) and actual skin temperatures (thermography) were assessed before (t0), immediately after footbaths (t1), and 10 minutes later (t2). The primary outcome was perceived warmth in the feet. Secondary outcomes were warmth perception in the face, hands and overall, as well as actual skin temperature in the feet, face, and hands.Perceived warmth at the feet (primary outcome) increased significantly (all p's.001) for MU and GI at t1 as well as for GI at t2 when compared to t0 with high effect sizes. At t2, GI differed significantly from WA (p .001) and MU (p = .048). With regards to the secondary measures of outcome, no significant effects were seen for perceived warmth at the face or hands. Overall warmth was significantly higher at t1 compared to t0 (p = .01). Thermography assessments of skin temperature at the feet at t1 increased after all conditions (p .001). No effects were seen in the face. At the hands, temperature decreased at t1 (p = .02) and t2 compared to t0 (p .001).The present study provides preliminary evidence that mustard and ginger increase warmth perception at the feet more than warm water alone, with only the effects for GI enduring at the brief follow-up.

The aim of the qualitative study was the evaluation of experiences with integrated care especially with the care in network "NetzWerk psychische Gesundheit" (NWpG) from the perspective of mental ill patients. The patients were recruited from the NWpG. Focus groups were conducted in five of these networks and analyzed with qualitative content analysis. 40 mental ill patients participated on the focus groups. Overall, they were very positive about their care in such a network. Especially, aspects like need orientation, 24/7 telephone hotline, involvements of relatives as well as outreach care has been experienced as a support for their own care. The health care in NWpG seems to be important for an independent existence and presents relevant components for an autonomous life.Das Ziel der qualitativen Studie war es, die Erfahrungen psychisch Erkrankter mit der Versorgung im NetzWerk psychische Gesundheit (NWpG) zu erheben. Die Rekrutierung erfolgte über die Netzwerke. Es fanden Fokusgruppen mit insgesamt 40 Patienten in 5 Netzwerken statt. Die Analyse der Fokusgruppen wurde mittels qualitativer Inhaltsanalyse durchgeführt. Die Versorgung im NWpG wurde durchwegs positiv wahrgenommen. Bedürfnisorientiertheit, 24-Stunden-Erreichbarkeit per Telefon, der Einbezug von Angehörigen sowie auch aufsuchende Betreuung wurden als relevant für die eigene Versorgung erlebt. Ein eigenverantwortliches und selbstständiges Dasein wird durch das NWpG gezielt unterstützt.

Background: As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives’ experiences with severely mentally ill patients in different integrated care service providers. Methods: Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. Results: Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges. Conclusion: Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.

In previous studies by the same research group it has been shown in post-stroke patients that the autonomic system can be affected by acupuncture. Within this study, teleacupuncture between China and Austria is used for quantifying the effects of heart rate variability (HRV) in Chinese patients suffering from depression. In 22 Chinese depression patients (17 f, 5 m; mean age ± SD 52.3 ± 10.6 years; range 31 - 70 years) electrocardiographic signals before, during and after acupuncture at the acupoint Jianshi (PC 5) were recorded in Harbin and analyzed in Graz using teleacupuncture via internet. HRV data were analyzed in the time and frequency domain and a protocol from Austria was sent to the team in China immediately after the treatment and recording session. Mean heart rate decreased significantly (p < 0.001) during and after acupuncture, whereas total HRV increased significantly during (p < 0.034) and after (p < 0.001) acupuncture, always immediately following manual needle stimulation. Furthermore, there is a marked decrease in balance between sympathetic and parasympathetic activity (low frequency/high frequency HRV ratio) during treatment. This study shows that HRV could be a useful parameter for quantifying clinical effects of acupuncture on the autonomic nervous system. Teleacupuncture between China and Austria over a distance of more than 8,500 km has been successfully used.

Rationale Poststernotomy pain and impaired breathing are common clinical problems in early postoperative care following heart surgery. Insufficiently treated pain increases the risk of pulmonary complications. High-dose opioids are used for pain management, but they may cause side effects such as respiratory depression. Study Design We performed a prospective, randomized, controlled, observer-blinded, three-armed clinical trial with 100 patients. Group 1 (n = 33) and Group 2 (n = 34) received one 20 min session of standardized acupuncture treatment with two different sets of acupoints. Group 3 (n = 33) served as standard analgesia control without additional intervention. Results Primary endpoint analysis revealed a statistically significant analgesic effect for both acupuncture treatments. Group 1 showed a mean percentile pain reduction (PPR) of 18 % (SD 19, P Conclusion Acupuncture revealed specific analgesic effects after sternotomy. Objective measurement of poststernotomy pain via lung function test was possible

Background. Acupuncture has been reported to affect the human autonomic system. Within this pilot study, teleacupuncture between China and Austria is used for the first time for quantifying the effects of heart rate variability (HRV) in poststroke rehabilitation.Methods. In 29 Chinese post-stroke patients (15 f, 14 m; mean age ± SD64.7±11.3years; range 40–80 years) electrocardiographic signals before, during, and after acupuncture at the acupoint Tongli (HT 5) were recorded in Harbin and analyzed in Graz using teleacupuncture via internet. HRV data were analyzed in the time and frequency domain, and a protocol from Austria was sent to the team in China immediately after the treatment and recording session.Results. Acupuncture does not change heart rate in the post-stroke patients; however, total HRV increased significantly (P<.05) during and 5–10 minutes after acupuncture. In addition, balance between sympathetic and parasympathetic activity (low frequency/high frequency HRV ratio) changes markedly during treatment.Conclusions. Based on innovative HRV analysis, it could be demonstrated that teleacupuncture between China/Harbin and Austria/Graz over a distance of about 8,500 km is no longer a future vision; it has become reality.