Search

Introduction: The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort., Methods: An initial item pool was assessed by rehabilitation patients ( N  = 3) in cognitive interviews, rated by physicians and other health professionals ( N  = 11), and then further modified. The final QPL version (16 items) was used by patients ( N  = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant ( N  = 6; k  = 39 interviews)., Results: The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure., Discussion: While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Lukasczik, Wolf and Vogel.)

Purpose: Social work services are a major part of the treatment spectrum in medical rehabilitation. Given new demands and differences in the practical implementation of social work interventions, there is a need for good clinical practice standards of care. Therefore, practice guidelines (PG) for social work in medical rehabilitation facilities were developed. These are intended to support decision-making processes in interventions and give other professions working in rehabilitative care insight into the range of social work services. The PG were developed in a multi-stage process involving experts from social work practice., Methods: A national and international literature search was conducted on the current evidence on social work interventions in medical rehabilitation. In a survey of social work services in inpatient and outpatient medical rehabilitation facilities (all indications except addictive disorders, child/adolescent rehabilitation; N max =311), social workers were asked to provide information on current practice and their expectations towards the PG. On this basis, a preliminary version of the PG was modified and expanded in an expert workshop and evaluated in a second survey of social work services in rehabilitation facilities (N max =184). The results were discussed at a second workshop and on this basis the final PG version was prepared., Results: The PG include information on framework conditions of social work in rehabilitation and on social diagnostics. At the center of the PG are frequent needs and problems of rehabilitation patients. These include work-related problems, social and financial problems, participation of persons with disability, and aftercare/follow-up. Each chapter provides information on needs assessment, the content and scope of suitable interventions, and additional materials and references., Conclusion: The PE are intended as a practical aid, based on both practical expertise and existing scientific evidence, to provide social work staff and other professional groups in rehabilitation with information on social work services and their implementation. The focus of the content reflects the expressed expectations of social services for PE., Competing Interests: Die Autor*innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: To develop, implement and evaluate a health navigator service (HNS) for visitors and guests in a German health resort., Method: Information on local health services providers was collected and included in a database. A complementary national and international literature search was conducted. Health and wellness guests were interviewed about information needs and expectations with respect to a HNS. During the implementation of the HNS, all consultations were continuously documented. In interviews, cooperation partners and stakeholders were asked to evaluate the concept and its potentials., Results: The literature search showed no comparable models or studies. The database was routinely used by the health navigator. In pre-implementation interviews, health and wellness guests stressed the need for neutral and objective counseling provided by a HNS. Routine documentation showed that more than half of the guests using the HNS were older than 65 years. Questions regarding local medical, healthcare and wellness institutions were frequent in consultations. The initial line of work of the HNS was modified during the implementation toward a stronger focus on involvement in health tourism-related issues. Cooperation partners and stakeholders rated this repositioning favorably., Conclusions: The HNS concept was successfully implemented. The realignment of HNS job specifications facilitated its local establishment. An implementation manual is intended to support the transfer of the HNS concept to other health resorts and spas., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Question prompt lists (QPL) are an instrument to promote patient participation in medical encounters by providing a set of questions patients can use during consultations. QPL have predominantly been examined in oncology. Less is known about their use in other contexts. Therefore, we plan to conduct a scoping review to provide an overview of the fields of healthcare in which QPL have been developed and evaluated. MEDLINE/PUBMED, PSYCINFO, PSYNDEX, WEB OF SCIENCE, and CINAHL will be systematically searched. Primary studies from different healthcare contexts that address the following participants/target groups will be included: persons with an acute, chronic, or recurring health condition other than cancer; healthy persons in non-oncological primary preventive measures. There will be no restrictions in terms of study design, sample size, or outcomes. However, only published studies will be included. Studies that were published in English and German between 1990 and 2019 will be examined. Two independent reviewers will apply defined inclusion/exclusion criteria and determine study eligibility in the review process guided by the PRISMA statement.

Background: The sociomedical evaluation by the German Pension Insurance serves the purpose of determining entitlement to disability pensions. A quality assurance concept for the sociomedical evaluation was developed, which is based on a peer Review process. Peer review is an established process of external quality assurance in health care. The review is based on a hierarchically constructed manual that was evaluated in this pilot project., Methods: The database consists of 260 medical reports for disability pension of 12 pension insurance agencies. 771 reviews from 19 peers were included in the evaluation of the inter-rater reliability. Kendall's coefficient of concordance W for more than 2 raters is used as primary measure of inter-rater reliability., Results: Reliability appeared to be heterogeneous. Kendalls W varies for the particular criteria from 0.09 to 0.88 and reached for primary criterion reproducibility a value of 0.37., Conclusion: The reliability of the manual seemed acceptable in the context of existing research data and is in line with existing peer review research outcomes. Nevertheless, the concordance is limited and requires optimisation. Starting points for improvement can be seen in a systematic training and regular user meetings of the peers involved., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (n = 28); two workshops with experts from rehabilitation centers, health payers, and research institutions (n = 14); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers' requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations.

Introduction: Psychosocial patient education programs focusing on work-related issues are a core element in the German statutory pension insurance's profile of requirements (POR) regarding inpatient vocationally oriented medical rehabilitation (VOMR)., Aim: This study aims at analyzing the prevalence of patient education programs focusing on work-related issues in German rehabilitation centers with regard to their content and quality.Data were collected in a national survey on the current state of patient education within medical rehabilitation programs in Germany in 1473 inpatient and outpatient medical rehabilitation centers., Method: Data were analyzed both quantitatively and qualitatively, with free text responses being assigned to categories, drawing upon criteria developed by the German Center of Patient Education and the pension insurance's POR., Results: 283 of the 908 institutions participating in the survey provided information on 454 psychosocial patient education programs focusing on work-related issues. "Unemployment and job training", "work hardening", "stress"/"relaxation" were named most frequently. The criteria derived from the POR regarding group content and from the Center of Patient Education regarding group size and education methods were largely fulfilled., Conclusions: There is a need for existing group programs in VOMR to be further manualized, evaluated and published. More patient education programs focusing on work-related issues should be developed specifically for relevant indications., (© Georg Thieme Verlag KG Stuttgart · New York.)

Vocational orientation in medical rehabilitation has become an important issue in rehabilitation science and practice in Germany. Although a variety of vocationally oriented interventions has been developed in recent years, there is still a lack of consensus with regard to the definition of specific types of interventions as well as relevant criteria (e. g., methods; instruments; duration/frequency; patient groups). Building on preliminary definitions, basic types of vocationally oriented measures/interventions were conceptually modified and refined in the context of a consensual process. 39 experts of various professions were contacted during a 2-stage Delphi survey to evaluate existing definitions of vocationally oriented interventions using key questions. Standardized descriptions of 5 vocationally oriented basic interventions were specified in cooperation with an interdisciplinary panel of experts. Descriptions were published in a workbook and a homepage for researchers and clinicians, which also contain information on the implementation of measures into rehabilitative care as well as good practice examples. The media developed in this project may contribute to the transfer of research results on vocationally oriented rehabilitation into health care practice., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this paper is to outline a current trend in inpatient medical rehabilitation in Germany, i.e. vocationally oriented medical rehabilitation (VOMR). Since employment-related demands and challenges pose a potential source of strain regarding employees' health and work ability, rehabilitative treatment in Germany is increasingly geared towards including work-related issues in diagnostics and therapy. To date, German rehabilitation research and practice have focussed primarily on the development of screening instruments for identifying vocational problems, interface management and inter-sectoral cooperation and the specification and standardisation of vocationally oriented interventions and programmes (e.g. work hardening, group interventions). Further developments in VOMR should examine the varying needs of patients for work-related interventions as well as the neglect of specific subgroups of patients (e.g. long-term unemployed) and topics (e.g. interference between work and other life domains).

A simple new pump geometry for optical excitation of microcavities and vertical-cavity surface-emitting lasers is presented. The technique circumvents the high reflectivity of the cavity stop band by excitation through the substrate at a large angle of incidence. Under these conditions, the reflectivity of the bottom Bragg reflector is small, and optical pumping at any desired photon energy becomes possible. Experimental results for optical excitation with this new geometry are compared with resonant optical pumping through the cavity mode.

Objective: The effect of opposed-phase imaging on the interpretation of MR contrast studies is highlighted., Materials and Methods: A model calculation is performed. It demonstrates the change of signal intensity of an average tumor before and after application of Gd-DTPA on an in-phase and an opposed-phase image, depending on the percentage of fat within the voxels. The effect is then demonstrated, using a small cotton stick soaked with water or a solution of contrast agent representing a tumor before and after i.v. application of Gd-DTPA., Results: If an average enhancing tumor, which is surrounded by fat, occupies less than 50-60% of the slice thickness, it becomes undetectable on opposed-phase images. The reason is that due to signal cancellation on the opposed image, no signal change or even signal decrease results, while signal increase is visible on the in-phase image., Conclusion: In those areas of the body where significant partial volume of a tumor with fat may occur (such as for breast tumors growing along ducts, which are surrounded by fat), severe errors can result. Therefore we explicitly warn from using opposed-image sequences for MR contrast studies.

The functional urethral length (FUL), the maximum urethral closure pressure (MUCP), and the urethro vesical quotient (u/v) have been measured in 32 women suffering from urinary stress incontinence. The pressure was registrated in four different sectors of the urethra (left, posterior, right, anterior). We found statistical significant differences (t-Test, Wilcoxon-Test). The average FUL at the anterior urethral wall was 27.5 mm, at the posterior wall 30.2 mm. Concerning the UVDR and the u/v-quotient we found higher values at the ventral wall than at the posterior and lateral sides (9.79 kPa and 6.87 kPa and 1.63 and 1.14 resp.). Because of spatial different results of pressure distribution along the urethra walls the microtransducer had to be marked to enable the investigator to localize the direction of the pressure chip during registration. The pressure profile should be registrated only at the dorsal or dorsolateral parts of the urethra. Measurements at the anterior walls of the urethra showed no correlation between history, clinical tests, and urodynamic measurements. By reason of the submitted results we developed a new 5-channel microtransducer for simultane measurements of the urethra pressure profile at rest and at stress in four directions and we proved it in patients with and without urinary stress incontinence. New aspects are visible concerning the functional and morphological states of the urethra by use of the spatial urethral pressure profile.