Suchergebnisse

Aim: This study examined modifications in secondary preventive medication between the time of hospital discharge (HD) and during a 6-month follow-up treatment of outpatients with acute coronary syndromes (ACS) and stroke. Subjects and methods: During a 6-month period, a health diary was completed on a weekly basis by 98 patients who were initially hospitalised with ACS and 29 patients with strokes in the Cologne area (Germany). Changes in medication between the time of HD and follow-up treatment (weeks 2, 12, and 24) were recorded. Results: On average, patients with ACS took six medications, whereas patients with stroke took five medications per day. ACS patients received beta-blockers (96%), lipid-lowering agents (80%), and angiotensin-converting enzyme (ACE) inhibitors (64%) at HD, and no changes in medication were made during follow-up treatment. However, there was a significant decrease in prescriptions of clopidogrel among ACS patients within 6 months, and about 13% of ACS patients did not receive an antiplatelet agent at any time. Stroke patients received beta-blockers (50%), lipid-lowering agents (67%), and antiplatelet agents, such as acetylsalicylic acid (57%) or clopidogrel (27%), at the time of HD, and no significant changes in medication were instituted during follow-up treatment. Conclusion: Treatment of ACS patients with the combination of acetylsalicylic acid and clopidogrel was insufficient, although it has been shown that this combination is highly effective in secondary prevention of ACS. Besides medical reasons, the cost-containment restrictions ("medication budget") for German physicians might explain the observed failure of guideline-oriented medication. Furthermore, no changes in medications occurred regarding blood-pressure- and lipid-lowering agents.

Background: About 30% of doctors working in inpatient and outpatient departments suffer from burnout, characterized, for example, by emotional exhaustion. The prevention of burnout constitutes a great challenge for those responsible for the healthcare system.Aims: Research into the relationship between social capital in hospitals and the occurrence of emotional exhaustion in clinicians is still at an early stage. The aim of the current study is to examine the effects of social capital in the workplace on the emotional exhaustion of clinicians.Method: A questionnaire was posted to 2,644 employees working in four German hospitals, and 1,645 responded. Responses from the 277 clinicians (61%) are analyzed here. The questionnaire looked at symptoms of emotional exhaustion and levels of organizational social capital.Results: Logistic regression identified two significant predictors of emotional exhaustion in clinicians: low self-efficacy and subjectively perceived lower levels of social capital in the hospitals where they worked. The model accounted for 26 % of Nagelkerke's R2.Conclusion: Efforts to create a good working atmosphere, with the readiness to provide mutual support and the pursuit of joint values and objectives within a hospital, may reduce the development of, or even prevent, emotional exhaustion in clinicians.

BACKGROUND: Immigration has taken the central stage in world politics, especially in the developed countries like Germany, where the continuous flow of immigrants has been well documented since 1960s. Strikingly, emerging data suggest that migrant patients have a poorer response to the treatment and lower survival rates in their new host country, raising concerns about health disparities. Herein, we present our investigation on the treatment response rate and cancer survival in German patients with and without an immigrant background that were treated at our comprehensive cancer center in Germany. METHODS: Initially, we considered 8162 cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (April 2002–December 2015) for matched-pair analysis. Subsequently, the German patients with a migration background and those from the native German population were manually identified and catalogued using a highly specific name-based algorithm. The clinical parameters such as demographic characteristics, tumor characteristics, defined staging criteria, and primary therapy were further adjusted. Using these stringent criteria, a total of 422 patients (n = 211, Germans with migration background; n = 211, native German population) were screened to compare for the treatment response and survival rates (i.e., 5-year overall survival, progression-free survival, and time to progression). RESULTS: Compared to the cohort with migration background, the cohort without migration background was slightly older (54.9 vs. 57.9 years) while having the same sex distribution (54.5% vs. 55.0% female) and longer follow-up time (36.9 vs. 42.6 months). We did not find significant differences in cancer survival (5-year overall survival, P = 0.771) and the response rates (Overall Remission Rate; McNemar's test, P = 0.346) between both collectives. CONCLUSION: Contrary to prior reports, we found no significant differences in cancer survival between German patients with immigrant background and native ...