Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2009
[Competition and the legal ramifications of physician advertising].
Various healthcare reforms have spurred the idea of competition among physicians. As physicians compete for a limited pool of patients advertising has become commonplace. ⋯ Especially any advertisement likely to mislead or deceive because of a failure to disclose material facts is prohibited. Important cases of German jurisdiction concerning physician advertising are given.
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Z Evid Fortbild Qual Gesundhwes · Jan 2009
[Integrative assessment of evidence in healthcare: the GRADE system].
Decisions are a double-edged sword: they always and inevitably come with positive and negative consequences. Decisions in healthcare--from a systems level to the individual patient--are not different. This approach acknowledges that for all recommendations and decisions all the important consequences need to be considered. ⋯ If, for example, the evidence for six of seven critical outcomes is of low quality while moderate quality evidence is available for the other critical outcome, the overall quality of evidence is considered low to avoid a false sense of certainty with the assessment of the evidence for a given topic. A recommendation according to GRADE also requires a considerate judgement about the magnitude of the expected balance of benefits and downsides for the important outcomes, the relative values and preferences associated with these outcomes and considerations about the required resources. The international collaboration and acceptance by many organisations is an indicator of GRADE's innovative nature and advances in the assessment of evidence and development of recommendations in the context of healthcare.
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Medical leadership requires specific communication skills in order to meet professional demands. Communicative behaviour is usually highly automated and not necessarily conscious. ⋯ Accordingly, competent medical leadership requires the awareness of individual communication habits as well as the knowledge and ability to use conversation techniques suitable for a specific situational context. The training of leadership-related communication techniques requires the de-automation of existing skills and a problem-oriented construction and re-automation of new communication techniques.
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Z Evid Fortbild Qual Gesundhwes · Jan 2009
[GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice].
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group represents an international collaboration of guideline developers, clinicians, health services researchers and methodologists. Many leading organizations, including the World Health Organization (WHO), use the GRADE approach because it has led to progress in the assessment of evidence and in the development of healthcare recommendations. The GRADE system distinguishes the quality of evidence from the strength of a recommendation. ⋯ The GRADE system includes a systematic approach to evaluate the generalizability of study results to healthcare practice. Judgments about generalizability, better termed directness, are separated into judgments about the availability of direct comparisons between two alternative management strategies and judgments about differences between the population, intervention, comparator to the intervention, and outcomes (PICO) of interest for a given question, and those included in the relevant studies. In addition to providing an overview of the GRADE system, this article focuses on the approach to assessing directness or generalizability.
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Z Evid Fortbild Qual Gesundhwes · Jan 2009
[General legal conditions for prioritisation within the scope of the German Statutory Health Insurance system].
In setting health care priorities the law, and in particular the constitution, has to be obeyed. The social constitutional state must guarantee minimum access to health care. Members of the Statutory Health Insurance (SHI) shall have access to health care services protecting their life and ensuring their participation in society. ⋯ The decisions of the Federal Joint Committee (Gemeinsamer Bundesausschuss) are sophisticated enough but have to respect the rule of law. There are deficits in research on the prioritisation effects of health care law. Diminishing these deficits is a prerequisite for turning political priorities into effective legal provisions.