Das Gesundheitswesen
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Das Gesundheitswesen · Mar 2012
[Public health measures at the airport of Hamburg during the early phase of pandemic influenza (H1N1) 2009].
After the World Health Organization issued a global alert for the occurrence of a novel pandemic influenza (H1N1) in 2009, most international airports in Germany implemented intensified public health measures to delay local transmission. At Hamburg airport it was decided not to implement a general entry and exit screening of all travelers during the pandemic influenza (H1N1) 2009. Travelers were advised on symptoms and protective measures by public information displayed in the airport. A mobile Airport Medical Assessment Center (AMAC) for up to 260 persons was used which barred 6 gates from traffic for this reason. Travelers were medically examined by the public health authority after notification from the flight captain according to Article 28 (4) of the International Health Regulations or were referred to the medical assessment by other service providers such as the information desk in the airport. From May to August 2009 n=108 affected travelers were medically examined and advised by the public health authority at the airport. 9 out of 108 affected travelers (8.3%) who presented to the public health service at the airport were diagnosed with pandemic influenza (H1N1) 2009. Overall, only 0.002% of all travelers through the airport in the given time-frame were seen by the service. Most of the affected travelers presented themselves to the public health service before embarkation or after disembarkation. On 6 occasions the pilots declared a person with illness on board to the public health authority. Out of the 6 persons 4 were diagnosed with pandemic influenza (H1N1) 2009. In the case of notification, the delay in traveling for contact persons ranged from 30 min to 2 h. None of the sick travelers was referred to a hospital, all returned home. In addition to the medical assessment of affected travelers the public health authority issued "free-pratique" according to Article 28 (3) of the International Health Regulations, after talking to the cabin crew or flight captain. Out of 167 (0.3% of all flights to Hamburg) inspected airplanes only in one case was a notification not issued by the pilot despite a known case of sickness on the plane. ⋯ To avoid unnecessary interference with travel, the public health service at airports must be able to react in a timely manner to notifications of disease. During the influenza pandemic (H1N1) 2009, 4 out 9 (36%) of the cases that were diagnosed with pandemic influenza (H1N1) 2009 were notified to the public health authority via the aircraft. It is the authors' experience during the pandemic influenza (H1N1) 2009 that the notification requirement of the pilot is of importance because it enables the public health service to react before disembarkation. However, more often affected persons sought advice from the public health service before or after the flight. A prerequisite for this is that the public health service is known to the relevant bodies at the airport and accessible to the public. Routine health inspections of airplanes with visual inspection of travelers result in high manpower requirements. In the authors' view these routine inspections of airplanes are only justified if there is a suspicion of disease on board, or to train the staff of public health authorities. It can be concluded from the experiences during the pandemic influenza (H1N1) 2009 that the core capacities required for designated airports according to Annex 1 B of the International Health Regulations must include trained medical professionals, communication and transportation infrastructure amongst appropriate facilities. One must distinguish between medical facilities for some affected travelers in the public areas of the airport, and a medical assessment area in the security area of the airport that is appropriate for the number of persons that may be carried by the largest vessel to that destination.
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Das Gesundheitswesen · Feb 2012
Review Comparative Study[Variations in the epidemiolgy of adverse events: methodology of the Harvard Medical Practice Design].
The Harvard Medical Practice (HMP) Design is based on a multi-staged retrospective review of inpatient records and is used to assess the frequency of (preventable) adverse events ([P]AE) in large study populations. Up to now HMP studies have been conducted in 9 countries. Results differ largely from 2.9% to 3.7% of patients with AE in the USA up to 16.6% in Australia. ⋯ Further conclusions are hindered by divergences in defining periods of observation, by presenting frequencies as cumulative prevalences, and differences in the reporting of study results. As a consequence future HMP studies should go for complete, consistent and transparent coverage. Further research should concentrate on advancing methods for collecting data on (P)AE.
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Das Gesundheitswesen · Feb 2012
[Evaluation of the sponsoring initiative of the "action plan healthy life-style and life worlds" - instruments and first results on planning quality].
In line with the National Action Plan "IN FORM" the German Federal Ministry of Health funds the establishment of 11 regional community health promotion networks (alliances). To meet quality development standards, an external evaluation project has been established in addition to the alliances' internal evaluation. Scientific monitoring focuses on alliance-spanning investigation of quality of planning, structures and processes and uses different methods and instruments (e.g., guided interviews, analytical framework, Goal Attainment Scaling). ⋯ The situation is similar with the descriptions of the work planning and statements concerning the sustainability at which the implemented activities are aimed. On the other hand, in explaination criteria like consideration of target group's needs or definition of goals the possibilities are not exhausted yet considering the state of the debate. Hence in similar future projects there is a clear necessity of assistance in approaching these aspects, provided preferably in an early stage of the planning phase.
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Das Gesundheitswesen · Jan 2012
[Factors influencing the decision to establish a primary care practice: results from a postal survey of young physicians in Germany].
Although the estimated need for primary health care is covered to 108% in Germany, a primary care physician shortage is emerging in some regions. Moreover, the number of young physicians completing a specialist medical training for general medicine is decreasing. Therefore the present study aimed to investigate factors influencing young physicians to aspire to such a specialist training as well as aspects considered as important for practice establishment by these physicians. ⋯ The results point to measures which could be suited for rendering the decision-making in favour of the establishment of a primary care practice by young physicians in rural areas more attractive again.
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Das Gesundheitswesen · Jan 2012
[Patients as customers? The term "customer" in the perception of medical students at the end of their university training].
In the preceding decades a new perspective on the role of patients in the health-care system has gained ground, considering patients not merely as "suffering persons" but additionally as "customers". Physicians, however, tend to disagree with this approach because of the economic connotation of the term customer. Until now, there is only poor evidence of whether students of medicine - who are going to work as physicians in the future - agree or disagree with that approach and whether they are ready to accept patients as customers. ⋯ Considering recent developments in the organisation of medical services and health services in general, it becomes increasingly important to know what kind of 'service behaviour' patients expect from their doctors and other health providers. Obviously, it is not self-evident for medical students to perceive their future patients as customers and to act as customer-oriented 'service providers'. In view of this, the faculties of medicine at universities - which provide professional training to students of medicine - should be aware of the challenge to 'socialise' their students so that they can keep up with patients' expectations.