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BACKGROUND: The adaptation of structures and processes in treatment procedures can contribute to increasing patient satisfaction and is the focus of patient-oriented quality assurance. OBJECTIVE: To identify patient satisfaction as well as needs, expectations and preferences with respect to care and, based on this, to formulate recommendations for action to optimize the quality of care at a large tertiary rheumatology center. MATERIAL AND METHODS: As part of a qualitative research approach, semi-structured patient interviews and a focus group interview consisting of physicians in rheumatology training in outpatient specialist care were conducted. The quality dimensions of Donabedian were recorded. The data material was evaluated and analyzed using the content-structuring qualitative content analysis according to Kuckartz with the MAXQDA evaluation software. RESULTS: Using 12 patient interviews and a focus group of 3 future rheumatologists, recommendations for action to optimize the quality of care were derived on the basis of the structural, process and outcome quality. There was a need for optimization in the areas of personnel management, internal practice processes, practice equipment and treatment processes in the outpatient clinic. CONCLUSION: The results from the patient interviews and the focus group revealed the aspects in need of optimization. The methodology and results of this study can serve as a reference point for analyses of other rheumatology clinics in order to improve the quality of care within the framework of patient-oriented quality management and continuous further development.

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Two years after COVID-19 pandemic starting, the studies of patient satisfaction with medical services quality become topical again. The article presents the results of three-year project (2019-2022) of studying level of loyalty (Net Promoter Score) of legal representatives of patients of one of municipal children polyclinics. It is established that in Moscow, with implementation of first restrictive measures level of loyalty in the children polyclinic increased from 45% to 70%. In following years, level of loyalty was fixed at the level of 60%. The four groups of factors determining such changes as high level of panic moods due to pandemic, changes in organization of polyclinic functioning, energetic activity of mass media and users of social networks in glorifying image of medical workers and cultural psychological characteristics of Russians. The "optimistic", "realistic" and "pessimistic" prognoses concerning further dynamics of level of loyalty are proposed. The conclusion was made that COVID-19 pandemic served as key factor of positive changes in assessments of patients (and their legal representatives) of functioning both of particular polyclinic and the Russian health care in general. As far as each following time coronavirus infection will cause less and less concern among Russians it can be expected the requirements presented to medical services will soon increase, that means workload of medical personnel will only intensify. The following prospective directions of organizing functioning of medical institutions are proposed: monitoring of psycho-social indicators of medical personnel, implementation of telemedicine technologies, transfer of part of functionality of physicians and nurses to specialists without medical education.

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Nowadays, the idea of the patient as the main subject of medical care is being established in the public consciousness. It is around the patient that all types of professional medical activities and all forms of relationships with other subjects of modern health care are organized.In the professional sphere, this idea is seen as a principle of patient focus. In the provision of paid care, this factor acquires special relevance and is largely determined by the compliance of the process and results of the provision of medical care with the expectations of consumers of medical services. In this regard, the study of the expectations of the contingent of people applying for paid medical services to state medical organizations, and the degree of their satisfaction with receiving paid medical care was the purpose of this study.

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BACKGROUND: To address the problem of overuse of elective surgery and to support patients in their decision-making process, a Second Opinion Directive was introduced in Germany, which enables patients with statutory health insurance to obtain a second opinion for certain surgical indications. The study aims to identify, based on the experiences of patients who have undergone elective surgery, the role of seeking a second opinion in reaching their decision. METHODS: Sixty-two patients who had undergone an elective surgery (hysterectomy, tonsillectomy, shoulder arthroscopy) were recruited using purposive sampling and interviewed during October to December 2020. The transcribed interviews were analysed using a framework analysis to create a typology from the patient's perspective. RESULTS: The time spent by patients in making the decision to undergo surgery varies between individuals, and is influenced by factors such as the type of physician-patient relationship, individual patient aspects, prior experiences in the health care system, as well as information needs. Within the framework of the analysis, we were able to identify three patterns of patient types based on the three different time-points or phases when decisions were typically made, with one type being divided into two subtypes: Type 1a: Quick decision making, Type 1b: Overwhelmed quick decision making, Type 2: Time to consider, Type 3: Struggling with the decision. CONCLUSIONS: Patients who followed a recommendation for elective surgery appreciate having the possibility to seek a second opinion. However, various factors influenced their opting for a second opinion during the decision-making process. Patients have differing information needs, such that a one-size-fits-all second opinion service may not fit adequately for all patients.

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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.

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OBJECTIVE: While the development of communication competencies in medical schools plays a pivotal role in the curriculum, studies show that students' communication skills and patient-centred attitudes may vary based on gender and ethnicity. The goal of this study was to investigate the socio-demographic factors that influence medical students' communication abilities and, more specifically, to what extent their attitude toward communication skills learning and patient orientation associate with communication abilities. Our population included medical students admitted in 2017. Used tools included a communication score, the patient-provider orientation and communication skills attitudes scales. RESULTS: Three hundred and sixty-five students participated in the study (56.4% female, 85.2% German native speakers, mean age 24.2 ± 3.5 years). Female and German native speaking students had a better communication skills OSCE performance, were more patient-oriented and had more positive attitudes toward communication skills learning than male and non-native speaking students. There was a significant association between gender, native tongue, attitudes towards communication skills learning and communication skills OSCE performance. In conclusion, to support medical students to improve their communication proficiency and attitudes towards the importance of clear communication and patient-oriented care, medical educators should consider teaching and assessment strategies that address socio-cultural aspects of communication.

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BACKGROUND: Intravitreal drug delivery belongs to the most common medical procedures, with approximately 1.5 million treatments per year in Germany. However, for this enormous challenge to provision of proper care, there is a lack of empirical data regarding the treatment process and its clinical and subjective effect. MATERIALS AND METHODS: This publication presents the development and structure of the Hamburg register for intravitreal therapies (QIVOM). Patients undergoing intravitreal injection therapy were invited to join the register study. Patients were recruited from the Hamburg eye clinics in Heidberg-Nord and Barmbek as well as from the University Medical Center Hamburg-Eppendorf (UKE). Both subjective patient-reported information about the perception of their eye disease and its treatment as well as medical parameters were stored in a central electronic database. RESULTS: Of the first 162 study patients (aged 41-95 years), 64% suffered from wet age-related macular degeneration (AMD), 22% had a retinal vein occlusion, and 11% a diabetic macula edema. Disease severity and subjective impairment were heterogenous. Among these patients, 31.8% had a visual acuity above 10/20 on the treated eye compared to 79.1% on the other eye. The reduced ability to read was the most relevant limitation for more than one third of patients. However, 62% were able to drive a vehicle. An improvement of vision through intravitreal therapy was experienced by 45%. CONCLUSION: Collection of patient-reported as well as treatment-related data comprises the advantage of the newly created register. This extension of the data basis should deliver new findings in the future and contribute to quality assurance in intravitreal care.

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The concept of health literacy has received much attention in recent years. Essential approaches are the provision of health information, teaching through educational programs, and transfer via communication techniques. From a dental point of view, the individual discussion between patient and dentist is of particular importance ("talking dentistry").The aim of our article is to present the current state of knowledge on the relationship between oral health literacy and talking dentistry, to present existing concepts for teaching communicative competencies, and to identify the further need for action from the point of view of the German Dental Association. Several health psychology models emphasize a positive relationship between oral health literacy, oral health behavior, and oral health. Further determinants seem to be the patient's self-efficacy beliefs and the individual interaction with the dentist. Therefore, it seems purposeful to intervene in an occasion-related manner in the sense of talking dentistry. The personal conversation between dentist and patient can cover counselling, education, motivation, and practical guidance and can lead to participatory decision-making.Offers for learning and deepening communication techniques represent important aids for the practice. Some are presented in this article as examples. However, in order to establish talking dentistry on a broad level, more far-reaching offers and incentives are needed. Through our suggestions, we would like to show ways in which talking dentistry can be further promoted and consolidated as an integral part of dental care.

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PURPOSE: This paper studies the RF-induced heating for modular external fixation devices applied on the leg regions of the human bodies. Through numerical investigations of RF-induced heating related to different patient orientations, landmark positions, and device positions under 1.5T and 3T MRI systems, simple and practical methods to reduce RF-induced heating are recommended. METHODS: Numerical simulations using a full-wave electromagnetic solver based on the finite-difference time-domain method were performed to characterize the effects of patient orientations (head-first/feet-first), landmark positions (the scanning area of the patient), and device positions (device on left or right leg) on the RF-induced heating of the external fixation devices. The G32 coil design and three anatomical human models (Duke model, Ella model, and Fats model) were adopted to model the MRI RF coil and the patients. RESULTS: The relative positions of the patient, device, and coil can significantly affect the RF-induced heating. With other conditions remaining the same, changing the device position or patient orientation can lead to a peak 1-g averaged spatial absorption ratio variation of a factor around four. By changing the landmark position and the patient orientation, the RF-induced heating can be reduced from 1323.6 W/kg to 217.5 W/kg for the specific scanning situations studied. CONCLUSION: Patient orientations, landmark positions, and device positions influence the RF-induced heating of modular external fixation devices at 1.5 T and 3 T. These features can be used to reduce the RF-induced heating during MRI simply and practically.

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The article gives an overview of how health services research helps to plan and optimize patient-centered health services. The decision-making processes on the micro-level (individual treatment decisions) and the macro-level (decisions about structuring of the healthcare system) are examined. Examples from the field of rheumatology illustrate how results of health services research can help to improve decisions about treatment by providing relevant information about quality of health services which helps in the joint decision-making process. Furthermore, it becomes clear that political decisions to improve health care service structures can be better achieved if scientific proof of deficits in existing health service structures can be provided. The article also shows how health services research helps to describe and redefine the roles of patients and patient-doctor communication. Additionally, the active role of patients in (health services) research is addressed.

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Aim: To assess the relationship among perceived nursing group power, organizational trust and patient orientation and identify patient orientation predictors. Background: Nurses and nursing organizations should use all resources to give care. Methods: Survey data were collected from 193 nurses at six acute care hospitals in South Korea. Characteristics of hospitals and nurses were analysed using t tests, one-way ANOVAs and regression models. Results: The means for perceived nursing group power, organizational trust and patient orientation were 3.71 (SD± 0.58), 3.22 (SD± 0.83) and 3.94 (SD± 0.53), respectively. Multiple regression analysis revealed that 40% of the variance in patient orientation was explained by perceived nursing group power, organizational trust and work experience. Conclusion: Hospitals should increase nursing group power and improve organizational trust to enhance patient orientation. Hospital executives and nurse managers should work to enhance nursing group power and positive perceptions of organizational trust, which could contribute to patient orientation.

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The article addresses deficits in patient orientation and patient involvement in medical research from a patient's perspective and provides recommendations for their further development. Researchers often practice patient orientation as well as patient involvement in an unstructured and inconsistent manner. The decision if and how patient involvement takes place is, to a considerable extent, the researchers' responsibility. This decision should always be part of a patient-oriented alignment of the research project, which researchers pursue regardless of the existence, initiative and participation of a patient organization. Possible modes of involvement are assigned to different phases of the research process. In this article, patient orientation and the choice of the form of involvement is considered to constitute an obligation of researchers and decision makers early in the process. Involvement should take place on a fair basis. Decision makers should consider determining specific requirements for patient orientation, e. g. in their calls for proposals or selection/award criteria.

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The Voice Handicap Index (VHI) is today regarded as the gold standard for measuring the subjective impairment of a voice disorder. The aim of our study is to present how the VHI in our version with 18 questions (VHI-18) can be evaluated with other patient collectives (practice visitors or everyday patients). The previous publications have shown that most patient groups were stationary or clinical. A total of 100 adult patients (72 female, 28 male) in our medical practice KOPFZENTRUM were examined. The reliability of the VHI-18 results from a Cronbach's Alpha (0.92). The VHI-18 is suitable as a diagnostic instrument for medical practices or logopaedic practices.

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This article illustrates the development, framework conditions and results of research promotion by the patient self-help organization PRO RETINA Deutschland e. V. and its foundation, with a special focus on patient participation. Instruments of research promotion applied by the patient organization included the articulation and clarification of research needs, cooperation with research institutes on a project level, accompanying of research programs in advisory boards, public acknowledgement of successful researchers, support of patient recruitment for studies, biomaterial banks and registers. As examples for the initiated and supported research work, the isolation of the choroideremia gene, the development of a retinal implant and cooperation on Usher syndrome are described. In 2007 PRO RETINA established its own research foundation as a closely linked but independent organization. This foundation financially supported 52 projects (including PhD grants and small projects), 19 research awards and 3 foundation professorships, with a main focus on the support and encouragement of young scientists. Nowadays, apart from success in research promotion, patient participation also covers drug approval procedures, benefit assessment and decisions on regulations in medical care. The work of PRO RETINA and its foundation demonstrates the potential of self-help organizations for initiation, acceleration and support of patient-oriented medical research.

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The article considers the need for a new model of health care. In the provision of patient care, individual needs and desired outcomes are the driving force behind all decisions in health and quality measurement. Medical care should correspond to individual preferences, needs and values of patients and take into account patient's wishes when making clinical decisions. This approach contributes to improving the quality of medical services and improving the economic well-being of the country, as evidenced by foreign research.

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BACKGROUND: Implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The idea of human rights developed during the era of the Enlightenment. This idea has been publicly discussed since the French Revolution of 1789 and its specification has been demanded politically. Important steps in this process were the General Declaration of Human Rights adopted by the UN in 1948 and the CRPD from 2006, which was especially relevant for psychiatric actions. Meanwhile, the idea of human rights has influenced the legislation in many countries and has thus become normatively binding, e. g. in the Basic Law of Germany, in the regulations for patient care and in the professional rules for physicians. AIM AND QUESTIONS: To sensitize for reflection on one's own actions and to gain a critical distance from the general overall opinion. Then not only the global validity of the CRPD is frequently violated, as in crisis regions but also in the everyday routine when, for example, the workload prevents psychiatric personnel from taking time for essential conversations with psychiatric patients in order to support their self-determination. MATERIAL AND METHODS: These aspects are illustrated and explained with the aid of multifarious examples from the relevant literature and from own experience. RESULTS AND DISCUSSION: Human rights are a regulative idea that provide a framework and direction for psychiatric actions; however, as an idea they compete with other ideas that try to control the trends of the day (the Zeitgeist) that determine daily practice. Not only the suppression of human rights from public consciousness, e. g. with the eugenics in the first third of the previous century but also their absolutization and poor implementation, as in the Italian psychiatry reform of 1978, damage psychiatric patients. Therefore, it appears necessary to sensitize psychiatrists to reflect on the Zeitgeist and its influence on their own actions and to recognize that their own opinions and actions can also influence the Zeitgeist.

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The involvement of the patient perspective in decision-making processes in the healthcare system is commonly welcome, especially in Germany, with self-help organizations currently providing the vast majority of patient representatives in the various committees. The central plank of organized self-help is the mutual support of chronically diseased and disabled people as well as their relatives in self-help groups.Patient involvement, however, seems to lead organized self-help to an insoluble dilemma. Either organized self-help must give up their traditional working principles in order to be capable of acting as a professional player in the discourse of the joint self-government of doctors and healthcare funds, or they will simply be unable to cope with patient involvement if they remain true to their original way of mutual exchange and communication. But if organized self-help and joint self-government are considered as social systems, it becomes clear that though patient involvement relates these systems to each other, it does not give rise to a relation of dominance and subordination. Organized self-help may have to handle the requirements and inputs of self-government as well as of the systems of science and law, but also has to be considered a challenge to and an opportunity for the self-government to help them achieve their system-related goals.

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INTRODUCTION: Hoarseness occurs as a symptom of a multitude of neurological diseases. The importance people attribute to their voice differs greatly and it seems advisable to take this into account during consultation. The Questionnaire for the assessment of the voice self-concept (FESS) is able to measure this importance. The aim of this study was to determine the applicability of the FESS in a neurological and psychiatric medical practice. MATERIAL AND METHODS: A total of 556 patients of a neurological and psychiatic medical practice completed the FESS and the severity of hoarseness was measured objectively by means of the Acoustic Voice Quality Index (AVQI). Another 75 patients only completed the questionnaire. The value distribution of the questionnaire, the correlation with age and gender, the voice quality as well as the daily strain on the voice were investigated. RESULTS: The value distribution ranges of all three scales of the FESS are completely utilized. Floor and ceiling effects do not play a relevant role. Gender and age do not seem to be of significance. The influence of the measurable voice quality is minor. In contrast a correlation between voice self-concept and the daily voice strain was detected. DISCUSSION: The FESS has the potential to be an interesting instrument for the measurement of the subjective importance of a patient's voice. Here reference values are generated, against which individual results can be correlated. The AVQI provides an inexpensive fast instrument for the objective measurement of hoarseness in a neurological and psychiatric medical practice.

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INTRODUCTION: Patients affected by food allergies and intolerance need to apply dedicated avoidance strategies and also prevent the consequences of unbalanced diets. In most countries, the health economic costs for these patients are unknown. METHODS: To measure temporal and financial burdens of the patients in multinational settings, the BELANA questionnaire (Burdens and Expenses of Living as an Adult with Nutrition based Allergy or Intolerance) has been developed. For the complementary measurement of Health Related Quality of Life (HR-QoL), a combined appliance of the disease-specific FAQLQ-AF (Food Allergy Quality of Life Questionnaire - Adult Form) and the generic SF-12v1 (Short Form-12 Health Survey) has been chosen. RESULTS: BELANA collects six economic items while avoiding questions, which are already included in the HR-QoL questionnaires or could lead to denial tendencies. In a web-based pilot survey with 51 patients, the practicability of using BELANA together with the complementary quality of life instruments was investigated. The electronic data collection offers real time plausibility checks and limits the workload for completion and data evaluation. DISCUSSION: The response rates at BELANA health-economic items (76 - 100%) and the high amount of completed questionnaires (50 of 51) confirm the patients acceptance of the chosen methodology. Within the web-based survey, the combination of BELANA, FAQLQ-AF and SF-12v1 was completed in an average of 22 minutes. An age-related selection bias was not been confirmed in this pilot application. The median age in the pilot trial was 37.9 years (minimum age to participate was 18 years, range from 19 to 72 years, Standard Deviation (SD) = 12.4 years). Most of the participants were female (44 of 50). CONCLUSION: It is assumed that the BELANA questionnaire should be a useful tool for the evaluation of health-economic burden for patients with food allergy and intolerance.

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Patient orientation has already been taken into account in healthcare planning approaches in Austria by using constantly improved routine health data, though primarily falling in the category of an indirect influence on or improvement of the individual patient-provider interaction. Data bases available in "Österreichische Gesundheitsinformationssystem (ÖGIS)" at Gesundheit Österreich GmbH (GÖG) have been used for years to both intensify the patient orientation within the needs-based planning framework (designed as "integrated regional healthcare planning", bearing the interactions between the sectors in mind) and to define and monitor the ten "Health Goals Austria". For the next few years, we can expect a further advancement and completion of the database in favour of healthcare planning to support the necessary adaptation and reorganization of the regional healthcare systems, the intensification of healthcare research and subsequently an improved patient orientation in Austria. In general, efforts are being made in Austria to improve the integration of the patient's perspective in the area of health care planning (e.g. by involving patients 'attorneys' or self-help groups). However, these efforts have not yet reached the stage of full implementation (inter alia also because the organizational potential for improvement or the quality of results from the patient's perception could not yet be adequately taken into account). Accordingly, further efforts to this end will be necessary in the upcoming years.

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