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Den Empfehlungen fur verordnete Malariachemoprophylaxe oder Stand-by-Therapien mangelt es an einer soliden Beweisgrundlage, sodass die tagliche Praxis von reisemedizinischen Beratern von Subjektivitat und grosen Unterschieden gepragt ist. Wir befragten reisemedizinische Berater in Deutschland mithilfe der Delphi-Methode. Die Erfahrungen mit reisemedizinischen Beratungen der Teilnehmer waren vielfaltig, genau wie ihre Empfehlungen und Risikoabschatzungen. Es scheint notwendig zu sein, die Faktenlage auf Wirksamkeit, Risiken, Empfehlungen und Einnahme von Arzneimitteln gegen Malaria auf nationaler als auch internationaler Ebene zu verbessern. Austausch unter deutschen Experten konnte die Variabilitat in der Verschreibung von Chemoprophylaxe und Stand-by-Medikamenten zukunftig reduzieren.

Introduction Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing. Objective The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA). Methods Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals. Ethics and dissemination The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.

In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health status of refugees and asylum seekers (RAs). Especially, notifiable infectious diseases (NIDs) carry the risk of outbreaks in communal accommodations hosting RAs. We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811 RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the setting of a communal accommodation (RIDs) could be identified. The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from East Africa and Nigeria were significantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepatitis B, and vaccine-preventable and parasitic diseases. Significant risk factors included country of origin (COI) and age for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis. Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis were mostly strongly elevated. COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene could be effective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protection measures are necessary to prevent the transmission of diseases.

Palliative medicine is an essential component of the health care system. Basic palliative care should be provided by primary care services (family physician and home nursing) with palliative-medical basic qualification. Often it is very difficult to identify patients that would profit from a specialized palliative care team. For the evaluation of the case complexity of a palliative patient, we present a Spanish diagnostic tool IDC-Pal, which tries to specify when, why and where a palliative patient should be referred. The aims of this study were the translation and cultural adaptation of the diagnostic tool for complexity in palliative care IDC-Pal to the German language, and the measurement of its feasibility and face validity.During the first phase, a forward-backward translation with linguistic and cultural adaptation of the tool IDC-Pal as well as the validation of its content by a review committee was performed. During the second phase, the preliminary version of the tool was tested by 38 family physicians that were asked for a qualitative assessment using a 10-points Likert scale (1 = "strongly disagree" and 10 = "totally agree"). Finally, a definitive version was developed.The translation and adaptation were achieved without major problems. Both feasibility and apparent validity of the tool IDC-Pal were rated as high. The mean response in the Likert scale was 7.79, with a SD of 0.36. Participants strongly agreed on the apparent validity of the tool with a mean of 7.82 and a SD of 0.26 and on its feasibility with a mean of 7.79, and a SD of 0.39.A conceptually, culturally and linguistically equivalent version of the original instrument IDC-Pal was obtained. German family physicians agreed on the usability of IDC-Pal as a tool for rating the case complexity of palliative patients. These results indicate that physicians in Bavaria and eventually in Germany could benefit of the full validation of IDC-Pal.Die Palliativmedizin ist ein essentieller Bestandteil der medizinischen Versorgung einer Gesellschaft. Unter idealen Bedingungen erfolgt diese von der Primärversorgung (Hausärzte und Pflegedienste) mit palliativmedizinischer Basisqualifikation. Hierbei ist es oft schwierig zu identifizieren, welche Patienten von einem spezialisierten Palliativ-Care Team profitieren würden. Zur Beurteilung der Komplexitätssituation eines palliativen Patienten stellen wir das spanische Diagnostik-Tool IDC-Pal (Instrumento Diagnóstico de la Complejidad en Cuidados Paliativos) vor, welches versucht zu spezifizieren wann, warum und wohin ein/-e palliative/-r Patient/-in überwiesen werden sollte. Die Ziele dieser Studie waren daher zum einen die deutsche Übersetzung und kulturelle Anpassung des bisher in Spanien verwandten Diagnostik-Tools IDC-Pal, sowie die Überprüfung der Machbarkeit und der Augenschein Validität dieses Diagnosetools.In der ersten Phase der Studie erfolgten die Vorwärts-Rückwärts-Übersetzung mit sprachlicher und kultureller Anpassung von IDC-Pal, sowie die Validierung des Inhalts durch ein Revisionskomitee. In der zweiten Phase wurde die vorläufige Version des Diagnostiktools von 38 Hausärzten mithilfe einer 10-stufigen Likert-Skala (1= „auf keinen Fall einverstanden“ und 10= „völlig einverstanden“) qualitativ bewertet. Entsprechend wurde abschließend eine endgültige Version des Diagnostiktools IDC-Pal entwickelt.Die Übersetzung und die Anpassung konnten ohne Probleme verwirklicht werden. Die Machbarkeit und die Augenschein Validität des Diagnostiktools IDC-Pal wurden als überdurchschnittlich gut eingestuft. So betrug der Mittelwert der globalen Antworten in der Likert-Skala 7,79 mit einer Standardabweichung (SD) von 0,36. Die Teilnehmer bestätigten ebenfalls die Augenschein Validität mit einem Durchschnitt von 7,82 und einer SD von 0,26 und eine Machbarkeit des Werkzeugs mit einem Durchschnitt von 7,79 und einer SD von 0,39.Eine konzeptionelle, kulturelle und sprachlich gleichwertige Version des Diagnostiktools IDC-Pal konnte entwickelt werden. Die befragten deutschen Hausärzte waren sich einig, dass sie mit dem IDC-Pal Tool die Komplexitätssituation von palliativen Patienten einschätzen können. Diese Ergebnisse zeigen, dass die Ärzte in Bayern und eventuell in Deutschland von der vollständigen Validierung von IDC-Pal profitieren könnten.

Background The World Health Organization (WHO) set the year 2020 as a target date for the eradication of measles in Europe, yet Germany is still far away from this goal. In this article, we provide an overview of current vaccination gaps and barriers to vaccination among children and adults in Germany, as well as potential strategies for overcoming them. Methods This review is based on pertinent publications identified by a selective literature search in PubMed (Medline). Results Measles vaccinations are not carried out in the appropriate timely fashion in Germany. Moreover, current vaccination rates among both children and adults are too low to achieve the goal of measles eradication. For example, among children born in 2014, the recommended vaccination rate of more than 95% was only reached when these children were 24 months old. Primary care physicians bear the responsibility for this situation, as they have the greatest influence on the decision to vaccinate. The main causes of vaccination gaps are safety worries and complacen- cy on the patients' part, and partial skepticism regarding vaccination on the part of the caregivers. We identified promising strategies for overcoming these problems: an instructive talk to provide evidence-based information to patients in an atmos- phere of mutual trust, reminder systems, multifactorial interventions, and facilitated access to vaccination, or, as a last resort, the reintroduction of compulsory vacci- nation. Conclusion Primary care physicians play a key role in vaccination. The focus of further strategies should lie above all in improved patient education and in targeted reminders for patients who neglect to vaccinate themselves and/or their children.

There is still a lack of attention paid to the subject of vaccinations indicated for people with chronic disease, so the vaccination rates in this field are low or hardly known. Hospitals only play a minor part in the vaccination subject, although they play a big part in the treatment of chronically ill patients.In this study we wanted to test the practicability of the implementation of vaccination recommendations in discharge letters as a chance to give the subject more attention and involve hospital doctors in the vaccination process. In addition, we analyzed clinical und primary care physicians' attitudes towards these recommendations and vaccination in general.88.5% of the general practitioners and 81.3% of the hospital doctors consider vaccination recommendations in discharge letters reasonable. 86.3% of the general practitioners said they were willing to perform the recommended vaccinations. The main responsibility in the vaccination process is clearly allocated to general practitioners, but many hospital doctors want to raise the level of attention given to the vaccination subject in their departments.Standardized implementation of vaccination recommendations in discharge letters is a reasonable way to involve hospital doctors in the vaccination process as part of the preventive care services for chronically ill patients. At the same time, general practitioners will be regularly informed about indicated vaccinations for the individual patient.

In view of medical care being required more and more, the doctors' tight time should be reserved for tasks which correspond to their qualification. A standardization of certificates might save time and improve quality.This paper overviews the role of certificates and the required examinations in family doctor's everyday practice. Current practices, difficulties and suggestions for improvements were worked out in order to illuminate the potential for standardization.In a questionnaire for family doctors data concerning expenditure of time and billing of diverse certificates were collected and quantitatively evaluated. By means of expert interviews difficulties were identified and suggestions for improvement were developed.The use of templates shows a significant saving of time compared to free wording. Also, billing could be enhanced if carried out more systematically. Difficulties are mainly caused by unclear and unrealistic requests.It's worth being proactive and developing a systematic approach in order to save time and to improve the quality of certificates. Templates facilitate modest certificates, while elaborate certificates need adjustable textmodules and checklists. Consistent information and billing promote patients' understanding.

Background In September 2011, the German Standing Committee on Vaccinations (STIKO) changed their recommendation regarding the mumps–measles–rubella–varicella vaccination (MMRV). We compared the immunization rates against MMRV in Germany before and after the STIKO intervention. Methods We recorded the immunization status of children born between 09/2008 and 08/2012 in 35 selected doctor’s surgeries in Germany. Results After the STIKO intervention, the ratio of the combined MMRV vaccine as the first dose immunization was reduced to approximately 25% of the initial value. A slight increase in the number of children not sufficiently vaccinated against varicella (1.2%) was observed, but the immunization rates against measles, mumps, rubella and varicella did not significantly decrease. Conclusions The STIKO intervention led to a significant change in physicians’ vaccination procedures. The separate administration MMR + V vaccination may be a helpful option to improve the immunization rates in general.