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Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

Contains fulltext : 232384.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To provide a new perspective on integrated biomedical and psychosocial dementia research. BACKGROUND: Dementia is being recognized as a multifactorial syndrome, but there is little interaction between biomedical and psychosocial approaches. A way to improve scientific knowledge is to seek better understanding of the mechanisms underlying the interaction between biomedical and psychosocial paradigms. One rationale for integrating biomedical and psychosocial research is the discordance between neuropathology and cognitive functioning. The concept of social health might bridge the two paradigms. It relates to how social resources influence the dynamic balance between capacities and limitations. HYPOTHESES: Social health can act as the driver for accessing cognitive reserve, in people with dementia through active facilitation and utilization of social and environmental resources. Thereby we link lifestyle social and opportunities to the brain reserve hypothesis. MANIFESTO: We provide a Manifesto on how to significantly move forward the dementia research agenda.

Objective The Fluids in Shock (FiSh) Trial proposes to evaluate whether restrictive fluid bolus therapy (10 mL/kg) is more beneficial than current recommended practice (20 mL/kg) in the resuscitation of children with septic shock in the UK. This qualitative feasibility study aimed to explore acceptability of the FiSh Trial, including research without prior consent (RWPC), potential barriers to recruitment and participant information for a pilot trial. Design Qualitative interview study involving parents of children who had presented to a UK emergency department or been admitted to a paediatric intensive care unit with severe infection in the previous 3 years. Participants Twenty-one parents (seven bereaved) were interviewed 16 (median) months since their child’s hospital admission (range: 1–41). Results All parents said they would have provided consent for the use of their child’s data in the FiSh Trial. The majority were unfamiliar with RWPC, yet supported its use. Parents were initially concerned about the change from currently recommended treatment, yet were reassured by explanations of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the research discussion and content of participant information. Bereaved parents stated that recruiters should not discuss research immediately after a child’s death, but supported a personalised postal ‘opt-out’ approach to consent. Conclusions Findings show that parents whose child has experienced severe infection supported the proposed FiSh Trial, including the use of RWPC. Parents’ views informed the development of the pilot trial protocol and site staff training. Trial registration number ISRCTN15244462—results.

Contains fulltext : 81501.pdf (Publisher’s version ) (Open Access) BACKGROUND: The purpose of this article is to describe and evaluate the methodology of online focus group discussions within the setting of paediatric oncology. METHODS: Qualitative study consisting of separate moderated asynchronous online discussion groups with 7 paediatric cancer patients (aged 8-17), 11 parents, and 18 survivors of childhood cancer (aged 8-17 at diagnosis). RESULTS: All three participant groups could be actively engaged over a one-week period. Respondents highly valued the flexibility and convenience of logging in at their own time and place to join the discussion. Adolescent patients and survivors emphasized that the anonymity experienced made them feel comfortable to express their views in detail. The findings indicate a strong preference for online group discussions across all participant groups. CONCLUSION: The findings show that online focus group methodology is a feasible tool for collecting qualitative data within the setting of paediatric oncology, and may offer new opportunities to collect data in other hard-to-include populations. The evaluations seem to indicate that the online group discussions have given participants an opportunity to articulate their experiences and views in a way they might not have done in a traditional group discussion. 9 p.

Titelblatt und Inhaltsverezcihnis Einleitung Theoretischer Rahmen Material und Methode Darstellung der Ergebnisse und Diskussion Zusammenfassung - die Interaktion um die Kernkategorie "Wissen sammeln und sich stärken" Interpretation der Ergebnisse und Schlussfolgerungen Literatur, Im Krankenhaus werden Gesundheitsleistungen am Patienten in Form von perso- nenbezogenen Dienstleistungen im uno-actu Prinzip erbracht (Dienstleistungsemp-fänger und Dienstleistungserbringer sind zur selben Zeit am selben Ort anwesend). Diese Dienstleistungen sind Interaktionsarbeit. Interaktionsarbeit besteht aus Kom-munikation, Gefühlsarbeit (sentimental work und emotional work) sowie aus Körper-arbeit. Interaktionsarbeit ist beeinflusst die Qualität der personenbezogenen Dienst-leistung. Im Krankenhaus findet Interaktionsarbeit im Schwerpunkt zwischen den Personen des Beziehungsdreiecks statt. Bisher ist Interaktion in dieser Personen- konstellation nicht untersucht worden. Ziel dieser Arbeit ist es, Interaktion als Phä-nomen zu verstehen. Die vorliegende qualitative Studie nach der Grounded Theory zeigt Interaktionsmuster auf und stellt im Ergebnis ein abstrahiertes Interaktionsmo-dell um die Kernkategorie Wissen sammeln und sich stärken dar. Defizite der Inter-aktion im Beziehungsdreieck werden aufgedeckt. Die Ergebnisse werden in Bezug auf die aktuellen Veränderungen im Gesundheitswesen interpretiert und die wech-selseitigen Auswirkungen dargestellt., In hospital Health Care Services for patients are delivered individually on site and involves interaction. Interaction is physical but also includes aspects of communica-tion, sentimental work and emotional work. It influences the quality of the individual health care. In hospital the focal point of interaction takes place within a patient-nurse-physician relationship. Up till now this constellation of interaction has not been examined. The goal of this work is to achieve an understanding of interaction as a phenomenon. This study is founded on the Grounded Theory. It demonstrates pat-terns of interaction and presents its results as an conceptualized interactions model. It is based on the principle of increasing knowledge and skills . Deficits of interaction within this relationship constellation are revealed. The results are interpreted with regard to current changes in the Health Care System and their mutual effects.