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BackgroundPatient safety is a priority worldwide. When things go wrong in the provision of patient care, the healthcare professionals involved can be psychologically affected (second victims, SVs). Recently, different initiatives have been launched to address this phenomenon.AimTo identify through the ERNST Pan-European Consortium the current study lines in Europe on SVs and other topics related to how the lack of well-being of healthcare professionals can affect the quality of care.MethodsA cross-sectional study was conducted based on an ad hoc online survey. All 82 academics and clinicians who had formalized their membership to the COST Action 19113 by September 2020 and represented 27 European and one neighboring country were invited to participate. The survey consisted of 19 questions that explored the participants’ scientific profile, their interests, and previous experiences in the SVs’ topic, and related areas of work in Europe.ResultsSeventy (85.4%) COST Action members responded to the survey. Thirty-seven (37.1%) had conducted SV studies in the past or were doing so at the moment of the survey. Seventeen participants were involved in implementing interventions to support SVs. Future lines of study included legal issues, open disclosure, training programs, and patient safety curricula.ConclusionsStudies have been conducted in Europe on the magnitude of the SV phenomenon and the usefulness of some techniques to promote resilience among healthcare professionals. New gaps have been identified. The COST Action 19113 aims to foster European collaboration to reinforce the healthcare professionals’ well-being and thus contribute to patient safety.

Background: Patient care in the prehospital emergency setting is error-prone. Wu’s publications on the second victim syndrome made very clear that medical errors may lead to severe emotional injury on the caregiver’s part. So far, little is known about the extent of the problem within the field of prehospital emergency care. Our study aimed at identifying the prevalence of the Second Victim Phenomenon among Emergency Medical Services (EMS) physicians in Germany. Methods: Web-based distribution of the SeViD questionnaire among n = 12.000 members of the German Prehospital Emergency Physician Association (BAND) to assess general experience, symptoms and support strategies associated with the Second Victim Phenomenon. Results: In total, 401 participants fully completed the survey, 69.1% were male and the majority (91.2%) were board-certified in prehospital emergency medicine. The median length of experience in this field of medicine was 11 years. Out of 401 participants, 213 (53.1%) had experienced at least one second victim incident. Self-perceived time to full recovery was up to one month according to 57.7% (123) and more than one month to 31.0% (66) of the participants. A total of 11.3% (24) had not fully recovered by the time of the survey. Overall, 12-month prevalence was 13.7% (55/401). The COVID-19 pandemic had little effect on SVP prevalence within this specific sample. Conclusions: Our data indicate that the Second Victim Phenomenon is very frequent among prehospital emergency physicians in Germany. However, four out of ten caregivers affected did not seek or receive any assistance in coping with this stressful situation. One out of nine respondents had not yet fully recovered by the time of the survey. Effective support networks, e.g., easy access to psychological and legal counseling as well as the opportunity to discuss ethical issues, are urgently required in order to prevent employees from further harm, to keep healthcare professionals from leaving this field of medical care and to maintain a high level of system safety and well-being of subsequent patients.

Introduction: The experience of a second victim phenomenon after an event plays a significant role in health care providers’ well-being. Untreated; it may lead to severe harm to victims and their families; other patients; hospitals; and society due to impairment or even loss of highly specialised employees. In order to manage the phenomenon, lifelong learning is inevitable but depends on learning motivation to attend training. This motivation may be impaired by overconfidence effects (e.g., over-placement and overestimation) that may suggest no demand for education. The aim of this study was to examine the interdependency of learning motivation and overconfidence concerning second victim effects. Methods: We assessed 176 physicians about overconfidence and learning motivation combined with a knowledge test. The nationwide online study took place in early 2022 and addressed about 3000 German physicians of internal medicine. Statistics included analytical and qualitative methods. Results: Of 176 participants, 83 completed the assessment. Analysis showed the presence of two overconfidence effects and in-group biases (clinical tribalism). None of the effects correlated directly with learning motivation, but cluster analysis revealed three different learning types: highly motivated, competent, and confident “experts”, motivated and overconfident “recruitables”, and unmotivated and overconfident “unawares”. Qualitative analysis revealed four main themes: “environmental factors”, “emotionality”, “violence and death”, and “missing qualifications” contributing to the phenomenon. Discussion: We confirmed the presence of overconfidence in second victim management competencies in about 3% of all persons addressed. Further, we could detect the same three learning motivation patterns compared to preceding studies on learning motivation in other medical competencies like life support and infection control. These findings considering overconfidence effects may be helpful for safety managers, medical teachers, curriculum developers and supervisors to create preventive educational curricula on second victim recognition and management.

This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.

An editorial is presented on the mitigating the July effect. Topics include the arrival of a crop of newly graduated medical students beginning their internships, the influx of so many freshly trained physicians arriving at the same time always triggers concern, and the belief in a July effect with presumed adverse consequences for patient safety and quality of care.

The COVID-19 pandemic led to the implementation of interventions to provide emotional and psychological support to healthcare workers in many countries. This ecological study aims to describe the strategies implemented in different countries to support healthcare professionals during the outbreak. Data were collected through an online survey about the measures to address the impact of the pandemic on the mental health of healthcare workers. Healthcare professionals, researchers, and academics were invited to respond to the survey. Fifty-six professionals from 35 countries contributed data to this study. Ten countries (28.6%) reported that they did not launch any national interventions. Both developed and developing countries launched similar initiatives. There was no relationship between the existence of any type of initiative in a country with the incidence, lethality, and mortality rates of the country due to COVID-19, and per capita income in 2020. The 24 h hotline for psychological support was the most frequent intervention. Tools for self-rescue by using apps or websites were extensively used, too. Other common interventions were the development of action protocols, availability of regular and updated information, implantation of distance learning systems, early detection of infection programs for professionals, economic reinforcements, hiring of staff reinforcement, and modification of leave and vacation dates. ispartof: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH vol:19 issue:9 ispartof: location:Switzerland status: published

ZusammenfassungDer Begriff Second Victim beschreibt eine an der Patientenversorgung beteiligte Person, die durch eine außergewöhnliche Situation in der Patientenversorgung selbst traumatisiert wird. Dieses in der Öffentlichkeit noch weitgehend unbekannte, aber weit verbreitete Phänomen wird durch die COVID-19-Pandemie verschärft und birgt das Risiko, durch eine ausgeprägte psychische Überlastung der Behandelnden Gesundheitssysteme zusätzlich unter Druck zu setzen. Dies stellt sowohl für die Patienten als auch für die Mitarbeitersicherheit eine ernstzunehmende Gefahr dar. Das Second-Victim-Phänomen ist gut erforscht und bedarf einer zweigleisigen Strategie. Einerseits müssen Second Victims in einem flächendeckenden, möglichst niederschwellig erreichbaren gestuften System schnell, persönlich und vertraulich unterstützt werden. Andererseits kommt der Stärkung der Resilienz aller Behandelnden besondere Bedeutung zu. Die Resilienz und damit die langfristige Leistungsfähigkeit der Behandelnden kann durch eine besondere Berücksichtigung im Führungsverhalten und in der Krisenkommunikation nachhaltig unterstützt werden. Sie leistet somit sowohl kurzfristig als auch nachhaltig einen positiven Beitrag für die Patientensicherheit und damit die Überlebenschancen vieler Patienten während und nach der COVID-19-Pandemie.

Zusammenfassung Einleitung Second Victims, definiert als medizinische Fachpersonen, die durch einen unvorhergesehenen klinischen Zwischenfall traumatisiert werden, sind ein verbreitetes Phänomen im Gesundheitswesen. Studien aus den USA zeigen hohe Inzidenzen zwischen 10 und 42 % bei medizinischem Personal. Allerdings existiert kein validierter deutscher Fragebogen, der sich mit der Inzidenz und den Auswirkungen auseinandersetzt. Deshalb wurde im Rahmen des SeViD-Projekts (Second Victims im Deutschsprachigen Raum) ein deutschsprachiger Fragebogen zur Beurteilung von Second-Victim-Erfahrungen entwickelt. Methoden Basierend auf einer Literaturrecherche nach existierenden Fragebögen in englischer Sprache wurde eine vorläufige Version des Fragebogens bestehend aus 4 Bereichen und 14 Fragen erstellt. Diese wurde kognitiven Pretests unterzogen, um die Inhaltsvalidität zu überprüfen. Ergebnisse Fünfzehn medizinische Fachpersonen aus Krankenhäusern in Deutschland (n = 6) und Österreich (n = 9) nahmen nach Einverständniserklärung als Freiwillige an allen Pretests teil. Sieben Fragen in 3 Bereichen wurden basierend auf kognitiven Pretests leicht modifiziert. Die durchschnittliche Bearbeitungszeit des Fragebogens betrug 9:01 (±3:05) min im Fall einer vorherigen Second-Victim-Erfahrung und 4:19 (±0:59) min ohne entsprechendes Erlebnis. Die Befragung wurde von allen Freiwilligen als angemessen bewertet. Schlussfolgerung Es konnte ein inhaltsvalidierter Fragebogen entwickelt werden, der die Auswirkung des Second-Victim-Phänomens in stationären Gesundheitseinrichtungen im deutschsprachigen Raum beurteilen kann. Dieser Fragebogen soll in verschiedenen Settings für medizinisches Fachpersonal sowohl für Erhebungen des Status quo als auch für Verlaufsbeobachtungen in Interventionsstudien eingesetzt werden.

Introduction: Comparable to second victim phenomenon (SVP), moral injury (MI) affects health professionals (HP) working in stressful environments. Information on how MI and SVP intercorrelate and their part in a psychological trauma complex is limited. We tested and validated a German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP) instrument, screening for MI and correlated it with the recently developed German version of the Second Victim Experience and Support Tool (G-SVESTR) instrument, testing for SVP. Methods: After translating Moral Injury Symptom and Support Scale for Health Professionals (MISS-HP), we conducted a cross-sectional online survey providing G-MISS-HP and G-SVEST-R to HP. Statistics included Pearson’s interitem correlation, reliability analysis, principal axis factoring and principal components analysis with Promax rotation, confirmatory factor and ROC analyses. Results: A total of 244 persons responded, of whom 156 completed the survey (33% nurses, 16% physicians, 9% geriatric nurses, 7.1% speech and language therapists). Interitem and corrected item-scale correlations did not measure for one item sufficiently. It was, therefore, excluded from further analyses. The nine-item score revealed good reliability (Guttman’s lambda 2 = 0.80; Cronbach’s alpha = 0.79). Factor validity was demonstrated, indicating that a three-factor model from the original study might better represent the data compared with our two-factor model. Positive correlations between G-MISS-HP and G-SVESTR subscales demonstrated convergent validity. ROC revealed sensitivity of 89% and specificity of 63% for G-MISS-HP using a nine-item scale with cutoff value of 28.5 points. Positive and negative predictive values were 62% and 69%, respectively. Subgroup analyses did not reveal any differences. Conclusion: G-MISS-HP with nine items is a valid and reliable testing instrument for moral injury. However, strong intercorrelations of MI and SVP indicate the need for further research on the distinction of these phenomena.

Background: The second victim phenomenon is common among nurses in intensive care units. Apart from quantitative studies, little is known about individual cases among those high-risk groups. This study evaluates the natural history and cause of second victim traumatization in Western Austria for the first time to tailor specific intervention. Methods: A total of 20 guided interviews were conducted with intensive care nurses in Western Austria. All interviews were transcribed and analyzed with MAXQDA software. Evaluation followed the structuring qualitative content analysis scheme according to Kuckartz. Results: The most frequent symptoms of the second victim phenomenon reported were feelings of guilt and problems with falling asleep. Coping with the second victim phenomenon was accomplished by conversations in private as well as among work colleagues. Conclusions: Intensive care nurses are exposed to many exceptional situations which have a high likelihood of resulting in second victim traumatization. As proximal psychosocial support is considered to be a main source of coping, wide-spread implementation of effective psychosocial peer support programs ought to be applied by medical organizations. Patient safety measures such as proactive and reactive clinical risk management (e.g., CIRS) should be linked to second victim support.

The concept of second victims (SV) was introduced 20 years ago to draw attention to healthcare professionals involved in patient safety incidents. The objective of this paper is to advance the theoretical conceptualization and to develop a common definition. A literature search was performed in Medline, EMBASE and CINAHL (October 2010 to November 2020). The description of SV was extracted regarding three concepts: (1) involved persons, (2) content of action and (3) impact. Based on these concepts, a definition was proposed and discussed within the ERNST-COST consortium in 2021 and 2022. An international group of experts finalized the definition. In total, 83 publications were reviewed. Based on expert consensus, a second victim was defined as: "Any health care worker, directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury and who becomes victimized in the sense that they are also negatively impacted". The proposed definition can be used to help to reduce the impact of incidents on both healthcare professionals and organizations, thereby indirectly improve healthcare quality, patient safety, person-centeredness and human resource management. ispartof: International Journal Of Environmental Research And Public Health vol:19 issue:24 ispartof: location:Switzerland status: Published online

Ein unverzichtbarer Ratgeber für alle, die sich im Studium oder in der Arbeit mit dem Gesundheitssystem und der Medizin beschäftigen. Reinhard Strametz stellt medizinisches Grundwissen fundiert und leicht verständlich vor und führt kundig in Fachtermini ein. In den Mittelpunkt stellt er u.a. den Ablauf des medizinischen Behandlungsprozesses von der Anamnese bis zur Therapie sowie wichtige Methoden und Ansätze der Medizin, etwa die Evidenzbasierte Medizin und die Prävention. Auf Krankheitsbilder wie etwa Adipositas, Diabetes mellitus, Schlaganfall und Krebs geht er ebenso ein wie auf Pandemien und das Coronavirus SARS-CoV-2 (Covid-19). Auch Spannungsfelder der Medizin, die sich aus der Ökonomisierung und Digitalisierung ergeben, finden Beachtung. Die 5. Auflage wurde überarbeitet und in den Bereichen Diabetes, Covid-19 und Regelungen zum assistierten Suizid überarbeitet und erweitert.

Background: Second victim phenomena (SVP) are critical to workplace and patient safety, and epidemiological data are limited to investigate the causes and impact on German health care. We investigated SVP in German nurses regarding prevalence, causes, and predisposition compared to a preceding study on German physicians (Second Victims in Deutschland/SeViD-I). Methods: We conducted a nationwide anonymous cross-sectional online study in 2020 using a modified SeViD questionnaire including the BFI-10 (personality traits). Statistical analysis was conducted using chi² tests and binary logistic regression models. Results: Of 332 nurses, 60% reported to experience SVP at least once a working lifetime, with a 12-month prevalence among SVP of 49%. Of the nurses, 24% reported recovery times of more than 1 year. In contrast to physicians from SeViD-I, a main cause for becoming a second victim was aggressive behavior by patients. High neuroticism values, higher age, and medium work life experience, but neither gender nor workplace position, were predisposing for SVP. Like SeViD-I, nurses reported demand for an institutional response in cases of SVP. Conclusions: SVP is common among German nurses and comprises other causes and a different course than in physicians. Further research should concentrate on specific prevention strategies, e.g., profession- and workplace-based educational programs.

Introduction The second victim phenomenon that occurs after critical events poses a serious factor for patient and workplace safety. These experiences can be evaluated using the Second Victim Experience and Support Tool (SVEST), originally in English, or the translated and validated Korean or Chinese versions. In 2020, a revised version was published (SVESTR) with the addition of resilience items. The aim of this study is the validation of the German version, the G-SVESTR, in a multiprofessional setting. Methods The G-SVESTR questionnaire was designed according to World Health Organization recommendations. This entails translation, test for face validity, back translation, pretest, expert panel evaluation, and a test in a large population for validity and reliability. We provided an anonymous online questionnaire to physicians, nurses, paramedics, medical assistants, and physician assistants to test our developed tool. Statistics were accomplished using XL-Stats. Results Altogether, 72% (306 of 428) of the participants completed the survey. The mean time for completion was 9.4 minutes. Physician assistants and medical assistants were significantly younger than other respondents. The analysis revealed satisfactory reliability (Cronbach α = 0.844). A principal component analysis showed 11 factors with eigenvalues greater than 1. Factor loading on distinct dimensions was satisfactory with one exception, the absenteeism item (item 31), which showed cross-loadings and poor factor loading on the absenteeism dimension. The results of the G-SVESTR revealed only some differences between the professional subgroups. Conclusion The G-SVESTR is a valid and reliable testing instrument for the evaluation of second victim experiences in different medical professions.

Seit 2013 ist im Bachelor-Studiengang Gesundheitsokonomie der Hochschule RheinMain ein verpflichtendes Krankenpflegepraktikum von 2 Monaten Dauer vorgesehen. Dies stellt eine gefahrengeneigte Tatigkeit mit Risiken fur Patienten und Studierende dar. Daher wurde eine Risikobeurteilung durchgefuhrt, um durch geeignete Masnahmen diese Risiken zu minimieren und andernfalls entstehende Haftungsrisiken fur die Hochschule zu berucksichtigen. Mittels Szenario-Analyse nach ONR 49002-2 wurden die wesentlichen Risiken fur die Patienten- und Mitarbeitersicherheit unter Annahme des „credible worst case“ beurteilt. Auf Basis dieser Analyse wurden Praventionsmasnahmen vor Beginn der Entsendung der ersten Kohorte in ein Pflegepraktikum abgeleitet, umgesetzt und Masnahmen zur Uberprufung der Wirksamkeit festgelegt. Funf Risiken wurden als relevant und als in dieser bisherigen Auspragung ohne weitere Intervention nicht tragbar angesehen: nosokomiale Infektionen, Verzogerung einer Notfallbehandlung, Nadelstichverletzungen (NSV), mangelhafte Beachtung bzw. Umsetzung von Brandschutzmasnahmen und fehlerhafte Handlungen im Brandfall sowie Ubernahme uberfordernder, unbeaufsichtigt durchgefuhrter Tatigkeiten. Basierend auf der Risikoanalyse wurden eine arbeitsmedizinische Vorsorge, eine Kurzzeitlehrintervention vor Aufnahme der praktischen Tatigkeit und eine schriftliche Belehrung etabliert. Durch die praventive, systematische Risikobeurteilung konnten die wesentlichen Risiken durch anerkannte Praventionsmasnahmen fur alle Betroffenen minimiert werden. Die Anwendung der Szenario-Technik erwies sich hierbei als hilfreich und sollte bei der Beurteilung komplexer Risiken auch abseits von Gefahrdungsbeurteilungen in Betracht gezogen werden.

Zusammenfassung Hintergrund Das Krankheitsverständnis der Patienten sowie deren Erwartungen an das Aufklärungsgespräch und den Therapieerfolg entsprechen nicht immer den ärztlichen Zielsetzungen und Einschätzungen. Umso wichtiger ist es, dass man im Aufklärungsgespräch gezielt auf Erwartungen und Wissenslücken der Patienten eingehen kann, insbesondere wenn es um den therapeutischen Erfolg geht. Das Ziel dieser Arbeit ist die Erhebung des krankheitsbezogenen Wissensstands und die Evaluierung der Erwartungen von Patienten in ophthalmologischer Behandlung. Methode Mittels überwiegend geschlossener Fragen wurden in einer ophthalmologischen Ambulanz einer Universitätsklinik konsekutiv 100 Patienten anonym und strukturiert befragt. Die Antwortmöglichkeiten wurden überwiegend als Einzelauswahl auf einer Ratingskala vorgegeben. Ergebnis 55% der Patienten hatten im Vorfeld einen ophthalmologischen Eingriff erlebt, 36% mindestens 2 ophthalmologische Eingriffe. Mehr als die Hälfte der Patienten hatte sich nicht näher mit dem bevorstehenden Eingriff beschäftigt (52%). Am meisten hatten die Patienten Angst vor Komplikationen (59%), am wenigsten vor der Betäubung (29%). Am wichtigsten war den Patienten eine Aufklärung über Komplikationen und sie wünschten sich am meisten Informationen über die Auswirkungen des Eingriffs auf den Alltag. Schlussfolgerung Etwa die Hälfte der Patienten hatte sich im Vorfeld des Aufklärungsgesprächs nicht mit dem erforderlichen operativen Eingriff beschäftigt. Eine verständliche Aufklärung hinsichtlich der Erfolgsraten und der möglichen postoperativen Beeinträchtigungen sowie die Bereitstellung von übersichtlichem Aufklärungsmaterial erscheinen maßgeblich. So könnten über die Klinikhomepage Patienten im Vorfeld eines operativen Eingriffs allgemeine Informationen angeboten werden. Neue Medien scheinen für Patienten in diesem Zusammenhang bisher allerdings noch eine untergeordnete Rolle zu spielen.

Zusammenfassung Hintergrund Die intravitreale operative Medikamenteneingabe (IVOM) ist eine der häufigsten ophthalmologischen Operationen. Eine hohe Therapieadhärenz ist erforderlich, um einen guten Behandlungserfolg zu erreichen. Da der Wissensstand der Patienten um Krankheit und Therapie mit einer erhöhten Therapieadhärenz assoziiert ist, wurde dieser systematisch erhoben. Patienten und Methode Die Studie wurde als explorative Befragung konzipiert. Insgesamt wurden im Zeitraum von November bis Dezember 2016 100 konsekutive Patienten der Ambulanz einer Universitätsaugenklinik ein anonymisierter, strukturierter Fragebogen mit mehrheitlich geschlossenen Fragen ausgehändigt. Die Auswertung erfolgte deskriptiv. Ergebnisse Das mediane Alter betrug 73 Jahre. Über die Hälfte der Patienten hatte bereits 3 oder mehr IVOMs an einem Auge bekommen. Die häufigste Erkrankung war eine altersbezogene Makuladegeneration (52%). 64% der Patienten erhofften sich eine Verbesserung des Sehvermögens. 42% der Patienten konnten das verwendete Präparat nicht benennen. 55% der Patienten fühlten sich ausreichend aufgeklärt. 69% der Patienten konnten nicht einschätzen, wie häufig eine Endophthalmitis nach IVOM auftritt. Schlussfolgerung Der Wissensstand der Patienten bez. Augenerkrankung, Zielsetzung der Therapie und postoperativen Komplikationen wies trotz vorheriger ausführlicher Aufklärung Lücken auf. Standardisierte Informationsblätter sind von den Patienten gewünscht und können helfen, den Wissensstand sowie die Therapieadhärenz zu verbessern.

Digital transformation in healthcare presents enormous challenges as it partially redefines care processes and interaction between patients and doctors. In order to seize opportunities to improve patient care as well as patient safety by using digital innovations, arising patient safety risks due to these changes have to be considered and addressed. The German Coalition for Patient Safety, the Austrian Network for Patient Safety and the Swiss Foundation for Patient Safety decided to develop a recommendation for members of all professional groups in healthcare to sensitize for arising risks, inform about cause-effect relationships and to empower professionals to perform an individual risk-benefit-assessment for existing and upcoming digital innovations. In May 2017 the German Coalition on Patient Safety implemented its working group Digitization and Patient Safety with its subgroup Digitization and Risk Management. Based on open brainstorming of experts followed by a nominal group technique process the most relevant risks for patient safety arising from digitization were identified and assessed by using a modified scenario analysis. After internal consultation of all members of the German Coalition for Patient Safety and all executive boards of participation associations, the recommendation was published at the annual meeting of the German Coalition for Patient Safety in May 2018. We identified six core risks that were assessed by modified scenario technique: insufficient protection of the IT system from external attacks, insufficient protection of the IT system from unauthorized access, non-availability of IT system or patient data, handing over data to external service providers, unsafe embedding of medical devices in IT systems and insufficient digital literacy of healthcare professionals. In addition, we developed a checklist for the self-assessment of risks arising from implementing digital innovation, using risk criteria according to ONR 49002-2:2014, and provided key questions for decision makers. On the basis of the approach described a multiprofessional and intersectoral recommendation for clinical core risks associated with digitization in healthcare was developed within a 12-month period. The dissemination of this recommendation in German language can be regarded as very successful since the German Coalition for Patient Safety received more than 22,000 requests for paper copies, and 1,200 downloads of this open-access publication have been registered. An English version of this recommendation will soon be available.

(1) Background: Patient safety is a pressing issue in healthcare. Besides economical and organizational issues, human factors play a crucial role in providing safe care. Safe and clear communication on both the healthcare workers’ and patients’ sides contribute to the avoidance of medical errors and increase patients’ and healthcare workers’ satisfaction. Globally, the incidence of experiencing at least one adverse event in obstetrics is about 10%, of which half are classified as preventable. According to international research, improving communication skills may decrease preventable adverse events. The research question was to what extent communication training for pregnant women impacts the quality of communication and mutual understanding during birth. (2) Methods: Communication interventions with pregnant women were conducted in two German university obstetric departments in a mixed methods research design, based on the Health Action Process Approach. The online classes covered the awareness of personal wishes, the understanding and usage of communication strategies, self-efficacy and empathy. This study presents the qualitative results. Out of 142 mothers who answered two questionnaires before the communication training and after the birth, 24 in-depth semistructured interviews were conducted to explore the subjective impact of the communication training. The results were analyzed with qualitative content analysis. (3) Results: The majority of participants felt incentivized to be aware of their personal wishes for birth and to express them. Perceived positive experiences with sufficient competency in communication, empathy and mutual understanding outweighed negative treatments and experiences in the hospital, some of which could be attributed to structural problems. (4) Discussion: The reported positive effects of the communication training underline the need but also the potential for communication lessons to reflect and improve communication skills in obstetrics. However, negative experiences due to structural problems in the healthcare system may be buffered by communication skills but not solved.

A version of the Institute for Safe Medication Practices (ISMP) questionnaire adapted to the Austrian inpatient setting was used to sample the estimates of a group of experts regarding the level of medication safety in a level II hospital. To synthesize expert opinions on a group level reproducibly, classical Delphi method elements were combined with an item weight and performance weight decision-maker. This newly developed information synthesis method was applied to the sample dataset to examine method applicability. Method descriptions and flow diagrams were generated. Applicability was then tested by creating a synthesis of individual questionnaires. An estimate of the level of medication safety in an Austrian level II hospital was, thus, generated. Over the past two decades, initiatives regarding patient safety, in general, and medication safety, in particular, have been gaining momentum. Questionnaires are state of the art for assessing medication practice in healthcare facilities. Acquiring consistent data about medication in the complex setting of a hospital, however, has not been standardized. There are no publicly available benchmark datasets and, in particular, there is no published method to reliably synthesize expertise regarding medication safety on an expert group level. The group-level information synthesis method developed in this study has the potential to synthesize information about the level of medication safety in a hospital setting more reliably than unstructured approaches. A medication safety level estimate for a representative Austrian level II hospital was generated. Further studies are needed to establish convergence characteristics and benchmarks for medication safety on a larger scale.

Background Second victims, defined as healthcare team members being traumatised by an unanticipated clinical event or outcome, are frequent in healthcare. Evidence of this phenomenon in Germany, however, is sparse. Recently, we reported the first construction and validation of a German questionnaire. This study aimed to understand this phenomenon better in a sample of young (

BACKGROUND: Mycosis fungoides (MF) is the most common type of cutaneous T‐cell lymphoma, a malignant, chronic disease initially affecting the skin. Several therapies are available, which may induce clinical remission for a time. This is an update of a Cochrane Review first published in 2012: we wanted to assess new trials, some of which investigated new interventions. OBJECTIVES: To assess the effects of interventions for MF in all stages of the disease. SEARCH METHODS: We updated our searches of the following databases to May 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched 2 trials registries for additional references. For adverse event outcomes, we undertook separate searches in MEDLINE in April, July and November 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) of local or systemic interventions for MF in adults with any stage of the disease compared with either another local or systemic intervention or with placebo. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcomes were improvement in health‐related quality of life as defined by participants, and common adverse effects of the treatments. Key secondary outcomes were complete response (CR), defined as complete disappearance of all clinical evidence of disease, and objective response rate (ORR), defined as proportion of patients with a partial or complete response. We used GRADE to assess the certainty of evidence and considered comparisons of psoralen plus ultraviolet A (PUVA) light treatment as most important because this is first‐line treatment for MF in most guidelines. MAIN RESULTS: This review includes 20 RCTs (1369 participants) covering a wide range of interventions. The following were assessed as either treatments or comparators: imiquimod, peldesine, hypericin, mechlorethamine, nitrogen mustard and intralesional injections of interferon‐α (IFN‐α) (topical applications); PUVA, extracorporeal photopheresis (ECP: photochemotherapy), and visible light (light applications); acitretin, bexarotene, lenalidomide, methotrexate and vorinostat (oral agents); brentuximab vedotin; denileukin diftitox; mogamulizumab; chemotherapy with cyclophosphamide, doxorubicin, etoposide, and vincristine; a combination of chemotherapy with electron beam radiation; subcutaneous injection of IFN‐α; and intramuscular injections of active transfer factor (parenteral systemics). Thirteen trials used an active comparator, five were placebo‐controlled, and two compared an active operator to observation only. In 14 trials, participants had MF in clinical stages IA to IIB. All participants were treated in secondary and tertiary care settings, mainly in Europe, North America or Australia. Trials recruited both men and women, with more male participants overall. Trial duration varied from four weeks to 12 months, with one longer‐term study lasting more than six years. We judged 16 trials as at high risk of bias in at least one domain, most commonly performance bias (blinding of participants and investigators), attrition bias and reporting bias. None of our key comparisons measured quality of life, and the two studies that did presented no usable data. Eighteen studies reported common adverse effects of the treatments. Adverse effects ranged from mild symptoms to lethal complications depending upon the treatment type. More aggressive treatments like systemic chemotherapy generally resulted in more severe adverse effects. In the included studies, CR rates ranged from 0% to 83% (median 31%), and ORR ranged from 0% to 88% (median 47%). Five trials assessed PUVA treatment, alone or combined, summarised below. There may be little to no difference between intralesional IFN‐α and PUVA compared with PUVA alone for 24 to 52 weeks in CR (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.87 to 1.31; 2 trials; 122 participants; low‐certainty evidence). Common adverse events and ORR were not measured. One small cross‐over trial found once‐monthly ECP for six months may be less effective than twice‐weekly PUVA for three months, reporting CR in two of eight participants and ORR in six of eight participants after PUVA, compared with no CR or ORR after ECP (very low‐certainty evidence). Some participants reported mild nausea after PUVA but no numerical data were given. One participant in the ECP group withdrew due to hypotension. However, we are unsure of the results due to very low‐certainty evidence. One trial comparing bexarotene plus PUVA versus PUVA alone for up to 16 weeks reported one case of photosensitivity in the bexarotene plus PUVA group compared to none in the PUVA‐alone group (87 participants; low‐certainty evidence). There may be little to no difference between bexarotene plus PUVA and PUVA alone in CR (RR 1.41, 95% CI 0.71 to 2.80) and ORR (RR 0.94, 95% CI 0.61 to 1.44) (93 participants; low‐certainty evidence). One trial comparing subcutaneous IFN‐α injections combined with either acitretin or PUVA for up to 48 weeks or until CR indicated there may be little to no difference in the common IFN‐α adverse effect of flu‐like symptoms (RR 1.32, 95% CI 0.92 to 1.88; 82 participants). There may be lower CR with IFN‐α and acitretin compared with IFN‐α and PUVA (RR 0.54, 95% CI 0.35 to 0.84; 82 participants) (both outcomes: low‐certainty evidence). This trial did not measure ORR. One trial comparing PUVA maintenance treatment to no maintenance treatment, in participants who had already had CR, did report common adverse effects. However, the distribution was not evaluable. CR and OR were not assessable. The range of treatment options meant that rare adverse effects consequently occurred in a variety of organs. AUTHORS' CONCLUSIONS: ​​There is a lack of high‐certainty evidence to support decision making in the treatment of MF. Because of substantial heterogeneity in design, missing data, small sample sizes, and low methodological quality, the comparative safety and efficacy of these interventions cannot be reliably established on the basis of the included RCTs. PUVA is commonly recommended as first‐line treatment for MF, and we did not find evidence to challenge this recommendation. There was an absence of evidence to support the use of intralesional IFN‐α or bexarotene in people receiving PUVA and an absence of evidence to support the use of acitretin or ECP for treating MF. Future trials should compare the safety and efficacy of treatments to PUVA, as the current standard of care, and should measure quality of life and common adverse effects.

German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was to improve our understanding of the factors that trigger intentions to leave the profession. For this purpose, data from 1060 young physicians and nurses in hospital care were analysed. Intentions to leave the profession was assessed with the Copenhagen Psychosocial Questionnaire (COPSOQ). In the first step, the association was determined between intention to leave the profession and the factors of perceived quality of care and job satisfaction. In a second step, a mediation analysis was performed to determine the effect of perceived quality of care after correction for the possible mediator of job satisfaction. There were statistically significant negative associations between perceived quality of care and intention to leave the profession (beta: &minus, 2.9, 95% CI: &minus, 4.48&ndash, &minus, 1.39) and job satisfaction and intention to leave the profession (beta: &minus, 0.5, 95% CI: &minus, 0.64&ndash, 0.44). The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions.

Background Second victims, defined as health care team members being traumatized by an unanticipated clinical event or outcome, are supposed to be a common phenomenon in health care. Surveys in the US health care system indicate high incidence rates among physicians between 10 and 44%. However, no systematic assessment of second victims in health care in German speaking countries has been published yet and no validated German questionnaire for assessing incidence of and impact on second victims exists. Therefore, we initiated the SeViD (Second Victims im Deutschsprachigen Raum/second victims in German speaking countries) project and developed a German questionnaire for the assessment of second victim incidents. Methods Based on an intensive literature review of available questionnaires in English we defined a preliminary version of our questionnaire consisting of 4 domains and 14 items. This version was subject to cognitive pretesting using paraphrasing, probing and think aloud methods in order to ensure content validity. Retest reliability of second victim symptoms was assessed three weeks after the initial pretest. Results Fifteen health care professionals (physicians, nurses, therapeutic and diagnostic professions and administrative staff) of hospitals in Germany (n=6) and Austria (n=9) with or without previous second victim experience participated as volunteers for all pretests after informed consent. Seven items in three domains were slightly modified based on cognitive pretests. Retest reliability for second victim symptoms was rho = 0.76. Mean duration of completion for this questionnaire took 9:01 (±3:05) minutes in case of a previous second victim experience and otherwise 4:19 (±0:59) minutes and was regarded acceptable by all volunteers. No volunteer regarded any question to be inappropriate. Conclusion We successfully developed a validated questionnaire assessing the impact of the second victim phenomenon in inpatient health care facilities. This questionnaire will be used in different settings for health care professionals and for stand-alone baseline assessment as well as pre/post-survey along with complex educational interventions to reduce negative impacts of the second victim phenomenon.

The patient's knowledge about their illness, as well as their expectations regarding pre-intervention, consultation and treatment, may differ from the physician's assumptions. Therefore, it is of great importance that the physician can identify misconceptions and missing knowledge and to focus on those points in the preoperative consultation, as well as meeting patient expectations as to the consultation itself. The aim of this study was to identify such expectations and the knowledge gaps of patients scheduled for ophthalmologic treatment.An anonymous questionnaire containing predominantly closed questions was handed out to 100 patients in an ophthalmological outpatient clinic of a tertiary care center. Answers were mostly single choice items on a rating scale.55% of patients had received ophthalmological interventions prior to receiving the questionnaire; 36% received more than two. More than half had not informed themselves about the planned procedure prior to their appointment. They were worried the most about complications (59%) and least about the anaesthesia (29%). When asked, patients attributed the highest priority to provision of information regarding complications and most often requested information on implications of the planned surgery on daily activities.Roughly half of the patients came without having informed themselves prior to the consultation. A comprehensive explanation with regard to success rates and possible post-surgical impairments appears to be essential. Possibilities of new media, such as the internet, surprisingly do not seem to be of importance to patients in this context.Das Krankheitsverständnis der Patienten sowie deren Erwartungen an das Aufklärungsgespräch und den Therapieerfolg entsprechen nicht immer den ärztlichen Zielsetzungen und Einschätzungen. Umso wichtiger ist es, dass man im Aufklärungsgespräch gezielt auf Erwartungen und Wissenslücken der Patienten eingehen kann, insbesondere wenn es um den therapeutischen Erfolg geht. Das Ziel dieser Arbeit ist die Erhebung des krankheitsbezogenen Wissensstands und die Evaluierung der Erwartungen von Patienten in ophthalmologischer Behandlung.Mittels überwiegend geschlossener Fragen wurden in einer ophthalmologischen Ambulanz einer Universitätsklinik konsekutiv 100 Patienten anonym und strukturiert befragt. Die Antwortmöglichkeiten wurden überwiegend als Einzelauswahl auf einer Ratingskala vorgegeben.55% der Patienten hatten im Vorfeld einen ophthalmologischen Eingriff erlebt, 36% mindestens 2 ophthalmologische Eingriffe. Mehr als die Hälfte der Patienten hatte sich nicht näher mit dem bevorstehenden Eingriff beschäftigt (52%). Am meisten hatten die Patienten Angst vor Komplikationen (59%), am wenigsten vor der Betäubung (29%). Am wichtigsten war den Patienten eine Aufklärung über Komplikationen und sie wünschten sich am meisten Informationen über die Auswirkungen des Eingriffs auf den Alltag.Etwa die Hälfte der Patienten hatte sich im Vorfeld des Aufklärungsgesprächs nicht mit dem erforderlichen operativen Eingriff beschäftigt. Eine verständliche Aufklärung hinsichtlich der Erfolgsraten und der möglichen postoperativen Beeinträchtigungen sowie die Bereitstellung von übersichtlichem Aufklärungsmaterial erscheinen maßgeblich. So könnten über die Klinikhomepage Patienten im Vorfeld eines operativen Eingriffs allgemeine Informationen angeboten werden. Neue Medien scheinen für Patienten in diesem Zusammenhang bisher allerdings noch eine untergeordnete Rolle zu spielen.

Intravitreal treatment (IVT) is one of the most common ophthalmological procedures. Therapeutic effectiveness is however dependent on patient compliance. Unwanted treatment cessation rates are high though. The authors therefore decided to analyse the patient's knowledge and treatment expectations, as discrepancies are known to negatively affect compliance and thus treatment outcomes.The study was designed as an exploratory survey. In total, 100 patients presenting to an outpatient clinic of a tertiary care centre from October to December 2016 were included. A structured, anonymised questionnaire was handed out, consisting mainly of question items with closed code lists as response domains. Solely descriptive analysis of results was performed.The median age of patients was 73 years. 70% had received more than 3 IVTs in at least one eye. Age-related macula degeneration was the most common underlying cause (52%). 64% expected improvement of visual acuity after IVT. 42% could not name one medication used in their IVT. 55% felt that the information provided during informed consent had been adequate. 69% did not know the post-surgical occurrence of endophthalmitis. Three patients were confident of being able to drive a car directly after IVT.Patient's knowledge of their underlying disease, treatment goals and complications rates exhibited some deficiencies. Standardised patient information sheets could be of significant use and were actively suggested by patients to improve the informed consent process.Die intravitreale operative Medikamenteneingabe (IVOM) ist eine der häufigsten ophthalmologischen Operationen. Eine hohe Therapieadhärenz ist erforderlich, um einen guten Behandlungserfolg zu erreichen. Da der Wissensstand der Patienten um Krankheit und Therapie mit einer erhöhten Therapieadhärenz assoziiert ist, wurde dieser systematisch erhoben.Die Studie wurde als explorative Befragung konzipiert. Insgesamt wurden im Zeitraum von November bis Dezember 2016 100 konsekutive Patienten der Ambulanz einer Universitätsaugenklinik ein anonymisierter, strukturierter Fragebogen mit mehrheitlich geschlossenen Fragen ausgehändigt. Die Auswertung erfolgte deskriptiv.Das mediane Alter betrug 73 Jahre. Über die Hälfte der Patienten hatte bereits 3 oder mehr IVOMs an einem Auge bekommen. Die häufigste Erkrankung war eine altersbezogene Makuladegeneration (52%). 64% der Patienten erhofften sich eine Verbesserung des Sehvermögens. 42% der Patienten konnten das verwendete Präparat nicht benennen. 55% der Patienten fühlten sich ausreichend aufgeklärt. 69% der Patienten konnten nicht einschätzen, wie häufig eine Endophthalmitis nach IVOM auftritt.Der Wissensstand der Patienten bez. Augenerkrankung, Zielsetzung der Therapie und postoperativen Komplikationen wies trotz vorheriger ausführlicher Aufklärung Lücken auf. Standardisierte Informationsblätter sind von den Patienten gewünscht und können helfen, den Wissensstand sowie die Therapieadhärenz zu verbessern.