Publications by authors named "Joachim Graf"

15 Publications

  • Page 1 of 1

Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study.

JMIR Cancer 2021 Oct 12;7(4):e25776. Epub 2021 Oct 12.

Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany.

Background: Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis.

Objective: This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments.

Methods: A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments.

Results: The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9%) than the EQ-5D-5L (47/163, 28.8%) and EORTC QLQ-C30 (65/176, 36.9%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS.

Conclusions: Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/25776DOI Listing
October 2021

Academisation of the Midwifery Profession and the Implementation of Higher Education in the Context of the New Requirements for Licensure.

Geburtshilfe Frauenheilkd 2020 Oct 25;80(10):1008-1015. Epub 2020 Sep 25.

Universitätsklinikum Tübingen, Institut für Gesundheitswissenschaften, Abteilung für Hebammenwissenschaft, Tübingen, Germany.

The academization of the midwifery profession poses great challenges for Germany, especially due to the tight timelines: Corresponding courses of study can in principle be offered at both universities and technical colleges - although contrary to the recommendations of the Science Council. This means that there is a heterogeneity in midwifery qualifications and promotes a discussion regarding coherent study concepts. This process must be accompanied with great care so that midwifery courses of study are not designed to be of poorer quality than other courses of study due to a lack of financial resources. First concepts are already available and will be discussed and examined below.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1138-1948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518934PMC
October 2020

The academization of midwifery: State-wide implementation of the new law governing the education of midwives (Hebammenreformgesetz) is leading to heterogeneous education.

GMS J Med Educ 2020 15;37(4):Doc37. Epub 2020 Jun 15.

Universitätsklinikum Tübingen, Institut für Gesundheitswissenschaften, Abteilung für Hebammenwissenschaft, Tübingen, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3205/zma001330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346290PMC
July 2021

Rare genital malformations in women's health research: sociodemographic, regional, and disease-related characteristics of patients with Mayer-Rokitansky-Küster-Hauser syndrome.

BMC Womens Health 2020 06 29;20(1):135. Epub 2020 Jun 29.

University Hospital Tübingen, Department of Women's Health, Tübingen, Germany.

Background: The Mayer-Rokitansky-Küster-Hauser syndrome, MRKHS, is a rare (orphan) disease characterized by the aplasia or hypoplasia of the uterus and the vagina. In women's health research, little is known as to how much care provision for patients with MRKHS takes into account their socio-demographic together with their clinical characteristics. This work examines the patients' socio-demographic characteristics, highlighting issues of inappropriate and deficient provision of care.

Methods: The study was carried out as part of the larger TransCareO project and included a group of N=129 MRKHS patients who underwent surgery between 2008 and 2012. Using a specially developed questionnaire, we analyzed MRKHS patients' data found both in the clinical documentation of the Department for Women's Health, University Hospital of Tübingen and the patient surveys of the Center for Rare Genital Malformations (CRGM/ ZSGF). Patients who took part in interviews were compared with non-respondents.

Results: Patient respondents and non-respondents did not differ as to the parameters of interest. In most cases, primary amenorrhea was reported as an admission reason. In 24% of patients, a medical intervention (hymenal incision or hormone treatment) already occurred before admission to the Center in Tübingen and proper diagnosis of MRKHS. About one third received in advance inappropriate treatment. During the therapy, more than half of the patients were in a solid partnership. 10% of the family anamneses documented the occurrence of urogenital malformations.

Conclusions: Care provision for MRKHS patients is largely characterized by delayed proper diagnosis and in part, by inappropriate treatment attempts; there are also indications of regional differences. Anamnestic clues such as an asymptomatic amenorrhea or renal abnormalities of unclear origin still fail to result early enough in referral to a center on the basis of suspected MRKHS diagnosis. Urogenital malformations in the family are more common in patients than in the general population. For patients, a wide range of burdens are associated with the diagnosis. Abnormalities compared to their female peers occur, for instance, in the partnership status: MRKHS patients have more rarely a partner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12905-020-00969-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322870PMC
June 2020

[Academisation of the Midwifery Profession (Part 2): Risks - and How they can Be Avoided as Best as Possible in the Degree Programs].

Z Geburtshilfe Neonatol 2020 Jun 17;224(3):130-135. Epub 2020 Jun 17.

Institut für Gesundheitswissenschaften, Abteilung für Hebammenwissenschaft, Universitätsklinikum Tübingen, Tübingen.

The full academisation of midwifery training, which thus far has been given in technical colleges, is now beginning in Germany and poses a great challenge for both the German federal states and the universities. Against this background, the aim of this article is to identify possible risks arising from the full academisation of training and the revision of the Midwifery Act and to show possible solution strategies to promote the implementation of study programmes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1124-9729DOI Listing
June 2020

Communication skills of medical students: survey of self- and external perception in a longitudinally based trend study.

BMC Med Educ 2020 May 11;20(1):149. Epub 2020 May 11.

Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstrasse 5, 72076, Tuebingen, Germany.

Background: As good communication skills are crucial for doctor-patient interactions, it is recommended to incorporate them in medical school programs from the very beginning. On this basis medical schools in Germany introduced the OSCE (objective structured clinical examination) to examine and by this foster learning of communication skills as assessment drives learning. The aim of the study was to examine the development of the communication skills of medical students during an OSCE to investigate how communication competence has developed between different student cohorts.

Methods: This study is a longitudinal trend study based on seven semester-cohorts, examining the communication skills of medical students in the OSCE both from the perspective of students and from the viewpoint of standardized patients (SP). Altogether, 1027 students from seven semester cohorts were asked to rate their own communication skills (self-perception) before the OSCE exam started. Here, sub-analyses were performed to outline a potential influence of previous history-taking group participation. The SP evaluated the students' communication skills in external perception during the OSCE exam at each station with history-taking or physical examinations. The communication skills in both groups were ascertained in the dimensions of empathy, content structure, verbal expression, and non-verbal expression.

Results: Only in the dimension of non-verbal expression could a statistically significant change be found in students' self-perception over the years. Notably, the rating of communication skills as self-rated by the students has risen constantly, whereas they deteriorated from the perspective of standardized patients (SP). It has also been found that previous history-taking courses have a positive influence on the structural dimension of communication skills in particular.

Conclusions: The results of this study support conclusions of other studies which also suggest differences between self- and external perception of medical students' communication skills. Nevertheless, students showed good overall communication skills in the four dimensions of empathy, content structure, verbal expression, and non-verbal expression, as demonstrated in a longitudinal trend study over seven semesters. However, we noted that externally rated empathy levels declined over the semester cohorts, suggesting the need for new priorities to be set in student teaching.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12909-020-02049-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216673PMC
May 2020

The Academization of Midwifery in the Context of the Amendment of the German Midwifery Law: Current Developments and Challenges.

Geburtshilfe Frauenheilkd 2019 Aug 12;79(8):854-862. Epub 2019 Aug 12.

Universitätsklinikum Tübingen, Institut für Gesundheitswissenschaften, Abteilung für Hebammenwissenschaft, Tübingen, Germany.

Germany faces the challenge of enforcing the academization of midwifery training in the upcoming months in order to comply with Directive 2013/55/EU. This paper outlines the related developments and challenges. At the moment, midwifery training in Germany is still predominantly carried out in technical colleges. In 2019, less than 20% of midwifery training places were college-based. The current standard training is a dual training system which combines vocational training with academic-based courses, but this approach will no longer be feasible once the EU directive has been fully implemented. Although the existing draft legislation completely transfers midwifery training to institutions of higher education, various aspects of this concept have remained vague and do not take account of the laws on higher education in the individual federal states. Moreover, if midwifery training is to be provided by both universities and colleges, this will lead to quite different levels of academization within a relatively small professional group. The concept that universities offer primary qualifications comes closest to the required quality standards for professional, science-based, practical and evidence-based midwifery training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0958-9519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690737PMC
August 2019

An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study.

J Med Internet Res 2019 01 22;21(1):e10004. Epub 2019 Jan 22.

Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.

Background: The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far.

Objective: The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients.

Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ρ) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed.

Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients' response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score.

Conclusions: The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/10004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362389PMC
January 2019

Pregnancy-associated breast cancer: maternal breast cancer survival over 10 years and obstetrical outcome at a university centre of women's health.

Arch Gynecol Obstet 2018 08 21;298(2):363-372. Epub 2018 Jun 21.

Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.

Purpose: Pregnancy-associated breast cancer (PABC) is considered the second most common malignancy affecting pregnancy. The limited knowledge as to long-term survival is nonuniform. This retrospective study aims to contribute by a follow-up of pregnancies of breast cancer patients treated at a single university centre with focus on maternal long-term survival in relation to time point of diagnosis (before, during, and after pregnancy).

Methods: Data of 25 patients were reviewed for the period between 2000 and 2009 in relation to their neonatal and maternal outcome parameters as well as their maternal breast cancer outcomes by assessing maternal mortality at annual intervals up to a maximum of 10 years follow-up.

Results: Median age at diagnosis was 33 years. Maternal survival rate of the total collective came to 76% after 5 years and to 68% after 10 years. The newborns were healthy, 22% of them presented with a 1'Apgar score 5-7. Preterm delivery occurred in 53%. PABC significantly affected maternal survival compared to the national breast cancer cohort at 5 years and barely significantly at 10 years, with highly significant (p < 0.003) to significant (p < 0.01) effects at 5 and 10 years, respectively, for PABC diagnosed during and after pregnancy.

Conclusions: The present findings on survival rates suggest that maternal medical assessment at the beginning of and during further course of pregnancy should include a scrutinized thorough breast examination. Conveying/delivering special competences to monitor these high-risk pregnancies at the interface of oncological care should be considered an obligatory part of academic medical education, obstetrical training and interprofessional midwifery education.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-018-4822-5DOI Listing
August 2018

[Practicability and Efficiency of E-health Applications in Patient-Reported Outcomes: State of and Need for Research].

Gesundheitswesen 2018 Nov 27;80(11):953-962. Epub 2018 Feb 27.

Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen.

Aims: E-health-based technologies also play an increasing role in the collection of patient- reported outcomes (ePRO). However, it remains unclear how feasible and powerful e-health applications are in the collection of PRO. Therefore, it should be examined to what extent the requirements for the use of technology-based PRO instruments has already been explored in order to allow its broad use in the "e-health world". Specifically, the research focus is on practicability, capability and technical implementation of ePRO. The design of the basic legal requirements for the conduct of PRO interviews and how the challenges of ePRO have already been harmonized here need to be examined.Methods Literature study: selective literature research in Pubmed as well as in the databases of DIMDI, G-BA, FDA and EMA.

Results: Current scientific knowledge about hurdles, acceptance and usefulness in relation to sociodemografic factors, health status and technical skills as well as about technical implementation is low. The legal standards for ePRO are restricted only to the composition of the survey instrument and methodology quality criteria. There are no prerequisites for a broad use of ePRO, which is why therapeutic measures should not be based on them.

Conclusion: The standards of the legislators must be specified and adapted to the requirements of ePRO. Because the design of the tool surface and the rate of usability can influence the response behavior of the patients, the focus should be on the reliability and validity of ePRO surveys in the context of their implementation in relation to the patients, disease, questionnaire and ePRO-specific variables, which determine the response behavior, in order not to endanger the meaningfulness of PRO surveys.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0044-100037DOI Listing
November 2018

Physical examination in undergraduate medical education in the field of general practice - a scoping review.

BMC Med Educ 2017 Nov 25;17(1):230. Epub 2017 Nov 25.

University Hospital Tuebingen, Institute for General Medicine and Interprofessional Care, Österbergstraße 9, D-72074, Tuebingen, Germany.

Background: Physical examination (PE) is an essential clinical skill and a central part of a physician's daily activity. Teaching of PE has been integrated into medical school by many clinical disciplines with respective specific examination procedures. For instance, PE teaching in general practice may include a full-body examination approach. Studies show that PE-skills of medical students often need enhancement. The aim of this article was to scope the literature regarding the teaching and research of PE within general practice during undergraduate medical education. We evaluated a wide breadth of literature relating to the content, study design, country of research institution and year of publication.

Methods: Literature search in Medline along the PRISMA-P protocol was performed by search syntax ("physical examination" AND "medical education" AND "undergraduate" AND general practice) considering Medline MeSH (Medical Subject Heading)-Terms and Medline search term tree structure. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. Full texts were analyzed by publication year, country of origin, study design and content (by categorizing articles along their main topic according to qualitative content analysis of Mayring).

Results: One-hundred seven articles were included. The annual number of publications ranged from 4 to 14 and had a slightly rising trend since 2000. Nearly half of the publications originated from the United States (n = 54), 33 from Canada and the United Kingdom. Overall, intervention studies represented the largest group (n = 60, including uncontrolled and controlled studies, randomized and non-randomized), followed by cross-sectional studies (n = 29). The 117 studies could be assigned to five categories "teaching methods (n = 53)", "teaching quality (n = 33)", "performance evaluation and examination formats (n=19)", "students' views (n = 8)" and "patients' and standardized patients' views (n=4)".

Conclusions: The present work shows a wide spectrum of teaching and research activities and a certain level of evidence for the effectiveness of individual teaching methods. It can be used as orientation and impulse generator for the further development of medical education in the field of PE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12909-017-1074-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702119PMC
November 2017

Reliability of an e-PRO Tool of EORTC QLQ-C30 for Measurement of Health-Related Quality of Life in Patients With Breast Cancer: Prospective Randomized Trial.

J Med Internet Res 2017 09 14;19(9):e322. Epub 2017 Sep 14.

Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany.

Background: Breast cancer represents the most common malignant disease in women worldwide. As currently systematic palliative treatment only has a limited effect on survival rates, the concept of health-related quality of life (HRQoL) is gaining more and more importance in the therapy setting of metastatic breast cancer. One of the major patient-reported outcomes (PROs) for measuring HRQoL in patients with breast cancer is provided by the European Organization for Research and Treatment of Cancer (EORTC). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. Facing the possibilities associated with evolving digitalization in medicine, validation of electronic versions of well-established PRO is essential in order to contribute to comprehensive and holistic oncological care and to ensure high quality in cancer research.

Objective: The aim of this study was to analyze the reliability of a tablet-based measuring application for EORTC QLQ-C30 in German language in patients with adjuvant and (curative) metastatic breast cancer.

Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female patients with adjuvant and metastatic breast cancer recruited as part of the e-PROCOM study. All patients were required to complete the electronic- (e-PRO) and paper-based versions of the HRQoL EORTC QLQ-C30 questionnaire. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability [Wilcoxon test] and test of internal consistency [Spearman rho and agreement rates for single items, Pearson correlation and Kendall tau for each scale]) were analyzed.

Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient's response behavior between paper- and electronic-based questionnaires. Regarding the test of parallel forms reliability, no significant differences were found in 27 of 30 single items and in 14 of 15 scales, whereas a statistically significant correlation in the test of consistency was found in all 30 single items and all 15 scales.

Conclusions: The evaluated e-PRO version of the EORTC QLQ-C30 is reliable for patients with both adjuvant and metastatic breast cancer, showing a high correlation in almost all questions (and in many scales). Thus, we conclude that the validated paper-based PRO assessment and the e-PRO tool are equally valid. However, the reliability should also be analyzed in other prospective trials to ensure that usability is reliable in all patient groups.

Trial Registration: ClinicalTrials.gov NCT03132506; https://clinicaltrials.gov/ct2/show/NCT03132506 (Archived by WebCite at http://www.webcitation.org/6tRcgQuou).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.8210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620457PMC
September 2017

Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients.

JMIR Cancer 2017 Aug 7;3(2):e11. Epub 2017 Aug 7.

Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany.

Background: Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients' subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited.

Objective: The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients' willingness to participate in such programs.

Methods: The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes' bias-corrected bootstrap) were performed.

Results: A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ≤.001). Significant differences were found in relation to willingness to use ePRO (92.3% in the exposed group vs 59% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13% in the exposed patients vs 30% in the nonexposed patients; P=.003] and no prior technology usage [5% in the exposed group vs 15% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4% in the exposed group vs 9% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness.

Conclusions: Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/cancer.6996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565790PMC
August 2017

Psychosocial Stress, Course of Pregnancy and Pregnancy Outcomes in the Context of the Provision of Sexual Services.

Geburtshilfe Frauenheilkd 2017 Apr;77(4):366-376

Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany.

There has been very little medical research into pregnancies which occur in the context of prostitution, even though the associated health risks for mother and child, e.g. violence or maternal drug abuse, are well known. The aim of this study was to compile and summarize what is known (inter-)nationally about this topic and identify key points of support as part of a uniform standard of healthcare in pregnancy. A selective search of the literature was done in Pubmed and Livivo/Medpilot and in the databases NIH, Cochrane, DARE, NHSEED and HTA on the factors influencing preterm delivery. There are no systematic studies on pregnancy risks in the context of sexual services. But there is data available on specific risk factors, for example the increased risk of prematurity associated with sexual/physical violence (OR = 1.28-4.7). The Prostitute Protection Act provides only limited protection for affected women, and statutory maternity protection regulations also have little impact as they require a formal contract of employment which rarely exists even in the context of legal prostitution. Approximately 400 000 women are currently working as prostitutes in the Federal Republic of Germany. The number of unreported cases is high. Nevertheless, there is little concrete data available on the probable health risks if these women become pregnant. The existing laws that should offer protection fall short of the mark. There is a need for more research into the future implementation of the Prostitute Protection Act which should focus on health counselling, health promotion and additional protective legislation. Low-threshold healthcare services offered in the context of prenatal care could be an opportunity to improve care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0042-124045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406233PMC
April 2017

Communication skills of medical students during the OSCE: Gender-specific differences in a longitudinal trend study.

BMC Med Educ 2017 May 2;17(1):75. Epub 2017 May 2.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Internal Medicine, Osianderstrasse 5, D-72076, Tuebingen, Germany.

Background: Communication skills are essential in a patient-centred health service and therefore in medical teaching. Although significant differences in communication behaviour of male and female students are known, gender differences in the performance of students are still under-reported. The aim of this study was to analyse gender differences in communication skills of medical students in the context of an OSCE exam (OSCE = Objective Structured Clinical Examination).

Methods: In a longitudinal trend study based on seven semester-cohorts, it was analysed if there are gender differences in medical students' communication skills. The students (self-perception) and standardized patients (SP) (external perception) were asked to rate the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests in SPSS 21.

Results: Across all ratings in the self- and the external perception, there was a significant gender difference in favour of female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception between 2011 and 2014.

Discussion & Conclusion: It is important to consider if gender-specific teaching should be developed, considering the reported differences between female and male students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12909-017-0913-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414383PMC
May 2017
-->