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  • 1
    Online-Ressource
    Online-Ressource
    Springer Science and Business Media LLC ; 2022
    In:  Systematic Reviews Vol. 11, No. 1 ( 2022-08-13)
    In: Systematic Reviews, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2022-08-13)
    Kurzfassung: Interprofessional collaboration (IPC) is seen as the “gold standard” of comprehensive care, but credible evidence concerning the effects on patient-reported outcomes (PRO) is lacking. The aim of this systematic review is to study the effect of IPC on PRO in inpatient care. Methods We systematically searched six electronic databases (PubMed, Web of Science/Social Science Citation Index, CENTRAL (Cochrane Library), Current Contents (LIVIVO), CINAHL, and Embase) for studies published between 1997 and 2021. Additional studies were identified through citation tracking, manually searching the Internet and Google Scholar, and consultation of experts. Risk of bias (RoB) was assessed using the RoB 2 tool for randomized controlled trials (RCTs) and ROBINS-I for non-randomized studies (NRS). The included controlled before-and-after study (CBA) was assessed using both the ROBINS-I and the Effective Practice and Organization of Care (EPOC) quality criteria. Results were synthesized through narrative description, grouping, and thematic analysis of extracted data. Results The search yielded 10,213 records, from which 22 studies (16 RCTs, five NRS, and one CBA) fulfilled the inclusion criteria. In all but five studies, RoB was assessed as being high (RoB 2) resp. critical or serious (ROBINS-I). Within these 22 studies, nine inductively derived outcomes were assessed: (i) quality of life, (ii) coping, (iii) functional ability and health status, (iv) psychiatric morbidity, (v) pain, (vi) managing one’s own health care, (vii) treatment success, (viii) satisfaction, and (ix) therapeutic relationship. While some studies do not report effect estimates, and some of the reported effects appear to be imprecisely estimated, the overall results indicate that IPC may affect PRO positively across all outcomes. Conclusions Due to high clinical heterogeneity and high RoB, the question whether IPC affects PRO cannot be answered conclusively. Methodically rigorous studies are needed in order to answer the question of effectiveness of IPC. Systematic review registration PROSPERO CRD42017073900
    Materialart: Online-Ressource
    ISSN: 2046-4053
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2022
    ZDB Id: 2662257-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-11-08)
    Kurzfassung: To address the problem of overuse of elective surgery and to support patients in their decision-making process, a Second Opinion Directive was introduced in Germany, which enables patients with statutory health insurance to obtain a second opinion for certain surgical indications. The study aims to identify, based on the experiences of patients who have undergone elective surgery, the role of seeking a second opinion in reaching their decision. Methods Sixty-two patients who had undergone an elective surgery (hysterectomy, tonsillectomy, shoulder arthroscopy) were recruited using purposive sampling and interviewed during October to December 2020. The transcribed interviews were analysed using a framework analysis to create a typology from the patient’s perspective. Results The time spent by patients in making the decision to undergo surgery varies between individuals, and is influenced by factors such as the type of physician-patient relationship, individual patient aspects, prior experiences in the health care system, as well as information needs. Within the framework of the analysis, we were able to identify three patterns of patient types based on the three different time-points or phases when decisions were typically made, with one type being divided into two subtypes: Type 1a: Quick decision making, Type 1b: Overwhelmed quick decision making, Type 2: Time to consider, Type 3: Struggling with the decision. Conclusions Patients who followed a recommendation for elective surgery appreciate having the possibility to seek a second opinion. However, various factors influenced their opting for a second opinion during the decision-making process. Patients have differing information needs, such that a one-size-fits-all second opinion service may not fit adequately for all patients.
    Materialart: Online-Ressource
    ISSN: 1472-6963
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2022
    ZDB Id: 2050434-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    In: Systematic Reviews, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2018-12)
    Materialart: Online-Ressource
    ISSN: 2046-4053
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2018
    ZDB Id: 2662257-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Journal of the American College of Surgeons Vol. 216, No. 5 ( 2013-05), p. 1015-1025e18
    In: Journal of the American College of Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 216, No. 5 ( 2013-05), p. 1015-1025e18
    Materialart: Online-Ressource
    ISSN: 1072-7515
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2013
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    In: Journal of Pediatric Surgery, Elsevier BV, Vol. 55, No. 12 ( 2020-12), p. 2555-2565
    Materialart: Online-Ressource
    ISSN: 0022-3468
    RVK:
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2020
    ZDB Id: 2039299-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
    Online-Ressource
    Springer Science and Business Media LLC ; 2023
    In:  BMC Health Services Research Vol. 23, No. 1 ( 2023-01-03)
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-01-03)
    Kurzfassung: While interprofessional collaboration (IPC) is widely considered a key element of comprehensive patient treatment, evidence focusing on its impact on patient-reported outcomes (PROs) is inconclusive. The aim of this study was to investigate the association between employee-rated IPC and PROs in a clinical inpatient setting. Methods We conducted a secondary data analysis of the entire patient and employee reported data collected by the Picker Institute Germany in cross-sectional surveys between 2003 and 2016. Individual patient data from departments within hospitals was matched with employee survey data from within 2 years of treatment at the department-level. Items assessing employee-rated IPC (independent variables) were included in Principal Component Analysis (PCA). All questions assessing PROs (overall satisfaction, less discomforts, complications, treatment success, willingness to recommend) served as main dependent variables in ordered logistic regression analyses. Results were adjusted for multiple hypothesis testing as well as patients’ and employees’ gender, age, and education. Results The data set resulted in 6154 patients from 19 hospitals respective 103 unique departments. The PCA revealed three principal components (department-specific IPC, interprofessional organization, and overall IPC), explaining 67% of the total variance. The KMO measure of sampling adequacy was .830 and Bartlett’s test of sphericity highly significant ( p   〈  0.001). An increase of 1 SD in department-specific IPC was associated with a statistically significant chance of a higher (i.e., better) PRO-rating about complications after discharge (OR 1.07, 95% CI 1.00–1.13, p  = 0.029). However, no further associations were found. Exploratory analyses revealed positive coefficients of department-specific IPC on all PROs for patients which were treated in surgical or internal medicine departments, whereas results were ambiguous for pediatric patients. Conclusions The association between department-level IPC and patient-level PROs remains – as documented in previous literature - unclear and results are of marginal effect sizes. Future studies should keep in mind the different types of IPC, their specific characteristics and possible effect mechanisms. Trial registration Study registration: Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2NYAX ); Date of registration: 09 November 2021.
    Materialart: Online-Ressource
    ISSN: 1472-6963
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 2050434-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    In: BMC Pregnancy and Childbirth, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Kurzfassung: The rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG. Methods We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed. Results We identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0–6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG. Conclusion Our systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health. Systematic review registration Registered in PROSPERO (CRD42017078231).
    Materialart: Online-Ressource
    ISSN: 1471-2393
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2020
    ZDB Id: 2059869-5
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    In: BMJ Open, BMJ, Vol. 11, No. 2 ( 2021-02), p. e045264-
    Kurzfassung: Second opinion programmes aim to support the patients’ decision-making process and to avoid treatments that are unnecessary from a medical perspective. The German second opinion directive, introduced in December 2018, constitutes a new legal framework in statutory health insurance for seeking second opinions for elective procedures and so far includes tonsillectomy, tonsillotomy, hysterectomy and shoulder arthroscopy. The directive mandates physicians who recommend one of the above-mentioned surgeries to inform their patients of their legal right to visit a certified second opinion provider. Since second opinion programmes are a fairly recent phenomenon in Germany, no comprehensive data are yet available on the degree of implementation, users, potential barriers and their effectiveness. We aim to examine the characteristics and the use of second opinion programmes as well as the needs and wishes from the perspective of (potential) users in Germany, with focus on the decision-making process, the patient–physician relationship and the motivation to seek a second opinion, as well as the role of health literacy. Methods and analysis Six substudies will include the following stakeholders: (1 and 2) patients with one of the four surgery-indications covered by the directive, (3) patients who electively sought an online-based second opinion, (4) patients with oncological diseases, (5) the general population and (6) medical specialists. A mixed-methods approach will be used, including questionnaires, interviews and focus groups. The data will be evaluated using quantitative descriptive analysis and qualitative content analysis. The integration of the results will take place in the form of a triangulation protocol. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Brandenburg Medical School. The findings will be published in peer-reviewed journals and presented at scientific conferences.
    Materialart: Online-Ressource
    ISSN: 2044-6055 , 2044-6055
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2021
    ZDB Id: 2599832-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    Online-Ressource
    Online-Ressource
    Georg Thieme Verlag KG ; 2021
    In:  Zeitschrift für Orthopädie und Unfallchirurgie Vol. 159, No. 04 ( 2021-08), p. 406-411
    In: Zeitschrift für Orthopädie und Unfallchirurgie, Georg Thieme Verlag KG, Vol. 159, No. 04 ( 2021-08), p. 406-411
    Kurzfassung: Ziel der Studie In dieser Studie werden Kostendaten einer Erst- und Zweitmeinung von Patienten mit orthopädischen Indikationen eines deutschen Zweitmeinungsportals erhoben und verglichen. Methodik Es wurden anonymisierte Patientendaten eines Zweitmeinungsportals aus dem Zeitraum 2013 bis 2015 verwendet. Kosten einer Erst- bzw. Zweitmeinung wurden mithilfe von DRG, dem EBM-Katalog, der Vergütungsvereinbarung über physikalische Therapie und mithilfe von Abgabepreisen von Medikamenten erhoben. Um die Übertragbarkeit zu erhöhen, wurden in einer Kostenanalyse Erstempfehlung und Zweitmeinung gegenübergestellt, um ein theoretisches Einsparpotenzial zu ermitteln. Ergebnisse Insgesamt wurden 170 konsekutive Patienten mit orthopädischer Indikation und Erst- und Zweitmeinung in dieser Studie analysiert. Nur rund 1 von 3 Erstempfehlungen wurde durch die Zweitmeinung bestätigt. In der Zweitmeinung wurden häufig Physio- und Schmerztherapie bei Indikationen, die in der Erstempfehlung häufig eine OP-Empfehlung bekamen, empfohlen. In Szenario 1 (durchschnittliche Ressourcennutzung) lagen die Kosten der Erstempfehlung im Median bei 5020,96 € (IQR = 961,71 – 7342,66), die der Zweitmeinung bei 322,07 € (IQR = 146,39 – 1341,32). Im Median entsprachen die OP-Kosten der Erstempfehlung 156,12 physiotherapeutischen Sitzungen und 26,02 N3-Packungen Ibuprofen 800. Schlussfolgerung Therapiekosten für die Erstempfehlung liegen deutlich über den Therapiekosten der Zweitmeinung, wodurch man der Nutzung der Zweitmeinung ein Potenzial zusprechen kann, Therapiekosten zu senken. Diese Studie liefert die Basis, um weitere qualitativ aussagekräftigere Analysen diesbezüglich durchzuführen.
    Materialart: Online-Ressource
    ISSN: 1864-6697 , 1864-6743
    Sprache: Englisch
    Verlag: Georg Thieme Verlag KG
    Publikationsdatum: 2021
    ZDB Id: 2280747-0
    ZDB Id: 2304338-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: Implementation Science, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2019-12)
    Materialart: Online-Ressource
    ISSN: 1748-5908
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2019
    ZDB Id: 2225822-X
    Standort Signatur Einschränkungen Verfügbarkeit
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