Christoph Schweikardt

The historical development of the Dutch Sentinel General Practice Network from a paper-based into a digital primary care monitoring system

AimThe Dutch Sentinel General Practice Network (SGPN) was founded in 1970 for disease surveillance in primary care, based on paper questionnaires. Advances in information technology offered new prospects of data collection from electronic health records (EHRs). This study investigates the resulting challenges for the SGPN and its transition towards electronic data collection.MethodsA qualitative approach included triangulation of SGPN annual reports, network publications, its computerisation project protocol of 2004, public health policy documents, and expert interviews.ResultsIn the 1990s, the design of the SGPN, coordinated by the research institute NIVEL, no longer corresponded to new Dutch government information demands regarding developments in primary care utilisation and quality. The emergence of the EHR-based Netherlands Information Network of General Practice (LINH) could have rendered the SGPN obsolete. However, NIVEL researchers recognised that routine EHR data on health problems could not fully provide required information obtained by questionnaires and samples for laboratory analysis. They developed a plan (1) taking EHR-based routine data collection as a basis, and (2) simultaneously retaining the more detailed supplementary data collection that was the core of the SGPN. The transition towards electronic data collection from 2005 onwards was followed by the integration of both networks into the NIVEL Primary Care Database in 2014.ConclusionThe Dutch model is an example of a process responding to the challenges and opportunities associated with the emergence of electronic data collection, leading towards the integration of routine and supplementary data collection for both sentinel surveillance and health services research.

Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study

Background General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. Objectives This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed. Methods A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc. Results Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Conclusion Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.

Gonorrhoea and Syphilis Epidemiology in Flemish General Practice 2009-2013: Results from a Registry-based Retrospective Cohort Study Compared with Mandatory Notification

Background The number of newly diagnosed gonorrhoea and syphilis cases has increased in Flanders in recent years. Our aim was to investigate, to which extent these diagnoses were registered by general practitioners (GPs), and to examine opportunities and limits of the Intego database in this regard. Methods Data from a retrospective cohort study based on the Flemish Intego general practice database was analyzed for the years 2009–2013. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from figures of mandatory notification. Results A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively. Conclusion In spite of limitations such as small numbers and different case definitions, comparison with mandatory notification suggests that the GP was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the GP.

Mobile phone health risk policy in Germany: The role of the federal government and the Federal Office for Radiation Protection

Abstract In order to establish a regulatory framework for a given technology important to society, the government must make decisions in the face of existing unknowingness. In the last decade, health risks originating from electromagnetic fields of mobile telecommunication transmitting stations and devices have become a regulation policy issue in Germany. This article investigates the role of the government and the Federal Office for Radiation Protection in regard to policy-making by analysing publications and Federal Parliament reports, hearings and debates. The government and Federal Parliament perceived the research situation in 2001 as insufficient in the absence of hard evidence for health impairment. Against this background, the government struck a compromise with mobile telecommunication network operators, who did not want to integrate stricter limit values for transmission stations as precautionary measures. The network operators’ voluntary self-commitment included financing half the budget of the German Mobile Telecommunication Research Programme (2002–2008) under the lead management of the Federal Office for Radiation Protection, which concluded that it was not required to change the position taken in 2001. The results of this programme provided the basis to continue the agreement of that year. With regard to health issues and all the other interests involved, this agreement was an acceptable and remarkably stable compromise.

The Introduction of Deaconess Nurses at the German Hospital of the City of Philadelphia in the 1880s

In 1884, seven deaconesses from Iserlohn, Germany, came to the Philadelphia German Hospital to take over nursing care and hospital administration. This article deals with the preparation and implementation of deaconess rule at the German Hospital and conflicts during the tenure of the first two Sisters Superior, Marie Krueger (1826–1887) and Wanda von Oertzen (1845–1897). Recruitment of the deaconesses took place within a network of relations between German and American motherhouses. Before their arrival in Philadelphia, the benefactor of the German Hospital, John D. Lankenau (1817–1901), had committed himself to hospital rule by the Sister Superior. A Deaconess Committee was created to deal with the opposition of the Medical Board. Introducing deaconesses to the Philadelphia German Hospital led to a major change of medical personnel and allowed the hospital to develop a new corporate identity.

The development of a national HIV Plan in Belgium: Achieving consensus despite institutional complexity

BACKGROUND The development of a national HIV Plan poses serious challenges to countries with a complex distribution of legal powers such as Belgium. This article explores how the Belgian national HIV Plan 2014-2019 was developed. METHODS Applying the policy streams model of John Kingdon, the analysis of the HIV Plan development process was based on published government statements, parliamentary documents, and websites of stakeholders. RESULTS The Federal Ministry of Health initiative to achieve the HIV Plan was characterized by a coordinating role with a participatory approach towards the other Belgian governments and stakeholders. The 2013 protocol agreement of the Belgian governments committed them to principles, actions, and cooperation, but not to budgets, priorities, or target figures. DISCUSSION The Federal government followed a successful strategy to create momentum and commitment to a common national vision on HIV/AIDS. The window of opportunity was not sufficient to create an implementation plan prior to the 2014 elections, and major challenges were left to the subsequent governments, including financing. CONCLUSION The country of Belgium represents an example of a consensus strategy to achieve a national HIV Plan with its achievements and limits within institutional complexity and limited Federal legal powers.

Konkrete Ausdrucks- und Umgangsformen

Eine Patientenverfugung ist eine von einem einwilligungsfahigen Volljahrigen schriftlich verfasste Erklarung, in der er fur den Fall seiner Einwilligungsunfahigkeit festlegt, ob er in bestimmte, zum Zeitpunkt der Festlegung noch nicht unmittelbar bevorstehende Untersuchungen seines Gesund heitszu standes, Heilbehandlungen oder arztliche Eingriffe einwilligt oder sie untersagt. Mit dieser sog. Legaldefinition beschreibt der Gesetzgeber in § 1901 a Abs. 1 des Burgerlichen Gesetzbuches (BGB) das rechtliche Instrument, mit dem sichergestellt werden soll, dass der Wille von Menschen am Lebensende respektiert wird. Die Patientenverfugung ist erst seit dem Inkrafttreten des 3. Betreuungsrechtsanderungs gesetzes am 1. September 2009 (BGBl I 2009, 2286) gesetzlich geregelt. Der Gesetzgeber hat die entsprechenden Normen in §§ 1901 a, 1901 b und 1904 BGB dem Betreuungsrecht — und nicht den Regelungen zur Personlichkeit oder Willenserklarung — zugeordnet.

Nursing history in Germany: past, projects, papers, and prospects.

As compared with Great Britain and the United States in the same period, the degree to which, in the nineteenth and twentieth centuries, Germany’s nurses became professionalized was not as marked—in terms of nurse education, nursing research, and the status of nurses in the health system. In the nineteenth century, the period and the course of nurse training were not in general regulated, nor did state recognition yet exist. Th e education of nurses was left largely to nursing organizations and local communities, with a paucity of teaching hospitals in the latter. Around 1900, the length of training varied signifi cantly, often as much as from three months to one year.1 Th e introduction of statewide nursing examinations followed upon a decision of the Upper House (Bundesrat) of the Federal Parliament in 1906. Prussia, the most important of the German states, introduced the examination in 1907, while other German states, such as Baden and Bavaria, delayed the introduction of the examination until after the end of World War I. Th e examination itself represented a compromise between government, medical profession, and denominational interests:2 only one year of vocational training was required. At fi rst, the extent of theoretical education was not fi xed, and the educational requirements for the examination (elementary school [Volksschule] or its equivalent) were low. In the examination regulations, which were published following the Upper House decision in 1906, nursing was defi ned as an