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Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals.

ABSTRACT: Introduction: In spite of the existence of guidelines and international recommendations, many aspects in the diagnosis, therapy and follow-up of patients with cervical cancer are not based on validated data. A broad spectrum of different opinions and procedures concerning the therapy for patients with cervical cancer is under controversial discussion by the responsible gynaecologists in German hospitals. Methods: The present study is intended to picture the current treatment situation for cervical cancer in Germany. For this purpose a specially developed questionnaire with questions divided into 19 subsections was sent to all 688 gynaecological hospitals in Germany. Results: The response rate to the questionnaire was 34?%. 91?% of the hospitals treated between 0 and 25 patients with cervical cancer per year. 7.5?% treated between 26 and 50 and 1.4?% of the hospitals more than 50 patients per year. The bimanual examination was the most frequently used staging method (98?%); PET-CT was the least used staging method (2.3?%). Interestingly 48?% of the hospitals used surgical staging. The great majority of the hospitals (71?%) used abdominal radical hysterectomy (Wertheim-Meigs operation) to treat their patients. TMMR via laparotomy was used by 13?%. 16?% of the hospitals performed laparoscopic or robot-assisted radical hysterectomies. The sentinel concept was hardly used even in the early stages. It must be emphasised that in 74?% of the hospitals radical hysterectomies were performed even in cases with positive pelvic lymph nodes and in 43?% also in cases with positive paraaortic lymph nodes. The therapy of choice for FIGO IIB cancers is primary radiochemotherapy (RCTX) in 21?% of the hospitals; operative staging followed by radiochemotherapy in 24?% and treatment by radical hysterectomy followed by adjuvant RCTX was employed in this situation by 46?% of the hospitals. In 15-97?% of the hospitals for node-negative and in sano resected patients in stage pT1B1/1B2 after radical hysterectomy, an adjuvant RCTX is recommended when further risk factors exist (LVSI, tumour >?4?cm, age Conclusion: A broad spectrum of differing staging and therapy concepts is in use for patients with cervical cancer in Germany. A standardisation of therapy is needed. An update of national guidelines could help to achieve more transparency and a standardisation of treatment for patients with cervical cancer.

SUBMITTER: Mangler M

PROVIDER: S-EPMC3964377 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

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Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals.

Mangler M M Zech N N Schneider A A Köhler C C Marnitz S S

Geburtshilfe und Frauenheilkunde 20130301 3

<b>Introduction:</b> In spite of the existence of guidelines and international recommendations, many aspects in the diagnosis, therapy and follow-up of patients with cervical cancer are not based on validated data. A broad spectrum of different opinions and procedures concerning the therapy for patients with cervical cancer is under controversial discussion by the responsible gynaecologists in German hospitals. <b>Methods:</b> The present study is intended to picture the current treatment situat ...[more]

PMID: 24771915

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Project description:Question: Endoscopy is an integral part of surgical gynaecology and is playing an increasingly important role in ensuring adequate gynaecological training in the context of specialty training in general. At present, little is known about the expectations and notions of young junior doctors with respect to endoscopic training. For this reason, junior doctors throughout Germany were surveyed on this topic and asked to share their opinions. Methods: Using an anonymized standardized survey, the following information was elicited: importance of endoscopic training, willingness to take courses, expectations for instructors and the hospital, ideas about the number of required operations, both as a surgical assistant and as a surgeon, as well as satisfaction with the current status of training. The questionnaires were sent via the Young Forum (Junges Forum) of the German Society of Gynaecology and Obstetrics (DGGG) and the newsletter of the Working Group for Gynaecological Endoscopy (AGE). Results: The evaluation of the study was based on 109 completed questionnaires. The resident junior doctors were 31 years old on average and were in their third to fourth year of their specialty training on average. The majority of the participants (87?%) considered the learning of endoscopic techniques to be very important and advocated regular participation in endoscopy training courses. Among the participants, 48?% were prepared to invest up to €1500 of their own funds to attend courses up to twice a year during the entire specialty training period. The expectations of the instructors and institutions focused on technical expertise, the willingness and time for teaching and on the number and range of surgical procedures, followed by being granted leave for the courses and having costs covered for the courses. Thirty-eight per cent stated that their expectations had been completely or mostly met and 62?% said they had been met in part or inadequately. Eighty-three per cent of the respondents reported that they would change specialty training institutions in order to achieve their own goals in the context of specialty training. Conclusions: This study presents data for the first time on the satisfaction of young junior doctors and their expectations for endoscopic specialty training. The residents exhibited a high level of interest in endoscopy and a high level of willingness to actively shape the specialty training, including course participation. However, there appears to be a great deal of room for improvement for endoscopic specialty training, independent of the current training institution, training year or sex of the junior doctors.

Project description:Background: Simulation trainings offer the opportunity to replicate parts of or entire processes of medical care in a controlled environment. Some hospitals operate simulation centres dedicated to training their staff. Which organisational factors support or impede the implementation of such units in hospitals? Methods: In an exploratory survey experts and decision makers in German hospitals were interviewed. The answers were evaluated qualitatively in order to identify patterns in argumentation. Among the eleven participants were practitioners heading simulation centres (n=4), managers or executives in charge of finances (n=2), medical directors or head physicians with disciplinary responsibility for medical personnel (n=3), and researchers who deal with simulation trainings in medicine (n=2). The interview partners were guaranteed confidentiality in order to allow for them to speak freely about the obstacles and weaknesses in their respective organisations. Results: The interviewees showed a very heterogeneous picture of the simulation trainings in their respective hospitals in terms of content as well as target groups. Asked about purpose and benefit of simulation centres, subgroups of the interviewees gave various arguments. Financing is comprised of subsidies, fees from external participants, and of vocational training budgets. Several obstacles for the implementation were mentioned such as insufficient error culture, deficient interaction of quality and risk management, high equipment costs, or staffing levels that are too low to schedule entire teams for vocational trainings. Conclusions: Patterns in argumentation could be identified that support the implementation and operation of simulation centres in hospitals. Yet strikingly enough there were no coherent arguments i.e. there was no uniform reasoning of aim and purpose of simulation centres. Furthermore, the survey indicated the need to approach quality- and risk management more holistically wherefore simulation centres could offer laboratory environments. All in all, the survey indicates that the assessment of success and economic benefits of simulation centres haven't yet been examined thoroughly.

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Project description:BackgroundThe purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges.MethodsIn this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated.ResultsCommunication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments.ConclusionsOur study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments.Clinical relevanceTo our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.

Dataset Information

Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals.

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Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals.

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