Interprofessionalität – ein gesundheitswissenschaftlicher Begriff aus dem Blickwinkel der Linguistik

Viele Hoffnungen werden an das Thema «Interprofessionalität» geknüpft. Eine genaue Definition des Begriffs fehlt jedoch, wie in einigen gesundheitswissenschaftlichen Arbeiten bereits festgestellt wurde. Linguistische Analysen, die sich dem Begriff der Interprofessionalität und dessen Verwendung widmen, liegen bisher nicht vor. Diese Lücke geht die vorliegende Analyse an. Konkret wurden die Begriffe «Interprofessionalität», «interprofessionell» und «interprofessionelle Zusammenarbeit» in Texten aus zwei linguistischen Korpora quantitativ erfasst. In einem zweiten Arbeitsschritt wurde die Begriffsverwendung qualitativ analysiert. In einem kurzen Fazit werden die Ergebnisse reflektiert und diskutiert. Die linguistische Analyse zeigte einen erheblichen Anstieg der Verwendung aller drei Begriffe, eine Beschränkung auf fachmedizinische Publikationen, einen Fokus auf die interprofessionelle Zusammenarbeit zwischen Ärzten und Ärztinnen und dem Pflegepersonal, ein Fehlen der Patient/-innenperspektive sowie eine typische Relation mit entwicklungsfokussierten Schlagworten, die darauf hinweisen, dass die Schärfung des Begriffsfeldes «Interprofessionalität» noch nicht abgeschlossen ist

Nursing and therapy professions to the universities! : documentation of the online symposia «Are dual degree programs in midwifery a model for the therapy professions?» and «Bachelor degree programs in Austria and Switzerland: models for the therapy and nursing professions in Germany?» held on March 18, and September 8, 2021

Der Verein zur Förderung der Wissenschaft in den Gesundheitsberufen VFWG veranstaltete zwei Online-Symposien zum Stand der Akademisierung in Deutschland, wo lediglich die Hebammen dank EU-Vorschriften seit 2020 an Fachhochschulen ausgebildet werden. Für die Pflege- und Therapieberufe gilt nach wie vor die Modellklausel, die bis 2024 verlängert wurde. In Österreich und der Schweiz sind die Ausbildungen für die Therapieberufe vollständig an den Fachhochschulen angesiedelt, für diejenigen für die Pflege und die medizinisch-technischen Berufe teilweise. Das erste Symposium erörterte, ob sog. duale Studiengänge ein Modell sein könnten für die Therapieberufe in Deutschland. Das zweite Symposium fragte, ob der Weg, den Österreich und die Schweiz eingeschlagen haben, Argumente liefern kann für eine Akademisierung der Gesundheitsberufe in Deutschland. Dieser Beitrag führt ins Thema ein; die folgenden Beiträge dokumentieren die Beiträge verschiedener Autoren zu den beiden Symposien

Cost recommendation under uncertainty in IQWiG’s efficiency frontier framework

Background: The National Institute for Quality and Efficiency in Health Care (IQWiG) employs an efficiency frontier (EF) framework to facilitate setting maximum reimbursable prices for new interventions. Probabilistic sensitivity analysis (PSA) is used when yes/no reimbursement decisions are sought based on a fixed threshold. In the IQWiG framework, an additional layer of complexity arises as the EF itself may vary its shape in each PSA iteration, and thus the willingness-to-pay, indicated by the EF segments, may vary. Objectives: To explore the practical problems arising when, within the EF approach, maximum reimbursable prices for new interventions are sought through PSA. Methods: When the EF is varied in a PSA, cost recommendations for new interventions may be determined by the mean or the median of the distances between each intervention’s point estimate and each EF. Implications of using these metrics were explored in a simulation study based on the model used by IQWiG to assess the cost-effectiveness of 4 antidepressants. Results. Depending on the metric used, cost recommendations can be contradictory. Recommendations based on the mean can also be inconsistent. Results (median) suggested that costs of duloxetine, venlafaxine, mirtazapine, and bupropion should be decreased by €131, €29, €12, and €99, respectively. These recommendations were implemented and the analysis repeated. New results suggested keeping the costs as they were. The percentage of acceptable PSA outcomes increased 41% on average, and the uncertainty associated to the net health benefit was significantly reduced. Conclusions: The median of the distances between every intervention outcome and every EF is a good proxy for the cost recommendation that would be given should the EF be fixed. Adjusting costs according to the median increased the probability of acceptance and reduced the uncertainty around the net health benefit distribution, resulting in a reduced uncertainty for decision makers

Unconscious bias among health professionals : a scoping review

Background: Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. Methods: We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. Results: A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. Conclusions: Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions

Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations

Background: Low- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries. Objective: This review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination. Methods: The databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015. A descriptive, narrative, and interpretative synthesis of data was undertaken. Results: Of the 33 studies included in the review, the majority acknowledged cost per vaccinated girl (CVG) (26 studies) and vaccine coverage rate (21 studies) as particular challenges for LMICs, while nine studies identified screening coverage rate as a challenge. Most of the studies estimated CVG as a composite of different cost items. However, the basis for the items within this composite cost was unclear. The majority used an assumption rather than an observed rate to represent screening and vaccination coverage rates. CVG, vaccine coverage and screening coverage were shown by some studies through sensitivity analyses to reverse the conclusions regarding cost-effectiveness, thereby significantly affecting policy recommendations. Conclusions: While many studies recognized aspects of the particular challenges of HPV vaccination in LMICs, greater efforts need to be made in adapting models to account for these challenges. These include adapting costings of HPV vaccine delivery from other countries, learning from the outcomes of cervical cancer screening programmes in the same geographical region, and taking into account the country’s previous experience with other vaccination programmes

Evaluation of the Interprofessional Education Day 2019

Interprofessional education (IPE) means that students from different professions learn with, from and about each other. In 2019, an interprofessional education day (IPE day) was held in the canton of Zurich with 68 students and eight lecturers over eight lessons with the aim of improving interprofessional competencies. Students from six health care disciplines and PhD students with different professional backgrounds had to work together in groups on two cases with standardised patients. A pre-post online survey was conducted to evaluate the IPE day. It included self-assessment using items from the Zürcher InterProfessionelle AusbildungsStation (ZIPAS ®) competency framework and the Interprofessional Collaborative Competency Attainment Survey (ICCAS) as well as open-ended questions about the IPE day. ZIPAS ® competency framework and ICCAS were evaluated quantitatively, while the open-ended questions were evaluated qualitatively. There were statistically significant improvements in most of the subscales of the ZIPAS ® competency framework but only in one third of the ICCAS subscales. In addition, the qualitative analysis of the statements showed improvements in collaboration in particular, as well as positive statements on the exchange with students from other professions, whereby many students attributed great importance to the topic of interprofessionality and have already focused their attention on the future and their everyday lives. The IPE day could be a good method to improve the collaboration and communication with students from other professions in the health sector. Keywords - Interprofessional Education DayMixed Methods Studyinterprofessional educationInterprofessional Collaboration = Interprofessionelle Ausbildung bzw. Lehre und Zusammenarbeit gewinnen im Gesundheitswesen zunehmend an Bedeutung. Bei der interprofessionellen Lehre (IPL, engl. Interprofessional Education [IPE]) handelt es sich um das «mit-, von- und übereinander» Lernen verschiedener Professionen oder Studierender dieser (Centre for the Advancement of Interprofessional Education [CAIPE], 2016, S. 1). Ziel der IPL ist, dass die Auszubildenden unter anderem Aufgaben, Kompetenzen und Verantwortung der anderen Berufsgruppen kennenlernen und weitere Kompetenzen erwerben, die für die interprofessionelle Zusammenarbeit unabdingbar sind (Barr, 1998). Bei der Planung von interprofessionellen Ausbildungsprogrammen gibt es verschiedene Aspekte zu berücksichtigen, die Oandasan und Reeves (2005) in drei Ebenen einteilen. Auf der «Mikroebene» werden der Einfluss vorgefertigter Ansichten und die Entwicklung der Teilnehmenden zu Gesundheitsfachleuten beschrieben. Die «Mesoebene» beinhaltet Organisation und Planung sowie die Unterstützung einflussreicher institutioneller Personen. Auf der «Makroebene» wird der Politik und verschiedenen Institutionen eine wichtige Rolle beigemessen. IPL kann einen positiven Effekt auf verschiedenen Ebenen bewirken und so das Gesundheitssystem beeinflussen. So zeigten sich in der Studie von Nagge et al. (2017) durch IPL Verbesserungen in der Zusammenarbeit und im Rollenverständnis. Auch kann eine Wertschätzung gegenüber anderen Professionen gefördert werden (Singer et al., 2018). In der Studie von Strasser et al. (2008) konnte durch ihre Intervention ein gewisser positiver Einfluss auf ein Patienten-Outcome gezeigt werden. Im Review von Reeves et al. (2013), welcher letztere Studie inkludiert hat, weisen die Autoren darauf hin, dass die Ergebnisse aufgrund der großen Heterogenität der eingeschlossenen Studien keine allgemeinen Aussagen erlauben. In der Schweiz gibt es Bestrebungen, die interprofessionelle Zusammenarbeit durch gemeinsame Ausbildungsangebote, darunter die Zürcher InterProfessionelle AusbildungsStation (ZIPAS®; Ulrich et al., 2019), zu verbessern. Solche Angebote sind jedoch oft singulär und (noch) nicht fest in den Curricula verankert. Zudem sind Studierende der Gesundheits- und Medizinalberufe meist institutionell und örtlich voneinander getrennt. Im Kanton Zürich beispielsweise bietet die Zürcher Hochschule für Angewandte Wissenschaften (ZHAW) die Studiengänge «Ergotherapie», «Hebamme», «Pflege» und «Physiotherapie» an. Dagegen studiert man Humanmedizin an der Universität Zürich (UZH) und Pharmazie an der Eidgenössischen Technischen Hochschule (ETH). Die ETH bietet zudem neu Humanmedizin auf Bachelor-Stufe an. Zwischen den Studiengängen der Universitäten und Fachhochschulen gibt es bisher nur wenig gemeinsame Lehrveranstaltungen, da vielfach die entsprechenden Strukturen und Prozesse (z. B. Flexibilität der einzelnen Curricula) fehlen. Die Institutionen ZHAW und UZH haben am 12. Oktober 2019 erstmalig den Interprofessionellen Ausbildungstag (IPE-Tag) durchgeführt, mit der Zielsetzung, das gegenseitige Rollenverständnis von Studierenden verschiedener Fachrichtungen im Gesundheitswesen zu verbessern und interprofessionelle Kompetenzen zu vermitteln bzw. zu vertiefen. Das Ziel dieser Untersuchung war es, den IPE-Tag inklusive der Erwartungen, positiven Aspekte und Verbesserungsvorschläge seitens der Studierenden zu evaluieren und den Kompetenzerwerb der Studierenden zu messen

Estimation of input costs for a Markov model in a German health economic evaluation of newer antidepressants

Background: Estimating input costs for Markov models in health economic evaluations requires health state-specific costing. This is a challenge in mental illnesses such as depression, as interventions are not clearly related to health states. We present a hybrid approach to health state-specific cost estimation for a German health economic evaluation of antidepressants. Methods: Costs were determined from the perspective of the community of persons insured by statutory health insurance (“SHI insuree perspective”) and included costs for outpatient care, inpatient care, drugs, and psychotherapy. In an additional step, costs for rehabilitation and productivity losses were calculated from the societal perspective. We collected resource use data in a stepwise hierarchical approach using SHI claims data, where available, followed by data from clinical guidelines and expert surveys. Bottom-up and top-down costing approaches were combined. Results: Depending on the drug strategy and health state, the average input costs varied per patient per 8-week Markov cycle. The highest costs occurred for agomelatine in the health state first-line treatment (FT) (“FT relapse”) with €506 from the SHI insuree perspective and €724 from the societal perspective. From both perspectives, the lowest costs (excluding placebo) were €55 for selective serotonin reuptake inhibitors in the health state “FT remission.” Conclusion: To estimate costs in health economic evaluations of treatments for depression, it can be necessary to link different data sources and costing approaches systematically to meet the requirements of the decision-analytic model. As this can increase complexity, the corresponding calculations should be presented transparently. The approach presented could provide useful input for future models

Personalisierte Medizin: Grundlagen für die interprofessionelle Aus-, Weiter- und Fortbildung von Gesundheitsfachleuten

Hinweise zur Ausarbeitung dieser Publikation: Die SAMW hat im Auftrag der Akademien der Wissenschaften Schweiz die thematische Plattform «Chancen und Risiken der Personalisierten Gesundheit» etabliert. In diesem Rahmen hat der SAMW-Vorstand eine Arbeitsgruppe beauftragt, das Thema der Aus-, Weiter- und Fortbildung von Gesundheitsfachleuten im Bereich «Personalisierte Medizin» zu bearbeiten

Membrane Bridging and Hemifusion by Denaturated Munc18

Neuronal Munc18-1 and members of the Sec1/Munc18 (SM) protein family play a critical function(s) in intracellular membrane fusion together with SNARE proteins, but the mechanism of action of SM proteins remains highly enigmatic. During experiments designed to address this question employing a 7-nitrobenz-2-oxa-1,3-diazole (NBD) fluorescence de-quenching assay that is widely used to study lipid mixing between reconstituted proteoliposomes, we observed that Munc18-1 from squid (sMunc18-1) was able to increase the apparent NBD fluorescence emission intensity even in the absence of SNARE proteins. Fluorescence emission scans and dynamic light scattering experiments show that this phenomenon arises at least in part from increased light scattering due to sMunc18-1-induced liposome clustering. Nuclear magnetic resonance and circular dichroism data suggest that, although native sMunc18-1 does not bind significantly to lipids, sMunc18-1 denaturation at 37°C leads to insertion into membranes. The liposome clustering activity of sMunc18-1 can thus be attributed to its ability to bridge two membranes upon (perhaps partial) denaturation; correspondingly, this activity is hindered by addition of glycerol. Cryo-electron microscopy shows that liposome clusters induced by sMunc18-1 include extended interfaces where the bilayers of two liposomes come into very close proximity, and clear hemifusion diaphragms. Although the physiological relevance of our results is uncertain, they emphasize the necessity of complementing fluorescence de-quenching assays with alternative experiments in studies of membrane fusion, as well as the importance of considering the potential effects of protein denaturation. In addition, our data suggest a novel mechanism of membrane hemifusion induced by amphipathic macromolecules that does not involve formation of a stalk intermediate