Bottle microresonator with actively stabilized evanescent coupling

The evanescent coupling of light between a whispering-gallery-mode bottle microresonator and a subwavelength-diameter coupling fiber is actively stabilized by means of the Pound-Drever-Hall technique. We demonstrate the stabilization of a critically coupled resonator with a control bandwidth of 0.1 Hz, yielding a residual transmission of (9±3)×10(-3) for more than an hour. Simultaneously, the frequency of the resonator mode is actively stabilized.

Complementary therapy use in patients with glioma: an observational study

OBJECTIVE

Despite novel multimodal therapeutic approaches, the vast majority of glial tumors are not curable. Patients may search for complementary therapies in order to contribute to the fight against their disease or to relieve symptoms induced by their brain tumor. The extent of the use of complementary or alternative therapies, the patients' rationale behind it, and the cost of complementary therapy for gliomas are not known. We used a questionnaire and the database of the German Glioma Network to evaluate these questions.

METHODS

A total of 621 questionnaires were available for evaluation from patients with glial tumors of WHO grades II to grade IV. The patients were recruited from 6 neuro-oncologic centers in Germany. Complementary therapy was defined as methods or compounds not used in routine clinical practice and not scientifically evaluated.

RESULTS

Forty percent of the responding patients reported the use of complementary therapies. Significant differences between the group of complementary therapy users and nonusers were seen with respect to age (younger > older), gender (female > male), and education (high education level > low education level). The motivation for complementary therapy use was not driven by unsatisfactory clinical care by the neuro-oncologists, but by the wish to add something beneficial to the standard of care.

CONCLUSIONS

In clinical practice, patients' use of complementary therapies may be largely overseen and underestimated. The major motivation is not distrust in conventional therapies. Neuro-oncologists should be aware of this phenomenon and encourage an open but critical dialogue with their patients.

Non-conventional treatments sought by patients after surgery for intramedullary spinal cord tumors

OBJECTIVE

Despite modern microsurgical techniques and interdisciplinary treatment options, intramedullary spinal cord tumors often lead to profound neurological deficits. Some patients may search for non-scientific or unconventional therapeutic options to treat the symptoms induced by the tumor itself or arising from treatment. The extent of non-scientific therapy use, the rationale behind it, and costs of these forms of therapy are unknown.

METHODS

A questionnaire consisting of 20 questions was sent to 60 patients of a single neurosurgical center who had undergone surgery for an intramedullary spinal cord tumor. A retrospective study was carried out based on this data. Histological findings ranged from ependymoma (52.9%), hemangioblastoma (17.6%), cavernoma (14.7%), astrocytoma (8.8%), oligodendroglioma (2.9%) to ganglioglioma (2.9%). Non-scientific therapy was defined as a method not used in routine clinical practice for the treatment of symptoms induced by intramedullary spinal cord tumors.

RESULTS

A total of 38 questionnaires was returned. About 55.3% of the patients claimed to use non-scientific therapies. No significant difference between histological types and the percentage of alternative therapy use was detected. There was a gender difference. One third (non user group) to one fourth (user group) did not feel adequately informed about their disease. The monthly costs for non-scientific therapies ranged from 50 to 500 Euros. The main motive for the use of non-scientific therapies was the wish to try everything possible.

CONCLUSION

In the daily clinical routine, patients' use of non-scientific therapies may be largely overlooked and underestimated. Neurooncologists should be aware of this phenomenon and encourage an open but critical dialogue with their patients.

[Empowerment by capacity building in urban quarters--first results and assessment of a new standardised instrument]

AIMS

Capacity building is regarded as an intermediate outcome and success parameter for community health promotion and empowerment. The first aim of the study was the development and examination of a tool to measure capacity building in the context of a programme of health promotion for children and parents in a socially disadvantaged quarter in Hamburg (about 3000 residents, 60% with migration background). The second aim was to measure capacity building within a period of five years.

METHOD

A survey was carried out with 27 professionals from the health and social field. Dimensions of the instrument were: citizen participation, local leadership, available resources, networking and co-operation, support of residents. At the same time, we tested to what extent the instrument is suitable for resident surveys. Furthermore, pretest instrument and results were discussed with our advisory board regarding potential improvements.

RESULTS

The result of the project, in addition to its practical use in the quarter, consists of the generation of a psychometrically tested instrument to measure capacity building. Furthermore, the experience contributed to the expertise on how such a study can be conducted. A comparison of the situation in 2006 with the situation in 2001 showed considerable improvements in all dimensions of capacity building in the quarter.

CONCLUSION

Establishing the instrument on a long-term basis calls for more intensive examination not only of the chances, but also the limitations of the tool. We mainly attribute the overall positive picture that was gained within a period of five years to the generally supportive climate of development in the quarter as well as to the strong and continuous commitment of individual persons involved.

[The economic benefits of self-help associations]

OBJECTIVES

This article primarily reflects on the economic benefits of self-help associations, and the problems of their adequate evaluation.

METHODS

We present a critical discussion of the concepts in the economic evaluation and empiricism by secondary analysis of data available based on a review of published studies as well as the re-analysis of primary data from our Hamburg study in 2003 (n=345 or 52.4% of the self-help associations registered in Hamburg).

RESULTS

Most approaches to evaluate the economic benefits of self-help groups were inspired by the idea of output-related, cost-benefit analysis, by which activities of members were monetarily estimated. Projected for Hamburg, the productive performance amounts to nearly 1.8 million Euro per month, and 21.5 million per year. Furthermore, additional voluntary commitment can be mobilized at 300,000 Euro per month.

CONCLUSION

All calculations are based on some assumptions (e.g., coefficient of productivity, wages) which cannot be finally verified. In view of the state of research reviewed we strongly recommend to bring forward both outcome-oriented approaches of economic evaluation, and new representative studies of self-help groups for Germany as a whole.

Patient-reported outcomes in hernia repair

BACKGROUND

The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for groin hernia repair.

METHODS

In two centres for short-stay surgery all patients referred for hernia repair were surveyed between August 1999 and January 2002. Patients reported on health-related quality of life (SF-36), symptoms (Hernia Symptom Checklist, HSCL) and other indicators pre-operatively (T0) and 14 days (T1) and 6 months post-operatively (T2). Three of the eight SF-36 subscales (physical functioning, bodily pain, and role physical) and the HSCL at T2 were considered as main outcome indicators. The main outcomes were analysed by generalized linear models with regard to predictors.

RESULTS

At T0 a total of 342 hernia patients were included. The response rate at T2 was 54.1% (92.4% males, 58.6 years of age). At T2 only 21.1% did not report complaints (i.e. haematoma, pain, numbness) post-operatively. The overall positive course is reflected by the HSCL: from 32.4% pre-operatively, it rises slightly to 38.5% at T1 and decreases to 10.6% at T2 (T0-T2: P < 0.001). The SF-36 subscales "physical functioning", "bodily pain", and "role physical" showed the same course over time (slight decrease of health-related quality of life at T1 and large increase at T2). The main patient-reported outcomes were mainly influenced by the pre-operative level, age, and self-reported post-operative complaints.

CONCLUSION

The low response rate was mainly due to non-delivery of questionnaires at T1 during the regular post-operative visit by the operating physician. Though non-response occurs under conditions of routine care, meaningful information was gained which should be used for quality improvement activities. Because the pre-operative level is a major determinant of the post-operative health outcomes, the prospective pre-post measurement should be standard, in case institutional comparisons are intended.

[Social factors influencing participation in self-help groups or organisations--results from selected questions for the health monitor]

OBJECTIVES

Using selected data collected by the Health Monitor (Bertelsmann-Stiftung) from 1,539 adults aged between 18 and 79 years this article describes which social factors have an impact on participation in self-help groups or organisations. Furthermore, questions about the length of participation, fields of self-help activity, and their usefulness were analysed.

METHODS

All participants were approached in written form. The questionnaire included 103 health-related items (6 about self-help), and 15 demographic characteristics. The sample was weighted statistically by federal state, sex and age.

RESULTS

4.1% stated to be a member of self-help organisations for chronically ill or disabled people. On the whole, 9.1% have participated in self-help activities during their lifetime (currently active: 2.8%). Membership in self-help organisations increases with age, social class and according to personal involvement, whereas participation in self-help groups is quite different. The rate of participation of women is nearly twice as high as that of men (11.1 versus 6.9%). Generally, participation in self-help groups was also rated positively, but assessments vary with social class and the length of using them.

CONCLUSION

Particularly with regard to the distribution of self-help participants depending on social class there are some discrepancies to other studies. These differences can supposedly be ascribed to methodical factors (e. g., social class index, sample size).

[Work-satisfaction and Health of Hospital Nursing and Medical Personnel]

The implementation of new service demands and increasing rationalisation measures exercise stress and pressure on medical and nursing personnel in German hospitals. However, their satisfaction and health are important quality criteria in the ranking of a hospital. Basing on the introduction of a new tool, an inquiry was conducted among the medical and nursing personnel of two hospitals (A and B) in respect of the quality of their working conditions. The scope of the questionnaires covered the nature and kind of the work, opportunities of professional success, management of co-operation and conflicts, physical and structural obstacles to smooth working as well as the management of quality. Finally, a scale of complaints and a burn-out scale served to assess the personnel's subjective health situation. The questionnaire was submitted in hospital A between November 1999 and February 2000 to a total of 39 doctors (58 % compliance) and 84 nursing personnel (47 % compliance) of the specialist departments concerned with internal medicine, rheumatology, urology, general and accident surgery. In hospital B the questionnaire was completed between March and July 2001 by a total of 40 doctors (54 %) and 91 nursing personnel (68 %) of two departments of internal medicine, surgery, neurosurgery and gynaecology. Comparable to other studies, the nursing personnel in both the hospitals rated the working conditions more negatively than the medical personnel. The differences, however, are more of a quantitative (number of frequency of problems) than of a qualitative nature (type or kind of problems). With both groups, problems connected with structural difficulties in working and with quality management were by far most important while the nursing personnel also underlined physical stress. Individual health condition were also classified more negatively by the nursing personnel than by the doctors, and the overall physical complaints of the nursing personnel were generally greater than with the average population, whereas medical personnel registered fewer complaints. Health promotion measures in hospitals may help to prevent negative developments. Such measures are too rarely translated into reality.

[Quality evaluation from the patient viewpoint--exemplary results from the European WHO Project "Health-Promoting Hospitals"]

This article has two objectives: first of all, to present the European WHO project "Health Promotion in Hospitals" in a general way and secondly, to report on results of empirical concomitant research on a sub-project on quality assessment from the patient's viewpoint in a Hamburg member hospital of the international WHO pilot project and to present the essential partial aims of this approach to health promotion. An interim report on the international pilot project showed clearly that among all the realisation projects those are the most frequent ones that aim at promoting the health of patients (87 of a total 181). We report on one of these projects (partly sponsored by the North German Centre of Public Health). Focus is on the results of a quantitative query among patients (n = 157 = 58% response rate). The methods on which the study is based as well as the relevant limitations of its representative nature are outlined. Essential results quoted are the assessments made by the patients themselves taking into consideration 11 dimensions of hospital quality. It becomes evident that action should be taken in the area of several communicative dimensions and in hospital facilities. The results of the inquiry provided the basis for hospital quality improvements. An internal project group within the hospital worked out recommendations that have since been translated into reality to a large extent.