German Ophthalmological Research Articles

The utilization of ophthalmological emergency departments is on the rise : 14-year results from aGerman tertiary university outpatient department

The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time. The aim of this study is to make awell-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived. Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1January 2010 to 31December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, aquestionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022. The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, ashift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without areferral from adoctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic. The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to adouble burden: providing treatment for emergency cases with specialist referrals and at the same time acting as acatchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.

Ten-Year Effectiveness and Safety of Trabecular Micro-BypassStentImplantation with Cataract Surgery in Patients with Glaucoma or Ocular Hypertension.

This study evaluated 10-year results of implanting one iStent trabecular micro-bypass stent during cataract surgery in eyes with open-angle glaucoma (OAG) or ocular hypertension. This retrospective, non-randomized study examined 10-year outcomes of iStent trabecular micro-bypass stent implantation with cataract surgery by one surgeon in eyes with OAG [including primary OAG (POAG) and pseudoexfoliative glaucoma (PXG)] or ocular hypertension at a multi-specialty German ophthalmology center. Study visits were conducted preoperatively and at 2.5, 3, 5, and 10years postoperatively; examinations included intraocular pressure (IOP), medications, corrected-distance visual acuity (CDVA), and adverse events. A total of 63 eyes of 45 patients with OAG (n = 60 eyes) or ocular hypertension (n = 3 eyes) and data through 10years were analyzed. Mean preoperative IOP was 18.6 ± 4.4mmHg on 1.83 ± 1.03 mean medications. At study visits through 10years postoperative, mean IOP reduced by 12.9-19.0% (p < 0.005 at all points), and mean medication burden reduced by 37.8-51.4% (p ≤ 0.006 at all points). At 10years postoperatively, 77.8% of eyes had IOP ≤ 18mmHg and 47.6% had IOP ≤ 15mmHg (vs. 50.8% and 25.4% preoperatively, respectively; p = 0.016). One-third (33.3%) of eyes were medication-free vs. 3.2% preoperatively (p < 0.001); 17.5% were on 2-5 medications (vs. 55.6% preoperatively, p = 0.005); and 93.7% of eyes were on the same or fewer medications vs. preoperative. Post-phacoemulsification CDVA improvement was maintained; no filtering surgeries were completed over 10-year follow-up. Significant and safe IOP and medication reductions were observed through 10years after iStent implantation with cataract surgery in patients with OAG or ocular hypertension.

Ophthalmological research in Germany: suggestions by an international expert panel.

To evaluate the research performance in ophthalmology in Germany based on the findings of the recent research map of the German Ophthalmological Society (DOG) and to suggest strategies for future improvements on anational level both to DOG as well as to politics. The focus is on preclinical and translational clinical research. International expert panel evaluation and discussion organized by the Task Force Research of the German Ophthalmological Society (DOG). The international view on the German ophthalmological research landscape was generally positive. The value for money relationship was judged as very good. As Germany is facing an aging society and vision impairment will create an ever-increasing socioeconomic burden, the reviewers suggested several lines of future activities: an increased activity of securing intellectual property, more lay audience lobbying, intensified collaboration and critical mass building between "lighthouses" of ophthalmic research in Germany, as well as the establishment of aGerman national eye institute equivalent. The ophthalmological research performance in Germany was rated to be very good by an international expert panel. Nonetheless significant improvements were requested in the fields of translation (clinical trials, IP), synergy between specialized institutions and governmental funding for aGerman center for eye research.

Ophthalmological research in Germany: evaluation by an international expert panel

To evaluate the research performance in ophthalmology in Germany based on the findings of the recent research map of the German Ophthalmological Society ( DOG) and to suggest strategies for future improvements on anational level both to DOG as well as to politics. The focus is on preclinical and translational clinical research. International expert panel evaluation and discussion organized by the Task Force Research of the German Ophthalmological Society (DOG). The international view on the German ophthalmological research landscape was generally positive. The value for money relationship was judged as very good. As Germany is facing an aging society and vision impairment will create an ever-increasing socioeconomic burden, the reviewers suggested several lines of future activities: an increased activity of securing intellectual property, more lay audience lobbying, intensified collaboration and critical mass building between "lighthouses" of ophthalmic research in Germany, as well as the establishment of aGerman national eye institute equivalent. The ophthalmological research performance in Germany was rated to be very good by an international expert panel. Nonetheless significant improvements were requested in the fields of translation (clinical trials, IP), synergy between specialized institutions and governmental funding for aGerman center for eye research.

The 2022 Activity Report of the Tissue Transplantation and Biotechnology Section of the German Ophthalmological Society

The 2022 Activity Report of the Tissue Transplantation and Biotechnology Section of the German Ophthalmological Society

Frequency and distribution of the active agent of intravitreal injections in German centers 2015-2021-An oregis study

Digitalization in medicine, especially the electronic documentation of patient data, is revolutionizing healthcare systems worldwide. The evaluation of real-world data collected under everyday conditions presents opportunities but also challenges. Electronic medical registries provide ameans to compile extensive patient data for scientific inquiries. Oregis is the first nationwide digital registry for health services research established by the German Ophthalmological Society (DOG). Intravitreal operative medicinal injections (IVOM) are among the most frequently performed procedures in ophthalmology. Data on injection numbers and injection frequencies with anti-vascular endothelial growth factor (VEGF) are already available from other countries, whereas data at a national level are not yet available in Germany due to the lack of anationwide register. It is known that the treatment success of anti-VEGF IVOMs depends largely on the adherence to treatment and thus on the number of injections. There are also differences in cost. In the context of this study, real-world data on the frequency and distribution of intravitreal injections in German centers from 2015 to 2021 were compiled for the first time since the introduction of oregis. The aim of this study is to collect data on the use of anti-VEGF IVOMs in Germany from oregis for the first time and to show the development of injection numbers and anti-VEGF drugs used. At the same time, the possibilities of data retrieval from oregis are demonstrated using aconcrete example from daily ophthalmological practice. An automated query of records was performed for all patients who received IVOM at oregis-affiliated healthcare facilities between 2015 and 2021. The number of treated patients and the use of anti-VEGF medications, including aflibercept, bevacizumab, brolucizumab, and ranibizumab, were determined. The data were collected in apseudonymized and anonymized manner. At the time of data collection, 9German ophthalmological healthcare facilities were affiliated with oregis. In total, 309,152 patients were registered during the observation period, with 8474 receiving IVOMs. Over the observation period, the number of participating centers, patients, and intravitreal injections increased. The proportional share of anti-VEGF agents among the total number of injections varied during the observation period. Real-world data captured in oregis offer significant potential for enhancing healthcare provision. Oregis enables the depiction of ophthalmological care conditions in Germany and contributes to research and quality assurance. The ability to query the presented data exemplifies the multitude of inquiries through which oregis can contribute to the representation of ophthalmological care in Germany.

Diagnostics and management of patients with inherited retinal diseases in Germany : Results of a nationwide survey of university and non-university eye departments and specialized practices

Inherited retinal diseases (IRDs) refer to aheterogeneous group of rare disorders that potentially lead to blindness. Emerging therapeutic options have led to agrowing interest in IRDs; however, there are insufficient systematic studies on IRDs in Germany characterizing the demographics and management in clinical practice. To characterize the care for IRD patients in Germany, to assess the applied diagnostics, the use of databases and the implementation of education in ophthalmic genetics. The anonymous online survey (SoSci Survey GmbH) was sent to all German ophthalmology departments listed on the website of the German Ophthalmological Society and to three practices focusing on IRDs. The overall response rate was 44.8%. Almost all institutions (93.6%) reported seeing IRD patients, but university and non-university hospitals differed in the number of patients. Databases are used in 60% of universities but only in 5.9% of non-university hospitals. Regarding the number of patients with genetic diagnostics, 53% of the non-university and 12% of the university sites reported that 20% at most of their patients had received amolecular genetic diagnosis. The results of the IRD practices are comparable with the university hospitals. Patients with biallelic RPE65 mutations-associated IRD, potential candidates for treatment with voretigene neparvovec (Luxturna®), were followed in 9/25 participating university departments. This survey highlights the deficits in the management of IRD patients. In particular, we found aclear difference between university and non-university hospitals in the rate of patients with known molecular genetic results. Improvements should be initiated in the latter, especially because of existing and emerging therapeutic options.

National survey of user-reported usability of electronic medical record software in ophthalmology in Germany.

A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.

The 2021 Activity Report of the Tissue Transplantation and Biotechnology Section of the German Ophthalmological Society

The Section on Tissue Transplantation and Biotechnology of the German Ophthalmologic Society presented its 11th annual report for the year 2021. The number of corneal samples has still risen in comparison to former years. Nevertheless, there is still a need for import of transplants from abroad. Therefore, the transplant bottleneck has not yet been eliminated.

Career prospects for ophthalmologists under 49years old : Asurvey in Germany from 2022

The need for care in ophthalmology is constantly increasing due to demographic changes. The study analyzed the current professional situation and future prospects of ophthalmologists under 49years old. The survey of members of the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft) was conducted in 2022. All members under the age of 49years received an online questionnaire on the current professional situation as well as future perspectives (desired working hours, form of organization). The results of the survey were additionally compared with the 2016 survey of the German Association of Ophthalmologists. Asimilar questionnaire was used at that time. Atotal of 1014 people participated in the survey (62.7% women, mean age 39.3 ± 8years, 75.6% specialists). The response rate to the survey was 25%. Specialist practice from0 to 5years showed ahigher number of employed ophthalmologists (21% self-employed vs. 32% employed); over time the number of self-employed ophthalmologists increased (6-10years: 40%, > 10years: 59.3%). Overall, 46% of women were employed in apractice compared with 33% of men. Of the self-employed specialists, 95.9% said they planned to work in the same type of employment in 10years as currently. Regarding ophthalmologists' career future, the other employment types showed adesire to move to independent practice. Compared to the 2016 survey, gender differences related to the current type of employment were evident. The number of self-employed women decreased from 43% to 26% and self-employed men decreased from 63% to 39%. The number of ophthalmologists in ambulatory healthcare centers was doubled compared to 2016. Ophthalmologists reported similar future perspectives at both survey times. The results of the survey of ophthalmologists under 49years in Germany showed similar perceptions as in 2016. It became clear that the desire to be self-employed in 10years is very high; however, ophthalmologists expected large practices or medical care centers to prevail in the market. The number of self-employed doctors is decreasing and the desire for self-employment is difficult to realize.

Features of neuro-ophthalmic symptoms in patients with parasellar meningiomas

Goal. To analyze the features of neuro-ophthalmic symptoms and study visual functions recovery following parasellar meningiomas (PM) surgery. Material and methods. We have analyzed the results of treating 47 patients with PM which have been operated in the Romodanov Neurosurgery Institute in 2017 - 2021. The main group included 47 patients (94 eyes) with PM with visual disorders. Clinical-neurological and ophthalmological examination and a range of neuroimaging studies were carried out. To evaluate the visual functions, the results were analyzed according to the recommendations of the German Ophthalmological Society. Results. Binocular visual disturbances have been detected in 34 (72.3%) patients. Among visual field defects, absolute bitemporal hemianopia prevailed in 14.9% of patients and a combination of relative upper quadrant temporal hemianopia with absolute temporal hemianopia in 19.2% of patients. Monocular visual disturbances have been detected in 13 (27.7%) patients. Optic nerve atrophy was found in 38 patients (80.9%): unilateral - 21 patients (21 eyes), bilateral - 17 patients (34 eyes). A probable difference was revealed in the average visual acuity: before treatment 0.55±0.04, after treatment 0.67±0.04 (p&lt;0.05) and the average total loss of sensitivity: before treatment 11.37±0, 78 dB and after treatment 9.14±0.79 dB (p&lt;0.05). Conclusions. Parasellar meningiomas constitute a significant part of extracerebral tumors. As a result of surgical treatment, there is a significant improvement in visual acuity and visual field.

Macular hole and vitreomacular traction : S1 guideline of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 22 September 2022

Macular hole and vitreomacular traction : S1 guideline of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 22 September 2022

The 2019 and 2020 Activity Report of the Tissue Transplantation and Biotechnology Section of the German Ophthalmological Society

The 2019 and 2020 Activity Report of the Tissue Transplantation and Biotechnology Section of the German Ophthalmological Society

Diagnostics and treatment of ocular toxoplasmosis : Results of a survey

Ocular toxoplasmosis (OT) is the most common infectious cause of posterior uveitis. This survey aimed to evaluate the current diagnostic and therapeutic approach to OT in Germany. Adetailed questionnaire with specific patient examples was sent in July 2021 to the members of the Uveitis Section of the German Ophthalmological Society (DOG) and the Retinological Society (RG). The questionnaire was answered by 53 (29RG and 24DOG) ophthalmologists. Of the respondents 16 (30%) work in private practice, 18 (34%) in aclinical facility and 19 (36%) in university hospital, 9 (17%) colleagues see < 50, 28 (53%) 50-200 and 16 (30%) more than 200 uveitis patients per year. The clinical results are still the gold standard (87%) for the diagnosis of OT and in cases of first manifestation 60% are supported by serological antibody investigations, while 10out of 53 (19%) ophthalmologists rely on the clinical presentation only. An IgM test is requested by 25 (47%) respondents, 6 expected an increase in IgG titer (11%) and 1 the detection of specific IgA antibodies (2%). The majority (n = 28, 53%) of ophthalmologists would aim at confirming the diagnosis by an anterior chamber puncture, from which 20(38%) prefer PCR, 3(6%) determination of Goldmann-Witmer coefficients (GW) and 5(9%) acombination of both methods. Clindamycin was most frequently used for treatment (n = 21, 40%), followed by pyrimethamine/sulfadiazine (n = 17, 32%) and trimethoprime + sulfamethoxazole (TMP/SMX) (n = 10, 19%); the latter was also used (n = 40, 75%) for secondary prophylaxis. The results show that apart from the clinical results as the gold standard for the diagnosis, there is no uniform approach to diagnosis and treatment of OT. The high request rate for serum IgM antibodies indicates awidespread uncertainty about the importance of serological findings. This should be viewed critically, given the continued high seroprevalence in Germany.

Glaucoma care in Germany-results of asurvey among German ophthalmologists-part2: treatment

The options for glaucoma treatment are quite diverse. The question therefore arises what is considered beneficial and feasible in daily practice. Our anonymized survey among members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA) intends to explore treatment patterns and strategies in routine glaucoma care in Germany. The current article reflects current opinions of German ophthalmologists regarding glaucoma care, therapeutic strategies, and the role of glaucoma surgery. The survey was conducted using an online questionnaire with 26 questions (107 items) regarding care practice for glaucoma diagnosis and treatment. Complete responses were available from 1361 participants. Atotal of 84.8% of responders define a target pressure regularly. Asystemic therapeutic approach is followed by 44.9%. Two thirds consider side effects of eye drops to impair quality of life. Most common are conjunctival hyperemia and burning. Non-adherence to treatment is estimated to occur in 32% of patients. Approximately 5-10% of glaucoma patients are treated surgically. Among interventional treatment options, 90% consider trabeculectomy beneficial, followed by minimally invasive glaucoma surgery (MIGS) and selective laser trabeculoplasty (SLT), which are, however, the most commonly performed procedures. The choice of treatment should intend along-lasting reduction of intraocular pressure and yet to be reasonable and manageable. There is ademand for more overview and structured care.

On the Current Care Situation and Treatment of Ocular Mucous Membrane Pemphigoid in Germany.

Ocular involvement in mucous membrane pemphigoid (MMP) is relatively rare, with a prevalence of 25 cases per million population, equating to approx. 2,100 patients throughout Germany. Diagnosis can be difficult - especially in cases of isolated ocular involvement - and treatment can be complex and lengthy. Immunosuppressants or immunomodulatory drugs are often used. Due to the complexity of diagnosis and treatment, MMP patients are usually referred to specialized centers. The aim of this project was to evaluate the current care situation of patients with ocular MMP in Germany. A paper-based survey was designed and sent to all university eye clinics and other specialized centers in Germany in April 2020. The survey asked about the existence of a specialized outpatient service, the total annual number of patients with MMP, the annual number of newly diagnosed patients, any interdisciplinary collaboration for diagnostic or therapeutic purposes, as well as the local and systemic therapy used. Of a total of 44 clinics, 28 (64%) responded, reporting a total average of 27 ± 42 (0 - 200) patients and 3.6 ± 2.2 (0 - 10) new cases per year. This corresponds to a total of 741patients. Only nine (32%) of the responding clinics offer specialized MMP clinics. 93% of the centers collaborate with the local dermatology department. 79% perform serological and histological diagnostics in-house. About half of the centers (n = 16) apply a standardized treatment regime. Systemic glucocorticoids (66.7%) are most commonly used, followed by mycophenolate mofetil and dapsone (57.1%), rituximab (33.3%), azathioprine and cyclophosphamide (28.6%), as well as methotrexate (19.0%). The least frequently used treatment is intravenous immunoglobulin (14.3%). This survey of German ophthalmology departments obtained data from about one third of the estimated total cohort of all patients with MMP in Germany. These are presumed to be exclusively patients with at least one ocular involvement. The complex care of these patients is usually provided in collaboration with a dermatologist and with the use of systemic anti-inflammatory medication. Currently, an ophthalmological MMP register is being established to better record the epidemiology and care situation of this rare disease in Germany and to improve it in the long term.

Scientific performance of ophthalmological research institutions in Germany 2018-2020 : Studies, publications, third-party funding and more-The research map of the German Ophthalmological Society (DOG)

The German Ophthalmological Society (DOG) regularly records the scientific activities of ophthalmological research institutions in Germany. With this publication the DOG wants to make the performance of scientific ophthalmology in Germany transparent and increase the options for future research cooperation with facilities of research institutions. Systematic survey of German research centers in ophthalmology. The current research map records the data from 41German research centers for the reporting period 2018-2020. Compared to previous editions of the research map, there has been asignificant increase in scientific activity. The number of studies reported rose to 496. The number of government funded research projects (n = 121) and projects funded by foundations (n = 108) also increased. Furthermore, the number of scientific publications has almost doubled: while 1919 were published in the period from 2012 to 2014 and 2305 in the period from 2015 to 2017, there were 4215 in the current reporting period. The map also reports on acontinuous increase in the number of young scientists in ophthalmology. The research map demonstrates the performance of German scientific ophthalmology. At the same time, the need for research in ophthalmology remains high because many diseases that affect the eyes are not yet or not yet completely curable.

National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology

National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology

High User Acceptance of a Retina e-Learning App in Times of Increasing Digitalization of Medical Training for Ophthalmologists

Introduction: The aim was to identify changes in continuing education and training in ophthalmology in the context of the COVID-19 pandemic and advancing digitalization and to analyse the acceptance of e-learning tools among German ophthalmologists using a novel Retina Case App as an example. Methods: The participants’ training behaviour before and during the COVID-19 pandemic was surveyed. Furthermore, the acceptance and usability of the Retina Case App were evaluated using the System Usability Scale (SUS). A possible influence of the app on everyday clinical practice was assessed. Results: A total of 145 ophthalmologists participated in the survey. The frequency of continuing medical education did not decrease for 62.8% of ophthalmologists during the pandemic. A significant increase in at least monthly use of online courses or lectures has been observed (90.3% vs. 28.2%, p < 0.001). No significant difference was identified in terms of frequency of use of print and digital journals or printed textbooks. The majority of participants stated that online training platforms are well suited to replace the absence of face-to-face events (73.8%). The mean SUS score was 87.7 (SD 11.9), which categorizes the app’s usability as excellent. The majority agreed that the newly developed app enables faster learning (82.1%) and leads to increased motivation (71.7%). Most ophthalmologists (80.7%) felt that regular use of the app would improve confidence in the treatment of retinal diseases. Conclusions: The COVID-19 pandemic has led to a significant change in training behaviour in ophthalmology towards e-learning and online courses, which has not been accompanied by a general decline in training activity. The exemplarily investigated application showed a high user acceptance among ophthalmologists.

The most serious incident-Experiences of aggression and violence in ophthalmology

HintergrundErfahrungen von Aggressionen/Gewalt beeinflussen die Arbeitszufriedenheit und können die Mitarbeiter psychisch und physisch langfristig belasten. Im Herbst 2018 führten der Berufsverband der Augenärzte Deutschlands e. V. (BVA) und die Deutsche Ophthalmologische Gesellschaft e. V. (DOG) eine Umfrage zu Erfahrungen von Aggressionen und Gewalt durch. Die ersten Ergebnisse wurden 2020 veröffentlicht. In der Umfrage konnte zudem der bislang schwerwiegendste Vorfall unter anderem durch Freitextfelder geschildert werden.MethodikAlle 9411 Mitglieder von DOG und BVA erhielten 2018 die Möglichkeit, online einen Fragebogen zu Aggressionen und Gewalt in der Augenheilkunde auszufüllen.ErgebnisseEs berichteten 253 von 1508 (16,8 %) an der Umfrage teilgenommenen Ophthalmologen über ihren schwerwiegendsten Vorfall, der zu 46,8 % als mittelschwer eingestuft wurde und zu 34,3 % verbale Gewalt wie Beleidigung und Bedrohung umfasste. Den schwerwiegendsten Vorfall erlebten 171 (67,6 %) Ärzte in einer Praxis; 71 % waren zum Tatzeitpunkt Fachärzte. Die Vorfälle ereigneten sich zu 74,3 % in der regulären Arbeitszeit. Ursachen waren v. a. interkulturelle Konflikte, lange Wartezeiten, Probleme bei der Terminvergabe, zu hohe Erwartungshaltung, Behandlungsdifferenzen oder eine Grundaggressivität. Dabei waren die Täter zu 86,3 % männlich. Bei 15,8 % der Vorfälle erfolgte eine polizeiliche Meldung; 21 (8,3 %) Ärzte erteilten einen Praxisverweis oder Hausverbot.DiskussionDie Schilderung der schwerwiegendsten Vorfälle veranschaulicht mitunter kaum vorstellbare Situationen und auch, welche Vorfälle als gravierend eingeschätzt wurden. Es existieren dabei große subjektive Schwankungen in der Beurteilung der Vorfälle. Schutzmaßnahmen in Praxen und Kliniken sind unerlässlich.