@article {527, title = {Primary Health Care Modelle in Tirol {\textendash} Erhebung und Analyse innovativer Ans{\"a}tze}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, month = {01/2017}, pages = {128}, publisher = {Medizinische Universit{\"a}t Innsbruck}, type = {Diplomarbeit}, address = {Innsbruck}, abstract = {

Zielsetzung

Die {\"o}sterreichische Bundes-Zielsteuerungskommission (BZ) hat ein Konzept zur Reformierung des bestehenden Primary Health Care Systems\  (PHCS)\  beschlossen. Die bestehenden Modelle der Allgemeinmedizin sollen im Rahmen dieser Reform verbessert und die Prim{\"a}rversorgung gest{\"a}rkt werden. Ziel der vorliegenden Arbeit ist es, innovative Modelle und Arbeitsweisen in der\  Prim{\"a}rversorgung\  des\  Bundeslandes Tirol\  zu\  erheben und in Relation zu den geplanten Ma{\ss}nahmen zu stellen. Dar{\"u}ber hinaus sollen die Meinungen und W{\"u}nsche der AllgemeinmedizinerInnen (AM) zu Verbesserungen einflie{\ss}en. Die Ergebnisse der Arbeit sollen eine Pr{\"u}fungsbasis zur Umsetzbarkeit des Reformkonzeptes in Tirol bieten.

Methoden

Um\  die\  bestehenden Modelle erheben und analysieren zu k{\"o}nnen wurde unter dem Titel INNOVAMT (Innovative allgemeinmedizinische Modelle in Tirol) eine prospektive Querschnittstudie in Form einer Onlineumfrage unter den niedergelassenen AM im Bundesland\  Tirol (n=572) durchgef{\"u}hrt. Die Auswertung\  erfolgte\  mittels Methoden der deskriptiven Statistik. Letztlich wurden 87 der 572 AM (ca. 15\%) in die Stichprobe inkludiert. Zur Vergleichbarkeit der\  Modelle wurde ein Innovationsscore eingef{\"u}hrt, welcher die Kernelemente des Konzeptes der BZ enth{\"a}lt.

Ergebnisse

Die\  Erhebung zeigt, dass in Tirol bereits heute\  ein\  relativ\  hohes\  Ma{\ss}\  an Interdisziplinarit{\"a}t besteht. Mehr als die H{\"a}lfte der Praxisteams umfassen neben OrdinationsassistentInnen auch mindestens eine weitere Berufsgruppe. Dennoch bestehen Unterschiede bei der Umsetzung innovativer Merkmale im Sinne der Reformpl{\"a}ne,\  vor allem abh{\"a}ngig vom Stadt-Land-Verh{\"a}ltnis. Zwischen dem entwickelten Innovationsscore und der erhobenen Zufriedenheit sowie zwischen der Zusammenarbeit und r{\"a}umlicher N{\"a}he lassen sich\  keine deutlichen Zusammenh{\"a}nge feststellen. Die gr{\"o}{\ss}te Unzufriedenheit der AM besteht in der Administration, der Finanzierung sowie der Wertsch{\"a}tzung des Berufsbildes.

Schlussfolgerung

Einerseits besteht der Wunsch nach Gruppenpraxen, andererseits jedoch gibt es eine negative Erwartungshaltung bez{\"u}glich PHC-Zentren. Verbesserungsw{\"u}rdig ist die Verf{\"u}gbarkeit insbesondere\  an Wochenenden, Tagesrandzeiten und in der Nacht. Niedrige Zufriedenheitswerte bieten Verbesserungspotenziale f{\"u}r die prim{\"a}re Gesundheitsversorgung in Tirol.

}, keywords = {PHC}, author = {Raphael Bertsch}, editor = {Herbert Bachler} } @article {413, title = {Physicians{\textquoteright} exodus: why medical graduates leave Austria or do not work in clinical practice.}, journal = {Wien Klin Wochenschr}, volume = {127}, year = {2015}, month = {2015 May}, pages = {323-9}, abstract = {

BACKGROUND: Austria has the highest number of medical graduates of all Organisation for Economic Co-operation and Development (OECD) countries in relation to its population size, but over 30\% choose not to pursue a career as physicians in the country.

OBJECTIVE AND RESEARCH DESIGN: This article describes under- and postgraduate medical education in Austria and analyses reasons for the exodus of physicians.

MEDICAL EDUCATION: In Austria, medicine is a 5- or 6-year degree offered at four public and two private medical schools. Medical graduates have to complete training in general medicine or a speciality to attain a licence to practice. While not compulsory for speciality training, board certification in general medicine has often been regarded as a prerequisite for access to speciality training posts.

ANALYSIS: Unstructured postgraduate training curricula, large amounts of administrative tasks, low basic salaries and long working hours present for incentives for medical graduates to move abroad or to work in a non-clinical setting. The scope of current reforms, such as the establishment of a new medical faculty and the implementation of a common trunk, is possibly insufficient in addressing the issue.

CONCLUSION: Extensive reforms regarding occupational conditions and the structure of postgraduate medical education are necessary to avoid a further exodus of junior doctors.

}, keywords = {Attitude of Health Personnel, Austria, Career Choice, Curriculum, Education, Medical, Graduate, Emigration and Immigration, Faculty, Medical, General Practice, Health Care Reform, Humans, Job Satisfaction, Licensure, Medical, Medicine, National Health Programs, Physician{\textquoteright}s Role, Specialty Boards, Students, Medical}, issn = {1613-7671}, doi = {10.1007/s00508-015-0786-7}, author = {Scharer, Sebastian and Freitag, Andreas} } @article {554, title = {Patient and preceptor attitudes towards teaching medical students in General Practice.}, journal = {BMC Med Educ}, volume = {13}, year = {2013}, month = {2013 Jun 07}, pages = {83}, abstract = {

BACKGROUND: Curricula in most western medical universities include teaching in the primary care setting as core elements. This affects GP-teachers, their patients and their interaction. Therefore, it was the aim of this study to assess the influence of the presence of medical students in the teaching practice on the attitudes of both GPs and patients.

METHODS: Seventy-four GP-preceptors were invited to answer an online survey. Patients attending consultations with a medical student present completed questionnaires either before the consultation (WR group) or immediately after consultation (AC group).

RESULTS: Fifty- nine preceptors completed the online survey. Physicians showed positive attitudes towards their activities as preceptors: 95\% expressed a positive attitude predominantly towards being a role model and to represent the discipline and for 64\% remuneration was not important. In 28 practices 508 questionnaires were completed by patients in the WR-group and 346 by the AC-group. Only 12\% (WR) and 7.2\% (AC) of patients expressed a preference for being seen by the doctor alone. While 16\% of doctors rated that confidentiality of the doctor-patient relationship is compromised, only 4.1\% (WR) and 1.7\% (AC) of patients felt so.

CONCLUSION: The motivation to be a preceptor is primarily driven by personal and professional values and not by economic incentives. Further, patients have even more positive attitudes than the preceptors towards the presence of students during their consultation. Reservations to teaching students in GP-practices are, therefore, unwarranted.

}, keywords = {Attitude, Attitude of Health Personnel, Curriculum, Education, Medical, Female, General Practice, General Practitioners, Humans, Male, Middle Aged, Patients, Preceptorship, Students, Medical, Surveys and Questionnaires}, issn = {1472-6920}, doi = {10.1186/1472-6920-13-83}, url = {http://dx.doi.org/10.1186/1472-6920-13-83}, author = {Pichlh{\"o}fer, Otto and T{\"o}nies, Hans and Spiegel, Wolfgang and Wilhelm-Mitter{\"a}cker, Andree and Maier, Manfred} } @article {17, title = {Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.}, journal = {Wien Klin Wochenschr}, volume = {125}, year = {2013}, month = {2013 Apr}, pages = {180-8}, abstract = {

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents{\textquoteright} characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents{\textquoteright} and facilities{\textquoteright} characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents{\textquoteright} characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 \% (95 \% CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 \%). The most often prescribed PIP were Prothipendyl (25.9 \% residents), Lorazepam (14.5 \%) and Diclofenac (6.1 \%). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

}, keywords = {Adult, Age Distribution, Aged, Austria, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Diclofenac, Female, Humans, Inappropriate Prescribing, Lorazepam, Male, Middle Aged, Nursing Care, Nursing Homes, Prescriptions, Prevalence, Psychomotor Agitation, Psychotropic Drugs, Risk Assessment}, issn = {1613-7671}, doi = {10.1007/s00508-013-0342-2}, author = {Mann, Eva and Haastert, Burkhard and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Iglseder, Bernhard and Roller-Wirnsberger, Regina and Meyer, Gabriele} } @article {196, title = {Priorit{\"a}ten von Patientinnen und Patienten im {\"a}rztlichen Gespr{\"a}ch in der Allgemeinmedizin: Eine Querschnittstudie in {\"O}sterreich im Rahmen des QUALICOPC Projektes}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2013}, month = {10/2013}, pages = {121}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

Diese Diplomarbeit behandelt die Priorit{\"a}ten von Patientinnen und Patienten im {\"a}rztlichen Gespr{\"a}ch in der {\"o}sterreichischen Allgemeinmedizin und wie sich diese nach Geschlecht, Bildungsgrad und Alter unterscheiden. Um gute Versorgung bieten zu k{\"o}nnen, m{\"u}ssen diese Pr{\"a}ferenzen erfasst und bedacht werden. Bisher gibt es in der {\"o}sterreichischen Allgemeinmedizin keine Untersuchung zu dieser Fragestellung. Diese Arbeit soll erste Ans{\"a}tze f{\"u}r die weitere Erforschung hinsichtlich Priorit{\"a}ten allgemein, wie auch hinsichtlich m{\"o}glicher Unterschiede zwischen den untersuchten Untergruppen bilden.

Methodik

Patientinnen und Patienten wurden im Rahmen der QUALICOPC-Studie (Quality and Costs of Primary Care in Europe) mittels anonymer Frageb{\"o}gen zu unterschiedlichen Bereichen der Allgemeinmedizin befragt, wobei in dieser Arbeit zehn Fragen zum {\"a}rztlichen Gespr{\"a}ch ausgewertet wurden. Mittels SPSS 21.0 wurden H{\"a}ufigkeiten der Antworten insgesamt sowie Unterschiede zwischen den Subgruppen untersucht.

Ergebnisse

Von 3.050 kontaktieren Haus{\"a}rztinnen und Haus{\"a}rzten nahmen 184 an der Studie teil (R{\"u}cklaufrate ca. 6\%). Von 2.662 angesprochenen Patientinnen und Patienten f{\"u}llten schlie{\ss}lich 1.791 einen Fragebogen aus (R{\"u}cklaufrate ca. 67\%). Generell bewerteten die Probandinnen und Probanden die untersuchten Aspekte als wichtig. Vor allem von {\"A}rztinnen/{\"A}rzten ernst genommen ({\quotedblbase}sehr wichtig{\textquotedblleft} 70,4\%) und verstanden zu\  werden (65,2\%), sowie aufmerksames Zuh{\"o}ren (59\%) und klare Anweisungen durch Medizinerinnen und Mediziner (69,5\%) sind Patientinnen und Patienten unabh{\"a}ngig vonden untersuchten\  Merkmalen wichtig. Zwischen M{\"a}nnern und Frauen zeigen sich am h{\"a}ufigsten Unterschiede, am seltensten zwischen den unterschiedlichen Bildungsgraden. Der Vergleich nach dem Alter l{\"a}sst keine klaren Schl{\"u}sse zu. Patientinnen und Patienten des prim{\"a}ren Bildungsgrades bevorzugen gegen{\"u}ber denjenigen des dritten Grades eine abschlie{\ss}ende Frage, ob sie die {\"A}rztin beziehungsweise den Arzt richtig verstanden h{\"a}tten (63,6\% vs. 29,2\%; p \< 0,05). Der Augenkontakt war Frauen anders als erwartet nicht wichtiger als M{\"a}nnern ({\quotedblbase}wichtig{\textquotedblleft} M: 46,2\% vs. F: 55\%, p \< 0,05; {\quotedblbase}sehr wichtig{\textquotedblleft} M: 17,9\% vs. F: 29,4\%, p \< 0,05). Die Wichtigkeit nonverbalen Verhaltens, das gr{\"o}{\ss}tenteils unbewusst abl{\"a}uft, ist aber m{\"o}glicherweise durch einen Fragebogen nicht fassbar.

Diskussion

Unterschiede in der Wichtigkeit von Kommunikation zeigen sich am h{\"a}ufigsten zwischen Frauen und M{\"a}nnern. Insgesamt d{\"u}rften Patientinnen und Patienten kommunikative Aspekte wichtig sein. Um dies zu {\"u}berpr{\"u}fen sollte eine genauere Untersuchung mit gr{\"o}{\ss}erer Stichprobe und ohne Selektionsbias erfolgen. Weiters sollte die Beachtung des Geschlechts der {\"A}rztin beziehungsweise des Arztes (Dyaden) sowie eine genauere Untersuchung des Alterseffektes Ziel zuk{\"u}nftiger Forschung sein.

}, keywords = {Gender, Kommunikation, Patientenzentriertheit, Prim{\"a}rversorgung}, url = {http://media.obvsg.at/AC10775689}, author = {Johannes Singer}, editor = {Kathryn Hoffmann and Manfred Maier} } @article {19, title = {Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list.}, journal = {Wien Klin Wochenschr}, volume = {124}, year = {2012}, month = {2012 Mar}, pages = {160-9}, abstract = {

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing.

OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail.

METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95\% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95\% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds.

RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2\%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate.

CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Humans, Inappropriate Prescribing, Male}, issn = {1613-7671}, doi = {10.1007/s00508-011-0061-5}, author = {Mann, Eva and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Roller-Wirnsberger, Regina E and Dovjak, Peter and D{\"u}ckelmann-Hofer, Christine and Fischer, Peter and Rabady, Susanne and Iglseder, Bernhard} } @article {20, title = {Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts.}, journal = {J Am Med Dir Assoc}, volume = {13}, year = {2012}, month = {2012 Feb}, pages = {187.e7-187.e13}, abstract = {

BACKGROUND: Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents.

METHODS: We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents{\textquoteright} characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation.

RESULTS: Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6\% (95\% CI 72.0-77.2\%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8\% (95\% CI 48.3-55.2\%) and 52.4\% (95\% CI 48.7-56.1\%). Of all antipsychotics, 66\% (Austria) and 47\% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender.

CONCLUSION: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Austria, Cluster Analysis, Cross-Sectional Studies, Dementia, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, Female, Geriatric Assessment, Germany, Homes for the Aged, Humans, Logistic Models, Long-Term Care, Male, Nursing Homes, Prevalence, Psychotropic Drugs, Risk Assessment, Sex Distribution}, issn = {1538-9375}, doi = {10.1016/j.jamda.2011.03.007}, author = {Richter, Tanja and Mann, Eva and Meyer, Gabriele and Haastert, Burkhard and K{\"o}pke, Sascha} } @article {25, title = {Psychotropic medication use among nursing home residents in Austria: a cross-sectional study.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 21}, pages = {18}, abstract = {

BACKGROUND: The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.

METHODS: Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents{\textquoteright} charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents{\textquoteright} characteristics associated with prescription.

RESULTS: Residents{\textquoteright} mean age was 81; 73\% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6\% (95\% confidence interval, CI, 72.0-77.2). A total of 45.9\% (95\% CI 42.7-49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2\% (95\% CI 20.0-24.5), hypnotics in 13.3\% (95\% CI 11.3-15.4), and antidepressants in 36.8\% (95\% CI 34.1-39.6) of residents. None of the institutional characteristics and only few residents{\textquoteright} characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95\% CI 1.32-1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95\% CI 0.56-0.88).

CONCLUSION: Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Psychotropic Drugs}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-18}, author = {Mann, Eva and K{\"o}pke, Sascha and Haastert, Burkhard and Pitk{\"a}l{\"a}, Kaisu and Meyer, Gabriele} } @article {30, title = {Preventive health risk appraisal for older people and impact on GPs{\textquoteright} patient management: a prospective study.}, journal = {Fam Pract}, volume = {24}, year = {2007}, month = {2007 Dec}, pages = {604-9}, abstract = {

BACKGROUND: Health risk appraisals (HRAs) are recommended for detection of potentially modifiable risk factors for health status decline of older people. Little is known how family physicians manage detected risk factors.

OBJECTIVE: We evaluated (i) if risk factors in one or more of five predefined domains were detected in a primary care-based HRA and (ii) how often these findings had an impact on the further management of patients.

METHODS: We performed a prospective observational study in a rural community in Austria and included persons (age >or= 70 years) living at home. We applied the standardized assessment for elderly people in primary care (STEP) instrument and evaluated risk factors for status decline assessing five domains (cognitive function, depression, urinary incontinence, hearing impairment and mobility/falls).

RESULTS: Two hundred and sixty-four persons participated and the HRA revealed a wide range of risk factors for health status decline [from 4.5\% (12/264) in the depression domain up to 31\% (81/264) for mobility/falls and 41\% (107/264) in the cognitive domain]. The findings had an impact on the further management in four domains: hearing impairment (100\% of findings with impact), mobility/falls (93\%), depression (83\%) and urinary incontinence (65\%). In contrast, abnormal cognitive findings lead to action only in every fifth participant (18\%; 19/107).

CONCLUSION: In contrast to other domains, family physicians are hesitant to act upon abnormal findings of cognitive testing. Additional knowledge is needed to clarify the value of abnormal cognitive findings for management of patients and support of their carers.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Health Status Indicators, Humans, Male, Observation, Patient Care Management, Physicians, Family, Prospective Studies, Risk Factors}, issn = {0263-2136}, doi = {10.1093/fampra/cmm063}, author = {Eichler, Klaus and Scrabal, Clemens and Steurer, Johann and Mann, Eva} }