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  • 1
    In: Trials, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)
    Abstract: Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVE job intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel. Methods In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVE job intervention or (2) the waiting-list control group. The IMPROVE job intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVE job facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVE job facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes. Discussion It is hypothesised that participation in the IMPROVE job intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises. Trial registration German Clinical Trials Register: DRKS00012677 . Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML & TRIAL_ID = DRKS00012677.
    Type of Medium: Online Resource
    ISSN: 1745-6215
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2040523-6
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  • 2
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-10-25)
    Abstract: Leadership has become an increasingly important issue in medicine as leadership skills, job satisfaction and patient outcomes correlate positively. Various leadership training and physician psychological well-being programmes have been developed internationally, yet no standard is established in primary care. The IMPROVE job leadership program was developed to improve job satisfaction among German general practitioners and practice personnel. Its acceptance and effectiveness were evaluated. The IMPROVE job intervention is a participatory, interdisciplinary and multimodal leadership intervention that targets leadership, workflows and communication in general practices using three elements: (1) two leadership workshops with skills training; (2) a toolbox with printed and online material, and (3) a 9-month implementation phase supported by facilitators. A cluster-randomised trial with a waiting-list control evaluated the effectiveness on the primary outcome job satisfaction assessed by the Copenhagen Psychosocial Questionnaire (range 0–100). A mixed-methods approach with questionnaires and participant interviews evaluated the acceptance of the intervention and factors influencing the implementation of intervention content. Statistical analyses respected the clustered data structure. The COVID-19 pandemic necessitated intervention adjustments: online instead of on-site workshops, online material instead of facilitator practice visits. Overall, 52 of 60 practices completed the study, with altogether 70 practice leaders, 16 employed physicians, and 182 practice assistants. According to an intention-to-treat analysis, job satisfaction decreased between baseline and follow-up (not significantly) in the total study population and in both study arms, while the subgroup of practice leaders showed a non-significant increase. A mixed multilevel regression model showed no effect of the intervention on job satisfaction ( b  = − 0.36, p   〉  0.86), which was influenced significantly by a greater sense of community ( b  = 0.14, p   〈  0.05). The acceptance of the IMPROVE job workshops was high, especially among practice leaders compared to assistants (1 = best to 5 = worst): skills training 1.78 vs. 2.46, discussions within the practice team 1.87 vs. 2.28, group discussions 1.96 vs. 2.21. The process evaluation revealed that the COVID-19 pandemic complicated change processes and delayed the implementation of intervention content in practice routines. The workshops within the participatory IMPROVE job intervention were rated very positively but the multimodal intervention did not improve job satisfaction 9 months into the pandemic. Qualitative data showed an impairment of implementation processes by the unforeseeable COVID pandemic. Trial registration Registration number: DRKS00012677 on 16/10/2019.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2615211-3
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  • 3
    In: European Radiology, Springer Science and Business Media LLC, Vol. 25, No. 9 ( 2015-9), p. 2567-2574
    Type of Medium: Online Resource
    ISSN: 0938-7994 , 1432-1084
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 1472718-3
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  • 4
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  BMC Family Practice Vol. 21, No. 1 ( 2020-12)
    In: BMC Family Practice, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)
    Abstract: Dementia is an age-related syndrome that is estimated to affect 46.8 million people worldwide (2015). In ageing populations, the prevalence of dementia is expected to increase. General practitioners (GPs) are often the first to be contacted when signs of dementia appear. This cluster-randomised trial (CRT) investigates the effects of a dementia care toolbox mailed to GP practices to facilitate dementia care. It contained patient brochures and posters for the waiting room in three languages, information cards for professionals and practical tools in three languages. The GPs’ and practice assistants’ (PrAs) use of and opinion about the toolbox is reported here. Methods Three months after receiving the toolbox, participating GPs and PrAs were sent a standardised, self-administered questionnaire asking about the use and helpfulness of the various toolbox items by mail. Results A total of 50 GPs and PrAs (14 GPs and 36 PrAs) from 15 practices completed the questionnaire. Of the participants, 82.0% reported using at least one of the tools, while 18.0% had used none. In descending order, the patient brochures (70.0%), the information card (58.0%) and the poster (40.0%) were used. In general, the brochures (52.1%), the information card (44.9%) as well as the poster (28.6%) were perceived as helpful. Conclusion Overall, the dementia toolbox was widely accepted by both professional groups. Future research should investigate long-term effects of information strategies for GP practice settings. Trial registration German Clinical Trials Register, DRKS00014632 . Registered 02 August 2018. Clinical register of the study coordination office of the University hospital of Bonn. Registered 05 September 2017 .
    Type of Medium: Online Resource
    ISSN: 1471-2296
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041495-X
    detail.hit.zdb_id: 3107315-3
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  • 5
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2016
    In:  BMC Medical Informatics and Decision Making Vol. 16, No. 1 ( 2016-12)
    In: BMC Medical Informatics and Decision Making, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 1472-6947
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
    detail.hit.zdb_id: 2046490-3
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  • 6
    In: Das Gesundheitswesen, Georg Thieme Verlag KG, Vol. 85, No. 10 ( 2023-10), p. 857-870
    Abstract: Hintergrund Unterbrechungen der Impfstoffkühlkette mit Temperaturen außerhalb des Zielbereichs von+2°C bis+8°C können die Wirksamkeit von Impfstoffen verringern und die Immunantwort beeinträchtigen. Die Einhaltung von Standards zum Impfstoffmanagement ist daher essentiell, doch sind für Deutschland bisher keine Leitlinien dazu formuliert. Dieser Review vergleicht die Qualität und die Inhalte internationaler Leitlinien und Empfehlungen zum Impfstoffmanagement mit Hilfe des AGREE II Instruments (Appraisal of Guidelines for Research and Evaluation). Aus den Ergebnissen werden Empfehlungen für das Impfstoffmanagement in der ambulanten Versorgung in Deutschland abgeleitet. Methodik Ausgehend von einer systematischen Recherche wurden internationale Leitlinien und Empfehlungen zum Impfstoffmanagement durch drei Reviewer anhand der AGREE II-Domänen bewertet. Die Domänen waren: Geltungsbereich und Zweck, Beteiligung von Interessengruppen, Genauigkeit der Leitlinienentwicklung, Klarheit der Gestaltung, Anwendbarkeit und Redaktionelle Unabhängigkeit. Die inhaltlichen Empfehlungen der Leitlinien wurden nach den fünf Kernthemen Kühlkette, Ausrüstung, Personal und Personalqualifikation, Lagerung und Monitoring analysiert. Das Studiendesign wurde in PROSPERO (CRD42021270524) registriert. Ergebnisse Insgesamt wurden neun Leitlinien und Empfehlungen bewertet. Die Gesamtpunktzahl der einzelnen Publikationen variierte zwischen 17% und 89% der maximal möglichen Punktzahl. Alle Leitlinien enthielten Empfehlungen zu den fünf Kernthemen, unterschieden sich jedoch in der Detailtiefe. Die wichtigsten Empfehlungen lauteten: a) durchgehende Kühlkette erforderlich; b)≥2 geschulte Verantwortliche pro Einrichtung; c) Lagerung in der Originalverpackung; d) geeigneter Kühlschrank, vorzugsweise Spezialkühlschrank, mit Min-Max-Thermometer oder Datenlogger; e) routinemäßiges Monitoring des Impfkühlschranks mit täglicher Temperaturaufzeichnung. Ein öffentliches Überwachungssystem wird in einigen Leitlinien empfohlen. Schlussfolgerung Unsere systematische Übersichtsarbeit identifizierte Schlüsselinformationen für die Lagerung und das Management von Impfstoffen, um die zukünftige Entwicklung deutscher Empfehlungen zur Impfstofflagerung anzuregen und zu unterstützen.
    Type of Medium: Online Resource
    ISSN: 0941-3790 , 1439-4421
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    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 1101426-X
    SSG: 20,1
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  • 7
    Online Resource
    Online Resource
    Elsevier BV ; 2020
    In:  Vaccine Vol. 38, No. 47 ( 2020-11), p. 7551-7557
    In: Vaccine, Elsevier BV, Vol. 38, No. 47 ( 2020-11), p. 7551-7557
    Type of Medium: Online Resource
    ISSN: 0264-410X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 1468474-3
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  • 8
    Online Resource
    Online Resource
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 9 ( 2017-09), p. e017629-
    In: BMJ Open, BMJ, Vol. 7, No. 9 ( 2017-09), p. e017629-
    Abstract: Overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other regions, although percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. Various studies investigated health system, physician and patient factors driving non-adherence to guidelines which recommend a stepwise approach with invasive procedures only in case of signs of ischaemia in non-invasive testing. In a larger-scale project, we aim to better understand the patients’ perspective in order to develop an intervention that enhances patient’s acceptance of this stepwise diagnostic approach for stable CAD. As a first step, this qualitative study aims to identify patient factors that prevent and promote the described overuse. Methods and analysis The exploratory qualitative interview study will include about 20 patients with stable CAD and a history of acute coronary syndrome from two German teaching practices. Narrative, structured interviews designed to last 30 to 90 min will be conducted. The interviews will be analysed using qualitative content analysis by Mayring. The analysis will address the following questions: (1) What are reasons for stable patients to undergo CC? (2) How do patients deal with their heart disease (secondary prevention)? (3) Which processes do patients describe regarding decision-making for non-invasive and invasive coronary procedures? (4) What information needs exist on behalf of patients to better understand the stepwise diagnostic approach outlined in guidelines and thereby avoid low-appropriate CCs? Based on these data, empirical typification will be conducted. Ethics and dissemination Ethical approval for the study was obtained. All participants will provide written informed consent. Data will be pseudonymised for analysis. The findings will contribute to the development of an appropriate intervention. Results will be disseminated by conference presentations and journal publications.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 9
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results Of 3,175 invited GPs, 54% responded ( N  = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients ( 〉  80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
    Type of Medium: Online Resource
    ISSN: 1471-2318
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2059865-8
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  • 10
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 3 ( 2020-03), p. 504-510
    Abstract: To achieve blood pressure (BP) control adequate dosing of first-line antihypertensive medications is recommended in addition to life-style changes. Given observations that dosing of antihypertensive agents is frequently insufficient, we compared the changes of BP control rates and antihypertensive drug regimens in a prospective German population using a new strategy to analyze medication dosing. Methods: This analysis is based on data of the baseline (2000–2003) and the first follow-up examination (2005–2008) of the population-based Heinz Nixdorf Recall study. Participants with hypertension at baseline (BP ≥140/90 mmHg or at least one antihypertensive agent) who participated in both examinations were included. Results: Of the 4157 participants, 2289 (55.1%) had hypertension at baseline. The prevalence of participants on antihypertensive agents was 60.3% at baseline and increased to 75.1% at follow-up. The mean number of antihypertensive agents was 2 [±1 SD (standard deviation)] initially and at follow-up. The prevalence of medication-controlled BP did not improve over time (baseline: 54.5%, follow-up: 56.5%). When stratifying by medication-controlled BP, the medication dosing rate slightly increased over time without differences between groups [controlled versus uncontrolled BP: 40.9 versus 46.2% (baseline); 50.1 versus 51.9% (follow-up)] . Conclusion: Although the prevalence of antihypertensive medication use increased in the study period, the BP control rate did not. In contrast to clinical reasoning, participants with uncontrolled BP did neither receive more agents nor higher dosing despite outcome-relevant hypertension. Our approach to analyze medication dosing suggests a potential to improve cardiovascular outcomes by increasing dosages of antihypertensive agents.
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2017684-3
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