610 Medizin, Gesundheit
- 610 Medizin und Gesundheit
- 611 Menschliche Anatomie, Zytologie, Histologie
- 612 Humanphysiologie
- 613 Persönliche Gesundheit und Sicherheit
- 614 Inzidenz und Prävention von Krankheiten
- 615 Pharmakologie, Therapeutik
- 616 Krankheiten
- 617 Chirurgie und verwandte medizinische Fachrichtungen
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618 Gynäkologie, Geburtsmedizin, Pädiatrie, Geriatrie
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- Pflege (29)
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- Literaturrecherche (12)
- Patient (12)
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- COVID-19 (7)
Background: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility.
Objective: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective.
Methods: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis.
Results: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation.
Conclusions: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations.
Treatment thresholds and minimal clinically important effect sizes of antiosteoporotic medication
(2022)
Background
Patient decisions to take preventative treatments for osteoporosis depend on their perceptions of fracture risk, medication effect sizes (ES) of benefits and harms. However, physicians and lay persons may have differing perceptions of risks and medication efficacy. Both tend to overestimate medication benefits. This study surveyed at what risk physicians would prescribe and lay persons would be willing to take bisphosphonates, the minimum ES both groups do demand and the physicians estimates of the actual benefit of bisphosphonates.
Design
Cross-sectional online questionnaire survey.
Methods
Respondents were confronted with a case vignette with an osteoporotic patient (10-year femoral fracture risk: 32%). They were asked at what threshold of 10-year-risk of femoral neck fracture they would prescribe or take a drug. They were asked for the minimum ES (absolute risk reduction, ARR) they demand from bisphosphonates to prescribe or take them. Physicians were asked to provide their estimate of the actual ARR of bisphosphonates.
Results
114 physicians and 140 lay persons answered (convenience sample/snowball distribution). The 10-year-risk threshold of lay persons (Mdnlay = 60%) willing to take medication was twice as high as the physicians’ threshold (Mdnphy = 30%) to prescribe it (p < .001). The median minimum ARR physicians demanded for bisphosphonates prescription was 17%, whereas lay persons demanded 22% (p < .001). Physicians estimated the actual ARR of bisphosphonates to be 12%. This estimated effect size was below their own minimum threshold for prescription.
Conclusions
Lay persons tolerate a higher fracture risk and demand a larger benefit of antiosteoporotic medication for fracture prevention than physicians. Physicians demand higher minimum benefits than their own estimates which in turn are above the benefit evidence suggests. Physicians should be more familiar with ES of antiosteoporotic drugs concerning patient outcomes and actively advise lay persons before preventive treatment decisions are taken.
Serotonin immunoreactivity was previously found in myenteric neurons co-innervating motor endplates in the mouse esophagus striated muscle and aninvolvement in motility control was suggested. However, it is not known ifother neuroactive substances are present in these neurons and to what extentthey co-localize. First, vasoactive intestinal peptide (VIP) was established as abona fide marker for putative inhibitory myenteric neurons by evaluating co-localization with neuronal nitric oxide synthase (nNOS) and neuropeptide Y(NPY). Then, co-localization of serotonin and VIP was tested in co-innervatingaxons on motor endplates, which were visualized withα-bungarotoxin (α-BT)by multilabel immunofluorescence. Myenteric ganglia were also surveyed forco-localization in neuronal perikarya and varicosities. nNOS, NPY, and VIPwere completely co-localized in enteric co-innervating nerve terminals onmotor endplates. After co-staining with VIP, we found (a) serotonin (5-HT)-positive nerve endings without VIP (44% of 5-HT-positively innervated end-plates), (b) 5-HT- and VIP-positive endings without co-localization (35%), and(c) 5-HT- and VIP-positive endings with co-localization (21%). About one-fifthof nerve terminals on motor endplates containing 5-HT originate from putativeinhibitory peptidegic nitrergic neurons. However, the majority represents a different population presumably subserving different functions.
Background and teaching situation: The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture “General Practice” was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic.
Methodology: Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis.
Results: In terms of overall impression, the students (N=199) rated the lecture on average as “very good” (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work.
Discussion and implications: The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students’ time investment and practical relevance of digital self-learning mechanisms.
Praxisanleitung
(2022)
Die ANP-Rollenentwicklung für die Anästhesie-Pflege ist aufgrund der Herausforderungen der Folgen des demographischen Wandels von großer Bedeutung. Mit der Annahme einer Sicherung und Verbesserung der Qualität sowie Quantität der zukünftigen pflegerischen Versorgung ist es notwendig, die Veränderungen an die pflegerische Versorgung zu erkennen und sich diesen durch eine evidenzbasierte pflegerische Praxis anzupassen.
In diesem Beitrag werden die Bedeutung, der Bedarf, die Implementierung und deren Vorgehensweise sowie die anschließende Evaluation der neuen ANP-Rolle in der Anästhesie und des dazugehörigen Pflegemodells dargestellt. Der Fokus ist dabei auf die Versorgung der Menschen mit Demenz imperioperativen Bereich gerichtet. Mit Blick auf die Zukunft werden die für eine erfolgreiche Realisierung der ANP-Rolle in der Anästhesie notwendige finanzielle,
personelle und ideelle Unterstützung sowie die Forschung und die Vernetzung betont.
Integrierte Notfallzentren
(2022)
Hintergrund
Die deutschen Notaufnahmen sind überfüllt. Immer mehr Patienten suchen im Bedarfsfall eine Notaufnahme auf, obwohl diese teilweise von einem niedergelassenen Arzt behandelt werden könnten. Durch die geplante Einführung von integrierten Notfallzentren (INZ) soll dieser Überfüllung und Überlastung der Notaufnahmen entgegengewirkt werden. Doch können INZ zur Patientensteuerung genutzt werden und welche personellen und strukturellen Voraussetzungen müssen dafür erfüllt sein?
Methode
Zur Beantwortung dieser Fragestellungen wurde eine literaturgestützte empirische Primärdatenerhebung durchgeführt. Eine systematische Literaturrecherche bildete dabei die Grundlage für eine weiterführende Querschnittserhebung. Ziel war es, publizierte Meinungen und Positionen verschiedener Fachverbände, Gesellschaften und Experten unter Klinikern zu hinterfragen. Die Datenerhebung fand durch eine quantitative Befragung in Form einer Online-Umfrage statt. Adressaten der Online-Umfrage waren alle ärztlichen und pflegerischen Notaufnahmeleitungen (N = 331) in Bayern. Zur Datenauswertung wurde das Statistikprogramm SPSS verwendet.
Ergebnisse
Ein Drittel der Notaufnahmeleitungen (N = 107) hat sich an der Online-Umfrage beteiligt. Die Teilnehmer setzen sich aus 57 ärztlichen und 50 pflegerischen Leitungen zusammen. Mehr als 80 % der befragten Teilnehmer erachten INZ als sinnvoll. Als wichtige Voraussetzungen für die Etablierung von INZ gelten dabei die Zusammenarbeit aller Beteiligten, eine validierte Ersteinschätzung, angemessene Personalbemessungsmodelle sowie eine transparente Ausgestaltung von INZ.
Diskussion
INZ werden momentan als ein vielversprechender Lösungsansatz betrachtet. Damit eine Patientensteuerung gelingen kann, müssen die genannten Voraussetzungen erfüllt sein.
Der folgende Beitrag beschreibt Qualifikationsvoraussetzungen, Visionen und konkrete Rollenprofile von PflegeexpertInnen APN in der Akutpflege und psychiatrischen Pflege. Zudem wird der Ansatz einer hochschulisch begleiteten ANP-Rollentwicklung vorgestellt, um aufzuzeigen, wie ANP-Studierende und Praxiseinrichtungen zur Implementierung einer erweiterten und vertieften Pflegepraxis befähigt werden können.
