Osteopathy in Germany: attitudes, beliefs and handling among general practitioners - results of a nationwide cross-sectional questionnaire survey.

BACKGROUND: Osteopathy is a type of complementary medicine based on specific manual techniques. In many countries, including Germany, the profession is not officially regulated, and evidence for the effectiveness of osteopathy is insufficient for most diseases. Nevertheless, many health insurances in Germany offer reimbursement for therapy costs, if osteopathy is recommended by a physician. This cross-sectional survey of German general practitioners (GPs) explored beliefs and attitudes towards osteopathic medicine and described their daily interactions with it. METHODS: A random sample of 1000 GPs from all federal states was surveyed by mail using a self-designed questionnaire. We collected data on sociodemographics, personal experiences with osteopathy, and attitudes and expectations towards osteopathy. In particular, participants were asked about indications for osteopathic treatment and their beliefs about its effectiveness for different patient groups and diagnoses. A self-designed score was used to estimate general attitudes towards osteopathy and identify factors correlated with greater openness. Additionally, we performed logistic regression to reveal factors associated with the frequency of recommending osteopathy to patients. RESULTS: Response rate was 34.4%. 46.5% of participants were women, and the median age was 56.0 years. 91.3% of GPs had referred patients to an osteopath, and 88.0% had recommended osteopathy to their patients. However, 57.5% acknowledged having little or no knowledge about osteopathy. Most frequent reasons for a recommendation were spinal column disorders (46.2%), other complaints of the musculoskeletal system (18.2%) and headaches (9.8%). GPs estimated the highest benefit for chronically ill and middle-aged adults. Female gender (OR 2.09; 95%CI 1.29-3.38) and personal treatment experiences (OR 5.14; 95%CI 2.72-9.72) were independently positively associated with more frequent treatment recommendation. CONCLUSION: GPs in Germany have frequent contact with osteopathy, and the vast majority have recommended osteopathic treatment to some extent in their practice, with foci and opinions comparable to other Western countries. The discrepancy between GPs making frequent referrals for osteopathic treatment while self-assessing to have little knowledge about it demonstrates need for intensified research on the collaboration with osteopaths and how to best integrate osteopathic treatments. Our results may help to focus future effectiveness studies on most relevant clinical conditions in general practice.

Use of point-of-care tests among general practitioners: a cross-sectional study in Saxony, Germany.

INTRODUCTION: There is little knowledge about the use of point-of-care (POC) tests among general practitioners (GPs). The aim of this study was to determine which POC tests are known and used by GPs and how they estimate the usefulness of those tests. The use of POC tests among GPs and university-associated general practitioners who teach undergraduates (GPTUs) was elucidated. Differences between GPs working in urban and rural areas were also investigated. METHODS: The knowledge, utilisation and usefulness (as estimated by the responders) of 27 POC tests were assessed with a self-designed questionnaire in a random sample of GPs (n=244) and GPTUs (n=48) in Saxony, Germany. RESULTS: A total of 63 GPs and 31 GPTUs (response rates 26.5% and 64.6%, respectively) responded. No relevant difference between GPs and GPTUs was found. The GPs were familiar with 22.5±4.5 (mean ± standard deviation) of the laboratory parameters, the GPTUs with 22.9±4.3 (p=0.427). The amount of recognised POC tests was 11.6±4.9 vs 12.4±5.5 (GPs vs GPTUs; p=0.441). The amount of utilised POC tests was 5.5±2.3 vs 6.0±2.5 (GPs vs GPTUs; p=0.431). Rural GPs were familiar with more POC tests than urban GPs (mean number of tests (rural vs urban): 13.3±5.5 vs 10.6±4.4; p=0.011), but there was no difference in the amount of utilised POC tests. Twelve of the 27 POC tests were estimated as useful by more than 50% of the responders who answered this item. CONCLUSIONS: Only a limited number of rapid tests are estimated as useful and are used by GPs in Saxony.

Sirolimus treatment of severe PTEN hamartoma tumor syndrome: case report and in vitro studies.

BACKGROUND: Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is caused by germ line mutations in the PTEN gene. Symptoms include cancer predisposition, immune deviations, and lipomas/lipomatosis. No causal standard therapy is available. We describe a therapeutic attempt with the mammalian target of rapamycin (mTOR) inhibitor sirolimus for a PHTS patient suffering from thymus hyperplasia and lipomatosis. We furthermore assessed the in vitro effects of sirolimus and other inhibitors on lipoma cells of the patient. METHODS: The patient underwent clinical and blood examinations and whole-body magnetic resonance imaging to assess tumor sizes. Lipoma cells of the patient were incubated with inhibitors of the phosphoinositide-3-kinase (PI3K)/AKT/mTOR signaling pathway to analyze the effects on proliferation, adipocyte differentiation, and survival in vitro. RESULTS: Sirolimus treatment improved somatic growth and reduced thymus volume. These effects diminished over the treatment period of 19 mo. Sirolimus decreased lipoma cell proliferation and adipocyte differentiation in vitro but did not cause apoptosis. PI3K and AKT inhibitors induced apoptosis significantly. CONCLUSION: Sirolimus treatment led to an improvement of the patient's clinical status and a transient reduction of the thymus. Our in vitro findings point to PI3K and AKT inhibitors as potential treatment options for patients with severe forms of PHTS.

Considering additive effects of polypharmacy : Analysis of adverse events in geriatric patients in long-term care facilities.

BACKGROUND: Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. METHODS: A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses' interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. RESULTS: (i) We found 424 adverse events with a median of 4 per patient (range 1-14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0-11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as "doubtful," in 218 (51.2%) as "possible," in 7 (1.7%) as "probable," and in 1 (0.2%) adverse event as a "definitive" cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. CONCLUSION: Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

A new human adipocyte model with PTEN haploinsufficiency.

Few human cell strains are suitable and readily available as in vitro adipocyte models. We used resected lipoma tissue from a patient with germline phosphatase and tensin homolog (PTEN) haploinsufficiency to establish a preadipocyte cell strain termed LipPD1 and aimed to characterize cellular functions and signalling pathway alterations in comparison to the established adipocyte model Simpson-Golabi-Behmel-Syndrome (SGBS) and to primary stromal-vascular fraction cells. We found that both cellular life span and the capacity for adipocyte differentiation as well as adipocyte-specific functions were preserved in LipPD1 and comparable to SGBS adipocytes. Basal and growth factor-stimulated activation of the PI3 K/AKT signalling pathway was increased in LipPD1 preadipocytes, corresponding to reduced PTEN levels in comparison to SGBS cells. Altogether, LipPD1 cells are a novel primary cell model with a defined genetic lesion suitable for the study of adipocyte biology.