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1.
BMC Res Notes ; 13(1): 55, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019577

RESUMO

OBJECTIVE: Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population. Forty-five participants aged 65 to 89 years performed six computerized and non-computerized neuropsychological tests at baseline and again at 7 day and 3 months follow-up sessions. Mean scores on each test were compared across time points using repeated measures analyses of variance (ANOVA) with pairwise comparison. Two-way mixed effects, absolute agreement analyses of variance intra-class correlation coefficients (ICC) determined test-retest reliability. RESULTS: All tests had moderate to excellent test-retest reliability during 7-day (ICC range 0.63 to 0.94; all p < 0.01) and 3-month intervals (ICC range 0.60 to 0.92; all p < 0.01) though confidence intervals of ICC estimates were large throughout. Practice effects apparent at 7 days eased off by 3 months. No substantial differences between computerized and non-computerized tests were observed. We conclude that the present six-test neuropsychological test battery is appropriate for use in POCD research though small sample size of our study needs to be recognized as a limitation. Trial registration ClinicalTrials.gov Identifier NCT02265263 (15th October 2014).

2.
JMIR Med Inform ; 7(2): e13064, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038467

RESUMO

BACKGROUND: In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients' health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. OBJECTIVE: The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. METHODS: This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff-5 physicians, 6 nurses, and 4 respiratory therapists-were recorded, transcribed, and analyzed using the grounded theory approach. RESULTS: Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. CONCLUSIONS: This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. TRIAL REGISTRATION: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk).

3.
Int J Behav Med ; 25(6): 658-668, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30105602

RESUMO

PURPOSE: The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields. METHOD: Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure. RESULTS: Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS. CONCLUSION: Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes. TRIAL REGISTRATION: NCT01357694.


Assuntos
Depressão/epidemiologia , Solidão/psicologia , Apoio Social , Adulto , Comorbidade , Feminino , Hospitais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Acta Haematol ; 140(1): 1-9, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30007981

RESUMO

BACKGROUND/AIMS: The generic quality of life KINDL-R -questionnaire is validated for use in children/adolescents ≤16 years. The aim of this cross-sectional investigation was to modify the KINDL-R questionnaire for use in adults and to validate its psychometric properties. METHODS: Five items of the KINDL-R questionnaire were adapted and the newly developed KINDL-A(dult) questionnaire administered to 255 patients with hereditary and acquired bleeding disorders (mean age 53 years). Its internal consistency and convergent and divergent construct validity were investigated and confirmatory factor analysis was used to evaluate the latent factor structure. RESULTS: The KINDL-A questionnaire showed satisfactory reliability, varying construct validity, but inconclusive factor structure. The KINDL-AB(rief) was developed by removing half of the items and combining 2 sub-axes. This led to factor loadings between 0.62 and 0.91 and increased overall fit (Goodness of fit > 0.8 and Root Mean Square Error of Approximation, RMSEA, < 0.08). Results were validated in 966 healthy blood donors (mean age 38 years). In this group, the KINDL-AB questionnaire showed factor loadings between 0.43 and 0.77, Goodness of fit > 0.95 and RMSEA < 0.05. CONCLUSIONS: The new KINDL-AB suggests sufficient to good psychometric properties in adult patients with hereditary and acquired bleeding disorders.


Assuntos
Transtornos da Coagulação Sanguínea/psicologia , Psicometria/métodos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários
5.
Crisis ; 39(4): 294-303, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29473473

RESUMO

BACKGROUND: At times, the question for meaning comes to nothing and a crisis of meaning ensues. This state is very painful, but difficult to account. Both those who suffer from it and care professionals find themselves at a loss for words. AIMS: This study introduces an operationalization of a crisis of meaning. It aims to distinguish the concept from depression, and to investigate whether a crisis of meaning can explain suicidality beyond the known protective and risk factors self-esteem, family functioning, life-event load, and depression. METHOD: Final-year school pupils in Ecuador (N = 300) completed questionnaires assessing the above variables. Data were analyzed using chi-square, hierarchic multiple regression, serial mediation, and moderator analyses. RESULTS: Crisis of meaning was distinguished from depression. It explained a significant amount of variance in suicidality beyond the mentioned protective and risk factors. For males, crisis of meaning was the only significant risk factor, and the strongest predictor overall. The acute risk factors depression and crisis of meaning mediated the effects of the baseline factors self-esteem, family functioning, and life-event load on suicidality. LIMITATIONS: The study was cross-sectional; assessed factors predicted variance in suicidal thoughts, plans, and past suicide attempts, while their relevance cannot be generalized to actual future suicide attempts. CONCLUSION: A crisis of meaning is an important factor to take into account in further research on the prevention and treatment of people at risk of suicide.


Assuntos
Depressão/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
6.
BMC Psychiatry ; 17(1): 417, 2017 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-29284443

RESUMO

BACKGROUND: Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care. METHODS: The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only. RESULTS: Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness. CONCLUSIONS: Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01357694.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Entrevista Motivacional/métodos , Cuidados Pré-Operatórios/métodos , Psicoterapia Breve/métodos , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Motivação , Análise de Regressão , Procedimentos Cirúrgicos Operatórios/psicologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 95(27): e4077, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27399095

RESUMO

Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery.Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0-100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis.Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th-75th percentiles: 10-52) versus 21 (10-46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men.This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.


Assuntos
Medição da Dor , Período Pré-Operatório , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais
8.
Anesthesiology ; 123(1): 148-59, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25915712

RESUMO

BACKGROUND: The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA. METHODS: This randomized, parallel-group, open-label, controlled trial was conducted in the preoperative anesthesiological assessment clinics and surgical wards of a large university hospital in Germany. A total of 220 surgical patients with comorbid mental disorders were randomized by using the computer-generated lists to one of two intervention groups: BRIA psychotherapy sessions up to 3 months postoperatively (BRIA) versus no psychotherapy/computerized brief written advice (BWA) only. Primary outcome was participation in psychosocial mental healthcare options at month 6. Secondary outcome was change of self-reported general psychological distress (Global Severity Index of the Brief Symptom Inventory) between baseline and month 6. RESULTS: At 6-month follow-up, the rate of patients who engaged in psychosocial mental healthcare options was 30% (33 of 110) in BRIA compared with 11.8% (13 of 110) in BWA (P = 0.001). Number needed to treat and relative risk reduction were 6 (95% CI, 4 to 13) and 0.21 (0.09 to 0.31), respectively. In BRIA, Global Severity Index decreased between baseline and month 6 (P < 0.001), whereas it did not change significantly in BWA (P = 0.197). CONCLUSIONS: Among surgical patients with comorbid mental disorders, BRIA results in an increased engagement in subsequent therapy options and a decrease of general psychological distress. These data suggest that it is reasonable to integrate innovative psychotherapy programs into the context of interdisciplinary surgical care.


Assuntos
Anestesiologia/métodos , Cuidados Pré-Operatórios/métodos , Psicoterapia/métodos , Terapias em Estudo/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cuidados Pré-Operatórios/psicologia , Estudos Prospectivos , Terapias em Estudo/psicologia , Resultado do Tratamento
9.
J Pain Palliat Care Pharmacother ; 29(1): 59-60, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25643233

RESUMO

Definitions and difficulties relating to managing acute and chronic pain in patients with current or past substance abuse disorders are discussed. Problems with too rapid discontinuation of drugs are described. An interdisciplinary approach involving pain specialists, substance abuse clinicians and mental health professional is advocated.


Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/complicações , Analgésicos Opioides/efeitos adversos , Humanos , Comunicação Interdisciplinar
10.
Eur J Anaesthesiol ; 32(3): 147-51, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24979586

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor. OBJECTIVE: The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients. DESIGN: A prospective, clinical observational study. SETTING: This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia. INCLUSION CRITERIA: at least 60 years of age; noncardiac surgery with general anaesthesia. EXCLUSION CRITERIA: impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression. STATISTICS: Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed. RESULTS: A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor). CONCLUSION: The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery. TRIAL REGISTRATION: ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/


Assuntos
Anestesia Geral/efeitos adversos , Delírio/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores Etários , Idoso , Cognição , Delírio/diagnóstico , Delírio/psicologia , Depressão/epidemiologia , Alemanha/epidemiologia , Hospitais Universitários , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
11.
Addiction ; 109(2): 173-4, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24164582

RESUMO

Implementation of effective clinical interventions as part of routine medical care to combat problem drinking and tobacco use is recognized to be low. Insufficient training is an important barrier preventing physicians from delivering interventions recommended in current guidelines. High-impact medical journals publish almost nothing on how to address this. If they start to take an interest perhaps we will see more progress and many thousands of lives saved at minimal cost.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Pesquisa Biomédica , Educação Médica , Prevenção do Hábito de Fumar , Saúde Global , Humanos
12.
Nicotine Tob Res ; 15(11): 1892-901, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23803393

RESUMO

INTRODUCTION: In many countries, smoking cessation interventions are not routinely delivered as recommended in national and international guidelines. This may be because of incorrect beliefs about their effectiveness. This study assessed which cessation methods are believed to be effective by medical students in different years of undergraduate education as well as predictors of correct beliefs about effectiveness. METHODS: In this cross-sectional study, undergraduate students from 27 German medical schools were invited to complete a survey addressing demographic characteristics, smoking status, self-rated knowledge of health consequences, and treatment options for smoking and beliefs about the effectiveness of 8 different methods to achieve long-term smoking cessation. Predictors of beliefs were identified by means of multilevel modeling. RESULTS: A total of 19,526 students completed the survey. Students greatly overestimated the effectiveness of unaided quitting, and differences between years of undergraduate education were small. In the final year, 51% of students wrongly believed that willpower alone was more effective than a comprehensive group cessation program, including nicotine replacement therapy. Multilevel modeling revealed that having never smoked, supporting public smoking bans, and recalling theoretical training in smoking cessation were associated with correct beliefs. CONCLUSIONS: A considerable proportion of German medical students believe that willpower alone is more effective than comprehensive treatment programs to support a quit attempt.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Estudantes de Medicina/estatística & dados numéricos , Aconselhamento , Estudos Transversais , Cultura , Educação de Graduação em Medicina , Feminino , Alemanha , Humanos , Masculino , Modelos Teóricos , Autorrelato , Abandono do Hábito de Fumar/psicologia , Inquéritos e Questionários
13.
Eur Addict Res ; 19(5): 245-51, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23428902

RESUMO

BACKGROUND/AIMS: A minority of German medical students believe they know how to support smokers willing to quit. This paper examined whether the same would be true for treating alcohol use disorder (AUD), and individual factors associated with incorrect beliefs about the effectiveness of methods to treat AUD. METHODS: In this cross-sectional study, 19,526 undergraduate students from 27 German medical schools completed a survey addressing beliefs about the effectiveness of different methods of overcoming AUD. Beliefs about AUD treatment effectiveness were compared across the 5 years of undergraduate education and predictors identified by means of multiple linear regression. RESULTS: Even in the fifth year, 28.1% (95% CI: 26.5-29.7) of students believed that willpower alone was more effective for overcoming AUD than a comprehensive treatment program. The only significant predictor of this belief was a similar belief for stopping smoking. CONCLUSION: Our results indicate that a considerable proportion of German medical students overestimate the effectiveness of willpower to treat smoking and AUD. The addictive nature of these disorders needs to be stressed during undergraduate medical education to ensure that future physicians will be able and motivated to support patients in their quit attempts.


Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Atitude do Pessoal de Saúde , Motivação , Estudantes de Medicina/psicologia , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Grupos de Autoajuda/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/métodos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Inquéritos e Questionários , Resultado do Tratamento
14.
PLoS One ; 7(12): e51167, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23227250

RESUMO

OBJECTIVES: This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. METHODS: A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. RESULTS: 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. CONCLUSION: In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.


Assuntos
Psicoterapia , Estresse Psicológico/terapia , Procedimentos Cirúrgicos Operatórios/psicologia , Alcoolismo/psicologia , Demografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários
15.
Addiction ; 107(10): 1878-82, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22551065

RESUMO

AIM: To assess the extent of undergraduate medical training on alcohol use disorders (AUD) and smoking, and medical students' perceived knowledge regarding consequences of, and treatment options for, these disorders compared with other chronic conditions. DESIGN: Cross-sectional survey assessing teaching and perceived knowledge of health consequences and treatment options for AUD and smoking compared with diabetes and hypertension. SETTING: Medical schools in Germany. PARTICIPANTS: Twenty-five of 36 medical school offices (response rate 69.4%) and 19 526 of 39 358 students from 27 medical schools (response rate 49.6%). MEASUREMENT: Medical schools were asked to provide information on curricular coverage of the four conditions. Students reported their year of study and perceived knowledge about the consequences of all four disorders and perceived knowledge of treatment options. FINDINGS: Courses time-tabled approximately half as many teaching hours on AUD and tobacco as on diabetes or hypertension. Final-year students reported high levels of knowledge of consequences of all four conditions and how to treat diabetes and hypertension, but only 20% believed they knew how to treat alcohol use disorders or smoking. CONCLUSIONS: Curriculum coverage in German medical schools of alcohol use disorders and smoking is half that of diabetes and hypertension, and in the final year of their undergraduate training most students reported inadequate knowledge of how to intervene to address them.


Assuntos
Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Competência Clínica/normas , Educação de Graduação em Medicina/normas , Psiquiatria/educação , Prevenção do Hábito de Fumar , Estudantes de Medicina/psicologia , Estudos Transversais , Currículo/normas , Alemanha , Humanos , Ensino/normas
17.
Artigo em Alemão | MEDLINE | ID: mdl-22020575

RESUMO

At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has potential advantages for both patient and anesthesiologist, not least due to a higher patient safety.


Assuntos
Anestesia/normas , Anestésicos/efeitos adversos , Medicina Baseada em Evidências , Internet , Anamnese/métodos , Medição de Risco/métodos , Algoritmos , Lista de Checagem , Hemodinâmica/fisiologia , Humanos , Tempo de Internação , Registros Médicos , Educação de Pacientes como Assunto , Satisfação do Paciente , Assistência Perioperatória , Garantia da Qualidade dos Cuidados de Saúde
18.
Arch Gen Psychiatry ; 68(12): 1247-56, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21810631

RESUMO

CONTEXT: Stress plays a major role in the development of comorbid alcohol use disorder (AUD). In turn, AUD worsens the outcome of psychiatric patients with respect to global disease severity, social situation, and socioeconomic burden. Prediction of persons at risk for AUD is crucial for future preventive and therapeutic strategies. OBJECTIVE: To investigate whether genetic variants of the corticotropin-releasing factor system or their interaction influence the risk of developing AUD in chronic disease populations. DESIGN: Genotype analysis comprising selected single-nucleotide polymorphisms within the CRHR1 and CRHBP genes in patients with schizophrenia and in a nonschizophrenic psychiatric disease control sample should allow the extraction of predictors of comorbid AUD. Gene expression (messenger RNA) analysis in peripheral blood mononuclear cells was performed to gain the first mechanistic insight. SETTING: An ideal setup for this study was the Göttingen Research Association for Schizophrenia Data Collection of schizophrenic patients, specifically intended to enable association of genetic information with quantifiable phenotypes in a phenotype-based genetic association study. Patients  A total of 1037 schizophrenic patients (Göttingen Research Association for Schizophrenia sample), 80 nonschizophrenic psychiatric disease controls as a small replicate sample, and a case-control study including 1141 healthy subjects. MAIN OUTCOME MEASURES: Association of CRHR1 and CRHBP genotypes with the following: (1) AUD; (2) a newly developed alcoholism severity score comprising 5 AUD-relevant variables; and (3) quantitative CRHR1 and CRHBP messenger RNA expression. RESULTS: An interaction of CRHR1 rs110402 and CRHBP rs3811939 predicts high risk of comorbid AUD in schizophrenic patients (odds ratio = 2.27; 95% confidence interval, 1.56-3.30; P < .001) as well as psychiatric disease controls (odds ratio = 4.02; 95% confidence interval, 0.95-17.05; P = .06) and leads to the highest CRHR1/CRHBP messenger RNA ratio (P = .02; dysbalanced stress axis). CONCLUSIONS: The high predictive value of a genetic interaction within the stress axis for the risk of comorbid AUD may be used for novel preventive and individualized therapeutic approaches.


Assuntos
Alcoolismo/genética , Proteínas de Transporte/genética , Hormônio Liberador da Corticotropina/genética , Receptores de Hormônio Liberador da Corticotropina/genética , Esquizofrenia/genética , Adolescente , Adulto , Idoso , Alcoolismo/epidemiologia , Alcoolismo/fisiopatologia , Estudos de Casos e Controles , Comorbidade , Hormônio Liberador da Corticotropina/fisiologia , Estudos Transversais , Feminino , Estudos de Associação Genética , Humanos , Masculino , Transtornos Mentais/genética , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Esquizofrenia/epidemiologia , Esquizofrenia/fisiopatologia , Adulto Jovem
19.
Eur J Anaesthesiol ; 28(10): 733-41, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21610503

RESUMO

BACKGROUND AND OBJECTIVE: Depression is common in patients with medical illness. However, little is known about frequency and clinical relevance of preoperative depression in surgical patients. The objective of this study was to investigate the frequency of depression, essential health risk factors and hospital length of stay (LOS) of patients in preoperative anaesthesiological assessment. METHODS: Patients were consecutively screened in the preoperative anaesthesiological assessment clinics. In total, 5429 patients gave written informed consent to perform a computerised self-assessment of lifestyle factors, including alcohol use, tobacco smoking, weight, physical status, physical exercise, sleeping disturbance, subjective health and sense of coherence (SOC). Depression was defined by a WHO-5 well-being score of 13 or less. LOS was obtained from the electronic patient management system. RESULTS: A clinically relevant depressive state was found in 29.7% of the patients. Patients with depression had a median LOS of 6.0 days as compared to patients with positive well-being who had a LOS of 4.8 days (P < 0.001). Worse subjective health, less physical exercise and experience of SOC, as well as more severe sleeping disturbances were independently and significantly associated with depression (P < 0.001). CONCLUSION: Clinically significant depressive states are frequent conditions in surgical patients of preoperative anaesthesiological assessment and are associated with an increased LOS. Different clinical pathways delivering adequate preoperative information according to the needs, considering subjective health and SOC of the patient as well as avoiding immobilisation and sleep disturbances during hospital stay should be considered. Long-term treatment programmes including brief intervention in the hospital and an outpatient concept should be offered.


Assuntos
Anestesiologia/métodos , Depressão/complicações , Cuidados Intraoperatórios/métodos , Adulto , Depressão/diagnóstico , Feminino , Nível de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Período Pré-Operatório , Projetos de Pesquisa , Fatores de Risco , Fatores de Tempo
20.
Alcohol Clin Exp Res ; 35(10): 1732-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21569053

RESUMO

BACKGROUND: This commentary discusses the systematic review "The efficacy of disulfiram for the treatment of alcohol use disorder (AUD)" by Jørgensen and colleagues (2011, Alcohol Clin Exp Res DOI: 10.1111/j.1530-0277.2011.01523.x). The main focus of the commentary is on long-term effects, long-term use, and psychotherapeutic application of supervised disulfiram. METHODS: A brief qualitative overview is given of previous and recent clinical studies on disulfiram in alcoholism treatment. RESULTS: The alcohol deterrent disulfiram is an effective pharmacological adjunct to the treatment of AUD when it is administered as supervised low-dose disulfiram and is integrated in comprehensive biopsychosocial alcoholism therapy. However, the assumed underlying psychological effects of psychotherapeutic disulfiram application have never been properly investigated. Prospective long-term follow-up studies are rare and suggest that long-term effects of disulfiram are associated with long-term use and/or integration of the medication in cognitive behavior therapy. CONCLUSIONS: Evidence from decades of research suggests psychological effects as principal mode of action of supervised disulfiram. Future randomized controlled trials are needed that investigate psychological actions and long-term outcomes of this alcohol deterrent.


Assuntos
Dissuasores de Álcool/uso terapêutico , Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Dissulfiram/uso terapêutico , Prevenção Secundária , Feminino , Humanos , Masculino
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