Individualized versus Standardized Risk Assessment in Patients at High Risk for Adverse Drug Reactions (The IDrug Randomized Controlled Trial)–Never Change a Running System?

The aim of this study was to compare effects of an individualized with a standardized risk assessment for adverse drug reactions to improve drug treatment with antithrombotic drugs in older adults. A randomized controlled trial was conducted in general practitioner (GP) offices. Patients aged 60 years and older, multi-morbid, taking antithrombotic drugs and at least one additional drug continuously were randomized to individualized and standardized risk assessment groups. Patients were followed up for nine months. A composite endpoint defined as at least one bleeding, thromboembolic event or death reported via a trigger list was used. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. In total, N = 340 patients were enrolled from 43 GP offices. Patients in the individualized risk assessment group met the composite endpoint more often than in the standardized group (OR 1.63 [95%CI 1.02–2.63]) with multiple adjustments. The OR was higher in patients on phenprocoumon treatment (OR 1.99 [95%CI 1.05–3.76]), and not significant on DOAC treatment (OR 1.52 [95%CI 0.63–3.69]). Pharmacogenenetic variants of CYP2C9, 2C19 and VKORC1 were not observed to be associated with the composite endpoint. The results of this study may indicate that the time point for implementing individualized risk assessments is of importance

The BGO Calorimeter of BGO-OD Experiment

The BGO Rugby Ball is a large solid angle electromagnetic calorimeter now installed in the ELSA Facility in Bonn. The BGO is operating in the BGO-OD experiment aiming to study meson photoproduction off proton and neutron induced by a Bremsstrahlung polarized gamma beam of energies from 0.2 to 3.2 GeV and an intensity of 5 x 10(7) photons per second. The scintillating material characteristics and the photomultiplier read-out make this detector particularly suited for the detection of medium energy photons and electrons with very good energy resolution. The detector has been equipped with a new electronics read-out system, consisting of 30 sampling ADC Wie-Ne-R modules which perform the off-line reconstruction of the signal start-time allowing for a good timing resolution. Performances in linearity, resolution and time response have been carefully tested at the Beam Test Facility of the INFN National Laboratories in Frascati by using a matrix of 7 BGO crystals coupled to photomultipliers and equipped with the Wie-Ne-R sampling ADCs

Measurements of the Delta(1232) Transition Form Factor and the Ratio sigma_n\sigma_p From Inelastic Electron-Proton and Electron-Deuteron Scattering

Measurements of inclusive electron-scattering cross sections using hydrogen and deuterium targets in the region of the Delta(1232) resonance are reported. A global fit to these new data and previous data in the resonance region is also reported for the proton. Transition form factors have been extracted from the proton cross sections for this experiment over the four-momentum transfer squared range 1.64 < Q^2 < 6.75 (GeV/c)^2 and from previous data over the range 2.41 < Q^2 < 9.82 (GeV/c)^2. The results confirm previous reports that the Delta(1232) transition form factor decreases more rapidly with Q^2 than expected from perturbative QCD. The ratio of sigma _n \sigma_p in the \Delta(1232) resonance region has been extracted from the deuteron data for this experiment in the range 1.64 < Q^2 < 3.75 (GeV/c)^2 and for a previous experiment in the range 2.4 < Q^2 < 7.9 (GeV/c)^2. A study has been made of the model dependence of these results. This ratio sigma_n\sigma_p for \Delta(1232) production is slightly less than unity, while sigma_n\sigma_p for the nonresonant cross sections is approximately 0.5, which is consistent with deep inelastic scattering results.Comment: 10 figures. 42 pages, including figures. submitted to Physical Review

General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

BACKGROUND: 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

Pilotierung eines neuen Blended-Learning-Konzepts zur Integration Evidenzbasierter Medizin in das Blockpraktikum Allgemeinmedizin

Objective: The present study investigates the feasibility of the application of evidence-based medicine (EBM) procedures by students as part of practical training in general medicine through a newly developed blended-learning teaching concept.Methodology: This study describes the development, piloting and evaluation of a blended-learning concept for implementing EBM education as part of general practice training. Our concept consists of an online tutorial introducing the theoretical background, two classroom seminars for consolidation and practical exercises based on case studies. Following this, students were to apply their knowledge to real-life cases during their training. To evaluate the learning outcome, we have developed an evaluation tool based on the Fresno Test (Bonn Test). At the end of the seminar, students were invited to evaluate the concept.Results: A total of 35 students took part in the feasibility study and 27 Bonn tests were evaluated. All students achieved more than the pass mark required in the Bonn Test in the preparation of clinical case studies. Because of the differentiated assessment of learning outcomes in all categories of the 5A EBM process, difficulties in the translation process can be revealed by the Bonn test. As a result, the concept can be refined and improved continuously. In the evaluation, 74% of the students rated the teaching concept "good" or "very good".Conclusion: Overall, this study confirmed the feasibility of our EBM concept while demonstrating that students are able to apply the theoretical knowledge acquired to real-life settings. Further research with our concept is needed, especially at an earlier stage in the curriculum.Zielsetzung: Die vorliegende Arbeit prüft die Machbarkeit der praktischen Anwendung von Evidenzbasierter Medizin (EbM) durch Studenten während des Blockpraktikums (BP) im Fachgebiet Allgemeinmedizin durch ein neu entwickeltes Blended-Learning-Lehrkonzept.Methodik: Entwicklung, Pilotierung und Evaluation eines Blended-Learning Konzepts zur Einführung der Lehre der EbM im BP der Allgemeinmedizin werden beschrieben. Das Konzept besteht aus einem Online-Modul zur Vermittlung der theoretischen Grundlagen der EbM anhand des 5A-Schritteprozesses, zwei Präsenzseminaren zur Vertiefung der Inhalte und praktischen Übungen in Form von Fallbeispielen. Anschließend sollen die Studenten ihr erworbenes Wissen auf realen Patientenfällen in der Praxiszeit ihres BP anwenden. Zur Überprüfung des Lernerfolgs wurde auf Grundlage des Fresno Tests ein EbM-Evaluationsinstrument entwickelt - der Bonn- Test. Am Ende des Seminars können die Studenten das Konzept in einer schriftlichen Evaluation bewerten und Verbesserungsvorschläge einbringen.Ergebnisse: Insgesamt nahmen 35 Studenten an der Machbarkeitsstudie teil, 27 Bonn-Tests konnten ausgewertet werden. Alle Studierende erreichten bei der Ausarbeitung klinischer Fallbeispiele mehr als die zum Bestehen benötigte Mindestpunktzahl im Bonn Test. Die differenzierte Leistungsdarstellung in den einzelnen Kategorien des 5-A-Schritteprozesses der EbM mit Hilfe des Bonn-Tests ermöglicht spezifische Schwierigkeiten bei der Translation von EbM-Wissen in die Praxis aufzudecken und das Lehrkonzept fortlaufend weiterzuentwickeln und zu verbessern. In der Evaluation bewerteten die Studenten das Lehrkonzept zu 74 % mit "gut" oder "sehr gut".Schlussfolgerungen: Insgesamt bestätigt die vorliegende Studie, dass die Erweiterung des Blockpraktikums im Fachbereich für Allgemeinmedizin um das neu entwickelte EbM-Modul machbar ist und die Studenten die erlernten Inhalte erfolgreich in der Praxis anwenden können. Weitere Untersuchungen des Lehrkonzepts, insbesondere zu einem früheren Zeitpunkt des Medizinstudiums, sind empfehlenswert