Pilot cluster randomized controlled trial of a complex intervention to improve management of vertigo in primary care (PRIMA-Vertigo): study protocol

<p><b>Objectives:</b> Vertigo and dizziness are highly prevalent symptoms in primary care, frequently misdiagnosed. Based on a thorough need assessment, INDICORE (INform, DIagnose, COmmunicate, REfer), an evidence-based complex intervention has been developed to transfer knowledge of specialized tertiary clinics to primary care providers (PCPs), improve the referral process and, ultimately, improve the functioning and quality of life of patients with vertigo/dizziness. The main objective of the PRIMA-Vertigo pilot study is to examine whether the INDICORE intervention is feasible and sufficiently promising to warrant a larger trial.</p> <p><b>Methods:</b> We plan to perform a single-blind, pragmatic cluster-randomized controlled pilot study with an accompanying process evaluation. PCPs will be the cluster units of randomization. Patients who consult these PCPs because of vertigo/dizziness symptoms will be included consecutively and considered the units of analysis. The intervention will be multi-faceted training on diagnostics targeted at the PCPs, supported by patient education material and a newly developed tool to structure the referral process. To balance the influence of non-specific effects, all clusters will receive generic communication training.</p> <p><b>Expected results:</b> The process evaluation aims to provide results on the acceptability and feasibility of the INDICORE intervention components to PCPs and patients. Additionally, this study will provide a first estimate of the likely effectiveness of the intervention on patients’ quality of life, functioning and participation.</p> <p><b>Conclusions:</b> The PRIMA-Vertigo pilot study will allow further tailoring of the INDICORE intervention to stakeholder needs before its effectiveness is evaluated in a large-scale main study.</p

Prevention of Depression and Anxiety in Residential Homes for the Elderly

Codebook of content analysis. This codebook contains definitions of meta-codes and sub-codes according to which the interview meaning units were to be clustered. In addition, examples for meaning units are given for each meta-code and the questions which were expected to trigger responses belonging to each meta-code are listed. (DOCX 80 kb

Additional file 1: of Determinants for utilization and transitions of long-term care in adults 65+ in Germany: results from the longitudinal KORA-Age study

Germany’s nursing care insurance. (DOCX 23 kb

Self-Efficacy Beliefs Are Associated with Visual Height Intolerance: A Cross-Sectional Survey

<div><p>Background</p><p>Responses to height may range from indifference to minor distress to severe symptoms of fear of heights (acrophobia); visual height intolerance (vHI) denotes the whole spectrum of symptoms. Although there are options to manage vHI, only a small part of persons affected by vHI are willing to seek professional help or confront their problem. Purpose of this study was to determine if persons with vHI, specifically those who show avoidant behavior towards heights (avoiders), score lower in their general self-efficacy (GSE) than those who confront vHI (confronters).</p><p>Method</p><p>Cross-sectional survey in 607 individuals living in the urban region of Munich, Germany, using a mailed questionnaire on presence or absence of vHI, confronting or avoiding behaviour, and GSE.</p><p>Results</p><p>Of all participants (mean age 53.9, 50.3% female), 407 reported life-time presence of vHI. Participants with vHI had a mean GSE score of 31.8 (SD 4.3) points (participants without vHI: 32.5, SD 4.3, p  = 0.008 for difference). Among individuals with vHI, 23% reported confronting behavior. Confronters were significantly younger (p<.0001, 50.2 vs. 55.7 years), more likely to be female (p  = 0.0039, 64.3% female), and had a higher GSE score (p  = 0.0049, 32.5 vs. 31.1). Associations remained significant after multiple adjustment.</p><p>Conclusions</p><p>Our study provides evidence for the association of GSE and vHI. These findings may have consequences for strategies of alleviation and therapy of vHI.</p></div

*PRISMA flow diagram of the screened and included papers.

<p><i>* Preferred Reporting Items for Systematic Reviews and Meta-Analyses.</i></p

Content analysis of measures and individual ICF representation.

<p>Content analysis of individual measures indicate a small ICF representation (bandwidth %). Environmental factors are only represented in one measure (TOP). The concepts contained in the TOP was also linked to the most ICF categories (n = 93) and the GOS had the least ICF categories.</p><p>*Content density – number of ICF categories/number items in an instrument.</p><p>** Bandwidth (%) - number of distinct ICF categories/total number of second level ICF categories (363) x100.</p>†<p>Content diversity - total number of different ICF categories/number of meaningful concepts in the instrument.</p

Overview of the thirty eight outcome measures identified in 34 studies.

<p>Overview of the thirty eight outcome measures identified in 34 studies.</p

DAG derived from literature and expert knowledge - Nodes represent variables and arrows represent causal associations.

<p>Darkly colored nodes label exposure (general self-efficacy, GSE) and outcome (visual height intolerance, vHI). The dashed arrow indicates the postulated association between exposure and outcome. Numbers represent available sources of literature describing the associations. References for these associations are given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116220#pone.0116220.s001" target="_blank">S1 Appendix</a>.</p

Sociodemographic characteristics.

<p>¹ SF-12.</p><p>vHI+ =  participants with visual height intolerance.</p><p>vHI− =  participants without visual height intolerance.</p><p>Sociodemographic characteristics.</p

Trend of prevalence of vertigo.

<p>The prevalence of MD episodes is illustrated over the first 365 days after inclusion in the study. The black line corresponds to the loess smoother with k = 0.75. The dotted line displays the pointwise 95%-confidence intervals of the smoother. We observed a decrease in MD episode prevalence over the first 240 days and an increase thereafter.</p