Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

Background: An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners' perspective on long-term care after myocardial infarction focussing on medical prevention. Methods: In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners' prescribing and patients' non-adherence was performed. Results: Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital; however, they described deviating from guidelines because of drugs' side effects or patients' intolerances. Some questioned the benefits of medical secondary prevention for the oldest of patients. General practitioners perceived good adherence among their patients who had had an MI while they regarded their methods for assessing medical non-adherence as limited. They perceived diverse reasons for non-adherence, particularly side effects, patients' freedom from symptoms and patients' indifference to health. They attributed mainly negative characteristics, like lack of knowledge and understanding, to non-adherent patients. These characteristics contribute to the difficulty of convincing these patients to take medications as prescribed. General practitioners improved adherence by preventing side effects, explaining the medication's necessity, facilitating intake and involving patients in decision-making. However, about half of the general practitioners reported threatening their patients with negative consequences of non-adherence. Conclusions: General practitioners should be aware that discharge medication can be insufficient and thus, should always check hospital recommendations for accordance with guideline recommendations. Improving physicians' communication skills and informing and motivating patients in an adequate manner, for example in simple language, should be an important goal in the hospital and the general practitioner setting. General practitioners should assess patients' motivations through motivational interviewing, which no general practitioner mentioned during the interviews, and talk with them about adherence and long-term treatment goals regularly

A Berger type normal holonomy theorem for complex submanifolds

We prove a kind of Berger-Simons' Theorem for the normal holonomy group of a complex submanifold of the projective spac

An alternative search for the electron capture of Te-123

A search for the electron capture of Te-123 has been performed using CdZnTe detectors. After a measuring time of 195 h no signal could be found resulting in a lower half-life limt of $T_{1/2} > 3.2 \cdot 10^{16}$ yrs (95 % CL) for this process. This clearly discriminates between existing experimental results which differ by six orders of magnitude and our data are in strong favour of the result with longer half-lifes.Comment: 2 pages, 2 eps-figures, reanalysis of data set

Invariant four-forms and symmetric pairs

We give criteria for real, complex and quaternionic representations to define s-representations, focusing on exceptional Lie algebras defined by spin representations. As applications, we obtain the classification of complex representations whose second exterior power is irreducible or has an irreducible summand of co-dimension one, and we give a conceptual computation-free argument for the construction of the exceptional Lie algebras of compact type.Comment: 16 pages [v2: references added, last section expanded

Lp-cohomology of negatively curved manifolds

We compute the $L^p$-cohomology spaces of some negatively curved manifolds. We deal with two cases: manifolds with finite volume and sufficiently pinched negative curvature, and conformally compact manifolds

General practitioners' views and experiences in caring for patients after sepsis:a qualitative interview study

Contains fulltext : 232438.pdf (Publisher’s version ) (Open Access)BACKGROUND: Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied. OBJECTIVES: The aim of this study is to describe GPs' views and experiences of caring for postsepsis patients and of participating a specific outreach training. DESIGN: Semistructured qualitative interviews. SETTING: 14 primary care practices in the metropolitan area of Berlin, Germany. PARTICIPANTS: 14 GPs who had participated in a structured sepsis aftercare programme in primary care. RESULTS: Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP's experiences during their patient's critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice. CONCLUSIONS: GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit-GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare. TRIAL REGISTRATION NUMBER: ISRCTN61744782

Social Prescribing: Systematic Review of the Effectiveness of Psychosocial Community Referral Interventions in Primary Care

Introduction: Social prescribing (SP) aims to provide targeted psychosocial support and close the gap between medical and non-medical services. This review assesses the effectiveness of community-based SP interventions. Methods: We performed a systematic review and qualitative synthesis of interventional studies of community referral interventions focused on facilitating psychosocial support. We considered health-related endpoints, other patient reported outcomes, or health care utilization. Six databases, grey literature, and additional trials registers were searched. Results were screened in a two-step process, followed by data extraction, each by two independent reviewers. If data permitted such, effect sizes were calculated. Risk of bias was assessed with the EPHPP and the Cochrane RoB2 tools. Results: We identified 68 reports from 53 different projects, three were controlled studies. Uncontrolled studies with shorter time frames frequently reported positive effects. This could largely not be seen in controlled settings and for longer follow-up periods. Designs, populations, and outcomes evaluated were heterogeneous with high risk of bias for most studies. Discussion and conclusion: Current evidence suggests positive effects of SP on a variety of relevant endpoints. Due to quality deficits in the available studies, scope for conclusions concerning clinical relevance and sustainability is limited. Further methodologically rigorous controlled trials are needed

Volume Comparison for Hypersurfaces in Lorentzian Manifolds and Singularity Theorems

We develop area and volume comparison theorems for the evolution of spacelike, acausal, causally complete hypersurfaces in Lorentzian manifolds, where one has a lower bound on the Ricci tensor along timelike curves, and an upper bound on the mean curvature of the hypersurface. Using these results, we give a new proof of Hawking's singularity theorem.Comment: 15 pages, LaTe

Small optic suspensions for Advanced LIGO input optics and other precision optical experiments

We report on the design and performance of small optic suspensions developed to suppress seismic motion of out-of-cavity optics in the Input Optics subsystem of the Advanced LIGO interferometric gravitational wave detector. These compact single stage suspensions provide isolation in all six degrees of freedom of the optic, local sensing and actuation in three of them, and passive damping for the other three

Hamiltonian reductions of free particles under polar actions of compact Lie groups

Classical and quantum Hamiltonian reductions of free geodesic systems of complete Riemannian manifolds are investigated. The reduced systems are described under the assumption that the underlying compact symmetry group acts in a polar manner in the sense that there exist regularly embedded, closed, connected submanifolds meeting all orbits orthogonally in the configuration space. Hyperpolar actions on Lie groups and on symmetric spaces lead to families of integrable systems of spin Calogero-Sutherland type.Comment: 15 pages, minor correction and updated references in v