82 research outputs found
Details acquired from medical history and patientsâ experience of empathy â two sides of the same coin
BACKGROUND: History taking and empathetic communication are two important aspects in successful physician-patient interaction. Gathering important information from the patientâs medical history is needed for effective clinical decision making while empathy is relevant for patient satisfaction. We wanted to investigate whether medical students near graduation are able to combine both skills as required in daily medical practice. METHODS: Thirty near graduates from Hamburg Medical School participated in an assessment for clinical competences including a consultation hour with five standardized patients. Each patient interview was videotaped and standardized patients rated participants with the CARE questionnaire for consultation and relational empathy. All videotaped interviews were rated with a checklist based on the number of important medical aspects for each case. Data were analysed with the linear mixed model to correct for random effects. Regression analysis was performed to look for correlations between the number of questions asked by a participant and their respective empathy rating. RESULTS: Of the 123 aspects that could have been gathered in total, students only requested 56.4% (95% CI 53.5-59.3). While no difference between male and female participants was found, a significant difference (pâ<â.001) was observed between the two parts of the checklist with 61.1% (95% CI 57.9-64.3) of aspects asked for in part 1 (patientâs symptoms) versus 52.0 (95 47.4-56.7) in part 2 (further history). All female standardized patients combined rated female participants (mean score 14.2, 95% CI 12.3-16.3) to be significantly (pâ<â.01) more empathetic than male participants (mean score 19.2, 95% CI 16.3-22.6). Regression analysis revealed no correlation between the number of medical aspects gathered by a participant and his or her respective empathy score given by the standardized patient in the CARE questionnaire. CONCLUSION: Gathering sufficient medical data from a patientâs history and empathetic communication are two completely separate sides of the coin of history taking. While both skills have to be acquired during medical school training with particular focus on their respective learning objectives, medical students need to be provided with additional learning and feedback opportunities where they can be observed exercising both skills combined as required in physiciansâ daily practice
Threats to Belonging-Stressful Life Events and Mental Health Symptoms in Aging Men-A Longitudinal Cohort Study.
Objectives: Stressful life events, especially relationship events, are frequent in adult life. We investigated the impact of a variety of stressful life events on symptoms of depression, anxiety, and hostility. Methods: We analyzed data from a large prospective cohort study of men (n = 1,437) in the Boston area (assessed in 1985, 1988, and 1991). Main outcomes were measures of depression, anxiety and hostility symptoms. We used the Elders Life Stress Inventory (ELSI) to measure stressful life events in the past 12 months and examine their association with symptoms of depression, anxiety and hostility. First, we analyzed the association of stressful life events with symptom changes; second, we categorized stressful life events into finance/work, health, relationships, loss, living situations events; and third, we estimated the specific association between relationship events and depression, anxiety and hostility symptoms using multilevel models. Results: The most frequent stressful life events were health, relationship, and financial events. Depression, anxiety, and hostility symptoms were relatively stable among men who did not experience these life events. However, those who reported life events in the past 12 months had a greater increase in symptoms of depression (+0.05; 95% CI: 0.01 to 0.10) and of hostility (+0.05; 95% CI: 0.01 to 0.09) than those who did not. Additionally, we found a significant decrease in hostility (-0.05; 95% CI: -0.08 to -0.01) in those experiencing no life events. Conclusion: Relationship events were more important than any other type of events, and were significantly associated with increased depression and hostility in aging men. Although the effects were small, the results point to a need to understand better the impact of relationships on psychopathology in the aging population
Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIMâHF) study
Aims:
Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12âmonths.
Methods and results:
The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores â„10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score â„10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12âmonths and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up.
Conclusion:
Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression
Reducing barriers to trauma inquiry in substance use disorder treatment â A cluster-randomized controlled trial
Background: Despite of the high rate of trauma in clients with substance use disorders, trauma often remains undetected in a majority of treatment-seeking clients. Improving professionalsâ knowledge and competences in the inquiry of traumatic events is therefore of utmost importance to appropriately address the specific trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to inquiring about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings to improve the systemtic inquiry of traumatic events in clients. Methods: In this cluster-randomized trial, we examined whether a one-day training in trauma inquiry (âLearning How to Askâ) would reduce professionalsâ perceived barriers to trauma inquiry. 148 professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals of the intervention group received a one-day training plus a refresher session 3 months later, the professionals of the control group received no training. Professionals rated their level of six common barriers to trauma inquiry on four-point Likert scales at baseline, at 3-month and 6-month follow-up, namely âFeeling uncomfortable when asking about traumatic eventsâ, âFear of offending the clientâ, âFear of retraumatizing the clientâ, âFear that client may terminate treatmentâ, âUnsure whether authorities have to be informed when perpetrator is knownâ, and âNo trauma-specific treatment availableâ. Results: Five of the six perceived barriers to inquiring about traumatic events significantly decreased from baseline to 6-month follow-up to a greater extent in the trained group than in the control group (âFeeling uncomfortableâ: b = -0.32, 95% CI [-0.52, -0.12]; âFear of offending the clientâ: b = -0.33, 95% CI [-0.56, -0.09]); âFear of retraumatizing the clientâ: b = -0.45, 95% CI [-0.69, -0.22]; âFear that client may terminate treatmentâ: b = -0.28, 95% CI [-0.49, 0.07]; âNo trauma-specific treatment availableâ: b = -0.25, 95% CI [-0.51, -0.01]). Conclusions: Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may improve detection of traumatic events
Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies
Background & Aims
Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors.
Methods
We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness.
Results
Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75â1.17). However, compared with adenomas â€5 mm, the OR for missing adenomas of 6â9 mm was 0.62 (95% CI, 0.44â0.87), and the OR for missing adenomas of â„10 mm was 0.51 (95% CI, 0.33â0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16â2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49â4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34â1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47â1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21â1.33) than women (0.86; 95% CI, 0.80â0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57â0.94).
Conclusions
In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men
Study approach and field work procedures of the MentDis_ICF65+ project on the prevalence of mental disorders in the older adult European population
Background This study describes the study approach and field procedures of the MentDis_ICF65+ study, which aims to assess the prevalence of mental disorders in older adults. Methods An age-appropriate version of the Composite International Diagnostic Interview (CIDI65+) was developed and tested with regard to its feasibility and psychometric properties in a pre-test and pilot phase. In the cross-sectional survey an age-stratified, random sample of older adults (65â84Â years) living in selected catchment areas of five European countries and Israel was recruited. Results Nâ=â3142 participants (mean age 73.7Â years, 50.7% female) took part in face-to-face interviews. The mean response rate was 20% and varied significantly between centres, age and gender groups. Sociodemographic differences between the study centres appeared for the place of birth, number of grandchildren, close significants, retirement and self-rated financial situation. The comparison of the MentDis_ICF65+ sample with the catchment area and country population of the study centres revealed significant differences, although most of these were numerically small. Conclusions The study will generate new information on the prevalence of common mental disorders among older adults across Europe using an age-appropriate, standardized diagnostic instrument and a harmonized approach to sampling. Generalizability of the findings and a potentially limited representativeness are discussed
Learning How to Ask - Does a one-day training increase trauma inquiry in routine substance use disorder practice? Results of a cluster-randomized controlled trial
Aims
To examine the effectiveness of a one-day skills training program for increasing trauma inquiry in routine substance use disorder treatment.
Design
Cluster-randomized two-armed controlled trial, with 12 substance use disorder (SUD) organizations operating 25 counseling centers, randomly assigned to training in trauma inquiry (13 counseling centers of 8 SUD organizations) or no training (12 counseling centers of 4 SUD organizations).
Setting
SUD counseling centers in Northern Germany.
Cases
NâŻ=âŻ5204 SUD counseling services.
Intervention
The professionals assigned to the intervention group received a one-day training in trauma inquiry plus a 1.5-hour refresher session 3âŻmonths later. Professionals in the control group received no training.
Measures
Over a 12-month period, professionals documented for each counseling service whether they asked the client about four traumatic events: physical abuse, emotional abuse, sexual abuse and neglect.
Analysis
Primary outcomes were rates of asking about physical abuse, sexual abuse, emotional abuse and neglect in the 6âŻmonths after training. These were compared across conditions, while adjusting for baseline probabilities in the 6âŻmonths before the intervention, using mixed-effects logistic regression.
Findings
In the 6âŻmonths after training, the rate of asking about physical abuse was 18% higher in the SUD counseling services of trained professionals, relative to services of untrained professionals (ORâŻ=âŻ1.18, 95% CIâŻ=âŻ[1.01â1.37, pâŻ=âŻ.035]). No effect was found for asking about sexual abuse, emotional abuse and neglect.
Conclusion
A one-day training program in trauma inquiry, combined with a brief refresher session, was effective in increasing inquiries about physical abuse in routine counseling practice. The training was ineffective in increasing inquiries about sexual abuse, emotional abuse and neglect. The effectiveness of a one-day training of trauma inquiry might be increased by a longer training, or by combining it with additional elements, such as ongoing supervision
Anticoagulation with edoxaban in patients with long Atrial High-Rate Episodes â„24â hours
BACKGROUND AND AIMS: Patients with long atrial high-rate episodes (AHRE)ââ„â24â
hours and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared to no anticoagulation in these patients.METHODS: This secondary prespecified analysis of NOAH-AFNET 6 examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared to placebo in patients with AHRE and stroke risk factors. The primary efficacy outcome was a composite of stroke, systemic embolism, or cardiovascular death. The safety outcome was a composite of major bleeding and death. Key secondary outcomes were components of these outcomes and ECG-diagnosed atrial fibrillation.RESULTS: AHRE â„24â
hours were present at baseline in 259/2389 patients enrolled in NOAH-AFNET 6 (11%, 78â±â7 years old, 28% women, CHA2DS2-VASc score 4). Clinical characteristics were not different from patients with shorter AHRE. During a median follow-up of 1.8 years, the primary outcome occurred in 9/132 patients with AHRE â„24â
hours (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). AHRE duration did not interact with the efficacy (p-interactionâ=â0.65) or safety (p-interactionâ=â0.98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE â„24â
hours developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; pâ<â0.001).CONCLUSIONS: This hypothesis-generating analysis does not find an interaction between AHRE duration and anticoagulation therapy in patients with device-detected AHRE and stroke risk factors. Further research is needed to identify patients with long AHRE at high stroke risk.</p
Influence of motivation, self-efficacy and situational factors on the teaching quality of clinical educators
Abstract Background Being exposed to good teachers has been shown to enhance studentsâ knowledge and their clinical performance, but little is known about the underlying psychological mechanisms that provide the basis for being an excellent medical teacher. Self-Determination Theory (SDT) postulates that more self-regulated types of motivation are associated with higher performance. Social Cognitive Theory (SCT) focuses on self-efficacy that has been shown to be positively associated with performance. To investigate the influences of different types of teaching motivation, teaching self-efficacy, and teachersâ perceptions of studentsâ skills, competencies and motivation on teaching quality. Methods Before the winter semester 2014, physicians involved in bedside teaching in internal medicine at the University Medical Center Hamburg-Eppendorf completed a questionnaire with sociodemographic items and instruments measuring different dimensions of teaching motivation as well as teaching self-efficacy. During the semester, physicians rated their perceptions of the participating students who rated the teaching quality after each lesson. We performed a random intercept mixed-effects linear regression with studentsâ ratings of teaching quality as the dependent variable and studentsâ general interest in a subject as covariate. We explored potential associations between teachersâ dispositions and their perceptions of studentsâ competencies in a mixed-effects random intercept logistic regression. Results 94 lessons given by 55 teachers with 500 student ratings were analyzed. Neither teaching motivation nor teaching self-efficacy were directly associated with studentsâ rating of teaching quality. Teachersâ perceptions of studentsâ competencies and studentsâ general interest in the lessonâs subject were positively associated with studentsâ rating of teaching quality. Physiciansâ perceptions of their studentsâ competencies were significantly positively predicted by their teaching self-efficacy. Conclusions Teaching quality might profit from teachers who are self-efficacious and able to detect their studentsâ competencies. Studentsâ general interest in a lessonâs subject needs to be taken into account when they are asked to evaluate teaching quality
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