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Biomedical subjects

H Sandholzer

Publications and source records attributed to H Sandholzer.

30 records · Page 2Linked to original sources
PubMed1996

Prescribing practice with cognition enhancers in outpatient care: are there differences regarding type of dementia?--Results of a representative survey in lower Saxony, Germany.

Previous studies of cognition enhancers have mainly focused on insufficiently defined groups of cognition disorders, e.g., "cerebral insufficiency". With regard to the various biological changes in senile dementia of Alzheimer's type (SDAT) and in vascular dementia (VD), which together make up the great majority of senile dementias, many authors have encouraged different studies of these types of dementias, especially since both can be diagnosed clinically with satisfying certainty. Since primary care physicians treat the majority of elderly and demented patients, they have their own experience with cognition enhancers. We were therefore interested to know, how far these physicians differ in their treatment of SDAT and VD. We performed a representative survey (response rate 83.2%; 145 family physicians and 14 neuropsychiatrists) in the Goettingen area. A written case vignette described a 70-year-old widow with moderate dementia and vascular risk factors which are easily treated with drugs. Two versions were randomly assigned, in which (version A) either a "typical" VD history or a typical SDAT history (version B) were described. After perusal, the physician was asked whether and which drugs he would choose to treat the cognitive disorders in this patient. Most frequently, piracetam (A/B: 25.6%/30.9%), ginkgo biloba (24.4%/28.4%), and nimodipine (14.1%/25.9%) were considered. Aspirin was cited by 29.5%(A) and 17.3%(B) of the physicians respectively. As far as the type of dementia was concerned, significant differences were found only for co-dergocrine, which was preferred in SDAT. The following inter-group trends were observed: family physicians considered ginkgo biloba more often than nimodipine or co-dergocrine. The results show the apparent importance of cost-and safety aspects, while the type of dementia has hardly any impact. The latter impression corresponds to the results of drug trials demonstrating no different efficacy. In our opinion, aspirin was not sufficiently taken into consideration.

Adult↗
PubMed1996

[Quality assurance in basic psychosomatic care. Report of an expert survey within the scope of the Federal Public Health Administration instigated pilot project].

This article outlines a nationwide quality improvement project in counselling funded by the German Ministry of Health. To develop the project, expert surveys and consensus conferences are currently organized by the coordination center. A questionnaire with mainly open questions was sent to 32 teachers in general practice. Counselling for psychiatric, psychosomatic and psychosocial problems in primary care was regarded as an important field for quality assurance. The experts believed short psychotherapy to be an integral part of family medicine as some 30% of our patients present with complaints caused by psychosocial or psychological reasons. However, only some 70% of patients receive a specific treatment. The experts rated better recognition of psychosomatic problems as the most important area for quality improvement. Suitable interventions to improve the physicians' ability in the area mentioned were continuing medical education, balint groups, quality circles and flexible guidelines. The experts made invaluable contributions to the development of a practice documentation for psychosocial problems.

Adult↗
PubMed1996

[Cerebral cognitive deficits in the aged. Diagnostic and therapeutic standards: organization of strategies for problem detection and solution].

This paper reports the results of a representative survey which was performed in cooperation with 145 family physicians and 14 primary care neuropsychiatrists (response rate 83.2%) in the area of Göttingen, Germany. With the use of a standardised interview referring to written sample case histories, we investigated the diagnostic and therapeutic management of memory disturbances in old age. The results showed, that dementia and depression are underdiagnosed in primary care, and that memory disturbances are mainly regarded as consequences of disturbed cerebrovascular perfusion. About 70% of all physicians would prescribe a cognition enhancer, however about a third of them would do it in spite of major doubts about their efficacy. The results underline the necessity of continuing education especially with regard to early diagnosis of dementive and affective disorders in later life. The development of therapeutic standards in this area should take "irrational" motives into account. Appropriate exemplary case histories seem to be a potentially useful tool for the measurement of physicians' competence and its changes.

Aged↗
PubMed1995

[Factors influencing the prescribing of nootropic drugs. Results of a representative inquiry in Lower Saxony].

AIM OF INVESTIGATION: To discover (1) to what extent patients' wishes and the extent of any abnormality of brain performance influence the frequency with which "nootropic" drugs (those thought to affect brain activity, e.g. piracetam, pyritinol, or improve cerebral circulation, e.g. xanthine derivatives, Ginkgo biloba, secale alkaloids, calcium antagonists) are prescribed; (2) the medical practitioner's expectations of the effectiveness of such medications. METHOD: In a personal interview, 145 family doctors and 14 neurologists in private practice in the Göttingen area of Germany (participation rate: 83.2% of those asked to participate) were questioned about fictitious cases (case 1: mild memory problem with or without expressed wish for medication; case 2: moderate dementia, of Alzheimer or multi-infarct type). The previously arranged interviews, which took place in the doctors' practice rooms, consisted of standardized open questions to the written case reports. RESULTS: Regardless of the wish of the patient and the extent and type of the abnormal brain function about 70% of all participating doctors would prescribe those drugs, even though about 56% had doubts about their effectiveness. About 28% expected a positive effect on brain performance. A nearly equal proportion of doctors would continue an existing drug regimen as would prescribe one. CONCLUSION: The prescription of the named group of drugs is influenced less by medical criteria than by factors which concern doctor-patient relationship.

Adult↗
PubMed1995

Sleep disturbances in the demented elderly: treatment in ambulatory care.

We report the results of a representative survey in Lower Saxony, Germany, that focused on the treatment of sleep disturbances in the moderately demented elderly. Two written sample case histories (vignettes) described either a vascular demented patient suffering from nocturnal wandering or an Alzheimer's-type demented patient without apparent psychotic or behavioral (sleep) disorder. These were randomly assigned and presented to 145 family physicians and 14 neuropsychiatrists working in private practice by a trained investigator, who then conducted a standardized interview with the physicians. The study was representative of physicians (response rate: 83.2%). In response to the question concerning how they would treat the patient's sleep disturbances, about 20% of the physicians (with respect to both versions) answered that they would not choose drugs. More than 40% considered neuroleptics to be the drugs of choice. Benzodiazepines, antidepressants and other substances were seldom considered. No significant difference was noted in the response to the two different case histories. The results allow for the conclusion that non-drug treatments, which (at least initially) should be the treatment of choice, are mainly disregarded by the majority of the ambulatory care physicians. The reason for this seems to be a lack of education in sleep medicine and also in geriatric medicine.

Aged↗
PubMed1995

[Problem-oriented learning at the Göttingen University. Report of a 1 week introductory conference ("sample course")].

In Germany, a reform of the medical academic training is hotly discussed. However, only a few teachers and students can base their arguments on practical experience with new learning methods. Therefore, a one-week-try-out course ("Schnupperkurs Reformstudiengang") was organised at the university of Göttingen to gain experience in the problem-based learning. Tutorials took place according to the principle of the "seven steps" as practised in Maastricht. The students developed their own learning goals guided by a tutor. The acquiring of the subject was achieved by private studies, accompanying seminars, and practical training. An evaluation of the student's opinions on problem based learning and their satisfaction with the course was carried out by a questionnaire and group discussions. Our experiences show an open-mindedness of the academic staff and real enthusiasm on the part of the 21 participating students. Substantial for this success are--according to the results of the survey--the following items: The problem-orientated practical and interdisciplinary approach and teaching in small groups, which enabled a very close relationship between academic staff and students. A try-out-course might be a welcome entry to new forms of learning, because it offers practical experiences in new learning and teaching methods to open-minded lecturers and students. Therefore, such courses can contribute to an evolution at universities as they slowly but smoothly generate the essential competence needed to reform the medical education.

Attitude of Health Personnel↗
PubMed1995

Reasons for prescribing cognition enhancers in primary care. Results of a representative survey in Lower Saxony, Germany.

With regard either to the controversial debate about the efficacy of cognition enhancers (CEs) or to the high costs which the frequent prescription of these drugs causes the German health system's economy, we wanted to know what physicians expect from a therapy with these drugs. We performed a representative survey (response rate 83.2%) in Lower Saxony, Germany from February to July 1993. We designed two written case vignettes which described either a patient with slight memory problems or a moderately demented patient who also suffers from common systemic disorders. In a face-to-face interview 145 general practitioners and primary care internists (family physicians) and 14 community neuropsychiatrists answered the question, whether they would prescribe CEs to each of the patients described and what they would expect from this therapy. 70.4% of all physicians would prescribe a cognition enhancer to the slightly impaired patient and 63.5% to the multimorbid moderately demented patient, respectively. More than 50% of the family physicians would not expect any positive therapeutic effect in both patients, while the neuropsychiatrists did so in 57.1% in the patient with slight memory disturbances and in 35.7% in the moderately demented patient. A positive effect on cognition was expected by 28.2% of all physicians in the slight and by 18.3% in the moderately impaired patient, respectively. Other reasons mentioned were amelioration of cerebral perfusion and drive, as well as effects on disease progression. In conclusion, the results of this study clearly demonstrate that cognition enhancers are prescribed in spite of major doubts in their efficacy.

Aged↗
PubMed1995

COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes in functional ability among general practice patients with acute low back pain. This may partly be a result of patients misunderstanding the instructions. If the COOP-WONCA charts are used with acutely ill patients, the fixed two-weeks timescale is not appropriate. It is suggested that patients consider their present complaints when rating their condition.

Activities of Daily Living↗
PubMed1994

[Ambulatory treatment of sleep disorders in the aged].

An enquiry into the handling by medical practitioners of sleeping problems among elderly patients was conducted in southern Lower Saxony by personal interview, combined with a standard questionnaire. A typical case report had been drafted concerning a 70-year-old, previously healthy widow: her complaints were "nonspecific" and could be classified as an example of either depression, of the onset of senile dementia or as within normal limits for age. This case report was presented by two interviewers to 145 general practitioners (GPs) and 14 neurologists in private practice (response rate of 83.2%) who were asked how they would have treated the patient's sleeping disorder. 30.3% of the GPs and 14.3% of the neurologists would initially not have prescribed medication. Only GPs (19.5%) mentioned possible herbal medication. Sedative neuroleptics were preferred by 57.1% of neurologists and 26.2% of GPs, while benzodiazepines would have been given by 14% of both groups. Antidepressive drugs and chloral hydrate were chosen less often (5.7% and 2.5%, respectively). These data support the finding of a high frequency of neuroleptic prescriptions given to the elderly. They also make clear that the possibility of treatment without drugs is usually not sufficiently explored.

Aged↗
PubMed1994

Diagnosis of dementia in primary care: results of a representative survey in lower Saxony, Germany.

To investigate whether an early diagnosis of dementia is established, whether a differentiation is made between vascular and primary degenerative etiology, and whether treatable causes of dementia are considered in primary care, we performed a survey using three written sample case histories describing slight memory impairment (case 1) or moderate dementia (case 2a: vascular dementia; case 2: degenerative dementia of Alzheimer type). The combinations 1 and 2a or 1 and 2b were randomly assigned and presented to ambulatory-care physicians (145 general practitioners and primary care internists and 14 neuropsychiatrists in private practice) in Göttingen and rural surroundings by a trained investigator who then performed a standardized interview. The study was representative (response rate 83.2%). For the sample case with slight memory complaints 13.8% of all physicians arrived at a primary diagnosis of depression and 44.0% considered depression for differential diagnosis. Senile dementia of Alzheimer type was considered less often. In the sample cases with moderate dementia according to established scientific criteria, there was a striking under-diagnosis of dementia, and in both cases an over-diagnosis of underlying vascular etiology. Treatable causes of dementia, such as possible drug interactions and substance abuse, were considered only by a minority of physicians. In conclusion, memory deficits seem to be regarded mainly as consequences of disturbed cerebral perfusion, and dementia as well as depression and drug adverse effects seem to be under-diagnosed in primary care.

Aged↗
PubMed1994

Attitudes of primary care physicians towards the use of a drug formulary--preliminary results of a study in Germany.

Although the concept of a drug formulary in primary health care is known for more than 10 years it was only recently that the drug budget of the new German Health Legislation has drawn doctors' attention to the use of such formularies. The loose-leaf form "Göttingen formulary" has been specifically compiled for the need of primary care doctors. It contains less than 300 drugs and drug combinations (including pseudo-placebos). This formulary was ordered by 830 colleagues from November 1992 until the end of May. In June 1993 we sent a semi-structured questionnaire to the users to learn about their experience with and attitude towards the formulary and about changes in their prescribing habits. Until the end of August 223 questionnaires have been returned. Seventy-four % of the respondents were general practitioners with considerable experience (more than 10 years in practice: 77%). The majority were satisfied or very satisfied with the drugs selected for the formulary and found the list helpful or very helpful (68%). Sixty-seven % indicated that the use of the formulary changed their prescribing habits; 70% appreciated an official (governmental) positive list. Although this study did not use a representative sample and the response rate was rather low until the cut-off point, it is noteworthy that the overall appreciation of a drug formulary for primary health care was very positive. The great majority of the respondents were convinced that an individual drug formulary does not render an official positive list superfluous.

Attitude of Health Personnel↗