Biomedical subjects

Matthias Nübling

Publications and source records attributed to Matthias Nübling.

8 recordsLinked to original sources

PubMed2006

A prospective multi-center cohort study of acute non-displaced fractures of the scaphoid: operative versus non-operative treatment [NCT00205985].

BACKGROUND: Acute scaphoid fractures are common in active adults and do lead to reasonable time lost to work. One important goal of treatment is early return to work or sport. On this background, the adequate treatment of non-displaced acute scaphoid fractures is still under discussion. The aim of this study is to compare time to return to previous activity level comparing surgical versus non-surgical treatment of non-displaced acute scaphoid fractures. METHODS/DESIGN: The study is designed as a non-randomized multiple center cohort study including 12 sites in Germany and Austria. The inclusion period is planned to be 12 months with a follow up of 6 months. Allocation to operative or non-operative treatment is chosen by the patient together with his treating surgeon. The primary outcome is time to return to previous activity level adapted for loading of the wrist in daily life as measured by a newly developed questionnaire (PLDL-wrist). Factors identified a priori to be associated with the outcome, e.g., poverty status, age, education, smoking status, gender, and occupation, are measured to ensure adequate control for their potential confounding effects. DISCUSSION: The rationale and the design of a multiple center cohort study are presented. As it is not considered feasible to randomize patients in this study, potential confounding effects need to be controlled adequately.

Absenteeism↗

PubMed2006

Hospital patients' preferences for involvement in decision-making. A questionnaire survey of 1040 patients from a Swiss university hospital.

OBJECTIVES: Assessing patients' preferences for shared decision-making and receiving information. DESIGN: Cross-sectional cohort study. SETTING: University Hospital in Northwest Switzerland. PARTICIPANTS: 1825 in-patients (mean age: 58 years, 48.7% female) were asked to participate, 1040 patients responded (59%). MAIN OUTCOME MEASURES: Proportion of positive answers to two questions depicting typical elements of shared decision-making plus a question asking for patients' information needs. These questions were embedded in a questionnaire sent to patients two weeks after discharge from the hospital, asking for perceived deficits during their hospital stay and socio-demographic characteristics. RESULTS: 779/947 (79.1%) agreed to the statement: "One should stick to the physician's advice even if one is not fully convinced of his ideas". 620/945 (65.6%) agreed to the statement: "It should completely be left to physicians to decide on a patient's treatment." 914/952 (96%) agreed to the statement: "Even when the news is bad the patient must be informed." Older patients and less educated patients are more likely to agree with the first two statements, patients with a non-Swiss cultural background favour the information needs statement slightly less than other patients (92.4 vs 96.7% agreement). The severity of illness had no influence on agreeing or not. However, patients who disagreed on any statement were more likely to report a lack of information from the hospital. CONCLUSIONS: A substantial number of patients in this study wanted the physician to take medical decisions. Yet, almost all patients wanted honest information about their health status. Health professionals have to find out to what extent an individual patient wants to be involved in decision-making.

Adolescent↗

PubMed2004

[Patient survey in general practice: development, validation and application of a survey instrument].

Patient surveys are one of the most important sources for quality management in ambulatory care. The quality assurance of the survey instrument itself is of outstanding importance, since only a high-quality instrument is able to supply high-quality data, which can serve as a reliable basis for improvement strategies. The present paper outlines the process of development and optimisation of a survey instrument for patients' rating in all sectors of general practice and primary care on the basis of one of the largest surveys of this kind that have so far been conducted in German-speaking countries. The technique presented here of building quality dimensions of care out of single items has been methodologically validated. On the one hand it allows rapid identification of critical areas at a glance, and on the other hand helps to focus--if necessary--on single aspects in order to define detailed improvement actions.

Family Practice↗

PubMed2003

[Patient opinion surveys in the hospital: revalidation and improvement of a questionnaire].

Measures to improve quality of care in hospitals should best be based upon the results of patient surveys. The present paper reports in the validation of a questionnaire originally developed in the US in 658 patients from two Swiss hospitals in a tertiary care setting. Questionnaires were sent out two weeks after release from hospital, more than 75 percent of questionnaires were returned. Based upon the experience that feedback of many single items rarely results in distinct actions to improve quality of care a factor analysis followed by an analysis of reliability was undertaken to validate the instrument and to reduce the amount of information, to help hospital officials to deal with the data, and finally to reduce the number of items in the questionnaire. Factor analysis revealed a 3-factor-solution based upon 25 out of 37 deficit-oriented questions, explaining 34.4 % of total variance. The factors can be described as: 1. Patient information (9 items; explained variance: 13.0 %); 2. Patient involvement and shared decision making (11 items; explained variance: 11.2 %); 3. Nursing quality (5 items; explained variance: 10.2 %). Cronbach's alpha values of these scales are 0.75, 0.72, and 0.69, respectively. As further analyses show, reducing the item pool does not lead to the loss of relevant information. Single wards show substantial differences in scores based on these factors (e.g. between 10 and 27 percent deficit in factor 2). The sensitivity of the factors in describing specific profiles of single wards will help to target measures to improve quality of care to those wards where improvement is most utterly needed.

Hospitals↗

PubMed2002

Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany.

OBJECTIVES: To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed. METHODS: As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms. RESULTS: The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.

Adult↗

PubMed2002

[Communication matters--deficits in hospital care from the patients' perspective].

The importance of professional communication for nursing staff and physicians is increasingly accepted. In order to support this tendency it would be helpful to investigate whether this development does reflect an actual need from the patients' perspective. The current investigation reports on the results of a questionnaire survey in 668 patients (79 % response rate) from two tertiary Swiss hospitals. Questionnaires were sent out two weeks after discharge from hospital. The questionnaire is mainly asking "reporting"-type questions, which ask a patient to describe what actually had happened and not to evaluate his or her experiences. Results show a high acceptance of the somewhat lengthy questionnaire (mean time to fill in the questionnaire: about one hour). Main deficits were concerned with a lack in communication competence in nurses and physicians: 18 out of 23 deficits mentioned by more than 10 % of patients' were in this area. The questionnaire describes deficits precisely enough to yield significant differences between single wards.

Adolescent↗

PubMedDate not supplied

Doctor's responses to patients' concerns; an exploration of communication sequences in gynaecology.

AIMS: Like other medical doctors, gynaecologists have difficulty attending to psychosocial issues and concerns. Communication training has proven to be effective in teaching them to spend more time on discussing these factors. However, whether or not they do this in response to patients' utterances remains unclear. The question is how gynaecologists respond to patients' concerns, whether or not they do this adequately and what the effects of a communication training are on the use of these communication sequences. METHODS: Nineteen gynaecologists participated in a study which examined the effects of a three-day residential communication training. Before and after the training the gynaecologists videotaped series of consecutive outpatient visits. The communication during these visits was rated using the Roter Interaction Analysis System. Gynaecologists' responses to patients' concerns were examined at lag one, i.e. immediately following the patient's concern. RESULTS: The most prevalent responses made by the gynaecologists were showing agreement and understanding and giving medical information. Affective responses were observed less. At postmeasurement, the gynaecologists responded neither more adequately nor inadequately to patients' concerns. CONCLUSIONS: The gynaecologists did not respond in a very affective way to patients' concerns. However, the patients did not express many concerns. Future studies should focus on more prevalent communication behaviours and incorporate more lags.

Attitude to Health↗

PubMedDate not supplied

A theory-based approach to analysing conversation sequences.

AIMS: To assess the quality of communication generally two procedures are used: one defines categories of utterances and counts their frequency, the other uses global observer ratings. We investigated whether a sequence analysis of utterances yields results which more precisely reflect the process of a conversation. METHODS: We re-examined data from a randomised controlled intervention study in which residents' interviews with simulated patients were analysed with the Maastricht History and Advice Checklist (MAAS-R) and the Roter Interaction Analysis System (RIAS). Using the U-file of the RIAS we studied the effect of different types of physician questions (open, closed questions, facilitators, other physician actions) on the length of uninterrupted patients' speech and content of utterances. We investigated also whether reciprocity indices improve after a communication skills training, and whether they correlate with global scores form MAAS-R. RESULTS: Patients respond to a closed question with a mean of 1.78 (+/- 1.49) utterances as compared to 2.75 (+/- 2.72) utterances after an open question. The likelihood of a concern was more than 10 fold higher after an open question compared to closed questions. Reciprocal sequences make up less than 2 percent of the conversation, Still, they correlate with global items form MAAS-R. The 'empathy index' improves after the training.

Communication↗