Biomedical subjects

W Niebling

Publications and source records attributed to W Niebling.

9 recordsLinked to original sources

PubMed2006

[Ensuring safe medication in the physician's office].

The risk of adverse drug reactions can be appreciably reduced by limiting prescribing practice to a manageable number of medications, exercising restraint with regard to new drugs, and using a computerized system for the documentation of drug prescriptions. In order to further improve patient safety in this area appropriate efforts need to be made by medical self-administration, politicians and the computer industry to develop and apply computer-based prescription systems, with the additional requirement that their integration into existing doctor's office software should be simple and user-friendly, as well as free from "industrial contamination".

Adverse Drug Reaction Reporting Systems↗

PubMed2005

What do primary care patients think about generic drugs?

OBJECTIVE: To examine the attitude of patients towards generic drugs and prescriptions containing generic drugs as an alternative to brand-name products, with a special focus on information on patients attitude to generic drugs provided by their general practitioners (GPs). METHODS: A total of 804 patients in 31 general practices were surveyed using a self-questionnaire. The influence of age, sex, education, disease, knowledge of generic drugs, experience with generic substitution and information provided by the GP on patient attitudes towards generic drugs and substitutions were examined. RESULTS: Nearly two thirds of the patients (509/804) stated that they knew of the difference between brand-name drugs and generics; of these, one third were not satisfied with the information given by their GPs and 37% of patients expressed general skepticism towards generic drugs because of their lower price. This attitude was more frequent among those who felt that generic prescribing was "invented" to solve the financial crisis in the German health insurance system at their expense (odds ratio (OR): 6.2; 95% confidence interval: 4.0 - 9.8) and those who had not been confronted personally with a generic substitution (OR: 1.8; 1.3 3.0). Patients who had been skeptical when first confronted with a generic substitution were more frequently among those who considered inexpensive drugs to be inferior (OR: 4.5; 2.0 10.4) and they were frequently not satisfied with the information on substitution provided by their GP (OR: 2.7; 1.2 - 5.9). CONCLUSION: GPs are in an ideal position to inform their patients adequately about the equivalence of brand-name and generic drugs. However, the patient view that inexpensive drugs must be inferior may be difficult to rectify in the short term.

Drugs, Generic↗

PubMed2004

[Outcome of interactive training in detection and management skills for schizophrenic outpatient treatment by general practitioners].

THEORETICAL BACKGROUND: Of all outpatients with a diagnosis of schizophrenia, 30-40% refuse a psychiatrist's care. For this group of patients the general practitioner holds a key position for such different tasks as detection of prodromal schizophrenia or early warning signs of relapse and identification of risk variables for deteriorating outcome, gatekeeping (referral to specialists or other services), integration, and counseling of key relatives. Fifty percent of GPs are interested in disease-specific medical education programs. STUDY DESIGN AND METHODS: A control trial examined the changes that participating GPs intended to make in three main topics of the curriculum: (1) changing attitudes (pessimistic outcome expectation, low self-esteem), (2) enhancement of detection skills (prodromal schizophrenia, early warning signs of relapse, and risk factors for poor social and vocational integration), and (3) enhancement of management skills (dosing schemes, motivational interviewing). RESULTS: In the assessment 2 weeks after the training session, we found significant changes in favor of the trained group in detection and management skills and also improved self-confidence of GPs. CONCLUSIONS: Problem-oriented and case-based learning strategies should be preferred to lectures in training programs for psychiatric skills in primary care.

Adult↗

PubMed2003

[Medical care research based on family doctor routine data--are interface-communicated treatment data feasible?].

AIMS OF THE STUDY: As part of an ongoing project on the utilisation of generic drugs in general practice we aimed at determining whether the transfer of prescriptions and patient characteristics from doctors' computerized medical records via the BDT (Behandlungsdatenträger) interface was feasible, and whether these data are suitable for research in pharmacoepidemiology. METHODS: All 1,395 general practitioners from 6 regions in Germany were invited to participate in the 'generics project'; 232 (17 %) agreed. The 17 software companies whose systems were used by the participating practices were asked to grant access to the BDT interface. For a prescription survey, doctors were supposed to export BDT files from two 3-month periods each in 2000 and 2001. Data were anonymised and relevant information extracted with a special programme. RESULTS: So far, BDT data are available from 79 practices. They are suitable for practice- and patient-related prescribing analyses. By filter modifications, additional information (such as diagnoses, referrals, clinical findings or accounting codes) can be obtained. The procedure was well accepted if doctors and practice staff were assisted by computer experts. Some difficulties, however, were encountered in obtaining access to the BDT-interface from the software companies. Lack of standardisation of the BDT interface required additional conditioning of the data. CONCLUSION: The BDT interface offers an opportunity to export computerised patient records without the requirement of additional documentation. If routine data are more readily available for health services research, a standardised data structure and open access must be assured e. g. by centralised certification via the Federal statutory health organisation.

Data Collection↗

PubMed1999

[Management of mental health and primary care. Development and evaluation of a training program based on the PLISSIT approach].

Deficits in current approaches of psychosomatic and psychiatric education for general practitioners are reviewed. A skill-based training was developed in line with the four step counseling approach of the "PLISSIT" approach: The GP helps in first step ("permission") the patient to accept his problem and assesses informations about causing and maintaining factors of his symptomatology. In the second step he should provide information about the disorder and reverse misunderstanding and passivity (Limited Information). The GP's should develop preliminary strategies for change in the third step ("coping strategies", "symptom management", "special suggestions") and preparate the intensive phase of therapy as the last step. First results of the evaluation of the training program are presented demonstrate the effectiveness and acceptance of the education program.

Disease Management↗

PubMed1996

[Conception, implementation and evaluation of the new general medicine continuing education curriculum in Südbaden].

Since 1994, seminars for the new curriculum in general practice are conducted by the Academy of Continuing Medical Education (consists of the regional medical board and the association of public health insurance in Südbaden). Specialists of different medical disciplines supported by general practitioners in the role of moderators are preparing and teaching a wide range of topics. The general practitioners are supervising the different courses, thus, facilitating the learning process of the participants. Furthermore, the facilitators have to work out the specific needs and requirements of general practice and family medicine. The topics are presented in a form of lessons and clinical cases discussed in small groups (problem-oriented approach). The evaluation of two seminars was carried out in 1994 and 1995 including two thirds of the complete curriculum in general practice. From the positive results of the evaluation, modification and improvement of the didactic concept for future seminars in 1996 are derived.

Curriculum↗

PubMed1995

[Implementation and evaluation of quality circles in general practice].

In the beginning of 1993, society of panel doctors Südbaden, Germany, has constituted a group of experts from the Department of General Medicine of the university hospital and practising general practitioners (GPs) to develop an organisational and conceptional framework for setting up quality circles. At present, 23 quality circles with 6-12 participants are holding regular meetings every 4 to 8 weeks in the region of Südbaden. The group members, who are all physicians working in primary health care, are selecting and discussion topics which are important in general practice. In order to facilitate the discussions, the research group has developed predefined guidelines covering a wide range of common and important conditions in general practice (Hypertension, sleeping disorders, diabetes mellitus, COPD, dementia, lower back pain, cardio-vascular disease, depression, headache, vertigo etc). In presenting these structurized guidelines, the moderator prompts and encourage the group members to identify common problems in their own practices. The use of these guidelines in, quality circles and research may provide a starting point for developing consensus guidelines. The quality circle projects is given as systematic evaluation for both participants and moderators at different levels. Main objectives of the assessment are the recruitment, motivation and the specific goals of general practitioners to participate in quality circles. Currently, we are evaluating the development of quality circle for a period of 18 months.

Education, Medical, Continuing↗

PubMedDate not supplied

Campylobacter coli septicaemia associated with septic abortion.

A 19-year-old patient was 27 weeks pregnant when admitted to hospital with fever, chills and premature labours. The following day she aborted. Campylobacter coli was isolated from blood cultures, maternal placenta and amniotic fluid and from the ear, nose and pharynx of the stillbirth. Campylobacter could not be isolated from stool specimens after antimicrobial treatment had been started.

Abortion, Septic↗

PubMedDate not supplied

[Guidelines for back pain].

Chronic back pain is one of our society's most important health problems, causing long periods of sick leave and early retirements. Recently the German Society of General Practice and Family Medicine (DEGAM) published an evidence-based guideline for low back pain. It has been developed according to the 10-step concept of guideline development of the DEGAM, aiming for early detection of complicated clinical conditions, avoidance of unnecessary diagnostic tests and prevention of chronicity. Complicated, uncomplicated and radicular pain are defined by patient history and a short clinical examination. Imaging and further diagnostic tests are reserved for patients at risk. Basic therapy consists of structured advice. The aim of the guideline is to get patients back to their usual activity supported by effective pain relief. Psychosocial factors which are important for the prognosis should be evaluated already during the first consultation. Manual therapy might help in acute pain. Patients with persistent pain symptoms and long periods of sick leave should be transferred to multiprofessional management including pain treatment, behavioural therapy and physiotherapy. A randomised controlled trial has been set up to study the efficacy of guideline implementation.

Activities of Daily Living↗