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Biomedical subjects

Wolf Langewitz

Publications and source records attributed to Wolf Langewitz.

16 recordsLinked to original sources
PubMed2006

Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice.

UNLABELLED: A cluster-randomised controlled trial in general practice BACKGROUND: Physician-patient communication plays a key role in treatment decisions in primary care. We aimed to reduce the antibiotic prescription rate for acute respiratory tract infections using a short training programme in patient-centred communication. METHODS: We conducted a cluster-randomised controlled trial in 45 general practices in Switzerland. Thirty physicians received evidence-based guidelines for the management of acute respiratory tract infections; 15 physicians randomised to the full intervention additionally received training in patient-centred communication. A further 15 physicians, not randomised, served as a control to blind the physicians in the other two groups to the true comparison. The primary outcome was the antibiotic prescription rate reported by pharmacists. Secondary outcomes were patient satisfaction and enablement, re-consultation rates, days with restrictions, and days off work. 1108 adults with acute respiratory infections were screened between January and May 2004. Outcomes were measured in 837 consultations; 624 patients had follow-up interviews at 7 and 14 days. RESULTS: The antibiotic prescription rate reported by pharmacists was low in both full and limited intervention groups (13.5% and 15.7% respectively) but only half of the antibiotics were prescribed according to guidelines (53.8% and 53.1%). No significant differences were seen between the two randomised groups in primary and secondary outcomes. In both groups patient satisfaction was high (median score for both 68 out of 70). CONCLUSIONS: In this trial, patient-centred communication training did not reduce the rate of antibiotic prescriptions below an already unusually low level. Even with this low prescription rate, patient satisfaction with received care was high.

Adult↗
PubMed2006

Prevalence and influence of diagnostic tests for acute respiratory tract infections in primary care.

BACKGROUND: General practitioners (GPs) use diagnostic tests to help distinguish between viral and bacterial acute respiratory tract infections (ARTI). We investigated the prevalence of these tests, and how tests are associated with diagnosis, treatment and patient satisfaction. METHODS: As part of a clinical trial, 45 GPs screened 1108 patients with ARTI and collected information on signs and symptoms, diagnostic test results, and subsequent diagnosis and treatment. A sample of 636 patients was interviewed after 7 days and their opinions recorded. We used multivariate mixed models to estimate associations between the use of tests and (1) baseline characteristics, (2) subsequent antibiotic treatment, and (3) patient satisfaction. RESULTS: GPs carried out at least one test in 42% of the 1108 patients screened. The tests used were (percentage of patients): CRP (35%), leucocyte count (17%), rapid Strep A (9%), chest X-ray (5%), sinus X-ray (1%), and throat culture (1%). The use of tests was associated with increasing patient age, education, and degree of discomfort. Antibiotic therapy was strongly associated with a positive test, with odds ratios of 26 (95% CI, 10-67) for a CRP above 50 mg/l; 9.6 (95% CI, 3.6-26) for a leucocyte count above 10,000/microl; and 122 (4.4-3435) for a positive StrepA test. There was no evidence of an association between the use of tests and patient satisfaction. CONCLUSIONS: Nearly half of these patients with ARTI received a diagnostic test. Older patients, those with higher education and those in more discomfort were more likely to get tests. A positive test was strongly associated with antibiotic treatment.

Acute Disease↗
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↗
PubMed2005

Evidence that baroreflex feedback influences long-term incidental visual memory in men.

Sympathetic nervous system (SNS) activity at the time of acquisition is associated with human memory. However, rather than SNS activity per se, it may be afferent baroreflex feedback that is responsible for this effect. A pharmacological design was employed to unload (SNP, sodium nitro-prusside) and load (norepinephrine) baroreceptors. In addition to two placebo periods, epinephrine and esmolol (a peripherally acting beta1-blocker) served as control conditions for altered cardiac perception. During drug infusion blood pressure, heart rate, and perception of heartbeat were tested. Twenty-four healthy men were participated. The participants viewed emotional slides while their electromyographic eye blink responses to random noise bursts were measured (affective startle modulation paradigm) to determine potential drug impact on emotional processing. Subjects were not informed that memory testing would take place after 4 weeks. Drugs did not impact startle, thus indicating unbiased emotional processing at the time of acquisition. Norepinephrine had no effect on heartbeat perception, but improved (p = .002) recognition memory. SNP (p = .0001) increased heartbeat perception but impaired (p = .038) recognition memory. Epinephrine, on the other hand, increased heartbeat perception (p = .0001) yet did not impair but partially improve memory (effect on high arousing pictures only: p = .05). Heartbeat perception in the placebo condition did not correlate with recognition memory (p's > .5). We suggest that baroreflex unloading, with subsequent feedback activation of the SNS, impairs long-term incidental visual recognition memory in humans while baroreflex loading enhances it. Further, we propose that these memory effects are neither secondary to cardiac sensations that accompany SNS activation nor to altered emotional picture processing at the time of acquisition.

Adolescent↗
PubMed2005

Recipients' perspective on breaking bad news: how you put it really makes a difference.

OBJECTIVE: The goal of this study was to show that physician communication style of breaking bad news affects how the physician is perceived, how satisfied recipients of bad news are with the consultation, and how they feel after the consultation. METHOD: Female participants (students, N=159) were asked to put themselves in the shoes of a patient receiving the bad news of a breast cancer diagnosis. Participants were randomly assigned to watch one of three prototypical physician communication styles of breaking bad news on videotape: patient-, disease-, or emotion-centered communication. RESULTS: Results showed that these three prototypical communication styles were perceived very differently and they determined how satisfied participants were with the consultation and how they felt after the consultation. Participants exposed to the patient-centered communication perceived the physician as most emotional, least dominant, most appropriate when it comes to conveying information, most available and most expressive of hope. Also, they reported to be most satisfied with the visit and they showed the least increase in negative emotions. CONCLUSION: A patient-centered communication style has the most positive outcome for recipients of bad news on a cognitive, evaluative, and emotional level. PRACTICE IMPLICATIONS: Results of this study provide guidelines to physicians on how to convey bad news.

Adolescent↗
PubMed2005

Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study.

BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.

Adolescent↗
PubMed2004

Coronary artery disease and depression.

Coronary artery disease (CAD) as well as depression are both highly prevalent diseases. Both cause a significant decrease in quality of life for the patient and impose a significant economic burden on society. There are several factors that seem to link depression with the development of CAD and with a worse outcome in patients with established CAD: worse adherence to prescribed medication and life style modifications in depressive patients, as well as higher rates in abnormal platelet function, endothelial dysfunction and lowered heart rate variability. The evidence is growing that depression per se is an independent risk factor for cardiac events in a patient population without known CAD and also in patients with established diagnosis of CAD, particularly after myocardial infarction. Treatment of depression has been shown to improve patients' quality of life. However, it did not improve cardiovascular prognosis in depressed patients even though there is open discussion about the trend to better outcome in treated patients. Large scale clinical trials are needed to answer this question. Selective serotonin reuptake inhibitors seem to be preferable to tricyclic antidepressants for treatment of depressive patients with comorbid CAD because of their good tolerability and absence of significant cardiovascular side effects. Hypericum perforatum (St. John's wort), an increasingly used herbal antidepressant drug should be used with caution due to severe and possibly dangerous interaction with cardioactive drugs.

Antidepressive Agents↗
PubMed2003

Prepulse inhibition of the human startle eye blink response by visual food cues.

We present a new paradigm to investigate cognitive processing of food cues. The study assessed if pictures of food induce prepulse inhibition (PPI) of startle eye blink, and if any such effect is sensitive to food deprivation. In a balanced cross-over design, 16 healthy male volunteers (mean age: 29 years) were tested on 2 days 1 week apart, either after a period of normal food intake (NFI) or after a 24 h period of food restriction (RFI). On each experimental day, 80 control and 20 food pictures (slides) were displayed. Noise stimuli were presented 250 ms after slide onset. Startle responses were assessed by EMG recordings of the right M. orbicularis oculi. Startle elicited during dark inter-slide periods served as control responses to calculate PPI effects. The arousing content of each picture was rated by all subjects at the end of the session. The perceived arousal effect of control slides was strongly related to their PPI effect; no impact of food access status on this association was detectable. After NFI, food slides significantly induced PPI of startle (mean: -14.5%). After RFI, arousal ratings for food pictures increased but PPI did not. These results are evidence for a pre-attentive mechanism operative in the processing of visual food cues.

Adult↗
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

[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↗