Christoph Heintze

Effects of mindfulness-based stress reduction on quality of life in nursing home residents: a feasibility study.

Background: With demographic change, the number of elderly people is increasing. The aging process and associated stress diminishes their quality of life. Mindfulness-based stress reduction (MBSR) has been claimed to reduce stress and alleviate suffering. It might be a useful approach to improve the condition in the elderly. Patients and Methods: To examine feasibility and potential effects of MBSR on nursing home residents in Germany, a non-randomized feasibility study was conducted including 22 participants; 15 of them participated in an 8-week MBSR course, 7 served as untreated comparison group. Health-related quality of life (SF-12), depressive symptoms (GDS-12R), cognitive impairment (MMST), activities of daily living (Barthel Index), satisfaction with life, physical pain and major complaints were assessed pre- and post-intervention. Results: 9 out of 15 course participants completed the course (60%). They showed a significant increase in the SF-12 physical health score (p = 0.017). Depressive symptoms (GDS-12R) significantly declined within the meditation group (p = 0.04) and as compared to the untreated group (p = 0.011). In the comparison group, a significant decrease in major complaints (p = 0.011) and an increase in the SF-12 mental health score were found. The meditation group yielded positive changes in the SF-12 mental health score, in satisfaction with life and in pain intensity. Conclusions: In view of the setting, the completion rate of 60% appears to be acceptable. Significant results suggest that MBSR may help improve health-related quality of life and reduce symptoms of depression. Yet, as participants did not meet the requirement to practice independently, feasibility of conducting MBSR with elderly who live in a nursing home has to be questioned.

Counseling overweight patients: analysis of preventive encounters in primary care

OBJECTIVE The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI ≥ 30 kg/m² would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI < 30 kg/m². DESIGN Cross sectional comparison of audiotaped encounters of patients with a BMI ≥ 30 kg/m² and those with a BMI < 30 kg/m². SETTING Twelve GP surgeries in Berlin, Germany. PARTICIPANTS Fifty patients who agreed to have preventive check-up encounters audiotaped. MAIN OUTCOME MEASURES Based on the Roter Interaction ANALYSIS System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. RESULTS An increased BMI was found to be a predictor for the length of encounters (P = 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P > 0.05). CONCLUSIONS Our results indicate that GPs rarely use the check-up program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.

Innovative strategy for implementing chronic heart failure guidelines among family physicians in different healthcare settings in Berlin

The aim of this study was to improve drug therapy for chronic heart failure (CHF) patients.

GPs’ attitudes, objectives and barriers in counselling for obesity—a qualitative study

Abstract Background: Increasing prevalence of obesity worldwide requires providing support for many patients. GPs in particular, as long-term supervisors of patients, are asked to deliver care to those affected. Objectives: This qualitative study aimed at identifying GPs’ perspectives on counselling overweight and obese patients. Methods: To that end, semi-structured interviews were conducted in Berlin with GPs regarding their objectives and barriers in overweight care. Fifteen GPs participated; interviews were audio taped, transcribed and analysed using qualitative content analysis. Results: Analysis showed a differentiated pattern of medical and psychosocial objectives in obesity treatment. Overall, it was seen that GPs wanted to play a relatively passive role in treatment of obesity. In particular, motivating patients was a key goal of primary care consultations; at the same time patients’ lack of motivation was a main barrier to successful treatment. Conclusions: Care for obese patients is perceived as ineffective and frustrating. Recommended solutions include further education to improve GPs’ communication techniques, e.g. to trigger patients’ motivation.

Statements of general practitioners on cooperation with specialists and a future health care system

Zusammenfassung.Hintergrund und Ziel:Bei den gesundheitspolitischen Diskussionen um die Neustrukturierung des ambulanten Gesundheitssystems in Deutschland kommt den Hausärzten eine besondere Bedeutung zu. Von Interesse ist, wie das Versorgungsgeschehen von Hausärzten eingeschätzt wird. Ziel der vorliegenden Studie war, Einstellungen von Berliner Hausärzten zu einzelnen Bereichen ihres beruflichen Alltags zu erfassen.Methodik:Mit 14 Hausärztinnen und 16 Hausärzten aus Berlin wurde eine qualitative Befragung durchgeführt. Die 30 niedergelassenen Kollegen wurden u.a. nach ihren Einstellungen bezüglich der Zusammenarbeit mit Spezialisten und den Vorstellungen zukünftiger Versorgungsstrukturen befragt. Die Interviews wurden durch formalisiertes Zusammenfassen, durch Strukturieren und durch Explikation im Sinne der qualitativen Inhaltsanalyse nach Mayring ausgewertet.Ergebnisse: Aus Sicht der Hausärzte wird die ambulante Zusammenarbeit durch Kenntnis des Spezialisten, durch den schnellen telefonischen Kontakt und die Möglichkeit einer kurzfristigen Terminvergabe beim Fachkollegen erleichtert. Eine digitale Vernetzung in regionalen Ärzteverbünden wird als wegweisend für zukünftige ambulante Versorgungsstrukturen betrachtet.Schlussfolgerung:Schnelle patientenbezogene Lösungsstrategien sind für die Entscheidung zur Zusammenarbeit mit Spezialisten von großer Bedeutung. Durch digitale Vernetzungsstrukturen lässt sich die Zusammenarbeit von Hausärzten und Spezialisten zukünftig möglicherweise verbessern.Abstract.Background and Purpose:Ideas of general practitioners (GPs) could be of value for the restructuring of the German ambulant health care system. The way managed care is seen by GPs is of particular interest. The aim of this study was to record opinions of GPs, working in Berlin, in regard to several aspects of their daily work.Methods:14 female and 16 male GPs from Berlin participated in a qualitative survey. These 30 GPs were interviewed about their attitude toward cooperation with specialized colleagues and their opinions on a future medical care sysem. The interviews performed were summarized, structured and analyzed according to the qualitative content analysis by Mayring.Results:From the GPs’ point of view, ambulant cooperation is facilitated by knowing specialized colleagues, by staying in close contact to them via telephone and by being able to arrange short–term appointments with these specialists. A closer cooperation with specialists in a network as well as an advanced use of digital information systems for accessing patients’ data were considered to be vital elements for a future health care system.Conclusion: An important reason for choosing the cooperation with specialists is to find quick comprehensive treatment strategies for patients. It may be concluded that ambulant managed care of patients could be optimized with the creation of medical networks.

The Diagnosis and Treatment of Acute Cough in Adults

BACKGROUND Cough is the most common complaint for which patients visit their primary care physician, being present in about 8% of consultations. A profusion of new evidence has made it necessary to produce a comprehensively updated version of the guideline on cough of the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM), which was last issued in 2008. METHOD The interdisciplinary evidence and consensus based S3 guideline on cough of the DEGAM was updated on the basis of a systematic review of the relevant literature published from 2003 to July 2012 (MEDLINE, Cochrane Library, EMBASE, Web of Science). Evidence levels were assessed and consensus procedures were followed as prescribed by AWMF standards, with the participation of 7 medical societies. RESULTS 182 publications were used to update the guideline, including 45 systematic reviews (26 of which included a meta-analysis) and 17 randomized controlled trials (RCTs). 11 recommendations for acute cough were approved by consensus in a nominal group process. The history and physical examination are the basis of diagnostic evaluation. When the clinical diagnosis is that of an acute, uncomplicated bronchitis, no laboratory tests, sputum evaluation, or chest x-rays should be performed, and antibiotics should not be given. There is inadequate evidence for the efficacy of antitussive or expectorant drugs against acute cough. The state of the evidence for phytotherapeutic agents is heterogeneous. Persons with community-acquired pneumonia should receive empirical antibiotic treatment for 5 to 7 days; specific risk factors can influence the choice of drug to be used. It is recommended that laboratory tests should not be performed and neuraminidase inhibitors should not be given in the routine management of influenza. CONCLUSION A specifically intended effect of these recommendations is to reduce the use of antibiotics to treat colds and acute bronchitis, for which they are not indicated. Further clinical trials of treatments for cough should be performed in order to extend the evidence base, which is now fragmentary.

Primary prevention in general practice - views of German general practitioners: a mixed-methods study.

BackgroundPolicy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention.MethodsMixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention.ResultsMost respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions.ConclusionsThe mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.

Cardiovascular Disease and Obesity Prevention in Germany: An Investigation into a Heterogeneous Engineering Project

Cardiovascular diseases present the leading cause of death worldwide. Over the last decade, their preventio has become not only a central medical and public health issue but also a matter of political concern as well as a major market for pharma, nutrition, and exercise. A preventive assemblage has formed that integrates diverse kinds of knowledges, technologies, and actors, from molecular biology to social work, to foster a specific healthy lifestyle. In this article, the authors analyze this preventive assemblage as a heterogeneous engineer, that is, as an attempt to order complex everyday life into an architecture of modernism. This article draws on research conducted as part of the interdisciplinary research cluster ‘‘preventive self’’ (2006-2009) bringing together analyses from social anthropology, history, linguistics, sociology of knowledge, and medicine. The authors report here primarily from ethnographic investigations into biomedical research, primary care, and educational practices in kindergartens. The authors conclude that the preventive assemblage largely fails to install any kind of singular order. Instead, it is translated into existing orderings producing heterogeneity of a different nuance.

Problemlagen von versteckt lebenden Migranten in Deutschland: Analyse der medizinischen Beratungsanlässe in Berlin, Bonn und Köln

INTRODUCTION Little is known about health related problems of undocumented migrants in Germany. Patterns for medical consultations and socio-demographic characteristics are only available in isolated reports. This article identifies and compares empirical data from non-governmental organisations (NGOs) who provide medical care for unregistered migrants. METHODS Annual reports of 2006 and 2007 of the Malteser Migranten Medizin (Berlin, Cologne) and the MediNetz Bonn were selected for this document analysis. RESULTS We identified similarities and differences in the socio-demographic background and patterns of medical consultations between the explored regions. The number of documented migrants without medical insurance increased during the observed period. DISCUSSION The patterns of health-care utilisation for undocumented immigrants changed in the observed period which might be caused by the EU enlargement to the East. The heterogeneous quality of the annual reports and the lack of information about the use of alternative health-care facilities limit the results of this analysis.

The significance of rebiopsy in the diagnosis of prostate cancer

OBJECTIVE The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significant increase in the detection rate of prostate cancer compared with performing a single biopsy. METHODS Data from 406 patients were evaluated retrospectively. The patients had undergone ultrasound-guided transrectal biopsy of the prostate between January 2004 and August 2005. Besides demographic data, the patient information was reviewed with regard to the number of biopsy samples taken per patient, histological results, and the occurrence of complications during or after the examination. If prostate cancer was detected, data acquisition included the number of positive biopsy samples taken per examination as well as the subsequent therapy and the TNM classification of the tumor. After a follow-up time between 24 and 42 months, all patients with a histologically negative first biopsy were reevaluated regarding rebiopsy. We evaluated the follow-up time (in months) and the histological results. If prostate cancer was detected, we assessed the number of positive biopsy cores as well as the subsequent therapy and the TNM classification. RESULTS In 37.7% of all patients (n=153), prostate cancer was detected in the first biopsy. In 56.9% of these (n=87), a high-grade carcinoma with a Gleason score >or=7 was diagnosed. In 108 patients, a second biopsy was performed. The mean time between the first biopsy and rebiopsy was 21.7 months (range 1.3-41.2 months). With the second biopsy, prostate cancer was detected in 29 cases (26.9%), of which 51.7% (n=15) showed a high-grade carcinoma. There was no significant difference between the first biopsy and the second biopsy concerning either the detection rate of carcinomas related to the total number of transrectal multibiopsies or the detection of high-grade carcinomas related to the number of detected carcinomas. Provided that values beyond the second standard deviation were excluded from analysis, prostate-specific antigen (PSA) values at the time of rebiopsy were significant elevated compared with PSA values at the time of first biopsy. More than two-thirds of all patients with a histologically positive result in the second biopsy revealed a PSA velocity >or=0.6 ng/ml/year. Furthermore, there was no significance between the number of histologically positive samples per multibiopsy when prostate cancer was diagnosed in the first biopsy compared with the number of positive samples in the second biopsy. Complications after biopsy were noted in 19 patients. In three cases, hospitalization was necessary. CONCLUSION As a result of performing a rebiopsy, the detection rate of prostate cancer increased significantly compared with the detection rate after a single biopsy. Thus, the number of patients who could receive therapy was also increased. Due to the relatively low complication rate of prostate multibiopsy, this examination can be widely indicated. There was not a higher detection rate of high-grade prostate cancer in the second biopsy compared with performing only a single biopsy. The indication for a second biopsy as well as the determination of the time interval between the first and second biopsy should consider the current PSA value and PSA dynamics. Therapeutic consequences should also be taken into consideration. In the event of a PSA velocity >0.6 ng/ml/year, a rebiopsy should definitely be performed.