ZusammenfassungHintergrund: Die Effektivität einer komplexen Intervention ist abhängig vom Erfolg ihrer Implementierung. Wir wollten Hinderungs-und Motivationsgründe für die Umsetzung der Beratungsstrategie ARRIBA-Herz J in verschiedenen Stadien der Verhaltensänderung erfassen. Methoden: Bei ARRIBA-Herz J handelt es sich um eine Beratungsstrategie in der Herz-Kreislaufprä-vention auf der Grundlage von Framingham-Daten. Der Patient wird nach der Berechnung seines individuellen Globalrisikos für ein kardiovaskuläres Ereignis im Sinne einer Partizipativen Entscheidungsfindung (PEF) an der Therapieentscheidung beteiligt. Nach der Implementierung des Beratungskonzepts in hausärzt-lichen Praxen wurden strukturierte Leitfadeninterviews mit 90 Hausärzten durchgeführt, denen das Konzept vorgestellt worden war. Die Kategorisierung der Interviews erfolgte anhand der Stufen des Transtheoretischen Modells der Verhaltensänderung (TTM), das einzelne Stufen der Verhaltensänderung klar definiert. Ergebnisse: Motivation und individueller Bedarf bestimmten den Grad von Kompetenzerwerb und Umsetzung von Risikokalkulation und Partizipativer Entscheidungsfindung. Persön-liche Grundhaltungen spielten eine wichtige Rolle. Praktikabilität, Effekte für Arzt und Patienten sowie ökonomische Erwägun-gen hatten in einzelnen TTM-Stadien unterschiedliche Relevanz. Diskussion und Schlussfolgerungen: Implementierungsmaß-nahmen sollten spezifisch an Motivationsstadien und Bedürfnis-se in der Zielgruppe angepasst sein und vorhandene Grundhaltungen berücksichtigen. AbstractObjectives: The effectivity of a complex intervention depends on its succesful implementation. Our aim was to find possible barriers and facilitators for the application of the counseling strategy ARRIBA-Herz J during different stages of behaviour change. Methods: ARRIBA-Herz J is a counseling strategy for coronary prevention based on Framinham-data. Once a patient's individual global risk for a coronary event has been calculated, he/she will be involved in the decision making process. After the Implementation of the counseling practice stuctured interviews were conducted with 90 GPs, who had got to know ARRIBA-Herz J . The categorisation of the interviews followed the transtheoretical model of behaviour change (TTM) which gives a distinct definition of different stages of behaviour change. Results: Motivation and individual needs were responsible for learning and for using the acquired competence. Personal attitudes played an important role. Organisational issues, effects on GP and patients and economic considerations were of variing relevance in different stages of change. Conclusion: Implementation measures should be tailored for motivational stages and individual needs of the target population and personal attitudes should be taken into account. Versorgung 429Heruntergeladen von: Universite Laval. Urheberrechtlich geschützt. HintergrundDie erfolgreiche Implementierung einer Innovation in der ärzt-lichen Praxis ist abhängig von einer Vielzahl von Faktoren. Patentrezepte gibt es...
60 patients with a marked penile deviation [40 because of a congenital penile deviation (CPD) and 20 as a result of the Peyronie's disease] were questioned about the result of the operation by means of a questionnaire in a retrospective study with an average follow-up of 45 month. The Nesbit procedure had been used with 49 of these 60 patients, the modified Schroeder-Essed technique had been used with 11 patients. There were 15 patients (25%) in all, who suffered a relapse. In spite of the continual use of non-absorbable suture material with the Schroeder-Essed technique, the number of relapses was in this group plainly higher than in the Nesbit group (55% and 18% respectively). In our opinion this is caused by the insufficient tensile strength of pure plications. Regardless of the operating method, patients suffering from IPP showed a higher number of relapses than patients having a CPD (35% and 20% respectively). The reason for this might be the fact that one can never rule out completely the possibility of a further progress of the disease. 71% of the patients in the Nesbit group were satisfied with the results of the operation, in the Schroeder-Essed group there were only 36%. Irrespective of the operating method, IPP patients complained moreoften about late complications and erection problems after the operation and were more rarely satisfied with the result than patients with a CPD (50% and 73% respectively). We put this down to the fact that patients with a CPD and patients suffering from IPP represent very different collectives as far as age structure and morbidity are concerned. IPP patients frequently have erection problems even before the operation. Especially with IPP patients, preoperative erectile disfunction must be excluded, in the case of their occurrence there are to prefer other programmes of therapy.
In old-aged patients with distal radius fractures, the indication for surgical treatment should be made very carefully, since certain degrees of radiological malalignment are tolerated well.
Es wurde ein Modell zur parenteralen Ernährung der nicht fixierten oder sedierten Ratte, basierend auf einfachsten technischen Hilfsmitteln und auf Nährlösungen, wie sie in jeder Klinik greifbar sind, erarbeitet. Die durchschnittliche Überlebenszeit beträgt 6–8 Wochen. Die Ratten nehmen unter der parenteralen Ernährung an Gewicht zu und sind in einem guten gesundheitlichen Zustand. Die kumulative Stickstoffbilanz ist bei einer medianen Retention von 95 % der zugeführten Menge hoch positiv.
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