BackgroundThe implementation of new medical knowledge into general practice is a complex process. Blended learning may offer an effective and efficient educational intervention to reduce the knowledge-to-practice gap. The aim of this study was to compare knowledge acquisition about dementia management between a blended learning approach using online modules in addition to quality circles (QCs) and QCs alone.MethodsIn this cluster-randomised trial with QCs as clusters and general practitioners (GPs) as participants, 389 GPs from 26 QCs in the western part of Germany were invited to participate. Data on the GPs' knowledge were obtained at three points in time by means of a questionnaire survey. Primary outcome was the knowledge gain before and after the interventions. A subgroup analysis of the users of the online modules was performed.Results166 GPs were available for analysis and filled out a knowledge test at least two times. A significant increase of knowledge was found in both groups that indicated positive learning effects of both approaches. However, there was no significant difference between the groups. A subgroup analysis of the GPs who self-reported that they had actually used the online modules showed that they had a significant increase in their knowledge scores.ConclusionA blended learning approach was not superior to a QCs approach for improving knowledge about dementia management. However, a subgroup of GPs who were motivated to actually use the online modules had a gain in knowledge.Trial registrationCurrent Controlled Trials ISRCTN36550981.

Background: Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs.Methods: Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns.Results: Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. Conclusion:Despite a growing use of the Internet it seems that German GPs favor "classical/ traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities.Trial registration: Current Controlled Trials ISRCTN36550981. BackgroundIn the context of medical care recent, significant developments in the areas of technology, therapy and new forms of medical treatment ask for a timely diffusion of available evidence on interventions. Thus the translation of knowledge into practice is essential in order to maintain and increase the quality of daily practice [1]. As a consequence, health professionals such as General Practitioners (GPs) have to ensure that their knowledge and skills are up to date. Since the early Eighties, a number of studies and reviews have demonstrated the positive influence continuing medical education (CME) has on a physicians' knowledge and competence [2][3][4]. Over the same period of time, peer review groups and quality circles (QCs) have formed, i.e. regional meetings of GPs including specialists in order to discuss both clinical topics and new developments in politics and funding. The first QCs of GPs in Germany were founded in 1991/92 to help GPs tackle problems of quality management in the patients' daily care. Today, the participation of German GPs in QCs is mandatory in order to be part of most of the governmental funded disease management programs or to be part of model projects and initiatives from health insurers. Hence, nearly 50% of all German GPs are now organized in QCs [5]. Parallel to this proce...

Background The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods This analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

Background: It is often stated that external validity is not sufficiently considered in the assessment of clinical studies. Although tools for its evaluation have been established, there is a lack of awareness of their significance and application. In this article, a comprehensive checklist is presented addressing these relevant criteria.

In summary, little evidence exists for the positive effects of case conferences in the care of people with dementia. This review highlights the need for methodologically well-designed intervention studies to provide conclusive evidence of the effects of case conferences.

The intervention showed no effects on time to institutionalization and secondary outcomes.

BackgroundDementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.MethodsTwenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.ResultsDuring the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).ConclusionsThis study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher.

The IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.