The prevalence of gout is rising around the world. Patients with gout could benefit greatly from consistent implementation of the existing treatment guidelines and recommendations. In the future, controlled trials should be conducted to determine the best time to start treatment and the optimal target level for the serum uric acid concentration in terms of a risk/benefit analysis.
Background Diagnosing dementia, a syndrome affecting 35.6 million people worldwide, can be challenging, especially in patients with a migrant background. Language barriers and language-based diagnostic tools, cultural differences in the perception of the syndrome as well as restricted access to healthcare can influence medical care. For the first time in Germany, this study investigates whether German general practitioners (GPs) feel prepared to meet the diagnostic needs of these patient groups and whether there are challenges and support needs. Methods A cross-sectional study among a random sample of 982 general practitioners in Germany was conducted from October 2017 to January 2018 (response rate: 34.5%). A self-developed, written, standardised questionnaire was used. Descriptive statistics as well as multiple logistic regression analyses were performed using data of 326 GPs. Results Ninety-six percent of GPs reported having experienced barriers at least once. Uncertainties in diagnosing dementia in patients with a migrant background were indicated by 70.9%. There was no significant association between uncertainties in diagnosing dementia and GPs’ sociodemographic characteristics. The most frequently reported barriers were language barriers that affected or prevented diagnostics (89.3%) and information deficits in patients with a migrant background (59.2%). Shameful interaction or lack of acceptance of the syndrome was also common (55.5%). A demand for more information about the topic was expressed by 70.6% of GPs. Conclusions Public health measures supporting GPs in their interaction with patients with a migrant background as well as information and services for dementia patients are needed. Efforts to facilitate access to interpreting services and to focus on people with a migrant background in healthcare are necessary. Trial registration German Clinical Trials Register: DRKS00012503 , date of registration: 05/09/2017 (German Institute of Medical Documentation and Information. German Clinical Trials Register (DRKS) 2017). Clinical register of the study coordination office of the University hospital of Bonn: ID530, date of registration: 05/09/2017 (Universitätsklinikum Bonn. Studienzentrum. UKB-Studienregister 2017).
Background: One way to improve the quality of palliative care for elderly patients is to use an interprofessional team approach, which may be encouraged through interprofessional education (IPE). However, the effectiveness of IPE interventions has yet to be proven. We therefore designed a randomized controlled trial using a simulated practice setting to measure the effects of an IPE intervention on medical students’ clinical behaviour.Methods: Undergraduate nursing (N = 20) and medical (N = 20) students were evenly assigned to either an intervention or a control group. Students in the intervention group received interprofessional curriculum (12 teaching units), and the control group was given written material containing the content of the IPE curriculum. Using a pre-post design, clinical behaviour of matched pairs of nursing and medical students was analyzed for qualitative (care objectives) and quantitative aspects of communication (initiation, interruptions, speaking time, and exchanged information items). Statistical analyses included chi-square, Fisher’s exact, and t-tests, where appropriate.Results: Care objective scores improved in both groups (categories N = 6, p-range = intervention group: .001–.630; control group: .001–.888). Interruptions and speaking time showed no change between or within groups, while the number of nursing student-initiated contacts increased (p = .0007). The number of information items exchanged increased significantly in both the intervention group (Pre: M = 9.65, SD = 1.79; Post: M = 12.35, SD = 1.87; p = .001) and the control group (Pre: M = 8.75, SD = 2.59; Post: M = 11.75, SD = 2.22; p = .001).Conclusions:We found a moderate effect of IPE on a change in interprofessionalcommunication style.
ObjectivesThe DSM-5 diagnosis ‘opioid use disorder’ (OUD) was established to better describe and detect significant impairment or distress related to opioid use. There is no data on rates of OUD in chronic non-cancer pain (CNCP) in European countries. Therefore, our objective was to screen patients in specialised pain centres for signs of OUD.DesignCross-sectional questionnaire study.SettingFour outpatient pain clinics in the area of Bonn, Germany.Participantsn=204 patients participated in the study (response rate: 87.9%). All adult patients with opioid pain therapy >6 months for CNCP were included. Excluded were patients with malignant disease, patients who could not collect their prescription themselves due to age or multimorbidity and patients on opioid-maintenance therapy.Primary and secondary outcome measurePrimary outcome measure was the proportion of patients with mild to severe OUD.ResultsOne-fourth (26.5%) of participants were diagnosed with OUD. Moderate to severe disorder was found in 9.3. Young age was the only connected risk factor (OR 0.96 [95% CI 0.94 to 0.99], p: 0.003).ConclusionsOUD is a relevant diagnosis in patients on long-term opioid therapy for CNCP in the Bonn area. Careful follow-up by the attending physicians is advisable, especially in patients with moderate or severe disorder.
BackgroundEfforts to improve treatment of pain using opioids have to adequately take into account their therapeutic shortcomings which involve addictiveness. While there are no signs of an “opioid epidemic” in Germany similar to that in the US, there is little data on the prevalence of prescription opioid misuse and addiction. Therefore, our objective was to screen primary care patients on long-term opioid therapy for signs of misuse of prescription opioids.MethodsWe recruited 15 GPs practices and asked all patients on long-term opioid therapy (> 6 months) to fill out a questionnaire including the “Current Opioid Misuse Measure” (COMM®), a self-report questionnaire. Patients with a malignant disease were excluded.ResultsN = 91 patients participated in the study (response rate: 75.2%). A third (31.5%) showed a positive COMM® - Score which represents a high risk of aberrant drug behaviour. A positive COMM® - Score showed a statistically significant correlation with a lifetime diagnosis of depression and neck pain.ConclusionsWhile Germany does not face an “opioid eoidemic”, addictiveness of opioids should be considered when using them in chronic non-tumor pain. In our study population, almost every third patient was at risk and should therefore be followed up closely. Co-prevalence of depression is a significant issue and should always be screened for in patients with chronic pain, especially thus with aberrant drug behaviour.
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