Polypharmacy in Older Patients with Multimorbidity: The Agreement Between Patient and General Practitioner-Reported Drugs Observed in a Pilot cRCT.

Polypharmacy (≥5 drugs) increases the risk of discrepancies between patient- and general practitioner (GP)-reported drugs, leading to adverse outcomes. This explorative analysis assesses the agreement between patient- and GP-reported drugs under the influence of a paper-based patient portfolio in a pilot cluster randomized controlled trial (cRCT). Complete data were available for 68 patients aged 65 or older (26 were female), with multimorbidity, polypharmacy, and at least one hospitalization in the past year.

Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study.

Background: To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures.

Gradient-based feature-attribution explainability methods for spiking neural networks.

Introduction: Spiking neural networks (SNNs) are a model of computation that mimics the behavior of biological neurons. SNNs process event data (spikes) and operate more sparsely than artificial neural networks (ANNs), resulting in ultra-low latency and small power consumption. This paper aims to adapt and evaluate gradient-based explainability methods for SNNs, which were originally developed for conventional ANNs.

White Matter Microstructural Changes and Episodic Memory Disturbances in Late-Onset Bipolar Disorder.

Bipolar disorder (BD) has been associated with distributed network disruption, but little is known on how different clinical subtypes, particularly those with an earlier and later onset of disease, are related to connectivity changes in white matter (WM) tracts. Diffusion tensor imaging (DTI) and volumetric measures were carried out in early-onset bipolar patients [(EOD) ( = 16)], late-onset bipolar disorder [(LOD)( = 14)] and healthy controls ( = 32). We also computed ROI analysis of gray matter (GM) and white matter (WM) volumes using the regions with significant group differences in the DTI parameters.

Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention.

Purpose: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories.

Methods: We conducted a cluster-randomized controlled trial in primary care.

How can General Practice be incorporated longitudinally in medical studies? Students' views on the development of a new rural health program.

Participation of medical students in the conceptual development of targeted and attractive teaching content for rural areas. A questionnaire was developed to gather information on students' views of their current medical studies, career interests, and what requirements should be met by an optional rural health program in general practice. By means of an online survey in summer 2015, all medical students from the fourth preclinical semester onwards (n=2,150) at Goethe University Frankfurt were surveyed on one occasion.

Cluster-randomized controlled trials evaluating complex interventions in general practices are mostly ineffective: a systematic review.

Objectives: The aim of this study was to evaluate how frequently complex interventions are shown to be superior to routine care in general practice-based cluster-randomized controlled studies (c-RCTs) and to explore whether potential differences explain results that come out in favor of a complex intervention.

Study Design And Setting: We performed an unrestricted search in the Central Register of Controlled Trials, MEDLINE, and EMBASE. Included were all c-RCTs that included a patient-relevant primary outcome in a general practice setting with at least 1-year follow-up.

[On the way to becoming an MD (Dr. med.): What kind of support do doctoral students need? Part 2: Establishing the program].

The poor quality of medical dissertations has repeatedly been criticized by scientific and higher education institutions. In medicine, doctoral students rated their own knowledge of fundamental scientific issues as low. The establishment of a doctoral research program could solve this problem.

[On the way to becoming an MD (Dr. med.): What kind of support do doctoral students need? Part 1: Survey and development of a program].

In Germany, medical doctorates are regularly criticized for their insufficient quality. In order to improve the quality of doctorates and to support doctoral candidates, a department-wide doctoral research program was established at the Goethe University of Frankfurt am Main in 2011 taking into account the practical needs of doctoral students at the School of Medicine. The program development proceeded in several steps: in the first step (2009/2010), a pilot study with eleven doctoral candidates was carried out at the Institute of General Practice.

Factor structure and measurement invariance of the Patient Health Questionnaire-9 for female and male primary care patients with major depression in Germany.

Background: Depression is characterized by gender-specific distinctions, with women being affected more often than men. The Patient Health Questionnaire-9 (PHQ-9) is frequently used to assess depression in primary healthcare. Previous research has yielded heterogeneous findings on the factor structure, and little is known of its measurement invariance across gender.

Long-term effects of a collaborative care intervention on process of care in family practices in Germany: a 24-month follow-up study of a cluster randomized controlled trial.

Objective: The aims of this study were (1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and (2) to describe whether case management was continued after the end of the original one-year intervention.

Methods: This 24-month follow-up of a randomized controlled trial took place 12 months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records.

Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

Background: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.

A survey on worries of pregnant women--testing the German version of the Cambridge worry scale.

Background: Pregnancy is a transition period in a woman's life characterized by increased worries and anxiety. The Cambridge Worry Scale (CWS) was developed to assess the content and extent of maternal worries in pregnancy. It has been increasingly used in studies over recent years.