Does peer feedback for teaching GPs improve student evaluation of general practice attachments? A pre-post analysis.

The extent of university teaching in general practice is increasing and is in part realised with attachments in resident general practices. The selection and quality management of these teaching practices pose challenges for general practice institutes; appropriate instruments are required. The question of the present study is whether the student evaluation of an attachment in previously poorly evaluated practices improves after teaching physicians have received feedback from a colleague.

Associations and correlates of general versus specific successful ageing components.

The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling.

Training general practitioners in the ABC 5As method of delivering stop-smoking advice: a pragmatic, two-arm cluster randomised controlled trial.

This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice - ABC 5As - on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany.

Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice - ABC 5As.

We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%).

Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study).

Background: Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence.

Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1.

Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases.

Methods: The guidelines address all aspects of CR including indications, contents and delivery.

Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care-results of the cluster-randomised controlled DEBATE trial.

Background: We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus?

Methods: We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included.

Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications.

Background: Legally recognized advance directives (ADs) have to be signed by the person to whom the decisions apply. In practice, however, there are also ADs written and signed by legal proxies (surrogates) on behalf of patients who lack decision-making capacity. Given their practical relevance and substantial ethical and legal implications, ADs by proxy (AD-Ps) have received surprisingly little scientific attention so far.

Applying the COM-B behaviour model to overcome barriers to heart failure self-care: A practical application of a conceptual framework for the development of complex interventions (ACHIEVE study).

Background: Effective interventions to enhance adherence to self-care recommendations in patients with heart failure have immense potential to improve health and wellbeing. However, there is substantial inconsistency in the effectiveness of existing self-management interventions, partly because they lack theoretical models underpinning intervention development.

Aim: To outline how the capability, opportunity and motivation behaviour model has been applied to guide the development of a theory-based intervention aiming to improve adherence to heart failure self-care recommendations.

GPs' awareness of car driving among oldest patients: exploratory results from a primary care cohort.

Background: Increasingly more very old people are active drivers. Sensory, motor and cognitive limitations, and medication can increase safety risks. Timely attention to driving safety in the patient-doctor relationship can promote patient-centred solutions.

Mapping the evidence regarding school-to-work/university transition and health inequalities among young adults: a scoping review protocol.

Introduction: School-to-work/university transition is a sensitive period that can have a substantial impact on health and health behaviour over the life course. There is some indication that health and health behaviour is socially patterned in the age span of individuals in this transition (16-24 years) and that there are differences by socioeconomic position (SEP). However, evidence regarding this phenomenon has not been systematically mapped.

What the guide does not tell you: reflections on and lessons learned from applying the COM-B behavior model for designing real life interventions.

Substantial inconsistency exists in the effectiveness of existing interventions to improve heart failure (HF) self-care, which can be partially explained by the fact that self-management interventions often lack theoretical models that underpin intervention development. The COM-B behavior model is a comprehensive theoretical framework that can be used to develop effective, theory-based interventions. The aim of this article is to highlight the challenges and practical solutions when applying the COM-B model to HF self-care, in order to provide useful support for researchers intending to use the model for designing behavior change interventions.

Waterpipe use and associated consumer characteristics in the German population: Data from a national representative survey (DEBRA study).

Background: Waterpipes (WP) have a long tradition in certain regions of the world, and their use has been increasing worldwide. Current data on the use of WP in different subgroups of the German population are missing.

Objective: To estimate the current prevalence of WP use and associated socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour in the German population aged ≥14 years; to describe the frequency of use and starting age in current WP users.

Do people know that cigarette filters are mainly composed of synthetic material? A representative survey of the German population (the DEBRA study).

Introduction: Most cigarettes are smoked with filters made of synthetic plastic, which are not fully biodegradable. Littering used cigarette filters (butts) represents a substantial environmental hazard. It is unclear if people, in particular smokers, know that filters consist of synthetic plastic.

The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice.

Background: Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.

Aim: To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.

Design And Setting: Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.

Subjective Cognitive Decline May Be a Stronger Predictor of Incident Dementia in Women than in Men.

Background/objective: Subjective cognitive decline (SCD) has often been associated with an increased risk for subsequent dementia. However, sex-specific associations are understudied until now.

Methods: Cross-sectional and longitudinal associations over a follow-up period of up to 13 years were investigated in a sample of participants without objective cognitive impairment at baseline (n = 2,422, mean age = 79.

Association of anxiety symptoms with health care use and costs in people aged 85 and over.

Objective: To analyze the association of anxiety symptoms with health care use and costs in people aged 85 and older.

Methods: Baseline data from AgeQualiDe (N = 856), a multicenter prospective cohort study of primary care patients aged 85 and older, were analyzed. Anxiety symptoms (Geriatric Anxiety Inventory-Short Form) and health care use were assessed via questionnaires.

Which patients with type 2 diabetes mellitus are perceived as 'difficult' by general practitioners?

Aims: To find factors that are associated with a general practitioner's (GP's) subjective impression of a patient being 'difficult' within a sample of patients with type 2 diabetes mellitus (T2DM).

Methods: Secondary cross-sectional analysis of a cohort of GP patients with T2DM. GP questionnaire on clinical data and GPs' subjective ratings of patient attributes (including 'patient difficulty').

Enhancing self-care adherence in patients with heart failure: a study protocol for developing a theory-based behaviour change intervention using the COM-B behaviour model (ACHIEVE study).

Introduction: Although international guidelines recommend self-care as an integral part of routine heart failure management, and despite evidence supporting the positive outcomes related to self-care, patients are frequently unable to adhere. Self-care can be modified through behaviour change interventions (BCIs). However, previous self-care interventions have shown limited success in improving adherence to self-care, because they were neither theory-based nor well defined, which precludes the identification of underlying causal mechanisms as well as reproducibility of the intervention.

Cross-cultural validation of the German version of the Four-Dimensional Symptom Questionnaire (4DSQ) in multimorbid elderly people.

Purpose: Psychosomatic symptoms and mental health problems are highly prevalent in multimorbid elderly people challenging general practitioners to differentiate between normal stress and psychopathological conditions. The 4DSQ is a Dutch questionnaire developed to detect anxiety, depression, somatization, and distress in primary care. This study aims to analyze measurement equivalence between a German version and the original Dutch instrument.

General practitioners' attitudes towards patients with poorly controlled type 2 diabetes: a qualitative study.

Background: Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs' attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control.

Potentially inappropriate medication: Association between the use of antidepressant drugs and the subsequent risk for dementia.

Background: Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia.

Putting dementia awareness into general practice : The CADIF approach.

Background: International studies show that dementia is often recognized at later stages in general practice. Pure knowledge-sharing interventions could not change this in a sustainable manner. Concepts for changing attitudes of general practitioners (GPs) are required.

Subjective memory impairment in general practice : Short overview and design of a mixed methods study.

Background: Public awareness for dementia is rising and patients with concerns about forgetfulness are not uncommon in general practice. For the general practitioner (GP) subjectively perceived memory impairment (SMI) also offers a chance to broach the issue of cognitive function with the patient. This may support GPs' patient-centered care in terms of a broader frailty concept.