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"Kalitzkus, Vera"
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General practitioners treating their own family members: a cross-sectional survey in Germany
Background
In Germany, there are neither guidelines provided by the medical associations nor a public discussion about general practitioners (GPs) treating their family members. Only few studies on this topic from the primary care setting exist. The aim of this study is to describe GPs’ treatment of family members and to generate empirical data on the most common reasons for this.
Methods
In June 2018 we conducted a postal survey among GPs in the North Rhine region of Germany. The questionnaire was developed in a stepwise process including initial expert panels, interviews with GPs, item construction workshops, cognitive pre-tests and pilot testing with 40 questionnaires. The final questionnaire addressed: type and frequency of treatment, documentation and place of treatment, engagement as the official GP as well as reasons for and against the treatment. For data evaluation, descriptive and explorative statistical analyses were conducted.
Results
Overall, 393 questionnaires were returned (response rate 39.8%). 96.7% of the GPs had treated at least one family member during the last 12 months. Services that were provided frequently (more than three times in the last 12 months) included the prescription or dispensing of medication (partner 45%, children 37%, parents 43%, partner’s parents 26%), physical examinations (partner 18%, children 24%, parents 25%, partner’s parents 15%), and the arrangement or provision of laboratory tests (partner 14%, children 7%, parents 16%, partner’s parents 9%). Less than one third of the study participants always treated their relatives in their office. Male GPs more often provided care to family members (except children) registered in their practice. Senior male GPs treated their relatives more often than junior female GPs. Family members were most commonly treated for practical reasons.
Conclusion
The subject of GPs treating their relatives is of high everyday relevance, since nearly all GPs are involved in the treatment of their family members. Frequent at-home treatments and low documentation rates may indicate risks due to deviating from the professional routine.
Journal Article
Family conferences and shared prioritisation to improve patient safety in the frail elderly (COFRAIL): study protocol of a cluster randomised intervention trial in primary care
Background
Frailty in elderly patients is associated with an increased risk of poor health outcomes, including falls, delirium, malnutrition, hospitalisation, and mortality. Because polypharmacy is recognised as a possible major contributor to the pathogenesis of geriatric frailty, reducing inappropriate medication exposure is supposed to be a promising approach to improve health-related quality of life and prevent adverse outcomes. A major challenge for the process of deprescribing of inappropriate polypharmacy is to improve the communication between general practitioner (GPs), patient and family carer. This study investigates the effects of a complex intervention in frail elderly patients with polypharmacy living at home.
Methods
This is a cluster randomised controlled trial including 136 GPs and 676 patients. Patients with a positive clinical screening for frailty are eligible if they are aged 70 years or older, receiving family or professional nursing care at home, and taking in five or more drugs per day. Exclusion criteria are higher grade of dementia and life expectancy of 6 months or less. The GPs of the intervention group receive an educational training promoting a deprescribing guideline and providing information on how to conduct a family conference focussing on prioritisation of treatment goals concerning drug therapy. During the 1-year intervention, GPs are expected to perform a total of three family conferences, each including a structured medication review with patients and their family carers. GPs of the control group will receive no training and will deliver care as usual. Geriatric assessment of all patients will be performed by study nurses during home visits at baseline and after 6 and 12 months. The primary outcome is the hospitalisation rate during the observation period of 12 months. Secondary outcomes are number and appropriateness of medications, mobility, weakness, cognition, depressive disorder, health-related quality of life, activities of daily living, weight, and costs of health care use.
Discussion
This study will provide evidence for a pragmatic co-operative and patient-centred educational intervention using family conferences to improve patient safety in frail elderly patients with polypharmacy.
Trial registration
German Clinical Trials Register,
DRKS00015055
(WHO International Clinical Trials Registry Platform [ICTRP]). Registered on 6 February 2019.
Journal Article
The Tapestry of Health, Illness and Disease
Human suffering and illness as well as health and healing are topics of ongoing actuality. In a world of growing complexity and interrelatedness a broader perspective on these topics is needed. The global conference project on \"Making Sense of: Health, Illness and Disease\" is a forum for scholars from various countries who are interested in deepening the interdisciplinary discourse on the subject. This book is the outcome of the 5th conference held at Mansfield College, Oxford, in July 2006. It combines essays that transgress traditional disciplinary boundaries in the field of health care delivery and medicine. It thus will be of interest to students in the medical humanities, researchers as well as health care providers who wish to gain insight into the various perspectives through which health, illness and disease can be understood.
eBook
Social studies of health, illness and disease : perspectives from the social sciences and humanities
The studies of the human being in health and illness and how he can be cared for is concerned with more than the biological aspects and thus calls for a broader perspective. Social sciences and medical humanities give insight into the context and conditions of being ill, caring for the ill, and understanding disease in a respective socio-cultural frame. This book brings together scholars from various countries who are interested in deepening the interdisciplinary discourse on the subject. This book is the outcome of the 4th global conference on \"Making Sense of: Health, Illness and Disease,\" held at Mansfield College, Oxford, in July 2005. This volume will be of interest to students in the medical humanities, researchers as well as health care provider who wish to gain insight into the various perspectives through which we can understand health, illness and disease.
eBook
Bordering Biomedicine
Biomedicine is the dominant organizing framework of modern medicine but it is not the only lens through which health, illness and disease can be understood. This interdisciplinary collection of essays brings together scholars from around the world who seek to probe the boundaries of biomedicine. This book is the outcome of the third global conference on \"Making Sense of: Health, Illness and Disease,\" held at St Catherine's College, Oxford, in July 2004. The papers selected for this volume take a variety of theoretical positions but share an interest in the social study of health, illness and disease. They consider how biomedicine is a cultural system and is imbued with other meanings and that a full exploration of health, illness and disease requires a variety of perspectives, including those of social scientists, humanists and practicing clinicians. This volume will be of interest to students, researchers and health care providers who wish to gain insight into the many ways through which we can understand health, illness and disease.
eBook
Activation of the maternal caregiving system by childhood fever - a qualitative study of the experiences made by mothers with a German or a Turkish background in the care of their children
Doc number: 35 Abstract Background: Childhood fever represents a frequent cause to consult a primary care physician. \"Fever phobia\" describes a fearful and irrational view of fever shared by many parents with different cultural backgrounds. The study aims to explain the experiences of mothers of children having a fever and to analyze the role of the mothers' cultural background with regard to their experiences by comparing the accounts of mothers with a German with those from a Turkish background. Disease and context specific knowledge about the influence of culture can be important for effective counselling. Methods: We applied a qualitative approach using in-depth interviews with 11 mothers with a Turkish and 9 with a German background living in Germany. The interviews were conducted at the participants´ homes from May to October 2008. Data was audio-recorded and transcribed verbatim. Grounded Theory was used as a framing methodology including open, axial and selective coding. Analysis was performed in a group with members of different professional and cultural backgrounds. Results: Mothers experienced their child's fever not merely as elevated temperature but as a potentially dangerous event. A deeply rooted urge to protect the child from harm was central to all participants' experience. The caregiving system model offers a good theoretical foundation to explain the findings as it incorporates the unique relational quality of care giving mothers to their children. The cultural background represents an important context variable influencing the explanatory models and strategies of dealing with fever. The identified culturally influenced concepts sometimes match and sometimes conflict with medical knowledge. Conclusion: By applying the caregiving system model which is a part of attachment theory (Bowlby) maternal actions can be understood as an understandable attempt to protect the child from harm. The mothers´ decisions what to do when a child has a fever can be culturally influenced. This may lead either to a frequent use of services or to an underestimation of the child's state of health. The mothers´ caring role and emotional state should be acknowledged; her concerns, explanatory models and strategies should be elicited and taken seriously in order to maintain a trustful relationship, provide effective counselling and thereby insuring optimal care for the children.
Journal Article