Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated.This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis.In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen.Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.Stigmatisierung durch Mitarbeitende im Gesundheitswesen ist eine Herausforderung in der Versorgung psychisch kranker Menschen. Der Unterricht am Krankenbett in der medizinischen Ausbildung bietet die Möglichkeit, durch direkten Kontakt reflektierte Erfahrungen im Umgang mit Kranken diverser psychosomatischer Krankheitsbilder zu machen. In der vorliegenden Studie wurde untersucht, ob der angeleitete Kontakt zu psychisch Kranken in einer einwöchigen klinischen Lehrveranstaltung der psychosomatischen Medizin bei Medizinstudierenden zu einer Reduktion der Stigmatisierung führt. Zusätzlich wurden Einflussfaktoren der Stigmatisierung untersucht.Dies erfolgte anhand einer prospektiven, nicht-randomisierten, kontrollierten Interventionsstudie im Wintersemester 2019/20 bei Medizinstudierenden im 4. Studienjahr, die an einer Praxisblockwoche der psychosomatischen Medizin teilnahmen (Interventionsgruppe). Verglichen wurde diese mit Studierenden, die im gleichen Zeitfenster eine Praxisblockwoche mit somatischem Schwerpunkt absolvierten (Kontrollgruppe). Hierbei wurde Stigmatisierung vor Beginn und unmittelbar nach Ende der Woche mittels der MICA4-Skala erhoben. Zusätzlich wurden vor Beginn Alter, Geschlecht, Erfahrung mit psychisch Kranken, Interesse am Fachgebiet Psychiatrie/Psychosomatik sowie Selbstwertgefühl erfragt. Die Auswertung der Stichprobe von 143 Studierenden mit vollständigem Basis-Datensatz erfolgte mittels Mixed-ANOVA, multipler linearer Regression und Moderatoranalyse.Im Rahmen des klinischen Unterrichts mit psychisch Kranken in der Interventionsgruppe nahm die Stigmatisierung psychisch Kranker durch Medizinstudierende im Vergleich zu Unterricht in somatischen Fächern der Kontrollgruppe signifikant stärker ab (p=.019, η2p=.04). Zudem gingen zu T0 weibliches Geschlecht, Vorerfahrung mit psychisch Kranken sowie allgemeines Interesse an den Fächern Psychiatrie oder Psychosomatik mit einer niedrigeren Stigmatisierung einher. Hingegen war Stigmatisierung bei männlichem Geschlecht und geringem Selbstwertgefühl zu Beginn der Untersuchung erhöht. Ein moderierender Effekt der Faktoren auf die Reduktion der Stigmatisierung zeigte sich nicht.Klinischer Unterricht in der medizinischen Ausbildung, der direkten Kontakt und reflektierte Erfahrungen mit psychisch Kranken ermöglicht, führt bei den Studierenden zur Reduktion einer stigmatisierenden Haltung gegenüber psychisch Kranken. Dies unterstreicht die Notwendigkeit eines praxisnahen klinischen Unterrichts unter Einbezug von Patient*innen.
Manufacturing execution systems (MESs) play a significant role in the manufacturing paradigm. MES is there to link between the Enterprise Resource Planning (ERP) systems and the plant equipment control or Supervisory Control and Data Acquisition (SCADA) applications. In this paper the MES of the INAPRO aquaponics system which was developed to support and advise the aquaponics managers in operating the complex aquaponic farms, will be presented. One important feature of the INAPRO aquaponics system is to minimize fresh water < 3%, energy and nutrient supplies. This can only be achieved by appropriate design of the fish and crop mixture, considering the fish to crop ratio, when to sow the crops etc. and to monitor the system to see whether it performing as designed or not. Therefore, the MES has a view to show the designed system with all the material flow (water, energy and nutrients) balances and also how the system will be performing for a given predictive horizon. Knowing the future developments of the system, the operator can taking corrective measures to make sure that the system is behaving as required. An example of water balance of a system with 40 m3 fish tanks coupled with a hydroponic NFT system with 1,000 m2 which can produce five tons of Tilapia and 75 tons of tomato yearly is given.
The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.
Background: Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden.To reduce this burden, several programmes for optimising the care for these diseases have been developed.In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied.These DMPs have proven effective.Nevertheless, there are opportunities for improvement.Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation.The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD.This programme consists of four components:
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.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.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.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.
Die Förderung von Selbstmanagement und das Angebot von zusätzlichen Unterstützungsangeboten für Patient*innen mit besonderem Bedarf stellen wichtige Aspekte in der Weiterentwicklung der Disease Management Programme (DMP) für Diabetes Mellitus Typ 2 und koronare Herzkrankheit dar. Ziel von P-SUP ist es, mit einem strukturierten Selbstmanagement-Programms mit gestufter risikostratifizierter Unterstützung die Versorgung zu verbessern und die Anzahl der Krankenhausaufenthalte von Patient*innen beider DMPs zu reduzieren.
ABSTRACT Objective The German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and harmful (exhibit health events) drinking patients. We aimed to estimate the implementation of this recommendation using data from the general population in Germany. Design Cross-sectional analysis of data (2021/2022) of a nationally representative household survey. Setting Population of Germany. Participants Representative sample of 2,247 adult respondents (>18 years) who reported hazardous or harmful drinking according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; score females: 4-12, males: 5-12). Main outcome measure Ever receipt of “brief GP advice on, or support with, reducing alcohol consumption”. Differences in the likelihood of ever receiving advice and/or support (yes/no) relative to respondents’ sociodemographic, smoking, and alcohol consumption characteristics were estimated using logistic regressions. Results Ever receipt of GP advice on/support with reducing alcohol was reported among 6.3% (95%CI=5.3%-7.4%), and the offer of support among 1.5% (95%CI=1.1%-2.1%) of the hazardous and harmful drinking respondents. The likelihood of having ever received advice/support was positively associated with being older (odds ratio (OR)=1.03 per year, 95%CI=1.01-1.04), a current or former (versus never) smoker (OR=2.36, 95%CI=1.46-3.80; OR=2.17, 95%CI=1.23-3.81), and with increasing alcohol consumption (OR=1.76 per score, 95%CI=1.59-1.95). One in two harmful drinking respondents (AUDIT-C score 10-12) reported appropriate advice/support. The likelihood was negatively associated with being female (e.g., OR=0.32, 95%CI=0.21-0.48), having a medium and high (versus low) education, and with increasing household income. Conclusions A small proportion of people drinking at hazardous and harmful levels in Germany report having ever received brief GP advice on, or support with, reducing alcohol consumption. The implementation of appropriate advice or support seems to be strongly linked to specific sociodemographic characteristics, tobacco smoking, and the alcohol consumption level. Strengths and limitations of this study The principal strength of this study is the large, nationally representative population sample. The cross-sectional study design and temporality issues with our measures (alcohol consumption was measured with reference to the present and the outcome as “ever receipt of GP advice or support”) limited our ability to explore causal relationships. The outcome measure had a complex, not entirely hierarchical structure, which may have led to respondents being unsure of which response option to select. Data were collected during the COVID-19 pandemic, during which alcohol consumption in Germany seemed to have changed. It is unclear how this might have influenced GPs’ behaviour. Due to the socially loaded topic, respondents may not have answered truthfully or repressed a previous conversation with their GP on their alcohol consumption. We did not assess the GPs’ view on the topic.
