Search

Background: Clinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence., Methods: A multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire., Results: The study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi 2 (1)  = 1.65, p = 0.199, T1: Chi 2 (1)  = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion., Conclusions: While the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers., Trial Registration: https://drks.de/search/de/trial/DRKS00028895., (© 2024. The Author(s).)

Objective: The influence of guideline recommendations and other factors on the utilization of psychosocial interventions in people with severe mental illness was examined., Methods: Data from a cross-sectional study of 397 people with severe mental illness were analysed descriptively., Results: Patients are less likely to receive therapies with a strong recommendation compared to other levels of recommendation. Various other factors are diffusely associated with utilization rates, but no ubiquitous predictors could be identified across all therapies., Conclusion: Current practice in the use of psychosocial interventions does not follow guideline recommendation strength. Interventions with strong recommendations are probably not available across services. Consequently, routine practice is not able to follow guideline recommendations according to their strength. Other consistent predictors could not be identified., Competing Interests: Alkomiet Hasan erhielt Vortragshonorare von AbbVie, Advanz, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Er war Mitglied in Advisory Boards für Boehringer-Ingelheim, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Einladungen zu Kongressen oder Essen wurden nicht angenommen. Er ist Herausgeber der AWMF S3-Leitlinie Schizophrenie, Angestellter des Freistaats Bayern und der Bezirkskliniken Schwaben. Karel Frasch hat Kongressreiseunterstützungen von Janssen erhalten. Er ist stellv. Sprecher von ackpa und Mitglied im Vorstand der DGPPN. Alle anderen Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Assessing the experience with and the attitudes towards exercise therapy in persons with severe mental illness (SMI). Furthermore, potential variables of high preference towards exercise therapy are investigated., Methods: Cross-sectional observational study of SMI patients aged between 18 and 65 years (n=385). Patients were interviewed by trained staff using standardised instruments. Potential variables were analysed using a hierarchic binary logistic regression model., Results: 84,4% of SMI patients had a high preference for exercise therapy; of these, 44,1% exercised regularly. Among patients with severe mental illness especially a higher value in the GAF-assessment (p=0,041) and living in a metropolitan area (p=0,011) predict a high preference for exercise therapy., Conclusion: Most of the patients with severe mental illness interviewed in this study place a surprisingly high value on sports and exercise therapy. Due to the increasing evidence with regard to positive effects of these therapies, it may be an excellent starting point to expand sports and exercise therapy as part of a comprehensive treatment plan. At the same time, strategies for everyday transfer need to be implemented more rigorously., Competing Interests: Alkomiet Hasan ist Herausgeber der AWMF S3-Leitlinie Schizophrenie. Er erhielt Vortragshonorare von Janssen, Otsuka, Lundbeck und Recordati und war Mitglied in Advisory Boards dieser Firmen und bei Rovi. Karel Frasch hat Kongressreiseunterstützungen von Janssen erhalten. Er ist außerdem Mitglied des Geschäftsführenden Ausschusses von ackpa. Stephan Heres hat in den zurückliegenden drei Jahren Vortragshonorare der Firmen Johnson & Johnson und Otsuka/Lundbeck erhalten, ferner Honorare für wissenschaftliche Beratertätigkeit in klinischen Studien der Firmen TEVA, ROVI und KYE., (Thieme. All rights reserved.)

Objective: Peer support is playing an increasing role in the treatment of severely mentally ill people. International findings are available on its effectiveness. However, little is known about knowledge, use and benefit assessment in Germany. This paper addresses this question and presents results from an observational study with 10 participating clinics in southern Germany., Methods: As part of the observational cross-sectional study with people with severe mental illness (IMPPETUS, N=359), sociodemographic and illness- and treatment-associated data were collected by trained study staff between March 2019 and September 2019. Binary logistic regression was used to analyse a possible association with peer support use., Results: 38% (N=138) of respondents reported knowledge about the possibility of peer support; 15% (N=55) affirmed its use. Use of peer support varied across sites (between 6.5 and 37.5%) and was associated with household income. Significantly less frequent use of peer support was among those with high versus low household income (OR=0.20 [95% CI: 0.06-0.68], p=0.01). Of respondents with peer support use (N=55), 78% reported perceiving peer support to be helpful or highly helpful., Discussion: Peer support not only proves to be effective under study conditions with regard to various outcomes, but is also assessed as beneficial under routine conditions in a defined care region by the majority of users. However, only a few respondents knew and used the possibility of peer support., Conclusion: In order to implement peer support more strongly, information about this kind of service should be provided more effectively and a dialogue about successful implementation experiences should be initiated on a regional level., Competing Interests: Stephan Heres hat in den zurückliegenden drei Jahren Vortragshonorare der Firmen Johnson & Johnson und Otsuka/Lundbeck erhalten, ferner Honorare für wissenschaftliche Beratertätigkeit in klinischen Studien der Firmen TEVA, ROVI und KYE.Darüber hinaus liegt kein Interessenkonflikt vor., (Thieme. All rights reserved.)

Aim: Investigation of the compatibility of work and family life for physicians in the Munich metropolitan area., Methods: Survey of a representative sample of 1,800 physicians using a questionnaire., Results: Men were less satisfied (7% very satisfied vs. 21%) with compatibility between work and family life than women. The group least satisfied overall was hospital-based physicians (p=0.000, chi-square=122.75). Women rather than men cut back their career due to children, perceived their professional advancement as impaired, desisted from establishing private practice or quit hospital employment altogether. Respondents strove for flexible childcare and makeshift solution if the established service failed. Most did not have that at their disposal. Hospital-based physicians wished for predictable working hours, and would like to have a say in the structure of their schedule. For the majority this was not the case. While for 80% it would be important to participate in the definition of their working hours, this was only possible in 17%. 86% found the opportunity to work part-time important, but many doctors (more than 30%) did not have that option. The biggest help for office-based physicians would be an expedited procedure by the Bavarian Association of Statutory Health Insurance Physicians (KVB) when applying for a proxy. The second most important would be the ability to hand over on-call duties. 36% of respondents felt that compatibility of work and family life was best achieved outside of patient care, during residency 42% believed this to be the case. Only 6% of physicians felt the best compatibility to be achieved in a hospital. Among the physician owners of practices, 34% considered their model to be the best way to reconcile both aspects of life., Conclusion: More flexible options for childcare and more influence on the definition of working hours are necessary in order to better reconcile work and family life. For office-based physicians it must be made easier to find a substitute. Currently, especially women consider children as hindering their careers. Hospitals are perceived as extremely unfavorable workplaces for achieving compatibility between work and family life., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Varicella is the most common infection which is preventable by vaccination. Even though varicella usually runs a mild course, some patients require hospitalization and a small number die. The German Immunization Commission (STIKO) in 2004 recommended varicella vaccination for all children. The discussion remains controversial. We review the most frequently asked questions about varicella vaccination, with emphasis on its effectiveness with the possibilities for use after incubation or exposure to limit the spread, as well as its effects on the prevalence of herpes zoster. The average age of varicella patients has not increased in the USA after 10 years of childhood vaccination. In addition, there has not been an expected increase of herpes zoster in non-immunized individuals. Vaccinated children have a lower incidence of herpes zoster than those who have had varicella. Finally, a recent study using a live zoster vaccine with increased antigenicity in older adults halved the incidence of herpes zoster and reduced that of post-herpetic neuralgia to one-third.