@article{BachfischerBarbosaRojasetal.,
  author    = {Bachfischer, Andreas and Barbosa, Martha Cecilia and Rojas, Angel Alberto Riveras and Bechler, Reinaldo and Schwienhorst-Stich, Eva-Maria and Kasang, Christa and Simmenroth, Anne and Parisi, Sandra},
  title     = {Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned},
  series = {International Journal for Equity in Health},
  volume    = {22},
  journal   = {International Journal for Equity in Health},
  doi       = {10.1186/s12939-023-01966-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357261},
  abstract  = {Background Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. Methods This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. Results A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0\%) and reported knowledge on health care routes (46.0\%). Unemployment (87.9\%) and inadequate housing (57.8\%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). Conclusion People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.},
  language  = {en}
}
@phdthesis{BraeunlingverhRiegel2023,
  author    = {Br{\"a}unling [verh. Riegel], Lisa-Marie},
  title     = {Durchf{\"u}hrung und Evaluation einer psychiatrischen Kurz-Psychotherapie zur Behandlung von depressiven Patienten in der haus{\"a}rztlichen Praxis: eine Machbarkeitsstudie},
  doi       = {10.25972/OPUS-33024},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-330248},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Der Weg von der Diagnose einer Depression, bis hin zu einer ad{\"a}quaten Therapie, ist oft eine langer. Der Hausarzt ist dabei zumeist der erste Ansprechpartner. Sulz \& Deckert (2012) haben zur Durchf{\"u}hrung einer psychiatrischen Kurz-Psychotherapie Psychotherapiekarten zur Anwendung durch {\"A}rzte in ihrer Sprechstunde entwickelt. Ihre Wirksamkeit wurde in der ambulanten Psychotherapie bereits best{\"a}tigt, jedoch die M{\"o}glichkeit ihrer Anwendung im haus{\"a}rztlichen Bereich bislang noch nicht untersucht. Diese Dissertation soll pr{\"u}fen, ob sich die Sprechstundenkarten, im haus{\"a}rztlichen Setting, effektiv einsetzen lassen und ob generell der Bedarf an einer solchen Methodik seitens der Haus{\"a}rzte besteht.},
  subject      = {Kurzpsychotherapie},
  language  = {de}
}
@article{DreischulteSanftenbergHennigsetal.2023,
  author    = {Dreischulte, Tobias and Sanftenberg, Linda and Hennigs, Philipp and Z{\"o}llinger, Isabel and Schwaiger, Rita and Floto, Caroline and Sebastiao, Maria and K{\"u}hlein, Thomas and Hindenburg, Dagmar and Gagyor, Ildik{\´o} and Wildgruber, Domenika and Hausen, Anita and Janke, Christian and H{\"o}lscher, Michael and Teupser, Daniel and Gensichen, Jochen},
  title     = {Detecting medication risks among people in need of care: performance of six instruments},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {20},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {3},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph20032327},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304921},
  year      = {2023},
  abstract  = {Introduction: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection. Methods: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa. Results: We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95\% CI, 87.2-94.9)\% and the overall PPO prevalence was 63.7 (57.1-69.9\%)\%. The detected PIM prevalence ranged from 76.5\%, for FORTA-C/D, to 6.6\% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7\%) and FORTA-A (62.8\%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1\%), and increased to 79.2\% when distinct items from STOPP were added. Conclusion: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.},
  language  = {en}
}
@article{GagyorGreserHeuschmannetal.2021,
  author    = {G{\´a}gyor, Ildik{\´o} and Greser, Alexandra and Heuschmann, Peter and R{\"u}cker, Viktoria and Maun, Andy and Bleidorn, Jutta and Heintze, Christoph and Jede, Felix and Eckmanns, Tim and Klingeberg, Anja and Mentzel, Anja and Schiemann, Guido},
  title     = {REDuction of Antibiotic RESistance (REDARES) in urinary tract infections using treatments according to national clinical guidelines: study protocol for a pragmatic randomized controlled trial with a multimodal intervention in primary care},
  series = {BMC Infectious Diseases},
  volume    = {21},
  journal   = {BMC Infectious Diseases},
  doi       = {10.1186/s12879-021-06660-0},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-264725},
  year      = {2021},
  abstract  = {Background: Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40\% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine. Methods/design: In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10\% absolute difference in the prescribing rate after one year, with a significance level of 5\% and a power of 86\%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10\%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention. Discussion: If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care.},
  language  = {en}
}
@phdthesis{Hajduk2024,
  author    = {Hajduk, Maurice Martin},
  title     = {Darf es etwas mehr sein? Neuroenhancement im Studium - eine Befragung an W{\"u}rzburger Hochschulen},
  doi       = {10.25972/OPUS-35981},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-359812},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2024},
  abstract  = {Neuroenhancement (NE) bezeichnet die Einnahme psychotroper Substanzen mit dem Ziel der geistigen Leistungssteigerung oder Beruhigung. NE wird durch gesunde Perso- nen genutzt. Es besteht somit keine Indikation zur Einnahme psychotroper Wirkstoffe. Zum NE genutzte Substanzen sind z.B. Koffeintabletten, verschreibungspflichtige Medi- kamente oder illegale Substanzen. Die bisherige Forschung findet Hinweise auf einen Zusammenhang zwischen NE und ADHS-Symptomen, einigen Aspekten psychischer Gesundheit, sowie Substanzkonsum. Bisher gibt es keine Forschung zu NE am Hoch- schulstandort W{\"u}rzburg. Es wurde eine anonyme online Querschnittsbefragung im ersten Quartal 2021 durchge- f{\"u}hrt. Eingeladen waren 5600 Studierende der Julius-Maximilians-Universit{\"a}t W{\"u}rzburg und der Hochschule f{\"u}r angewandte Wissenschaften W{\"u}rzburg Schweinfurt. Der Frage- bogen bestand aus 53 Items und enthielt u. a. die folgenden validierten Messinstrumente: ASRS, PSS-10, PHQ-4 und AUDIT-C. Die Response Rate lag bei 18\% (n = 1011). Das Wissen {\"u}ber NE war weit unter den Stu- dierenden verbreitet. Die Pr{\"a}valenz f{\"u}r Neuroenhancement im Studium lag bei 12.7\%. Die drei meistgenannten Substanzen waren Koffeintabletten (6.6\%), Cannabis (4.5\%) und Methylphenidat (4.3\%). H{\"a}ufigster Anlass f{\"u}r NE war die Pr{\"u}fungsvorbereitung. Es zeigten sich deutliche Unterschiede zwischen den Fachbereichen, u.a. hinsichtlich der Pr{\"a}valenz von NE. ADHS-Symptomen, Stress, {\"A}ngstlichkeit, und Depressivit{\"a}t waren positiv mit NE assoziiert. Ein st{\"a}rkerer Effekt ergab sich f{\"u}r den Zusammenhang zwi- schen NE und riskanten Alkoholkonsum bzw. Tabakkonsum. Diese Ergebnisse wurden durch eine binomial logistische Regression best{\"a}tigt. Die konsumierten Substanzen, das Wissen {\"u}ber NE, die Pr{\"a}valenz von NE und die Gr{\"u}nde f{\"u}r dessen Nutzung f{\"u}gen sich nahtlos in die bisherige Forschung ein. Auch die Assoziation zwischen ADHS-Symptomen, Stress, {\"A}ngstlichkeit, Depressivit{\"a}t, riskan- tem Alkoholkonsum und Tabakkonsum best{\"a}tigt bisherige Forschungsergebnisse. Es konnte gezeigt werden, dass rund ein Zehntel der Studierenden NE bereits genutzt haben. In Anbetracht der gesundheitlichen Gefahren, die mit NE einhergehen ist die Etab- lierung bzw. der Ausbau von Aufkl{\"a}rung-, Beratungs- und Hilfsangeboten f{\"u}r Studie- rende anzustreben sowie weitere Forschung zum Thema indiziert.},
  subject      = {Psychische Gesundheit},
  language  = {de}
}
@phdthesis{Harasim2022,
  author    = {Harasim, Anna Sophia},
  title     = {Nutzung von Komplement{\"a}r- und Alternativmedizin und Evaluation der Impfquote bei erwachsenen Patienten mit prim{\"a}ren Immundefekten},
  doi       = {10.25972/OPUS-29229},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-292290},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Der Begriff CAM beschreibt ein breites Spektrum von Therapiemethoden, die nicht g{\"a}nzlich Teil des konventionellen Gesundheitssystems sind. Da CAM h{\"a}ufig als immunstimulierend beworben wird, kann die Nutzung gerade f{\"u}r Patienten mit prim{\"a}rem Immundefekt interessant sein. Aufgrund des erh{\"o}hten Infektionsrisikos in diesem Patientenkollektiv empfiehlt das Robert Koch-Institut dar{\"u}ber hinaus spezielle Indikationsimpfungen zur Infektionsprophylaxe. Ziel dieser Studie war es, Informationen zur Inanspruchnahme von CAM bei Patienten mit prim{\"a}rem Immundefekt zu sammeln sowie einen {\"U}berblick {\"u}ber deren Impfstatus zu geben. In dieser multizentrischen Studie wurden 101 Patienten in die Analyse eingeschlossen. Im Zentrum der Studie stand ein selbst entwickelter Fragebogen zur Inanspruchnahme von CAM. Dieser wurde durch etablierte psychologische Tests (MARS-D, WHO-5, PHQ9 und EFK) erg{\"a}nzt. Im Rahmen ihrer Erkrankung hatten 72 \% der befragten Patienten CAM bereits angewandt. Charakteristisch f{\"u}r den klassischen CAM-Nutzer zeigte sich das weibliche Geschlecht, ein mittleres Alter und mindestens ein Realschulabschluss. Am verbreitetsten waren die Nutzung von Bewegungstraining, Nahrungserg{\"a}nzungsmitteln sowie Hom{\"o}opathie. Ungeachtet der STIKO-Empfehlungen zeigten sich im Patientenkollektiv niedrige Durchimpfungsraten. Allerdings waren die Impfquoten {\"a}hnlich hoch wie die der deutschen Allgemeinbev{\"o}lkerung. Oft waren zudem gerade saisonale Impfungen, wie Influenza, unzureichend erfolgt bzw. dokumentiert. Bei der Betreuung von Patienten mit Immundefekten sollte daher mehr Wert auf die Um-setzung der Impfempfehlungen gelegt werden. Da auch CAM f{\"u}r das Wohlergehen der Patienten f{\"o}rderlich sein kann, sollten {\"A}rzte im klinischen Alltag eine Plattform zur Diskussion von Bed{\"u}rfnissen bieten, die {\"u}ber die konventionelle Therapie hinausgehen.},
  subject      = {Komplement{\"a}rmedizin},
  language  = {de}
}
@phdthesis{Hemkeppler2023,
  author    = {Hemkeppler, Juliane},
  title     = {Qualitative Studie zu Einflussfaktoren auf das Verordnungsverhalten bei der Therapie akuter unkomplizierter Harnwegsinfekte in der ambulanten allgemeinmedizinischen Versorgung in Deutschland},
  doi       = {10.25972/OPUS-32006},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-320061},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Hintergrund: Die Studie ermittelte die Einflussfaktoren auf haus{\"a}rztliches Verord¬nungs-verhalten bei der Therapie von akuten unkomplizierten HWI in Deutschland. Methodik: In offenen Leitfadeninterviews mit Haus{\"a}rztinnen und Haus{\"a}rzten in Stadt und Region W{\"u}rzburg wurde untersucht, wie diese ihre Verordnungsentscheidung treffen und durch welche Faktoren sie dabei beeinflusst werden. Von besonderem Interesse wa-ren der Umgang mit Patientenerwartungen, Gr{\"u}nde f{\"u}r Abweichungen vom {\"u}blichen Thera¬pie¬verhalten, Unsicherheiten bei der Verordnungsentscheidung und W{\"u}nsche nach Un¬ter¬st{\"u}tzung bei der Behandlung von HWI. Die Interviews wurden mithilfe der Soft-ware MAXQDA anonymisiert transkribiert und anhand der inhaltlich strukturierenden qualitativen Inhaltsanalyse nach Kuckartz ausgewertet. Ergebnisse: Die Studie zeigte, dass Haus{\"a}rztinnen und Haus{\"a}rzte bei der Behandlung von Patientinnen mit HWI aufgrund der Notwendigkeit, wirtschaftlich zu agieren, Zeit-druck empfinden. Dies erschwert ausf{\"u}hrliche Beratungsgespr{\"a}che, was sich auf das Ver-ordnungsverhalten auswirkt. Hohen Beratungsbedarf sahen die Teilnehmenden insbeson-dere bez{\"u}glich der Pr{\"a}vention von HWI, aber auch im Umgang mit Erwartungen, Erfah-rungen und hohem Leidensdruck der Patientinnen. Die genannten Faktoren wurden f{\"u}r die Verordnungsentscheidung teilweise als wichtiger angesehen als die Leitlinienemp-fehlungen. Die Vermeidung finanzieller Belastung der Patien¬tinnen wurde ebenfalls als relevanter Faktor gesehen, da bei HWI Pr{\"a}parate zur symptomatischen The¬rapie anders als Antibio¬tika durch die Krankenkassen nicht finanziert werden. Der Wunsch nach vali-den In¬formationen zur lokalen Resistenzlage uropathogener Erreger weist zudem darauf hin, dass {\"A}rztinnen und {\"A}rzte ihr Verordnungsverhalten an Informa¬tionen zur Resistenz-situ¬ation orientieren w{\"u}rden. Diskussion: Wirtschaftlichkeit und Zeitdruck sowie Erwartungen und hoher Beratungs-bedarf der Patien¬tinnen wirken einer leitliniengerechten Behandlung von HWI nach Ein-sch{\"a}tzung der Haus{\"a}rztinnen und Haus{\"a}rzte entgegen. Diese Faktoren bieten Ansatz-punkte zum Abbau von Hindernissen f{\"u}r Haus{\"a}rztinnen und Haus{\"a}rzte und zur Steige-rung der Leitlinienad¬h{\"a}¬renz. Die Studienergebnisse k{\"o}nnen als Basis f{\"u}r Interventionen zur F{\"o}rderung einer rationalen Antibiotikaverordnung dienen.},
  subject      = {Harnwegsinfektion},
  language  = {de}
}
@article{KaussnerKuraszkiewiczSchochetal.2020,
  author    = {Kaussner, Y. and Kuraszkiewicz, A. M. and Schoch, S. and Markel, Petra and Hoffmann, S. and Baur-Streubel, R. and Kenntner-Mabiala, R. and Pauli, P.},
  title     = {Treating patients with driving phobia by virtual reality exposure therapy - a pilot study},
  series = {PLoS ONE},
  volume    = {15},
  journal   = {PLoS ONE},
  number    = {1},
  doi       = {10.1371/journal.pone.0226937},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201051},
  pages     = {e0226937},
  year      = {2020},
  abstract  = {Objectives Virtual reality exposure therapy (VRET) is a promising treatment for patients with fear of driving. The present pilot study is the first one focusing on behavioral effects of VRET on patients with fear of driving as measured by a post-treatment driving test in real traffic. Methods The therapy followed a standardized manual including psychotherapeutic and medical examination, two preparative psychotherapy sessions, five virtual reality exposure sessions, a final behavioral avoidance test (BAT) in real traffic, a closing session, and two follow-up phone assessments after six and twelve weeks. VRE was conducted in a driving simulator with a fully equipped mockup. The exposure scenarios were individually tailored to the patients' anxiety hierarchy. A total of 14 patients were treated. Parameters on the verbal, behavioral and physiological level were assessed. Results The treatment was helpful to overcome driving fear and avoidance. In the final BAT, all patients mastered driving tasks they had avoided before, 71\% showed an adequate driving behavior as assessed by the driving instructor, and 93\% could maintain their treatment success until the second follow-up phone call. Further analyses suggest that treatment reduces avoidance behavior as well as symptoms of posttraumatic stress disorder as measured by standardized questionnaires (Avoidance and Fusion Questionnaire: p < .10, PTSD Symptom Scale-Self Report: p < .05). Conclusions VRET in driving simulation is very promising to treat driving fear. Further research with randomized controlled trials is needed to verify efficacy. Moreover, simulators with lower configuration stages should be tested for a broad availability in psychotherapy.},
  language  = {en}
}
@article{KleinertMuellerFuraijatetal.2019,
  author    = {Kleinert, Evelyn and M{\"u}ller, Frank and Furaijat, Ghefar and Hillermann, Nele and Jablonka, Alexandra and Happle, Christine and Simmenroth, Anne},
  title     = {Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting},
  series = {Conflict and Health},
  volume    = {13},
  journal   = {Conflict and Health},
  doi       = {10.1186/s13031-019-0223-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325869},
  year      = {2019},
  abstract  = {Background Providing adequate healthcare to newly arrived refugees is considered one of the significant challenges for the German healthcare system. These refugees can be classified mainly into two groups: asylum seekers (who have applied for asylum after arrival in Germany and are waiting for the refugee-status decision) and resettlement refugees (who have already been granted asylum status before arriving in Germany). Whereas earlier studies have explored the health status of asylum seekers especially in terms of mental and behavioural disorders and infectious diseases without distinguishing between these two groups, our study aims to evaluate possible relationships of asylum status and medical needs of these two groups with a special focus on mental and behavioural disorders and infectious diseases. Methods In this retrospective observational study, collected data on all asylum-seeker and resettlement-refugee patients (N = 2252) of a German reception centre (August 2017 to August 2018) is analysed by absolute and relative frequencies and medians. Patient data, collected by chart review, include age, gender, country of origin, asylum status, and diagnoses (ICD-10). To describe the relationship between sociodemographic factors (including asylum status) and diagnoses, we used tests of significance and bivariate correlations with Spearman correlation coefficients. All collected data are pseudonymised. Results Of all 2252 patients, 43\% were resettlement refugees. In almost all ICD-10 categories, asylum seekers received significantly more diagnoses than resettlement refugees. According to our data, asylum seekers presented with mental and behavioural disorders nine times more often (9\%) than resettlement refugees (1\%). In the case of infectious diseases, the results are mixed: asylum seekers were twice as frequently (11\%) diagnosed with certain infectious and parasitic diseases than resettlement refugees (5\%), but resettlement refugees were treated twice as often (22\% of the asylum seekers and 41\% of the resettlement refugees) for diseases of the respiratory system, of which 84\% were acute respiratory infections (in both groups). Conclusion This study indicates that patients with unregulated migration more frequently present symptoms of psychiatric diseases and somatoform symptoms than resettlement refugees. A health policy approach within migration policy should aim to enable persecuted persons to migrate under regulated and safe conditions. Trial registration German Clinical Trials Register: DRKS00013076, retrospectively registered on 29.09.2017.},
  language  = {en}
}
@article{KurotschkaFulgenzioDaCasetal.2022,
  author    = {Kurotschka, Peter Konstantin and Fulgenzio, Chiara and Da Cas, Roberto and Traversa, Giuseppe and Ferrante, Gianluigi and Massidda, Orietta and G{\´a}gyor, Ildik{\´o} and Aschbacher, Richard and Moser, Verena and Pagani, Elisabetta and Spila Alegiani, Stefania and Massari, Marco},
  title     = {Effect of fluoroquinolone use in primary care on the development and gradual decay of Escherichia coli resistance to fluoroquinolones: a matched case-control study},
  series = {Antibiotics},
  volume    = {11},
  journal   = {Antibiotics},
  number    = {6},
  issn      = {2079-6382},
  doi       = {10.3390/antibiotics11060822},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-278771},
  year      = {2022},
  abstract  = {The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case-control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95\%CI 1.92-3.70, p < 0.0001), decreased during the second year (OR 1.54, 95\%CI 1.09-2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95\%CI 0.80-1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use.},
  language  = {en}
}
@article{KurotschkaTiedemannWolfetal.2021,
  author    = {Kurotschka, Peter Konstantin and Tiedemann, Elena and Wolf, Dominik and Thier, Nicola and Forster, Johannes and Liese, Johannes G. and Gagyor, Ildiko},
  title     = {Management of common infections in German primary care: a cross-sectional survey of knowledge and confidence among General Practitioners and outpatient pediatricians},
  series = {Antibiotics},
  volume    = {10},
  journal   = {Antibiotics},
  number    = {9},
  issn      = {2079-6382},
  doi       = {10.3390/antibiotics10091131},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246272},
  year      = {2021},
  abstract  = {Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70\% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9\%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.},
  language  = {en}
}
@phdthesis{Lauerer2022,
  author    = {Lauerer, Elias},
  title     = {K{\"o}nnen Gespr{\"a}chsfertigkeiten zur Raucherentw{\"o}hnung online vermittelt werden? Eine randomisierte prospektive Studie zum Vergleich von Online- und Pr{\"a}senzkurs in der medizinischen Ausbildung},
  doi       = {10.25972/OPUS-27565},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275654},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Das Durchf{\"u}hren von Beratungsgespr{\"a}chen mit rauchenden PatientInnen auf Basis validierter Leitf{\"a}den, beispielsweise des 5A-Modells, ist eine wichtige Kompetenz, die noch zu wenig gelehrt und im {\"a}rztlichen Alltag zu selten durchgef{\"u}hrt wird (Twardella et al., 2005; Strobel et al., 2012). Der Erwerb von Wissen und praktischen Beratungsf{\"a}higkeiten ist f{\"u}r die Behandlung rauchender PatientInnen unerl{\"a}sslich und sollte ein integraler Bestandteil der medizinischen Ausbildung werden. Im Zentrum dieser prospektiven randomisierten Interventionsstudie steht der Vergleich zweier didaktischer Ans{\"a}tze hinsichtlich der Aneignung von Wissen, Einstellung und praktischen Gespr{\"a}chsfertigkeiten. An der Julius-Maximilians-Universit{\"a}t W{\"u}rzburg wurde im Wintersemester 2018/2019 eine neu konzipierte Lehrveranstaltung zur Raucherberatung im Humanmedizinstudium implementiert. Alle 145 Studierenden des sechsten Semesters wurden nach dem Zufallsprinzip einem Online- oder einem Pr{\"a}senzkurs zugewiesen. Die Studierenden wurden in einer einmaligen, f{\"u}r einen Zeitraum von 90 Minuten ausgelegten Veranstaltung in der Raucherentw{\"o}hnungsberatung nach dem 5A-Modell (ask, advise, assess, assist, arrange) geschult. Unabh{\"a}ngig von der Lehrmethode bestand die Intervention aus einem inhaltlich identischen Theorieteil und einem {\"U}bungsteil. Im {\"U}bungsteil wurde der Online-Gruppe ein Beratungsgespr{\"a}ch als Videobeispiel zur Verf{\"u}gung gestellt, w{\"a}hrend die TeilnehmerInnen der Seminargruppe in Kleingruppen ein Rollenspiel mit KommilitonInnen durchf{\"u}hrten. Durch die Kombination verschiedener, neu entwickelter Messinstrumente (Frageb{\"o}gen, Klausur, OSCE) wurde die Leistung der Studierenden auf den Miller'schen Kompetenzebenen knows und knows how und shows how (Miller GE, 1990) subjektiv und objektiv erfasst. Die praktischen Gespr{\"a}chsfertigkeiten wurden mittels eines OSCE erhoben und stellen den prim{\"a}ren Endpunkt dieser prospektiven Vergleichsstudie dar. Als sekund{\"a}re Endpunkte wurden Ver{\"a}nderungen im theoretischen Wissen und der Einstellung zum Thema Tabak durch pr{\"a}- und postinterventionelle Frageb{\"o}gen und eine abschließende schriftliche Pr{\"u}fung bewertet. Die Ergebnisse von 130 Studierenden konnten ausgewertet werden. Die Stichprobe charakterisierte sich durch einen hohen Frauen- und Nichtraucher-Anteil und war repr{\"a}sentativ f{\"u}r ein Semester deutscher Medizinstudierender im klinischen Studienabschnitt. Auf Grundlage einer Fallzahlberechnung wurde der OSCE mit 19 Studierenden je Gruppe durchgef{\"u}hrt. Die Seminargruppe erzielte im OSCE deskriptiv ein besseres Gesamtergebnis (Ms = 70,8 \% vs. 62,8 \%; U = 119; p = .087; n = 36). Ein statistisch signifikanter Vorteil wurde jedoch ausschließlich in einem einzelnen Gespr{\"a}chsabschnitt ("Assist": Ms = 66,7 \% vs. 51,4 \%; p = .049) erreicht. Auch die SchauspielpatientInnen bewerteten die Beratungsleistungen der Seminargruppe besser (Ms = 4,7 vs. 4,2 von 5 Punkten, t(27,836) = 2,0; p = .028). Die Ergebnisse der Selbsteinsch{\"a}tzung der Studierenden (n = 130) und die Resultate der schriftlichen Pr{\"u}fungen deuten darauf hin, dass beide didaktische Ans{\"a}tze gleich gut geeignet sind, das theoretische Wissen zu erweitern. Der Online-Kurs war dabei zeitlich effizienter (90 vs. 73 Minuten). Die Einstellung zum Thema Tabakrauchen blieb in beiden Lehrformaten praktisch unver{\"a}ndert. Die Studierenden bewerteten die Veranstaltung als „gut". Die TeilnehmerInnen bearbeiteten den Online-Kurs ernsthaft und sind offen gegen{\"u}ber E-Learning-Angeboten. Aus diesen Ergebnissen kann gefolgert werden, dass Seminar und Online-Kurs gleichermaßen gut geeignet sind, um Medizinstudierenden das f{\"u}r ein Beratungsgespr{\"a}ch zur Tabakentw{\"o}hnung n{\"o}tige Wissen und die erforderlichen Fertigkeiten zu vermitteln. Unter Ber{\"u}cksichtigung ihrer jeweiligen St{\"a}rken k{\"o}nnten diese beiden Lehrans{\"a}tze zu einer Inverted Classroom - Veranstaltung kombiniert werden. Eine Folgestudie, zur Untersuchung zu l{\"a}ngerfristigen Effekten auf das Wissen und die Gespr{\"a}chsfertigkeiten sowie der Durchf{\"u}hrbarkeit einer praktischen Umsetzung mit PatientInnen wurde im Sommersemester 2020 durchgef{\"u}hrt. Da sich die Veranstaltung als effektiv erwiesen hat, sollte sie verpflichtend im fr{\"u}hen klinischen Studienabschnitt weitergef{\"u}hrt und das Thema im Sinne eines longitudinalen Kompetenzerwerbs zum Ende des Studiums nochmals aufgegriffen werden. Gr{\"o}ßere zeitliche oder inhaltliche {\"A}nderungen stehen nach der Evaluation dieses Kurses nicht an. Pers{\"o}nliche Berichte von (Ex)- RaucherInnen den Umgang mit der Nikotinsucht k{\"o}nnten die Praxisn{\"a}he st{\"a}rken und helfen, Barrieren abzubauen und die Studierenden zum regelhaften und proaktiven Ansprechen des Themas Rauchens zu motivieren. Der Online-Kurs k{\"o}nnte anderen Universit{\"a}ten oder Gesundheits- und Krankenpflegeschulen im deutschsprachigen Raum f{\"u}r die Ausbildung zur Verf{\"u}gung gestellt werden.},
  subject      = {E-learning},
  language  = {de}
}
@article{LauererTiedemannPolaketal.2021,
  author    = {Lauerer, Elias and Tiedemann, Elena and Polak, Thomas and Simmenroth, Anne},
  title     = {Can smoking cessation be taught online? A prospective study comparing e-learning and role-playing in medical education},
  series = {International Journal of Medical Education},
  volume    = {12},
  journal   = {International Journal of Medical Education},
  doi       = {10.5116/ijme.5ff9.bccc},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230056},
  pages     = {12-21},
  year      = {2021},
  abstract  = {Objectives: We compared the effect of different didactic formats - e - learning and role-playing - on medical students' knowledge and counselling skills in smoking cessation training. Methods: At a German medical school, 145 third-year students were randomly allocated to attend an online course with video examples or an attendance course with role-playing. Students were trained in smoking cessation counselling according to the 5A's (ask, advise, assess, assist, arrange) for approximately 90 minutes. Practical skills were measured in an objective structured clinical examination (OSCE) and represent the primary endpoint of this prospective comparative study. Additionally, changes in theoretic knowledge were assessed by pre - and post - interventional questionnaires and a final written exam. Results: In the OSCE, overall scores were higher in the attendance group (Mdn=70.8 \% vs. 62.8 \%; U=119; p=.087, n=36), but a statistical advantage was only found in one single counselling sequence ("Assist": Mdn=66.7 \% vs. 51.4 \%; p = .049) and the rating of the standardised patients (M=4.7 vs. 4.2 out of 5 points, t(27.836)=2.0, p=.028). Students' results (n=130) from self-assessment and written exams suggest that both approaches are equally well suited to increase theoretical knowledge. The online course was more time efficient (90 vs. 73 minutes). Conclusions: Seminar and web-based training seem equally well suited for transferring knowledge and skills on tobacco cessation counselling. Considering their particular strengths, these two teaching approaches could be combined.},
  language  = {en}
}
@article{LaurenceGoerlichSimmenroth2020,
  author    = {Laurence, D. and G{\"o}rlich, Y. and Simmenroth, A.},
  title     = {How do applicants, students and physicians think about the feminisation of medicine? - a questionnaire-survey},
  series = {BMC Medical Education},
  volume    = {20},
  journal   = {BMC Medical Education},
  number    = {48},
  doi       = {10.1186/s12909-020-1959-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228990},
  year      = {2020},
  abstract  = {Background The implications of the feminisation of medicine, which is characterised by a growing proportion of female doctors, is a topic currently being debated worldwide. To date, however, there has been no systematic survey of the viewpoint of present and future doctors on this subject. The aim of the present study is to determine how future and present doctors view this trend in terms of its relevance to the medical profession and its present impacts. Methods Of a total sample of 3813 people, 181 applicants for the winter term 2014, 590 medical students and 225 doctors of the UMG participated in this cross-sectional electronic questionnaire. The answers were analysed by means of the statistics program IBM SPSS Statistics 22. Open answers were qualitatively evaluated and categorised using the "Basiswissengeleitete offene Kategorienfindung" (Werner Fruh) and coded for statistical analysis. Results The majority of our participants favoured a balanced gender-ratio among doctors: 77\% of applicants, 68\% of students and 61\% of doctors rated this as important or very important. The results from the student and applicant groups differed concerning female gender. When answering in the role of a patient, the doctor's gender was found to be more relevant than when the participants were answering in the role of the doctor. The majority of the respondents opined that feminisation had had an impact on their workplace: particular factors included part-time work, work-related organisation and the diversity of the medical profession. Commentaries were mostly categorised as negative. Conclusions The feminisation of medicine was viewed largely critically by the participants of this study. The respondents evaluated gender as being relevant for the medical profession and favoured a diverse workforce; however, the significance of one's own gender in medical practice was underrated in comparison, implying a need for more awareness of the effect of a doctor's gender on the patient-doctor-relationship. The mainly negative comments concerning the impact of feminisiation on work organisation, work satisfaction and patient care show the need for further research and action to adapt current medical work practices to the changing demographics in order to improve work satisfaction and quality of care.},
  language  = {en}
}
@article{MuellerChandraFuraijatetal.2020,
  author    = {M{\"u}ller, Frank and Chandra, Shivani and Furaijat, Ghefar and Kruse, Stefan and Waligorski, Alexandra and Simmenroth, Anne and Kleinert, Evelyn},
  title     = {A digital communication assistance tool (DCAT) to obtain medical history from foreign-language patients: development and pilot testing in a primary health care center for refugees},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {17},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {4},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph17041368},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200640},
  year      = {2020},
  abstract  = {Background: Language barriers play a critical role in the treatment of migrant and refugee patients. In Germany, primary care interpreters are often not available especially in rural areas or if patients demand spontaneous or urgent consultations. Methods: In order to enable patients and their physicians to communicate effectively about the current illness history, we developed a digital communication assistance tool (DCAT) for 19 different languages and dialects. This paper reports the multidisciplinary process of the conceptual design and the iterative development of this cross-cultural user-centered application in an action-oriented approach. Results: We piloted our app with 36 refugee patients prior to a clinical study and used the results for further development. The acceptance and usability of the app by patients was high. Conclusion: Using digital tools for overcoming language barriers can be a feasible approach when providing health care to foreign-language patients.},
  language  = {en}
}
@article{MuellerHummersHillermannetal.2020,
  author    = {M{\"u}ller, Frank and Hummers, Eva and Hillermann, Nele and Dopfer, Christian and Jablonka, Alexandra and Friede, Tim and Simmenroth, Anne and Wetzke, Martin},
  title     = {Factors influencing the frequency of airway infections in underage refugees: a retrospective, cross sectional study},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {17},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {18},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph17186823},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-213134},
  year      = {2020},
  abstract  = {Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3\% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4\% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.},
  language  = {en}
}
@article{ParisiLehnerSchraderetal.2023,
  author    = {Parisi, Sandra and Lehner, Nina and Schrader, Hanna and Kierer, Leonard and Fleischer, Anna and Miljukov, Olga and Borgulya, Gabor and R{\"u}ter, Gernot and Viniol, Annika and G{\´a}gyor, Ildik{\´o}},
  title     = {Experiencing COVID-19, home isolation and primary health care: A mixed-methods study},
  series = {Frontiers in Public Health},
  volume    = {10},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2022.1023431},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301498},
  year      = {2023},
  abstract  = {Objectives Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8\%; 95.2\%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8\%; 15.5\%, P < 0.001), telephone consultation remained the main mode of consultation (78.5\%) and video remained insignificant (1.9\%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.},
  language  = {en}
}
@article{PerraGalettiZacchedduetal.2023,
  author    = {Perra, Alessandra and Galetti, Alessia and Zaccheddu, Rosanna and Locci, Aurora and Piludu, Federica and Preti, Antonio and Primavera, Diego and Di Natale, Lorenzo and Nardi, Antonio Egidio and Kurotshka, Peter Konstantin and Cossu, Giulia and Sancassiani, Federica and Stella, Giusy and De Lorenzo, Valerio and Zreik, Thurayya and Carta, Mauro Giovanni},
  title     = {A recovery-oriented program for people with bipolar disorder through virtual reality-based Cognitive Remediation: results of a feasibility randomized clinical trial},
  series = {Journal of Clinical Medicine},
  volume    = {12},
  journal   = {Journal of Clinical Medicine},
  number    = {6},
  issn      = {2077-0383},
  doi       = {10.3390/jcm12062142},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311201},
  year      = {2023},
  abstract  = {Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021},
  language  = {en}
}
@article{PerraRiccardoDeLorenzoetal.2023,
  author    = {Perra, Alessandra and Riccardo, Chiara Laura and De Lorenzo, Valerio and De Marco, Erika and Di Natale, Lorenzo and Kurotschka, Peter Konstantin and Preti, Antonio and Carta, Mauro Giovanni},
  title     = {Fully immersive virtual reality-based cognitive remediation for adults with psychosocial disabilities: a systematic scoping review of methods intervention gaps and meta-analysis of published effectiveness studies},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {20},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {2},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph20021527},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304948},
  year      = {2023},
  abstract  = {Background: Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. Methods: Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. Results: We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components. Conclusions: Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.},
  language  = {en}
}
@article{RohdeHimmelHofingeretal.2022,
  author    = {Rohde, J{\"o}rn and Himmel, Wolfgang and Hofinger, Clemens and L{\^a}m, Thi{\^e}n-Tr{\´i} and Schrader, Hanna and Wallstabe, Julia and Kurzai, Oliver and G{\´a}gyor, Ildik{\´o}},
  title     = {Diagnostic accuracy and feasibility of a rapid SARS-CoV-2 antigen test in general practice - a prospective multicenter validation and implementation study},
  series = {BMC Primary Care},
  volume    = {23},
  journal   = {BMC Primary Care},
  number    = {1},
  doi       = {10.1186/s12875-022-01756-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299659},
  year      = {2022},
  abstract  = {Background PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff. Methods In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95\% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests. Results In 40 practices in W{\"u}rzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3\% and a specificity of 99.5\% compared to RT-PCR. With a prevalence of 9.5\%, the positive predictive value was 93.9\% and the negative predictive value was 97.8\%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice. Conclusion The point of care test used in this study showed a sensitivity below the manufacturer's specification (Sensitivity 96.25\%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results.},
  language  = {en}
}
@article{SchmiemannGreserMaunetal.2023,
  author    = {Schmiemann, Guido and Greser, Alexandra and Maun, Andy and Bleidorn, Jutta and Schuster, Angela and Miljukov, Olga and R{\"u}cker, Viktoria and Klingeberg, Anja and Mentzel, Anja and Minin, Vitalii and Eckmanns, Tim and Heintze, Christoph and Heuschmann, Peter and G{\´a}gyor, Ildik{\´o}},
  title     = {Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial},
  series = {BMJ},
  volume    = {383},
  journal   = {BMJ},
  issn      = {1756-1833},
  doi       = {10.1136/bmj-2023-076305},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349395},
  year      = {2023},
  abstract  = {Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was -0.13 (95\% confidence interval -0.21 to -0.06, P\&lt;0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of -0.08 (95\% confidence interval -0.15 to -0.02, P\&lt;0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389},
  language  = {en}
}
@article{SchraderRuckBorgulyaetal.2023,
  author    = {Schrader, Hanna and Ruck, Jessica and Borgulya, G{\´a}bor and Parisi, Sandra and Ehlers-Mondorf, Jana and Kaduszkiewicz, Hanna and Joos, Stefanie and Grau, Anna and Linde, Klaus and G{\´a}gyor, Ildik{\´o}},
  title     = {Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic},
  series = {Frontiers in Public Health},
  volume    = {11},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2023.1238144},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-327427},
  year      = {2023},
  abstract  = {Background: At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020. Methods: From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol. Results: One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5\% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources. Discussion: It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.},
  language  = {en}
}
@article{SimonParisiWabnitzetal.2023,
  author    = {Simon, Johanna and Parisi, Sandra and Wabnitz, Katharina and Simmenroth, Anne and Schwienhorst-Stich, Eva-Maria},
  title     = {Ten characteristics of high-quality planetary health education},
  series = {Frontiers in Public Health},
  volume    = {11},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2023.1143751},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313856},
  year      = {2023},
  abstract  = {Aim: The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods: In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results: A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions: In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.},
  language  = {en}
}
@phdthesis{Sudmann2023,
  author    = {Sudmann, Jessica},
  title     = {Evaluation einer longitudinalen Erweiterung einer Lehrveranstaltung zur Nikotinentw{\"o}hnung im Medizinstudium},
  doi       = {10.25972/OPUS-32163},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-321634},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Hintergrund: An der Universit{\"a}t W{\"u}rzburg wurde bereits im Wintersemester 2018/19 eine 90-min{\"u}tige Lehrveranstaltung zur Nikotinentw{\"o}hnung als Pr{\"a}senz- oder E-Learning-Seminar im 6. Semester implementiert. In 2020 wurden weitere Bausteine erg{\"a}nzt: eine Kurzinfo zur Raucherberatung im 9. Semester und die Beratung realer Patienten im 10. Semester im Blockpraktikum-Allgemeinmedizin (BPA). Fragestellung: Wie wirkt sich der Besuch des Seminars langfristig auf das Beratungs-Wissen aus? Ist eine Nikotinentw{\"o}hnungsberatung im Rahmen des BPA machbar? Erh{\"o}ht sich dadurch die subjektive Sicherheit der Studierenden? Methoden: Im Sommersemester 2020 wurden Studierende des 9. Semesters, die regul{\"a}r das Seminar zur Raucherberatung im Wintersemester 2018/19 besucht haben sollten, online bzgl. Wissen zur Nikotinentw{\"o}hnungsberatung befragt. Es folgten vertonte PowerPoint-Folien zur Raucherberatung (Kurzinfo). Im Wintersemester 2020/21 im BPA sollten die Studierenden ein Nikotinentw{\"o}hnungsgespr{\"a}ch mit einem Patienten in der Lehrpraxis durchf{\"u}hren und ihre Erfahrungen und subjektive Sicherheit mittels Online-Befragung retrospektiv evaluieren. Ergebnisse: In der Befragung des 9. Semesters (n=54, R{\"u}cklauf: 35\%) sch{\"a}tzten Teilnehmende der Ursprungskohorte (n=35 von urspr{\"u}nglich 130) im Vergleich zu Nicht-Teilnehmenden (n=19) ihr Wissen deutlich h{\"o}her ein (p=0,016). Dabei spielte die zuvor besuchte Lehrform keine Rolle (p=0,963). Im BPA f{\"u}hrten 50\% (n=57) der 114 Befragten (R{\"u}cklauf: 74\%) eine Nikotinberatung mit einem Patienten durch, dabei stieg die Sicherheit, ein solches Gespr{\"a}ch zu f{\"u}hren, signifikant (p<0,001). Beratende Studierende beurteilten den Zugewinn an Fertigkeiten durch das BPA h{\"o}her (p<0,001) und hielten es f{\"u}r wichtiger, Patienten zu ihrem Rauchverhalten zu beraten (p=0,048). Diskussion: Unabh{\"a}ngig von der Lehrform scheint sich ein Seminar zur Raucherberatung langfristig positiv auf das Wissen auszuwirken. F{\"u}r 50\% war eine Nikotinentw{\"o}hnungsberatung im BPA machbar. Als Hinderungsgr{\"u}nde wurden fehlende Gelegenheiten und ungeeignete Patienten angegeben. Die Beratung eines Patienten in einer realen Situation erh{\"o}ht die Beratungssicherheit.},
  subject      = {Raucherentw{\"o}hnung},
  language  = {de}
}
@article{WabnitzSchwienhorstStichAsbecketal.2023,
  author    = {Wabnitz, Katharina and Schwienhorst-Stich, Eva-Maria and Asbeck, Franziska and Fellmann, Cara Sophie and Gepp, Sophie and Leberl, Jana and Mezger, Nikolaus Christian Simon and Eichinger, Michael},
  title     = {National Planetary Health learning objectives for Germany: A steppingstone for medical education to promote transformative change},
  series = {Frontiers in Public Health},
  volume    = {10},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2022.1093720},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-306027},
  year      = {2023},
  abstract  = {Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.},
  language  = {en}
}