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Clayman ML, Scheibler F, Rüffer JU, Wehkamp K, Geiger F. The Six Steps of SDM: linking theory to practice, measurement and implementation. BMJ Evid Based Med 2024; 29:75-78. [PMID: 37673467 PMCID: PMC10982624 DOI: 10.1136/bmjebm-2023-112289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Marla L Clayman
- CHOIR, VA Center for Healthcare Organization & Implementation Research Bedford Campus, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
- Share To Care GmbH, Cologne, Germany
| | | | - Kai Wehkamp
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Kiel, Germany
- Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Stolz-Klingenberg C, Bünzen C, Coors M, Flüh C, Stürner KH, Wehkamp K, Clayman ML, Scheibler F, Rüffer JU, Schüttig W, Sundmacher L, Berg D, Geiger F. Comprehensive Implementation of Shared Decision Making in a Neuromedical Center Using the SHARE TO CARE Program. Patient Prefer Adherence 2023; 17:131-139. [PMID: 36660043 PMCID: PMC9844139 DOI: 10.2147/ppa.s388432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/09/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE SHARE TO CARE (S2C) is a comprehensive, multi-module implementation program for shared decision making (SDM). It is currently applied at the University Hospital Schleswig-Holstein in Kiel, Germany, and among general practitioners at the Federal State of Bremen. This study examines the results of the full implementation of S2C in terms of effectiveness within the Kiel Neuromedical Center comprising the departments of neurology and neurosurgery. METHOD AND DESIGN The S2C program consists of four combined intervention modules: 1) multimodal training of physicians; 2) a patient activation campaign including the ASK-3 method; 3) digital evidence-based patient decision aids; and 4) SDM support by nurses, e.g., as decision coaches. The SDM level before and immediately after implementation was retrospectively assessed in consecutively selected patients on the subscale "Patient Decision Making" of the Perceived Involvement in Care Scale (PICSPDM). Mean scores were compared with t-tests. RESULTS Eighty-nine percent of all physicians (N = 56) completed the SDM training. We developed a total of 12 evidence-based digital decision aids in the center, educated two decision coaches to support patients' decision processes by using decision aids. Physicians adjusted patients' pathways to incorporate the use of decision aids. Patients (n = 261) reported a significant increase in participation (p<0.001; Hedges' g = 0.49) in medical decision making. CONCLUSION The S2C program has been successfully implemented within the entire Neuromedical Center. Patients reported a medium to small increase of perceived involvement in decision making demonstrating the effectiveness of the implementation. For future research, it might be interesting to investigate the sustainability of the effects of S2C. In addition, it seems useful to complement the patient-based evaluation with observer-based data.
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Affiliation(s)
- Constanze Stolz-Klingenberg
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
- Correspondence: Constanze Stolz-Klingenberg, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 9, Kiel, 24105, Germany, Tel +49 431 500 20208; +49 151 17271928, Email
| | - Claudia Bünzen
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marie Coors
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Kai Wehkamp
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
| | - Marla L Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Fueloep Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
- SHARE TO CARE Patientenzentrierte Versorgung GmbH, Cologne, Germany
| | - Jens Ulrich Rüffer
- SHARE TO CARE Patientenzentrierte Versorgung GmbH, Cologne, Germany
- TakePart Media+Science GmbH, Cologne, Germany
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
- SHARE TO CARE Patientenzentrierte Versorgung GmbH, Cologne, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Stolz-Klingenberg C, Bünzen C, Coors M, Flüh C, Margraf NG, Wehkamp K, Clayman ML, Scheibler F, Wehking F, Rüffer JU, Schüttig W, Sundmacher L, Synowitz M, Berg D, Geiger F. Sustainability of large-scale implementation of shared decision making with the SHARE TO CARE program. Front Neurol 2022; 13:1037447. [PMID: 36504657 PMCID: PMC9726727 DOI: 10.3389/fneur.2022.1037447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction SHARE TO CARE (S2C) is a comprehensive implementation program for shared decision making (SDM). It is run at the University Hospital Schleswig-Holstein (UKSH) in Kiel, Germany, and consists of four combined intervention modules addressing healthcare professionals and patients: (1) multimodal training of physicians (2) patient activation campaign including the ASK3 method, (3) online evidence-based patient decision aids (4) SDM support by nurses. This study examines the sustainability of the hospital wide SDM implementation by means of the Neuromedical Center comprising the Departments of Neurology and Neurosurgery. Methods Between 2018 and 2020, the S2C program was applied initially within the Neuromedical Center: We implemented the patient activation campaign, trained 89% of physicians (N = 56), developed 12 patient decision aids and educated two decision coaches. Physicians adjusted the patients' pathways to facilitate the use of decision aids. To maintain the initial implementation, the departments took care that new staff members received training and decision aids were updated. The patient activation campaign was continued. To determine the sustainability of the initial intervention, the SDM level after a maintenance phase of 6-18 months was compared to the baseline level before implementation. Therefore, in- and outpatients received a questionnaire via mail after discharge. The primary endpoint was the "Patient Decision Making" subscale of the Perceived Involvement in Care Scale (PICSPDM). Secondary endpoints were an additional scale measuring SDM (CollaboRATE), and the PrepDM scale, which determines patients' perceived health literacy while preparing for decision making. Mean scale scores were compared using t-tests. Results Patients reported a significantly increased SDM level (PICSPDM p = 0.02; Hedges' g = 0.33; CollaboRATE p = 0.05; Hedges' g = 0.26) and improved preparation for decision making (PrepDM p = 0.001; Hedges' g = 0.34) 6-18 months after initial implementation of S2C. Discussion The S2C program demonstrated its sustainability within the Neuromedical Center at UKSH Kiel in terms of increased SDM and health literacy. Maintaining the SDM implementation required a fraction of the initial intensity. The departments took on the responsibility for maintenance. Meanwhile, an additional health insurance-based reimbursement for S2C secures the continued application of the program. Conclusion SHARE TO CARE promises to be suitable for long-lasting implementation of SDM in hospitals.
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Affiliation(s)
- Constanze Stolz-Klingenberg
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany,*Correspondence: Constanze Stolz-Klingenberg
| | - Claudia Bünzen
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marie Coors
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nils G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
| | - Marla L. Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, MA, United States,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Fueloep Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | | | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Hahlweg P, Bieber C, Levke Brütt A, Dierks ML, Dirmaier J, Donner-Banzhoff N, Eich W, Geiger F, Klemperer D, Koch K, Körner M, Müller H, Scholl I, Härter M. Moving towards patient-centered care and shared decision-making in Germany. Z Evid Fortbild Qual Gesundhwes 2022; 171:49-57. [PMID: 35595668 DOI: 10.1016/j.zefq.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.
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Affiliation(s)
- Pola Hahlweg
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Christiane Bieber
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Anna Levke Brütt
- Carl von Ossietzky University of Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Marie-Luise Dierks
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hanover, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | | | - Wolfgang Eich
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Friedemann Geiger
- University Hospital Schleswig-Holstein, National Competency Center for Shared Decision Making, Kiel, Germany
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Faculty of Social and Health Sciences, Regensburg, Germany
| | - Klaus Koch
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Mirjam Körner
- University of Freiburg, Department of Medical Psychology and Medical Sociology, Freiburg, Germany
| | - Hardy Müller
- Health Insurance Fund Techniker Krankenkasse (TK), Health Care Management, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
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Danner M, Debrouwere M, Rummer A, Wehkamp K, Rüffer JU, Geiger F, Wolff R, Weik K, Scheibler F. A scattered landscape: assessment of the evidence base for 71 patient decision aids developed in a hospital setting. BMC Med Inform Decis Mak 2022; 22:44. [PMID: 35177043 PMCID: PMC8855583 DOI: 10.1186/s12911-022-01777-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale “Share to Care (S2C)” Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments’ impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe how PtDAs are developed and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence.
Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Results Evidence reviews assessed on average 25 systematic reviews/guidelines/studies and took about 3 months to be completed. Despite rigorous review processes, nearly 70% of outcome-specific information derived for decision aids was based on low-quality and mostly on non-directly comparative evidence. Evidence on quality of life and harms was often not provided or not in sufficient form/detail. Challenges in evidence interpretation for use in decision aids resulted from, e.g., a lack of directly comparative evidence or the existence of very heterogeneous evidence for the diverse treatments being compared.
Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a “scattered landscape” and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn’t mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients.
Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01777-x.
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Affiliation(s)
- Marion Danner
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Marie Debrouwere
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Anne Rummer
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kai Wehkamp
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jens Ulrich Rüffer
- SHARE TO CARE (S2C) GmbH, Cologne, Germany.,TAKEPART Media+Science GmbH, Cologne, Germany
| | - Friedemann Geiger
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,SHARE TO CARE (S2C) GmbH, Cologne, Germany
| | | | | | - Fueloep Scheibler
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,SHARE TO CARE (S2C) GmbH, Cologne, Germany
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Röseler J, Wolff R, Bauerschlag DO, Maass N, Hillemanns P, Ferreira H, Debrouwere M, Scheibler F, Geiger F, Elessawy M. Challenges and Controversies in the Surgical Treatment of Cervical Cancer: Open Radical Hysterectomy versus Minimally Invasive Radical Hysterectomy. J Clin Med 2021; 10:jcm10173761. [PMID: 34501212 PMCID: PMC8432133 DOI: 10.3390/jcm10173761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The aim of the study was to perform a systematic assessment of disease-free survival (DFS), overall survival, and morbidity rates after open radical hysterectomy (ORH) and minimally invasive surgery (MIS) for early-stage cervical cancer and discuss with experts the consequences of the LACC trial (published by Ramirez et al. in 2018) on clinical routine. METHODS A total of 5428 records were retrieved. After exclusion based on text screening, four records were identified for inclusion. Five experts from three independent large-volume medical centers in Europe were interviewed for their interpretation of the LACC trial. RESULTS The LACC trial showed a significantly higher risk of disease progression with MIS compared to ORH (HR 3.74, 95% CI 1.63 to 8.58). This was not seen in one epidemiological study and was contradicted by one prospective cohort study reported by Greggi et al. A systematic review by Zhang et al. mentioned a similar DFS for robot-assisted radical hysterectomy (RRH) and LRH. Recurrence rates were significantly higher with MIS compared to ORH in the LACC trial (HR 4.26, 95% CI 1.44 to 12.60). In contrast, four studies presented by Greggi reported no significant difference in recurrence rates between LRH/RRH and ORH, which concurred with the systematic reviews of Zhang and Zhao. The experts mentioned various limitations of the LACC trial and stated that clinicians were obliged to provide patients with detailed information and ensure a shared decision-making process. CONCLUSIONS The surgical treatment of early-stage cervical cancer remains a debated issue. More randomized controlled trials (RCT) will be needed to establish the most suitable treatment for this condition.
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Affiliation(s)
- Jona Röseler
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.O.B.); (N.M.); (M.E.)
- Correspondence:
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd., Escrick, York YO19 6FD, UK;
| | - Dirk O. Bauerschlag
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.O.B.); (N.M.); (M.E.)
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.O.B.); (N.M.); (M.E.)
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, 30625 Hannover, Germany;
| | - Helder Ferreira
- Department of Gynecology, Centro Hospitalar, University of Porto, 4099-001 Porto, Portugal;
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.D.); (F.S.); (F.G.)
| | - Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.D.); (F.S.); (F.G.)
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.D.); (F.S.); (F.G.)
| | - Mohamed Elessawy
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (D.O.B.); (N.M.); (M.E.)
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Geiger F, Hacke C, Potthoff J, Scheibler F, Rueffer JU, Kuch C, Wehkamp K. The effect of a scalable online training module for shared decision making based on flawed video examples - a randomized controlled trial. Patient Educ Couns 2021; 104:1568-1574. [PMID: 33334633 DOI: 10.1016/j.pec.2020.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Shared Decision Making (SDM) is considered the gold standard of medical decision making as it provides a method to systematically integrate the patient's preferences, evidence-based medicine and the experience of health care professionals. Therefore, evidence-based training methods for a broad implementation into healthcare are needed. A new online training was designed, based on the concept of flawed/flawless video examples and additional educational concepts. METHODS In a single-blind randomized-controlled trial, medical students were randomly assigned to intervention group receiving the online training (n = 82) or waiting control group (n = 105). SDM-related knowledge and the ability to judge distinct levels of SDM were compared between both groups. Additionally, feedback regarding the intervention was collected. RESULTS SDM-related knowledge and judging ability increased significantly in the intervention group compared to controls (SDM knowledge: mean difference: 12 %; 95 % CI: 7.3-18.5; p < 0.001; SDM judging ability (inter-rater concordance displayed by weighted t): mean difference: 0.07; 95 %CI: 0.03-0.11; p = 0.001). Feedback was positive. CONCLUSION The online training with its distinctive methodology prove effective. As it shares the theoretical and didactical background with an already existing face-to-face training, both approaches may also be used complementarily. PRACTICE IMPLICATIONS SDM can be trained effectively and efficiently with this easily scalable online training.
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Affiliation(s)
- Friedemann Geiger
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany; Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel, Germany; Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
| | - Claudia Hacke
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Judith Potthoff
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fueloep Scheibler
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Christine Kuch
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kai Wehkamp
- Department of Pediatrics, The SHARE TO CARE project, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
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9
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Geiger F, Novelli A, Berg D, Hacke C, Sundmacher L, Kopeleva O, Scheibler F, Rüffer JU, Kuch C, Wehkamp K. The Hospital-Wide Implementation of Shared Decision-Making. Dtsch Arztebl Int 2021; 118:225-226. [PMID: 34090543 DOI: 10.3238/arztebl.m2021.0144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Ben Charif A, Plourde KV, Guay-Bélanger S, Zomahoun HTV, Gogovor A, Straus S, Beleno R, Kastner K, McLean RKD, Milat AJ, Wolfenden L, Paquette JS, Geiger F, Légaré F. Strategies for involving patients and the public in scaling-up initiatives in health and social services: protocol for a scoping review and Delphi survey. Syst Rev 2021; 10:55. [PMID: 33573701 PMCID: PMC7877693 DOI: 10.1186/s13643-021-01597-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/20/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS. METHODS We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: (1) participants-any stakeholder involved in creating or testing a strategy for PPI; (2) intervention-any PPI strategy proposed for scaling-up initiatives; (3) comparator-no restriction; (4) outcomes: any process or outcome metrics related to PPI; and (5) setting-HSS. We will search electronic databases (e.g., Medline, Web of Science, Sociological Abstract) from inception onwards, hand search relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities. DISCUSSION Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS. SYSTEMATIC REVIEW REGISTRATION We registered this protocol with the Open Science Framework on August 19, 2020 ( https://osf.io/zqpx7/ ).
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Affiliation(s)
- Ali Ben Charif
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Karine V Plourde
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada
| | - Sabrina Guay-Bélanger
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine, School of Physical and Occupational Therapy, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Amédé Gogovor
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec City, QC, Canada
| | - Sharon Straus
- LiKaShing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ron Beleno
- Age-Well NCE, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | - Robert K D McLean
- International Development Research Centre, Ottawa, ON, Canada.,Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jean-Sébastien Paquette
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Laboratoire ARIMED, Groupe de médecine de famille universitaire (GMF-U) de Saint-Charles-Borromée, Saint-Charles-Borromée, QC, Canada
| | - Friedemann Geiger
- SHARE TO CARE Project, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Department of Pediatrics, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Institute for Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada. .,Diabetes Action Canada, a SPOR Network in Diabetes and its Related Complications, Université Laval, Quebec City, QC, Canada.
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Wehkamp K, Kiefer FB, Geiger F, Scheibler F, Rueffer JU, Donner-Banzhoff N, Betsch C. Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial. Patient Prefer Adherence 2021; 15:1269-1279. [PMID: 34163144 PMCID: PMC8214525 DOI: 10.2147/ppa.s311470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Health literacy is an important competency to make informed, shared decisions in line with patient's preferences. On the other hand, lower health literacy is associated with poorer health outcomes. Evidence-based patient decision aids (EbPDA) are validated instruments to support informed medical decisions and empower patients for relevant involvement in their care. This study aimed to investigate the effect of a digital EbPDA for hypertension on health literacy. METHODS In a randomized controlled trial, 124 participants were presented with a web-based scenario related to a newly diagnosed condition of arterial hypertension. The intervention group was provided with an online decision aid, while the control group was prompted to search for related information without support. Specific health literacy for hypertension was operationalized based on the European survey for health literacy (HLS-EU-Q47). RESULTS The intervention group showed a statistically significant increase in subjectively perceived overall specific health literacy regarding hypertension (p=0.02, Cohen's d=0.44). The effect was also statistically significant for the subcategories understanding, appraising, and applying health-related information (all p<0.05). At least equal results could be shown for participants with a lower level of education compared to participants with a high level. CONCLUSION The findings suggest that digital EbPDAs can be an effective and easily scalable instrument to improve populations' specific health literacy. A possible advantage of the measure could be that patients are addressed concerning important and pressing personal decisions, fostering awareness of the individual's need for health literacy to reflect one's options and preferences. EbPDAs may also be a promising approach to target vulnerable populations, as the investigated EbPDA seems to perform equally in less versus more educated individuals. For future research, it may be interesting to investigate whether EbPDAs have effects on general health literacy that go beyond the disease specifically addressed.
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Affiliation(s)
- Kai Wehkamp
- Department of Pediatrics/Project SHARE TO CARE, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
- Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
- Correspondence: Kai Wehkamp Department of Internal Medicine I, Project SHARE TO CARE, University Hospital Schleswig-Holstein (UKSH), Arnold-Heller-Straße 3, Kiel, 24105, GermanyTel +49 (0)431-500-0 Email
| | - Felicia Beatrice Kiefer
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Thüringen, Germany
| | - Friedemann Geiger
- Department of Pediatrics/Project SHARE TO CARE, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Fueloep Scheibler
- Department of Pediatrics/Project SHARE TO CARE, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, University of Marburg, Marburg, Hessen, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Thüringen, Germany
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12
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Danner M, Geiger F, Wehkamp K, Rueffer JU, Kuch C, Sundmacher L, Skjelbakken T, Rummer A, Novelli A, Debrouwere M, Scheibler F. Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital. BMJ Open 2020; 10:e037575. [PMID: 33039998 PMCID: PMC7549440 DOI: 10.1136/bmjopen-2020-037575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Shared decision-making (SDM) is not yet widely used when making decisions in German hospitals. Making SDM a reality is a complex task. It involves training healthcare professionals in SDM communication and enabling patients to actively participate in communication, in addition to providing sound, easy to understand information on treatment alternatives in the form of evidence-based patient decision aids (EbPDAs). This project funded by the German Innovation Fund aims at designing, implementing and evaluating a multicomponent, large-scale and integrative SDM programme-called SHARE TO CARE (S2C)-at all clinical departments of a University Hospital Campus in Northern Germany within a 4-year time period. METHODS AND ANALYSIS S2C tackles the aforementioned components of SDM: (1) training physicians in SDM communication, (2) activating and empowering patients, (3) developing EbPDAs in the most common/relevant diseases and (4) training other healthcare professionals in SDM coaching. S2C is designed together with patients and providers. The physicians' training programme entails an online and an in situ training module. The decision coach training is based on a similar but less comprehensive approach. The development of online EbPDAs follows the International Patient Decision Aid Standards and includes written, graphical and video-based information. Validated outcomes of SDM implementation are measured in a preintervention and postintervention evaluation design. Process evaluation accompanies programme implementation. Health economic impact of the intervention is investigated using a propensity-score-matched approach based on potentially preference-sensitive hospital decisions. ETHICS AND DISSEMINATION Ethics committee review approval has been obtained from Medical Ethics Committee of the Medical Faculty of the Christian-Albrechts-University Kiel. Project information and results will be disseminated at conferences, on project-hosted websites at University Hospital Medical Center Schleswig Holstein and by S2C as well as in peer-reviewed and professional journals.
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Affiliation(s)
- Marion Danner
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Friedemann Geiger
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
| | - Kai Wehkamp
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
| | - Jens Ulrich Rueffer
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
- TAKEPART Media & Sciences GmbH, Cologne, Germany
| | - Christine Kuch
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | | | - Tove Skjelbakken
- Universitetet i Tromso Helsevitenskapelige fakultet Helsefak, Tromso, Norway
| | - Anne Rummer
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Anna Novelli
- Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Marie Debrouwere
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Fueloep Scheibler
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
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Geiger F, Tumbev Y, Groeber-Becker F, Berberich-Siebelt F. 358 Human-based T cell-skin models for graft-versus-host disease. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Zinssius D, Jünemann KP, Geiger F, Hamann C, Seiler F, Osmonov D. [Evaluation of the Padua and R.E.N.A.L. scores regarding their validity and implication in the perioperative management during partial nephrectomy]. Aktuelle Urol 2019; 53:423-430. [PMID: 31242516 DOI: 10.1055/a-0888-7234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to the rapid development of minimally-invasive surgery, there is a broader indication for surgical preservation of renal tissue. Current research suggests that, apart from the size of the tumour, its exact anatomical position should be considered when seeking optimal surgical treatment for individual patients. Therefore, numerous nephrometry scores have emerged, the Padua score and the R.E.N.A.L. score being most commonly used. Based on our patient population, we aimed to shed light on the question which score is best suited to assess the feasibility of nephron-sparing surgery and which can predict complications most accurately. PATIENTS AND METHODS This study included 117 patients treated with partial nephrectomy at the University Hospital in Kiel (UKSH, Campus Kiel) between 2014 and 2017. The imaging results (computed tomography and magnetic resonance tomography) were retrospectively evaluated according to the Padua and R.E.N.A.L. score criteria. In some cases, radical nephrectomy became necessary despite the planned partial nephrectomy. We evaluated group differences regarding both nephrometry scores in these cases and the cases without radical nephrectomy. Then we performed correlation analyses regarding score outcome, operation time as well as perioperative, postoperative and overall complications. RESULTS The tumours requiring treatment by radical nephrectomy (10 out of 117) had significantly higher scores only when the R.E.N.A.L. score was applied (mean difference 1.059, p < 0.05). Both the Padua and the R.E.N.A.L. score were positive correlated with operation time (R.E.N.A.L. score: correlation coefficient 0.284, p < 0.05, Padua score: coefficient 0.312, p < 0.05) as well as perioperative, postoperative and overall complications (R.E.N.A.L. score: coefficient 0.216, p < 0.05, Padua score: coefficient 0.192, p < 0.05). CONCLUSION Each of the examined scores can be used to assess the risk of partial nephrectomy. For our patients, the preoperative application of the R.E.N.A.L. score would have been advantageous. Preoperative nephrometry scores are a useful tool and should be applied in addition to the surgeon's subjective evaluation. There is a lack of prospective studies investigating this issue.
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Affiliation(s)
- Daniel Zinssius
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Klaus-Peter Jünemann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Friedemann Geiger
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Institut für medizinische Psychologie und medizinische Soziologie, Kiel
| | - Claudius Hamann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Felix Seiler
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Daniar Osmonov
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
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Zinssius D, Jünemann KP, Geiger F, Hamann C, Seiler F, Osmonov D. [Evaluation of the Padua and R.E.N.A.L. scores regarding their validity and implication in the perioperative management during partial nephrectomy]. Aktuelle Urol 2019. [PMID: 31242516 DOI: 10.1055/a-0888–7234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Due to the rapid development of minimally-invasive surgery, there is a broader indication for surgical preservation of renal tissue. Current research suggests that, apart from the size of the tumour, its exact anatomical position should be considered when seeking optimal surgical treatment for individual patients. Therefore, numerous nephrometry scores have emerged, the Padua score and the R.E.N.A.L. score being most commonly used. Based on our patient population, we aimed to shed light on the question which score is best suited to assess the feasibility of nephron-sparing surgery and which can predict complications most accurately. PATIENTS AND METHODS This study included 117 patients treated with partial nephrectomy at the University Hospital in Kiel (UKSH, Campus Kiel) between 2014 and 2017. The imaging results (computed tomography and magnetic resonance tomography) were retrospectively evaluated according to the Padua and R.E.N.A.L. score criteria. In some cases, radical nephrectomy became necessary despite the planned partial nephrectomy. We evaluated group differences regarding both nephrometry scores in these cases and the cases without radical nephrectomy. Then we performed correlation analyses regarding score outcome, operation time as well as perioperative, postoperative and overall complications. RESULTS The tumours requiring treatment by radical nephrectomy (10 out of 117) had significantly higher scores only when the R.E.N.A.L. score was applied (mean difference 1.059, p < 0.05). Both the Padua and the R.E.N.A.L. score were positive correlated with operation time (R.E.N.A.L. score: correlation coefficient 0.284, p < 0.05, Padua score: coefficient 0.312, p < 0.05) as well as perioperative, postoperative and overall complications (R.E.N.A.L. score: coefficient 0.216, p < 0.05, Padua score: coefficient 0.192, p < 0.05). CONCLUSION Each of the examined scores can be used to assess the risk of partial nephrectomy. For our patients, the preoperative application of the R.E.N.A.L. score would have been advantageous. Preoperative nephrometry scores are a useful tool and should be applied in addition to the surgeon's subjective evaluation. There is a lack of prospective studies investigating this issue.
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Affiliation(s)
- Daniel Zinssius
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Klaus-Peter Jünemann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Friedemann Geiger
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Institut für medizinische Psychologie und medizinische Soziologie, Kiel
| | - Claudius Hamann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Felix Seiler
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Daniar Osmonov
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
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Abstract
BACKGROUND Spondylolisthesis (Greek for sliding vertebra) in children is usually the result of a defect (=lysis) or an elongation of the interarticular portion. The cause can be a congenital dysplasia of the dorsal stabilizing structures or pressure of the facet on the interarticular portion. This is a consequence of lumbar lordosis which is necessary for an upright posture. TREATMENT The treatment depends on the symptoms and the risk of progression. This is related to the sliding distance, the degree of secondary dysplasia of the vertebral bodies and the sagittal profile, which is considered in the Mac-Thiong classification. For low-grade olistheses, conservative therapy is an option; for a symptomatic lysis without disc degeneration, pars repair should be considered. In higher-grade olistheses, repositioning and spondylodesis are usually recommended. Repositioning improves the fusion rate and sagittal profile, but increases the risk of nerve root damage, so complete repositioning should not be forced.
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Affiliation(s)
- F Geiger
- Wirbelsäulenzentrum, Orthopädische Fachkliniken, Hessing Kliniken Augsburg, Hessingstraße 17, 86199, Augsburg, Deutschland.
| | - A Wirries
- Wirbelsäulenzentrum, Orthopädische Fachkliniken, Hessing Kliniken Augsburg, Hessingstraße 17, 86199, Augsburg, Deutschland
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Schroeder C, Geiger F, Siebert FA, Baumann R, Bockelmann G, Schultze J, Kimmig B, Dunst J, Galalae R. Radical dose escalation by high-dose-rate brachytherapy for localized prostate cancer-Significance of prostate-specific antigen nadir level within 18 months as correlation for long-term biochemical control. Brachytherapy 2018; 18:8-12. [PMID: 30482622 DOI: 10.1016/j.brachy.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE High-dose-rate brachytherapy (HDR-BT) for dose escalation in localized prostate cancer has been established as one standard treatment option. However, long-term results at followup (FU) ≥5 years are usually needed to ensure robustness of reported outcomes. Potential benefit of salvage therapy is, nevertheless, higher when relapse is diagnosed early. This study aimed to solve this dilemma by evaluating the prostate-specific antigen (PSA) nadir for early prediction of long-term biochemical control. METHODS AND MATERIALS Combined pelvis-external beam radiation/HDR-BT boost to EQD2 >100 Gy (α/β = 3) was performed in 459 consecutively treated patients. These patients with an FU ≥ 24 months were analyzed and stratified in PSA nadir (nPSA)-groups by PSA nadir within 18 months after radiotherapy (nPSA18). Kaplan-Meier/log-rank tests and Cox-regression models were used to compare the study endpoints. RESULTS The mean FU was 77 months. A PSA nadir within 18 months (nPSA18) <0.5 ng/mL was achieved in 222 patients with median time to reach nPSA18 of 7 months. The 5-year American Society of Therapeutic Radiology and Oncology (ASTRO) biochemical control (prostate-specific antigen disease-free survival) for the nPSA18 group <0.5 ng/mL was 89% and for the group ≥ 0.5 ng/mL, it was 78.6% (p = 0.011). nPSA18 was an independent predictor of cancer-specific survival, distant metastasis-free survival, and biochemical control (ASTRO) (p = 0.026, p = 0.020, and p = 0.01, respectively). CONCLUSIONS The present results suggest that the PSA nadir level within 18 months after radiotherapy may serve as an early parameter for long-term biochemical control according to ASTRO definitions following radical dose escalation by HDR-BT for prostate cancer. Excellent outcomes were associated with nPSA18 < 0.5 ng/mL.
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Affiliation(s)
| | - Friedemann Geiger
- Department of Pediatrics, Christian-Albrechts-University Kiel, Kiel, Germany
| | | | - René Baumann
- Christian-Albrechts-University Kiel, Clinic for Radiotherapy, Kiel, Germany
| | - Gunnar Bockelmann
- Christian-Albrechts-University Kiel, Clinic for Radiotherapy, Kiel, Germany
| | - Jürgen Schultze
- Christian-Albrechts-University Kiel, Clinic for Radiotherapy, Kiel, Germany
| | - Bernhard Kimmig
- Christian-Albrechts-University Kiel, Medical Faculty, Kiel, Germany
| | - Jürgen Dunst
- Christian-Albrechts-University Kiel, Clinic for Radiotherapy, Kiel, Germany
| | - Razvan Galalae
- Christian-Albrechts-University Kiel, Medical Faculty, Kiel, Germany.
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Kasper J, Liethmann K, Heesen C, Reissmann DR, Geiger F. Training doctors briefly and in situ to involve their patients in making medical decisions-Preliminary testing of a newly developed module. Health Expect 2017; 20:1254-1263. [PMID: 28521082 PMCID: PMC5689231 DOI: 10.1111/hex.12565] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To carry out preliminary evaluation of a training module for doctors to enhance their ability to involve their patients in medical decision making. The training refers to the shared decision-making (SDM) communication concept. METHODS The training module includes a comprehensive manual, a corresponding video tutorial with communication examples and a 15-minute face-to-face feedback session based on an SDM analysis of a consultation recording provided by the trainee. Ten trainees (four neurologists, three dentists, and three general practitioners) participating in the pretest each recorded four clinical consultations (total sample: N=40) and received three training components. After the training, doctors provided feedback on the module's feasibility in a questionnaire. Communication performance of doctors, patients and doctor-patient dyads was assessed by trained observers and self-assessed by doctors and patients using the MAPPIN'SDM approach. Training effects were determined using Wilcoxon signed-rank tests comparing baseline values with post-intervention performance as assessed in the fourth consultations. RESULTS The face-to-face training sessions were short and feasible with regard to clinical reality. Participants considered the training supportive for acquiring SDM skills and recommended more emphasis on the face-to-face feedback. Communication improved according to observers rating doctors (P=.05) and doctor-patient dyads (P=.07) and to doctors' own judgements (P=.02). No improvement was observed in patients' SDM behaviour (P=.11); accordingly, patients' judgements did not indicate improvement (P=.14). CONCLUSIONS The training is designed to meet clinicians' needs. Improvement of risk communication after training encourages optimization according to doctors' feedback. Following this study, the efficacy of the training is now being examined in a randomized controlled trial.
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Affiliation(s)
- Jürgen Kasper
- Department Health and Caring SciencesFaculty of Health SciencesThe Arctic University of NorwayTromsøNorway
- Medical ClinicsUniversity Medical CenterTromsøNorway
| | - Katrin Liethmann
- Unit of Health Sciences and EducationFaculty of MathematicsInformatics and Natural SciencesUniversity of HamburgHamburgGermany
| | - Christoph Heesen
- Department of NeurologyInstitute of Neuroimmunology and Multiple SclerosisUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Daniel R Reissmann
- Institute of Dental ProstheticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Friedemann Geiger
- MSH Medical School HamburgHamburgGermany
- Department of PediatricsUniversity Medical Center Schleswig‐HolsteinKielGermany
- Institute of Medical Psychology and SociologyUniversity Medical Center Schleswig‐HolsteinKielGermany
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Thaller M, Böhm H, Lingenfelder C, Geiger F. [Hyaluronic acid gels for pressure regulation in glaucoma treatment]. Ophthalmologe 2017; 115:195-201. [PMID: 29119227 DOI: 10.1007/s00347-017-0602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The increasing numbers of glaucoma patients and complications occuring during treatment, such as restenosis and hypotony, require new treatment options to prevent blindness in patients. Therefore, the abovementioned problems should be solved to prolong the lifetime of implants and to prevent repeated surgery. OBJECTIVE Can a novel stent with hyaluronic acid hydrogels (HA gel) as a functional unit be used to regulate pressure in glaucoma therapy in the long term? MATERIAL AND METHODS Model stents were filled with HA gels and it was investigated if these could regulate the pressure and what the underlying mechanism is. RESULTS The results of the investigations showed that the HA gel inside the stent functions as a pressure valve. Under certain equilibrium pressures the HA gel closes the stent and therefore retains the fluid. At a certain overpressure the HA gel enables the fluid to be released and leads to a self-regulated adjustment of the equilibrium pressure. DISCUSSION The next step will involve miniaturization of the stents. Experiments will then show if the valve function will also work in the dimensions necessary for an eye implant and if the current problem of hypotension in glaucoma therapy can be solved.
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Affiliation(s)
- M Thaller
- Abt. Zelluläre Biophysik, Max-Planck-Institut für medizinische Forschung, Jahnstr. 29, 69120, Heidelberg, Deutschland
- Biophysikalische Chemie, Universität Heidelberg, INF 253, 69120, Heidelberg, Deutschland
| | - H Böhm
- Abt. Zelluläre Biophysik, Max-Planck-Institut für medizinische Forschung, Jahnstr. 29, 69120, Heidelberg, Deutschland
- Biophysikalische Chemie, Universität Heidelberg, INF 253, 69120, Heidelberg, Deutschland
| | - C Lingenfelder
- Pharmpur GmbH, Messerschmittring 33, 86343, Königsbrunn, Deutschland
| | - F Geiger
- Abt. Zelluläre Biophysik, Max-Planck-Institut für medizinische Forschung, Jahnstr. 29, 69120, Heidelberg, Deutschland.
- Biophysikalische Chemie, Universität Heidelberg, INF 253, 69120, Heidelberg, Deutschland.
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Kienlin S, Kristiansen M, Ofstad E, Liethmann K, Geiger F, Joranger P, Tveiten S, Kasper J. Validation of the Norwegian version of MAPPIN'SDM, an observation-based instrument to measure shared decision-making in clinical encounters. Patient Educ Couns 2017; 100:534-541. [PMID: 28029570 DOI: 10.1016/j.pec.2016.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To validate the Norwegian version of MAPPIN'SDM observer scales with regard to reliability, accuracy and the extent to which the scales include the essentials of the shared decision-making concept. METHODS Three MAPPIN'SDM scales, focusing on the skills of doctor, patient and dyad, were applied to audiovisual records of 35 decision sequences. Inter-rater reliabilities were determined based on kappa coefficients. Sensitivities and specificities were calculated with regard to an expert reference standard. Convergent validities were calculated with the OPTION5 scale. MAPPIN'SDM was qualitatively compared to OPTION5 using Makoul & Clayman's Integrative Model structure. RESULTS Inter-rater reliabilities were high on average over 11 items in each of three observer scales (MAPPINdoctor=0.77, MAPPINpatient=0.82, MAPPINdyad=0.77). Patient involvement was detected accurately (MAPPINdyad: mean sensitivity/specificity 93/91%). Comparison with OPTION5 showed weak to moderate correlation (Spearman's ρ/p-value: MAPPINdoctor:=0.44/0.009, MAPPINpatient: 0.38/0.024, MAPPINdyad 0.40/0.016) and little content overlap. CONCLUSION MAPPIN'SDMnorge is capable of assessing SDM highly reliably and accurately. Divergence from OPTION5 reflects explicit disagreement regarding the concept's assumptions. PRACTICE IMPLICATIONS MAPPIN'SDMnorge is ready for use in Norway. In-depth debate on the SDM concept's essentials is urgently needed.
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Affiliation(s)
- Simone Kienlin
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Maria Kristiansen
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway.
| | - Eirik Ofstad
- Department of Internal Medicine, Nordland Hospital, Bodø, Norway; Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, Tromsø, Norway.
| | - Katrin Liethmann
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Friedemann Geiger
- MSH Medical School Hamburg, Hamburg, Germany; Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany.
| | - Pål Joranger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway.
| | - Sidsel Tveiten
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway.
| | - Jürgen Kasper
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway.
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Bäcker M, Koch C, Eiben S, Geiger F, Eber F, Gliemann H, Poghossian A, Wege C, Schöning M. A New Class of Biosensors Based on Tobacco Mosaic Virus and Coat Proteins as Enzyme Nanocarrier. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.proeng.2016.11.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Affiliation(s)
- Friedemann Geiger
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany Medical School Hamburg, Department of Psychology, Faculty of Human Sciences, Hamburg, Germany
| | - Marla L Clayman
- American Institutes for Research, Chicago, Illinois, USA Akershus University Hospital, Lørenskog, Norway
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Liethmann
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany Department of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel, Germany Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Kasper
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Etter T, Kunze K, Geiger F, Meidani H. Reduction in mechanical anisotropy through high temperature heat treatment of Hastelloy X processed by Selective Laser Melting (SLM). ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1757-899x/82/1/012097] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Galalae R, Schroeder C, Geiger F, Jiang P, Siebert F, Kimmig B, Dunst J. High-Dose-Rate Brachytherapy for Radical Dose Escalation in Patients With Localized Prostate Cancer: A Longitudinal Comparative Study of 3 Historical Protocols. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bergemann A, Hansen JH, Rotermann I, Voges I, Scheewe J, Otto-Morris C, Geiger F, Kramer HH. Neuropsychological performance of school-aged children after staged surgical palliation of hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2014; 47:803-11. [DOI: 10.1093/ejcts/ezu299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/26/2014] [Indexed: 11/12/2022] Open
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Galalae RM, Zakikhany NH, Geiger F, Siebert FA, Bockelmann G, Schultze J, Kimmig B. The 15-year outcomes of high-dose-rate brachytherapy for radical dose escalation in patients with prostate cancer—A benchmark for high-tech external beam radiotherapy alone? Brachytherapy 2014; 13:117-22. [DOI: 10.1016/j.brachy.2013.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/24/2013] [Accepted: 11/01/2013] [Indexed: 01/02/2023]
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27
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Galalae R, Zakikhany N, Geiger F, Siebert F, Nebelin A, Kimmig B. Combined High-Dose-Rate (HDR) Brachytherapy and External Beam Radiation Therapy (EBRT) for Prostate Cancer: 5- and 10-Year Outcomes of Protocols 1 Versus 2. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heesen C, Köpke S, Solari A, Geiger F, Kasper J. Patient autonomy in multiple sclerosis--possible goals and assessment strategies. J Neurol Sci 2013; 331:2-9. [PMID: 23711752 DOI: 10.1016/j.jns.2013.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 02/20/2013] [Indexed: 11/24/2022]
Abstract
Patient autonomy has been increasingly acknowledged as prerequisite for successful medical decision making in Western countries. In medical decisions with a need to involve a health professional, patient autonomy becomes apparent in the extent of patients' participation in the communication as described in the concept of shared decision making. Patient autonomy can be derived from different perspectives or goals and the focus of evaluation approaches may vary accordingly. Multiple sclerosis (MS) is a paradigmatic disease to study patient autonomy mainly because MS patients are highly disease competent and due to ambiguous evidence on many aspects of disease-related medical decision making. This review gives an overview on measurement issues in studying decision making in MS, categorized according to prerequisites, process measures and outcomes of patient autonomy. As relevant prerequisites role preferences, risk attribution, risk tolerance, and risk knowledge are discussed. Regarding processes, we distinguish intra-psychic and interpersonal aspects. Intra-psychic processes are elucidated using the theory of planned behavior, which guided development of a 30-item scale to capture decisions about immunotherapy. Moreover, a theory of uncertainty management has been created resulting in the development of a corresponding measurement concept. Interpersonal processes evolving between physician and patient can be thoroughly analyzed from different perspectives by use of the newly developed comprehensive MAPPIN'SDM inventory. Concerning outcomes, besides health related outcomes, we discuss match of preferred roles during the decision encounters (preference match), decisional conflict as well as an application of the multidimensional measure of informed choice to decisions of MS patients. These approaches provide an overview on patient-inherent and interpersonal factors and processes modulating medical decision making and health behavior in MS and beyond.
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Affiliation(s)
- C Heesen
- Institute of Neuroimmunology and Clinical MS Research, University Medical Center Hamburg, Hamburg, Germany.
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Geiger F, Wolfgram L. Overshadowing as prevention of anticipatory nausea and vomiting in pediatric cancer patients: study protocol for a randomized controlled trial. Trials 2013; 14:103. [PMID: 23782493 PMCID: PMC3821553 DOI: 10.1186/1745-6215-14-103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/22/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Emesis and nausea are side effects induced by chemotherapy. These effects lead to enormous stress and strain on cancer patients. Further consequences may include restrictions in quality of life, cachexia or therapy avoidance. Evidence suggests that cancer patients develop the side effects of nausea and vomiting in anticipation of chemotherapy. Contextual cues such as smell, sounds or even the sight of the clinic may evoke anticipatory nausea and vomiting prior to infusion. Anticipatory nausea and vomiting are problems that cannot be solved by administration of antiemetica alone.The purpose of the proposed randomized placebo-controlled trial is to use an overshadowing technique to prevent anticipatory nausea and vomiting and to decrease the intensity and duration of post-treatment nausea and vomiting. Furthermore, the effect on anxiety, adherence and quality of life will be evaluated. METHODS/DESIGN Fifty-two pediatric cancer patients will be evenly assigned to two groups: an experimental group and a control group. The participants, hospital staff and data analysts will be kept blinded towards group allocation. The experimental group will receive during three chemotherapy cycles a salient piece of candy prior to every infusion, whereas the control group will receive flavorless placebo tablets. DISCUSSION If an effectiveness of the overshadowing technique is proven, implementation of this treatment into the hospitals' daily routine will follow. The use of this efficient and economic procedure should aid a reduced need for antiemetics. TRIAL REGISTRATION Current Controlled Trials ISRCTN30242271/
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Affiliation(s)
- Friedemann Geiger
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 20, Kiel, 24105, Germany
- Tumor Center, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Levke Wolfgram
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 20, Kiel, 24105, Germany
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Kasten P, Beverungen M, Lorenz H, Wieland J, Fehr M, Geiger F. Comparison of platelet-rich plasma and VEGF-transfected mesenchymal stem cells on vascularization and bone formation in a critical-size bone defect. Cells Tissues Organs 2012; 196:523-33. [PMID: 22796828 DOI: 10.1159/000337490] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 12/27/2022] Open
Abstract
Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF(165)-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors.
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Affiliation(s)
- P Kasten
- Division of Experimental Orthopaedics, Orthopaedic University Hospital of Heidelberg, Heidelberg, Germany
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Geiger F, Kasper J. Of blind men and elephants: suggesting SDM-MASS as a compound measure for shared decision making integrating patient, physician and observer views. Z Evid Fortbild Qual Gesundhwes 2012; 106:284-9. [PMID: 22749076 DOI: 10.1016/j.zefq.2012.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/06/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Shared decision making (SDM) between patient and physician is an interpersonal process. Most SDM measures use the view of one party (patient, physician or observer) as a proxy to capture this process although these views typically diverge. This study suggests the compound measure SDM(MASS) (SDM Meeting its concept's ASSumptions) integrating these three perspectives in one single index. METHODS SDM(MASS) was derived theoretically and compared empirically to unilateral perspectives of patients, physicians and observers by application to a data set of 10 physicians (40 consultations) receiving an SDM training. RESULTS The constituting parts of SDM(MASS) were highly reliable (Cronbach's alpha .94; interrater reliability .74-.87). Unilateral appraisal of training effects was divergent. SDM(MASS) revealed no effect. CONCLUSION SDM(MASS) combines noteworthy information about SDM processes from different viewpoints and thereby delivers plausible assessments. It could overcome immanent shortcomings of unilateral approaches. However, it is a complex measure needing further validation.
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Affiliation(s)
- Friedemann Geiger
- Tumor Center, University Medical Center Schleswig-Holstein, Kiel, Germany.
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Kasper J, Hoffmann F, Heesen C, Köpke S, Geiger F. MAPPIN'SDM--the multifocal approach to sharing in shared decision making. PLoS One 2012; 7:e34849. [PMID: 22514677 PMCID: PMC3325952 DOI: 10.1371/journal.pone.0034849] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/09/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The wide scale permeation of health care by the shared decision making concept (SDM) reflects its relevance and advanced stage of development. An increasing number of studies evaluating the efficacy of SDM use instruments based on various sub-constructs administered from different viewpoints. However, as the concept has never been captured in operable core definition it is quite difficult to link these parts of evidence. This study aims at investigating interrelations of SDM indicators administered from different perspectives. METHOD A comprehensive inventory was developed mapping judgements from different perspectives (observer, doctor, patient) and constructs (behavior, perception) referring to three units (doctor, patient, doctor-patient-dyad) and an identical set of SDM-indicators. The inventory adopted the existing approaches, but added additional observer foci (patient and doctor-patient-dyad) and relevant indicators hitherto neglected by existing instruments. The complete inventory comprising a doctor-patient-questionnaire and an observer-instrument was applied to 40 decision consultations from 10 physicians from different medical fields. Convergent validities were calculated on the basis of Pearson correlation coefficients. RESULTS Reliabilities for all scales were high to excellent. No correlations were found between observer and patients or physicians neither for means nor for single items. Judgements of doctors and patients were moderately related. Correlations between the observer scales and within the subjective perspectives were high. Inter-perspective agreement was not related to SDM performance or patient activity. CONCLUSION The study demonstrates the contribution to involvement made by each of the relevant perspectives and emphasizes the need for an inter-subjective approach regarding SDM measurement.
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Affiliation(s)
- Jürgen Kasper
- Faculty of Mathematics, Informatics, Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany.
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Kasper J, Hoffmann F, Heesen C, Köpke S, Geiger F. Completing the third person's perspective on patients’ involvement in medical decision-making: approaching the full picture. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2012; 106:275-83. [DOI: 10.1016/j.zefq.2012.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/19/2012] [Accepted: 04/19/2012] [Indexed: 11/17/2022]
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Geiger F, Liethmann K, Hoffmann F, Paschedag J, Kasper J. Investigating a training supporting Shared Decision Making (IT'S SDM 2011): study protocol for a randomized controlled trial. Trials 2011; 12:232. [PMID: 22029737 PMCID: PMC3267675 DOI: 10.1186/1745-6215-12-232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022] Open
Affiliation(s)
- Friedemann Geiger
- Tumor Center, University Medical Center Schleswig-Holstein, Niemannsweg 4, 24105 Kiel, Germany.
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Kasper J, Heesen C, Köpke S, Fulcher G, Geiger F. Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared decision making. PLoS One 2011; 6:e26255. [PMID: 22043310 PMCID: PMC3197148 DOI: 10.1371/journal.pone.0026255] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022] Open
Abstract
Objective Patient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered. Methods The study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale). Results OPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations. Conclusion Existing SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement. Practice Implications Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement. Trial Registration Controlled-Trials.com ISRCTN25267500.
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Affiliation(s)
- Jürgen Kasper
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
- Unit of Health Sciences and Education, MIN-Faculty, University of Hamburg, Hamburg, Germany
- * E-mail:
| | - Christoph Heesen
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
| | - Sascha Köpke
- MIN-Faculty, Institute of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | | | - Friedemann Geiger
- Tumor Center, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
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Abstract
The current study examined the relationship between psychopathy, intelligence and two variables describing the conviction history (length of conviction and number of prior convictions). It was hypothesized that psychopathy factors (interpersonal and antisocial factors assuming a 2-factor model or interpersonal, affective, lifestyle and antisocial factors assuming a 4-factor model) would be related in different ways to IQ scores, length of conviction and number of prior convictions. Psychopathy and IQ were assessed using the PCL:SV and the CFT 20-R respectively. Results indicated no association between interpersonal psychopathy features (Factor 1, two-factor model), IQ and the number of prior convictions but a positive association between Factor 1 and the length of conviction. Antisocial features (Factor 2, two-factor model) were negatively related to IQ and the length of conviction and positively related to the number of prior convictions. Results were further differentiated for the four-factor model of psychopathy. The relationship between IQ and psychopathy features was further assessed by statistically isolating the effects of the two factors of psychopathy. It was found that individuals scoring high on interpersonal features of psychopathy are more intelligent than those scoring high on antisocial features, but less intelligent than those scoring low on both psychopathy features. The results underpin the importance of allocating psychopathic individuals to subgroups on the basis of personality characteristics and criminological features. These subgroups may identify different types of offenders and may be highly valuable for defining treatment needs and risk of future violence.
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Affiliation(s)
- Hanna Heinzen
- Zentrum für Integrative Psychiatrie und Psychotherapie, Niemannsweg 147, 24105 Kiel, Germany.
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Abstract
Shared decision making (SDM) is being increasingly challenged for promoting an innovative role model while adhering to an archaic approach to patient-clinician communication, both in clinical practice and the research field. Too often, SDM has been studied at the individual level, which ignores the interpersonal system between patients and physicians. We aimed to encourage debate by reflecting on the essentials of SDM in terms of epistemology. We operationalized the SDM core concept of information exchange in terms of social systems theory. An epistemological analysis of the term information refers to its inherent process character. Exchange of information thereby becomes synonymous with social sense construction, indicating that, rather than just being a vehicle, the act of communication itself is the information. We plead for the adoption of existing dyadic analytical methods such as those offered by the interpersonal paradigm. Implications of an updated concept of information for the use of SDM-evaluation methods, for SDM-goal setting, and for clinical practice of SDM are described.
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Affiliation(s)
- Jürgen Kasper
- Institute of Neuroimmunology and Clinical MS-Research, University Medical Center, Hamburg, Germany.
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Brack HP, Koebel MM, Tsukada A, Huslage J, Buechi F, Geiger F, Rota M, Scherer GG. Characterization and Fuel Cell Testing of Radiation-Grafted Psi Membranes. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-575-259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe have demonstrated earlier the useful performance of our PSI radiation-grafted membranes in terms of the current-voltage characteristics of 30 cm2 active area fuel cells containing these membranes and their long-term testing over 6,000 h at 60 °C. We report here on testing of PSI radiation-grafted membranes in these fuel cells at 80 °C and in short stacks comprised of two or four 100 cm2 active area cells. The in-situ degradation of membranes has been investigated by characterizing membranes both before testing in fuel cells and post-mortem after testing in fuel cells. Characterization was accomplished by means of ion-exchange capacity and infrared and Raman spectroscopic measurements. In addition, a rapid screening method for our ex-situ testing of the oxidative stability of proton-conducting membranes was developed in this work. Comparison of the initial screening test results concerning the oxidative stability of some perfluorinated, partially-fluorinated, and non-fluorinated membranes compare well qualitatively with the relative stability of these same membranes during their long-term testing in fuel cells.
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Braun A, Bärtsch M, Geiger F, Schnyder B, Kötz R, Haas O, Carlen M, Christen T, Ohler C, Unterinahrer P, Krause E. A Study on Oxidized Glassy Carbon sheets for Bipolar Supercapacitor Electrodes. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-575-369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTElectrochemical Double Layer Capacitors (EDLC) for high energy and power density applications, based on glassy carbon (GO) electrodes, are being developed in our laboratory. In the context of this project, GC sheets were oxidized and investigated with Small Angle X-ray Scattering (SAXS), Electrochemical Impedance Spectroscopy (EIS) and Nitrogen Gas Adsorption (BET). During oxidation an active film with open pores is built on the surface of the GC. Upon oxidation, the internal volumetric surface area of the active film decreases, whereas the volumetric electrochemical double layer capacitance increases. We show that this effect is correlated with the opening, the growth and the coalescence of the pores.
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Kasper J, Légaré F, Scheibler F, Geiger F. [Shared decision-making and communication theory: grounding the tango]. Z Evid Fortbild Qual Gesundhwes 2010; 104:636-41. [PMID: 21129700 DOI: 10.1016/j.zefq.2010.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Shared decision-making (SDM) has the potential to overcome outdated social role models in the health care system. The concept, however, adheres to archaic epistemological assumptions as can be inferred from the rudimentary stage of the measurement methods used and from the information monopoly that the physician still holds in this concept. Advantages of an up-to-date model of knowledge for understanding and operationalising SDM are outlined. To this purpose, essential definitions of the concept are reflected in terms of epistemology. Accordingly, information emerges through a process of social construction. Likewise, interpersonal relations do not represent a static condition; rather, they develop anew with each interaction. Therefore, constructs suitable to focus on dyadic interaction processes can be used as indicators of sharing in SDM. Theories and methods of the interpersonal paradigm are advocated.
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Affiliation(s)
- Jürgen Kasper
- Gesundheitswissenschaften, MIN Fakultät, Universität Hamburg, Hamburg.
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Kafchitsas K, Geiger F, Rauschmann M, Schmidt S. Zementverteilung bei Vertebroplastieschrauben unterschiedlichen Designs. Orthopäde 2010; 39:679-86. [DOI: 10.1007/s00132-010-1603-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Galalae R, Brüske N, Geiger F, Siebert F, Schultze J, Kimmig B. Online Planned TRUS-based HDR Brachytherapy for Localized Prostate Cancer (Pca): Demonstration of a Learning Curve. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gruen A, Korde J, Geiger F, Kimmig B, Galalae R. 2009 Prevalence of erectile dysfunction in men with prostate cancer (PCa) prior to definitive radiotherapy: a prospective assessment. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Klinger R, Geiger F, Schiltenwolf M. [Can failed back surgery be prevented? Psychological risk factors for postoperative pain after back surgery]. Orthopade 2009; 37:1000, 1002-6. [PMID: 18806999 DOI: 10.1007/s00132-008-1339-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aside from the surgical technique used, the development of peri- and postoperative pain and impairments in patients following intervertebral disk surgery is also determined to a crucial extent by psychological factors. Based on a systematic literature review, we checked whether evidence-based recommendations could be deduced on how to take into account psychological risk factors in back surgery in order to avoid postoperative complications, such as failed back surgery syndrome. The current state of research suggests three groups of risk factors: (1) negative psychological factors, (2) preexisting pain chronification, and (3) psychological disorders. In the case of elective intervertebral disk surgery, these factors should therefore be determined and identified preoperatively and taken into account in the indication for surgery. Multimodal treatments could conceivably prove to be more effective, or else psychological pain management therapy might be considered prior to surgery so as to avoid postoperative complications. If surgery is medically unavoidable despite existing risk factors, postoperative treatment should incorporate psychological pain management therapy at an early stage in the context of a multidisciplinary approach.
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Affiliation(s)
- R Klinger
- Psychotherapeutische Hochschulambulanz Verhaltenstherapie, Fachbereich Psychologie, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Deutschland.
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Szelényi A, Geiger F, Rauschmann M, Ziemann U. 152. Cortical representation of hand and paraspinal muscles in patients with adolescent idiopathic scoliosis compared to healthy control. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Geiger F, Kessler P, Rauschmann M. [Pain therapy after spinal surgery]. Orthopade 2008; 37:977-83. [PMID: 18797843 DOI: 10.1007/s00132-008-1333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A dorsal approach during spinal surgery offers the possibility to distribute drugs directly to the nerve root or epidurally. This can be done via a single intraoperative dose or by placing an epidural catheter. A safe and effective analgesia can thereby be achieved. As placement is done under visual control, no major complications are to be expected. In nerve root compressions, additional local application of steroids and preoperative gabapentin seems sensible. No advantage of preemptive administration of other analgesics can be determined. Another problem, especially of ventral fusions, is the commonly needed autologous pelvic bone grafts. Here the local application of local anesthetics or opioids makes sense. In transthoracic approaches epidural analgesia is recommended by thoracic surgeons, but this is difficult to perform especially in children with deformities. Furthermore it is generally important not to compromise neuralgic controls by analgesic measures.
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Affiliation(s)
- F Geiger
- Abteilung für Wirbelsäulenchirurgie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstrasse 2, 60528, Frankfurt/M., Deutschland.
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Rauschmann MA, Thomann KD, Geiger F. [Pain and its treatment reflected in time]. Orthopade 2008; 37:1007-8, 1010-5. [PMID: 18773193 DOI: 10.1007/s00132-008-1338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article describes the history of pain therapy and anesthesiology with respect to the field of surgery. The history of this part of medicine is dependent upon the development of the appropriate medication groups, which were of great importance in the field of pain therapy and anesthesiology. Specifically the development of nitrous oxide, ether, morphine and the first local anesthesiologic substances will be described and discussed. The above mentioned developments combined with the knowledge of physiology of pain and new results from psychological studies led to the modern pain therapy in recent perioperative treatment concepts. Modern pain therapy is a multimodal therapy concept with a variety of specialties working as a team to optimize an individualized therapy plan which respects the needs of every single patient under different circumstances (acute, perioperative and chronic pain).
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Affiliation(s)
- M A Rauschmann
- Abteilung für Wirbelsäulenerkrankungen, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstrasse 2, 60528, Frankfurt am Main, Deutschland.
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Schroeder K, Geiger F. [Special features of procedures in paediatric orthopaedics]. Orthopade 2008; 37:984, 986-9. [PMID: 18773194 DOI: 10.1007/s00132-008-1334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To get good to excellent results in paediatric orthopaedics perioperative pain treatment is essential. Guidelines are in general similar to those for adults. Some special features should be taken into account. Differences are reduced possibilities of communication in the early years, different pharmacokinetics and a different perception of pain itself. A multimodal approach has proven to be very effective: workflow tailored to children's needs, ambiance appropriate for children and pharmacological analgesia. Children and parents have to be informed carefully about procedures, hospital setting and pain therapy in the first session. Pain therapy is orientated to the reversed WHO pain treatment scheme completed by surface and regional anaesthesia. After discharge pain treatment has to be administered. This article presents concepts of perioperative analgesia.
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Affiliation(s)
- K Schroeder
- Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Deutschland.
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