Barriers to Swiss guideline-recommended cholesterol management in general practice

BACKGROUND

Standard guidelines for the management of dyslipidaemia are often not followed in general practice. The reasons for guideline non-adherence are not known.

METHODS

Charts of 1000 consecutive unselected patients of 20 general practitioners in northwestern Switzerland were reviewed. An independent committee of experienced study physicians checked the data and assessed the reasons for not measuring plasma cholesterol and for not treating dyslipidaemia as recommended by guidelines.

RESULTS

Complete data of 866 patients were studied. 29% of all patients qualified for secondary prevention. 6% had no additional cardiovascular risk factors (apart from cholesterol values), 24% had one and 41% had 2 or more additional cardio- vascular risk factors. Guidelines were followed in 44% of all cases and were not followed in 56%. In 37.5% of all cases we found diagnostic guideline non-adherence, and in 10% only treatment guideline non-adherence. 8.5% of all patients had both diagnostic and treatment non-adherence. The main reasons for diagnostic non-adherence were relevant comorbidity (45%) and GPs' belief that the risk did not require screening (42%). The main reasons for treatment non-adherence were GPs' belief that the risk did not require treatment (42%) and relevant comorbidity (38%).

CONCLUSION

More than half of all patients aged 35-80 years are not screened or treated according to current guidelines. The reasons are to an equal extent patient-related (relevant comorbidity) and physician-related (acceptance and knowledge of guidelines). These reasons should be considered when programmes to improve the quality of GPs' adherence to guidelines are implemented.

Benefits from aerobic exercise in patients with major depression: a pilot study

BACKGROUND

Several reports indicate that physical activity can reduce the severity of symptoms in depressed patients. Some data suggest that even a single exercise bout may result in a substantial mood improvement.

OBJECTIVE

To evaluate the short term effects of a training programme on patients with moderate to severe major depression.

METHODS

Twelve patients (mean (SD) age 49 (10) years; five men, seven women) with a major depressive episode according to the Diagnostic and Statistical Manual of the American Society of Psychiatry (DSM IV) criteria participated. The mean (SD) duration of the depressive episode was 35 (21) weeks (range 12--96). Training consisted of walking on a treadmill following an interval training pattern and was carried out for 30 minutes a day for 10 days.

RESULTS

At the end of the training programme, there was a clinically relevant and statistically significant reduction in depression scores (Hamilton Rating Scale for Depression: before, 19.5 (3.3); after, 13 (5.5); p = 0.002. Self assessed intensity of symptoms: before, 23.2 (7); after, 17.7 (8.1); p = 0.006. Values are mean (SD)). Subjective and objective changes in depression scores correlated strongly (r = 0.66, p = 0.01).

CONCLUSIONS

Aerobic exercise can produce substantial improvement in mood in patients with major depressive disorders in a short time.

[Early orthopedics in Munich around 1860]

Case histories and patient photographs have recently been discovered from the private "Orthopaedic and Physiotherapeutic Clinic of the Licensed Orthopaedist Ludwig Hugo Krieger", which was located in Munich from 1857 to 1888 under the directorship of the surgeon Johann Nepomuk Nussbaum. The photographs include the oldest existing patient photographs in Germany. The documents reveal the early successes in Orthopaedics, which at the time was not a subject of academic study. Orthopaedics was primarily practised by interested amateurs, who were frequently quite talented, such as the bandage-specialist Krieger, ideally in co-operation with medical physicians.

[Praying for the hunchback man. On the cultural history of scoliosis and kyphosis]

Numerous ancient burial sites contain spines with scoliotic deformities. However, very little is known about the lives of these people, the "hunchbacks". Their everyday life, how they saw themselves and were seen by others, their social status and perspectives can usually only be deduced indirectly from a variety of sources. These include fairy-tales and myths, beliefs and superstitions, classical and light literature, and accounts by theological and philosophical writers. The present paper proves that severely deformed scoliosis patients were generally burdened with a pitful fate in ancient times and during the Middle Ages. There was no effective treatment, healthy citizens showed little compassion, hunchbacks were said to have a vile and base character, and they were usually stigmatised outsiders. The sociopsychological situation for these patients did not improve until modern times, beginning with increased public awareness during the last century, in parallel with the slow development of orthopaedic treatment methods for scoliosis.