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Search Results: 1 - 10 of 729 matches for " Elke Jeschke "
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Psychometric properties of the Confidence and Trust in Delivery Questionnaire (CTDQ): a pilot study
Elke Jeschke, Thomas Ostermann, Natalie Dippong, Dagmar Brauer, Harald Matthes
BMC Women's Health , 2012, DOI: 10.1186/1472-6874-12-26
Abstract: A pilot validation study of 221 women 6 weeks before childbirth was conducted in Germany between October 2007 and June 2008. To detect structural relations between the items, factor and reliability analyses were applied to the CTDQ items. Factor analysis was performed by means of principal components analysis and varimax rotation. Internal reliability was assessed by Cronbach’s alpha. External validation was performed using the sense of coherence (SOC) scale.The CTDQ comprises of 11 items. We found a 4-factor structure. The internal consistency of the whole item pool (Cronbach’s α = 0.79) and the 4 subscales [confidence in labor (α = 0.82); partner’s support (α = 0.62); trust in medical competency (α = 0.68); being informed (α = 0.60)] can be regarded as sufficient or even excellent. The 4 factors explained 69.6% of total variance. Except for a high intercorrelation (0.70) between “partner’s support” and “trust in medical competence”, the subscales show low intercorrelations, indicating an adequate independence of the respective subscales. Regarding the external validity we found minor respective moderate correlations with the SOC scale.Our data suggest that the CTDQ is a useful instrument to assess confidence and trust in delivery. With 4 clinically relevant dimensions, the CTDQ is now open for further studies in the field of labor.The expectation of childbirth is a fundamental experience in a woman’s life. There is no doubt that pregnant women fear the intense pain of giving birth and the feeling that something might go wrong. Expectations do vary among women with respect to her social status, educational level, previous experience with childbirth and the level of available information on childbearing [1-4]. Independent of those dimensions, both qualitative research and quantitative evaluations have identified a variety of factors, which seem to have important meaning for expectant mothers. According to a literature review by Hodnett in 2002 [5], trust, confidence
QuaDoSta - a freely configurable system which facilitates multi-centric data collection for healthcare and medical research
Jeschke, Elke,Schad, Friedemann,Pissarek, J?rg,Matthes, Burkhard
GMS Medizinische Informatik, Biometrie und Epidemiologie , 2007,
Abstract: This article describes QuaDoSta (quality assurance, documentation and statistics), a flexible documentation system as well as a data collection and networking platform for medical facilities. The user can freely define the required documentation masks which are easily expandable and can be adapted to individual requirements without the need for additional programming. To avoid duplication, data transfer interfaces can be configured flexibly to external sources such as patient management systems used in surgeries or hospital information systems. The projects EvaMed (Evaluation Anthroposophical Medicine) and the Network Oncology are two scientific research projects which have been successfully established as nationally active networks on the basis of QuaDoSta. The EvaMed-Network serves as a modern pharmacovigilance project for the documentation of adverse drug events. All prescription data are electronically recorded to assess the relative risk of drugs. The Network Oncology was set up as a documentation system in four hospitals and seven specialist oncology practices where a complete record of all oncological therapies is being carried out to uniform standards on the basis of the ‘basic documentation for tumour patients’ (BDT) developed by the German Cancer Society. The QuaDoSta solution system made it possible to cater for the specific requirements of the presented projects. The following features of the system proved to be highly advantageous: flexible setup of catalogues and user friendly customisation and extensions, complete dissociation of system setup and documentation content, multi-centre networkability, and configurable data transfer interfaces.
Depression, Comorbidities, and Prescriptions of Antidepressants in a German Network of GPs and Specialists with Subspecialisation in Anthroposophic Medicine: A Longitudinal Observational Study
Elke Jeschke,Thomas Ostermann,Horst C. Vollmar,Manuela Tabali
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/508623
Fearful or functional - a cross-sectional survey of the concepts of childhood fever among German and Turkish mothers in Germany
Thorsten Langer, Miriam Pfeifer, Aynur Soenmez, Bilge Tarhan, Elke Jeschke, Thomas Ostermann
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-41
Abstract: In this study we determine 1) the influence of socio-economic status and cultural background on two concepts of fever which we labelled "functional" and "fearful", each representing typical experiences of mothers, and 2) the actions taken by the mothers related to these concepts.A standardized interview study was conducted among German and Turkish mothers in Germany in 2009. The questionnaire consisted of 36 questions and 205 items. Interviews were conducted in 16 private practices of paediatricians and 2 paediatric emergency departments in an urban region of Germany. The two fever concepts were represented in 6 statements that could be rated with a six-point Likert scale. The association of the socio-economic status and the cultural background with one of the fever concepts was determined by a multiple logistic regression.A total of 338 mothers (49% with a Turkish background) completed the interview (response rate 92%). The average age of mothers with a German background was higher (34.1 years vs. 32.0 years, p = 0.0001). Mothers with a Turkish background were more likely to relate to the concept "fearful" [adjusted Odds Ratio (AOR) 1.99; confidence interval (CI) 1.16-3.44]. Mothers with a middle or high socio-economic status were more likely to respond to the concept "functional" [middle: AOR, 0.53; CI, 0.30-0.92; high: AOR, 0.44; CI, 0.21-0.95].Mothers adhering to the concept "fearful" more often gave acetaminophen before the recommended interval of 6 hours (46.8% vs. 31.3%, p = 0.005) and visited out-of-hours services more frequently in the preceding 9 months than the other group (0.7 vs. 0.4, p = 0.001).A Turkish migrant background and a low socio-economic status are associated with the fever concept "fearful". Mothers with these attributes seem to require specific and reassuring counselling as they use antipyretic drugs extensively and out-of-hours services frequently.The subjective meaning a symptom or a disease has for a person often varies between doctors a
Educational intervention to improve physician reporting of adverse drug reactions (ADRs) in a primary care setting in complementary and alternative medicine
Manuela Tabali, Elke Jeschke, Angelina Bockelbrink, Claudia M Witt, Stefan N Willich, Thomas Ostermann, Harald Matthes
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-274
Abstract: Objective was to evaluate the impact of an educational intervention and monitoring programme designed to improve physician reporting of ADRs in a primary care setting.A prospective multicentre study with 38 primary care practitioners specialized in CAM was conducted from January 2004 through June 2007. After 21 month all physicians received an educational intervention in terms of face-to-face training to assist them in classifying and reporting ADRs. The study centre monitored the quantity and quality of ADR reports and analysed the results.To measure changes in the ADR reporting rate, the median number of ADR reports and interquartile range (IQR) were calculated before and after the educational intervention. The pre-intervention and post-intervention quality of the reports was assessed in terms of changes in the completeness of data provided for obligatory items. Interrater reliability between the physicians and the study centre was calculated using Cohen's kappa with a 95% confidence interval (CI). We used Mann Whitney U-test for testing continuous data and chi-square test was used for categorical data. The level of statistical significance was set at P < 0.05.A total of 404 ADRs were reported during the complete study period. An initial 148% increase (P = 0.001) in the number of ADR reports was observed after the educational intervention. Compared to baseline the postinterventional number of ADR reportings was statistically significant higher (P < 0.005) through the first 16 months after the intervention but not significant in the last 4-month period (median: 8.00 (IQR [2.75; 8.75]; P = 0.605). The completeness of the ADR reports increased from 80.3% before to 90.7% after the intervention. The completeness of the item for classifying ADRs as serious or non-serious increased significantly (P < 0.001) after the educational intervention. The quality of ADR reports increased from kappa 0.15 (95% CI: 0.08; 0.29) before to 0.43 (95% CI: 0.23; 0.63) after the interventi
Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians
Elke Jeschke, Thomas Ostermann, Horst C Vollmar, Manuela Tabali, Friedemann Schad, Harald Matthes
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-99
Abstract: Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia dru
Depression, Comorbidities, and Prescriptions of Antidepressants in a German Network of GPs and Specialists with Subspecialisation in Anthroposophic Medicine: A Longitudinal Observational Study
Elke Jeschke,Thomas Ostermann,Horst C. Vollmar,Manuela Tabali,Harald Matthes
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/508623
Abstract: Background. Depression is a major reason for counselling in primary care. Our study aims at evaluating pharmacological treatment strategies among physicians specialised in anthroposophic medicine (AM). Methods. From 2004 to 2008, twenty-two German primary care AM-physicians participated in this prospective, multicentre observational study. Multiple logistic regression was used to determine factors associated with a prescription of any antidepressant medication. Results. A total of 2444 patients with depression were included (mean age: 49.1 years (SD: 15.4); 77.3% female). 2645 prescriptions of antidepressants for 833 patients were reported. Phytotherapeutic preparations from Hypericum perforatum were the most frequently prescribed antidepressants over all (44.6% of all antidepressants), followed by amitriptyline (16.1%). The likelihood of receiving an antidepressant medication did not depend on comorbidity after controlling for age, gender, physician specialisation, and type of depression (adjusted OR ; CI: 0.81–1.26). Patients who had cancer were significantly less likely to be prescribed an antidepressant medication than those who had no cancer ( ; CI: 0.57–0.97). Conclusion. This study provides a comprehensive analysis of everyday practice for the treatment of depression in AM -physicians. Further analysis regarding the occurrence of critical combinations is of high interest to health services research. 1. Background Depression is one of the three leading causes of disease burden worldwide strongly correlated with increased morbidity and a major reason for counselling and primary patient care [1, 2]. Depending on the study origin and setting, the prevalence of depression in the general population is estimated between 10% and 25% in females and 5–12% in males with a one-year incidence rate of approximately 2% [3–5]. Thus, early detection and treatment of depression is a major task for health care policy makers. Due to increasing patient numbers and the development of new antidepressive drugs, family physicians today play an important role in the treatment of depressed patients [6, 7]. Although approximately 40% of patients with depression still remain untreated, those patients who decide to consult a therapist are more likely to see a family physician than a psychiatric specialist for both diagnosis and treatment. This is quite important as knowledge and accuracy of nonpsychiatric physicians in treating depression have a great influence the outcome of the illness. Although research has significantly advanced in the last years, and depression is now
Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: a prospective observational study
Elke Jeschke, Thomas Ostermann, Horst C Vollmar, Matthias Kr?z, Angelina Bockelbrink, Claudia M Witt, Stefan N Willich, Harald Matthes
BMC Family Practice , 2009, DOI: 10.1186/1471-2296-10-78
Abstract: In this prospective, multicentre observational study, which included 25 primary care physicians specialized in CAM treatment, prescriptions and diagnoses were analysed for each consecutive hypertensive patient using routine electronic data. Data analysis was performed using univariate statistical tests (Chi square test, Cochran-Armitage trend test). Multiple logistic regression was used to determine factors associated with antihypertensive medication.In the year 2005, 1320 patients with 3278 prescriptions were included (mean age = 64.2 years (SD = 14.5), 63.5% women). Most patients were treated with conventional antihypertensive monotherapies (n = 838, 63.5%). Beta-blockers were the most commonly prescribed monotherapy (30.7%), followed by ACE inhibitors (24.0%). Combination treatment usually consisted of two antihypertensive drugs administered either as separate agents or as a coformulation. The most common combination was a diuretic plus an ACE inhibitor (31.2% of dual therapies). Patient gender, age, and comorbidities significantly influenced which treatment was prescribed. 187 patients (14.2%) received one or more CAM remedies, most of which were administered in addition to classic monotherapies (n = 104). Men (OR = 0.66; 95% CI: 0.54-0.80) and patients with diabetes (OR = 0.55; 95% CI: 0.42-0.0.73), hypercholesterolaemia (OR = 0.59; 95% CI: 0.47-0.75), obesity (OR = 0.74; 95% CI: 0.57-0.97), stroke (OR = 0.54; 95% CI: 0.40-0.74), or prior myocardial infarction (OR = 0.37; 95% CI: 0.17-0.81) were less likely to receive CAM treatment.The large majority of antihypertensive treatments prescribed by CAM physicians in the present study complied with the current German Hypertension Society treatment guidelines. Deviations from the guidelines were observed in one of every seven patients receiving some form of CAM treatment.The management of hypertension is a key challenge in modern health systems. One of the most frequent chronic conditions and the most common treatabl
Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study
Elke Jeschke, Thomas Ostermann, Manuela Tabali, Horst C Vollmar, Matthias Kr?z, Angelina Bockelbrink, Claudia M Witt, Stefan N Willich, Harald Matthes
BMC Geriatrics , 2010, DOI: 10.1186/1471-2318-10-48
Abstract: Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions.In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22).The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.With average life expectancy increasing and birth rates declining, the proportion of elderly people expands in almost every
Jeschke K
Journal für Urologie und Urogyn?kologie , 2001,
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