Stefanie Joos

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany

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Publications (119)154.02 Total impact

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    ABSTRACT: Health-related quality of life (HRQoL) is most adversely affected in cancer patients between diagnosis and the end of chemotherapy. The aim of the Complementary Nursing in Gynecologic Oncology (CONGO) study is to assess the effectiveness of a complex nursing care intervention of CAM to increase HRQoL in cancer patients undergoing chemotherapy. CONGO is a prospective partially randomized patient preference (PRPP) trial including adult women diagnosed with breast and gynecologic cancer starting a new chemotherapy regimen. Patients without strong preferences for CAM will be randomized to usual nursing care or complex nursing care; those patients with strong preferences will be allowed their choice. The intervention consists of three interacting and intertwined elements: CAM nursing intervention packet, counseling on CAM using a resource-oriented approach and evidence-based informational material on CAM. Primary outcome data on participants' HRQoL will be collected from baseline until the end of treatment and long-term follow-up using the EORTC-QLQ-C30. Secondary outcomes include nausea, fatigue, pain, anxiety/depression, social support, self-efficacy, patient competence, spiritual wellbeing, and satisfaction with care. Accompanying research on economic outcomes as well as a mixed-methods process evaluation will be conducted. A total of 590 patients (236 patients in the randomized part of the study and 354 patients in the observational part of the study) will be recruited in the two outpatient clinics. The first analysis step will be the intention-to-treat (ITT) analysis of the randomized part of the trial. A linear mixed model will be used to compare the continuous primary endpoint between the intervention and control arm of the randomized group. The observational part of the trial will be analyzed descriptively. External validity will be assessed by comparing randomized with nonrandomized patients. Cancer patients are increasingly using CAM as supportive cancer care, however, a patient-centered model of care that includes CAM for the patient during chemotherapy still needs to be evaluated. This protocol has been designed to test if the effects of the intervention go beyond potential benefits in quality-of-life outcomes. German Clinical Trials Register (DRKS), DRKS00006056 (15 April 2014).
    Trials 12/2015; 16(1). DOI:10.1186/s13063-014-0538-4 · 2.12 Impact Factor
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    ABSTRACT: Nonspecific low back pain (LBP) is a common reason for accessing primary care. Manual therapy (MT) may be an effective treatment, but data from clinical studies including relevant subgroups and clinical settings are sparse. The objective of this article is to describe the protocol of a study that will measure whether an MT protocol provided by general medical practitioners will lead to a faster pain reduction in patients with nonspecific LBP than does standard medical care.
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    ABSTRACT: Background: The ageing of physicians working in ambulatory care make regional health planning a challenging task. This study examines the current supply of general practitioners (GP) within the communities from the perspective of mayors. The information gained on a community level can be used when discussing over- and undersupply as well as future health care planning. Methods: A questionnaire was sent to all 1101 mayors of the Federal state of Baden-Württemberg (BW) in May 2011. For the evaluation of the location of the communities, subjective ratings by the mayors were compared with official criteria, provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR). Results: The participation rate was 63% (n=698). According to the mayors about 70% (n=468) were located in a rural area, according to BBSR criteria were about 26% (n=177) of answers given by rural communities. Of the participating mayors about 54% (n=355) stated that their community is cared for merely by GPs. From this information there was a locally experienced undersupply of GPs calculated for 13.5% (n=86) of the communities. This affected rural as well as non-rural communities. In communities up to 20 000 inhabitants, the ratio between GPs and other specialists seems to be 60:40 whereas in bigger cities the proportion of other specialists appears to be much higher. Conclusion: Half of the participating communities seem to not have a practicing specialised physician. An accumulation of specialised physicians in larger cities was reported. The GP shortage appears to mainly be experienced subjectively. Regarding the location (urban vs. rural) of the community, subjective views differ distinctly from the BBSR criteria. This discrepancy could influence a community's marketing strategy when competing for new physicians. © Georg Thieme Verlag KG Stuttgart · New York.
    Das Gesundheitswesen 03/2015; DOI:10.1055/s-0034-1398592 · 0.62 Impact Factor
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    ABSTRACT: There is an international consensus that quality indicators (QIs) of health care ought to represent patient-relevant aspects. Therefore, patient involvement in the development process is essential. However, there is no methodological gold standard for involving patients in QI development. The aim of this study is to explore experts' views on the representation of patient-relevant aspects in the QI development process using the QIs developed in the context of the German National Disease Management Guideline for Heart Failure as an example. Semi-structured, open telephone interviews were conducted with 15 German experts (patient representatives, physicians, researchers, and methodologists involved in guideline development or quality assessment). Interview themes were the relevance of the exemplary set of QIs for patients, as well as the legitimacy of, competence of, and collaboration with the patient representative who participated in the development process. Interviews were fully transcribed and content analyzed. Deductive categories derived from the research questions were supplemented by inductively formed categories during the review of the interview material. The qualitative analysis suggests a discrepancy between the guidelines' QIs and those relevant to patients from an expert's point of view, such as physician-patient communication and quality of counseling. Experts reported only minor communication and cooperation problems while working together in the guideline/QI development team. Concerns existed, for example, regarding the recruitment of patient representatives for diseases without self-help organizations, the financing of patient representation, and the training of patient representatives. Only few potential strategies for improving the process of patient involvement were mentioned. Integrating the patients' perspectives through the recruitment of a patient representative to participate in the development team was well established and broadly accepted. However, experts stated that the finally selected QIs represent only a small part of the patient-relevant aspects of medical care. According to the experts' perceptions, the current processes provide a very limited scope for integrating the patients' perspectives in a more extensive way. Supplementing the set of "conventional" QIs with additional, separately developed, "patient-side" QIs might help to include patient priorities in quality measurement.
    Patient Preference and Adherence 01/2015; 9:151-159. DOI:10.2147/PPA.S74064 · 1.49 Impact Factor
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    ABSTRACT: Joint replacement is an established therapy for arthrosis. The quality index for joint replacement (knee and hip) should include screening for quality of patient-centred care in hospitals providing replacements, on the basis of administrative data. The quality index summarizes 16 inpatient and posthospital complications (indicators). The aim of the study was to evaluate this quality index from the medical practitioner's viewpoint. Four semistructured focus groups with 11 family physicians and 8 orthopaedic/trauma surgeons were conducted. The discussions were recorded, transcribed and analysed qualitatively according to Mayring. Infections and the revision of a total joint arthroplasty have been weighted as the most important indicators from the existing quality indicators. Between the participants some differences regarding the relevance of the indicators thrombosis and pulmonary embolism occurred. These indicators were weighted as more important by family physicians than orthopedic/trauma surgeons. For eight of the indicators, imprecision in words/meaning was criticized. In an open-ended second section, 20 new indicators within the areas complications, management and overall sector communication were identified. Major amendments of the quality index for the joint replacement are necessary. The knowledge gained from this study may serve as a basis for this development.
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    ABSTRACT: Reliable information regarding patient knowledge of home remedies and the types of health problems patients use them for is scarce. Nevertheless, anecdotal evidence indicates that home remedies are used by patients for managing minor health problems and that this can be sufficient for symptom management while the body recovers from minor health problems. The aim of the presented study was to explore patient use of home remedies in Germany.
    BMC Family Practice 06/2014; 15(1):116. DOI:10.1186/1471-2296-15-116 · 1.74 Impact Factor
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    ABSTRACT: In many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany. After receiving permission, two researchers independently translated the RRS. In a consensus meeting, four items were identified that had to be culturally adapted. The modified RRS-Germany (mRRS-G) was sent to 724 GPs located in urban, semi-rural and rural areas to validate the "rurality" scoring system for conditions in Germany. Four items, "travelling time to next major hospital", "on-call duty", "regular peripheral clinic" and "on-call for major traumas" had to be adapted due to differences in the health care system. The survey had a response rate of 33.7%. A factor analysis showed a three dimensional structure of the mRRS-G scale with a poor internal consistency. Nevertheless, the three items regarding "on-call duty", "next major hospital" and "most distant boundary covered by your practice" were identified as significant predictors for rurality. The adapted cut-off point for rurality in Germany was 16. From this study's participants, 9 met the RRS cut-off point for rurality (a score of 35 or more). Compared with New Zealand rurality scores based on this tool, German scores are far less rural from a health care delivery point of view. We consider that the construct of rurality has more aspects than those assessed by the mRRS-G. Nevertheless, rural areas from a health care delivery viewpoint can be effectively defined using mRRS-G and therefore it can support tailored strategies against GPs shortage.
    BMC Health Services Research 04/2014; 14(1):147. DOI:10.1186/1472-6963-14-147 · 1.66 Impact Factor
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    ABSTRACT: There are more than 100,000 asylum seekers registered in Germany, who are granted limited access to health services. This study aims to provide a systematic overview of the empirical literature on the health status of and health-care provision to asylum seekers in Germany in order to consolidate knowledge, avoid scientific redundance, and identify research gaps. A systematic review and evidence mapping of empirical literature on the health status of and health-care provision to asylum seekers in Germany will be performed. We will apply a three-tiered search strategy: 1. search in databases (PubMed/MEDLINE, Web of Science, IBSS, Sociological Abstracts, Worldwide Political Science Abstracts, CINAHL, Sowiport, Social Sciences Citation Index, ASSIA, MedPilot, DNB), dissertation and theses databases, and the internet (Google); 2. screening references of included studies; 3. contacting authors and civil society organizations for grey literature. Included will be studies which report quantitative and/or qualitative data or review articles on asylum seekers in Germany, published in German or English language. Outcome measures will include physical, mental, or social well-being, and all aspects of health-care provision (access, availability, affordability, and quality). Search results will be screened for eligibility by screening titles, abstracts and full texts. Data extraction comprises information on study characteristics, research aims, and domains of health or health-care services analyzed. The quality of studies will be appraised and documented by appropriate assessment tools. A descriptive evidence map will be drawn by categorizing all included articles by research design and the health conditions and/or domains of health-care provision analyzed. The body of evidence will be evaluated, and a narrative evidence synthesis will be performed by means of a multi-level approach, whereby quantitative and qualitative evidence are analyzed as separate streams and the product of each stream is configured in a final summary. This systematic review will provide an evidence map and synthesis of available research findings on the health status of and health-care provision to asylum seekers in Germany. In anticipation of identifying areas which are amenable to health-care interventions, deserve immediate action, or further exploration, this review will be of major importance for policy-makers, health-care providers, as well as researchers. PROSPERO 2014: CRD42014013043.
    01/2014; 3(1):139. DOI:10.1186/2046-4053-3-139
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    ABSTRACT: Interprofessional collaboration leads to an improvement in health care. This call for increased interprofessional collaboration has led to national and international recommendations for interprofessional learning and education. The GMA has taken up this challenge and has implemented a working group on "interprofessional education in the health professions" to address this topic. The terminology used to describe collaboration among the health professions seems to vary and does not reflect any clear consensus. The aim of this paper is to identify the different terms used to describe collaboration between health professions and to analyse their use in German journals. The terms frequently used to describe collaboration between health professionals were identified and defined. German medical journals were then pragmatically analyzed regarding the use of the terms interprof* and interdiszip*. The German terms for interprofessional and interdisciplinary were not used consistently in the journals reviewed. There seems to be no agreement on the use of terms to describe the collaboration between health professions. Consistent terminology should be used as a basis for promoting collaboration and improving understanding among the parties involved.
  • Health and Quality of Life Outcomes 01/2014; 12(1):112. DOI:10.1186/s12955-014-0112-5 · 2.10 Impact Factor
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    ABSTRACT: Multimorbid patients frequently receive complex medication regimens and are at higher risk for adverse drug reactions and hospitalisations. Managing patients with polypharmacy is demanding, because it requires coordination of multiple prescribers and intensive monitoring. Three evidence-based recommendations addressing polypharmacy in primary care are structured medication counselling, use of medication lists and medication reviews to avoid potentially inappropriate medication (PIM). Although promising to improve patient outcomes, these recommendations are not well implemented in German routine care. Implementation of guidelines is often hindered by specific "determinants of change". "Tailored" interventions are designed to specifically address previously identified determinants. This study examines a tailored intervention to implement the aforementioned recommendations into primary care practices. This study is part of the European Tailored Interventions for Chronic Diseases project, which aims at contributing knowledge about the methods used for tailoring. The study is designed as a cluster randomized controlled trial with primary care practices of general practitioners (GPs) who are organized in quality circles. Quality circles will be the unit of randomization with a 1:1 ratio. Follow-up time is 6 months. GPs and healthcare assistants in the intervention group will receive training on medication management. Each GP will create a tailored concept of how to implement the three recommendations into his/her practice. Evidence-based checklists for medication counselling and medication reviews will be provided for physicians. A tablet PC with an interactive educational tool and information leaflets will be provided for use by patients to inform about the necessity of continuous medication management. Control practices will not receive special training and will provide care as usual. Primary outcome is the degree of implementation of the three recommendations, which will be measured using a prespecified set of indicators. Additionally, the PIM prescription rate, patient activation, patients' beliefs about medicine, medication adherence and patients' social support will be measured. This study will contribute knowledge about the feasibility of implementing recommendations for managing patients with polypharmacy in primary care practices. Additionally, this study will contribute knowledge about methods for tailoring of implementation interventions.Trial registration: Clinicaltrials.gov ISRCTN34664024.
    Trials 12/2013; 14(1):420. DOI:10.1186/1745-6215-14-420 · 2.12 Impact Factor
  • S Uslu, I Natanzon, S Joos
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    ABSTRACT: In order to improve the medical care of people with migration background, the existing specialties in medical understanding must be taken into account. The aim of this study was to explore the image of general practitioners from the viewpoint of patients and to evaluate possible differences in the perception of patients with and without a Turkish migration background.5 focus groups with participants with and without migration background were assessed in German language. In addition to a predefined interview guideline, the collage technique was used in order to explore the image of the practitioners through pictures. The content analysis was conducted according to Mayring using the software program ATLAS.ti.The patients revealed a highly positive image about the general practitioners. By means of the collage technique some negative aspects could be identified which were not discussed in the focus groups. Only minimal differences in the opinions of participants with and without Turkish migration background could be observed. These were a strongly negative attribution to the general practitioners with regard to financial aspects by the participants without migration background on the one hand and a rather paternalistic viewpoint by the participants with Turkish migration background on the other hand. Asked about an image change of general practi-tioners, the overall opinion has changed over the years from doctors being considered to be "powerful" and "unapproachable" to a "normal" level. Major reasons for this image change were attributed to the fact that patients are becoming increasingly informed about medical issues through the internet and the high work pressure of general practitioners. The image of general practitioners in Turkey was perceived more negative as compared to Germany.The image of general practitioners from the perspective of patients is predominantly positive. Altogether, only minor differences in the perception of German speaking patients with and without Turkish migration background could be identified. Therefore, specific ways of proceeding or qualification measures for general practitioners do not seem necessary in this context.
    Das Gesundheitswesen 10/2013; 76(6). DOI:10.1055/s-0033-1357199 · 0.62 Impact Factor
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    ABSTRACT: Improving postgraduate medical training is one important step to attract more medical students into general practice. Keeping pace with international developments moving to competence-based curricula for general practice training, the aim of this project was to develop and implement such a curriculum in Germany. A five-step, peer-based method was used for the curriculum development process including panel testing and a "test version" of the curriculum for the pilot implementation phase. The CanMEDS framework served as a basis for a new German competence-based curriculum in general practice training. Four curricula from European countries and Canada were reviewed and, following required cultural adaptions, key strengths from these were integrated. For the CanMEDS "medical expertise" element of the curriculum, the WONCA ICPC-2 classification of patient's "reason for encounters" was also integrated. Altogether, 37 participants were involved in the development process representing 12 different federal states in Germany, and including an expert advisor from Denmark. An official "test version" of the curriculum consisting of three parts: medical expertise, additional competencies and medical procedures was established. A system of self-assessment for trainees was integrated into the curriculum using a traffic light scale. Since March 2012, the curriculum has been made freely available online as a "test version". In 2014, an evaluation is planned using feedback from users of the test model as a further stage of the implementation process. The first German competence-based curriculum for general practice training has been developed using a pragmatic peer controlled approach and implementation is being trialed with a "test version" of the curriculum. This model project and its peer-based methodology may support competence-based curriculum development for other medical specialties both inside and outside Germany.
    BMC Research Notes 08/2013; 6(1):314. DOI:10.1186/1756-0500-6-314
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    ABSTRACT: Although resource orientation, as a part of health promotion, should play a major role in general practice, the anchoring and realization of resource-oriented approaches remain small in Germany. The aim of this study was to analyze what resource orientation means to general practitioners (GPs) and develop strategies as to how this can be facilitated in GP practice. Within a qualitative research approach, 19 semi-structured telephone interviews were recorded, transcribed, and analyzed using qualitative content analysis. Within the interviews, the inclusion of the patients' individual resources is described as core competence of GPs. Supporting the patients' disease coping strategies and self-help were seen as important by GPs. However, perceptions as to which resources are considered to be fundamental ranged widely across the participant group. The results confirm the important role of resource-oriented approaches in general practice. However, a general definition of resource orientation is needed. In addition, working conditions for GPs need to be taken into account to ensure that these contribute to a healthy work-life balance. The need for GP training was identified to improve communication skills. Further integration of GPs in health promotion and communal structures would be beneficial.
    Evidence-based Complementary and Alternative Medicine 08/2013; 2013:187641. DOI:10.1155/2013/187641 · 2.18 Impact Factor
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    ABSTRACT: Background: In the context of physician shortages, critical factors influencing career choice need to be better understood. The aim of this study was to explore experiences students have had with family medicine in order to develop additional strategies for recruiting family medicine trainees.Methods: Students from the five medical faculties in the federal state of Baden-Wuerttemberg were invited to participate in an online-survey via email. A purpose-built questionnaire was used. In addition to descriptive statistics, analysis included linear partial correlations controlled for age, gender, and semester, which were calculated between the variable "I believe family medicine is an attractive job" and the 31 variables of the survey. Linear regression was used to analyze the influence of experiences with family medicine and statements about family medicine to the perception of family medicine as an attractive specialty.Results: 1299 students participated in the survey. About half of the participants (49.7 %) considered working as a primary care physician to be attractive or partly attractive. 49.6 % of students reported positive experiences with family medicine as a patient and 33.1 % as a family member. 24.3 % reported positive experiences during the compulsory 1-2 weeks general practice internship and 18.1 % during a four weeks elective placement. For 302 participants (23.3 %), family medicine is presented positively in the media. 178 (13.7 %) consider family medicine to have high importance in both undergraduate and postgraduate education. Positive influences on judging attractiveness of family medicine were: own experience with family medicine as a clinical elective (rpart= + 0.450), own experience with family medicine as a patient (rpart= + 0.218), perception that family medicine offers a diversified working day (rpart= + 0.259), and perception that family medicine offers a good salary (rpart= + 0.242).Conclusion: To enable students during undergraduate studies to have practical experience with family medicine seems to be an important influence on judging family medicine attractive.
    DMW - Deutsche Medizinische Wochenschrift 08/2013; DOI:10.1055/s-0033-1349450 · 0.65 Impact Factor
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    ABSTRACT: Germany is facing a shortage of young family doctors. In search of possible reasons the aim of this study was to explore the perception of specialists on family doctors. Within a qualitative study 16 medical specialists from different fields in hospital and outpatient care setting were interviewed. Interviews were analysed using qualitative content analysis according to Mayring. Most of the interviewed specialists have a positive view on family doctors although a certain depreciative assumption is resonated in a number of statements. According to the specialists, family doctors enjoy a high status in public, even if social processes of change may have a negative influence on their rather old-fashioned image. Specialists find that family medicine is underrepresented in university education suffering from an upgrading of specialized disciplines. Altogether the majority of the interviewed specialists certify family doctors in Germany a positive image. Lecturer in medical education and training should be aware of their key role in the career choices of young trainees and avoid degradation or upgrading of certain medical disciplines. Interlinked measures on different levels focusing on the improvement of working conditions and representation at the universities would be needed to regain attractiveness for the family doctor's profession as a career choice for young doctors.
    06/2013; 2013:729473. DOI:10.1155/2013/729473
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    ABSTRACT: Lyme disease, also known as Lyme borreliosis, is caused by infection with Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex, a Gram-negative spirochaete bacterium. Infection in humans takes place through tick bites. In principle, Lyme disease may affect every organ of the body and may manifest in different stages. Early localised or disseminated stages are characterised by erythema migrans, lymphadenosis benigna cutis, facial palsy and arthritis and the later stages by arthritis, acrodermatitis chronica atrophicans or encephalomyelitis. The incubation time of the earlier stages varies from several days to months and that of the later stages from weeks to months or even years. Lyme arthritis commonly manifests mono- or oligoarticularly (< 5 joints). Most frequently the knee joint is affected, followed by the ankle, wrist and elbow. The work-up of Lyme arthritis should include a careful history including residence in, or time spent visiting, an endemic region, previous history of tick bite(s), and erythema migrans. In order to confirm a diagnosis of Lyme arthritis clinical findings and specific IgG antibodies are necessary. A lack of IgG antibodies practically rules out Lyme arthritis. Antibodies can be detected even years after infection(s) in asymptomatic individuals with previous Lyme disease treated with antibiotics. In general, the prognosis of Lyme disease is assumed to be good, in particular after antibiotic therapy of early manifestations.
    The Practitioner 02/2013; 257(1758):25-7, 3.
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    ABSTRACT: Workload, personal health behavior, and job satisfaction of the physicians are crucial aspects for the quality of care they provide. The aim of our study was to identify influencing factors on job satisfaction with regard to general practitioners' (GPs) characteristics such as age, gender, health behavior, body mass index (BMI), and workload. A cross-sectional survey with a sample of 1,027 German GPs was used. Job satisfaction was measured according to a modified version of the Warr-Cook-Wall job satisfaction scale. Further, we collected data about health behavior and BMI of GPs and demographic data. Group comparison was evaluated using ANOVA with Bonferroni correction for post-hoc tests. A linear regression analysis was performed in which each of the job satisfaction items were handled as a dependent variable. The response rate was 34.0%. GPs were rather satisfied with their job with the exception of "hours of work," "physical working condition," and "income." GPs working in cities had less working hours per week, less number of patients per day, longer consultation times, and a higher proportion of privately insured patients compared to GPs working in rural areas. Being female, a higher age, a good health behavior, a lower BMI, and a high proportion of privately insured patients were positively associated with job satisfaction. Our results suggest that job satisfaction depends on different aspects of working conditions and individual characteristics. Therefore, strategies to improve job satisfaction should target improving working conditions and activating physicians' health resources.
    Family medicine 02/2013; 45(2):95-101. · 0.85 Impact Factor
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    ABSTRACT: Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. One competency is professionalism, a definition of which has not yet been developed but is being discussed in the literature. The aim of this qualitative study is an approximation to professionalism among German general practitioners and general practitioner trainees. A qualitative study was conducted by interviewing seven pairs of GPs and their trainees. All interviews were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. Four categories of professionalism emerged: responsibility towards patients, responsibility towards other professionals, responsibility towards the society and responsibility towards oneself. Professionalism was perceived as important for general practice in Germany. In addition, barriers of professional behaviour have been identified. The perception of professionalism among German GPs and GP trainees is in accordance with the frameworks of professionalism found in the literature. These results underline the need for conceptualising professionalism among general practice trainees in Germany.
    01/2013; 107(7):475-83. DOI:10.1016/j.zefq.2013.04.011
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    ABSTRACT: In recent years studies not falling under the German Pharmaceutical Law ("non-drug trials") have also been increasingly expected to be conducted according to Good Clinical Practice (GCP) in order to ensure that uniform standards are maintained for data quality and patient safety. However, simple transfer of the GCP criteria is not always possible and often not useful. Given the fact that research questions regarding non-drug interventions are common in primary care (e.g., general practice), the "Network for Clinical Studies in General Practice" has developed a manual for planning and conducting non-drug trials. This manual is based on the GCP guideline, taking account of the conditions and circumstances in primary care settings. Both structure and relevant content of the manual are presented in the article. (As supplied by the authors).
    01/2013; 107(1):87-92. DOI:10.1016/j.zefq.2012.12.019

Publication Stats

1k Citations
154.02 Total Impact Points

Institutions

  • 2000–2015
    • Universität Heidelberg
      • Department of General Medicine and Health Services Research
      Heidelburg, Baden-Württemberg, Germany
  • 2012
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
  • 2011
    • University of Sydney
      • George Institute for Global Health
      Sydney, New South Wales, Australia
  • 2004–2010
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      Erlangen, Bavaria, Germany
  • 2009
    • University of Tuebingen
      Tübingen, Baden-Württemberg, Germany