Behaviour of general dental practitioners in Germany regarding posterior restorations with flowable composites

Because the recommendation to use flowables for posterior restorations is still a matter of debate, the objective of this study was to determine in a nationwide survey in Germany how frequently, for what indications, and for what reasons, German dentists use flowable composites in posterior teeth. In addition, the acceptance of a simplified filling technique for posterior restorations using a low stress flowable composite was evaluated. Completed questionnaires from all over Germany were returned by 1,449 dentists resulting in a response rate of 48.5%; 78.6% of whom regularly used flowable composites for posterior restorations. The most frequent indications were cavity lining (80.1%) and small Class I fillings (74.2%). Flowables were less frequently used for small Class II fillings (22.7%) or other indications (13.6%). Most frequent reasons given for the use of flowables in posterior teeth were the prevention of voids (71.7%) and superior adaptation to cavity walls (72.9%), whereas saving time was considered less important (13.8%). Based on the subjective opinion of the dentists the simplified filling technique seemed to deliver advantages compared to the methods used to date particularly with regard to good cavity adaptation and ease of use. In conclusion, resin composites are the standard material type used for posterior restorations by general dental practitioners in Germany and most dentists use flowable composites as liners.

[Periprosthetic joint infections - a review for general practitioners]

The number of prosthetic joint implantation is continuously increasing. Periprosthetic joint infection is a rare but serious complication. The correct diagnosis is essential for successful treatment. It requires the close collaboration between general practitioners, orthopaedic surgeons and infectious disease specialists. A delayed diagnosis sets hurdles to the medical and surgical treatment. Also, antimicrobial treatment without proper microbiological sampling must be avoided. Swabs from wounds are not helpful, because the results represent the skin flora, but not the causative pathogen of infection. The general practitioner is the first physician that patients contact and has, therefore, a central role in diagnosing and managing periprosthetic joint infections. In this review, classification, diagnostic means and treatment concepts of periprosthetic joint infections are presented.

Impact of a nurse vaccination program on hepatitis B immunity in a Swiss HIV clinic

We evaluated the impact of a nurse program for hepatitis B virus vaccination in a center from the Swiss HIV Cohort Study. Immunity (anti-HBs >10 IU/mL) increased from 32% to 76% in the intervention center (n = 238) where vaccine management was endorsed by nurses, but only from 33% to 39% in control centers (n = 2712, P < 0.001) where management remained in charge of physicians. Immunity against HBV in the HIV population is insufficient in Switzerland. Specific nurse vaccination program may efficiently improve health care.

A nurse is a nurse? A systematic review of the effectiveness of specialised nursing in breast cancer

The effectiveness of specialised nursing in breast cancer has received limited attention. This systematic literature review aims at (i) presenting and discussing role models of specialised nursing in the area of breast cancer and (ii) suggesting avenues for future research in this field. The ten studies included in the review differ with respect to the roles of specialised nurses as well as the measured outcome variables; thus, the comparability and generalisability of results are limited. Nevertheless, the review indicates that specialised nursing in breast cancer may contribute to improved physical and psycho-social well-being. In view of the limited comparability, the authors call for (i) a more uniform definition of models of specialised nursing in breast cancer care, as well as (ii) rigorous confirmatory studies to evaluate their effectiveness. These two aspects are pivotal in providing a reliable basis for future health care strategies.

Complementary and conventional medicine in Switzerland: comparing characteristics of general practitioners

OBJECTIVES: Do structural characteristics of general practitioners (GPs) who practice complementary medicine (CAM) differ from those GPs who do not? Assessed characteristics included experience and professional integration of general practitioners (GPs), workload, medical activities, and personal and technical resources of practices. The investigated CAM disciplines were anthroposophic medicine, homoeopathy, traditional Chinese medicine, neural therapy and herbal medicine. MATERIAL AND METHODS: We designed a cross-sectional study with convenience and stratified samples of GPs providing conventional (COM) and/or complementary primary care in Switzerland. The samples were taken from the database of the Swiss medical association (FMH) and from CAM societies. Data were collected using a postal questionnaire. RESULTS: Of the 650 practitioners who were included in the study, 191 were COM, 167 noncertified CAM and 292 certified CAM physicians. The proportion of females was higher in the population of CAM physicians. Gender-adjusted age did not differ between CAM and COM physicians. Nearly twice as many CAM physicians work part-time. Differences were also seen for the majority of structural characteristics such as qualification of physicians, type of practice, type of staff, and presence of technical equipment. CONCLUSION: The study results show that structural characteristics of primary health care do differ between CAM and COM practitioners. We assumed that the activities of GPs are defined essentially by analyzed structures. The results are to be considered for evaluations in primary health care, particularly when quality of health care is assessed.

Systematic counselling by general practitioners for promoting physical activity in elderly patients: a feasibility study

RESEARCH QUESTIONS: To investigate how the daily physical activities of elderly patients can be enhanced by systematic counselling conducted by general practitioners (GPs). METHODS: In this feasibility study with pre-post design, 29 people (14 females, mean age 72.2 years, SD = 6.1) were enrolled during routine visits by two general practitioners. A baseline assessment of current physical activity based on the stages according to the Transtheoretical Model was followed by a counselling session. The target behaviour was defined by performance of 30 minutes of daily moderate-intensity activities that increase the breathing rate, on five days per week. At the 2-month follow-up, subjects were assessed for improvement in stage of physical activity since baseline. After the end of the intervention, participating GPs and patients were asked questions focusing on the feasibility, acceptance and usefulness of counselling. RESULTS: Interview results showed that the two GPs considered the counselling protocol easy to handle and useful for promoting physical activity. Counselling sessions were especially encouraging for the not sufficiently active people. Most of them would like to have additional counselling session. At baseline, 9 of 29 people were sufficiently active. After 2 months, this proportion was 21 of 29. The mean of the number of minutes of physical activity during the previous 4 weeks increased from 247 to 436 minutes (weekly). CONCLUSIONS: The programme was judged positively by the general practitioners and the participating elderly patients. Systematic counselling by general practitioners led to an increase in the physical activity behaviour. Therefore, a more rigorous randomised controlled trial with adequate followup is recommended.

Competencies in arts therapies: A rating of importance, training and performance by practitioners and referring professionals in Switzerland

This survey was conducted in developing a final specialized examination for all arts therapists in Switzerland by the Council of Swiss Arts Therapy Associations (CSATA). Forty-eight generic key competencies (GKC) were sent to all 1235 arts therapists in five different disciplines in Switzerland (response 47.5%) and to 384 referring professionals and employers (RPE) listed by therapists (response 42%). The mean importance of GKC was rated high (4 points of 5) by practitioners and RPE. Different opinions on importance of GKC in disciplines included artistic ability and psychotherapeutic relative to medical orientation. The training of competencies was rated lower by practitioners (3.48 points) and different in the eight competence categories and five disciplines. Areas of weak training were identified. The performance of GKC was rated by referring professionals equally to its importance (mean +0.3 points) and showed a good understanding of competencies by RPE. Judging of performance was difficult for RPE in more than 20% of items. The results provide criteria for detailed outcome assessments and the advancement of a final examination for arts therapists in Switzerland.

[Optimised glycaemic control and dose titration with insulin glargine (Lantus) by general practitioners in Switzerland: results of the OPTI-LAN Postmarketing Study]

National and international societies have published guidelines regarding glycaemic control in type-2 diabetes mellitus. Clinical studies have shown that glycaemic control of type-2 diabetes mellitus can be improved using simple algorithms for titration of insulin Glargine (Lantus). It is unclear, to what degree published guidelines are adopted in daily practice in Switzerland.

Do patients respect the line? Transgression of boundaries reported by Swiss general practitioners

OBJECTIVE: Transgression of boundaries in the relationship between physician and patient is commonly studied with patient as victim and physician as transgressor. A recent survey in the U.S. reported that almost 90% of physicians face transgression by patients over one year. Incidents happened mainly through verbal abuse, disregarding privacy, and overly affectionate behavior. Since this incidence seems to be alarmingly high, we were interested to analyze how often general practitioners in Switzerland experience transgression by patients. METHODS: 24% of the members of the Swiss Society of Internal Medicine (SGIM) and of the Swiss Society of General Medicine (SGAM) (n=675/2781) responded to an internet-based survey which asked for experiences of transgression by patients and for physicians' responses to transgression in the last 12 months. RESULTS: 81% of responding physicians experienced transgression over the period of one year. Analyzing the frequency of incidents per physician per year, the most common forms of transgression were 'use of physician's first name' (7.7/y), 'asking personal questions' (1.8/y), 'being verbally abusive' (1.5/y), and 'being overly affectionate' (1.4/y). Calculated incidence of transgression was 3 per 1000 patient contacts. 39% of physicians decided to ignore the incident, 37% discussed the event openly. Transgression led to dismissal of patients in 13% of events. CONCLUSION: Transgression even in mild and modest form is a rare phenomenon in Swiss practices. PRACTICE IMPLICATION: The Swiss data do not suggest that there is a specific risk for Swiss practitioners to be exposed to major transgression for which they should specifically be prepared for example in communication skills trainings.