Publications by authors named "Dagmar Schaffler-Schaden"

10 Publications

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COVI-Prim survey: Challenges for Austrian and German general practitioners during initial phase of COVID-19.

PLoS One 2021 10;16(6):e0251736. Epub 2021 Jun 10.

Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.

Background: Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response.

Methods: 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April).

Results: The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly.

Conclusion: Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met.

Registration: Trial registration at the German Clinical Trials Register: DRKS00021231.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251736PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191874PMC
June 2021

Home care nursing for persons with dementia from a family caregivers' point of view: Predictors of utilisation in a rural setting in Austria.

Health Soc Care Community 2021 May 7. Epub 2021 May 7.

Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.

The service utilisation of persons with dementia (PwD) and their caregivers is subject to lively debate. The reasons for non-utilisation are manifold and heterogeneous. Conceptual models and explanatory frameworks may help identify predictors of the usage of health services. Literature examining the utilisation of home care services for PwD is scarce. This study explored predictors of home care nursing utilisation of PwD and their informal caregivers in a rural setting, according to the Andersen Behavioural Model of Health Care Use. A mixed-methods study was conducted in a rural area of Austria. In using non-random multistage sampling, anonymous questionnaires were distributed to collect data on family caregivers of PwD. Data were analysed using sequential binary logistic regression to characterise home care service users. To reflect the complexity of the Andersen model, a regression tree model was used. In total, 107 family caregivers completed the survey. Predisposing factors for home care nursing utilisation were higher age of the caregiver, female gender of PwD and kinship of the PwD and caregiver. Disruptive behaviour and independence in activities of daily living of PwD were associated with need factors for service use. According to the Andersen model, the predisposing and need factors contributed most to the explanation of home care nursing utilisation. The enabling factors employment, education and income tend to predict service use. Our findings indicate that higher age of the family caregiver and female gender of PwD are the main predictors for utilisation of home care nursing in a rural setting. To improve utilisation, the advantages of professional care services should be promoted, and the awareness about the variety of services available should be increased. To ensure a better understanding of the barriers to accessing home care, PwD should more often be included in healthcare service research.
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http://dx.doi.org/10.1111/hsc.13412DOI Listing
May 2021

Attitudes of medical students to general practice: a multinational cross-sectional survey.

Fam Pract 2021 Jun;38(3):265-271

Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria.

Background: A shortage of general practitioners (GPs) is common to many European countries. To counteract this, it is essential to understand the factors that encourage or discourage medical students from choosing to become a GP.

Objective: To evaluate medical students' attitudes towards general practice and to identify factors that discourage them from considering a career as a GP.

Methods: In this multinational cross-sectional online survey, 29 284 students from nine German, four Austrian and two Slovenian universities were invited to answer a questionnaire consisting of 146 closed and 13 open-ended items.

Results: Of the 4486 students that responded (response rate: 15.3%), 3.6% wanted to become a GP, 48.1% were undecided and 34.6% did not want to be a GP. Significant predictors for interest in becoming a GP were higher age [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.02-1.10], positive evaluation of the content of a GP's work (OR = 4.44; 95% CI = 3.26-6.06), organizational aspects (OR = 1.42; 95% CI = 1.13-1.78), practical experience of general practice (OR = 1.66; 95% CI = 1.08-2.56) and the country of the survey [Slovenian versus German students (Reference): OR = 2.19; 95% CI = 1.10-4.38; Austrian versus German students (Reference): OR = 0.50; 95% CI = 0.32-0.79].

Conclusion: Strategies to convince undecided students to opt for a career as a GP should include a positive representation of a GP's work and early and repeated experience of working in a general practice during medical school.
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http://dx.doi.org/10.1093/fampra/cmaa126DOI Listing
June 2021

Improving medication appropriateness in nursing homes via structured interprofessional medication-review supported by health information technology: a non-randomized controlled study.

BMC Geriatr 2020 11 26;20(1):506. Epub 2020 Nov 26.

Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.

Background: In nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications. Managing medication in NHRs is a priority, but prone to several challenges, including interprofessional cooperation. Against this background, we implemented and tested an interprofessional intervention aimed to improve medication appropriateness for NHRs.

Methods: A non-randomized controlled study (SiMbA; "Sicherheit der Medikamentherapie bei AltenheimbewohnerInnen", Safety of medication therapy in NHRs) was conducted in six nursing homes in Austria (2016-2018). Educational training, introduction of tailored health information technology (HIT) and a therapy check process were combined in an intervention aimed at healthcare professionals. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI). Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention via self-administered assessments and electronic health records.

Results: We included 6 NHs, 17 GPs (52.94% female) and 240 NHRs (68.75% female; mean age 85.0). Data of 159 NHRs could be included in the analysis. Mean MAI-change was - 3.35 (IG) vs. - 1.45 (CG). In the subgroup of NHRs with mean MAI ≥23, MAI-change was - 10.31 (IG) vs. -3.52 (CG). The intervention was a significant predictor of improvement in MAI when controlled for in a multivariable regression model.

Conclusions: Improvement of medication appropriateness was clearest in residents with inappropriate baseline MAI-scores. This improvement was independent of variances in certain covariates between the intervention and the control group. We conclude that our intervention is a feasible approach to improve NHRs' medication appropriateness.

Trial Registration: DRKS Data Management, ID: DRKS00012246 . Registered 16.05.2017 - Retrospectively registered.
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http://dx.doi.org/10.1186/s12877-020-01895-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690110PMC
November 2020

Skeletal muscle index is an independent predictor of early recurrence in non-obese colon cancer patients.

Langenbecks Arch Surg 2020 Jun 5;405(4):469-477. Epub 2020 Jun 5.

Department of Surgery, St. John of God Hospital, Kajetanerplatz 1, 5020, Salzburg, Austria.

Purpose: Progressive loss (sarcopenia) and fatty infiltration of muscle mass (myosteatosis) are well-established risk factors for an adverse clinical outcome in obese patients. Data concerning non-obese sarcopenic patients in oncologic surgery are scarce and heterogeneous. The aim of this study was to determine the impact of sarcopenia and myosteatosis in non-obese patients with cancer of the right colon on clinical outcome.

Methods: This study comprised 85 patients with a BMI < 30 kg/m, who underwent surgery for right colon cancer in a single center. Skeletal muscle area (SMA), visceral fat area (VFA), and myosteatosis were retrospectively assessed using preoperative abdominal CT images. Univariate und multivariate analysis was performed to evaluate the association between body composition, complications, and oncologic follow-up.

Results: Traditional risk factors such as visceral fat (p = 0.8653), BMI (p = 0.8033), myosteatosis (p = 0.7705), and sarcopenia (p = 0.3359) failed to show any impact on postoperative complications or early recurrence. In our cohort, the skeletal muscle index (SMI) was the only significant predictor for early cancer recurrence (p = 0.0467).

Conclusion: SMI is a significant prognostic factor for early cancer recurrence in non-obese colon cancer patients. Our study shows that conventional thresholds for sarcopenia and BMI do not seem to be reliable across various cohorts. Target prehabilitation programs could be useful to improve outcome after colorectal surgery.

Trial Registration: DRKS00014655, www.apps.who.int/trialsearch.
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http://dx.doi.org/10.1007/s00423-020-01901-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359173PMC
June 2020

Comparison of high tone therapy and transcutaneous electrical nerve stimulation therapy in chemotherapy-induced polyneuropathy.

Medicine (Baltimore) 2020 May;99(19):e20149

Institute of Physical Medicine and Rehabilitation.

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN.

Methods: This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed.

Discussion: This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.
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http://dx.doi.org/10.1097/MD.0000000000020149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220357PMC
May 2020

Evaluation of baseline fracture risk in younger postmenopausal women with breast cancer using different risk assessment methods.

Skeletal Radiol 2020 Jun 24;49(6):1015-1019. Epub 2020 Jan 24.

University Clinic for Nuclear Medicine and Endocrinology, Salzburg, Austria.

Objective: Controversy exists about the impact of bone mineral density (BMD) and fracture risk in newly diagnosed patients with breast cancer (BC). It is presumed that there are differences in BMD between women with BC and healthy controls. BMD is therefore considered as a potential marker to predict BC risk. This study was conducted to investigate the association of BMD, trabecular bone score (TBS) and fracture risk in younger postmenopausal women with hormone responsive BC.

Methods: Overall, 343 women were examined. Women with BC were matched to a control group of the general population. Forty-nine women and fifty-nine controls were included in the final analysis. All subjects underwent dual energy x-ray absorptiometry (DXA) of the lumbar spine, femoral neck, and the total hip to evaluate bone mineral density. The 10-year fracture risk for a major osteoporotic fracture was assessed using the FRAX-score and the TBS-adjusted FRAX-Score, respectively.

Results: Lumbar and femoral neck BMD were similar in BC patients and controls. No difference was found for TBS of the spine (1.38 ± 0.1 vs.1.36 ± 0.09) in the BC and the control group, respectively (p = 0.19). The 10- year probability for a major osteoporotic fracture (MoF) or femoral neck (FN) fracture was 6.1 (± 2.6%) and 0.9 (± 1.2%) in the BC group vs. 6.7 (± 3.5%) (p = 0.33) and 0.9 (± 1.1%) (p = 0.73) in the control group.

Conclusion: Postmenopausal women younger than 60 years with breast cancer do not show any differences in baseline BMD, TBS, or TBS adjusted FRAX in comparison to controls.
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http://dx.doi.org/10.1007/s00256-020-03378-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170974PMC
June 2020

Comparing perspectives of family caregivers and healthcare professionals regarding caregiver burden in dementia care: results of a mixed methods study in a rural setting.

Age Ageing 2020 02;49(2):199-207

Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.

Background: Persons with dementia (PwD) need support to remain in their own homes as long as possible. Family caregivers, homecare nurses and general practitioners (GPs) play an important role in providing this support, particularly in rural settings. Assessing caregiver burden is important to prevent adverse health effects among this population. This study analysed perceived burden and needs of family caregivers of PwD in rural areas from the perspectives of healthcare professionals and family caregivers.

Methods: This was a sequential explanatory mixed methods study that used both questionnaires and semi-structured interviews. Questionnaires measuring caregiver burden, quality of life and nursing needs were distributed to the caregivers; health professionals received questionnaires with adjusted items for each group. Additionally, in-depth qualitative interviews were carried out with eight family caregivers.

Results: The cross-sectional survey population included GPs (n = 50), homecare nurses (n = 140) and family caregivers (n = 113). Healthcare professionals similarly assessed the psychosocial burden and stress caused by behavioural disturbances as most relevant. Psychological stress, social burden and disruptive behaviour (in that order) were regarded as the most important factors from the caregivers' perspective. It was found that 31% of caregivers reported permanent or frequent caregiver overload. Eight themes related to caregiver burden emerged from the subsequent interviews with caregivers.

Conclusions: Professional support at home on an hourly basis was found to be highly relevant to prevent social isolation and compensate for lack of leisure among caregivers of PwD. Improvement of interprofessional dementia-related education is needed to ensure high-quality primary care.
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http://dx.doi.org/10.1093/ageing/afz165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047818PMC
February 2020

Risk of needle tract seeding after coaxial ultrasound-guided percutaneous biopsy for primary and metastatic tumors of the liver: report of a single institution.

Abdom Radiol (NY) 2020 10;45(10):3301-3306

Department of Radiology and Nuclear Medicine, Hospital of St. John of God, Kajetanerplatz 1, 5020, Salzburg, Austria.

Purpose: The objective of this study was to determine the incidence of needle track seeding after ultrasound-guided percutaneous biopsy of indeterminate liver lesions with a coaxial biopsy system without any other additional intervention or ablation therapy.

Methods: We identified 172 patients in a retrospective cohort study who underwent ultrasound-guided biopsy due to a liver mass in our institution between 2007 and 2016. The same coaxial biopsy system was used in all patients, no consecutive ablation was performed.

Results: None of the finally included 131 patients developed neoplastic seeding. There was one major complication (0.76%), the rest of the complications were minor (3.8%) and did not require further intervention.

Conclusion: Needle track seeding is a rare delayed complication after percutaneous liver biopsy. Coaxial liver biopsy is a safe method to obtain multiple samples with a single punch in patients with primary or metastatic liver lesions.
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http://dx.doi.org/10.1007/s00261-019-02120-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455584PMC
October 2020

Improving medication appropriateness in nursing home residents by enhancing interprofessional cooperation: A study protocol.

J Interprof Care 2018 Jul 9;32(4):517-520. Epub 2018 Mar 9.

b Institute of Nursing Science and Practice , Paracelsus Medical University, Salzburg , Austria.

Polypharmacy in elderly people is an increasing challenge for health professionals. Drug-Drug interactions, dosing or administration errors can cause preventable incidents and hospitalizations. Due to chronic illness and multi-morbidity, older people are considered as a particularly vulnerable group of patients. Furthermore, it is well known that communication between health professionals is often insufficient. The aim of this study is to improve the appropriateness of medication of nursing home residents by establishing a long-term structured medication review process and to enhance the interprofessional communication between general practitioners (GPs), nurses and pharmacists. GPs review and adapt medication of residents, nurses perform structured monitoring of residents for drug-related symptoms. Pharmacists check the appropriateness of prescribed therapy by performing a medication analysis. For this purpose, a special electronic platform (SiM-Pl) is developed to extend the original health documentation system with additional tools. SiM-Pl enables participants to gain access to relevant information regardless of time and place and shall facilitate health documentation and exchange of information. All involved health professionals receive a topic-related, specific education. The study is designed as a non-randomized, controlled trial. Health-related benefits and improved quality of life are expected for the participating residents.
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http://dx.doi.org/10.1080/13561820.2018.1448372DOI Listing
July 2018