Himmel, Wolfgang

[["dc.bibliographiccitation.firstpage","e022642"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","BMJ Open"],["dc.bibliographiccitation.volume","9"],["dc.contributor.author","Palant, Alexander"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2021-08-26T14:00:20Z"],["dc.date.available","2021-08-26T14:00:20Z"],["dc.date.issued","2019"],["dc.description.abstract","Social support is considered an important resource in coping with chronic conditions. By conducting a series of interviews with people who suffer from inflammatory bowel disease (IBD), we received the impression that social support in face-to-face or online communication could also be a source of stress and strain. The aim of our study was to better understand and describe possible negative effects of social support."],["dc.identifier.doi","10.1136/bmjopen-2018-022642"],["dc.identifier.pmid","30670504"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/16455"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/88847"],["dc.language.iso","en"],["dc.notes.intern","Merged from goescholar"],["dc.relation.eissn","2044-6055"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 4.0"],["dc.rights.uri","https://creativecommons.org/licenses/by-nc/4.0"],["dc.title","Are there also negative effects of social support? A qualitative study of patients with inflammatory bowel disease"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","905"],["dc.bibliographiccitation.issue","12"],["dc.bibliographiccitation.journal","International Journal of Clinical Pharmacology and Therapeutics"],["dc.bibliographiccitation.lastpage","910"],["dc.bibliographiccitation.volume","55"],["dc.contributor.author","Heinemann, Stephanie"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2021-08-26T14:46:04Z"],["dc.date.available","2021-08-26T14:46:04Z"],["dc.date.issued","2017-12"],["dc.description.abstract","A chart review at a mid-sized German general hospital found a high usage of benzodiazepines among older patients. Therefore, all doctors and nurses of this hospital were surveyed about the benefits and risks of benzodiazepines that they considered to be the strongest and their own overall assessment of the risk-benefit ratio for their patients Response rate was 54% (63/116) for doctors and 30% (73/243) for nurses. \"Reduced fear or agitation\" was perceived by many doctors (71%) and nurses (49%) to be a strong benefit of benzodiazepines. With regards to the overall risk-benefit ratio, doctors who indicated that \"falls\" and/or \"craving\" often occur in combination with benzodiazepines were more likely to estimate that the risks of benzodiazepines outweigh the benefits. For nurses, \"confusion\" strongly influenced their overall assessment of the risk-benefit ratio. The results of this study will be incorporated into interventions for reducing benzodiazepine prescriptions.
."],["dc.identifier.doi","10.5414/CP203104"],["dc.identifier.pmid","29092732"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/88877"],["dc.language.iso","en"],["dc.relation.issn","0946-1965"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.title","Searching for factors that may reduce the use of benzodiazepines in hospitals - a survey of hospital doctors and nurses
"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.journal","Kölner Zeitschrift für Soziologie und Sozialpsychologie"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2021-10-01T09:58:56Z"],["dc.date.available","2021-10-01T09:58:56Z"],["dc.date.issued","2021"],["dc.identifier.doi","10.1007/s11577-021-00797-1"],["dc.identifier.pii","797"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/90178"],["dc.language.iso","de"],["dc.notes.intern","DOI Import GROB-469"],["dc.relation.eissn","1861-891X"],["dc.relation.haserratum","/handle/2/113413"],["dc.relation.issn","0023-2653"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 4.0"],["dc.title","Stadtsoziologie"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","810"],["dc.bibliographiccitation.issue","6"],["dc.bibliographiccitation.journal","Medical Decision Making"],["dc.bibliographiccitation.lastpage","818"],["dc.bibliographiccitation.volume","28"],["dc.contributor.author","Fischer, Thomas"],["dc.contributor.author","Fischer, Susanne"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Kochen, Michael M."],["dc.contributor.author","Hummers-Pradier, Eva"],["dc.date.accessioned","2018-11-07T11:09:39Z"],["dc.date.available","2018-11-07T11:09:39Z"],["dc.date.issued","2008"],["dc.description.abstract","Background. The influence of patient characteristics on family practitioners' (FPs') diagnostic decision making has mainly been investigated using indirect methods such as vignettes or questionnaires. Direct observation-borrowed from social and cultural anthropology-may be an alternative method for describing FPs' real-life behavior and may help in gaining insight into how FPs diagnose respiratory tract infections, which are frequent in primary care. Objective. To clarify FPs' diagnostic processes when treating patients suffering from symptoms of respiratory tract infection. Methods. This direct observation study was performed in 30 family practices using a checklist for patient complaints, history taking, physical examination, and diagnoses. The influence of patients' symptoms and complaints on the FPs' physical examination and diagnosis was calculated by logistic regression analyses. Dummy variables based on combinations of symptoms and complaints were constructed and tested against saturated (full) and backward regression models. Results. In total, 273 patients (median age 37 years, 51% women) were included. The median number of symptoms described was 4 per patient, and most information was provided at the patients' own initiative. Multiple logistic regression analysis showed a strong association between patients' complaints and the physical examination. Frequent diagnoses were upper respiratory tract infection (URTI)/common cold (43%), bronchitis (26%), sinusitis (12%), and tonsillitis (11%). There were no significant statistical differences between \"simple heuristic'' models and saturated regression models in the diagnoses of bronchitis, sinusitis, and tonsillitis, indicating that simple heuristics are probably used by the FPs, whereas \"URTI/common cold'' was better explained by the full model. Conclusion. FPs tended to make their diagnosis based on a few patient symptoms and a limited physical examination. Simple heuristic models were almost as powerful in explaining most diagnoses as saturated models. Direct observation allowed for the study of decision making under real conditions, yielding both quantitative data and \"qualitative'' information about the FPs' performance. It is important for investigators to be aware of the specific disadvantages of the method (e. g., a possible observer effect)."],["dc.identifier.doi","10.1177/0272989X08315254"],["dc.identifier.isi","000261037800003"],["dc.identifier.pmid","18448702"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/13099"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/53054"],["dc.notes.intern","Merged from goescholar"],["dc.notes.status","zu prüfen"],["dc.notes.submitter","Najko"],["dc.publisher","Sage Publications Inc"],["dc.publisher.place","Thousand oaks"],["dc.relation.conference","25th Annual Meeting of the Society-for-Medical-Decision-Making"],["dc.relation.eventlocation","Chicago, IL"],["dc.relation.issn","0272-989X"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","Goescholar"],["dc.rights.uri","https://goescholar.uni-goettingen.de/licenses"],["dc.title","Family Practitioners' Diagnostic Decision-Making Processes Regarding Patients with Respiratory Tract Infections: An Observational Study"],["dc.type","conference_paper"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","yes"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.artnumber","e159"],["dc.bibliographiccitation.issue","7"],["dc.bibliographiccitation.journal","Journal of medical Internet research"],["dc.bibliographiccitation.lastpage","e1"],["dc.bibliographiccitation.volume","17"],["dc.contributor.author","Koschack, Janka"],["dc.contributor.author","Weibezahl, Lara"],["dc.contributor.author","Friede, Tim"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Makedonski, Filip Dobrinov"],["dc.contributor.author","Grabowski, Jens"],["dc.date.accessioned","2019-07-09T11:42:34Z"],["dc.date.available","2019-07-09T11:42:34Z"],["dc.date.issued","2015"],["dc.description.abstract","BACKGROUND: The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions. OBJECTIVE: We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience. METHODS: By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion. RESULTS: There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the \"downfall of the professional knowledge providers\" and (2) the \"rise of the nonprofessional treasure trove of experience.\" The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions \"trust in evidence-based knowledge,\" \"trust in experience-based knowledge,\" and \"subjectivity\" (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement). CONCLUSIONS: By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information."],["dc.identifier.doi","10.2196/jmir.4103"],["dc.identifier.fs","618834"],["dc.identifier.pmid","26133525"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/13579"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/58698"],["dc.language.iso","en"],["dc.notes.intern","Merged from goescholar"],["dc.relation.issn","1438-8871"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 2.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/2.0"],["dc.subject.mesh","Chronic Disease"],["dc.subject.mesh","Evidence-Based Medicine"],["dc.subject.mesh","Humans"],["dc.subject.mesh","Internet"],["dc.subject.mesh","Multiple Sclerosis"],["dc.subject.mesh","Patient Satisfaction"],["dc.subject.mesh","Social Media"],["dc.subject.mesh","Spinal Cord"],["dc.subject.mesh","Venous Insufficiency"],["dc.title","Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum."],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","149"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","BMC primary care"],["dc.bibliographiccitation.volume","23"],["dc.contributor.author","Rohde, Jörn"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Hofinger, Clemens"],["dc.contributor.author","Lâm, Thiên-Trí"],["dc.contributor.author","Schrader, Hanna"],["dc.contributor.author","Wallstabe, Julia"],["dc.contributor.author","Kurzai, Oliver"],["dc.contributor.author","Gágyor, Ildikó"],["dc.date.accessioned","2022-11-20T14:35:30Z"],["dc.date.available","2022-11-20T14:35:30Z"],["dc.date.issued","2022"],["dc.description.abstract","Background: PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff.\r\n\r\nMethods: In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests.\r\n\r\nResults: In 40 practices in Würzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3% and a specificity of 99.5% compared to RT-PCR. With a prevalence of 9.5%, the positive predictive value was 93.9% and the negative predictive value was 97.8%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice.\r\n\r\nConclusion: The point of care test used in this study showed a sensitivity below the manufacturer's specification (Sensitivity 96.25%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results."],["dc.identifier.doi","10.1186/s12875-022-01756-1"],["dc.identifier.pii","1756"],["dc.identifier.pmid","35690722"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/117162"],["dc.identifier.url","https://publications.goettingen-research-online.de/handle/2/112148"],["dc.language.iso","en"],["dc.notes.intern","DOI-Import GROB-581"],["dc.relatedmaterial.fulltext","https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187884/pdf/12875_2022_Article_1756.pdf"],["dc.relation.eissn","2731-4553"],["dc.relation.issn","2731-4553"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.subject.gro","Attitude of health personnel; COVID-19 testing; Feasibility study; General practice; Sensitivity and specificity"],["dc.title","Diagnostic accuracy and feasibility of a rapid SARS-CoV-2 antigen test in general practice - a prospective multicenter validation and implementation study"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","285"],["dc.bibliographiccitation.issue","2"],["dc.bibliographiccitation.journal","European Journal of Clinical Pharmacology"],["dc.bibliographiccitation.lastpage","290"],["dc.bibliographiccitation.volume","76"],["dc.contributor.author","Heinemann, Stephanie"],["dc.contributor.author","Brockmöller, Jürgen"],["dc.contributor.author","Hagmayer, York"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2020-12-10T14:09:57Z"],["dc.date.available","2020-12-10T14:09:57Z"],["dc.date.issued","2019"],["dc.identifier.doi","10.1007/s00228-019-02783-1"],["dc.identifier.eissn","1432-1041"],["dc.identifier.issn","0031-6970"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/70614"],["dc.language.iso","en"],["dc.notes.intern","DOI Import GROB-354"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 4.0"],["dc.title","Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks—a hospital survey"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.artnumber","e10"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Journal of Medical Internet Research"],["dc.bibliographiccitation.volume","16"],["dc.contributor.author","Sudau, Fabian"],["dc.contributor.author","Friede, Tim"],["dc.contributor.author","Grabowski, Jens"],["dc.contributor.author","Koschack, Janka"],["dc.contributor.author","Makedonski, Filip Dobrinov"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2018-11-07T09:46:33Z"],["dc.date.available","2018-11-07T09:46:33Z"],["dc.date.issued","2014"],["dc.description.abstract","Background: Increasing numbers of patients are raising their voice in online forums. This shift is welcome as an act of patient autonomy, reflected in the term \"expert patient\". At the same time, there is considerable concern that patients can be easily misguided by pseudoscientific research and debate. Little is known about the sources of information used in health-related online forums, how users apply this information, and how they behave in such forums. Objective: The intent of the study was to identify (1) the sources of information used in online health-related forums, and (2) the roles and behavior of active forum visitors in introducing and disseminating this information. Methods: This observational study used the largest German multiple sclerosis (MS) online forum as a database, analyzing the user debate about the recently proposed and controversial Chronic Cerebrospinal Venous Insufficiency (CCSVI) hypothesis. After extracting all posts and then filtering relevant CCSVI posts between 01 January 2008 and 17 August 2012, we first identified hyperlinks to scientific publications and other information sources used or referenced in the posts. Employing k-means clustering, we then analyzed the users' preference for sources of information and their general posting habits. Results: Of 139,912 posts from 11,997 threads, 8628 posts discussed or at least mentioned CCSVI. We detected hyperlinks pointing to CCSVI-related scientific publications in 31 posts. In contrast, 2829 different URLs were posted to the forum, most frequently referring to social media, such as YouTube or Facebook. We identified a total of 6 different roles of hyperlink posters including Social Media Fans, Organization Followers, and Balanced Source Users. Apart from the large and nonspecific residual category of the \"average user\", several specific behavior patterns were identified, such as the small but relevant groups of CCSVI-Focused Responders or CCSVI Activators. Conclusions: The bulk of the observed contributions were not based on scientific results, but on various social media sources. These sources seem to contain mostly opinions and personal experience. A small group of people with distinct behavioral patterns played a core role in fuelling the discussion about CCSVI."],["dc.identifier.doi","10.2196/jmir.2875"],["dc.identifier.isi","000331450500019"],["dc.identifier.pmid","24425598"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/14475"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/34899"],["dc.notes.intern","Merged from goescholar"],["dc.notes.status","zu prüfen"],["dc.notes.submitter","Najko"],["dc.relation.issn","1438-8871"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 2.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/2.0"],["dc.title","Sources of Information and Behavioral Patterns in Online Health Forums: Observational Study"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.artnumber","208"],["dc.bibliographiccitation.journal","BMC Medical Education"],["dc.bibliographiccitation.volume","15"],["dc.contributor.author","Rogausch, Anja"],["dc.contributor.author","Beyeler, Christine"],["dc.contributor.author","Montagne, Stephanie"],["dc.contributor.author","Jucker-Kupper, Patrick"],["dc.contributor.author","Berendonk, Christoph"],["dc.contributor.author","Huwendiek, Soren"],["dc.contributor.author","Gemperli, Armin"],["dc.contributor.author","Himmel, Wolfgang"],["dc.date.accessioned","2018-11-07T09:48:48Z"],["dc.date.available","2018-11-07T09:48:48Z"],["dc.date.issued","2015"],["dc.description.abstract","Background: In contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises (mini-CEXs) take place at the clinical workplace. As both mini-CEXs and OSCEs assess clinical skills, but within different contexts, this study aims at analyzing to which degree students' mini-CEX scores can be predicted by their recent OSCE scores and/or context characteristics. Methods: Medical students participated in an end of Year 3 OSCE and in 11 mini-CEXs during 5 different clerkships of Year 4. The students' mean scores of 9 clinical skills OSCE stations and mean 'overall' and 'domain' mini-CEX scores, averaged over all mini-CEXs of each student were computed. Linear regression analyses including random effects were used to predict mini-CEX scores by OSCE performance and characteristics of clinics, trainers, students and assessments. Results: A total of 512 trainers in 45 clinics provided 1783 mini-CEX ratings for 165 students; OSCE results were available for 144 students (87 %). Most influential for the prediction of 'overall' mini-CEX scores was the trainers' clinical position with a regression coefficient of 0.55 (95 %-CI: 0.26-0.84; p <.001) for residents compared to heads of department. Highly complex tasks and assessments taking place in large clinics significantly enhanced 'overall' mini-CEX scores, too. In contrast, high OSCE performance did not significantly increase 'overall' mini-CEX scores. Conclusion: In our study, Mini-CEX scores depended rather on context characteristics than on students' clinical skills as demonstrated in an OSCE. Ways are discussed which focus on either to enhance the scores' validity or to use narrative comments only."],["dc.identifier.doi","10.1186/s12909-015-0490-3"],["dc.identifier.isi","000365251400001"],["dc.identifier.pmid","26608836"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/12552"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/35382"],["dc.notes.intern","Merged from goescholar"],["dc.notes.status","zu prüfen"],["dc.notes.submitter","Najko"],["dc.relation.issn","1472-6920"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 4.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","The influence of students' prior clinical skills and context characteristics on mini-CEX scores in clerkships - a multilevel analysis"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.journal","European Journal of Clinical Pharmacology"],["dc.contributor.author","Wedmann, Fabian"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Nau, Roland"],["dc.date.accessioned","2019-07-09T11:51:05Z"],["dc.date.available","2019-07-09T11:51:05Z"],["dc.date.issued","2019"],["dc.description.abstract","OBJECTIVE: To examine the impact of medication and medical conditions on the fall risk in older hospitalized patients. DESIGN: Matched case-control study. SETTING: Large regional hospital in a mid-sized German city. SUBJECTS: Four hundred eighty-one inpatients aged ≥ 65 years who fell during hospitalization (\"cases\") and a control group of 481 controls, matched for age, gender, and hospital department. METHODS: Diagnosis, medication, vital parameters, and injuries were compared between cases and controls. Univariate and multivariable odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. MAIN RESULTS: Several drugs were significantly associated with falls in multivariate analyses: long-acting benzodiazepines (adjusted OR = 3.49; 95%-CI = 1.16-10.52), serotonin-noradrenalin reuptake inhibitors (SNRI) (2.57; 1.23-5.12), Z-drugs (2.29; 1.38-3.59), low-potency neuroleptics (1.87; 1.08-3.23), ACE inhibitors/sartans (1.42; 1.07-1.89). Digoxin (0.32; 0.11-0.99) and aldosterone receptor antagonists (0.54; 0.33-0.88) were negatively associated with falls. No significant association in multivariate analyses was found for short- and intermediate-acting benzodiazepines, mirtazapine, and opioids. Hyponatremia (1.52; 1.15-2.03) and leukocytosis (1.39; 1.05-1.87) in blood examination on admission showed significant association with falls. As secondary diagnoses, Parkinson syndrome (2.38; 1.27-4.46) and delirium (3.74; 2.26-6.21) were strongly associated with falls. The use of more than one psychoactive drug was a separate risk factor for falls (p < 0.0001). CONCLUSION: Several drugs including SNRI, neuroleptics, and Z-drugs showed a significant association with inpatient falls. The frequently prescribed tetracyclic antidepressant mirtazapine did not appear to increase the risk of falls. Psychoactive polypharmacy should be avoided."],["dc.identifier.doi","10.1007/s00228-019-02668-3"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/16047"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/59874"],["dc.language.iso","en"],["dc.notes.intern","Merged from goescholar"],["dc.relation.issn","1432-1041"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.rights","CC BY 4.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.subject.ddc","610"],["dc.title","Medication and medical diagnosis as risk factors for falls in older hospitalized patients"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]