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Biomedical subjects

E Ernst

Publications and source records attributed to E Ernst.

At least 469 records · Page 26Linked to original sources
PubMed1996

The sick role of proponents and opponents of complementary medicine.

Three different samples of patients completed a questionnaire aimed at assessing to what extent Parsons postulates for the sick role were adopted. Most patients did not agree with the first two postulates, namely that a sick person is liberated from part of his/her responsibility and that he/she cannot consciously decide to stop being ill. There was, however, agreement with the third postulate, that a sick individual is expected to seek help in order to get better. Amongst the total sample, the views of the sub-populations of proponents and opponents of complementary medicine showed little and those of chronic versus acute cases some discrepancies. From these findings hypotheses can be derived which could be formally tested through future investigations.

Adult↗
PubMed1996

Familiarization with complementary medicine: report of a new course for primary care physicians.

A course entitled "Familiarization in Complementary Medicine" has been established at Exeter University. The syllabus of the course is presented, together with significant issues for debate that were raised by the attending primary care physicians. The delegates started with a positive but questioning attitude toward complementary medicine (CM) and acknowledge that they gained useful information, leading to increased confidence in discussing CM with patients. The course to a large extent met their needs and expectations. Benefits and draw-backs of integrating CM within general practice were explored. The main advantage of CM, apart from the potential intrinsic value of the techniques themselves, was identified as the time to establish a good therapeutic relationship with the patient. The particular concerns about CM that were expressed by the doctors included poor dialogue with CM practitioners, doubts about competence, and lack of readily identifiable and recognized qualifications. The risk of holding out unrealistic hope of cure was their greatest concern, however, especially if patients were thereby denied an effective orthodox treatment. The course was popular and will be repeated on a regular basis; similar courses for other health professionals including nurses are being planned.

Attitude of Health Personnel↗
PubMed1996

Towards quality in complementary health care: is the German "Heilpraktiker" a model for complementary practitioners?

Complementary medicine is increasing in popularity. In most countries its practice is in the hands of non-medically trained practitioners, professions which are often not properly regulated. When discussing solutions to this problem the German "Heilpraktiker" is often mentioned. The history and present situation of this profession are briefly outlined. The reasons why the "Heilpraktiker concept" is not an optimal solution are discussed. It is concluded that the best way forward consists of regulation and filling the considerable gaps in knowledge relating to complementary medicine.

Clinical Competence↗
PubMed1996

Exercise therapy for osteoporosis: results of a randomised controlled trial.

OBJECTIVE: To define the effects of therapeutic exercise on bone density and back complaints. METHODS: A randomised controlled trial with parallel groups was conducted in an outpatient clinic, Medical School, University of Vienna. Ninety two sedentary post-menopausal women with back problems were randomly allocated to either exercise (groups 1 and 2) or control (group 3, no exercise, n = 31); the exercise group was retrospectively subdivided into compliant (group 1, n = 27) and not fully compliant patients (group 2, n = 34). Regular, initially supervised therapeutic exercise aimed at restoring biomechanical function was performed for four years. Bone density in the forearm was measured by single photon absorptiometry at entry and after four years; subjective back complaints were documented. RESULTS: A significant decrease in bone density was observed in groups 2 and 3; no change was noted in group 1; back complaints decreased in group 1 only. CONCLUSIONS: Sedentary postmenopausal women may benefit from regular long term therapeutic exercise in terms of subjective back complaints and slowed loss of bone mass.

Absorptiometry, Photon↗
PubMed1996

Identifying environmental risk to male reproductive function by occupational sperm studies: logistics and design options.

Malfunction of the male reproductive system might be a sensitive marker of environmental hazards, the effects of which may extend beyond reproductive function. The testis is more vulnerable to heat and ionising radiation than any other organ of the body and several xenobiotics are known to disrupt spermatogenesis after low level exposure. Studies of environmental impact on human health are often most informative and accurate when carried out in the workplace where exposures can be high and easy to document. Semen analysis provides readily obtainable information on testicular function. The main advantages in comparison with functional measures such as fertility rates and time taken to conceive are the possibilities to examine men independently of marriage and pregnancy, to find changes of fecundity with different exposures within the same person and to detect adverse effects when no alteration of fertility is yet taking place. In the implementation of an occupational sperm study considerable attention must be paid to logistic issues. A mobile laboratory unit for initial semen preparation and processing may in some situations increase worker compliance and the quality of sperm cell motility. The cross sectional design which has been used in almost all male reproductive studies so far has several severe limitations including selection bias because of differential participation, difficulties in defining a suitable reference group, and lack of information about the time dimension of the cause-effect relation. The longitudinal design deals adequately with most of these constraints. Semen samples are collected before, during, and possibly after exposure to the risk factor of interest and causal inferences are based upon change of semen variables within a man over time rather than upon differences between men. The logistics of the longitudinal study may benefit from pre-employment health examinations to enrol newly hired workers and require fewer participants to obtain comparable statistical power. In conclusion, andrological methods and epidemiological designs are available for the implementation of valid studies concerned with environmental impact on human testicular function. Occupational sperm studies should probably not be the first choice when the objective is initial screening of environmental impact on fertility but should be implemented when their is a need to corroborate or refuse earlier evidence that specific exposures have impact on testicular function.

Biomarkers↗
PubMed1996

Analysis of intra-operative aspirates taken during microsurgical refertilization in obstructive azoospermia--preliminary results. The BMFT Study Group for Microsurgery, Giessen.

The reasons for the discrepancy between 'patency' and 'pregnancy' in the outcome of microsurgical refertilization are partially unknown. The quality of the intra-operative aspirate and of the spermatozoa at the level of the anastomosis are discussed worldwide as important factors influencing the success of fertilization in the case of post-operative patency. In 152 men undergoing microsurgical refertilization (vasovasostomy, tubulovasostomy, microsurgical epididymal sperm aspiration, transurethral resection of the ejaculatory duct), 281 aspirates were classified intra-operatively according to Silber, and post-operatively using the Shorr staining technique. In 62 aspirates a computer-aided sperm analysis (CASA) was performed. The percentage of intact spermatozoa decreased from 94.9% at the caput to 9.4% at the cauda epididymidis. The post-operative classification demonstrated an acceptable correlation (0.71) to all grades of intraoperative classification. There was a good correspondence in Silber 4 and 5 but worse in Silber 1 and 2. In CASA, the percentage of motile spermatozoa was not different between epididymal and post-epididymal aspirates. Furthermore, velocity parameters did not differ significantly, but there was a significantly higher straightness of post-epididymal spermatozoa in comparison to epididymal spermatozoa.

Adult↗
PubMed1996

Acupuncture as an adjuvant therapy in stroke rehabilitation?

The optimal treatment during stroke rehabilitation has not yet been identified. Several recent reports claim that acupuncture may be a useful addition to conventional stroke rehabilitation. The aim of this paper is to critically review these data. All controlled trials published on this subject were identified by systematic literature searches. Without exception, these trials suggest positive effects of acupuncture on functional recovery. None of them, however, attempted to account for a possible placebo effect. Several other methodological flaws must be considered as well. It is therefore concluded that, according to the data published to date, the evidence that acupuncture is a useful adjunct for stroke rehabilitation is encouraging but not compelling. More and better trials are required to clarify this highly relevant issue.

Acupuncture Therapy↗
PubMed1996

50 years ago: the Nuremberg Doctors' Tribunal. Part 1: The descent towards medicalised murder.

This series of four parts is an attempt to summarise some aspects of medicine during the Third Reich. Its aim is not to provide a systematic review but to remind us of this darkest chapter in the history of medicine and its consequences. The paper summarises the complex evolution of "race hygiene" during the Third Reich and tries to show how politics were medicalised by this idea. On the basis of "race hygiene", involuntary sterilisation was a first step followed by involuntary euthanasia of (mostly) handicapped psychiatric patients. The know-how acquired during these activities was used in the "Final Solution". It presented a level of medical barbarism only to be exceeded by criminal medical research conducted in some concentration camps.

Eugenics↗
PubMed1996

50 years ago: the Nuremberg doctors' tribunal. Part 2: Medical resistance during the Third Reich.

The subject of German medical resistance against the Third Reich is grossly under-researched. From all we know, there was little of it and this may have complex reasons. The publication of "International Medical Bulletin", the fate of Dr Rittmeister, the attitude of some German psychiatrists, the activities of the "Weisse Rose" and the behaviour of Prof. Sauerbruch are briefly discussed as examples of medical resistance.

Editorial Policies↗
PubMed1995

[St. John's wort as antidepressive therapy].

St. John's Wort (Hypericum perforatum) has been used to treat a variety of complaints since ancient times. Recent studies have shown that it is clinically effective for the treatment of the symptoms of depression. It has proved superior to placebo, equally as effective as standard medication and has a clear advantage over the latter in terms of side-effects. It follows that, on the basis of our present knowledge, St. John's Wort can be recommended for use as an anti-depressant.

Antidepressive Agents↗
PubMed1995

Concept of true and perceived placebo effects.

We often and wrongly equate the response seen in the placebo arm of a clinical trial with the placebo effect. In order to obtain the true placebo effect, other non-specific effects can be identified by including an untreated control group in clinical trials. A review of the literature shows that most authors confuse the perceived placebo effect with the true placebo effect. The true placebo effect is highly variable, depending on several factors that are not fully understood. A distinction between the perceived and the true placebo effects would be helpful in understanding the complex phenomena involved in a placebo response.

Clinical Trials as Topic↗