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Biomedical subjects

E Laerum

Publications and source records attributed to E Laerum.

At least 19 recordsLinked to original sources
PubMed2001

Learning to have less pain - is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain.

A randomised controlled study with the objective to explore the effects of a group learning programme based on a phenomenological epistemology and personal construct theory. Main outcome measures were: experienced pain, pain coping strategies, absenteeism, disability pension and health care consumption. One hundred and twenty-one patients with chronic musculoskeletal pain and high absenteeism were included in this study. The intervention group (n=77) consisted of nine smaller groups with 6-10 persons in each and were counselled by health personnel with special training. The control group consisted of 44 persons. The learning programme emphasised awareness, possible relations between bodily symptoms, emotions, mind and life situation, and change of focus from pain and disability to resources and potentials. One year after the end of the learning programme (T3), patients in the intervention group reported significant pain reduction, increased pain-coping abilities and a higher reduction of health care consumption than the control group (P<0.05). Absenteeism was not significantly reduced compared to the control group, but there were fewer persons receiving disability pension in the intervention group at T3 (38 versus 59%) (P<0.05). This group-learning programme should be considered an important adjunct to the therapy of patients with chronic muscular pain.

Absenteeism↗
PubMed2001

Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice.

BACKGROUND: Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause. METHODS: We conducted a 4-week randomized, double-blind, placebo-controlled study in 116 individuals selected by a 7-item questionnaire to determine whether the antifungal agent nystatin given orally was superior to placebo. At the onset of the study, the patients were free to select either their regular diet or a sugar- and yeast-free diet, which resulted in four different subgroups: nystatin + diet (ND); placebo + diet (PD); nystatin (N); and placebo (P). RESULTS: Nystatin was significantly better than placebo in reduction of the overall symptom score (P < 0.003). In six of the 45 individually recorded symptoms, the improvement was significant (P < 0.01). All three active treatment groups reduced their overall symptom scores significantly (P < 0.0001), while the placebo regimen had no effect (P = 0.83). The benefit of diet was significant within both the nystatin (ND > N) and the placebo groups (PD > P). CONCLUSIONS: Nystatin is superior to placebo in reducing localized and systemic symptoms in individuals with presumed fungus hypersensitivity as selected by a 7-item questionnaire. This superiority is probably enhanced even further by a sugar- and yeast-free diet.

Adult↗
PubMed2001

A new, brief questionnaire (PEQ) developed in primary health care for measuring patients' experience of interaction, emotion and consultation outcome.

BACKGROUND: A deepened understanding of patients' perspectives is essential in order to improve medical communication. By changing focus from patient satisfaction to patient experiences, more immediate, personal and affective responses may be captured. OBJECTIVE: Our aim was to develop a new consultation-specific questionnaire on patient experiences. METHODS: The questionnaire was developed in Norwegian primary care in three main phases. Phase 1: focus groups with patients in order to identify important aspects of patients' experiences, and their words and language when describing such experiences. Phase 2: a questionnaire survey with 110 items including 660 patients. Extensive testing resulted in a reduction to 25 items on six dimensions. Phase 3: a questionnaire survey with 25 items including 1092 patients. Psychometric analyses and feedback from patients and physicians involved dimensionality and tests of validity and reliability. RESULTS: A final questionnaire was produced with 18 items on five dimensions: communication; emotions; short-term outcome; barriers; and relations with the auxiliary staff. The validity and reliability estimates were highly satisfactory. Three scales were skewed while two were more equally distributed. Forty-eight per cent of the patients described less than optimal communication experiences; some communication barriers were detected in 70% of the visits and less helpful experiences with the staff were reported in 55% of the visits. Twenty-four per cent of patients left with no positive feelings, and 48% scored low on the outcome scale (knowledge, perceived result). CONCLUSIONS: The patient experience questionnaire (PEQ) emphasizes what patients value the most, i.e. interaction, emotions and outcome, and may represent a valuable tool for doctors who want feedback from their patients on the function of their doctor-patient relationships.

Adolescent↗
PubMed2001

Renal colic and recurrent urinary calculi. Management and prevention.

BACKGROUND: Urinary calculi are a relatively common problem and up to 80% of patients with calculi who are untreated will experience one or more recurrences within five years. OBJECTIVE: This paper outlines the causes of urinary calculi and presents evidence for the less conventional treatment of renal colic with NSAIDs such as intramuscular diclofenac in preference to traditional pethidine injections. The paper also deals with ways to prevent recurrence of stone formation. DISCUSSION: Effective treatment requires a clear understanding of the cause, and investigations need to be directed toward establishing this. Prevention is the cornerstone of management and requires patients to have a clear understanding of the problem. Follow up of these patients is essential.

Australia↗
PubMed2001

The patient perspective survey. Can consultations for complex health problems be enhanced?

BACKGROUND: Patients with complex health problems pose particular difficulties due to the interaction between psychosocial factors and physical disease. The aim of this study is to investigate the usefulness of a paper based instrument (the Patient Perspective Survey, or PPS) to enhance general practitioner-patient communication and patients' self reported coping skills. METHODS: A previously validated questionnaire was modified and distributed to a self selected group of 21 GPs. They recruited 77 patients with complex health problems and asked them to complete a PPS questionnaire. The patients then returned for an extended consultation to discuss the results of the questionnaire with the GP. Patients and GPs subsequently completed PPS evaluation forms. RESULTS: The PPS was useful for patients with chronic conditions with mixed physical and psychological components. It appeared to enhance the GP-patient relationship and gave patients a better understanding of their coping skills. DISCUSSION: Patients with complex health problems can use paper based questionnaires to improve the quality of communication between themselves and their GPs.

Adaptation, Psychological↗
PubMed2000

[What is the most important for the patient in the meeting with a general practitioner?].

Efficient medical communication depends on an understanding of the patient perspective. The purpose of this study was to characterise the most important consultation elements as perceived by primary care patients. The experience of 31 patients regarding their most recent medical encounter were recorded in six focus groups. All groups were audiotaped and analysed by qualitative methodology. Five consultation themes emerged spontaneously in all groups: Interaction between doctor and patient (e.g. communication, emotional experiences, and personal relationship with the doctor) and consultation outcome were the most important elements. Information, continuity of care, and time with the doctor were considered reasonably important. Six other themes received limited attention in a few groups only (e.g. availability, doctor's gender, time in the waiting room, auxiliary personnel, the clinical examination, and technical skills). Patients value the personal, attentive, and listening doctor. The feeling of not having to hurry during the consultation is more important than the actual number of minutes. Patients' level of emotional involvement and their specific expectations are often undisclosed. There are large individual differences with regard to the meaning of and need for information.

Communication↗
PubMed2000

[Words and language used by patients when describing consultation with general practitioners].

Increased knowledge of how patients express their experiences may help physicians to capture their patients' perceptions and agenda. The aim of the present study was to examine words and language used by patients when describing specific primary care consultation experiences. Six focus group sessions with a total of 31 patients were conducted shortly after a general practice consultation. All group sessions were audiotaped and analysed by qualitative ethnographic methodology. Seven distinct grammatical and verbal characteristics were found: The consultations were recited in the first person with little recollection of the doctors' talk or actions. Subjectivity was constantly underlined by the verbs "feel" or "think". When expressing negative emotions, the personal pronoun constantly was changed from the personal singular to the impersonal or plural form. Language tended to be evasive in connection with possible criticism. Negative emotions were diminished by the use of limiting expressions and modest wording. Non-committal expressions, with a wide range of possible meanings, were frequent, and were possible to decipher only by close attention to non-verbal cues. We conclude that doctors may capture more of their patients' hidden emotional messages in the consultation by increased awareness of specific verbal characteristics and non-verbal cues.

Communication↗
PubMed2000

Is homeopathic 'immunotherapy' effective? A double-blind, placebo-controlled trial with the isopathic remedy Betula 30c for patients with birch pollen allergy.

The objective of the study was to examine the effect of the homeopathic remedy Betula 30c vs. placebo for patients with birch pollen allergy. A double-blind, randomized, placebo-controlled trial was carried out. Tablets were given for 4 weeks during the birch pollen season. The setting was Oslo, Norway, May 1995. Patients were aged between 18 and 50 y; 32 patients received Betula 30c tablets and 34 patients received placebo tablets. The main outcome measure was the total score of 17 different allergy symptoms. Daily total scores were calculated, as well as differences and ratios between the run-in and the following time periods. Point estimates of the median difference between the experimental and placebo groups, with their 95% confidence intervals, were the main measure of effect. No statistically significant difference between the groups was found during the first and last period of May. However, from 8 to 18 May, a clinically interesting difference was revealed between the groups, those receiving Betula 30c having fewer and less serious symptoms. For some days these differences were statistically significant. Surprisingly, this group reported more aggravation from the tablets than did the placebo group. With a statistical power of 70% for a defined clinically interesting difference (25%), the present results indicate that treatment with Betula 30c during the pollen season deserves further attention.

Adult↗
PubMed2000

Smoking cessation. A comparative, randomised study between management in general practice and the behavioural programme SmokEnders.

OBJECTIVE: To compare the effectiveness of two different stop smoking interventions. DESIGN: A randomised, controlled trial. Results based on intention to treat. SETTING: Three towns in the south-eastern part of Norway. INTERVENTIONS: Visits to GP for "practice as usual" (GP group) or participation in the behavioural programme SmokEnders (SE group) with follow-up 2 weeks, 2 months and 1 year after an agreed stopping date. SUBJECTS: 139 smokers recruited through open invitation. MAIN OUTCOME MEASURE: Self-reported smoking stop rate 2 weeks, 2 months and 1 year after an agreed stopping date, completed with biochemical indicators by the 1-year registration. RESULTS: Two weeks after the agreed cessation date, 10/70 (14%) of the GP group and 46/69 (67%) of the SE group had stopped smoking. After 2 months, 9/70 (13%) in the GP group and 37/69 (54%) in the SE group were non-smokers. One year after cessation 5/70 (7%) in the GP group and 21/69 (30%) in the SE group were non-smokers. CONCLUSIONS: Both interventions were effective as measured by the smoking cessation rate. However, the intervention in the SE group was considerably more effective than in the GP group, which suffered from a sizeable number of drop-outs.

Adult↗
PubMed2000

Agency orientation and chronic musculoskeletal pain: effects of a group learning program based on the personal construct theory.

OBJECTIVE: This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control. DESIGN: The study was a randomized controlled study. PATIENTS: One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held. RESULTS: The intervention group reported a significantly higher score for the variable "management of everyday life" (p <0.005) and for the variable "health care consumption" (p <0.001) than did the control group. Patients with high agency orientation benefited more from the program with regard to pain reduction and improved pain coping than did those patients with low agency orientation (p <0.05). Patients with high agency orientation also reported less absenteeism than did those patients with low agency orientation (p <0.05).

Absenteeism↗
PubMed2000

Distance education. Part 3. Assessment of and feedback to students at a distance.

INTRODUCTION: Assessment of students at distance, in a course with over 20 units (subjects), provides special challenges in providing timely, accurate and detailed feedback both formatively and summatively. METHOD: A description of assessment practices including reflective journals, essays, critical appraisal of literature, case studies or teaching presentations in video and written format, clinical audits, and large research projects is provided. The impact of a multitude of criterion-referenced methods of students, teachers and administrative services as well as quality assurance issues are measured. CONCLUSION: Students preferred multiple levels of formative and summative assessment using criterion referencing to exams. These methods were thought to be contextually relevant to clinical practice and examined knowledge, cognition and performance appropriately. Length of assessment task, difficulty with English as a second language and lack of detail or clarity on written feedback posed problems for a number of students. Quality assurance procedures have been put into place to rectify some of these problems.

Clinical Competence↗
PubMed2000

Distance education. Part 4. Supervision of family medicine research at a distance. A formative evaluation.

INTRODUCTION: A survey on supervision of research projects was undertaken among current general practitioner students, recent graduates and supervisors of a Masters of Family Medicine degree. The aim was to describe and compare the experience of the three groups and, in particular, to identify the problems associated with distance supervision. METHODS: A self-administered questionnaire survey was distributed to current students (n = 21), graduates (n = 16) and current supervisors (n = 7). RESULTS: Forty out of 44 doctors returned completed questionnaires. Distance was a relatively minor barrier to successful supervision, provided that the student and supervisor established good communication patterns and were able to respond to each other with minimal delay. The commencement of the study and its final write-up were critical phases in the supervision process. DISCUSSION: Communication, including emotional and psychological support, was at least as important as expert opinion in helping Masters students to successfully complete their research projects. Attention must be paid to establishing good understanding and regular means of communication at the beginning of the supervisory process.

Data Collection↗
PubMed2000

Distance education. Part 5. Family medicine research at a distance. Guidelines for supervisors.

INTRODUCTION: This paper recommends guidelines for the supervision of Masters degrees or similar postgraduate courses, in which research projects are supervised at a distance. METHODS: The guidelines are based on the experiences of the authors with a five year old Masters of Family Medicine degree and a formative evaluation conducted by questionnaire survey among its students, graduates and supervisors. RESULTS: It is important to establish ground rules for communication at an early point in the supervisory process. Supervisors need to take into account psychosocial, pedagogical and organisational aspects of their mentorship of students. DISCUSSION: These guidelines are relevant to courses where there remains a strong one-to-one relationship between supervisors and students. In these cases, 'distance' need not be a barrier provided that both sides are aware of and committed to maintaining good patterns of communications with each other.

Communication↗
PubMed1999

[Spinal disorders in Norway--an epidemiological report].

Low back disorders are prevalent and induce large costs to the health services, the national insurance system and employers. This paper describes the prevalence of low back pain and low back work disability in the Norwegian population, and the incidence and duration of low back work disability in Aust-Agder county. Data from the Norwegian Health Survey 1995 and the registers of the National Insurance Administration are presented. 45% of women and 38% of men reported low back pain within a 14 day period. The prevalence of low back work disability was 1.9%. Low back disorders caused 13-17% of sickness absence, rehabilitation allowance and disability pensions in 1995. In Aust-Agder, the incidence of sickness absence caused by low back disorders was higher among men. In 16% of persons sick-listed due to low back pain without radiating symptoms, the sickness absence episode lasted for more than seven weeks. When radiating symptoms were present, the corresponding figure was 35%. The number of persons with low back disorders with radiating symptoms seems to have increased the most. Further research, preventive measures and guidelines for clinical work should focus on the group of persons who develop chronic low back work disability.

Adolescent↗
PubMed1999

Patient satisfaction and quality of care at four diagnostic imaging procedures: mammography, double-contrast barium enema, abdominal ultrasonography and vaginal ultrasonography.

The objective of this study was to measure patient satisfaction and to investigate the practical implications of monitoring the quality of care at four radiology procedures. A survey was conducted immediately after the examinations in eight radiology departments: 550 patients attending for mammography, 110 for double-contrast barium enema (DCBE), 97 for abdominal ultrasonography and 90 for vaginal ultrasonography. Outcome measures were seven questionnaire scales: pain, emotional distress, information received, staff's punctuality and technical ability, facilities, and general satisfaction. Response rate was 87 %. Multivariate regression analysis showed significant differences between procedures on all scales (p < 0.001). Differences considered to be of practical importance, i. e. >/= 7 scale points, were detected on five of the scales. Mammography and DCBE caused the most pain, and vaginal US and DCBE caused the most distress. The US procedures entailed dissatisfaction with information about the procedures. The DCBE patients recorded dissatisfaction with the staff's lack of punctuality, and these and the mammography patients recorded dissatisfaction with the facilities. The findings indicate a potential for improving patients' experiences. Several aspects of care, i. e. pain management, attention to the patient's emotional concerns, explanation of procedures, punctuality and quality of the facilities, can be improved.

Abdomen↗
PubMed1999

The importance of self-efficacy in cardiovascular risk factor change.

SUBJECTS AND DESIGN: The study was based on the total patient sample (n = 110) of a randomized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice. Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables. SETTING: Twenty-two general practice centres in the county of Hordaland, western Norway. RESULTS: Self-efficacy of increased physical exercise was the only variable significantly related to exercise change. Age and self-efficacy were statistical significant predictors of smoking cessation success. None of the independent variables was statistically significantly related to blood pressure or cholesterol change. Educational level related negatively, although statistically insignificantly, with total risk change. CONCLUSION: The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change. OBJECTIVES: The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change, predictors such as education, age, self-efficacy, doctors' interpersonal skills, and number of appointments.

Adult↗
PubMed1998

[Effects of a health-education approach on health behavior, consultation satisfaction and psychological well being].

78 patients were recruited from a local occupational health clinic service and from general practices. They were allocated randomly to either an intervention group (40 patients) for a patient-centred approach to health care, or to a control group (38 patients) for conventional care. The patients were free to express their attitudes to health-related behaviour and to suggest behaviour changes. Emphasis was placed on the doctor being an active listener, with an understanding and sympathetic approach to the patient. 27 of the 40 patients in the intervention group suggested initiating change. After six weeks 24 patients reported having accomplished changes. There was a more significant reduction in the use of tobacco in the intervention group (p = 0.05) than in the control group. The patients' evaluation of the two approaches was the same, except for four patients in the intervention group, who felt provoked. Psychological well-being was measured using the Goldberg General Health Questionnaire, 28 item version (GHQ-28). In the control group there was a significant improvement in the GHQ-28 score (p = 0.022) after six weeks; the intervention group showed a near-significant improvement (p = 0.068) after 12 weeks. There was no significant difference in the change in GHQ-28 score between the groups. A patient-centred approach to health care may have potential for changing attitudes to health-related behaviour and bringing about actual behaviour changes. Further research with more extensive material is needed to confirm both this, and the effects on psychological well-being.

Attitude to Health↗