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Biomedical subjects

Erika Baum

Publications and source records attributed to Erika Baum.

5 recordsLinked to original sources
PubMed2006

Determinants for receiving acupuncture for LBP and associated treatments: a prospective cohort study.

BACKGROUND: Acupuncture is a frequently used but controversial adjunct to the treatment of chronic low back pain (LBP). Acupuncture is now considered to be effective for chronic LBP and health care systems are pressured to make a decision whether or not acupuncture should be covered. It has been suggested that providing such services might reduce the use of other health care services. Therefore, we explored factors associated with acupuncture treatment for LBP and the relation of acupuncture with other health care services. METHODS: This is a post hoc analysis of a longitudinal prospective cohort study. General practitioners (GPs) recruited consecutive adult patients with LBP. Data on physical function, subjective mood and utilization of health care services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months. RESULTS: A total of 179 (13 %) out of 1,345 patients received acupuncture treatment. The majority of those (59 %) had chronic LBP. Women and elderly patients were more likely to be given acupuncture. Additional determinants of acupuncture therapy were low functional capacity and chronicity of pain. Chronic (vs. acute) back pain OR 1.6 (CL 1.4-2.9) was the only significant disease-related factor associated with the treatment. The strongest predictors for receiving acupuncture were consultation with a GP who offers acupuncture OR 3.5 (CL 2.9-4.1) and consultation with a specialist OR 2.1 (CL 1.9-2.3). After adjustment for patient characteristics, acupuncture remained associated with higher consultation rates and an increased use of other health care services like physiotherapy. CONCLUSION: Receiving acupuncture for LBP depends mostly on the availability of the treatment. It is associated with increased use of other health services even after adjustment for patient characteristics. In our study, we found that receiving acupuncture does not offset the use of other health care resources. A significant proportion of patients who received did not meet the so far only known selection criterion (chonicity). Acupuncture therapy might be a reflection of helplessness in both patients and health care providers.

Acupuncture Therapy↗
PubMed2006

Evaluating the accuracy of a simple heuristic to identify serious causes of low back pain.

BACKGROUND: Among patients presenting with low back pain (LBP), GPs have to identify those with serious, treatable conditions. However, excluding these conditions in every patient with LPB is time consuming and of low yield. We have suggested that identifying those patients where these serious conditions need to be considered can be made more efficient through asking patient if they feel their LBP is new or unfamiliar in some way. OBJECTIVE: To evaluate the diagnostic validity of a simple heuristic based on the patient's view of the familiarity of LBP. METHODS: Cross-sectional diagnostic study with delayed-type reference standard, nested within a three-arm randomized trial of quality improvement for LBP. A total of 1378 patients presenting, with LBP, to one of 126 participating GPs were included. They were asked whether their LBP was familiar or not (index test). At 1 year, patients were interviewed with regard to relevant conditions that in hindsight might explain their LBP. Reviewers deciding on disease status (reference standard) were blinded to the results of the index test. RESULTS: Totally 1190 patients answered the index test question and were available for interview at 1 year. Only four of these had a serious cause of their LBP. Two of these were identified by the familiarity heuristic, resulting in low sensitivity. CONCLUSION: The number of diseased patients was too small to obtain a reliable estimate of sensitivity. Low prevalence of serious disease in primary care poses difficulties for diagnostic research. In hindsight we would question whether an RCT-setting emphasizing non-specific LBP is suitable for this kind of research. At present, the familiarity heuristic cannot be recommended for patients presenting with LBP.

Adult↗
PubMed2004

Enhancing recognition of early Parkinsonism in the community.

Because Parkinsonism is underdiagnosed in the community, we have validated screening modalities in the field setting and developed a screening procedure to enhance recognition of undiagnosed patients. In a first survey, we identified suspect cases among patients consulting 9 general practitioners (GPs) over a 3-week period using in parallel: (1) a published questionnaire; (2) a standardized examination by the GPs; (3) clinical impression of the GPs; or (4) pre-established diagnoses. Parkinsonism was ascertained by two neurologists with a 1-year follow-up and FP-CIT-SPECT. In total, 1,411 patients consulted the GPs, 1,030 participated in the study, 87 possible cases were identified by at least one of four screening modalities, 12 suffered from Parkinsonism, and 4 of these 12 were de novo cases. Statistical analysis demonstrated that with appropriate evaluation, the questionnaire is highly sensitive and excludes most nonaffected persons, and that the GPs' clinical impression is more specific. We therefore tested in a second survey the efficacy of a serial screening, starting with the questionnaire, followed by a standardized GP evaluation, and then by neurological examination. Of 1,353 participants seen by 9 GPs during a 3-week period, 5 de novo cases were identified. This simple screening protocol significantly enhances recognition of incipient Parkinsonism.

Aged↗
PubMed2003

Feedback for general practice trainers: developing and testing a standardised instrument using the importance-quality-score method.

INTRODUCTION: Although general practice vocational training has been mandatory in Germany since 1993, a service philosophy still prevails. To help general practice trainers develop their identity and skills as trainers we developed and tested a standardised instrument. The questionnaire is to be filled in by registrars after their attachment to a given practice and handed to the trainer as personal feedback on the training provided. METHODS: Items were collected by asking experts in the field to name content that should be covered. The resulting items were reduced using the importance-quality method derived from health-related quality of life research. Reliability was tested by registrars rating their training twice 3 weeks apart. They also provided free text comments that were coded and analysed to establish criterion validity. RESULTS: A total of 121 items were collected. Eighty registrars provided importance and quality ratings to reduce these to 43 items. Test-re-test reliability and criterion validity were also established. CONCLUSION: The importance-quality method proved to be useful for item reduction according to the objective of the questionnaire. Instruments evaluating the quality of vocational training must be context-sensitive.

Education, Medical, Continuing↗