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H Raspe

Publications and source records attributed to H Raspe.

At least 19 recordsLinked to original sources
PubMed2006

Beyond mammography screening: quality assurance in breast cancer diagnosis (The QuaMaDi Project).

As many breast cancer cases are detected outside mammographic screening, a multidisciplinary quality management (QuaMaDi) project involving gynaecologists, double reading by radiologists. and centralised assessment, documentation, evaluation and feedback was implemented into routine breast cancer diagnosis in part of Schleswig-Holstein (Germany) with a population of 365,000 women. A cohort of 59,514 patients eligible for diagnostic mammography was examined from May 2001 to December 2005 and quality indicators, breast cancer incidence and tumour stage distribution were analysed. A total of 102,744 diagnostic processes were initiated, for 23.8% of which (24,470) a third expert reading at the reference centre was performed. Further assessment was recommended for 6.3% (6442) of all patients. In total, 1056 breast cancer cases were diagnosed (10.3 per 1000 examinations). Patients of the QuaMaDi project had a higher proportion of 'in situ' and T1 tumours (62.6% vs Schleswig-Holstein: 48.6%), showing that the implementation of high standards in routine diagnostic mammography can improve the quality of breast cancer diagnosis and care.

Adolescent↗
PubMed2006

[Health services research. A joint funding programme of the BMBF and GKV].

The article reports on a funding programme jointly initiated in 2000 by Germany's Federal Ministry of Education and Research and its statutory health insurance funds ("Health Services Research in the German Health Care System"). In the past 5 1/2 years about 30 heterogeneous projects were funded with overall less than 6 million euros. Though in some projects obstacles to the research process have already become evident, it seems too early to evaluate their scientific merit. If health services research under the auspices of Germany's social insurance schemes is to develop further more funds must be invested and additional institutions (e.g. pension funds) included.

Financing, Government↗
PubMed2006

[Validity of patient self report data in rehabilitation research: identifying circumstances of the patients' completion of questionnaires].

BACKGROUND: Self-report questionnaires have become wide-spread and are an integral part in different fields of rehabilitation. However, it is still unclear to what extent the validity of the patients' reports is affected by motivational factors. How difficult is it for the patient to fill out questionnaires? What are the situational characteristics in which the patients fill them out? The present study aims to identify the situational, motivational and cognitive requisites of the respondents and to analyse possible impacts on the validity of self-reports. METHOD: A total of n = 105 patients scheduled for inpatient rehabilitation were interviewed by means of a guided open-ended interview in the admission phase. It is a consecutive sample of all admissions in two rehabilitation clinics in Schleswig-Holstein, which provide each patient with a questionnaire to fill out prior to their stay. The analysis involved a description of statements (categories) that have been derived by content analysis based on the patient interviews. In addition, physicians rated various patients' characteristics at the end of their hospital stay. RESULTS: The participation rate of the patients was 95.5 %. Of all patients, 95 % filled out the questionnaires at home, 69 % without a break. 57 % of the patients interviewed had filled out the questionnaires by themselves without any help, another 22 % worked it through together with their partner or spouse. The extent of influence on the responses appeared to be dependent on the amount of help necessary. In a substantial number of patients the questionnaires were regarded as an "official" document that had to be worked through meticulously. Physicians attested 96 % of the patients to have provided honest reports with regard to personal characteristics, and 95 % to have shown a sufficient degree of willingness of self-disclosure. By and large the patients' perceptions of themselves fit with the perceptions the physician in 76 % of the patients from the physicians' point of view. All patients except one were attested a positive motivation to take part in rehabilitation activities in the clinic by the physician. In individual cases there were substantial deficits of cognitive capacities necessary to work through a questionnaire, as well as limitations in literacy. Four patients had insufficient mastery of the German language. DISCUSSION AND CONCLUSION: The vast majority of the patients possessed sufficient motivational and cognitive prerequisites to provide valid self-reports. Patients with problems in responding asked partners or others for help, its impact on the self-reports being as yet not clear-cut. In individual cases it can not be ruled out that patients who think about early retirement provide distorted statements.

Adult↗
PubMed2006

[Regional quality assurance in medical rehabilitation. The Schleswig-Holstein medical rehabilitation quality community--initiative and testing].

In light of the growing age of the population in Germany and worldwide as well as the increasing of chronic diseases, there can be no doubt about the importance of medical rehabilitation. Yet the unbalanced proportions of treatment (costs), effectiveness and efficiency have been discussed critically in the past. The Statutory Pension Insurance scheme responded to this imbalance with a comprehensive quality assurance programme. Furthermore, a nation-wide Rehabilitation Research Funding Programme was established. Still missing, however, are transfer of scientific results into practice and a quality assurance programme that focuses on outcomes and effectiveness. In 2001, in Schleswig-Holstein, a "Medical Rehabilitation Quality Community" was initiated. The Community aims are a higher level of transparency of rehabilitation treatment procedures, providing proof of effects on patient outcomes, and comparison of effects achieved in different rehabilitation clinics, based on patient surveys. After completion of funded pre- and main phases, the Medical Rehabilitation Quality Community will be continued on a self-initiative and self-financing basis. In this paper, procedures and feasibility of the project are described. The main empirical results (outcomes, patient satisfaction, treatment after rehabilitation, n = 2026, and indication related benchmarking) will be presented in a subsequent article.

Community Health Services↗
PubMed2006

[Predicting gainful employment in a population sample of 4225 statutory pension insurance members covering a prognostic period of five years using a brief subjective prognostic employment scale (SPE Scale)].

PURPOSE: Vocational (dis-)ability is a key concept in social medicine. It plays a major role in the realm of statutory pension funds (e. g. appraisal of applications for early retirement) as well as in epidemiologic or rehabilitation research. In a former population-based survey reliability of a short scale assessing the subjective prognosis of gainful employment (SPE-Scale, range = 0 - 3) had been tested. We now wanted to explore whether the SPE-Scale allows a prediction of vocational outcomes (early retirement) in the population sample over longer periods of time. METHODS: Statutory pension insurees from Luebeck and surroundings aged between 40 and 55 were surveyed by questionnaire in 1999/2000. For 4225 subjects (= 95% of the original cohort) we obtained the following outcome data from pension fund records: dates of any applications for early retirement and beginning of retirement, date of death. The follow-up period covers 4.75 years on average. During this period 323 applications for early retirement (= 7.6%) were filed, and 200 subjects (= 4.7%) actually retired. RESULTS: First analysis including age and sex as covariates showed a threefold (SPE = 2) and eightfold (SPE = 3) risk of early retirement. Multivariate analysis (covariates: overall health status, number of chronic conditions, approved disability, subjective vocational ability, and length of sick leave measured at study onset) yielded a twofold risk of filing an application for early retirement (SPE = 3). CONCLUSIONS: The SPE-Scale is an appropriate screening instrument for hazards regarding gainful employment. It also can be recommended for use in epidemiologic or rehabilitation surveys.

Adult↗
PubMed2006

[Offering multidisciplinary medical rehabilitation to workers with work disability due to musculoskeletal disorders: results of randomized controlled trial].

AIMS: In Germany medical rehabilitation has to be initiated by members of statutory pension fund and health insurances. This often leads to delays in the application for and provision of rehabilitation services. Since January 2000 a regional statutory pension fund for blue collar workers (LVA Schleswig-Holstein), 4 statutory health insurances and their medical service MDK have been evaluating a pro-active system to offer rehabilitation to certain member groups. Its acceptance, performance and outcomes were evaluated within a randomized controlled study. METHODS: Over one year actively insured (i. e. working) members of the a. m. institutions were screened for longer work disability due to musculoskeletal disorders (ICD-10: M05 - 25, M40 - 54, M60 - 99). Based on further inclusion criteria eligible persons were randomized either to an intervention (invitation, counselling, application support) or control (usual care) group. At baseline and six and 12 months all participants completed a postal questionnaire enquiring about various health status aspects (secondary outcomes). Information on sick leave (cases, days), hospital treatment and disability pension was based on administrative data (primary outcomes). Analyses were run on an intention to treat-, per protocol-, as actual-, and matched pairs-basis. RESULTS: 230 persons gave written informed consent (IG: n = 134, KG: n = 96). Within 6 months after study entry 69% of the IG- and 20 % of the KG-members participated in a 3 week in-patient multidisciplinary rehabilitation program. Compared to 6 months prior to the study the occurrence of sick leave due to musculoskeletal disorders was clearly reduced during follow-up between month 6 and 12, however with no significant difference between the two groups. Additionally, IG and CG did not differ in any other primary and secondary outcomes. CONCLUSION: Contrary to our expectations the IG-members do not seem to benefit from the PETRA-programme including inpatient rehabilitation.

Adult↗
PubMed2006

[Results of a comparison: active versus passive reporting in cases of community acquired pneumonia. Results of the German Competence Network CAPNETZ].

INTRODUCTION: Since 2002, the German competence network CAPNETZ has been collecting data from inpatients and outpatients with community acquired pneumonia (CAP) at eight local clinical centres. Contrary to the literature reports, the proportion of outpatients in CAPNETZ averages out at 28 %. Therefore, this study determines whether an active reporting system can increase the number of cases reported in medical practices. METHOD: In ten medical practices in Lübeck, the passive reporting system was changed to an active reporting system consisting of a) a weekly announcement of CAP cases including negative reporting, b) a study nurse who was responsible for the reporting, c) additional payment, d) a telephone call after two weeks by absent announcements and e) incentives like benchmarking or additional information. The number of the reported cases between the active reporting period (2004) and the same period in the year before was recorded. RESULTS: The number of reported cases increased in eight of the ten medical practices. Overall 72 CAP cases were reported, 33 % more than in the period of passive reporting. The number of patients encompassed in CAPNETZ increased from 17 to 34. CONCLUSION: We did not find a comparable increase of CAP cases either in Lübeck overall (including inpatients) or in all the local clinical centres together. Thus, it is assumed that the increase of reported cases depends on the methodical effect.

Community Networks↗
PubMed2006

[Regional quality assurance in medical rehabilitation. The Schleswig-Holstein Medical Rehabilitation Quality Community--main study and empirical findings from orthopaedic clinics].

The "Quality Community Medical Rehabilitation" (QGmR) is a voluntary association of several rehabilitation clinics in Schleswig-Holstein. The QGmR is closely oriented along the quality assurance programme of the national pension insurance scheme. As local initiative its emphasis lies in patient outcomes. The patients of the QGmR were interviewed twice (pre-post: before and four months after rehabilitation), and all patients were included consecutively during a defined period of time. After a pilot phase the main study of the QGmR was accomplished between 2002 and 2004. Twenty Schleswig-Holstein rehabilitation clinics with six diagnostic groups and a total of 3094 patients participated (2026 at both points of measurement). The majority of the patients interviewed were orthopaedic patients, and the smallest number were patients with heart disease and neurologic conditions. Most patients showed clearly health-related impairments before rehabilitation compared with population-referred data, four months after rehabilitation patients showed significant improvements in all health-related parameters. In addition to health improvement the patients showed a high satisfaction with all areas of the rehabilitation treatment and processes they were asked to judge (administration, therapy, care) independent of diagnostic group or rehabilitation clinic. But, also independent of diagnostic group and clinic, there were clear deficits in the field of post-rehabilitative treatment. Some of the results varied according to diagnostic group and clinic. The results of a comparison between the clinics showed some differences to the effect that some clinics were better than others, but these differences were not very large although statistically significant in a few cases. Nevertheless the "best" can be determined, which could motivate the clinics to participate in regular quality assurance working groups.

Persons with Disabilities↗
PubMed2005

[Is there a German history of evidence-based medicine? Methodic standards of therapeutic research in the early 20th century and Paul Martini's "Methodology of therapeutic investigation" (1932)].

The article addresses the history of evidence-based medicine in Germany. Its aim was to reconstruct the standard of clinical-therapeutic investigation in Germany at the beginning of the 20 (th) century. By a historical investigation of five important German general medical journals for the time between 1918 and 1932 an overview of the situation of clinical investigation is given. 268 clinical trails are identified, and are analysed in view of their methodological design. Heterogeneous results are found: While few examples of sophisticated methodology exist, the design of the majority of the studies is poor. A response to the situation described can be seen in Paul Martini's book "Methodology of Therapeutic Investigation", first published in 1932. Paul Martini's biography, his criticism of the situation of clinical-therapeutic investigation of his time, the major points of his methodology and the reception of the book in Germany and abroad are described.

Evidence-Based Medicine↗
PubMed2005

[Benefits from clinical research: for both patients and test subjects?].

The Convention on Human Rights and Biomedicine, its Additional Protocol, the European Parliament's Good Clinical Practice (GCP)-Directive as well as the German Medicines Law and GCP-Decree all require certain forms of "benefit" for participants of clinical trials and other forms of clinical-evaluative research. However, they do not provide any attempt to define e. g. "direct benefit" or group benefit -- contrary to our text. It additionally discusses qualitative and quantitative aspects and the inherently probabilistic nature of any benefit from clinical research. Clinically most relevant study types and designs (such as placebo-controlled trials; diagnostic studies of phases 1 - 3) do not offer any potential individual benefit at least for parts of the samples, they are at best beneficial for the group of similarly affected patients. At present those trials if including incapacitated adults not able to give informed consent are forbidden by German law, a situation different from that of trials involving minors.

Biomedical Research↗
PubMed2005

[Risk factors for community acquired pneumonia (CAP). A systematic review].

BACKGROUND AND OBJECTIVE: Community acquired pneumonia (CAP) is the most frequent mortal infectious disease in the western industrial countries. So far no detailed information about incidence, pathogenetic agents, medical service and risk factors existed within Germany. This article reviews international studies, which identified risk factors for CAP. METHOD: The MEDLINE database search comprised 743 articles from 1966 to December 2003. Ten published studies analysing risk factors for CAP were included in this study. RESULTS: Age, gender, smoking and chronic lung diseases ranged among the leading risk factors. Other variables, like medication, dangerous substances, alcohol or sociodemographic factors have so far been insufficiently proved. CONCLUSION: Comparable data concerning CAP in Germany are currently inadequate. In order to improve the data situation, in 2002, the Community Acquired Pneumonia NETwork (CAPNET) was established. CAPNET assembles and soon intends to publish detailed information about incidence and risk factors of Community Acquired Pneumonia.

Adolescent↗
PubMed2005

[Missing data in the somatisation subscale of the scl-90-R due to a 'checklist effect': occurrence in different surveys and results of various imputation methods].

Item non-response is a potential threat to the validity of study results. Taking the somatisation subscale of the SCL-90-R as an example, we hypothesise a specific response pattern ("checklist-effect") that is characterised by symptom-free persons not checking the "not at all"-category. The present study analyses the extent and relevance of this postulated "checklist-effect". Our data is derived from a survey of n = 228 blue-collar workers who previously had filed applications for medical rehabilitation benefits (A1-study), and two additional surveys as well. We defined the "checklist-effect" by the following response pattern: (1) at least one missing value and (2) at least one valid item response and (3) no "not at all"-responses. Occurrence of the "checklist-effect" in the three datasets differed widely. 75 % of the responders in the A1-Study had complete data, 16.2 % a postulated "checklist-effect". Imputation of missing values under the assumption of a "checklist-effect" led to a reduction of missing data in the somatisation-subscale from 12.3 % to 0.4 %. Ignoring the "checklist-effect" would overestimate the symptom level. Possible explanations for the effect are discussed. However, the validity of this effect has yet to be proven via methodological studies.

Bias↗
PubMed2005

[Efficacy of inpatient rehabilitation for chronic back pain in Germany: update of a systematic review].

BACKGROUND: The ninth book of the German social code, SGB IX, has intensified questions on the effectiveness and usefulness of medical rehabilitation, a multimodal multidisciplinary team care model, especially but not exclusively for chronic back pain. In 2002 back pain was the reported leading cause for 29 % of all medical and other rehabilitative services provided by German statutory pension funds. A previous systematic review of all available German studies (January 1980 to June 2001) analysed the effectiveness of inpatient rehabilitation for chronic back pain. The present report provides an update and critical appraisal of the review. METHOD: Again we conducted a systematic search for relevant German studies from between July 2001 and December 2003 using electronic data bases, hand-searching of congress abstracts and postal questionnaires. The quality of relevant studies was assessed according to the recommendations of the Cochrane Back Review Group. For each study effect sizes for up to six central outcome parameters were calculated using pre-post comparisons from short and medium term follow-ups, they were correlated with prognostically relevant characteristics of the studies and samples. The combined weighted intra-group effect sizes were compared with results from international studies. RESULTS: 16 studies, both controlled and uncontrolled, were included. Again we could not identify any study confirming the effectiveness of medical rehabilitation in chronic back pain compared to no treatment or usual care. The methodological quality of the new studies did not seem to exceed that of the earlier ones. Depending on the outcome variable, small effects (e. g. on functional ability) to relevant effects (e. g. vitality) can be observed at or immediately after the end of rehabilitation. Now the effects after three to 12 months seem to be smaller than previously observed. DISCUSSION AND CONCLUSIONS: The small size of medium term effects indicates a basic problem of inpatient rehabilitation for chronic back pain in Germany. This becomes even greater when the results of international controlled studies are used as reference. Possible reasons for the disappointing situation (weak methodology, inappropriate selection of patients, weak intervention) are to be discussed. At present, we have no convincing evidence for a general effectiveness of Germany's system of inpatient rehabilitation for chronic back pain.

Controlled Clinical Trials as Topic↗
PubMed2005

[The need for rehabilitation services: concept and data].

Whether rehabilitation services are initiated, applied for and (granted by German statutory pension funds) according to objectifyable need is uncertain as long as we lack a scientifically valid and operationally defined concept of "rehabilitation need". Traditionally three criteria are mentioned: neediness, ability, and prognosis. The text extends and specifies these criteria based on theoretical grounds, research evidence, and sociolegal considerations. It introduces a screening algorithm to objectify and assess individual rehabilitation needs focusing, as far as they are risk factors for participation restrictions, on a central disorder and its complications, risk and prognostic factors, comorbidities, motivational and other context factors. It proposes to relate more or less complex disturbances of functional health to more or less complex rehabilitation programmes and to indicate the typically complex ("holistic") in-patient rehabilitation only for equally complex health impairments and participation restrictions. Illustrative empirical data relate to three disorders, diabetes mellitus type 2, chronic disabling back pain, and chronic obstructive lung disease.

Algorithms↗
PubMed2004

[Chronic widespread pain and tender points in low back pain: a population-based study].

BACKGROUND: Clinical observation suggests a frequent coincidence of back pain (BP) and fibromyalgia (FMA). Based on data from a population survey on back pain we studied the hypothesis of FMA being a frequent underlying condition of BP. We additionally studied the association of the severity of back pain and both chronic widespread musculoskeletal pain and active tender points. PROBANDS AND METHODS: Data from a regional two-stage survey on urban German residents (aged 25-74 years) of Luebeck/Northern Germany (N=3969) were reanalyzed. The survey combined a postal questionnaire screening with a subsequent medical-psychological examination. Only subjects with back pain on the day of filling in the questionnaire were invited (n = 875). The response and participation rates were 82% and 73%, respectively. The severity of back pain was graded according to Kohlmann and Raspe (1994; based on pain severity and disability). In assessing widespread pain and tender points and classifying FMA-cases, we followed the criteria of the American College of Rheumatology (Wolfe et al. 1990). Standardized psychometric scales were used to measure general health status, bodily complaints, depressiveness, and catastrophizing cognitions. RESULTS: In Luebeck, the overall point prevalence of back pain reached 39%. Among those invited and examined we found 27%, 25%, and 19% with back pain grade 1, 2 or 3, respectively. 29% reported no back pain on the day of examination. 12.6% of probands with actual back pain reported chronic widespread pain. The number of active tender points showed a significant and relevant association with back pain grade and was additionally correlated with all indicators of somatic and psychological distress. CONCLUSION: Our data do not support the hypothesis of FMA as a frequent underlying condition of BP. We found, however, a close correlation between BP grade (and amount of distress) and tender points count. More severe forms of BP imply an increasing allodynia/hyperalgesia, itself being associated with a higher amount of somatic and psychological distress (Chronic severe) back pain seems to be more than simply pain in the back.

Adult↗
PubMed2003

Health-related quality of life and radiographic vertebral fracture.

BACKGROUND: Vertebral fractures are associated with back pain and disability; however, relatively little is known about the impact of radiographic vertebral fractures on quality of life in population samples. The aim of this study was to determine the impact of a recent radiographic vertebral fracture on health-related quality of life (HRQoL). METHODS: Men and women aged 50 years and over were recruited from population registers in 12 European centers. Subjects completed an interviewer-administered questionnaire and had lateral spine radiographs performed. Subjects in these centers were followed prospectively and had repeat spinal radiographs performed a mean of 3.8 years later. Prevalent deformities were defined using established morphometric criteria, and incident vertebral fractures by both morphometric criteria and qualitative assessment. For each incident fracture case, three controls matched for age, gender, and center were selected: one with a prevalent deformity (at baseline) and two without prevalent deformities. All subjects were interviewed or completed a postal questionnaire instrument which included Short Form 12 (SF-12), the EQ-5D (former EuroQol), and the quality of life questionnaire of the International Osteoporosis Foundation (QUALEFFO). The median time from the second spinal radiograph until the quality of life survey was 1.9 years. Comparison between cases and their matched controls was undertaken using the signed rank test. RESULTS: 73 subjects with incident vertebral fracture (cases), mean age 64.8 years (of whom 23 had a baseline deformity), and 196 controls, mean age 63.9 years (of whom 60 had a baseline deformity), were studied. There were strong correlations between the domain scores for each of the three instruments. There was no statistically significant difference in any of the domain scores between cases and those controls with a prevalent deformity. However, compared with the controls without a prevalent deformity the cases had significantly impaired quality of life as determined using the total QUALEFFO score (38.2 vs 33.7), the physical component score of the SF-12 (39.9 vs 43.7) and the health status score of the EQ-5D (62.3 vs 69.9). When the analysis was repeated after stratification of the cases by baseline deformity status (i.e., cases with and without a prevalent deformity at baseline), cases with a prevalent deformity had impaired quality of life compared with their matched controls, both with and without a prevalent deformity. In contrast there was no significant difference in quality of life among the cases without a prevalent deformity and either control group. CONCLUSIONS: In this population-based study a recent vertebral fracture was associated with impairment in quality of life, though this was mainly among those who had sustained a previous vertebral deformity.

Aged↗
PubMed2003

Elements of fibromyalgia in an open population.

OBJECTIVE: To examine the nosological concept of fibromyalgia in the general population. METHODS: A postal survey of rheumatic pain and non-specific bodily complaints was sent to all 3174 German female residents of Bad Säckingen, Germany, aged 35 to 74 yr. A stratified random sample of 653 subjects was further examined in a clinical survey. RESULTS: On the population level the point prevalence of chronic widespread pain was 13.5%. In the clinical survey, tender point count was associated not only with the extent of rheumatic pain, but also independently with the extent of bodily complaints. Subjects with no history of rheumatic pain but with non-specific bodily complaints had as many positive tender points as subjects without bodily complaints but with a history of rheumatic pain. Subjects could be identified who met the tender point criterion of the ACR without a history of widespread pain. Multivariate analyses demonstrated that some symptoms carry a risk for positive tender points (low physical mobility, pain, bodily complaints) and some for chronic widespread pain (poor health status, catastrophizing, emotional reactions, low energy level, sleep disturbances) that are independent of each other and of age. CONCLUSIONS: The results do not only question the relevance and specificity of a history of widespread pain in diagnosing fibromyalgia, but also the concept of fibromyalgia as a distinct rheumatological disorder. The results support the concept of fibromyalgia as part of a wider spectrum of dysfunctional syndromes.

Adult↗