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Biomedical subjects

H Raspe

Publications and source records attributed to H Raspe.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Evidence-based medicine: an introduction for clinical practitioners].

In Germany, the term "evidence-based medicine" still leads to confusion. To our continental understanding "evidence" refers to the self-evident, what is obvious and unequivocally clear without any methodological mediation. In English speaking countries, "evidence" is defined as available and disputable facts indicating whether or not a proposition is valid. In clinical medicine both types of evidence are indispensable. However at present "external (i.e. anglosaxon) evidence" from sound-evaluative clinical research is actually needed to define and justify clinical indication rules. The rationale of the concept is obviously consequentialistic, it primarily considers the clinical and community effectiveness of any medical intervention. The paper finally discusses some of the ethical problems involved in evidence-based medicine.

Aged↗
PubMed2000

[Subjective health and rehabilitation needs of LVA insured patients currently applying for medical rehabilitation].

Unlike services paid through the Federal German Health Insurance, applications for medical rehabilitation are granted based on defined criteria. In some cases, rehabilitation is granted without apparent reason. Seeking to minimize this problem, this study integrates information on the subjective health status into the decision-making process of medical examiners. The return rate of the postal questionnaire (87%) as well as the evaluation of the examiners documented the practicability of the approach. The interviewed applicants described themselves as more limited in their abilities on several health dimensions (ICIDH) compared to a population of prestationary interviewed rehabilitation patients, whereby the standard deviations in both populations were similar. Furthermore, the applicants rarely utilized complementary treatments and sociomedical/legal advice. A surprising result lies in the mostly non-existent association between the subjective health status and the medical decisions. This constitutes a significant difficulty in legitimizing the decision-making process of the medical examiners.

Adult↗
PubMed2000

Does location of vertebral deformity within the spine influence back pain and disability? European Vertebral Osteoporosis Study (EVOS) Group.

OBJECTIVE: Vertebral deformity is associated with back pain and disability. The aim of this analysis was to determine whether location within the spine influences the strength of association between vertebral deformity, back pain and disability. METHODS: Men and women aged 50 years and over were recruited from population registers in 30 European centres. Subjects were invited for an interviewer administered questionnaire, and for lateral spinal radiographs. The questionnaire included questions about back pain, general health and functional ability. The spinal radiographs were evaluated morphometrically and vertebral deformity defined according to the McCloskey-Kanis method. RESULTS: 756 (11.7%) men and 885 (11. 8%) women had evidence of one or more vertebral deformities. Among women with a single deformity, after adjusting for age and centre, those with a lumbar deformity were more likely than those with a thoracic deformity to report back pain, both currently (OR=1.4; 95% CI 1.0, 2.0) and in the past year (OR=1.5; 95% CI 1.0, 2.3). No association was observed in men. Among women with two deformities, those with adjacent deformities were more likely than those with non-adjacent deformities to report poor general health (OR=2.2; 95%CI 0.9, 5.6), impaired functional ability (OR=1.9; 95%CI 0.8, 4. 7) and current back pain (OR=2.1; 95%CI 0.9, 4.9), though none of these associations were statistically significant. By contrast, among men, non-adjacent deformities were associated with impaired functional ability compared with those with adjacent deformities. CONCLUSION: Location within the spine influences the strength of association between self reported health factors and vertebral deformity.

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PubMed2000

[Use of bone densitometry in the framework of prevention and therapy of osteoporosis. Example of a systematic evaluation (health technology assessment)].

There is an ongoing controversy concerning the use of bone density measurements within therapeutic and preventive strategies of osteoporosis. Since there are no randomized controlled trials evaluating the effectiveness of bone density measurement with subsequent therapy we used a "critical pathway" model to determine possible benefit of tertiary, secondary and primary preventive strategies utilizing bone density measurement. In a first step data for fracture risk in each group are extracted from the literature. The second step outlines possible benefit from therapeutic studies. It may be estimated that in groups of patients with prevalent fractures use of bone density measurement and therapy according to bone density values may reduce fracture rates up to 30%. Bone density measurements performed with secondary preventive intent, however will probably lead to a reduction of fracture rates markedly below 10%. A set of risk factors that allows identification of a high risk group that may benefit from bone density measurement and subsequent therapy to a relevant extent remains to be developed. Primary preventive strategies do not require bone density measurements.

Absorptiometry, Photon↗
PubMed2000

[International practice guidelines on the management of osteoporosis-- assessment of methodologic quality].

To a growing extent evidence-based clinical practice guidelines are considered helpful in supporting high quality medical care. Our study assessed the methodological quality of 20 clinical practice guidelines on the management of osteoporosis. Results indicated that only 2 out of 20 guidelines were developed with sufficient methodological rigour to be called evidence-based--none of them from Germany. Comparative reports including quality assessments may not only be helpful for clinicians to choose an appropriate guideline for their daily practice but also to stimulate guideline developers to use more rigorous methodology.

Cross-Cultural Comparison↗
PubMed1999

[Changes in the quality of life after organ transplantations].

138 patients with end-stage kidney disease and 118 patients with end-stage liver disease were included in an observational cohort study regarding their quality of life. Instruments used were the Nottingham Health Profile (NHP), a scale for Activities of Daily Life (ADL), a Symptom Check List (SCL-90-R), and the Center of Epidemiology and Statistics Depression Scale (CES-D), all for self rating, as well as the indices of Spitzer and Karnofsky for foreign rating of life quality. Apart from the early postoperative period in both groups there was significant and persistent improvement in quality of life already three months after transplantation. In some dimensions, patients after kidney transplantation presented even lower trouble scores than a population sample. In addition, semistructured interviews showed clearly the need for psychotherapeutic support to guarantee the success for specific cases. The present investigation demonstrates, that systematic registration of the patients perception of illness and treatment is possible even in extreme situations and leads to a differentiated evaluation of medical procedures. Thereby the study also contributes to the development of modern evaluation research according to the spirit of evidence based medicine.

Activities of Daily Living↗
PubMed1999

[Evidence-based medicine: context and relevance].

Currently, evidence-based medicine is subject of a controversial discussion. This review is focused on the different types of evidence in clinical medicine and elaborates the history and context of evidence-based medicine. Evidence-based medicine insists that the theoretical plausibility of a therapeutical concept alone does not substitute for the empirical proof of its efficacy. Evidence-based medicine emphasizes the necessity to complement the individual physician's clinical experience with valid external evidence. This evidence has to be obtained by laborious systematic reviews rather than the traditional fragmentary study of the literature. The Cochrane Collaboration stands for this concept. The application of evidence-based medicine links the individual patient's problems with external evidence by asking defined answerable questions and supplies criteria for the critical evaluation of the evidence found. Evidence-based medicine, however, is not devoid of problems and contradictions. Above all, it has to be subjected to its own criteria and has to prove its efficacy.

Evaluation Studies as Topic↗
PubMed1999

[Determinations in the applications for a medical rehabilitation--screening of blue color workers in the statutory pension insurance in Schleswig-Holstein].

During the first 6 months of 1997 the number of applications for medical rehabilitation measures dropped markedly by 50% compared with the number in the previous year. To clarify the reasons for this decline the regional statutory pension fund of blue collar workers in Schleswig-Holstein (LVA) and the Institute for Social Medicine, Medical University Lübeck initiated a survey among 4400 blue collar workers (2% of the LVA population aged of 40-59 years). Between November 1997 and January 1998 a postal survey inquired of the perceived need for rehabilitation and various criteria influencing the decision to apply for such a measure. After two months the response rate was 64%. A quarter of the workers answering considered themselves in need of rehabilitation. Of those 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for supporting an application were encouragement by the GP and family members as well as the hope to improve working capacity. The decision against applying for rehabilitation was evoked by consequences of the recent legislation (WFG), job uncertainty and the public debate about the rehabilitation system in Germany.

Adult↗
PubMed1999

[Effectiveness of back-school programs in controlled trials. A review of the literature].

Backschools are utilized for primary, secondary and tertiary prevention of nonspecific low back pain while there is considerable doubt concerning their effectiveness. We present the results of controlled clinical trials that examine the effectiveness of back schools as reported in recent systematic reviews of the literature. An extensive literature search for systematic reviews summarizing the results of controlled trials was performed. Publications which satisfied a number of inclusion criteria concerning methodology and content were critically appraised. Their main results and conclusions are presented and discussed.

Controlled Clinical Trials as Topic↗
PubMed1999

[Medical rehabilitation in long-term disability].

UNLABELLED: Based on data from a prospective observational cohort study the following article attempts to answer two key questions of rehabilitation research in Germany: (1) What are the utilization rates of rehabilitation measures in patients with long-term work-incapacity due to low-back pain? (2) In this group of patients: does participation in rehabilitation programs correlate with return to work? Patients with long-term work-incapacity due to low-back pain report a severely impaired health status (measured by FFbH, SF-36, numeric rating scale for pain intensity) which calls for comprehensive medical treatment and rehabilitation. 40.5% of study patients received first time medical rehabilitation between three months and one year after the beginning of long-term work-incapacity, 20.5% between one year and two years after the beginning of long-term work-incapacity. These figures were not influenced by age. Considering the severity of impairment we judge these rates as being quite low. There was no positive correlation found between utilization of medical rehabilitation measures or any other medical treatment and return to work. A positive correlation was observed for utilization of first time medical rehabilitation between three months to one year after the beginning of long-term work-incapacity and functional capacity. This effect was demonstrable for patients 50 years of age or younger. CONCLUSIONS: (1) In our cohort utilization of medical rehabilitation measures in patients with low-back pain and long-term work-incapacity is quite low. This suggests a considerable amount of underutilization. (2) In order to avoid underutilization the process of accessing medical rehabilitation within the German health care system should be critically reviewed. (3) In the given context of high unemployment rates and the German early pensioning system the use of "return to work" as the main criterion to judge effectiveness of rehabilitation measures remains debatable.

Adult↗
PubMed1999

[Empirical determination of the need for rehabilitation].

In Germany, members of social insurance (e.g., pension) schemes have to apply for medical rehabilitation. Usually, the applications are the expression of a subjective demand. If the applications are granted this leads to the actual supply of medical rehabilitation services. Formerly, long waiting lists were common. These have been replaced by a new balance between demand (amount of applications), "offer" (capacity of rehabilitation clinics) and the amount of granted applications. In addition to these notions, the article develops the concept of need for rehabilitation services based on sociomedical indications. Consequently, the need for medical rehabilitation can--to a certain degree--be objectified. The concept of need should not be mixed up with that of demand: not every member of a social insurance scheme who objectively is in need of medical rehabilitation realizes the need, not everybody who realizes a need will apply for rehabilitation, and not all applications will be granted. The article gives an overview of different ways of needs assessment.

Germany↗
PubMed1999

[Subjective need for rehabilitation, intention to apply and application for medical rehabilitation--results of a survey of federal insurance office].

The survey "Determinants in Applying for Medical Rehabilitation" intended to examine the interest of using rehabilitation services among workers in need of rehabilitation and clarify the reasons for the decline in applications for rehabilitation since 1995. For this reason 4400 blue collar workers of the regional pension fund (2% of the LVA population aged 40-59 years) were asked with a postal questionnaire. The response rate was 64%. In order to ensure the validity of the intentions stated, the pension fund verified how many workers actually filed an application for medical rehabilitation during the following twelve months. A quarter of the workers answering considered themselves in need for rehabilitation. Of these, 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for intending to apply were encouragement by the GP and family members as well as the expectation of improving the working capacity. After one year, only 11% of the workers who claimed themselves to be in need for rehabilitation had filed an application for rehabilitation. This low number of applications from workers in subjective need for rehabilitation indicates a deficit in medical rehabilitation provision.

Adult↗
PubMed1998

[Epidemiology of osteoporosis].

Epidemiological studies have identified osteoporosis as a disease of significant public health impact and have delineated numerous potential risk factors. Nevertheless, it has proven difficult to establish preventive strategies for several reasons. First, there has been no final agreement on the definition of osteoporosis, which has hampered efforts to characterize the magnitude of the problem as a whole. Secondly, as osteoporosis is a multifactorial chronic disorder, effective programs for risk assessment and intervention depend on the development of complex disease models. In summarizing the contributions of epidemiological studies to the current understanding of osteoporosis this review intends to outline the scientific background for the European Vertebral Osteoporosis Study (EVOS) and its successors.

Cross-Sectional Studies↗
PubMed1998

[European Study of Vertebral Osteoporosis (EVOS): design and implementation in 8 German study centers].

BACKGROUND: The European Vertebral Osteoporosis Study (EVOS), a multinational multicenter cross sectional study, was aimed to determine the prevalence of vertebral deformities, their risk factors and health impact. METHODS: Between 1991 and 1993 4487 men and women aged 50 to 79 years were examined in 8 German study centres. Health impact, back pain and functional capacity were assessed in postal questionnaires. In medical interviews data was also collected on putative risk factors for osteoporosis including details on personal and medical history, drug use, diet, smoking, alcohol, exercise and gynaecological characteristics. Four thousand one hundred and twenty-two persons underwent a lateral X-ray examination of the thoracical and lumbar spine, representing a quarter of the 16,000 European participants.

Aged↗
PubMed1998

[European Study of Vertebral Osteoporosis (EVOS): cooperation of participants and selection bias in Germany].

BACKGROUND: In population-based studies non-participation rates of about one third of the sample can be expected. The number of refusals may even be higher, if personal attendance of the subjects is requested. A different participation behaviour of the diseased and non-diseased may affect the prevalence estimation of a disease as well as the risk factor association. METHODS AND RESULTS: The European Vertebral Osteoporosis Study (EVOS) is an international, multicenter, cross-sectional survey in men and women aged 50 to 79 years. Within Europe 36 centres recruited 17,342 participants. The 8 German centres contribute about one forth of the data. In Germany subjects were recruited in several steps: random sample drawing from population registries, initial postal questionnaire, medical interview, lateral X-rays of the thoracic and lumbar spine. Depending on the extent of participation a variable amount of sociodemographic data and information on subjective health is available from the non-reachable, non-responders, and responders with incomplete and with complete examination. A comparison of the different participation groups showed, that especially old women were lost from the study. Compared to those, who only answered to an initial questionnaire, subjects, who were interviewed and X-rayed, more often suffered from back pain but reported a better functional capacity. This could be a hint on a selection of a population of the "worried well". CONCLUSION: On the whole the selection processes seem to have a minor influence on the outcome. The initial postal questionnaire turned out to be effective in collecting basic information from those who refused to attend a personal examination.

Aged↗