[Effect of written patient information on knowledge and function of patients with acute uncomplicated back pain (PIK Study)]. / Patienteninformationen und Kreuzschmerzen (PIK-Studie) - Einfluss von Patienteninformationen auf Wissen und Funktionskapazität von Patienten mit akuten, unkomplizierten Rückenschmerzen.

BACKGROUND: If patients return early in the course of acute, uncomplicated back pain to their normal activities, their symptoms improve more quickly. Written detailed patient information can have a positive effect on knowledge and can increase physical activity. In this study the effect of a short evidence-based back pain leaflet on knowledge, function and patients' beliefs was investigated. METHODS: A randomised controlled trial was carried out in 12 primary care practices. Patients with acute, uncomplicated back pain received either the back-pain specific information (intervention) or a leaflet without content regarding back pain (control). Participants' data were inquired before consultation of the general practitioner, as well as 1 week and 3 months later. Outcome measures were SF-36, FABQ-D, FFbH-R, knowledge concerning back pain, frequency of use of the leaflet, usefulness of the information and change of behaviour. RESULTS: The included patients totaled 174. The response rates were 74.7% (1 week) and 67% (3 months). Patients receiving the intervention leaflet showed better knowledge at 1 week and greater improvement in function scores at 3 months. There was no effect on patients' beliefs. Patients of the intervention group reported more activity in everyday life. CONCLUSION: Short written information may have small, in total possibly positive effects on knowledge, support of activity and function in patients with acute, uncomplicated back pain.

[Shared decision making]. / Shared Decision Making. Gemeinsame Entscheidungsfindung aus Patientenperspektive.

BACKGROUND AND OBJECTIVE: The demand for integration of patients in medical decisions becomes more and more obvious. Little is known about whether patients are willing and ready to share therapeutic decisions. So far information is lacking, whether existing communication skills of both -- patients and physicians -- are sufficient for shared decision making (SDM). This paper presents new data on patients perspectives regarding SDM. METHODS: Standardized survey of 3058 German speaking people (1565 females, 1493 males), aged 18-79 years, a population based random sample of an access panel (pool of german households available for specific surveys) regarding the following topics: medical decision making in practice, communication skills and behaviour of physicians. RESULTS: A majority of patients approved the model of SDM. However, some subgroups of patients, especially older patients, were less interested in the concept of SDM. Necessary communication skills which may help patients to participate in decision making were used rather scarcely. Patients who approved the model of SDM more often experienced a common and trustful exchange of information. CONCLUSION: Most patients favour the concept of SDM. The communication skills necessary for this process are to be promoted and extended. Research on patients' preferences and their participation in health care reform should be intensified. Academic and continuous medical education should focus on knowledge transfer to patients.

[Acute otitis media in children: an evidence-based practice guideline]. / Akute Otitis media (AOM) bei Kindern (ICD: H66.0): eine evidenzbasierte Leitlinie -- Neue Perspektiven für Kinderärzte in Deutschland.

Acute Otitis media is one of the most common acute respiratory infections managed in primary care and the most common infection among in children. Diagnostic criteria, however, do not always correspond to scientific evidence. They often differ depending on individual preferences and competences. Treatment, also, is controversial. In Germany, most children attending their pediatrician or primary care physician will be prescribed antibiotics. Evidence from several randomized studies and systematic reviews suggests that routine usage of antibiotics provides only modest benefit. The benefit of prescribing antibiotics should not only be balanced against the increased likelihood of side effects such as diarrhoea but also against the potential to contribute to longterm antibiotic resistance.

Learning with computerized guidelines in general practice?: A randomized controlled trial.

BACKGROUND: Evidence-based guidelines are seen as an important instrument to transfer scientifically generated knowledge into daily clinical practice and to ensure high standards of clinical care. Despite wide promulgation, clinical guidelines so far have a limited impact on individual professional learning and on changing daily medical practice. OBJECTIVES: Our aims were (i) to study a potential knowledge increase among German GPs after implementation of web- and evidence-based guidelines and (ii) to identify and analyse potential barriers to individual professional learning with computerized guidelines. METHODS: A prospective, randomized controlled trial was conducted including 72 GPs (21% female, 79% male). The intervention group (n = 38) had access to clinical guidelines via the Internet or CD-ROM, the control group had not (n = 34). Both groups received a standardized two-part questionnaire. An increase of knowledge was measured with 25 multiple choice questions related to four different medical topics. In addition, reasons for using or not using computerized guidelines were analysed after access to guidelines was open to all participating physicians. RESULTS: There was no significant knowledge increase in the intervention group (P = 0.69). Twenty-two (58%) GPs of the intervention group had used the guidelines. Unspecified curiosity (76%) and a specific medical question (38%) were predominant motives for usage among physicians who had used the guidelines. Among 'non-users', 78% stated 'lack of time' as the main reason for not using guidelines. CONCLUSION: An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access.

[Evidence-based guidelines as tools for medical knowledge transfer. The work mode of the Medical Knowledge Network evidence.de]. / Evidenzbasierte Leitlinien als Instrumente des Wissenstransfers in die Praxis. Die Arbeitsweise des medizinischen Wissensnetzwerks evidence.de.

The amount of medical knowledge is growing with increasing speed. Physicians are confronted with more and more--and often useless--information. However, the time lag between the creation of new knowledge and its implementation into daily medical practice is often exceeding a decade. In view of these challenges the knowledge network of the medical faculty of the University Witten/Herdecke is focusing on two different tasks: It provides evidence based medical guidelines in a format that is meant for easy access and use in daily practice. It scientifically explores different ways of presenting and transferring evidence based guidelines in order to develop better and easier ways of implementation. National and international guidelines and studies are screened, evaluated, updated and adapted for its use in the academic network by a team of five university based physicians. In addition, clinical specialists as well as primary care physicians provide expertise for detailed scientific adaptations and for adequate implementation strategies. The implementation process of the guidelines among the faculty based primary care physicians is continuously monitored and evaluated. The main goal of this concept is to create a learning environment for the complex process of medical knowledge transfer.