Markus Herrmann

Definition, Klassifikation und Diagnose des Fibromyalgiesyndroms

ZusammenfassungHintergrundEine interdisziplinäre Leitlinie auf Entwicklungsstufe S3 der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF – systematische Literatursuche und -bewertung, Logikanalyse, formaler Konsensusprozess) zu Definition, Klassifikation, Diagnose, Verlauf und Prognose chronischer Schmerzen in mehreren Körperregionen („chronic widespread pain“, CWP) und des Fibromyalgiesyndroms (FMS) wurde in Kooperation von 10 medizinischen bzw. psychologischen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen erstellt.MethodikEine Literatursuche wurde unter Benutzung der Cochrane Library (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006) und Scopus (1980–12/2006) durchgeführt. Für die Vergabe von Evidenzklassen wurde das System des Oxford Centre for Evidence-Based Medicine herangezogen. Für die Vergabe von Empfehlungsgraden wurde die Empfehlungsgraduierung der nationalen Versorgungsleitlinien verwendet. Die Erstellung der Empfehlungen erfolgte in einem mehrstufigen nominalen Gruppenprozess.ErgebnisseChronische Schmerzen in mehreren Körperregionen werden durch die Kriterien des Amerikanischen Kollegiums für Rheumatologie definiert (ACR – starker Konsens). Die klinische Diagnose des FMS kann sowohl symptombasiert (ohne klinische Untersuchung von Tenderpoints) als auch nach den ACR-Kriterien erfolgen (starker Konsens).AbstractBackgroundInterdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations.MethodsA systematic literature search was performed in the Cochrane Library (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006), and Scopus (1980–12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used.ResultsCWP is defined by the criteria of the American College of Rheumatology (ACR – strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom und chronischen Schmerzen in mehreren Körperregionen

BACKGROUND A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS Patients information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

[Definition, classification and diagnosis of fibromyalgia syndrome].

ZusammenfassungHintergrundEine interdisziplinäre Leitlinie auf Entwicklungsstufe S3 der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF – systematische Literatursuche und -bewertung, Logikanalyse, formaler Konsensusprozess) zu Definition, Klassifikation, Diagnose, Verlauf und Prognose chronischer Schmerzen in mehreren Körperregionen („chronic widespread pain“, CWP) und des Fibromyalgiesyndroms (FMS) wurde in Kooperation von 10 medizinischen bzw. psychologischen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen erstellt.MethodikEine Literatursuche wurde unter Benutzung der Cochrane Library (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006) und Scopus (1980–12/2006) durchgeführt. Für die Vergabe von Evidenzklassen wurde das System des Oxford Centre for Evidence-Based Medicine herangezogen. Für die Vergabe von Empfehlungsgraden wurde die Empfehlungsgraduierung der nationalen Versorgungsleitlinien verwendet. Die Erstellung der Empfehlungen erfolgte in einem mehrstufigen nominalen Gruppenprozess.ErgebnisseChronische Schmerzen in mehreren Körperregionen werden durch die Kriterien des Amerikanischen Kollegiums für Rheumatologie definiert (ACR – starker Konsens). Die klinische Diagnose des FMS kann sowohl symptombasiert (ohne klinische Untersuchung von Tenderpoints) als auch nach den ACR-Kriterien erfolgen (starker Konsens).AbstractBackgroundInterdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations.MethodsA systematic literature search was performed in the Cochrane Library (1993–12/2006), Medline (1980–2006), PsychInfo (1966–12/2006), and Scopus (1980–12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used.ResultsCWP is defined by the criteria of the American College of Rheumatology (ACR – strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

[Principles of treatment, coordination of medical care and patient education in fibromyalgia syndrome and chronic widespread pain].

BACKGROUND A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS Patients information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). CONCLUSIONS The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

Faculty development in general practice in Germany: experiences, evaluations, perspectives.

From 1999 to 2001, the German Society of General Practice and Family Medicine (DEGAM) pioneered a faculty development programme to help general practitioners (GPs) interested in an academic career to develop their skills in teaching, primary care, quality assurance and research. The programme involves five weekend-training sessions over 18 months and applies a learner-centred approach. Participants choose the learning formats and switch between the roles of learners, teachers, chair persons and programme organizers. This article evaluates the acceptability and feasibility of the programme. Data were collected over a two-year period from the 16 participants who completed the first training programme. The evaluation involved a focus group, telephone interviews and email questionnaires. Participants appreciated the learner centred format of the programme and gained new teaching and research skills. They also learned to better assess and critically reflect on their professional work as GPs and reported improved academic ‘survival skills’ due to collaborative networks with colleagues. The faculty development programme proved advantageous for the personal and professional development of the participating GPs. It constitutes a promising tool for the further development of General Practice as an academic discipline that is still in the process of establishing itself at medical schools in Germany. The journey of a thousand miles begins with a first step: (Lao-Tse, 6th century B.C.)

[Definition, classification and diagnosis of fibromyalgia syndrome.]

BACKGROUND Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS A systematic literature search was performed in the Cochrane Library (1993-12/2006). Medline (1980-2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Center for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS CWP is defined by the criteria of the American College of Rheumatology (ACR-strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

Problemlagen von versteckt lebenden Migranten in Deutschland: Analyse der medizinischen Beratungsanlässe in Berlin, Bonn und Köln

INTRODUCTION Little is known about health related problems of undocumented migrants in Germany. Patterns for medical consultations and socio-demographic characteristics are only available in isolated reports. This article identifies and compares empirical data from non-governmental organisations (NGOs) who provide medical care for unregistered migrants. METHODS Annual reports of 2006 and 2007 of the Malteser Migranten Medizin (Berlin, Cologne) and the MediNetz Bonn were selected for this document analysis. RESULTS We identified similarities and differences in the socio-demographic background and patterns of medical consultations between the explored regions. The number of documented migrants without medical insurance increased during the observed period. DISCUSSION The patterns of health-care utilisation for undocumented immigrants changed in the observed period which might be caused by the EU enlargement to the East. The heterogeneous quality of the annual reports and the lack of information about the use of alternative health-care facilities limit the results of this analysis.

Learning about general practice through qualitative interviews: Lessons from a seminar course with medical students

Background: A seminar course was developed in order to train medical students in qualitative research methods, while providing an introduction to the field of General Practice. Students were enabled to conduct semi-structured interviews with general practitioners (GPs), during which they learned about the prevention, diagnosis, and treatment of frequently encountered medical problems. The course was carried out four times at two universities in Germany. Aims: The study explores the students’ learning experiences focusing on their research experience. Methods: Data were collected in four focus groups and analyzed. Results: The students perceived the course as very different from their usual medical education. This was appreciated, but also caused some difficulties. Three themes emerged: (1) Missing ‘facts’, (2) New horizons: ‘Thinking outside the box’, and (3) The challenge of interpretation: ‘Reading between the lines’. Conclusions: Learning qualitative research methods can be particularly challenging for medical students as the tasks and epistemology of qualitative research run counter to the usual learning formats and research paradigms in medical education. When teaching qualitative research, special care should be taken to address the cognitive dissonance experienced by students and to explain the unique contribution of qualitative research to medical practice and the field of General Practice especially.

Knowledge and Attitudes of GPs in Saxony-Anhalt concerning the Psychological Aspects of Bronchial Asthma: A Questionnaire Study

Bronchial Asthma is a worldwide condition with particularly high prevalence in first world countries. The reasons are multifactorial but a neglected area is the psychological domain. It is well known that heavy emotions can trigger attacks and that depression negatively affects treatment outcomes. It is also known that personality type has a greater effect on disease prevalence than in many other conditions. However, many potential psychological treatments are hardly considered, neither in treatment guidelines nor in reviews by asthma specialists. Moreover, there is very little research concerning the beliefs and practices of doctors regarding psychological treatments. Using a questionnaire survey we ascertained that local GPs in Saxony-Anhalt have reasonably good knowledge about the psychological elements of asthma; a third consider it to be some of the influence (20-40% aetiology) and a further third consider it to be even more important than that (at least 40% total aetiology). Our GPs use psychosomatic counseling sometimes or usually in the areas of sport and smoking (circa 85% GPs), although less so regarding breathing techniques and relaxation (c40% usually or sometimes do this) However despite this knowledge they refer to the relevant clinicians very rarely (98% sometimes, usually or always refer to a respiratory physician compared with only 11% referring for psychological help).

Patients' subjective concepts about primary healthcare utilisation: the study protocol of a qualitative comparative study between Norway and Germany

Background In Germany, utilisation of ambulatory healthcare services is high compared with other countries: While a study based on the process data of German statutory health insurances showed an average of 17.1 physician-patient-contacts per year, the comparable figure for Norway is about five. The usual models of healthcare utilisation, such as Rosenstocks Health Belief Model and Andersens Behavioural Model, cannot explain these differences adequately. Organisational factors of the healthcare system, such as gatekeeping, do not explain the magnitude of the differences. Our hypothesis is that patients’ subjective concepts about primary healthcare utilisation play a major role in explaining different healthcare utilisation behaviour in different countries. Hence, the aim of this study is to explore these subjective concepts comparatively, between Germany and Norway. Methods/design With that aim in mind, we chose a comparative qualitative study design. In Norway and Germany, we are going to interview 20 patients each with qualitative episodic interviews. In addition, we are going to conduct participant observation in four German and four Norwegian primary care practices. The data will be analysed by thematic coding. Using selected categories, we are going to conduct comparative case and group analyses. Ethics and dissemination The study adheres to the Declaration of Helsinki. All interviewees will sign informed consent forms and all patients will be observed during consultation. Strict rules for data security will apply. Developed theory and policy implications are going to be disseminated by a workshop, presentations for experts and laypersons and publications.