Michael M. Kochen

Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

BackgroundAlthough back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.MethodsThis is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve monthsResultsA total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.ConclusionThe frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

Impact of diabetes on left ventricular diastolic function in patients with arterial hypertension.

To analyse the effect of diabetes (DM) on diastolic function in hypertensive patients.

Can student tutors act as examiners in an objective structured clinical examination

Context  The dissemination of objective structured clinical examinations (OSCEs) is hampered by requirements for high levels of staffing and a significantly higher workload compared with multiple‐choice examinations. Senior medical students may be able to support faculty staff to assess their peers. The aim of this study is to assess the reliability of student tutors as OSCE examiners and their acceptance by their peers.

Learning core clinical skills—a survey at 3 time points during medical education

Background: It is generally unknown which clinical skills students acquire during medical education and which factors influence their levels of competence. Methods: We asked German medical students how competent they felt in performing individual clinical skills. Results: Third year students evaluated their competence in clinical skills, on average, not better than 4.7 on a Likert scale ranging from 1 (= ‘excellent’) to 6 (= ‘insufficient’). The average score for fifth year students was 4.1, for final-year students 3.3. Deficits in all groups of students were most prominent in communication skills and diagnostic skills. Conclusions: These results are a plea for a structured curriculum including training courses to practice clinical skills.

Depressivität, Bewegungsangst- Kognitionen und körperliche Aktivität bei Patienten mit Rückenschmerz

Zusammenfassung. Ziel der Arbeit war die Untersuchung der Rolle von Depression und Bewegungsangst-Kognitionen (“fear-avoidance beliefs”) fur die Bereitschaft zur Aufnahme und zur Beibehaltung korperlicher Aktivitat bei Patienten mit Ruckenschmerz. In die Sekundaranalyse einer randomisierten, kontrollierten Interventionsstudie gingen Daten von N = 1378 Patienten mit vorwiegend akuten Ruckenschmerzen ein (58 % weiblich, mittleres Alter 49 Jahre). Personen mit hoher Depressivitat und gleichzeitig starken “fear-avoidance beliefs” zeigten den niedrigsten Aktivitatsumsatz zur Baseline (kcal/Woche). Bedeutsamster Pradiktor fur den Aktivitatsumsatz nach sechs bzw. 12 Monaten war neben der Baseline-Aktivitat eine hohe Selbstwirksamkeitserwartung zur Baseline; Ruckfalle in Inaktivitat wurden v.a. durch geringe Selbstwirksamkeit und geringe wahrgenommene Vorteile von Bewegung vorhergesagt. Weder Depressivitat noch Bewegungsangst erwiesen sich als bedeutsame Pradiktoren fur korperliche Aktivitat bzw. Ruckfall in Inak...