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Biomedical subjects

Anders Baerheim

Publications and source records attributed to Anders Baerheim.

At least 19 recordsLinked to original sources
PubMed2007

[Use of out-of-hours services before and after introduction of a patient list system].

BACKGROUND: Our aim was to better understand why inhabitants in a typical Norwegian town use out-of-hours services in primary care, and whether introduction of a patient list system (Fastlegeordningen) in 2001 had any influence on this choice. We analyzed changed use of out-of-hours service in Stavanger, Norway (approx. 110,000 inhabitants) from 1989 to 2002. METHODS: Changes in the number of consultations and home visits between 4 to 11 pm seven days a week, were assessed in the light of changes in operational presumptions for both the out-of-hours service and the family physicians' day-time service. RESULTS: There was a steady increase in the number of consultations and home visits from 1989 to 1997, except for in 1994. The absolute increase in the proportion of the population who sought this kind of care was 4.6%, i.e. a relative increase of 20%. From 1997 to 2002, there was an absolute decrease in consultations and home visits of 5.3%, or a 19% relative reduction. The percentage of patient encounters in patients' homes, decreased from 25% in 1989 to 11% in 2002. The number of consultations and home visits in the evenings during the first 17 months after the list system was introduced, decreased (absolute value) with 2.2% (1.7-2.6), i.e. a 10% relative decrease, as compared to those during a similar period two years earlier. INTERPRETATION: A 20 % change in the use of out-of-hours service during few years, indicates that patients have used the service for other purposes than the intended emergency care. The demand for out-of-hours service is most influenced by the availability of primary care physicians during daytime. The list system has most likely encouraged both doctors and patients to promote the "personal doctor" to solve everyday health emergencies during the day.

Emergency Medical Services↗
PubMed2007

Quantitative sensory testing of patients with long lasting Patellofemoral pain syndrome.

BACKGROUND: Anterior knee pain, diagnosed as Patellofemoral Pain Syndrome (PFPS), is one of the most common musculoskeletal problems found in adolescents and young adults. There is no consensus in medical literature concerning the aetiology of the PFPS. AIMS: To assess by means of Quantitative Sensory Testing (QST) whether patients suffering from long-lasting unilateral PFPS demonstrate somatosensory dysfunction related to afferent fibres from the local pain area. METHODS: A descriptive non-experimental study with two independent samples, consisting of 25 men and women between 18 and 44 years of age with unilateral PFPS, and a comparable group of 23 healthy subjects. Somedic Thermotest apparatus was used to assess thresholds of thermal perception, and of heat and cold pain thresholds. Von Frey filaments were used to detect tactile sensitivity. Furthermore, quality and intensity of knee pain, symptoms and signs from a clinical neurological examination were recorded. RESULTS: Decreased sensitivity to tactile stimulation, when tested with von Frey filaments, was demonstrated on both the painful and pain-free knee in subjects with PFPS, compared to the mean between the knees of the control group (p< or =0.001). The mean detection threshold for warmth was increased by 1.9 degrees C (p< or =0.01) in the painful knee, and 1.4 degrees C (p< or =0.01) in the non-painful knee in the PFPS group, compared to the mean of the healthy control group. The mean detection threshold for cold was increased by 1.6 degrees C (p< or =0.01) in the painful knee of the PFPS group, compared to the control group. These findings were supported by clinical sensory tests. No significant differences of mean thermal pain thresholds between the PFPS group and controls were found, and there were no significant differences in mean detection thresholds for warmth, cold or thermal pain thresholds between the painful and the non-painful knees in the PFPS group. CONCLUSION: This study demonstrated an abnormal sensory function in the painful and non-painful knee in some individuals with long lasting unilateral Patellofemoral Pain Syndrome using Quantitative Sensory Testing supported by clinical neurological examinations. A dysfunction of the peripheral and/or the central nervous system may cause neuropathic pain in some subjects with PFPS.

Adolescent↗
PubMed2006

[Earth rays--a concept with no scientific basis].

Earth rays are claimed to cause several types of illness and shielding against earth rays to have a therapeutic effect. There have been many reports in the media of the dangers of earth rays and the usefulness of protective shielding. As with several other alternative therapies, the theory of earth rays and its effects is incompatible with modern medicine, chemistry and physical science. We have earlier shown that earth rays can not be consistently detected, and that children sleeping on earth rays are no more ill than other children are. Recently, a randomised, controlled trial has convincingly though hardly surprisingly shown no effect of TX-disc shielding against earth rays. TX-discs are of plastic with rings of copper. Eighty patients with longstanding muscular-skeletal complaints were enrolled. Patients were, after a few weeks, substantially better (20-40%) whether they had received real TX-discs or not. The concept of earth rays lacks any scientific verification. We advocate prudence in taking success stories, whether published or from one's own clinical experience, as proof of any treatment's effectiveness before having it confirmed by research.

Adult↗
PubMed2006

Analysis of role-play in medical communication training using a theatrical device the fourth wall.

BACKGROUND: Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. METHOD: The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively. RESULTS: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process. CONCLUSION: The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.

Adult↗
PubMed2006

[Use of actors to train medical students in communication skills].

BACKGROUND: The aim of our study was to investigate how medical students perceive the use of actors in the communication and consultation training at the University of Bergen, Norway. MATERIAL AND METHODS: A questionnaire was distributed to third year medical students attending the communication course the autumn 2004 and sixth year students attending the consultation course spring 2005. The students were asked to respond to statements related to how they had benefited from training with an actor. Further, they were asked to describe advantages and disadvantages with this teaching method. Quantitative data were presented descriptively as percentages. Qualitative data were analysed with a phenomenological method, as described by Giorgi and modified by Malterud. A total of 188 out of 215 students (87 %) answered the questionnaire. RESULTS: Nearly all students (97 %) expressed that the teaching sessions with an actor had been valuable. The role-plays were described as credible and realistic. However, the students pointed at the risk of exaggerating the patient roles and lack of nuancing. Many students expressed the benefit of observing and practicing communication skills in role-plays based on theoretical models that had been taught in the lectures. Teaching with an actor was regarded as entertaining, engaging and beneficial. INTERPRETATION: The students expressed that the use of an actor in the communication and consultation training was beneficial. However, it remains to investigate whether this teaching method contributes to educating doctors with improved communication skills.

Clinical Competence↗
PubMed2005

[Physicians in the TV soap--a study of ER].

Health providers are constantly exposed to patients' cultural expressions. Television is a central agent forming our cultural surroundings. The aim of this study has been to elucidate how a specific genre - the medical soap opera - represents the health system, and shape our expectations of it. The first part of the study is a genre analysis based on media science, literary theory and narrative-based medicine. The second part of the study applies these theoretical elements on the series Emergency Room (ER). Using text analysis, one episode was reviewed in detail. The medical soap opera is a genre characterised by qualities such as a narration, its focus on the physician in her professional role and as a private individual, and by a glamour medical reality. These theoretical considerations support how soap operas focus on the physician as a type and a causally stringent construction of the narrative. The narrative qualities of the soap opera are found to satisfy people's desire for more causality in daily life. Wish fulfillment is a central function of the soap opera. In sum, medical soap operas fulfill a desire for a more comprehensive health system, showing health actors as human beings rather than just white coats.

Emergency Service, Hospital↗
PubMed2005

Feedback on video recorded consultations in medical teaching: why students loathe and love it - a focus-group based qualitative study.

BACKGROUND: Feedback on videotaped consultations is a useful way to enhance consultation skills among medical students. The method is becoming increasingly common, but is still not widely implemented in medical education. One obstacle might be that many students seem to consider this educational approach a stressful experience and are reluctant to participate. In order to improve the process and make it more acceptable to the participants, we wanted to identify possible problems experienced by students when making and receiving feedback on their video taped consultations. METHODS: Nineteen of 75 students at the University of Bergen, Norway, participating in a consultation course in their final term of medical school underwent focus group interviews immediately following a video-based feedback session. The material was audio-taped, transcribed, and analysed by phenomenological qualitative analysis. RESULTS: The study uncovered that some students experienced emotional distress before the start of the course. They were apprehensive and lacking in confidence, expressing fear about exposing lack of skills and competence in front of each other. The video evaluation session and feedback process were evaluated positively however, and they found that their worries had been exaggerated. The video evaluation process also seemed to help strengthen the students' self esteem and self-confidence, and they welcomed this. CONCLUSION: Our study provides insight regarding the vulnerability of students receiving feedback from videotaped consultations and their need for reassurance and support in the process, and demonstrates the importance of carefully considering the design and execution of such educational programs.

Adult↗
PubMed2005

[How to improve continuing education and quality improvement in general practice?].

BACKGROUND: Research has shown that many activities routinely used for continuing education and quality improvement in general practice, such as written information and lectures, have little or no effect on practice. MATERIAL AND METHODS: The Norwegian Institute of Public Health initiated a consensus-building process on how to improve continuing education and quality improvement in Norwegian general practice. RESULTS AND INTERPRETATION: The work of the consensus panel led to a report in which nine initiatives were proposed: development of a national plan, strengthening of the support available for group-based learning, academic outreach visits, practice based activities, personal learning plans, a national centre for quality improvement in general practice, improved use of referral and discharge information, multidisciplinary collaboration, and patient involvement.

Biomedical Research↗
PubMed2005

Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis.

PURPOSE: We performed a meta-analysis to ascertain the efficacy and safety of the currently practiced 3-day antibiotic therapy for cystitis versus prolonged therapy (5 days or longer) to relieve symptoms and to achieve bacteriological cure. METHODS: The Cochrane Library, the Cochrane Renal Group's Register of trials, EMBASE and MEDLINE were searched to identify all randomized controlled trials comparing 3-day oral antibiotic therapy with prolonged therapy (5 days and longer) for uncomplicated cystitis in adult non-pregnant women. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Relative risks (RR) with their 95% confidence intervals (CI) were estimated; a fixed effect model was used. An intention-to-treat analysis was performed whenever possible. RESULTS: Thirty-two trials and 9605 patients met inclusion criteria. For symptomatic failure rates no difference between 3-day and prolonged antibiotic regimens was found at short term (RR 1.16, 95% CI: 0.96-1.41) and long-term follow-up (RR 1.17, 95% CI: 0.99-1.38). Three-day treatment was less effective than prolonged therapy in preventing bacteriological failure, relative risk 1.37 (95% CI: 1.07-1.74) for short-term follow-up, and 1.47 (95% CI: 1.22-1.77) for long-term follow-up. Adverse effects were more common in the prolonged therapy group (RR 0.83, 95% CI: 0.79-0.91). The results were consistent for subgroup and sensitivity analyses. CONCLUSION: Antibiotic therapy for 3 days is similar to prolonged therapy in achieving symptomatic cure for cystitis, while the prolonged treatment is more effective in obtaining bacteriological cure.

Administration, Oral↗
PubMed2005

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study.

OBJECTIVES: To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress. METHODS: Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models. RESULTS: Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills. DISCUSSION: The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress. CONCLUSIONS: Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum. PRACTICE IMPLICATIONS: Curricula should be evaluated for improvement implementations.

Adolescent↗
PubMed2005

Utilizing theatrical tools in consultation training. A way to facilitate students' reflection on action?

The aim was to give the individual student a group-based opportunity to reflect on possible consultation strategies as the consultation was evolving. An actress acted as patient in the consultation training for a group of 30 students. The consultation was stopped at each critical incidence, and time-out given to allow the students to reflect on possible continuation strategies, and then to carry out one of them. The project was evaluated adopting a pragmatic version of the reflective practitioner research strategy as developed by Taylor. The evaluation was based on tutor and actress's field notes, students' written free text evaluation and students' evaluation through two focus groups. The qualitative analysis resulted in the three categories: the fiction created, temporality manipulated, and students' learning through reflection. Implications for students' learning process are discussed. We conclude that our way of creating fiction and manipulating temporality in the consultation training was paralleled by most students' report on substantial learning feed-forward abilities from reflection on action.

Education, Medical↗
PubMed2005

Does change from a traditional to a new medical curriculum reduce negative attitudes among students? A quasi-experimental study.

The authors investigated whether a new type of medical school curriculum-with problem-based learning, integrated preclinical and clinical phases, and increased levels of contact between students, patients and teachers--is associated with lower levels of students' negative attitudes towards medical training than is a traditional medical school curriculum. This association was found, and was confirmed by a comparison between students in a university that had changed from a traditional curriculum to a new curriculum. Curriculum design may explain differences in students' attitudes towards medical school.

Adult↗
PubMed2005

Knee function and pain related to psychological variables in patients with long-term patellofemoral pain syndrome.

STUDY DESIGN: Nonexperimental, descriptive study, including 2 independent samples. OBJECTIVES: To assess the levels of mental distress and self-perceived health in subjects with long-term patellofemoral pain syndrome (PFPS) compared to a group of healthy subjects, and the relationship between knee function and knee pain to these psychological variables. BACKGROUND: Psychological variables and those describing self-perceived health status have been given little focus in PFPS research. METHODS AND MEASURES: One group of 25 men and women between 19 and 44 years of age with unilateral long lasting PFPS, and a control group (n = 23) of healthy subjects (age range, 18-44 years) participated in the study. Knee function was assessed with the use of the Cincinnati Knee Rating System (CKRS) and the triple jump test, and knee pain was measured by a visual analogue scale (VAS). Self-perceived health and mental distress were assessed with the Coop-Wonca Chart and the Hopkins Symptoms Checklist-25 (HSCL-25) questionnaire. RESULTS: The mean (+/- SD) score on the Coop-Wonca Chart was 2.02 +/- 0.73 in the PFPS group, compared to 1.20 +/- 0.53 in the controls (P < .001). HSCL-25 mean (+/- SD) scores were 1.46 +/- 0.47 and 1.08 +/- 0.18 (P < .001) for the PFPS and the control group, respectively. When analyzed with correlation statistics, CKRS and VAS scores were found to correlate to those of the Coop-Wonca Chart and HSCL-25 scores. CONCLUSION: Levels of mental distress were higher in the group with PFPS than in the control group, while levels of self-perceived health were lower. Our data indicate that the levels of knee pain and knee function correlate closely to the degree of mental distress and self-perceived health in individuals with PFPS.

Adult↗
PubMed2004

Guidelines, evidence, and cultural factors.

OBJECTIVE: To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. DESIGN: Descriptive study with a qualitative analysis of authors' reasons for recommendations. MATERIAL: Guidelines for general practitioners published 1999-2000 from Germany, The Netherlands, Norway, and Belgium on diagnosis and treatment of uncomplicated cystitis. Opinions of the guideline authors on the influence of local factors on the recommendations were collected before and after feedback on the differences between the guidelines. RESULTS: Few cited references were shared between the guidelines, and recommendations differed substantially, especially on diagnostic strategies and referral criteria. The authors attributed parts of the differences to local factors. German and Belgian authors stressed the need for safety in their diagnostic and therapeutic approach, while Dutch authors felt confident in their gatekeeper role and the Norwegian authors mainly relied on "the evidence". Dutch and Belgian authors perceived patients to hold power, German authors referred to the power of the sub-specialists, while the Norwegians aimed to share power with the patient through a patient-centred approach. CONCLUSION: There are substantial differences even between high-standard guidelines on the same well-defined clinical entity. The selection of literature data, and diagnostic and therapeutic recommendations, seemed to be influenced by such cultural aspects as habits, the patient's expectations, and the structure of the healthcare system.

Adult↗
PubMed2003

[Medical students' evaluation of preceptorship in general practice in Vestlandet].

BACKGROUND: Preceptorship in general practice is increasingly popular the world over. Norwegian medical curricula include 4-8 weeks of such instruction. In this study we focus on the experience of University of Bergen medical students with preceptorships, based on their written evaluation. MATERIAL AND METHODS: In spring 2002, 60 sixth-year medical students had four-week preceptorships. All students returned an evaluation form, giving free-text descriptions on how satisfied they were with structure and supervision. RESULTS: Many students experienced working in general practice as surprisingly exiting and educational. Their preceptors were mostly experienced as very competent, and working conditions reported as safe and including. Quite a large number of students received supervision during clinical work and got constructive feedback from their preceptors, and many participated in structuring their own work schedule and educational progression. INTERPRETATION: Even though the preceptorship period was experienced by most of the students as productive for learning and evoked much enthusiasm, there is still a need for quality assurance in order to secure a sufficient level of skills among all preceptors.

Adult↗
PubMed2003

[Teaching clinical communication to medical students in Norway].

BACKGROUND: Clinical communication as part of the doctor-patient relationship has gained increased attention in the undergraduate medical education in Norway. Such teaching programmes require considerable resources, as much of the instruction has to be carried out in small groups, and they should be subjected to a thorough assessment from a cost-benefit perspective. MATERIALS AND METHODS: A working group representing the four medical faculties in Norway initiated EKKO, a project designed as a quality assurance of the instruction in clinical communication. In this paper comparable data are presented relating to the extent, form and content of the instruction. RESULTS AND INTERPRETATION: There are great variations as to what part of the curriculum the instruction is placed in, the extent of faculty-based teaching, training periods in general practice and hospital settings with feed-back on communication skills, as well as in faculty development. To what degree these variations influence doctors' communication skills when fully qualified could be assessed in a further stage of this project, which could also provide an empirical basis for improvements in the instruction given.

Clinical Competence↗
PubMed2003

[Urinary tract pathogens in uncomplicated lower urinary tract infections in women in Norway].

BACKGROUND: We wanted to investigate the antimicrobial susceptibility of urinary tract pathogens in uncomplicated lower urinary tract infections in adult women in Norway. MATERIAL AND METHODS: Urine samples from 312 adult women with symptoms of uncomplicated urinary tract infections from eight general practices were included. RESULTS: Significant bacteriuria was found in 187 samples (60%). E coli was isolated from 153 (82%) of these samples. Other isolated uropathogens were S saprophyticus 18 (10%), Proteus spp 6 (3%), Klebsiella spp 4 (2%), Enterobacter spp 2 (1%), enterococci 1 (0.5%) and other Gram-positive bacteria 3 (1,5%). No fungi were isolated. Of the E coli isolates, 1 %, 1 % and 9 % were resistant to nitrofurantoin, mecillinam and trimetoprim respectively. All S saprophyticus isolates were sensitive to nitrofurantoin and trimetoprim. INTERPRETATION: Antibiotic resistance of urinary tract pathogens causing uncomplicated urinary tract infections in adult women in general practice is still low in Norway.

Adult↗