Biomedical subjects

Bernd Richter

Publications and source records attributed to Bernd Richter.

12 recordsLinked to original sources

PubMed2006

Comparison between Long-Menu and Open-Ended Questions in computerized medical assessments. A randomized controlled trial.

BACKGROUND: Long-menu questions (LMQs) are viewed as an alternative method for answering open-ended questions (OEQs) in computerized assessment. So far this question type and its influence on examination scores have not been studied sufficiently. However, the increasing use of computerized assessments will also lead to an increasing use of this question type. Using a summative online key feature (KF) examination we evaluated whether LMQs can be compared with OEQs in regard to the level of difficulty, performance and response times. We also evaluated the content for its suitability for LMQs. METHODS: We randomized 146 fourth year medical students into two groups. For the purpose of this study we created 7 peer-reviewed KF-cases with a total of 25 questions. All questions had the same content in both groups, but nine questions had a different answer type. Group A answered 9 questions with an LM type, group B with an OE type. In addition to the LM answer, group A could give an OE answer if the appropriate answer was not included in the list. RESULTS: The average number of correct answers for LMQs and OEQs showed no significant difference (p = 0.93). Among all 630 LM answers only one correct term (0.32%) was not included in the list of answers. The response time for LMQs did not significantly differ from that of OEQs (p = 0.65). CONCLUSION: LMQs and OEQs do not differ significantly. Compared to standard multiple-choice questions (MCQs), the response time for LMQs and OEQs is longer. This is probably due to the fact that they require active problem solving skills and more practice. LMQs correspond more suitable to Short answer questions (SAQ) then to OEQ and should only be used when the answers can be clearly phrased, using only a few, precise synonyms.LMQs can decrease cueing effects and significantly simplify the scoring in computerized assessment.

Adult↗

PubMed2006

A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children.

BACKGROUND: It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children. METHODS: The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy. RESULTS: No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 +/- 7.5 vs 34.6 +/- 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 +/- 8.7 vs 20.2 +/- 5.3 minutes, P < .05). CONCLUSION: At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.

Adolescent↗

PubMed2005

[Patient participation in the Cochrane Collaboration--barriers, experience, and concepts in Germany].

The aim of the Cochrane Collaboration (CC) is to bridge the gap of information transfer between the clinician and the patient. For this purpose, the CC pursues since years the concept of involving the consumers in the process of collaborative review groups. In spite of a positive experience altogether, some barriers (for example the communication between the scientists involved in CC review groups and the patients) remain to be overcome. To improve the information transfer, the Cochrane Hematological Malignancies Group (CHMG) has built a consumer network within the initiatives of the German Cancer Association, for example devising specific training concepts. The German Cochrane Center, on the other hand, focuses on direct information of patients and interested consumers, and provides translated consumer synopses of all available systematic reviews (SR) adapted for use in the German health system. In the future, it will be necessary to develop more concepts to optimize the patient participation process, and to find methods to measure the impact of these projects on the patient outcome.

Germany↗

PubMed2005

[Patient participation in the Cochrane Collaboration: how can patients/consumers actively participate in a worldwide Cochrane Review Group?].

In Cochrane Review Groups, consumers are usually involved in every phase of the production of systematic reviews, as patient-oriented outcomes are expected to be integral part of all review projects. A further enlargement of participation consists of a new project aimed at contacting patient organizations worldwide, in order to identify particular socio-cultural preferences and needs and to integrate them in the work of the Review Groups. As a first step, information about healthcare issues from people suffering from metabolic and endocrine disorders is gathered by means of structured questionnaires. These activities should be able to detect new research areas, and to draw the attention of the sponsors to a possible western-focused bias in the preparation of systematic reviews.

Developing Countries↗

PubMed2003

Criteria for decision-making--what makes sense?

Rational medical decision-making increasingly demands the acquisition of critical appraisal skills through application of the principles of evidence-based medicine and clinical epidemiology. Moreover, mastery of information technology to reduce time constraints and data overload is necessary. Ultimately, decision-making has to take into account patient preferences in order to establish real communication to optimise shared decision endeavours.

Decision Making↗

PubMed2003

Incidence of blindness in southern Germany due to glaucoma and degenerative conditions.

PURPOSE: To estimate population-based incidence rates of registered blindness separately, to determine its main causes. METHODS: The files of all newly registered blindness-allowance recipients in Württemberg-Hohenzollern, Germany (population: approximately 5 million), between 1994 and 1998 were reviewed. From ophthalmological reports on file the fulfillment of the German criteria for blindness (visual acuity of 1/50 or less or equivalent reduction of visual function) was ascertained, and the causes of blindness were obtained. Incidence rates of blindness due to macular degeneration, glaucoma, cataract, optic atrophy, and diabetic retinopathy were estimated. RESULTS: There were 3531 newly registered blindness-allowance recipients (67.1% female; mean age, 72.8 +/- 21.0 years). Standardized incidence rates in the general population (per 100,000 person-years; 95% confidence interval): All causes 12.27 (11.87-12.68), macular degeneration 5.29 (5.02-5.55), cataract 3.32 (3.11-3.52), optic atrophy 2.86 (2.66-3.05), glaucoma 2.43 (2.25-2.61), diabetic retinopathy 2.13 (1.96-2.30), other or unknown causes 5.17 (4.91-5.43). In many cases, blindness was attributable to more than one cause. Assuming that incidence rates are the same in other parts of the country, 9,939 (9,608-10,270) new cases of blindness were estimated to occur in Germany per year. CONCLUSIONS: The most common single cause of blindness was macular degeneration. Incidence rates of blindness due to such treatable conditions as glaucoma were also high. This finding suggests that the taking of measures for secondary prevention (e.g., early detection and optimal treatment of patients with glaucoma and diabetic retinopathy) should be intensified.

Adolescent↗

PubMed2002

Body weight, blood pressure, and mortality in a cohort of obese patients.

The associations between body weight, raised blood pressure, and mortality remain controversial. The authors examined these relations by considering all degrees of obesity in the Düsseldorf Obesity Mortality Study (1961-1994). Among 6,193 obese German patients aged 18-75 years and having a body mass index (BMI) of > or =25 kg/m(2), 1,059 deaths were observed after a median follow-up of 14.8 years. The entire cohort was grouped into quartiles according to BMI (25-<32, 32-<36, 36-<40, > or =40 kg/m(2)) and systolic blood pressure (SBP) (<140, 140-<160, 160-<180, > or =180 mmHg). Cox proportional hazards analyses were performed to adjust for age. For women, the mortality risk curves for the four BMI groups in relation to SBP were flat without crossing, whereas the risk curve for moderately obese men (BMI 25-<32 kg/m(2)) crossed the risk curves for the higher BMI groups. In the group of patients with very high blood pressure (SBP > or = 180 mmHg), moderately obese subjects (BMI 25-<32 kg/m(2)) had a higher mortality risk for men when compared with the BMI group 32-<36 kg/m(2) (hazard ratio =1.62, 95% confidence interval: 1.0, 2.7) but not for women (hazard ratio = 0.71, 95% confidence interval: 0.4, 1.2). These findings support previous observations that the risk of death is lower for hypertensive men in high compared with low BMI groups.

Adolescent↗

PubMed2002

Glucocorticoid withdrawal schemes in chronic medical disorders. A systematic review.

This systematic review highlights the uncertainty about the safety and efficacy of glucocorticoid withdrawal in many chronic diseases, elucidating the need for further research in this area. The problem of glucocorticoid withdrawal seems to be good example for wide variation in physicians' approaches to weaning patients off glucocorticoids. This practice variation appears justified, given the well known extraordinary array of individual reactions to systemic glucocorticoid therapy [44], the obligation to individualize treatment, and scientific uncertainty. Moreover, only sparse information concerning health-related quality of life, well-being and symptoms, and socioeconomic sequelae after glucocorticoid withdrawal is available from published randomized trials. In conclusion, clinicians and patients need many more--and in a number of conditions, initial--high quality studies to assess the safety and efficacy of systemic glucocorticoid withdrawal schedules in chronic diseases.

Autoimmune Diseases↗

PubMed2002

Pharmacotherapy for thyroid nodules. A systematic review and meta-analysis.

The review highlights the uncertainty in the management of nodular thyroid disease. Thyroxine suppressive treatment is given in the hope that nodules might decrease in size, sometimes assuming that dependency on TSH is different in benign and malignant nodular disease. Follow-up of benign nodules over 10 years suggested that most remain the same, shrink, or disappear [14]. TSH suppression may lead to hyperthyroidism, reduced bone density [37.39], and atrial fibrilation; however, apart from reduction of nodule size or arrest in nodule growth, thyroxine therapy may benefit patients by reducing perinodular volume. Consequently, both pressure symptoms and cosmetic complaints could improve. Unfortunately, no information concerning symptoms or well-being is available from published randomized trials. In conclusion, more high quality studies of sufficient duration with adequate power estimation are needed. Uncertainty about predictors of response or the impact on outcomes that are important to patients leaves considerable doubt about the wisdom of applying suppressive therapy. Future studies shoudl include patient-important outcomes including thyroid cancer incidence, health-related quality of life and costs.

Humans↗

PubMed2002

Systematic reviews in endocrinology. The Cochrane Metabolism and Endocrine Disorders Review Group.

The Cochrane Collaboration is an international nonprofit organization that aims to make up-to-date accurate information about the effects of health care readily available worldwide by preparing, maintaining, and disseminating systematic reviews of the effects of health care. The Cochrane Metabolism, Endocrinology, and Diabetes Review Group's primary concern is the evaluation of randomized controlled trials and other controlled comparisons of health care interventions relevant to the prevention, treatment or management, and rehabilitation of metabolic, nutritional, and endocrine disorders. This article discusses the role of systematic reviews and metaanalyses and invites interested parties to get involved and contribute.

Clinical Competence↗

PubMed2002

Aspirin in diabetic retinopathy. A systematic review.

Diabetes mellitus is a risk factor for eye disease that can lead to blindness. There have been both concerns that aspirin use might worsen diabetic retinopathy, as well as hopes that aspirin might be beneficial in treating it. We investigated whether there are beneficial effects of aspirin alone and in combination with other antiplatelet agents in the treatment of diabetic retinopathy, and the relative hazards for the development of high-risk proliferative retinopathy following aspirin treatment. We conducted a sensitive search for randomized controlled trials combined with index terms for identifying studies on aspirin treatment in diabetic retinopathy in the Cochrane Library (issue 4, 2001) and Medline (1966 to October, 2001). We examined randomized controlled clinical trials in diabetic patients with (non) proliferative diabetic retinopathy and aspirin treatment alone or in combination with dipyramidole versus placebo administration. Two independent reviewers judged trial eligibility, collected details of study population, interventions, and outcomes using a standard data extraction form. One reviewer assessed the quality of trial reporting. We identified six publications pertinent to our objective. Aspirin dosages ranged from 650 mg to 990 mg daily, the dose of dipyridamole, used in only one trial, was 225 mg per day. Studies lasted 8 weeks to 5 years. All trials showed that aspirin alone or in combination with dipyridamole neither lowered nor increased the risk of the development of diabetic retinopathy. The results suggest that there are no ocular contraindications to taking aspirin if required as part of a treatment for cardiovascular diseases or other medical indications.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

Human versus animal insulin in people with diabetes mellitus. A systematic review.

This review is in accordance with the findings of the systematic review of Airey et al [18] with respect to the absence of a differential effect on hypoglycemia between human and animal insulin. For the first time, however, the review compares the relative efficacies of human and animal insulin, which indicates that human insulin was introduced without proof of being superior to animal insulin. Studies have not assessed patient-centered outcomes [41,42], such as patient satisfaction, health-related quality of life, and diabetes-related morbidity. Randomized trials did not report on qualitative assessments of patients' experiences when using different insulin species. Because history tends to repeat itself, we probably will be faced with other "innovations" (e.g., insulin analogs) evaluated in clinical trials tht focus on surrogate outcomes followed by marketing of insulins "proved" to be effective in short-term, underpowered, and badly executed studies.

Animals↗