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Ingrid Mühlhauser

Publications and source records attributed to Ingrid Mühlhauser.

10 recordsLinked to original sources
PubMed2004

[Cardiovascular risk assessment for informed decision making. Validity of prediction tools].

BACKGROUND AND PURPOSE: Patient involvement in health care decisions is increasingly requested. The authors investigated whether currently available assessment tools for prediction of cardiovascular risk can be used for individual risk prediction as a basis of informed decision making. METHODS: The authors searched for risk assessment tools and respective validation studies in Medline (until August 16, 2004) and the Cochrane Library (issue 2/2004). The following criteria were used for evaluation of prognostic studies: (1) discrimination between risk groups; (2) predictive values; (3) prognostic agreement; (4) transferability across populations. RESULTS: A total of twelve assessment tools were identified. The Framingham function, Sheffield Tables, Canadian Tables, Framingham Categorial, New Zealand, Joint British, and European Charts (1994 and 1998) are based on the Framingham Study; PROCAM Risk Score, UKPDS Risk Engine, and SCORE Risk Charts use different source data. Framingham-based instruments overestimate cardiovascular risk of Central-European populations by at least 30%, with substantial regional variation even within a country (between 30% and 100%, British Regional Heart Study). Therefore, prior to application the assessment tools would need recalibration using regional data of cardiovascular mortality and adjustment for social class differences. Published sensitivity, specificity, and C-statistics for external validation (area under the curve [AUC] approximately 0.6) are clearly inferior to internal validation (AUC approximately 0.8). Agreement between instruments beyond chance is moderate (kappa approximately 0.5). No studies on external validation could be identified for the new European SCORE Risk Charts and UKPDS Risk Engine. CONCLUSION: Validation of currently available assessment tools for cardiovascular risk prediction is inadequate. Uncritical use may lead to substantial under- or overestimation of individual cardiovascular risk and inappropriate treatment decisions.

Adult↗
PubMed2004

Explaining computation of predictive values: 2 x 2 table versus frequency tree. A randomized controlled trial [ISRCTN74278823].

BACKGROUND: Involving patients in decision making on diagnostic procedures requires a basic level of statistical thinking. However, innumeracy is prevalent even among physicians. In medical teaching the 2 x 2 table is widely used as a visual help for computations whereas in psychology the frequency tree is favoured. We assumed that the 2 x 2 table is more suitable to support computations of predictive values. METHODS: 184 students without prior statistical training were randomised either to a step-by-step self-learning tutorial using the 2 x 2 table (n = 94) or the frequency tree (n = 90). During the training session students were instructed by two sample tasks and a total of five positive predictive values had to be computed. During a follow-up session 4 weeks later participants had to compute 5 different tasks of comparable degree of difficulty without having the tutorial instructions at their disposal. The primary outcome was the correct solution of the tasks. RESULTS: There were no statistically significant differences between the two groups. About 58% achieved correct solutions in 4-5 tasks following the training session and 26% in the follow-up examination. CONCLUSIONS: These findings do not support the hypothesis that the 2 x 2 table is more valuable to facilitate the calculation of positive predictive values than the frequency tree.

Adult↗
PubMed2004

Risk information--barrier to informed choice? A focus group study.

OBJECTIVES: To study consumers' information needs for informed choice on colorectal cancer screening, and to develop and evaluate information material that is evidence-based and communicates benefit as well as lack of benefit and risks as natural frequencies. METHODS DESIGN: Focus group study; during a first round consumers' needs and attitudes were surveyed, in a second round the information material was evaluated. The study was carried out in Hamburg, Germany. PARTICIPANTS: 50 women and men, 40 years or older without colorectal diseases. RESULTS: Consumers opted for traditional information that advises and guides them. If consumers were nevertheless given evidence-based information that considers the defined criteria it evoked cognitive dissonance which consumers tried to cope with by devaluating, minimising and not noticing the information. Cognitive dissonance inhibits processing of information. Researchers are confronted with a dilemma to either respect consumers' requests or to facilitate informed choice. CONCLUSION: Cognitive dissonance may be a barrier to informed choice. This should be considered when aiming at communicating risk information.

Adaptation, Psychological↗
PubMed2004

Predictors of adherence to the use of hip protectors in nursing home residents.

OBJECTIVES: To assess predictors of hip-protector use in nursing home residents under usual-care conditions and after intervention consisting of structured education of nurses and nursing home residents and provision of free hip protectors. DESIGN: Nested cohort analyses within a cluster randomized, controlled trial with 18 months follow-up. SETTING: Forty-nine nursing home clusters in Hamburg, Germany. PARTICIPANTS: Residents with at least one fall during the study period (intervention group, n=237; usual-care group, n=274). MEASUREMENTS: Use of hip protector while falling. Regression analyses were performed for each of the two cohorts of fallers using the time to the first fall without hip protector as the dependent variable. Predefined nursing home cluster-related parameters (center, staffing ratio, proportion of registered nurses in nursing staff, hip-protector use before study period) and resident-related parameters (sex, history of falls and fractures, fear of falling, urinary incontinence, use of walking aid, degree of disablement) were considered as explanatory variables. RESULTS: Under usual care, 97% of fallers (n=266), compared with 62% (n=148) in the intervention group, experienced at least one fall without hip protection. Using Cox proportional hazards models with and without frailty parameter (random cluster effect), the following predictors were identified: intervention group: use of walking aid, hazard ratio (HR)=1.53 (95% confidence interval (CI):0.98-2.39) and no urinary incontinence, HR=1.47 (95% CI:1.03-2.09); usual care: nursing staff per 10 residents, HR=0.78 (95% CI=0.63-0.96); high degree of disablement, HR=1.38 (95% CI=1.06-1.80); strong fear of falling, HR=0.78 (95% CI=0.60-1.02). The nursing home cluster was a significant predictor in the control group (P=.029), but not in the intervention group (P=.100). CONCLUSION: Only a few and weak predictors of hip-protector use of questionable relevance could be identified in both groups. Future research should concentrate on the implementation of interventions of proven efficacy, such as provision of hip protectors combined with structured education of staff and residents.

Accidental Falls↗
PubMed2004

Decisional role preferences, risk knowledge and information interests in patients with multiple sclerosis.

OBJECTIVE: Shared decision making is increasingly recognized as the ideal model of patient-physician communication especially in chronic diseases with partially effective treatments as multiple sclerosis (MS). To evaluate prerequisite factors for this kind of decision making we studied patients' decisional role preferences in medical decision making, knowledge on risks, information interests and the relations between these factors in MS. METHODS: After conducting focus groups to generate hypotheses, 219 randomly selected patients from the MS Outpatient Clinic register (n = 1374) of the University Hospital Hamburg received mailed questionnaires on their knowledge of risks in MS, their perception of their own level of knowledge, information interests and role preferences. RESULTS: Most patients (79%) indicated that they preferred an active role in treatment decisions giving the shared decision and the informed choice model the highest priority. MS risk knowledge was low but questionnaire results depended on disease course, disease duration and ongoing immune therapy. Measured knowledge as well as perceived knowledge was only weakly correlated with preferences of active roles. Major information interests were related to symptom alleviation, diagnostic procedures and prognosis. CONCLUSION: Patients with MS claimed autonomous roles in their health care decisions. The weak correlation between knowledge and preferences for active roles implicates that other factors largely influence role preferences.

Adult↗
PubMed2003

[Evidence-based treatment and education programs--evaluation of complex interventions].

Patient education and treatment programmes are complex interventions that require a multiphased stepwise evaluation. The continuum of increasing evidence of effectiveness of structured treatment and teaching programmes for diabetes and hypertension as implemented in Germany is presented, and the indispensable components of the program and the conditions of their effective implementation are described.

Education, Medical↗