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Biomedical subjects

Kristian Larsen

Publications and source records attributed to Kristian Larsen.

18 recordsLinked to original sources
PubMed2006

Coping and back problems: analysis of multiple data sources on an entire cross-sectional cohort of Swedish military recruits.

BACKGROUND: As the literature now stands, a bewildering number and variety of biological, psychological and social factors are, apparently, implicated in back problems. However, if and how these have a direct influence on back problems is not clear. Obesity, for example, has in many studies been shown to be associated with back problems but there is no evidence for a causal link. This could be explained by a dearth of suitably designed studies but also because obesity may be but a proxy for some other, truly explanatory variable. Coping has been linked with, particularly, persistent back problems as well as with health in general. The question is, whether coping could be the explanatory link between, for example, these two variables. A cross-sectional study was undertaken using data from the Swedish Army, consisting of the entire cohort of males (N = 48,502) summoned in 1998 to serve in the military. The purpose of the study was to investigate the relation between five independent variables and two dependent variables ("outcome variables"). The independent variables were two anthropomorphic variables (height and body mass index), two psychological variables (intellectual capacity and coping in relation to stress), and one social variable (type of education). The two outcome variables were back problems and ill health. In particular, we wanted to determine whether controlling for coping would affect the associations between the other four independent variables and the two outcome variables. METHODS: Data for the analysis come from a battery of standardized examinations, including medical examinations, a test of intellectual capacity, and a test of coping in relation to stress. Each of these examinations was conducted independently of the others. Unadjusted and adjusted odds ratios were calculated for the outcome variables of back problems and ill health. RESULTS: The associations between height, body mass index, intellectual capacity, type of education and the two outcome variables (back problems and ill health) were weak to moderate. Additionally, there were strong associations between coping and the two outcome variables and when controlling for coping the previously noted associations diminished or disappeared, whereas none of the other variables had a large effect on the association between coping and the two outcome variables. CONCLUSION: Coping emerged as strongly associated with both back problem and ill health and coping had a leveling effect on the associations between the other independent variables and the two outcome variables. This study is noteworthy particularly because the association with coping is so robust. It is a retrospective, cross-sectional study, however, and, as such it raises questions of causality; which - if any - came first, inability to cope or back pain? The results of this study call attention to the need for a prospective study, in which coping is clearly defined. Such a study has been undertaken and will be presented separately. Index terms: back pain, coping, education, height, BMI, intellectual capacity, bio-psycho-social model, epidemiology, cohort, cross-sectional study.

Adaptation, Psychological↗
PubMed2006

Coping and back problems: a prospective observational study of Danish military recruits.

OBJECTIVE: The aim of this study was to investigate if Antonovsky's coping questionnaire ("sense of coherence" [SOC]-13) can be used to predict self-reported low back pain (LBP) and associated leg pain in young men subjected to the first 3 months of military service and to challenge such a link with a number of biosocial variables. METHODS: A prospective observational study of a fixed cohort consisting of 357 military conscripts was completed. Data were collected at baseline and after 3 months of military service. The outcome variables were self-reported LBP and leg pain at any time during those 3 months. The main independent (predictor) variable was coping. Covariables were biological (age, height, weight, fitness, strength, and a history of previous problems) and social (type of work, years of education, and social support). The clinical usefulness was shown for the best model, with each outcome variable in relation to sensitivity/specificity, positive/negative predictive value, numbers correctly classified, and the area under the receiver operating characteristics curve. RESULTS: The SOC-13 questionnaire could successfully predict leg pain (odds ratio [OR], 3.3), but only 1 of its 13 items predicted LBP (OR 2.0). For leg pain, the strongest predictor was age (OR, 4.5), and for LBP, the strongest predictor was previous LBP (OR, 6.7). The receiver operating characteristics curves of the final models were 0.85 and 0.79, respectively. CONCLUSIONS: In these young Danish conscripts, coping or elements of coping (as defined with the help of the SOC-13 questionnaire) could predict LBP and leg pain occurring during a 3-month period. Biological and psychological variables dominated the final models, but none of the social variables could significantly predict LBP or leg pain.

Adaptation, Psychological↗
PubMed2005

[Should health care information be provided in more than words? Experiences of plastic surgery in patients at looking at clinical photos].

INTRODUCTION: This article deals with an empirical study on the use of clinical photos as part of the information/communication between health professionals and patients. Normally the verbal method is used to provide information to patients. The hypothesis is that figurative and illustrative material can be a useful supplement to the spoken word. The study focused on patients' experience of looking at clinical photos. MATERIALS AND METHODS: The research was conducted in the Department of Plastic Surgery and Burn Care, Rigshospitalet, Copenhagen, Denmark. The study was a quality, explorative and descriptive interview research including 10 patients. RESULTS: This study shows that patients find it positive to look at clinical photos, because it gives them knowledge and understanding, as well as realistic expectations and a sense of security in having made the right decision. The photographs help confirm or invalidate their expectations. The combination of listening to verbal information and looking at pictures makes sense to the patient. DISCUSSION: This study shows that looking at clinical photos is one way to improve the information/communication between patient and health professionals. Clinical photos contribute to the emotional and bodily part of gaining knowledge and thereby complement the verbal information, which is primarily cognitive. The study shows that patients experience photos as a positive element in their treatment and demonstrates that photos give them an answer to how they will appear after surgery, which is difficult to describe in words. In this study age, sex and diagnosis did not seem to matter for the experiences of the patients.

Adult↗
PubMed2005

Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey.

BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. METHODS: During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. RESULTS: Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33-0.90). This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2-3.0, for the highest educated group), but not of the consequences (leg pain and exemption from duty), whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1-0.8 for exemption from duty in the group with highest IQ). Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1-10.8), leg pain (OR: 3.3;1.3-8.3) and exemption from duty during service (OR: 5.9;2.4-14.8). CONCLUSION: Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the duration of low back pain prior to service and IQ-level are the most important factors.

Adult↗
PubMed2005

The Nordic back pain subpopulation program: a 1-year prospective multicenter study of outcomes of persistent low-back pain in chiropractic patients.

OBJECTIVES: The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time. DESIGN: Prospective uncontrolled multicenter study. METHODS: Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months. STUDY SUBJECTS AND SETTING: Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months). RESULTS: Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve. CONCLUSION: The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers "cured" appear to be a feasible outcome variable in this type of study population.

Adult↗
PubMed2005

The Bournemouth Questionnaire: can it be used to monitor and predict treatment outcome in chiropractic patients with persistent low back pain?

OBJECTIVE: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). STUDY DESIGN: Predictive and concurrent validation study. STUDY PARTICIPANTS AND SETTING: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. METHODS: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. DATA ANALYSIS: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. RESULTS: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. CONCLUSIONS: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes.

Absenteeism↗
PubMed2005

The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden.

OBJECTIVES: (1) To describe the low back pain (LBP) pattern at baseline; (2) to describe the long-term outcome pattern; (3) to investigate the presence of distinct subgroups in relation to outcome; (4) to establish whether short-term outcome is a predictor of long-term outcome. METHODS: A 3- to 6- and 12- to 18-month, multicenter practice-based, prospective descriptive study was performed in private chiropractic practices in Sweden. Fifty-eight of 64 previously compliant chiropractors each recruited a maximum of 30 consecutive patients with LBP. Complete baseline clinical information was provided on 1054 patients, of which 93% were interviewed approximately 3 months later, and 57% responded to a questionnaire at approximately 12 months. Chiropractic treatment was decided by the treating chiropractor. Twelve descriptive subgroups were created based on (1) duration of LBP at baseline, (2) duration of LBP in the past year, and (3) LBP pattern in the past year. The predictive value was tested for outcome status at the fourth visit. Information on self-reported LBP status and improvement over the past months were collected. RESULTS: Patients were spread in a U-shaped fashion from benign to severe with the 2 extreme groups being most prevalent. About half the participants reported "no LBP in the past week" at 3 months and somewhat fewer at 12 months. Almost 75% claimed to be definitely better at 3 months, and approximately 50% at 12 months. Specific predictive subgroups can be identified, mainly in relation to the past-year history of LBP. Improvement at the fourth visit is a predictor of long-term outcome. CONCLUSION: Knowledge of specific subgroups may improve the quality of care and the selection of homogeneous study populations in clinical trials.

Adult↗
PubMed2004

The nordic back pain subpopulation program: demographic and clinical predictors for outcome in patients receiving chiropractic treatment for persistent low back pain.

OBJECTIVE: To identify demographic and clinic-related predictors for successful outcome in patients with persistent low-back pain who received chiropractic treatment. DESIGN: Prospective uncontrolled multicenter study with internal control groups. SUBJECTS: Each of 115 Norwegian chiropractors, out of 205 invited, were asked to recruit 10 consecutive patients who had low-back pain for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. In all, 875 patients were included at baseline. The response rates at the fourth visit and at 3 and 12 months were 799, 598, and 512, respectively. METHODS: Baseline data were obtained through questionnaires administered to chiropractic patients and to their treating chiropractors; clinical information was obtained through questionnaires at the fourth visit from patients and chiropractors. Outcome was obtained from patients at the fourth visit. Mail surveys of patients were conducted after 3 and 12 months, and additional information was obtained from chiropractors at 12 months in relation to treatment history. POTENTIAL PREDICTORS: Demography and information on past and present history, clinical findings, and prognosis. OUTCOME VARIABLE: Number of low-back pain"free patients (defined as those with a maximum pain score of 1/10 and a maximum Oswestry score of 15/100). DATA ANALYSIS: Positive predictive values and relative risks were calculated for each categorized predictor variable singly and in combination in relation to being low-back pain free at the 3 follow-up surveys. RESULTS: Treatment outcome at the fourth visit was best predicted by a model containing the following 5 variables: sex, social benefit, severity of pain, duration of continuous pain at first consultation, and additional neck pain (odds ratios between 2.2 and 4.3). A similar profile was found at 3 months, but 2 different variables (relating to disability) were the final variables in relation to the 12-month status. These final models were best at predicting absence of treatment success. Being low-back pain free at the fourth visit was a strong predictor for being low-back pain free both at 3 months and 12 months, with relative risks of 3.0 (2.2-4.8) and 3.1 (1.5-6.5), respectively. CONCLUSION: In patients with persistent low-back pain, it is possible to exclude from treatment those who are unlikely to become low-back pain free after chiropractic care and to do this before they have been examined clinically. Early recovery is a strong predictor for outcome up to 1 year later.

Adolescent↗
PubMed2004

Compliance in contact allergy with focus on cosmetic labelling: a qualitative research project.

Elimination of the allergen is an effective remedy in allergic contact dermatitis. When contact allergy to a preservative is diagnosed, the patient is instructed to read the labelling of contents and to avoid the use of products containing the allergens. The present study, using qualitative research methods, was performed to examine how socially different groups of patients handle everyday life with allergic contact dermatitis caused by preservatives in consumer products. 8 women were interviewed about reading the ingredient labelling on cosmetic products. Observational studies were carried out as well. The study illustrates that the patients experienced problems when trying to read the labelling of contents. The problems were related to social status and ranged from not being able to read the chemical names of the preservatives to doubting the accuracy of the ingredient labelling. The study indicates that non-compliance with instructions on reading the ingredient labelling is not only a question of patients' lack of knowledge, but also the result of patients not possessing the resources necessary to act in accordance with the medical instructions. The present study is, to our knowledge, the first to apply qualitative research methods to contact dermatitis. The study points out interesting observations about social status and resources in relation to compliance. Further research on this area is necessary to expose the extent of the problem.

Adult↗
PubMed2003

Moving forward in a role as a researcher: the effect of a research method course on nurses' research activity.

The aim of this study was to investigate whether a 1-year research course in basic research methodology, designed for clinical nurses, had a positive effect on the nurses' own research activity and their commitment to research in general. The research method applied was use of semistructured interviews. Seventy-nine clinical nurses participated in the study. Students of the research course (n = 37), i.e. the study group, were compared with a group of clinical nurses who did not participate in the course (n = 42), i.e. the reference group. A statistically significant difference was found in several variables between the two groups. Eighty-nine per cent of the study group members were active in planning their own research projects compared with 35.7% in the reference group. The study group also showed a higher level of interest and commitment to research results of others and read English language articles. A total of 13.9% of the study group experienced being unable to find time during working hours to participate in research projects, while this was true for 50% of nurses in the reference group. Experiences from the research course in basic methodology show that educational programmes designed for clinical nurses may facilitate and support their own research efforts as well as enhance their commitment to research in general. The course reinforced nurses' self-confidence in research-based practice. Clinical nurses require personal initiative, perseverance and competence in research methodology as well as sensitization towards a research culture in order to move away from the salaried work of a practitioner and into the role of a researcher.

Adult↗
PubMed2003

Danish research-active clinical nurses overcome barriers in research utilization.

AIM: The aim of this study was to examine whether there was a difference between clinical nurses who were research-active, and clinical nurses who were nonresearch-active in utilization of research. A further aim was to identify the most significant barriers faced by a group of Danish clinical nurses in their use of research. BACKGROUND: Discrepancy between the improved quality of research results and the lack of implementing them was the starting point for a series of studies which showed the types of barriers clinical nurses found especially cumbersome when applying the research results of other researchers. This study investigates whether the clinical nurses' own engagement in research had any impact on their perception of research utilization. METHODOLOGY: The study had an exploratory and descriptive design. Seventy-nine Danish clinical nurses participated and semi-structured interviewing was used as the research method. FINDINGS: There was a statistically significant difference between the research-active and nonresearch-active nurses on various variables. The study showed that, to a larger extent, research-active nurses used evidence-based knowledge and were generally more internationally orientated. Furthermore, two important barriers for research utilization were identified by all 79 clinical nurses included in the study, i.e. 90% of the nurses explained that the quantity of research results was overwhelming, and 75% of them found that they were unable to evaluate the quality of the research. CONCLUSIONS: Clinical nurses, who were research-active themselves, experienced more success in overcoming some of the barriers, which existed in applying research to practice. The research potential found amongst clinical nurses in Denmark needed to be further supported through training and guidance in research methodology, establishing introductory stipends and part-time research positions. By doing so, some of the barriers affecting research utilization and the so-called theory-practice gap might be reduced. Further empirical studies, based on Giddens theory of sociological reflectivity, might see clinical nurses in a more serious light and simultaneously perceive them as producers of knowledge.

Adult↗
PubMed2002

Can passive prone extensions of the back prevent back problems? A randomized, controlled intervention trial of 314 military conscripts.

SUMMARY OF BACKGROUND DATA: Back schools may be effective in treating back problems, but there is conflicting evidence of the effect on prevention. OBJECTIVES: To investigate if passive prone extensions of the back can prevent back problems. STUDY DESIGN: Prospective, randomized controlled intervention trial. METHODS: In total, 314 male conscripts were randomized into two groups. After randomization, 65 conscripts dropped out for administrative reasons, leaving 249 conscripts to participate fully in the study. Data were collected through questionnaires at the start of military duty and after 10 months. All conscripts in the intervention group had one 40-minute theoretical lesson on back problems and ergonomics and had to perform passive prone extensions of the back daily during the rest of their military duty. The control group had no intervention. Outcome variables were as follows: 1) number of persons with self-reported back problems during the last 3 weeks; 2) number of persons with self-reported back problems during the last year; and 3) number of persons who reported having consulted the regiment medical physician with back problems during their military service. RESULTS: In an intention-to-treat analysis, significantly fewer persons in the intervention group versus those in the control group reported back problems during the last year (33% versus 51%), and the number needed to prevent was 6. Significantly fewer persons in the intervention group versus those in the control group consulted the regiment infirmary (9% versus 25%), and the number needed to prevent was 6. CONCLUSION: It may be possible to reduce the prevalence rate of back problems and the use of health care services during military service, at a low cost, using passive prone extensions of the back motivated by a back school approach, including the theory of the disc as a pain generator and ergonomic instructions.

Adult↗
PubMed2002

Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.

BACKGROUND: Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented. OBJECTIVES: To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible. DESIGN: Prospective, randomized, controlled intervention trial. STUDY SUBJECTS: One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment. METHOD: Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated. OUTCOME VARIABLES: Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems. RESULTS: Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups. CONCLUSIONS: This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.

Adolescent↗
PubMedDate not supplied

The Nordic back pain subpopulation program: can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in nonpersistent low back pain?

OBJECTIVE: To investigate whether 3 distinct patterns of reactions to chiropractic care can predict early favorable treatment outcome in patients with nonpersistent low back pain (LBP). DESIGN: Multicenter practice-based predictive validity study. STUDY SUBJECTS: Sixty private practice chiropractors in Sweden recruited a maximum of 20 consecutive patients with LBP each, with a duration of less than 2 weeks at the time of consultation and a maximum of 30 days totally over the past year. METHODS: Chiropractic management was decided on by the treating chiropractor. The outcome variable was self-reported "definite improvement" at the fourth visit. The predictor variables included 3 hypothesized prognostic groups (best, intermediate, and least favorable) on the basis of clinical information collected at baseline and at the second visit. The covariates included age, sex, pain intensity during the past 24 hours, description of disability, duration and pattern of pain during the present attack, and duration and pattern of pain during the past 12 months. The 3 predictor groups were cross-tabulated against the outcome variable and the other covariates. Backward stepwise logistic regression was performed to test for confounding or modification from relevant covariates. RESULTS: Information was provided on 708 patients, of which 674 questionnaires were valid. Of the 223 patients in the hypothesized best prognostic group, 91% (95% CI, 79-100) reported to be "definitely improved" by the fourth visit, vs 76% (72-80) of the 420 patients in the intermediate prognostic group, and 36% (19-53) of the 31 patients in the least favorable prognostic group. These results were not altered after controlling for the covariates. CONCLUSION: For chiropractic patients with nonpersistent LBP, these findings show that it is possible to predict already by the second visit which patients may or may not report improvement at the fourth visit.

Adult↗
PubMedDate not supplied

The Nordic Back Pain Subpopulation Program: validation and improvement of a predictive model for treatment outcome in patients with low back pain receiving chiropractic treatment.

OBJECTIVE: The aim of this study was to develop a predictive model for treatment outcome in patients with low back pain (LBP) receiving chiropractic treatment. METHODS: This multicenter practice-based predictive validity study was conducted in private chiropractic practices in Sweden. Of 64 previously compliant chiropractors, 58 recruited a maximum of 30 consecutive patients with LBP each. Information was provided on 1061 patients, of which 1057 questionnaires were valid. Chiropractic treatment was decided by the treating chiropractor. The outcome variable was the self-reported "definite improvement" at the fourth visit. The predictor variables included model 1, 3 hypothesized prognostic groups (best, intermediate, and least favorable) based on clinical information collected at baseline and at the second visit; and 4 additional models based on the following variables: age, sex, pain intensity during past 24 hours, description of disability, duration and pattern of pain during present attack, total duration of pain, and pain pattern during the past 12 months. RESULTS: Three of our factors were best at predicting the absence of improvement by the fourth visit and were able to correctly classify 79% of patients and to cover 74% of the receiver operated characteristics curve. These were (1) no definite overall improvement by the second treatment, (2) presence of leg pain, and (3) the minimum total duration of pain over the last 12 months being 30 days. CONCLUSION: In this study, patients with LBP who also had leg pain and LBP occurring sufficiently frequently or having lasted sufficiently long to add up to at least 30 days in the past year, and who did not report definite general improvement by the second treatment were not good candidates for short-term recovery. It is suggested that patients who fit the criteria of potential nonresponders should be carefully monitored to allow a selective approach of care.

Adult↗
PubMedDate not supplied

There is no gap 'per se' between theory and practice: Research knowledge and clinical knowledge are developed in different contexts and follow their own logic.

The aim of this article is to highlight relations between theory and practice and the genesis of professional action in clinical nursing and among researchers. With use of a sociologically based empirical approach, focus is placed on the knowledge involved in the work of researchers and practitioners in terms of the source of their knowledge. Unlike a dominant barrier paradigm, theory and practice have different logics; they are not on a continuum nor are they hierarchically ordered. They exist in their own right as theoretical knowledge and practical knowledge. In daily practice, clinical nurses are inspired and learn from the context, including each other, and they are active producers of knowledge, not simply recipients of knowledge. This study, therefore, claims that there is no research-practice gap "in itself" (per se) as argued in the "barriers paradigm."

Ethics, Clinical↗
PubMedDate not supplied

Unexpected expansive paranasal sinus mucormycosis.

Mucormycosis infection of the paranasal sinuses is a very rare but serious condition. Patients are usually immunocompromised by systemic disease. We report an unexpected case of expansive paranasal sinus mucormycosis in an immunocompetent European treated successfully with surgical debridement and intravenous amphotericin B. The pathogenesis, diagnosis and treatment of paranasal sinus mucormycosis is discussed.

Anti-Bacterial Agents↗