Health Care Professionals' Evidence-Based Medicine Internet Searches Closely Mimic the Known Seasonal Variation of Lyme Borreliosis: A Register-Based Study.

BACKGROUND: Both health care professionals and nonprofessionals seek medical information on the Internet. Using Web-based search engine searches to detect epidemic diseases has, however, been problematic. Physician's databases (PD) is a chargeable evidence-based medicine (EBM) portal on the Internet for health care professionals and is available throughout the entire health care system in Finland. Lyme borreliosis (LB), a well-defined disease model, shows temporal and regional variation in Finland. Little data exist on health care professionals' searches from Internet-based EBM databases in public health surveillance. OBJECTIVE: The aim of this study was to assess whether health care professionals' use of Internet EBM databases could describe seasonal increases of the disease and supplement routine public health surveillance. METHODS: Two registers, PD and the register of primary health care diagnoses (Avohilmo), were used to compare health care professionals' Internet searches on LB from EBM databases and national register-based LB diagnoses in order to evaluate annual and regional variations of LB in the whole country and in three selected high-incidence LB regions in Finland during 2011-2015. RESULTS: Both registers, PD and Avohilmo, show visually similar patterns in annual and regional variation of LB in Finland and in the three high-incidence LB regions during 2011-2015. CONCLUSIONS: Health care professionals' Internet searches from EBM databases coincide with national register diagnoses of LB. PD searches showed a clear seasonal variation. In addition, notable regional differences were present in both registers. However, physicians' Internet medical searches should be considered as a supplementary source of information for disease surveillance.

[Treatment of hyperhidrosis (excessive sweating)]. / Liikahikoilu.

Hyperhidrosis can be localized or generalized and may cause the patient significant discomfort. Localized hyperhidrosis is usually primary, often begins in adolescence and is partly based on genetic dispositions. As a rule it does not necessitate investigations for secondary causes (e.g. endocrine or neurologic conditions). Generalized hyperhidrosis is commonly associated with environmental or lifestyle factors, and sometimes physiological factors. In new-onset generalized sweating of unclear origin, it may be appropriate to consider secondary causes (underlying diseases, medications, infections). Relatively effective symptomatic treatments are available in localized hyperhidrosis. The treatment of generalized hyperhidrosis is almost always directed against the underlying factors.

[Electronically or face to face - quicker and more facile services for the client]. / Sähköisesti vai kasvokkain?

While many services have moved or are moving to the Net, the standard of activity of the healthcare still continues to be based on booking an appointment and face-to-face consultation. Electronic services may solve the availability problem in basic healthcare. The client and the producer of a health service can meet electronically both synchronically at the same time and non-synchronically, i.e. through communicating at a time that is best suited for each. The asymmetry of information changes when the patient and the professional have access to the same information. The expansion of virtual services presents a challenge to our training, which is based on a chain advancing from anamnesis to status, investigations and treatment plan.

Radiofrequency denervation for chronic low back pain.

BACKGROUND: Radiofrequency (RF) denervation, an invasive treatment for chronic low back pain (CLBP), is used most often for pain suspected to arise from facet joints, sacroiliac (SI) joints or discs. Many (uncontrolled) studies have shown substantial variation in its use between countries and continued uncertainty regarding its effectiveness. OBJECTIVES: The objective of this review is to assess the effectiveness of RF denervation procedures for the treatment of patients with CLBP. The current review is an update of the review conducted in 2003. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, three other databases, two clinical trials registries and the reference lists of included studies from inception to May 2014 for randomised controlled trials (RCTs) fulfilling the inclusion criteria. We updated this search in June 2015, but we have not yet incorporated these results. SELECTION CRITERIA: We included RCTs of RF denervation for patients with CLBP who had a positive response to a diagnostic block or discography. We applied no language or date restrictions. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected RCTs, extracted data and assessed risk of bias (RoB) and clinical relevance using standardised forms. We performed meta-analyses with clinically homogeneous studies and assessed the quality of evidence for each outcome using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: In total, we included 23 RCTs (N = 1309), 13 of which (56%) had low RoB. We included both men and women with a mean age of 50.6 years. We assessed the overall quality of the evidence as very low to moderate. Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall, moderate evidence suggests that facet joint RF denervation has a greater effect on pain compared with placebo over the short term (mean difference (MD) -1.47, 95% confidence interval (CI) -2.28 to -0.67). Low-quality evidence indicates that facet joint RF denervation is more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Evidence of very low to low quality shows that facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produces conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, low-quality evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur. AUTHORS' CONCLUSIONS: The review authors found no high-quality evidence suggesting that RF denervation provides pain relief for patients with CLBP. Similarly, we identified no convincing evidence to show that this treatment improves function. Overall, the current evidence for RF denervation for CLBP is very low to moderate in quality; high-quality evidence is lacking. High-quality RCTs with larger patient samples are needed, as are data on long-term effects.

[Cognitive symptoms in an elderly patient--maintaining the functional capacity is always important]. / Iäkkään potilaan kognitiiviset oireet--toimintakyvyn ylläpito on aina tärkeää.

In primary health care, elderly patients having problems in their ability to deal with information are increasingly encountered as a result of lessened institutional care and altered population structure. The most common causes of cognitive problems in the elderly include delusional disorder, various progressive memory diseases and delirium. Treatment of cognitive problems is multidisciplinary collaboration, and maintaining the functional capacity is important at all stages of the disease. Memory disorder medications clearly increase the time of functional capacity, provided that their use is started early enough. Pharmacologic therapy of behavioral symptoms requires expertise, and easily emerging drawbacks frequently exceed the benefits of the medications.

[Update on Current Care Guideline: Low back pain]. / Alaselkäkipu.

Classification to severe diseases, sciatic symptoms or non-specific back pain is recommended. Radiography in acute or subacute non-specific back pain is not recommended in the primary health care. In specialized care magnetic resonance imaging is the main imaging modality. Importance of patient information is emphasized. In acute non-specific pain avoidance of bed rest, advice and paracetamol are recommended. Indications for an emergency referral should be considered. In disabling pain for 6 weeks, multidisciplinary measures are needed. Pain over 3 months indicates intensive multidisciplinary rehabilitation, and also surgery may be considered.

Patients, health information, and guidelines: A focus-group study.

BACKGROUND: Evidence-based clinical guidelines could support shared decision-making and help patients to participate actively in their care. However, it is not well known how patients view guidelines as a source of health information. This qualitative study aimed to assess what patients know about guidelines, and what they think of their presentation formats. RESEARCH QUESTION: What is the role of guidelines as health information for patients and how could the implementation of evidence-based information for patients be improved? METHODS: A qualitative study with focus groups that were built around a semi-structured topic guide. Focus groups were audiotaped and transcribed and analysed using a phenomenographic approach. RESULTS: Five focus groups were carried out in 2012 with a total of 23 participants. Patients searched for health information from the Internet or consulted health professionals or their personal networks. The concepts of guidelines included instructions or standards for health professionals, information given by a health professional to the patient, and material to protect and promote the interests of patients. Some patients did not have a concept for guidelines. Patients felt that health information was abundant and its quality sometimes difficult to assess. They respected conciseness, clarity, clear structure, and specialists or well-known organizations as authors of health information. Patients would like health professionals to deliver and clarify written materials to them or point out to them the relevant Internet sites. CONCLUSIONS: The concept of guidelines was not well known among our interviewees; however, they expressed an interest in having more communication on health information, both written information and clarifications with their health professionals.

[Facilitating scientific data collection systems]. / Tutkimustiedon keruuta helpottavat tietojärjestelmät.

Electronic information systems continuously accumulate huge amounts of quantitative information related to the functioning of primary health care and utilizable in the monitoring of the population's health status, correct allocation of resources and in many types of research. A centralized data bank can function as a general practice research network, the members collecting data both for their own studies and for studies carried out by others. In Finland a computer-assisted "virtual health check" involving the whole population was carried out in Sipoo in 2009.

[Update on Current Care Guideline: Sinusitis]. / Sivuontelotulehdus.

Patients with common cold have often symptoms similar to sinusitis. These symptoms often resolve in time, but symptomatic treatment (e.g. analgesics, decongestants) may be used. If symptoms continue for over 10 days, or severe symptoms continue for over 3 days, or symptoms turn worse in the course of the disease, bacterial sinusitis should be suspected. Diagnosis is based on clinical findings, and can be confirmed with ultrasound examination. Amoxicillin, penicillin or doxicyclin are recommended for bacterial sinusitis. Patients with chronic or recurrent sinusitis should be referred to specialist care.

[Judgment of the level of evidence and strength of recommendations in healthcare according to the GRADE working group]. / Hoitosuositusten näytönasteen ja vahvuuden arviointi GRADE-työryhmän tapaan.

Finnish doctors are pioneers in the production and utilization of evidence-based recommendations in healthcare. Doctor's databases were established by the end of the 1980s and Current Care guidelines have been devised since 1994. In evidence-based recommendations it is essential to provide the user with a description of the quality of research data used as the basis for the recommendation. Consistent, applicable and transparent methods are helpful in the judgment of the quality of studies and strength of evidence. In this article we describe the judgment of the level of evidence and the strength of recommendations according to the international GRADE working group.

[Dysphagia--a multidisciplinary challenge]. / Dysfagia--moniammatillinen haaste.

Difficulty in swallowing, i.e. dysphagia should be distinguished from the sensation of a lump in the throat and the pain on swallowing. A careful anamnesis will help in determining the ailment as a problem of oral, pharyngeal or esophageal stage of swallowing. Videofluorography, FEES investigation and transnasal esophagoscopy as well as gastroscopy are helpful for the diagnosis. Cerebral infarction is the most significant cause of oropharyngeal dysphagia. Esophageal causes include reflux disease, tumors and achalasia. Diagnostics, treatment and rehabilitation of dysphagia patients require multidisciplinary collaboration. In addition, surgical therapy may be required.

Electronic primary care guidelines with links to Cochrane reviews--EBM Guidelines.

In Finland, guidelines have been used in primary care since the late 1980s to bridge the gap between research evidence and practice. From the very beginning, the electronic format has been the primary source for EBM Guidelines (EBMG). Although also published on CD and in print, the guidelines are currently mostly used via the Internet. Keeping more than 1000 guidelines up to date is a great challenge to the editorial group, and several methods are used to guarantee the quality. The Cochrane Library has become the most important source of information for the guideline producers and all Cochrane reviews relevant to GPs are summarized and linked to the guidelines. In this article we present our experience of producing the electronic guidelines for GPs, the methodology used, and data on the clinical use of these guidelines and their Cochrane links. We also discuss the barriers and facilitators to our process and present ideas for future development.

Primary care guidelines on consultation practices: the effectiveness of computerized versus paper-based versions. A cluster randomized controlled trial among newly qualified primary care physicians.

OBJECTIVE: To compare the effects of computerized and paper-based versions of guidelines on recently qualified physicians' consultation practices. METHODS: Two arm cluster randomized controlled trial. Physicians were randomized to receive computerized or textbook-based versions of the same guidelines for a 4-week study period. Physicians' compliance with guideline recommendations about laboratory, radiological, physical and other examinations, procedures, nonpharmacologic and pharmacologic treatments, physiotherapy, and referrals were measured by case note review. RESULTS: There were 139 recently qualified physicians working in 96 primary healthcare centers in Finland who participated in the study. Data on 4,633 patient encounters were abstracted, of which 3,484 were suitable for further analysis. Physicians' compliance with guidelines was high (over 80% for use of laboratory, radiology, physical examinations, and referrals). There were no significant differences in physicians' consultation practices in any of the measured outcomes between the computerized and textbook group. CONCLUSION: Guidelines are a useful source of information for recently qualified physicians working in primary care. However, the method of presentation of the guidelines (electronic or paper) does not have an effect on guideline use or their impact on decisions. Other factors should be considered when choosing the method of presentation of guidelines, such as information-seeking time, ease of use during the consultation, ability to update, production costs, and the physician's own preferences.