DÄ internationalArchive22-23/2016The Foundation in Evidence of Medical and Dental Telephone Consultations

Original article

The Foundation in Evidence of Medical and Dental Telephone Consultations

Dtsch Arztebl Int 2016; 113: 389-95. DOI: 10.3238/arztebl.2016.0389

Albrecht, M; Isenbeck, F; Kasper, J; Mühlhauser, I; Steckelberg, A

Background: Patients can only make well-informed decisions if the information they are given by health professionals is based on scientific evidence. In this study, we assessed the foundation in evidence of free, publicly available telephone consultations in Germany.

Methods: From March 2013 to January 2014, four hidden clients seeking information asked standardized questions about three medical topics (screening for colorectal cancer, for glaucoma, and for trisomy 21) and three dental ones (the sealing of dental fissures, professional dental cleaning, and mercury detoxification). Depending on the topic, the questions addressed such issues as the risk of disease and the purpose, content, validity, benefits, and risks of potential diagnostic and therapeutic measures. All identifiable telephone consultation services that provided counselling on the above topics were included in the study (23 government-sponsored institutions, 31 institutions independently run by physicians, 521 institutions under religious auspices, 25 dental counselling services).

Results: Of the 599 telephone consultation services that were identified, 567 were contacted; 404 did not offer any relevant counselling. A total of 293 conversations were held with the remaining 163 consultation services. Six of these conversations fully met predefined criteria for evidence-based counselling. The percentage of appropriate answers to the key questions on each topic was 5% for colorectal cancer screening (7/140), 23.8% for glaucoma screening (25/105), 33.9% for trisomy 21 screening (121/357), 27.5% for the sealing of dental fissures (28/102), 16.2% for professional dental cleaning (19/117), and 12.9% for mercury detoxification (12/93). The percentage of appropriate answers also varied depending on the type of institution: 26.8% for government-sponsored institutions (67/250), 4.5% for institutions independently run by physicians (4/88), and 31.1% for institutions under religious auspices (82/264).

Conclusion: The medical and dental counselling now offered over the telephone by the types of institutions included in this study does not satisfy the criteria for evidence-based health information.

LNSLNS

Patients in Germany want to receive detailed information and be involved in medical decision processes (1, 2). According to the German law on patients' rights they are entitled to evidence-based health information (3).

National and international working groups have defined criteria for evidence-based health information with the aim of enabling informed decision making (47). The same standards apply to telephone consultations (5). Information enabling the patient to evaluate the potential benefit and adverse effects of a diagnostic or therapeutic intervention is particularly relevant in this context.

The number of persons contacting the Independent Patient Counselling Service Germany (Unabhängige Patientenberatung Deutschland, UPD) is increasing year on year and reached around 80 500 consultations in 2015 (8). The proportion of telephone inquiries was around 80% (8). Telephone calls also represent the majority of inquiries to the Cancer Information Service (Krebsinformationsdienst, KID) of the German Cancer Research Center (82% of 32 774 contacts in 2010) (9). Clarimedis, the information service of the large statutory health insurance provider AOK, receives around half a million telephone calls each year (10).

There are many other sources of free counselling on health-related topics in Germany that can be contacted by telephone.

Previous analyses of these services by means of user surveys and the use of “hidden clients” have served primarily to ascertain demand and have focused mainly on the availability of the counsellors, the target groups reached, and the subjective satisfaction of those seeking advice (1114).

While doctor–patient communication and information materials for patients have been researched in depth, there are only isolated publications investigating to what extent the content and communication of health-related information provided to patients and consumers is founded on evidence (1517). Studies from the Max Planck Institute for Human Development in Berlin report considerable deficiencies in the advice given personally to patients. In a 1998 study on the quality of information given by Aids consultation services to clients at low risk of infection, half of the 20 advisors who were questioned falsely stated that a positive test result definitely indicated HIV infection even in the case of low risk (15). A recent study by the same investigators shows that the quality of information has not improved (17). Moreover, physicians' understanding of health statistics is poor (18, 19).

The consumer protection center of the city of Hamburg sent sham patients to a number of medical specialists and reported that deficient information was given in a high proportion of consultations (2022).

In contrast to these investigations of the personal advice given by physicians, we were unable to identify any studies on the foundation in evidence of telephone consultations.

We therefore set out to evaluate the quality of telephone consultations on selected health topics by means of inquiries by hidden clients. We investigated whether the information they were given fulfilled the criteria for evidence-based health information.

Methods

Study design

The study took the form of a telephone survey in which male and female hidden clients asked standardized questions.

Sample and setting

Our goal was to include as wide a spectrum as possible of the groups offering telephone consultation on medical and dental topics in Germany. To this end, we strove to identify, by means of internet searches, all telephone counselling services available to the general public free of charge (eBox 1).

Research strategies for identification of the organizations offering telephone consultation
eBox 1
Research strategies for identification of the organizations offering telephone consultation

The following were excluded from the outset:

  • Advice hotlines of medical or dental companies and organizations with commercial interests
  • Websites where written questions can be submitted to experts
  • Services offered by statutory health insurance providers, because these are generally open only to those insured by the respective provider
  • Second opinion hotlines on the subject of dental prostheses, because the standardized inquiries in our study all related to preventive measures

The contact details (telephone number, times available) of all eligible consultation services were documented.

The sample for medical topics embraced consultation services (n = 574) offered by the UPD, the KID, the medical associations (MA), the associations of statutory health insurance physicians (ASHIP), and denominational groups (Donum Vitae and the Diakonie [the social welfare organization of Germany’s Protestant churches]) (eFigure). For dental topics we included consultation services (n = 25) of the federal state dental associations (DA), the associations of statutory health insurance dentists (ASHIP), and the Dental Consumers' and Patients' Advisory Service of the Working Group on Dental Health (Zahnärztliche Verbraucher- und Patientenberatung der Arbeitsgemeinschaft Zahngesundheit).

Flow chart of consultations
eFigure 1
Flow chart of consultations

Following initial contact and determination of the principal topics covered by each telephone service, denominational facilities that confined themselves to counselling on pregnancy options or offered only face-to-face consultation were excluded (n = 404) (eFigure).

Topics

Topics were selected for which evidence was available and which were of wide interest or had been the subject of recent media coverage. We aimed to include a wide range of consultation facilities. The chosen topics included both interventions covered by the statutory health insurance providers and services for which the clients would have to pay out of their own pocket.

The medical topics were bowel cancer screening with colonoscopy, glaucoma screening with measurement of internal ocular pressure, and screening for trisomy 21 with amniocentesis. The dental topics were fissure sealing, professional cleaning, and mercury detoxification.

The content of the inquiries varied depending on the topic. For the medical consultations the following aspects were included: risk of illness, test quality, benefit and harm, underlying evidence, and further sources of information. For dental topics, the areas addressed were: aim of intervention, elements and course of intervention, benefits and adverse effects, and further sources of information.

Development of standardized inquiries and survey instruments

Regarding the content of the inquiries, three or four so-called central queries were formulated. The correct answers were determined using the methods of evidence-based medicine (for details see eBox 2). Next, standards for counselling were drawn up according to the criteria for evidence-based health information (4). Each standard response contained the required information (23) presented in such a way as to be readily understandable to the lay person (4, 5). For risk of illness and other numerical data, we defined ranges within which the answers should lie (Table). All responses outside these ranges were defined as under- or overestimates.

Methods used to establish the underlying evidence regarding the inquiries
eBox 2
Methods used to establish the underlying evidence regarding the inquiries

Pilot phase and training

In a pilot phase, two of us (M.A. and F.I.) tested the standardized inquiries and documentation forms by making telephone calls to experts (qualified dental assistants n = 5, dentists n = 2, midwives n = 2, ophthalmologist n = 1, primary care physician n = 1, gastroenterologist n = 1) under realistic conditions. The aim was to ensure that the inquiries were expressed in a natural-sounding way and in lay language. In an iterative process, they were revised until information saturation was achieved. Supplementary questions were asked to make the conversation appear authentic, but these were not included in later analysis.

The hidden clients were students of health sciences (age 24–35 years) who were learning to become teachers at vocational schools. A female bachelor's student, two female master's students, and a male with a master's degree were trained individually for all inquiries. Their training comprised an introduction to the standardized inquiries, pseudonymization, and documentation of the consultations. The telephone conversations were then practiced in the form of role-play under realistic conditions.

Data acquisition

For the medical topics, we set out to put the three inquiries to at least two counsellors at each local branch of each consultation service. The only exceptions were the KID (bowel cancer screening only) and the denominational organizations (trisomy 21 only).

For the dental topics, our aim was to pose all three inquiries to all (at least two) of the counsellors at every branch of each consultation service. Each part of the survey was ended at the conclusion of the predefined period (dental topics: March to June 2013; medical topics: July 2013 to January 2014).

The hidden client's telephone number was always withheld. The conversation began with the reason for calling. In cases where the caller's age or sex did not match the topic, the explanation was that the inquiry was being made on behalf of someone else, e.g., a female relative. After asking whether the counsellor could give information as a doctor, the hidden client followed up with the central queries (see Box 1 for an example) and supplementary questions, some of which were predefined. The central queries are reproduced in eBox 3. Finally, the hidden client requested information material about the content of the consultation and asked about further sources of information or the addresses of relevant institutions.

Example of a central query: prevalence of bowel cancer
Box 1
Example of a central query: prevalence of bowel cancer
Standardized inquiries
eBox 3
Standardized inquiries

During and immediately after the conversation, the hidden client noted on the documentation form the information given. Audio recording was prohibited because it would have contravened the German law on data protection. To avoid duplication, the pseudonymization codes contained information on the organization and on the individual counsellor consulted. Because the consultation services are partly staffed by non-medical personnel who are neither qualified nor authorized to dispense medical advice, e.g., lawyers, it was decided in advance that conversations with such counsellors could be terminated prematurely and not be included in later analysis.

Outcome parameters

The primary outcome parameter was evidence-based counselling. A consultation was considered to be founded on evidence if the information regarding all central queries (three or four per topic) was correct and understandable for lay persons (consultation standards). The secondary outcome parameters were adequate answers to the individual central queries and information on further sources.

Answers to the central queries were coded as adequate if they were both correct (i.e., reflected the current state of knowledge) and intelligible to lay persons. Answers about test quality were coded as correct when one criterion of test quality (sensitivity, specificity, positive predictive value, negative predictive value) was communicated with a correct numerical value. By intelligible to lay persons, we mean expression of numerical data as percentages or X out of Y (e.g., 1 out of every 100 people). An example of coding is given in eBox 4.

Examples of coding
eBox 4
Examples of coding

A consultation was classified as being founded on evidence if all central queries were answered adequately according to the consultation standard.

Analysis

Two of us (M.A. and A.S.) analyzed the documented contents of the consultations separately in a blinded fashion. Codes were assigned according to the defined consultation standards and coding discrepancies were resolved by discussion.

To ensure anonymity of the consultation services, those providing information on medical topics were grouped into publicly funded organizations (UPD, KID), services offered autonomously by physicians (MA, ASHIP), and denominational organizations (Donum Vitae, Diakonie). The organizations supplying counselling on dental topics were not divided into subgroups.

For the primary outcome parameter, the results are presented as frequency of evidence-based consultations. For the secondary outcome parameters, the results are expressed as proportions of adequate answers in relation to the individual topics and the provider groups. The statistical software PASW version 22 was used for all calculations.

Ethics and data protection

The study protocol was presented to the data protection authority responsible for all universities and colleges in Hamburg and to the ethics committee of the Hamburg Medical Association. The data protection officer approved the study. Audio recordings of the consultations were prohibited by the German law on data protection. To protect the anonymity of the individual counsellors, the results of individual consultation services cannot be presented. In order to avoid distortion of the results, the consultation services were not informed of our study in advance.

The ethics committee stated that its approval was not required because the study contained no scientific research on humans.

Results

The survey of medical telephone consultations took place between July 2013 and January 2014. Contact was established with 542 of the 574 identified local branches of the consultation services, and of these 542, 138 were included. Altogether, 189 of 211 documented consultations were analyzed. The remaining 22 conversations were ended prematurely after the counsellors stated they were unable to give medical information.

In the dental survey, from March to June 2013, all 25 identified branches of the consultation services were contacted. Altogether, 104 consultations were included in the analysis. Five consultations were excluded because the counsellors could not provide information on dental topics (eFigure). The qualifications of all counsellors are summarized in eTable 1.

Rate of adequate answers and correct content per central query
Table 1
Rate of adequate answers and correct content per central query
The counsellors' qualifications
eTable 1
The counsellors' qualifications

Primary outcome parameter

Six of the 189 completed consultations on medical topics and none of the 104 consultations on dental concerns fulfilled the defined standard for foundation in evidence. Five of the six evidence-based consultations were with counsellors from publicly funded organizations on the topics of glaucoma screening (n = 4) and trisomy 21 screening (n = 1). The sixth evidence-based consultation was with a denominational organization on the subject of trisomy 21 screening.

Secondary outcome parameters

The rate of adequate answers to the central queries was 5% (7 of 140) for bowel cancer screening, 23.8% (25 of 105) for glaucoma screening, 33.9% (121 of 357) for trisomy 21 screening, 27.5% (28 of 102) for fissure sealing, 16.2% (19 of 117) for professional dental cleaning, and 12.9% (12 of 93) for mercury detoxification.

The rate of adequate answers to the central queries on medical topics was 26.8% (67 of 250) for publicly funded organizations, 31.1% (82 of 264) for denominational organizations, and 4.5% (4 of 88) for services offered autonomously by physicians.

The Table gives an overview of the adequately and correctly answered central queries on all six topics. The incidence of under- or overestimation and the frequency of false or missing responses are shown in eTable 2.

Frequency of under- and overestimation
eTable 2
Frequency of under- and overestimation

The answers to the question “Where does this information come from?” revealed a broad spectrum of sources. These included, among others, personal experience or opinion, the internet, patient information leaflets, specialist media, training courses, and scientific studies/investigations. The numbers of counsellors who provided inaccurate information despite claiming scientific findings were 15 of 31 (professional dental cleaning), 2 of 5 (mercury detoxification), 10 of 23 (bowel cancer screening), 2 of 14 (glaucoma screening) und 5 of 46 (amniocentesis).

Information sources

In 278 of the 293 telephone consultations analyzed, when prompted the counsellor provided details of persons, institutions, or other sources where further information on the topic in question could be obtained (eTable 3).

Stated sources of further information in 278 telephone consultations
eTable 3
Stated sources of further information in 278 telephone consultations

Discussion

The telephone consultations on medical and dental topics provided by the organizations we included in this study do not currently meet the criteria for evidence-based health information. With regard to both content and presentation, the findings of recent research are largely ignored.

Strengths and limitations

For the test inquiries we selected topics for which evaluated evidence-based health information (24, 25) and other sources of syntheses of evidence (2630) were freely accessible. All counsellors therefore had access to these data or could call the client back to complete the consultation.

The inclusion of a large and representative number of local branches of the telephone consultation services we covered means that our results have high validity for these organizations.

Although a telephone consultation differs from other ways of furnishing information, it is subject to the same criteria for evidence-based risk communication (5).

Health insurance providers could not be included among the organizations covered, because their consultation services are open only to their members. For some of the organizations we were unable to complete the planned number of consultations. Moreover, no valid comparison of individual organizations is possible. On the one hand, the content and scope of the inquiries were not directly comparable; on the other, the impact of the respective organizations' internal arrangements could not be quantified.

The conversations could not be recorded without contravening the German law on data protection. However, the pilot phase showed that our documentation procedure entailed no relevant loss of information. Nevertheless, from the point of view of ethics it needs to be discussed how future investigations of this nature can protect workers' rights but also prevent patients from receiving substandard counselling.

The significance of the results

This study complements and supports the findings of previous research into the quality of personal consultations on Aids and mammography, which has revealed grave deficiencies (15, 17, 31) despite the existence of defined obligations and clear concepts. For instance, the professional bodies representing dentists in Germany have defined principles to be observed in dental consultations (32). These target both the expertise of the counsellors, who should be in a position to provide a “consultation commensurate with the latest findings in dental science,” (first principle) and the intelligibility of the information for the patient (eighth principle).

However, differing findings regarding the UPD were presented in a recently published evaluation report. In each of the four phases of the survey one or two scenarios were employed for the test topic medicine and health. The rates of correct answers in the four phases were 90%, 76%, 59%, and 78% (12). To what extent the queries were geared towards evidence-based information—and thus yielded results comparable with our findings—is unclear.

Implications for practice

The results point to room for improvement in the provision of medical and dental telephone consultations. The counsellors seem not to be taking specific advantage of the evidence-based information and data syntheses that are available and do not always possess the expertise required. The methods of evidence-based medicine, including the compilation and use of health data, must be systematically integrated into the counsellors' training plans.

In Germany, the German Evidence-Based Medicine Network (Deutsches Netzwerk Evidenzbasierte Medizin) has recently published a revised and extended version of its “Good Practice Guidelines for Health Information” (5). This document explicitly demands transparency of the procedures for compilation and communication of health information. Providers of telephone consultation services for patients should fulfill these criteria.

Conflict of interest statement
Mrs Albrecht, Dr. Steckelberg, Prof. Mühlhauser, and Prof. Kasper have, in the course of their work on evidence-based medicine and evidence-based health information, carried out a number of research projects in cooperation with statutory health insurance providers, communal organizations, and public sponsors. The funds provided went to the university. In connection with these studies honoraria were paid and/or travel costs were reimbursed.

In connection with private activity for his institute for communication, Prof. Kasper has received honoraria from public funds for designing training in evidence-based counselling to patients and for scientific services.

Mr. Isenbeck declares that no conflict of interest exists.

Translated from the original German by David Roseveare

Manuscript submitted on 15 July 2015, revised version accepted on
9 February 2016

Corresponding author
Martina Albrecht
MIN-Fakultät, Gesundheitswissenschaften
Universität Hamburg
Martin-Luther-King-Platz 6
20146 Hamburg, Germany
martina.albrecht@uni-hamburg.de

@Supplementary material
For eReferences please refer to:
www.aerzteblatt-international.de/ref2216

eTables, eBoxes:
www.aerzteblatt-international.de/16m0389

1.
Hamann J, Neuner B, Kasper J, et al.: Participation preferences of patients with acute and chronic conditions. Health Expect 2007; 10: 358–63 CrossRef MEDLINE
2.
Braun B, Marstedt G: Partizipative Entscheidungsfindung beim Arzt: Anspruch und Wirklichkeit. In: Böcken J, Braun B, Meierjürgen R (eds.): Gesundheitsmonitor 2014. Bürgerorientierung im Gesundheitswesen. Gütersloh: Verlag Bertelsmann Stiftung 2014; 107–31.
3.
Gesetz zur Verbesserung der Rechte von Patientinnen und Patienten, vom 20. Februar 2013. In: Bundesgesetzblatt (BGBl.) 2013; 277.
4.
Bunge M, Mühlhauser I, Steckelberg A: What constitutes evidence-based patient information? Overview of discussed criteria. Pat Educ Couns 2010; 78: 316–28 CrossRef MEDLINE
5.
Deutsches Netzwerk Evidenzbasierte Medizin e. V., Arbeitsgruppe Gute Praxis Gesundheitsinformation: Gute Praxis Gesundheitsinformation. Z Evid Fortbild Qual Gesundhwes 2016; 110: 85–92.
6.
Trevena LJ, Davey HM, Barratt A, Butow P, Caldwell P: A systematic review on communicating with patients about evidence. J Eval Clin Pract 2006; 12: 13–23 CrossRef MEDLINE
7.
International Patient Decision Aids Standards (IPDAS) Collaboration. http://ipdas.ohri.ca/ (last accessed on 28 January 2016).
8.
Unabhängige Patientenberatung Deutschland: Monitor Patientenberatung 2015. http://www.patientenbeauftragter.de/images/pdf/Monitor_Patientenberatung_2015bf.pdf (last accessed on 28 January 2016).
9.
Krebsinformationsdienst: Nutzerstatistik 01.01.2010–31.12.2010. www.krebsinformationsdienst.de/aufbewahrung/statistik-2010.pdf (last accessed on 28 January 2016).
10.
AOK-Clarimedis: Nutzerzahlen. www.aok.de/niedersachsen/gesundheit/behandlung-aok-clarimedis-frage-der-woche-210871.php (last accessed on 26 January 2016).
11.
Niekusch U, Wagner C, Klett M: Unabhängige zahnärztliche Patientenberatung – Erfahrungen aus der Beratungsstelle für den Rhein-Neckar-Kreis. Gesundheitswesen 2006; 68: 18–25 CrossRef MEDLINE
12.
IGES Institut GmbH (ed.)/Deckenbach B, Rellecke J, Stöppler C:
Externe Evaluation der neutralen und unabhängigen Verbraucher- und Patientenberatung nach § 65b SGB V. www.gkv-spitzenverband.de/media/dokumente/krankenversicherung_1/praevention__ selbsthilfe__ beratung/beratung/Evaluation_der_NUVP_Abschlussbericht_IGES_ 10–2015.pdf (last accessed on 28
January 2016).
13.
Dierks ML, Haverkamp A, Hofmann W, Kurtz V, Seidel G: Evaluation der Modellprojekte zur unabhängigen Patienten- und Verbraucherberatung nach §65b SGB V. Hannover: Medizinische Hochschule Hannover 2006.
14.
Kurtz V: Qualität telefonischer Patientenberatung zu präventiven Gesundheitsthemen. Ergebnisse einer Hidden Client-Untersuchung (Masterarbeit). München: GRIN-Verlag 2006.
15.
Gigerenzer G, Hoffrage U, Ebert A: AIDS counselling for low-risk clients. AIDS Care 1998; 10: 197–211 CrossRef MEDLINE
16.
Bryant AG, Levi EE: Abortion misinformation from crisis pregnancy centers in North Carolina. Contraception 2012; 86: 752–6 CrossRef MEDLINE
17.
Prinz R, Feufel MA, Gigerenzer G, Wegwarth O: What counselors tell low-risk clients about HIV test performance. Curr HIV Res 2015; 13: 369–80 CrossRef
18.
Wegwarth O, Gigerenzer G: Mangelnde Statistikkompetenz bei Ärzten. In: Gigerenzer G, Muir Gray JA (eds.): Bessere Ärzte, bessere Patienten, bessere Medizin: Aufbruch in ein transparentes Gesundheitswesen (Strüngmann Forum Reports). Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft 2013; 137–51.
19.
Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G: Do physicians understand cancer screening statistics? A national survey of primary care physicians. Ann Int Med 2012; 156: 340–9 CrossRef MEDLINE
20.
Verbraucherzentrale Hamburg: „Sie haben eine sehr schöne Brust. Da kann man alles machen.“ www.vzhh.de/gesundheit/96503/ 2010–11–15_Schoenheitsprojekt.pdf (last accessed on 28 January 2016).
21.
Verbraucherzentrale Hamburg: Beratung bei Hamburger Orthopäden: Note 3,9. www.vzhh.de/gesundheit/335196/Orthop%C3%A4dentest_ vzhh_2014.pdf (last accessed on 28 January 2016).
22.
Verbraucherzentrale Hamburg: „Wenn Sie diese Zahnlücke nicht behandeln lassen, fallen Ihnen bald alle Zähne aus!“ www.vzhh.de/gesundheit/293166/2013-01-17_-Zahn%C3%A4rztetest.pdf (last accessed on 28 January 2016).
23.
General Medical Council: Consent: patients and doctors making decisions together. www.gmc-uk.org/static/documents/content/Consent_-_English_1015.pdf (last accessed on 28 January 2016).
24.
Steckelberg A, Hülfenhaus C, Haastert B, Mühlhauser I: Effect of evidence-based risk information on „informed choice“ in colorectal cancer screening: a randomised controlled trial. BMJ 2011; 342: d3193.
25.
Steckelberg A , Mühlhauser I: Darmkrebs Früherkennung.
www.gesundheit.uni-hamburg.de/upload/Barmer_Darmkrebsbroschuere.pdf (last accessed on 8 April 2016).
26.
IGeL-Monitor: Professionelle Zahnreinigung. www.igel-monitor.de/IGeL_A_Z.php?action=abstract&id=74 (last accessed on 28 January 2016).
27.
IGeL-Monitor: Messung des Augeninnendrucks zur Glaukom-Früherkennung. www.igel-monitor.de/pdf_bewertungen/Messung%20 des%20Augeninnendrucks_Evidenzsynthese.pdf (last accessed on 28 January 2016).
28.
Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde: S3-Leitlinie Fissuren- und Grübchenversiegelung. 2010.
www.awmf.org/uploads/tx_szleitlinien/083–002l_S3_Fissuren-Gruebchenversiegelung-2010-abgelaufen.pdf (last accessed on 28 January 2016).
29.
Bundesinstitut für Qualität im Gesundheitswesen: Professionelle Zahnhygiene. Quick Assessment. www.goeg.at/cxdata/media/download/berichte/Professionelle_Dentalhygiene.pdf (last accessed on 28 January 2016).
30.
Alfirevic Z, Mujezinovic F, Sundberg K: Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev 2003; 3: CD003252.
31.
Wegwarth O, Gigerenzer G: „There is nothing to worry about“: Gynecologists’ counseling on mammography. Pat Educ Couns 2011; 84: 251–56 CrossRef MEDLINE
32.
Bundeszahnärztekammer/Kassenzahnärztliche Bundesvereinigung: Patienten im Mittelpunkt: Die Patientenberatung der Zahnärzteschaft in Deutschland. www.bzaek.de/fileadmin/PDFs/pati/patientenberatung_zahnaerzte.pdf (last accessed on 28 January 2016).
e1.
Scottish Intercollegiate Guidelines Network (SIGN) (2015): Critical appraisal: Notes and checklists. www.sign.ac.uk/methodology/checklists.html (last accessed on 28 January 2016).
e2.
Higgins JPT, Altman DG, Sterne JAC: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds.): Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011; www. cochrane-handbook.org (last accessed on 28 January 2016).
e3.
Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V.: Beiträge zur Gesundheitsberichterstattung des Bundes: Krebs in Deutschland 2007/2008. 2012.
www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/KID2012.pdf (last accessed on 7 July 2015).
e4.
Pickhardt PJ, Hassan C, Halligan S, Marmo R: Colorectal cancer: CT colonography and colonoscopy for detection: systematic review and meta-analysis. Radiology 2011; 259: 393–405 CrossRef MEDLINE PubMed Central
e5.
Ludwig Boltzmann Institut: Screening for colorectal cancer, part 1: screening tests and program design. HTA 41a 2012. http://eprints.hta.lbg.ac.at/981/1/HTA-Projektbericht_Nr.41a_Update_2012.pdf (last accessed on 7 July 2015).
e6.
Bretthauer M: Colorectal cancer screening. J Intern Med 2011; 270: 87–98.
e7.
Crispin A, Birkner B, Munte A: Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy 2009; 41: 1018–25 CrossRef MEDLINE
e8.
Warren JL, Klabunde CN, Mariotto AB, et al.: Adverse events after outpatient colonoscopy in the medicare population. Ann Intern Med 2009; 150: 849–57 CrossRef MEDLINE
e9.
Burr JM, Mowatt G, Hernandez R: The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. 2007. www.hta.ac.uk/fullmono/mon1141.pdf ( last accessed on 22 February 2013).
e10.
Ervin AM, Boland MV, Myrowitz EH, et al.: Screening for glaucoma: comparitive effec-tiveness review 59. 2012. www.effectivehealthcare.ahrq.gov/ehc/products/182/1026/CER59_Glaucoma-Screening_Final-Report_20120524.pdf (last accessed on 22 April 2015).
e11.
Fleming C, Whitlock E, Beil T, et al.: Primary care screening for ocular hypertension and primary open-angel glaucoma: evidence syntheses 34. 2005. www.ncbi.nlm.nih.gov/books/NBK42905/ (last accessed on 22 April 2015).
e12.
Hatt SR, Wormald R, Burr J: Screening for prevention of optic nerve damage due to chronic open angle glaucoma. Cochrane Database Syst Rev 2006; 4: CD006129.
e13.
Moyer V: Screening for glaucoma, U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159; 484–9.
e14.
Bray I, Wright DE, Davies C, Hook EB: Joint estimation of down syndrome risk and ascertain-ment rates: a meta-analysis of nine published data-sets. Prenat Diagn 1998; 18: 9–20 CrossRef CrossRef
e15.
Morris JK, Mutton DE, Alberman E: Revised estimates of the maternal age specific live birth prevalence of Down´s syndrome. J Med Screen 2002; 9: 2–6 CrossRef
e16.
Snijders RJM, Holzgreve W, Chuckle H, Nicolaides KH: Maternal age-specific risks for trisomies at 9–14 weeks gestation. Prenat Diagn 1994; 14: 543–52 CrossRef
e17.
Loft A, Tabor A: Discordance between prenatal cytogenetic diagnosis and outcome of pregnancy. Prenat Diagnosis 1984; 4: 51–9 CrossRef
e18.
Tabor A, Philip J, Madsen M: Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287–93.
e19.
Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, et al.: Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev 2013; 3: CD001830.
e20.
Bravo M, Montero J, Bravo JJ, Baca P, Llodra JC: Sealant and fluoride varnish in caries: a randomized trial. J Dent Res 2005; 84: 1138–43 CrossRef
e21.
Albani F, Ballesio I, Campanella V, Marzo V, Marzo G: Pit and fissure sealants: results at five and ten years. Eur J Paediatr Dent 2005; 6: 61–5.
e22.
Eidelman E, Fuks AB, Chosack A: The retention of fissure sealants: rubber dam or cotton rolls in a private practice. ASDC J Dent Child 1983; 50: 259–61.
e23.
Ganss C, Klimek J, Gleim A: One year clinical evaluation of the retention and quality of two fluoride releasing sealants. Clin Oral Investig 1999; 4: 188–93.
e24.
Griffin SO, Oong E, Kohn W, et al.: The effectiveness of sealants in managing caries lesions. J Dent Res 2008; 87: 169–74 CrossRef MEDLINE
e25.
Lygidakis NA, Oulis KI, Christodoulidis A: Evaluation of fissure sealants retention following four different isolation and surface preparation techniques: four years clinical trial. J Clin Pediatr Dent 1994; 19: 23–5.
e26.
McConnachie I: The preventive resin restoration: A
conservative alternative. J Can Dent Assoc 1992; 58:
197–200.
e27.
Straffon LH, Dennison JB, More FG: Three-year evaluation of sealant: effect of isolation on efficacy. J Am Dent Assoc 1985; 110: 714–7 CrossRef
e28.
Wood AJ, Saravia ME, Farrington FH: Cotton roll isolation versus Vac-Ejector isolation. ASDC J Dent Child 1989; 56: 438–41.
e29.
Wright GZ, Friedman CS, Plotzke O, Feasby WH: A comparison between autopolymerizing and visible-light-activated sealants. Clin Prev Dent 1988; 10: 14–7.
e30.
Worthington HV, Clarkson JE, Bryan G, Beirne PV: Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2013; 11: CD004625.
e31.
Needleman I, Suvan J, Moles DR, Pimlott J: A systematic review of professional mechanical plaque removal for prevention of
periodontal diseases. J Clin Periodontol 2005; 32 (Suppl 6): 229–82 CrossRef MEDLINE
e32.
Bernhoft RA: Mercury toxicity and treatment: a review of the literature. J Environ Public Health 2012; Article ID 460508; doi: 10.1155/2012/460508 CrossRef
e33.
Adams JB, Baral M, Geis E, et al.: Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A—medical results. BMC Clin Pharmacol 2009; 9: 16 CrossRef CrossRef
e34.
Cao Y, Chen A, Jones RL, et al.: Efficacy of succimer chelation of mercury at background exposures in toddlers: a randomized trial. J Pediatr 2011; 158: 480–5.e1.
e35.
Grandjean P, Guldager B, Larsen IB, Jørgensen PJ, Holmstrup P: Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings. J Occup Environ Med 1997; 39: 707–14 CrossRef MEDLINE
e36.
Sandborgh Englund G, Dahlqvist R, Lindelöf B, et al.: DMSA administration to patients with alleged mercury poisoning from dental amalgams: a placebo-controlled study. J Dent Res 1994; 73: 620–8.
e37.
Schuurs A, Exterkate R, ten Cate JM: Biological mercury measurements before and after administration of a chelator (DMPS) and subjective symptoms allegedly due to amalgam. Eur J Oral Sci. 2000; 108: 511–22 CrossRef
e38.
Kaminski MF, Bretthauer M, Zauber AG, et al.: The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 2012; 44: 695–702 CrossRef MEDLINE
e39.
Day LW, Kwon A, Inadomi JM: Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74: 885–96 CrossRef MEDLINE PubMed Central
e40.
Pox CP, Altenhofen L, Brenner H, Theilmeier A, von Stillfried D, Schmiegel W: Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012; 142: 1460–7 CrossRef MEDLINE
e41.
Schmiegel W, Pox C, Reinacher-Schick A, et al. S3-Leitlinie kolorektales Karzinom 2004/2008. Zeitschrift für Gastroenterologie 2008; 46: 1–73 CrossRef MEDLINE
e42.
Sillars-Hardebol AH, Carvalho B, van Engeland M, Fijneman RJ, Meijer GA: The adenoma hunt in colorectal cancer screening: defining the target. J Pathol 2012; 226: 1–6 CrossRef MEDLINE
e43.
Whitlock EP, Lin J, Liles E, et al.: Screening for colorectal cancer: an updated systematic review, evidence syntheses 65.1. 3, key questions & results. 2008. www.ncbi.nlm.nih.gov/books/NBK35186/ (last accessed on 7 July 2015).
e44.
Antony K, Genser D, Fröschl B: Erkenntnisgüte und Kosteneffektivität von Screeningverfahren zur Erfassung von primären Offenwinkel-Glaukomen. DIMDI-HTA 50 2007. http://portal.dimdi.de/de/hta/hta_berichte/hta144_bericht_de.pdf (last accessed on 8 July 2015).
e45.
Bahrami H. Causal inference in primary open angle glaucoma: specific discussion on intra-ocular pressure. Ophthalmic Epidemiol 2006; 13: 283–9 CrossRef CrossRef MEDLINE
e46.
Berufsverband der Augenärzte Deutschlands e. V., Deutsche Ophthalmologische Gesellschaft e.V.: Leitlinie Nr. 15 c: Detektion des primären Offenwinkelglaukoms (POWG): Glaukom-Screening von Risikogruppen, Glaukomverdacht, Glaukomdiagnose. 2006. www.augeninfo.de/leit/leit15c.pdf (last accessed on 28 April 2015).
e47.
Burr JM, Botello-Pinzon P, Takwoingi Y: Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. 2012. www.ncbi.nlm.nih.gov/books/NBK100061/pdf/TOC.pdf (last accessed on 22 February 2013).
e48.
Claessen H, Genz J, Bertram B: Evidence for a considerable decrease in total and cause-specific incidences of blindness in Germany. Eur Journal Epidemiol 2012; 27: 519–24 CrossRef MEDLINE
e49.
Foster PJ, Buhrmann R, Quigley HA, et al.: The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002; 86: 238–42 CrossRef MEDLINE PubMed Central
e50.
National Institute for Health and Clinical Excellence: Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension. 2009. www.nice.org.uk/nicemedia/live/12145/43887/43887.pdf (last accessed on 22 April 2015).
e51.
Quigely HA: Glaucoma. Lancet 2011; 377: 1367–77 CrossRef
e52.
Vass C, Hirn C, Sycha T, et al.: Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev 2007; 4: CD003167.
e53.
Wolfram C, Pfeiffer N: Glaukomerkrankungen in Rheinland-Pfalz 2010: Epidemiologie und Inanspruchnahme der Versorgung. Ophthalmologe 2012; 109: 271–6 CrossRef MEDLINE
e54.
European Surveillance of Congenital Anomalies: EUROCAT-Prävalenz, -Daten ,-Tabellen: Trisomie-21, Lebendgeburtenrate. 2010. www.eurocat-network.eu/accessprevalencedata/prevalencetables (last accessed on 8 April 2016).
e55.
Loane M, Morris JK, Addor MC, et al.: Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening. Eur J Hum Genet 2013; 21: 27–33 CrossRef MEDLINE PubMed Central
e56.
Los FJ, van Den Berg C, Wildschut HI, et al: The diagnostic performance of cytogenetic investigation in amniotic fluid cells and chorionic villi. Prenat Diagn 2001; 21: 1150–8 CrossRef MEDLINE
e57.
Morris JK, Alberman E: Trends in Down´s syndrome live births and antenatal diagnoses in England and Wales from 1989 to 2008: analysis of data from the National Down Syndrome Cytogenetic Register. BMJ 2009; 339: b3794 CrossRef MEDLINE PubMed Central
e58.
Tabor A, Alfirevic Z: Update on procedure-related risks for prenatal diagnosis techniques. Fetal Diagn Ther 2010; 27: 1–7 CrossRef MEDLINE
e59.
Waters JJ, Waters KS: Trends in cytogenetic prenatal diagnosis in the UK: results from UKNEQAS external audit 1987–1998. Prenat Diagn 1999; 19: 1023–6 CrossRef CrossRef
e60.
Brothwell DJ, Jutai DK, Hawkins RJ: An update of mechanical oral hygiene practices: evidence-based recommendations for disease prevention. J Can Dent Assoc 1998; 64: 295–306 MEDLINE
Faculty of Mathematics, Informatics, and Natural Sciences, Health Sciences and Education, University of Hamburg: Albrecht, Isenbeck, Prof. Kasper, Prof. Mühlhauser, Dr. Steckelberg
Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, Norway:
Prof. Kasper
Acknowledgments
The authors thank Birgit Müller, Raphaela Wiedemann, Anna Geiling, and Anto Cetina (M. Ed.) for their help with acquisition of data in the context of telephone consultations.
Example of a central query: prevalence of bowel cancer
Box 1
Example of a central query: prevalence of bowel cancer
Key messages
Rate of adequate answers and correct content per central query
Table 1
Rate of adequate answers and correct content per central query
Research strategies for identification of the organizations offering telephone consultation
eBox 1
Research strategies for identification of the organizations offering telephone consultation
Methods used to establish the underlying evidence regarding the inquiries
eBox 2
Methods used to establish the underlying evidence regarding the inquiries
Standardized inquiries
eBox 3
Standardized inquiries
Examples of coding
eBox 4
Examples of coding
Flow chart of consultations
eFigure 1
Flow chart of consultations
The counsellors' qualifications
eTable 1
The counsellors' qualifications
Frequency of under- and overestimation
eTable 2
Frequency of under- and overestimation
Stated sources of further information in 278 telephone consultations
eTable 3
Stated sources of further information in 278 telephone consultations
1.Hamann J, Neuner B, Kasper J, et al.: Participation preferences of patients with acute and chronic conditions. Health Expect 2007; 10: 358–63 CrossRef MEDLINE
2. Braun B, Marstedt G: Partizipative Entscheidungsfindung beim Arzt: Anspruch und Wirklichkeit. In: Böcken J, Braun B, Meierjürgen R (eds.): Gesundheitsmonitor 2014. Bürgerorientierung im Gesundheitswesen. Gütersloh: Verlag Bertelsmann Stiftung 2014; 107–31.
3. Gesetz zur Verbesserung der Rechte von Patientinnen und Patienten, vom 20. Februar 2013. In: Bundesgesetzblatt (BGBl.) 2013; 277.
4.Bunge M, Mühlhauser I, Steckelberg A: What constitutes evidence-based patient information? Overview of discussed criteria. Pat Educ Couns 2010; 78: 316–28 CrossRef MEDLINE
5.Deutsches Netzwerk Evidenzbasierte Medizin e. V., Arbeitsgruppe Gute Praxis Gesundheitsinformation: Gute Praxis Gesundheitsinformation. Z Evid Fortbild Qual Gesundhwes 2016; 110: 85–92.
6.Trevena LJ, Davey HM, Barratt A, Butow P, Caldwell P: A systematic review on communicating with patients about evidence. J Eval Clin Pract 2006; 12: 13–23 CrossRef MEDLINE
7.International Patient Decision Aids Standards (IPDAS) Collaboration. http://ipdas.ohri.ca/ (last accessed on 28 January 2016).
8. Unabhängige Patientenberatung Deutschland: Monitor Patientenberatung 2015. http://www.patientenbeauftragter.de/images/pdf/Monitor_Patientenberatung_2015bf.pdf (last accessed on 28 January 2016).
9. Krebsinformationsdienst: Nutzerstatistik 01.01.2010–31.12.2010. www.krebsinformationsdienst.de/aufbewahrung/statistik-2010.pdf (last accessed on 28 January 2016).
10.AOK-Clarimedis: Nutzerzahlen. www.aok.de/niedersachsen/gesundheit/behandlung-aok-clarimedis-frage-der-woche-210871.php (last accessed on 26 January 2016).
11. Niekusch U, Wagner C, Klett M: Unabhängige zahnärztliche Patientenberatung – Erfahrungen aus der Beratungsstelle für den Rhein-Neckar-Kreis. Gesundheitswesen 2006; 68: 18–25 CrossRef MEDLINE
12. IGES Institut GmbH (ed.)/Deckenbach B, Rellecke J, Stöppler C:
Externe Evaluation der neutralen und unabhängigen Verbraucher- und Patientenberatung nach § 65b SGB V. www.gkv-spitzenverband.de/media/dokumente/krankenversicherung_1/praevention__ selbsthilfe__ beratung/beratung/Evaluation_der_NUVP_Abschlussbericht_IGES_ 10–2015.pdf (last accessed on 28
January 2016).
13. Dierks ML, Haverkamp A, Hofmann W, Kurtz V, Seidel G: Evaluation der Modellprojekte zur unabhängigen Patienten- und Verbraucherberatung nach §65b SGB V. Hannover: Medizinische Hochschule Hannover 2006.
14. Kurtz V: Qualität telefonischer Patientenberatung zu präventiven Gesundheitsthemen. Ergebnisse einer Hidden Client-Untersuchung (Masterarbeit). München: GRIN-Verlag 2006.
15. Gigerenzer G, Hoffrage U, Ebert A: AIDS counselling for low-risk clients. AIDS Care 1998; 10: 197–211 CrossRef MEDLINE
16. Bryant AG, Levi EE: Abortion misinformation from crisis pregnancy centers in North Carolina. Contraception 2012; 86: 752–6 CrossRef MEDLINE
17. Prinz R, Feufel MA, Gigerenzer G, Wegwarth O: What counselors tell low-risk clients about HIV test performance. Curr HIV Res 2015; 13: 369–80 CrossRef
18.Wegwarth O, Gigerenzer G: Mangelnde Statistikkompetenz bei Ärzten. In: Gigerenzer G, Muir Gray JA (eds.): Bessere Ärzte, bessere Patienten, bessere Medizin: Aufbruch in ein transparentes Gesundheitswesen (Strüngmann Forum Reports). Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft 2013; 137–51.
19. Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G: Do physicians understand cancer screening statistics? A national survey of primary care physicians. Ann Int Med 2012; 156: 340–9 CrossRef MEDLINE
20.Verbraucherzentrale Hamburg: „Sie haben eine sehr schöne Brust. Da kann man alles machen.“ www.vzhh.de/gesundheit/96503/ 2010–11–15_Schoenheitsprojekt.pdf (last accessed on 28 January 2016).
21.Verbraucherzentrale Hamburg: Beratung bei Hamburger Orthopäden: Note 3,9. www.vzhh.de/gesundheit/335196/Orthop%C3%A4dentest_ vzhh_2014.pdf (last accessed on 28 January 2016).
22. Verbraucherzentrale Hamburg: „Wenn Sie diese Zahnlücke nicht behandeln lassen, fallen Ihnen bald alle Zähne aus!“ www.vzhh.de/gesundheit/293166/2013-01-17_-Zahn%C3%A4rztetest.pdf (last accessed on 28 January 2016).
23. General Medical Council: Consent: patients and doctors making decisions together. www.gmc-uk.org/static/documents/content/Consent_-_English_1015.pdf (last accessed on 28 January 2016).
24.Steckelberg A, Hülfenhaus C, Haastert B, Mühlhauser I: Effect of evidence-based risk information on „informed choice“ in colorectal cancer screening: a randomised controlled trial. BMJ 2011; 342: d3193.
25.Steckelberg A , Mühlhauser I: Darmkrebs Früherkennung.
www.gesundheit.uni-hamburg.de/upload/Barmer_Darmkrebsbroschuere.pdf (last accessed on 8 April 2016).
26. IGeL-Monitor: Professionelle Zahnreinigung. www.igel-monitor.de/IGeL_A_Z.php?action=abstract&id=74 (last accessed on 28 January 2016).
27. IGeL-Monitor: Messung des Augeninnendrucks zur Glaukom-Früherkennung. www.igel-monitor.de/pdf_bewertungen/Messung%20 des%20Augeninnendrucks_Evidenzsynthese.pdf (last accessed on 28 January 2016).
28. Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde: S3-Leitlinie Fissuren- und Grübchenversiegelung. 2010.
www.awmf.org/uploads/tx_szleitlinien/083–002l_S3_Fissuren-Gruebchenversiegelung-2010-abgelaufen.pdf (last accessed on 28 January 2016).
29.Bundesinstitut für Qualität im Gesundheitswesen: Professionelle Zahnhygiene. Quick Assessment. www.goeg.at/cxdata/media/download/berichte/Professionelle_Dentalhygiene.pdf (last accessed on 28 January 2016).
30.Alfirevic Z, Mujezinovic F, Sundberg K: Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev 2003; 3: CD003252.
31.Wegwarth O, Gigerenzer G: „There is nothing to worry about“: Gynecologists’ counseling on mammography. Pat Educ Couns 2011; 84: 251–56 CrossRef MEDLINE
32.Bundeszahnärztekammer/Kassenzahnärztliche Bundesvereinigung: Patienten im Mittelpunkt: Die Patientenberatung der Zahnärzteschaft in Deutschland. www.bzaek.de/fileadmin/PDFs/pati/patientenberatung_zahnaerzte.pdf (last accessed on 28 January 2016).
e1.Scottish Intercollegiate Guidelines Network (SIGN) (2015): Critical appraisal: Notes and checklists. www.sign.ac.uk/methodology/checklists.html (last accessed on 28 January 2016).
e2.Higgins JPT, Altman DG, Sterne JAC: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds.): Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011; www. cochrane-handbook.org (last accessed on 28 January 2016).
e3.Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V.: Beiträge zur Gesundheitsberichterstattung des Bundes: Krebs in Deutschland 2007/2008. 2012.
www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/KID2012.pdf (last accessed on 7 July 2015).
e4.Pickhardt PJ, Hassan C, Halligan S, Marmo R: Colorectal cancer: CT colonography and colonoscopy for detection: systematic review and meta-analysis. Radiology 2011; 259: 393–405 CrossRef MEDLINE PubMed Central
e5. Ludwig Boltzmann Institut: Screening for colorectal cancer, part 1: screening tests and program design. HTA 41a 2012. http://eprints.hta.lbg.ac.at/981/1/HTA-Projektbericht_Nr.41a_Update_2012.pdf (last accessed on 7 July 2015).
e6.Bretthauer M: Colorectal cancer screening. J Intern Med 2011; 270: 87–98.
e7. Crispin A, Birkner B, Munte A: Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy 2009; 41: 1018–25 CrossRef MEDLINE
e8.Warren JL, Klabunde CN, Mariotto AB, et al.: Adverse events after outpatient colonoscopy in the medicare population. Ann Intern Med 2009; 150: 849–57 CrossRef MEDLINE
e9.Burr JM, Mowatt G, Hernandez R: The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. 2007. www.hta.ac.uk/fullmono/mon1141.pdf ( last accessed on 22 February 2013).
e10.Ervin AM, Boland MV, Myrowitz EH, et al.: Screening for glaucoma: comparitive effec-tiveness review 59. 2012. www.effectivehealthcare.ahrq.gov/ehc/products/182/1026/CER59_Glaucoma-Screening_Final-Report_20120524.pdf (last accessed on 22 April 2015).
e11.Fleming C, Whitlock E, Beil T, et al.: Primary care screening for ocular hypertension and primary open-angel glaucoma: evidence syntheses 34. 2005. www.ncbi.nlm.nih.gov/books/NBK42905/ (last accessed on 22 April 2015).
e12.Hatt SR, Wormald R, Burr J: Screening for prevention of optic nerve damage due to chronic open angle glaucoma. Cochrane Database Syst Rev 2006; 4: CD006129.
e13.Moyer V: Screening for glaucoma, U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159; 484–9.
e14.Bray I, Wright DE, Davies C, Hook EB: Joint estimation of down syndrome risk and ascertain-ment rates: a meta-analysis of nine published data-sets. Prenat Diagn 1998; 18: 9–20 CrossRef CrossRef
e15.Morris JK, Mutton DE, Alberman E: Revised estimates of the maternal age specific live birth prevalence of Down´s syndrome. J Med Screen 2002; 9: 2–6 CrossRef
e16.Snijders RJM, Holzgreve W, Chuckle H, Nicolaides KH: Maternal age-specific risks for trisomies at 9–14 weeks gestation. Prenat Diagn 1994; 14: 543–52 CrossRef
e17.Loft A, Tabor A: Discordance between prenatal cytogenetic diagnosis and outcome of pregnancy. Prenat Diagnosis 1984; 4: 51–9 CrossRef
e18.Tabor A, Philip J, Madsen M: Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287–93.
e19.Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, et al.: Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev 2013; 3: CD001830.
e20.Bravo M, Montero J, Bravo JJ, Baca P, Llodra JC: Sealant and fluoride varnish in caries: a randomized trial. J Dent Res 2005; 84: 1138–43 CrossRef
e21.Albani F, Ballesio I, Campanella V, Marzo V, Marzo G: Pit and fissure sealants: results at five and ten years. Eur J Paediatr Dent 2005; 6: 61–5.
e22.Eidelman E, Fuks AB, Chosack A: The retention of fissure sealants: rubber dam or cotton rolls in a private practice. ASDC J Dent Child 1983; 50: 259–61.
e23.Ganss C, Klimek J, Gleim A: One year clinical evaluation of the retention and quality of two fluoride releasing sealants. Clin Oral Investig 1999; 4: 188–93.
e24.Griffin SO, Oong E, Kohn W, et al.: The effectiveness of sealants in managing caries lesions. J Dent Res 2008; 87: 169–74 CrossRef MEDLINE
e25.Lygidakis NA, Oulis KI, Christodoulidis A: Evaluation of fissure sealants retention following four different isolation and surface preparation techniques: four years clinical trial. J Clin Pediatr Dent 1994; 19: 23–5.
e26.McConnachie I: The preventive resin restoration: A
conservative alternative. J Can Dent Assoc 1992; 58:
197–200.
e27. Straffon LH, Dennison JB, More FG: Three-year evaluation of sealant: effect of isolation on efficacy. J Am Dent Assoc 1985; 110: 714–7 CrossRef
e28.Wood AJ, Saravia ME, Farrington FH: Cotton roll isolation versus Vac-Ejector isolation. ASDC J Dent Child 1989; 56: 438–41.
e29.Wright GZ, Friedman CS, Plotzke O, Feasby WH: A comparison between autopolymerizing and visible-light-activated sealants. Clin Prev Dent 1988; 10: 14–7.
e30.Worthington HV, Clarkson JE, Bryan G, Beirne PV: Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2013; 11: CD004625.
e31.Needleman I, Suvan J, Moles DR, Pimlott J: A systematic review of professional mechanical plaque removal for prevention of
periodontal diseases. J Clin Periodontol 2005; 32 (Suppl 6): 229–82 CrossRef MEDLINE
e32.Bernhoft RA: Mercury toxicity and treatment: a review of the literature. J Environ Public Health 2012; Article ID 460508; doi: 10.1155/2012/460508 CrossRef
e33.Adams JB, Baral M, Geis E, et al.: Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A—medical results. BMC Clin Pharmacol 2009; 9: 16 CrossRef CrossRef
e34.Cao Y, Chen A, Jones RL, et al.: Efficacy of succimer chelation of mercury at background exposures in toddlers: a randomized trial. J Pediatr 2011; 158: 480–5.e1.
e35.Grandjean P, Guldager B, Larsen IB, Jørgensen PJ, Holmstrup P: Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings. J Occup Environ Med 1997; 39: 707–14 CrossRef MEDLINE
e36.Sandborgh Englund G, Dahlqvist R, Lindelöf B, et al.: DMSA administration to patients with alleged mercury poisoning from dental amalgams: a placebo-controlled study. J Dent Res 1994; 73: 620–8.
e37.Schuurs A, Exterkate R, ten Cate JM: Biological mercury measurements before and after administration of a chelator (DMPS) and subjective symptoms allegedly due to amalgam. Eur J Oral Sci. 2000; 108: 511–22 CrossRef
e38.Kaminski MF, Bretthauer M, Zauber AG, et al.: The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 2012; 44: 695–702 CrossRef MEDLINE
e39. Day LW, Kwon A, Inadomi JM: Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74: 885–96 CrossRef MEDLINE PubMed Central
e40.Pox CP, Altenhofen L, Brenner H, Theilmeier A, von Stillfried D, Schmiegel W: Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012; 142: 1460–7 CrossRef MEDLINE
e41.Schmiegel W, Pox C, Reinacher-Schick A, et al. S3-Leitlinie kolorektales Karzinom 2004/2008. Zeitschrift für Gastroenterologie 2008; 46: 1–73 CrossRef MEDLINE
e42.Sillars-Hardebol AH, Carvalho B, van Engeland M, Fijneman RJ, Meijer GA: The adenoma hunt in colorectal cancer screening: defining the target. J Pathol 2012; 226: 1–6 CrossRef MEDLINE
e43.Whitlock EP, Lin J, Liles E, et al.: Screening for colorectal cancer: an updated systematic review, evidence syntheses 65.1. 3, key questions & results. 2008. www.ncbi.nlm.nih.gov/books/NBK35186/ (last accessed on 7 July 2015).
e44.Antony K, Genser D, Fröschl B: Erkenntnisgüte und Kosteneffektivität von Screeningverfahren zur Erfassung von primären Offenwinkel-Glaukomen. DIMDI-HTA 50 2007. http://portal.dimdi.de/de/hta/hta_berichte/hta144_bericht_de.pdf (last accessed on 8 July 2015).
e45.Bahrami H. Causal inference in primary open angle glaucoma: specific discussion on intra-ocular pressure. Ophthalmic Epidemiol 2006; 13: 283–9 CrossRef CrossRef MEDLINE
e46.Berufsverband der Augenärzte Deutschlands e. V., Deutsche Ophthalmologische Gesellschaft e.V.: Leitlinie Nr. 15 c: Detektion des primären Offenwinkelglaukoms (POWG): Glaukom-Screening von Risikogruppen, Glaukomverdacht, Glaukomdiagnose. 2006. www.augeninfo.de/leit/leit15c.pdf (last accessed on 28 April 2015).
e47.Burr JM, Botello-Pinzon P, Takwoingi Y: Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. 2012. www.ncbi.nlm.nih.gov/books/NBK100061/pdf/TOC.pdf (last accessed on 22 February 2013).
e48. Claessen H, Genz J, Bertram B: Evidence for a considerable decrease in total and cause-specific incidences of blindness in Germany. Eur Journal Epidemiol 2012; 27: 519–24 CrossRef MEDLINE
e49.Foster PJ, Buhrmann R, Quigley HA, et al.: The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002; 86: 238–42 CrossRef MEDLINE PubMed Central
e50.National Institute for Health and Clinical Excellence: Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension. 2009. www.nice.org.uk/nicemedia/live/12145/43887/43887.pdf (last accessed on 22 April 2015).
e51.Quigely HA: Glaucoma. Lancet 2011; 377: 1367–77 CrossRef
e52.Vass C, Hirn C, Sycha T, et al.: Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev 2007; 4: CD003167.
e53.Wolfram C, Pfeiffer N: Glaukomerkrankungen in Rheinland-Pfalz 2010: Epidemiologie und Inanspruchnahme der Versorgung. Ophthalmologe 2012; 109: 271–6 CrossRef MEDLINE
e54.European Surveillance of Congenital Anomalies: EUROCAT-Prävalenz, -Daten ,-Tabellen: Trisomie-21, Lebendgeburtenrate. 2010. www.eurocat-network.eu/accessprevalencedata/prevalencetables (last accessed on 8 April 2016).
e55.Loane M, Morris JK, Addor MC, et al.: Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening. Eur J Hum Genet 2013; 21: 27–33 CrossRef MEDLINE PubMed Central
e56.Los FJ, van Den Berg C, Wildschut HI, et al: The diagnostic performance of cytogenetic investigation in amniotic fluid cells and chorionic villi. Prenat Diagn 2001; 21: 1150–8 CrossRef MEDLINE
e57.Morris JK, Alberman E: Trends in Down´s syndrome live births and antenatal diagnoses in England and Wales from 1989 to 2008: analysis of data from the National Down Syndrome Cytogenetic Register. BMJ 2009; 339: b3794 CrossRef MEDLINE PubMed Central
e58.Tabor A, Alfirevic Z: Update on procedure-related risks for prenatal diagnosis techniques. Fetal Diagn Ther 2010; 27: 1–7 CrossRef MEDLINE
e59.Waters JJ, Waters KS: Trends in cytogenetic prenatal diagnosis in the UK: results from UKNEQAS external audit 1987–1998. Prenat Diagn 1999; 19: 1023–6 CrossRef CrossRef
e60.Brothwell DJ, Jutai DK, Hawkins RJ: An update of mechanical oral hygiene practices: evidence-based recommendations for disease prevention. J Can Dent Assoc 1998; 64: 295–306 MEDLINE
  • Eichler, Martin; Blettner, Maria
    Deutsches Ärzteblatt international, 2016
    10.3238/arztebl.2016.0387