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- Selander, Helena, 1975-, et al.
(författare)
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Läkares hantering av medicinsk körkortslämplighet : En enkätundersökning
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Att bedöma och bestämma när en patient inte är en säker bilförare är en svår och ibland känslig arbetsuppgift för sjukvården. Transportstyrelsen och dess föreskrifter lämnar inte heller några detaljerade riktlinjer för lämpliga bedömningsmetoder eller tester. Detta innebär risk för godtycke, olika bedömningsunderlag eller total avsaknad av bedömning i vissa delar av landet.Syftet med projektet var att undersöka hur den medicinska lämplighetsbedömningen utförs och upplevs av läkare inom olika discipliner. Ambitionen med enkätundersökningen var att få uppgifter från olika delar av landet och från olika läkarkategorier. Enkäterna har distribuerats genom strategiska läkargruppers yrkesföreningar inom Svenska Läkaresällskapet. Något stort stickprov eller representativt urval har inte eftersträvats, snarare att få en rikhaltig och bred bild av hur det kan se ut i olika regioner och bland olika läkargrupper.Resultatet visar att läkarna har ett tydligt och stort intresse för körkortsmedicinska frågor och att dessa frågor ses som en naturlig del av arbetet inom offentlig sjukvård. Hur högt man prioriterar läkarbesök som rör medicinska lämplighetsbedömningar för körkort varierar dock stort över landet och dokumenterade rutiner för den egna enheten saknas ofta. En tydlig efterfrågan på mer kunskap och beslutstöd påvisas, där särskilt den grannlaga uppgiften som rör läkares anmälningsskyldighet motiverar stor säkerhet i läkarnas bedömningar. Det finns en tydlig efterfrågan på fler utbildningsinsatser, både på utbildningsnivå (ST) och specialistnivå.En efterfrågan på kunskap om patientens ”körförmåga” är vanlig och man önskar en möjlighet att få till stånd praktiska körbedömningar eller körprov. Begränsningen till att bedöma den medicinska lämpligheten med medicinska metoder uppfattas inte alltid som tillräcklig, speciellt inte i gränsfall. Möjligheten till remittering av komplicerade bedömningar efterfrågas och det ses som en viktig tillgång där sådana mer specialiserade trafikmedicinska enheter finns. Projektets resultat ger stöd för att utveckla sådana enheter med en jämnare spridning över landet.
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| 2. |
- Carlsson, Lars, et al.
(författare)
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Early multidisciplinary assessment was associated with longer periods of sick leave : A randomized controlled trial in a primary health care centre
- 2013
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:3, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial.SettingPatients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to "standard care". The therapists used methods and tools they normally use in their clinical work.Main outcome measureProportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.ResultsAt follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).ConclusionsIn this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.
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| 5. |
- Engblom, Monika, et al.
(författare)
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When physicians get stuck in sick-listing consultations : A qualitative study of categories of sick-listing dilemmas
- 2010
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 35:2, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice. Design and subjects: Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis. Results: Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing - reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se). Implications: The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.
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| 7. |
- Rodhe, Nils, 1951-
(författare)
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Asymptomatic Bacteriuria in the Elderly
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI). All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls. ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB. There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.
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| 8. |
- Rodhe, Nils, et al.
(författare)
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Bacteriuria is associated with urge urinary incontinence in older women
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26:1, s. 35-39
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men. DESIGN: Cross-sectional study. SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town. SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537). MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence. RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence. CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.
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| 9. |
- Rodhe, Nils, et al.
(författare)
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Asymptomatic bacteriuria in a population of elderly residents living in a community setting : prevalence, characteristics and associated factors
- 2006
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 23:3, s. 303-7
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Tidskriftsartikel (refereegranskat)abstract
- Background. Asymptomatic bacteriuria (ASB) is common among the elderly in institutionalcare, but less is known about its prevalence among the elderly living in community settings.Knowledge of the prevalence of ASB in this population could contribute to a reduction inunnecessary use of antibiotics.Objective. To study the prevalence of ASB and associated health and social factors in apopulation of elderly people, aged 80 and over, in a community setting.Design. A cross-sectional study.Setting. The catchment area of a primary health care centre in a Swedish middle-sized town.Method. All residents, aged 80 and over, except for those in institutional living, were invited. Astructured interview was carried out and urinary culture obtained.Results. ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of themen. In women independent associations with ASB were found for urinary incontinence (OR:2.99, CI: 1.60–5.60), reduced mobility (OR: 2.68, CI: 1.42–5.03) and oestrogen treatment (OR: 2.20,CI: 1.09–4.45).Conclusion. Bacteriuria is common among the elderly living in non-institutional communitysettings, especially among women, although not as common as among the elderly in institutionalsettings. A woman over 80, with urinary incontinence, and needing support to walk has arisk of nearly 50% of presenting with ASB, a condition about which there is consensus not totreat with antibiotics. This should be borne in mind when examining patients with diffusesymptomatology and an accidental finding of bacteriuria.
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