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- Hlebowicz, Joanna, et al.
(författare)
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Effect of commercial rye whole-meal bread on postprandial blood glucose and gastric emptying in healthy subjects
- 2009
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Ingår i: Nutrition Journal. - : Springer Science and Business Media LLC. - 1475-2891. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: The intake of dietary fibre has been shown to reduce the risk of developing diabetes mellitus. The aim of this study was to compare the effects of commercial rye whole-meal bread containing whole kernels and white wheat bread on the rate of gastric emptying and postprandial glucose response in healthy subjects. Methods: Ten healthy subjects took part in a blinded crossover trial. Blood glucose level and gastric emptying rate (GER) were determined after the ingestion of 150 g white wheat bread or 150 g whole-meal rye bread on two different occasions after fasting overnight. The GER was measured using real-time ultrasonography, and was calculated as the percentage change in antral cross-sectional area 15 and 90 minutes after completing the meal. Results: No statistically significant difference was found between the GER values or the blood glucose levels following the two meals when evaluated with the Wilcoxon signed rank sum test. Conclusion: The present study revealed no difference in postprandial blood glucose response or gastric emptying after the ingestion of rye whole-meal bread compared with white wheat bread.
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- Ingemansson, Maria
(författare)
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Evidence-based practice for children with asthma in primary care : quality of management and effects of learning
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Asthma is the most common chronic disease among children in Sweden. Many school-aged (7-17 years), but also preschool (0-6 years) children with asthma are managed in primary care. Evidence-based guidelines have been developed to support the use of current best clinical evidence in practice and to ensure high quality care. However, there is a gap between the actual care provided for children with asthma and the recommendations stated in the guidelines. Aim: To investigate the evidence-based practice for children with asthma in primary care. We wanted to evaluate the potential influence of quality of management and effects of learning to apply the evidence-based guidelines in routine care. Methods: In study I register data regarding dispensed prescriptions was collected. Dispensed prescriptions were followed over 24 consecutive months for all children (0-16 years) visiting 14 primary health care centres (PHCs) and initiated on anti-asthmatic drugs during one year (n=1033). In study II physicians and nurses participated in interactive education in these PHCs. 14 PHCs served as controls. Register data was collected regarding dispensed prescriptions and recorded diagnosis during 24 months before and after the intervention. Data was included from all children (0-17 years) (n= 114 175) listed at the 28 PHCs 2006-2012. Focus group interviews (FGIs) were used in study III to evaluate how general practitioners (GPs) approach, learn from and use evidence-based guidelines in their decision-making. Qualitative content analysis was used. 22 GPs participated. In study IV quality of care was assessed as a composite of quality indicators (CQI). Adherence to quality indicators was retrieved by scrutinising electronic health care records at 14 PHCs. By using the multivariate regression analysis orthogonal projection to latent structures (OPLS) the relationship between CQI and contextual features was evaluated. Results: In study I 54% of the school-aged children had only one prescription dispensed and 50% of them were initiated on short-acting beta2-agonist (SABA) as monotherapy. In study II 66% of the school-aged children with a recorded diagnosis of asthma were dispensed SABA as well as an anti-inflammatory anti-asthmatic drug before the intervention. There was no significant statistical difference between the intervention and control group at baseline or at follow-up. Approximately one-fourth of all children who were dispensed anti-asthmatic drugs did not have a recorded diagnosis of asthma. In study III three themes were conceptualised in the evaluation of the guidelines: Learning to use guidelines by contextualised dialogues; Learning that establishes confidence to provide high quality care; Learning by the use of relevant evidence in the decision-making process. In study IV more scheduled time for asthma care, lower age-limit for performing spirometry, lower duty-grade for GPs and higher activity at the educational seminars were the contextual features with highest influence on CQI. Conclusion: Most GPs show good adherence to evidence-based guidelines regarding pharmacological treatment in children with a recorded diagnosis of asthma. Correct diagnosis of asthma is crucial to enable use of evidence-based guidelines. To achieve this, spirometry needs to be performed more often. Contextualised dialogue, based on own experience, feedback on own results and easy access to short guidelines that were perceived as trustworthy, were important aspects for the use of the guidelines. To allocate time, interprofessional collaboration and to create an organisational structure with opportunities for engagement in asthma care, are contextual features that have the potential to facilitate evidence-based practice for children with asthma.
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- Jonsson, Marina, et al.
(författare)
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Adherence to national guidelines for children with asthma at primary health centres in Sweden : potential for improvement
- 2012
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Ingår i: Primary Care Respiratory Journal. - : Elsevier. - 1471-4418 .- 1475-1534. ; 21:3, s. 276-282
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. AIMS: To evaluate adherence to national guidelines for primary care management of children with asthma. METHODS: This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. RESULTS: Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). CONCLUSIONS: This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines.
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