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| 2. |
- Anderson, P., et al.
(författare)
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Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial
- 2016
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Ingår i: Addiction. - : Wiley. - 1360-0443 .- 0965-2140. ; 111:11, s. 1935-1945
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. Design: Cluster randomized factorial trial with 12-week implementation and measurement period. Setting: Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. Participants: A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. Interventions: PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. Measurements: The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. Findings: During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI=1.13–1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI=1.56–2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI=1.77–3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI=1.11–2.53). Conclusions: Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption. © 2016 Society for the Study of Addiction
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| 3. |
- Bendtsen, Preben, et al.
(författare)
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Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study
- 2015
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Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 50:4, s. 430-437
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Tidskriftsartikel (refereegranskat)abstract
- To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.
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| 5. |
- Keurhorst, M., et al.
(författare)
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Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial
- 2016
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science.
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| 8. |
- Palacio-Vieira, J., et al.
(författare)
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Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C
- 2018
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Ingår i: Journal of Evaluation In Clinical Practice. - : WILEY. - 1356-1294 .- 1365-2753. ; 24:2, s. 369-374
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and objectiveThe ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. MethodFrom 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. ResultsThirty-two of 36711 questionnaires were incorrectly completed, and 65 of 29641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR=0.56; 95% CI, 0.31-0.99; Pamp;lt;.05). ConclusionAlthough the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.
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| 10. |
- Bendtsen, Preben, 1956-, et al.
(författare)
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Sociodemographic gender differences in patients attending a community-based alcohol treatment centre
- 2002
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Ingår i: Addictive Behaviours. - 0306-4603 .- 1873-6327. ; 27:1, s. 21-33
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Tidskriftsartikel (refereegranskat)abstract
- This study included all individuals attending a community-based treatment centre during a 4-year period. Patients were referred to the treatment centre from the primary health care (17%), social insurance office (8%), social workers (19%), employers (7%), prisons and probation administration (3%), on their own initiative (25%), and by other means (21%). The participants, 355 men and 164 women, all between 18 and 64 years of age, were compared with the total population in the municipality with regards to gender differences in sociodemographic characteristics. Adult life circumstances such as legal problems, broken relationships, unemployment and lower social class, in both men and women, were clearly associated with an alcohol dependence or at least of seeking help for this problem. The study also emphasises important social consequences of alcohol dependence in women, such as legal problems and drunk driving, normally associated with male alcohol dependence. The study revealed that living with an abusing partner was associated with a higher frequency of alcohol dependence in women. The findings are important issues to address when offering treatment to women with alcohol dependence. ⌐ 2001 Elsevier Science Ltd. All rights reserved.
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| 15. |
- Foldager, C. B., et al.
(författare)
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Aarhus Regenerative Orthopaedics Symposium (AROS): Regeneration in the ageing population
- 2016
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 87, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- The combination of modern interventional and preventive medicine has led to an epidemic of ageing. While this phenomenon is a positive consequence of an improved lifestyle and achievements in a society, the longer life expectancy is often accompanied by decline in quality of life due to musculoskeletal pain and disability. The Aarhus Regenerative Orthopaedics Symposium (AROS) 2015 was motivated by the need to address regenerative challenges in an ageing population by engaging clinicians, basic scientists, and engineers. In this position paper, we review our contemporary understanding of societal, patient-related, and basic science-related challenges in order to provide a reasoned roadmap for the future to deal with this compelling and urgent healthcare problem.
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| 17. |
- Kragh, Jörgen, et al.
(författare)
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Optimization of thin asphalt layers : state-of-the-art review
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- ERA-NET ROAD initiated a transnational research project titled "Optimization of thin asphalt layers" (OPTHINAL). The DRI-BRRC-VTI Consortium was trusted with carrying out the project and began with a State-of-the-Art report covering, among other things, a literature study and an inventory of experience with using thin asphalt layers (TAL). The results of this phase of the project are given in the present report.This study was limited to thin asphalt mixtures with a maximum thickness of 30 mm, which means that surface dressings or slurry seals were outside the scope of the project. Neither were top layers of double-layer porous pavements considered as TAL, even though such top layers often are 20-30 mm thick. Mix design and optimization was the subject of another study in this project and is therefore not treated here. The main conclusions are that the application of TAL is certainly worthwhile, in particular asa renewable “skin” of a stable road construction having sufficient bearing capacity. The skin serves road users’ need for sufficient skidding resistance and other important functions.
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| 18. |
- Perner, Anders, et al.
(författare)
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Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis
- 2012
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 367:2, s. 124-134
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Hydroxyethyl starch (HES) 130/0.4 is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. METHODS In this multicenter, parallel-group, blinded trial, we randomly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6% HES 130/0.4 or Ringer's acetate at a dose of up to 33 ml per kilogram of ideal body weight per day. The primary outcome measure was either death or end-stage kidney failure (dependence on dialysis) at 90 days after randomization. RESULTS Of the 804 patients who underwent randomization, 798 were included in the modified intention-to-treat population. The two intervention groups had similar baseline characteristics. At 90 days after randomization, 201 of 398 patients (51%) assigned to HES 130/0.4 had died, as compared with 172 of 400 patients (43%) assigned to Ringer's acetate (relative risk, 1.17; 95% confidence interval [CI], 1.01 to 1.36; P=0.03); 1 patient in each group had end-stage kidney failure. In the 90-day period, 87 patients (22%) assigned to HES 130/0.4 were treated with renal-replacement therapy versus 65 patients (16%) assigned to Ringer's acetate (relative risk, 1.35; 95% CI, 1.01 to 1.80; P=0.04), and 38 patients (10%) and 25 patients (6%), respectively, had severe bleeding (relative risk, 1.52; 95% CI, 0.94 to 2.48; P=0.09). The results were supported by multivariate analyses, with adjustment for known risk factors for death or acute kidney injury at baseline. CONCLUSIONS Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.4 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate.
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| 19. |
- Ring, Lena, et al.
(författare)
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Feasibility and validity of a computer administered version of SEIQoL-DW
- 2006
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 15:7, s. 1173-1177
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Tidskriftsartikel (refereegranskat)abstract
- Computer administrered QoL instruments are increasingly used to assess outcomes. Our aim was to assess the feasibility and validity of an electronic version of the SEIQoL-DW. Pharmacy students (n = 40; mean age 25; 92% women) were administrated both the touch screen and the paper-and-pen versions in a cross-over study. The majority of the students (65 %) preferred the computer version, while almost a third (27%) preferred the paper and pen version. There was no overall order effect and the SEOQoL-DW index mean scores differed with 1.2 between the two versions. Those respondents completing the computer version first had higher scores than those completing the computer version second. The ICC comparing the formats was 0.77 (CI: 0.57-0.88) and the limits of agreement method showed that 85% of the observations were within +/- 1-10 units. Most students (82%) judged their QoL as being equivalent to their SEIQoL-DW score. The computer version of the SEIQoL-DW seems to be feasible and acceptable and seems to be valid alternative to the paper and pen version. However, further validation studies in larger patient populations are needed.
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