| 1. |
- Harbin, N. J., et al.
(författare)
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Does C-reactive protein predict time to recovery and benefit from oseltamivir treatment in primary care patients with influenza-like illness? A randomized controlled trial secondary analysis
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:4, s. 527-532
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Tidskriftsartikel (refereegranskat)abstract
- Objective Recovery time and treatment effect of oseltamivir in influenza-like illness (ILI) differs between patient groups. A point-of-care test to better predict ILI duration and identify patients who are most likely to benefit from oseltamivir treatment would aid prescribing decisions in primary care. This study aimed to investigate whether a C-reactive protein (CRP) concentration of >= 30 mg/L can predict (1) ILI disease duration, and (2) which patients are most likely to benefit from oseltamivir treatment. Design Secondary analysis of randomized controlled trial data. Setting Primary care in Lithuania, Sweden and Norway during three consecutive influenza seasons 2016-2018. Subjects A total of 277 ILI patients aged one year or older and symptom duration of <= 72 h. Main outcome measures Capillary blood CRP concentration at baseline, and ILI recovery time defined as having 'returned to usual daily activity' with residual symptoms minimally interfering. Results At baseline, 20% (55/277) had CRP concentrations >= 30mg/L (range 0-210). CRP concentration >= 30 mg/L was not associated with recovery time (adjusted hazards ratio (HR) 0.80: 95% CI 0.50-1.3; p = 0.33). Interaction analysis of CRP concentration >= 30 mg/L and oseltamivir treatment did not identify which patients benefit more from oseltamivir treatment (adjusted HR 0.69: 95% CI 0.37-1.3; p = 0.23). Conclusion There was no association between CRP concentration of >= 30 mg/L and recovery time from ILI. Furthermore, CRP could not predict which ILI patients benefit more from oseltamivir treatment. Hence, we do not recommend CRP testing for predicting ILI recovery time or identifying patients who will receive particular benefit from oseltamivir treatment.
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| 2. |
- Johansson, Elin, 1978, et al.
(författare)
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Inter-professional teamwork in emergency care: pedagogical use of video in post-simulation debriefings
- 2014
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Ingår i: SESAM 2014, 20th Anniversary SESAM Meeting Poznań 12-14 June 2014.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- MAIN ABSTRACT Background: The use of video for feedback in debriefings is widespread and considered to be essential for the effective use of simulations. However, empirical studies that focus on how video can be optimized as a pedagogical means in debriefings are still rare. Objective: The study aims to investigate how video can be used to encourage reflection and discussion on scenarios in subsequent debriefings. Methods: The data consists of forty video recorded debriefings following interprofessional team training scenarios for medical and nursing students. First, a number of video sequences were selected from the debriefings in which the facilitators used video-clips from the scenario as a basis for discussion. These represented a variation of the ways in which video clips were introduced. The video sequences then served as basis for a focus group interview with three facilitators. The interview explored the variation in introducing the video clips and what implications this had for subsequent discussions. Results: Different strategies for introducing video clips were identified, ranging from very specific to very open-ended. Whilst the specific ones were characterized by detailed information about the situation and what parts of the clip to focus on, the open-ended introductions were characterized by brief information about the situation without instructions for what aspects to focus on. The interview resulted in a model involving four interrelated factors – moment of time in training, complexity of the situation, group characteristics and purpose ¬– that are important to take into account when choosing between open-ended versus specific introductions. Conclusions: The proposed model provides a conceptual tool for discussing and planning successful use of video recordings for feedback purposes in post-simulation debriefings. It can also be used to increase awareness of how the selection and introduction of video clips affect subsequent discussions.
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| 3. |
- Moller, H., et al.
(författare)
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Technology-Enhanced Learning of Human Trauma Biomechanics in an Interprofessional Student Context
- 2022
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Ingår i: Teaching and Learning in Medicine. - : Informa UK Limited. - 1040-1334 .- 1532-8015. ; 34:2, s. 135-144
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Tidskriftsartikel (refereegranskat)abstract
- Phenomenon This study aimed to investigate how students can develop their understanding of trauma biomechanics by means of technology-enhanced learning-an interactive visualization tool developed to enhance understanding of the biomechanics underlying an injury via dynamic imaging sequences. Approach: Students were invited to explore the content as a learning resource during an interprofessional clinical placement on an orthopedic ward. Thirty volunteer medical, nursing, and physiotherapy/occupational therapy students participated in 10 interprofessional groups of three participants. They were video recorded while interacting with learning software that was divided into five sections: Work Up, General Information, Biomechanical Case Study, Biomechanical Risk Assessment, and Treatment. Investigators probed students' learning experiences via four focus group discussions. A sociomaterial perspective was adopted, directing the analytical focus to how students' made use of talk, gestures, bodies, and material objects to understand the visualized phenomena. Findings: When connecting the visualization to a patient case, certain features of the technology stood out as important for promoting engagement and understanding trauma mechanisms. Decreased tempo, showing the directions and dynamics of trauma biomechanics in slow-motion, and color coding of the strain on the affected structures were especially important for evoking the emotional responses. The visualization tool also supported students' explorations of causal relationships between external forces and their biomedical effects. These features emphasize the sociomaterial relation between the design of the technology and the student activities. Insights: Dynamic visualization of biomechanical events has the potential to improve the understanding of injury mechanisms and specifically to identify anatomical structures at high risk of injury. Dynamic visualizations for educational purposes seem to promote possibilities for learners to contextualize visual representations relative to one's own body. Educational methods and practice need explicit attention and development in order to use the full potential of the visualization technology for learning for the health care professions.
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| 4. |
- Rystedt, Karin, et al.
(författare)
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Agreement between rapid antigen detection test and culture for group A streptococcus in patients recently treated for pharyngotonsillitis-a prospective observational study in primary care
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim was to compare rapid antigen detection test (RADT) and throat culture for group A streptococci (GAS) among patients recently treated with penicillin V for GAS pharyngotonsillitis.Design and settingThe study was a secondary analysis within a randomized controlled trial comparing 5 versus 10 days of penicillin V for GAS pharyngotonsillitis. Patients were recruited at 17 primary health care centres in Sweden.SubjectsWe included 316 patients >= 6 years of age, having 3-4 Centor criteria, a positive RADT and a positive throat culture for GAS at inclusion, and also having a RADT and throat culture for GAS taken at a follow-up visit within 21 days.Main outcome measuresRADT and conventional throat culture for GAS.ResultsThis prospective study showed 91% agreement between RADT and culture at follow-up within 21 days. Only 3/316 participants had negative RADT with a positive throat culture for GAS at follow-up, and 27/316 patients with positive RADT had a negative culture for GAS. Log rank test did not reveal any difference in the decline over time of positive tests between RADT and throat culture (p = 0.24). Agreement between RADT and throat culture for GAS at the follow-up was not associated with treatment duration, number of days from inclusion until follow-up, throat symptoms at follow-up, gender, or age.ConclusionRADT and culture for GAS agreed to a high extent also after recent penicillin V treatment. RADT for GAS means a low risk for missing the presence of GAS.
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| 5. |
- Rystedt, Karin, et al.
(författare)
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Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis-an observational study
- 2022
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Ingår i: JAC - Antimicrobial Resistance. - : OXFORD UNIV PRESS. - 2632-1823. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The intestinal microbiota functions as a reservoir of antibiotic resistance. Objectives To evaluate penicillin V (phenoxymethylpenicillin) effects on the faecal microbiota with focus on beta-lactam resistance. Methods We included 31 primary care patients with group A streptococcal pharyngotonsillitis treated with penicillin V for 5 (800 mg x 4) or 10 days (1000 mg x 3). Twenty-nine patients contributed with three faecal swab samples each. The faecal specimens were collected at the start of penicillin V treatment, after the last dose and at follow-up 7-9 days after completed treatment. Samples were inoculated semiquantitatively on selective screening agar plates to study beta-lactam resistance, species shifts among Enterobacterales and enterococci, and colonization with Candida spp. and Clostridioides difficile. Representative colonies were identified using MALDI-TOF. Results were analysed by non-parametric statistical methods. Results An increase in the proportion of patients colonized with ampicillin-resistant Enterobacterales, from 52% to 86% (P = 0.007), and Enterobacterales with decreased susceptibility to third-generation cephalosporins, from 32% to 52% (P = 0.034), was observed between the first and second samples. This increase was no longer significant at follow-up. New colonization with ampicillin-resistant Enterobacterales species and non-Enterobacterales Gram-negative species was observed, and persisted at follow-up. Conclusions Following treatment with penicillin V, we observed decreased susceptibility to ampicillin and third-generation cephalosporins, and prolonged colonization with non-Escherichia coli Gram-negative species. These findings challenge the perception that penicillin V has limited ecological effect on the intestinal microbiota, and emphasizes the importance of avoiding even narrow-spectrum antimicrobials when possible.
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| 6. |
- Rystedt, Karin, et al.
(författare)
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Is C-reactive protein associated with influenza A or B in primary care patients with influenza-like illness? A cross-sectional study.
- 2020
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 38:4, s. 447-53
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Tidskriftsartikel (refereegranskat)abstract
- Identifying influenza A or B as cause of influenza-like illness (ILI) is a challenge due to non-specific symptoms. An accurate, cheap and easy to use biomarker might enhance targeting influenza-specific management in primary care. The aim of this study was to investigate if C-reactive protein (CRP) is associated with influenza A or B, confirmed with PCR testing, in patients presenting with ILI.Cross-sectional study.Primary care in Lithuania, Norway and Sweden.A total of 277 patients at least 1year of age consulting primary care with ILI during seasonal influenza epidemics.Capillary blood CRP analysed as a point-of-care test and detection of influenza A or B on nasopharyngeal swabs in adults, and nasal and pharyngeal swabs in children using PCR.The prevalence of positive tests for influenza A among patients was 44% (121/277) and the prevalence of influenza B was 21% (58/277). Patients with influenza A infection could not be identified based on CRP concentration. However, increasing CRP concentration in steps of 10mg/L was associated with a significantly lower risk for influenza B with an adjusted odds ratio of 0.42 (0.25-0.70; p<.001). Signs of more severe symptoms like shortness of breath, sweats or chills and dizziness were associated with higher CRP.There was no association between CRP and influenza A. Increased concentration of CRP was associated with a lower risk for having influenza B, a finding that lacks clinical usefulness. Hence, CRP testing should be avoided in ILI, unless bacterial pneumonia is suspected. Key points Identifying influenza A or B as cause of influenza-like illness (ILI) is a challenge due to non-specific symptoms. There was no association between concentration of CRP and influenza A. Increased concentration of CRP was associated with a lower risk for having influenza B, a finding that lacks clinical usefulness. A consequence is that CRP testing should be avoided in ILI, unless bacterial pneumonia or similar is suspected.
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| 7. |
- Rystedt, Karin
(författare)
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Respiratory tract infections in primary care - aspects of diagnosis and treatment
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Primary health care is accountable for most of the antibiotic prescriptions in humans. In Sweden, most of these antibiotics are used for respiratory tract infections, and pharyngotonsillitis (acute sore throat) is the single respiratory tract infection that leads to most antibiotic prescriptions. The first line treatment for pharyngotonsillitis with presence of group A streptococci is penicillin V 1000 mg three times daily for 10 days. Though, effectiveness of shorter penicillin V treatment for pharyngotonsillitis is unknown. Antibiotic treatment can induce ecological changes in the intestinal microbiota, including emergence of antimicrobial resistance. Previous studies on side-effects from penicillin V therapy, including antimicrobial resistance in the intestinal microbiota, are lacking. To restrict the use of antibiotics, two point-of-care tests have become very popular in Swedish primary care: the C reactive protein (CRP) and rapid antigen detection test for group A streptococci (GAS). They have capacity to restrict unnecessary use of antibiotics in primary care, when used according to the guidelines. However, concentration of CRP in primary care patients with influenza-like illness has not been investigated earlier, and the reliability of rapid tests for GAS after recent penicillin V treatment for pharyngotonsillitis has been questioned. Aim The overall aim of the thesis was to contribute to a safe reduction in antibiotic use and to investigate the benefit of two popular near-patient tests in patients with common RTIs. We set out to: i) determine if a shorter but more intense penicillin V treatment could give a clinical cure rate of GAS pharyngotonsillitis comparable to the currently recommended treatment; ii) compare the presence of GAS in rapid antigen detection test (RADT) and throat culture among patients recently treated with penicillin V for pharyngotonsillitis; iii) evaluate penicillin V effects on the microbiota with a focus on the emergence of β-lactam resistance; iv) examine if CRP can predict presence of influenza A in primary care patients presenting with influenza-like symptoms. Methods The first paper was a randomised controlled non-inferiority trial, comparing penicillin V 800 mg x 4 for 5 days to 1000 mg x 3 for 10 days. The second paper was an observational study comparing the results from RADT and culture for GAS at a follow-up visit within 21 days from inclusion. In the third paper we explored some clinically relevant changes in cultures of faecal swab samples from patients, before and after pencillin V treatment for pharyngotonsillitis. The fourth paper was a cross-sectional study in patients with an influenza-like illness for less than 72 h. The main outcome measures were capillary blood CRP and PCR test for detection of influenza A or B in the upper respiratory tract. Results and conclusions We found penicillin V for 5 days to be non-inferior to the 10-day treatment regarding clinical cure. Hence, it is possible to maintain the clinical effectiveness with a shorter penicillin V treatment for GAS pharyngotonsillitis. The most reported side-effects from treatment were diarrhoea and vulvovaginal symptoms. With the 10-day treatment 35% of patients reported gastrointestinal side-effects and 25% of female patients reported vulvovaginal symptoms. The incidence of these side-effects was lower with the 5-day treatment. We found penicillin V treatment to induce several alterations in the faecal microbiota that are generally considered signs of ecological disturbance, including a significant increase of resistance towards ampicillin and third generation cephalosporins. These findings emphasise the importance to restrict the use of penicillin V. Further, we found no significant difference between the results of RADT and throat culture for GAS after recent penicillin V treatment for pharyngotonsillitis. Thus, we conclude that RADT for GAS is reliable also after recent penicillin V treatment. Finally, we found that the CRP concentrations in patients with influenza-like illness of different confirmed aetiology had a great overlap. We found no association between CRP and confirmed influenza A. We conclude that the CRP concentration cannot predict influenza A in patients with influenza-like illness. The results of this thesis is relevant in other primary care settings. It may influence the future treatment recommendation for pharyngotonsillitis and the clinical use of two popular rapid tests. The demonstrated ecological disturbances in the microbiota from penicillin V treatment ought to raise awareness of the risks from treatment and may guide the design of future studies in the field.
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| 8. |
- Sandblom, Viktor, 1987, et al.
(författare)
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Visualisering av osynliga risker: optimering av strålskydd för säkrare arbetsmiljö
- 2013
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Ingår i: Röntgenveckan 2013, 3-6 september 2013, Uppsala.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Joniserande strålning innebär en ökad risk för cancer och katarakt. Sänkning av gränsvärden och att fler grupper av personal exponeras för strålning, t ex i hybridsalar, kan leda till att fler hamnar i riskzonen. För att minska dessa risker har tekniker utvecklats som visar exponeringen av strålning i realtid, vilket ger helt nya möjligheter för optimering av strålskydd. Mot denna bakgrund initierades ett tvärvetenskapligt samarbete vid Göteborgs universitet, Det övergripande syftet med projektet är att bidra med kunskap om hur visualisering av joniserande strålning i realtid kan användas för att åstadkomma en säkrare arbetsmiljö. Vi undersöker a) om och i så fall för vilka procedurer visuell feedback kan minska personalens exponering för strålning, b) hur personalens agerande kan bidra till detta och c) hur personal förstår information om de registrerade stråldoserna och hur deras individuella erfarenheter kan tas tillvara för att förbättra arbetsmetoder. En pilotstudie av visualisering av doser i realtid under röntgenvägledda procedurer visade att en av tre kardiologer och de assisterande sjuksköterskorna som grupp uppvisade en statistiskt signifikant minskning av sina doser. En slutsats är att systemet för visualisering kan ha en positiv påverkan för optimering av strålskydd och bidra till minskade risker i arbete med joniserande strålning.
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| 9. |
- Stahlgren, G. S., et al.
(författare)
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Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study
- 2019
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Ingår i: Bmj-British Medical Journal. - : BMJ. - 1756-1833 .- 0959-8138. ; 367
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. 17 primary healthcare centres in Sweden between September 2015 and February 2018. Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever >= 38.5 degrees C, tender lymph nodes, coatings of the tonsils, and absence of cough). Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The noninferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. Penicillin V four times daily for five days was noninferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.
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| 10. |
- Tell, David, et al.
(författare)
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Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care
- 2022
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Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Sore throat is a common reason for prescribing antibiotics in primary care, and 10 days of treatment is recommended for patients with pharyngotonsillitis with group A streptococcus (GAS). Our group recently showed that penicillin V (PcV) four times daily for 5 days was non-inferior in clinical outcome to PcV three times daily for 10 days. This study compares duration, intensity of symptoms, and side effects in patients with a Centor Score (CS) of 3 or 4 respectively, after treatment with PcV for 5 or 10 days and evaluates whether all patients with pharyngotonsillitis with a CS of 3 or 4 should be treated for 5 days or if severity of symptoms or CS suggest a longer treatment period. Method Data on symptoms and recovery from patient diaries from 433 patients included in a RCT comparing PcV 800 mg x 4 for 5 days or PcV 1 g x 3 for 10 days was used. Patients six years and older with CS-3 or CS-4 and positive rapid antigen detection test for GAS-infection were grouped based on CS and randomized treatment. Comparisons for categorical variables were made with Pearson's chi-squared test or Fisher's exact test. Continuous variables were compared with the Mann-Whitney U test. Results Patients with CS-3 as well as patients with CS-4 who received PcV 800 mg x 4 for 5 days self-reported that they recovered earlier compared to patients with CS-3 or CS-4 who received treatment with PcV 1 g x 3 for 10 days. In addition, the throat pain as single symptom was relieved 1 day earlier in patients with CS-4 and 5 days of treatment compared to patients with CS-4 and 10 days of treatment. No differences in side effects between the groups were found. Conclusion Intense treatment with PcV four times a day for 5 days seems clinically beneficial and strengthens the suggestion that the 4-dose regimen with 800 mg PcV for 5 days may be the future treatment strategy for GAS positive pharyngotonsillitis irrespectively of CS-3 or CS-4. Trail registration ClinicalTrials.gov ID: NCT02712307 (3 April 2016).
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