| 11. |
- André, Malin, et al.
(författare)
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The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned
- 2004
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:3, s. 192-197
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Tidskriftsartikel (refereegranskat)abstract
- A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p<0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p<0.001). However, 59% of the patients assigned viral diagnoses with CRP≥25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.
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| 12. |
- André, Malin, et al.
(författare)
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Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests
- 2002
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 0036-5548 .- 1651-1980. ; 34, s. 880-
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Tidskriftsartikel (refereegranskat)abstract
- A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.
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| 13. |
- André, Malin, et al.
(författare)
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Use of rules of thumb in the consultation in general practice : an act of balance between the individual and the general perspective
- 2003
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 20:5, s. 514-519
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Tidskriftsartikel (refereegranskat)abstract
- Background. Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice. Objective. The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice. Methods. An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis. Results. A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment. Conclusion. Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.
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| 14. |
- Axelsson, Inge, 1947-, et al.
(författare)
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Luftvägsinfektioner hos barn och vuxna
- 2009
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Ingår i: Läkemedelsboken 2009-2010. - Stockholm : Apoteket AB. ; , s. 670-695
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Luftvägsinfektioner är en av de vanligaste orsakerna till ett akut besök i sjukvården. Antalet läkarbesök och antibiotikarecept ökar markant några veckor efter daghemseller skolstarten och minskar under lovperioder. Hos läkare och allmänhet finns en ökad medvetenhet om nödvändigheten av att vara försiktig med antibiotika. Flera studier har visat att nyttan av antibiotika är liten vid flera av våra vanligaste bakteriella infektioner, vilket också framkommit i de nya nationella rekommendationerna för handläggning av öroninflammationer (år 2000), halsinfektioner (år 2001), bihåleinfektioner (år 2005) och nedre luftvägsinfektioner (år 2008) (, ). En hög följsamhet till barnvaccinationsprogrammet och en hög vaccinationsgrad av äldre mot influensa och pneumokocker förebygger infektioner och bakteriella komplikationer och medför minskad morbiditet och mortalitet. Förbättrad basal hygien, speciellt i småbarnsgrupper, med handtvätt, pappersnäsdukar och pappershanddukar kan minska infektionsspridning och sjuklighet i luftvägsinfektioner.
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| 15. |
- Barabas, G, et al.
(författare)
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No association between elevated post-void residual volume and bacteriuria in residents of nursing homes
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:1, s. 52-56
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.
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| 16. |
- Bolmsjö, Beata Borgström, et al.
(författare)
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Risk factors and consequences of decreased kidney function in nursing home residents : A longitudinal study
- 2017
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Ingår i: Geriatrics & Gerontology International. - : Wiley. - 1444-1586 .- 1447-0594. ; 17:5, s. 791-797
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the present study was to study the renal function and the relationship of deterioration in renal function with major outcomes in elderly nursing home residents. A second aim was to compare the internationally recommended formulae for estimated glomerular filtration rate (eGFR) consisting of both creatinine and cystatinC in a nursing home population. Methods: A total of 429 patients from 11 nursing homes were included during 2008-2011. GFR was estimated, from formulae based on both creatinine and cystatinC, at baseline and after 1 and 2years. The patients were divided into groups based on chronic kidney disease level, and comparisons were made for mortality, morbidity, the use of medications and between the different formulae for eGFR. Results: Survival was lower in the groups with lower renal function. Over 60% of the residents had impaired renal function. Those with impaired renal function were older, had a higher number of medications and a higher prevalence of heart failure. Higher number of medications was associated with a greater risk of rapid decline in renal function with an odds ratio of 1.2 (95% confidence interval 1.06-1.36, P=0.003). The compared eGFR formulae based on both cystatinC and creatinine were in excellent concordance with each other. Conclusions: Decreased renal function was associated with increased mortality. A majority of nursing home residents had declining renal function, which should be considered when prescribing medications. The more medications, the higher the risk for rapidly declining renal function.
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| 17. |
- Borgström-Bolmsjö, Beata, et al.
(författare)
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Prevalence and treatment of heart failure in Swedish nursing homes
- 2013
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 13:118
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since the burden of care for elderly patients with heart failure (HF) can be decreased by therapeutic measures, it is important that such patients are identified correctly. This study explores the prevalence of HF in nursing homes in Sweden, with special consideration of the risk of failure to diagnose HF in the study population. A second aim is to explore medication and the adherence to guidelines for the treatment of HF. Methods: 429 patients from 11 nursing homes were included during 2008-2011. Information about diagnoses and medications from patient records, blood samples, questionnaire responses and blood pressure measurements were collected. The baseline characteristics of the patients, their medications and one-year mortality were identified and then compared regarding HF diagnosis and B-type natriuretic peptide (BNP) levels. A BNP level of greater than 100 ng/L was used to identify potential cases of HF. Results: The point prevalence of HF diagnosis in the medical records in the study population was 15.4%. With the recommended cut-off value for BNP, up to 196 subjects in the study population (45.7%) qualified for further screening of potential HF. The subjects in the HF and non-HF groups were similar with the exception of mean age, BNP levels and Mini Mental State Examination results which were higher in the HF group, and the eGFR and blood pressure, which were lower when HF. The subjects with higher BNP values were older and had lower eGFR, Hb, diastolic blood pressure and BMI. The subjects with HF diagnoses were in many cases not treated according to the guidelines. Loop diuretics were often used without concomitant ACE inhibitors or angiotensin receptor blockers. The subjects without HF diagnoses in the medical records at inclusion but with BNP values greater than 100 ng/L had less appropriate HF medication. The one-year mortality was 52.9% in the population with HF. Conclusions: Our study suggests that the estimated prevalence of HF in nursing homes in Sweden would increase if BNP measurements were used to select patients for further examinations. The pharmacological treatment of HF varied substantially, as did adherence to guidelines.
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| 18. |
- Borgström-Bolmsjö, Beata, et al.
(författare)
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The nutritional situation in Swedish nursing homes - A longitudinal study
- 2015
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 60:1, s. 128-133
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Tidskriftsartikel (refereegranskat)abstract
- Poor nutritional status is widespread among the elderly and is associated with increased morbidity and mortality. The aim of this study was to longitudinally describe the nutritional status in elderly people living in nursing homes. Nutritional status was recorded longitudinally in elderly people living in 11 different nursing homes in Sweden. Participants were examined at baseline by specially trained nurses who also assisted with questionnaires and collected data for current medical treatment from patient records. Nutritional status was evaluated at baseline and after 24 months with the mini nutritional assessment (MNA). The study included 318 subjects. The mean age of the participants was 85.0 years (range 65-101). At baseline, 41.6% were well nourished, 40.3% at risk of malnutrition, and 17.7% malnourished according to the MNA. Survival was significantly lower in the malnourished group. After 24 months, almost half of the population had died. The group of participants who survived at 24 months represents a population of better nutritional state, where 10.6% were malnourished at baseline increasing to 24.6% after 24 months. After 24 months, 38.7% of the participants showed a decline in nutritional state. The group with deteriorating MNA scores had higher weight, BMI values, and a higher hospitalization rate. The prevalence of malnutrition in nursing home residents increased over time and it is important to evaluate nutritional state regularly. Nutritional interventions should be considered in better nourished groups, as well as in malnourished individuals, to prevent a decline in nutritional state.
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| 19. |
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| 20. |
- Butler, Christopher, et al.
(författare)
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Antibiotica voor acute hoest: het voorschrijfgedrag van huisartsen in dertien Europese landen [Antibiotics in case of acute cough: Prescribing habits of general practitioners in 13 European countries]
- 2009
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Ingår i: Huisarts en Wetenschap. - 0018-7070 .- 1876-5912. ; 52:12, s. 571-575
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Tidskriftsartikel (refereegranskat)abstract
- Doel Ons doel was in kaart te brengen hoe vaak huisartsen in verschillende Europese landen antibiotica voorschrijven voor acute hoest, en welk effect dit heeft op het ziektebeloop.Methode Wij verrichtten een cross-sectioneel prospectief observationeel onderzoek onder volwassen patiënten in 13 Europese landen die met een nieuwe of verergerende hoest bij de huisarts kwamen of bij wie de huisarts een infectie van de lage luchtwegen vermoedde. De huisartsen noteerden bij presentatie de symptomen en welk beleid zij volgden, de patiënten hielden 28 dagen een symptoomdagboek bij. Onze primaire uitkomstmaten waren het voorschrijven van antibiotica en het beloop van de symptomen in de tijd.Resultaten Aan het onderzoek namen 384 huisartsen deel, die 3402 patiënten includeerden. Van 3296 (97%) patiënten ontvingen de onderzoekers een volledig registratieformulier en van 2560 (75%) patiënten een compleet symptoomdagboek. De ernst van de symptomen bij presentatie (gescoord door de huisarts op een schaal van 0 tot 100) varieerde van 19 in Spanje en Italië tot 38 in Zweden. In gemiddeld 53% van de episoden schreven de artsen antibiotica voor, maar dit varieerde per land van 20% tot bijna 90% (België 25,9%, Nederland 41,5%). Ook na correctie voor klinische presentatie en demografische kenmerken bleven de verschillen aanzienlijk. Noorse huisartsen schreven het minst vaak antibiotica voor (OR 0,18; 95%-BI 0,11 tot 0,30), Slowaakse het vaakst (OR 11,2; 95%-BI 6,20 tot 20,27). Ook het soort antibioticum varieerde sterk. Amoxicilline, het meest voorgeschreven middel, werd in Noorwegen het minst vaak gegeven (3% van de voorgeschreven antibiotica), in Engeland het vaakst (83%). Fluorochinolonen werden in sommige landen helemaal niet voorgeschreven, maar in Italië aan 18% van de patiënten. Patiënten die geen antibiotica kregen, herstelden nagenoeg even snel als patiënten die wel antibiotica kregen.Conclusie De variatie in de klinische presentatie biedt geen verklaring voor de grote verschillen in het voorschrijven van antibiotica bij lageluchtweginfecties en/of hoest in Europa. Antibiotica hebben nauwelijks invloed op het herstel van de hoestklachten.
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