[Something for something--physicians, drug industry and general welfare].
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Clinical Trials as Topic↗
Biomedical subjects
Frede Olesen
Publications and source records attributed to Frede Olesen.
Mycoplasma genitalium: prevalence and behavioural risk factors in the general population.
BACKGROUND: Mycoplasma genitalium has been shown to cause urethritis in men and cervicitis in women and may also be a causative agent in female infertility. OBJECTIVE: To estimate the prevalence of urogenital M genitalium infection and identify sexual behavioural risk factors in the general population. METHODS: Participating individuals were 731 men and 921 women aged 21-23 years and not seeking the healthcare system because of symptoms. They answered questionnaires on sexual behaviour and provided samples for M genitalium testing. RESULTS: In women aged 21-23 years, the prevalence of infection was 2.3% (21/921) and in men of the same age it was 1.1% (8/731). For both sexes, an increasing number of partners was associated with a greater chance of being infected. Among women a shorter duration of a steady relationship and having a partner with symptoms was associated with being infected, and for men younger age at first intercourse was associated with M genitalium infection. CONCLUSIONS: We conclude that the prevalence of infection in the general population is too low for population-based screening. However, the development of test algorithms based on behavioural risk factors is a promising alternative.
Adult↗
[The first HPV vaccine is now available].
More than two thirds of carcinomas of the uterine cervix are caused by human papilloma virus (HPV) types 16 and 18, and 90% of all genital warts are caused by HPV 6 and 11. In June 2006, the US Food and Drug Administration accepted the first prophylactic HPV vaccine against HPV 6, 11, 16 and 18 to be offered to girls and young women. This new vaccine is also now available in Denmark. Questions concerning economics, ethics, organization, and vaccine monitoring need to be discussed in connection with the establishment of a vaccine program. In addition, information to the general population as well as to health care providers and decision-makers should have been given a high priority.
Adolescent↗
[A nine-year controlled follow-up study of delirium patients discharged after treatment in a psychogeriatric university department].
INTRODUCTION: Although delirium is a reversible cerebral syndrome, the effect of treatment of the elderly is unsatisfactory, involving prolonged hospitalizations and increased risk of relapse and mortality. The purpose of this study was to evaluate whether hospitalization for delirium (severe delirium) diagnosed by ICD-10 criteria predicts increased morbidity, utilization of health services and mortality. MATERIALS AND METHODS: Delirious inpatients (n = 26) discharged after treatment in an old-age psychiatric university clinic were studied for nine years. In a register-based design, the above-mentioned parameters of the delirium cohort were compared with a group of controls (n = 116). RESULTS: There was a trend to increased mortality in the delirium cohort. Compared with the controls, the delirium cohort had a significantly increased incidence of disorders of vital organs, serious psychiatric disorders, particularly depression, increased use of hospital psychiatry and general practitioner's out-of-hours service, but less use of office-hour services. The incidence of delirium in the cohorts was low. In the delirium cohort, there was no significantly increased use of services or the number of diagnoses in somatic hospitals. CONCLUSION: Increased somatic and psychiatric morbidity and a trend to increased mortality indicate a serious prognosis after severe delirium in the elderly. It is noteworthy that the delirium cohort had increased use of GPs' out-of-hours services but less use of office-hour services.
Aged↗
[General practitioners' attitudes towards the diagnosis of lung cancer and the diagnostic organisation].
INTRODUCTION: The aim of this study was to determine whether there is a nihilistic attitude towards diagnosing lung cancer among Danish general practitioners (GPs) and to obtain the GPs' evaluation of the present approach to lung cancer diagnosis. MATERIALS AND METHODS: A questionnaire was sent to 1,186 randomly selected GPs. Most of the questions addressed the possibilities of improving primary prevention, GPs' attitudes towards diagnosing lung cancer, their opinions about waiting times and their clinical practice. RESULTS: A total of 848 (71%) completed the questionnaire. Only 12% agreed with the statement that the prognosis for lung cancer is so unfavourable that there is no hurry to diagnose the disease, while 22% agreed to the statement that diagnostic delay rarely means anything for the prognosis. About half of the GPs found the diagnostic period too long. There were, however, wide variations among the different counties in Denmark. The majority of GPs followed the recommendations of the Danish Lung Cancer Group for diagnosing lung cancer, especially the elderly GPs, who were also more inclined to make follow-up appointments after lung infections. More than one in every four practitioners was reluctant to use the word "cancer" in referrals to hospitals or for investigation. CONCLUSION: The study showed that Danish GPs do not have a nihilistic attitude towards diagnosing lung cancer and that elderly practitioners are more careful about diagnosing lung cancer. GPs' satisfaction with waiting times varies widely among the different counties in Denmark. Many practitioners were reluctant to use the word "cancer" in referrals.
Adult↗
General practitioners' attitudes toward reporting and learning from adverse events: results from a survey.
OBJECTIVE: To investigate GPs' attitudes to and willingness to report and learn from adverse events and to study how a reporting system should function. DESIGN: Survey. SETTING: General practice in Denmark. MAIN OUTCOME MEASURES: GPs' attitudes to exchange of experience with colleagues and others, and circumstances under which such exchange is accepted. SUBJECTS: A structured questionnaire sent to 1198 GPs of whom 61% responded. RESULTS. GPs had a positive attitude towards discussing adverse events in the clinic with colleagues and staff and in their continuing medical education groups. The GPs had a positive attitude to reporting adverse events to a database if the system granted legal and administrative immunity to reporters. The majority preferred a reporting system located at a research institute. CONCLUSION: GPs have a very positive attitude towards discussing and reporting adverse events. This project encourages further research and pilot projects testing concrete reporting systems.
Adult↗
Evaluation of an intervention designed to enhance involvement of older patients in their own care.
OBJECTIVE: To implement a programme for involvement of older patients aged 70+ in general practice, and to detect quality changes after its implementation. METHODS: The study was performed in 11 European countries as an uncontrolled before-and-after study, in which a number of GPs and patients answered a questionnaire before and after receiving an intervention. The intervention was aimed at motivating, instructing and facilitating GPs and older patients to increase patient involvement during consultation by use of a specially designed consultation leaflet. RESULTS: Valid data from seven countries exist. There was a total of 765 patients and 70 GPs in the pre-intervention phase, and 564 patients and 49 GPs in the post-intervention phase. In the post-intervention group, 43% of the patients thought that the consultation leaflet had improved the consultation and 62% of the GPs found it to be useful. There were no significant differences between pre- and post-intervention patient perceptions of the level of involvement, evaluations of consultations and perceptions of feeling enabled to deal with their health situation. CONCLUSION: Quality of consultations as measured by patient satisfaction and patient enablement did not improve as a result of the intervention, but nearly half of the patients and two thirds of the GPs found the intervention to be useful. Unselected use of this intervention on all patients cannot be advised without further studies on possible effects. Future studies should focus on the applicability and benefits of the methods for special patient groups.
Adult↗
A cluster-randomized trial of the significance of a reminder procedure in a patient evaluation survey in general practice.
OBJECTIVE: . To determine whether adding a reminder procedure to the personal handing out of questionnaires to patients by general practitioners (GPs) in a patient evaluation survey added further information to the study and whether this influenced the results of the evaluations fed back to the GPs. DESIGN: Patient evaluation survey in general practice. STUDY PARTICIPANTS: 6822 patients consulting 60 GPs in a Danish county. GPs were voluntarily participating in a national patient evaluation project. INTERVENTION: We used the EUROPEP instrument for patient evaluation in general practice. It contains 23 items in five dimensions and two additional questions on general satisfaction. GPs were randomized into two groups with and without a reminder procedure. Main outcome measure. Scores in the six assessment dimensions and patient characteristics were compared for the primary and the reminder respondents and between the two randomization groups. In the analyses, we adjusted for the clustering of patients. RESULTS: We found that the use of a reminder procedure increased the response rate. Respondents to a reminder were younger than the primary responding patients and were more critical in their GP assessment. Patient evaluations of the individual GPs were statistically significantly more critical if these reminder responses were included. Absolute differences were too small to have any practical implications. CONCLUSIONS: Adding a reminder procedure to the face-to-face handing out of questionnaires to patients by the GPs increased the response rate significantly but produced no clinically significant differences in the assessment of the GPs.
Adult↗
Psychosocial impact of Chlamydia trachomatis testing in general practice.
BACKGROUND: Urogenital Chlamydia trachomatis infections are widespread, and each year many tests are performed in general practice. AIM: First, to quantify the magnitude of stigmatization, problems related to partner, and anxiety of infertility among men and women tested for C. trachomatis in general practice. Second, to investigate the effect of a C. trachomatis test result on planned future condom use. DESIGN OF STUDY: Comparative cross-sectional study. SETTING: General practices in Aarhus County, Denmark. METHOD: Men and women tested for C. trachomatis in general practice were given a questionnaire about feelings of stigmatization, fear of partner's reaction, fear of future infertility and other psychosocial side effects related to being infected or not infected with C. trachomatis. RESULTS: A total of 277 participated in the study. The response rates were 61% (82/135) and 54% (195/365) among infected and non-infected individuals, respectively. Among the infected individuals 32% (9/28) of the men's partners and 35% (19/54) of the women's partners were upset about the test result, 9% (5/54) of the women and 11% (3/28) of the men split with their partner, 59% (32/54) of the women and 54% (15/28) of the men expressed nervousness about infertility, and 91% (19/21) of the women but only 56% (5/9) of the men said that they would use a condom more often in the future. All these figures were significantly lower for both men and women having C. trachomatis negative test results. CONCLUSION: A chlamydia test affects the individual in terms of sexuality, relation to partner, reproduction, and future contraceptive strategy. The influence is highest among women and individuals with a positive test result. These findings should be taken into account in screening programmes targeting young women and men.
Adolescent↗
Delay in diagnosis of lung cancer in general practice.
BACKGROUND: Lung cancer is a common cancer disease; nevertheless, in Denmark a GP only sees one new case of lung cancer per year. The core symptoms of lung cancer, cough and dyspnoea, are on the other hand very common in general practice. This represents a challenge to the diagnostic process and increases the risk of diagnostic delay. AIM: To explore diagnostic delay in primary health care among patients with lung cancer. DESIGN OF STUDY: A population based observational case series of 84 lung cancer patients' delay. SETTING: The County of Aarhus, Denmark. METHOD: From county-based registers of all histological and cytological tests we identified all patients in the County of Aarhus with lung cancer diagnosed during a 6 month period in 2003. Inclusion was verified by contacting the departments involved in the treatment of lung cancer. Data were based on telephone interviews with patients' GPs. A review of delay was made starting with the first symptom until referral to secondary care. RESULTS: The overall median delay in primary health care was 32.5 days (interquartile interval (IQI) = 12-68 days). One-third of the patients were referred to the diagnostic investigation after their first consultation. Important reasons for delay in primary care were: symptoms not related to the lungs, chest X-ray without suspicion of cancer, comorbidity, waiting times for investigations and lack of explicit follow-up appointment. Prolonged delay was often due to a combination of these factors. CONCLUSION: When diagnosing lung cancer, it is important that GPs are aware of the low sensitivity of chest X-ray. Shorter waiting times for investigations could reduce delay considerably.
Adult↗
[The use of Danish day-time general practice. Status and perspectives].
This paper examines the development in the use of Danish general practice in the years 1992 to 2001. The use of general practice increased by 17%. The number of consultations increased by 12%, the number of telephone consultations increased by 25%, and the number of home visits decreased by 18%. The number of Danish citizens increased by 3.6%, but the number of GPs increased by 7.2%. The number of contacts per GP increased by more than 10%. The percentage of citizens attending general practice within a year increased from 80% to 85%. This would have resulted in only a 6% increase, assuming an average attendance rate similar to that of the population. The 50% least frequently attending patients accounted for 18% of all contacts. In comparison, the 10% most frequently attending patients accounted for 33% of all contacts.
Adult↗
[A new, empirically established hypochondriasis diagnosis--secondary publication].
The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it a rarely used diagnosis. Based on a latent class analysis of the symptoms exhibited by 701 patients (ages 18-65) in general practice, a new and more valid hypochondriasis diagnosis was defined in this study. The main symptom is "obsessive rumination about illnesses", and the patient must also have at least one of five other symptoms. The prevalence was 9.5 for both genders. There was a good agreement between the diagnoses made during the psychiatric interview and the physicians' assessments.
Adult↗
[Does the introduction of electronic medical records affect the use of ambulatory services?].
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Ambulatory Care↗
Screening for common mental disorders: who will benefit? Results from a randomised clinical trial.
BACKGROUND: Outcomes of studies on mental health screening in primary care are conflicting. A feasible and effective case-finding approach could benefit both GPs and their patients. OBJECTIVES: (1) to examine the effect of using a composite screening questionnaire (SQ) on GPs' recognition and provision of care, and (2) to outline useful strategies for case-finding. METHODS: 38 GPs in Aarhus County, Denmark, volunteered to participate in this trial. 1785 consecutive patients aged 18-65 years consulting with new health problems were included. Patients were screened before consultation using an SQ including scales for somatisation, anxiety, depression and alcohol abuse. Patients were randomised into one of two groups: 900 questionnaires were disclosed to and scored by GPs, 885 were blinded. Number of diagnoses, subjects of conversation, and actions taken were analysed. Additional analyses aimed to identify GP and patient factors that could predict improved outcomes. RESULTS: Overall, disclosure of SQ results increased GPs' recognition of mental disorders by 3.8% [95% confidence interval (CI) -0.5% to 8.0%], and 6.6% (95% CI 1.2% to 12.0%) for patients screened positive. There was a marked variation in GPs' detection rates, and for GPs with moderate or low recognition rates increases were significant (P = 0.001). Conversation on psychological topics increased by 3.2% (95% CI -0.7% to 7.1%), and by 7.0% (95% CI 1.8% to 12.3%) for patients screened positive. Rates of planned follow-up consultations increased by 3.9% (95% CI 0.6% to 7.3%) and by 4.9% (95% CI 0.7% to 9.1%) for patients screened positive. GPs' self-reported benefit from screening was related to better outcomes. A range of patient and GP factors suggesting added value from using SQs were identified. CONCLUSION: GPs' recognition and provision of mental health care can be influenced by the use of composite SQs. Perceived benefit from screening may serve as a useful predictor of better patient management. Pragmatic case-finding approaches need further evaluation.
Adolescent↗
A randomised controlled trial of brief training in assessment and treatment of somatisation: effects on GPs' attitudes.
BACKGROUND: Somatising patients frequently present in primary care but GPs often express frustration in dealing with them. A negative attitude may result in missed diagnoses and ineffective treatment. OBJECTIVE: This study aimed to evaluate the effect of a novel, multifaceted training programme on GPs' attitudes towards somatisation. METHODS: The study was performed as a cluster randomised controlled trial with practices as randomisation unit and with a follow-up period of 12 months. Forty-three GPs from 27 practices in Vejle County, Denmark participated. The intervention consisted of a cognitive-oriented educational programme on assessment, treatment and management of somatisation (The Extended Reattribution and Management Model). Outcome measures were GPs' attitudes toward somatoform disorder and somatisation in general measured by the means of questionnaires at baseline and follow-up. The primary outcome was a change in response. RESULTS: Baseline values confirmed previous findings that GPs find it difficult to deal with somatising patients. Compared with the control doctors, intervention doctors' attitudes towards patients with somatoform disorders had changed significantly 12 months after training on the parameters enjoyment (P = 0.008) and anxiety (P = 0.002). Doctors also felt more comfortable in dealing with somatising patients in general (P = 0.002). Attitudes about other parameters related to the doctors feelings, aetiology and course of somatisation changed in the expected direction, but these changes were not statistically significant. CONCLUSION: A brief multifaceted training programme focussing on somatisation was accompanied by a significant change in GPs' attitude towards patients with somatoform disorders.
Adult↗
A brief case-finding questionnaire for common mental disorders: the CMDQ.
OBJECTIVES: The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). METHODS: A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias. RESULTS: Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated. CONCLUSION: The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.
Adolescent↗
[Management of medically unexplained symptoms].
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Humans↗
Elderly patients' and GPs' views on different methods for patient involvement: an international qualitative interview study.
BACKGROUND: Elderly patients' interaction with the GP may be improved through patient involvement techniques, and there is a variety of such techniques which improve patients' involvement in their own care, although little is known about their acceptability. OBJECTIVES: The aim of this study was to identify barriers and facilitators for using patient information leaflets and patient satisfaction questionnaires as methods for increasing elderly patients' involvement in general practice care by comparing their views with the GPs' views on these two types of methods. METHODS: In seven countries (Austria, Denmark, Germany, The Netherlands, Portugal, Slovenia and Switzerland) 146 GPs and 284 patients aged 70 and over were interviewed about the use and the acceptability of these two methods. Interviewers followed a semi-structured interview guide, and all interviews were tape-recorded and transcribed verbatim. RESULTS: The arguments for using patient satisfaction questionnaires were that they would provide the GP with more information, function as a basis for change, increase patients' self-confidence and make them more conscious of what to expect. Barriers for their use were cognitive impairment among patients, fear that they would not answer honestly and opposition to written material. The arguments for patient information leaflets were that they could support patients' memories, educate patients and promote their self-responsibility. The barriers were cognitive impairment among patients and fear that they would give them false impressions of what to expect. CONCLUSION: Both instruments were generally well accepted by both GPs and patients. Their use seemed to be dependent upon the individual GP's attitude and the patients' cognitive capacities.
Adult↗