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Biomedical subjects

H Melbye

Publications and source records attributed to H Melbye.

13 recordsLinked to original sources
PubMed1992

Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice.

Etiology and clinical manifestations have been studied in 153 adult patients with lower respiratory tract infection, and the results are presented according to clinical and radiographic diagnosis. Laboratory investigations revealed that bacterial infection, mycoplasma and chlamydia included, occurred as often in 22 patients whose clinical diagnoses of pneumonia were not evident radiographically, as in 20 patients with radiographic pneumonia. In the latter group significantly higher values of erythrocyte sedimentation rate and C-reactive protein were demonstrated. The most common pathogen was influenzavirus A, followed by respiratory syncytial virus, Streptococcus pneumoniae, and Mycoplasma pneumoniae. Chlamydia pneumoniae infection was found in 3 patients with radiographic pneumonia. The study supports the traditional view that patients with a positive chest radiograph as a rule present more serious manifestations of lower respiratory tract pathology than patients with a normal radiograph. However, as only 1/9 patients with pneumococcal infection and 2/7 with mycoplasmal infection had radiographic evidence of pneumonia, radiography alone did not seem to offer sufficient information for selecting patients for antibacterial therapy.

Adult↗
PubMed1992

Diagnosis of pneumonia in adults in general practice. Relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard.

The diagnostic value of typical symptoms and abnormal chest signs for pneumonia have been evaluated against a radiographic reference standard in 402 adult patients with respiratory tract infection in general practice. Pneumonia was diagnosed in 20 patients by a positive chest radiograph. The doctors diagnosed pneumonia in seven of these on the basis of history and physical examination alone, and in addition in 22 patients with normal radiographs. The diagnostic value of the typical symptoms cough, chest pain, and dyspnoea, reported by the patients on a questionnaire, increased with increasing intensity of the symptoms, and both "very annoying lateral chest pain" and "very annoying dyspnoea" had likelihood ratios (LR) between 4 and 5. The LR of crackles was 3.7. When evaluated against the doctor's clinical diagnosis of pneumonia as reference standard, crackles achieved an LR of 14.8, while the typical symptoms achieved lower LRs than when evaluated against the radiographic reference standard. These discrepancies, which were confirmed by logistic regression, indicate that crackles and other abnormal chest findings are interpreted too frequently as features of pneumonia and that the importance of typical symptoms is underestimated in the diagnosis of pneumonia.

Adult↗
PubMed1992

Laboratory tests for pneumonia in general practice: the diagnostic values depend on the duration of illness.

The usefulness in the diagnosis of pneumonia of temperature and the laboratory tests: erythrocyte sedimentation rate (ESR), leucocyte count, and C-reactive protein (CRP) was evaluated against a radiographic reference standard in 402 adult patients with respiratory tract infection in general practice. Radiographic pneumonia was diagnosed in 20 patients. CRP and ESR were the most useful tests. CRP greater than 50 mg/l had lower sensitivity and likelihood ratio (LR), 0.50 and 4.8, respectively, compared with previous studies of selected patient populations. Among patients whose duration of illness exceeded six days the corresponding LR was 11.3, due to a higher specificity in this subgroup of patients. ESR and oral temperature were also more useful in this subgroup than in patients with a shorter duration of illness. A highly significant diagnostic contribution of adding ESR and CRP to history and physical examination, particularly when the illness had lasted one week or more, was demonstrated by logistic regression.

Blood Sedimentation↗
PubMed1992

Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia.

Acute chest radiographs were obtained from 319 adult patients with acute respiratory infections. Where a lower respiratory infection was diagnosed, follow-up chest radiographs were obtained in most patients. A radiologic panel diagnosed pneumonia in 21 patients. The agreements between the panel and 3 independent interpreters, 2 residents in radiology, and one senior chest physician, were assessed. Also the reports given by the specialist in radiology at the Department of Radiology were compared with the panel's evaluation. While the kappa-agreements between the panel's interpretations and those by the Department of Radiology and the consultant in chest medicine was 0.71 and 0.72, respectively, the corresponding kappa-values between the residents and the panel was only 0.50. The proportion of agreement when pneumonia was diagnosed was 0.56 between the panel and the Department of Radiology, and 0.59 between the panel and the chest consultant, compared to 0.36 between the panel and the residents. The study demonstrates the difficulty of diagnosing outpatient pneumonia and the importance of experience.

Adolescent↗
PubMed1991

["Hello, doctor's office? May I talk to the doctor?" An analysis of telephone accessibility in offices of general practitioners. A survey of patients in northern Norway 1987].

In a survey among 3,739 patients belonging to 36 general practices in northern Norway, 33% reported difficult access to their local surgery by telephone. 43% reported difficulty in obtaining access to the doctor once they had obtained contact with the reception. The proportion of patients reporting problems of accessibility by telephone varied greatly, from 5 to 75%. Patients belonging to practices located in towns, with long waiting lists and many doctors, were most dissatisfied with the telephone service. Stable doctor/patient-relationships made direct contact with the doctor easier, while a scheduled time when patients could call the office made direct contact more difficult. We discuss ways to improve accessibility by telephone.

Family Practice↗
PubMed1991

[C-reactive protein, SR and white blood cell count in acute lower respiratory tract diseases. The usefulness of blood tests in diagnosis of pneumonia].

C-reactive protein (CRP) analysis, erythrocyte sedimentation rate and white blood cell count were evaluated as tests in the diagnosis of pneumonia in 84 patients with acute lower respiratory disease. Marked elevated values of CRP were frequently found in pneumonia patients, whereas in most patients with acute asthma, acute exacerbation of chronic obstructive bronchitis and acute bronchitis the values were within the normal range. The combined sensitivities and specificities of the tests were best for CRP, followed by erythrocyte sedimentation rate and white blood cell count.

Adolescent↗
PubMed1991

Symptomatic effect of inhaled fenoterol in acute bronchitis: a placebo-controlled double-blind study.

The symptomatic effect of inhaled fenoterol, a beta 2-agonist, 0.2 mg 4 times daily for 7 days, was evaluated in 80 patients with acute bronchitis examined at the Chest Clinic, Department of Medicine, University Hospital of Tromsø. Seventy-three patients completed the trial. End-point FEV1 (% predicted) showed a mean increase of 5.1% in the fenoterol group and 0.5% in the placebo group (p = 0.006). The corresponding decrease in total symptom score after one week was 67% and 51%, respectively (p = 0.06). In a subgroup of 35 patients with either bronchial hyper-responsiveness, wheezes on auscultation or FEV1 less than 80% of predicted at entry, a statistically significant difference in reduction of total symptom score in favour of fenoterol was demonstrated on the second day of the trial. No difference was found in the 38 patients with normal lung findings. Fenoterol was useful when objective signs of bronchial involvement was present and may be applicable to the treatment of acute bronchitis.

Acute Disease↗
PubMed1991

Chlamydia pneumoniae respiratory tract infection: the interpretation of high titres in the complement fixation test.

Sera from 5 acute respiratory disease patients from Northern Norway presenting with high chlamydia complement fixation (CF) titres, were analyzed for Chlamydia pneumoniae-specific IgG and IgM in a micro-immunofluorescence (micro-IF) test that included antigens from the prototype strain TW 183, and a Norwegian isolate, FML 10. The patients were confirmed to have had C. pneumoniae infection based on serologic findings. This establishes the clinical significance of early CF results in this geographical area. However, different micro-IF titres against the 2 C. pneumoniae isolates tested suggest antigenic variability among the species.

Adolescent↗
PubMed1990

[What do patients think of primary health care? A questionnaire study among patients in Northern Norway in 1987].

Doctors and professional health administrators have been the principal decision-makers and the patients have hardly had any direct influence on the planning and organization of primary health care in Norway. In 1987, in order to draw attention to patient opinions, the Institute of Community Medicine, University of Tromsø, conducted a questionnaire survey among patients attending general practices in North Norway. The question were selected to cover issues in the contemporary debate on the ideology, organization and standards of services of general practitioners. 36 teaching practices in the region were included in the survey. Altogether 3,739 questionnaires were returned, a response rate of over 60%. The respondents reported more than 16,000 consultations during the last year. This paper presents the methods used and the main findings concerning the representativeness of the results and the potential for generalization. Subsequent publications will present detailed results from the study within the framework of patient experiences, preferences and expectations.

Adolescent↗
PubMed1990

[A personal physician, wishes and realities in Northern Norway. A patient study in Northern Norway in 1987].

Among patients consulting general practitioners in northern Norway, 57% had a stable relationship with one doctor, according to answers to a questionnaire. Rather than having a free choice between several doctors, 85% preferred to have a personal doctor. About half the patients wanted the same doctor for the whole family. Even if they had to wait longer for the consultation, 63% would prefer to meet their own doctor. A personal doctor was much less common in northern Norway than in the rest of the country, which could be put down to lower stability in the practices.

Adolescent↗
PubMed1988

The diagnosis of adult pneumonia in general practice. The diagnostic value of history, physical examination and some blood tests.

Because of lower respiratory infection that was treated with antibiotics on the suspicion of pneumonia, 71 patients aged 15 years or more were referred to the study by general practitioners. Using a positive chest X-ray as a "gold standard", 15% had pneumonia. The diagnostic value of variables from history, physical examination and blood tests was evaluated by calculating the likelihood ratio (LR). A duration of illness less than 24 hours before consulting the general practitioner was the variable from the history with the highest LR, 13.5. The white blood cell count and particularly the C-reactive protein analysis had a high diagnostic value, CRP greater than 50 mg/l had an LR of 37. In this selected material pulmonary symptoms and lung findings were of minor value in differentiating patients with and without pneumonia, with no LR exceeding 2.3. This can be explained to some extent by selection bias.

Adolescent↗