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Biomedical subjects

J Straand

Publications and source records attributed to J Straand.

27 records · Page 2Linked to original sources
PubMed1997

General practitioners' drug prescribing practice and diagnoses for prescribing: the Møre & Romsdal Prescription Study.

We have examined the prescribing patterns among general practitioners (GPs) in a Norwegian county in relation to the patients' age and sex and the diagnosis for prescribing. Altogether 69,843 contacts with patients were recorded during which 56,758 items were prescribed. The average number of items prescribed per patient contact was 0.81 (male 0.76, female 0.83). Diazepam, the compound analgesic of paracetamol (i.e. acetaminophen) and codeine, and triazolam were the three most frequently prescribed drugs for females as compared to phenoxymethylpenicillin, paracetamol/codeine and diazepam for males. Insomnia was the most frequently recorded diagnosis for prescribing. Listed second were upper respiratory tract infections (males) and anxiety (females). Hypertension was the number three diagnosis. The twenty most frequently prescribed items accounted for 48.5% of all drugs prescribed and the twenty most frequently recorded diagnoses for prescribing accounted for 61.7% of all diagnoses. This makes it possible to analyze a substantial part of the GPs' total prescribing by focusing on a few drugs or diagnoses.

Adult↗
PubMed1997

Drug prescribing during direct and indirect contacts with patients in general practice. A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To describe general practitioners' (GPs) prescribing patterns during direct contacts (DC) vs. indirect contacts (IC) with respect to the patients (age and sex), diagnoses, and drugs. DESIGN: Descriptive study. SETTING: In the Norwegian county Møre & Romsdal, the GPs recorded all contacts with patients and prescriptions during two months. SUBJECTS: 69843 contacts with patients (42202 DC; 24983 IC) during which 56758 prescriptions were issued. MAIN OUTCOME MEASURES: Prescriptions (drugs, strength of tablets, amount prescribed, initial/repeat). Diagnoses for prescribing. RESULTS: 72 drugs were prescribed per 100 DC; 93 per 100 IC. The drugs prescribed most frequently during DC were CNS-drugs (19%), antibiotics (18%), and respiratory drugs (14%); and during IC, CNS-drugs (34%), cardiovascular (16%), and respiratory drugs (12%). More prescriptions during IC were repeat (IC, 79%; DC, 37%). 57% of all CNS-drugs were issued during IC (90% of which were repeat prescriptions). 25% of the antibiotics were issued during IC (70% of which were initial prescriptions). CONCLUSION: The GPs' prescribing patterns during DC and IC are different, which probably reflects that different health problems are handled during DC and IC. Prescription studies should address both settings. Our findings raise concern about the medical foundation for antibiotic and psychotropic prescribing during IC.

Adolescent↗
PubMed1997

Are prescribing patterns of diuretics in general practice good enough? A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To examine general practitioners' (GPs) prescribing patterns of diuretics with respect to indications, drugs and doses to reveal possible needs for prescribing audits. DESIGN: Observational, cross-sectional study. SETTING: The Norwegian county Møre & Romsdal. SUBJECTS: 1896 prescriptions for diuretics prescribed by GPs during two months. MAIN OUTCOME MEASURES: Prescriptions (drugs, strength of tablets, volume prescribed, directions for use). Diagnoses for prescribing. RESULTS: Furosemide was prescribed most frequently (48.7%) followed by the compound diuretic of hydrochlorothiazide and amiloride (26.4%), thiazides and related drugs (13.0%), and spironolactone (5.8%). Diuretics were mainly prescribed for hypertension (48.4%), congestive heart failure (35.6%), and oedemas (e.g. orthostatic) (6.1%). The patients' mean age was 69.2 years; two of three were females. When thiazides and related drugs were prescribed for hypertension, we found that the daily dose was excessive in 37.2% of the cases. In congestive heart failure, furosemide was prescribed in about four of five cases, while bumetanide was prescribed in 1.5% of the cases. CONCLUSION: Our findings indicate that GPs need more knowledge about low-dose diuretic therapy in hypertension, about different diuretic regimens in heart failure, and about non drug treatment for orthostatic oedema. Clinical pharmacology regarding diuretics should be given priority in the vocational training and continuing education for GPs.

Adolescent↗
PubMed1997

General practitioners' prescribing patterns of benzodiazepine hypnotics: are elderly patients at particular risk for overprescribing? A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To compare general practitioners' (GPs) prescribing patterns of benzodiazepine hypnotics with current recommendations. DESIGN: Observational, cross-sectional study. SETTING: The Norwegian county Møre and Romsdal. SUBJECTS: 3452 prescriptions for benzodiazepine hypnotics prescribed by GPs for patients aged 20 years and older during two months. MAIN OUTCOME MEASURES: Prescriptions (strength of tablets, amount prescribed given in Defined and Prescribed Daily Doses: DDDs and PDDs, directions for use); initial or repeat, patients (age, sex); kind of GP-patient contact during prescribing. RESULTS: 68.4% of the prescriptions for benzodiazepine hypnotics were for women; 52.7% were for patients aged 65 or older (65+); 59.9% were issued during indirect contacts; 81.9% were repeat prescriptions. The amount of drug per prescription increased with patients' age: 65+ received on average 69.9 DDDs (76.9 PDDs) per prescription compared with 34.4 DDDs (37.1 PDDs) for young adults (20-29 years). About four of five prescriptions were for the "strong" (i.e. 1 tablet = 1 DDD) sleeping pills irrespective of patients' age and type of prescription (initial or repeat). Written directions for use were: "to be taken daily" in 55.1%, and "only if required" in 38.0% of the prescriptions. Written information on duration of "cure" was only found in one case. CONCLUSIONS: GPs' prescribing patterns are not in accordance with recommended dosage and duration of treatment; this pattern is most pronounced for elderly patients.

Adult↗
PubMed1996

[From barber-surgeons' guild to medical association. A 400th anniversary].

The barber-surgeons' guild in Bergen was founded on 17 January 1597. For nearly 250 years this was the only "medical association" in Norway. The guild disappeared with the death of its latest master, Christian Wilhelm Wisbech (1740-1822). However, only nine years later his son, Christian Wisbech (1801-69), founded the Medical Association in Bergen. The barber-surgeons were craftsmen who got their education by apprenticeship. They were the medical practitioners of their times. Their empirical knowledge was more in touch with real life than was the medicine taught by the professors. This paper describes the barber-surgeons' education and work, including their conflicts with other craftsmen and doctors. During the 18th century the barber-surgeons' education was improved, and eventually was given full academic status.

Barber Surgeons↗
PubMed1995

Can drug treatment be improved by feedback on prescribing profiles combined with therapeutic recommendations? A prospective, controlled trial in general practice.

We have carried out a prospective, controlled trial to ascertain whether mailed feedback on general practitioners' (GPs) own prescribing combined with relevant recommendations on drug treatment, can improve the prescribing. The GPs in the Norwegian county of Møre and Romsdal recorded all their contacts with patients and prescriptions during two periods. After the first period the GPs in Romsdal only (intervention group) received a mailed report giving their prescribing profiles as well as treatment recommendations for insomnia and acute cystitis. The total number of contacts with patients was 68,625 in which 55,747 items were prescribed. The GPs in the intervention group changed their prescribing in accordance with the intervention: they prescribed significantly less sleeping-pills for each patient, preferred short- to long-acting benzodiazepine hypnotics and tranquilizers, and they chose trimethoprim as a first line treatment for acute cystitis. We conclude that it is possible to improve the GPs' prescribing through mailed feedback.

Acute Disease↗
PubMed1994

[Roboratio or relaxatio? Clinical theory and practice in the 19th century].

The first Norwegian medical school was founded in 1814. Niels Berner Sørenssen (1774-1857), one of three professors, was responsible for teaching pathology and therapy, and for clinical education. Together with his student and successor, Andreas Christian Conradi (1809-68), he made his mark on Norwegian physicians for a period of 50 years. A few years ago a small handwritten book by a medical student, dated 1828, turned up in a second-hand market. This book, which contains notes from Professor Sørenssen's lectures on therapy, demonstrates that his teaching was heavily influenced by the speculative theories of John Brown (1735-88). Similar influence is traceable in the annual reports from Norwegian physicians during the second half of the 19th century. Sørenssen urged his students to thoroughly investigate the medical history and make a detailed clinical examination, and his attitude to therapy was careful, almost reluctant. This personal clinical attitude was probably more important than the theoretical foundation upon which he based his lectures.

Curriculum↗
PubMed1993

Withdrawing long-term diuretic treatment among elderly patients in general practice.

The aim of this study was to elaborate, implement and evaluate a strategy for discontinuation of long-term diuretic treatment in elderly patients in general practice. Thirty-three patients were enrolled for a supervised step-down and withdrawal of diuretics. After withdrawal, the patients were followed up for 6 months or until diuretic treatment was re-established. Withdrawal was successful according to the protocol in 18 cases. Diuretic withdrawal failed and the treatment was re-established in 15 cases, four of which were sudden cardiovascular events. Most withdrawal failures were identified by routine examinations through the follow-up programmes, thus they had few consequences for the patients. This demonstrates that careful follow-up is essential after diuretic withdrawal. Our findings support the view that a large proportion of elderly patients on diuretics may not need such treatment.

Aged↗