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Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines.

https://arctichealth.org/en/permalink/ahliterature128584
Source
Scand J Prim Health Care. 2012 Mar;30(1):10-5
Publication Type
Article
Date
Mar-2012
Author
Mark Fagan
Marthe Mæhlen
Morten Lindbæk
Dag Berild
Author Affiliation
Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway. markfagannor@gmail.com
Source
Scand J Prim Health Care. 2012 Mar;30(1):10-5
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Drug Resistance, Microbial
Female
Guideline Adherence - statistics & numerical data
Humans
Infection - drug therapy
Male
Norway
Nursing Homes - statistics & numerical data
Physician's Practice Patterns - standards
Practice Guidelines as Topic
Retrospective Studies
Abstract
To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing.
Retrospective examination of patients' records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008.
Patients residing in the nursing homes of Arendal, Norway.
Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing.
A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital.
Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians.
Notes
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Comment In: J Urol. 2013 Jan;189(1):15623235224
PubMed ID
22188479 View in PubMed
Less detail

Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study.

https://arctichealth.org/en/permalink/ahliterature269775
Source
BMC Geriatr. 2015;15:98
Publication Type
Article
Date
2015
Author
Mark Fagan
Morten Lindbæk
Nils Grude
Harald Reiso
Maria Romøren
Dagfinn Skaare
Dag Berild
Source
BMC Geriatr. 2015;15:98
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Infective Agents, Urinary - classification - pharmacology
Cross-Sectional Studies
Drug Resistance, Bacterial
Escherichia coli - drug effects
Escherichia coli Infections - diagnosis - drug therapy - epidemiology
Female
Homes for the Aged - statistics & numerical data
Humans
Independent Living - statistics & numerical data
Male
Norway - epidemiology
Nursing Homes - statistics & numerical data
Practice Guidelines as Topic
Proteus Infections - diagnosis - drug therapy - epidemiology
Proteus mirabilis - drug effects
Sex Factors
Urinalysis - methods
Urinary Tract Infections - diagnosis - drug therapy - epidemiology - microbiology
Abstract
Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted.
This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community.
There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64%) and 2275 (64%) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70%) than in males 303 (39%) (p?
Notes
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PubMed ID
26238248 View in PubMed
Less detail

[Are too many antibiotics prescribed to Norwegian children?]

https://arctichealth.org/en/permalink/ahliterature31192
Source
Tidsskr Nor Laegeforen. 2002 Nov 20;122(28):2690
Publication Type
Article
Date
Nov-20-2002

Behaviour among children of substance-abusing women attending a Special Child Welfare Clinic in Norway, as assessed by Child Behavior Checklist (CBCL).

https://arctichealth.org/en/permalink/ahliterature122915
Source
Scand J Caring Sci. 2013 Jun;27(2):285-94
Publication Type
Article
Date
Jun-2013
Author
Bjørg Hjerkinn
Morten Lindbaek
Elin Olaug Rosvold
Author Affiliation
Addiction Unit/Research Unit, Sørlandet Hospital, Kristiansand, Norway. bjorg.hjerkinn@sshf.no
Source
Scand J Caring Sci. 2013 Jun;27(2):285-94
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Ambulatory Care Facilities
Breast Feeding
Child
Child Behavior
Child Welfare
Female
Humans
Male
Neuropsychological Tests
Norway
Pregnancy
Pregnancy Complications
Substance-Related Disorders - complications
Abstract
A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment is given without substitution. This investigation assesses the behaviour of the children between the ages 6 and 13 years of women who attended the clinic. It also explores the correlation between the behaviour and a neuropsychological screening performed one and a half year earlier. The study was set up to investigate the influence of prenatal substance exposure.
Thirty-eight SCWC children and 63 children in a comparison group were scored by Child Behavior Check List (CBCL). Twenty-one (55%) SCWC mothers were classed as short-term users (ceased substance abuse before the end of first trimester), and 17 (45%) were classed as long-term users (continued a moderate substance abuse throughout pregnancy). Thirteen (77%) of the children of the long-term users were living in foster homes at the time of the investigation.
SCWC children were scored within normal ranges for most items, but their scores were significantly worse than those of the comparison group. Children of short-term users were given lower scores than comparisons on more issues in CBCL than were children of long-term users. The SCWC children were breastfed for a shorter time (p = 0.023) and had moved house more often (p
PubMed ID
22757723 View in PubMed
Less detail

Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155].

https://arctichealth.org/en/permalink/ahliterature168800
Source
BMC Health Serv Res. 2006;6:75
Publication Type
Article
Date
2006
Author
Svein Gjelstad
Arne Fetveit
Jørund Straand
Ingvild Dalen
Sture Rognstad
Morten Lindbaek
Author Affiliation
Department of General Practice and Community Medicine, University of Oslo, PO Box 1130 Blindern, 0317 Oslo, Norway. svein.gjelstad@medisin.uio.no
Source
BMC Health Serv Res. 2006;6:75
Date
2006
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Cluster analysis
Drug Utilization Review
Education, Medical, Continuing
Family Practice - education
Humans
Norway
Physician's Practice Patterns
Practice Guidelines as Topic
Program Evaluation - methods
Quality Indicators, Health Care
Randomized Controlled Trials as Topic - methods
Software
Abstract
More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved.
Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention.
Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.
Notes
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PubMed ID
16776824 View in PubMed
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[Chronic diseases among and social benefits to four-to-five-year-old children]

https://arctichealth.org/en/permalink/ahliterature15023
Source
Tidsskr Nor Laegeforen. 2005 Sep 8;125(17):2362-5
Publication Type
Article
Date
Sep-8-2005
Author
Morten Lindbaek
Karl W Wefring
Tor Bjerkedal
Author Affiliation
Institutt for allmenn- og samfunnsmedisinske fag, Universitetet i Oslo, Boks 1130 Blindern, 0317 Oslo. morten.lindbak@medisin.uio.no
Source
Tidsskr Nor Laegeforen. 2005 Sep 8;125(17):2362-5
Date
Sep-8-2005
Language
Norwegian
Publication Type
Article
Keywords
Child Welfare - economics
Child, Preschool
Chronic Disease - economics - epidemiology - rehabilitation
Cost of Illness
Disabled Children - rehabilitation - statistics & numerical data
English Abstract
Humans
Norway - epidemiology
Questionnaires
Social Security - economics - statistics & numerical data - utilization
Socioeconomic Factors
Abstract
BACKGROUND: The purpose of this study was to estimate the prevalence of chronic diseases among four-to-five-year-old children in a Norwegian county in order to identify significant prognostic factors and to investigate the use of social benefits. METHODS: In the context of ordinary medical examinations in a Norwegian county, a questionnaire was given to 2430 parents, of whom 1913 (79%) responded. Children with chronic disease and with frequent episodes of disease were selected for further examination. Of the 391 children selected, 263 (69%) attended. The parents answered questions about diagnosis, prognosis, marital status, parents' health, use of social benefits, and the development of the disease. RESULTS: Almost half of the 263 children who met for further examination had airway diseases, nearly all of them asthma. Of the remaining, 17% had congenital malformations, 13% had neurological development disorders, 10% had skin and joint diseases, and 12% various conditions including gastrointestinal diseases and hormonal disorders. One third had recovered, one third had diminishing problems, and one third was unchanged or worse. Parents of 15 children born in 1991 who received basic or supplementary benefits stated that the child had recovered or had a diminishing problem. However, 53 children who had a stable or deteriorating condition did not receive any benefits. In 22 of these, the parents stated that their child's general functioning was significantly affected. It is possible that they would have met criteria for supplementary and/or basic benefits. INTERPRETATION: The results suggest that in 1996, 13% of four-to-five-year-old children in this county had a chronic disease. This finding is in line with other studies. Overuse and, more frequently, underuse of social benefits for these children was disclosed.
PubMed ID
16151496 View in PubMed
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Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A.

https://arctichealth.org/en/permalink/ahliterature29528
Source
Br J Gen Pract. 2005 Aug;55(517):615-9
Publication Type
Article
Date
Aug-2005
Author
Morten Lindbaek
Ernst Arne Høiby
Gro Lermark
Inger Marie Steinsholt
Per Hjortdahl
Author Affiliation
Department of general practice and community medicine, University of Oslo, Oslo, Legekontoret, Kongsberg. morten.lindbak@medisin.uio.no
Source
Br J Gen Pract. 2005 Aug;55(517):615-9
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child, Preschool
Family Practice
Female
Humans
Logistic Models
Male
Norway - epidemiology
Pharyngitis - epidemiology - microbiology
Prospective Studies
Research Support, Non-U.S. Gov't
Streptococcal Infections - epidemiology - microbiology
Streptococcus - isolation & purification
Streptococcus pyogenes - isolation & purification
Abstract
BACKGROUND: The role of large colony streptococci groups C or G as pathogen agents in sore throat has been questioned. AIM: To analyse clinical features of patients with large colony streptococci groups C or G compared with patients with group A streptococci (GAS) and with negative cultures. DESIGN OF STUDY: Prospective study of patients with sore throat. SETTING: Two Norwegian general practices in Stokke and Kongsberg communities with 6500 patients.METHOD: Frequency of clinical features in the three patient categories including the four Centor criteria (fever, anterior cervical lymphadenopathy, tonsillar exudates, and lack of cough), degree of pain on swallowing, pharyngeal rubor, C-reactive protein (CRP) values, patient age between 3 and 14 years, and duration of symptoms before seeing the doctor. A logistic regression analysis to find independent predictors was performed. RESULTS: Out of 306 patients with a sore throat, 244 were adults and 62 were children under 10 years old; 40% were men. One hundred and twenty-seven had GAS, 33 had streptococci groups C or G, and 146 had negative throat cultures. Forty-eight per cent of the GAS patients and 45% of the C or G patients met three or four of the Centor criteria. The logistic regression revealed that in patients with GAS considerable pain on swallowing, an age of 3-14 years and a duration of symptoms of
PubMed ID
16105370 View in PubMed
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Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial.

https://arctichealth.org/en/permalink/ahliterature269804
Source
BMC Musculoskelet Disord. 2015;16:122
Publication Type
Article
Date
2015
Author
Morten Olaussen
Øystein Holmedal
Ibrahimu Mdala
Søren Brage
Morten Lindbæk
Source
BMC Musculoskelet Disord. 2015;16:122
Date
2015
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adrenal Cortex Hormones - administration & dosage
Adult
Aged
Biomechanical Phenomena
Chi-Square Distribution
Combined Modality Therapy
Double-Blind Method
Elbow Joint - drug effects - physiopathology
Female
Humans
Injections, Intra-Articular
Linear Models
Logistic Models
Male
Massage
Middle Aged
Muscle Stretching Exercises
Norway
Odds Ratio
Primary Health Care
Recovery of Function
Single-Blind Method
Tennis Elbow - diagnosis - physiopathology - therapy
Time Factors
Treatment Outcome
Young Adult
Abstract
Lateral epicondylitis of the elbow is a frequent condition with long-lasting symptoms. Corticosteroid injection is increasingly discouraged and there is little knowledge on the combined effect of corticosteroid injection and physiotherapy for acute conditions. We wanted to investigate the efficacy of physiotherapy alone and combined with corticosteroid injection for acute lateral epicondylitis.
A randomized, controlled study with one-year follow-up was conducted in a general practice setting in Sarpsborg, Norway. We included 177 men and women aged 18 to 70 with clinically diagnosed lateral epicondylitis of recent onset (2 weeks to 3 months). They were randomly assigned to one of three treatments: physiotherapy with two corticosteroid injections, physiotherapy with two placebo injections or wait-and-see (control). Physiotherapy consisted of deep transverse friction massage, Mills manipulation, stretching, and eccentric exercises. We used double blind injection of corticosteroid and single blind assessments. The main outcome measure was treatment success defined as patients rating themselves completely recovered or much better on a six-point scale.
One hundred fifty-seven patients (89 %) completed the trial. Placebo injection with physiotherapy showed no significant difference compared to control or to corticosteroid injection with physiotherapy at any follow-up. Corticosteroid injection with physiotherapy had a 10.6 times larger odds for success at six weeks (odds ratio 10.60, p
Notes
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PubMed ID
25989985 View in PubMed
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Do general practitioners' consultation rates influence their prescribing patterns of antibiotics for acute respiratory tract infections?

https://arctichealth.org/en/permalink/ahliterature132748
Source
J Antimicrob Chemother. 2011 Oct;66(10):2425-33
Publication Type
Article
Date
Oct-2011
Author
Svein Gjelstad
Jørund Straand
Ingvild Dalen
Arne Fetveit
Hanne Strøm
Morten Lindbæk
Author Affiliation
Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway. svein.gjelstad@medisin.uio.no
Source
J Antimicrob Chemother. 2011 Oct;66(10):2425-33
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Drug Prescriptions
Drug Utilization
Female
General practitioners
Health Policy
Humans
Male
Middle Aged
Norway
Penicillin V - therapeutic use
Physician's Practice Patterns
Respiratory Tract Infections - drug therapy
Abstract
To examine general practitioners' (GPs') antibiotic prescribing patterns for acute respiratory tract infections (ARTIs) as compared with national guidelines. We also wanted to explore possible predictors of antibiotic prescription patterns.
Observational study based on prescription data from 440 Norwegian GPs in December 2004 through to November 2005. Outcome measures were the type and frequency of antibiotic prescriptions for various ARTI diagnoses, with patients' and GPs' characteristics as explanatory variables.
In the study period, the 440 GPs treated a total of 142?900 ARTI episodes. In 33.5% [95% confidence interval (CI): 31.9%-35.1%] of these episodes an antibiotic was issued, of which penicillin V (pcV) accounted for 41.2% (95% CI: 37.4%-44.9%). GPs with a high number of total annual encounters had higher antibiotic prescription rates for ARTIs and used more non-pcV antibiotics compared with GPs with fewer annual patient encounters. GPs in the highest quintile with respect to the total annual encounter rate had 1.6 times the odds of prescribing antibiotics compared with GPs in the lowest quintile. Correspondingly, the odds of choosing a non-pcV antibiotic were 2.8 times higher in the top quintile of GPs compared with GPs in the bottom quintile with respect to antibiotic prescription rates.
ARTIs are frequently treated with antibiotics and often with broader spectrum agents than pcV, which is the recommended first-line antibiotic in the Norwegian guidelines. GPs with a high practice activity are, in general, more liberal with respect to the prescription of antibiotics for ARTIs, and the higher the antibiotic prescription rate, the larger the share of non-pcV agents.
PubMed ID
21784782 View in PubMed
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