A list of 266 abbreviations from dieticians' notes in patient records was used to extract the same abbreviations from patient records written by three professions: dieticians, nurses and physicians. A context analysis of 40 of the abbreviations showed that ambiguous meanings were common. Abbreviations used by dieticians were found to be used by other professions, but not always with the same meaning. This ambiguity of abbreviations might cause misunderstandings and put patient safety at risk.
Non-expert clinical practitioners who had received bone density reports based on 10-year absolute fracture risk were surveyed to determine their response to this new system. Absolute fracture risk reporting was well received and was strongly preferred to traditional T-score-based reporting. Non-specialist physicians were particularly supportive of risk-based bone mineral density (BMD) reporting.
Absolute risk estimation is preferable to risk categorization based upon BMD alone. The objective of this study was to specifically assess the response of non-expert clinical practitioners to this approach.
In January 2006, the Province of Manitoba, Canada, started reporting 10-year osteoporotic fracture risks for patients aged 50 years and older based on the hip T-score, gender, age, and multiple clinical risk factors. In May 2006 and October 2006, a brief anonymous survey was sent to all physicians who had requested a BMD test during 2005 and 206 responses were received.
When asked whether the report contained the information needed to manage patients, the mean score for the absolute fracture risk report was higher than for the T-score-based report (p
The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists.
A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week.
A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P
Standards in Intensive Care Medicine were approved by the Board of the Norwegian Medical Association in 1997. Their purpose is to clarify issues of responsibility, accountability and management in intensive care units. It also gives recommendations on management, staffing, education and resources.
In order to obtain a reference point for any future assessment of the impact of the Standards document, a survey was carried out, addressing work load, medical staff, and questions of accountability, responsibility and cooperation.
16 hospitals responded (76%). The results seem to indicate that medical staff in relation to work load is smaller than recommended. It also seems that junior doctors only to a small extent are present in the intensive care units during ordinary working hours, and consequently have little opportunity to learn from working with experienced colleagues. However, both conclusions, especially the first one, are not entirely reliable, as close examination of the answers indicate that important concepts concerning the description of work load and staffing are poorly defined, and that the monitoring of work load is insufficient.
It is concluded that staffing and work load in intensive care units are still insufficiently defined and monitored. The training environment for specialists is not optimal.
To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums.
Retrospective study of structured data from electronic patient records.
Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database.
All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012).
Physicians' adherence to current guidelines for respiratory tract infections regarding the use of antibiotics.
We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors.
In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.
The trend towards polypharmacy is increasing among the elderly, and associated with this trend is an increased risk of adverse drug effects and drug-drug interactions. Our objective was to assess whether drug adverse effects reported by patients are in general agreement with those identified by a physician.
We evaluated the medication of 404 randomly selected individuals aged 75 years or older by means of interviews carried out by trained nurses and examinations conducted by a physician. The medication used by these patients was recorded prior to the physician's examination and modified thereafter if considered appropriate. Adverse effects noted by the physician were compared to those self-reported by the patients.
Almost all of the patients (98.8%) were using at least one drug, and the mean total number of drugs used was 6.5. Adverse effects were self-reported by 11.4% of the patients, whereas the physician observed apparent adverse drug effects in 24.0% of the patients. No adverse effects were reported in 53.2% of the patients. There were only seven patients that had adverse effects that were both self-reported and identified by the physician, and only four of these patients reported the same adverse effect that had been identified by the physician.
There was a great disparity between the adverse effects identified by the physician and those reported by the patients themselves. Based on our results, it would appear that elderly people tend to neglect adverse drug effects and may consider them to be an unavoidable part of normal ageing. Therefore, physicians should enquire about possible adverse effects even though elderly patients may not complain of any drug-related problems.
AIMS: To describe and discuss the alcohol drinking patterns of the younger generation of hospital doctors in Norway and Germany - respectively the abstainers, frequent drinkers, episodic heavy drinkers and hazardous drinkers. METHODS: Data were collected in nationwide postal surveys among doctors in Norway (2000) and Germany (2006). A representative sample of 1898 German and 602 Norwegian hospital doctors aged 27-65 years were included in the analyses (N=2500). Alcohol drinking patterns were measured using the first three items of AUDIT in Norway and the AUDIT-C in Germany, scores of >or=5 (ranking from 0 to 12) indicating hazardous drinking. Episodic heavy drinking was defined by the intake of >or=60 g of ethanol, on one occasion, at least once a week. Frequent drinkers were who drank alcoholic beverages at least twice a week. Abstainers were persons who drank no alcohol. The analyses were performed separately for age groups (27-44 years versus 45-65 years) and genders. RESULTS: Compared to the age groups 45 to 65 years in the Norwegian and German samples, the younger age groups (27-44 years) tend to have higher rates of abstainers, higher rates of infrequent drinking of moderate amount of alcoholic drinks, lower rates of episodic heavy drinking and lower rates of hazardous drinking. CONCLUSION: The younger generation of hospital doctors in Norway and Germany showed tendencies to healthier drinking habits. Changes in professional life, and in the attitude towards alcohol consumption, may go some way towards explaining these findings.
Thyroid ultrasound and fine-needle aspiration (FNA) have been implicated in the overdiagnosis of thyroid cancer. To study how the use of diagnostic tools impacts thyroid cancer incidence, we propose using physician age as a surrogate. We aimed to determine whether thyroid cancer incidence is higher in areas with a high density of young physicians compared with areas with a high density of older physicians.
SEER 13 database was used to determine thyroid cancer incidence. These data were linked to the Area Resource File data (2000), containing information on physician age at a county-specific level. Cohorts were divided by age based on the concentration of physicians within a population of 1,000,000 persons. The study period was divided into two time periods (1992-1995, 2006-2009).
The incidence of thyroid cancer was stable in areas with high concentrations of young and older physicians during the 1992-1995 time period [
Drug interaction databases are important tools in today's clinical decision support. However, there is great variation with regard to classification and presentation of interactions among databases. The present study aimed to investigate consensus among databases with regard to combinations of psychotropics. A database integrated in Norwegian computerised clinical decision support systems and three international recommended subscription databases were compared. Combinations of psychotropics (two or more) prescribed to patients 65 years or older on a single day from three nursing homes in Bergen, Norway 16 years apart (2000 and 2016) were studied. The databases were compared in a common analysis with the following questions: interaction (no, not contraindicated or contraindicated), type (pharmacodynamic or pharmacokinetic), the total number of interactions, and the first ranked interaction among several in each patient. Consensus among the four drug interaction databases was associated with pharmacokinetic interactions involving mainly older psychotropics in the common analysis. The qualities that best characterised interactions with consensus was primarily the evidence including a description of manageability. There was a surprising lack of consensus with regard to contraindicated interactions, even when older psychotropics were involved. Lack of consensus decreased with the number of psychotropics in the combinations. This was mainly because the highest ranked interactions in the respective databases involved different drugs. We propose evidence and manageability as core factors when ranking and presenting interactions in clinical decision support.