It is well established that teenagers are generally dissatisfied with the sexual education they receive from school and parents. While several alternative sources of sex counselling have been suggested (i.e. an anonymous and semi-official telephone hot-line), the role of the general practitioner in sexual guidance of youngsters is only poorly evaluated. One hundred and sixty-eight teenage callers of "The Adolescent Sexuality Hot-line" were asked about their experience with sexual counselling by their family doctor. One third had actually discussed such topics with their g.p., and a total of 44.6% (significantly more girls than boys) regarded their g.p. as a desirable interlocutor on these issues. The reasons for having approached a g.p. for counselling differed according to gender, as did the causes for not wanting to involve a g.p. in sexual matters: boys tended to state shyness and lack of anonymity as main causes, whereas girls more often pointed to personal aspects of the doctor.
The aim of the present study was to assess the long-term impact of carrier screening for cystic fibrosis. The impact of being identified as a carrier for cystic fibrosis was assessed through three questionnaires measuring the emotional responses, changes in reproductive attitudes and decisions, retention of the result, and sharing of the information about the result with relatives. The questionnaires were sent to 160 women identified as carriers between 1990 and 1992 and to 200 randomly selected women with a negative result. Carriers became surprised, anxious and worried upon receipt of their result. However, this response disappeared once the partners had been tested and found negative. No sign of residual anxiety was found among carriers who answered the third questionnaire in November 1994. Carriers freely shared the information about their result with relatives, friends, and general practitioners. Few carriers changed their reproductive plans or attitudes to abortion of a foetus with CF due to the result. No decline in fertility or change in reproductive pattern were observed among carriers after testing. The imperfect sensitivity of the carrier test caused some misunderstanding in the retention of the result. This may reflect inadequacies in the information and counselling. Psychological factors are also believed to contribute to the misunderstanding of the result. The information should be improved to avoid false reassurance.
The Danish Medical Association and the scientific societies have initiated three studies to evaluate the use of questionnaires for continuous medical education. One study was a questionnaire in anaesthesiology with 30 questions with answers yes/no/no answer, which was sent to 600 specialists in anaesthesiology. One study was in cardiology with a multiple choice questionnaire, sent to 300 general practitioners and 75 specialists in internal medicine outside cardiology. One study concerned the educational value of State-of-the-Art articles about neurology in Ugeskrift for Laeger (Journal of the Danish Medical Association) sent to 500 doctors outside neurology. All questionnaires were sent anonymously, with one general reminder. For the anaesthesiology study 234 questionnaires were returned (40.5%). In the cardiology study 195 questionnaires were returned (52%). For the study on neurology 278 answered (56%). Only about half of the questionnaires were returned for the three studies, and a lot of effort and resources were put into the studies. An extension from these small pilot studies to a general systematic continuous methodology with updated questionnaires in the postgraduate medical education seems troublesome. An optional self-registration for medical education such as The Canadian "Mocomp concept" might be a more realistic suggestion.
In half of the patients admitted with chest pain on suspicion of an acute myocardial infarction (AMI), this diagnosis is not confirmed (non-AMI). Both AMI and non-AMI patients have a mortality which exceeds the mortality of the background population in the years following discharge based on a high incidence of cardiac death. As a pilot investigation, a comprehensive investigation programme was tested in 32 consecutive non-AMI patients. The possible organic causes of acute chest pain were thus illustrated systematically in each individual patient. In ten of the patients, a definitive diagnosis was established within the first 24 hours of admission and no further investigation was thus performed. The remaining 22 patients participated in the planned investigation programme. In 30 of the patients (94%) a probable organic cause for the chest pain was found. This investigation demonstrates that the investigation programme is employable and it suggests that the cause of chest pain in non-AMI patients usually can be placed in one of the three main groups: 1) IHS, 2) oesophageal disease and 3) physiurgic conditions.
INTRODUCTION: Do not resuscitate (DNR) orders should prevent pointless life-prolonging procedures. Practicing DNR orders in Denmark is not described and there are no national guidelines. The purpose of this study is to clarify how DNR orders, patient autonomy, and living wills are handled in a Danish medical ward. MATERIALS AND METHODS: All 193 medical wards in Denmark received questionnaires (Figure 1) addressed to the medical Head of Department. 138 (71.5 %) questionnaires were analysed. RESULTS: 127 (92 %) wards had DNR orders. In 52 (38 %) wards DNR orders could include reduction of other treatment modalities. Competent patients were 'always' asked in 20 (14 %), 'often' in 34 (25 %), 'seldom' in 59 (43 %), and 'never' in 12 (9 %) of the wards prior to DNR decisions. Spouses were asked more often than the patient; 'always' in 31 (22 %), 'often' in 68 (49 %), 'seldom' in 21 (15 %), and 'never' in 4 (3 %) of the wards. The Danish Living Will Registry was contacted 'always' in 2 (1 %), 'often' in 15 (11 %), 'seldom' in 68 (49 %), and 'never' in 37 (27 %) of the wards. 112 (81 %) wards did not have a written guideline on DNR orders. CONCLUSION: Patients should be asked more often prior to DNR decisions. Health workers should contact The Danish Living Will Registry more frequently. As a decision aid and in order to strengthen both health workers' and patients' legal rights, a national guideline on DNR ordering could be established.
During a two year period, general practitioners in a local area were called to all 112 alarms (the number dialled in Denmark in emergencies) in order to improve the prognosis of patients with cardiac arrest. In 55% of the calls, the practitioners arrived within five minutes, whereas the ambulance arrived within five minutes in only 16% of the cases (p
Comment In: Ugeskr Laeger. 1994 Mar 28;156(13):1974-57755682