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Biomedical subjects

P Vedsted

Publications and source records attributed to P Vedsted.

17 recordsLinked to original sources
PubMed2005

Frequent attenders in general practice care: a literature review with special reference to methodological considerations.

OBJECTIVE: To describe the basis on which our knowledge of frequent attendance in general practice rests and to propose recommendations for further research on frequent attenders (FAs). DESIGN: The literature review (finished February 2004) encompassed peer-reviewed articles in English describing contacts with general practice in terms of frequency. Searches were performed in the Medline, CINAHL, EMBASE, PsycINFO, Social Sciences Expanded Index and ISI Citation databases with additional searches in reference lists and the 'related articles' function in the ISI Citation database and Medline. SETTING: General practice. SUBJECTS: Sixty-one articles (54 studies). MEASURES: The articles were assessed according to the following design variables: setting; definition of FAs; sampling; sample size; control groups; study aim; study design; data sources; effect measure; and main results. RESULTS: There was no generally accepted definition of frequent attendance. Research designs differed substantially. Eight articles gave sufficient information on all design variables. The top 10% of attenders accounted for 30-50% of all contacts, and up to 40% of FAs were still FAs the following year. More than 50% of FAs had a physical disease, more than 50% of FAs suffered from psychological distress, social factors (low social support, unemployment, divorce) were associated with frequent attendance in more than 50% of FAs, multiproblems (physical, psychological and social) were found in one-third of FAs, and frequent attendance was associated with increasing age and female gender. CONCLUSION: The diversity of designs, definitions and methods in the current literature on FAs in general practice hampers comparison of their precision, validity and generalizability, and calls for cautious interpretation and adoption of a common, generally acceptable definition in future studies.

Family Practice↗
PubMed2005

Intramuscular pressure and tissue oxygenation during low-force static contraction do not underlie muscle fatigue.

AIM: To test the hypothesis that time-wise increase in intramuscular pressure (IMP) and subsequent decrease in muscle tissue oxygenation (TO(2)) results in muscle fatigue development during a non-exhaustive, low-force contraction evidenced by changes in electromyogram (EMG) and particular mechanomyogram (MMG). METHODS: Seven subjects performed static elbow flexion at 10% maximal voluntary contraction (MVC) for 10 min (10% MVC(10 min)). Surface EMG, MMG, IMP and TO(2) measured by near-infrared spectroscopy was recorded from m. biceps brachii during 10% MVC(10 min) and during 5% MVC test contractions of 1 min duration performed before 10% MVC(10 min), 10 and 30 min post-exercise. EMG and MMG were analysed for root mean square (rms) and mean power frequency (mpf). RESULTS: During 10% MVC(10 min) MMGrms increased from initial level of 0.04 +/- 0.01 to 0.11 +/- 0.07 m s(-2) in the last minute and MMGmpf and EMGmpf decreased from 34.9 +/- 8.2 to 21.3 +/- 3.8 Hz and from 71.7 +/- 10.9 to 61.7 +/- 10.0 Hz respectively. Similar changes were present in 5% MVC test contractions 30 min post-exercise. Initially, TO(2) decreased by 6.9 +/- 6.5% of resting level but returned to rest within 1 min. IMP remained constant during the contraction after an initial fourfold increase from resting level of 12.2 +/- 10.4 mmHg. CONCLUSIONS: IMP was anticipated to increase with time of contraction due to e.g. increased muscle water content; but this was not confirmed. Consequently, muscle blood flow was unlikely to be impeded with contraction time, which may account for the maintenance of TO(2). Thus, decreased TO(2) did not underlie either acute or long-term muscle fatigue development evidenced by changes in EMG and particular MMG variables.

Aged↗
PubMed2003

Muscle performance following fatigue induced by isotonic and quasi-isometric contractions of rat extensor digitorum longus and soleus muscles in vitro.

AIM: To study the effect of contraction mode on fatigue development. METHODS: Muscle fatigue was induced by isotonic and quasi-isometric contractions in rat soleus (SOL) and extensor digitorum longus (EDL) muscles, using identical stimulation protocol (60 Hz, 400 ms s-1) for 100 s in SOL and 60 s in EDL. Fatigue was quantified as the decline in peak values of shortening, shortening velocity, relaxation and work during the isotonic contractions, and, correspondingly, of force, rate of force development, relaxation and work during the quasi-isometric contractions. Maximal test contractions (60 Hz, 1.5 s) performed before and after fatigue were analysed for decline in force development (Fmax), rate of force development (dF/dtmax) and relaxation (-dF/dtmax). RESULTS: Fmax declined to significantly lower values after isotonic than after quasi-isometric fatiguing contractions (fatigued in percentage of unfatigued): 58.5 +/- 6.4% vs. 64.4 +/- 7.0% in SOL, and 30.4 +/- 4.1% vs. 33.3 +/- 3.6% in EDL, respectively. The same pattern was seen for dF/dtmax which decreased to: 46.3 +/- 9.9% vs. 52.3 +/- 8.5% in SOL, and 19.1 +/- 4.3% vs. 22.3 +/- 3.2% in EDL after isotonic and quasi-isometric contractions, respectively. Similarly, when comparing fatigue development during the two contraction modes, the respective fatigue variables decreased more rapidly and to lower levels during isotonic vs. quasi-isometric contractions. During maximal test contractions, the dynamic fatigue variables (+/-dF/dtmax) declined to significantly lower levels than Fmax. CONCLUSIONS: Fatigue development was significantly larger during isotonic vs. quasi-isometric contractions. The use of force as the only experimental fatigue variable may underestimate the functional impairment of fatigued muscle, neglecting the fatigue effect on time and length dimensions.

Animals↗
PubMed2001

[The significance of a reminder and physician's motivation for the response rate of a questionnaire survey in general practice].

The use of a mailed reminder to improve the response rate in a questionnaire survey was analysed in a general practice multicentre survey in Denmark, Norway, and the Netherlands. In total 14 general practitioners (GP's) handed out the questionnaire to 650 adult patients. A randomized sample of the patients who did not respond after three weeks received a reminder including a new questionnaire. In the group that received a reminder the response rate was significantly higher compared with the group that did not (79% vs. 62%). In Denmark, two of the four participating GP's were specially motivated. The response rate for these GP's was significantly higher compared to the normally motivated GP's (91% vs. 71%). Specially motivated GP's can increase the response rate and thereby minimise the effect of the reminder.

Adult↗
PubMed2001

The effect of an out-of-hours reform on attendance at casualty wards. The Danish example.

OBJECTIVE: A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect of this out-of-hours reform on the number of contacts with the casualty wards. DESIGN: A register-based ecologic time-trend study of the mean number of annual contacts per inhabitant from 1988 to 1997. SETTING: The County of Aarhus. SUBJECTS: All 630000 inhabitants in the county. MAIN OUTCOME MEASURES: Mean number of annual contacts with casualty wards per inhabitant. Intercepts derived from two regression models. RESULTS: The mean number of contacts with casualty wards rose significantly during the whole period. Given this constant increase in contact rates, a regression model showed that the increase in the attendance rate with casualty wards after the reform was statistically insignificant. CONCLUSIONS: The decrease in the total number of contacts with the out-of-hours primary health care after the reform was not met by a corresponding increase in casualty ward contacts. A clear-cut significant increase in the use of casualty wards following the out-of-hours reform could not be demonstrated.

Appointments and Schedules↗
PubMed2001

The association between daytime attendance and out-of-hours frequent attendance among adult patients in general practice.

BACKGROUND: Frequent attenders (FAs) account for a large proportion of daytime consultations in general practice. However, no studies have so far been conducted to establish whether daytime FAs are also out-of-hours FAs. AIM: To analyse the association between daytime attendance and out-of-hours frequent attendance. DESIGN OF STUDY: A registry-based study of individual face-to-face contacts with general practice during daytime and out of hours, based on National Health Insurance files. SETTING: General practices in Aarhus County, Denmark (630,000 inhabitants). METHOD: A total of 416,172 adults, i.e. all adults registered with a general practice during a 12-month period from November 1997 to October 1998 were included. Odds ratios (OR) for frequent attendance out of hours were stratified for age, sex, and frequency of contacts during daytime were calculated. RESULTS: A strong association was observed between daytime level of attendance and out-of-hours level of attendance (OR = 2.9-6.3 among patients with low daytime attendance, OR = 33.7-99.8 among daytime FAs). Daytime FAs accounted for one-third of the daytime contacts, one-third of the out-of-hours contacts, and 42% of out-of-hours FAs. More than half of the daytime FAs did not attend out of hours. Two per cent of the out-of-hours FAs had no contacts during the daytime. CONCLUSION: Frequent attendance in daytime was very strongly associated with frequent attendance out of hours, and daytime FAs accounted for a large proportion of all contacts with general practice.

Adult↗
PubMed2000

[How do patients evaluate their general practitioners? Danish results from a European study].

This study aims to assess how patients evaluate the quality of general practice care. With a questionnaire answered by a sample of 1309 (90.9% response) from 36 practices. Patients answered 25 questions relating to their general practice care. Patients were, generally seen, very positive about their general practitioners. "Keeping your records and data confidential" and "providing quick services for urgent health problems" received most positive evaluations, while "waiting time in the waiting room", "being able to speak to the general practitioner on the telephone" and "getting through to the practice on the phone" were assessed most negatively.

Adult↗
PubMed1999

Frequent attenders in out-of-hours general practice care: attendance prognosis.

OBJECTIVE: We aimed to describe the use of out-of-hours service and analyse attendance prognosis for frequent attenders and other groups of attenders, and to present a concept describing frequent attendance over time. METHODS: All adult attenders in 1990 were included in a 4-year follow-up study. Frequent attenders (FAs) were defined as those 10% among the attenders who most frequently used the out-of-hours service during a calendar year (12 months). This gave an intersection point of four or more contacts for frequent attenders. Three more groups were defined according to whether they had one, two or three contacts per year. The setting was out-of-hours general practice in Aarhus County, Denmark. Data were collected from the database of the Public Health Insurance, Aarhus County. The county had approximately 600,000 inhabitants, of whom 465,000 were aged 18 years and over. The subjects were 101,321 individuals aged 18 years and over who contacted the out-of-hours service in 1990. Outcome measures were attendance per year, age and sex. RESULTS: FAs made 42% of the out-of-hours contacts in 1990, and 33% of those who were FAs in 1990 were also FAs in 1991. Among the 1990 FAs, 67% contacted the out-of-hours service at least once in 1991, 25% contacted the service at least once in each of the following 4 years and 7% remained FAs in the following 4 years. The probability of being an FA rose with the duration of previous frequent attendance. Age above 50 years significantly predicted future status as an FA. Females made up two-thirds of FAs, but sex did not predict future frequent attendance. CONCLUSION: Frequent attendance could be regarded as a short-lived phenomenon. On the other hand, FAs were the most stable attenders of all groups of attenders over the years. Older FAs had the highest probability of remaining FAs.

Adolescent↗
PubMed1999

Effect of a reorganized after-hours family practice service on frequent attenders.

BACKGROUND AND OBJECTIVES: A governmental reorganization of the after-hours general practice service in Denmark was launched in January 1992. The biggest change was the introduction of mandatory county-wide telephone triage systems staffed by general practitioners. This study assesses the effect of this reorganization on the use of services by frequent attenders (FAs). METHODS: From 1990 to 1994, methods of contact and annual costs per attender were analyzed in an ecological time-trend study based on aggregated administrative data collected from the database of the Public Health Insurance, Aarhus County, Denmark (600,000 inhabitants). The study only included attenders ages 18 and over. FAs were defined as the group that, within each calendar year (12 months), had 4 or more contacts with the after-hours family practice service. RESULTS: FAs made up 9.5% of the attenders and accounted for more than 40% of the contacts and the aggregate costs. The effect of the reorganization was a 12% decrease in the number of attenders, a 16% decrease in the number of contacts, and a 29% decrease in the costs. Reorganization had a significantly bigger effect on FA attendance than on non-FA attendance, and more than half of the overall reduction in use of services could be ascribed to changes in FA behavior. CONCLUSIONS: The reorganization of the after-hours service produced a significant fall in attendance and costs, especially with respect to adult FAs.

Adolescent↗
PubMed1998

[Accidental injection of adrenaline in a finger with EpiPen].

We report a case of accidental injection of 0.3 mg epinephrine in the right pollux. The actual case was treated with systemic nitroglyceride and immersion of the finger in hot water. A review of the literature shows that the adequate treatment is local infiltration with Phentholamine Mesylate. There is a need to describe this treatment in conventional literature.

Accidents↗
PubMed1998

[Does a computerized price comparison module reduce prescribing costs in general practice?].

The aim was to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module. On January 1993 the module was introduced in 20 practices in Aarhus County that used the computer record system APEX. Two control groups were made. From the Public Health Insurance in Aarhus County (600,000 inhabitants) data were collected during 1992 and 1993. Compared with te controls there were no changes in prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD in the intervention group after the introduction of the module. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid.

Decision Making, Computer-Assisted↗
PubMed1998

[What do patients expect from the general practitioner? Danish results from a European study].

This study aims to identify and explain which aspects of medical care patients valued and expected from the general practitioner. A questionnaire was given to a sample of 774 patients (86% response rate) from 15 practices. Patients rated the importance and ranked 40 different questions relating to their medical care. Aspects related to technical care were ranked highest. Patients gave low priority to aspects of care related to practice organisation. Enough time during consultations and quick services in case of emergencies got top rank in the study. The study provides information on patients' priorities regarding their general practitioner.

Adolescent↗
PubMed1997

Does a computerized price comparison module reduce prescribing costs in general practice?

OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were examined. METHOD: We performed a controlled follow-up study on antecedent data before and after intervention. A questionnaire was administered to the intervention group at the introduction and 1 year later. Data on prescribing were collected in the database of the Health Insurance Aarhus County, as a normal routine for accounting. The GPs were not aware of the ongoing cost supervision study. Additional cost information software was introduced on 1 January 1993 to 20 practices with 28 GPs. The software assisted the GPs in a semiautomatic way to identify and prescribe the cheapest drugs. The subjects comprised 158 practices including 231 GPs in Aarhus County, Denmark. Questionnaires were sent to the 20 intervention practices. The main outcome measures were prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD quarterly during 1992 and 1993. RESULTS: Compared with the controls there were no changes in prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD in the intervention group after the introduction of the module. CONCLUSION: Simply giving a random group of GPs computer assistance to choose less expensive drugs did not reduce expenditure per DDD. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid.

Case-Control Studies↗
PubMed1996

Change in ranking order of prescribing patterns by age and sex standardization of the practice population--audit may be misleading.

OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information on the age, sex, and numbers of patients per practice was also obtained. The direct standardization method was used to adjust practice populations for age and sex. SETTING: The town of Randers, Aarhus County, Denmark. SUBJECTS: 35 practices, 41 GPs. MAIN OUTCOME MEASURES: Ranking of the 35 practices with respect to number of prescribed daily doses of cardiovascular drugs in crude utilization index and standardized utilization index. The slope of the regression curve of variation between the practices. RESULTS: The change from crude to standardized utilization index gave an entirely new ranking order of the practices. Only four practices did not change ranking position, while four moved more than ten places. The slope between highest and lowest ranked practice did not diminish after standardization. CONCLUSION: Care should be taken when comparing peer prescribing patterns from crude utilization data, and we recommend prior age and sex standardization. Our results are of value in creating a more reliable basis for a debate on variation in prescribing patterns between peers.

Adult↗
PubMedDate not supplied

Psychological distress as a predictor of frequent attendance in family practice: a cohort study.

In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice. In 1990, 185 consecutive adults who consulted their primary care physician (PCP) about an illness were rated on two psychometric scales (Hopkins Symptom Check List [SCL-8] and Whiteley-7), and their annual number of face-to-face contacts with a family practice was followed until 1996. Frequent attenders (FAs) were defined as the top 10%. A logistic regression analysis showed a significantly increased risk of becoming an FA with an increase of 1 point (odds ratio [OR] 1.17 [1.03-1.33]) on SCL and 1.28 (1.06-1.53) on Whiteley). An association was found between score and number of years as an FA (OR 1.16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness.

Adult↗