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Per Grinsted

Publications and source records attributed to Per Grinsted.

9 recordsLinked to original sources
PubMed2006

[Skin prick tests of patients with hay fever carried out in general practices compared with those carried out in a specialist outpatient clinic].

INTRODUCTION: The aim of our study was to assess whether general practitioners and their staff (practices) who had attended a short CME course with technical instruction in the skin prick test could diagnose and treat unselected patients with allergic rhinoconjunctivitis at the same quality level as the allergy outpatient clinic. MATERIAL AND METHODS: We performed a multicentre study with the participation of 38 general practices and the Allergy Centre at Odense University Hospital (OUH). After a two-day course for the general practitioner and his practice staff, every practice performed a skin prick test on 10 consecutive adult patients with symptoms of allergic rhinoconjunctivitis during the spring and summer. A standardised questionnaire was also filled in and sent to the Allergy Centre, where the patient subsequently had another skin prick test carried out. The results of the tests were determined in duplicate and then compared. RESULTS: No significant differences in the quality of the skin prick test for 10 allergens or histamine control were found between the general practice and the Allergy Centre. Discordant results were found in 9%, i.e., a positive result either at the practice or the Allergy Centre, but not at both. CONCLUSION: After a training course, general practitioners and their staff are fully able to perform and validate skin prick tests for inhalation allergens.

Adult↗
PubMed2006

[Screening for cervical cancer in the county of Funen. Status of 25 years of development and experiences].

INTRODUCTION: Since 1979 screening against cervical cancer has been conducted in the County of Funen. In the period 1979-1988 the screening against cervical cancer was opportunistic, where women aged 25-55 years had a PAP-smear taken once a year by their GP or gynaecologists at the hospitals. In this period the coverage was only about 50% and the number of cervical cancer was not decreasing as seen in Counties with organised screening programmes. Since 1989 the screening has been organised in the County of Funen, which will be described in the following, including updating and quality improvements such as implementation of liquid based cytology and semiautomated screening (ThinPrep Imaging System, Cytyc). MATERIAL AND METHOD: The programme is based on an automated call-recall system designed to invite women aged 23-59 years. The offer is free of charge and the PAP-smears are taken by the general practitioners. All cervical cytological samples from the County are processed and screened at the Department of Pathology Odense University Hospital. Since 2001 the liquid based technique, ThinPrep-Paptest, has been used, and from 2004 an assisted screening (ThinPrep Imaging System) has been implemented in the routine screening. RESULTS: Switching from opportunistic to organised screening and implementation of liquid based cytology has resulted in a reduction in the number of samples, about 6,500 per year. The diagnostic quality has increased; the number of incidences of cervical cancer was reduced from 62 in 1988 to 18 in 2004 and the mortality from 29 in 1988 to 12 in 2001. CONCLUSION: Since implementation of the organized screening programme and later of the liquid based cytology the coverage and diagnostic quality have increased. The incidence and mortality of cervical cancer have decreased.

Adult↗
PubMed2006

[Quality improvement of referrals from practising physicians. An example of a practicable strategy].

INTRODUCTION: Referrals from practising physicians to hospital departments are of varying quality. This increases the risk of inappropriate or even incorrect patient treatment courses. We examined the quality of referrals to a large department of nuclear medicine before and after initiatives aimed at improving the information and feedback to the practising physicians. MATERIALS AND METHODS: An evaluation of the quality of referrals (n = 579) from praticising physicians to the Department of Nuclear Medicine, Odense University Hospital, Denmark, recorded during two periods of three months each before and after (1) publication of a referral guideline and (2) a feedback response to those physicians whose referrals were insufficient. A general practitioner (GP) and a specialist in nuclear medicine (NM) judged independently whether the referrals were good, acceptable or unacceptable. RESULTS: During the two periods, 281 and 298 referrals were received, respectively. Of these, 37% and 27%, respectively, were from practising specialists (PSs). After intervention, 23% more referrals were received from GPs, and the share of "good" referrals also increased (before/after: 48%/72% (GP), 61%/84% (NM)). In contrast, there was a 23% decrease in referrals from PSs, whereas the share of "good" referrals remained unchanged or increased (before/after: 64%/66 % (GP), 64%/96% (NM)). In addition, there was a change in the referral pattern from both GPs and PSs. CONCLUSION: Relatively simple and inexpensive intervention caused an increase in the number and quality of referrals from GPs and a fall in referrals from PSs without an obvious improvement in quality.

Denmark↗
PubMed2006

[Quality control of whole-body bone scintigraphy. Patient surveys].

INTRODUCTION: The quality of health care is but sparsely elucidated; surveys of complete patient courses hardly exist. We established and used benchmarks for a major nuclear medicine examination: whole-body bone scintigraphy. MATERIALS AND METHODS: The study material included 458 out of 512 consecutive examinations. Patients were referred by general practitioners (12%), practising specialists (16%) and hospital departments (72%). The survey dealt with waiting times and information provided, as judged by the patient, the referring physician and the Department of Nuclear Medicine (DNM) in relation to referrals, reporting and the passing on of the results to the patient. The DNM judged the quality of the examinations, and the referring physician assessed the implications for diagnosis and treatment. RESULTS: In 10% of the cases, the patient felt that the waiting time was unsatisfactory, as the referring physician might take up to 150 days to send the referral and because 11% had, after two months, still not been informed of the examination result. Supplementary tomography was used in 38 examinations (8%); of these, only one (3%) provided new evidence. Based on the examination results, the referring physician could make a diagnosis and/or wanted to change management for 61% of patients. CONCLUSION: Referrals were delayed mainly by the referring physicians, who often forgot to inform their patients of the examination results. Special admissions seldom yielded extra information. The examination result had important clinical implications in almost two thirds of patients.

Adolescent↗
PubMed2002

[Can we rely on the results of urine microscopy and culture when tests are performed in general practice?].

INTRODUCTION: Urinary tract infections (UTI) account for 2-5% of consultations in general practice, but only about half the patients with dysuria have significant bacteriuria (> 100,000 bacteria per ml). A microbiological diagnosis can be made by examination of a urine sample, and in Danish family practice the diagnosis of UTI is often reached by a microscopic analysis or a dip-slide culture test. These methods have a high validity when performed in hospital, but we need knowledge about the validity of microbiological urine examinations when performed in general practice. The aim of this study was to validate detection of bacteriuria by urine microscopy and dip-slide culture in general practice. MATERIAL AND METHODS: Urine specimens artificially produced by adding a known quantity of bacteria (Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Staphylococcus epidermidis and Enterococcus faecalis) to sterile urine were sent to 25 general practices for microscopic examination and dip-slide culture. No prior instruction in testing procedure was given. As the gold standard, the results of a standardised culture method performed by skilled laboratory technicians at the Department of Microbiology, University of Southern Denmark, were used. RESULTS: Significant bacteriuria was identified by microscopy with a sensitivity of 95% and a specificity of 83%. The corresponding figures for urine culture were 95% and 96%. The morphology of bacteria was interpreted correctly in 80% of microscopic examinations, and 60% of the bacteria strains were classified correctly in terms of their motility. DISCUSSION: The results of urine microscopy and culture performed in general practice are to be relied on.

Bacteriological Techniques↗
PubMed2002

[Resistance tests in general practice. Validity can be improved by standardized procedures].

INTRODUCTION: Susceptibility testing of bacteria in urine is one of the commonest laboratory tests in general practice in Denmark. It is quick and easy to perform, but recent studies have shown low validity when the test is performed in general practice. If it is to continue as a diagnostic tool in general practice, its quality should be improved. The aim of this study was to investigate the effect of an intervention to improve the quality of susceptibility testing in general practice. MATERIAL AND METHODS: Twenty-three randomly selected general practices took part in the study. The intervention consisted of visits by laboratory technicians who instructed the practitioners in standardised procedures for susceptibility testing. Before and after the intervention, urine specimens containing monocultures of typical uropathogenic bacteria were sent to the practices. The practitioners performed susceptibility testing by the Sensicult and the Iso-Resagar methods, and the validity of the results before and after the intervention was compared. Results from susceptibility testing at the bacteriological laboratory, Odense University Hospital, were used as the gold standard. RESULTS: The median frequency of correct results increased from 82% to 98% for susceptibility testing by the Sensicult method (p = 0.001) and from 90% to 96% by the Iso-Resagar method (p = 0.05). DISCUSSION: The validity of susceptibility testing in general practice improves when preceded by instruction in standardised procedures.

Anti-Infective Agents, Urinary↗