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Biomedical subjects

S Mölstad

Publications and source records attributed to S Mölstad.

At least 19 recordsLinked to original sources
PubMed2003

Use of rules of thumb in the consultation in general practice--an act of balance between the individual and the general perspective.

BACKGROUND: Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice. OBJECTIVE: The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice. METHODS: An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis. RESULTS: A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment. CONCLUSION: Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.

Family Practice↗
PubMed2003

Chest pain and ischaemic heart disease in primary care.

BACKGROUND: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain. AIMS: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population. DESIGN OF STUDY: Prospective descriptive study. SETTING: Three primary health centres in south-eastern Sweden. METHOD: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively. RESULTS: Out of 38,075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 441 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old). CONCLUSION: The incidence of a new episode of chest pain bringing the patients to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

Adult↗
PubMed2002

Asking for 'rules of thumb': a way to discover tacit knowledge in general practice.

BACKGROUND: Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice. OBJECTIVE: To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like. METHODS: An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis. RESULTS: Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP's clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work. CONCLUSION: GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

Decision Making↗
PubMed2001

Variation in antibiotic use in the European Union.

Data on antibiotic use are not publicly available in most European Union countries. We obtained data for non-hospital antibiotic sales for 1997 from the 15 member states and analysed these according to the Anatomic Therapeutic Chemical classification system, and expressed them as defined daily doses per 1000 people per day. Sales of antibiotics varied more than four-fold: France (36.5), Spain (32.4), Portugal (28.8), and Belgium (26.7) had the highest sales, whereas the Netherlands (8.9), Denmark (11.3), Sweden (13.5), and Germany (13.6) had the lowest. There was also profound variation in use of different classes of antibiotics. Detailed knowledge of antibiotic use is necessary to implement national strategies for optimum antibiotic use, and to address the threat posed by resistant microorganisms.

Anti-Bacterial Agents↗
PubMed2000

Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics.

OBJECTIVE: To study the impact of the utilization of antibiotics in children at the population level on the frequency of penicillin-nonsusceptible pneumococci (PNSP). DESIGN: Children ages 0 to 6 years with a nasopharyngeal culture of PNSP were registered on place of residency in the 20 municipalities of the former Malmöhus County (since 1998 a part of Skåne County). Where possible the total number of nasopharyngeal cultures with growth of pneumococci was registered as well. All antibiotic prescriptions for 0- to 6-year-old children were analyzed in the 20 municipalities. MAIN OUTCOME MEASURES: Correlation between the utilization of antibiotics and the frequency of PNSP in children at the municipality level. RESULTS: The proportion of PNSP among all isolates of pneumococci from nasopharyngeal cultures varied between 0 and 49.5%. The antibiotic utilization in children varied among the 20 neighboring municipalities from 8.5 to 19.7 defined daily doses per 1000 children per day. The municipalities with high total utilization also had more frequent use of macrolides and broad spectrum antibiotics. The was a significant correlation between antibiotic use and the proportion of PNSP (correlation coefficient, 0.96; P = 0.002), and the correlation coefficients for trimethoprim-sulfamethoxazole, amoxicillins, macrolides and cephalosporins were significant at the 0.001 level. There was no significant correlation between the use of penicillin V and the frequency of PNSP. CONCLUSIONS. There was a significant correlation between the frequency of PNSP and the utilization of antibiotics in children at the population level.

Anti-Bacterial Agents↗
PubMed1999

[Reduced frequency of resistant pneumococci in Southern Sweden. Community based disease control projects to minimize antibiotic resistance].

In an attempt to limit the spread of penicillin non-susceptible pneumococci (PNSP) in southern Sweden, early in 1995 an intervention project was launched, using a combination of traditional communicable disease control measures and actions aimed at reducing antibiotics consumption. Patients carrying PNSP (penicillin G MIC (0.5 mg/L) are monitored with nasopharyngeal cultures until PNSP-negative. Pre-school children are kept home from group day-care facilities. Previous antibiotic consumption was identified as a risk factor for PNSP carriage. Antibiotics sales decreased during the study period, and epidemiological findings suggest the dissemination of PNSP in the area to have been reduced by the intervention project.

Adult↗
PubMed1999

Major change in the use of antibiotics following a national programme: Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA).

In order to reduce inappropriate use of antibiotics and to counteract the increase in antimicrobial resistance in community-acquired and nosocomial infections, a national project was initiated in Sweden in 1994: the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance. In the first years the project focused on inappropriate prescribing of antibiotics to children with respiratory tract infections and on the surveillance of resistance in pneumococci. Statistics on antibiotic sales on a national and county level and for different age-groups were studied. Between 1993 and 1997 antibiotic prescribing was reduced by 22%, from 16.3 to 13.0 defined daily doses (DDD) per 1000 inhabitants/d. The reduction was most pronounced for children, 0-6-y-old, from 15.7 to 9.7 DDD/1000 children/d. Macrolides and amoxicillin/co-amoxyclav decreased most. There were large variations in antibiotic sales in different counties, and a decrease was also noted in counties starting from a low level. In the county with the highest sales in 1993, antibiotic prescribing to children was reduced by 40%. The national frequency of penicillin-non-susceptible pneumococci (MIC > or =0.1 mg/l) has not increased during the 1990s and the increasing incidence in southern Sweden seems to have been curtailed. During the period that the project has been running, a major change in the use of antibiotics, especially for pre-school children, has been achieved.

Child↗
PubMed1999

Medical audit changes physicians' prescribing of antibiotics for respiratory tract infections.

OBJECTIVE: To reduce the prescribing of antibiotics in respiratory tract infections (RTI). DESIGN AND SUBJECTS: The Audit Odense model for registration and quality development was used for RTI. Twenty general practitioners registered their consultations for RTIs during 4 weeks in February-March (n = 1124) and November-December (n = 926) in 1995. Diagnosis, choice of antibiotics and diagnostic tools were registered. In between the two registrations an active intervention took place. Consultations for RTIs among 25 physicians (who had not participated in any intervention or follow-up discussion) served as a control. SETTING: General practice in southern Sweden. OUTCOME MEASURES: Prescribing of antibiotics before and after an intervention. RESULTS: The proportion of patients not receiving an antibiotic increased from the first to the second registration in both groups, in the intervention group from 45 to 55% (p < 0.001) and in the control group from 36 to 40% (p = 0.0298). The reduction was most evident in patients diagnosed with tonsillitis and bronchitis. This was in concordance with an increase in the use of desktop diagnostics (Strep A and CRP). CONCLUSION: These results indicate that it is possible to achieve a change in the utilisation of antibiotics in the treatment of RTIs and that the Audit Project Odense (APO) model could be a valuable tool.

Anti-Bacterial Agents↗
PubMed1999

Penicillin-resistant pneumococci in southern Sweden, 1993-1997.

In Malmöhus County, Southern Sweden, the frequency of penicillin-resistant pneumococci in nasopharyngeal specimens of outpatients with respiratory tract infections increased from 3.1% in 1993 to 7.6% in 1995, and was thereafter rather stable. Over the period, 82-85% of the patients with penicillin-resistant strains were children 0-6 years of age. Ten groups/types constituted 96-100% of the penicillin-resistant isolates. Grouping/typing of 200 consecutive isolates in October and November each year indicated that the distribution of groups/types amongst patients with respiratory tract infections was rather constant over the period. The frequency of penicillin-resistant pneumococci of groups/types 6, 14, and 19 roughly corresponded to the occurrence of these groups/types amongst the consecutive isolates. Other groups/types 9, 15, 21, and 23 either showed a pronounced increase or decrease, which could not be related to the prevalence of these groups/types among the consecutive isolates or degree of antibiotic resistance. Penicillin-resistant group 9, introduced in the area in 1993, consisted of one single clone, 9V. The stabilized level of penicillin resistance since 1995 may be related to the preventive measures implemented in the area, including day-care interventions, and measures to reduce the prescription rate of antibiotics to outpatients with respiratory tract infections.

Child↗
PubMed1998

Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors.

OBJECTIVE: The aim of this study was to investigate the intra-urban variation of antibiotic utilization in children in Malmö and to evaluate the influence of socio-economic factors on this variation. METHODS: In an ecological analysis, the variations in antibiotic utilization in children, expressed as defined daily dose (DDD) or as the number of prescriptions per 1000 inhabitants per day, were compared with variations in socio-economic and demographic factors in the 17 administrative districts of the Swedish city of Malmö (235000 inhabitants). RESULTS: There were large between-area differences in antibiotic utilization, especially in children aged 0-6 years. Socio-economic factors reflecting a privileged situation correlated positively with antibiotic utilization. Thus, in districts with a high median family income and a high employment rate, the utilization of antibiotics was higher than in other districts. Conversely, in districts with a high proportion of blue-collar workers, people with foreign backgrounds and recipients of social benefit, antibiotic utilization was comparatively low. In contrast, the utilization of penicillin V relative to other antibiotics showed an opposite pattern, including positive correlations with the proportion of social benefit, immigrants and blue-collar workers and a negative correlation with employment rate. Conversely, the utilization of macrolides in relation to other antibiotics in children aged 0-6 years was highest in districts inhabited by those who were socio-economically privileged. INTERPRETATION: The findings suggest that utilization of antibiotics in children may vary considerably within a city, that it may increase with the degree of parental affluence, and that such affluence may reduce the utilization of penicillin V relative to other antibiotics.

Adolescent↗
PubMed1998

Previous antibiotic consumption and other risk factors for carriage of penicillin-resistant Streptococcus pneumoniae in children.

As part of the South Swedish Pneumococcal Intervention Project, aimed at reducing the spread of penicillin-resistant pneumococci with MICs for penicillin G > or =0.5 mg/l (PRP), all patients in Malmöhus county, southern Sweden, with a culture positive for PRP were followed up by means of repeated nasopharyngeal cultures until PRP-negative. If a child carrying PRP attended a day-care centre, nasopharyngeal cultures were obtained from the other children and staff. All children screened for PRP carriage in 30 day-care centres with an identified index case were included in the analysis, and several outcome variables (antibiotic consumption during the preceding 6 months, previous health and social situation) were assessed in relation to the end-point PRP carriage. Of 1036 children, 128 were found to be PRP carriers and 908 were PRP non-carriers. The PRP carriers had higher antibiotic consumption, were younger and were more often of male sex than the non-carriers (P<0.05). Consumption of antibiotics during the preceding 6 months was noted in 53% of carriers and 45% of non-carriers (relative risk 1.20, 95% confidence interval 1.01-1.43). When adjusting for age, gender and day-care centre attendance, recent consumption of cotrimoxazole (trimethoprim/sulfamethoxazole) emerged as an independent risk factor for PRP-carriage (relative risk 3.48, 95% confidence interval 1.10-11.07). The PRP-carriage rate in three day-care centres with high cotrimoxazole consumption was significantly higher (24%) than in the other day-care centres (10%) (P<0.005). The results indicate that measures aimed at reducing consumption of antibiotics in general, and cotrimoxazole in particular, may decrease the incidence of penicillin resistance, but such measures are, by themselves, probably not sufficient to halt the spread.

Anti-Bacterial Agents↗
PubMed1998

Introduction and clonal spread of penicillin- and trimethoprim/sulfamethoxazole-resistant Streptococcus pneumoniae, serotype 9V, in southern Sweden.

As part of an intervention project, all patients in Malmöhus county with a culture positive for penicillin-resistant pneumococci, MIC > or =0.5 mg/L (PRP), have been registered since January 1995. Nasopharyngeal specimens were obtained from family members and close contacts of identified carriers. Children were denied attendance at regular day-care until PRP-negative. In 1995 and 1996, PRP were isolated from 882 individuals, 364 of whom had clinical infection and the remaining of whom were asymptomatic carriers. In 49%, the PRP were of serogroup 9, with MIC of penicillin 0.5-2.0 mg/L and resistance to trimethoprim/sulfamethoxazole. Further analyses with serotyping and genetic fingerprinting suggested strongly that most of the isolates belonged to a single serotype 9V clone. Month by month, an apparently continuous spread appeared from one municipality to a neighboring one. In most communities, the serotype 9V PRP appeared and disappeared within a few months. The active procedures of the intervention project may have limited the spread of the clone in the county.

Child↗
PubMed1998

Limiting the spread of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project.

In an attempt to limit the spread of penicillin-resistant pneumococci (PRP), an intervention project was initiated in the Malmöhus County, southern Sweden in January 1995. The ongoing project combines traditional communicable disease control measures and actions aiming at reducing antibiotics consumption. All patients in the county with a nasopharyngeal culture positive for PRP with MIC of Penicillin G > or =0.5 mg/L are followed with nasopharyngeal cultures until PRP-negative. Nasopharyngeal cultures are obtained from family members and close contacts of the index cases. Preschool children carrying PRP are denied attendance at group day-care. From January 1995 to March 1997, 1,038 PRP-carriers (429 index cases and 609 contact cases) were identified. Children aged 1-6 years dominated (83%). Antibiotics sales decreased during the study period, and epidemiologic data indicate that the intervention may have limited the dissemination of PRP in the county, but further evaluation is needed.

Adolescent↗