DSAM’s publikationsinformation om seneste resultater inden for almenmedicinsk forskning i Danmark.
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DSAM’s publikationsinformation om seneste resultater inden for almenmedicinsk forskning i Danmark. December 2012

Kære practicus

Der udføres megen god forskning i almen praksis i Danmark. Imidlertid kan det være uoverskueligt at følge med, blandt andet fordi den publiceres i mange forskellige tidsskrifter rundt om i verden.

Det er jo en naturlig del af at være praktiserende læge, at man følger med i udviklingen i sit eget speciale, og det er intentionen, at denne opsamling af al danskbaseret forskning inden for almen medicin kan bidrage til at lette dette.

Der medtages al dansk forskning i almen medicin, som har gennemgået peer review inden publikation, uanset hvor i verden artiklen offentliggøres.

Vi viderebringer resume, og i de fleste tilfælde et link til den fulde artikel. Nogle tidsskrifter kræver betaling (det er jo forretninger), og i de tilfælde vil den fulde artikel kunne rekvireres ved direkte henvendelse til forfatter(ne) eller ved køb hos forlaget for tidsskriftet.

Forskningsmiljøerne i København, Aarhus og Odense sørger for materialet.

Sidst i mailen vil doctordisputatser og Ph.D. afhandlinger blive annonceret og resume offentliggjort i det omfang, det er blevet os bekendt.

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Gregers Hansen-Nord
DSAM's bestyrelse


Identifying specific non-attending groups in breast cancer screening - population-based registry study of participation and socio-demography

Jensen LF, Pedersen AF, Andersen BA, Vedsted P.
BMC Cancer 2012, 12:518 [Epub ahead of print].

Artiklen undersøger sammenhængen mellem sociodemografi og ikke-deltagelse i brystkræftscreening. Vi inkluderede alle kvinder, som var inviteret til første screeningsrunde i Region Midtjylland (n=149.234) og indhentede sociodemografiske data fra registre. Vi fandt en social gradient i deltagelsen forstået på den måde, at kvinder med fx lav indkomst, lav uddannelse og kvinder uden for arbejdsmarkedet var mere tilbøjelige til ikke at deltage. Samtidig så vi, at kvinder med høj uddannelse ligeledes deltog mindre end kvinder med en mellemlang uddannelse. Yderligere undersøgte vi gruppen af ikke-deltagere nærmere og fandt, at disse ikke nødvendigvis består af en homogen gruppe i forhold til sociodemografi.

Abstract

Background. A population-based breast cancer screening programme was implemented in the Central Denmark Region in 2008–09. The objective of this registry-based study was to examine the association between socio-demographic characteristics and screening participation and to examine whether the group of non-participants can be regarded as a homogeneous group of women. Method. Participation status was obtained from a regional database for all women invited to the first screening round in the Central Denmark Region in 2008–2009 (n=149,234). Participation data was linked to registries containing socio-demographic information. Distance to screening site was calculated using ArcGIS. Participation was divided into ‘participants’ and ‘non-participants’, and non-participants were further stratified into ‘active non-participants’ and ‘passive non-participants’ based on whether the woman called and cancelled her participation or was a ‘no-show’. Results. The screening participation rate was 78.9%. In multivariate analyses, non-participation was associated with older age, immigrant status, low OECD-adjusted household income, high and low level education compared with middle level education, unemployment, being unmarried, distance to screening site >20 km, being a tenant and no access to a vehicle. Active and passive non-participants comprised two distinct groups with different socio-demographic characteristics, with passive non-participants being more socially deprived compared with active non-participants. Conclusion. Non-participation was associated with low social status e.g. low income, unemployment, no access to vehicle and status as tenant. Non-participants were also more likely than participants to be older, single, and of non-Danish origin. Compared to active nonparticipants, passive non-participants were characterized by e.g. lower income and lower educational level. Different interventions might be warranted to increase participation in the two non-participant groups.

Link til artiklen

A randomised controlled trial of hospital-based case management to improve colorectal cancer patients’ health-related quality of life and evaluations

Wulff CN, Vedsted P, Søndergaard J.
BMJ Open 2012;2:e001481.

Artiklen beskriver effekten af en forløbskoordinatorfunktion for patienter under udredning og/eller i behandling for tarmkræft med hensyn til patientrapporterede outcomes. Effekten blev undersøgt i et RCT, hvor forløbskoordinatoren var placeret på Kirurgisk Afdeling P, AUH.

Vi fandt, at den testede forløbskoordinatorfunktion ingen effekt havde på patienternes selvrapporterede livskvalitet, men at patienterne, som var tilkoblet en forløbskoordinator. i højere grad oplevede sammenhæng og tryghed i deres udrednings- og behandlingsforløb.

Abstract

Objective. To analyse the effectiveness of hospitalbased case management (CM) in terms of patientreported outcomes. Design. Randomised controlled trial allocating participants 1 : 1 to either a CM intervention or a control group. Allocation status was evident to participants and case managers, but blinded to researchers. Setting. Patients were recruited at a Danish surgical department where the case managers were situated. Participants. Colorectal cancer patients who were to undergo further investigation or treatment. Exclusion criteria were participation in another study, poor Danish language skills or apparent cognitive impairment. 140 participants were randomised to each group. Recruitment period was 11 March 2009 to 29 December 2010. Interventions. Control group patients had usual care. Intervention group patients had usual care supplemented by hospital-based CM started at first visit to the outpatient clinic (before treatment start) and ended 4 weeks after completed cancer treatment. CM was conducted by nurse case managers who undertook care pathway supervision, information dissemination to health professionals and outreaching patient support. Outcome measures. Patient-reported global quality of life measured with the EORTC QLQ-C30 and eight ad hoc, piloted patient evaluation items assessed at eight, 30 and 52 weeks after randomisation. Results. The two groups were comparable as to questionnaire response rates and completed scales/items. There were no statistically significant group differences on any of the health-related quality of life subscales at eight, 30 or 52 weeks. In patient evaluations, all point estimates favoured CM at week 8 and 30; at week 52, 6 of 7 estimates favoured CM. Conclusions. We found no evidence that CM influenced colorectal cancer patients’ health-related quality of life. Patients allocated to CM evaluated their care more positively than patients receiving usual care.

Link til artiklen

Faced with a dilemma: Danish midwives’ experiences with and attitudes towards late termination of pregnancy

Anne Vinggaard Christensen, Anne Høllund Christiansen, Birgit Petersson
Scand J Caring Sci; 2012   Scandinavian journal of Caring Sciences (Empirical Studies) 

Abstract:

Background: The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives’ experiences with late termination of pregnancy (TOP) are still poorly described in the scientific literature.

Aim: To explore Danish midwives’ experiences with and attitudes towards late TOP. Focus was on how midwives perceive their own role in late TOP, and how their professional identity is influenced by working with late TOP in a time where prenatal screening is rapidly developing.

Method: A qualitative study consisting of ten individual interviews with Danish midwives, all of whom had taken part in late TOP.

Results: Current practice of late TOP resembles the practice of normal deliveries and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women’s legal right to choose TOP and considerations about the foetus’ right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis.

Conclusions: The midwives’ practice in relation to late TOP was characterised by an acknowledgement of the growing ethical status of the foetus and the emotional reactions of the women/couples going through late TOP. Other professions as well as structural factors at the hospital highly influenced the midwives’ ability to organize their work with late terminations. There is a need for more thorough investigation of how to secure the best possible working conditions for midwives, and how to optimise the care for women/couples going through late TOP.


Brug af foetocidium ved sene provokerede aborter i Danmark.

Anne Vinggaard Christensen, Birgit Petersson
Ugeskrift for Læger nov 2012 , Videnskab, Statusartikel.

Summary
As a result of prenatal screening the number of late terminations of pregnancy is increasing in Denmark. The fact that the foetus sometimes shows signs of life after the termination is a large concern for health-care staff and parents. In other countries foeticide is performed intrauterinely to ensure that the foetus is dead before the delivery. In Denmark this method is legally used in foetal reduction, but not in late termination of pregnancy. In the light of international literature on the subject, perspectives on foeticide in late termination of pregnancy are explored.

Korrespondance:
Anne Vinggaard Christensen 
Enhed for Medicinsk Kvinde- og Kønsforskning
Afdeling for Almen Medicin og Forskningsenheden for Almen Praksis
Institut for Folkesundhedsvidenskab
Københavns Universitet, Øster Farimagsgade, København K.
E-mail: anne.christensen@sund.ku.dk


Gynecological cancer patients’ differentiated use of help from a nurse navigator: a qualitative study.

Marianne Thygesen, Birthe Pedersen, Jakob Kragstrup, Lis Wagner, Ole Mogensen.
BMC Health Services Research 2012;12:168.

Abstract

Background
Fragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context.

Methods
A longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels.

Results
Prior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help.

Conclusions
Not everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients’ guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients’ trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.

Keywords:Nurse navigator; Patients’ view; Distrust; Qualitative research.

Link til artiklen

A randomised controlled trial to improve general practitioners¹ services in cancer rehabilitation: Effects on general practitioners¹ proactivity and o

Stinne Holm Bergholdt, Jens Søndergaard, Pia Veldt Larsen, Lise Vilstrup Holm, Jakob Kragstrup, Dorte Gilså Hansen
Acta Oncologica 2012; E-pub ahead of print.

Vi testede effekten af en kompleks intervention rettet mod at inddrage den praktiserende læge i kræftpatienters rehabiliteringsforløb, tidligt efter diagnosetidspunktet, i et randomiseret studie med i alt 955 inkluderede patienter. Interventionen bestod af en behovsafdækkende samtale med en projektsygeplejerske, efterfølgende telefonisk kontakt til patientens egen læge med videregivelse af informationen om de aktuelle rehabiliteringsbehov identificeret under interviewet, samt opfølgende skriftlig besked til lægen der gentog informationen givet i den telefoniske kontakt vedr. den specifikke patient, og derudover indeholdt en oversigt over kræftpatienters forskellige behov og problemer generelt, som lægen kunne anvende som inspiration i de følgende konsultationer. Både telefonisk og skriftligt blev lægerne opfordret til at være proaktive i forhold til patienternes rehabiliteringsforløb, og altså selv kontakte patienten og tilbyde sin støtte og hjælp. Data blev indsamlet via spørgeskemaer til patienter og praktiserende læger efter 14 måneder. Vi fandt ingen effekt af interventionen på lægernes grad af proaktivitet, hverken patient- eller lægerapportteret, eller på patienternes deltagelse i forskellige rehabiliteringsaktiviteter. På tværs af randomiseringen så vi dog, at de patienter, der rapporterede, at deres egen læge havde været proaktive i deres forløb, deltog i signifikant flere rehabiliteringsaktiviterer. Det tyder altså på, at proaktivitet blandt læger kan mobilisere øget deltageaktivitet blandt deres patienter.

Abstract
Few studies have evaluated initiatives targeting implementation of cancer rehabilitation. In this study we aim to test the effects of a complex intervention designed to improve general practitioners’ (GPs) involvement in cancer rehabilitation. Outcomes were proactive contacts to patients by their GP reported by the patients and GPs, respectively, and patients’ participation in rehabilitation activities. Methods. Cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention group or to a control group (usual procedures). Patients were subsequently allocated to the intervention or the control group based on randomisation status of their GP. Between May 2008 and February 2009, adult patients treated for incident cancer at Vejle Hospital, Denmark, were assessed for eligibility. A total of 323 general practices were included, allocating 486 patients to an intervention and 469 to a control group. The intervention included a patient interview about rehabilitation with a rehabilitation coordinator at the hospital, comprehensive information to the GP about individual needs for rehabilitation, and an encouragement to the GP to contact the patient proactively. Questionnaires were administered to patients and GPs at 14 months after inclusion. Results. At baseline average age of patients was 63 years and 72% were female. The most frequent cancer localisations were breast (43%), lung (15%), and malignant melanoma (8%). The intervention had no effect on either patient- or GP-reported extent of GP proactivity. Further, no effect was observed on patient participation in rehabilitation activities during the 14-month follow-up period. Discussion. The intervention had no effect on GP proactivity or on patient participation in rehabilitation activities. However, analyses showed a significant association between proactivity and participation and we, therefore, conclude that increased GP proactivity may facilitate patient participation in rehabilitation activities.

Link til artiklen

Postpartum infections: occurrence, healthcare contacts and association with breastfeeding

Peder Ahnfeldt-Mollerup, Line Kirkeby Petersen, Jakob Kragstrup, René dePont Christensen, Bente Sørensen

Acta Obstetricia et Gynecologica Scandinavica 2012;91: E-pub ahead of print.

Abstract
Objectives. To investigate 1) the occurrence of postpartum infections, 2) the frequency of contact with either a general practitioner or a hospital due to postpartum infections, and 3) the association of postpartum infections with continuation of breastfeeding. Design. Cross-sectional study. Population. A total of 1871 women who gave birth at a regional hospital in Denmark over a one-year period (2007-2008). Methods. Data were collected by a questionnaire to the women and combined with data from general practitioner and hospital records. Distribution of different infections as well as the overall occurrence of any infection were evaluated according to mode of delivery and breastfeeding status (stopped/continued). Results. Within four weeks after delivery 24% of all women had experienced one or more self-reported infection episode. Breast infections (12%) were most frequent, followed by wound (3%), airway (3%), vaginal (3%) and urinary tract infections (3%), endometritis (2%) and "other infections" (2%). Of the women with an infection 66% (265/395) contacted their general practitioner, while 9% (37/395) had contact with a hospital. A significantly larger proportion of women with a postpartum infection stopped breastfeeding (21%) within the first four weeks after delivery compared to women without infection (12%) (p<0.001). Conclusion. Postpartum infections were common, and the occurrence is likely to be underestimated if based on hospital medical records only. Infection was associated with higher rates of discontinuation of breastfeeding.

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Ph.D.-afhandlinger

  • Diagnostic pathways for women with gynecological cancer
    Cand.med. Mai Partridge Vandborg
     
  • Quality indicators for diagnosis and treatment of respiratory tract infections in general practice
    Cand.med. Malene Plejdrup Hansen
     
  • Patient complaint cases in general practicee
    Speciallæge, cand.med. Søren Fryd Birkeland

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