Clinicians' management strategies for patients with dyspepsia: a qualitative approach

BACKGROUND: Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own. METHODS: Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted. RESULTS: For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced. CONCLUSION: Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate evidence so that clinicians are able to interpret and implement it in practice. Of particular significance is that scientific evidence leads to an evidence-based care which is effective clinical practice and to the promotion of health from the perspective of the patient, together with cost-effectiveness as a priority

A comparison of diagnostic tests for lactose malabsorption - which one is the best?

<p>Abstract</p> <p>Background</p> <p>Perceived milk intolerance is a common complaint, and tests for lactose malabsorption (LM) are unreliable. This study assesses the agreement between diagnostic tests for LM and describes the diagnostic properties of the tests.</p> <p>Methods</p> <p>Patients above 18 years of age with suspected LM were included. After oral intake of 25 g lactose, a combined test with measurement of serum glucose (s-glucose) and hydrogen (H2) and methane (CH4) in expired air was performed and symptoms were recorded. In patients with discrepancies between the results, the combined test was repeated and a gene test for lactose non-persistence was added. The diagnosis of LM was based on an evaluation of all tests. The following tests were compared: Increase in H2, CH4, H2+CH4 and H2+CH4x2 in expired air, increase in s-glucose, and symptoms. The agreement was calculated and the diagnostic properties described.</p> <p>Results</p> <p>Sixty patients were included, seven (12%) had LM. The agreement (kappa-values) between the methods varied from 0.25 to 0.91. The best test was the lactose breath test with measurement of the increase in H2 + CH4x2 in expired air. With a cut-off level < 18 ppm, the area under the ROC-curve was 0.967 and sensitivity was 100%. This shows that measurement of CH4 in addition to H2 improves the diagnostic properties of the breath test.</p> <p>Conclusion</p> <p>The agreement between commonly used methods for the diagnosis of LM was unsatisfactory. A lactose breath test with measurement of H2 + CH4x2 in expired air had the best diagnostic properties.</p

The effect of ApoE e4 on blood pressure in patients with and without depression

Knut A Hestad,1&ndash;3 Knut Engedal,4 Jon Elling Whist,1,5 Per G Farup1,6 1Department of Research, Innlandet Hospital Trust, Brumunddal, Norway; 2Department of Psychology, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Public Health, Hedmark University College, Elverum, Norway; 4Norwegian Center for Aging and Health, Vestfold Health Trust, T&oslash;nsberg, Norway; 5Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway; 6Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of&nbsp;Medicine, Norwegian University of&nbsp;Science and Technology, Trondheim,&nbsp;Norway Introduction: Depression is considered an independent risk factor for hypertension, particularly for people with recurrent episodes or a long history of depression. Another risk factor for cardiovascular disease is the Apolipoprotein E e4 allele (ApoE e4). The aim of this study was to examine how ApoE e4 was related to blood pressure (BP) in patients with depression and&nbsp;a control group.Methods: A total of 78 patients, 49 with depression and 29 without, all recruited from the same hospital, underwent ApoE e genotyping (24 had at least one ApoE e4 allele) and examination of BP.Results: In the depression group, but not in the control group, both systolic and diastolic BP were significantly higher in patients with ApoE e4 than in those without. The effect of ApoE e4 on BP differed significantly between the two groups.Conclusion: Our findings showed that the effect of ApoE e4 on BP differed between the patients with depression and the control group. In patients with depression, ApoE e4 was associated with an increase in BP. We suggest that patients with depression and ApoE e4-positive status are particularly prone to develop BP elevation. Keywords: depression, blood pressure, ApoE e4, ApoE, genotypin

Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments

Bodil R&oslash;yset,1 Bente A Talseth-Palmer,2&ndash;4 Stian Lydersen,5 Per G Farup6,7 1Department for Medicine and Rehabilitation, M&oslash;re og Romsdal Hospital Trust, &Aring;lesund, Norway; 2Department for Research, Innovation, Education and Competence Development, M&oslash;re og Romsdal Hospital Trust, Molde, Norway; 3Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 4School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; 5Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 6Department of Research, Innlandet Hospital Trust, Brumunddal, Norway; 7Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway Purpose: Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety.Materials and methods: Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64&nbsp;years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees&rsquo; perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire).Results: Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: -2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety.Conclusion: The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety. Keywords: accidental falls, accident prevention, adverse effects, patient safety, safety cultur

Patients with depression display cytokine levels in serum and cerebrospinal fluid similar to patients with diffuse neurological symptoms without a defined diagnosis

Knut A Hestad,1&ndash;3 Knut Engedal,4 Jon Elling Whist,1 P&aring;l Aukrust,5&ndash;9 Per G Farup,1,10 Tom Eirik Mollnes,9,11&ndash;13 Thor Ueland5,7,91Department of Research, Innlandet Hospital Trust, Brumunddal, 2Department of Psychology, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), Trondheim, 3Department of Public Health, Hedmark University College, Elverum, 4Norwegian Centre for Aging and Health, Vestfold Health Trust, T&oslash;nsberg, 5Research Institute of Internal Medicine, 6Section of Clinical Immunology and Infectious Diseases, 7Institute of Clinical Medicine, Oslo University Hospital Rikshospitalet, 8K.G. Jebsen IRC, University of Oslo, Oslo, 9K.G. Jebsen TREC, University of Troms&oslash;, Troms&oslash;, 10Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, 11Centre of Molecular Inflammation Research, Norwegian University of Science and Technology (NTNU), Trondheim, 12Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, 13Research Laboratory, Nordland Hospital, Bod&oslash;, NorwayIntroduction: Several reports indicate that inflammation may play a role in depression and demonstrate enhanced systemic levels of inflammatory mediators. We hypothesized that 44 patients with a diagnosis of depression would present with a specific and different serum and cerebrospinal fluid (CSF) cytokine profile compared to 21 patients with diffuse neurological symptoms, of whom 15 had fatigue as a major symptom, but no change in emotional state.Methods: The diagnoses of the patients with depression were according to the International Classification of Diseases, tenth edition (F32&ndash;34 spectra). Cytokine profiles in serum and CSF were determined by multiplex analysis, including 27 cytokines, chemokines, and growth factors.Results: No differences could be found between the two groups studied regarding cytokine levels in serum or CSF except for serum interleukin (IL)-1 receptor antagonist that was lower in the depression group. There were only four high correlations (&gt;0.4) between serum and CSF levels of the cytokines, reflecting independent synthesis and turnover in these two compartments. In the control group, fatigue was associated with increased IL-1 receptor antagonist, IL-10, granulocyte-colony stimulating factor, and interferon-&gamma; (all P&lt;0.01).Conclusion: Patients with depression had a similar cytokine profile as nondepressive patients, both systemically and in CSF. Fatigue was associated with higher levels of some inflammatory markers in the control group. It is possible that the presence of fatigue in a large proportion of patients and controls could contribute to the lack of difference in cytokine levels between these two groups.Keywords: depression, cytokines, chemokines, inflammation, fatigue, serum, CSF, multiplex analysi