COPD, stage and treatment in a large outpatient clinic

Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62 patients (11.3%) met the criteria for treatment with roflumilast. Among the patients eligible for roflumilast treatment, only 14 patients (22.6%) were receiving treatment. There were no significant differences in FEV1, number of exacerbations, hospitalization due to exacerbation, MRC grade, age, smoking status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients fulfilling the criteria for this therapy

Monitoring the normal body:ideals and practices among normal-weight and moderately overweight people

Introduction: An extensive body of literature is concerned with obese people, risk, and weight management. However, little is known about weight management among people not belonging to the extreme BMI categories. Management of weight among normal-weight and moderately overweight individuals provides us with knowledge about how to prevent future overweight or obesity. This paper investigates body size ideals and monitoring practices among normal-weight and moderately overweight people. Methods: The study is based on in-depth interviews combined with observations. 24 participants were recruited by strategic sampling based on self-reported BMI 18.5-29.9 kg/m2 and socio-demographic factors. Inductive analysis was conducted. Results: Normal-weight and moderately overweight people have clear ideals for their body size. Despite being normal weight or close to this, they construct a variety of practices for monitoring their bodies based on different kinds of calculations of weight and body size, observations of body shape, and measurements of bodily firmness. Biometric measurements are familiar to them as are health authorities' recommendations. Despite not belonging to an extreme BMI category, they translate such measurements and recommendations in meaningful ways to fit their everyday life. Conclusions: Normal-weight and moderately overweight people are concerned with their body size and continuously monitor it. Future health promotion work should consider the kind of practices already established in daily life when recommending ways of conducting body management

EVIDENSBASERET POLITIKUDVIKLING

Brudflader mellem forskning og bureaukrati Det har i en årrække været en ambition i det danske embedsværk at kunne baserestadig flere indsatser på evidens. Hvor den evidensbaserede tilgang tidligereprimært var at finde på de sundhedsfaglige indsatsområder, har tilgangen nuogså vundet frem på det sociale område og i beskæftigelsesindsatsen. Dermedskriver Danmark sig ind i en bredere tendens, som også omfatter det amerikanskeog det britiske embedsværk. Bestræbelserne på at frembringe evidensbaseretpolicy er imidlertid blevet problematiseret både fra forskningsmiljøerne oginternt i statsadministrationerne. I disse analyser konkluderes det, at evidenskun sjældent, hvis nogensinde, bruges direkte i politikudviklingen, men oftere erenten håndplukket til lejligheden eller indgår som et blandt flere input. I denneartikel vil jeg på baggrund af feltarbejde i det danske embedsværk diskutere,præcis hvori udfordringerne ved at arbejde evidensbaseret består. Hvordan gårdet altså til, at evidens ikke anvendes direkte i udviklingen af politik? Via enanalyse af udviklingen og implementeringen af et dansk forsøg på at udvikleevidensbaseret policy på beskæftigelsesområdet vil jeg vise, hvordan detevidensbaserede paradigme grundlæggende er i konflikt med embedsværketstraditionelle håndværk og arbejdsbetingelser.Søgeord: evidensbaseret politik, embedsværket, policy, bureaukrati, Danmar

Underernæring hos eldre hjemmeboende personer med demens

Bakgrunn: Eldre personer med hukommelsestap er svært utsatt for underernæring. Tidligere studier har i hovedsak fokusert på pasienter som bor på institusjon. Hensikt: Hensikten med denne studien er å kartlegge og belyse ernæringsstatusen til eldre hjemmeboende pasienter med demens og kognitiv svikt som får bistand av hjemmetjenesten i fire bydeler i Oslo. Metode: Det ble gjennomført en tverrsnittsstudie i fire utvalgte bydeler i Oslo, (N=282). Instrumentet Mini Nutritional Assessment (MNA) ble benyttet til innsamling av data. Logistisk regresjonsanalyse ble anvendt for å analysere dataene, og resultatene presenteres i oddsratioer. Resultater: Studien viser at underernæring er svært utbredt blant hjemmeboende pasienter med kognitiv svikt og demenssykdom. Omkring halvparten av pasientene var underernært eller sto i fare for underernæring. Det å være kvinne og ha problemer med matinntak viser seg å være viktige risikofaktorer for underernæring. Konklusjon: Resultatene i studien viser at det er avgjørende at helsepersonell og pårørende er kjent med risikofaktorene for underernæring. Nødvendige tiltak må iverksettes på et tidlig stadium for å forhindre alvorlig underernæring og sykdom som følge av dette.Malnutrition in elderly people living at home with cognitive impairment and dementia Background: Elderly people with memory loss are particularly vulnerable to malnutrition. Previous studies have mainly focused on elderly living in an institution. Objective: The purpose of this study is to identify the nutritional status of elderly with dementia who live at home. Method: The survey design was conducted in four selected districts in Oslo (N = 282). Mini Nutritional Assessment Instrument (MNA) was used for data collection. Logistic regression analysis was used to analyze the data and the results were presented in odds ratios. Results: Our results show that malnutrition is highly prevalent among home-living patients with cognitive impairment and dementia. About one-half of the patients were malnourished or were at risk of malnutrition. Being a woman and having problems with food intake appears to be important risk factors for malnutrition. Conclusion: One interpretation of these results is that it is essential that health professionals and the patients’ relatives are aware of these risk factors, and that necessary measures are implemented at an early stage, in order to prevent severe malnutrition and subsequent disease

Cold steel versus impedance-dependent tissue sealer tonsillectomy - a study protocol for a randomised controlled trial

INTRODUCTION: Approximately 7,000 tonsillectomies are performed annually in Denmark on a benign basis. The cold steel surgical technique is the gold standard. The risk of post tonsillectomy bleeding (PTH) in a centre in Jutland is 7.9%. A new impedance-dependent tissue sealer (IDTS) device has been developed, with preliminary results showing a reduction in operation time, perioperative bleeding and post-operative risk of bleeding of 4.5%.METHODS: A randomised, controlled, double-blinded multicentre trial of cold steel tonsillectomy versus IDTS will be performed on 1,250 patients. The main endpoint is PTH, perioperative bleeding, operation time and post-operative pain. The secondary outcomes are days until return to work, food intake, activity and quality of life. Included in the study are patients with indication for surgery weighing ≥ 16 kg, and excluded are patients with malignancy, bleeding disorders and unwillingness to participate in the study.CONCLUSIONS: To our knowledge, the present study is the largest randomised controlled trial in ENT surgery in the Nordic countries. The study will potentially provide evidence on PTH regarding two tonsillectomy methods.FUNDING: The authors have no potential conflicts of interest to declare. The study is supplied with instruments from Medtronic needed for the surgical procedures. Furthermore, a minor part of the funding of the entire project is provided by the aforementioned company. The funding providers have no role in design or conduct of the study.CLINICALTRIALS: gov with the identification number NCT05270109.</p