Dietary Advice on Prescription: A novel approach to dietary counseling

This article describes a novel approach to giving dietary advice, which is called “Dietary Advice on Prescription” (DAP; Matordning på Recept [MoR] in Swedish). It is the same principle as prescription on medicine and “Physical Activity on Prescription” (PAP; Fysisk aktivitet på Recept [FaR] in Swedish). The main idea is that a written prescription will strengthen the oral advice and emphasize certain aspects of the dietary recommendation. The DAP is on the brink of being tested in a planned study

Uncertain trajectories in old age and implications for families and for palliative and end-of-life care policy and practice

© 2019 Taylor & Francis Group, LLC.The provision of high-quality end-of-life care for all is high on national (and international) agendas, but areas of unmet needs identified includes elderly people. This article draws on an autoethnographic account of the dying and death of my father to identify and interrogate disjunctions between end-of-life care policy and commonplace experiences of elderly people who die in a hospital setting. There are significant disjunctions between the “blunt” tools of end-of-life care policy and the everyday experiences of the dying and death of an elderly patient and an urgent need to improve end-of-life care for our oldest generations.Peer reviewe

CT head reporting by radiographers: results of an accredited postgraduate programme

Aim: To evaluate the results of the summative objective structured examination (OSE) for the first four cohorts of radiographers (n ¼ 24) undertaking an accredited postgraduate course in reporting computer tomography (CT) head examinations. Method: The construction of a summative OSE contained twenty five CT head examinations that incorporated 1:1 normal to abnormal pathological examples. All cases were blind reported by three consultant radiologists to produce a valid reference standard report for comparison with the radiographer's interpretation. The radiographers (n ¼ 24) final reports (n ¼ 600) were analysed to determine the sensitivity, specificity and agreement values and concordance for the four cohorts. Results: The four cohorts (2007e2013) of postgraduate radiography students' collective OSE results established a mean sensitivity rate of 99%, specificity 95% and agreement concordance rates of 90%. The final grades indicate that within an academic environment, trained radiographers possess high levels of diagnostic performance accuracy in the interpretation of CT head examinations

Physical activity referrals in Swedish primary health care – prescriber and patient characteristics, reasons for prescriptions, and prescribed activities

<p>Abstract</p> <p>Background</p> <p>Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.</p> <p>Methods</p> <p>Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.</p> <p>Results</p> <p>During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.</p> <p>The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).</p> <p>Conclusion</p> <p>Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.</p

AFROC analysis of reporting radiographer’s performance in CT head interpretation

Aim: A preliminary small scale study to assess the diagnostic performance of a limited group of reporting radiographers and consultant radiologists in clinical practice undertaking computer tomography (CT) head interpretation . Method: A multiple reader multiple case (MRMC) alternative free response receiver operating characteristic (AFROC) methodology was applied. Utilising an image bank of 30 CT head examinations, with a 1:1 ratio of normal to abnormal cases. A reference standard was established by double reporting the original reports using two additional independent consultant radiologists with arbitration of discordance by the researcher. Twelve observers from six southern National Health Service (NHS) trusts were invited to participate. The results were compared for accuracy, agreement, sensitivity, specificity. Data analysis used AFROC and area under the curve (AUC) with standard error. Results: The reporting radiographers results demonstrated a mean sensitivity rate of 88.7% (95% CI 82.3 to 95.1%), specificity 95.6% (96% CI 90.1 to 100%) and accuracy of 92.2% (95% CI 89.3 to 95%). The consultant radiologists mean sensitivity rate was 83.35% (95% CI 80 to 86.7%), specificity 90% (95% CI 86.7 to 93.3%) and accuracy of 86.65% (95% CI 83.3 to 90%). Observer performance between the two groups was compared with AFROC, AUC, and standard error analysis (p=0.94, SE 0.202). Conclusion: The findings of this research indicate that within a limited study, a small group of reporting radiographers demonstrated high levels of diagnostic accuracy in the interpretation of CT head examinations that was equivalent to a small selection of consultant radiologists

Breast-milk iodine concentration declines over the first 6 mo postpartum in iodine-deficient women.

BACKGROUND: Little is known about the iodine status of lactating mothers and their infants during the first 6 mo postpartum or, if deficient, the amount of supplemental iodine required to improve status. OBJECTIVE: The objective was to determine maternal and infant iodine status and the breast-milk iodine concentration (BMIC) over the first 6 mo of breastfeeding. DESIGN: A randomized, double-blind, placebo-controlled supplementation trial was conducted in lactating women who received placebo (n = 56), 75 μg I/d (n = 27), or 150 μg I/d (n = 26) after their infants' birth until 24 wk postpartum. Maternal and infant urine samples and breast-milk samples were collected at 1, 2, 4, 8, 12, 16, 20, and 24 wk. Maternal serum thyrotropin and free thyroxine concentrations were measured at 24 wk. RESULTS: Over 24 wk, the median urinary iodine concentration (UIC) of unsupplemented women and their infants ranged from 20 to 41 μg/L and 34 to 49 μg/L, respectively, which indicated iodine deficiency (ie, UIC < 100 μg/L). Mean maternal UIC was 2.1-2.4 times higher in supplemented than in unsupplemented women (P < 0.001) but did not differ significantly between the 2 supplemented groups. BMIC in the placebo group decreased by 40% over 24 wk (P < 0.001) and was 1.3 times and 1.7 times higher in women supplemented with 75 μg I/d (P = 0.030) and 150 μg I/d (P < 0.001), respectively, than in unsupplemented women. Thyrotropin and free thyroxine did not differ significantly between groups. CONCLUSION: BMIC decreased in the first 6 mo in these iodine-deficient lactating women; supplementation with 75 or 150 μg I/d increased the BMIC but was insufficient to ensure adequate iodine status in women or their infants. The study was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12605000345684

Regionalization of pediatric emergency care in Korea

In order to care for an ill or injured child, it is crucial that every emergency department (ED) has a minimum set of personnel and resources because the majority of children are brought to the geographically nearest ED. In addition to adequate preparation for basic pediatric emergency care, a comprehensive, specialized healthcare system should be in place for a critically-ill or injured victim. Regionalization of healthcare means a system providing high-quality and cost-effective care for victims who present with alow frequency, but critical condition, such as multiple trauma or cardiac arrest. Within the pediatric field, neonatal intensive care and pediatric trauma care are good examples of regionalization. For successful regionalized pediatric emergency care, all aspects of a pediatric emergency system, from pre-hospital field to hospital care, should be categorized and coordinated. Efforts to set up the pediatric emergency care regionalization program based on a nationwide healthcare system are urgently needed in Korea

Surveillance of compliance with tobacco regulations in Örebro County, Sweden: a mixed methods study after the ban of test purchases

<p>Abstract</p> <p>Background</p> <p>Tobacco has long been known to be one of the most common reasons for sickness and premature deaths in the world. An important aspect of tobacco use is the youth's access to tobacco, and surveillance visits are one way to make sure how retailers are complying with age limit in the tobacco law. In Örebro County, Sweden, a project to reinforce the tobacco legislation was carried out in 2009-2010. One part of the project was surveillance visits that were done according to three different themes, called thematic surveillance.</p> <p>Methods</p> <p>This study is an evaluation of the results from thematic surveillance and has a mixed methods approach. The quantitative analyses concerns protocols from 217 surveillance visits, where questions were asked about three themes (self-monitoring programs; marketing; labeling of products and pricing). In addition, questionnaires filled out by six tobacco administrators who worked within the project were analyzed qualitatively by content analysis in order to study their perceptions and opinions of the project.</p> <p>Results</p> <p>This study shows that half of the visited retailers had self-monitoring programs. Lack of self-monitoring programs was significantly more common in smaller stores/kiosks and at restaurants. Further, the tobacco administrators who worked within the project perceived thematic surveillance as a good method for accomplishing better structure in surveillance work, but not as effective as purchase attempts (mystery shopping).</p> <p>Conclusions</p> <p>Thematic surveillance was perceived as positive and the method was also regarded to be a good way to work with surveillance. However, the method could be developed further for optimal use and better effect at the retailers. It is clear that people who work with tobacco prevention at the local level in Örebro County want to use purchase attempts as a surveillance method, and that they believe that purchase attempts is the best way to make sure if store comply with the tobacco law.</p