Tympanometry in general practice: use, problems and solutions.

OBJECTIVES: The diagnosis in children with middle ear symptoms is often difficult. Tympanometry is recommended as a supplementary diagnostic tool with a high predictive value for fluid or no fluid in the middle ear. The aim of this study was to examine how tympanometry was used in Danish general practice in 2009, to report common problems general practitioners (GPs) and GP nurses encounter in tympanometry and to evaluate the effect of a practical and theoretical course. METHODS: A 1-year registration of the use of tympanometry in the Danish National Health Service Register in two regions with 40% of all Danish GPs and a survey among 197 participants in a course on diagnosis of otitis media and tympanometry in children were used. The Danish National Health Insurance covers 100% of GPs because they administer reimbursement for their activities, including tympanometry. RESULTS: During the year 2009, 1433 GPs in 702 clinics were on the list. A total of 417 clinics performed 35 529 tympanometries. Some 285 clinics (40.6%) did not perform tympanometry in 2009. The active clinics performed 42 tympanometries per GP. A 1-day course improved the knowledge and practical skills of the participating GPs and nurses. A majority (70%) stated in a self-reported questionnaire that tympanometry often provided important information, especially about middle ear fluid, and 48% reported that tympanometry several times during the past 2 weeks had changed their management of a middle ear problem. Few had not used their tympanometer during the 2 weeks preceding the survey. The response rate was 72%. CONCLUSIONS: The use of tympanometry is very skewed. A 6-hour course could improve GPs' care of patients with middle ear problems by using tympanometry.

Is a targeted intensive intervention effective for improvements in hypertension control? A randomized controlled trial.

BACKGROUND: High blood pressure (BP) is one of the most important risk factors for stroke, and antihypertensive therapy significantly reduces the risk of cardiovascular morbidity and mortality. However, achieving a regulated BP in hypertensive patients is still a challenge. OBJECTIVE: To evaluate the impact of an intervention targeting GPs' management of hypertension. METHODS: A cluster randomized trial comprising 124 practices and 2646 patients with hypertension. In the Capital Region of Denmark, the participating GPs were randomized to an intensive or to a moderately intensive intervention group or to a control group and in Region Zealand and Region of Southern Denmark, practices were randomized into a moderately intensive intervention and to a control group. The main outcome measures were change in proportion of patients with high BP and change in systolic BP (SBP) and diastolic BP (DBP) from the first to the second registration. RESULTS: The proportion of patients with high BP in 2007 was reduced in 2009 by ~9% points. The mean SBP was reduced significantly from 2007 to 2009 by 3.61 mmHg [95% confidence interval (CI): -4.26 to -2.96], and the DBP was reduced significantly by 1.99 mmHg (95% CI: -2.37 to -1.61). There was no additional impact in either of the intervention groups. CONCLUSION: There was no impact of the moderate intervention and no additional impact of the intensive intervention on BP.

[Menopause, hormone therapy and self-rated health. A cross-sectional study in Roskilde county in 1998]. / Overgangsalder, hormontilskud og selvvurderet helbred. Tvaersnitsundersogelse i Roskilde Amt 1998.

INTRODUCTION: Middle-aged women are often faced with the dilemma of whether to use hormone therapy or not. Until recently, advertisements, as well as, very often, the scientific literature, advocated the use of hormone therapy. The aim of this study was to determine women's use of hormone therapy and its correlation with age, self-rated health status and lifestyle factors. MATERIALS AND METHODS: An anonymous postal questionnaire was sent to 5,300 women over 44 years of age. The public health insurance office in Roskilde County picked 100 women at random for each of the 53 general practitioners who entered the survey in 1998. 72% of the women answered the questionnaire. The data set was statistically analysed using multiple linear logistic regression, taking account of the fact that the data had been obtained through general practitioners. RESULTS: 35% (95% CI 32-38) of the women 50-55 years of age were currently using or had formerly used hormone therapy. As many as 51% (95% CI 46-56) of the women 60-64 years of age were currently using or had formerly used hormone therapy. More than 50% of the women who were using hormone therapy had done so for more than 10 years. The group of women 45-59 years of age with the worst self-rated health status had odds of 5.1 (95% CI 3.0-8.6) of current or former use of hormone therapy as compared with the women with the highest self-rated health status. The odds of current use of hormone therapy were comparable at 2.7 (95% CI 1.5-4.7) for the women with the lowest self-rated health status as compared with the women with the highest self-rated health status. There was a positive correlation between the use of hormone therapy and physical exercise, tobacco use, former use of oral contraceptives and examination of cholesterol level. DISCUSSION: The percentage of women over 44 years of age who currently use or have formerly used hormone therapy in our study is comparable with the results of Danish surveys since 1983. Women 45-59 years of age who use hormone therapy do not have the same high level of self-rated health as that of women aged 45-59 years who have not used hormone therapy.

[Menopause, hormone therapy and alternative medicine:. A cross-sectional study in Roskilde County in 1998]. / Overgangsalder, hormontilskud og naturmedicin. Tvaersnitsundersogelse i Roskilde Amt 1988.

INTRODUCTION: The aim of this study was to determine how many women use alternative medicine to alleviate menopausal symptoms and how often they feel relieved of those symptoms. We also examined whether there was a negative correlation between the use of alternative medicine and the use of hormone therapy, as well as whether there was any correlation between the use of alternative medicine and self-rated health status. MATERIALS AND METHODS: An anonymous postal questionnaire was sent to 5,300 women older than 44 years in Roskilde County, Denmark. The public health insurance in Roskilde County picked 100 woman at random for each of the 53 general practitioners, who entered the survey in 1998. 72% answered the questionnaire. RESULTS: 24% (95%; C.I. 22-26%) used alternative medicine either formerly or currently. 54% felt that their symptoms had been relieved by the alternative medicine. More women who had formerly used hormone therapy were using alternative medicine currently or formerly (OR 2.5; 95% C.I. 1.9-3.4 for ages 45-59 and OR 3.9; 95% C.I. 2.6-6.0 for ages 60+) than women who had never used hormone therapy. Some women were using alternative medicine and hormone therapy at the same time, although fewer current users of hormone therapy aged 45-59 years were also using alternative medicine (OR 0.5; 95% C.I. 0.3-0.8) than were those who never had used hormone therapy. Fewer former users of alternative medicine reported good plus very good (OR 0.7; 95% C.I. 0.6-0.9) or very good (OR 0.6; 95% C.I. 0.5-0.8) self-rated health status than those who had never used alternative medicine. DISCUSSION: Women who had formerly used hormone therapy used alternative medicine more often than women who had never used hormone therapy. Women who had formerly used alternative medicine tended to report lower self-rated health status than women who had never used alternative medicine.

Respiratory tract infections in Greenland: results of an audit project.

OBJECTIVES: To elucidate and improve quality of diagnosis and treatment of respiratory tract infections in Greenland. STUDY DESIGN: All district medical officers and nursing staff in the Greenlandic coastal health services were invited to participate in the study. Twenty-five district medical officers and the nursing staff from nine districts completed the project and registered in a 3-week period 1,163 contacts involving respiratory tract infections. METHODS: Self-registration according to the Audit Project Odense (APO) method on a simple APO registration chart. All contacts involving respiratory tract infections were registered with regard to sex, type of contact, contact form, infection focus, diagnosis and treatment, origin of infection, antibiotic treatment, choice of antibiotics and possible sick-leave. RESULTS: Of the 1,163 registered contacts lung infections represented 26%, throat infections 22% and otitis media 16%. Paraclinical tests were performed in 32% of the cases, 47% of the cases were treated with antibiotics, in 2/3 of the cases with penicillin V. The use of paraclinical tests was somewhat lower and the use of antibiotics was higher than in Denmark. CONCLUSION: The study showed that it is possible to carry out an APO audit in Greenland, and that there was a moderate difference in the diagnosis and treatment between Greenland and Denmark. An increased use of paraclinical tests may result in quality improvement.