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Introduction Acute sinusitis, an inflammation in the paranasal sinuses lasting no longer than one month, is a common clinical problem in general practice.[1-3] Acute sinusitis is a common reason for [...]

Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups.

Authors' choice of study was ill informed EDITOR--McCormack and Greenhalgh's suggestion that those involved in running and reporting clinical trials might be able to engineer a worldwide 'groupthink' spin on [...]

•The incidence of erythema migrans in Norway has great geographical variation.•Norwegian general practitioners adhere to antibiotic guidelines for erythema migrans.•Almost 1/5 of mere tick bites in Norway receive antibiotic prophylaxis.•There is an abundant use of Borrelia antibody testing after tick bites.•Tick bites and erythema migrans in Norway are almost exclusively seen in primary care.

ObjectiveTo evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention.DesignPragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period.Setting38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021.Participants1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period.InterventionHealthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual.Main outcome measuresThe primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality.ResultsThe numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v0.05 per person year), hospital referrals (<0.01 v0.05), admissions to hospital (0.01 v0.05), and mortality (0 v0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v0.26).ConclusionsImplementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults.Trial registrationClinicalTrials.gov NCT03970356.

EDITOR--In their meta-analysis Fahey et al concluded that treatment with antibiotics made no significant difference to the resolution of acute cough,[1] although they found a trend favouring antibiotics. The Cochrane [...]

The frequency of tick bites, risk factors, as well as simple outcome measures after tick bites in a healthy adult population (blood donors) from Sogn and Fjordane county situated at the western coast of Norway, was assessed. The study was based on cross-sectional data from blood donors at 4 different blood banks in the county during the period January to June 2010. Data on tick bites and potential risk factors were collected from 1213 blood donors using a questionnaire. Among participants, 65.7% had experienced tick bites during their life time, whereas 30% reported recent tick bites (during the latest 12 months). There were fewer tick bites in the eastern, inland part of the county, where the tick Ixodes ricinusis less prevalent compared to the western, coastal regions. The number of total and recent tick bites increased with the respondent's age, hours spent outdoors during summertime, educational level, ownership of domestic animals, and hunting. Women older than 50 years reported more bites than similarly aged men and younger females.

Abstract: Objective: The aim of the study was to assess patients’ attitudes towards and experiences of generic substitution 3 years after generic substitution of prescription medicines was permitted in Norway.Methods: Prescriptions from 2,128 consecutive patients in a Norwegian pharmacy were retrospectively reviewed to identify all patients (n = 274) receiving eight or more different prescription drugs on the fifth level in the Anatomical Therapeutic Chemical (ATC) classification system during the last 6 months. An age-adjusted control group (n = 269) of patients receiving three to seven different prescription drugs was randomly selected. Of the 543 patients, 386 were eligible for inclusion. Both groups received a mailed questionnaire addressing their experiences with and attitudes towards generic substitution.Results: The overall response rate was 73% (281/386) and the average age of the respondents was 66 years old. The study found that patients who reported to have received information from their physician or the pharmacy about generic substitution were more likely to have switched (P < 0.001). About half (138/281) of the patients had experienced a generic switch, and a higher proportion of the polypharmacy patients had their medication substituted compared to the control patients (P < 0.001). Altogether 50 (36%) of the patients who had experienced a switch, reported one or more negative experiences connected to the substitution, and 29 of these (21%) reported an overall negative experience after the change. The experiences of the patients were not related to age, gender, or number of medications or information about generics from either the pharmacy or the physician. About 41% of the patients would not switch if they had no personal economic incentives.Conclusions: About 1/3 of the patients who had their medication substituted reported negative experiences. Generic drug substitution for a number of patients is not considered an equal alternative to branded drugs, and these patients may need additional information and support. The lack of correlation between patient experiences and age, gender, and medical regimen complexity is interesting and should be investigated further.

Objective. To evaluate health care providers’ adherence to management guidelines for acute respiratory infection and diarrhoea in children under 5 years old in Botswana primary health care.Design. Cross-sectional prospective field survey. Data collection was carried out through observation of consecutive consultations at 30 randomly assigned clinics and health posts in three purposely chosen districts.Study participants. This study comprises 185 cases of acute respiratory infection and 85 cases of diarrhoea.Main measures. Criteria for acceptable standards of history taking and physical examination for acute respiratory infection and diarrhoea were defined as well as criteria for categorizing the appropriateness of antibiotic prescription. The percentage of oral dehydration salts provided in cases of diarrhoea was calculated.Results. Acute respiratory infection and diarrhoea accounted for 270 (including 15 missing cases) of all main diagnoses (n = 539). In 262 cases (97%) health care providers were nurses or enrolled nurses; in 3% family welfare educators. Acceptable history taking, physical examination, and both combined in acute respiratory infection was found in 113 (63%), 32 (18%), and 28 (16%), and in diarrhoea in 45 (58%), 26 (34%) and 20 (26%) cases, respectively. Antibiotics were prescribed in 76 of 255 (30%) cases. Prescription was assessed as inappropriate in 56 of 76 (74%) of all cases; in 41 of 52 (79%) cases with acute respiratory infection, in none of the pneumonia cases, and in all 15 cases of diarrhoea. Oral rehydration salts were prescribed in 74 (87%) of the diarrhoea cases.Conclusions. Health care providers’ adherence to guidelines on history taking was suboptimal in acute respiratory infection and diarrhoea but poor on examination in both conditions. A high level of inappropriate antibiotic prescription was found in acute respiratory infection and diarrhoea. Overall, there is considerable scope for improving diagnostic and therapeutic management of these major childhood diseases in Botswana primary health care.

To evaluate changes in quality of life, anxiety, and depression after cochlear implantation in adults.

Eighty-four adult cochlear implant (CI) users were compared with 3 other groups of severely to profoundly hearing impaired adults concerning quality of life (QOL): 1) 19 CI candidates who were accepted as candidates for implantation, but who were not operated on; 2) 16 CI candidates whose impairment was not severe enough for implantation; and 3) 60 users of acoustic hearing aids. Generic and disease-specific QOL questionnaires were used. The CI group scored significantly better than the CI candidates who met the criteria for implantation, but who were not operated on, on 2 of 6 categories of a disease-specific QOL measure. The CI patients had significantly less anxiety and depression than the unoperated CI candidates who met the criteria for implantation. Validation and reliability testing of 2 disease-specific QOL measures were performed by factor analyses.

Objectives: To estimate the incidence of acute sinusitis among patients older than 14 years in Norwegian general practice. Furthermore, to register complications related to acute sinusitis, to assess the number of patients referred to an ENT specialist, and to estimate the costs that patients with acute sinusitis generate in the Norwegian health budget on a yearly basis.Methods: Adult patients with the clinical diagnosis of acute sinusitis seen in primary care in the municipality of Larvik were registered during a one-year period. During the winter of 1993, computed tomography (CT) was used as a reference standard to divide the patients into two groups; with and without confirmed sinusitis. Patients referred to the ENT specialist and his conclusions as to the differential diagnosis and prognosis were registered. The yearly cost of acute sinusitis was estimated by summating the costs of consultations, referrals, medication and sick leave.Results: During the one-year period, 1053 patients with 1138 episodes of acute sinusitis were clinically diagnosed, 69% women and 31% men. In the more detailed part of the study, 87 of the 138 patients (63%) had their clinical diagnoses confirmed by CT. The incidence of acute sinusitis was 21.7 episodes per 1000 adult inhabitants per year. 2% of the patients needed sinus puncture. Acute sinusitis generated an estimated cost of 192 million NOK per year, 75% of this was due to sick leave.Conclusions: The yearly incidence of acute sinusitis in Norway is similar to that of other countries, such as Denmark, the Netherlands, and the United Kingdom. Two thirds of the patients with sinusitis are women. Not many of these patients are referred to an ENT specialist. The disease has few complications. Acute sinusitis generates considerable national health care expenses, sick leave being a major part.

ObjectiveTo assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.DesignCluster randomised controlled study.Setting Existing continuing medical education groups were recruited and randomised to intervention or control.Participants79 groups, comprising 382 general practitioners, completed the interventions and data extractions.InterventionsThe intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.Main outcome measuresPrescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.ResultsIn an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.ConclusionsThe intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.Trial registrationClinical trials NCT00272155.