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Background. The loss of a loved person may lead to complicated grief (CG). General practitioners (GPs) consider bereavement care to be important but find training for this task to be insufficient. We hypothesized that improvement in skills that facilitate early identification of CG and enhance GPs’ clinical care may reduce adverse health outcomes. Aim. To test whether implementation of a bereavement management program in general practice could improve the GPs’ ability to identify CG and provide clinical care. Design. A cluster-randomized controlled trial allocating GPs and their listed patients suffering from bereavement to either a intervention or a control group. Setting. Close relatives of patients who had died from cancer in Denmark were recruited (N = 402). Method. The primary outcomes were defined as the bereaved relatives’ score on the Beck’s Depression Inventory II and the Inventory of Complicated Grief-Revised (ICG-R), the GP’s clinical assessment of the relative’s grief reaction and the relative’s number of contacts with general practice. Results. Larger improvements in ICG-R scores were found in the intervention group than in the control group. In the intervention group, patients exhibiting CG symptoms were more likely to receive supportive care and to be referred to mental health practitioners, whereas GP’s in the control group more often prescribed psychotropic drugs for patients with symptoms of CG. The GP’s ability to identify CG at 13 months did not seem to be better in the intervention group than in the control group. Conclusion. While only statistically near significant, we found some indications of an effect of the intervention compared with usual care. Our results underscore the need for improving GPs’ clinical skills in identifying patients with CG. [ABSTRACT FROM PUBLISHER]

Background. Elderly patients' interaction with the GP may be improved through patient involvement techniques, and there is a variety of such techniques which improve patients' involvement in their own care, although little is known about their acceptability. [ABSTRACT FROM PUBLISHER]

Submission of samples from the home allows screening for Chlamydia trachomatis without preceding professional assessment of clinical risk factors. Therefore, a validation of self-reportable information for use as selective screening criteria is needed. We asked a total of 1175 women and 1033 men who participated in an in-home sampling screening study to provide information on behavior and sociodemographic characteristics. In a multivariate model, selective screening criteria were developed on the basis of information from a random part of the tested population (development group), and the validity was assessed for the remaining part of the tested population (validation group). To find all infections, 95% of the subjects had to be screened, and screening 63% of them would have detected 86% of infections. Low predictive values were found when selective screening criteria from other studies were assessed. Selective screening by means of in-home sampling strategies among men and women aged 21-23 years cannot be recommended in the area studied. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to compare patient and GP priorities for general practice care.Methods: A questionnaire survey was carried out in general practice in Denmark which included 900 consecutive patients aged over 18 years from 15 practices collected in 1995, and 919 randomly sampled GPs in 1999. The postal questionnaire, developed by the EUROPEP group, contained 40 questions about eight aspects of primary care. Participants were asked to state their priorities for each question ranging from "not at all important" to "most important". A reminder questionnaire was sent to non-responders after 2 weeks. Top priority percentages ("very/most important") were calculated for each question as were differences between participant groups.Results: Questionnaires were answered by 771 (85.7%) patients and 584 (64.2%) GPs. Their priorities were highly correlated (r = 0.754, P < 0.001). Patients gave higher priority than GPs to availability and accessibility of the practice and seeing the same GP. The GP should be capable of providing information on illness, investigations and treatments and patient associations, and should know the patient's history and be regularly updated through courses.Conclusions: Patient and GP priorities for primary care were highly correlated. The higher priority awarded by patients than by GPs to specific aspects of primary care should be acknowledged when organizing and developing general practice. [ABSTRACT FROM AUTHOR]

Background The need to optimize frequent attender (FA) care and to economize on scarce resources in primary care has given rise to calls for intervention. However, precise knowledge of the specifics of this need is scarce, as is knowledge of how best to orchestrate intervention vis‐à‐vis particular FA groups. The aim of the study was to analyse the need for a special FA status consultation and to analyse if such need springs from physical, mental or social factors among FAs. [ABSTRACT FROM PUBLISHER]

The effect of 2 population-based outreach screening strategies that used in-home sampling was compared with usual care practices for Chlamydia trachomatis infection. All 30,439 persons 21-23 years old in Aarhus County, Denmark, were divided randomly into 3 groups: group 1 (n = 4500) had a home sampling kit mailed directly to their centrally registered home address; group 2 (n = 4500) had a reply card mailed to their home address with which a home sampling kit could be ordered; and group 3 (n = 21,439) had access to usual care. For women in groups 1 and 2, the relative risks of being tested were 4.1 (95% confidence interval [CI], 3.8-4.4) and 3.5 (95% CI, 3.2-3.9), respectively, compared with usual care. The corresponding figures for men were 19.1 (95% CI, 16.0-22.8) and 11.8 (95% CI, 9.8-14.2), respectively. Both screening strat-egies were highly effective, but men benefited the most from having the home sampling kit pro-vided directly. [ABSTRACT FROM AUTHOR]

Background: The aim was to evaluate and compare inter-observer reproducibility by magnetic resonance imaging (MRI), transvaginal ultrasonography (TVS), hysterosonographic examination (HSE) and hysteroscopy (HY).Methods: Different observers consecutively evaluated MRI, TVS, HSE and HY independently in 51 pre-menopausal women, who underwent hysterectomy for benign diseases.Results: Inter-observer agreement (kappa) was as follows: Exclusion of uterine cavity abnormalities: MRI 0.97, TVS 0.68, HSE 0.48 and HY 0.63; submucous myomas: MRI 0.97, TVS 0.59, HSE 0.60 and HY 0.67; polyps: MRI 0.49, TVS 0.48, HSE 0.35 and HY 0.50; identification of myometrial myomas: MRI 0.97, TVS 0.74; adenomyosis: MRI 0.73 and TVS 0.38. Mean difference between observers in number of observed myomas was (absolute values) MRI 0.58, TVS 0.93. Agreement on evaluation of abnormalities in the uterine cavity, submucous myomas, number of myomas and adenomyosis was significantly greater by MRI than by any of the other techniques, whereas agreement was in line by TVS, HSE and HY.Conclusions: Inter-observer disagreement reached substantial levels only for exclusion of uterine cavity benign abnormalities by HY, TVS and HSE. Strategies should be adopted to reduce observer variation of common gynaecological imaging techniques or the less observer-dependent MRI technique could be favoured. [ABSTRACT FROM AUTHOR]

Compares the efficacy of a screening program for urogenital Chlamydia trachomatis infections based on home sampling with that of a screening program based on conventional swab sampling performed at a physician's office. Assessment of the number of new infections and the number of subjects who reported being treated for pelvic inflammatory disease at one-year follow-up.

The number of previous vaginal smear examinations in 428 patients who developed invasive cancer of the cervix was compared with previous screening in age- and area-matched controls. The average age was 53 years. There was a highly significant difference in the numbers who had never undergone screening, ie 55% of the cancer patients and 33% of the controls. Equally there was a highly significant difference between cases and controls in the number examined according to recommended guidelines for prophylactic examination. It was shown that about 40% of the cytological testa were done for gynaecological reasons, and it is probable that the number of false negatives among the cases was not negligible. Despite this, however, regular screening reduced the relative risk of cancer to about 0.25, compared with those never examined. When only symptom less patients were considered in the assessment of regular screening, the relative risk was reduced to 0.15 in patients screened every three years. Even the group which was screened more than five years previously had a relative reduction in risk to 0.67, compared with those never screened. It is concluded that PAP-smears are important in the prevention of cancer of the cervix. The greatest need is to eliminate the group which is never examined. An increase in the number of screenings has only a marginal benefit [ABSTRACT FROM PUBLISHER]

The aim of the present paper was to study the implementation of new medical knowledge. We investigated whether Danish doctors have implemented new national guidelines for oral anti-coagulation of atrial fibrillation. An anonymous questionnaire with six standardized case stories was sent to 315 general practitioners in the county of Viborg and Ringkøbing, 79 heads of departments of medicine and cardiology, and 20 heads of departments of neuromedicine across the country. The answers showed that the Danish doctors recommended anticoagulant therapy only to a low extent for this group of patients despite the guidelines and the scientific evidence. The reasons for not choosing anticoagulant therapy were lack of knowledge concerning risk of stroke associated with the disease, worries about the disadvantages of the treatment, and lack of knowledge of its benefits. It is concluded that despite solid scientific documentation and an intensive implementation process of guidelines, issued by well-known respected colleagues in a small homogeneous country as Denmark (5 million inhabitants), knowledge of new research findings varies greatly and is generally limited. To obtain optimal use of new research findings, a powerful implementation effort must be recommended and the study reveals a need for a closer link between research and post-graduate education. [ABSTRACT FROM PUBLISHER]

Data from the Danish National Health Service records on activities of each of 146 general practices in the county of North Jutland, Denmark, were studied to determine whether the use of proctoscopy influenced the stage at which cancer of the rectum was recognized. Information for all patients in the county who received the diagnosis of cancer of the rectum was obtained from the Danish Cancer Registry. Proctoscopy was performed significantly more often in partnership practices (96%) than in single practices (81%). The frequency with which the test was used varied from 1 to 107 proctoscopies per general practitioner per year. In the 95 patients with cancer of the rectum, no relationship was found between the stage (Dukes') at the time of diagnosis and work-load, size and activity of practice, or use of proctoscopy. [ABSTRACT FROM PUBLISHER]