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Search Results: 1 - 10 of 402067 matches for " Susanna M. Wallerstedt "
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Short Answer Questions or Modified Essay questions – More Than a Technical Issue  [PDF]
Sven Wallerstedt, Gudrun Erickson, Susanna M. Wallerstedt
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.31005
Abstract: Purpose, The present article was built on the assumption that the form of an examination may influence learning, and may also reflect different kinds of knowledge. The aim of the study was to evaluate whether the results of an examination differ when short answer questions (SAQ) or modified essay questions (MEQ) are used. Method, Forty-nine students in the internal medicine course in Gothenburg, Sweden, performed a written examination in 2003, which included both SAQ and MEQ. Result, The correlation between the results of SAQ and MEQ was 0.59 (P < 0.001). The percentage correctly answered questions in the two types did not differ significantly. Some students had poor results in either SAQ or MEQ. Conclusion, The general outcome of the study indicates that results of SAQ and MEQ demonstrate a significant correlation. However, they may also reflect differences in mastery of the knowledge domain, which should be considered in relation to aspects of validity
Educational Value of Doctor Trainee Employments (“Student Doctor”) —A Questionnaire Study  [PDF]
Sven Wallerstedt, Maria Odqvist, Susanna M. Wallerstedt
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.67062
Abstract: Background: In Sweden, medical students can work as employed doctor trainees under supervision during medical school breaks. The aim of the present study was to evaluate the educational value of such employments, as well as to compare university and non-university positions. Method: A questionnaire was administered to all employed doctor trainees at Sahlgrenska University Hospital, Gothenburg, in 2003-2004 (n = 67) plus all students in last term medical school 2005 who had had such a position inside or outside this university hospital (n = 43). The questionnaire included questions on trainee position/s, as well as statements regarding the educational value. Result: 75 unique individuals returned a filled-in questionnaire (response rate: 78%). The respondents experienced the positions as valuable concerning gain in professional confidence (mean ± standard deviation: 3.9 ± 1.1; 1 = total disagreement to 5 = total agreement) and independence (3.9 ± 1.1), subsequent learning in medical school (4.3 ± 0.9), and future professional work (4.2 ± 1.0). The gain in professional confidence and independence was greater for those who had worked in a non-university hospital (n = 17) than in a university hospital (n = 29): 4.4 ± 0.6 vs. 3.6 ± 3.6, P = 0.011; 4.3 ± 0.7 vs. 3.6 ± 1.1, P = 0.038. Conclusion: Employment as a doctor trainee seems to facilitate subsequent learning in medical school and enhance professional progress; the latter is particularly prominent in non-university hospitals.
Influence of an e-mail with a drug information attachment on sales of prescribed drugs: a randomized controlled study
Christina Edward, Anders Himmelmann, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2007, DOI: 10.1186/1472-6904-7-12
Abstract: The Swedish pharmaceutical benefit board found rizatriptan (Maxalt?) 10 mg to be the most cost-effective triptan. All 119 heads of primary care units in western Sweden were randomized to receive information concerning this conclusion via (i) e-mail with attachment I, (ii) e-mail with attachment II or (iii) no information (control). Attachment I was a short one (heading plus three lines text), whereas attachment II was a long one (heading plus one page text and one page with tables). The change in percentage rizatriptan of total triptans sold before and after the intervention (May – July 2004 and May – July 2005, respectively) was compared between the groups.Totally 48,229 (2004) and 50,674 (2005) defined daily doses of triptans were prescribed and sold during May – July in primary care units in the western part of Sweden. The absolute change in percentage rizatriptan was greater in the intervention groups compared with the control group 2 (25th – 75th percentile: -3 – 7) vs 0 (-7 - 5), P = 0.031). The absolute change in percentage rizatriptan did not differ between the two attachment groups (P = 0.93).An e-mail with a drug information attachment may influence sales of prescribed drugs. No difference between different designs of the attachment could be detected.Drugs are keystones in the treatment of patients. Rational treatment with drugs requires adequate knowledge on drugs' benefits, risks and cost-effectiveness. The increasing volume of information related to drugs and prescribing may make it difficult for an individual primary care doctor to keep up to date with best practice. Lack of time for reading and evaluating scientific papers in favour of direct patient work may be one explanation. To consider costs when prescribing may add an additional difficulty. However, in a survey, the majority of the doctors stated that costs of medicines are important and they were willing to make economic considerations in prescribing [1]. Therefore, it seems reasonable to provi
Individual case safety reports in children in commonly used drug groups – signal detection
Gertrud Brunl?f, Carina Tukukino, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2008, DOI: 10.1186/1472-6904-8-1
Abstract: Number and type of individual case safety reports in the 30 groups of drugs (5th level ATC-code) most sold (number of defined daily doses) in outpatient treatment to children (<15 years old) during 2005 were obtained. Descriptive analyses of the adverse drug reactions reported in children were performed.The number of individual case safety reports per million defined daily doses in children varied in the groups of drug between 0 and 24. The largest number was found in the drug group R03DC, the leukotriene receptor antagonist montelukast; the majority of the children being <5 years old and experiencing psychiatric adverse drug reactions.The number of individual case safety reports per million defined daily doses varies in different groups of drugs. A possible signal for montelukast and psychiatric adverse drug reactions was found, which should be further explored.Adverse drug reactions (ADRs) are a major health care problem. ADRs cause hospital care in both adults [1-3] and children [4]. Moreover, drug-related deaths have been reported for children [5,6]. Consequently, a risk-benefit analysis of drug treatment is essential in most patient consultations including paediatric patients. This implies access of adequate knowledge on both these parameters. Due to few paediatric drug safety studies, knowledge on risks in children is limited. At registration, little information on ADRs in children is available since many drugs have not been tested in children [7]. Off-label use of drugs in children results in questions to drug information centres [8] and has been reported to be extensive [9-11], reported to result in an increased risk of ADRs [9]. Risk-benefit analyses of drugs for children are therefore dependent on observations of ADRs and effects from clinical use.Spontaneous reporting of ADRs is an important method for detection of signals, which is one aim of pharmacovigilance. An ADR signal is defined as a possible relationship between an adverse event and a drug, the r
Impact of information letters on the reporting rate of adverse drug reactions and the quality of the reports: a randomized controlled study
Marie-Louise Johansson, Staffan H?gg, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2011, DOI: 10.1186/1472-6904-11-14
Abstract: All 151 primary healthcare units in the Region V?stra G?taland, Sweden, were randomly allocated (1:1) to an intervention (n = 77) or a control group (n = 74). The intervention consisted of one-page ADR information letters administered at three occasions during 2008 to all physicians and nurses in the intervention units. The number of ADR reports received from the 151 units was registered, as was the quality of the reports, which was defined as high if the ADR was to be reported according to Swedish regulations, that is, if the ADR was (i) serious, (ii) unexpected, and/or (iii) related to the use of new drugs and not labelled as common in the Summary of Product Characteristics. A questionnaire was administered to evaluate if the ADR information letter had reached the intended recipient.Before the intervention, no significant differences in reporting rate or number of high quality reports could be detected between the randomization groups. In 2008, 79 reports were sent from 37 intervention units and 52 reports from 30 control units (mean number of reports per unit ± standard deviation: 1.0 ± 2.5 vs. 0.7 ± 1.2, P = 0.34). The number of high quality reports was higher in intervention units than in control units (37 vs. 15 reports, 0.5 ± 0.9 vs. 0.2 ± 0.6, P = 0.048). According to the returned questionnaires (n = 1,292, response rate 57%), more persons in the intervention than in the control group had received (29% vs. 19%, P < 0.0001) and read (31% vs. 26%, P < 0.0001) an ADR information letter.This study suggests that repeated ADR information letters to physicians and nurses do not increase the ADR reporting rate, but may increase the number of high quality reports.Clinical trials contribute greatly to knowledge on drug safety. However, uncommon adverse drug reactions (ADRs) and ADRs in certain patient groups not included in clinical trials, e.g. children and older people with many concomitant diseases and medications, cannot be expected to be detected in these trials.
Characteristics of primary health care units with focus on drug information from the pharmaceutical industry and adherence to prescribing objectives: a cross-sectional study
Daniel Carlzon, Lena Gustafsson, Anna L Eriksson, Karin Rignér, Anders Sundstr?m, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2010, DOI: 10.1186/1472-6904-10-4
Abstract: A cross-sectional study was performed in all 25 primary health care units in G?teborg, Sweden. A questionnaire on characteristics of practice settings [(i) size of unit, (ii) profession of head, (iii) use of temporary physicians, (iv) drug information from the pharmaceutical industry, (v) producer-independent drug information, and (vi) education on prescribing for newly employed physicians] was sent to the heads of the units. A national sales register for prescribed drugs (Xplain) was used for evaluation of adherence to the six regional prescribing objectives concerning proton pump inhibitors (PPIs), angiotensin converting enzyme inhibitors (ACEIs), statins and antidepressants.Twenty-two out of 25 primary health care units responded to the questionnaire (response rate 88%). A physician as head and presence of producer-independent drug information was positively correlated with adherence to the prescribing objectives (median number of prescribing objectives adhered to (25th - 75th percentile): 2.5 (1-3.25) vs 1 (0-2), P = 0.013; 2 (1-3) vs 0, P = 0.043, respectively. Presence of drug information from the pharmaceutical industry and education on prescribing for newly employed physicians was negatively associated with adherence to the prescribing objectives: 1 (0-2) vs 3.5 (2.25-4.75), P = 0.005; 1 (0-2) vs 3 (1.5-4), P = 0.034, respectively.Several characteristics of the primary health care units correlated with adherence to prescribing objectives for rational drug use. Further research on this topic is needed and would constitute valuable information for health care decision makers.The prescribing of drugs is an important issue for the individual patient, since risks and benefits of the treatment directly affect the patient. In Sweden, prescribed drugs are reimbursed by the society. Hence, prescribing of drugs is also a key question from a public expense perspective. Financing of drugs is a vast problem, since costs for drugs are increasing and resources are limited
Drug Treatment in Older People before and after the Transition to a Multi-Dose Drug Dispensing System–A Longitudinal Analysis
Susanna M. Wallerstedt, Johan Fastbom, Kristina Johnell, Christina Sj?berg, Sten Landahl, Anders Sundstr?m
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0067088
Abstract: Background An association has been found between multi-dose drug dispensing (MDD) and use of many drugs. The aim of this study was to investigate the nature of this association, by performing a longitudinal analysis of the drug treatment before and after the transition to MDD. Methods Inclusion critera in this register-based study were inhabitants in Region V?stra G?taland, Sweden, who, at ≥65 years of age and between 1st July 2006 and 30th June 2010, filled their first MDD prescription. For each individual, prescribed drugs were estimated at three month intervals before and after (maximum 3 years, respectively) the first date of filling an MDD prescription (index date). Results A total of 30,922 individuals matched the inclusion criteria (mean age: 83.2 years; 59.9% female). There was a temporal association between the transition to MDD and an increased number of drugs: 5.4±3.9 and 7.5±3.8 unique drugs three months before and after the index date, respectively, as well as worse outcomes on several indicators of prescribing quality. When either data before or after the index date were used, a multi-level regression analysis predicted the number of drugs at the index date at 5.76 (95% confidence limits: 5.71; 5.80) and 7.15 (7.10; 7.19), respectively, for an average female individual (83.2 years, 10.8 unique diagnoses, 2.4 healthcare contacts/three months). The predicted change in the number of drugs, from three months before the index date to the index date, was greater when data before this date was used as compared with data after this date: 0.12 (0.09; 0.14) versus 0.02 (?0.01; 0.05). Conclusions After the patients entered the MDD system, they had an increased number of drugs, more often potentially harmful drug treatment, and fewer changes in drug treatment. These findings support a causal relationship between such a system and safety concerns as regards prescribing practices.
Use of and attitudes towards the prescribing guidelines booklet in primary health care doctors
Magnus AB Axelsson, Malin Spetz, Anders Mellén, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2008, DOI: 10.1186/1472-6904-8-8
Abstract: A questionnaire was administered to doctors working in primary health care in the region of V?stra G?taland in Sweden. Questions included characteristics of the responding doctor and use of the prescribing guidelines booklet, as well as attitude questions constructed as statements to which the responder should grade his level of agreement from 1 (total disagreement) to 6 (total agreement).Totally 603 filled-in questionnaires were returned (estimated response rate 60%). The majority of the doctors (n = 571, 97%) responded that they use the prescribing guidelines booklet, and when prescribing a drug for a new diagnosis, a drug from the booklet is chosen in most cases [median (25th – 75th percentile) 80 (75–90)]. However, at renewal of a drug prescription, active change to a drug from the prescribing guidelines booklet occurs less often [median (25th – 75th percentile) 50 (20–70)]. The booklet also includes short therapy advice sections, which 231 doctors (42%) use every day and 191 (34%) use every week. The attitudes towards the prescribing guidelines booklet were generally positive. Doctors in privately run primary health care units and doctors running their own business were generally more negative and judged themselves to be less adherent to the prescribing guidelines booklet compared with doctors in publicly run primary health care units.The prescribing guidelines booklet is frequently used and is generally appreciated, though differences exist between subgroups of users.Drugs are one of the keystones in the treatment of patients. Rational use of drugs requires adequate knowledge on benefits, risks and cost-effectiveness of drugs. Knowledge in the drug area is rapidly increasing and it may be difficult for a primary care doctor to be updated in all therapeutic areas. Lack of time for reading and evaluating scientific papers in favour of direct patient work may be one explanation. To determine the drug of choice on health economic bases may be an additional difficu
Association between Multi-Dose Drug Dispensing and Quality of Drug Treatment – A Register-Based Study
Christina Sj?berg, Christina Edward, Johan Fastbom, Kristina Johnell, Sten Landahl, Kristina Narbro, Susanna Maria Wallerstedt
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026574
Abstract: Background In the elderly in Scandinavia, multi-dose drug dispensing (MDD) is a common alternative to ordinary prescriptions (OP). MDD patients receive their drugs in unit bags, one for each dose occasion. The prescribing procedure differs between MDD and OP. The aim of the present study was to investigate the association between MDD and quality of drug treatment (QDT). Methodology/Principal Findings A cross-sectional study was performed of all inhabitants in Region V?stra G?taland alive on December 31st 2007, aged ≥65 years, with ≥1 prescribed drug and ≥2 health care visits for ≥2 diagnoses for obstructive pulmonary disease, diabetes mellitus, and/or cardiovascular disease in 2005–2007 (n = 24,146). For each patient, drug treatment on December 31st 2007 was estimated from drugs registered in the Swedish Prescribed Drug Register. QDT was evaluated according to established quality indicators (≥10 drugs, Long-acting benzodiazepines, Drugs with anticholinergic action, ≥3 psychotropics, and Drugs combinations that should be avoided). Logistic regression, with adjustments for age, sex, burden of disease, and residence, was performed to investigate the association between MDD and QDT. Mean age was 77 years, 51% were females, and 20% used MDD. For all quality indicators, the proportion of patients with poor QDT was greater in patients with MDD than in patients with OP (all P<0.0001). Unadjusted and adjusted odds ratios (95% confidence intervals) for poor QDT (MDD patients vs. OP patients) ranged from 1.47 (1.30–1.65) to 7.08 (6.30–7.96) and from 1.36 (1.18–1.57) to 5.48 (4.76–6.30), respectively. Conclusions/Significance Patients with MDD have poorer QDT than patients with OP. This cannot be explained by differences in age, sex, burden of disease, or residence. These findings must be taken into account when designing alternative prescribing systems. Further research is needed to evaluate causative factors and if the findings also apply to other dose dispensing systems.
Severe hepatotoxic adverse reaction in a healthy schoolgirl after treatment with flucloxacillin
C-J T rnhage, G Brunl f, S M Wallerstedt
Drug, Healthcare and Patient Safety , 2009, DOI: http://dx.doi.org/10.2147/DHPS.S4316
Abstract: e hepatotoxic adverse reaction in a healthy schoolgirl after treatment with flucloxacillin Case report (4482) Total Article Views Authors: C-J T rnhage, G Brunl f, S M Wallerstedt Published Date March 2009 Volume 2009:1 Pages 17 - 19 DOI: http://dx.doi.org/10.2147/DHPS.S4316 C-J T rnhage1, G Brunl f2, S M Wallerstedt2 1Department of Paediatrics, Central Hospital, Skaraborg, Sk vde, Sweden; 2Department of Clinical Pharmacology, Sahlgrenska University Hospital, G teborg, Sweden Abstract: This is the first detailed description of a severe hepatotoxic reaction in a previously healthy 9-year-old schoolgirl after ingestion of some flucloxacillin tablets. She was clinically well within one week and alanine aminotransferase in serum was normalized in one month. Follow up for more than one year was normal.
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