Scandinavian journal of primary health care
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Scand J Prim Health Care · Mar 2022
Diagnosing pancreatic cancer in general practice: a cross-sectional study on associations between suspicion of cancer, urgent referral and time to diagnosis.
This study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP's suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval. ⋯ The majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice.Key pointsPatients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage.The majority of patients with pancreatic cancer began their diagnostic process in general practice.General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients.The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis.
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Scand J Prim Health Care · Mar 2022
Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences.
To explore patients' and physicians' perspectives on a decision-making conversation for life-sustaining treatment, based on the Danish model of the American Physician Orders for Life Sustaining Treatment (POLST) form. ⋯ Patients and physicians found having a conversation about levels of life-sustaining treatment valuable, especially for strengthening patient autonomy. Relatives were considered key persons. The timing of the conversation and securing sufficient knowledge for shared decision-making were the main perceived challenges.KEY POINTSConversations about preferences for life-sustaining treatment are important, but not performed systematically.When planning a conversation about preferences for life-sustaining treatment, the timing of the conversation and the inclusion of relatives are key elements.Decision-making conversations can help patients feel in charge and less alone, and make it easier for health professionals to provide goal-concordant care.Using a model like the Danish POLST form may help to initiate, conduct and structure conversations about preferences for life-sustaining treatment.
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Scand J Prim Health Care · Mar 2022
Use and quality of point-of-care microscopy, urine culture and susceptibility testing for urinalysis in general practice.
Objective: To describe the use and quality of point-of-care (POC) microscopy, urine culture and susceptibility testing performed in general practice in Northern Denmark from 2013 to 2018. Design: Descriptive studySetting: General practices receiving a fee for examining urine samples. Subjects: Simulated urine samples containing uropathogenic bacteria distributed by the organisation for improvement of microbiological quality (MIKAP). ⋯ Interestingly, microscopy was the least used method even though the result may be reached within a few minutes. Key pointsThe quality of POC tests (microscopy, urine culture, susceptibility testing) performed in general practice was high when examining urine containing E. coli, whereas difficulties were observed for samples including S. saprophyticus or K. pneumoniae. Susceptibility testing was more often performed than urine culture, which indicates a problem as only urine cultures contribute with information about the flora composition and bacterial quantification.