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1.  Presenting the improved possibility for staying well might be better than talking about change in risk: Use of the Non-Occurrence Probability Increase (NOPI) 
Abstract
Objective
Talking about risk with patients is problematic since the individual's risk is not addressed and is usually very low. This study aimed to see how fact presentation influenced the decision-making process for general practitioners concerning treatment for the prevention of cardiovascular disease. Rather than looking at the risk of becoming ill, often presented as high figures of relative risk reduction (RRR), it could be useful to present the probability of staying well, i.e. from the concept of non-occurrence probability (NOP) and non-occurrence probability increase (NOPI) – simply a single measure of change in NOP.
Design
General practitioners (GPs) had personal response keypads to answer two questions, presented differently, concerning whether they would allow themselves to be treated or not be treated for the risk of cardiovascular death.
Setting and subjects
Five audiences consisting of general practitioners attending lectures.
Results
When the question was presented as RRR, 68% and 86%, respectively, of the physicians responded that they would take the decision to treat. When presented as the concept of NOPI the figures were reduced to 18% and 16%, respectively (p < 10–6).
Implications
Developing tools to explain treatment effect is crucial to enhancing health care quality. Since NOPI is one potential way of presenting prevention of risk we encourage future research to evaluate the NOPI concept compared with RRR and absolute risk reduction (ARR).
doi:10.3109/02813432.2013.811951
PMCID: PMC3750434  PMID: 23889596
Cardiovascular diseases; drug therapy; general practice; patient compliance; patient education; probability; risk assessment; Sweden
2.  The physician's self-evaluation of the consultation and patient outcome: A longitudinal study 
Abstract
Objective. To study whether the physician's evaluation of the consultation correlates to patient outcome one month later concerning symptom relief, sick leave, and drug compliance as perceived by the patient. The study also investigated whether the patient's evaluation of the consultation correlated to patient outcome. Design. A longitudinal study using questionnaires. Setting. A county in south-western Sweden. Subjects. Forty-six physicians and 316 primary care patients aged 16 years or more with a new complaint lasting one week or more were invited. A total of 289 patients completed a questionnaire presented at the consultation; 273 patients were reached in a follow-up telephone interview one month after the consultation. Main outcome measures. The association between each statement in the physician-patient questionnaire (PPQ) from the consultation and the answers obtained from the telephone interview were analysed by either multiple linear or logistic regression analysis. Results. Five out of 10 items in the PPQ were significantly associated with patient outcome. Physician's self-evaluation of the consultation was much more strongly associated with patient outcome than the patient's evaluation. Conclusion. The difference between the physician's and patient's evaluation of the consultation to predict patient outcomes indicates that the physician's self-evaluation of the consultation is of importance.
doi:10.3109/02813432.2012.751692
PMCID: PMC3587305  PMID: 23281893
Family practice; patient satisfaction; physician–patient relations; process assessment (health care); quality of health care; questionnaires; self-evaluation programs; Sweden
3.  Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes 
BMC Family Practice  2011;12:36.
Background
The high prevalence of bacteriuria in elderly individuals makes it difficult to know if a new symptom is related to bacteria in the urine. There are different views concerning this relationship and bacteriuria often leads to antibiotic treatments. The aim of this study was to investigate the relationship between bacteria in the urine and new or increased restlessness, fatigue, confusion, aggressiveness, not being herself/himself, dysuria, urgency and fever in individuals at nursing homes for elderly when statistically considering the high prevalence of asymptomatic bacteriuria in this population.
Methods
In this cross-sectional study symptoms were registered and voided urine specimens were collected for urinary cultures from 651 elderly individuals. Logistic regressions were performed to evaluate the statistical correlation between bacteriuria and presence of a symptom at group level. To estimate the clinical relevance of statistical correlations at group level positive and negative etiological predictive values (EPV) were calculated.
Results
Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself existing at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria.
Conclusions
Urinary cultures provide little or no useful information when evaluating diffuse symptoms among elderly residents of nursing homes. Either common urinary tract pathogens are irrelevant, or urine culture is an inappropriate test.
doi:10.1186/1471-2296-12-36
PMCID: PMC3142216  PMID: 21592413
Urinary Tract Infections; Homes for the Aged; Nursing Homes; Bacteriuria; Predictive Value of Tests
4.  Evaluation of dipstick analysis among elderly residents to detect bacteriuria: a cross-sectional study in 32 nursing homes 
BMC Geriatrics  2009;9:32.
Background
Few studies have evaluated dipstick urinalysis for elderly and practically none present confidence intervals. Furthermore, most previous studies combine all bacteria species in a "positive culture". Thus, their evaluation may be inappropriate due to Yule-Simpson's paradox. The aim of this study was to evaluate diagnostic accuracy of dipstick urinalysis for the elderly in nursing homes.
Methods
In this cross-sectional study voided urine specimens were collected from 651 elderly individuals in nursing homes. Dipstick urinalysis for nitrite, leukocyte esterase and urine culture were performed. Sensitivity, specificity, positive and negative predictive values with 95% confidence intervals were calculated. Visual readings were compared to readings with a urine chemistry analyzer.
Results
207/651 (32%) of urine cultures showed growth of a potentially pathogenic bacterium. Combining the two dipsticks improved test characteristics slightly compared to using only one of the dipsticks. When both dipsticks are negative, presence of potentially pathogenic bacteria can be ruled out with a negative predictive value of 88 (84–92)%. Visual and analyzer readings had acceptable agreement.
Conclusion
When investigating for bacteriuria in elderly people at nursing homes we suggest nitrite and leukocyte esterase dipstick be combined. There are no clinically relevant differences between visual and analyzer dipstick readings. When dipstick urinalysis for nitrite and leukocyte esterase are both negative it is unlikely that the urine culture will show growth of potentially pathogenic bacteria and in a patient with an uncomplicated illness further testing is unnecessary.
doi:10.1186/1471-2318-9-32
PMCID: PMC2724370  PMID: 19635163

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