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Article ; Online: Factors influencing antibiotic prescribing for respiratory tract infections in primary care - a comparison of physicians with different antibiotic prescribing rates.

Cronberg, Olof / Tyrstrup, Mia / Ekblom, Kim / Hedin, Katarina

Scandinavian journal of primary health care

2024 , Page(s) 1–11

Abstract: Background: There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years.: Objective: To compare primary care physicians who, over ... ...

Abstract	Background: There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years. Objective: To compare primary care physicians who, over time, reduced their antibiotic prescribing for respiratory tract infections with those who remained either high or low prescribers regarding potentially influencing factors. Design and setting: A register-based study including all RTI visits in primary care in Region Kronoberg, Sweden 2006-2014. The data were divided into three 3-year periods. Subjects: The data comprised all physicians who had diagnosed at least one RTI for each of the three-year periods. The antibiotic prescribing rate adjusted for the patients' sex and age group was calculated for each physician and period, and based on the change between the first and the third period, the physicians were divided into three prescriber groups: The High Prescribing Group, the Decreasing Prescribing Group, and the Low Prescribing Group. Main outcome measures: For the three prescriber groups, we compared factors influencing antibiotic prescribing such as the characteristics of the physicians, their use of point-of-care tests, their choice of diagnoses, and whether the patients returned and received antibiotics. Results: The High Prescribing Group ordered more point-of-care tests, registered more potential bacterial diagnoses, prescribed antibiotics at lower C-reactive protein levels, and prescribed antibiotics more often despite negative group A Streptococci test than in the Low Prescribing Group. The Decreasing Prescribing Group was between the High Prescribing Group and the Low Prescribing Group regarding these variables. The lower prescription rate in the Low Prescribing Group did not result in more return visits or new antibiotic prescriptions within 30 days. Conclusion: Point-of-care testing and its interpretation differed between the prescriber groups. Focus on interpreting point-of-care test results could be a way forward in antibiotic stewardship.
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	605763-9
ISSN	1502-7724 ; 0281-3432 ; 0284-6020
ISSN (online)	1502-7724
ISSN	0281-3432 ; 0284-6020
DOI	10.1080/02813432.2024.2332757
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Article ; Online: Reducing AST orders by reviewing test panels.

Ekblom, Kim / Petersson, Annika

Clinical biochemistry

2022 Volume 112, Page(s) 71–72

Language	English
Publishing date	2022-11-25
Publishing country	United States
Document type	Letter
ZDB-ID	390372-2
ISSN	1873-2933 ; 0009-9120
ISSN (online)	1873-2933
ISSN	0009-9120
DOI	10.1016/j.clinbiochem.2022.11.010
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Zs.A 624: Show issues

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Article ; Online: Detection of subarachnoid haemorrhage with spectrophotometry of cerebrospinal fluid - a comparison of two methods.

Clarin, Marcus / Petersson, Annika / Zetterberg, Henrik / Ekblom, Kim

Clinical chemistry and laboratory medicine

2022 Volume 60, Issue 7, Page(s) 1053–1057

Abstract: Objectives: Spectrophotometric absorption curve analysis of cerebrospinal fluid (CSF) for oxyhaemoglobin and bilirubin is necessary to accurately diagnose subarachnoid haemorrhage (SAH) in patients with typical symptoms but with negative findings on X- ... ...

Abstract	Objectives: Spectrophotometric absorption curve analysis of cerebrospinal fluid (CSF) for oxyhaemoglobin and bilirubin is necessary to accurately diagnose subarachnoid haemorrhage (SAH) in patients with typical symptoms but with negative findings on X-ray examinations. In this study, we evaluated the performance of two methods for interpreting absorption curves; one method from the United Kingdom National External Quality Assessment Service (UK-NEQAS) and the other from the national quality assurance programme in Sweden (Equalis). Methods: Consecutive absorbance curves (n=336) were interpreted with two different methods, and their performance was compared to the diagnosis as stated in the patient records. Results: The UK-NEQAS method displayed equal sensitivity to the Equalis method, but the specificity of the UK-NEQAS method was significantly higher than the Equalis method resulting in fewer false positive results. For UK-NEQAS, a positive predictive value (PPV) of 84.6% and a negative predictive value (NPV) of 99.7% were observed, whereas the Equalis method had a PPV of 27.5% and an NPV of 99.7%. Conclusions: The semi-automated method based on the guidelines from UK-NEQAS provides an efficient and correct interpretation of absorbance curves with short turn-around times. We propose using this method for the routine interpretation of CSF spectrophotometric curves.
MeSH term(s)	Bilirubin ; Cerebrospinal Fluid ; Humans ; Oxyhemoglobins ; Software ; Spectrophotometry ; Subarachnoid Hemorrhage/cerebrospinal fluid ; Subarachnoid Hemorrhage/diagnosis
Chemical Substances	Oxyhemoglobins ; Bilirubin (RFM9X3LJ49)
Language	English
Publishing date	2022-04-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2021-1320
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Article: ABO Blood Groups, RhD Factor and Their Association with Subclinical Atherosclerosis Assessed by Carotid Ultrasonography.

Mickelsson, Malin / Ekblom, Kim / Stefansson, Kristina / Liv, Per / Nyman, Emma / Själander, Anders / Näslund, Ulf / Hultdin, Johan

Journal of clinical medicine

2024 Volume 13, Issue 5

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2024-02-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13051333
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Article ; Online: Evaluation of urine dipsticks for quality control of residual erythrocytes and leukocytes in leukocyte-depleted donor plasma.

Ekblom, Kim / Petersson, Annika

Scandinavian journal of clinical and laboratory investigation

2019 Volume 80, Issue 1, Page(s) 39–45

Abstract: Currently used methodologies for quality control of residual leukocytes and erythrocytes in leukocyte-depleted plasma are either expensive or time-consuming. It has been proposed that urine dipsticks could be used as a screening method for residual ... ...

Abstract	Currently used methodologies for quality control of residual leukocytes and erythrocytes in leukocyte-depleted plasma are either expensive or time-consuming. It has been proposed that urine dipsticks could be used as a screening method for residual erythrocytes. The aim was, therefore, to evaluate if urine dipsticks could be used to detect residual erythrocytes and also residual leukocytes in leukocyte-depleted plasma. Dilution series ranging over the decision limits for residual erythrocytes and leukocytes were prepared. Positive, negative and overall agreements, as well as the precision and joint frequency distributions, were calculated for five dipstick analyzers and their corresponding dipsticks. Twenty-four consecutive leukocyte-depleted donor plasma samples were also tested. None of the dipstick analyzers had both a high positive and a high negative agreement. Accordingly, none of the analyzers were able to discriminate between cell concentrations close to the decision limits. The inconsistency count revealed differences in precision between the dipstick analyzers. In the 24 consecutive donor samples, no significant correlation between the dipstick analyzers and the reference methods were found. In conclusion, urine dipsticks are not suitable for quality control of residual leukocytes and erythrocytes in leukocyte-depleted donor plasma.
MeSH term(s)	Blood Donors ; Cell Count/instrumentation ; Cell Count/methods ; Erythrocytes ; Humans ; Leukocytes ; Plasma/cytology ; Quality Control ; Urinalysis/instrumentation
Language	English
Publishing date	2019-11-26
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	3150-1
ISSN	1502-7686 ; 0036-5513
ISSN (online)	1502-7686
ISSN	0036-5513
DOI	10.1080/00365513.2019.1692233
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Article ; Online: Evaluation of a routine hematology analyzer for quality control of leukoreduced plasma.

Petersson, Annika / Ekblom, Kim

Transfusion

2019 Volume 59, Issue 10, Page(s) 3214–3218

Abstract: Background: Quality control of residual white blood cells (WBCs) and red blood cells (RBCs) in leukoreduced plasma is mandatory. Although technological advances have been made, analysis of quality controls using routine hematology analyzers has not ... ...

Abstract	Background: Quality control of residual white blood cells (WBCs) and red blood cells (RBCs) in leukoreduced plasma is mandatory. Although technological advances have been made, analysis of quality controls using routine hematology analyzers has not generally been introduced. The aim of this study was to evaluate if the routine hematology analyzer Sysmex XN-10, (Sysmex Nordic ApS) could be used for quality control of residual WBCs and RBCs in leukoreduced plasma. Study design and methods: Linearity, accuracy, and precision were established for two Sysmex XN-10 analyzers using spiked donor plasma. ADAM rWBC (NanoEnTek) and manual counting in the Bürker chamber (NanoEnTek) were reference methods for WBCs and RBCs, respectively. Twenty-five consecutive leukoreduced donor plasma samples were also tested. Results: For WBCs, the linearity criteria were met for the ADAM rWBC, but not for the Sysmex XN-10 instruments. Precision on both Sysmex XN-10 instruments was accurate only at 6 cells/μL, and accuracy was consistently acceptable only at 5 to 6 cells/μL. The precision and accuracy of the ADAM rWBC were acceptable at 2 to 6 cells/μL. For RBCs, both Sysmex XN-10 instruments and manual counting in the Bürker chamber were linear and fulfilled the precision criteria. Accuracy was acceptable for both Sysmex instruments at 6 to 12 × 10 Conclusion: For quality control purposes of leukoreduced plasma, the Sysmex XN-10 analyzer is suitable for the enumeration of residual RBCs but not of residual WBCs.
MeSH term(s)	Blood Donors ; Humans ; Leukocytes ; Plasma ; Quality Control
Language	English
Publishing date	2019-08-09
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.15481
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Article ; Online: Introduction of cost display reduces laboratory test utilization.

Ekblom, Kim / Petersson, Annika

The American journal of managed care

2018 Volume 24, Issue 5, Page(s) e164–e169

Abstract: Objectives: To study the effects on the number of laboratory tests ordered after introduction of cost display (showing the cost in the computerized test ordering system at test ordering and test result delivery) and cost charge (requiring all primary ... ...

Abstract	Objectives: To study the effects on the number of laboratory tests ordered after introduction of cost display (showing the cost in the computerized test ordering system at test ordering and test result delivery) and cost charge (requiring all primary healthcare centers to pay full laboratory costs of the ordered tests). Study design: The study included cost display for secondary healthcare centers (inpatient hospitals, emergency departments, and outpatient specialist providers) as well as publicly and privately operated primary healthcare centers (sites of nonemergency, nonspecialist healthcare). After 3 months, cost charge was introduced by management for all primary healthcare centers. Methods: Information on laboratory test cost was appended to the laboratory test name in the test ordering system, resulting in cost display both at the moment of test ordering and at the presentation of the test result. Numbers of laboratory tests were obtained from the laboratory information system and calculated as tests per physician visit. Cost charge was managed through the established laboratory invoicing system. Results: In the publicly operated primary healthcare centers, neither of the interventions had any effect on laboratory test volume, nor did cost display have an effect in the privately operated primary healthcare centers. However, introduction of cost charge significantly decreased laboratory test ordering in the privately operated primary healthcare centers. In contrast, secondary healthcare centers lowered test volumes when cost display was introduced. Conclusions: The results support cost awareness and cost charge as means of reducing laboratory utilization. However, the outcome varies with the setting.
MeSH term(s)	Cost Savings ; Diagnostic Tests, Routine/economics ; Humans ; Medical Order Entry Systems ; Practice Patterns, Physicians'/economics ; Unnecessary Procedures/economics
Language	English
Publishing date	2018-05-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
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Article ; Online: Patients developing inflammatory bowel disease have iron deficiency and lower plasma ferritin years before diagnosis: a nested case-control study.

Widbom, Lovisa / Ekblom, Kim / Karling, Pontus / Hultdin, Johan

European journal of gastroenterology & hepatology

2020 Volume 32, Issue 9, Page(s) 1147–1153

Abstract: Background: Iron deficiency is common among inflammatory bowel disease (IBD) patients, generally reported without comparisons with controls. The aim of this study was to analyse if iron deficiency was more common among those later developing IBD ... ...

Abstract	Background: Iron deficiency is common among inflammatory bowel disease (IBD) patients, generally reported without comparisons with controls. The aim of this study was to analyse if iron deficiency was more common among those later developing IBD compared to matched controls in a prospective setting. Methods: We included 96 healthy subjects later developing IBD and 191 matched controls from the Northern Sweden Health and Disease Study. We analysed iron, ferritin, transferrin, and calculated transferrin saturation in plasma sampled at least 1 year prior to IBD diagnosis. Iron deficiency was defined as plasma ferritin <30 µg/L if C-reactive protein (CRP) was <3 mg/L. When CRP was >3 mg/L, iron deficiency could not be excluded if ferritin was <100 µg/L. Results: Iron deficiency could not be excluded among more male cases vs controls (25.0% vs 2.2%; P < 0.001), whereas with no differences for women (39.6% vs 35.3%; P = 0.538). Ferritin was lower among male IBD cases (P = 0.001) and for ulcerative colitis (P = 0.016 for males and 0.017 for females), but not for Crohn's disease. Ferritin was associated with a lower risk for IBD and in the ulcerative colitis subgroup when using sex-based z-scores. Ferritin quartiles 2-4 had a 65% lower odds ratio for all IBD, ulcerative colitis, and Crohn's disease in multivariable analysis. Conclusions: Lower ferritin was associated with higher risk for developing IBD in a prospective setting. Iron deficiency was more common among healthy males years later developing IBD compared to matched controls, but not among women.
MeSH term(s)	Anemia, Iron-Deficiency/diagnosis ; Anemia, Iron-Deficiency/epidemiology ; Case-Control Studies ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/epidemiology ; Female ; Ferritins ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/epidemiology ; Male ; Prospective Studies ; Sweden/epidemiology
Chemical Substances	Ferritins (9007-73-2)
Language	English
Publishing date	2020-02-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000001816
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Article ; Online: Diagnosis-linked antibiotic prescribing in Swedish primary care - a comparison between in-hours and out-of-hours.

Cronberg, Olof / Tyrstrup, Mia / Ekblom, Kim / Hedin, Katarina

BMC infectious diseases

2020 Volume 20, Issue 1, Page(s) 616

Abstract: Background: The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. ... ...

Abstract	Background: The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population. Methods: This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006-2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours. Results: The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change - 8.5 [95% CI - 11.9 to - 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections. When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar. Conclusions: Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.
MeSH term(s)	Adolescent ; Adult ; After-Hours Care/statistics & numerical data ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Databases, Factual ; Drug Prescriptions/statistics & numerical data ; Female ; Humans ; Infant ; Infections/drug therapy ; Male ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Primary Health Care/statistics & numerical data ; Referral and Consultation/statistics & numerical data ; Retrospective Studies ; Sweden/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-08-20
Publishing country	England
Document type	Comparative Study ; Journal Article
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-020-05334-7
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Article ; Online: UGT1A1*33 (TA)5 is more common in Romania and Northern Sweden than previously believed.

Ekblom, Kim / Hultdin, Johan

Journal of gastrointestinal and liver diseases : JGLD

2017 Volume 26, Issue 4, Page(s) 427–428

MeSH term(s)	Genotype ; Glucuronosyltransferase/genetics ; Humans ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Romania ; Sweden
Chemical Substances	Glucuronosyltransferase (EC 2.4.1.17)
Language	English
Publishing date	2017-12-18
Publishing country	Romania
Document type	Letter ; Comment
ZDB-ID	2427021-0
ISSN	1842-1121 ; 1841-8724
ISSN (online)	1842-1121
ISSN	1841-8724
DOI	10.15403/jgld.2014.1121.264.ugt
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