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Objective: To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. Design: The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs. Setting: OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation. Patients: Audio-recorded OOH patient contacts. Main outcome measures: Test-retest and inter-rater reliability were analysed using ICC agreement , Fleiss’ kappa and percent agreement. Results: Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage – AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICC agreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICC agreement and in Fleiss’ kappa. Percent agreement revealed satisfactory agreements when differentiating between ‘poor’ and ‘sufficient’ quality). Conclusion: The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between ‘poor’ and ‘sufficient’ quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT. KEYPOINTS Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage

The kinetics of 14C-glycerol exchange was studied in human red cells. Glycerol appeared to be transported by two mechanisms: (i) by facilitated diffusion with permeability depending on glycerol concentration, and (ii) by an unspecific pathway, presumably representing the diffusion of individual glycerol molecules through the membrane with permeability independent of glycerol concentration. The latter permeability was 8 X 10(-8) cm/s at 20 degrees C, it was independent of pH, and had an activation energy of 25 kcal/mol. The facilitated transport of glycerol was completely inhibited by Cu++, and the activation energy was low, about 10 kcal/mol. The transport system was competitively inhibited by H+, reacting with at least three hydrogen analogue, as well as dimethylsulfoxide (a hydrogen bonding molecule with no structural resemblance to glycerol), inhibited glycerol transport competitively. Steins "dimerizer hypothesis" was revised according to our findings. A kinetic scheme describing the reactions of a transport controlling site with glycerol is presented in the Appendix. It is demonstrated in the article that the scheme accounts for out experimental results.

Objective. The aim was to study symptoms managed as the main problem by the general practitioner (GP) and to describe the frequencies and characteristics of presented symptoms when no specific diagnosis could be made. Design. Cross- sectional study. Setting. General practices in the Central Denmark Region. Subjects. In total, 397 GPs included patients with face-to-face contacts during one randomly assigned day in 2008–2009; 7008 patients were included and 5232 presented with a health problem. Main outcome measures. GPs answered a questionnaire after each patient contact. Symptoms and specific diagnoses were subsequently classified using the International Classification of Primary Care (ICPC). Symptom frequency, comorbidity, consultation length, and GP-assessed final outcome and burden of consultations were analysed. Results. The GPs could not establish a specific diagnosis in 36% of patients with health problems. GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients. Musculoskeletal (lower limb and back) and respiratory (cough) symptoms were most frequent. More GPs had demanding consultations when no specific diagnosis could be made. Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made. Conclusion. Interpretation and management of symptoms is a key task in primary care. As symptoms are highly frequent in general practice, symptoms without a specific diagnosis constitute a challenge to GPs. Nevertheless, symptoms have been given little priority in research. More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.

Dry urine-diverting toilets may be used in order to collect excreta for the utilisation of nutrients. A quantitative microbial risk assessment was conducted in order to evaluate the risks of transmission of infectious disease related to the local use of faeces as a fertiliser. The human exposures evaluated included accidental ingestion of small amounts of faeces, or a mixture of faeces and soil, while emptying the storage container and applying the material in the garden, during recreational stays to the garden, and during gardening. A range of pathogens representing various groups of microorganisms was considered. Results showed that 12-months' storage before use was sufficient for the inactivation of most pathogens to acceptable levels. When working or spending time in the garden the annual risk of infection by Ascaris was still slightly above 10(-4) in these scenarios, although the incidence rate for Ascaris is very low in the population in question. Measures to further reduce the hygienic risks include longer storage, or treatment, of the faeces. The results can easily be extended to other regions with different incidence rates.

For patients with screening-detected hyperglycaemia, a participant-driven health education programme was not associated with improvements in most clinical, behavioural and patient-reported outcomes after 3 years of follow-up.

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BackgroundBodily distress syndrome (BDS) is a newly proposed diagnosis of medically unexplained symptoms, which is based on empirical research in primary care.AimTo estimate the frequency of BDS in primary care and describe the characteristics of patients with BDS.Design and settingA cross-sectional study of primary care patients in urban and rural areas of Central Denmark Region.MethodData were obtained from GP one-page registration forms, patient questionnaires (including a checklist for BDS), and national registers.ResultsA total of 1356 primary care patients were included, of whom 230 patients (17.0%, 95% confidence intervals [CI] = 15.0 to 19.1) fulfilled the BDS criteria. BDS was more common among primary care patients aged 41–65 years (odds ratio [OR] = 1.9, 95% CI = 1.3 to 3.0) and was equally frequent among males and females (female sex, OR 0.9, 95% CI = 0.6 to 1.3). Patients with BDS were characterised by poor health-related quality of life (HRQOL) on the 12-item Short-Form Health Survey, that is, physical component summary scores <40 (OR 20.5, 95% CI = 12.9 to 32.4) and mental component summary scores <40 (OR 3.5, 95% CI = 2.2 to 5.6). Furthermore, patients with BDS were more likely to have high scores on the Symptom Checklist for anxiety (OR 2.2, 95% CI = 1.4 to 3.4) and depression (OR 5.1, 95% CI = 3.3 to 7.9), but regression analyses showed that mental morbidity did not account for the poor HRQOL.ConclusionBDS is common among primary care patients, and patients with BDS have a higher probability of poor HRQOL and mental health problems.