Danish Hospital Setting Research Articles

Problematized Patients – Intersectional Perspectives on Gender, Ethnicity, Class and Biomedicine

Problematized patients – Intersectional perspectives on gender, ethnicity, class and biomedicine. This article presents an empirical analysis of the constitutional processes of becoming a patient in a Danish hospital setting by focusing on the intersections between biomedicine, gender, ethnicity, and class. The article uses the concept of intersectionality to emphasize institutional practices and how they shape knowledge, how inequalities are intersectional and contextual, and how the positioning of patients and thereby access to health care is differentiated by race, class, and gender. Three ‘problematized’ patients are analysed, showing how patients are subjectified by the hegemonic knowledge regimes of the hospital. This illustrates that gender, ethnicity, age and class play a constitutive role in the way patients are constructed as problematic within the clinic, thus supporting existing research in biomedicine as not neutral but negotiable. In addition, the arti- cle shows how the categories of gender, ethnicity, and class are put into play, silenced, and/or merged and mixed differently in each case.

Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission—a randomized trial

Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT ≥0.25 µg/L. Physicians could overrule treatment guidelines. The mean duration of hospital stay was 5.9 days in the PCT group vs. 6.7 days in the control group (p 0.22). The mean duration of antibiotic treatment during hospitalization in the PCT group was 5.1 days on average, as compared to 6.8 days in the control group (p 0.007). In a subgroup analysis of chronic obstructive pulmonary disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25% without compromising outcome. No effect on the length of hospital stay was found.

Validation of the PHEEM instrument in a Danish hospital setting

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.