Helsebibliotekets Research Archive
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Behandling og rehabilitering av pasienter med hjerneslag
No full textNORSK: Bakgrunn\ud
En nasjonal pasientsikkerhetskampanje, med planlagt oppstart i 2011, er under forberedelse. For å støtte beslutningsprosessen rundt valg av innsatsområder og tiltak, har vi foretatt en hurtigoppsummering av kunnskapsgrunnlaget om effekt av behandling og oppfølging i egen slagenhet sammenlignet med behandling i generelle sengeavdelinger.\ud
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Oppdrag\ud
Oppdraget ble gitt av Nasjonalt kunnskapssenter for helsetjenesten, sekretariatet for pasientsikkerhetskampanjen 2011.\ud
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Hovedkonklusjoner \ud
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Behandling i egne slagenheter kan gi reduksjon i antall dødsfall (middels kvalitet) og redusere liggetiden i sykehus (lav kvalitet).\ud
Behandling i egne slagenheter har trolig liten eller ingen effekt for avhengighet av hjelp (middels kvalitet) og behov for pleie i institusjon (lav kvalitet).\ud
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Konklusjonene er basert på resultater i en ny rapport fra Nasjonalt kunnskapssenter for helsetjenesten og en Cochrane-oversikt fra 2007.ENGLISH: 1-page key messages\ud
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Background\ud
A national patient safety campaign, planned to start in 2011, is being prepared. To support decisions regarding the choice of priority areas and interventions, we have performed a rapid summary of evidence supporting treatment in organised stroke units compared to treatment in general wards.\ud
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Commission\ud
The summary was performed on commission of The Norwegian Knowledge Centre for the Health Services, The secretary of the patient safety campaign 2011. \ud
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Main conclusions \ud
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Treatment in organised stroke units compared may result in reduced mortality (medium quality) and reduced length of hospital stay (low quality)\ud
Treatment in organised stroke units probably has very little or no effect on dependency (medium quality) and the need for institutionalisation (low quality)\ud
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The conclusions are based on a new report from The Norwegian Knowledge Centre for the Health Services and a Cochrane review from 2007
Experience of unpleasant sensations in the mouth after injection of saline from prefilled syringes.
No full textBACKGROUND: Nurses at The Norwegian Radium Hospital have reported that some patients notice an unpleasant smell or taste in accordance with flushing of intravenous lines with commercially available prefilled syringes. We have conducted a study in healthy volunteers to investigate the occurrence, consistency and intensity of this phenomenon. METHODS: A randomised, blinded, crossover study comparing commercial available prefilled saline 9 mg/ml syringes to saline 9 mg/ml for injection in polyethylene package was performed in 10 healthy volunteers. The volunteers were given intravenous injections of varying volume and speed. Data were analysed using descriptive statistics, and also Wilcoxon Signed Rank Test to compare groups. RESULTS: After intravenous injection, 2 of 15 recordings demonstrated any sensation of smell or taste after injection of saline from polyethylene package, while 14 of 15 recordings noted a sensation after injection of saline from prefilled syringes. The intensity of the unpleasant sensation was rated significantly higher after injection of saline from prefilled syringes compared to saline from polyethylene (p = 0.001). CONCLUSIONS: Injection of saline from prefilled syringes in healthy volunteers resulted in an experience of bad taste or smell. It is important that nurses and health workers are aware of the phenomenon as described in this article in order to choose the preferred product for a given patient
Metabolomic analyses of plasma reveals new insights into asphyxia and resuscitation in pigs.
No full textBACKGROUND: Currently, a limited range of biochemical tests for hypoxia are in clinical use. Early diagnostic and functional biomarkers that mirror cellular metabolism and recovery during resuscitation are lacking. We hypothesized that the quantification of metabolites after hypoxia and resuscitation would enable the detection of markers of hypoxia as well as markers enabling the monitoring and evaluation of resuscitation strategies. METHODS AND FINDINGS: Hypoxemia of different durations was induced in newborn piglets before randomization for resuscitation with 21% or 100% oxygen for 15 min or prolonged hyperoxia. Metabolites were measured in plasma taken before and after hypoxia as well as after resuscitation. Lactate, pH and base deficit did not correlate with the duration of hypoxia. In contrast to these, we detected the ratios of alanine to branched chained amino acids (Ala/BCAA; R(2).adj = 0.58, q-value<0.001) and of glycine to BCAA (Gly/BCAA; R(2).adj = 0.45, q-value<0.005), which were highly correlated with the duration of hypoxia. Combinations of metabolites and ratios increased the correlation to R(2)adjust = 0.92. Reoxygenation with 100% oxygen delayed cellular metabolic recovery. Reoxygenation with different concentrations of oxygen reduced lactate levels to a similar extent. In contrast, metabolites of the Krebs cycle (which is directly linked to mitochondrial function) including alpha keto-glutarate, succinate and fumarate were significantly reduced at different rates depending on the resuscitation, showing a delay in recovery in the 100% reoxygenation groups. Additional metabolites showing different responses to reoxygenation include oxysterols and acylcarnitines (n = 8-11, q<0.001). CONCLUSIONS: This study provides a novel strategy and set of biomarkers. It provides biochemical in vivo data that resuscitation with 100% oxygen delays cellular recovery. In addition, the oxysterol increase raises concerns about the safety of 100% O(2) resuscitation. Our biomarkers can be used in a broad clinical setting for evaluation or the prediction of damage in conditions associated with low tissue oxygenation in both infancy and adulthood. These findings have to be validated in human trials
A novel dosimetric protocol for high energy photon radiotherapy beams in Norway : thesis for the degree Master of Science, Institute of Physics, University in Oslo
No full textAbstract:\ud
In 2008, a master's thesis project was carried out at the NRPA, concentrating on the\ud
implementation and use of radiochromic film for dosimetric purposes in photon radiotherapy. A\ud
method for the use of radiochromic film in a clinical setting was developed and tested at 7 of\ud
Norway's 10 radiotherapy hospitals. This report contains the finished thesis in its entirety.Resymé:\ud
I 2008 ble det gjennomført et prosjekt i form av en masteroppgave ved Statens Strålevern, som\ud
omhandlet bruk av radiokromisk film til dosimetriformål innen stråleterapi. En metode for bruk\ud
av radiokromisk film i klinisk sammenheng ble utviklet og uttestet ved 7 av landets 10\ud
stråleterapisentra. Rapporten inneholder den ferdige masteroppgaven i sin helhet
Mal for utarbeidelse av faglige anbefalinger for strålebehandling i Norge
No full textAbstract:\ud
A template for the content of a professional evidence based guideline of how to do radiation\ud
therapy of various cancer diagnosis in Norway developed under the KVIST programme\ud
(Norwegian acronym for «quality assurance in radiotherapy»). KVIST offers to do the\ud
implementation of the template for different cancer diagnosis in collaboration with the\ud
radiotherapy society in Norway and other health authorities.Resymé:\ud
Mal for enhetlig utforming av faglige kunnskapsbaserte anbefalinger ved strålebehandling av\ud
ulike kreftdiagnoser i Norge utarbeidet under programmet «kvalitetssikring i stråleterapi»\ud
(KVIST) ved Statens strålevern. KVIST tilbyr å koordinere arbeidet med implementering av\ud
malen for ulike diagnoser i samarbeid med faggruppene under Onkologisk Forum og i samarbeid\ud
med Helsedirektoratet
Har leger realistiske oppfatninger om tilsynsmyndighetenes bruk av reaksjoner?
No full textNorsk sammendrag: Helsepersonell ilegges ulike administrative reaksjoner av tilsynsmyndighetene. Noen er av den oppfatning at disse reaksjonene brukes for ofte, altså at det personlige ansvaret er for omfattende, mens andre mener slike reaksjoner anvendes i for liten grad. Denne undersøkelsen kartlegger legenes egne oppfatninger om utbredelsen av slike reaksjoner. \ud
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Spørsmål om utbredelsen av reaksjoner ble inkludert i et spørreskjema til referansepanelet til Legeforeningens forskningsinstitutt høsten 2008. Svarandelen var på rundt 70 %. Legenes oppfatninger om hyppigheten av slike reaksjoner blir beskrevet, og vi undersøker om det er systematiske forskjeller i oppfatninger mellom grupper av leger. \ud
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I gjennomsnitt overvurderer legene sannsynligheten for administrative reaksjoner mens de undervurderer sannsynligheten for at pliktbrudd blir påpekt, samtidig som et flertall av legene undervurderer det sanne antallet av administrative reaksjoner og påpekte pliktbrudd. Det er viss variasjon mellom legene når det gjelder rapporterte verdier og det er systematiske forskjeller mellom grupper av leger. Mannlige leger i privat praksis er den gruppen som rapporterte de høyeste verdiene for utbredelsen av administrative reaksjoner. \ud
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Legene i denne studien må sies å estimere forekomsten av reaksjoner overraskende bra, noe som kan tilsi at de som gruppe er relativt godt informert om hvor vanlig bruken av tilsynsmyndighetenes reaksjonsformer er. Samtidig er det slik at en minoritet av legene har betydelige misoppfatninger når det gjelder utbredelsen av de samme reaksjonene. Mer og bedre informasjon til denne gruppen kan endre deres oppfatninger, men det er uvisst om slike justeringer vil ha konsekvenser for legenes kliniske praksis.English summary: Health care personnel can be given different administrative reactions by the supervision authorities. Some people believe that these are given too often, in other words, that too much emphasis is placed on personal responsibility. Other people believe that they are given too infrequently. In this study, doctors’ beliefs about the level of use of administrative reactions were investigated.\ud
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Questions about the use of administrative reactions were included in a questionnaire given to the reference panel of the Norwegian Medical Association’s research institute in the autumn of 2008. The response rate was about 70 per cent. We described doctors’ beliefs about the level of use of administrative reactions, and we investigated whether there are systematic differences in the beliefs of different groups of doctors.\ud
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In general, doctors overestimate the probability for doctors to be given an administrative reaction, and they underestimate the probability for breach of duty being pointed out. At the same time, a majority of the doctors underestimated the actual number of administrative reactions, and the number of times breach of duty was pointed out. There is some variation between doctors with regard to their estimations, and there are systematic differences between groups of doctors. Male doctors in private practice reported the highest estimates for the use of administrative reactions.\ud
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It must be said that the doctors in this study estimated the number of administrative reactions surprisingly well. This indicates that as a group they are relatively well informed about how often administrative reactions are given by the supervision authorities. At the same time, there are a few doctors who have very unrealistic beliefs about how often administrative reactions are given. More and better information to this group may cause a change in their beliefs, but is not certain whether such changes would lead to changes in their clinical practice
Effectiveness of telemedicine: a systematic review of reviews.
No full textOBJECTIVES: To conduct a review of reviews on the impacts and costs of telemedicine services. METHODS: A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review. RESULTS: In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes. CONCLUSIONS: The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest
Effekt av tiltak for å forbedre kvaliteten på helsetjenester til etniske minoriteter: en systematisk oversikt over randomiserte kontrollerte forsøk
No full textNORSK: Bakgrunn\ud
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Ifølge helseforetakslovens § 1 skal alle pasienter ytes et likeverdig tilbud. Både nasjonale og internasjonale studier tyder imidlertid på at det eksisterer ulikheter i kvaliteten på helsetjenester på grunnlag av etnisitet, og at dette kan ha sin årsak i strukturelle, organistoriske og kliniske barrierer. \ud
Oppdrag\ud
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Helse Sør-Øst RHF har gitt oss i oppdrag å innhente og kritisk vurdere tilgjengelig forskning om effekten av tiltak for å forbedre kvaliteten på helsetjenester til etniske minoriteter. Vi har i denne omgangen konsentrert oss om effekten av tiltak rettet mot helsepersonell og helseorganisasjoner.\ud
Hovedfunn\ud
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Forskjellige former for opplæringstiltak og elektroniske påminnelser til helsepersonell kan under visse betingelser muligens ha en liten effekt på helsepersonells praksis og minoritetspasienters helseutfall. Kvaliteten på dokumentasjonen varierer isolert sett fra svært lav til lav, men funnene støttes av annen omfattende forskning om denne typen tiltak i andre sammenhenger.\ud
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Det er for lav kvalitet på tilgjengelig dokumentasjon til å avgjøre:\ud
om bruk av fjerntolking påvirker pasientens tilfredshet med lege og tolk og fører til bedre kommunikasjon sammenlignet med tradisjonell tolking \ud
om etnisk matching av klient og terapeut påvirker pasientens forståelse, symptomstatus og aksept og tro på nytten av terapeutiske strategier \ud
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om oppfølgings- og støttetiltak i form av økte personellressurser påvirker helseutfall hos minoritetspasienter.ENGLISH: 1-page key messages\ud
Background\ud
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All patients regardless of sex, ethnicity or social status should be provided health services according to their needs. However, both national and international studies suggest that there may be differences in quality of health care on the basis of ethnicity and that this may be due to structural, organizational and clinical barriers.\ud
Mission\ud
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On behalf of South-Eastern Norway Regional Health Authority we collected, critically assessed and summarised the effect of interventions to improve the quality of health services for ethnic minorities. We focused on the effect of interventions aimed at health professionals and health organisations.\ud
Main findings\ud
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Different kinds of educational interventions and electronic reminders to health care providers may under certain circumstances have a small effect on health professionals' practice and minority patients' health outcomes. The quality of the evidence varied from very low to low, but findings are supported by other extensive research on this type of initiatives in other contexts.\ud
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The quality of available evidence is insufficient to determine whether the use of remote interpretation compared to traditional interpretation leads to better communication, whether ethnic matching of client and therapist affects the patient's understanding, symptom status or belief in the usefulness of therapeutic strategies and whether supportive interventions in the form of increased staff resources influence health outcomes for minority patients
Is cannabis a gateway to hard drugs?
No full textThe gateway hypothesis proposes that use of cannabis directly increases the risk of consuming hard drugs. We test this controversial, but influential, hypothesis on a sample of cannabis users, exploiting a unique set of drug price data. A flexible approach is developed to identify the causal gateway effect using a bivariate survival model with shared frailty estimated using a latent class approach. The model suggests two distinct groups; a smaller group of “troubled youths” for whom there is a statistically significant gateway effect that more than doubles the hazard of starting to use hard drugs and a larger fraction of youths for whom previous cannabis use has less impact.NORSK SAMMENDRAG: Trappetrinnshypotesen hevder at bruk av cannabis øker risikoen for også å starte med tyngre rusmidler. Vi har testet denne kontroversielle, men innflytelsesrike, hypotesen på et utvalg cannabisbrukere i Norge.\ud
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For å undersøke om det finnes en årsaksmessige trappetrinns-effekt, gjorde vi en bivariat forløpsanalyse og tok hensyn til ulikheter i ”sårbarhet” for rusmiddelbruk ved å anvende en metode med latente klasser. I tillegg til å kontrollere for en rekke andre variable, har vi kunnet gjøre bruk av et unikt datasett for narkotikapriser.\ud
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Modellen finner to klart avgrensede grupper; en liten gruppe ”problemungdom”, der det er en statistisk signifikant trappetrinns-effekt, som mer enn dobler risikoen for å starte med tyngre stoffer, og en større gruppe ungdommer der tidligere cannabisbruk har mindre innflytelse