Helsebibliotekets Research Archive
Not a member yet
1049 research outputs found
Sort by
Forskning på verdiarbeid i helsetjenesten – litteratursøk
No full textBAKGRUNN: Nasjonalt kunnskapssenter for helsetjenesten har fått i oppdrag fra Diakonhjemmet sykehus å identifisere forskningslitteratur om verdiarbeid i helsetjenesten. METODE: Vi utørte et systematisk litteratursøk i følgende databaser: Ovid MEDLINE, Ovid EMBASE, Ovid British Nursing Index, ISI Web Of Science (Science Citation Index, Social Science Citation Index, Arts and Humanities Citation Index), SveMed, Cochrane Library of Systematic Reviews, Cochrane Method Studies, DARE, HTA, Sociological Abstracts, Emerald Management Journals og Google Scholar. Søket inneholdt relevante søkeord for å fange opp studier på fire verdiområder: organisatoriske verdier, ledelsesverdier, profesjonsverdier og individuelle verdier. Søket ble avgrenset til publikasjoner utgitt f.o.m. 1994 og med søkefiltre for relevante studiedesign. RESULTAT: 256 publikasjoner ble vurdert som relevante. Disse ble sortert i henhold til de fire verdiområdene
Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter?
No full textOBJECTIVE: Our aim was to estimate the relative and absolute risk of shoulder dystocia in the second delivery according to history of shoulder dystocia and offspring birthweight. STUDY DESIGN: A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). RESULTS: In the second delivery shoulder dystocia occurred in 0.8% of all women. In women with a prior shoulder dystocia the recurrence risk was 7.3%. Most cases of shoulder dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. CONCLUSION: Prior shoulder dystocia increased the risk of shoulder dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor
A small subgroup of operable breast cancer patients with poor prognosis identified by quantitative real-time RT-PCR detection of mammaglobin A and trefoil factor 1 mRNA expression in bone marrow.
No full textPURPOSE: The utility of three different epithelial mRNA markers to detect clinically significant, disseminated tumour cells in bone marrow (BM) was explored. METHODS: Mammaglobin A (hMAM), trefoil factor 1 (TFF-1) and prostate derived Ets factor (PDEF) mRNA were quantitated by real-time RT-PCR in BM samples from 192 breast cancer patients undergoing surgery (control group: 26 healthy women). RESULTS: During a median follow-up of 72 months, four of the five hMAM BM-positive and three of the seven TFF-1 BM-positive patients experienced a systemic relapse. Kaplan-Meier survival analyses demonstrated significantly shorter recurrence-free-, breast-cancer-specific- and overall survival for both hMAM and TFF-1 BM-positive patients. In contrast, PDEF mRNA quantitation did not reveal any significant differences in the survival analyses. Multivariate Cox regression demonstrated hMAM mRNA BM expression to be an independent predictor of both overall- (hazard ratio = 5.896), breast-cancer-specific- (hazard ratio = 10.208) and systemic-recurrence-free survival (hazard ratio = 14.304). TFF-1 status was related to hMAM status (P < 0.001). CONCLUSION: Breast cancer patients with pre-operative elevated BM levels of hMAM and/or TFF-1 mRNA seem to constitute a small group of patients with a very poor prognosis
Tapte arbeidsår ved uførepensjonering for psykiske lidelser. En analyse basert på FD-trygd
No full textSUPPORT Tools for evidence-informed health Policymaking (STP) 17: Dealing with insufficient research evidence.
No full textABSTRACT : This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.In this article, we address the issue of decision making in situations in which there is insufficient evidence at hand. Policymakers often have insufficient evidence to know with certainty what the impacts of a health policy or programme option will be, but they must still make decisions. We suggest four questions that can be considered when there may be insufficient evidence to be confident about the impacts of implementing an option. These are: 1. Is there a systematic review of the impacts of the option? 2. Has inconclusive evidence been misinterpreted as evidence of no effect? 3. Is it possible to be confident about a decision despite a lack of evidence? 4. Is the option potentially harmful, ineffective or not worth the cost
Catalytically impaired hMYH and NEIL1 mutant proteins identified in patients with primary sclerosing cholangitis and cholangiocarcinoma.
No full textThe human hMYH and NEIL1 genes encode DNA glycosylases involved in repair of oxidative base damage and mutations in these genes are associated with certain cancers. Primary sclerosing cholangitis (PSC), a chronic cholestatic liver disease characterized by inflammatory destruction of the biliary tree, is often complicated by the development of cholangiocarcinoma (CCA). Here, we aimed to investigate the influence of genetic variations in the hMYH and NEIL1 genes on risk of CCA in PSC patients. The hMYH and NEIL1 gene loci in addition to the DNA repair genes hOGG1, NTHL1 and NUDT1 were analyzed in 66 PSC patients (37 with CCA and 29 without cancer) by complete genomic sequencing of exons and adjacent intronic regions. Several single-nucleotide polymorphisms and mutations were identified and severe impairment of protein function was observed for three non-synonymous variants. The NEIL1 G83D mutant was dysfunctional for the major oxidation products 7,8-dihydro-8-oxoguanine (8oxoG), thymine glycol and dihydrothymine in duplex DNA, and the ability to perform delta-elimination at abasic sites was significantly reduced. The hMYH R260Q mutant had severe defect in adenine DNA glycosylase activity, whereas hMYH H434D could excise adenines from A:8oxoG pairs but not from A:G mispairs. We found no overall associations between the 18 identified variants and susceptibility to CCA in PSC patients; however, the impaired variants may be of significance for carcinogenesis in general. Our findings demonstrate the importance of complete resequencing of selected candidate genes in order to identify rare genetic variants and their possible contribution to individual susceptibility to cancer development
Evaluering av prosjektet "Barn i rusfamilier - tidlig intervensjon"
No full textNORSK SAMMENDRAG: Bergljot Baklien og Tonje Wejden har evaluert prosjektet Barn i rusfamilier – tidlig intervensjon som Borgestadklinikkene gjennomførte i 2006 og 2007. Målet var å øke handlingskompetansen for ansatte i skoler, barnehager, sosialtjenesten og barnevernet, slik at de så tidlig som mulig kan oppdage barn som vokser opp i familier med rusmiddelproblemer og gi dem riktig hjelp. Ca. 160 ansatte i fire kommuner i Telemark og Vestfold ble kurset i prosjektet, som søkte å skape endring både på individnivå og kollektivt nivå.\ud
\ud
Økt handlingsevne og -vilje\ud
Evalueringen viser at prosjektet har vært vellykket på individnivå. Det har ikke bare økt lærerne og de barnehageansattes kompetanse, men også endret deres måte å handle på. Andelen som sier de er blitt bedre til å lese tegn på at et barn lider på grunn av belastende rusmiddelbruk i familien har økt betraktelig. De har fått en forsterket trygghet og vilje til å ta tak i problemer de oppdager, og dette har overføringsverdi til andre typer problemer enn rus også. De diskuterer oftere en bekymring med kolleger, leder eller barnevernet. Mange forteller at de i løpet av det siste året har tatt kontakt med barnevernet på grunn av rusmiddelbruk hos foresatte.\ud
\ud
Krevende samarbeid\ud
Samarbeidet mellom barnehage og skole på den siden og barnevernet på den andre er ofte krevende. Barnevernet er både et hjelpe- og kontrollorgan, og dette kan gjøre samarbeidet med skoler og barnehage vanskelig. Prosjektets mål om å skape nye modeller for samarbeid og forsterkede rutiner på arbeidsplassene ble ikke nådd. En viktig grunn til dette ser ut til å være at det var uklart hvem som skulle ta initiativ til samarbeid. Innsatsen i prosjektet var primært rettet inn mot endringer på individnivå.\ud
\ud
Overføringsverdi\ud
I rapporten diskuterer forfatterne om prosjektet bør prøves ut andre steder. De konkluderer med at det ut fra de gode erfaringene på individnivå er gode grunner for å anbefale andre kommuner å prøve ut prosjektet. Men det forutsetter at man får gode rammebetingelser og kan trekke på den kompetansen som gjorde Borgestadklinikkens prosjekt vellykket.ENGLISH SUMMARY: The project “Children in families with drug or alcohol problems - early intervention” was developed and implemented by the Borgestad Clinic’s competence centre during 2006 and 2007. The goal was to increase the action competence of staff at schools, day care facilities, social services and child welfare services. The intention was to enable those involved to identify as early as possible children in families with alcohol and drug problems, and provide adequate follow-up and help as early as possible. The project organized a special training program attended by 160 teachers, day care staff and others from four municipalities in Telemark and Vestfold to bring about change both at an individual and a collective level. This evaluation attempts to track those processes of change within professions working with children from families at risk, in relations between persons and agencies, and in matters of a more structural nature in the municipalities.\ud
\ud
The main data source consisted of extensive qualitative interviews with 62 course participants and other key persons. The evaluation is also based on a questionnaire survey and document analysis. The findings from the survey are compared with those of a pre-project study done by the Borgestad Clinic. It shows a sharp pre- and post-program rise in attendees’ confidence in their ability to identify children with substance abuse in the home environment.\ud
\ud
A program which inspired commitment\ud
The qualitative interviews allow us to examine this wider picture in greater detail and penetration. Respondents are unanimously positive to the program, which, they say, was excellent. They had expected something that appealed to the intellect, but got something which hit them at least as hard in the guts. The program inspired commitment, and wakened a sense of moral obligation to help children in need. Not all expectations were met, however. Some missed certain topics, mainly to do with cross-agency collaboration and information about the care services. They also missed a stronger focus on ways of developing a cross-disciplinary model. They would also have appreciated it if responsibility for post-program work and collaboration had been clearly allocated.\ud
\ud
When participants were asked to pinpoint the most relevant aspect of the program, three elements stand out. The first is the item on confidentiality, the second stories about children and domestic substance abuse, and the third was a role-playing item where participants practiced talking with parents and children about the problem. Participants highlight several lessons as they talk about feeling increasingly confident to manage a useful, productive conversation with parents about a matter of concern. They write up their observations more frequently, noting episodes that cause them worry. By starting with an account of actual events, it is easier to decide where to focus and what to aim for in the conversation. They also stressed the importance of making a plan and making sure both you and the parents are agreed about the next steps in the process. A final element is concern for the child. It makes the necessary conversation easier because parents are less likely to reject concerns for the child.\ud
\ud
Program participants grew more confident and more observant. There are still many who are reluctant to conduct the necessary conversation with the parents, but all agree it is easier to discuss concerns with parents now than before. In addition, participants take their gut feelings about a child more seriously and act on them. We can hope, in other words, that at least some children will be helped sooner and more capably as a result of the project.\ud
\ud
Difficult collaboration\ud
To do something about the situation of a child in need often requires input from several people, professions and agencies working together. Relations between school and day care on the one hand, and child welfare service on the other depend on their mutual perceptions. According to respondents in the child welfare service, potential collaborators often have unrealistic expecta-tions. For instance, they expect the service to solve the problem for the school and day care establishment, which in practice is rarely possible.\ud
\ud
In the opinion of the teachers and day care staff, it is important to establish a trusting relationship with parents. Parents often perceive the child welfare service as a system of control, one in which they have little faith. This in turn makes day care staff and teachers reluctant to alert the child welfare authorities because it could undermine their relations with the parents and their willing¬ness to cooperate. It is less threatening to work with a familiar community nurse. Teachers and day care staff also feel that collaboration would be easier if they were informed as soon as possible about developments in a case. They wonder whether the child welfare authorities under¬estimate the type of information a teacher, for instance, might find useful. Many do not believe the child welfare service can do much to help even if they do report a concern. Nevertheless, participants’ opinions of the child welfare service are quite mixed. Mutual knowledge is anyway an important precondition of cooperation, and lowers the contact threshold.\ud
\ud
The project aspired to change structures and relations, with a view to developing a template for coordinating action for children exposed to domestic substance abuse. This goal was not reached. While participants spoke enthusiastically about what the program had meant to them personally, they were clearly disappointed with efforts to set up a cooperation forum. Several day care employees and teachers had high expectations following the group work during the program’s final assembly, at which they spoke about establishing a new cooperation model and cross-disciplinary forum. There was wide agreement, shared also by the child welfare authorities, of the need for a forum, but little of practical value had actually been done. Models facilitating better cooperation do not appear out of thin air, however. One important reason for the lack of success here appears to be the lack of clarity on where responsibility for initiating the work lay.\ud
\ud
The project may also have failed to anticipate the difficulties involved in developing cooperation models of a regulatory and economic nature. The focus remained on engineering change at the level of the individual. The Borgestad Clinic and their project team were skilled and knowledgeable in the area of children living in substance abuse families, they were good educators and communicators. Perhaps they knew less about how municipalities worked and what cooperation needs to flourish. And the project’s resources, both economic and personnel related, were consumed by the program and competence building measures. Post-program work did not have access to such resources.\ud
\ud
Diffusion and replication\ud
The role of the regulatory and economic environment will require careful consideration if the question of piloting the project elsewhere arises. There are good reasons to recommend it to other municipalities so that they can profit from what has been learned on this occasion. But it will be a regulatory and economic challenge. It is not just about getting the best lecturers and letting participants attend free of charge. As some of the respondents pointed out, without money to cover the cost of substitutes, their own attendance would have been impossible. And because of the involvement of the Borgestad Clinic, leading experts were on hand. There is no guarantee that other competence centers would do as well in terms of expertise. Despite the positive effects of the project, and the valuable processes it initiated at the level of the individual, as the evaluation can confirm, it may not necessarily be transferable to other municipalities and other regional competence centers
SUPPORT Tools for evidence-informed health Policymaking (STP)
No full textAbstract This article is the Introduction to a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Knowing how to find and use research evidence can help policymakers and those who support them to do their jobs better and more efficiently. Each article in this series presents a proposed tool that can be used by those involved in finding and using research evidence to support evidence-informed health policymaking. The series addresses four broad areas: 1. Supporting evidence-informed policymaking 2. Identifying needs for research evidence in relation to three steps in policymaking processes, namely problem clarification, options framing, and implementation planning 3. Finding and assessing both systematic reviews and other types of evidence to inform these steps, and 4. Going from research evidence to decisions. Each article begins with between one and three typical scenarios relating to the topic. These scenarios are designed to help readers decide on the level of detail relevant to them when applying the tools described. Most articles in this series are structured using a set of questions that guide readers through the proposed tools and show how to undertake activities to support evidence-informed policymaking efficiently and effectively. These activities include, for example, using research evidence to clarify problems, assessing the applicability of the findings of a systematic review about the effects of options selected to address problems, organising and using policy dialogues to support evidence-informed policymaking, and planning policy monitoring and evaluation. In several articles, the set of questions presented offers more general guidance on how to support evidence-informed policymaking. Additional information resources are listed and described in every article. The evaluation of ways to support evidence-informed health policymaking is a developing field and feedback about how to improve the series is welcome
Kikkhullskirurgi ved godartede gynekologiske lidelser
No full textNORSK: Bakgrunn\ud
\ud
Laparoskopi (kikkhullskirurgi) benyttes i dag ved mange kirurgiske og gynekologiske lidelser som tidligere krevde behandling med åpen kirurgi.\ud
\ud
Oppdrag\ud
\ud
Det er stor variasjon i bruk av kikkhullskirurgi mellom de ulike gynekologiske avdelingene i Norge. Den nasjonale veilederen i generell gynekologi anbefaler kikkhullskirurgi ved kirurgisk behandling av kvinner med graviditet utenfor livmor, men gir ingen klare anbefalinger om hvilken operasjonsmetode som er å foretrekke ved behandling av cyster på eggstokk eller ved fjerning av livmor. \ud
\ud
\ud
Hovedfunn\ud
\ud
Samlet sett er dokumentasjonen for kikkhullskirurgi ved godartede gynekologiske tilstander av lav til middels kvalitet. \ud
Fordelene ved kikkhullskirurgi er kortere liggetid, mindre smerter, færre infeksjoner etter operasjonen og raskere rekonvalesens enn tradisjonell åpen operasjon \ud
Ulempene er lengre operasjonstid, og ved laparoskopisk hysterektomi (fjerning av livmor) er det større risiko for skader på urinblære eller urinleder.ENGLISH: 1-page key messages\ud
\ud
Background\ud
Today laparoscopy, or minimally invasive surgery, is used for many surgical and gynaecological conditions which earlier required open surgery\ud
\ud
The use of laparoscopic operations in Norway varies from one gynaecological department to another. The national guide in general gynaecology gives no clear advice on which procedure should be preferred for operations on ovarian cysts or hysterectomy.\ud
\ud
Main findings\ud
\ud
Overall the documentation on clinical effectiveness of laparoscopic surgery for benign gynaecological diseases is of low to medium quality. \ud
The benefits are shorter hospital stay, less pain, fewer infections and faster recovery compared with open surgery \ud
The disadvantages are the longer operating time and greater risk of damage to the bladder or urethra
Kostnadseffektivitet av å inkludere vaksinasjon mot rotavirus i det norske barnevaksinasjonsprogrammet
No full textNORSK: Bakgrunn\ud
Rotavirusinfeksjoner er en ledende årsak til akutt gastroenteritt hos barn under 5 år. Det finnes i dag to vaksiner (Rotarix® og Rotateq®) mot rotavirusinfeksjoner som har fått innvilget markedsføringstillatelse i Norge. Kunnskapssenteret fikk i oppdrag av Nasjonalt folkehelseinstitutt å evaluere kostnadseffektiviteten ved å inkludere vaksinasjon mot rotavirus i det norske barnevaksinasjonsprogrammet.\ud
\ud
Metode\ud
Det ble foretatt en helseøkonomisk evaluering som sammenlignet kostnader og helsegevinster for de to vaksinekandidatene mot en ikke-vaksinasjonsstrategi. Analysene ble basert på en modell som beregnet kostnader per kvalitetsjusterte leveår for de to vaksinene. Resultatene av analysene ble presentert som inkrementelle kostnadseffektivitetsratioer, både fra et helsetjenesteperspektiv og et samfunnsperspektiv. NOK 500 000 per vunnet kvalitetsjusterte leveår ble brukt som terskelverdi for å definere kostnadseffektivitet.\ud
\ud
Resultat\ud
\ud
Inkrementelle kostnadseffektivitetsratioer fra et helsetjenesteperspektiv:\ud
\ud
Rotarix®: NOK 687 500 per vunnet kvalitetsjusterte leveår \ud
Rotateq®: NOK 762 000 per vunnet kvalitetsjusterte leveår \ud
\ud
Inkrementelle kostnadseffektivitetsratioer fra et samfunnsperspektiv:\ud
\ud
Rotarix®: NOK 27 500 per vunnet kvalitetsjusterte leveår \ud
Rotateq®: NOK 104 000 per vunnet kvalitetsjusterte leveår \ud
\ud
Konklusjon\ud
Med en terskelverdi på NOK 500 000 per vunnet kvalitetsjusterte leveår som definisjon på kostnadseffektive intervensjoner, er det lite sannsynlig at vaksinasjon mot rotavirus vil være kostnadseffektivt i Norge sett fra et helsetjenesteperspektiv. I et tilnærmet samfunnsperspektiv som også inkluderte indirekte kostnader som følge av produktivitetstap ved foreldres sykefravær vil det derimot være overveiende sannsynlig at vaksinasjon vil være et kostnadseffektivt behandlingsalternativ.ENGLISH: 1-page key messages\ud
\ud
Background\ud
Rotavirus is a leading cause of acute gastroenteritis among infants and children under 5 years old. In Norway, there are two vaccines (Rotarix® and Rotateq®) licensed for preventing rotavirus gastroenteritis. The Norwegian Knowledge Centre for the Health Services was assigned by the National Institute of Public Health to estimate the cost-effectiveness of including vaccination against rotavirus in the childhood immunization programme.\ud
\ud
Methods\ud
We performed a cost-utility analysis that compared costs and effects of the two vaccine alternatives to a non-vaccination strategy. The analyses were based on a model that estimated costs per quality adjusted life-years for the vaccine candidates. The results were presented as incremental cost-effectiveness ratios, and were presented both from a healthcare- and a societal perspective. NOK 500 000 per quality adjusted life-years gained was used as threshold for defining cost-effective interventions.\ud
\ud
Results\ud
\ud
Incremental cost-effectiveness ratios from a healthcare perspective:\ud
\ud
Rotarix®: NOK 687 500 per quality adjusted life-year gained \ud
Rotateq®: NOK 762 000 per quality adjusted life-year gained \ud
\ud
Incremental cost-effectiveness ratios from a societal perspective:\ud
\ud
Rotarix®: NOK 27 500 per quality adjusted life-year gained\ud
Rotateq®: NOK 104 000 per quality adjusted life-year gained\ud
\ud
Conclusions\ud
With NOK 500 000 per quality adjusted life-years gained as threshold for cost-effectiveness, it is unlikely that vaccination against rotavirus will be a cost-effective intervention when viewed from a healthcare perspective. However, adopting a societal perspective, which also included indirect costs related to production losses from parent’s sick absence, the conclusion was changed to vaccination being considered a cost-effective intervention