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Pasientvolum og behandlingskvalitet ved operasjoner for kreft i lever
No full textNORSK: Kunnskapssenteret fikk i april 2008 forespørsel fra Helse Sør-Øst RHF om å foreta en vurdering av litteraturen om sammenheng mellom pasientvolum og behand-lingskvalitet ved operasjoner for kreft i lever. \ud
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Vi har tatt utgangspunkt i rapporten om pasientvolum og behandlingskvalitet fra 2001 fra det tidligere Senter for medisinsk metodevurdering (SMM), og oppdatert med nyere litteratur publisert frem til august 2008. Vi har inkludert ti studier som analyserte sammenhengen mellom pasientvolum og kvalitet ved operasjoner for kreft i lever, åtte av disse er nye i forhold til rapporten fra 2001.\ud
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Resultatene viser:\ud
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Bedre overlevelse og lavere prosedyrerelatert dødelighet for pasienter behand-let i sykehus med høye volum. \ud
Definisjonen av lave og høye volum varierer. I noen studier er terskelen 10–12, mens andre har 25–30.\ud
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De fleste arbeidene har analysert behandling gitt på 1990-tallet. Studiene er fra USA og har til dels overlappende datagrunnlag. Dersom mortalitet i forbindelse med operasjonen trekkes fra langtidsoverlevelse, synes ikke effekten av volum å være like avgjørende.\ud
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To studier har analysert mortalitet for pasienter med primær leverkreft behandlet i høyvolumsykehus. Mortaliteten for denne sykdommen er spesielt høy i forbindelse med kirurgi. Her er det veldig stor forskjell på høy- og lavvolumsykehus, og ingen studier har sett på langtidsresultater. Vi fant ingen studier om betydningen av volum ved behandling av kolangiokarsinomer, en prosedyre som også er forbundet med høy mortalitet.\ud
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Det forventes en økning i leverkirurgi ved kreft, som særlig knytter seg til at behandling og forbehandling med cellegift er i forandring, noe som gjør det mulig å operere pasienter som tidligere var inoperable. Antall operasjoner synes å ha økt både for behandling av primær leverkreft og lever-metastaser. Data fra Norsk pasientregister viste at 9 sykehus i landet var registrert med operasjoner for kreft i lever. Median volum i 2007 ved norske sykehus var 6 prosedyrer for primærleverkreft og 8 for levermetastaser
Brukererfaringer med poliklinikker for voksne i psykisk helsevern. Nasjonale resultater i 2007 og utvikling fra 2004
No full text1-Page KEY MESSAGES\ud
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The Norwegian Knowledge Centre for the Health Services conducted the second national survey on patient experiences with adult mental health outpatient clinics during the autumn of 2007. The previous survey was conducted in 2004. In 2007, 100 outpatient clinics participated, and a total of 11 085 patients answered the questionnaire.\ud
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Patients reported positive experiences with the outpatient clinics on several areas. One example is perceived outcome from individual therapy: 60 % of the patients reported a large or very large benefit from individual therapy. Patients were particularly satisfied with their clinicians. For instance, more than 70 % reported that they had the opportunity to tell the clinician everything of importance about their condition, and that the clinician understood their situation.\ud
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Our study also identified several areas of improvement at the clinics, especially related to co-determination, information, and cooperation with other public services. For instance, 23 % of the patients reported that they had little or no influence on decisions related to their medication, while 25 % reported that the information about treatment options was very poor or rather poor. In addition, 30 % of the responders to a question about how their clinic cooperated with other public institutions, perceived the cooperation as very poor or rather poor.\ud
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The outpatient clinics and the health enterprises they belong to were compared on three indicators concerning patient experiences at the clinic, perceived waiting time, and external cooperation. There were considerable variations in the results between clinics and between health enterprises, especially related to the indicator perceived waiting time.\ud
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At the national level, scores for patient perceived quality were significantly lower in 2007 than in 2004 for the three indicators. The same pattern was found for all regional health enterprises and most of the health enterprises, but several outpatient clinics had a higher score in 2007 than in 2004 for one or more indicators
Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study.
No full textOBJECTIVE: To examine the use of qualitative approaches alongside randomised trials of complex healthcare interventions. DESIGN: Review of randomised controlled trials of interventions to change professional practice or the organisation of care. DATA SOURCES: Systematic sample of 100 trials published in English from the register of the Cochrane Effective Practice and Organisation of Care Review Group. METHODS: Published and unpublished qualitative studies linked to the randomised controlled trials were identified through database searches and contact with authors. Data were extracted from each study by two reviewers using a standard form. We extracted data describing the randomised controlled trials and qualitative studies, the quality of these studies, and how, if at all, the qualitative and quantitative findings were combined. A narrative synthesis of the findings was done. RESULTS: 30 of the 100 trials had associated qualitative work and 19 of these were published studies. 14 qualitative studies were done before the trial, nine during the trial, and four after the trial. 13 studies reported an explicit theoretical basis and 11 specified their methodological approach. Approaches to sampling and data analysis were poorly described. For most cases (n=20) we found no indication of integration of qualitative and quantitative findings at the level of either analysis or interpretation. The quality of the qualitative studies was highly variable. CONCLUSIONS: Qualitative studies alongside randomised controlled trials remain uncommon, even where relatively complex interventions are being evaluated. Most of the qualitative studies were carried out before or during the trials with few studies used to explain trial results. The findings of the qualitative studies seemed to be poorly integrated with those of the trials and often had major methodological shortcomings
BayesPI - a new model to study protein-DNA interactions: a case study of condition-specific protein binding parameters for Yeast transcription factors.
No full textBACKGROUND: We have incorporated Bayesian model regularization with biophysical modeling of protein-DNA interactions, and of genome-wide nucleosome positioning to study protein-DNA interactions, using a high-throughput dataset. The newly developed method (BayesPI) includes the estimation of a transcription factor (TF) binding energy matrices, the computation of binding affinity of a TF target site and the corresponding chemical potential. RESULTS: The method was successfully tested on synthetic ChIP-chip datasets, real yeast ChIP-chip experiments. Subsequently, it was used to estimate condition-specific and species-specific protein-DNA interaction for several yeast TFs. CONCLUSION: The results revealed that the modification of the protein binding parameters and the variation of the individual nucleotide affinity in either recognition or flanking sequences occurred under different stresses and in different species. The findings suggest that such modifications may be adaptive and play roles in the formation of the environment-specific binding patterns of yeast TFs and in the divergence of TF binding sites across the related yeast species
Filling knowledge gaps in radiation protection methodologies for non-human biota: Final summary report: GAPRAD
No full textRapport fra Nordisk kjernesikkerhetsforskning, NKS, RoskildeThe activities of the GAPRAD project are summarised in this report. The background and rationale to GAPRAD are presented and explained. Most notably this relates to a lack of information on naturally occuring radionuclides in terrestrial and aquatic systems that have direct applicability for use in envrionmental impact assessments. Results from field activities are presented from the Dovrefjell area in Norway (terrestrial study) and selected lake and brackish water systems in Finland. The data mainly concern activity concterations of Po-210 in environmental media and selected biota allowing concentration ratios to be derived where appropriate. Furthermore, details in relation to Po-210 uptake and biokinetics in humans based on experimental work conducted within the project are presente
Knowledge gaps in relation to radionuclide levels and transfer to wild plants and animals, in the context of environmental impact assessements, and a strategy to fill them
No full textInternational activities with regards the development of methods for assessing impacts on the environment from ionising radiation have been substantial in recent years. In developing these methods, there are requirements (i) to determine the transfer of radionuclides within ecosystems and (ii) to determine background dose-rates arising from the presence of naturally occurring radionuclides, in a satisfactory manner. It has quickly become evident that fulfilling these 2 requirements is not entirely straightforward reflecting a lack of data in many cases. This report specifies exactly where these data-gaps lie through analyses of data generated from the most recent studies conducted internationally on this topic. It is evident that information is limited for numerous radionuclides from U-238 and Th-232 decay series and notably, in view of its importance as a contributor to dose-rates in plants and animals, Po-210. The simple way to rectify these data deficiencies is to organise target field campaigns focusing on particular species and radionuclides where information is lacking. To this end, field sampling has been conducted in a semi-natural mountain ecosystem in Norway and freshwater aquatic systems in Finland. It is envisaged that the data derived from the studies briefly described in this report will provide fundamental information for our understanding of the behaviour and fate of natural decay series radionuclides in terrestrial and aquatic systems and provide the basis for more robust wa
Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries.
No full textBACKGROUND: Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO(4)) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case). METHODS: We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. FINDINGS: Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO(4 )and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO(4 )than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO(4), and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries. CONCLUSION: Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups
Pasientvolum og kvalitet ved behandling av kreft i magesekken
No full textNORSK: Kunnskapssenteret fikk i april 2008 forespørsel fra Helse Sør-Øst RHF om å gjennomgå kunnskapsgrunnlaget for sammenheng mellom pasientvolum og behandlingskvalitet. \ud
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Vi har tatt utgangspunkt i SMM-rapport 2/2001 om pasientvolum og behandlingskvalitet og oppdatert med nyere litteratur publisert frem til august 2008. Samlet sett inkluderte vi 13 studier, ingen av disse var fra den tidligere SMM-rapporten.\ud
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De 13 studiene er i all hovedsak studier basert på administrative registerdata som har analysert pasienter behandlet før 2000. Fem av studiene var enten basert på klinisk materiale eller fra gode registre, tre studier var fra Europa, én fra USA og én fra Taiwan.\ud
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Det er ikke entydige resultater om betydningen av sykehusvolum for prosedyrerelatert dødelighet i de 11 studiene som har analysert dette. \ud
Fire av fem studier rapporterte bedre overlevelse for pasienter behandlet i sykehus med høyt volum. Det synes å være en terskel for sykehusvolum et sted mellom 13 og 35 operasjoner per år. Kun én studie har analysert betydningen av kirurgens volum for overlevelse. \ud
Det er et problem med skjevt utvalg av pasienter i mange av disse studiene, og da særlig høy andel øyeblikkelig hjelp i sykehus med lave volum.\ud
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Antall tilfeller av kreft i magesekken har vært synkende, også i Norge. Årlig registrerte operasjoner ved norske sykehus var 246 i 2003 og 187 i 2007. Operasjonene ble utført ved 36 sykehus i 2003 og 26 sykehus i 2007. Median pasientvolum var fem pasienter per sykehus for alle årene (2003–2007)
