Helsebibliotekets Research Archive
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DPS: landsdekkende tjenester, men varierende kvalitet. Oppsummering av første halvdel av landsomfattende tilsyn 2008-09 med spesialisthelsetjenester ved distriktspsykiatriske sentre
No full textNORSK SAMMENDRAG: I 2008 ble det gjennomført tilsyn i 28 av landets 75 distriktspsykiatriske sentre (DPS). Tilsynet er toårig og fortsetter ut 2009. Tilsynet undersøker DPS-ets helsetjenester til pasienter med alvorlige psykiske lidelser og utføres av regionale tilsynslag supplert med psykologspesialist og psykiater som eksterne fagrevisorer. Denne ”midtveis”-rapporten handler om funn som gjelder DPS-enes vurdering og prioritering av henviste pasienter og sikring av forsvarlig utredning og behandling/oppfølging. I rapporten som kommer i 2010 blir også temaene brukermedvirkning, samhandling, tilgjengelighet og forebygging/bruk av tvang omtalt.\ud
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Tilsynet har vist at i over halvparten av DPS-ene var håndteringen av henvisninger ikke alltid i overensstemmelse med lovkravene. Det kan derved bli tilfeldig og uforutsigbart hvorvidt henviste pasienter med alvorlige psykiske lidelser prioriteres. Om lag halvparten av DPS-ene sikret ikke forsvarlig utredning og behandling av pasientene. For eksempel manglet prosedyrer og/eller en omforent praksis for hvordan disse prosessene skal foregå, hva de skal inneholde og hvordan de skal dokumenteres. Flere DPS sørget ikke systematisk for at det diagnostiske og behandlingsmessige arbeidet ble kvalitetssikret av spesialist (psykologspesialist/psykiater). \ud
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Etter Statens helsetilsyns vurdering har det første årets tilsyn vist at det i mange DPS foreligger viktige svakheter når det gjelder tjenestene som tilbys pasienter med alvorlige psykiske lidelser. Kritiske trinn mangler styring og oppfølging fra ledelsens side for å sikre forsvarlig utredning og behandling. Mange DPS synes å mangle en velfungerende internkontroll, som skal redusere risikoen for svikt og sikre at virksomhetens oppgaver løses i henhold til kravene i helselovgivningen.SUMMARY IN ENGLISH: In 2008, supervision of 28 of the 75 district psychiatric centres (DPS) in the country was carried out. Supervision will continue over two years until 2009. We investigated health services provided by the DPSs to patients with serious mental disorders. Supervision was carried out by regional supervision teams, augmented with specialist psychologists and psychiatrists as professional auditors. This “half-way” report presents results about the DPSs’ assessment and prioritization of referred patients and about whether they ensure that patients are adequately examined, treated and followed up. The report that will be published in 2010 will deal with client participation, cooperation, availability and prevention/use of coercion and restraint.\ud
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Supervision has shown that in over half of the DPSs, the way in which referrals were dealt with was not always in accordance with legislative requirement. This can mean that prioritization of referred patients with serious psychiatric disorders can be unpredictable and left to chance. About half of the DPSs did not ensure that patients were adequately assessed and treated. For example, they lacked procedures and/or standard practice for how these procedures should be carried out, what they should involve, and how they should be documented. Several DPSs did not systematically ensure that diagnosis and treatment were quality controlled by specialists (psychologists and psychiatrists). \ud
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According to the assessment of the Norwegian Board of Health Supervision, the first year with supervision has shown that in many DPSs there are serious deficiencies in the services that are offered to patients with serious mental disorders. Critical phases lack management and follow-up from leadership to ensure that patients are adequately assessed and treated. In many DPSs there was no well-functioning internal control system, to reduce the risk of deficiencies, and to ensure that services are provided in accordance with legislative requirements
User requirements for a practice-integrated nurse-administered online communication service for cancer patients.
No full textThis paper describes the use of participatory design methods in the development of a nurse-administered online patient-provider communication (OPPC) service that is designed to be integrated into routine clinical practice. The OPPC service let patients stay connected with expert nurses and other health care providers to ask questions and receive advice from home. Through focus groups, workshops, heuristic evaluations and usability testing, we identified patients' and clinicians' (nurses' and physicians') user requirements, factors important for successful adoption, implementation and maintenance of the OPPC service, and usability. This paper shares important insights from these participatory design processes that may be helpful for other researchers who wish to implement clinical applications into routine practice
Health effects of different amines and possible degradation products relevant for CO2 capture
No full textMycophenolate pharmacokinetics and pharmacodynamics in belatacept treated renal allograft recipients - a pilot study.
No full textBACKGROUND: Mycophenolic acid (MPA) is widely used as part of immunosuppressive regimens following allograft transplantation. The large pharmacokinetic (PK) and pharmacodynamic (PD) variability and narrow therapeutic range of MPA provide a potential for therapeutic drug monitoring. The objective of this pilot study was to investigate the MPA PK and PD relation in combination with belatacept (2nd generation CTLA4-Ig) or cyclosporine (CsA). METHODS: Seven renal allograft recipients were randomized to either belatacept (n = 4) or cyclosporine (n = 3) based immunosuppression. Samples for MPA PK and PD evaluations were collected predose and at 1, 2 and 13 weeks posttransplant. Plasma concentrations of MPA were determined by HPLC-UV. Activity of inosine monophosphate dehydrogenase (IMPDH) and the expressions of two IMPDH isoforms were measured in CD4+ cells by HPLC-UV and real-time reverse-transcription PCR, respectively. Subsets of T cells were characterized by flow cytometry. RESULTS: The MPA exposure tended to be higher among belatacept patients than in CsA patients at week 1 (P = 0.057). Further, MPA concentrations (AUC0-9 h and C0) increased with time in both groups and were higher at week 13 than at week 2 (P = 0.031, n = 6). In contrast to the postdose reductions of IMPDH activity observed early posttransplant, IMPDH activity within both treatment groups was elevated throughout the dosing interval at week 13. Transient postdose increments were also observed for IMPDH1 expression, starting at week 1. Higher MPA exposure was associated with larger elevations of IMPDH1 (r = 0.81, P = 0.023, n = 7 for MPA and IMPDH1 AUC0-9 h at week 1). The maximum IMPDH1 expression was 52 (13-177)% higher at week 13 compared to week 1 (P = 0.031, n = 6). One patient showed lower MPA exposure with time and did neither display elevations of IMPDH activity nor IMPDH1 expression. No difference was observed in T cell subsets between treatment groups. CONCLUSION: The significant influence of MPA on IMPDH1 expression, possibly mediated through reduced guanine nucleotide levels, could explain the elevations of IMPDH activity within dosing intervals at week 13. The present regulation of IMPDH in CD4+ cells should be considered when interpreting measurements of IMPDH inhibition
Emotion regulation in patients with rheumatic diseases: validity and responsiveness of the Emotional Approach Coping Scale (EAC).
No full textBACKGROUND: Chronic rheumatic diseases are painful conditions which are not entirely controllable and can place high emotional demands on individuals. Increasing evidence has shown that emotion regulation in terms of actively processing and expressing disease-related emotions are likely to promote positive adjustment in patients with chronic diseases. The Emotional Approach Coping Scale (EAC) measures active attempts to acknowledge, understand, and express emotions. Although tested in other clinical samples, the EAC has not been validated for patients with rheumatic diseases. This study evaluated the data quality, internal consistency reliability, validity and responsiveness of the Norwegian version of the EAC for this group of patients. METHODS: 220 patients with different rheumatic diseases were included in a cross-sectional study in which data quality and internal consistency were assessed. Construct validity was assessed through comparisons with the Brief Approach/Avoidance Coping Questionnaire (BACQ) and the General Health Questionnaire (GHQ-20). Responsiveness was tested in a longitudinal pretest-posttest study of two different coping interventions, the Vitality Training Program (VTP) and a Self-Management Program (SMP). RESULTS: The EAC had low levels of missing data. Results from principal component analysis supported two subscales, Emotional Expression and Emotional Processing, which had high Cronbach's alphas of 0.90 and 0.92, respectively. The EAC had correlations with approach-oriented items in the BACQ in the range 0.17-0.50. The EAC Expression scale had a significant negative correlation with the GHQ-20 of -0.13. As hypothesized, participation in the VTP significantly improved EAC scores, indicating responsiveness to change. CONCLUSION: The EAC is an acceptable and valid instrument for measuring emotional processing and expression in patients with rheumatic diseases. The EAC scales were responsive to change in an intervention designed to promote emotion regulation. The instrument has not yet been tested for test-retest reliability, which is recommended in future studies
Norwegian physicians' knowledge of and opinions about evidence-based medicine: cross-sectional study.
No full textTo answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources?Cross sectional survey in 2006.Norway.966 doctors who responded to a questionnaire (70% response rate).In total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM.The results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library
SUPPORT Tools for evidence-informed health Policymaking (STP) 7: Finding systematic reviews
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. Systematic reviews are increasingly seen as a key source of information in policymaking, particularly in terms of assisting with descriptions of the impacts of options. Relative to single studies they offer a number of advantages related to understanding impacts and are also seen as a key source of information for clarifying problems and providing complementary perspectives on options. Systematic reviews can be undertaken to place problems in comparative perspective and to describe the likely harms of an option. They also assist with understanding the meanings that individuals or groups attach to a problem, how and why options work, and stakeholder views and experiences related to particular options. A number of constraints have hindered the wider use of systematic reviews in policymaking. These include a lack of awareness of their value and a mismatch between the terms employed by policymakers, when attempting to retrieve systematic reviews, and the terms used by the original authors of those reviews. Mismatches between the types of information that policymakers are seeking, and the way in which authors fail to highlight (or make obvious) such information within systematic reviews have also proved problematic. In this article, we suggest three questions that can be used to guide those searching for systematic reviews, particularly reviews about the impacts of options being considered. These are: 1. Is a systematic review really what is needed? 2. What databases and search strategies can be used to find relevant systematic reviews? 3. What alternatives are available when no relevant review can be found
Pasienters erfaringer med rehabiliteringsinstitusjoner. Resultater fra en pilotundersøkelse
No full textKunnskapssenteret gjennomførte høsten 2008 en spørreundersøkelse blant pasienter som hadde hatt et opphold ved én av åtte private rehabiliteringsinstitusjoner i Norge. Undersøkelsen var en pilotundersøkelse og inngikk i utviklingen av et spørreskjema og et innsamlingsopplegg for å måle brukeres erfaringer med slike institusjoner. Det er første gangen dette gjøres i Norge med henblikk på alle typer rehabiliteringsinstitusjoner og pasientgrupper.\ud
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I dette notatet presenterer vi resultatene fra pilotundersøkelsen.\ud
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Resultatene er delt inn i ulike temaer:\ud
1. Generell tilfredshet\ud
2. Ankomst\ud
3. Om behandlerne\ud
4. Organisering av hverdagen\ud
5. Omgivelser og miljø\ud
6. Tiden etterpå\ud
7. Opplevd endring i helsetilstand\ud
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Generelt ga pasientene positive vurderinger av institusjonene. 26 av spørsmålene oppnår en gjennomsnittsskåre høyere enn 4 på en skala fra 1 til 5 der 5 er best. Aller best skåre (4,8) får spørsmålet om pasienten mener at hun er feilbehandlet. Her svarte i alt 96 prosent at de ikke i det hele tatt, eller i liten grad hadde opplevd dette.\ud
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Kun to spørsmål oppnår en gjennomsnittsskåre under 3. Begge disse spørsmålene relaterer seg til tiden etter oppholdet; om institusjonen samarbeider med lokalt hjelpeapparat (2,7), og om pasienten har fått tilstrekkelig oppfølging av lokalt tjenestetilbud (2,6). På begge disse spørsmålene svarer 45 prosent ”ikke i det hele tatt” eller ”i liten grad”. En dårlig skåre på disse spørsmålene kan imidlertid kun i noen grad tillegges institusjonene. Vi opplever dem likevel som viktige fordi overgangen mellom ulike tjenestenivåer kan være avgjørende for pasientforløpet.\ud
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Spørreskjemaet inneholdt to sett spørsmål som skulle måle endringer i helsetilstand og funksjonsnivå på ulike livsområder. Det ene settet besto av sju spørsmål og bygger på SF-8, som er et mye brukt instrument for måling av livskvalitet. Det andre settet besto av 15 spørsmål som bygger på Internasjonal klassifikasjon av funksjon, funksjonshemming og helse (ICF). Mange pasienter rapporterte om liten eller ingen endring, hvis spørsmålet i det hele tatt var aktuelt. For dem som rapporterte endringer var det i hovedsak endring til det bedre. Fordi det var mange som svarte at disse spørsmålene ikke var aktuelle eller at tilstanden var omtrent som før, har vi valgt ikke å rapportere svarene på disse spørsmålene.\ud
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Det er store ulikheter i pasientsammensetningen ved de ulike institusjonene.\ud
Eventuelle forskjeller i pasientenes vurderinger av institusjonen kan derfor skyldes egenskaper ved pasientene, og tallene i dette notatet er lite egnet til å sammenligne en institusjon med en annen