Helsebibliotekets Research Archive
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Patient satisfaction questionnaires for primary care out-of-hours services: a systematic review.
No full textBACKGROUND: Patient satisfaction questionnaires are increasingly used for assessing quality of care. AIM: To review the evidence for the reliability and validity of patient satisfaction questionnaires for out-of-hours care. DESIGN: Systematic review. SETTING: Primary care out-of-hours services. METHOD: Searches of CINAHL, EMBASE, MEDLINE((R)) and PsycINFO using terms relevant to the measurement of patient satisfaction and out-of-hours services. Abstracts were reviewed and information relating to questionnaire content, data quality, reliability, and validity were extracted from articles by two independent researchers. RESULTS: Four questionnaires were found, two from the UK - the Patient Satisfaction with Out-of-Hours Care (PSOC) and Short Questionnaire for Out-of-Hours Care (SQOC) - and two from the Netherlands - the van Uden and Moll van Charante questionnaires. Questionnaire content was based on literature reviews and expert opinion; the PSOC and Moll van Charante questionnaires were also developed following interviews or focus groups with patients. Cronbach's alpha values were below 0.7 for some scales within the PSOC and van Uden questionnaires. Test-retest reliability was reported for the PSOC and Moll van Charante questionnaires. Tests of validity were few and did not give explicit consideration to the size of expected associations. CONCLUSION: Potential users wishing to assess patient satisfaction should carefully consider the content of the questionnaires and its relevance to the application and patient group. The four questionnaires have limitations relating to their development and evaluation. The PSOC and van Uden questionnaires have low levels of reliability for some scales, which should be used with caution in future surveys
Vurdering av data rapportert til Norsk pasientregister for utvikling av volumindikatorer
No full textNasjonalt kunnskapssenter for helsetjenesten har fått i oppdrag av Sosial – og helsedi-rektoratet å vurdere om Norsk pasientregisters database over sykehusinnleggelser kan brukes til å utvikle indikatorer for volum av aktivitetsnivå i spesialisthelsetjenesten in-nen somatikk. Norsk pasientregister (NPR), Sosial- og helsedirektoratet, er en nasjonal serviceinstitusjon for data- og statistikktjenester fra spesialisthelsetjenesten i Norge.\ud
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Arbeidet er utført ved å analysere en datafil over alle sykehusinnleggelser i 2006. Fremgangsmåten har vært å se på databasens struktur og tilgjengelig informasjon gjennom å definere temaer som man mener kan være aktuelle som grunnlag for utvikling av volumindikatorer. Det gis noen eksempler på disse.\ud
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Konklusjon\ud
• NPR er primært laget for å gi foretakene refusjon etter DRG-basert stykkprisfinansie-ring. Dette reflekteres i dataene.\ud
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• Data fra NPR kan brukes til å utvikle indikatorer på volum i utførte prosedyrer innen kirurgi og medisin, men dataenes beskaffenhet begrenser valg av mulige volumindikatorer.\ud
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• Dataenes beskaffenhet er usikre. Utvikling av volumindikatorer kan gjøres etter at databasen er vurdert med hensyn på gyldighet og pålitelighet.\ud
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• Det er usikkert hvor komplett datasettet er. Vi antar at totale innleggelser er i orden, men er usikre på om informasjon om diagnoser og prosedyrer er komplett og at det føres likt i alle institusjoner. Prosedyrer som det ikke gis økonomisk uttelling for, blir ulikt rapportert.\ud
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• Slik databasen er nå, kan det gis resultater for antall innleggelser per sykehus som enhet. Resultater per avdeling krevernoe omkoding.\ud
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• Utvikling av volumindikatorer bør gjøres i samarbeid med spesialister som er involvert i aktuell behandling, for å sikre relevans i valg av indikatorer og riktig operasjonalisering av volumindikatorer fra databasen.\ud
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• Personidentifiserbart register vil bedre kunne følge pasienter over tid, og gjøre det lettere å lage behandlingsforløp.\ud
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• Geografiske og demografiske data er nyttige for å lage volumindikatorer.\ud
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• For å gjøre arbeidet rutinemessig, må databasen kvalitetssikres for:\ud
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- Kompletthet i databasen ved at diagnose- og prosedyrespesifikk\ud
informasjon er korrekt utfylt. \ud
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- Lik koding og lik bruk av kodeverket
CMV quantitative PCR in the diagnosis of CMV disease in patients with HIV-infection - a retrospective autopsy based study.
No full textBACKGROUND: Patients with advanced HIV infection at the time of diagnosis and patients not responding to antiretroviral therapy are at risk of cytomegalovirus (CMV) disease. Earlier studies of patients with HIV infection have demonstrated that the diagnosis is often first made post-mortem. In recent years new molecular biological tests have become available for diagnosis of CMV disease. Although clinical evaluation of tests for diagnosis of CMV disease in HIV-infected individuals is suboptimal without autopsy, no results from such studies have been published. The aim of this study was to explore the diagnostic utility of CMV quantitative polymerase chain reaction (PCR) in plasma from HIV and CMV seropositive patients who died during the period 1991-2002 and in whom autopsy was performed. METHODS: Autopsy was performed in all cases, as part of routine evaluation of HIV-infected cases followed at Ullevaal University Hospital. Of 125 patients included, 53 had CMV disease, 37 of whom were first diagnosed at autopsy. CMV disease was diagnosed either by ophthalmoscopic findings typical of CMV retinitis, biopsy or autopsy. One or two plasma samples taken prior to the first diagnosis of CMV disease (alive or at autopsy) or death without CMV disease were analysed by CMV quantitative PCR. Sensitivity, specificity, positive and negative predictive values were calculated for different CMV viral load cut-offs and according to detection of viraemia in one versus two samples. RESULTS: Twenty-seven of 53 patients with CMV disease (51%) and 10 of 72 patients without CMV disease (14%) had detectable viraemia in at least one sample. Sensitivity and negative predictive value (NPV) of the test, maximised with a cut-off at the test's limit of detection of CMV viraemia (400 copies/mL), were 47% and 70%, respectively. With cut-off at 10 000 copies/mL, specificity and positive predictive value (PPV) were 100%. With a requirement for CMV viraemia in two samples, specificity and PPV were 100% in patients with CMV viraemia above the limit of detection. CONCLUSION: Our results indicate that quantitative CMV PCR is best used to rule in, rather than to rule out CMV disease in HIV-infected individuals at high risk
Use of evidence in WHO recommendations.
No full textBACKGROUND: WHO regulations, dating back to 1951, emphasise the role of expert opinion in the development of recommendations. However, the organisation's guidelines, approved in 2003, emphasise the use of systematic reviews for evidence of effects, processes that allow for the explicit incorporation of other types of information (including values), and evidence-informed dissemination and implementation strategies. We examined the use of evidence, particularly evidence of effects, in recommendations developed by WHO departments. METHODS: We interviewed department directors (or their delegates) at WHO headquarters in Geneva, Switzerland, and reviewed a sample of the recommendation-containing reports that were discussed in the interviews (as well as related background documentation). Two individuals independently analysed the interviews and reviewed key features of the reports and background documentation. FINDINGS: Systematic reviews and concise summaries of findings are rarely used for developing recommendations. Instead, processes usually rely heavily on experts in a particular specialty, rather than representatives of those who will have to live with the recommendations or on experts in particular methodological areas. INTERPRETATION: Progress in the development, adaptation, dissemination, and implementation of recommendations for member states will need leadership, the resources necessary for WHO to undertake these processes in a transparent and defensible way, and close attention to the current and emerging research literature related to these processes
Five-factor model personality traits in opioid dependence.
No full textBACKGROUND: Personality traits may form a part of the aetiology of opioid dependence. For instance, opioid dependence may result from self-medication in emotionally unstable individuals, or from experimenting with drugs in sensation seekers. The five factor model (FFM) has obtained a central position in contemporary personality trait theory. The five factors are: Neuroticism, Extraversion, Openness to Experience, Agreeableness and Conscientiousness. Few studies have examined whether there is a distinct personality pattern associated with opioid dependence. METHODS: We compared FFM personality traits in 65 opioid dependent persons (mean age 27 years, 34% females) in outpatient counselling after a minimum of 5 weeks in buprenorphine replacement therapy, with those in a non-clinical, age- and sex-matched sample selected from a national database. Personality traits were assessed by a Norwegian version of the Revised NEO Personality Inventory (NEO PI-R), a 240-item self-report questionnaire. Cohen's d effect sizes were calculated for the differences in personality trait scores. RESULTS: The opioid-dependent sample scored higher on Neuroticism, lower on Extraversion and lower on Conscientiousness (d = -1.7, 1.2 and 1.7, respectively) than the controls. Effects sizes were small for the difference between the groups in Openness to experience scores and Agreeableness scores. CONCLUSION: We found differences of medium and large effect sizes between the opioid dependent group and the matched comparison group, suggesting that the personality traits of people with opioid dependence are in fact different from those of non-clinical peers
Differentiating malingering from genuine cognitive dysfunction using the Trail Making Test-ratio and Stroop Interference scores.
No full textPatterns of test performance that are inconsistent with knowledge of brain dysfunction can potentially differentiate between malingering and true impairment among litigants with low scores on neuropsychological tests. In this study possible malingerers (n = 41), impaired (30) or cognitively normal (17) litigants were compared on the Trail Making Test B:A ratio score and Stroop Interference. The majority of possible malingerers had a low TMT-ratio (<2.5) and an inverted Stroop effect, whereas the majority of impaired subjects had a high TMT-ratio and specific Stroop interference. Sensitivity to malingering was 61 and 68 percent, and specificity was 57 and 59 percent. This is too low for valid classification of individuals. However, the combination of both measures increases predictability. The clinician is advised to look for other evidence of malingering in cases of simultaneous low TMT-ratio and inverted Stroop. Patients with high TMT-ratio and Stroop interference, should be thoroughly examined for indications of brain disease
Cross-national reliability of clinician-rated outcome measures in child and adolescent mental health services.
No full textClinician-rated measures are in extensive use as routine outcome measures in child and adolescent mental health services. We investigated cross-national differences and inter-rater reliability of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), the Children's Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD). Thirty clinicians from 5 nations independently rated 20 written vignettes. The national groups afterwards established national consensus ratings. There were no cross-national differences in independent scores, but there were differences in national consensus scores, which were also more severe than independent scores. The ICC for the HoNOSCA total score was 0.84, for the CGAS 0.61 and for the GAPD 0.54. These measures may usefully contribute to cross-national comparison studies
Measuring radon levels at high exposures with alpha-track detectors. Calibration and analysis
No full textDenne rapporten presenterer TADTAC-metoden for analyse av overeksponert sporfi lm. TADTAC\ud
er en metode for å beregne radonkonsentrasjonen på grunnlag av det totale arealet av spor på en\ud
sporfi lm, og ikke antall individuelle spor som er vanlig ved standardmetoden. Metoden er utviklet\ud
av Gammadata Mätteknik AB og er implementert hos Statens strålevern. Sporfi lm benyttet for\ud
testing og kalibrering av metoden ble eksponert ved Physikalisch-Technische Bundesanstalt\ud
(PTB) i Tyskland.This report presents the TADTAC method - a track area dependent total area counting method,\ud
for measuring radon levels at high exposures with alpha-track detectors. Normally radon levels\ud
are measured by counting individual tracks. The TADTAC method is developed by Gammadata\ud
Mätteknik AB and implemented at The Norwegian Radiation Protection Authority. Alpha-track\ud
detectors used for testing and calibrating the method where exposed at Physikalisch-Technische\ud
Bundesanstalt (PTB) in Germany