Helsebibliotekets Research Archive
Not a member yet
1049 research outputs found
Sort by
Rational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs.
No full textBACKGROUND: A randomised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides, but detected no impact on the use of cardiovascular risk assessment tools or achievement of treatment targets. We carried out a predominantly quantitative process evaluation to help explain and interpret the trial-findings. METHODS: Several data-sources were used including: questionnaires completed by pharmacists immediately after educational outreach visits, semi-structured interviews with physicians subjected to the intervention, and data extracted from their electronic medical records. Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practices for the three main outcomes. RESULTS: The attendance rate during the educational sessions in each practice was high; few problems were reported, and the physicians were perceived as being largely supportive of the recommendations we promoted, except for some scepticism regarding the use of thiazides as first-line antihypertensive medication. Multivariate regression models could explain only a small part of the observed variation across practices and across trial-outcomes, and key factors that might explain the observed variation in adherence to the recommendations across practices were not identified. CONCLUSION: This study did not provide compelling explanations for the trial results. Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses, particularly organisational factors. More use of qualitative research methods in the course of the trial could have improved our understanding
Dokumentasjon og teieplikt i gastrokirurgien.” Oppsummering av landsomfattande tilsyn med kommunikasjonen mellom helsepersonell og mellom helsepersonell og pasientar i helseføretak som gir kirurgisk behandling til pasientar med akutte sjukdommar og kreftsjukdommar i mage-tarmkanalen i 2005
No full textNORSK SAMMENDRAG: Helsetilsynet i fylka gjennomførte i 2005 tilsyn med kommunikasjonen mellom helsepersonell og mellom helsepersonell og pasientar i 23 helseføretak som gir kirurgisk behandling til pasientar med akutte sjukdommar og kreftsjukdommar i mage- og tarmkanalen. \ud
\ud
Ved nesten to av tre tilsyn vart det funne vesentlege manglar ved kirurgane si journalføring. Manglande kjennskap til teieplikta gjorde styringa av tilgjenge til pasientjournalane nokså tilfeldig mange stader. Ved dei fleste tilsyna vart det funne at ordninga med pasientansvarleg lege ikkje fungerte etter intensjonane. Ved meir enn ein tredel av tilsyna vart det funne at pasientsamtalar på grunn av bygningsmessige tilhøve og høgt arbeidspress vart gjennomførde med uvedkommande til stades. Avvika som er funne ved tilsyna vert følgde opp gjennom ulike lokale og sentrale tiltak.\ud
\ud
Tilsynet gir haldepunkt for at helsetenesta driv med for høgt risikonivå. Den tryggleikstenkinga som har fått fotfeste i andre sektorar, har ikkje slått gjennom i helsetenesta i tilstrekkeleg grad. Sjølv om det er ein viss variasjon mellom helseføretaka, er det for ofte slik at verksemdene baserar seg på at menneska i systemet ikkje skal gjere feil. Slike system er i sin natur svært utrygge og sikringstiltak må setjast inn.SUMMARY IN ENGLISH: Summary of countrywide supervision in 2005 of communication between health care personnel and between health care personnel and patients in health trusts that provide surgical treatment for patients with acute diseases and cancer in the gastrointestinal tract \ud
\ud
In 2005 the Norwegian Board of Health in the counties carried out supervision in 23 health trusts that provide surgical treatment for patients with acute diseases and cancer in the gastrointestinal tract. The theme for supervision was communication between different health care personnel, and between health care personnel and patients. \ud
\ud
In nearly two out of three of the departments of gastrointestinal surgery, serious deficiencies were found in recording of patient records by the surgeons. Because of lack of knowledge about confidentiality, organization of the availability of patient records was not properly controlled in many places. In most of the departments of gastrointestinal surgery, the system of allocating patients a doctor with special responsibility for them did not function as intended. In more than one third of the departments of gastrointestinal surgery, patient consultations took place with uninvolved people present, because of limitations in the physical surroundings and because of high pressure of work. The departures from the regulations that were detected were followed up with various local and central measures.\ud
\ud
The results of supervision indicate that health services are run with a level of risk that is too high. The awareness of safety that has gained a foothold in other sectors, has not gained sufficient foothold in health services. Even though there is a degree of variation between the health trusts, very often, the services are organized based on the assumption that people working in the system do not make mistakes. Such systems are inherently very unsafe, and safety measures must be initiated
Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation.
No full textBACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the thirteenth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on applicability, transferability, and adaptation of guidelines. METHODS: We searched five databases for existing systematic reviews and relevant primary methodological research. We reviewed the titles of all citations and retrieved abstracts and full text articles if the citations appeared relevant to the topic. We checked the reference lists of articles relevant to the questions and used snowballing as a technique to obtain additional information. We used the definition "coming from, concerning or belonging to at least two or all nations" for the term international. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: We did not identify systematic reviews addressing the key questions. We found individual studies and projects published in the peer reviewed literature and on the Internet. Should WHO develop international recommendations? Resources for developing high quality recommendations are limited. Internationally developed recommendations can facilitate access to and pooling of resources, reduce unnecessary duplication, and involve international scientists. Priority should be given to international health problems and problems that are important in low and middle-income countries, where these advantages are likely to be greatest. Factors that influence the transferability of recommendations across different settings should be considered systematically and flagged, including modifying factors, important variation in needs, values, costs and the availability of resources. What should be done centrally and locally? The preparation of systematic reviews and evidence profiles should be coordinated centrally, in collaboration with organizations that produce systematic reviews. Centrally developed evidence profiles should be adaptable to specific local circumstances. Consideration should be given to models that involve central coordination with work being undertaken by centres located throughout the world. While needs, availability of resources, costs, the presence of modifying factors and values need to be assessed locally, support for undertaking these assessments may be needed to make guidelines applicable. WHO should provide local support for adapting and implementing recommendations by developing tools, building capacity, learning from international experience, and through international networks that support evidence-informed health policies, such as the Evidence-informed Policy Network (EVIPNet). How should recommendations be adapted? WHO should provide detailed guidance for adaptation of international recommendations. Local adaptation processes should be systematic and transparent, they should involve stakeholders, and they should report the key factors that influence decisions, including those flagged in international guidelines, and the reasons for any modifications that are made
Måling av pasienters erfaringer med legevakt: En systematisk litteraturgjennomgang
No full textVi identifiserte fire validerte måleinstrumenter. I et eventuelt utviklingsprosjekt kan det være nyttig å ta utgangspunkt i disse når spørsmål og dimensjoner for pasienterfaringer med legevakt skal bestemmes.\ud
\ud
Etter vår oppfatning er McKinley et al.s spørreskjema spesielt nyttig for et eventuelt norsk utviklingsprosjekt. Dette spørreskjemaet har blitt brukt i flere undersøkelser, enten i originalversjon, eller i Salisburys (1997) videreutviklede utgave. Dette spørreskjemaet er sammen med Salisbury et al.s forkortede versjon de som antakeligvis er de viktigste å ta utgangspunkt i. Vi er likevel fortsatt usikre på måleinstrumentenes psykometriske egenskaper, og derfor anbefaler vi at det utvikles et spørreskjema for Norge og at det testes etter anbefalte metoder.\ud
\ud
Et prosjekt for å utvikle og validere et instrument for å måle pasienterfaringer med legevakt i Norge bør ta utgangspunkt i malen for utvikling og validering av pasienterfaringsskjemaet i PasOpp (Pettersen et al. 2004; Garratt et al. 2005), og som beskrevet i denne rapporten
Polymorphisms of the XRCC1, XRCC3 and XPD genes and risk of colorectal adenoma and carcinoma, in a Norwegian cohort: a case control study.
No full textBACKGROUND: Genetic polymorphisms in DNA repair genes may influence individual variation in DNA repair capacity, which may be associated with risk of developing cancer. For colorectal cancer the importance of mutations in mismatch repair genes has been extensively documented. Less is known about other DNA repair pathways in colorectal carcinogenesis. In this study we have focused on the XRCC1, XRCC3 and XPD genes, involved in base excision repair, homologous recombinational repair and nucleotide excision repair, respectively. METHODS: We used a case-control study design (157 carcinomas, 983 adenomas and 399 controls) to test the association between five polymorphisms in these DNA repair genes (XRCC1 Arg194Trp, Arg280His, Arg399Gln, XRCC3 Thr241Met and XPD Lys751Gln), and risk of colorectal adenomas and carcinomas in a Norwegian cohort. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated by binary logistic regression model adjusting for age, gender, cigarette smoking and alcohol consumption. RESULTS: The XRCC1 280His allele was associated with an increased risk of adenomas (OR 2.30, 95% CI 1.19-4.46). The XRCC1 399Gln allele was associated with a reduction of risk of high-risk adenomas (OR 0.62, 95% CI 0.41-0.96). Carriers of the variant XPD 751Gln allele had an increased risk of low-risk adenomas (OR 1.40, 95% CI 1.03-1.89), while no association was found with risk of carcinomas. CONCLUSION: Our results suggest an increased risk for advanced colorectal neoplasia in individuals with the XRCC1 Arg280His polymorphism and a reduced risk associated with the XRCC1 Arg399Gln polymorphism. Interestingly, individuals with the XPD Lys751Gln polymorphism had an increased risk of low-risk adenomas. This may suggest a role in regression of adenomas
Association between cigarette smoking, APC mutations and the risk of developing sporadic colorectal adenomas and carcinomas.
No full textBACKGROUND: The association between colorectal cancer (CRC) and smoking has not been consistent. Incomplete smoking history and association to a specific subset of CRC tumors have been proposed as explanations. The adenomatous polyposis coli (APC) gene has been reported to have a "gatekeeper" function in the colonic mucosa. METHODS: To evaluate the hypothesis that cigarette smoking is associated with adenoma and carcinoma development and further to investigate whether this association is due to mutations in the APC gene, we used a study population consisting of 133 cases (45 adenomas and 88 carcinomas) and 334 controls. All tumors were sequenced in the mutation cluster region (MCR) of the APC gene. Cases and controls were drawn from a homogeneous cohort of Norwegian origin. RESULTS: The mutational spectra of the APC gene revealed no difference in frequencies of mutations in cases based on ever and never smoking status. An overall case-control association was detected for adenomas and "ever smoking" OR = 1.73 (95% CI 0.83-3.58). For CRC cases several smoking parameters for dose and duration were used. We detected an association for all smoking parameters and "duration of smoking > 30 years", yielded a statistically significant OR = 2.86 (1.06-7.7). When cases were divided based on APC truncation mutation status, an association was detected in adenomas without APC mutation in relation to "ever smoking", with an OR = 3.97 (1.26-12.51). For CRC cases without APC mutation "duration of smoking > 30 years", yielded a statistically significant OR = 4.06 (1.20-13.7). The smoking parameter "starting smoking > or = 40 years ago" was only associated with CRC cases with APC mutations, OR = 2.0 (0.34-11.95). A case-case comparison revealed similar findings for this parameter, OR = 2.24 (0.73-6.86). CONCLUSION: Our data suggest an association between smoking and adenoma and CRC development. This association was strongest for cases without APC truncation mutation. This may implicate other factors in development of these tumors. The association detected between smoking and CRC cases with APC mutation was in relationship to the smoking parameter "starting smoking > or = 40 years ago", a time period long enough to proceed CRC initiation
Psychosocial factors and distress: a comparison between ethnic Norwegians and ethnic Pakistanis in Oslo, Norway.
No full textBACKGROUND: In the Norwegian context, higher mental distress has been reported for the non-Western immigrants compared to the ethnic Norwegians and Western immigrants. This high level of distress is often related to different socio-economic conditions in this group. No efforts have been made earlier to observe the impact of changed psychosocial conditions on the state of mental distress of these immigrant communities due to the migration process. Therefore, the objective of the study was to investigate the association between psychological distress and psychosocial factors among Pakistani immigrants and ethnic Norwegians in Oslo, and to investigate to what extent differences in mental health could be explained by psychosocial and socioeconomic conditions. METHOD: Data was collected from questionnaires as a part of the Oslo Health Study 2000-2001. 13581 Norwegian born (attendance rate 46%) and 339 ethnic Pakistanis (attendance rate 38%) in the selected age groups participated. A 10-item version of Hopkins Symptom Checklist (HSCL) was used as a measure of psychological distress. RESULTS: Pakistanis reported less education and lower employment rate than Norwegians (p < 0.005). The Pakistani immigrants also reported higher distress, mean HSCL score 1.53(1.48-1.59), compared to the ethnic Norwegians, HSCL score 1.30(1.29-1.30). The groups differed significantly (p < 0.005) with respect to social support and feeling of powerlessness, the Pakistanis reporting less support and more powerlessness. The expected difference in mean distress was reduced from 0.23 (0.19-0.29) to 0.07 (0.01-0.12) and 0.12 (0.07-0.18) when adjusted for socioeconomic and social support variables respectively. Adjusting for all these variables simultaneously, the difference in the distress level between the two groups was eliminated CONCLUSION: Poor social support and economic conditions are important mediators of mental health among immigrants. The public health recommendations/interventions should deal with both the economic conditions and social support system of immigrant communities simultaneously
Increased mRNA expression levels of ERCC1, OGG1 and RAI in colorectal adenomas and carcinomas.
No full textBACKGROUND: The majority of colorectal cancer (CRC) cases develop through the adenoma-carcinoma pathway. If an increase in DNA repair expression is detected in both early adenomas and carcinomas it may indicate that low repair capacity in the normal mucosa is a risk factor for adenoma formation. METHODS: We have examined mRNA expression of two DNA repair genes, ERCC1 and OGG1 as well as the putative apoptosis controlling gene RAI, in normal tissues and lesions from 36 cases with adenomas (mild/moderat n = 21 and severe n = 15, dysplasia) and 9 with carcinomas. RESULTS: Comparing expression levels of ERCC1, OGG1 and RAI between normal tissue and all lesions combined yielded higher expression levels in lesions, 3.3-fold higher (P = 0.005), 5.6-fold higher (P < 3.10-5) and 7.7-fold higher (P = 0.0005), respectively. The levels of ERCC1, OGG1 and RAI expressions when comparing lesions, did not differ between adenomas and CRC cases, P = 0.836, P = 0.341 and P = 0.909, respectively. When comparing expression levels in normal tissue, the levels for OGG1 and RAI from CRC cases were significantly lower compared to the cases with adenomas, P = 0.012 and P = 0.011, respectively. CONCLUSION: Our results suggest that increased expression of defense genes is an early event in the progression of colorectal adenomas to carcinomas