Recommended content of referral letters from general practitioners to specialised mental health care: a qualitative multi-perspective study

Background: In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study’s aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients. Methods: Based on purposive sampling, four mixed discussion groups, which included general practitioners, mental health nurses from primary health care, psychiatrists and psychologists from specialised mental health care, managers and patient representatives, were formed; they were asked to identify the information they considered important in a mental health referral letter. In line with the Delphi technique, the importance of the themes was later individually rated by the participants. The study was conducted within The Western Norway Regional Health Authority.Results: The four groups identified 174 information themes. After excluding themes that were assessed as duplicates, replaceable or less important, 40 themes were suggested, organised in seven units. A set of check-off points of essential information is recommended as an introduction in the referral letter. Conclusion: Compared with general guidelines and guidelines for somatic care, the results of this study suggest that the referral letter to specialised mental health care should have a larger emphasis on the overall treatment plan, on the specific role of specialised health care in the continuum of care, and on patient involvement. Further research should evaluate the validity of these findings for other patient groups in need of integrated care and investigate how the quality of referral letters affects patient-related and organisational outcomes

The Significance of the Blood Content of the Bergen A4 Mouse Ascites Carcinoma

THE blood content of ascitic tumours had received only fleeting attention until 1961 when the present author started to investigate the possible significance of the blood content of the Ehrlich ascites carcinoma (Hartveit, 1961b). The conclusion reached from these investigations was that the blood that appeared in the tumour was a reflection of the mouse's response to the injection of homologous tissue (i.e. tissue of the same species but of different genetic make-up from the host). Although the tissue injected was tumour tissue, it could not be concluded that the blood appeared in response to the injection of tumour tissue, but only to tissue that differed genetically from the host. In view of the present controversy as to the existence or non-existence of tumour specific antigens, which is of fundamental importance in the field of tumour immunity, it was felt that an attempt should be made to go deeper into the question of whether the blood that appeared in response to the intraperitoneal injection of the Ehrlich ascites carcinoma appeared because the tumour is a homograft or because it is a tumour

Measurement of Information Security - a cost benefit analysis of measurements at Norsk Pasientregister (NPR)

ENGELSK: Measurement of information security seeks to improve the efficiency of the information security in an organization. Measurements can give advantages like: Enabling organizations to judge if the state of information security moves in the right direction over time Enabling benchmarking to see if they are performing better or worse than comparable actors Provide a basis for sound business decisions regarding information security Demonstrating compliance However, when implementing security controls, it is important to know what can be expected in return on the investments. To justify adding another control like security measurements, the value gained should be larger than the costs of implementation. Information security in Norwegian Health sector is regulated by a legal framework, but measurements are not compulsory. This thesis analyzes selected measurements through a case study in a Norwegian healthcare organization - the Norsk Pasient Register, NPR. The implementation in the case study is based on the recently published ISO/IEC 27004:2009 framework for information security measurement. A pilot on information security measurements was made in the case study and experiences gathered. A survey is also presented regarding the perceptions of information security measurements and practices among Norwegian health trusts (HF’s). Although guidelines for IS measurements have existed in Norwegian healthcare since 2004[1], the assumption is that there is little ongoing activity in this area. The contributions of the master thesis is: more insight on validity and costeffectiveness of selected information security measurements. more knowledge on the perceptions and practices of information security measurements in Norwegian health trusts(’Helseforetak’ - HF’s) and institutions. proposals for further research in this area The study shows that measurements of information security is beneficial for an health organization. When it comes to perceptions and practices, more than 50 % states that they measure information security, but with limited knowledge on standards and guidelines. Measurements are seldom requested by management and some organizations lack formally stated goals for information security.NORSK: Måling av informasjonssikkerhet søker å forbedre effekten av informasjonssikkerheten i en organisasjon. Slike målinger kan gi fordeler som: Mulighet for å bedømme om informasjonssikkerheten beveger seg i rett retning i en organisasjon. Muliggjør sammenlikning av status(benchmarking) for sammenliknbare aktører. Kan synliggjøre etterlevelse av relevante internt og eksternt regelverk (compliance). Utgjør et grunnlag for å treffe de rette beslutninger i organisasjonen. Når det implementeres ytterligere sikkerhetskontroller, er det imidlertid viktig å vite hva som kan oppnås med denne investeringen. For å rettferdiggjøre innføringen av ytterligere kontroller, bør disse gi en større verdi enn kostnadene forbundet med å implementere de. Denne masteroppgaven analyserer utvalgte målinger i en norsk helseorganisasjon i form av et case-studie hos Norsk pasientregister (NPR). Implementasjonen av målinger i studiet baserer seg på en nylig publisert standard for måling av informasjonssikkerhet - ISO/IEC 27004:2009. En pilot på måling av informasjonssikkerhet er gjennomført i dette studiet og erfaringer innsamlet. Det er også gjennomført en spørreundersøkelse om hva slags oppfatninger/ gjeldene praksis som finnes rundt måling av informasjonssikkerhet i norske helseforetak (HF’er). Selv om det har eksistert anbefalinger for slike målinger i norsk helsevesen siden 2004 [1], så er antagelsen at det er lite aktivitet som pågår på dette området. Bidragene fra denne masteroppgaven er: Mer innsikt vedrørende gyldighet og kosteffektivitet på utvalgte målinger. Mer kunnskap om hvordan de ulike helseforetak/institusjoner oppfatter og praktiserer måling av informasjonssikkerhet. Forslag til videre forskning på dette området. Studien viser at målinger av informasjonssikkerhet har nytte i en helseorganisasjon. Når det gjelder oppfatninger og praksis i helseforetak/institusjoner, så oppgir over halvparten at de måler informasjonssikkerhet, men har mindre kjennskap til målestandarder. Målinger er i liten grad etterspurt av ledelsen og noen organisasjoner har fortsatt ikke fastsatt formelle mål for informasjonssikkerhetsarbeidet