The rates of lumbar spinal stenosis surgery in Norwegian public hospitals: a threefold increase from 1999 to 2013

Accepted manuscript version of the following article: Grøvle, L., Fjeld, O.R., Haugen, A.J., Helgeland, J., Småstuen, M.C., Solberg, T., ... Grotle, M. (2018). The rates of lumbar spinal stenosis surgery in Norwegian public hospitals: a threefold increase from 1999 to 2013. Spine. Published version available at https://doi.org/10.1097/BRS.0000000000002858.Study Design: Retrospective administrative database study. Objective: To assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013. Summary of Background Data: Studies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway. Methods: A database consisting of discharges from all Norwegian public hospitals was established. Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an ICD-10 diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, i.e. spondylolisthesis or scoliosis were not included. Results: During the 15-year period, 19 543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100 000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (SD 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only. Conclusions: The rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days. Conclusions: Level of Evidence: 4</p

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

<p>Abstract</p> <p>Background</p> <p>The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).</p> <p>Methods</p> <p>In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution.</p> <p>Results</p> <p>The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.</p> <p>Conclusions</p> <p>A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.</p

Chronic fatigue syndromes: real illnesses that people can recover from

The ‘Oslo Chronic Fatigue Consortium’ consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation. Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them

En økonometrisk analyse av det europeiske markedet for blåskjell, østers og kamskjell = An econometric study of the European market of mussels, oysters an scallops

Rapporten analyserer markedsstrukturer for skjell i det europeiske markedet, og består av 6 avsnitt. I rapportens innledende del avgrenses først problemstillinger, deretter følger et kapittel som beskriver aspekter vedrørende biologi, produksjon, og marked for blåskjell, østers og kamskjell i europeisk sammenheng. Neste del utvikler og binder sammen markedsintegrasjon og produktaggregeringsteori, som er grunnlaget for den empiriske analysen. Denne teorien med hypoteser og empiriske tester, operasjonaliseres matematisk i kapittel 4. I den praktiske delen finner jeg at Frankrike er det dominerende konsummarkedet for skjell. I tillegg viser analysene at Nederland og Danmark er viktige produsentland for henholdsvis levende og frosne blåskjell. For østers er Frankrike det dominerende konsum og produsentlandet. For levende kamskjell og frosne Coquilles St.Jaques ser Frankrike ut til å være det største konsummarkedet og Storbritannia en viktig produsent. For samlekategorien av frosne kamskjell er det flere betydelige produsentland verden over. Avslutningsvis ser det generelt ut til at frosne og levende skjell på tvers av skjelltypene ikke følger samme pristrender over tid

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals

Impact of the COVID-19 pandemic on emergency and elective hip surgeries in Norway

Background and purpose — Many countries implemented strict lockdown policies to control the COVID-19 pandemic during March 2020. The impacts of lockdown policies on joint surgeries are unknown. Therefore, we assessed the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explored whether these procedures are more/less affected by lockdown restrictions than other hospital care. Patients and methods — In 1,344,355 persons aged ≥ 35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having (1) emergency surgeries due to hip fractures, and (2) electively planned surgeries due to hip osteoarthritis before and after COVID-19 lockdown restrictions were implemented nationally on March 13, 2020, for different age and sex groups. Incidence rate ratios (IRR) reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries. Results — After-lockdown elective hip surgeries comprised one-third the number of before-lockdown (IRR ∼0.3), which is a greater drop than that seen in all-cause elective hospital care (IRR ∼0.6). Men aged 35–69 had half the number of emergency hip fracture surgeries (IRR ∼0.6), whereas women aged ≥ 70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1). Only women aged 35–69 and men aged ≥ 70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0.80) Interpretation — It is important to note for future pandemics management that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact the number of emergency joint surgeries for men aged ≥ 35 but not those for women aged ≥ 70

30 dagers overlevelse og reinnleggelse etter sykehusinnleggelse. Resultater for 2019

Folkehelseinstituet beregner kvalitetsindikatorene “risikojustert sannsynlighet for overlevelse innen 30 dager eer innleggelse på sykehus” og “risikojustert sannsynlighet for reinnleggelse innen 30 dager eer utskrivning fra sykehus”. Indikatorene beregnes årlig og inngår i det nasjonale kvalitetsindikatorsystemet som forvaltes av Helsedirektoratet. NPR har levert pasientadministrative data fra alle landets sykehus. FHI har koblet innleggelser og innhentet eventuell dødsdato fra Folkeregisteret. I denne rapporten rapporten presenteres resultater for hvert enkelt sykehus, helseforetak (HF) og regionalt helseforetak (RHF) for begge indikatortypene. For reinnleggelse rapporteres det også per bostedskommune, fylke og Kommune-Stat-Rapporterings (KOSTRA)-gruppe. Beregningene tar hensyn til alder, kjønn, antall tidligere innleggelser og komorbiditet for å sikre mer valid sammenligningen av rapporteringsenhetene